Quiz Two Test Bank Flashcards
Role theory has its underpinnings in management theory. Management theories influence managers’ leadership styles. Which would a nurse manager be most likely to follow when
redesigning the staffing schedule?
a. Theory X.
b. Productivity theory.
c. Psychological theory.
d. Theory Y.
ANS: D
Rationale: Theory Y is effective in health care and helps reinforce the concept of team. Because the
manager needs to redesign staffing schedules, it would be important to use this participatory approach, inasmuch as the change involves a group.
A nurse manager has worked rapidly to persuade the staff to accept changes in the unit’s mission, through innovative use of technology, to avoid downsizing. This nurse manager is
displaying:
a. A focus on past concerns related to the mission.
b. How to teach staff members about self-management.
c. Facilitation of goal accomplishment.
d. A requirement that all staff members need to review and reinforce their technological skills.
ANS: C
Rationale: Nurse managers, who are successful in motivating staff, provide a work environment that
facilitates goal accomplishment and personal satisfaction. In this situation, the nurse manager worked quickly to avoid downsizing, thus facilitating the goal of avoiding staff layoffs.
The nurse manager, as the leader of the unit’s “customer (patient) first” initiative, has asked the staff nurses to develop and administer a survey to every patient before discharge. In
asking the staff nurses to accomplish this task, the nurse manager is demonstrating
a. Accountability.
b. Shared governance.
c. A common purpose.
d. Independence in the nursing manager’s role.
ANS: B
Rationale: Engaging staff and others in decision-making and obtaining information is one characteristic of creating a shared governance structure in which nurses are encouraged to make decisions.
A nurse manager is encountering considerable conflict among staff members because o weekend staffing coverage. During a called staff meeting, the nurse manager asks the
disgruntled staff to meet as a group and determine the best staffing practices. In doing this, the nurse manager is using the concept of collaboration to:
a. Demonstrate interdependence.
b. Depict flexibility and broadmindedness.
c. Focus all energies of staff members on a win-win strategy.
d. Defuse the possibility that staff members’ discontent will escalate when staffing the unit on weekends.
ANS: C
Rationale: Conflict resolution skills are important for nursing managers. When collaboration is used to solve a conflict, all energies are focused on solving the problem, rather than on defeating
other people with opposing views.
A nurse manager’s responsibility for financial management involves making budgetary decisions. Budgets that enable the nurse manager to allocate resources at the unit level allow:
a. Minimal nurse manager input.
b. Limited rationale for budgetary requests.
c. Budgetary allocations at the executive nurse level.
d. Budgetary decision making at the point of service.
ANS: D
Rationale: In organizational structures in which decision making occurs at the point of service, nurse managers are given responsibility for preparing and implementing a budget that meets the
long- and short-term needs of their unit without requiring hierarchical approval.
Which represents one of the Canadian Nurses Association’s top six competencies of a good nurse manager?
a. Political activism.
b. Conflict resolution skills.
c. Budgetary responsibility.
d. Current clinical practice knowledge.
ANS: B
Rationale: The top six competencies for nurse managers are: (1) accountability for professional
practice, (2) verbal communication, (3) team-building skills, (4) leadership skills, (5) conflict resolution, and (6) knowledge of ethical and legal issues.
Whenever a staff nurse asks Sue, the nursing manager, about the best way to perform a new procedure, Sue immediately goes to the computer with the staff nurse and searches for
online best practices related to the procedure in question. What is Sue demonstrating?
a. Lack of procedural knowledge.
b. Role-modelling evidence-informed decision-making.
c. Empowerment for the staff nurse to do this on her own, rather than involve the
manager.
d. The key role of informatics in the current health care system.
ANS: B
Rationale: Nurse managers can help staff use research evidence in their practice decision making by valuing research, role modelling, providing encouragement, ensuring policies are based on research and are up to date, and monitoring practice and patient outcomes.
In planning a new wing, the nurse manager complies with the workplace safety requirements of the US Occupational Safety and Health Administration (OSHA). Which of the following groups is considered to be at high risk for violence in the workplace?
a. Pediatric staff.
b. Postsurgical unit staff.
c. Emergency department staff.
d. Medical oncology unit staff.
ANS: C
Rationale: Emergency department staff members are considered to be at high risk for violence.
In orienting a 25-year-old nurse, the unit manager understands that this worker probably
a. Likes to attend to detail.
b. Is highly proficient in math and reading skills.
c. Enjoys being managed by superiors.
d. Likes to solve problems without being given solutions.
ANS: D
Rationale: A role of the manager is to understand various motivations of staff and to bring these together in the accomplishment of goals. In general, younger workers are motivated strongly by shared governance and decision making.
Nurses on Unit 4 are unhappy and frustrated with their nurse manager. They complain that “nothing is ever good enough for him.” Such statements suggest that the nurse manager’s goals may be:
a. Measurable.
b. Unrealistic.
c. Attainable.
d. Too low.
ANS: B
Rationale: Nurse managers need to set goals that are high enough to achieve excellence but reasonable enough to enable achievement. Lack of achievement can result in frustration.
Budgeting and protection of revenues is a function of:
a. Leadership.
b. Management.
c. Team leadership.
d. Followers.
ANS: B
Rationale: Managers address complex issues such as planning, budgeting, and allocating resources, whereas leaders address change.
Which of the following is important in a positive work environment?
a. One-way communication.
b. Accountability and clarity of roles and responsibilities.
c. Hierarchical decision making.
d. Challenge and striving for excellence.
ANS: B
Rationale: One of the six competencies of a good nursing manager is accountability for professional
practice; clarity of roles and responsibilities enhances accountability.
As the manager of a unit with a high percentage of young professionals, you increase job satisfaction among this young staff by:
a. Providing high levels of job structure and task orientation.
b. Developing schedules that are fair and observing contractual obligations.
c. Utilizing skills in the staffing mix to optimize the delivery of patient care.
d. Establishing opportunities to self-schedule.
ANS: D
Rationale: A manager is challenged to motivate staff and increase organizational commitment across
different generations of workers. Carver and Candela’s (2008) findings suggested that strategies such as shared governance and self-scheduling increase satisfaction among younger staff.
On the first day of every month, the nursing manager on the surgical unit posts a staff nurse’s name on the bulletin board with the caption “Look what this great nurse did this month” and outlines nursing behaviours that were displayed by that particular nurse. This is an example of:
a. Negative reinforcement.
b. Valuing employees.
c. Obtaining evidence for performance appraisals.
d. Reinforcing the vision and goals of the organization.
ANS: B
Rationale: Nurse managers must communicate their commitment so that staff members know they are
valued in accomplishing the work of the unit that furthers the mission of the organization. One way of demonstrating that employees are valued is through recognition. Recognizing staff’s efforts is part of effective management practices.
