Chapter 24

Question 1

What should the manager do in completing an annual performance appraisal?
A) Consider good intentions as well as actual performance
B) Base the appraisal on a standard to which all are held accountable
C) Always make an effort to include subjective data
D) Closely observe the employee for the 2 weeks preceding the appraisal conference

Answer 1

B) Base the appraisal on a standard to which all are held accountable

For an objective appraisal, the manager must have a fair performance appraisal tool that
is used for all employees in the same classification.

Question 2

What increases the likelihood that the performance appraisal will have a positive
outcome?
A) The manager refrains from making any comments about the worker’s performance
B) The employee is encouraged to identify three areas of satisfactory performance
C) The employee provides input into developing the performance standards
D) The manager identifies not more than three areas of deficient performance

Answer 2

C) The employee provides input into developing the performance standards

If the employee has some input into developing the standards or goals on which his or
her performance is judged, there is more of a chance that the appraisal will have a
positive outcome. The remaining options fail to contribute to an effective performance
appraisal.

Question 3

Although some subjectivity is inescapable in performance appraisals, what action can
the manager take to arrive at a more fair and accurate assessment?
A) Written anecdotal notes regarding the employee’s performance should be
maintained throughout the evaluation period
B) Evaluation criteria that reflect on the employee as a person rather than just on
work performance should be used
C) Data gathered by the manager in preparation for the performance appraisal should
be limited to not more than two sources, so no conflicting information is received
D) The manager should rate all employees using central tendency whenever possible

Answer 3

A) Written anecdotal notes regarding the employee’s performance should be
maintained throughout the evaluation period

Because a manager will tend to remember an employee’s performance better in the
weeks or months directly preceding the appraisal, a manager should take notes on an
employee’s performance throughout the year. The other options are less affective in
proving a balanced appraisal.

Question 4

Which statement accurately reflects self-appraisals?
A) Self-appraisals are more objective than the other types of appraisals
B) Self-appraisals provide an opportunity to give positive feedback to employees
C) Self-appraisals usually require some introspection on the part of the employee
D) Self-appraisals should be read before the supervisor does an appraisal

Answer 4

C) Self-appraisals usually require some introspection on the part of the employee

Although they require some work on the employees’ part, self-appraisals can provide
introspection and personal growth. The remaining options are not accurate statements.

Question 5

Which statement is true regarding the Behaviorally Anchored Rating Scale (BARS)?
A) Has long been used as a performance appraisal tool in the health-care industry
B) Requires that a separate rating form be developed for each job classification
C) Is often referred to as a free-form review
D) Is a rapidly scored and administered performance appraisal tool

Answer 5

B) Requires that a separate rating form be developed for each job classification

The BARS key areas of responsibility are delineated and ranked by importance. This
system reduces subjectivity, but has the drawback of being time-consuming.

Question 6

Which statement correctly describes using self-appraisal as a performance appraisal
tool?
A) It should always be totally unstructured so employees can write about whatever
they want to
B) It is effective because most employees are self-aware and rate themselves
accurately and appropriately
C) It works best when used in conjunction with other appraisal tools
D) It relieves the manager of the responsibility for preparing the performance
appraisal

Answer 6

C) It works best when used in conjunction with other appraisal tools

Because employees cannot be objective concerning their own performance, a selfappraisal
is most effective when used in conjunction with other appraisal tools. The
remaining options are incorrect statements regarding self-appraisal tools.

Question 7

Why have health-care organizations been slow to adopt peer review?
A) It tends to be an inaccurate performance appraisal tool
B) Colleagues generally have little data they can contribute regarding a peer’s work
performance
C) It requires staff be oriented to the process effectively
D) It works better for professionals such as physicians than for nurses

Answer 7

C) It requires staff be oriented to the process effectively

Peer review is effective only when adequate time is spent orienting staff to the process
and the necessary support is provided to complete the process. The remaining options
are not generally considered barriers to the use of peer reviews.

Question 8

What is the term used to identify the effect that results when some negative aspect of an
employee’s performance unduly influence all other aspects of performance?
A) A halo effect
B) A horns effect
C) Central tendency
D) A job dimension scale

Answer 8

B) A horns effect

Data should be gathered from many different sources and must reflect the entire time
period of the appraisal to avoid the horns effect, which is when some negative aspect of
an employee’s performance unduly influences all other aspects of his or her
performance. None of the other options accurately identifies this outcome.

