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2. A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who has called in sick five times in the past month. He tells the manager that he very much wants to come to work when scheduled but must often care for his wife, who is undergoing treatment for breast cancer. According to Maslow’s need hierarchy theory, what would be the best approach to satisfying the needs of this nurse, other staff, and patients?
3. A grievance brought by a staff nurse against the unit manager requires mediation. At the first mediation session, the staff nurse repeatedly calls the unit manager’s actions unfair, and the unit manager continues to reiterate the reasons for her actions. What would be the best course of action at this time?
4. At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution. It would now be best to:
5. The manager of a surgical area has a vision for the future that requires the addition of RN assistants or unlicensed persons to feed, bathe, and walk patients. The RNs on the staff have always practiced in a primary nursing-delivery system and are very resistant to this idea. The best initial strategy in this situation would include:
6. As the RN charge nurse on the night shift in a small long-term care facility, you’ve found that there is little turnover among your LPN and nursing assistant (NA) staff members, but they are not very motivated to go beyond their job descriptions in their work. Which of the following strategies might motivate the staff and lead to greater job satisfaction?
7. As the nurse manager who wants to increase motivation by providing motivating factors, which action would you select?
8. A charge nurse on a busy 40-bed medical/surgical unit is approached by a family member who begins to complain loudly about the quality of care his mother is receiving. His behavior is so disruptive that it is overheard by staff, physicians, and other visitors. The family member rejects any attempt to intervene therapeutically to resolve the issue. He leaves the unit abruptly, and the nurse is left feeling frustrated. Which behavior by the charge nurse best illustrates refined leadership skills in an emotionally intelligent practitioner?
9. The chief nursing officer has asked the staff development coordinator to facilitate the development of a clinical competency program for the facility. While making rounds on the units, the staff development coordinator overhears RN staff complaining that they feel it is insulting to be required to participate in a competency program. Which behavior by the staff development coordinator is most appropriate in this situation?
10. As a nurse, you are responsible for teaching ostomy patients self-management skills postoperatively. Mr. Jones is 2 days postoperative after an abdominal perineal resection. In spite of patient-controlled analgesia, Mr. Jones acknowledges inadequate pain relief and rates his pain as an 8, utilizing a 0-to-10 pain scale. When you approach him for teaching, he turns away and closes his eyes. Which approach incorporating Maslow’s hierarchy of needs motivational theory is most appropriate in this situation?
11. You overhear a newly graduated RN telling one of your colleagues that leadership and management belong to the unit manager and not to her. As a nursing colleague, your response demonstrates understanding that the perception of the new graduate:
13. After assessing an older adult patient in long-term care who has been slowly deteriorating for weeks, the nurse manager calls the family and asks them to come in, as the patient is dying. The nurse manager’s decision and actions are based on:
14. Chart audits have revealed significant omissions of data that could have legal and funding guidelines. As the unit manager, you meet with the staff to discuss audit findings and to find approaches that will address the gaps in charting and achieve desired goals. This is an example of:
15. A family is keeping vigil at a critically ill patient’s bedside. Other, distant family members, not yet able to come, call the unit continuously, asking for updates and wanting to express concern. You speak with the distant family members and suggest that you are going to refer them to the hospital social worker, whose role is to work with such situations. What role are you assuming through this action?
16. In response to the situation in Question 15, you approach the unit manager to apprise her of your concerns that the family dynamics of the patient involved may lead to staff-family and patient-family conflicts. You suggest that the physician may need to discuss the treatment plan with the family. The unit manager advises that he will arrange this discussion. If, after the meeting with family members, this is identified as a desired approach, you support the manager’s decision. Your actions indicate that you are acting in what role?
17. You pull staff together to assess a situation in which the family of a seriously ill patient is anxious and is absorbing a great deal of staff time in consultation, discussion, and questioning of treatment decisions. Staff members are becoming distanced from the family. After inviting the concerns of staff, you explain that the organization values patient-centered care and suggest that evidence supports that acting as an advocate and a listener is helpful to families. You ask the staff for ideas as to strategies that are effectively patient-centered in these situations. In this situation, you are taking on which role?
18. Joan, the nursing unit manager, finds it difficult to work with Thomas, a new graduate. Thomas has many ideas, and his manner of presenting them irks Joan. After reflection and discussion with others, Joan recognizes that she also feels threatened by his behavior. She comes to understand that Thomas is trying to establish his own role on the unit, is not trying to challenge her, and needs guidance, coaching, and affirmation. Joan is demonstrating:
19. As the head of a nursing program, you consistently invite the ideas of your team about innovations in teaching, community partnerships, and curriculum design and invite participation in decisions. Many of these ideas have been implemented successfully, and your staff members are keen to try on other ideas. You are employing _____ leadership.
