Chapter 25- Managing Personnel Changes

Question 1

The most important approach that a nurse manager can take with an emotionally troubled employee is to:
a. Act as a therapist for the employee.
b. Adjust the standard of care to assist the employee.
c. Assist the employee in obtaining professional help.
d. Adjust the employee’s work schedule to decrease stress.

Answer 1

ANS: C
Emotional difficulties are usually beyond the scope of skills that a nurse manager would normally employ. A referral needs to be made to a professional who is specifically prepared to deal with this kind of difficulty.

Question 2

The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is that:
a. Using replacement personnel with new ideas may be beneficial.
b. Salary costs are lower because personnel are fewer, and outcome is favourable.
c. Absence on the part of the rest of the staff is decreased.
d. Unacceptable patient care may result

Answer 2

ANS: D
Reduced staffing adversely affects patient care. Employee morale suffers, care standards may be lowered, and additional stress is placed on working staff.

Question 3

In keeping with guidelines of the organization, the nurse manager documents staff problems. Documentation of disciplinary problems should:
a. Include a plan to correct them and to prevent future occurrences.
b. State a detailed history of past problems that are related to the current one.
c. Be written at the convenience of the manager.
d. Accumulate until the evaluation period begins

Answer 3

ANS: A
In documenting staff problems, it is important to indicate specifically what rules were broken or violated, consequences if behaviour is not altered, employee’s explanation of the incidents, and the plan of action to achieve and to reach new goals. Accurate and factual documentation and follow-up actions are key elements in the successful management of all personnel issues.

Question 4

Before terminating an employee, a nurse manger must:
a. Be an expert in all legal aspects of employment termination and discipline
practices.
b. Know the organization’s specific policies for addressing disciplinary problems and
employment termination.
c. Function as a counsellor for problem employees.
d. Do everything to assist and protect the employee by adjusting standards and
policies.

Answer 4

B
It is important to know the policies of the organization to address disciplinary issues fairly and equitably, and also to know the model that is employed to address employee problems.

Question 5

A nurse manager understands that the typical first step in handling an employee with a disciplinary problem is to:
a. Provide a verbal reprimand.
b. Prepare a written reprimand.
c. Counsel the employee regarding the problem.
d. Give the employee the day off without pay.

Answer 5

C

Question 6

The chief nursing officer understands that clinical incompetence is best prevented by which of the following?
a. A flexible protocol for evaluating competency skills.
b. A standardized clinical skills checklist.
c. A newly established peer review process.
d. A formalized competency program with established standards for practice.

Answer 6

ANS: D
The competency program with established standards of practice outlines what the nurse must do to achieve desired competencies in her current position. Competency assessment and goal setting should help the nurse learn how to excel and identify which competencies the nurse wants to achieve in the future.

Question 7

A nurse manager understands that the second step in handling an employee with a disciplinary problem is to document the incident. Which of the following is best for documentation of personnel problems?
a. Use of the performance appraisal on an annual basis.
b. Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up.
c. A tally sheet of medication errors and other specific problems that will be used at annual review.
d. Copies of reports, placed in the employee’s file, of all unusual occurrences involving the employee.

Answer 7

B
In documenting staff problems, it is important to indicate specifically what rules were broken or violated, consequences if behaviour is not altered, employee’s explanation of the incidents, and the plan of action to reach new goals.

Question 8

The nurse manager places a staff member on probation because of reports of chemical dependency. The nurse manager should be aware that which of the following statements is true regarding chemical dependency?
a. The chemically dependent employee usually hides any changes in behaviour.
b. When confronted with the issue, the affected employee is usually relieved to have someone to talk to about the problem.
c. The chemically impaired nurse affects the entire health care organization.
d. Hospital policy, state laws, and nurse practice acts address procedures for the
chemically dependent employee in the most general terms.

Answer 8

C

Question 9

The chief nursing officer reviews the policy about “progressive discipline process.” The progressive discipline process includes which of the following?
a. The manager is a counsellor and friend to the employee.
b. The manager should reprimand and suspend the employee as a last resort.
c. The manager should rehire the employee after a reasonable length of time.
d. The manager should terminate the employee if the problem persists.

Answer 9

ANS: D
In some situations, despite best efforts of the manager/leader, the employee’s issue or disruptive behaviour may continue. In such cases, there is sometimes no choice but to terminate the employee.

Question 10

A nurse manager must be familiar with the agency’s policies regarding employment termination. Termination procedures include which of the following?
a. Following specific procedures at other organizations.
b. Having an attorney present at the termination meeting.
c. Having adequate written documentation to support the action. d. Having a friend present during the termination meeting.

Answer 10

ANS: C
All steps should be followed, including having full, appropriate, detailed documentation and following the procedures of the organization.

