Chapter Test Bank Flashcards
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 older patients. According to 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
Rationale: 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, everybody’s opinion counts; 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. In the practice of a strengths-based nursing leader, 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
Rationale: Placing the nurse on unpaid leave may threaten physiologic needs and demotivate the nurse. Unsatisfactory coverage of shifts on short notice could affect patient care and threaten staff members’ sense of competence. Strengths-based nurse leaders honour the uniqueness of individuals, teams, systems, and organizations; therefore arranging the schedule around the wife’s needs would result in a win-win situation, also creating a work environment that
promotes the health of all the nurses and facilitates their development.
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 the 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
Rationale: Nurses and leaders must assess each situation as unique, determining appropriate actions accordingly. Leaders must adapt their styles to complement specific issues being faced, such
as conflict. Examining motives and issues for the conflict in perceptions promotes equal
representation of each point of view.
As the nurse manager, you want to increase motivation by providing motivating factors.
Which action would you select?
a. Collaborate with the human resources/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
Rationale: Complexity theory suggests that systems interact and adapt and that decision-making occurs throughout systems, as opposed to being made unilaterally by different levels of the organizational hierarchy. In complexity theory, every person’s opinion counts, and therefore
all levels of staff would be involved in decision-making. This principle underlies shared governance. Shared governance is an example of nurse decision-making in which nurses at different organizational levels engage in shaping policy and practices.
A charge nurse on a busy 40-bed medical/surgical unit is approached by a patient’s son, who begins to complain loudly about the quality of care his mother is receiving. His behaviour 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 behaviour by the charge nurse best illustrates refined leadership skills in an emotionally intelligent practitioner?
a. Reflection to obtain insight into how the situation could be handled differently in
the future
b. Trying to catch up with the angry family member to resolve the concern
c. Discussing the concern with the patient after the family member has left
d. Notifying the nursing administration of the situation
ANS: A
Rationale: Emotional intelligence is closely aligned with individuals’ capacity to know themselves and
others. Reflecting to obtain insight and being able to “step” outside the situation to envision the context of what is happening is an example of the actions of an emotionally intelligent practitioner.
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 believe it is
insulting to be required to participate in a competency program. Which behaviour by the staff development coordinator is most appropriate in this situation?
a. Disregard staff concerns and continue with the development of the program.
b. Inform the nurses that this program is a requirement for accreditation by the Joint
Commission on Accreditation of Healthcare Organizations (JCAHO).
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
Rationale: The manager’s role involves guiding other people through a set of derived practices that are evidence-informed and known to satisfy pre-established outcomes such as participation in a competency program. This involves the engagement of staff through the sharing of concerns and ideas. This type of leader can instill hope and trust in followers, which influence their behaviours and attitudes (such as engagement and satisfaction) and cause work environments to become more positive.
You walk into a patient’s room and find him yelling at the licensed practical nurse. The
patient is obviously very upset, and after you speak with him regarding his behaviour, you
determine that he has not slept for three nights because of unrelieved pain levels. The licensed practical nurse is very upset with him and calls him an “ugly, old man.” You acknowledge her feelings and concerns and then suggest that the patient’s behaviour was aggressive but is
related to lack of sleep and to pain. You ask, “Can both you and the patient together determine
triggers for the pain and effective approaches to controlling his pain?” This approach
demonstrates:
a. Lack of empathy and understanding for the licensed practical nurse.
b. Concern with placating the patient.
c. Leadership behaviour.
d. Management behaviour.
ANS: C
Rationale: The situation between the patient and the licensed practical nurse is complex, involving unrelieved symptoms and aggressiveness toward a staff member. Health care is now delivered in a collaborative, and most often, an interdisciplinary manner, whereby select
leadership/management roles (e.g., first-line nurse leaders) serve as conduits for information
and care coordination. Providing engaged, collaborative guidance and decision-making in a
complex situation for which there is no standardized solution reflects leadership.
Which category is unique to management but is not part of leadership?
a. Initiating change
b. Personal qualities
c. Developing people
d. Information management
ANS: D
Rationale: Information management is a category of management only. Developing people is a category of solely leadership, not management. Initiating change and personal qualities are categories of both management and leadership.
Chart audits have revealed significant omissions of data that could have legal and funding
guidelines. As the unit manager, you meet with the staff to discuss audit findings and to find
approaches that will address the gaps in charting and achieve desired goals. This is an
example of:
a. Leadership.
b. Management.
c. Decision making.
d. Vision.
ANS: B
Rationale: The process of guiding other people to meet established goals, outcomes, and procedures is management. This can require collaborative decision-making to determine how best to reach
predetermined goals and follow established practices.
After a meeting with members of the family of a dying patient, the nursing manager discusses
with you the family’s desired approach to care, and you support the manager’s decision. Your
actions indicate that you are acting in what role?
a. Leadership
b. Management
c. Followership
d. Evidence-informed
ANS: C
Rationale: Followership is engaging with other people who are leading or managing by contributing to
the work that needs to be done. By accepting and implementing the desired approach to care
direction given by the manager in response to your concerns, you are demonstrating followership.
Marie-Claire, 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 Marie-Claire. After
reflection and discussion with others, Marie-Claire recognizes that she also feels threatened by
his behaviour. 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. Marie-Claire is demonstrating
a. A positive self-concept.
b. Deepening self-awareness.
c. Leadership.
d. Acquiescence.
ANS: B
Rationale: Individuals demonstrate emotional intelligence by raising their self-awareness and better
regulating their emotions. Being empathetic and showing sensitivity to the experiences of others help nurse leaders develop their emotional intelligence.
As the head of a nursing program, you consistently invite your team to develop ideas 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 other ideas. You are employing _____ leadership.
a. Situational
b. Trait-based
c. Contingency-based
d. Transformational
ANS: D
Rationale: Transformational leadership involves attending to the needs and motives of followers, which results in creativity, improvement, and employee development.
As a leader in a rehabilitation 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 science.
c. Situated theory.
d. Emotional intelligence.
ANS: B
Rationale: Complexity science involves decision-making distributed among the human assets within an organization, without regard to hierarchy.
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 science, you are engaging which principle?
a. Empowerment.
b. Systematic thinking.
c. Development of networks.
d. Bottom-up interactions.
ANS: C
Rationale: According to complexity science, networks evolve around areas of common interest and can
respond to problems in creative and novel ways.
According to complexity science, 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
Rationale: In complexity science, principles to better understand the nature of relationships within complex social systems, objective data, and non-measurable data cannot be ignored because
both inform decisions.
The Canadian government identifies the first point of care for Canadian residents.
a. Hospitalization
b. Acute care
c. Primary care
d. Specialized services
ANS: C
Rationale: The Government of Canada website states primary health care services should be every Canadian resident’s first point of contact with our publicly funded health care system. Primary health care providers also coordinate patients’ health services from “diagnosis to recovery” and access to specialized services and hospitalization.
Sarah is concerned about your direction regarding the management of incontinent, confused patients. She brings you evidence that she has found regarding incontinence interventions and asks you whether you both could talk about the guidance that you have given after you have had an opportunity to read the articles. This is an example of (Select all that apply.)
a. Leadership.
b. Followership.
c. Management.
d. Insubordination.
ANS: A, B
Rationale: This is an example of followership. Followers can promote team effectiveness, for instance, by maintaining collaborative work relationships, offering constructive criticism, and sharing leadership and management responsibilities. In addition, Sarah demonstrated leadership in seeking and presenting evidence that may influence the decision-making of her nurse leader and manager.
An experienced nurse is exhibiting signs of stress associated with workload issues and has
been abrupt with co-workers. The manager requests a meeting with the nurse to determine
how to best support her. What aspect of mindfulness supports the nurse learning this technique? (Select all that apply.)
a. Dampens negative thoughts.
b. Prevents mental drift.
c. Enhances authentic thinking.
d. Causes knee-jerk reactions.
ANS: A,B,C
Rationale: Mindfulness buffers against mental drift and it can also guard against ‘knee-jerk’ reactions.
Rather than immediately evaluating and labelling emotions in a situation, the mindful person
creates a neutral space for reflection. Mindfulness practice enhances positive and authentic
thinking.
When attending a clinical rotation in a geriatric setting a group of student nurses, Ashley
observed all staff worked seamlessly, morale was high, and resident and family satisfaction
rates are high. Upon discussing with the nurse manager their observations, the term “authentic
leadership” was identified as the primary reason. What characteristics of authentic leadership support this observation? (Select all that apply.)
a. Awareness of the people around them.
b. Apply balanced processing.
c. Align words to match beliefs.
d. Are swayed by external pressures.
ANS: A,B,C
Rationale: Authentic leaders have heightened awareness of themselves in relation to others around them; they have an internalized moral perspective, and they align their words and actions to match their underlying values and beliefs—they are not swayed by external pressures; they apply balanced processing or the thoughtful consideration of all.
Change in health care must occur at the micro, meso, and macro policy levels. Which of the
following addresses the meso level of change?
a. Emergency room
b. Clinic
c. Ministry of Health
d. College of Nurses
ANS: D
Rationale: The emergency room and Clinic is at the micro level. The Ministry of Health is at the macro level and the College of Nurses is at the meso level as a professional organization.
Nursing leaders require several competencies for successful leadership. Which of the following descriptions encompass the best candidate for Director of Nursing in a large urban hospital?
a. Graduate degree in Nursing, social skills, communication skills
b. Legal knowledge, philanthropy knowledge, an undergraduate degree in nursing
c. Finance knowledge, a graduate degree in nursing, excellent communication skills
d. Undergraduate degree in nursing, communication skills, social skills
ANS: C
Rationale: All are required to be in a leadership position. For a director of nursing, a graduate degree in nursing, finance knowledge, and excellent communication skills are the minimum needed. In addition legal and philanthropic experience would enhance the leader chosen.
Self-doubt in novice nurses is a common issue and is known as which of the following?
a. Insecurity
b. Imposter syndrome
c. Lack of confidence
d. Lack of knowledge
ANS: B
Rationale: Imposter syndrome is self-doubt is one’s ability to function adequately in one’s role and may prevent nurses from taking leadership roles.
Which of the following is a relational leadership approach?
a. Transactional
b. Laissez-faire
c. Transformational
d. Instrumental
ANS: C
Rationale: Transactional, Laissez-faire, and instrumental are task-focused. Transformational, resonant, and participatory leadership are relational leadership approaches.
The nurse manager in the emergency department needs to implement new staffing patterns.
As a transformational leader, the nurse manager should:
a. Explain in detail how well the new idea will work.
b. Make staff members think the idea was theirs in the first place.
c. Reason with staff members that the new idea will save money and allow more free time.
d. Imply that raises will be smaller than anticipated if the new idea is not accepted.
ANS: B
Rationale: Transformational leadership inspires and motivates other people through influence and persuasion rather than through rewards (e.g., free time) and punishment (e.g., smaller raises).
Which relational leadership approach is based on mindfulness and emotional intelligence?
a. Resonant
b. Instrumental
c. Participatory
d. Transactional
ANS: A
Rationale: Instrumental and transactional are task-focused. Participatory is based on respect and aims to optimize peoples’ strengths. Resonant is based on mindfulness, emotional intelligence, and openness and responsiveness without judgment.
Systematic reviews related to patient outcomes in nursing homes identified patients and
families responded to this leadership style.
a. Resonant
b. Transactional
c. Instrumental
d. Participatory
ANS: B
Rationale: The transactional style was identified as being more directional and clear-cut in providing resident care.
Nurse outcomes were identified to be predicated on which leadership styles?
a. Participatory and instrumental
b. Resonant and transformational
c. Laissez-faire and transformational
d. Transactional and instrumental
ANS: B
Rationale: Relational leadership approaches were described as influencing positive nurse outcomes. Transactional, laissez-faire, and instrumental are task-focused.
Hospital beds may be closed because of a nursing shortage and the increased amount of
overtime required to care for patients. For you as the nurse leader on the unit, which of the
following leadership approach is most effective to address this issue?
a. Transactional
b. Laissez-faire
c. Autocratic
d. Instrumental
ANS: D
Rationale: Instrumental leadership focuses on choosing strategy and resources to solve a problem.
Leaders with this style strive to maintain productivity and complete tasks that are in line with
the organization’s strategic direction.
Miles is interested in leadership positions within his nursing organization. Although he has
been on the same unit for 10 years, he has attended two workshops during that time and has steadfastly refused opportunities to engage in leadership development opportunities or other learning offered as part of the hospital’s succession planning strategy. He says that he is interested in a leadership role primarily because it will give him a more stable work schedule and will enable him to spend more time with his family. Miles is demonstrating attributes of which leadership style?
a. Transformational
b. Laissez-faire
c. Participatory
d. Transactional
ANS: B
Rationale: Laissez-faire leadership uses a hands-off approach allowing others to do the leading. They usually let things happen and do not address problems or assist others in making improvements.
Akash graduated 5 years ago and is keenly interested in pursuing leadership opportunities. She has been active in learning about leadership through workshops and Internet research and recently began a graduate degree program with a focus on nursing administration. She has excellent clinical skills and eagerly accepts responsibility for various projects on the unit. Her sarcastic and sometimes aggressive behaviour tends to alienate other staff members on the unit. Akash is demonstrating which leadership style?
a. Transformational
b. Participatory
c. Transactional
d. Resonant
ANS: A
Rationale: Leadership involves radiating positive energy and the ability to inspire and motivate others. Transactional leaders are closed-minded and controlling and exhibit negative behaviours using
blame and punishment. Transactional leaders do not consider input from others.
Which of the following nurses is most likely to inspire other professionals to do their best?
a. Nayla, RN, is an individual who enjoys details and organization. She regularly leaves notes for the next shift about what has been done incorrectly or omitted.
b. Roger, RN, has been involved in nursing for several years and is well-liked by patients and families. He continually searches for new knowledge and skills, and his sense of humour and optimism are infectious.
c. Clara has been the head nurse on Unit 3Y for years. She is quiet but enjoys patients and their families. She has not been to a conference in years because the unit is her entire life.
d. Katrin is a team leader. She is extraordinarily vigilant about ensuring that everyone is treated fairly in assignments. She is also very conscientious about care and
regularly checks up on what everyone is doing to ensure that it is done correctly.
ANS: B
Rationale: To be inspired, people must have a positive leader who radiates energy, a zest for learning, and an interest in the common good and who is engaged in self-renewal. This leader is hopeful and optimistic. Leaders, not managers, inspire other professionals to achieve their highest level.
The adage “leaders are born and not made” reflects which of the following ideas about leadership?
a. Management can be taught; leadership depends on abilities.
b. Mentorship is important in developing the innate skills of leaders.
c. Leadership is a natural skill that cannot be refined and developed.
d. Succession planning and formal education related to leadership are ineffective.
ANS: A
Rationale: Leadership is an abilities-dependent role that can be developed and refined through such strategies as coaching, mentorship, and reflection. Management can be taught and learned through traditional teaching techniques. Similarly, leadership is a learnable set of practices that requires continued opportunity for application and feedback.