As a nurse manager, you determine that a shift in nursing care models might decrease workplace violence. Members of the hospital administration are reluctant to adopt this new approach to care. To leverage your ideas, you:
a. Ask staff to send e-mails to administration members encouraging consideration of your option.
b. Invite a senior member of administration to your staff meeting, so you can tell him what you are planning.
c. Write a letter of complaint to a member of the institutional board about the lack of openness of the administration.
d. Identify influential members of your nurse manager group with similar ideas and request an opportunity to meet with administration members to discuss options.
ANS: D
Rationale: In addressing issues with higher administration, it is important to develop power strategies such as seeking support from other influences in the organization.
During staff meetings you make it a regular practice to encourage shared problem solving, and to recognize employees who go beyond basic roles and responsibilities to contribute to a
positive team environment and to quality patient care. This practice exemplifies:
a. Values-based management.
b. Shaping of workplace behaviour.
c. Cooperation and collaboration.
d. Recognition of institutional priorities.
ANS: A
Rationale: Values-based management recognizes that commitment to the vision, mission, and purpose of the organization is demonstrated in everyday behaviour and that managers communicate their commitment to staff members by expressing the value of their work in accomplishing the mission, purpose, and priorities of the institution.
The successful integration of informatics into health care settings is key to:
a. Quality decision making and processes related to management of resources.
b. Accessing current information about business practices.
c. Leveraging ideas from other managers.
d. Speeding up calculations and decisions in budget development.
ANS: A
Rationale: The use of informatics to research evidence and alternative models of delivery, to compare
data and solutions with those of other managers, and to assist with integrative functions that make budgeting more efficient is related to a high quality of decision making and processes related to management of resources such as revenues and personnel.
As a nurse manager, you embrace the usefulness of resources such as Smart Bed. This behaviour is important in:
a. Budget development.
b. A manager’s role.
c. Succession planning.
d. Encouragement of staff members’ use of technology.
ANS: D
Rationale: Advances in technology such as the Smart Bed facilitate effectiveness and efficiency in care. By becoming an early adopter of technology, staff members, particularly older staff, who may be less comfortable with technologic advances, are encouraged to value its use in care delivery and management.
A manager who is concerned with ensuring that patients on her surgical unit have the necessary information to make informed choices is:
a. Practicing legal nursing care.
b. Demonstrating respect for patients’ rights.
c. Avoiding risks.
d. Probably experiencing issues with informed consent.
ANS: B
Rationale: In advocating for informed consent, the nurse manager is modelling professionalism and a
professional philosophy that includes patient rights such as the right to informed consent. Concern for this right is associated with safe, competent, and ethical care.
The nurse manager plays a unique role in institutional management in that the nurse manager:
a. Encourages shared decision making.
b. Models professional nursing behaviour.
c. Interprets health care trends and their effect on revenues.
d. Coordinates care and allocates resources.
ANS: B
Rationale: Encouragement of shared decision making, coordination of resources, and interface between internal and external factors in a unit are all associated with effective management but could be performed by a manager from any discipline. The nurse manager’s unique role is modelling professional behaviour.
In developing an orientation program, the hospital educator breaks essential organizational information down into chunks, which she develops as online modules. This is an application of which one of Peter F. Drucker’s functions of management?
a. Establishment of goals and objectives.
b. Motivation and communication.
c. Analysis and interpretation of performance.
d. Organization of activities into manageable tasks.
ANS: D
Rationale: Organizing the information into online modules is an application of Drucker’s organizational analysis and the division of activities, decisions, and relations into manageable tasks.
Julia is a staff nurse who works on a rehabilitation unit. Julia tells you that the assistants are experiencing difficulty with the new lift and wonders what your thoughts on organizing an
educational session would be. Julia is:
a. Communicating a vision for safety.
b. Taking a risk in identifying the problem with safety.
c. Coordinating the development of knowledge and skills necessary to use the lift.
d. Taking responsibility for identifying a safety concern and conceding authority for a solution to you.
ANS: D
Rationale: Communication of a vision and risk taking are leader traits, whereas coordination is a manager trait. Taking responsibility while conceding authority to the leader is depicted in the example.
Which of the following is not one of Peter F. Drucker’s functions of management?
a. Establishment of goals and objectives.
b. Analysis and interpretation of performance.
c. Motivation and communication.
d. Political activism.
ANS: D
Rationale: Establishes objectives and goals for each area and communicates them to the persons who are responsible for attaining them, organizes and analyzes activities, decisions, and relations needed and divides them into manageable tasks, motivates and communicates with the
people responsible for various jobs through teamwork, analyzes, appraises, and interprets performance and communicates the meaning of measurement tools and their results to staff and superiors, develops people, including self.
Managers must understand generational differences related to the nursing work environment. Job satisfaction is crucial to a healthy work environment. Which of the following identifies as having the most job satisfaction?
a. Generation-x
b. Millennials
c. Generation-y
d. Baby boomers
ANS: D
Rationale: This idea was confirmed in a Canadian study of acute care nurses conducted by Widger, Pye, Wilson, et al. (2007). In that study, data were collected from 8207 registered Ontario
nurses and registered practical nurses made up of Baby Boomers, Generations Xers, and Generation Yers. Although Baby Boomer nurses showed a high degree of job satisfaction, Generation X and Y nurses did not.
The most important aspect of budgeting for the nurse manager is:
a. To have hierarchal approval
b. To have decision-making ability
c. To have budgetary control
d. To have input from others
ANS: C
Rationale: Mentoring has been defined as “an intense interpersonal exchange between a senior experienced colleague (mentor) and a less experienced junior colleague (protégé) in which the mentor provides support, direction, and feedback regarding career plans and personal development”. Mentoring is a voluntary, an interactive, and mutually beneficial and multifaceted relationship role that assists staff with setting realistic, attainable goals.
Management practices when instituting complex organizational change include which of the following (Select all that apply.)
a. Creating and sustaining trust.
b. Managing the change process actively.
c. Including workers in the work redesign and workflow decisions.
d. Actively managing the change process.
ANS: A, B, C, D
Rationale: Five management practices have been found to be effective when instituting change in complex organizations: Managing the change process actively, balancing the tension
between efficiency and reliability, creating a learning environment that creates and sustains trust, involving the workers in the work redesign and the workflow decision making.
The Code of Ethics for Canadian Registered Nurses ensures that nurses are accountable for patient care. This framework also includes the following aspects within a professional role (Select all that apply.)
a. Patient rights.
b. Broader social justice.
c. Quality work environments.
d. Is regulated by the Canadian Nurses Association.
ANS: A, B, C
Rationale: Professional nursing within an ethical framework also involves endeavouring to address broad aspects of social justice that are associated with health and well-being. The primary values within the code of ethics that support patient rights include preserving dignity, promoting and respecting informed decision making, and maintaining privacy and
confidentiality (CNA, 2008).
