2020 Exam 1 Flashcards
Contents:
Ch 41-Giddens: Leadership
Ch 01-Yoder-Wise: Leading, Managing, and Following
Ch 02-Yoder-Wise: Safe Care: The Core of Leading and Managing
Ch 26-Yoder-Wise: Delegation: An Art of Professional Nursing Practice
Ch 14-Yoder-Wise: Staffing and Scheduling
Ch 03-Yoder-Wise: Developing the Role of Leader
Ch 04-Yoder-Wise: Developing the Role of Manager
NMNEC Leadership Concept Overview (Not in this document)
Nurse Practice Act (Not in this document)
- The nursing unit director exhibits the definition of leadership in which of the following responses?
a. The nurse manager refers the concern to the director of the department.
b. The nurse manager corrects the concern with the patient directly and does not communicate her actions to the staff.
c. The nurse manager meets with the staff to discuss the concern and identify solutions.
d. The nurse manager tells the staff that they need to correct the situation by tomorrow and leaves the meeting.
ANS: C
c. The nurse manager meets with the staff to discuss the concern and identify solutions.
Leadership is defined as an interactive process that provides needed guidance and direction which is present in the correct answer. The other choices do not involve an interactive process with staff to resolve the concern.
- The nurse who is certified as a Critical Care Registered Nurse (CCRN™) represents the unit on the organizational performance improvement team. This is an example of which type of leadershipa. Formal
b. Unit
c. Organizational
d. Informal
ANS: D
d. Informal
Informal leaders are recognized as leaders because of their capabilities and actions. Formal leaders are recognized because of the position they hold such as director or manager. Unit leadership refers to the leader of the particular unit. Organizational leadership refers to any leader within the organization.
- The hospital must reduce the number of readmissions from 11% to 8% in the next year. Which of the following best represents the transformational leadership style in accomplishing this goal?
a. The director communicates the goal of reducing readmissions to the hospital operations team and tells them to submit their action plan by the end of the week.
b. The organization charters three work teams to identify solutions for the top three causes for readmissions. These teams are given full authority to implement their solution.
c. The director of quality develops a vision statement and action plan to achieve the goal. The director works directly with the involved departments to implement the action plan.
d. The CEO communicates the goal to the organizational directors and managers and states that they are entrusted to solve the problem.
ANS: C
c. The director of quality develops a vision statement and action plan to achieve the goal. The director works directly with the involved departments to implement the action plan.
Transformational leaders communicate a vision and motivate employees to accomplish the goal. The director who communicates the goal of reducing readmissions to the hospital operations team and tells them to submit their action plan by the end of the week leaves the solution to achieve the goal to the followers to develop without motivating them. The solution that is left to the work teams to resolve is not an example of transformational leadership. The CEO entrusts the managers and directors to solve the problem without giving them a vision or engaging in the solution with them.
- The new director of case management assessed the need to improve the organization’s patient satisfaction with the discharge process. Which statement below illustrates the vision that would lead the team to this goal?
a. “The department will deliver reliable, collaborative, and compassionate discharge planning services to all patients.”
b. “The department will hold weekly meetings every Tuesday at 11:00 AM.”
c. “There will be implementation of a new uniform policy so staff can be readily identified.”
d. “Staff are encouraged to complain about difficult patients, families, and physicians.”
ANS: A
a. “The department will deliver reliable, collaborative, and compassionate discharge planning services to all patients.”
A vision is a statement about the long-term desired state for the department. The other choices describe specific actions, not a long-term vision statement.
- The clinical nurse leader needs to identify the staff who must go home due to low census. Which answer below describes a democratic style of decision making?
a. The clinical nurse leader identifies the staff person with the most vacation and asks them to go home.
b. The clinical nurse leader tells the last person to show up for their shift to go home.
c. The clinical nurse leader decides not to send anyone home because it is too difficult to decide who should lose hours.
d. The clinical nurse leader asks the group if any of them would like the opportunity to go home and selects staff who volunteer.
ANS: D
d. The clinical nurse leader asks the group if any of them would like the opportunity to go home and selects staff who volunteer.
Democratic leaders use a participatory style of decision making. In the other choices, the clinical nurse leader makes the decision independent of the staff.
- According to situational and contingency theory, which statement is true?
a. The theory challenges the concept that one leadership style is always best.
b. The theory supports employee feelings, morale, and feedback during the change process.
c. Motivation through inspiration and recognition is the focus for transforming employee behavior.
d. A leader is someone who possesses great intelligence and decision-making authority.
ANS: A
a. The theory challenges the concept that one leadership style is always best.