Question 9

Which statement identifies an important consideration when using management by
objectives (MBO) as a performance appraisal tool?
A) The manager determines the objectives each employee should accomplish during
the upcoming evaluation period
B) Employees determine the objectives their manager should accomplish during the
upcoming evaluation period
C) The manager’s role is supportive, assisting employees to reach goals by
counseling and coaching
D) Managers should encourage employees to set lofty, difficult goals in an effort to
stretch the employees to their maximum

Answer 9

C) The manager’s role is supportive, assisting employees to reach goals by
counseling and coaching

MBO is in use when the manager supports employees to reach goals they identify for
themselves. None of the other options are associated with the use of MBO as a
performance appraisal tool.

Question 10

What does the employee’s signature on the performance appraisal form denote?
A) The employee agrees with everything written on the form
B) The employee objects to what is written on the form
C) The employee agrees that a merit raise is due
D) The employee has read the appraisal information

Answer 10

D) The employee has read the appraisal information

The employee’s signature on the performance appraisal form denotes that the employee
has received and read the appraisal information. The signature does not mean that the
employee agrees with or disagrees with the appraisal.

Question 11

Which is the best example of coaching used to encourage and improve daily work
performance?
A) ìLet’s discuss how to improve your charting notes.î
B) ìDid you enjoy working as team leader this weekend?î
C) ìWould you consider taking on the role of preceptor?î
D) ìYour interpersonal skills have shown great improvement.î

Answer 11

C) ìWould you consider taking on the role of preceptor?î

For coaching to be effective, it must be specific, not self-serving, directed toward
behavior that can be changed, well timed, and understood by the employee. This is the
only option that fulfills those criteria.

Question 12

What does the Joint Commission advocate about employee performance appraisals?
A) They be conducted at least every 6 months
B) They be based on employee job descriptions
C) They be documented by anecdotal notes
D) They be reflective of employees’ personal goals

Answer 12

B) They be based on employee job descriptions

The Joint Commission advocates that employee performance appraisals be based on
employee job descriptions. None of the other options are identified for this purpose.

Question 13

A nurse-manager is planning a performance appraisal of an employee who has a number
of performance deficiencies. What is the best approach to the performance appraisal of
this employee?
A) Tell the employee that he or she is not performing well and ask the employee
where improvement is needed
B) Prepare a list of the employee’s deficiencies and give him or her time to look it
over before asking for a response
C) Recognize the employee’s strengths, focus on one or two key deficiencies, and
create a long-term coaching plan
D) Tell the employee that he or she is liked as a person but is not meeting the
requirements for the job and will need to brush up on skills during the next year

Answer 13

C) Recognize the employee’s strengths, focus on one or two key deficiencies, and
create a long-term coaching plan

An employee who is overwhelmed with negative feedback during the performance
appraisal cannot grow as a result of the appraisal. The manager should recognize the
employee’s strengths, focus on one or two key deficiencies, and create a long-term
coaching plan.

Question 14

The nurse-manager is preparing for the unit ward clerk’s annual evaluation and sends
out a short questionnaire requesting feedback on the ward clerk’s effectiveness in her
job. The nurse-manager sent the request to one doctor who uses the unit frequently, to a
staff nurse on each shift, to the housekeeping department head, and to the head of the
volunteer program. In addition, the nurse-manager interviews three patients to determine
how courteous the ward clerk is when answering call lights from the unit desk. What is
this an example of?
A) Peer review
B) A 360-degree evaluation
C) An overreaching performance review
D) An anecdotal performance review

Answer 14

B) A 360-degree evaluation

Seeking feedback from patients, staff, and other departments who interact with an
employee to determine his or her effectiveness in his or her job is called a 360-degree
evaluation. None of the other options are associated with the scenario described.

Question 15

What type of evaluation has been proved to increase productivity and commitment in
employees?
A) Rating scale
B) Checklist
C) Essay
D) MBO

Answer 15

D) MBO

MBO has been proved to increase productivity and commitment in employees. Research
does not support that claim related to the other options.