Kari, a head nurse on the dialysis unit, has been informed during budget planning meetings
that budget cuts are likely. She discusses this at the next unit meeting and tells staff members
that unless they do their jobs well, their positions may be terminated, and there will be no replacement. Kari is enacting which management style?
a. Transformational
b. Transactional
c. Trusting
d. Truthful
ANS: B
Rationale: Transactional leaders tend to rely on position, power, and reward and punish according to performance and conformity with expectations.
The style of leadership that is exhibited by a nursing manager that indicates to staff that with
all of the budget cuts, there may be lost positions is likely to:
a. Ensure that the organization is financially stable.
b. Stifle innovative thinking about ways to move out of financial jeopardy.
c. Lead to apathy and disinterest in the organizational goals.
d. Lead to decreased attrition of staff on her unit.
ANS: B
Rationale: Whether the organization achieves financial stability is a function of financial envisioning and planning, but the style of leadership (transactional) that is demonstrated is likely to maintain the status quo within the organization, without an opportunity to generate more creative and innovative ideas to address the financial issues. Lower staff turnover is associated with
transformational leadership.
Future nursing leaders must consider which of the following concepts? (Select all that apply)
a. Leadership is a skill built over time.
b. Need to develop ongoing reflective practice.
c. Assume everyone has inherent leadership abilities.
d. To develop an intentional action plan.
ANS: A, B, D
Rationale: Nurse leaders of the future must have skills and knowledge related to population trends, and have competencies, which may expand what has traditionally been in nursing curricula. The knowledge, skills and attributes required for effective leadership are multifaceted and complex. As such, leadership is a skill that does not simply involve formal education but is developed over time.
The LEADS framework for leadership is being used to strengthen leadership in many
hospitals. Which of the following are considered elements of the LEAD framework when initiating change? (Select all that apply).
a. Does engage others.
b. Does lead self.
c. Does not pursue building coalitions.
d. Does achieve results.
e. Does not seek system transformation.
ANS: A, B, D
Rationale: Engages others: Without willing, energized, and engaged followers, a leader is unable to
accomplish results on any significant scale. Leads self: Effective leadership is associated with capabilities that can be learned by conscious and intentional effort. Achieves results: Leaders are accountable for managing the resources of the organization to achieve results.
Nurses are becoming engaged professionally through social media. They are able to share
expertise, ideas, and evidence, to become social media leaders at the micro to macro levels.
Which of the following are the outcomes of nurses’ engagement in social media? (Select all that apply).
a. Brings innovation to health care.
b. Shapes expert nurse leadership.
c. Engages nurses and patients.
d. Makes nurses more visible in health care.
ANS: A, B, C, D
Rationale: Social media is allowing more engagement between nurses, patients, and other health care providers, as it facilitates engagement of ideas, and allows for the evidence, opinions, expertise, and resources to be shared globally. It is important that students and registered nurses alike focus on developing their digital and interpersonal skills in order to become social media leaders. Through the use of data and social media listening tools, nurses can begin to understand and gain insight into a variety of issues. By using social media, nurses become visible and accessible role models.
Which of the following is a key function associated with the Canadian healthcare system?
a. Financing.
b. Accessibility.
c. Implementation of insurance programs.
d. Universality.
ANS: A
Rationale: Four key functions are associated with the Canadian healthcare system: (1) stewardship or governance, (2) financing, (3) human and physical resources, and (4) organization and management of service delivery.
What was the main purpose of the establishment of the Health Council of Canada in 2011?
a. Assess health and human resource allocation.
b. Monitor the progress of health care reform.
c. Evaluate the duplication in current scopes of practice.
d. Integrate technology in acute care institutions.
ANS: B
Rationale: As part of the renewal effort, the Health Council of Canada was established to monitor the progress and health outcomes (Health Council of Canada, 2011).
Which criterion of the Canada Health Act prohibits user charges or extra billing?
a. Universality.
b. Accessibility.
c. Public administration.
d. Universality.
ANS: B
Rationale: Accessibility is fulfilled when insured persons must have reasonable and uniform access to
insured health services, free of financial or other barriers. Contributions by patients through
user charges or extra billing are prohibited.
Who is responsible for providing health care funding for recent immigrants?
a. Local institutions.
b. Canada’s Immigrant Council.
c. Federal Government.
d. Provincial Government.
ANS: C
Rationale: The federal government directly funds services to such groups as First Nations and Inuit
people, military personnel, prisoners in federal penitentiaries, and recent immigrants.
A nurse manager at a home health care service has resigned to take a position at a local
ambulatory care centre. To initiate current changes, the nurse manager has to be knowledgeable about the differences between a home healthcare institution and an ambulatory care centre, which is a primary care institution. Primary care institutions are
facilities that provide:
a. Rehabilitative or long-term care.
b. Disease-restorative care.
c. First access to care.
d. Only outpatient services.
ANS: C
Rationale: In an ambulatory care institution, emphasis is placed on providing health maintenance and
chronic or long-term care in a team setting to individuals who have an identified need from
the time of diagnosis or impairment. This definition is consistent with that of primary healthcare.
A social determinant of health:
a. Is predictable of acuity.
b. Is biologic and genetic endowment.
c. Is related mainly to the psychological environment.
d. Has little impact on health status.
ANS: B
Rationale: Biologic and genetic endowment is one of 12 social determinants of health, as identified by the Canadian Nurses Association.
The Canadian Classification of Health Interventions database was created for:
a. Physicians.
b. Registered nurses.
c. Unregulated health care providers.
d. All health provider groups.
ANS: D
Rationale: The Canadian Classification of Health Interventions (Canadian Institute for Health Information, 2009) database includes a standardized list of diagnostic, therapeutic, support, and surgical interventions for all health provider groups.
An academic teaching hospital that provides care for patients who require inpatient and
ambulatory care for addictions, through a spectrum of wellness and illness services and providers, would be considered:
a. A health care network.
b. A tertiary care institution.
c. Rehabilitative.
d. Long-term care.
ANS: B
Rationale: Tertiary care institutions or tertiary hospitals provide highly specialized services (e.g., academic teaching hospitals).
Instituting similarities in services across healthcare regions among provinces and territories is considerably complex because of:
a. A lack of knowledge and skill in their associated use.
b. The vast geographic areas present in the Canadian landscape.
c. Minimal diversity in provincial health care needs.
d. An inability to accurately reflect the exact cost per service provided.
ANS: B
Rationale: Efforts to reduce services to regions may be divisive if they are perceived to distribute funds unfairly or inequitably between similar regions within a province. Instituting similarities
across healthcare regions is also considerably complex because of the vast geographic areas and diversity present in Canadian contexts.
Samuel, a 4-year-old boy, has just received a diagnosis in the clinic of an extremely rare medical condition. The family is counselled that Samuel will be referred to which type of care?
a. Primary.
b. Secondary.
c. Tertiary.
d. Quaternary.
ANS: D
Rationale: Quaternary centres provide treatment of extremely rare medical conditions (they are
generally part of a large, tertiary care hospital).
In Canada, which of the following has the most authority over the management and delivery of health care?
a. Hospital board of directors.
b. Regional health boards.
c. Provincial government.
d. Federal government.
ANS: C
Rationale: Provinces and territories have the most authority over the organization, management, and delivery of health care.
which of the following has placed a considerable strain on the Canadian health care system?
a) decreasing costs
b) a stable economy
c) increase in elderly population
d) status quo health care services
ANS: C
Rationale: Scarce resources, increasing costs, a variable economy, an anticipated increase in the
number of elderly people who will require care, and a growing demand for improvement in
health care have placed considerable strain on the Canadian health care system.
The Office of Nursing Policy is an advisory body for:
a) the Canadian Nurses Association
b) The Canada Health Act Implementation Committee
c) Health Canada
d) Provincial and territorial ministries of health
ANS: C
rationale: The Office of Nursing Policy is an advisory body within Health Canada that advises Health
Canada on nursing perspectives, healthcare-related policies, issues, and programs.
Which response is not a tenet of Strengths-Based Nursing Leadership?
a. Understands the significance of subjective reality and created meaning.
b. Values self-determination.
c. Resides within the organization.
d. Recognizes the uniqueness of staff, nurse leaders, and the organization.
ANS: C
Rationale: Principles of Strengths-Based Nursing Leadership recognize the uniqueness of staff, nurse leaders and the organization, value self-determination, understand the significance of subjective reality and created meaning, and focus on the person, not the organization.
Expanding the scope of practice for nurses is expected to? (Select all that apply.)
a. Reduce the number of unregulated care workers.
b. Improve access to care.
c. Increase work efficiency.
d. Alleviate the costs of delivering care.
ANS: B, C, D
Rationale: Expanding the scope of practice for nurses is expected to alleviate the costs of delivering
care, improve access to care, and increase work efficiency. In Canada, unregulated health
care providers have been assigned some traditional nurse tasks, such as administering
routine medication and obtaining routine vital signs, and the number of unregulated health
care providers (UCPs) have increased.
Implementing electronic health records (EHRs) and other health information technology as widely as possible in Canada is to ensure: (Select all that apply.)
a. Delivery of better quality of care.
b. Delivery of more efficient health services.
c. Reducing errors.
d. Reducing health care costs.
ANS: A, B, C
Rationale: Canada Health Infoway was established in 2001 as a not-for-profit organization funded by
the federal government to work with healthcare organizations and others to foster and
“accelerate the development, adoption and effective use of digital health innovations across
Canada . . . [to] help deliver better quality and access to care and more efficient delivery of
health services for patients and clinicians” (Canada Health Infoway, 2014, p. 1).
Which of the following recommendations are included in the First Ministers’ 10-Year
Plan to Strengthen Health Care (2004)? (Select all that apply.)
a. Increase funds for the supply of health care professionals.
b. Implement primary health care.
c. Introduce the use of electronic records.
d. Develop primary care.
ANS: A, C, D
Rationale: Included in the plan were recommendations to decrease wait times; increase funds for home care, aboriginal health care, and supply of health care professionals; introduce the use of electronic records; and develop primary care. Primary care, not primary health care, was
included in this plan.
Canada’s regulated nursing workforce was the slowest in 10 years in 2017 at 0.7%
compared to 1.3% to 2.8% over the past decade. This decline is related to which of the
following factors? (Select all that apply.)
a. Increase in part-time and casual positions.
b. Growing number leaving the profession late in their careers.
c. Increase in application to nursing degree programs.
d. Declining number of new nursing graduates.
ANS: A, B, D
Rationale: This slowed growth is attributed to the declining number of new nursing graduates, the growing number leaving the profession late in their careers and an increase in part-time and casual positions (CIHI, 2017). An increase in application to nursing degree programs is not a factor in a declining workforce as the number of applications is not indicative of an increasing number of new graduates.
A hospital and a nursing education program form a partnership to recruit more nurses to the region. This organizational structure is:
a. Being responsive to changes in the environment.
b. Being bureaucratic.
c. Creating permanent professional boundaries.
d. Delineating structures for all decision making.
ANS: A
Rationale: Shared decision making across organizations can lead to growth and responsiveness in meeting emerging needs.
A hospital is working toward becoming a Magnet hospital. The chief nursing officer is
aware that professional nursing departments of the future will:
a. Not be directed by nurses.
b. Be virtual organizations.
c. Be designed to maintain nursing standards of practice.
d. Be entitled to have patient care departments.
ANS: C
Rationale: Professional nursing departments of the future will be focused on patient care outcomes and nursing satisfaction.
The chief nursing officer and the dean of the school of nursing believe that by establishing
rules and regulations and controlling the environment, this partnership will:
a. Promote professional medical authority, autonomy, and responsibility.
b. Diminish quickly with no central figure.
c. Be essential for self-governance.
d. Provide for the establishment of medical committees.
ANS: B
Rationale: Centralized decision-making structures that emphasize high control, and rules and regulations that lay out expectations, can be slow to respond to emerging trends.
Organizations that are controlled in a heavily centralized way can diminish quickly without the strong central figure.
A nurse manager understands that a matrix organizational structure:
a. Is a simplified organizational structure.
b. Has both a functional manager and a service or product-line manager.
c. Arranges departments strictly according to function.
d. Promotes harmony in organizational decision making.
ANS: B
Rationale: Matrix structures are complex, integrated organizational structures that involve both functional managers and service or product-line managers. In this structure, team members
or teams from various functional departments may combine to complete a project or program, thereby becoming responsible to both their functional department manager and their product-line manager. Harmony or disharmony cannot be assumed.
Collaborative partnerships between hospitals and schools of nursing are examples of hybrid organizational structures. A hybrid organizational structure:
a. Has many divisions of labour.
b. Best fits long-term care units.
c. Has a mixture of the characteristics of various organizational types.
d. Places the authority for decision making closest to the places where workers
perform.
ANS: C
Rationale: Hybrid structures include characteristics of various organizational types and reflect the needs of the situation and the environment.
In opening a new dialysis unit, the nurse manager has to develop a philosophy for the unit. This philosophy needs to:
a. Reflect the culture of the unit and its values.
b. Be developed by the nursing manager on the unit.
c. Identify the patients who will be served on the unit.
d. Replicate the organization’s philosophy.
ANS: A
Rationale: The philosophy needs to state what the nurse manager and staff believe is the vision for
nursing management and practice, and sets the stage for establishing goals to make the
vision a reality. It is complementary to the organizational philosophy, but reflects the values of nursing. Shared governance enables staff and management to develop a vision and is congruent with contemporary views of management. The identification of patients to be served reflects a mission statement.
The hospital administration gives approval to the chief nursing officer to hire clinical nurse specialists in staff positions rather than in administrative positions. A clinical specialist who has staff authority but no line authority typically is able to:
a. Function through influence.
b. Take complete responsibility for the care of patients.
c. Interview and hire staff nurses for designated nursing units.
d. Be granted functional authority to determine standards of nursing care and enforce
them.
ANS: A
Rationale: Staff positions provide support to line positions but have no direct accountability for staff or patient outcomes and therefore function through influence.
A new director of nursing in a small rural hospital wants to make changes from the
traditional model of governance to a shared-governance model. Of the following
characteristics, which best describes the traditional organizational structure in which a staff nurse is assigned to carry out nursing tasks for patients but is not given the chance to provide input into forming the policies and procedures by which care is delivered or the standards by which care is evaluated?
a. Bureaucratic.
b. Decentralized.
c. Delegated authority and responsibility.
d. Delegated responsibility but no authority.
ANS: D
Rationale: In traditional structures, decision-making authority is held by a centralized decision-making body; thus staff members have responsibility for certain functions but do not participate in decisions related to those functions.
The chief nursing officer is given the task of reviewing and revising the organization’s
mission, philosophy, and technology. In reviewing them, the chief nursing officer
understands that they should be reflected in:
a. The organizational structure.
b. Line and staff responsibilities.
c. The policies and procedures.
d. Government regulations.
ANS: A
Rationale: The mission statement is an important foundation for the organizational structure and
defines technology and human resources required for the organization.
The facilities department is experiencing some challenges and is undergoing reorganization. Because of your familiarity with systems theory, you:
a. Know that this challenge is their issue and that it has nothing to do with your unit.
b. Understand that such events are localized and do not have an effect on the
organizational culture.
c. Know that the nature of challenges and reorganization in facilities will have an
effect on other areas.
d. Anticipate that your prior experiences with facilities have no effect on the current
situation.
