Chapter Test Bank Flashcards

Question

Which relational leadership approach is based on mindfulness and emotional intelligence? a. Resonant b. Instrumental c. Participatory d. Transactional

Answer 1

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.

Answer 2

ANS: B Rationale: The transactional style was identified as being more directional and clear-cut in providing resident care.

Answer 3

ANS: B Rationale: Relational leadership approaches were described as influencing positive nurse outcomes. Transactional, laissez-faire, and instrumental are task-focused.

Answer 4

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.

Answer 5

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.

Answer 6

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.

Answer 7

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.

Answer 8

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.

Answer 9

ANS: B Rationale: Transactional leaders tend to rely on position, power, and reward and punish according to performance and conformity with expectations.

Answer 10

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.

Answer 11

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.

Answer 12

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.

Answer 13

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.

Answer 14

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.

Answer 15

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).

Answer 16

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.

Answer 17

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.

Answer 18

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.

Answer 19

ANS: B Rationale: Biologic and genetic endowment is one of 12 social determinants of health, as identified by the Canadian Nurses Association.

Answer 20

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.

Answer 21

ANS: B Rationale: Tertiary care institutions or tertiary hospitals provide highly specialized services (e.g., academic teaching hospitals).

Answer 22

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.

Answer 23

ANS: D Rationale: Quaternary centres provide treatment of extremely rare medical conditions (they are generally part of a large, tertiary care hospital).

Answer 24

ANS: C Rationale: Provinces and territories have the most authority over the organization, management, and delivery of health care.

Answer 25

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.

Answer 26

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.

Answer 27

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.

Answer 28

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.

Answer 29

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).

Answer 30

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.

Answer 31

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.

Answer 32

ANS: A Rationale: Shared decision making across organizations can lead to growth and responsiveness in meeting emerging needs.

Answer 33

ANS: C Rationale: Professional nursing departments of the future will be focused on patient care outcomes and nursing satisfaction.

Answer 34

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.

Answer 35

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.

Answer 36

ANS: C Rationale: Hybrid structures include characteristics of various organizational types and reflect the needs of the situation and the environment.

Answer 37

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.

Answer 38

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.

Answer 39

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.

Answer 40

ANS: A Rationale: The mission statement is an important foundation for the organizational structure and defines technology and human resources required for the organization.

Answer 41

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.

Answer 42

ANS: A Rationale: A vision statement is an articulated goal that provides an inspirational target to which the organization aspires.

Answer 43

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.

Answer 44

ANS: D Rationale: The mission statements of nursing centres are oriented toward achieving optimal health status for a defined group of patients or consumers.

Answer 45

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.

Answer 46

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.

Answer 47

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.

Answer 48

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.

Answer 49

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.

Answer 50

ANS: C Rationale: In a bureaucratic organization, communication flows vertically from top to bottom.

Answer 51

ANS: D Rationale: Philosophy statements capture significant beliefs and values of the organization.

Answer 52

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.

Answer 53

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.

Answer 54

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.

Answer 55

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.

Answer 56

ANS: D Rationale: In differentiated nursing practice, rules are structured according to education and experience.

Answer 57

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.

Answer 58

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.

Answer 59

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.

Answer 60

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.

Answer 61

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.

Answer 62

ANS: A Rationale: Because of the breadth of nursing knowledge required, baccalaureate education is preferred for primary nurses.

Answer 63

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.

Answer 64

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.

Answer 65

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.

Answer 66

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.

Answer 67

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.

Answer 68

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.

Answer 69

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.

Answer 70

ANS: C Rationale: A particular challenge in team nursing is that staff mixes and personnel may change daily because of individual schedules and shortages.

Answer 71

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.

Answer 72

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.

Answer 73

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.

Answer 74

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.

Answer 75

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.

Answer 76

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.

Answer 77

ANS: C Rationale: The synergy model identifies patient characteristics as “drivers” of the necessary competencies for nurses.

Answer 78

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.

Answer 79

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.

Answer 80

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.

Answer 81

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.

Answer 82

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.

Answer 83

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.

Answer 84

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.

Answer 85

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.

Answer 86

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.

Answer 87

ANS: B Rationale: Risk management involves taking proactive steps to identify and eliminate risks and liability.

Answer 88

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.

Answer 89

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.

Answer 90

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.

Answer 91

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.

Answer 92

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.

Answer 93

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.

Answer 94

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.

Answer 95

ANS: B Rationale: Most matters of health care and hospitals fall under provincial jurisdiction.

Answer 96

ANS: C Rationale: Medicare is Canada’s publicly funded national health care program.

Answer 97

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.