Question 16

In performance management, appraisals are eliminated. What does the manager do in
place of the appraisal?
1. Periodical coaching
2. Mutual goal setting
3. Leadership training of subordinates
4. Employee accountability for own actions
A) 1, 2
B) 1, 4
C) 2, 3
D) 3, 4

Answer 16

C) 2, 3

In performance management, appraisals are eliminated. Instead, the manager places his
or her efforts into ongoing coaching, mutual goal setting, and the leadership training of
subordinates.

Question 17

In preparation for an appraisal conference, how many days of advanced notice will the
manager give the employee?
A) 1
B) 2 to 3
C) 4 to 5
D) 6 to 7

Answer 17

B) 2 to 3

Give the employee 2- to 3-day advance notice of the scheduled appraisal conference so
that he or she can be prepared mentally and emotionally for the interview.

Question 18

Which term is used to identify the effect that occurs when the appraisal is based on
recent performance over less recent performance during the evaluation period?
A) Halo
B) Horns
C) Recency
D) Mathew

Answer 18

C) Recency

Taking regular notes on employee performance is a way to avoid the recency effect,
which favors appraisal of recent performance over less recent performance during the
evaluation period. None of the other options accurately identifies this effect.

Question 19

What does a competence assessment evaluate?
1. Knowledge and education to perform the task
2. Skills to perform the task
3. Experience to perform the task
4. How well the individual completes the task
A) 1, 2, 3
B) 1, 2, 4
C) 1, 3, 4
D) 2, 3, 4

Answer 19

A) 1, 2, 3

A competence assessment evaluates whether an individual has the knowledge,
education, skills, or experience to perform the task, whereas a performance evaluation
examines how well that individual actually completes that task.

Question 20

Which method rates a person against a set standard, which may be the job description,
desired behaviors, or personal traits?
A) Trait Rating Scale
B) Checklist
C) Essay
D) MBOs

Answer 20

A) Trait Rating Scale

Trait Rating Scale is a method of rating a person against a set standard, which may be
the job description, desired behaviors, or personal traits. The Trait Rating Scale has been
one of the most widely used of the many available appraisal methods. None of the other
options rates a person against a set standard.

Question 21

How does a leader effectively use a performance appraisal?
A) To motive staff
B) To identify staff educational needs
C) To follow up on identified deficiencies
D) To provide feedback on work performance

Answer 21

A) To motive staff

Leaders use the appraisal process to motivate employees and promote growth. The
remaining options are manager responsibilities.

Question 22

What factor contributes most to a performance appraisal being viewed as relevant by the
employees?
A) Its influence on whether a raise will be awarded
B) Belief that it is based on the performance of job descriptionñrelated tasks
C) The perception that the manager truly likes and approves of them personally
D) The formality with which the appraisal is conducted and presented

Answer 22

B) Belief that it is based on the performance of job descriptionñrelated tasks

If employees believe that the appraisal is based on their job description rather than on
whether the manager approves of them, they are more likely to view the appraisal as
relevant. The remaining options are not viewed as being factors in the view that the
appraisal is relevant.

Question 23

What is the primary goal of a performance appraisal?
A) Promotion of employee growth
B) Compliance with stated regulations
C) Identification of ineffective staff
D) Providing a basis for staff wage increases

Answer 23

A) Promotion of employee growth

A performance appraisal wastes time if it is merely an excuse to satisfy regulations and
the goal is not employee growth. None of the remaining options express the goal of a
performance appraisal.

Question 24

Which factor is the focus of an individual's performance evaluation?
A) Related knowledge
B) Individual skills
C) Appropriate experience
D) History of task completion

Answer 24

D) History of task completion

A competence assessment evaluates whether an individual has the knowledge,
education, skills, or experience to perform the task, whereas a performance evaluation
examines how well that individual actually completes that task.

Question 25

What is the outcome when a manager provides vague and ambiguous feedback to an
employee during a performance appraisal?
A) The employee receives the information in a positive manner
B) The manager is able to avoid the appearance of being too negative
C) The employee is uncertain of the value of the feedback
D) The manager is viewed as being an ineffective communicator

Answer 25

C) The employee is uncertain of the value of the feedback

Indirectness and ambiguity are more likely to inhibit communication than enhance it,
and the employee is left unsure about the significance of the message. The employee is
not likely to feel positive about the process. When the feedback is present appropriately,
the manager will not be viewed as too negative but rather honest and helpful.