20. As a leader on a rehab unit, you encourage all staff members to see themselves as having a role in decision making and quality care. You see your role as involving particular responsibilities in decision making but not as a hierarchal role. This view of decision making and leadership is consistent with:
21. You recently acquired a position as a unit manager. During your time on the unit, you have formed a strong social network among your staff, have promoted the development of relationships between your staff and workers in other areas of the organization, and have formed relationships that generate ideas from patient organizations and the local nursing education program. According to complexity theory, you are engaging which principle?
22. According to the complexity theory, which of the following should be the focus of measurement?
23. During a staff meeting held to discuss developing a mission statement for the unit, the idea of placing patient needs first is:
24. A dispute arises between an RN staff member and an LPN over a patient issue. The tension between the two begins to affect other staff members, who are drawn into the conflict; eventually, the team becomes polarized toward either the RN or the LPN. This situation might have been prevented through:
25. The unit is shifting from primary nursing to a team model in an effort to contain costs. Staff members are angry and ask for a meeting to discuss the change. After hearing their concerns related to reduction in professional autonomy and care quality, you:
1. Sarah wonders about the direction that you have given regarding management of incontinent, confused patients. She brings you evidence that she has found regarding incontinence interventions and asks you if she and you could talk about the guidance that you have given after you have had an opportunity to read the articles she has given you. This is an example of (select all that apply):
1. In an effort to control costs and maximize revenues, the Rehabilitation Unit at Cross Hospital reduces the number of its managers and flattens its organizational structure. Within a year, the number of adverse events on the units has doubled. This may be attributable to:
2. Traditional approaches to ensuring patient safety have focused on:
3. To increase safety in patient care areas of the Valley Hospital, the executive begins by:
4. During review of back injuries, it is determined that mechanical lifts and transfer belts are not being properly used. In addressing this concern, the unit manager:
5. Before the IOM report was issued, “To err is human” adverse events were considered:
6. In complying with Crossing the Quality Chasm, you ensure that:
7. After consulting with practice environments about quality and safety concerns in health care, the Dean of Health Programs at US University develops:
8. In designing a quality, safe healthcare environment, the primary emphasis needs to be on:
9. As a patient care advocate, you regularly coach patients as to how to stay safe in health care by educating them about:
10. As a nurse manager on the West Surgery Unit, you are interested in increasing patient safety on your unit. Your initial focus is on the two encounters that the Chasm series identified as most likely to generate concerns about patient safety. As a result, you initiate which of the following?
11. Which philosophical statement would be MOST consistent with that of a learning organization?
12. To achieve nurse-sensitive care standards developed by the NQF, you advocate for which of the following in your health facility?
13. You notice that Sally, a student on your unit, is giving information to an anxious young teen, who seems very uncertain about preparation for an upper GI series. After Sally leaves the room, you ask her how she thought her conversation went and:
14. The NQF provides a model for advancement of healthcare quality that could be used in healthcare organizations. Using this model might involve councils or committees that dialogue openly regarding quality and:
15. A survey of safety practices and attitudes at hospital XYZ finds that staff members have concerns about their safety and that of patients. Results from the manager subgroup are likely to be:
16. As a result of the Joint Commission assessment, a healthcare facility loses it accreditation. What is the primary consequence for this institution?
17. How would you prepare your unit for a Joint Commission visit?
18. On the basis of a review of increased falls with injury and increased restraint use during evening hours, as the unit manager, you most likely would:
19. The STAR approach to patient safety encourages:
20. A logical response to the final step of the STAR Approach to Patient Safety might be to:
21. The culture of blame and punishment of errors tends to encourage a culture of:
22. Mary, an 85-year-old patient with cognitive impairment and gross instability, wanders continuously. Lately, she has fallen twice, and the family demands that she be restrained. As the unit manager, you have initiated a least restraint practice. An appropriate action in this situation would be:
23. A client requires an appendectomy. The surgeon explains the procedure and asks the client to sign the consent. The patient speaks very little English and looks worried. As a nurse, you would:
24. As the case manager in a home health service, you are interested in trying the Institute for Healthcare Improvement TCAB project in your service. In considering this application, you need to particularly consider:
1. Which of the following patients would be at greatest risk in a healthcare visit (select all that apply)?
a. Clyde requires an anticoagulant. He tells the nurse about his medications. He does not include an herbal supplement.
c. Sarah is a new parent who finds that nurses on the children’s unit are very helpful. She is eager to accept all suggestions, including those that she does not yet understand.
d. Claude is booked for bowel surgery. His doctor explains about the colostomy. Later, Claude tells his wife that he really doesn’t know what the doctor meant by colostomy.
1. As the clinical director of 24 employees, you have been asked to explain to staff members why they are not getting a raise this year, even though they have been working short-handed for many months and patient satisfaction scores have never been higher. Because you believe yourself to be a transformational leader, you will approach this problem by:
2. After a newly hired director of nursing has reviewed the hospital’s strategic plans, she develops a timeline for achieving those plans. The new leader is:
3. A nurse executive is hired to restore a unit’s productivity, which has decreased as the result of low staff morale. The nurse executive utilizes which of the following leadership principles?
