Chapter 29 Flashcards
You are a new nurse that is looking for your first nursing job. You are aware of some key elements to consider when choosing a first nursing job. Which is not necessarily one of those key elements?
a. patient fit c. scheduling
b. work environment d. orientation options
A: Patient fit would not be an element that you would consider. Some important considerations when choosing your first nursing position include patient type, work environment, scheduling, and orientation options. CHOOSING A POSITION
During your transition from student nurse to your first position as a staff nurse, your general an unit orientation are a key component of the transition. Which of the following questions would be most appropriate for you to ask about orientation?
a. How long should I expect to be in orientation?
b. How will I be paid for my time in orientation?
c. Do I have to attend every orientation session?
d. Will I be graded during the orientation?
A: It is appropriate for the new graduate to ask about the length of the orientation program. It would not be appropriate to ask about pay for orientation, grading of performance or whether the graduate should attend all sessions. Hospitals invest a great deal of funds in orientating new employees and it is expected that they will participate in the orientation fully. ORIENTATION CONSIDERATIONS
You are a new graduate and have been hired at the local hospital. Which of the following would be least likely to be included in this orientation?
a. validation of CPR
b. human resource policies
c. specific requirements for certain units
d. policies related to medication administration
C: General orientation usually includes information and skills measurement that all nurses new to the facility need to know regardless of their unit. Some examples are validation of CPR, human resource policies, policies related to medication administration, opportunities to hear from representatives from various departments, and patient safety concerns (per the Joint Commission). Specific requirements for certain units will come during the unit-specific orientation. GENERAL ORIENTATION
Your preceptor is providing you with a unit-specific orientation. Which of the following would be included in the unit-specific orientation?
a. benefits c. patient safety standards
b. IV pumps d. CPR
B: Unit-specific orientation focuses upon information and competencies that a new nurses needs to care for the diagnoses and ages of the patients on the assigned unit. Some elements in the unit-specific orientation include unit-specific policies and procedures such as IV pump usage and acquisition and paperwork needed for new admissions and discharges. Benefits, patient safety standards, and CPR validation are covered during general orientation. UNIT-SPECIFIC ORIENTATION
Utilizing the example of the unit-specific competency tool for the emergency department, there are a number of skills that are significant to any new nurse. Which of these is not necessarily correct?
a. monitor data so that I am up to date on evidence-based care for my patients
b. network primarily with other nurses
c. participate in professional committees at work
d. communicate pride in being a nurse
B; The unit-specific competency tool example of the Emergency Room provided in the text offers a number of useful skills and critical-thinking concepts that are valuable for new nurses. Some of these are to monitor data so that I am up to date on evidence based care for my patients, to network primarily with other professionals (not only nurses), to participate in professional committees at work, to communicate pride in being a nurse, to monitor data so that my patients are complication free and have no nurse-sensitive outcomes, and to give and receive professional respect to the health care team. CRITICAL THINKING 29-1
You tell a friend that one of the patients tried to intimidate you when the patient discovered that this was you first nursing position. You friend gives you several methods to prepare for such situations. Which method would your friend be least likely to suggest to you?
a. Keep your knowledge base up to date.
b. Look and act like a professional.
c. Demonstrate to your patients that you possess a body of nursing care knowledge.
d. When you are with your patient, don’t ask another nurse to help you, this can show the patient that you don’t know what you’re doing.
D: New nurses can often be surprised that their patients expect them to have the answers, hence may become intimidated. Your education and experiences give you a firm background in nursing process and patient care, but some other ways to help enhance one’s confidence are keeping your knowledge base up to date, looking and acting like a professional, demonstrating to your patients that you possess a body of nursing care knowledge, and demonstrating a sense of caring to your patients. If you are unsure about something or need advice do not be afraid to ask other nurses or professionals for advice or assistance. Completing a task correctly is better than proceeding with a task that not sure of. WORKING WITH PATIENTS
After completing a class on working collaboratively with other members of the health team, the nursing instructor asks the students to identify methods to implement collaboration as a new member of the team. Which comment by a student would indicate that additional teaching is needed?
a. establish rapport and introduce yourself
b. seek clarification if an order is unclear
c. do not be intimidated
d. be as assertive as possible, even aggressive if need be
D: Cardillo (2001) provides some tips for new nurses on working with health care practitioners. Some of these include establishing rapport and introducing yourself, seeking clarification if an order is unclear and repeating the order and clarifying it, not being intimidated, and being assertive but sincere (not possibly aggressive if need be). WORKING WITH DOCTORS
A nursing instructor asks a group of students if they know the traits that a successful preceptor would possess. Which trait identified by a student, would indicate to the instructor that further teaching is needed?
a. assertive/aggressive in clinical expertise
b. clinically prepared
c. enjoys teaching
d. committed to the role
A: Nurses are generally assigned the role as preceptor due to their expertise, experience, and knowledge of the unit and facility. Some important characteristics of effective preceptors: clinically prepared/experienced, enjoy teaching, committed to the role as preceptor, familiar with the organization’s policies and procedures, and willing to share knowledge and model behaviors for their orientees. Being assertive and/or aggressive related to clinical expertise may make a preceptor difficult to work with for new nurses, and this behavior is not conducive to effective precepting or to successful orientation. PRECEPTORS
As a nurse you are exposed to many performance feedback mechanisms. Which one of the following is not one of these mechanisms?
