Exam 3: Chapter 25 Flashcards
The most important approach that a nurse manager can take with an emotionally troubled employee is to:
a. act as a therapist for the employee.
b. adjust the standard of care to assist the employee.
c. assist the employee in obtaining professional help.
d. adjust the employee’s work schedule to decrease stress.
ANS: C
Emotional difficulties are usually beyond the scope of skills that a nurse manager would normally employ. A referral needs to be
made to a professional who is specifically prepared to deal with this kind of difficulty.
The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is that:
a. using replacement personnel with new ideas may be beneficial.
b. salary costs are lower because personnel are fewer, and outcome is favorable.
c. absence on the part of the rest of the staff is decreased.
d. unacceptable patient care may result.
ANS: D
Reduced staffing adversely affects patient care. Employee morale suffers, care standards may be lowered, and additional stress is
placed on working staff.
In keeping with guidelines of the organization, the nurse manager documents staff problems. Documentation of disciplinary
problems should:
a. include a plan to correct them and to prevent future occurrences.
b. state a detailed history of past problems that are related to the current one.
c. be written at the convenience of the manager.
d. not be discussed until the formal performance evaluation.
ANS: A
In documenting staff problems, it is important to identify the incident with an objective statement of facts and record actions taken
to correct/prevent future problems.
Before terminating an employee, a nurse manager must:
a. be an expert in all legal aspects of termination and discipline practices.
b. follow the organization’s specific policies for addressing disciplinary problems
and termination.
c. function as a counselor for problem employees.
d. do everything to assist and protect the employee by adjusting standards and
policies.
ANS: B
It is important to know the policies of the organization to address disciplinary issues fairly and equitably, as well as to know the
model that is employed to address employee problems. Human resource departments and legal departments are important sources
for consultation, advice, and support.
A nurse manager understands that the typical first step in handling an employee with a disciplinary problem is a:
a. verbal reprimand.
b. written reprimand.
c. reminder of employment standards.
d. day off without pay.
ANS: C
The progressive model of discipline advocates that the first step of the disciplinary process is the informal reprimand or verbal
admonishment. The nonpunitive discipline model advocates reminding the employee of the employment policies and procedures of
the agency.
The chief nursing officer understands that clinical incompetence is best prevented by a(n):
a. flexible protocol for evaluating competency skills.
b. standardized clinical skills checklist.
c. administration of personality tests and competency assessments at point of hire.
d. formalized competency program with established standards for practice.
ANS: D
The competency program with established standards of practice outlines what the nurse must do to achieve desired competencies in
her current position. Competency assessment and goal-setting should help the nurse identify how to excel and which competencies
the nurse wants to achieve in the future.
A nurse manager understands that the second step in handling an employee with a disciplinary problem is to document the incident. Which of the following is best for documentation of personnel problems?
a. Use of the performance appraisal on an annual basis
b. Notes made immediately after an incident that include a description of the
incident, actions taken, plans, and follow-up
c. A tally sheet of medication errors and other specific problems that will be used at
annual review
d. Copies of reports, placed in his or her file, of all unusual occurrences involving
the employee
ANS: B
In documenting staff problems, it is important to specifically indicate what rules were broken or violated, consequences if behavior
is not altered, employee’s explanation of the incidents, and the plan of action to achieve and to reach new goals.
The nurse manager places a staff member on probation because of reports of chemical dependency. The nurse manager should be
aware that which of the following statements is true regarding chemical dependency?
a. The chemically dependent employee usually hides any changes in behavior.
b. When confronted with the issue, the affected employee is usually relieved to have
someone to talk to about the problem.
c. The chemically impaired nurse affects the entire healthcare organization.
d. Hospital policy, state laws, and nurse practice acts address procedures for the
chemically dependent employee in the most general terms.
ANS: C
A chemically impaired nurse jeopardizes patient care through impaired skills and judgment. She or he also compromises teamwork
and continuity as peers attempt to cover deficiencies in work performance for their impaired team member.