Situational and contingency theory challenges the assumption that there is “one best way” to lead. “The theory supports employee feelings, morale, and feedback during the change process” describes behavioral leadership. “Motivation through inspiration and recognition is the focus for transforming employee behavior” describes transformational leadership. “A leader is someone who possesses great intelligence and decision-making authority” describes Great Man or Trait theory.
- To be an effective nursing leader today requires effective collaboration, which is modeled by which answer below?
a. The nursing manager of the observation unit was certain the psychology department would assist the unit with a motivational plan, so she did not request their assistance.
b. The nursing manager of the observation unit worked with the psychology department and physical therapy to develop a motivational plan for patients on the unit.
c. The nursing director of behavioral health services followed the administrative directive to reduce services and refused to provide services for patients on other units.
d. Frustrated by the trend of patients unwilling to work with therapy, the unit manager recommended that these patients be placed on another unit.
ANS: B
b. The nursing manager of the observation unit worked with the psychology department and physical therapy to develop a motivational plan for patients on the unit.
The nursing manager works collaboratively with other departments to solve the patient care issue. In the other choices, the unit manager does not involve collaboration to resolve the patient concern.
- What are the main features of complex adaptive systems that are relevant to nursing leadership? (Select all that apply.)
a. Focused on creating organizational change and looking at the whole versus individual parts.
b. Defined by efforts of leadership to mandate organizational change.
c. Autocratic in nature with a top-down structure for change.
d. Dependent on employees knowing what change is necessary and acting independently.
e. Non-linear and dynamic in nature, versus a static process.
ANS: A, E
a. Focused on creating organizational change and looking at the whole versus individual parts.
e. Non-linear and dynamic in nature, versus a static process.
Complexity science posits that interactions of the parts within a system are more important than the individual parts. Complexity science, however, recognizes that organizational processes are often non-linear and unpredictable. Through the dynamic interplay of negative and positive feedback an organization is able to make changes to keep abreast of the environmental context. The autocratic top-down decision-making and mandates do not create a sustainable change. Being dependent on employees knowing what change is necessary and acting independently lacks interaction of leadership to stimulate change and adaptation among employees.
- A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults. She is asked to assess and adapt the unit to better meet the unique needs of the older adult patient. Using complexity principles, what would be the best approach to take in making this change?
a. Leverage the hierarchical management position to get unit staff involved in assessment and planning.
b. Engage involved staff at all levels in the decision-making process.
c. Focus the assessment on the unit, and omit the hospital and community environment.
d. Hire a geriatric specialist to oversee and control the project.
ANS: B
b. Engage involved staff at all levels in the decision-making process.
Complexity theory suggests that systems interact and adapt and that decision making occurs throughout the systems, as opposed to being held in a hierarchy. In complexity theory, every voice counts, and therefore, all levels of staff would be involved in decision making.
- A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who has called in sick five times in the past month. He tells the manager that he very much wants to come to work when scheduled but must often care for his wife, who is undergoing treatment for breast cancer. According to Maslow’s need hierarchy theory, what would be the best approach to satisfying the needs of this nurse, other staff, and patients?
a. Line up agency nurses who can be called in to work on short notice.
b. Place the nurse on unpaid leave for the remainder of his wife’s treatment.
c. Sympathize with the nurse’s dilemma and let the charge nurse know that this nurse may be calling in frequently in the future.
d. Work with the nurse, staffing office, and other nurses to arrange his scheduled days off around his wife’s treatments.
ANS: D
d. Work with the nurse, staffing office, and other nurses to arrange his scheduled days off around his wife’s treatments.
Placing the nurse on unpaid leave may threaten the nurse’s capacity to meet physiologic needs and demotivate the nurse. Unsatisfactory coverage of shifts on short notice could affect patient care and threaten the needs of staff to feel competent. Arranging the schedule around the wife’s needs meets the needs of the staff and of patients while satisfying the nurse’s need for affiliation.
- 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?
a. Send the two disputants away to reach their own resolution.
b. Involve another staff nurse in the discussion so as to clarify issues.
c. Ask each party to examine her own motives and issues in the conflict.
d. Continue to listen as the parties repeat their thoughts and feelings about the conflict.
ANS: C
c. Ask each party to examine her own motives and issues in the conflict
Ury, Brett, and Goldberg outline steps to restoring unity, the first of which is to address the interests and involvement of participants in the conflict by examining the real issues of all parties.
- At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution. It would now be best to:
a. Arrange another meeting in a week’s time so as to allow a cooling-off period.
b. Turn the dispute over to the director of nursing.
c. Insist that participants continue to talk until a resolution has been reached.
d. Back the unit manager’s actions and end the dispute.