ANS: C
Rationale: By nature, a system such as an organization is an interacting collection of parts that together function as the whole. Changes in one part affect other parts and the system as a whole.
“Bayshore Hospital will provide care that is a national example of consumer service” is a:
a. Vision statement.
b. Statement of philosophy.
c. Mission statement.
d. Rationale for care.
ANS: A
Rationale: A vision statement is an articulated goal that provides an inspirational target to which the organization aspires.
“At Thoroughcare, we provide health care for women and children in transition” is an
example of a:
a. Vision statement.
b. Mission statement.
c. Goal statement.
d. Statement of philosophy.
ANS: B
Rationale: Mission statements provide a reason or rationale for the existence of the organization and are indicative of the structure of the organization and of whom consumes the services provided.
Which of the following is the most appropriate mission statement for a nursing centre?
a. “At Wellness, we provide rehabilitative services for addicted adolescents.”
b. “Georgetown provides treatment and prevention services for county residents.”
c. “At Heart, our aim is to provide services that lead the nation in health education
and research.”
d. “At Coeur, we strive to achieve optimal pain management with patients who are
experiencing chronic pain.”
ANS: D
Rationale: The mission statements of nursing centres are oriented toward achieving optimal health status for a defined group of patients or consumers.
Which of the following most influences the organizational structure of the organization?
a. Mission statement.
b. Statement of philosophy.
c. Vision statement.
d. Goal statement.
ANS: A
Rationale: Mission statements specify the reasons for the organization’s existence and include the population served and services offered, which, in turn, influence which technologies and human resources will be required.
In which of the following situations would you expect low morale and frustration?
a. Statement of philosophy indicates “We value our staff.” When staff members
resign, careful evaluation is done to determine whether staff should be replaced by
full- or part-time employees.
b. Practices include annual staff recognition celebrations. During times of change,
staff members are actively included in issue identification and solution finding.
c. Recruitment ads promise opportunities for advancement for everyone. Promotions
are given only to individuals with long-standing service and entrenched
relationships.
d. The vision indicates that there is strong commitment to lead in research. The
organization has tried to implement a strong campaign to attract leading nurse
researchers but has experienced difficulty in doing so.
ANS: C
Rationale: Although frustration may occur with external factors that affect ability to act on values and aspirations, lack of congruence between what is espoused as a value within the organization, such as promising advancement as an incentive to join the organization, and what is actually done, such as restricting advancement to internal candidates with much organizational history, can cause low morale and confusion.
At Limeville Hospital, the nursing department is developing a mission statement for nursing. Which of the following would be a suitable mission statement?
a. “Nursing provides services for patients admitted to Limeville Hospital.”
b. “Nurses participate fully in the professional services offered by Limeville
Hospital.”
c. “Limeville Hospital leads by the lamp, providing services for seniors.”
d. “At Limeville, the nursing department provides caring services that recognize the
diversity of patients and promote optimal health with patients through partnership
and education and in close partnership with other disciplines.”
ANS: D
Rationale: A nursing mission statement within an organization needs to establish the reason for nursing within the organization and specifies relationships with patients, the community, and members of other disciplines.
At Hospital XYZ, the current head nurse on unit Y3 is the third in 3 years. Donna, the
current head nurse, lacks confidence in patient-nurse relationships, and scheduling and other processes are routinely left to the last minute. Staff members approached Donna first and then administration with their concerns about Donna’s effectiveness as a leader. They were told that the problem is probably staff related, that it is simply an unhappy group, and that nothing further will be done about their concerns. The philosophy of the organization
indicates that “open, transparent communication between staff and management is desired and supported” and that “innovation and creative thinking are the foundation of the organization’s progress.” In assessing this situation as a newly hired senior executive, you anticipate that:
a. Staff members will resolve the conflict on their own.
b. The situation will lead to ongoing disgruntlement and attrition.
c. No further discussion or concerns will come out of the situation.
d. The head nurse will be able to resolve the conflict on her own.
ANS: B
Rationale: Lack of congruence between the stated philosophy of the hospital and the experienced organizational culture does not support either the staff or the head nurse and will probably result in ongoing frustration and increased attrition.
In the Unity Health Care organization, decisions, including those at the unit level, are made by a group of senior executives. Rules for employees are clear, and nursing care is
delineated by procedures and protocols. This exemplifies:
a. Transformational leadership.
b. Transactional leadership.
c. Bureaucratic organization.
d. Chaos theory.
ANS: C
Rationale: Organizational structure refers to the organization of a work group, rather than to its leadership, and includes where decisions are made and relationships between groups. In the example given, power is centrally located. All decisions regarding policies and procedures flow from this central location, which is characteristic of bureaucratic organizations. In organizations in which chaos theory is exemplified, decision making and accountability are decentralized.
In a health care agency that has a bureaucratic organization, communication flows:
a. Laterally.
b. Bottom to top.
c. Top to bottom.
d. Intermittently.
ANS: C
Rationale: In a bureaucratic organization, communication flows vertically from top to bottom.
A statement such as “We believe in the right of patients to make choices and to have care
that is sensitive to their preferences and needs” is a _____ statement.
a. Mission.
b. Goal.
c. Vision.
d. Philosophy.
ANS: D
Rationale: Philosophy statements capture significant beliefs and values of the organization.
What are key features of positive organizational culture? (Select all that apply.)
a. Supports professional development of members.
b. Promotes positive perceptions of unit leadership and workplace empowerment.
c. Respects values and norms.
d. Promotes new ways of improving practice.
ANS: A, B, C, D
Rationale: Organizational culture can be effective and promote success and positive outcomes, or it can be ineffective and result in disharmony, dissatisfaction, and poor outcomes for patients,
staff, and the organization. These key features reflect positive outcomes for the organization.
A nurse manager working in a hospital-based matrix structure understands that: (Select all
that apply.)
a. This structure includes reporting to both a functional manager and a service- or
product-line manager
b. This structure can be effective in the current health care environment
c. This structure leads to a decrease in bureaucracy
d. This structure permits better cross-communication among various organizational
units or departments
ANS: A, B, D
Rationale: A matrix structure causes an increase in bureaucracy, while a manager in this structure reports to different managers, thereby increasing better communication and effectiveness in health care.
Shared governance is a flat type of organizational structure that: (Select all that apply.)
a. Helps nursing staff have more autonomy to govern their practice.
b. Has a foundation of accountability.
c. Provides the functional areas needed to support professional practice.
d. Requires new behaviours of all staff.
ANS: A, B, C, D
Rationale: A shared governance model embraces that the structure’s foundation is the professional workplace rather than an organizational hierarchy and leads to nurse satisfaction and sense of empowerment.
Organizational culture includes: (Select all that apply.)
a. Norms.
b. Traditions.
c. Behaviours.
d. Values.
ANS: A, B, C, D
Rationale: Organizational culture, the reflection of the norms or traditions of the organization, is exemplified in behaviours that illustrate values and beliefs.
Complex care of acutely ill patients is required on a surgical unit in which differentiated nursing practice is its model of care delivery. The concept of differentiated nursing practice is based on:
a. Licensure status.
b. Experience in the agency.
c. Leadership capabilities.
d. Education and expertise.
ANS: D
Rationale: In differentiated nursing practice, rules are structured according to education and experience.
The relief charge nurse has assigned a newly registered baccalaureate-prepared nurse to be one of the team leaders for the shift from 1500 to 2300 hours. In making this decision, the charge nurse has overlooked this nurse’s:
a. Clinical expertise.
b. Leadership ability.
c. Communication style.
d. Conflict-resolution skills.
ANS: A
Rationale: The effective functioning of teams in this model is heavily reliant on the leadership, organization, and communication skills of the leader, in addition to comfort and confidence in providing care to a specific patient group. Although leadership and critical thinking are part of basic education in baccalaureate programs, the new registered nurse (RN) needs time to develop clinical confidence and expertise.
When interviewing an applicant for a position, the nurse manager describes the unit’s care delivery system as one in which each nursing assistant is cross-trained to perform specific tasks, and in which the RNs handle all intravenous medications, admissions, and discharge teaching. The nurse applicant knows this nursing care delivery strategy to be:
a. The case method.
b. Functional nursing.
c. Primary nursing.
d. Nurse case management.
ANS: B
Rationale: The functional care delivery model depends on the decision of care according to tasks or functions that are assigned to specific teams or team members.
You are the nurse manager of a nursing service organization that provides around-the-clock
care to patients in their homes. To achieve an optimal outcome for a patient who is
recovering from a hip replacement, the nursing staff will probably follow the nursing care guidelines presented in which of the following?
a. Nursing care plan.
b. Physician’s orders.
c. Critical pathway.
d. Clinical practice guidelines.
ANS: C
Rationale: A critical pathway outlines outcomes, clinical standards, and interventions for a patient in each phase of treatment. The goal of critical pathways is effective coordination of care across various staff and levels of care, and to optimize patient outcomes.
The nurse case manager is working with a patient admitted for end-stage renal disease. The
case manager’s major goal during this hospitalization is to:
a. Implement the care map on admission.
b. Provide direct nursing care throughout the hospitalization.
c. Supervise the nursing staff members who implement the care map.
d. Prevent the need for additional hospitalizations resulting from complications of the
patient’s disease.
ANS: D
Rationale: The goals and outcomes established in a care map or critical pathway are designed to support the aims of case management, which are shortened hospital stays and prevention of the need for hospital readmissions.
The nurse manager at a cardiac rehabilitation unit was asked to select a care delivery model.
Which of the following methods would be the most cost effective?
a. Functional method.
b. Case management method.
c. Primary care method.
d. Team method.
ANS: B
Rationale: Team nursing, functional nursing, and case management are all considered efficient, cost-effective methods of care delivery because they enable use of various types of health care providers (rather than baccalaureate nurses in direct care, which is the primary nursing method). Case management is considered particularly cost effective in patient care settings that have the potential for high resource consumption, such as settings with medically complex cases, through collaboration and close attention to outcomes.
A patient is admitted to a medical unit with pulmonary edema. His primary nurse admits him and then provides a written plan of care. What type of educational preparation best fits the role of primary nurse?
a. Baccalaureate.
b. Associate,
c. Diploma.
d. Licensed practical nurse/licensed vocational nurse.
ANS: A
Rationale: Because of the breadth of nursing knowledge required, baccalaureate education is preferred
for primary nurses.
In a small rural nursing home a director of nursing decides to implement a partnership
model, because of a shortage of nurses, to help with certain tasks. What combination of
health care providers constitutes a partnership care delivery model?
a. RN and licensed practical nurse/licensed vocational nurse.
b. RN and RN.
c. RN and medication assistants.
d. RN and certified nurses’ aides.
ANS: C
Rationale: The partnership care delivery model is a variation of primary nursing in which an RN works with a medication assistant, who performs basic nursing functions.
The case method of care delivery could be best justified for which of the following
scenarios?
a. Stable patient population with long-term care and family needs.
b. Acute care surgical unit with predictable postsurgical outcomes and many
technical procedures.
c. Pediatric intensive care unit that heavily involves families and also patients.
d. Home health care environment with patients who have varying degrees of acute
illness.
ANS: C
Rationale: The setting in which the case method of delivery can be most justified is the pediatric
intensive care unit, in which the status of patients can rapidly change and complex functions
of care involve both patients and families.
During times of nursing shortage and increased nursing costs in health care, which of the following nursing care delivery models might come under greatest scrutiny?
a. Case method.
b. Team nursing.
c. Functional nursing.
d. Nurse case management.
ANS: A
Rationale: The case method may involve an RN’s treatment of the “total patient.” Employment of the most highly paid nursing personnel (RNs) for all patient care is the most expensive model and may be difficult to operationalize in times of RN shortage.
A patient complains to you that she has no idea who “her nurse” is on any given day. “I ask
one nurse for my pills, and she says, ‘That is not my job.’ I ask the pill nurse about my lab
tests, and she says that I should ask another nurse.” The nursing care delivery model most
likely to be employed in this situation is
a. Differentiated practice.
b. Team nursing.
c. Functional nursing.
d. Case management.
ANS: C
Rationale: In functional nursing, licensed and unlicensed personnel perform specific tasks for a large number of patients. A disadvantage of this system is that care is assigned by task and not by patient, which can leave patients with the experience of multiple caregivers and a sense of confusion.
The functional nursing model might be particularly effective in which of the following?
a. Promoting communication among diverse team members.
b. Facilitating multiple perspectives on the total care of a patient.
c. Avoiding patient–provider conflict.
d. Developing competence and confidence in unlicensed workers.
ANS: D
Rationale: An advantage of functional nursing is that both unlicensed assistive personnel and licensed staff are involved in performance of specific tasks, and the repeated performance of tasks enables staff to become very efficient in specific functions. Disadvantages of the model include difficulty in being able to assess the patient’s nonphysical needs effectively and the potential for ineffective communication because of the focus on specific tasks.
For a nurse manager in the functional nursing model, which approach will assist in
maintaining staff satisfaction in this specific model?
a. Rotation of task assignments.
b. Frequent opportunities for in-service education.
c. Orientation to job responsibilities and performance expectations.
d. Team social events in off hours.
ANS: A
Rationale: Although repetition of tasks increases confidence and competence, it can also lead to
boredom. In-service opportunities, adequate orientation, and building a team culture are strategies that are important to all models, but rotation of tasks can specifically reduce the boredom that is a potential disadvantage of this model.
In comparing team and functional models of care, a nurse manager favours the team model. In particular, she finds that the team model:
a. Can be effective in recognizing individual strengths and backgrounds of staff
members.
b. Promotes autonomy and independence of the RN.
c. Avoids conflict because of role clarity.
d. Is efficient in delivering care to a large group of patients with the use of a staffing
mix.
ANS: A
Rationale: Team nursing delivers care to a small group of patients; the team is a mix of licensed and unlicensed personnel. Assignment is based on the needs and background of the patient and on the strengths, licensure, and roles of team members. Team functioning and satisfaction
can be compromised unless the team leader has strong delegation, communication, and
leadership skills.
To effectively delegate in a team nursing environment, the RN team leader must be familiar
with the legal and organizational roles of each group of personnel and must:
a. Be able to effectively communicate with patients.
b. Build relationships with physicians.
c. Be able to adapt to daily changes in staffing.
d. Adapt in communicating information to the supervisor.
ANS: C
Rationale: A particular challenge in team nursing is that staff mixes and personnel may change daily because of individual schedules and shortages.
A nurse manager questions the true difference between primary nursing and total patient care. After careful consideration of both models, the nurse manager concludes that primary nursing differs significantly from total patient care in which way?
a. Breadth of nursing knowledge and expertise required.
b. Intention to provide holistic nursing.
c. Time period of accountability.
d. Levels and types of assessment.
ANS: C
Rationale: Significant overlap can be seen between primary nursing and total patient care in terms of breadth of assessment and knowledge required to provide holistic care. A primary difference is that nurses in the total care model assume accountability while on shift, whereas primary nurses assume responsibility from a patient’s time of admission to discharge and 24 hours a day during the hospital stay.