A nurse manager is discussing with unit staff the repeated lack of staff compliance in documenting exercise activity for patients who have undergone cardiac surgery. The unit’s
licensed practical/vocational nurses are responsible for ensuring that patients carry out the prescribed exercise regimen and that the activity is documented. According to Drucker’s
five basic functions of a manager, which of the following are appropriate functions for the nurse manager to use when addressing this situation? (Select all that apply.)
a. Divide the necessary activities into manageable tasks, so that patients adhere to the exercise regimen.
b. Establish objectives and goals for each area and decide who is accountable for them.
c. Allow patients to organize the activities.
d. Engage in activities that motivate the health care team, and communicate effectively with the responsible staff members.
e. Analyze, appraise, and interpret the performance of responsible staff members, and communicate these findings to staff management.
f. Allow patients to establish objectives and goals.
ANS: A, B, D, E
Rationale: Drucker’s five basic functions include division of work into tasks; development and communication of goals and outcomes; motivation and communication; and analysis, approval, and interpretation of staff performance.
The risk manager informs the nurse manager of an orthopedic unit that her unit has had an increase in incident reports about patients falling during the shift from 2300 to 0700 hours. The nurse manager knows that the best way to resolve the problem is to:
a. Use creativity.
b. Obtain support from staff of the shift from 0700 to 1500 hours.
c. Use institutional research.
d. Identify the problem.
ANS: D
Rationale: Identification of a problem is the first step in problem solving and occurs before any other step. Improper identification of a problem is the most common reason for failure to resolve problems.
The nurse manager of a rehabilitation unit wants to purchase a new antiembolic stocking. To make a high-quality decision, the nurse manager would:
a. Involve the rehabilitation staff in the decision.
b. Involve the sales representative.
c. Make the decision alone.
d. Involve administration in the decision.
ANS: A
Rationale: Shared decision making leads to a number of successful outcomes, including team pride, the
team’s ability to engage in discussions with the nurse leader about work issues, and continued team involvement in shared decision making. Involvement of other health care professionals is essential in decisions involving patient care.
Several nurses on an adolescent psychiatric unit complain that the teenagers are becoming unmanageable on the shift from 2300 to 0700 hours. To resolve this problem, the nurse manager decides that the staff should have a brainstorming session. The goal of
brainstorming is to:
a. Evaluate problem solutions.
b. Critique the ideas of other staff members.
c. Generate as many solutions as possible.
d. Identify only practical and realistic ideas.
ANS: C
Rationale: Brainstorming encourages creativity in the beginning of problem solving and avoids premature shutting down of ideas through early evaluation.
During a fire drill several psychiatric patients become agitated. The nurse manager quickly assigns a staff member to each patient. This decision style is most appropriate for:
a. Routine problems.
b. Crisis situations.
c. Managers who prefer an authoritarian style.
d. Followers who cannot agree on a solution.
ANS: B
Rationale: Some problems, such as the crisis situation depicted in this example, necessitate immediate decision making to ensure patient safety.
After the nurses who work on an adolescent psychiatric unit have had a brainstorming session, they are ready to resolve the problem of teenagers who are unmanageable. To maximize group effectiveness in decision making and problem solving, the nurse manager has:
a. Prevented conflict.
b. Formed highly cohesive groups.
c. Used majority rule to arrive at decisions.
d. Encouraged equal participation among members.
ANS: D
Rationale: The nurse leader or manager needs to provide a nonthreatening and positive environment, in which group members actively participate, by controlling aggressive individuals and encouraging passive individuals to participate actively. Diversity, managed conflict, and moderate cohesiveness are effective in reaching quality decisions.
To solve a problem, the nurse manager understands that the most important problem-solving step is:
a. The implementation phase.
b. Identification of numerous solutions.
c. Accurate identification of the problem.
d. Evaluation of the effectiveness of problem resolution.
ANS: C
Rationale: To proceed effectively, it is important to determine whether a problem exists and to accurately identify a problem. Failure to resolve problems is most often linked to improper identification of the problem.
A clinic nurse has observed another nurse deviating from agency policy in performing wound care. The best approach for the clinic nurse to take is to:
a. Stay out of it.
b. Inform the nursing supervisor.
c. Fill out a notification form (incident report).
d. Assess the risk to the client and the agency before proceeding.
ANS: D
Rationale: In assessing risk, the nurse engages in the initial step of the problem-solving process, which involves asking, “What benefits (or risks) will be derived from solving it?” Purposeful inaction may not be appropriate when the individual cannot resolve the problem or when there is risk to patients.
The clinic nurse understands that problem solving is best defined as
a. A higher order thinking process.
b. Selecting the best option for reaching a predefined goal.
c. Identifying “what is” and “what should be.”
d. Determining creative approaches to resolving a problem or issue.
ANS: C
Rationale: Critical thinking is a higher order thinking process. Problem solving is a step in decision making that is focused on solving an immediate problem, which can be viewed as a gap between “what is” and “what should be.”
The risk manager wants to evaluate the reasons for an increased number of falls on the rehabilitation unit. The risk manager devises a fishbone diagram. A fishbone diagram is a useful tool to:
a. Identify the root causes of problems.
b. List possible solutions to problems.
c. Help leaders select the best options.
d. Evaluate the outcomes of decisions made.
ANS: A
Rationale: A fishbone diagram, also known as a cause-and-effect diagram, is useful for determining the reasons (causes) for an effect (falls).
An outpatient surgery manager is evaluating infusion pumps for the operating room. The manager should:
a. Select the least expensive brand.
b. Use a decision-making tool to evaluate brands.
c. Ask the nursing staff which brand they prefer.
d. Select the vendor from which the institution usually buys.
ANS: B
Rationale: Decision-making tools such as decision grids and SWOT (strengths, weaknesses, opportunities, and threats) analyses are most appropriate when information is available and options known.
Which statement best defines the difference between problem solving and decision making?
a. Decision making skills require critical thinking; problem-solving skills do not.
b. Problem-solving skills require critical thinking; decision-making skills do not.
c. Decision making is a goal-directed effort; problem solving is focused on solving
an immediate problem.
d. Problem solving is a goal-directed effort; decision making is focused on solving an immediate problem.
ANS: C
Rationale: Problem solving is focused on solving immediate problems, whereas decision making is a goal-directed process that is aimed at selecting appropriate actions from among options. Not all decisions begin with a problem.
Silvana, a nurse manager, has a staff nurse who has been absent a great deal for the past 3 months. A coworker gives some information to Silvana indicating that the staff nurse will be
resigning and returning to school. Because of this Silvana decides to do which of the following?
a. Immediately fire the staff nurse.
b. Speak to the coworker and elicit more information.
c. Speak to the staff nurse and ask her to resign.
d. Do nothing.
ANS: D
Rationale: Doing nothing is often warranted because of lack of energy, time, or resources to solve the real problem adequately, and because the benefits are not seen as sufficiently compelling to commit to an action.
The maintenance department wishes to have the nursing lounge renovated so that the lounge will be more “user-friendly.” The department asks the nursing staff to make a wish list of
everything that they would like to see in the new lounge. This process is an example of which part of the decision making process?
a. Assessment/data collection.
b. Planning.
c. Data interpretation.
d. Generating hypotheses.
ANS: A
Rationale: In this particular model (a model similar to the nursing model), data collection is the first step toward identifying important alternatives or determining whether there is a problem or problems.