Question 26

The nurse manager is coaching an employee who has been late for work three mornings this week. What statements and questions should the manager include in this coaching session?

Select all that apply.

1. “What is causing you to be late?”
2. “When you are late it throws the pace of the entire unit off and client care suffers.”
3. “Does it not bother you that your lateness makes everyone else’s job more difficult?”
4. “You have been late three times this week and that is not acceptable.”
5. “What are you going to do to avoid being tardy again?”

Answer 26

1. “What is causing you to be late?”
2. “When you are late it throws the pace of the entire unit off and client care suffers.”
3. “You have been late three times this week and that is not acceptable.”
4. “What are you going to do to avoid being tardy again?”

Rationale 1: The manager should investigate why the nurse is being tardy.
Rationale 2: The impact on client care is always the most important aspect of meeting job expectations.
Rationale 4: The employee must first know that the tardy behavior is unacceptable.
Rationale 5: The manager should develop a plan for behavior change that the nurse can agree to.

Question 27

What is the primary reason a nurse manager would confront a nurse who has been reported for violating infection control policy?

1. To punish the guilty
2. To protect the institution from liability
3. To set an example for other employees
4. To encourage the correct behavior

Answer 27

4. To encourage the correct behavior

The primary reason a manager confronts policy violation or inappropriate behavior is to encourage correct behavior.

Question 28

An employee has consistently violated policy and has not responded to coaching. The manager has decided that discipline is required. What should the manager do first?

1. Plan a private meeting for the disciplining.
2. Wait for one more infraction to occur and discipline immediately afterward.
3. Make certain that the information regarding policy violations is correct.
4. Keep the human resources department informed.

Answer 28

3. Make certain that the information regarding policy violations is correct.

The manager must first be certain that the facts about infraction are complete and correct.

Question 29

Which statement by the nurse manager is the best example of day-to-day coaching?

1. “Can we meet this afternoon for about 30 minutes to discuss your progress?”
2. “I think you need to get different day care that would allow you to be on time.”
3. “Over the past 6 months the narcotics count has been off on several days that you have worked.”
4. “Let me show you a method I have found to be effective in making patient assignments.”

Answer 29

4. “Let me show you a method I have found to be effective in making patient assignments.”

Rationale 4: Coaching is a mentoring relationship. It is a brief interaction.

Question 30

A certified nurse’s aide (CNA) has been reported to the nurse manager for refusing to perform hand hygiene between clients when providing morning care. Which statement by the nurse manager would be the most effective?

1. “Do you need a class on hand hygiene?”
2. “Forgetting to perform hand hygiene between clients can spread infection.”
3. “Why do you refuse to perform hand hygiene?”
4. “If I hear of any more instances of you not performing hand hygiene, I will write you up.”

Answer 30

2. “Forgetting to perform hand hygiene between clients can spread infection.”

The employee needs to realize the unwanted behavior has consequences for the client. A better understanding may prevent the behavior in the future.

Question 31

Coaching and discipline have failed and the nurse manager is faced with no alternative but to terminate an employee. Which aspect of this situation requires the most careful planning?

1. When the termination will occur
2. How to keep the human resources department informed
3. Accurately documenting all stages of the situation
4. Whether the termination will adversely affect unit staffing

Answer 31

3. Accurately documenting all stages of the situation

Before termination there must be sufficient and accurate documentation to support the termination. This not only protects the employee from wrongful termination, but also protects the manager and the institution.

Question 32

A terminated employee files a grievance against the nurse manager. Which situations would benefit the employee’s claim?

Select all that apply.

1. The nurse manager wrote notes on the expectations discussed during disciplinary sessions.
2. The terminated employee’s last evaluation discusses problems with performance, but no coaching is described.
3. When problems with the employee arose, the manager’s average time of intervention was less than 1 day.
4. There are notes in the employee’s record from human resources indicating the nurse manager had discussed issues with the HR director.
5. In one note, the manager describes the employee as “petulant, immature, and uncaring.”

Answer 32

2. The terminated employee’s last evaluation discusses problems with performance, but no coaching is described.
3. In one note, the manager describes the employee as “petulant, immature, and uncaring.”

