midterm

Question 1

The manager of a surgical area envisions a future that requires the addition of registered nurse (RN) assistants or unlicensed persons to feed, bathe, and walk patients. The RNs on the staff have always practiced in a primary nursing-delivery system and are very resistant to this idea.The best initial strategy in this situation would include:
a. Exploring the values of the RNs in relation to this change.
b. Leaving the RNs alone for a time so they can think about the change before they
are approached again.
c. Dropping the idea and trying for the change in another year or so.
d. Hiring the assistants and allowing the RNs to see what good additions they are.

Answer 1

A

Question 2

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.

Answer 2

C
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.

Question 3

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 nursing administration of the situation

Answer 3

A
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.

Question 4

As a leader on 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.

Answer 4

B
Complexity science involves decision making distributed among the human assets within an
organization, without regard to hierarchy.

Question 5

Which category is unique to leadership but is not part of management?
a. Initiating change
b. Personal qualities
c. Developing people
d. Information management

Answer 5

C
Developing people—coaching, mentoring, succession planning—is a category of solely
leadership, not management. Initiating change and personal qualities are categories of both
management and leadership. Information management is a category of management only.

Question 6

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 adult 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.

Answer 6

B
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.

Question 7

Which province or territory spends the highest percentage of its federal budget on health
care?
a. Quebec.
b. Ontario.
c. British Columbia.
d. New Brunswick.

Answer 7

ANS: A
Quebec spends approximately 4.5% of its total federal budget on health care. New
Brunswick, Ontario, and British Columbia spend 3.9%, 3.5%, and 2.8%, respectively, on
health care.

Question 8

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.

Answer 8

ANS: C
The federal government directly funds services to such groups as First Nations and Inuit
people, military personnel, prisoners in federal penitentiaries, and recent immigrants.

Question 9

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.

Answer 9

ANS: A
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.

Question 10

17. 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.

Answer 10

ANS: B
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.

Question 11

22. In a health care agency that has a bureaucratic organization, communication flows:
    a. Laterally.
    b. Bottom to top.
    c. Top to bottom.
    d. Intermittently.

Answer 11

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

Question 12

15. 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.

Answer 12

ANS: C
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.

Question 13

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.

Answer 13

ANS: B
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.

Question 14

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.

Answer 14

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

Question 15

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
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 15

ANS: A
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.

Question 16

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.

Answer 16

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

Question 17

In Valley Hospital, there is a great deal of discussion about the balance between
hospital-wide budget decision making and unit-based budget decision making. This
discussion represents:
a. A search for the “sweet spot.”
b. Conflict between the values of nursing and those of the health care organization.
c. Traditional organizational values.
d. Differences between bureaucratic and nonlinear thinking.

Answer 17

ANS: A
The important point for an organization—the balance between centralization and
decentralization of authority and decision making—is known as the “sweet spot.”

Question 18

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.

Answer 18

ANS: C

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.

Question 19

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.

Answer 19

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

Question 20

When hiring a case manager for a rehabilitation setting, you are most likely to consider
which of the following?
a. A registered nurse with a master’s degree.
b. A physiotherapist with a background in stroke rehabilitation.
c. A social worker with a background in counselling.
d. A health care provider with advanced background who is focused on patient and
outcome

Answer 20

ANS: D
Case managers can come from a variety of disciplines but should have advanced preparation
with the particular at-risk population being served, be comfortable in an advocate role, and
be focused on outcome and patient.

Question 21

In transitioning to a primary nursing model, it is important for a nurse manager who enjoys
a high level of control over patient care to understand that his or her decision-making at the
patient care level:
a. Is increased.
b. Is decreased.
c. Is relinquished.
d. Remains the same.

Answer 21

ANS: B
The nurse manager who is considering movement to primary nursing needs to consider how
the role of the manager changes, in addition to the roles of the staff. The role of
decision-making at the patient care level is relinquished to the primary nurse. The nurse
manager functions as a role model, advocate, coach, and consultant.

Question 22

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.

Answer 22

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

Question 23

15. 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:
    Collaboration.
    A coalition.
    Networking.
    Policy building.

Answer 23

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

Question 24

Which of the following is an unregulated health care worker?
A)Pharmacist.
B)Occupational therapist.
C)Practical nurse.
D)Care aide.

Answer 24

ANS: D
Regulated health care workers include nurses, pharmacists, and occupational therapists. They conduct reserved health care related actions authorized by licencing. Unregulated health care workers include care aides and certain therapists or counsellors.

Question 25

During a fire drill, the nurse manager becomes very assertive and directive in her communications with staff. This type of situational leadership depends on:
a)Supportive behaviour by the leader and immature followers.
b)The relationship with the followers and the type of behaviour of the leader.
c)Well-trained followers, combined with a strong leader who acts quickly.
d)The leader’s ability to evaluate personnel and communicate that evaluation.

Answer 25

ANS: B
The effectiveness of leaders depends on their relationships with followers, which should develop through motivating and inspiring others, as opposed to managing and controlling them.

Question 26

Although interdisciplinary health care teams are the ideal in Canada, which of the following is an identified barrier to interdisciplinary collaboration?
a)Power equalities.
b)Overlapping scopes of practice.
c)Lack of legislative authority.
d)Lack of professional association support.

ANS: B
Identified barriers to interdisciplinary collaboration include policies (including policy overload), funding, power inequalities, and overlapping scopes of practice.

Answer 26

ANS: B
Identified barriers to interdisciplinary collaboration include policies (including policy overload), funding, power inequalities, and overlapping scopes of practice.

Question 27

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
B. Motivation and communication.
C. Analysis and interpretation of performance.
D. Organization of activities into manageable tasks.

Answer 27

ANS: D
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.