A good nursing decision maker is one who:
a. Uses various models to guide the process on the basis of the circumstances of the situation.
b. Adopts one model and uses it to guide all decision making.
c. Decides not to use any models because they are all useless.
d. Develops a new model each time a decision has to be made.
ANS: A
Rationale: Research has determined that a structured approach to decision-making increases critical thinking and is the best way to learn how to make quality decisions because it eliminates
trial and error and focuses on proven processes.
From the information supplied in this chapter, which statements best defines critical thinking?
a. Critical thinking is a high-level cognitive process.
b. Critical thinking is a process that helps develop reflective criticism for the purpose of reaching a conclusion.
c. Critical thinking is an orderly approach to considering problems, through the use of knowledge of methods of logical inquiry and reasoning skills.
d. Critical thinking is a discussion that guides all aspects of the nursing process.
ANS: C
Rationale: Critical thinking is associated with a thoughtful and orderly approach to considering problems, knowledge of methods of logical inquiry and reasoning skills, and the ability to apply them. In practice, critical thinking involves recognizing problems and finding ways to solve them by gathering pertinent information, appraising evidence, and evaluating arguments.
Decision making is described by the nursing educator as the process that a person uses to
a. Solve a problem.
b. Choose between alternatives.
c. Reflect on a certain situation.
d. Generate ideas.
ANS: B
Rationale: The hallmark of decision making is choosing among options. Generating options is one phase of decision-making, and solving a problem refers to problem solving, which is problem centred. Decision making does not always begin with problems, but rather it is defined as a purposeful, goal-directed effort in which a systematic process is used to choose among options.
Justin is a nurse manager in a rehabilitation unit in a small urban centre. There is a high turnover rate among rehabilitation assistants because of the heavy work assignments. Justin decides to hire new staff in the order that applications are received until all vacant positions are filled. Which of the following decisions did Justin make?
a. Subjective.
b. Objective.
c. Optimizing.
d. Satisficing.
ANS: D
Rationale: The satisficing decision is a decision-making model whereby the decision-maker selects the solution that is the simplest and provides for the quickest solution.
Which of the following is an intuitive decision-making model?
a. Fishbone model.
b. SWOT model.
c. Clinical judgement model.
d. Bounded rationality model.
ANS: C
Rationale: The clinical judgement model described by Tanner (2006) emphasizes the role of intuition in decision making by nurses, particularly expert nurses.
When confronted with the controversy and the apparent poor morale of the evening staff, the unit manager decided the staff needed to take some time off. He scheduled holidays for the staff without consulting them. A couple of the staff nurses approached the manager and indicated that the problem was not scheduling, but rather the team leader and her patient
assignments. What was the unit manager’s first missed step in problem solving?
a. Not using a problem-solving model.
b. Not considering a number of alternatives.
c. Poor evaluation of outcomes.
d. Incorrect problem identification.
ANS: D
Rationale: The unit manager did not begin with an accurate identification of the problem. Problem solving needs to begin with “why?”
One of three managers at a research laboratory drafted a policy that would allow his department to do more testing in his laboratory. This policy included the times for regular collection in addition to a new process for emergency laboratory testing. The policy and procedures were never followed. The reason was that:
a. The policy was too lengthy and inundated readers with too much detail.
b. The policy made decisions for other departments in the company.
c. The staff did not believe that the new policy would be effective.
d. Testing should not be done in the laboratory.
ANS: B
Rationale: Other departments were not involved in the problem-solving process; therefore they lacked input into the concerns, issues, and possible solutions. Thus it is not surprising that they did not follow the new policy of another department. Problem solving should be a group process that should involve as many personnel as possible.
Decisions are most likely to be of high quality in nursing situations when:
a. Team leaders make the crucial decisions.
b. Individuals are advised of the problems.
c. Group size is neither too small nor too large.
d. Members are passively involved.
ANS: C
Rationale: Research has shown that group size is important. Too small a group means a limited number of options generated. Too large a group can mean lack of structure or lack of meaningful discussion.
Knowing when to have the entire team participate in the decision-making process or when to have only the team leader make the decisions depends on the situation and the desired outcomes. Which situation would warrant individual decision making?
a. The task and the outcome are relatively simple.
b. It is unlikely that the group will reach a consensus.
c. A decision has to be discussed thoroughly.
d. A number of options need to be considered.
ANS: A
Rationale: People respond to cues in the situation and draw from stored information (tacit knowledge that is hard to describe) in the subconscious to make rapid decisions instead of taking an incremental, analytical approach such as that found in the rational decision-making model.
Rational thinking and intuitive thinking are complementary, and successful decision making is a balance between the two approaches. If the task and the outcome are relatively simple, decisions can be made by one individual.
Marcella, an experienced head nurse, is given the task of completing the summer vacation schedule for the pediatric unit. She is fully aware of the hospital’s restrictions on time off
and the number of staff on vacation at any given time, in addition to its issues regarding seniority. She weighs the options of allowing staff choice, such as it takes more time but gives employees options. However, if choice is allowed, this could cause arguments. Which of the following is the best alternative?
a. Ask for requests for vacation time in advance, and post the times.
b. Post the completed vacation schedule.
c. Post a tentative schedule, and request feedback.
d. Post a blank schedule, and ask staff members to fill in their times by a given date.
ANS: D
Rationale: This choice is based on a decision-making model that allows experience and knowledge to predict whether a decision will or will not work. The experience of the head nurse suggests that it is important to involve staff in decisions that affect them the most.
With regard to decision making, critical thinking, and problem solving, which of the following statements are accurate and valid points?
a. The professional decision maker approaches problem solving by beginning with an outcome already in mind.
b. Involvement in decision making is of little use unless you are an expert
decision-maker.
c. Many models aid the nurse in improving his or her decision-making skills.
d. The nursing decision-maker who is successful recognizes that only those with similar experiences should be involved in decision making.
ANS: C
Rationale: A nurse can draw upon many models in making a decision. It is critical to realize that decision-making expertise grows with exposure to decision making, and that diversity in expertise helps in developing options.
The two elements essential to solving any problem are:
a. Problem analysis and decision making.
b. Strategy and rationality.
c. Operational and strategic.
d. Tactical and strategic.
ANS: A
Rationale: Problem analysis includes identifying, clarifying, and verifying a problem, whereas decision making focuses on developing cognitive strategies to solve a problem. Problem analysis begins with an investigation of the presenting problem. Decision making involves the individual, or organization, choosing a rational action, based on individuals’ preferences.
A decision making model based on a rational and logical approach to problem solving is termed:
a. Nursing process.
b. Ethical decision making.
c. Creative decision making.
d. Scientific decision making.
ANS: D
Rationale: The scientific method is a rational, logical, and widely used problem-solving approach. It is the foundation for many models of decision making.
Which decision-making model is based on the use of intuition when making a decision?
a. Bounded rationality.
b. Fishbone diagram.
c. Clinical judgement model.
d. Rational decision-making model.
