Exam 3: Chapter 14 Flashcards
The staff members in a local Emergency Department are experiencing stress and burnout as the result of excessive overtime. The
staff decides to unionize to negotiate for better working conditions. The increase in unionization within health care may be attributed to the:
a. movement from being “blue-collar workers” to being “knowledge workers.”
b. excess profits in health care.
c. level of risk that exists for health care.
d. number of people who are involved in health care.
ANS: D
As technology replaces unskilled workers, fewer workers are available for trade-union organizing, which has led to declines in
union memberships. Nurses represent a large pool of workers who may be available for union organizing in the face of the
declining pool available elsewhere.
The Emergency Department nurses’ decision to organize for the purpose of collective bargaining is being driven by a desire to:
a. establish the staffing pattern that will be used.
b. determine the hours that one is willing to work.
c. create a professional practice environment.
d. protect against arbitrary discipline and termination.
ANS: C
Historically, nurses were reluctant to unionize. However, concern with safety of care and quality of care, especially when tension is present in a work environment, makes unionization more desirable. US Supreme Court rulings have provided for RN-only units and protection to practice according to what the profession and licensure status require nurses to do.
The Emergency Department staff decides to use a collective bargaining model for negotiation rather than a traditional trade union
model. A traditional trade union model is characterized by:
a. positional conflict.
b. management support of labor’s initiatives.
c. a spirit of trust between management and labor.
d. an ability to resolve complaints.
ANS: A
Collective bargaining encompasses management support of labor’s initiative, a spirit of trust between labor and management, and
resolution of problems. It replaces the positional conflict that has been associated with traditional trade unions. Models such as the interest-based problem solving (IBPS) model seek to avoid positional conflicts such as those between labor and management that
do not take into account the opposing party in any way.
The chief nursing officer utilizes the hospital’s workplace advocacy to help the overwhelmed Emergency Department staff. Workplace Advocacy is designed to assist nurses by:
a. creating professional practice climates in their institutions.
b. equipping them to practice in a rapidly changing environment.
c. negotiating employment contracts.
d. representing them in labor-management disputes.
ANS: B
Workplace advocacy encompasses a number of activities that enable nurses to control the practice of nursing and to address
challenges that they face in the practice setting. These activities include career development, employment rights, employment
opportunities, and the labor-management relationship. The aim of workplace advocacy is to proactively equip nurses to practice
within a rapidly changing environment, rather than to negotiate contracts or provide representation in employment disputes.
Nursing labor-management partnerships:
a. engage nurses at all levels in problem solving for better patient care.
b. require unions and management to negotiate in good faith regarding hours of work and wages.
c. have been shown to have negligible effects on nurse turnover and patient
outcomes.
d. have typically resulted in increased polarization of nurses and management,
leading to formation of collective bargaining units.
ANS: A
The development of a nursing labor-management partnership is an approach that can be used in most professional nursing
environments. This process recognizes nurses as leaders on all levels and provides formal and informal mechanisms for
professional nurses to work together to achieve shared goals through collaboration and shared decision making or decentralized
decision making. A study of a nursing labor-management partnership suggested that nurse satisfaction was higher, turnover was
lower, and more time was available for patient care.
A Magnet® hospital surveys the staff about job satisfaction. This type of environment, in which nurses have authority and
autonomy, is linked with:
a. client satisfaction with the healthcare organization.
b. organizations with a limited number of nurse managers.
c. private, specialty organizations in urban areas.
d. sophisticated academic health sciences universities.
ANS: A
Autonomy and authority in decision making that is consistent with scope of practice are linked both to higher job satisfaction and to
higher patient satisfaction with care. Job satisfaction is an important indicator of the quality of patient care.
In a nurse managers’ meeting, strategies for ways to help retain staff are discussed. One strategy for assisting nurses in developing collective action skills is:
a. accepting the practice of “going along to get along.”
b. attending as many workshops as practical.
c. spending as much time as possible in clinical settings.
d. taking the opportunity to work with a mentor.
ANS: D
Mentoring facilitates development and adoption of positive interaction and other skills that facilitate good decision making.
Optimism, trust, and decision making are important in collective action and shared decision making and contribute to job
satisfaction and lower turnover in staff.
While making rounds, a night supervisor finds a unit with a low census and too many staff members. The night supervisor is
performing as a statutory supervisor when he or she:
a. assigns nurses to care for specific clients.
b. develops a protocol for unlicensed personnel.
c. recommends transferring a nurse to another service.
d. teaches a nurse to use a new piece of equipment.