Rationale 2: Even though coaching is done in short sessions, it should be documented.
Rationale 5: This note could be a problem for the institution as it is the manager’s opinion, not a defensible fact.

Question 33

It has been reported to the nurse manager that an employee is repeatedly parking in the patient/visitor parking area. What action should the manager take?

1. Confront the employee.
2. Check the parking lot each morning.
3. Discuss the issue at the next employee appraisal.
4. Provide an education session for all staff regarding parking policy.

Answer 33

1. Confront the employee.

When there is a policy violation, it is necessary to confront the employee. The steps of confrontation are similar to those of coaching.

Question 34

A nursing assistant has taken long lunch breaks for the last 2 days and today is 15 minutes late returning from the cafeteria. What should the manager do?
Select all that apply.
1. Go to the cafeteria and confront the assistant.
2. Send a message with a nurse going to lunch for the assistant to return to the unit immediately.
3. Call the cafeteria and ask that they send the assistant back to the unit.
4. Meet with the assistant and calmly say, “You have been late back from lunch for 3 days this week.”
5. Anticipate that the assistant will give an explanation for the lateness.

Answer 34

4. Meet with the assistant and calmly say, “You have been late back from lunch for 3 days this week.”
5. Anticipate that the assistant will give an explanation for the lateness.

Rationale 4: It is important to stay calm and to relate the facts. This assistant has been late twice already this week and is late again today.
Rationale 5: The manager should anticipate that the assistant will offer a reason for the lateness. It will be up to the manager to decide if the explanation is reasonable.

Question 35

A newly hired certified nurse’s aide (CNA) has been 15 minutes late returning from mealtime 4 days this week. The nurse manager coaches the employee and finds the CNA thought meal breaks were 45 minutes. What is the most appropriate response from the nurse manager?

1. Document the tardy behavior in the CNA’s record.
2. Show the CNA the break hours in the employee handbook.
3. Warn the CNA tardiness is not tolerated and follow up in 2 weeks.
4. Warn the CNA that the charge nurse will be timing future meal breaks.

Answer 35

2. Show the CNA the break hours in the employee handbook.

The first step is to determine whether the employee is aware of the policy. It seems this employee was not. It would be most appropriate to show the employee where the policy is written.

Question 36

A manager has been informed by a reliable registered nurse that an assistant lied about bathing a client. The manager calls the assistant into the office with a written warning. Why is this action inappropriate?

1. The registered nurse should issue the warning.
2. The first warning should be verbal.
3. The assistant should be allowed to discuss the matter.
4. This type of action should be conducted by the human resources department.

Answer 36

3. The assistant should be allowed to discuss the matter.

The manager should investigate the matter and listen to the assistant’s reasons for the registered nurse’s complaint. If a written warning is appropriate, it should not be written until after the complaint has been investigated and the assistant has had an opportunity to discuss the issue.

Question 37

A charge nurse on the night shift did not notify the anesthesiologist regarding an emergency case. The manager investigated the matter and learned the charge nurse thought the primary care nurse would call the anesthesiologist. Which response by the manager would be most appropriate?

1. “It is in your job description and your duty.”
2. “It is your responsibility. In the future, call anesthesia and transfer the call to the primary nurse.”
3. “It’s not the surgery nurse’s responsibility to call anesthesia!”
4. “Why was this considered an emergency case?”

Answer 37

2. “It is your responsibility. In the future, call anesthesia and transfer the call to the primary nurse.”

The manager should obtain information; ask questions in a calm manner and offer instruction or solutions so the supervisor learns from the experience.

Question 38

The nurse manager identifies a minor problem with the way a staff nurse documents client care. The manager meets with the nurse and discusses the issue, but does not issue a warning. What is the manager’s next action?

1. Report the meeting to human resources.
2. Enlist the aid of a more experienced nurse to help monitor the documentation.
3. Record the specific behavioral steps discussed for future reference.
4. Tell the nurse that failure to comply with steps discussed will result in a written warning.

Answer 38

3. Record the specific behavioral steps discussed for future reference.

Even when the discussion does not lead to a formal warning, the manager should record the specific behavioral steps discussed with the nurse for future reference. If there is absolutely no record of what was said, the manager may forget and be unable to evaluate the nurse’s progress.