A conflict develops between an associate nurse and a primary nurse over the assessment of a
patient with pulmonary edema. On the basis of her assessment of the patient, the associate
nurse insists that it is her role to change the care plan because she is the one who has made
the assessment. As the nurse manager, you clarify that:
a. It is the role of the primary nurse to make alterations on the basis of assessment
data and input.
b. The associate nurse is accountable and responsible while the primary nurse is off
duty and therefore is able to alter the care plan.
c. Neither the primary nurse nor the associate nurse should make changes without
first consulting you as the manager.
d. It really does not matter who alters the nursing care plan because it depends on
situation and time to do so.
ANS: A
Rationale: The primary nursing model assumes that the primary nurse is accountable for patient care, even while off duty. The primary nurse is responsible for establishing the patient plan of
care and therefore for altering it with the input of an associate. The associate is responsible
for implementation of the care plan that has been established when the primary nurse is off
duty.
When comparing functional nursing and primary nursing, a nurse manager, after evaluating
particular models of nursing care for potential adoption, determines that patient and nurse satisfaction in primary nursing are:
a. Similar to those in functional nursing.
b. Not of significance in either model.
c. Low in comparison with that in functional nursing.
d. High in comparison with that in functional nursing.
ANS: D
Rationale: Primary nursing tends to be satisfying for RNs who enjoy a high level of accountability and
autonomy in decision-making. Patient satisfaction is also high, inasmuch as patients form
close therapeutic relationships with the nurse because of the continuousness of the
relationship. Functional nursing is criticized for low patient satisfaction and potential staff
dissatisfaction related to boredom and an autocratic approach to management.
You are considering putting forward a proposal to move the model of care from team
nursing to a primary nursing hybrid—a patient-focused care model. In considering this
proposal, you recognize that significant costs specific to operationalizing this model are
related to which of the following?
a. Implementation of an all-RN staff complement.
b. Significant changes in the physical structure of units.
c. Orientation of staff to new roles and responsibilities.
d. Testing and piloting technology at the patient’s bedside.
ANS: B
Rationale: This particular model includes a focus on patient care that includes multidisciplinary teams and assistants at the patient’s bedside. Services, including those of laboratories and pharmacies, are decentralized to bring them closer to where care is delivered.
Case-managed care may enhance profit in a for-profit health organization by:
a. Minimizing costs in areas of high resource consumption.
b. Combining licensed and non-licensed care providers in delivering patient care.
c. Increasing reimbursement from third-party payers.
d. Reducing the amount of technology used to support clinical decision-making.
ANS: A
Rationale: Case-managed care does not generate revenue; rather, it protects revenue in that better coordination of care enables efficient achievement of patient outcomes, can result in a
shorter length of hospital stay, and can prevent the need for readmission.
In the hiring of nurses during the transition from team nursing to a primary nursing model, Benner’s (2001) work suggests that you give priority to nurses who are at least at which level of competency?
a. Advanced beginner.
b. Competent.
c. Proficient.
d. Novice.
ANS: B
Rationale: Nurses who have less than 2 or 3 years of experience in primary nursing or less than 2 or 3 years of nursing experience will probably require more assistance than do other nurses,
which will put a greater demand on the unit during a time of transition.
In considering whether to accept a job offer in a hospital in which the synergy model of care is used, you expect that which of the following is the driver of the necessary nurse
competencies for practising within this model?
a. Educational background of the nurse.
b. Patient population characteristics.
c. Interdisciplinary health care teams.
d. National nurse-to-patient ratios.
ANS: C
Rationale: The synergy model identifies patient characteristics as “drivers” of the necessary
competencies for nurses.
Differentiated nursing practice, or staff mix, is a model of clinical nursing practice that
combines different categories of health care personnel employed for the provision of direct
client care. What is the biggest aspect of this model in decreasing its success?
a. Supports each nurse’s level of education.
b. Varied educational backgrounds and philosophies of nurses.
c. Increases satisfaction of patients.
d. Increases satisfaction of nurses.
ANS: B
Rationale: Despite a variety of efforts to differentiate the roles and competencies of nurses with various educational backgrounds and experience, the demands of the workplace, the chronic shortage of nurses, and the greater use of technology have made it difficult to differentiate nursing practice in many clinical settings even among RNs with differing levels of education.
Nursing case management is geared to providing comprehensive care for those with complex health problems. Which of the following supports the use of a case management
model? (Select all that apply.)
a. Decreases length of stay.
b. Increases efficient use of services.
c. Increases nurse sense of satisfaction.
d. Decreases human resource inequities.
ANS: A, B, C
Rationale: Although case management has many benefits, there are also several barriers including financial barriers, lack of administrative support, human resource inequities, turf battles, and a lack of information support systems.
The total patient care method, or patient allocation method, of nursing care delivery is the
oldest model of providing care to patients. One nurse provides total care to one or two
critically ill patients, or to a group of patients. Which of the following contributes to the
success of this model? (Select all that apply.)
a. Current global nursing shortage.
b. High costs.
c. Provides high quality care.
d. Engenders trust between family and nurse.
ANS: C, D
Rationale: In today’s costly health care environment, total patient care provided by one nurse, typically an almost all registered nurse (RN) staff, is very expensive. In a time of a global nursing shortage, there may not be enough nurses to use this model or funding to provide for this model of care. The nurse, patient, and family trust one another and work together toward specific goals. Total patient care remains popular with patients as the care is seen as being consistent and high quality, and care that is provided by highly qualified nursing staff.
The chief nursing officer implements the team nursing model on the acute care units.
Expectations of the team leader include which of the following? (Select all that apply.)
a. Being attentive to the needs of the organization.
b. Being newly graduated with a baccalaureate degree.
c. Having several years of clinical nursing practice.
d. Being attentive to the needs of the patient.
e. Being attentive to the needs of the staff.
ANS: C, D, E
Rationale: Team leaders require both leadership skills and knowledge, in addition to clinical
confidence and expertise, to effectively delegate responsibilities according to staff background, role, and expertise and according to patient needs.
Which province in Canada does not have a set of common laws?
a. British Columbia.
b. Ontario.
c. Quebec.
d. Newfoundland.
ANS: C
Which of the following has the highest standard of proof associated with it?
a. Common law.
b. Criminal law.
c. Negligence law.
d. Malpractice law.
ANS: B
Rationale: The standard of proof of criminal actions is higher than that of actions involving other
liability, and penalty options in criminal sanctions generally include jail time. In criminal
law, people are presumed to be innocent until proven guilty.
Athena, a registered nurse (RN), has been operating an abortion clinic in one of the city’s
impoverished neighbourhoods. Athena is at risk for professional sanctions involving which behaviour?
a. Negligence.
b. Misconduct.
c. Incompetence.
d. Conduct unbecoming a member of the profession.
ANS: D
Rationale: Professional sanctions and disciplinary actions generally arise from three unacceptable
behaviours: (1) misconduct, (2) incompetence, and (3) conduct unbecoming a member of
the profession. Misconduct is unacceptable behaviour within the scope of the profession’s
practice; incompetence is a failure to meet minimum generally accepted standards; and conduct unbecoming a member of the profession is behaviour outside a profession’s practice that may bring the profession into disrepute. Because Athena is practising outside the scope of her RN practice, she is at risk for sanctions involving conduct unbecoming a member of
the profession.
A person in a wheelchair is applying for the position of receptionist in an outpatient clinic. The nurse manager understands that the Canadian Charter of Rights and Freedoms (1982) requires that employers:
a. Make reasonable accommodations for persons who are disabled.
b. Allow modified job expectations for persons recovering from alcoholism.
c. Hire disabled individuals before hiring other qualified, nondisabled persons.
d. For purposes of employment, treat homosexuals and bisexuals as disabled.
ANS: A
Rationale: The Canadian Charter of Rights and Freedoms (1982) outlines many of the provisions that prohibit discrimination in the workplace on the basis of national origin or ethnicity, race,
religion, age, colour, gender, sexual orientation, or mental or physical disability.
A staff nurse who was fired for reporting client abuse to the appropriate state agency files a
whistle-blower lawsuit against the former employer. Reasons that the court would use in
upholding a valid whistle-blower suit claiming retaliation include which of the following?
a. The nurse had previously reported the complaint, in writing, to hospital
administration.
b. The nurse had threatened to give full details of the client abuse to local media
sources.
c. The nurse was discharged after three unsuccessful attempts at progressive
discipline had failed.
d. The nurse had organized, before filing the complaint, a work stoppage action by
fellow employees.
ANS: A
Rationale: An employer cannot fire an employee who, in good faith, reports what is believed to be a violation of a law, rule, or state or federal law. Nurses may be affected by a variety of laws
that require reporting, and many statutes provide provisions to protect whistle-blowers from reprisals or retaliatory actions by employers or others as a result of the reporting. The intent is to advance the protection of the public and those who take action to safeguard it.
The nurse manager organizes an orientation for new staff members. As part of the
orientation the nurse manager reviews the unit’s policy and procedure manual, which is a
part of which type of law?
a. Employment law.
b. Common law.
c. Written law.
d. Legislated law.
ANS: B
Rationale: Basic employment law is found in common law and includes a duty for employees to follow legitimate employer commands related to their work. These commands may take the form of a manager’s direct request and are also contained within institutional rules, policies, and procedures.
To reduce the incidence of falls in a skilled nursing unit, the nurse manager contacts the risk
manager. Risk management is a process in which people attempt to identify potential
hazards and:
a. Compensate for previous injuries.
b. Eliminate these risks before anyone else is harmed.
c. Supersede the need for staff members to file incident reports.
d. Discipline staff members who have been involved in previous incident reports.
ANS: B
Rationale: Risk management involves taking proactive steps to identify and eliminate risks and liability.
A colleague asks you to give her your password access so that she can view her partner’s
health care record. This request violates the patient’s right to:
a. Privacy.
b. Confidentiality.
c. Undue authorization of treatment.
d. Protection against slander.
ANS: A
Rationale: Privacy refers to the right to protection against unreasonable and unwarranted interference with the patient’s affairs, which in the medical context, extends to protection against public disclosure of private facts about the patient to the public.
The chart of a patient who has undergone abdominal surgery indicates that one set of vital
signs were taken at 7 minutes after surgery; the next set were completed 10 hours after
surgery. This level of assessment illustrates which element of malpractice?
a. Breach of duty owed the patient.
b. Foreseeability.
c. Causation.
d. Injury or damage.
ANS: A
Rationale: The element of malpractice that is depicted in the example is a breach of the duty owed, as evidenced by failure to monitor vital signs of a surgical patient regularly.
A nurse on your inpatient psychiatric unit is found to have made sexually explicit remarks to a patient with a history of previous sexual abuse. The patient sues, claiming malpractice. Which of the following conditions would probably not apply in this situation?
a. Injury.
b. Causation.
c. Breach of duty.
d. Breach of duty of care owed.
ANS: A
Rationale: By virtue of employment, the nurse owes a duty of care to the patient; this care has been breached by a nurse, who would be expected to know that this behaviour violates usual standards of care. If further distress can be directly linked to the remarks, then causation is established. Because of the physical nature of injury, it may not be possible to establish injury in the suit.
As a charge nurse you counsel your RN staff member that he has satisfied his duty of care
by notifying a child’s physician of his concerns about deterioration in the child’s status at 0330 hours. The physician does not come in. The child dies at 0630 hours. As the charge nurse, you could be held liable for:
a. Professional negligence.
b. Assault.
c. Avoidance.
d. Murder.
ANS: A
Rationale: Negligence can be asserted when there is failure to do what a reasonable and prudent nurse would do in the same situation. In this situation, the charge nurse might have advocated further for the patient in light of the evident seriousness of the child’s condition.
The parents of a toddler, who dies after being brought to the emergency room, launch a
lawsuit claiming that the failure of nurses to pursue concerns related to their son’s
deteriorating condition contributed to his death. The senior nurse executive is viewed as:
a. A global respondent.
b. Vicariously liable.
c. Performing a frivolous action.
d. Being under the element of causation.
ANS: B
Rationale: According to the concept of vicarious liability, employers are accountable for the negligence of their employees; the rationale is that the employee could not have been in a position to have caused the wrongdoing unless hired by the employer.
Which of the following demonstrates a movement away from a culture of blame and liability to one in which a systematic approach is used to enhancing patient safety?
a. Avoiding harmful misrepresentation while assisting patients to understand their
health record.
b. Apology letters to patients who experienced an adverse event inadmissible in a
court of law.
c. Encouraging full disclosure of adverse events with patient identification
information removed.
d. Instituting monthly meetings of a risk management review committee.
ANS: B
Rationale: New legislation in Canada prevents apology letters to patients for adverse events being entered into evidence in courts to substantiate wrongdoing and legal liability; this is one step signalling a movement away from a culture of blame and liability to one in which a systematic approach is used to enhance patient safety.
You volunteer at a community clinic. A 17-year-old girl claims to have a diagnosis of a
sexually transmitted infection and presents with Chlamydia. The team leader at the clinic
advises that:
a. The age of legal consent is 18; therefore, no treatment can be delivered.
b. The teen is underage and should be referred to the family general practitioner.
c. Care can be provided as long as consent is voluntary and information about
treatment and options is provided.
d. Treatment is provided as long as telephone consent is obtained from a parent or
legal guardian.
ANS: C
Rationale: All provinces and territories have a legal age for consent; in general, this age is 18. However, minors seeking treatment can provide their own consent. An explanation and the
patient’s understanding of the proposed treatment or procedure to be performed, the
expected results, and the health condition it addresses must be discussed with the patient
before it is performed.
Which level of government is most responsible for hospitals and health care?
a. Local.
b. Provincial.
c. National.
d. International.
ANS: B
Rationale: Most matters of health care and hospitals fall under provincial jurisdiction.
Which of the following is a publicly funded national health care program in Canada?
a. Blue Cross.
b. Hospital Insurance Program.
c. Medicare.
d. Social assistance.
ANS: C
Rationale: Medicare is Canada’s publicly funded national health care program.
Mr. M. complains to you that one of your staff asked him details about his sexual
relationships and financial affairs. He says that these questions were probing and
unnecessary to his care, but he felt that if he refused to answer, the nurse would be angry
with him and would not provide him with good care. Mr. M.’s statements reflect concern with:
a. Privacy.
b. Confidentiality.
c. Veracity.
d. Informed consent.
ANS: A
Rationale: Privacy may be defined as the right of the individual to determine when, how, and to what extent he or she will release personal information. Privacy protection includes protection against unwarranted intrusion of the patient’s affairs.
To satisfy duty of care to a patient, a nurse manager is legally responsible for all of the
following except:
a. Notifying staff of changes to policies related to medication administration.
b. Scheduling and staffing to ensure safe care.
c. Delegating in accordance with practice acts.
d. Supervising the practice of the physician.
ANS: D
Rationale: Legally, the nurse manager is accountable to nursing practice standards, standards for nurse administrators, and hospital policies and procedures.
Which of the following is the least restrictive in governing health care occupations?
a. Association.
b. College.
c. Registration.
d. Certification.