The chief nursing officer reviews the policy about “progressive discipline process.” The progressive discipline process includes
which of the following? The manager:
a. acts as a counselor and friend to the employee.
b. should reprimand and suspend the employee as a last resort.
c. should rehire the employee after a reasonable length of time.
d. should terminate the employee if the problem persists.
ANS: D
Termination can be defined as the discharge of an employee who is performing at an unsatisfactory level or who is not a good
match for the organization. Termination is always considered the last resort when dealing with poor performance.
A nurse manager must be familiar with the agency’s policies regarding termination. Termination procedures include which of the
following?
a. Following specific procedures from other organizations
b. Having an attorney present at the termination meeting
c. Having adequate written documentation to support the action
d. Having a friend present during the termination meeting
ANS: C
All steps should be followed, including full appropriate detailed documentation and following the procedures of the organization.
Nathan has been on the cardiac unit for 6 months and has found it difficult to adjust to the expectations of his team. Which of the
following behaviors would most likely signal that Nathan is intending to resign from his position on the unit?
a. Increased absenteeism over the past month
b. Increased attempts to discuss his concerns with his colleagues
c. Testing of workplace guidelines
d. Frequent defensiveness
ANS: A
Many employees increase their absenteeism just before submitting their resignation. If the healthcare worker is experiencing some form of role stress, it might be manifested through absenteeism. Role strain may be reflected by (1) withdrawal from interaction;
(2) reduced involvement with colleagues and the organization; (3) decreased commitment to the mission and the team; and (4) job
dissatisfaction. Testing of workplace guidelines and defensiveness are associated with immaturity.
All of the following are grounds for immediate dismissal except:
a. failing to pursue further medical help for a patient; patient dies.
b. selling narcotics obtained from the unit supply of narcotics.
c. restraining a patient in bed for 7 hours, unsupervised, as punishment for hitting a
staff member.
d. grabbing the unit manager and threatening further physical harm after a poor
performance appraisal.
ANS: A
Situations that may warrant immediate dismissal include theft, violence in the workplace, willful abuse of the patient, harassment,
and chemical abuse.
The unit manager on 4E is concerned about the performance of Jean, a staff nurse. She is not involved directly with Jean, so she has
not been able to determine whether the problem is one of motivation, ability, or both. If Jean lacks ability, which of the following
strategies might the head nurse use?
a. Dismiss or transfer Jean.
b. Document all problem areas and then discuss them with Jean.
c. Develop appropriate solutions and make recommendations to human resources.
d. Smooth over the problems if they are minor in nature.
ANS: B
For the employee to change and grow, specific corrective measures need to be taken. Consultation with the employee is necessary,
and documentation is key to determining the issues.
Nurses generally experience difficulty in identifying behaviors and actions that could signal chemical dependency in a co-worker.
Which of the following is not a behavioral change that occurs with chemical dependency?
a. Personality and behavioral changes
b. Job performance changes
c. Changes in educational involvement and pursuit
d. Absenteeism
ANS: C
A manager needs to be alerted when suspicions of chemical dependency are raised by behavioral changes in the employee. These include mood swings, changes in hygiene and appearance, heightened interest in the pain control of patients, frequent changes in
shifts, increases in absenteeism, and increases in tardiness.
Nurse Stacey is a self-admitted drug addict and has been a heavy abuser of codeine. Stacey and the unit manager decide that
changes have to occur. Stacey enrolls in an addiction program, and the manager has her transferred to a drug-free area. What other
strategies might be appropriate?
a. The manager could refer Stacey to the human resources department.
b. The manager could assist in monitoring Stacey’s progress.
c. The manager could counsel Stacey if Stacey has formed a trusting relationship
with her.
d. Stacey needs to be asked not to involve her family in the recovery program
because this is a work-related situation.
ANS: B
Effective management demands that the organization take an active role in helping employees with special needs. Humanistic
strategies that counsel and assist employees are cost-effective and necessary.