Question 11

Nathan has been on the cardiac unit for 6 months and has found it difficult to adjust to the expectations of his team. Which of the following behaviours are most likely to signal that Nathan is intending to resign from his position on the unit?
a. Increased absenteeism over the past month.
b. Increased attempts to discuss his concerns with his colleagues.
c. Testing of workplace guidelines.
d. Frequent defensiveness.

Answer 11

ANS: A
Many employees increase their absenteeism just before submitting their resignation. If the health care worker is experiencing some form of role stress, it might be manifested through absenteeism. Role strain may be reflected by: (1) withdrawal from interaction; (2) reduced involvement with colleagues and the organization; (3) decreased commitment to the mission and the team; and (4) job dissatisfaction. Testing of workplace guidelines and defensiveness are associated with immaturity.

Question 12

All of the following are grounds for immediate dismissal except:
a. Failing to pursue further medical help for a patient, after which the patient dies. b. Selling narcotics obtained from the unit supply of narcotics.
c. Restraining a patient in bed for 7 hours, unsupervised, as punishment for hitting a
staff member.
d. Grabbing the unit manager and threatening further physical harm after a poor
performance appraisal.

Answer 12

ANS: A
Situations that may warrant immediate dismissal include theft, violence in the workplace, and wilful abuse of the patient.

Question 13

Nurses generally experience difficulty in identifying behaviours and actions that could signal chemical dependency in a coworker. Which of the following is not a behavioural change that occurs with chemical dependency?
a. Personality and behavioural changes.
b. Job performance changes.
c. Changes in educational involvement and pursuit.
d. Absenteeism.

Answer 13

ANS: C
When suspicions of chemical dependency are raised, a manager needs to be alert to behavioural changes in the affected employee. These changes include mood swings, changes in hygiene and appearance, heightened interest in the pain control of patients, increases in absenteeism, and increases in tardiness.

Question 14

Aurora, RN, is a self-admitted drug addict and has abused codeine heavily. Aurora and the unit manager decide that changes have to occur. Aurora enrolls in an addiction program, and the manager has her transferred to a drug-free area. What other strategies might be appropriate?
a. The manager could refer Aurora to the human resources department.
b. The manager could assist in monitoring Aurora’s progress.
c. The manager could counsel Aurora if Aurora has formed a trusting relationship
with her.
d. Aurora needs to be asked not to involve her family in the recovery program
because this is a work-related situation.

Answer 14

ANS: B
Effective management mandates that the organization take an active role in helping employees with chemical dependencies. It is important for the manager/nurse leader to be supportive, caring, empathic, and encouraging with such an employee. Many organizations have employee assistance programs, to which the manager should refer employees.

Question 15

Incivility is a disruptive behaviour or communication that creates negativity in the environment and interferes with quality of patient care and safety. The manager can implement steps that help to alleviate uncivil behaviour on a unit. Which of the following would not be an appropriate first step?
a. Suspending the staff member from work.
b. Providing written admonishment that is discussed and placed in the employee’s
file.
c. Providing verbal admonishment.
d. Terminating the staff member.

Answer 15

ANS: D
Dismissal does not enable the organization to attempt remediation of the behaviour and is not consistent with first steps in progressive discipline.

Question 16

In which order should the strategies below occur in progressive discipline?
a. Suspending the staff member from work.
b. Providing written admonishment that is discussed and placed in the employee’s file. c. Providing verbal admonishment.
d. Terminating the staff member.
a. A, B, C, D
b. B, A, C, D
c. C, B, A, D
d. C, A, B, D

Answer 16

ANS: C

Question 17

When progressive discipline is used, the steps are followed progressively only for repeated infractions of the same rule. On some occasions, the breaking of rules is so serious that the employee is:
a. Transferred to another unit.
b. Suspended indefinitely.
c. Asked to attend a union grievance meeting.
d. Terminated after the first infraction.

Answer 17

ANS: D
Situations that may warrant immediate dismissal include theft, violence in the workplace, and wilful abuse of a patient.

Question 18

You need to terminate Gregory, who has had a long-standing history of conflict with you and the staff and who recently was charged with theft of patient belongings. You consult the human resources department, and together you develop a plan, which includes:
a. A private meeting with Gregory, a human resources representative, and you to
deliver the news and deliver the employment termination notice and all other
documents that are related.
b. Planning an opportunity for Gregory to return and be recognized at a staff farewell.
c. Calling Gregory at home to tell him that he is fired and that his paperwork will be
sent to him at a future date.
d. Calling him into a meeting in your office on the ward, where assistance is
available, should he become upset or agitated.