Answer 98

ANS: D Rationale: Legally, the nurse manager is accountable to nursing practice standards, standards for nurse administrators, and hospital policies and procedures.

Answer 99

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.

Answer 100

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.

Answer 101

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.

Answer 102

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.

Answer 103

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.

Answer 104

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.

Answer 105

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.

Answer 106

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.

Answer 107

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.

Answer 108

ANS: B Rationale: Lack of understanding about the appropriate exercise of power affects internal and external relationships.

Answer 109

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.

Answer 110

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.

Answer 111

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.

Answer 112

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.

Answer 113

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.

Answer 114

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.

Answer 115

ANS: A Rationale: Influence involves the use of power to affect certain outcomes; in this situation, to arrange days off for a valued employee.

Answer 116

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.

Answer 117

ANS: C Rationale: Meeting individuals outside the usual workgroup to share ideas and obtain support and encouragement is an example of networking.

Answer 118

ANS: A Rationale: Emotions such as anger and apathy result from a workplace in which powerlessness is experienced.

Answer 119

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.

Answer 120

ANS: D Rationale: Successful networking involves sharing similar ideas and maintaining relationships with individuals who serve as sources of information, advice, and support.

Answer 121

ANS: B Rationale: Groups formed temporarily to achieve particular goals are known as coalitions.

Answer 122

ANS: C Rationale: A powerful image is an important aspect of demonstrating a positive professional attitude.

Answer 123

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.

Answer 124

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.

Answer 125

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.

Answer 126

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.

Answer 127

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).

Answer 128

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.

Answer 129

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.

Answer 130

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.

Answer 131

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.

Answer 132

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.

Answer 133

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.

Answer 134

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.

Answer 135

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.

Answer 136

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.

Answer 137

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.

Answer 138

ANS: C Rationale: Emergency department staff members are considered to be at high risk for violence.

Answer 139

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.

Answer 140

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.

Answer 141

ANS: B Rationale: Managers address complex issues such as planning, budgeting, and allocating resources, whereas leaders address change.

Answer 142

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.

Answer 143

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.

Answer 144

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.

Answer 145

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.

Answer 146

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.

Answer 147

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.

Answer 148

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.

Answer 149

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.

Answer 150

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.

Answer 151

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.

Answer 152

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.

Answer 153

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.

Answer 154

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.

Answer 155

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).

Answer 156

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.

Answer 157

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).

Answer 158

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.

Answer 159

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.

Answer 160

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.

Answer 161

ANS: C Rationale: Brainstorming encourages creativity in the beginning of problem solving and avoids premature shutting down of ideas through early evaluation.

Answer 162

ANS: B Rationale: Some problems, such as the crisis situation depicted in this example, necessitate immediate decision making to ensure patient safety.

Answer 163

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.

Answer 164

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.

Answer 165

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.

Answer 166

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.”

Answer 167

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).

Answer 168

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.

Answer 169

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.

Answer 170

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.

Answer 171

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.

Answer 172

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.

Answer 173

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.

Answer 174

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.

Answer 175

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.

Answer 176

ANS: C Rationale: The clinical judgement model described by Tanner (2006) emphasizes the role of intuition in decision making by nurses, particularly expert nurses.

Answer 177

ANS: D Rationale: The unit manager did not begin with an accurate identification of the problem. Problem solving needs to begin with “why?”

Answer 178

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.

Answer 179

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.

Answer 180

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.

Answer 181

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.

Answer 182

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.

Answer 183

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.

Answer 184

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.

Answer 185

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.

Answer 186

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.

Answer 187

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.

Answer 188

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.

Answer 189

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.

Answer 190

ANS: B Rationale: The occupancy level is calculated as 34/40, or 85%.

Answer 191

ANS: C Rationale: Nonproductive hours are hours of benefit time and include vacation, holiday, and personal or sick time.

Answer 192

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.

Answer 193

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.

Answer 194

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.

Answer 195

ANS: B Rationale: The numbers of acutely ill patients are determined through classification systems, which determine the nursing resources required.

Answer 196

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.

Answer 197

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.

Answer 198

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.

Answer 199

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.

Answer 200

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.

Answer 201

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.

Answer 202

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.

Answer 203

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.

Answer 204

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.

Answer 205

ANS: A Rationale: Adequate staffing, as demonstrated through a staffing plan and compliance reports, contributes to staff morale.

Answer 206

ANS: A Rationale: Rotating shifts and overtime past 12 hours (mandatory or not) are being shown to increase nurse error and jeopardize patient safety.

Answer 207

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.

Answer 208

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.

Answer 209

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.

Answer 210

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.

Answer 211

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.

Answer 212

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.

Answer 213

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.

Answer 214

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.

Answer 215

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.