Question 39

The staff has complained that a nurse receives frequent personal phone calls, which is a violation of policy. In what manner should the manager address this nurse?

1. Meet with the nurse privately and inquire as to the necessity of personal phone calls.
2. Meet with the nurse and give a verbal warning.
3. The manager should inform the nurse the other nurses are complaining about the phone calls.
4. Tell the complaining nurses to handle the situation with peer pressure.

Answer 39

1. Meet with the nurse privately and inquire as to the necessity of personal phone calls.

The manager should address the behavior in private and investigate the situation.

Question 40

A nurse who receives frequent phone calls informs the manager the phone calls are related to a health crisis concerning a family member. Other nurses also receive personal calls, but not as many as the first nurse. Which action by the manager is appropriate?

1. Tell the nurse to have family call the manager’s office if there is a crisis.
2. Discuss with the nurse how personal phone calls may affect client care and should be limited.
3. Inform the nurse the phone calls are causing morale issues among the staff.
4. Lift the policy against staff carrying personal cell phones for this nurse while the crisis continues

Answer 40

2. Discuss with the nurse how personal phone calls may affect client care and should be limited.

The manager should discuss how personal phone calls are affecting client care, perhaps by taking this nurse away from duties. The fact that calls should be limited should be stressed.

Question 41

A nurse has frequent visitors while working. The manager has discussed with the nurse the negative effect of these visits on client care. What should the manager do next?

1. Ask staff if the visits have decreased.
2. Arrange a follow-up meeting with the nurse.
3. Counsel all nursing staff regarding the limitations of personal visitors.
4. Arrange to be visible on the nursing unit when this nurse is working.

Answer 41

3. The manager should arrange a 20–30 minute meeting with the nurse to discuss the evaluation privately.

The manager should control the environment in which the appraisal meeting is conducted. The meeting should be private and the manager should allow at least 20–30 minutes for the interview.

Question 42

A nurse manager has discussed behavioral and unprofessional behaviors with a nurse. During the performance appraisal the manager addressed these issues and the two nurses have developed a specific plan to address the performance areas that can be strengthened. What should the manager’s next course of action be?

1. Take notes of the nurse’s behavior during the appraisal.
2. Inquire as to the nurse’s perception of the appraisal.
3. Schedule a follow-up session to determine if the nurse has made progress in the areas specified.
4. Schedule the next annual appraisal.

Answer 42

2. Inquire as to the nurse’s perception of the appraisal.

Arranging for a follow-up meeting allows for evaluation and communication regarding the issue.

Question 43

A nurse has been pulled from the surgical unit to the ICU unit and is asked by an ICU nurse to administer a medication that requires monitoring the cardiac rhythm. When asked about the client’s cardiac rhythm after the medication was administered, the surgical nurse states, “I don’t know.” What actions should be taken by the unit’s nurse manager?

Select all that apply.

1. Meet with the ICU nurse to discuss the situation.
2. Meet with the surgical nurse to discuss the situation.
3. Give a written warning to the surgical nurse for not following policy.
4. Give a written warning to the ICU nurse for not following policy.
5. Meet with the nurses together and issue an informal verbal warning to both.

Answer 43

1. Meet with the ICU nurse to discuss the situation.
2. Meet with the surgical nurse to discuss the situation.

Rationale 1: The manager should meet with the ICU nurse to determine if policy was followed in delegating medication administration.
Rationale 2: The manager should meet with the surgical nurse to determine if the nurse was aware of the policy requiring monitoring the cardiac rhythm.

Question 44

An ICU nurse does not follow policy when administering a medication intravenously. Which would be the most appropriate action by the manager to assist the employee?

1. Provide written instructions for administering the medication.
2. Remediate the situation with the ICU staff.
3. Provide a copy of the policy and discuss the rationale for the policy as it relates to client care.
4. Reprimand the ICU nurse for giving the medication.

Answer 44

3. The appraisal is not valid.

Because the majority of the appraisal focused on the nurse’s personality, the appraisal is not valid. The focus of the appraisal should be how the nurse’s actions affect the work of the unit.

Question 45

During the review of an organization’s appraisal policies, a nurse consultant finds that the facility uses a traditional rating scale based on general performance. What would be the consultant’s greatest concern with this choice of appraisal style?