ANS: C
Rationale: The Clinical Judgement Model described by Tanner (2006) emphasizes the role of intuition in decision making by nurses, particularly expert nurses. This model is systematic and similar in its sequence of steps to other models, although the thinking processes involved differ.
An efficient and useful technique for controlling negative group behaviours is:
a. Six thinking hats.
b. SWOT analysis.
c. SOAR analysis.
d. Nominal group technique.
ANS: D
Rationale: Nominal group technique involves asking individual group members to identify a problem, generate solutions, establish priorities and respond to questions posed by obtaining views on a topic by a moderator and arriving at a consensus (Harvey & Holmes, 2012). Typically this
is accomplished through asking participants to evaluate and prioritize the ideas of a structured, mediated, approach by all group members.
Many factors affect decision-making such as bias. Which of the following reflect bias? (Select all that apply.)
a. Past experiences.
b. Personal attributes.
c. Creativity.
d. Intuition.
ANS: A, B
Rationale: Internal factors include variables such as the decision maker’s physical and emotional state, personal philosophy, biases, values, interests, experience, knowledge, attitudes, and risk-seeking or risk-avoiding behaviours. External factors include environmental conditions, time, and resources.
In a busy rehabilitation unit, the team manager decided that the best way to reward the staff was to give them a monetary bonus rather than time off. The staff was very concerned about
the decision and went to the administration with a number of complaints. Critical thinking is a process that entails a number of steps. What steps did the manager omit? (Select all that apply.)
a. Identifying the assumptions that were underpinning the issues.
b. Considering the context of the current problem or situation.
c. Gathering data and evaluating all possible outcomes before making her decision.
d. Attaining a majority consensus of all staff.
ANS: A, B, C
Rationale: Taking a majority consensus is not a step in the critical thinking process. Steps A, B, and C are considered by most authors to be the essential steps in the process of critical thinking.
Complex care of acutely ill patients is required on a surgical unit in which differentiated nursing practice is its model of care delivery. The concept of differentiated nursing practice is based on:
a. Licensure status.
b. Experience in the agency.
c. Leadership capabilities.
d. Education and expertise.
ANS: D
Rationale: In differentiated nursing practice, rules are structured according to education and experience.
The relief charge nurse has assigned a newly registered baccalaureate prepared nurse to be one of the team leaders for the shift from 1500 to 2300 hours. In making this decision, the
charge nurse has overlooked this nurse’s:
a. Clinical expertise.
b. Leadership ability.
c. Communication style.
d. Conflict-resolution skills.
ANS: A
Rationale: The effective functioning of teams in this model is heavily reliant on the leadership, organization, and communication skills of the leader, in addition to comfort and confidence
in providing care to a specific patient group. Although leadership and critical thinking are part of basic education in baccalaureate programs, the new registered nurse (RN) needs time
to develop clinical confidence and expertise.
When interviewing an applicant for a position, the nurse manager describes the unit’s care delivery system as one in which each nursing assistant is cross-trained to perform specific
tasks, and in which the RNs handle all intravenous medications, admissions, and discharge teaching. The nurse applicant knows this nursing care delivery strategy to be:
a. The case method.
b. Functional nursing.
c. Primary nursing.
d. Nurse case management.
ANS: B
Rationale: The functional care delivery model depends on the decision of care according to tasks or functions that are assigned to specific teams or team members.
You are the nurse manager of a nursing service organization that provides around-the-clock care to patients in their homes. To achieve an optimal outcome for a patient who is
recovering from a hip replacement, the nursing staff will probably follow the nursing care guidelines presented in which of the following?
a. Nursing care plan.
b. Physician’s orders.
c. Critical pathway.
d. Clinical practice guidelines.
ANS: C
Rationale: A critical pathway outlines outcomes, clinical standards, and interventions for a patient in each phase of treatment. The goal of critical pathways is effective coordination of care across various staff and levels of care, and to optimize patient outcomes.
The nurse case manager is working with a patient admitted for end-stage renal disease. The case manager’s major goal during this hospitalization is to:
a. Implement the care map on admission.
b. Provide direct nursing care throughout the hospitalization.
c. Supervise the nursing staff members who implement the care map.
d. Prevent the need for additional hospitalizations resulting from complications of the patient’s disease.
ANS: D
Rationale: The goals and outcomes established in a care map or critical pathway are designed to support the aims of case management, which are shortened hospital stays and prevention of the need for hospital readmissions.
The nurse manager at a cardiac rehabilitation unit was asked to select a care delivery model. Which of the following methods would be the most cost effective?
a. Functional method.
b. Case management method.
c. Primary care method.
d. Team method.
ANS: B
Rationale: Team nursing, functional nursing, and case management are all considered efficient, cost-effective methods of care delivery because they enable use of various types of health
care providers (rather than baccalaureate nurses in direct care, which is the primary nursing method). Case management is considered particularly cost effective in patient care settings that have the potential for high resource consumption, such as settings with medically complex cases, through collaboration and close attention to outcomes.
In an acute care unit, the nurse manager utilizes the functional nursing method as the care delivery model. The nurse manager’s main responsibility is the needs of which of the following?
a. The department.
b. The unit.
c. Staff members.
d. The patient.
ANS: D
Rationale: In a functional nursing model, in which other team members are focused on performing specific tasks, the nurse manager assumes primary responsibility for patient outcomes.
A patient is admitted to a medical unit with pulmonary edema. His primary nurse admits him and then provides a written plan of care. What type of educational preparation best fits the role of primary nurse?
a. Baccalaureate.
b. Associate,
c. Diploma.
d. Licensed practical nurse/licensed vocational nurse.
ANS: A
Rationale: Because of the breadth of nursing knowledge required, baccalaureate education is preferred
for primary nurses.
In a small rural nursing home a director of nursing decides to implement a partnership model, because of a shortage of nurses, to help with certain tasks. What combination of health care providers constitutes a partnership care delivery model?
a. RN and licensed practical nurse/licensed vocational nurse.
b. RN and RN.
c. RN and medication assistants.
d. RN and certified nurses’ aides.
ANS: C
Rationale: The partnership care delivery model is a variation of primary nursing in which an RN works with a medication assistant, who performs basic nursing functions.
The case method of care delivery could be best justified for which of the following scenarios?
a. Stable patient population with long-term care and family needs.
b. Acute care surgical unit with predictable postsurgical outcomes and many technical procedures.
c. Pediatric intensive care unit that heavily involves families and also patients.
d. Home health care environment with patients who have varying degrees of acute illness.
ANS: C
Rationale: The setting in which the case method of delivery can be most justified is the pediatric intensive care unit, in which the status of patients can rapidly change and complex functions
of care involve both patients and families.
During times of nursing shortage and increased nursing costs in health care, which of the following nursing care delivery models might come under greatest scrutiny?
a. Case method.
b. Team nursing.
c. Functional nursing.
d. Nurse case management.
ANS: A
Rationale: The case method may involve an RN’s treatment of the “total patient.” Employment of the most highly paid nursing personnel (RNs) for all patient care is the most expensive model and may be difficult to operationalize in times of RN shortage.