4. The director of nursing has been observing staff interactions in a 20-bed coronary care unit. Based on her observations, which of the following staff members is an obvious leader?
5. After being interviewed for the unit manager position, the staff nurse reflects on the interview process. The staff nurse is aware that leadership begins:
6. The nurse manager in the emergency department needs to implement new staffing patterns. As a transformational leader, the nurse manager should:
Make staff members think the idea was theirs in the first place.
7. To retain supervisory staff members, the director of nursing develops a mentoring program. The best person to be a mentor for a new supervisor in a leadership position is someone who has:
Leadership experience and time to spend communicating with the new supervisor about his or her experiences.
8. Recruiting among the emerging workforce (18- to 35-year-olds) is a challenge for healthcare agencies. Marketing brochures should address the leadership and vision of the healthcare agency. Which of the following workplace environments will attract applicants in the emerging workforce?
A nurturing and receptive environment
9. A nurse executive who considers herself a Baby Boomer will have the challenge of convincing the emerging workforce of the necessity of committee meetings. One of the primary reasons that the Baby Boom generation appears to have so many meetings in the work environment is that:
They find that the journey to the solution is as important as the solution itself.
10. The hospital administration is discussing the possibility of closing hospital beds in your unit because of a nursing shortage and the increased amount of overtime required to care for patients. As the leader on the unit, which of the following examples best demonstrates your effective leadership style?
A group of your staff members goes to the administration to propose closing of a different unit.
11. John is interested in leadership positions within his nursing organization. Although he has been on the same unit for 10 years, he has attended two workshops during that time and has steadfastly refused opportunities to engage in leadership development opportunities or other learning offered as part of the hospital’s succession planning strategy. He says that he is interested in a leadership role primarily because it will give him a more stable work schedule and will enable him to spend more time with his family. In coaching John, it would be important to:
Encourage him to seek out new experiences and learning that will complement his existing strengths derived from experience and his interest in life-work balance.
12. Becky graduated five years ago and is keenly interested in pursuing leadership opportunities. She has been active in learning about leadership through workshops and Internet research and recently began a graduate degree program with a focus on nursing administration. She has excellent clinical skills and eagerly accepts responsibility for various projects on the unit. Her sarcastic and sometimes aggressive behavior tends to alienate other staff members on the unit. In coaching Becky, you:
Suggest that she reflect on situations in which she has had a positive influence and consider how her interactions contributed to the situation.
13. The Sunny Long Term Care Facility has experienced numerous difficulties with staff relationships, despite its success in maintaining financial viability and judicious use of resources. Staff members complain that the primary concerns of the facility include applying policy, saving money, and ensuring that lawsuits are avoided. There is little trust in and involvement of staff members. This facility may be:
Overly managed and not well led.
14. While explaining the importance of developing leadership skills among nurses to a group of first year nursing students, Natalie, a nursing unit manager emphasizes that:
The public depends on nurses to assume leadership in moving consumer advocacy concerns forward.
15. Which of the following nurses is MOST likely to inspire others to do their best?
Jim, RN, has been involved in nursing for several years and is well liked by patients and families. He continually searches for new knowledge and skills, and his sense of humor and optimism are infectious.
16. The new head nurse on G Unit has been the subject of a great deal of discussion and complaining during breaks. She is a competent nurse of tremendous integrity with approximately 30 years’ experience. Her predominant method of problem solving and communication is through meetings, which can go over the allotted time. The staff may:
Be presenting different generational values and attitudes than the head nurse.
17. The adage “leaders are born and not made” reflects which of the following ideas around leadership?
Management can be taught; leadership depends on abilities.
18. Kari, a head nurse on the dialysis unit, has been informed during budget planning meetings that budget cuts are likely. She discusses this at the next unit meeting and tells staff members that unless they do their jobs well, their positions may be terminated, and there will be no replacement. Kari is enacting which management style?
19. Susan, a new graduate on the dialysis unit (Question 18 above), appears to take Kari’s remarks very seriously and works even harder, often volunteering for extra assignments. She also is often in Kari’s office, advising of successes with her patients and of the extra effort that she is committing. This behavior suggests that Susan:
Knows how to “play the game.”
20. The style of leadership that Kari is exhibiting is likely to:
Stifle innovative thinking about ways to move out of financial jeopardy.
21. A group of managers is meeting to discuss ideas related to the successful implementation of evidence-based practice on their units. Susan has been asked by the director of care to assume leadership of these discussion groups. After two such sessions, Susan expresses disappointment to her mentor that the group seems disinterested in her ideas and that they are listening to Ken, who has much less experience with leadership. In discussing this with Susan, the mentor understands that leadership:
Must be earned.
22. The senior executive praises John for the positive patient evaluations that his unit has received. As an effective leader, John:
Points out the contributions of his staff to the outcomes and shares the praise with his staff.
Look directly at speakers and acknowledge their comments.