ANS: C
Rationale: Registration is the least restrictive regulation that governs health care occupations and may require individuals simply to register with a designated employer to obtain membership; registration also offers the least regulatory protection to the public.
Sally observes a colleague reading the chart of a patient who is not assigned to him. She
approaches him and inquires why he is reading the chart. His reply is he has a similar
diagnosis in one of my patients and “I want to see if this information could help me care for my patient.” Sally is concerned there is a breach of patient confidentiality and informs her nurse manager of the incident. The term used to describe Sally’s reporting this situation is:
a. Duty of care.
b. Negligence.
c. Duty to report.
d. Ethical dilemma.
ANS: C
Rationale: Some recent nursing regulations impose new statutory duties on nurses to report other nurses or health care providers to their registration bodies where concern exists that a professional is dangerous to the public or demonstrates sexual misconduct. Of concern here
is an individual health care provider’s fitness to practise and the protection of the public.
The term negligence includes which aspects of the following? (Select all that apply.)
a. Is a common type of unintentional tort.
b. Duty to care was breached.
c. There was reasonable foreseeability.
d. May be legally actionable.
ANS: A, B, C, D
Rationale: Negligence is a common type of unintentional tort and requires that there be an existent duty to care that was breached in a particular way by a person who was expected to uphold a standard of care, and who could reasonably foresee that their actions might result in a wrongful act or injury. Depending on circumstance it may be legally actionable.
Nurses cannot refuse to work under what circumstances? (Select all that apply.)
a. It is a usual scope of practice.
b. Employer has inadequate supports.
c. Endangers another person.
d. Places nurse in overtime.
ANS: A, C
Rationale: Occupational health and safety legislation gives employees the right to refuse to work where that work, including the operation of equipment, machines, or devices, poses a danger to themselves or others. Health care workers cannot refuse to work where refusal would directly endanger the life, health, or safety of another person.
Battery is termed which of the following? (Select all that apply.)
a. Intentional tort.
b. Intent to touch without consent.
c. Unintentional tort.
d. Exceeds consent given.
ANS: A, B, D
Rationale: Failure to obtain informed consent before performing an act on a patient, or where an act exceeds the consent given, results in what is termed a battery in tort law and takes place when someone intentionally touches another without consent.
Nurses who commit wrongful actions include which of the following? (Select all that apply.)
a. Criminal liability.
b. Have no liability.
c. Professional sanctions.
d. Ensures compliance.
ANS: A, C, D
Rationale: The consequences faced by nurses who perform wrongful actions fall into four basic categories: criminal liability, civil liability, professional sanctions, and employment ramifications. Nurses do not have an option to not have liability insurance; it is a requirement of the College of Nurses.
One of your staff nurses asks for your advice because a patient refuses to sign a consent form for surgery. The patient says that he will not sign because he does not understand the nature of the surgery. You advise that: (Select all that apply.)
a. Consent must not be coerced.
b. The patient has a right to choose not to consent.
c. The patient must sign the consent because the doctor wants him to sign.
d. Witnessing the signing of a consent from is related only to the voluntary nature of
the signature.
ANS: A, B, D
Rationale: Consent must be voluntary and not coerced; the patient must understand what he is signing, must have legal capacity, and must understand the consequences of refusal. Witnessing the signing of a consent form means attesting to the voluntary nature of the patient’s signature.
With regard to nursing practice, nurse managers are held responsible for: (Select all that
apply.)
a. Practising within legal guidelines established under provincial or territorial law
and nurse practice acts.
b. Ensuring that nursing staff members under their supervision are currently licenced
to practice.
c. Referring all errors in nursing judgement to state discipline boards.
d. Ensuring that physicians are properly licenced to provide care on patient care units.
ANS: A, B
Rationale: Nurses are responsible for knowing legal and nurse practice acts and for practising according to them. Managers are responsible for monitoring staff practice and ensuring that nursing staff members hold current, valid licensure.
A nurse manager is encountering poor staff morale on her unit. While participating in a baccalaureate course the nurse manager learned that one of the reasons nurses lack power today is probably because of the past. In the early decades of the profession, nurses lacked power because:
a. Nurses freely chose to defer to physicians and administrators with more education.
b. Women were not socialized to exert power.
c. The first nursing licensure laws prohibited nurses from making most decisions.
d. Nurses astutely recognized the risks of grabbing too much power too soon.
ANS: B
Rationale: Nurses’ lack of involvement in politics is sometimes associated with their discomfort with acknowledging and using power. Nursing has been a predominantly female profession, and women traditionally were not socialized to exert power.
Nurses who engage in infighting seek physician support against nursing colleagues, and avoid membership in nursing organizations:
a. Refuse to believe that they are acting like members of groups that suffer
socioeconomic oppression.
b. Do not understand how their failure to exercise power can limit the power of the
whole profession.
c. Purposefully choose to exercise their power in the workplace through indirect
means.
d. Suffer from learned helplessness as a result of abuse by powerful nurse executives.
ANS: B
Rationale: Lack of understanding about the appropriate exercise of power affects internal and external relationships.
A nurse belongs to several professional organizations, serving on a provincial-level
committee of one group and on two task forces at work. The nurse is committed to a range
of health issues. This nurse exemplifies which level of political activism in nursing?
a. Gladiator.
b. Buy-in.
c. Self-interest.
d. Political sophistication.
ANS: D
Rationale: The nurse recognizes that influence occurs at many levels and that public policy and politics shape what nurses do as nurses—from nursing practice acts that allow licensure, to policies that drive reimbursement.
A manager relies on his director of nursing (immediate supervisor) for advice about
enrolling in graduate school to prepare for a career as a nurse executive. The director may
exercise what kinds of power in the relationship with the manager in this advisory situation?
a. Expert, coercive, and referent.
b. Reward, connection, and information.
c. Perceived, expert, and connection.
d. Reward, referent, and connection.
ANS: C
Rationale: Because the director is in a leadership role, he comes with knowledge or expertise that is required to assume a leadership role, giving him perceived and expert power. He has connection power inasmuch as an expert registered nurse (RN) he is probably well
networked or connected to other professionals in the unit, facility, and organization.
A nurse manager must implement a 2% budget cut on the nursing unit. Which approach should the manager use to empower the staff of the unit most effectively?
a. Discuss the guidelines for the budget cuts with the staff, making the decisions with
those who participate in the discussion.
b. Inform the staff of the budget cuts in a series of small group meetings, and accept
their ideas in writing only.
c. Provide the staff with handouts about the budget cuts, and let them make
recommendations in writing.
d. Hold a series of mandatory meetings on the budget cuts, asking staff for ideas on
the cuts.
ANS: A
Rationale: Empowerment involves valuing the ideas and opinions of other people and involving them in the decision-making process. It means releasing authority and allowing other people to assume accountability as well.
During orientation of new nurse managers, the chief nursing officer stresses strategies that
help nurse managers to achieve a powerful image. Which groups of behaviours best contribute to a powerful image for the nurse manager?
a. Greeting patients, families, and colleagues with a handshake and a smile; listening
carefully when problems arise.
b. For men, no facial hair, always wearing a suit and tie; for women, always wearing
a suit and high-heeled shoes.
c. Maintaining a soft voice during times of conflict; making unbroken eye contact
during interactions.
d. Smiling all the time; always wearing a suit and carrying a briefcase; for women,
wearing no jewellery.
ANS: A
Rationale: A powerful and positive approach is communicated through confident behaviours such as
greeting other people, smiling, and showing respect for the opinions of other people through listening.
Tomas, a new RN, is finding it difficult to practice because he is encountering, on a daily
basis, differences between his learned ideals and what he is witnessing as nursing practice
on the unit. This situation is an example of:
a. The theory-to-practice gap.
b. Transition shock.
c. An inadequately prepared nurse.
d. Ethical distress.
ANS: B
Rationale: Entry into the workplace can cause a significant clash between learned ideals and actual
nursing practice. Reality shock was the term originally coined, but the clash is now referred
to as transition shock.
A nurse manager recognizes the need to expand her professional network as she begins a job search for a middle-management position. Which of the following actions is least likely to expand her job-searching network?
a. Reviewing her address book or card file for names and phone numbers of former
colleagues who are now in middle-management positions.
b. Making an appointment to meet with a former instructor from her graduate
program in nursing administration.
c. Making a long overdue return call to a former colleague who is now a chief nurse
executive.
d. Attending a state-level conference for nurse managers and executives and
attending informal luncheons and receptions.
ANS: C
Rationale: Networking is the result of identifying, valuing, and maintaining relationships with a system of individuals who are sources of information, advice, and support. In this situation, the chief nurse executive and the nurse may not have a close or valued relationship in view of
the length of time since their last communication, and so the executive may not be in the
best position to provide support or advice.
A staff nurse asks the nurse manager for a few days off for personal reasons. The nurse
manager turns in the request to the human resources office with a note indicating that the staff nurse has demonstrated excellent working skills and is a valued employee. The nurse
manager has used the influence of her position to help this staff member. Influence is the process of:
a. Using power.
b. Empowering others.
c. Understanding power.
d. Moving past apathy.
ANS: A
Rationale: Influence involves the use of power to affect certain outcomes; in this situation, to arrange days off for a valued employee.
Which of the following accurately represents the concept of political activism?
a. Meghan, an emergency room supervisor, encourages staff to write letters to the
local health board to protest closure of the emergency room and the loss of 30
full-time jobs.
b. Sarah refuses involvement in her professional organization, but is heavily involved
in the Little League organization to which her son belongs.
c. Because of her influential contributions to position papers on health care, Roberta
is asked to let her name stand for election as chair of the local organization of
gerontology nurse practitioners, who are lobbying for increased certification
standards.
d. Sondra volunteers to run for office with her professional nursing association
because of her concern about the underrepresentation of expertise from her area of
nursing practice.
ANS: D
Rationale: In this situation, Sondra is engaged in professional activism at the provincial and/or national
level, and therefore exemplifies the highest level of political activism. Roberta exhibits activism at the level of political sophistication, which involves holding office, for example,
at the provincial or national level.
One day, at coffee, your coworker suggests that you and she sit with unit members of the
hospital research committee. She suggests that this would be an excellent way to get to know people who share her interest in research. Her actions are an example of:
a. Mentorship.
b. Politics.
c. Networking.
d. Empowerment.
ANS: C
Rationale: Meeting individuals outside the usual workgroup to share ideas and obtain support and encouragement is an example of networking.
The workgroup on unit NU23 is marked by apathy toward the unit’s patients, high rates of
absenteeism, open conflict among team members, and high turnover of personnel, including managers. The behaviours in this situation are caused by feelings of:
a. Powerlessness.
b. Anger.
c. Apathy.
d. Oppression.
ANS: A
Rationale: Emotions such as anger and apathy result from a workplace in which powerlessness is experienced.
During a unit meeting you notice that the unit manager, Vivian, presents the current
scheduling problems and listens attentively when Yoon, an RN, is speaking, and offers support and advice when Yoon presents new ideas to the group that may alleviate current scheduling problems. You are surprised because Vivian has often confided that she does not
like Yoon. Vivian’s behaviour is best described as:
a. Insincere.
b. Networking.
c. Politically sophisticated.
d. Facilitating participatory decision-making.
ANS: D
Rationale: Vivian is using the leader-empowering behaviour of fostering participatory decision-making by presenting the facts surrounding the current scheduling problem, asking for staff input, and attentively listening to staff ideas.
Which of the following interactions is most consistent with the idea of networking?
a. Meeting with the same colleagues daily to have coffee and to share concerns about
the workplace and stories about colleagues.
b. Joining an online workplace forum to gain ideas about how to handle workplace
conflict.
c. Suggesting that you and a new team member meet after work for coffee to review
unit guidelines.
d. Joining a nurse executive informal lunch meeting to meet other executives for
support and for sharing ideas of expertise.
ANS: D
Rationale: Successful networking involves sharing similar ideas and maintaining relationships with individuals who serve as sources of information, advice, and support.
The institution in which you are a nurse manager has resisted the adoption of new document
management software, citing cost as a concern. You meet with other nurse managers who
are in favour of the software and prepare a proposal to take to the senior executive with the
goal of persuading the executive to adopt the software. This is an example of:
a. Collaboration.
b. A coalition.
c. Networking.
d. Policy building.
ANS: B
Rationale: Groups formed temporarily to achieve particular goals are known as coalitions.
Which of the following is an important component of demonstrating a positive professional attitude?
a. Knowledge.
b. Negotiation skills.
c. Powerful image.
d. Position power.
ANS: C
Rationale: A powerful image is an important aspect of demonstrating a positive professional attitude.
Amy has worked in the dialysis unit on staff for about 12 years. She is frequently consulted
by other nursing staff about protocols and policies on the unit. What type of power is Amy
using?
a. Position power.
b. Expert power.
c. Personal power.
d. Competency power.
ANS: B
Rationale: According to the types of power described, Amy is most likely evidencing expert power in that she is being consulted about areas of knowledge and competency on the unit and is at the same level, potentially, in the hierarchy as her colleagues.
Despite repeated invitations by his colleagues to become involved in regional and provincial nursing practice committees, Tom refuses. His reason is that “nursing committees rarely get
anything worthwhile done because of politics and conflicts.” According to the political activism model, Tom’s view of involvement:
a. Is rare in nursing today.
b. Reflects a fear of power.
c. Reflects apathy.
d. Reflects empowerment and capacity to make his own decisions.
ANS: C
Rationale: Tom`s behaviour reflects apathy on the political activism continuum; he has no membership in professional organizations and little or no interest in legislative politics as they relate to nursing and health care.
A unit manager watches a new RN graduate interacting with a patient. When the RN comes
out of the room, the unit manager says, “I don’t know what they taught you in your nursing program, but if I see you do that again I will write you up.” This example demonstrates an inappropriate use of which type of power?
a. Position.
b. Expert.
c. Personal.
d. Professional.
ANS: A
Rationale: In this example, the unit manager is basing her conversation upon the fact that she has position power, which reflects an inappropriate use of this type of power.
You have been offered a position as a head nurse in the emergency department. You
understand that:
a. You will have stature and power by accepting the position.
b. You will have stature but no power at this point in your position.
c. As a result of your position, you will need to keep much knowledge to yourself.
d. Knowledge is assumed as a result of your position.
ANS: B
Rationale: Having a formal leadership and management position in an organization confers stature, but power comes from the ability to accomplish goals from the position and to use and share
knowledge to expand the power of other employees.
Charmaine, an RN in the emergency department, would like to pursue leadership roles in her career. She is frustrated that her coworkers seem to pay little attention to her creative
ideas or place her in informal leadership positions. As her colleague, you want to provide
her with helpful feedback. Which of the following statements will provide feedback as to how she might communicate power and demonstrate that she is capable of handling other leadership responsibilities?
a. “I find your soft voice and manners very reassuring and calming to patients.”
b. “Try using a wider vocabulary and big words so that people will think that you are
knowledgeable.”
c. “At times, you tend to slump and avoid eye contact when you are talking with
colleagues and families.”
d. “Don’t worry about what others think of you. If you feel like saying something,
say it, even if it hurts other people’s feelings.”