A patient complains to you that she has no idea who “her nurse” is on any given day. “I ask one nurse for my pills, and she says, ‘That is not my job.’ I ask the pill nurse about my lab tests, and she says that I should ask another nurse.” The nursing care delivery model most likely to be employed in this situation is
a. Differentiated practice.
b. Team nursing.
c. Functional nursing.
d. Case management.
ANS: C
Rationale: In functional nursing, licensed and unlicensed personnel perform specific tasks for a large
number of patients. A disadvantage of this system is that care is assigned by task and not by patient, which can leave patients with the experience of multiple caregivers and a sense of
confusion.
The functional nursing model might be particularly effective in which of the following?
a. Promoting communication among diverse team members.
b. Facilitating multiple perspectives on the total care of a patient.
c. Avoiding patient–provider conflict.
d. Developing competence and confidence in unlicensed workers.
ANS: D
Rationale: An advantage of functional nursing is that both unlicensed assistive personnel and licensed
staff are involved in performance of specific tasks, and the repeated performance of tasks enables staff to become very efficient in specific functions. Disadvantages of the model
include difficulty in being able to assess the patient’s nonphysical needs effectively and the potential for ineffective communication because of the focus on specific tasks.
For a nurse manager in the functional nursing model, which approach will assist in maintaining staff satisfaction in this specific model?
a. Rotation of task assignments.
b. Frequent opportunities for in service education.
c. Orientation to job responsibilities and performance expectations.
d. Team social events in off hours.
ANS: A
Rationale: Although repetition of tasks increases confidence and competence, it can also lead to boredom. In-service opportunities, adequate orientation, and building a team culture are strategies that are important to all models, but rotation of tasks can specifically reduce the boredom that is a potential disadvantage of this model.
In comparing team and functional models of care, a nurse manager favours the team model. In particular, she finds that the team model:
a. Can be effective in recognizing individual strengths and backgrounds of staff members.
b. Promotes autonomy and independence of the RN.
c. Avoids conflict because of role clarity.
d. Is efficient in delivering care to a large group of patients with the use of a staffing mix.
ANS: A
Rationale: Team nursing delivers care to a small group of patients; the team is a mix of licensed and unlicensed personnel. Assignment is based on the needs and background of the patient and on the strengths, licensure, and roles of team members. Team functioning and satisfaction can be compromised unless the team leader has strong delegation, communication, and leadership skills.
To effectively delegate in a team nursing environment, the RN team leader must be familiar with the legal and organizational roles of each group of personnel and must:
a. Be able to effectively communicate with patients.
b. Build relationships with physicians.
c. Be able to adapt to daily changes in staffing.
d. Adapt in communicating information to the supervisor.
ANS: C
Rationale: A particular challenge in team nursing is that staff mixes and personnel may change daily because of individual schedules and shortages.
A nurse manager questions the true difference between primary nursing and total patient care. After careful consideration of both models, the nurse manager concludes that primary
nursing differs significantly from total patient care in which way?
a. Breadth of nursing knowledge and expertise required.
b. Intention to provide holistic nursing.
c. Time period of accountability.
d. Levels and types of assessment.
ANS: C
Rationale: Significant overlap can be seen between primary nursing and total patient care in terms of breadth of assessment and knowledge required to provide holistic care. A primary difference is that nurses in the total care model assume accountability while on shift, whereas primary nurses assume responsibility from a patient’s time of admission to discharge and 24 hours a day during the hospital stay.
A conflict develops between an associate nurse and a primary nurse over the assessment of a patient with pulmonary edema. On the basis of her assessment of the patient, the associate nurse insists that it is her role to change the care plan because she is the one who has made the assessment. As the nurse manager, you clarify that:
a. It is the role of the primary nurse to make alterations on the basis of assessment data and input.
b. The associate nurse is accountable and responsible while the primary nurse is off duty and therefore is able to alter the care plan.
c. Neither the primary nurse nor the associate nurse should make changes without first consulting you as the manager.
d. It really does not matter who alters the nursing care plan because it depends on situation and time to do so.
ANS: A
Rationale: The primary nursing model assumes that the primary nurse is accountable for patient care, even while off duty. The primary nurse is responsible for establishing the patient plan of care and therefore for altering it with the input of an associate. The associate is responsible for the implementation of the care plan that has been established when the primary nurse is off duty.
When comparing functional nursing and primary nursing, a nurse manager, after evaluating particular models of nursing care for potential adoption, determines that patient and nurse satisfaction in primary nursing are:
a. Similar to those in functional nursing.
b. Not of significance in either model.
c. Low in comparison with that in functional nursing.
d. High in comparison with that in functional nursing.
ANS: D
Rationale: Primary nursing tends to be satisfying for RNs who enjoy a high level of accountability and autonomy in decision-making. Patient satisfaction is also high, inasmuch as patients form
close therapeutic relationships with the nurse because of the continuousness of the relationship. Functional nursing is criticized for low patient satisfaction and potential staff
dissatisfaction related to boredom and an autocratic approach to management.
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.
ANS: B
Rationale: 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.
You are considering putting forward a proposal to move the model of care from team nursing to a primary nursing hybrid—a patient-focused care model. In considering this proposal, you recognize that significant costs specific to operationalizing this model are related to which of the following?
a. Implementation of an all-RN staff complement.
b. Significant changes in the physical structure of units.
c. Orientation of staff to new roles and responsibilities.
d. Testing and piloting technology at the patient’s bedside.
ANS: B
Rationale: This particular model includes a focus on patient care that includes multidisciplinary teams and assistants at the patient’s bedside. Services, including those of laboratories and pharmacies, are decentralized to bring them closer to where care is delivered.
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.
ANS: D
Rationale: 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.
Case-managed care may enhance profit in a for-profit health organization by:
a. Minimizing costs in areas of high resource consumption.
b. Combining licensed and nonlicenced care providers in delivering patient care.
c. Increasing reimbursement from third-party payers.
d. Reducing the amount of technology used to support clinical decision making.
ANS: A
Rationale: Case-managed care does not generate revenue; rather, it protects revenue in that better coordination of care enables efficient achievement of patient outcomes, can result in a shorter length of hospital stay, and can prevent the need for readmission.
In the hiring of nurses during the transition from team nursing to a primary nursing model, Benner’s (2001) work suggests that you give priority to nurses who are at least at which level of competency?
a. Advanced beginner.
b. Competent.
c. Proficient.
d. Novice.
ANS: B
Rationale: Nurses who have less than 2 or 3 years of experience in primary nursing or less than 2 or 3 years of nursing experience will probably require more assistance than do other nurses, which will put a greater demand on the unit during a time of transition.
In considering whether to accept a job offer in a hospital in which the synergy model of care is used, you expect that which of the following is the driver of the necessary nurse competencies for practising within this model?
a. Educational background of the nurse.
b. Patient population characteristics.
c. Interdisciplinary health care teams.
d. National nurse-to-patient ratios.
ANS: C
Rationale: The synergy model identifies patient characteristics as “drivers” of the necessary competencies for nurses.