24. In working with Cheryl, her mentor suggests that it is really important for Cheryl to engage in self-appraisal and to know her strengths. This observation is based on an understanding that:
There is little external motivation and affirmation in leadership.
1. As a senior executive, you are keen to develop your hospital as a learning organization. Part of your purpose in translating this vision into practice is to (select all that apply):
c.Maintain and/or improve quality of care.
d.Stay abreast of new knowledge and evidence.
1. Role theory has its underpinnings in management theory. Management theories influence managers’ leadership styles. Which of the following theories would a nurse manager be most likely to follow when redesigning the staffing schedule?
2. A nurse manager has worked rapidly to bring the staff to accept changes in the unit’s mission, so that downsizing can be avoided. This nurse manager is using quantum leadership by:
Determining accurately the direction of change in the institution.
3. The nurse manager, as the leader of the unit’s “customer (client) first” initiative, has asked the staff nurses to develop and administer a survey to every client before discharge. In asking the staff nurses to accomplish this task, the nurse manager is demonstrating:
Focus all energies of staff members on a win-win strategy.
Budgetary decision making at the point of service (POS).
6. The nurse manager is anticipating changes on the unit because of managed care. It is up to the manager to “sell” the staff on this care concept. A goal of managed care that the staff must understand is that managed care is:
Grounded in business theory.
7. The hospital administrator approves a case management position for a new rehabilitation unit to help reduce costs. In developing the job description, the nurse manager understands that a key element of case management is:
Coordination of resources for effective outcomes.
8. In planning a new wing, the nurse manager complies with the workplace safety requirements of the Occupational Safety & Health Administration (OSHA). Which of the following groups is considered to be at high risk for violence in the workplace?
Emergency department staff
9. In orienting a 25-year-old nurse, the unit manager understands that this worker:
Likes to solve problems without being given solutions.
10. Nurses on Unit 4 are unhappy and frustrated with their nurse manager. They complain that “nothing is ever good enough for him.” These statements suggest that the nurse manager’s goals may be:
11. While interviewing for a nurse manager position, Ann is asked to give an example of a situation in which she demonstrated leadership. Which of the following examples exemplifies leadership?
Through research and investigation of best practice and practice-based evidence, she proposed a change to management of incontinence in elderly patients.
12. Budgeting and protection of revenues is a function of:
Challenge and striving for excellence
14. As a manager with a high percentage of young professionals, you increase job satisfaction among this young staff by:
Establishing opportunities to self-schedule.
15. A nurse manager in a hospital is deeply concerned that senior administration makes decisions about budgetary directions that affect staffing and other resources without sharing the rationale for changes or demonstrating concern as to how these changes may affect patients or staff. She says she does not feel respected and is emotionally tired as a result. This situation represents:
16. As a nurse manager, you identify that a shift in nursing care models might increase patient and staff satisfaction and avoid downsizing. Administration is reluctant to adopt this approach because downsizing is seen as critical to reduction of costs. To leverage your ideas, you:
Identify influential members of your nurse manager group with similar ideas and request an opportunity to meet with administration to discuss options.
17. During staff meetings, you make it a regular practice to encourage shared problem solving and to recognize those who go beyond basic roles and responsibilities to contribute to a positive team environment and to quality patient care. This practice exemplifies:
18. The successful integration of informatics into healthcare settings is key to:
Quality decision making and processes related to management of resources.
19. As a nurse manager, you embrace the usefulness of resources such as Smart Bed. This behavior is important to:
Encouragement of staff utilization of technology.
20. A manager who is concerned with ensuring that patients on her surgical unit have the necessary information to make informed choices is:
Demonstrating respect for patient rights.
21. The nurse manager plays a unique role in institutional management in that the nurse manager:
Models professional nursing behavior.
22. In developing an orientation program, the hospital educator breaks essential organizational information down into chunks, which she develops as online modules. This is an application of which of Drucker’s functions of management?
Organization of activities into manageable tasks
23. Nancy is a staff nurse who works on a rehabilitation unit. Nancy tells you that the assistants are experiencing difficulty with the new lift and wonders what your thoughts on organizing an in-service would be. Nancy is exhibiting which trait of a follower?
Assumes responsibility for identifying a safety concern and concedes authority for solution to you
1. A nurse manager is discussing with unit staff the repeated lack of staff compliance in documenting exercise activity for post–cardiac surgery clients. The unit’s licensed practical/vocational nurses are responsible for ensuring that clients carry out the prescribed exercise regimen and that the activity is documented. Using Drucker’s five basic functions of a manager, identify appropriate functions for the nurse manager to use when addressing this situation (select all that apply):
a.Divide the necessary activities into manageable tasks, so clients adhere to the exercise regimen.
b.Establish objectives and goals for each area and decide who is accountable for them.
Engage in activities that motivate the team, and communicate effectively with the responsible staff members.
Analyze, appraise, and interpret the performance of responsible staff, and communicate these findings to staff management.