ANS: A
a. Arrange another meeting in a week’s time so as to allow a cooling-off period
According to the principles outlined by Ury, Brett, and Goldberg, a “cooling-off” period is recommended if resolution fails.
- 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:
a. Exploring the values and feelings of the RN group in relationship to this change.
b. Leaving the RNs alone for a time so they can think about the change before it is implemented.
c. Dropping the idea and trying for the change in a year or so when some of the present RNs have retired.
d. Hiring the assistants and allowing the RNs to see what good additions they are.
ANS: A
a. Exploring the values and feelings of the RN group in relationship to this change
Influencing others requires emotional intelligence in domains such as empathy, handling relationships, deepening self-awareness in self and others, motivating others, and managing emotions. Motivating others recognizes that values are powerful forces that influence acceptance of change. Leaving the RNs alone for a period of time before implementation does not provide opportunity to explore different perspectives and values. Avoiding discussion until the team changes may not promote adoption of the change until there is opportunity to explore perspectives and values related to the change. Hiring of the assistants demonstrates lack of empathy for the perspectives of the RN staff.
- As the RN charge nurse on the night shift in a small long-term care facility, you’ve found that there is little turnover among your LPN and nursing assistant (NA) staff members, but they are not very motivated to go beyond their job descriptions in their work. Which of the following strategies might motivate the staff and lead to greater job satisfaction?
a. Ask the director of nursing to offer higher wages and bonuses for extra work for the night LPNs and NAs.
b. Allow the LPNs and NAs greater decision-making power within the scope of their positions in the institution.
c. Hire additional staff so that there are more staff available for enhanced care and individual workloads are lessened.
d. Ask the director of nursing to increase job security for night staff by having them sign
contracts that guarantee work.
ANS: B
b. Allow the LPNs and NAs greater decision-making power within the scope of their positions in the institution
Hygiene factors such as salary, working conditions, and security are consistent with Herzberg’s two-factor theory of motivation; meeting these needs avoids job dissatisfaction. Motivator factors such as recognition and satisfaction with work promote a satisfying and enriched work environment. Transformational leaders use motivator factors liberally to inspire work performance and increase job satisfaction.
- As the nurse manager who wants to increase motivation by providing motivating factors, which action would you select?
a. Collaborate with the human resource/personnel department to develop on-site daycare services.
b. Provide a hierarchical organizational structure.
c. Implement a model of shared governance.
d. Promote the development of a flexible benefits package.
ANS: C
c. Implement a model of shared governance.
Complexity theory suggests that systems interact and adapt and that decision making occurs throughout systems, as opposed to being held in a hierarchy. In complexity theory, every voice counts, and therefore all levels of staff would be involved in decision making. This principle is the foundation of shared governance.
- 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?
a. Reflect to gain insight into how the situation could be handled differently in the future.
b. Try to catch up with the angry family member to resolve the concern.
c. Discuss the concern with the patient after the family member has left.
d. Notify nursing administration of the situation.
ANS: A
a. Reflect to gain insight into how the situation could be handled differently in the future.
Goleman suggests that emotional intelligence involves insight and being able to step outside of the situation to envision the context of what is happening as well as being able to manage emotions such as frustration effectively.
- 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?
a. Disregard staff concerns and continue with development of the program.
b. Inform the nurses that this program is a
requirement for JCAHO accreditation.
c. Schedule a meeting with the chief nurse
executive to apprise her of the situation.
d. Facilitate a meeting so nurses can articulate their values and concerns about a competency program.
ANS: D
d. Facilitate a meeting so nurses can articulate their values and concerns about a competency program.
The manager role involves guiding others through a set of derived practices that are evidence-based and known to satisfy preestablished outcomes such as participation in a competency program. This involves engagement of staff through sharing of concerns and ideas. A close analysis of the IOM report and the summary of the PPACA suggests that no health reform can unfold without active nursing engagement. Each document emphasizes that nurses must lead, manage, and behave as active collaborators with other members of the health team and with those being served.
- As the manager, you have been asked to implement an evidence-based approach to teach ostomy patients self-management skills postoperatively that is being operationalized throughout your organization. Which of the following illustrates effective leadership?
a. The training modules are left in the staff room for times when staff are available.
b. The current approach is continued because it is also evidence-based and is more familiar to staff.
c. You decide to implement the approach at a later date because of feedback from the RNs that the new approach takes too much time.
d. A RN who is already familiar with the new
approach volunteers to take the lead in mentoring and teaching others how to implement it.
ANS: D
d. A RN who is already familiar with the new approach volunteers to take the lead in mentoring and teaching others how to implement it.
Followership occurs when there is acquiescence to a peer who is leading in a setting where a team has gathered to ensure the best clinical decision making and actions are taken to achieve clinical or organizational outcomes. Followership promotes good clinical decisions and use of clinical resources.