1. It is time consuming for the manager to write the evaluation essay required by this method.
2. Ratings are based on the supervisor’s idea of satisfactory performance.
3. The standards used are so specific that they do not allow for individual variation.
4. Since this style involves input from peers, there is room for problems with confidentiality.

Answer 45

3. The standards used are so specific that they do not allow for individual variation.

This strategy helps to educate the nurse and improve practice. Documenting this action also sets the scene for further action if the policy is not followed in the future.

Question 46

An OB nurse has violated a unit policy. The OB manager is discussing the incident with the nurse. During the discussion the nurse informs the OB manager of the actions of other staff and the physician’s attitude leading up to the event. How should the manager address these issues?

1. Tell the nurse that physician’s attitude is none of the nurse’s business.
2. Inform the nurse of the policy violation.
3. Inquire about the physician’s attitude and the staff actions during the incident.
4. Redirect the nurse to focus on the issue.

Answer 46

4. Redirect the nurse to focus on the issue.

The nurse may be attempting to divert the manager’s focus from the nurse to others. The focus of this discussion is the nurse’s violation of policy.

Question 47

The nurse was reported for not following unit policy in relaying a client’s complaint regarding another staff member. During a meeting, the nurse insists he managed the situation appropriately. How should the manager respond?

1. “Let’s schedule another meeting for later in the week after you have had time to reflect on the situation a little more.”
2. “Let’s explore some alternative solutions to what happened.”
3. “I am going to request a meeting for both of us and the human resources director.”
4. “As I see it, the problem is your inability to follow the simplest of unit policies and to take direction.”

Answer 47

2. “Let’s explore some alternative solutions to what happened.”

Exploring alternatives allows the nurse to develop problem-solving skills and assist in the prevention of future problems related to the situation.

Question 48

An ICU nurse manager has been struggling to correct client care issues on the unit and has asked the unit director for assistance. The director says, “Training and discipline on your unit is your responsibility. I have other things to do.” Now, the manager is faced with disciplining a nurse regarding another client care issue. What is the most significant reason this manager is hesitant to administer this discipline?

1. The nurse may quit.
2. The nursing staff is a cohesive group and might retaliate.
3. The manager is not comfortable with confrontation.
4. The manager does not feel supported by the director.

Answer 48

4. The manager does not feel supported by the director.

The job of managing others is difficult without the full support of superiors.

Question 49

An emergency department (ED) manager is disciplining a nurse with a history of multiple client and staff complaints. The last disciplinary action was a verbal warning. If the institution follows the progressive method of addressing disciplinary issues, the manager would prepare for which action?

1. A written warning
2. A counseling session
3. Another verbal warning
4. Termination

Answer 49

1. A written warning

A written warning is the next step in progressive discipline.

Question 50

A nurse has complained to the human resources (HR) director regarding unfair treatment by the nurse’s manager. The nurse describes receiving a written warning, unlike other nursing staff who exhibit similar behaviors but are not reprimanded. Which concerns would the HR director discuss with the hospital chief nursing officer?

Select all that apply.

1. The unusual management styles within the department
2. Confronting the manager’s direct supervisor about allowing this situation to occur
3. The apparent inconsistencies in discipline within the unit
4. The potential for litigation that arises from this complaint
5. The need to terminate this problem employee

Answer 50

3. The apparent inconsistencies in discipline within the unit
4. The potential for litigation that arises from this complaint

Rationale 3: There is apparently an inconsistency in discipline that should be investigated.
Rationale 4: If this situation goes to court, the hospital could be found liable for the actions of the manager.

Question 51

A director must discipline an ICU manager. The director and manager have become friends. When disciplining the manager, what is the best approach by the director?

1. Notify the human resources director that the meeting will occur.
2. Include the chief nurse officer (CNO) in the session.
3. Ask a manager from another department to sit in on the meeting.
4. Discuss the issue, concentrate on the issue, and do not make it personal.

Answer 51

4. Discuss the issue, concentrate on the issue, and do not make it personal.

The director should focus on the issues and not allow the discussion to become personal. The manager should be treated as any other manager would.

Question 52

An OB manager discusses a nurse’s performance with the chief nurse officer (CNO). The CNO learns the nurse has had multiple client and physician complaints that the manager investigated and for which counseling was provided. The behavior continues even though the nurse has received verbal and written warnings. Which course of action would be most appropriate at this time?