ANS: C
The night supervisor is acting in accordance with the National Labor Relations Act, which would enable the supervisor to assign
nurses to care.
The Emergency Department staff members are concerned that working long hours without rest puts patient safety at risk. One staff member decides that she will risk her job and become a whistleblower. Whistle-blowing is an appropriate recourse when
management:
a. disregards due process when disciplining a nurse.
b. delays responding to repeated efforts to provide safe care.
c. hires nurses who are not a part of the union during a strike.
d. refuses to bargain in good faith with the elected bargaining agent.
ANS: B
Whistle-blowing is often a result of organizational failure, including failure of the organization to respond to serious danger or
wrongdoing created within the environment, which, in this instance, involves conditions that put the patient at risk.
As a new nurse manager who has “inherited” a unit with high nurse turnover and complaints of patient dissatisfaction, your first
course of action would be to:
a. determine levels of nurse engagement on the unit.
b. review the personnel files of nurses who have resigned.
c. interview upper management about their vision for the unit.
d. meet with your staff to clarify your vision for the unit.
ANS: A
Multiple studies demonstrate that a healthcare organization that provides a climate in which nurses have authority and autonomy has better patient outcomes, retains nurses at a higher rate, is more cost-effective, and has evidence of greater patient satisfaction than an organization in which such a climate does not exist. Organizational assessment assists in identifying the reasons for high
nurse turnover and patient complaints.
In an inner-city area, a group of nurses meet and develop a plan to negotiate with local businesses to support a breakfast program
for young elementary schoolchildren. This is an example of:
a. community development.
b. collective bargaining.
c. collective action.
d. shared governance.
ANS: C
Collective action refers to activities undertaken by a group of people with common interests and, in this example, by a group of
nurses who are interested in the welfare of children in their community.
Awareness and use of power have been challenging for nurses in general because of:
a. incidences of punishment by authority figures.
b. too little time in the workplace to collectively develop power strategies.
c. lack of cohesiveness and unity among nurses.
d. a tradition of obedience to authority.
ANS: D
Rituals and traditions such as the Nightingale Pledge have emphasized the need for the “good nurse” to be obedient to authority.
This prevailing attitude has made it difficult for nurses, who typically spend considerable time in the workplace and who have
opportunity through their work in teams to develop cohesiveness and unity, to develop awareness and use of power.
Collective action is effective in:
a. ensuring that needs of nurses are placed ahead of other disciplines.
b. defining nursing as a profession.
c. advising patients of the needs of nurses.
d. amplifying the influence of individuals.
ANS: D
Individuals may have limited influence in achieving various purposes such as advancement of quality care or of the profession,
whereas collective action helps to define and sustain individuals in achieving the desired purposes.
Nurses on the dialysis unit notice that changes in labeling of fluids have meant several alarming near miss in terms of wrong
administration of fluids. They take this concern to the unit manager. As an advocate of nurse autonomy, the most appropriate
response in this situation would be to:
a. ensure that the nurses are aware of the reasons for the change and how the
decision was made about the new labels.
b. discuss concerns about the labels and develop potential solutions that take into
account changes that can be made at the local level and those that need system
intervention.
c. suggest that the staff wait until they have become more familiar with the labels
before taking further action.
d. tell the staff that you will notify the pharmacy about these concerns and leave it
up to the pharmacy to decide what should be done.
ANS: B
Participation in decision making regarding one’s practice is an appropriate expectation for professional nurses, provides for greater
autonomy and authority over practice decisions, contributes to supporting the professional nurse, and is a major component of job
satisfaction. Autonomy is encouraged through supportive management and through unit-level support of changes without the need
for complex, multilevel approval of changes that can be made locally.
Martin, the unit manager, receives complaints from community agencies that patients who have been discharged from his unit seem to lack understanding about their disorder and immediate strategies for managing elements of their care. Martin checks the patient
teaching sheets and notes that the sheets are initialed by staff. He calls the agencies and indicates that teaching has been done.
Martin’s follow-up to complaints from the community is:
a. appropriate and indicates that he has assumed accountability for the actions of his
staff.
b. indicative that he does not clearly understand the concept of accountability.
c. indicative of strong support for his staff and their autonomy.
d. important in clarifying the difference between his accountability and that of the
community in patient care.
ANS: B
Accountability refers to the achievement of desired outcomes. If community agencies are noticing that limited or no change in
patient behavior has occurred despite teaching on the unit, then the staff has not achieved accountability, and he is not holding his
unit responsible for the outcomes. Martin is also demonstrating lack of accountability.