- 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, you respond by demonstrating understanding that the perception of the new graduate:
a. Is correct. Leadership is not the role of the staff nurse.
b. Would benefit from further understanding of her role as a professional, whose influence may affect the decision making of patients, colleagues, and other professionals.
c. Has been influenced by nurse leaders and managers who leave for other positions.
d. Is related to the general perception that nurse leaders and managers are not satisfied in their jobs.
ANS: B
b. Would benefit from further understanding of her role as a professional, whose influence may affect the decision making of patients, colleagues, and other professionals.
Care coordination that involves the intersection of individual, family, and community-based needs requires that nurses have self-confidence, knowledge of organizations and health systems, and an inner desire to lead and manage. There is often a view that leadership is isolated to those holding managerial positions and that a direct care nurse is subject to following by adhering to the direction of others. Such views fail to acknowledge that to be a nurse requires each licensed individual to lead, manage, and follow when practicing at the point-of-care and beyond.
- You walk into Mr. Smith’s room and find him yelling at the LPN, Miss Jones. He is obviously very upset and after you speak with him regarding his behavior, you determine that he has not slept for three nights because of unrelieved pain levels. The LPN is very upset with Mr. Smith and calls him an “ugly, old man.” You acknowledge her feelings and concerns and then suggest that Mr. Smith’s behavior was aggressive but is related to lack of sleep and to pain. You say to Miss Jones, “Can you both, together with Mr. Smith, determine triggers for the pain and effective approaches to controlling his pain?” This approach demonstrates:
a. Lack of empathy and understanding for Miss Jones.
b. Concern with placating Mr. Smith.
c. Leadership behavior.
d. Management behavior.
ANS: C
c. Leadership behavior.
The situation between Mr. Smith and Miss Jones is a complex situation involving unrelieved patient symptoms and aggressiveness toward a staff member. Providing engaged, collaborative guidance and decision making in a complex situation where there is no standardized solution reflects leadership.
- 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:a. An established clinical pathway.
b. Confirmatory scientific evidence.
c. Unit protocol.
d. Experience.
ANS: D
d. Experience.
The nurse manager is employing knowledge and experience in determining that the patient is dying, because the course of dying is not standardized and cannot be determined by clinical pathways.
- Chart audits have revealed significant omissions of data that could have legal and funding guidelines ramifications. 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:a. Leadership.
b. Management.
c. Decision making.
d. Vision.
ANS: B
b. Management.
The process of guiding others to meet established goals, outcomes, and procedures is management. This can require collaborative decision making to determine how best to reach pre-determined goals and follow established practices.
- 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 people in such situations. What role are you assuming through this action?a. Manager
b. Leader
c. Follower
d. Laissez-faire
ANS: A
a. Manager
As a manager, you are concerned with managing and coordinating resources to achieve outcomes in accordance with established clinical processes. Referral to a social worker alleviates demand on staff time and is consistent with hospital procedures.
- 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 people in such situations. In response to this situation, 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?a. Leadership
b. Management
c. Follower
d. Evidence-based
ANS: C
c. Follower
In the followership role, you bring to the manager your concerns about potential litigation and maximization of outcomes and accept the direction given by the manager in response to your concerns.
- 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 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?a. Leadership
b. Management
c. Follower
d. Visionary
ANS: A
a. Leadership
As a leader, you provide and communicate vision and direction based on evidence and experience, and you engage others in decision making that moves them toward the vision with a reasonable level of risk taking.
- 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:a. A positive self-concept.
b. Deepening self-awareness.
c. Leadership.
d. Acquiescence.
ANS: B
b. Deepening self-awareness.
According to Goleman (1995), stepping outside oneself to envision the situation while assuming ownership is a component of emotional intelligence.
- 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.a. Situational
b. Trait-based
c. Contingency-based
d. Transformational
ANS: D
d. Transformational
Transformational leadership involves attending to the needs and motives of followers, which results in creativity, improvement, and employee development.
- 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:a. Trait theories.
b. Complexity theory.
c. Situated theory.
d. Emotional intelligence.
ANS: B
b. Complexity theory.
Complexity theory involves envisioning each member of the team involved in decision making, management, and leadership, with the leader not seen in a hierarchal relationship to other team members.
- 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?a. Empowerment
b. Systematic thinking
c. Development of networks
d. Bottom-up interactions
ANS: C
c. Development of networks
According to complexity theory, social networks evolve around areas of common interest and are able to respond to problems in creative and novel ways.