1. Issue a written warning from the CNO.
2. Place the nurse on suspension pending a new investigation into the complaints.
3. Terminate the nurse.
4. Transfer the nurse to another department under another manager.

Answer 52

3. Terminate the nurse.

Since these complaints have been ongoing, even after investigation, counseling, and warnings, termination is likely the best alternative.

Question 53

The hospital’s new management company has assigned a “leadership coach” to groups of current nurse managers. Which statements made by a manager would the coach interpret as indicating the manager does not value this opportunity?

Select all that apply.

1. “Why do I need a coach?”
2. “I’ve been a manager longer than our coach has been a nurse.”
3. “I’m getting burned out with the way we manage.”
4. “Another new program to waste our time.”
5. “Coaching has helped my nurses improve their practice.”

Answer 53

2. “I’ve been a manager longer than our coach has been a nurse.”
3. “Another new program to waste our time.”

Rationale 2: A statement like this may well indicate that the manager does not think that the coach has any information that will be of benefit.
Rationale 4: When people go into a program thinking it is a waste of time, they often do not see its value.

Question 54

The manager is contemplating terminating a nurse. What should the manager consider regarding the expectations of the job prior to proceeding with termination?

Select all that apply.

1. Did the nurse receive and sign for a copy of the appropriate job description when hired?
2. Was the nurse apprised of the criteria on which evaluation would be based?
3. Have any changes to policy and procedure been discussed with the nurse and made available in writing?
4. Was the nurse hired using the same documentation as others hired at the same time?
5. Have others hired during the same time period been successful?

Answer 54

1. Did the nurse receive and sign for a copy of the appropriate job description when hired?
2. Was the nurse apprised of the criteria on which evaluation would be based?
3. Have any changes to policy and procedure been discussed with the nurse and made available in writing?

Rationale 1: The manager must have documentation that the nurse knew the expectations of the job. Documentation that the nurse received the job description is required.
Rationale 2: The nurse must be told in advance of the criteria on which evaluation will be based.
Rationale 3: Changes to policy and procedures change practice. These changes must be made known to the staff.

Question 55

The manager has disciplined a nurse with a written warning. At the end of the session, the manager asks the nurse to sign the warning and the nurse refuses. What should the manager do?

1. Tell the nurse that signing the form in mandatory.
2. Indicate on the form that the nurse declined to sign.
3. Sign the nurse’s name to the form and include the manager’s initials.
4. Complete a second warning for the nurse’s failure to follow procedure.

Answer 55

2. Indicate on the form that the nurse declined to sign.

The written disciplinary form should have an area to indicate that the employee refused to sign. If not, this should be written in by the manager.

Question 56

The manager has just terminated a nurse. What statement by the manager is appropriate?

Select all that apply.

1. “You may go back to the unit to say good-bye to your coworkers.”
2. “We have cleaned out your locker and have your personal belongings ready for you.”
3. “I have notified security to escort you as you leave the building.”
4. “As of this time, you are no longer an employee of this institution.”
5. “Please do not discuss your termination with any other nurses.”

Answer 56

3. “I have notified security to escort you as you leave the building.”
4. “As of this time, you are no longer an employee of this institution.”

Rationale 3: The terminated employee should be attended by the manager or by security at all times.
Rationale 4: It must be very clear that termination has occurred and that the nurse is no longer an employee.

Question 57

A nurse is being terminated due to continued violation of hospital policy. What statements by the manager are appropriate?

Select all that apply.

1. “Your actions have been degrading to the profession.”
2. “You may wish to resign rather than being terminated.”
3. “Human resources will answer any questions you may have about benefits.”
4. “I’m sorry you could not be happy here.”
5. “You are being terminated for the policy violations I have just outlined.”

Answer 57

2. “You may wish to resign rather than being terminated.”
3. “Human resources will answer any questions you may have about benefits.”
4. “You are being terminated for the policy violations I have just outlined.”

Rationale 2: In many cases, the nurse will choose to resign rather than being terminated.
Rationale 3: The terminated employee may have rights to some benefits. The HR department should handle those questions.
Rationale 5: The manager should outline the violations that led up to the termination and should make it clear that the violations are the reason for the termination.