1. To prepare for the orientation of newly hired nurses, the nurse manager plans a presentation outlining the concept of healthcare networks. Healthcare networks are:
Units that provide a full spectrum of services.
2. A local hospital has formed a corporate partnership with a reputable HMO (health maintenance organization). The nurse manager has had to educate staff and personnel about the financial implications of this partnership. A health maintenance organization:
Has a centralized administration that directs and compensates physician services.
3. With the help of a federal grant, the local school nurse has established a spreadsheet that contains relevant nursing data so that she can analyze children’s health. School health programs are:
Increasingly seen as primary care sites for children.
4. The local health department nurse manager has developed and implemented a disaster readiness plan as part of a community service. Community services:
Focus on the treatment of community-wide problems rather than on individual health problems.
5. A nursing informatics specialist hired by Blue Cross/Blue Shield (a form of third-party payers benefit packages that uses specific standards to approve a period of time for the use of inpatient and community health services) is participating in:
6. A merger has occurred between a hospital and a local home health agency, creating new roles for the nursing staff in both agencies. The nurse managers of both systems begin to evaluate and revise patient care processes and systems. With the merger, the healthcare organization’s changes are:
Creating more jobs in the community for registered nurses.
7. You are a nurse manager in a facility that is part of a national system of specialized hospitals that provide services to children and that is funded and managed through a religious charity organization. This system emphasizes compassionate, faith-based care. What level of consolidated system is represented in this example?
8. A nurse manager at a home healthcare service has resigned to take a position at a local ambulatory care center. She has been hired because of her expertise in TJC accreditation. To initiate the changes, the nurse manager has to be knowledgeable about the differences between a home healthcare institution and an ambulatory care center, which is a primary care institution. Primary care institutions are facilities that provide:
First access to care.
9. A nurse manager working for a not-for-profit organization should be familiar with the regulations that impact the organization. Not-for-profit organizations:
Pay no taxes.
10. In reviewing the current delivery model, the nurse manager is aware that a demographic change that will have a significant effect on the healthcare delivery systems of the future is:
The increasing percentage of the population that will be over age 65.
11. A facility that provides care for patients whose average length of stay is less than 30 days and to patients whose average length of stay is longer than 30 days, and who require inpatient and ambulatory care for addictions, through a spectrum of wellness and illness services and providers, would be considered:
A tertiary care institution.
12. Healthcare organization XYZ provides women’s health services on an inpatient basis (average stay of less than 30 days). This facility would likely be considered:
Acute care, specialized.
13. You are the nurse manager for a not-for-profit health service for the homeless and for drug users in an impoverished neighborhood. As the manager, your concern about sustainability is related to:
An increase in uncompensated care events.
14. A nurse manager in a for-profit environment finds it difficult to recruit staff. This difficulty may be most related to aggressive profit goals and:
Lower salary compensation for staff.
15. Which of the following is an example of an HMO?
Patients pay fixed annual fees for ambulatory care services, regardless of actual utilization of health services.
16. As a nurse manager, you have been asked to assist in designing a subacute facility for open heart patients who require further complex care after hospitalization. In setting up the facility, which of the following would require reassessment?
The facility is an older house that is more than 30 minutes away from the acute care center.
17. Which of the following would be the most appropriate focus in developing a business plan for a nurse-owned home healthcare service?
Pain management for patients with low back pain
18. As a nurse manager, you have been offered a position at a Veterans Administration hospital. In accepting the position, it is important for you to understand that veterans’ hospitals provide:
A range of services and are responsible to government and taxpayers.
19. A group of patients with early Alzheimer’s disease and their spouses approach you regarding help with the establishment of a local Alzheimer’s Society for the support and education of affected individuals and their families. As a manager in an ambulatory care clinic, you would advise that:
Partnering with patients and families to provide self-help geriatric services is a growing trend in health care.
20. Tracy is an RN case manager who interfaces between the Centers for Medicare and Medicaid. Tracy’s responsibilities most likely would include:
Monitoring physician documentation of the need for medical care.
21. The Wellington Mental Health Institute is fully accredited by the AOA and not directly by the CMS. This means that the Wellington facility:
Has been reviewed and accredited by the AOA, which is a deeming authority for CMS.
22. As a nurse manager, you would expect which of the following to be the major contributor to funding and revenues in your organization?
The federal government
23. In capitation, which of the following scenarios is most likely to occur?
If the costs of caring for a patient are less than the capitated amount, the organization realizes a profit.
24. Which of the following patients would be most likely to be covered under Medicare?
Dan, who is 68 years of age and in good health
25. Which of the following is an outcome of managed care?
Shift of patients to outpatient and home health services
1. As a nurse manager in a for-profit hospital, you are interested in promoting teaching programs for physicians, as evidence suggests that hospitals with teaching programs tend to promote better care for patients. Your administration indicates that it cannot support your ideas or proposal because of (select all that apply):
a.Increased salary costs.
b.Duplication of tests and procedures.
c.Higher costs of technology.