- According to the complexity theory, which of the following should be the focus of measurement?
a. Cost per hospital day
b. Bed utilization
c. Infection rates
d. Staff morale and budgets
ANS: D
d. Staff morale and budgets
According to complexity theory and the principle “Think systematically,” you cannot ignore objective data or nonmeasurable data, as both inform decisions.
- During a staff meeting held to discuss developing a mission statement for the unit, the idea of placing patient needs first is:
a. Empowering.
b. A leadership tag.
c. A symbol.
d. A management task.
ANS: B
b. A leadership tag.
According to complexity theory, leadership tags, which are similar to values, reflect the patient-centered philosophies and values-driven characteristics that define an organization and give it personality.
- 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:
a. Expediency in responding to the initial dispute, once it became apparent that it could not be resolved by the two parties themselves.
b. Asking other staff members what the real issues were in the dispute between the RN and the LPN.
c. Reassigning one of the parties to another unit when it became apparent that the two individuals could not resolve the dispute themselves.
d. Calling a staff meeting at the onset of the dispute to allow the team and the RN and LPN to discuss the initial dispute.
ANS: A
a. Expediency in responding to the initial dispute, once it became apparent that it could not be resolved by the two parties themselves.
The initial step in conflict resolution should have involved an expedient response to the issues and putting a focus on the issues involved in the dispute between the LPN and RN through negotiation involving the two parties, before the dispute involved others.
- 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:
a. Acknowledge the loss.
b. Explain the reasons for change, emphasizing the need to reduce costs.
c. Repeat the information several times, giving detailed budget overviews.
d. Adjourn the meeting and provide explanation through e-mail.
ANS: A
a. Acknowledge the loss.
Visioning involves engaging with others to assess the current reality, specify the end point, and then strategize to reduce differences. This requires trusting relationships that acknowledge the differences in values and ideas. When done well, the nurse and the nurses within a unit experience creative tension that inspires working in concert to achieve desired goals.
- 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):
a. Assertiveness.
b. Followership.
c. Management.
d. Insubordination.
ANS: A, B
a. Assertiveness.
b. Followership.
This is an example of followership in which a staff nurse is demonstrating assertive behavior and presenting evidence that may influence the decision making of her nurse leader and manager.
- In an effort to control costs and maximize revenues, the Rehabilitation Unit at Cross Hospital reduced the number of its managers and increased the number of units for which each manager was responsible. Within a year, the number of adverse events on the units had doubled. This may be attributable to:
a. The overload of staff nurses.
b. Resistance to change by staff.
c. A change in reporting systems.
d. Fewer clinical leaders to remove barriers to care.
ANS: D
d. Fewer clinical leaders to remove barriers to care.
Eliminating barriers to the implementation of best practices is the role of managers and leaders. When there are insufficient resources for leadership to encourage a culture in which evidence-based practice is embraced, frontline nurses recognize this as a stumbling block for delivering quality care.
- The Rehabilitation Unit at Pleasant Valley Hospital has a high number of falls. Which of the following interventions might assist to reduce the number of falls on the unit?
a. Determining who is responsible for the falls
b. Strengthening unit policies to avoid inappropriate admissions
c. Encouraging involvement of nurses in education related to falls and safety
d. Ensuring that patients are appropriately restrained if they are at risk for falls
ANS: C
c. Encouraging involvement of nurses in education related to falls and safety
The IOM (2010) emphasizes the need for nurses to engage in lifelong learning and to use evidence and best practices to inform practice and ensure safety.
- To increase safety in patient care areas of the Valley Hospital, the executive begins by:
a. Asking the community what the safety issues are.
b. Consulting with a management expert about staffing schedules.
c. Ensuring that the senior nursing officer attends the board meetings.
d. Instituting improved practices to reduce needle-stick injuries.
.
ANS: C
c. Ensuring that the senior nursing officer attends the board meetings
The IOM report (2004) highlighted the importance of the attendance of the senior nurse executive at board meetings to be a key spokesperson on safety and quality issues
- During review of back injuries, it is determined that a large number of injuries are occurring in spite of mechanical lifts being used. Furthermore, it is determined that some lifts are outdated. In addressing this concern, the unit manager:
a. Meets individually with nurses who are observed to be using the lifts incorrectly to review the correct procedure.
b. After consultation with the staff about the review, orders new lifts to replace older ones that are malfunctioning.
c. Blames the system for inadequate funding for resources.
d. Reviews the system of reporting incidents to ensure that appropriate reporting is occurring.
ANS: A
a. Meets individually with nurses who are observed to be using the lifts incorrectly to review the correct procedure
The IOM report (2004) points to the need to involve nurses in decisions that affect them and the provision of care.