Differentiated nursing practice, or staff mix, is a model of clinical nursing practice that combines different categories of health care personnel employed for the provision of direct
client care. What is the biggest aspect of this model in decreasing its success?
a. Supports each nurse’s level of education.
b. Varied educational backgrounds and philosophies of nurses.
c. Increases satisfaction of patients.
d. Increases satisfaction of nurses.
ANS: B
Rationale: Despite a variety of efforts to differentiate the roles and competencies of nurses with various
educational backgrounds and experience, the demands of the workplace, the chronic shortage of nurses, and the greater use of technology have made it difficult to differentiate nursing practice in many clinical settings even among RNs with differing levels of education.
Nursing case management is geared to providing comprehensive care for those with complex health problems. Which of the following supports the use of a case management model?(Select all that apply.)
a. Decreases length of stay.
b. Increases efficient use of services.
c. Increases nurse sense of satisfaction.
d. Decreases human resource inequities.
ANS: A, B, C
Rationale: Although case management has many benefits, there are also several barriers including financial barriers, lack of administrative support, human resource inequities, turf battles, and a lack of information support systems.
The total patient care method, or patient allocation method, of nursing care delivery is the oldest model of providing care to patients. One nurse provides total care to one or two critically ill patients, or to a group of patients. Which of the following contributes to the success of this model? (Select all that apply.)
a. Current global nursing shortage.
b. High costs.
c. Provides high quality care.
d. Engenders trust between family and nurse.
ANS: C, D
Rationale: In today’s costly health care environment, total patient care provided by one nurse, typically an almost all registered nurse (RN) staff, is very expensive. In a time of a global nursing shortage, there may not be enough nurses to use this model or funding to provide for this model of care. The nurse, patient, and family trust one another and work together toward specific goals. Total patient care remains popular with patients as the care is seen as being consistent and high quality, and care that is provided by highly qualified nursing staff.
The chief nursing officer implements the team nursing model on the acute care units. Expectations of the team leader include which of the following?(Select all that apply.)
a. Being attentive to the needs of the organization.
b. Being newly graduated with a baccalaureate degree.
c. Having several years of clinical nursing practice.
d. Being attentive to the needs of the patient.
e. Being attentive to the needs of the staff.
ANS: C, D, E
Rationale: Team leaders require both leadership skills and knowledge, in addition to clinical confidence and expertise, to effectively delegate responsibilities according to staff background, role, and expertise and according to patient needs.
John is part of an interdisciplinary care team on a surgical unit. Interdisciplinary care teams:
a. Increase fragmentation of care.
b. Improve quality of patient care.
c. Increase duplication of services.
d. Need to include licenced and unregulated care providers.
ANS: B
Rationale: The benefits of interdisciplinary care can be recognized through reduced duplication of services, decreased fragmentation of care, and improved quality of care for patients. Implementation and integration of interdisciplinary teams within Canada’s health care system has the potential to allow health care providers to practise to their full scope of practice and create innovative, sustainable ways to provide high quality health care for all
Canadians.
The nurse manager is setting up the room assignments for the unit. One patient on the unit is in critical condition and is going to require more care than the others. Before delegating a task, a nurse manager should:
a. Delegate the admission assessment to the licenced practical nurse.
b. Review the employee’s performance assessment for the most recent period.
c. Assess the amount of guidance and support needed in a particular situation.
d. Create a task analysis of critical behaviours for the patient.
ANS: C
Rationale: To delegate effectively, the nurse manager must assess the abilities required in the situation
and the abilities that staff have. The nurse manager can thereby anticipate the amount of direction, monitoring, explanation, and independence that are needed.
A key advantage that a nurse manager has in terms of delegating is that:
a. Patients receive less attention because too many staff members make it difficult to coordinate care.
b. Nurses report less pressure to perform necessary tasks themselves.
c. Administration can predict overtime more accurately.
d. Team skills can be used more effectively.
ANS: D
Rationale: The use of multilevel health care providers enables health care organizations and nurses to provide patient-centred care, with a focus on abilities and skills that can be employed to perform what is needed when it is needed. As tasks become more complicated, delegating skills to other workers enables the nurse to deliver a complex level of care effectively.
The nurse on the shift from 2300 to 700 hours is assigning a component of care to an unregulated care provider. The night nurse should remain:
a. Accountable and responsible.
b. Accountable and liable.
c. Authoritative and liable.
d. Responsible and task-oriented.
ANS: A
Rationale: The nurse manager should hold self and others accountable for actions and outcomes.
The night nurse understands that certain factors need to be considered before tasks are delegated to others. These factors include which of the following?
a. Complexity of the task and the age of the delegate.
b. Potential for benefit and the complexity of the task.
c. Potential for benefit and the number of staff.
d. Complexity of the task and the potential for harm.
ANS: D
Rationale: In delegating tasks to others, the nurse considers factors such as stability of the patient, safety of the situation and of the patient, time and intensity of the task involved, and level of critical thinking required to achieve desired outcomes.
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.
ANS: B
Rationale: 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.
The unit manager is working in a large metropolitan facility and is told that two unregulated care providers are to be assigned to work with her. Delegation begins with:
a. Acknowledging the arrival of the second unregulated care provider on the unit.
b. Providing clear directions to both unregulated care providers.
c. Matching tasks with qualified persons.
d. Receiving reports from the prior shift.
ANS: C
Rationale: In delegating tasks to unregulated care providers, the nurse must consider what cannot be delegated, in addition to the factors of safety, time, critical thinking, and stability of patients’ conditions.
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
Rationale: Identified barriers to interdisciplinary collaboration include policies (including policy overload), funding, power inequalities, and overlapping scopes of practice.
Who is accountable when a registered nurse performs a “transfer of function” from a physician activity?
a. The physician.
b. The director of nursing.
c. The nurse.
d. The institution.
ANS: C
Rationale: The registered nurse is accountable and responsible for nursing care provided. Activities
considered outside the legislative scope of nursing practice were “covered” by extensive use of delegation, or “transfer of function,” from physicians. In some cases, the physician apparently presumes that it would be the employer’s responsibility to ensure that the nurse was competent to provide the care, whereas the employer placed a large portion of the responsibility on the nurse and thus the nursing regulatory body.
In some provinces, a restricted activities or controlled acts model is currently in place. A main distinction between this model and the model of licensure that is still used in most other provinces is that:
a. Each health care provider is registered to conduct specific tasks.
b. Specific acts are licenced.
c. Acts cannot be shared among health care providers unless they are registered.
d. Nurses are bound by exclusive scopes of practice.
ANS: B
Rationale: In Ontario, Alberta, and British Columbia, a common framework known as a restricted
activities or controlled acts model created consistent approaches among the health professions with regard to discipline, registration, continuing competency, and restricted activities. A main distinction between this model and the model of licensure still used in all other provinces and territories is that nurses are not bound by exclusive scopes of practice. Rather than care providers being licenced, specific acts are licenced. This allows more than one profession to perform the same act, or parts of the act, for example, prescribing medication.