1. A hospital and a nursing education program form a partnership to recruit more nurses to the region. This organizational structure is:
Being responsive to changes in the environment.
2. A hospital is working toward becoming a Magnet™ hospital. The chief nursing officer is aware that professional nursing departments of the future will:
Be designed to maintain nursing standards of practice.
3. The chief nursing officer and the dean of the School of Nursing believe that by establishing rules and regulations and controlling the environment, this partnership will:
Need a degree of flexibility to engender success.
4. In matrix organizational structures, a nurse manager understands that this type of structure:
Has both a functional manager and a service or product-line manager.
5. Collaborative partnerships between hospitals and schools of nursing are examples of hybrid organizational structures. A hybrid organizational structure:
Has a mixture of the characteristics of various organizational types.
6. In opening a new dialysis unit, the nurse manager has to develop a philosophy for the unit. This philosophy needs to:
Reflect the culture of the unit and its values.
7. The hospital administration gives approval to the chief nursing officer to hire clinical nurse specialists in staff positions rather than in administrative positions. A clinical specialist who has staff authority but no line authority typically is able to:
Function through influence.
8. A new director of nursing in a small rural hospital wants to make changes from the traditional model of governance to a shared-governance model. Select the characteristic below that best describes the traditional organizational structure in which a staff nurse is assigned to carry out nursing tasks for clients but is not given the chance to provide input into forming the policies and procedures by which care is delivered or the standards by which care is evaluated:
Delegated responsibility but no authority
9. The chief nursing officer is given the task of reviewing and revising the organization’s mission, philosophy, and technology. In reviewing them, the chief nursing officer understands that they should be reflected in:
The organizational structure.
10. The facilities department is experiencing some challenges and is undergoing reorganization. Because of your familiarity with systems theory, you:
Know that the nature of challenges and reorganization in facilities will have an impact on other areas.
11. “Georgia Hospital will provide care that is a national example of consumer service” is a:
12. “At Thoroughcare, we provide healthcare for women and children in transition” is an example of a:
13. Which of the following would be the most appropriate mission statement for a nursing center?
“At Coeur, we strive to achieve optimal pain management with patients who are experiencing chronic pain.”
14. Which of the following most influences the organizational structure of the organization?
15. In which of the following situations would you expect low morale and frustration?
Recruitment ads promise opportunities for advancement for everyone. Promotions are given only to individuals with long-standing service and entrenched relationships.
16. At Orangetown Hospital, the nursing department is developing a mission statement for nursing. Which would be a suitable mission statement?
“At Orangetown, the nursing department provides caring services that recognize the diversity of clients and promote optimal health with clients through partnership and education and in close partnership with other disciplines.”
17. At Hospital XYZ, staff members on Y3 have dealt with the third head nurse in three years. Donna, the current head nurse, lacks confidence in patient-nurse relationships, and scheduling and other processes are routinely left to the last minute. Staff members approached Donna first and then administration with their concerns about Donna’s effectiveness as a leader. The staff was told that the problem is likely staff related, that it is simply an unhappy group, and that there is nothing that will be done further about their concerns. The philosophy of the organization indicates that “open, transparent communication between staff and management is desired and supported,” and that “innovation and creative thinking are the foundation of the organization’s progress.” In assessing this situation as a newly hired senior executive, you anticipate that:
The situation will lead to ongoing disgruntlement and attrition.
18. In Valley Hospital, there is a great deal of discussion about the balance between hospital-wide budget decision making and unit-based decision making. This discussion represents:
A search for the “sweet spot.”
19. With revenue reductions and cost saving measures, the number of managers has been reduced, which has increased the number of team leaders supervised by managers by as many as three. This change may result in:
Decreased patient satisfaction.
20. Taylor Hospital has well-defined organizational units that provide maintenance, financial services, care for cardiac patients, care for surgical patients, and so on. The organizational chart indicates that surgical units report to a surgical manager, and that all nursing units report to a vice president of nursing; financial services to an accountant and then to a business executive; and so on. The primary disadvantage of this organizational structure is:
Breakdown in function and communication across specialties.
21. In the Unity Healthcare organization, decisions, including those at the unit level, are made by a group of senior executives. Rules for employees are clear, and nursing care is delineated by procedures and protocols. This exemplifies:
22. In the Unity Healthcare organization, communication flows:
Top to bottom.
23. Sarah is a clinical nurse educator in the dialysis unit at Pines Health Center and provides education, consultation, and training support. Sarah has:
An influence over patient outcomes.
24. A statement such as “We believe in the right of patients to make choices and to have care that is sensitive to their preferences and needs” is a _____ statement.
1. Organizational culture includes (select all that apply):
1. Complex care of acutely ill patients is required on a surgical unit, which utilizes differentiated nursing practice as its model of care delivery. The concept of differentiated nursing practice is based on:
Education and expertise.