- The IOM Health Professions Education report highlighted patient safety concerns as:
a. A normal risk in professional practice.
b. A result of disciplinary silos.
c. A reflection of frontline staff.
d. Related to systems errors.
ANS: B A result of disciplinary silos.
ANS: B
The IOM Health Professions Education report (2004) highlighted the education of health disciplines in silos as a major concern in patient safety and endorsed five recommendations
- If you are supporting the steps in the AHRQ document “Five Steps to Safer Health Care,” you would ensure that:
a. Patients are actively encouraged to make decisions related to care.
b. Rules and decisions are made through centralized processes.
c. You monitor the performance of each staff member closely.
d. Preference is given to increasing staff numbers rather than staff credentials.
ANS: A
a. Patients are actively encouraged to make decisions related to care.
The Agency for Healthcare Research and Quality (AHRQ) outlines “Five Steps to Safer Health Care,” which suggests that safe, patient-centered care is facilitated by assisting patients to become active partners in their own care.
- After consulting with practice environments about quality and safety concerns in health care, the Dean of Health Programs at U.S. University develops:
a. A nursing program that emphasizes the development of a strong disciplinary identity.
b. Programming that stresses discipline-based research.
c. Partnerships with health care to develop software for the reporting of adverse events.
d. An interdisciplinary program for nurses, pharmacists, and medical practitioners that emphasizes collaborative learning teams.
ANS: D
d. An interdisciplinary program for nurses, pharmacists, and medical practitioners that emphasizes collaborative learning teams.
Health Professions Education identified that education related to health disciplines in silos leads to compromised communication and inability to function as an integrated whole for patient-centered care.
- In designing a quality, safe healthcare environment, the primary emphasis needs to be on:
a. Evidence-based practice.
b. Informatics.
c. Staffing.
d. The patient.
ANS: D
d. The patient.
Focusing on the patient moves care from concern about who controls care to a focus on what care is provided to and with patients, which was an aim identified in the IOM report Crossing the Quality Chasm.
- As a patient care advocate, you regularly coach patients on how to stay safe in health care by educating them about:
a. The need to understand and record all medications being taken.
b. Bringing their own linens and other personal items to the hospital.
c. Washing hands frequently while in a healthcare environment and using a hand sanitizer.
d. Following closely the directions and orders of healthcare providers.
.
ANS: A
a. The need to understand and record all medications being taken.
The Five Steps to Safer Health Care for patients include keeping a list of medications that patients are taking
Five Steps to Safer Health Care:
- Ask questions if you have doubts or concerns
- Keep and bring a list of ALL the medicines you take.
- Get the results of any test or procedure.
- Talk to your doctor about which hospital is best for your health needs.
- Make sure you understand what will happen if you need surgery.
- As a nurse manager on the West Surgery Unit, you are interested in increasing patient safety and reducing morbidity and mortality on your unit. Which of the following recommendations would be consistent with the IOM The Future of Nursing report?
a. Careful screening of nursing staff for substance use and abuse
b. Increased RN staffing on the unit
c. Salary and benefits that reflect nursing accountabilities
d. Increase in the percentage of baccalaureate-prepared nurses to 80%
ANS: D
d. Increase in the percentage of baccalaureate-prepared nurses to 80%
The Future of Nursing advocates for having 80% of the nursing population at a baccalaureate-prepared level. This recommendation reflects research that suggests that improved mortality and morbidity rates occur with a better educated workforce.
- On the West Surgery unit, you want to institute a new system for checking armbands that evidence suggests may increase safety in medication administration. The system involves technology. Which of the following strategies may assist with rapid adoption of the technology and system?
a. Employ a centralized decision-making approach.
b. Use simulators for initial practice to build confidence.
c. Bring in a nurse consultant who is familiar with the technology.
d. Use early adopters among the staff as leaders and role models in implementation.
ANS: D
d. Use early adopters among the staff as leaders and role models in implementation.
The Institute for Healthcare Improvement (IHI) is dedicated to rapid improvement in patient care through a variety of mechanisms such as rapid cycle change. Rapid cycle change diffuses innovation and changes quickly through early adopters who share information and energy over time and act as role models for others.
- To achieve nurse-sensitive care standards developed by the NQF, you advocate for which of the following in your health facility?
a. Evidence-based practice to reduce the prevalence of pressure sores
b. Implementation of informatics at the bedside
c. Staff-manager conferences to review reporting of adverse medical events
d. Patient councils to review food, recreation, and nurse-patient relations
ANS: A
a. Evidence-based practice to reduce the prevalence of pressure sores
The National Quality Forum (NQF) outlines nursing-centered intervention measures related to prevalence of pressure sores, ventilator-associated pneumonias, volunteer turnover, nursing care hours per day, and skill mix of staff.