a. 365-degree feedback c. formal performance feedback
b. preceptor feedback d. informal performance feedback
A: Performance feedback can take many forms. Some formats that new nurses may encounter are 360-degree feedback (not 365-degree feedback), preceptor feedback (feedback from one’s preceptor during the orientation period), formal performance feedback (regular formalized performance evaluation to maintain accreditation (for new nurses, generally after the orientation process or first 3 months, and then at 6- and 12-month intervals for the first year), and informal performance feedback (feedback from nurses and professional you work with such as “good job,” or “your IV placement technique is really nice”). PERFORMANCE FEEDBACK
You are the nurse manager and must conduct a performance evaluation on a nurse that you hired this year. Which aspect of your evaluation would indicate that improvement is needed?
a. demonstrates competency in knowledge base, skill level, and psychomotor skills
b. organizes and coordinates delivery of patient care in an efficient and cost-effective manner
c. participates in unit and service quality management activities
d. performs an ongoing and systematic assessment, focusing only on physiological status
D: Performance evaluations are based upon the nurse’s performance measured against the job description. Some examples of what may be covered during a performance evaluation include demonstrates competency in knowledge base, skill level, and psychomotor skills, organizes and coordinates delivery of patient care in an efficient and cost-effective manner, participates in unit and service quality management activities, performs an ongoing and systematic assessment focusing on physiological, psychological, and cognitive status (not only physiological), and demonstrates ability to identify, plan, implement, and evaluate patient’s educational needs. FIGURE 29-3 ALBANY MEDICAL CENTER HOSPITAL PATIENT CARE SERVICES JOB DESCRIPTION FOR REGISTERED PROFESSIONAL NURSES
A nursing instructor quizzes students on the 360-degree feedback evaluation tool. Which comment by a student would indicate that further clarification is needed?
a. potentially provides a broader more balanced assessment
b. is time consuming
c. does not include patient interviews or assessments
d. includes peer reviews
C: The 360-degree evaluation tool is used by some health care organizations where an individual is assessed by a variety of people in order to provide a broader perspective. Some other aspects of this evaluation tool include peer reviews, evaluation by the nurse’s immediate supervisor, and patient interviews, and it is time consuming yet yields valuable information from a number of different sources. 360-DEGREE FEEDBACK
A new nurse is beginning to establish short term goal to be addressed in the nurse’s performance appraisal. The nurse recognizes that part of the goal setting process would include which of the following?
a. goals should be developed by the nurse in collaboration with the nurse’s manager
b. one goal would be to successfully complete an advanced practice certificate
c. goals should be vague and general
d. goals do not have to be measurable but they must be achievable
A: The establishment of performance goals (short term) are an essential part of any performance appraisal. They are especially important for new nurses as they provide opportunities for mentorship and guidance from one’s immediate supervisor for attainable goal setting. Some aspects of effective goals setting: they are developed by the nurse and the nurse’s manager, are clearly articulated, are measurable, and are attainable. The goal of successfully completing an advance practice degree is not a sound short-term or initial goal for a new nurse graduate. However, it can be a long-term goal. The initial goals set by the new nurse and the nurse’s manager should be short term and attainable within a short period of time, such as “become an active participant in a unit-based or hospital wide committee.” GOAL SETTING
A variety of different organizational responses to performance exist. Some of these may be in response to positive feedback and others to negative feedback. Which of the following actions should the nurse manager implement when giving negative feedback?
a. 360-degree feedback c. punishment
b. ignoring the problem d. progressive discipline
D: When an individual’s appraisal feedback indicates a need for further improvement, the organization will use a corrective action program to help rectify the situation and guide the individual towards significant performance improvement. Progressive discipline is a form of corrective action where the employee’s and manager’s mutual goal is to correct the performance to an acceptable level. The 360-degree feedback evaluation tool may be used to initially identify the problem. Ignoring the problem and punishment are not effective means of dealing with problems. CORRECTIVE ACTION PROGRAMS
The nurse manager has implemented the process of progressive discipline with a nurse who has violated hospital policy. The nurse manager recognizes that two criteria for corrective actions to be effective are that the actions are:
a. consistent and impartial
b. very assertive and pertinent
c. pejorative and sound
d. measurable and administered by HR
A: Corrective action programs have certain criteria that make them effective. Two of these criteria are that they are consistent and impartial. Assertiveness can be construed as aggression, especially when an individual’s performance has been questioned, and pejorative measures are derogatory and should never be considered for any type of corrective action. Corrective action programs do not need to be administered by HR, but they are generally notified because a copy of any corrective action is placed in the individual’s HR file as well as the unit manager’s file. CORRECTIVE ACTION PROGRAMS
A nurse manager may encounter behaviors from staff that may necessitate corrective action. Which of the following is not one of those behaviors?
a. excessive absenteeism
b. failing to comply with policies or procedures
c. inability to complete assignments in a timely manner
d. a union complaint
D: Behaviors that result in corrective action measures can be categorized into developmental or a failure to follow policies and procedures. The nurse’s inability to complete assignments in a timely manner most likely does not have to do with the nurse’s inability to understand the rules, but shows that the nurse may need some guidance and coaching on time management from their manager. Excessive absenteeism is a form of failing to comply with policies and procedures, which necessitates disciplinary corrective action. A union complaint does not necessarily require corrective action unless it occurs as a result of a corrective or disciplinary action, such as a verbal warning. CORRECTIVE ACTION PROGRAMS