2. The relief charge nurse has assigned a newly licensed baccalaureate-prepared nurse to be one of the team leaders for the 3-11 shift. In making this decision, the charge nurse has overlooked this nurse’s:
3. When interviewing an applicant for a position, the nurse manager describes the unit’s care delivery system as one in which each nursing assistant is cross-trained to perform specific tasks, and the RNs do all treatment, medication administration, and discharge teaching. The nurse applicant knows this nursing care delivery strategy to be:
4. You are the nurse manager of a nursing service organization that provides around-the-clock care to clients in their homes. To achieve maximum reimbursement for a client who is recovering from a hip replacement, the nursing staff most likely will follow the nursing care guidelines presented in the:
5. The nurse case manager is working with a client admitted for end-stage renal disease. The case manager’s major goal during this hospitalization is to:
Prevent additional hospitalizations resulting from complications of the client’s disease.
6. The nurse manager at a cardiac rehabilitation unit was asked to select a care delivery model. Which of the following methods would be the most cost-effective?
Case management method
7. In an acute care unit, the nurse manager utilizes the functional nursing method as the care delivery model. The nurse manager’s main responsibility is the needs of the:
8. A patient is admitted to a medical unit with pulmonary edema. His primary nurse admits him and then provides a written plan of care. What type of educational preparation best fits the role of primary nurse?
9. In a small rural nursing home, a director of nursing decides, because of a shortage of nurses, to implement a partnership model to help with certain tasks. What type of design constitutes a partnership care delivery model?
RN and medication assistants
10. The case method of care delivery could be best justified in which of the following scenarios?
Pediatric intensive care unit that heavily involves families as well as patients
11. During times of nursing shortage and increased nursing costs in health care, which of the following nursing care delivery models might come under greatest scrutiny?
12. A patient complains to you that she has no idea who “her nurse” is on any given day. “I ask one nurse for my pills and she says ‘that is not my job.’ I ask the pill nurse about my lab tests and she says that I should ask another nurse.” The nursing care delivery model most likely employed in this situation is:
13. The model outlined in Question 12 might be particularly effective in:
Developing competence and confidence in unskilled workers.
14. For a nurse manager in the functional nursing model, an approach that will assist in maintaining staff satisfaction in this specific model is:
Rotation of task assignments.
15. In comparing team and functional models of care, a nurse manager favors the team model. In particular, she finds that the team model:
Can be effective in recognizing individual strengths and backgrounds of staff.
16. To effectively delegate in a team nursing environment, the RN team leader must be familiar with the legal and organizational roles of each group of personnel and must:
Be able to adapt to daily changes in staffing.
17. A nurse manager questions the true difference between primary nursing and total patient care. After careful consideration of both models, the nurse manager concludes that primary nursing differs significantly from total patient care in:
Time period of accountability.
18. A conflict develops between an associate nurse and a primary nurse over the assessment of a patient with pulmonary edema. Based on her assessment of the patient, the associate nurse insists that it is her role to change the care plan because she is the one who has made the assessment. As the nurse manager, you clarify that:
It is the role of the primary nurse to make alterations based on assessment data and input.
19. When comparing functional nursing and primary nursing, a nurse manager, after evaluating particular models of nursing care for potential adoption, determines that patient and nurse satisfaction in primary nursing are:
High when compared with functional nursing.
20. In transitioning to a primary nursing model, it is important for a nurse manager who enjoys a high level of control over patient care to understand that his or her decision making at the patient care level:
21. You are considering putting forward a proposal to move the model of care from team nursing to a primary nursing hybrid: patient-focused care model. In considering this proposal, you recognize that significant costs specific to operationalizing this model are related to:
Significant changes in the physical structure of units.
22. When hiring a case manager for a rehabilitation setting, you would most likely consider a:
Health professional with advanced background who is client and outcome focused.
23. Case managed care may enhance profit in a for-profit health organization by:
Minimizing costs in high resource consumption areas.
24. In hiring nurses during the transition from team nursing to a primary nursing model, Benner’s work would suggest that you give priority to nurses who are at least at which level of competency?
25. In considering whether or not to accept a job offer as a nurse manager at a Magnet™ hospital, you look at an environment that you might encounter as a head nurse at the hospital. You determine that you could expect to:
Find nurses who exemplify interest in quality care.
1. The chief nursing officer implements the team nursing model on the acute care units. Expectations of the team leader include which of the following (select all that apply)?
c.Having several years of clinical nursing practice
d.Being attentive to the needs of the patient
e.Being attentive to the needs of the staff
1. When goals/outcomes are somewhat unclear in early preparation for a complex change, the manager and the change management team develop several acceptable goals/outcomes. This change in management approach is termed:
2. The home health agency hired an expert in financial management to evaluate and propose a plan for reversing growing expenses and decreasing revenues. The expert is well respected, both personally and professionally, by members living in this small community. To be effective, staff will need to perceive this change agent as:
3. The nurse manager frequently interacts with staff and other hospice facility employees. Communication was purposeful because the manager assessed current issues, such as specific satisfactions and dissatisfactions with the newly implemented computerized documentation system. Informally, the manager gathered available staff members to address similar learning needs. Many times, staff members were found coaching other staff about improving use of the new system. According to Senge (1990), the activities demonstrated in this example are:
Dialogue, team learning.