- You notice that Sally, a student on your unit, is giving information to an anxious young teen who seems very uncertain about preparation for an upper GI series. After Sally leaves the room, you ask her how she thought her conversation with the patient went and:
a. Encourage her to ask the patient if he has questions or concerns about the procedure.
b. Advise her to consider providing the patient with more information.
c. Suggest that she leave some brochures on the procedure with the patient.
d. Suggest that she also provide teaching to the adolescent’s parents.
ANS: A
a. Encourage her to ask the patient if he has questions or concerns about the procedure
The Five Steps to Safer Health Care for Patients includes the step of asking questions if there are doubts or concerns. The nurse can encourage patients to take a larger role in care by taking these steps and by providing patients with coaching in the steps.
- The NQF provides a model for advancement of healthcare quality that could be used in healthcare organizations. The use of this model by the Centers for Medicare & Medicaid Services specifically affects the interaction between adverse events and:
a. Staffing.
b. Funding.
c. Composition of executive councils.
d. Composition of consumer-based councils.
ANS: B
b. Funding.
The Centers for Medicare & Medicaid Services (CMS) have adopted a policy based on the NQF’s “never events.” The CMS will no longer pay for patient conditions or events that result from poor practice while patients are under the care of a health professional.
- In accordance with changes by the Joint Commission (TJC), Pleasant Valley Hospital amends its safety practices and policies to emphasize:
a. Safety goals specific to Pleasant Valley.
b. Decision-making processes.
c. Sufficient staffing for safe care.
d. Increased numbers of baccalaureate-prepared RNs.
ANS: A
a. Safety goals specific to Pleasant Valley.
When the TJC, a not-for-profit organization that accredits healthcare organizations, changed its focus from processes to outcomes, it emphasized patient safety and issues setting-specific annual patient safety goals.
- Which of the following would managers and staff review annually in order to ensure compliance with the Joint Commission (TJC) to improve patient safety?
a. Appropriateness of charting terms and abbreviations
b. Nursing hours per patient
c. Acuity of patient admissions
d. Wait times for care
ANS: A
a. Appropriateness of charting terms and abbreviations
The Joint Commission issues setting-specific patient goals annually, as well as a list of “do-not-use” terms, abbreviations, and symbols and sentinel events.
- In preparation for redesignation as a MagnetTM Hospital, how would you prepare?
a. Commit staff resources over a 6-month period to updating procedure manuals.
b. Educate staff through meetings and training sessions regarding appropriate answers to questions.
c. Prepare a manual that outlines orientation procedures and ensure that all safety issues are addressed.
d. Ensure that there are empirical data to support review of patient outcomes, actions taken, and results of actions.
ANS: D
d. Ensure that there are empirical data to support review of patient outcomes, actions taken, and results of actions.
Through the MagnetTM model, organizations must demonstrate how they provide excellence in five areas. Between designation and redesignation as a MagnetTM organization, greater emphasis is placed on empirical quality results.
- Sarah is a second-year nursing student. The clinical instructor overhears Sarah telling a patient that she “always” checks patients’ bracelets before giving medication and she is not sure how the nurses on the unit “get away with” not making more errors than they do. The clinical instructor pulls Sarah aside and explores with her how her communication might affect the patient and what it reflects about her beliefs related to the team. The actions of the clinical instructor reflect competencies outlined by:
a. QSEN.
b. IHI.
c. DNV/NIAHO.
d. AHRQ.
ANS: A
a. QSEN.
The Quality and Safety Education for Nurses (QSEN) project provides resources related to competencies that prelicensure and graduate students need to develop to serve as safe practitioners. These competencies include leading and managing, teamwork and collaboration.
- The SBAR approach to patient safety encourages:
a. Consistency in assessment and practices.
b. Continuing education.
c. Multidisciplinary approaches.
d. Patient feedback.
ANS: A
a. Consistency in assessment and practices.
The use of SBAR (Situation, Background, Assessment, and Recommendation) checklists are designed to decrease omission of important information and practices.
- As a manager in a new nursing home, where might you consult for guidance and evidence to support the development of safe patient practices?
a. Hospitals
b. Business
c. Industry
d. Outpatient clinics
ANS: A
a. Hospitals
Practices that were once mostly studied in hospital settings are now scrutinized for implementation in other settings, such as outpatient clinics, rural settings, and nursing homes.
- As a manager, the development of your decision-making skills related to safe patient care is facilitated by:
a. Regular reflection on decisions.
b. A culture of perfectionism.
c. Recognition of who should be held responsible for individual errors.
d. A culture of trust between the staff and you.
ANS: A
a. Regular reflection on decisions.