Answer 18

ANS: A
Employment termination requires careful planning as to timing, privacy, safety, and how to preserve the employee’s dignity and avoid humiliation. Choosing a private location where colleagues are not present and organizing all documentation that is required to be given to Gregory achieves these goals and prevents his having to come to the organization at a future date.

Question 19

The nurse manager notices that Tia, a staff nurse, has been absent 2 to 3 days per month for the past 3 months. What is the manager’s best response?
a. “Why are you absent from shifts every month?”
b. “I am concerned that you have been absent 3 days this month.”
c. “Your attendance record is not very good. Do you want to talk about it?”
d. “I am changing your shift rotation as it is obvious that you are not able to
consistently implement your scheduled shifts.”

Answer 19

B

Question 20

Susan, a new graduate, is upset that so many staff members have been absent lately from the unit. She declares to you that all absenteeism could be eliminated with proper management. Your response is based on understanding that:
a. Not all absenteeism is voluntary.
b. High personal control contributes to absenteeism.
c. Direct discussions with employees who have high levels of absenteeism are not
recommended.
d. All absenteeism is related to personal issues and needs.

Answer 20

A
Not all absenteeism is voluntary or preventable, which means that absenteeism can never be fully eliminated. Absenteeism can result from personal issues and needs, work dissatisfaction, and involuntary reasons such as jury duty.

Question 21

The nursing director calls a meeting with one of the new unit managers. She is very concerned about a report of substance abuse on the manager’s unit, and she reviews the procedures involved in dealing with chemically dependent staff. Which of the following statements would not be included in the discussion?
a. “As a manager, you need to be aware of professional regulatory reporting requirements.”
b. “As a manager, you should check with the human resources department regarding chemically dependent employees and employment practices.”
c. “As a manager, you check the nurse practice acts for the province in which the nurse resides.”
d. “As a manager, you should realize that the nurse is a professional embarrassment and should be kept out of sight of other staff.”

Answer 21

D

Question 22

The education consultant for the hospital is presenting a workshop on “Documentation: A Manager’s Responsibility.” Which of the following points concerning documentation of personnel problems would she not include in her PowerPoint presentation?
a. “Documentation cannot be left to memory. A notation must be placed in the
personnel file.”
b. “Documentation should avoid discussion of the problem.”
c. “Documentation should include what was done about the problem when it
occurred.”
d. “Documentation needs to include date, time, and place.”

Answer 22

B

Question 23

Although the Health Professions Acts and professional nursing standards and competencies vary across Canada, the underlying expectation is that members of any health care profession recognized in Canada have on overarching mandate to:
a. Maintain competence.
b. Uphold nursing practice standards.
c. Duty to report.
d. Protect the public.

Answer 23

D

Question 24

Clinical incompetence is one of the more serious problems facing a nurse manager. Joyce, the nurse manager, is not aware of the problems of Sarah, a novice nurse. After she investigates, it is obvious that Sarah’s peers are covering for her. Which of the following might Joyce include in her meeting with the nurses? (Select all that apply.)
a. “It is a nurse’s professional responsibility to maintain quality control.”
b. “All instances of clinical incompetence are to be reported.”
c. “It is not considered being disloyal when one nurse reports another for poor care.”
d. “Patient care is the number one concern. Meeting standards is mandatory and
necessary.

Answer 24

ANS: A, B, C, D
The nurse leader must remind employees that professional responsibility is to maintain quality care, and thus they are obligated to report instances of clinical incompetence, even when it means reporting a coworker. Ignoring safety violations or poor practice is unprofessional and jeopardizes patient care.

Question 25

Role strain can result in which of the following manifestations? (Select all that apply.)
a. Withdrawal from interaction.
b. Feeling of belonging.
c. Job dissatisfaction.
d. Decreased commitment to the team.

Answer 25

ANS: A, C, D
If a nurse has a feeling of belonging there is job satisfaction, increased commitment to the team, and a withdrawal from interaction. If role strain continues, there is a likelihood of increased absenteeism and the possibility of changing jobs or leaving the profession.

Question 26

A nurse’s emotional transference from past trauma may affect their ability to function within a clinical setting. A manager must be attuned to a nurse’s level of emotional well-being. Which of the following could demonstrate a nurse who is exhibiting signs of past trauma? (Select all that apply.)
a. Hostility toward others.
b. Addictive tendencies.
c. Maladaptive perfectionism.
d. Testing of workplace guidelines.

Answer 26

ANS: A, B, C, D
All of the above are a manifestation of personal past trauma. Testing of workplace guidelines is a derivative of maladaptive perfectionism. If the nurse manager focuses on identifying the root cause of the undesirable behaviour, he or she will be better able to find the right solution and be better prepared to address the issue as a whole.