ANS: C
Rationale: A powerful image comes from thinking of oneself as powerful and effective, and this is communicated through posture, maintaining eye contact, treating others with courtesy and respect, and using a firm, confident voice with vocabulary that is appropriate (which does not necessarily involve using big-sounding words).
Judy, a recent graduate nurse was hired in a busy hospital emergency room. Although she
had completed one rotation in an emergency room as a student, she was now feeling
overwhelmed and lacking self-confidence. Her preceptor, an experienced nurse, was critical
of her performance and frequently found fault with Judy’s patient care, causing Judy’s self-confident to further decline. Judy determined she needed to change the situation. Which of the following is the best approach for her to take? (Select all that apply.)
a. Seeking a leader with empowering behaviours to be a mentor.
b. Accessing support to fulfill one’s job responsibilities.
c. Accessing organizational empowerment structures.
d. Advocating for enhanced orientation processes to include workplace violence.
ANS: A, C
Rationale: Empowerment through organizational supports and a mentor with empowering behaviours will assist novice nurses to develop empowering behaviours. Orientation changes and support to fulfill job responsibilities is a short-term approach to an embedded and long-term issue.
Laura Eggertson’s (2011) research highlighted staggering statistics related to nurse bullying, ranging from 44% to as high as 95%. The two most recommended approaches to this issue were? (Select all that apply.)
a. Creating empowering work environments
b. Coaching and mentoring nurses on how to value and respect one another
c. Creating online curriculum related to bullying
d. Supervisors acting immediately if nurses report bullying
ANS: B, D
Rationale: For long-term effect, coaching and mentoring nurses and immediately acting upon bullying will send a clear message to offenders, while supporting nurses who have been bullied, Online curriculum and creating empowering work environments are long-term approaches that will enhance the immediate actions.
Researchers have been able to gain policymaker attention through which of the following?
(Select all that apply.)
a. Creating a sense of urgency.
b. Assuming good data will lead to good policy.
c. Packaging of evidence.
d. Working with coalitions.
ANS: A, C, D
Rationale: There is an assumption that separation typically exists between researchers who generate
evidence versus decision makers who need evidence to make policy decisions. To address this issue is to gain policymaker attention by aligning themselves with other stakeholder groups to create one powerful and educated voice.
Role theory has its underpinnings in management theory. Management theories influence managers’ leadership styles. Which would a nurse manager be most likely to follow when redesigning the staffing schedule?
a. Theory X.
b. Productivity theory.
c. Psychological theory.
d. Theory Y.
ANS: D
Rationale: Theory Y is effective in health care and helps reinforce the concept of team. Because the manager needs to redesign staffing schedules, it would be important to use this participatory approach, inasmuch as the change involves a group.
A nurse manager has worked rapidly to persuade the staff to accept changes in the unit’s
mission, through innovative use of technology, to avoid downsizing. This nurse manager is displaying:
a. A focus on past concerns related to the mission.
b. How to teach staff members about self-management.
c. Facilitation of goal accomplishment.
d. A requirement that all staff members need to review and reinforce their
technologic skills.
ANS: C
Rationale: Nurse managers, who are successful in motivating staff, provide a work environment that facilitates goal accomplishment and personal satisfaction. In this situation, the nurse manager worked quickly to avoid downsizing, thus facilitating the goal of avoiding staff layoffs.
The nurse manager, as the leader of the unit’s “customer (patient) first” initiative, has asked the staff nurses to develop and administer a survey to every patient before discharge. In asking the staff nurses to accomplish this task, the nurse manager is demonstrating
a. Accountability.
b. Shared governance.
c. A common purpose.
d. Independence in the nursing manager’s role.
ANS: B
Rationale: Engaging staff and others in decision making and in obtaining information is one
characteristic of creating a shared governance structure in which nurses are encouraged to
make decisions.
A nurse manager is encountering considerable conflict among staff members because of weekend staffing coverage. During a called staff meeting, the nurse manager asks the disgruntled staff to meet as a group and determine the best staffing practices. In doing this, the nurse manager is using the concept of collaboration to:
a. Demonstrate interdependence.
b. Depict flexibility and broadmindedness.
c. Focus all energies of staff members on a win-win strategy.
d. Defuse the possibility that staff members’ discontent will escalate when staffing
the unit on weekends.
ANS: C
Rationale: Conflict resolution skills are important for nursing managers. When collaboration is used to solve a conflict, all energies are focused on solving the problem, rather than on defeating other people with opposing views.
A nurse manager’s responsibility for financial management involves making budgetary
decisions. Budgets that enable the nurse manager to allocate resources at the unit level
allow:
a. Minimal nurse manager input.
b. Limited rationale for budgetary requests.
c. Budgetary allocations at the executive nurse level.
d. Budgetary decision making at the point of service.
ANS: D
Rationale: In organizational structures in which decision making occurs at the point of service, nurse managers are given responsibility for preparing and implementing a budget that meets the long- and short-term needs of their unit without requiring hierarchical approval.
Which represents one of the Canadian Nurses Association’s top six competencies of a good
nurse manager?
a. Political activism.
b. Conflict resolution skills.
c. Budgetary responsibility.
d. Current clinical practice knowledge.
ANS: B
Rationale: The top six competencies for nurse managers are: (1) accountability for professional practice, (2) verbal communication, (3) team-building skills, (4) leadership skills, (5) conflict resolution, and (6) knowledge of ethical and legal issues.
Whenever a staff nurse asks Sue, the nursing manager, about the best way to perform a new procedure, Sue immediately goes to the computer with the staff nurse and searches for online best practices related to the procedure in question. What is Sue demonstrating?
a. Lack of procedural knowledge.
b. Role-modelling evidence-informed decision-making.
c. Empowerment for the staff nurse to do this on her own, rather than involve the
manager.
d. The key role of informatics in the current health care system.
ANS: B
Rationale: Nurse managers can help staff use research evidence in their practice decision making by valuing research, role modelling, providing encouragement, ensuring policies are based on research and are up to date, and monitoring practice and patient outcomes.
In planning a new wing, the nurse manager complies with the workplace safety requirements of the US Occupational Safety and Health Administration (OSHA). Which of
the following groups is considered to be at high risk for violence in the workplace?
a. Pediatric staff.
b. Postsurgical unit staff.
c. Emergency department staff.
d. Medical oncology unit staff.
ANS: C
Rationale: Emergency department staff members are considered to be at high risk for violence.
In orienting a 25-year-old nurse, the unit manager understands that this worker probably
a. Likes to attend to detail.
b. Is highly proficient in math and reading skills.
c. Enjoys being managed by superiors.
d. Likes to solve problems without being given solutions.
ANS: D
Rationale: A role of the manager is to understand various motivations of staff and to bring these together in the accomplishment of goals. In general, younger workers are motivated strongly by shared governance and decision making.
Nurses on Unit 4 are unhappy and frustrated with their nurse manager. They complain that
“nothing is ever good enough for him.” Such statements suggest that the nurse manager’s goals may be:
a. Measurable.
b. Unrealistic.
c. Attainable.
d. Too low.
ANS: B
Rationale: Nurse managers need to set goals that are high enough to achieve excellence but reasonable enough to enable achievement. Lack of achievement can result in frustration.
Budgeting and protection of revenues is a function of:
a. Leadership.
b. Management.
c. Team leadership.
d. Followers.
ANS: B
Rationale: Managers address complex issues such as planning, budgeting, and allocating resources, whereas leaders address change.
Which of the following is important in a positive work environment?
a. One-way communication.
b. Accountability and clarity of roles and responsibilities.
c. Hierarchical decision making.
d. Challenge and striving for excellence.
ANS: B
Rationale: One of the six competencies of a good nursing manager is accountability for professional practice; clarity of roles and responsibilities enhances accountability.
As the manager of a unit with a high percentage of young professionals, you increase job
satisfaction among this young staff by:
a. Providing high levels of job structure and task orientation.
b. Developing schedules that are fair and observing contractual obligations.
c. Utilizing skills in the staffing mix to optimize the delivery of patient care.
d. Establishing opportunities to self-schedule.
ANS: D
Rationale: A manager is challenged to motivate staff and increase organizational commitment across different generations of workers. Carver and Candela’s (2008) findings suggested that strategies such as shared governance and self-scheduling increase satisfaction among younger staff.
On the first day of every month, the nursing manager on the surgical unit posts a staff nurse’s name on the bulletin board with the caption “Look what this great nurse did this
month” and outlines nursing behaviours that were displayed by that particular nurse. This is
an example of:
a. Negative reinforcement.
b. Valuing employees.
c. Obtaining evidence for performance appraisals.
d. Reinforcing the vision and goals of the organization.
ANS: B
Rationale: Nurse managers must communicate their commitment so that staff members know they are valued in accomplishing the work of the unit that furthers the mission of the organization. One way of demonstrating that employees are valued is through recognition. Recognizing staff’s efforts is part of effective management practices.
As a nurse manager, you determine that a shift in nursing care models might decrease
workplace violence. Members of the hospital administration are reluctant to adopt this new
approach to care. To leverage your ideas, you:
a. Ask staff to send e-mails to administration members encouraging consideration of
your option.
b. Invite a senior member of administration to your staff meeting, so you can tell him
what you are planning.
c. Write a letter of complaint to a member of the institutional board about the lack of
openness of the administration.
d. Identify influential members of your nurse manager group with similar ideas and
request an opportunity to meet with administration members to discuss options.
ANS: D
Rationale: In addressing issues with higher administration, it is important to develop power strategies such as seeking support from other influences in the organization.
During staff meetings you make it a regular practice to encourage shared problem solving, and to recognize employees who go beyond basic roles and responsibilities to contribute to a positive team environment and to quality patient care. This practice exemplifies:
a. Values-based management.
b. Shaping of workplace behaviour.
c. Cooperation and collaboration.
d. Recognition of institutional priorities.
ANS: A
Rationale: Values-based management recognizes that commitment to the vision, mission, and purpose of the organization is demonstrated in everyday behaviour, and that managers communicate their commitment to staff members by expressing the value of their work in accomplishing the mission, purpose, and priorities of the institution.
The successful integration of informatics into health care settings is key to:
a. Quality decision making and processes related to management of resources.
b. Accessing current information about business practices.
c. Leveraging ideas from other managers.
d. Speeding up calculations and decisions in budget development.
ANS: A
Rationale: The use of informatics to research evidence and alternative models of delivery, to compare data and solutions with those of other managers, and to assist with integrative functions that make budgeting more efficient is related to a high quality of decision making and processes related to management of resources such as revenues and personnel.
As a nurse manager, you embrace the usefulness of resources such as Smart Bed. This behaviour is important in:
a. Budget development.
b. A manager’s role.
c. Succession planning.
d. Encouragement of staff members’ use of technology.
ANS: D
Rationale: Advances in technology such as the Smart Bed facilitate effectiveness and efficiency in care. By becoming an early adopter of technology, staff members, particularly older staff, who may be less comfortable with technologic advances, are encouraged to value its use in care delivery and management.
A manager who is concerned with ensuring that patients on her surgical unit have the necessary information to make informed choices is:
a. Practicing legal nursing care.
b. Demonstrating respect for patients’ rights.
c. Avoiding risks.
d. Probably experiencing issues with informed consent.
ANS: B
Rationale: In advocating for informed consent, the nurse manager is modelling professionalism and a professional philosophy that includes patient rights such as the right to informed consent.
Concern for this right is associated with safe, competent, and ethical care.
The nurse manager plays a unique role in institutional management in that the nurse
manager:
a. Encourages shared decision making.
b. Models professional nursing behaviour.
c. Interprets health care trends and their effect on revenues.
d. Coordinates care and allocates resources.
ANS: B
Rationale: Encouragement of shared decision making, coordination of resources, and interface between internal and external factors in a unit are all associated with effective management but could be performed by a manager from any discipline. The nurse manager’s unique role is
modelling professional behaviour.
In developing an orientation program, the hospital educator breaks essential organizational
information down into chunks, which she develops as online modules. This is an application
of which one of Peter F. Drucker’s functions of management?
a. Establishment of goals and objectives.
b. Motivation and communication.
c. Analysis and interpretation of performance.
d. Organization of activities into manageable tasks.
ANS: D
Rationale: Organizing the information into online modules is an application of Drucker’s
organizational analysis and the division of activities, decisions, and relations into manageable tasks.
Julia is a staff nurse who works on a rehabilitation unit. Julia tells you that the assistants are
experiencing difficulty with the new lift and wonders what your thoughts on organizing an
educational session would be. Julia is:
a. Communicating a vision for safety.
b. Taking a risk in identifying the problem with safety.
c. Coordinating the development of knowledge and skills necessary to use the lift.
d. Taking responsibility for identifying a safety concern and conceding authority for a
solution to you.
ANS: D
Rationale: Communication of a vision and risk taking are leader traits, whereas coordination is a
manager trait. Taking responsibility while conceding authority to the leader is depicted in the example.
Which of the following is not one of Peter F. Drucker’s functions of management?
a. Establishment of goals and objectives.
b. Analysis and interpretation of performance.
c. Motivation and communication.
d. Political activism.
ANS: D
Rationale: Establishes objectives and goals for each area and communicates them to the persons who are responsible for attaining them, organizes and analyzes activities, decisions, and relations needed and divides them into manageable tasks, motivates and communicates with the
people responsible for various jobs through teamwork, analyzes, appraises, and interprets performance and communicates the meaning of measurement tools and their results to staff and superiors, develops people, including self.
Managers must understand generational differences related to the nursing work environment. Job satisfaction is crucial to a healthy work environment. Which of the
following identifies as having the most job satisfaction?
a. Generation-x
b. Millennials
c. Generation-y
d. Baby boomers
ANS: D
Rationale: This idea was confirmed in a Canadian study of acute care nurses conducted by Widger, Pye, Wilson, et al. (2007). In that study, data were collected from 8207 registered Ontario nurses and registered practical nurses made up of Baby Boomers, Generations Xers, and Generation Yers. Although Baby Boomer nurses showed a high degree of job satisfaction, Generation X and Y nurses did not.
The most important aspect of budgeting for the nurse manager is:
a. To have hierarchal approval
b. To have decision-making ability
c. To have budgetary control
d. To have input from others
ANS: C
Rationale: Mentoring has been defined as “an intense interpersonal exchange between a senior experienced colleague (mentor) and a less experienced junior colleague (protégé) in which the mentor provides support, direction, and feedback regarding career plans and personal development” (Russell & Adams, 1997, p. 2). Mentoring is a voluntary, an interactive, and mutually beneficial and multifaceted relationship role that assists staff with setting realistic, attainable goals (McNamara, Fealy, Casey, et.al. 2014; Cherry & Jacob, 2008, CNA, 2004).
Management practices when instituting complex organizational change include which of the following? (Select all that apply.)
a. Creating and sustaining trust.
b. Managing the change process actively.
c. Including workers in the work redesign and workflow decisions.
d. Actively managing the change process.
ANS: A, B, C, D
Rationale: Five management practices have been found to be effective when instituting change in complex organizations: Managing the change process actively, balancing the tension
between efficiency and reliability, creating a learning environment that creates and sustains trust, involving the workers in the work redesign and the workflow decision making.