Reflection on how well decisions were enacted enables knowledge of the complexity of situations and ramifications of the decisions made. Reflection enables elimination of strategies and methods that are inappropriate in meeting needs and aids in narrowing choices of best actions to take.
- 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:
a. Setting up a nursing team meeting to review practices.
b. Calling the family to inform them of the practice.
c. Initiating a multidisciplinary and family meeting to focus on Mary’s needs.
d. Restraining Mary to satisfy the family’s wishes.
ANS: C
c. Initiating a multidisciplinary and family meeting to focus on Mary’s needs
Crossing the Quality Chasm emphasizes the importance of rendering care with the client (client-centered) rather than to the client. In this situation, the patient includes family in transparent discussions about quality needs and takes a team approach that involves healthcare professionals, the family, Mary’s needs, and evidence associated with safe practice.
- 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:
a. Suggest that an interpreter explain the procedure to the client and answer any questions.
b. Ask the client if he has any questions.
c. Draw a picture to show the incision.
d. Not intervene.
ANS: A
a. Suggest that an interpreter explain the procedure to the client and answer any questions.
The Five Steps to Safer Patient Care identifies that encouraging patients to ask questions when there are doubts and concerns and ensuring understanding before surgery is performed are ways in which nurses can support patients in having greater influence in their own care. In this situation, asking an interpreter to help enables access to information for the patient and active assessment of his understanding.
- As the manager on an acute care medical unit, you note that the incidence of medication errors has increased since the implementation of staffing changes. As part of your strategy to reduce errors, it is important to
a. Re-visit reporting standards for medication errors in your organization.
b. Ensure that medication errors are consistently reported.
c. Provide staff with additional education related to safe practice in medication administration.
d. Involve RN staff in determining reasons for errors and practice solutions to increase the safety of medication administration.
ANS: D
d. Involve RN staff in determining reasons for errors and practice solutions to increase the safety of medication administration.
Keeping Patients Safe: Transforming the Work Environment of Nurses (2004) identified many past practices that had a negative impact on nurses, and thus on patients, and recommended the inclusion of nurses in direct care in decision making involving their practice. Future of Nursing: Leading Change, Advancing Health (2010) also emphasizes the role of nurses as leaders in changes that improve health.
- 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.
b. George is very shy and withdrawn. He asks the nurse to leave him alone.
c. Sarah is a new parent who finds that nurses on the children’s unit are very helpful. She is eager to accept all suggestions, including those that she does not yet understand.
d. Claude is booked for bowel surgery. His doctor explains about the colostomy. Later, Claude tells his wife that he really doesn’t know what the doctor meant by colostomy.
ANS: A, C, D
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.
Safer health care involves the patient as an active consumer who keeps and brings a list of all medications, including natural remedies, and questions if there are doubts, concerns, or lack of understanding.
- You are a member of a team assigned to care for 15 general medical/surgical clients. You have all worked well together in the past in this same type of care. If you are assigned to coordinate this team’s work, your best strategy, based on the Hersey and Blanchard model, would be to:
a. Have a list of tasks to be accomplished and tell each member of the team what he or she must do.
b. Encourage people to discuss their frustrations in providing this care.
c. Ignore them—they’ve done it before.
d. Provide minimal direction and let them come to you with questions.
ANS: D
d. Provide minimal direction and let them come to you with questions.
According to the Hersey and Blanchard model, when ability (skills, job knowledge) and willingness are strong, the role of the delegator is less (“delegating behavior”).
- The nurse manager is setting up the room assignments for the unit. She has one critical patient on the unit, who is going to require more care than the others. Before delegating a task, a nurse manager should:
a. Delegate the admission assessment to the LPN.
b. Review the employee’s performance assessment for the most recent period.
c. Assess the amount of guidance and support needed in a particular situation.
d. Create a task analysis of critical behaviors for the individual.
ANS: C
c. Assess the amount of guidance and support needed in a particular situation.
To delegate effectively, the nurse manager must assess the abilities required in the situation and the abilities that staff have to anticipate the amount of direction, monitoring, explanation, and independence that can be assumed
- A key advantage that a nurse manager has in terms of delegating is that:
a. Clients receive less attention because too many staff make it difficult to coordinate care.
b. Nurses report less pressure to perform necessary tasks themselves.
c. Administration can predict overtime more accurately.
d. Team skills can be used more effectively.
ANS: D
d. Team skills can be used more effectively.
The use of multilevel healthcare providers enables healthcare organizations and nursing to provide patient-centered care, with a focus on abilities and skills that can be employed to perform “what is needed now.” As tasks become more complicated, delegating skills to others enables the nurse to effectively deliver a complex level of care.