4. The clinical coordinator expects the position description of the new wound care specialist to change nurses’ responsibilities in caring for clients with skin integrity problems. The best approach to address this need for change, yet to have the best outcomes for clients, staff nurses, and the organization, is to:
Apply both planned and nonlinear approaches.
5. Complex change situations require that the change leader promote ongoing visioning among staff members. One strategy is to:
Consciously evaluate invisible mental models.
6. To effectively achieve a change goal/outcome in a change situation, the wound care specialist will:
Strengthen facilitating forces.
7. The wound care nurse decided to involve those to be affected by change early in the change management process. This can positively result in:
Integrating the change.
9. An example of one strategy to improve participation in the change process by staff fitting the behavioral descriptions of laggards, early majority, late majority, and rejectors is to:
Delegate the roles and tasks of change.
10. An example of one strategy used to improve participation in the change process by staff fitting the behavioral description of innovators and early adopters is to:
Share change experiences early in the process.
11. As a new manager, you are shocked to learn that your unit is still using heparin in heparin locks. You are aware of evidence related to this practice and want to change this practice as quickly as possible on your unit. You are in which stage of Lewin’s stages of change?
12. To engage your staff in awareness of their current practice and how it is affirmed or not by evidence, you plan a short series of learning presentations on evidence and use of heparin and saline to maintain IV patency. You meet with the educator to plan out the goals for each session with the overall purpose of increasing knowledge and awareness of staff in readiness to consider questions related to the IV practice. This learning approach is an example of which change management approach?
13. In Question 12, staff nurses who gain information on current IV therapy practices are engaging in which phase of Rogers’ decision-making process?
14. Elizabeth, an RN with approximately 15 years of service on your unit (Question 11), walks away from one of the learning sessions on IV care, and you overhear her telling a colleague that she thought the session was a waste of time because “the unit has been using heparin for years and there has never been any adverse effect.” According to Havelock (1973), this comment may originate from failure in which phase of the six phases of planned change?
Building a relationship
15. You follow up with Elizabeth (Question 14) and discover that she is really quite angry about the information sessions because she feels that you are implying that “what she has been doing all these years means that she is incompetent and doesn’t care about her patients.” Your response to her indicates that:
Change involves emotions rather than intellect.
16. Which of the following would be the most effective response to Elizabeth (Question 14)?
“It is difficult sometimes to change what we know very well. Sometimes it can be frightening.”
17. Elizabeth is an example of a(n):
18. After speaking with Elizabeth, a few days later, you discover that she is now fine with the change but is concerned that other areas of the organization might resist the change because of perceptions related to patient safety and cost. She suggests that it is important to bring pharmacy on board as they have had previous concerns about the use of heparin. This type of campaign is best described as:
19. Based on Elizabeth’s insights and suggestions, you involve pharmacy, only to discover that the change in practice involves practice committees, a medical practice committee, and concerns from administration about potential costs and safety of the proposed change to the IV protocols. The change process at this point is:
20. Resistance is most likely when change:
Threatens personal security.
21. As the unit manager on the unit that is leading changes to heparin locks, you find that Elizabeth is very valuable in terms of her observations about other units and her knowledge of organizational processes, and now in discussing the new procedure with others. Elizabeth might be considered an:
Informal change agent.
22. As the unit manager, you spend a day performing direct patient care and work with a new system that is designed to capture patient documentation at the bedside. During discussions with staff while giving care, you discover that the number of screens that need to be opened during documentation makes charting more complex and time-consuming than traditional manual charting approaches. On the basis of this feedback, you:
Consult chart audit data and end user consultation reports to determine if errors and problems are occurring.
23. The situation in Question 22 is best captured in which theory of change?
Sarah, RN, is one of your most enthusiastic staff and has been to a workshop on preparing educational materials for patients. On the basis of this workshop, she would like to develop an information website for patients who are being admitted to the ward. An appropriate response to Sarah’s suggestion would be:
“There is a great group here that meets to look at technology pilots. Let’s see if you can join them and discuss your idea further.”
25. Edith has been vocal about her negative concerns related to a new charting system and frequently expresses the view that keeping the “old system” would have been just fine. In facilitating change, your best approach to Edith would be to:
Schedule her work assignment so that it coincides with those of two staff members who are confident with technology and the change.
1. Which of the following are examples of application of the Leadership Rounding Tool? (Select all that apply.)
a.“What is working well for you during bedside reporting?”
b.“What has not worked for you today?”
c.“Is there someone on your team who deserves special recognition for her efforts in the implementation?”
d.“Did you have a good vacation?”
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