The Code of Ethics for Canadian Registered Nurses ensures that nurses are accountable for patient care. This framework also includes the following aspects within a professional role. (Select all that apply.)
a. Patient rights.
b. Broader social justice.
c. Quality work environments.
d. Is regulated by the Canadian Nurses Association.
ANS: A, B, C
Rationale: Professional nursing within an ethical framework also involves endeavouring to address broad aspects of social justice that are associated with health and well-being. The primary values within the code of ethics that support patient rights include preserving dignity,
promoting and respecting informed decision making, and maintaining privacy and
confidentiality (CNA, 2008).
A nurse manager is discussing with unit staff the repeated lack of staff compliance in
documenting exercise activity for patients who have undergone cardiac surgery. The unit’s licensed practical/ vocational nurses are responsible for ensuring that patients carry out the
prescribed exercise regimen and that the activity is documented. According to Drucker’s five basic functions of a manager, which of the following are appropriate functions for the nurse manager to use when addressing this situation? (Select all that apply.)
a. Divide the necessary activities into manageable tasks, so that patients adhere to the
exercise regimen.
b. Establish objectives and goals for each area and decide who is accountable for
them.
c. Allow patients to organize the activities.
d. Engage in activities that motivate the health care team, and communicate
effectively with the responsible staff members.
e. Analyze, appraise, and interpret the performance of responsible staff members, and
communicate these findings to staff management.
f. Allow patients to establish objectives and goals.
ANS: A, B, D, E
Rationale: Drucker’s five basic functions include division of work into tasks; development and communication of goals and outcomes; motivation and communication; and analysis,
approval, and interpretation of staff performance.
The risk manager informs the nurse manager of an orthopedic
unit that her unit has had an
increase in incident reports about patients falling during the shift from 2300 to 0700 hours. The nurse manager knows that the best way to resolve the problem is to:
a. Use creativity.
b. Obtain support from staff of the shift from 0700 to 1500 hours.
c. Use institutional research.
d. Identify the problem.
ANS: D
Rationale: Identification of a problem is the first step in problem-solving and occurs before any other step. Improper identification of a problem is the most common reason for failure to resolve problems.
The nurse manager of a rehabilitation unit wants to purchase a new antiembolic stocking. To make a high-quality decision, the nurse manager would:
a. Involve the rehabilitation staff in the decision.
b. Involve the sales representative.
c. Make the decision alone.
d. Involve administration in the decision.
ANS: A
Rationale: Shared decision-making leads to a number of successful outcomes, including team pride, the team’s ability to engage in discussions with the nurse leader about work issues, and continued team involvement in shared decision-making. The involvement of other health care professionals is essential in decisions involving patient care.
Several nurses on an adolescent psychiatric unit complain that the teenagers are becoming
unmanageable on the shift from 2300 to 0700 hours. To resolve this problem, the nurse manager decides that the staff should have a brainstorming session. The goal of
brainstorming is to:
a. Evaluate problem solutions.
b. Critique the ideas of other staff members.
c. Generate as many solutions as possible.
d. Identify only practical and realistic ideas.
ANS: C
Rationale: Brainstorming encourages creativity in the beginning of problem solving and avoids premature shutting down of ideas through early evaluation.
During a fire drill several psychiatric patients become agitated. The nurse manager quickly assigns a staff member to each patient. This decision style is most appropriate for:
a. Routine problems.
b. Crisis situations.
c. Managers who prefer an authoritarian style.
d. Followers who cannot agree on a solution.
ANS: B
Rationale: Some problems, such as the crisis situation depicted in this example, necessitate immediate
decision making to ensure patient safety.
After the nurses who work on an adolescent psychiatric unit have had a brainstorming session, they are ready to resolve the problem of teenagers who are unmanageable. To maximize group effectiveness in decision making and problem solving, the nurse manager has:
a. Prevented conflict.
b. Formed highly cohesive groups.
c. Used majority rule to arrive at decisions.
d. Encouraged equal participation among members.
ANS: D
Rationale: The nurse leader or manager needs to provide a nonthreatening and positive environment, in which group members actively participate, by controlling aggressive individuals and encouraging passive individuals to participate actively. Diversity, managed conflict, and
moderate cohesiveness are effective in reaching quality decisions.
To solve a problem, the nurse manager understands that the most important problem-solving
step is:
a. The implementation phase.
b. Identification of numerous solutions.
c. Accurate identification of the problem.
d. Evaluation of the effectiveness of problem resolution.
ANS: C
Rationale: To proceed effectively, it is important to determine whether a problem exists and to accurately identify a problem. Failure to resolve problems is most often linked to improper identification of the problem.
A clinic nurse has observed another nurse deviating from agency policy in performing wound care. The best approach for the clinic nurse to take is to:
a. Stay out of it.
b. Inform the nursing supervisor.
c. Fill out a notification form (incident report).
d. Assess the risk to the client and the agency before proceeding.
ANS: D
Rationale: In assessing risk, the nurse engages in the initial step of the problem-solving process, which
involves asking, “What benefits (or risks) will be derived from solving it?” Purposeful inaction may not be appropriate when the individual cannot resolve the problem or when there is risk to patients.
The clinic nurse understands that problem solving is best defined as
a. A higher order thinking process.
b. Selecting the best option for reaching a predefined goal.
c. Identifying “what is” and “what should be.”
d. Determining creative approaches to resolving a problem or issue.
ANS: C
Rationale: Critical thinking is a higher order thinking process. Problem solving is a step in decision making that is focused on solving an immediate problem, which can be viewed as a gap
between “what is” and “what should be.”
The risk manager wants to evaluate the reasons for an increased number of falls on the rehabilitation unit. The risk manager devises a fishbone diagram. A fishbone diagram is a
useful tool to:
a. Identify the root causes of problems.
b. List possible solutions to problems.
c. Help leaders select the best options.
d. Evaluate the outcomes of decisions made.
ANS: A
Rationale: A fishbone diagram, also known as a cause-and-effect diagram, is useful for determining
the reasons (causes) for an effect (falls).
An outpatient surgery manager is evaluating infusion pumps for the operating room. The manager should:
a. Select the least expensive brand.
b. Use a decision-making tool to evaluate brands.
c. Ask the nursing staff which brand they prefer.
d. Select the vendor from which the institution usually buys.
ANS: B
Rationale: Decision-making tools such as decision grids and SWOT (strengths, weaknesses, opportunities, and threats) analyses are most appropriate when information is available and
options known.
Which statement best defines the difference between problem solving and decision making?
a. Decision making skills require critical thinking; problem-solving skills do not.
b. Problem-solving skills require critical thinking; decision-making skills do not.
c. Decision making is a goal-directed effort; problem solving is focused on solving an immediate problem.
d. Problem solving is a goal-directed effort; decision making is focused on solving an immediate problem.
ANS: C
Rationale: Problem solving is focused on solving immediate problems, whereas decision making is a goal-directed process that is aimed at selecting appropriate actions from among options. Not all decisions begin with a problem.
Silvana, a nurse manager, has a staff nurse who has been absent a great deal for the past 3 months. A coworker gives some information to Silvana indicating that the staff nurse will be resigning and returning to school. Because of this Silvana decides to do which of the
following?
a. Immediately fire the staff nurse.
b. Speak to the coworker and elicit more information.
c. Speak to the staff nurse and ask her to resign.
d. Do nothing.
ANS: D
Rationale: Doing nothing is often warranted because of lack of energy, time, or resources to solve the real problem adequately, and because the benefits are not seen as sufficiently compelling to commit to an action.
The maintenance department wishes to have the nursing lounge renovated so that the lounge will be more “user-friendly.” The department asks the nursing staff to make a wish list of everything that they would like to see in the new lounge. This process is an example of which part of the decision-making process?
a. Assessment/data collection.
b. Planning.
c. Data interpretation.
d. Generating hypotheses.
ANS: A
Rationale: In this particular model (a model similar to the nursing model), data collection is the first
step toward identifying important alternatives or determining whether there is a problem or
problems.
A good nursing decision maker is one who:
a. Uses various models to guide the process on the basis of the circumstances of the
situation.
b. Adopts one model and uses it to guide all decision making.
c. Decides not to use any models because they are all useless.
d. Develops a new model each time a decision has to be made.
ANS: A
Rationale: Research has determined that a structured approach to decision-making increases critical thinking and is the best way to learn how to make quality decisions because it eliminates trial and error and focuses on proven processes.
From the information supplied in this chapter, which statements best defines critical thinking?
a. Critical thinking is a high-level cognitive process.
b. Critical thinking is a process that helps develop reflective criticism for the purpose
of reaching a conclusion.
c. Critical thinking is an orderly approach to considering problems, through the use
of knowledge of methods of logical inquiry and reasoning skills.
d. Critical thinking is a discussion that guides all aspects of the nursing process.
ANS: C
Rationale: Critical thinking is associated with a thoughtful and orderly approach to considering
problems, knowledge of methods of logical inquiry and reasoning skills, and the ability to apply them. In practice, critical thinking involves recognizing problems and finding ways to solve them by gathering pertinent information, appraising evidence, and evaluating arguments.
Decision making is described by the nursing educator as the process that a person uses to
a. Solve a problem.
b. Choose between alternatives.
c. Reflect on a certain situation.
d. Generate ideas.
ANS: B
Rationale: The hallmark of decision making is choosing among options. Generating options is one phase of decision-making, and solving a problem refers to problem solving, which is problem centred. Decision making does not always begin with problems, but rather it is defined as a purposeful, goal-directed effort in which a systematic process is used to choose among options.
Justin is a nurse manager in a rehabilitation unit in a small urban centre. There is a high turnover rate among rehabilitation assistants because of the heavy work assignments. Justin decides to hire new staff in the order that applications are received until all vacant positions are filled. Which of the following decisions did Justin make?
a. Subjective.
b. Objective.
c. Optimizing.
d. Satisficing.
ANS: D
Rationale: The satisficing decision is a decision-making model whereby the decision-maker selects the
solution that is the simplest and provides for the quickest solution.
Which of the following is an intuitive decision-making model?
a. Fishbone model.
b. SWOT model.
c. Clinical judgement model.
d. Bounded rationality model.
ANS: C
Rationale: The clinical judgement model described by Tanner (2006) emphasizes the role of intuition in decision making by nurses, particularly expert nurses.
When confronted with the controversy and the apparent poor morale of the evening staff, the unit manager decided the staff needed to take some time off. He scheduled holidays for the staff without consulting them. A couple of the staff nurses approached the manager and indicated that the problem was not scheduling, but rather the team leader and her patient assignments. What was the unit manager’s first missed step in problem solving?
a. Not using a problem-solving model.
b. Not considering a number of alternatives.
c. Poor evaluation of outcomes.
d. Incorrect problem identification.
ANS: D
Rationale: The unit manager did not begin with an accurate identification of the problem. Problem solving needs to begin with “why?”
One of three managers at a research laboratory drafted a policy that would allow his
department to do more testing in his laboratory. This policy included the times for regular collection in addition to a new process for emergency laboratory testing. The policy and procedures were never followed. The reason was that:
a. The policy was too lengthy and inundated readers with too much detail.
b. The policy made decisions for other departments in the company.
c. The staff did not believe that the new policy would be effective.
d. Testing should not be done in the laboratory.
ANS: B
Rationale: Other departments were not involved in the problem-solving process; therefore they lacked input into the concerns, issues, and possible solutions. Thus it is not surprising that they did not follow the new policy of another department. Problem solving should be a group process that should involve as many personnel as possible.
Decisions are most likely to be of high quality in nursing situations when:
a. Team leaders make the crucial decisions.
b. Individuals are advised of the problems.
c. Group size is neither too small nor too large.
d. Members are passively involved.
ANS: C
Rationale: Research has shown that group size is important. Too small a group means a limited number of options generated. Too large a group can mean lack of structure or lack of meaningful discussion.
Knowing when to have the entire team participate in the decision-making process or when to have only the team leader make the decisions depends on the situation and the desired outcomes. Which situation would warrant individual decision-making?
a. The task and the outcome are relatively simple.
b. It is unlikely that the group will reach a consensus.
c. A decision has to be discussed thoroughly.
d. A number of options need to be considered.
ANS: A
Rationale: People respond to cues in the situation and draw from stored information (tacit knowledge
that is hard to describe) in the subconscious to make rapid decisions instead of taking an
incremental, analytical approach such as that found in the rational decision-making model. Rational thinking and intuitive thinking are complementary, and successful decision making is a balance between the two approaches. If the task and the outcome are relatively simple, decisions can be made by one individual.
Marcella, an experienced head nurse, is given the task of completing the summer vacation
schedule for the pediatric unit. She is fully aware of the hospital’s restrictions on time off and the number of staff on vacation at any given time, in addition to its issues regarding seniority. She weighs the options of allowing staff choice, such as it takes more time but gives employees options. However, if choice is allowed, this could cause arguments. Which of the following is the best alternative?
a. Ask for requests for vacation time in advance, and post the times.
b. Post the completed vacation schedule.
c. Post a tentative schedule, and request feedback.
d. Post a blank schedule, and ask staff members to fill in their times by a given date.
ANS: D
Rationale: This choice is based on a decision-making model that allows experience and knowledge to predict whether a decision will or will not work. The experience of the head nurse suggests that it is important to involve staff in decisions that affect them the most.
With regard to decision making, critical thinking, and problem solving, which of the following statements are accurate and valid points?
a. The professional decision maker approaches problem solving by beginning with an outcome already in mind.
b. Involvement in decision making is of little use unless you are an expert decision-maker.
c. Many models aid the nurse in improving his or her decision making skills.
d. The nursing decision-maker who is successful recognizes that only those with similar experiences should be involved in decision making.
ANS: C
Rationale: A nurse can draw upon many models in making a decision. It is critical to realize that decision-making expertise grows with exposure to decision making, and that diversity in expertise helps in developing options.
The two elements essential to solving any problem are:
a. Problem analysis and decision making.
b. Strategy and rationality.
c. Operational and strategic.
d. Tactical and strategic.
ANS: A
Rationale: Problem analysis includes identifying, clarifying, and verifying a problem, whereas decision making focuses on developing cognitive strategies to solve a problem. Problem analysis
begins with an investigation of the presenting problem. Decision making involves the individual, or organization, choosing a rational action, based on individuals’ preferences.
A decision making model based on a rational and logical approach to problem solving is termed:
a. Nursing process.
b. Ethical decision making.
c. Creative decision making.
d. Scientific decision making.
ANS: D
Rationale: The scientific method is a rational, logical, and widely used problem-solving approach. It is the foundation for many models of decision making.
Which decision-making model is based on the use of intuition when making a decision?
a. Bounded rationality.
b. Fishbone diagram.
c. Clinical judgement model.
d. Rational decision-making model.
ANS: C
Rationale: The Clinical Judgement Model described by Tanner (2006) emphasizes the role of intuition
in decision making by nurses, particularly expert nurses. This model is systematic and similar in its sequence of steps to other models, although the thinking processes involved differ.
An efficient and useful technique for controlling negative group behaviours is:
a. Six thinking hats.
b. SWOT analysis.
c. SOAR analysis.
d. Nominal group technique.
ANS: D
Rationale: Nominal group technique involves asking individual group members to identify a problem, generate solutions, establish priorities and respond to questions posed by obtaining views on a topic by a moderator and arriving at a consensus (Harvey & Holmes, 2012). Typically this is accomplished through asking participants to evaluate and prioritize the ideas of a structured, mediated, approach by all group members.
Many factors affect decision making such as bias. Which of the following reflect bias? (Select all that apply.)
a. Past experiences.
b. Personal attributes.
c. Creativity.
d. Intuition.
ANS: A, B
Rationale: Internal factors include variables such as the decision maker’s physical and emotional state, personal philosophy, biases, values, interests, experience, knowledge, attitudes, and risk-seeking or risk-avoiding behaviours. External factors include environmental conditions, time, and resources.
In a busy rehabilitation unit, the team manager decided that the best way to reward the staff
was to give them a monetary bonus rather than time off. The staff was very concerned about
the decision and went to the administration with a number of complaints. Critical thinking is
a process that entails a number of steps. What steps did the manager omit? (Select all that apply.)
a. Identifying the assumptions that were underpinning the issues.
b. Considering the context of the current problem or situation.
c. Gathering data and evaluating all possible outcomes before making her decision.
d. Attaining a majority consensus of all staff.
ANS: A, B, C
Rationale: Taking a majority consensus is not a step in the critical thinking process. Steps A, B, and C are considered by most authors to be the essential steps in the process of critical thinking.
The number of adverse events such as falls and pressure ulcers on your unit is increasing. An ideal staffing plan to address this issue would include which of the following?
a. Increasing the total number of staff on the unit.
b. Increasing the staff and registered nurse (RN) hours per patient.
c. Increasing the total number of staff and implementing 12-hour shifts.
d. Increasing the number of RNs and number of RNs with experience on the unit.
ANS: D
Rationale: A number of studies (for example, Dunton et al., 2007) have demonstrated that adverse events such as falls can be reduced by increasing the number of RNs on a unit (relative to other personnel), and the number of experienced RNs. Overtime and 12-hour shifts are linked to higher incidences of errors.
A small rural hospital has been designated as a critical access hospital. It has 40 beds and an average occupancy rate of 34 beds. To prepare the staffing, the chief nursing officer computes the occupancy as being;
a. 90%.
b. 85%.
c. 75%.
d. 60%.
ANS: B
Rationale: The occupancy level is calculated as 34/40, or 85%.
To prepare staffing schedules, a nurse manager needs to calculate paid nonproductive time. When calculating paid nonproductive time, the nurse manager considers:
a. Work time, educational time, and holiday time.
b. Paid hours minus worked hours.
c. Vacation time, holiday time, and sick time.
d. Paid hours minus meeting time.
ANS: C
Rationale: Nonproductive hours are hours of benefit time and include vacation, holiday, and personal or sick time.
An important aspect of managing the costs on a unit is to plan accurately for staffing needs. Nurse managers use staffing plans to:
a. Assign staff on the unit on a daily basis.
b. Ensure that days off are planned for the staff.
c. Outline the number of individuals by classification on a per-shift basis.
d. Predict the numbers and classifications of float staff needed to augment regular
staff.
ANS: C
Rationale: Among the largest expenditures for a nursing unit are employee salaries and benefits. In
order to manage the costs on a unit, it is important that the nurse manager develop staffing plans that outline the number of individuals by classification that are needed on a per-shift basis, thus optimizing the management of financial resources.
A nurse manager must consider a number of external variables when preparing the personnel budget and projecting the unit’s staffing needs. An external consideration is:
a. Organizational staffing policies.
b. Staffing models.
c. Changes in services that will be offered.
d. Department of Health licensing standards.
ANS: D
Rationale: Internal considerations are staffing policies, regulations, or recommendations and how they
can relate to the minimum number of regulated or professional nurses required on an acute care unit at a given time, or to the amount of minimum staffing in an ambulatory care program, a continuing care facility, or correctional facility. Licensing standards and staffing
recommendations by provincial and territorial professional association and regulatory bodies affect staffing plans and are considered to be external, or outside of the organization.
A nurse manager must also consider a number of internal variables that will affect staffing
patterns. Which of the following is an internal variable to be considered?
a. Organizational staffing policies.
b. Provincial/territorial licensing standards.
c. Canadian Nurses Association guidelines.
d. Consumer expectations.
ANS: A
Rationale: Internal policies determine what a nurse may do in a particular setting—for example,
organizational staffing policies. External variables to consider are provincial/territorial licensing standards that outline what a nurse can do; the Canadian Nurses Association is a national regulatory organization; and consumer expectations fall within the public realm, which is also an external variable that affects staffing plans.
A nurse manager uses many sources of data when planning the unit’s workload for the year. Which of the following data must be considered in the planning?
a. Hours of operation of the unit.
b. Trends in the numbers of acutely ill patients on the unit.
c. Maximum work stretch for each employee.
d. Weekend requirements.
ANS: B
Rationale: The numbers of acutely ill patients are determined through classification systems, which determine the nursing resources required.
Scheduling is a function of implementing the staffing plan by assigning unit personnel to work specific hours and specific days of the week. To retain nursing staff, the nurse manager must schedule:
a. All weekends off.
b. All holidays off.
c. A variety of scheduling options.
d. Rotating shifts.
ANS: C
Rationale: It is important for staff retention to have a variety of scheduling options. Exact constraints regarding weekends and holidays are determined through contracts and policies.
The difference between staffing and scheduling is that staffing:
a. Puts the right person in the right position.
b. Puts the right person in the right time and place.
c. Refers to the number of nursing hours per patient per day.
d. Accounts for interpretation of benefits and compensation.
ANS: A
Rationale: Staffing is concerned with finding and assigning qualified individuals to care for a group of
patients. Scheduling assigns personnel to specific hours and days of the week.
A busy neurologic intensive care unit and a step-down unit are most likely to use which patient classification system?
a. Factor evaluation.
b. Prototype evaluation.
c. Canadian National Database of Nursing Quality Indicators.
d. Agency for Healthcare Research and Quality (AHRQ) system.
ANS: A
Rationale: In complex patient care areas, a factor evaluation system, in comparison with a prototype system, would be used. The AHRQ produces studies related to staffing and scheduling. As of yet, there is no National Database of Nursing Quality Indicators in Canada, although it does exist in the United States.
Factor evaluation systems involve classification systems in which:
a. Financial data are used to determine staff-to-patient ratios.
b. Diagnosis-related groups are used to determine the numbers of acutely ill patients on a unit.
c. Interventions and time required for interventions are combined to determine the levels that are required.
d. Financial resources and nursing interventions are combined to determine patient contact hours.
ANS: C
Rationale: In a factor evaluation system, tasks, thought processes and patient care activities are
considered and given a time or rating. These times or ratings are then used to determine the number of patient care hours required.
Staff members on your unit raise concern that the number of acutely ill patients on the unit is rising and responsiveness in addressing these needs through appropriate staffing is lacking. They point to increased incidences of adverse and sentinel events on the unit. To address this concern, the best action for your hospital organization is to:
a. Implement a patient classification system immediately.
b. Participate in databases that compare the outcomes and staffing levels versus those
of institutions similar to yours.
c. Provide increased numbers of staff to the unit.
d. Ignore such concerns because the number of acutely ill patients is variable.
ANS: B
Rationale: Staff morale suffers both when models of acute illness indicate a gap between staffing and
the number of acutely ill patients, and when there is no model but perceived acute illness that is not being addressed. A truer approach is to monitor patient outcomes and participate in national databases that measure staffing levels through comparison with similar
institutions.
A particular classification system assigns revenue according to the functional capacity of patients and the progression of patients during their stay in rehabilitation units. More independent patient activities such as prompted voiding require higher staff utilization than do dependent activities but do not result in increased staff resources. This is an example of:
a. Bureaucracy.
b. Concern related to the validity of classification systems.
c. Inadequate reliability of classification systems.
d. Inappropriate subjectivity in making judgements about staffing.
ANS: B
Rationale: Validity of categories and implications for staffing levels are in question in this situation because staffing levels do not reflect the levels of activity required for patient care.
In the past year, you have noticed an increase in patient falls on your unit. In reading studies related to staffing and patient outcomes, you realize that you will need to plan for:
a. Higher patient care hours.
b. Safer facilities.
c. Institution of a patient classification system.
d. An increased number of RN positions.
ANS: D
Rationale: Lower fall rates are shown to be related to higher total nursing hours and a higher percentage of nursing hours supplied by RNs.
In evaluating mortality rates, the head nurse on the cardiac unit is surprised to find that they are higher on the weekend than on weekdays. In exploring the reasons for this apparent anomaly, the head nurse focuses on:
a. Availability of diagnostic personnel.
b. Availability of physicians.
c. Communication with on-call providers.
d. Numbers of acutely ill patients.
ANS: C
Rationale: Studies of off-peak hours (weekends and nights) are limited to date, but those that have been
done indicate that mortality increases during weekends and nights, when staff work with
fewer and often less experienced staff, and when communication among on-call health care providers may be strained.
What does a nurse staffing plan take into account?
a. Specific nurse-to-patient ratios per shift.
b. Participation of nurses in projecting staffing needs.
c. Compensation and benefits for each level of staff.
d. The occupancy load of a unit.
ANS: B
Rationale: Nurse staffing plans employ nursing judgement and flexibility that is based on the number of acutely ill patients, nurse experience, and unit configuration rather than set nurse-to-patient ratios.
As the unit manager you post the staffing plan and compliance reports. This initiative is aimed at:
a. Maintaining unit morale.
b. Complying with national requirements.
c. Demonstrating patient outcomes.
d. Inviting staff participation in decision making.
ANS: A
Rationale: Adequate staffing, as demonstrated through a staffing plan and compliance reports, contributes to staff morale.
To maintain patient safety, studies suggest that scheduling should avoid which of the following?
a. Rotating shifts.
b. Weekends.
c. Eight-hour shifts.
d. Mandatory overtime.
ANS: A
Rationale: Rotating shifts and overtime past 12 hours (mandatory or not) are being shown to increase
nurse error and jeopardize patient safety.
In a job interview for a staff position, which of the following indicates your knowledge of patient safety?
a. “Will I be able to get overtime hours on your unit?”
b. “If there is an opportunity to work extra shifts, I would really like that.”
c. “Is there a strategy in place to reduce the number of overtime hours on the unit?”
d. “I see no reason why I wouldn’t be able to work overtime.”
ANS: C
Rationale: Strategies to reduce overtime increase patient safety. Studies suggest that every additional 10% of overtime hours worked contributes to a 1.3% increase in hospital-related mortality.
To reduce reliance on overtime hours, an organization develops a strategy for floating nurses during staff shortages. To maximize patient safety and reduce costs, the health care organization:
a. Develops a centralized pool of float nurses.
b. Assigns nurses from less busy units to ones with increased numbers of acutely ill
patients.
c. Floats nurses only between units on which the nurses have been cross-trained.
d. Assigns float nurses to basic care only.
ANS: A
Rationale: A centralized pool usually includes experienced nurses who maintain a broad range of competencies. Other approaches are less satisfying for nurses, are less efficient, and may be less safe.
To project staffing needs and to avoid understaffing, it is important that nurse managers consider which of the following?
a. Maximum productive hours.
b. Average nonproductive hours.
c. Minimum benefit hours.
d. Maximum vacation time.
ANS: B
Rationale: To avoid understaffing, average nonproductive or benefit hours need to be considered, so that the unit is properly staffed when staff members are off.
Your health care organization has a decentralized system for scheduling. As part of this process, after you have developed a draft schedule, you may need to:
a. Seek budgetary approval.
b. Balance personal schedules against institutional needs.
c. Negotiate the schedule with unit staff.
d. Submit the schedule to a centralized staffing office for review.
ANS: D
Rationale: In a decentralized model, you may be completely responsible for approving all schedule changes and for development of the schedule, or you may need to submit a draft to a centralized office for review and determination of supplemental staff. Balancing personal schedules and negotiation are characteristics of staff self scheduling models.
Patient classification systems have been developed in an effort to give nurse managers the tools and language to describe the acuity of patients. “Sicker” patients receive higher classification scores, indicating that more nursing resources are required to provide patient care. Which of the following describes a factor evaluation system?
a. Subjective and descriptive.
b. More objective.
c. Uses broad categories to predict patient-care needs.
d. Patient-care needs based on diagnosis-related groups.
ANS: B
Rationale: Factor evaluation system is more objective and gives each task, thought process, and patient-care activity a time or rating. These indicators are then summed to determine the hours of direct care required, or they are weighted for each patient. Used for patients with
more complex care needs and a less predictable disease course.
Which of the following decrease the risk of patient mortality rates? (Select all that apply.)
a. Staff burnout.
b. Positive leadership support.
c. Increase of casual or temporary positions.
d. Staffing numbers and levels.
ANS: A, D
Rationale: Leadership support ensuring adequate staffing levels and appropriate skill, education, and experience of staff including staff mix decreases mortality rates. An increase in staff burnout and casual or temporary positions has been demonstrated to increase mortality rates.
The growth in evidence on nursing-sensitive indicators has been accompanied by significant
controversy regarding the level of nurse staffing required for various groups of patients, primarily in acute-care hospitals. Two major approaches to sufficient staffing have been put forward in Canada. These are? (Select all that apply.)
a. Mandated nurse-patient ratios
b. Increased numbers of registered nurses
c. Development of a staffing plan for a period of time
d. Better staff mix
ANS: A, C
Rationale: Although an increase in the number of registered nurses and a better staff mix will support
better patient care and decreased mortality rates. It is more important that, in Canada, mandated nurse-patient ratios and development of a staffing plan for a period of time,
usually a budget cycle, will provide consistency and ensure the nurse-patient ratio is appropriate based on evidence.
Eschiti and Hamilton (2011) learned that support services and numbers of nonnurse staff are greatly diminished on off-peak shifts leading to increased mortality rates. Which of the following factors influence the risk to patients in off-peak times (weekends and evenings and night shifts)? (Select all that apply.)
a. Rotating shifts
b. Mandatory overtime hours
c. Good staff mix
d. Nurse fatigue
ANS: B, D
Rationale: Research demonstrates that mandatory overtime hours and resulting nurse fatigue are
primary factors for increasing mortality rates in off peak hours. Rotating shifts may have a minor influence and a good staff mix increases mortality rates.
In reviewing the job description of a nurse manager, the staff members become aware that a nurse manager’s role is complex. Which of the following duties are required of a nurse manager? (Select all that apply.)
a. Responsibility for nursing benchmarks.
b. No responsibility for knowledge of staffing benchmarks.
c. Responsibility for planning staffing of unlicensed assistive personnel only.
d. Preparing a unit budget.
e. Changing staffing plans on the basis of service needs.
ANS: A, D, E
Rationale: A nurse manager manages financial resources by developing business and staffing plans. They also prepare nursing benchmarks and change staffing plans according to their unit’s needs.