Which of the following exemplifies accountability for a nurse manager?
a. Consistently submitting budgets on time.
b. Consistently performing the responsibilities outlined for nurse managers at the institution.
c. Explaining why registered nurse coverage was reduced on nights to the Nursing Practice Committee after serious patient injury.
d. Actively soliciting ideas regarding scheduling from staff.
ANS: C
Rationale: Reliability, dependability, and obligation to fulfill the roles and responsibilities of the nurse manager are consistent with responsibility. Accountability refers to being answerable for actions and results.
Which of the following is a benefit of the controlled acts model over the licensure model?
a. Decreased flexibility in allowing patients choice in their care provider.
b. Limited range of professional responsibility.
c. No firm boundaries.
d. Recognition that scope of practice is static.
ANS: C
Rationale: Several benefits of the controlled acts model over the licensure model have been identified:
It is viewed as allowing health care providers to perform to the range of their competency and abilities; the scope of practice is recognized as not static or to have firm boundaries; it
places greater emphasis on standards and competence; and it increases flexibility in allowing patients more choice in providers and employers more innovation in optimal skill mix, while protecting the public from harm.
Although benefits of the controlled acts model are advantageous and arguably necessary, the legislative reform to recognize overlapping competencies has caused:
a. Role clarity.
b. A decrease in “turf” competition among health care providers.
c. A difficulty in optimizing skill mix.
d. Static boundaries for health care providers.
ANS: C
Rationale: The legislative reform of the controlled acts model to recognize overlapping competencies has caused increased role confusion, further competition over “turf” for various providers, and difficulty in optimizing skill mix.
In delegating to an unregulated care provider in a home health setting, which of the following represents the most appropriate delegation communication?
a. “You will be taking care of Mrs. Srivastava. Mrs. Srivastava needs assistance with her bath.”
b. “You will need to help Mrs. Srivastava get into and out of her shower. Ensure that you check the condition of her feet, and let me know if you have any concerns when you check in.”
c. “I am not sure that you know how to do this, but I am giving you Mrs. Srivastava. She is quite obese and needs skin care.”
d. “Mrs. Srivastava needs help to get into and out of her bathtub. Her bath will need to be completed by 10:00. When you are helping her to dry, please check between her toes and toenails, and phone me by 10:30 if you notice nail discoloration or redness.”
ANS: D
Rationale: Delegation communication is very important and needs to be specific. Communication also includes conveying recognition of the authority to do what is expected.
Which of the following is a domain of the National Interprofessional Competency Framework?
a. Quality improvement.
b. Interprofessional conflict resolution.
c. Contextual issues.
d. Interdisciplinary communication.
ANS: B
Rationale: The framework consists of six competency domains: interprofessional communication;
patient-centred care; role clarification; team functioning; collaborative leadership; and interprofessional conflict resolution.
According to the National Interprofessional Competency Framework, which domain is considered relevant in every situation?
a. Role clarification.
b. Team functioning.
c. Patient-centred care.
d. Collaborative leadership.
ANS: C
Rationale: In every situation, the domains of patient-centred care and interprofessional communication are relevant and consistently influence and support the other four domains.
Which of the following is considered a system-relevant barrier to primary care and public health collaboration?
a. Lack of common agenda.
b. Power and control issues.
c. Resource limitations.
d. Relationship challenges.
ANS: B
Rationale: Although all the choices are considered barriers, only the barrier of power and control issues is considered a system-relevant barrier.
Which of the following is considered an organizational facilitator to primary care and public health collaboration?
a. Shared protocols.
b. Role clarity.
c. Education and training.
d. Philosophy and personal identity.
ANS: A
Rationale: Although all choices are considered facilitators, only shared protocols is considered an organizational facilitator.
Sammi, a registered nurse, is part of an interdisciplinary team that provides care to patients with acute cardiac interferences. The team has not been functioning optimally and Sammi is aware that this may cause a(n):
a. Increase in the cohesiveness of the team.
b. Escalation of turf protection.
c. Increase in the quality of patient care.
d. Decrease in workplace stress.
ANS: B
Rationale: When collaboration is ineffective or unsuccessful, disciplinary silos are reinforced, and turf protection escalates. These environments contribute to workplace stress and adversely affect patient care.
When there is lack of role clarity within an interdisciplinary health care team, health care providers tend to:
a. Work more closely together for role clarity.
b. Move away from their own disciplinary silos.
c. Revert to what is familiar and what they know in relation to health care roles.
d. Increase communication to enable a sharing of role expectations.
ANS: C
Rationale: Role clarity is defined as having an understanding of one’s own role and that of others, and this understanding is applied through description, performance, and communication to achieve patient goals (Canadian Interprofessional Health Collaborative, 2010). When there is lack of role clarity, health care providers tend to revert to what is familiar, often their own disciplinary silos.
When there is lack of role clarity, health care providers tend to remain in their own disciplinary silos. Which of the following would counteract this tendency?
a. Rearranging team membership.
b. Assigning a team leader.
c. Engaging licencing organizations to increase scope of practice details.
d. Practising patient-centred care.
ANS: D
Rationale: When there is lack of role clarity, health care providers tend to revert to what is familiar, often their own disciplinary silos; one way to counteract this tendency is to practise
patient-centred care.
In transferring a patient, Leslie, an unregulated care provider, uses improper techniques. The patient is injured, and as a result, a lawsuit is launched in which both Neha, the delegator, and Leslie, the delegatee, are named. Neha is named in the suit because she:
a. Retains responsibility for the care of the patient.
b. Worked the same shift as Leslie.
c. Has passive accountability for delegation.
d. Retains accountability for the outcomes of care for the patient.
ANS: D
Rationale: Whenever care is provided by someone other than a registered nurse, accountability for care remains with the manager/delegator even though other people provide aspects of care.
One strategy to facilitate clarity about team members and the team process is to:
a. Ensure a range of personality styles on the team.
b. Establish colocation of the team.
c. Appoint a physician as the team leader.
d. Engage a variety of healthcare providers on the team with different levels of power.
ANS: B
Rationale: All team members should be clear about what skills they bring to the health care and team process, and this can be facilitated by the colocation of the team. Although simply grouping a variety of healthcare providers together in the same building will not create a team, colocation can have many benefits, including timely and personal consultations or referrals regarding patient care, increased understanding, and respect for all members’ roles, and informal opportunities to connect, whether personally or professionally.
The rationale for the shift to interdisciplinary teams for health care delivery in Canada is related to: (Select all that apply.)
a. The aging of the population.
b. Increased utilization of unregulated care providers.
c. Nurse shortages.
d. An increase in acute illness and comorbidity.
e. Increasing specialization of health care providers.
ANS: A, C, D
Rationale: Every jurisdiction in Canada is currently implementing interdisciplinary teams in a variety
of settings. The rationale for this shift toward interdisciplinary care is directly related to changes in Canadian health care: the aging population, who have increasingly complex and comorbid illnesses; health care provider shortages; and the realization that no single health care provider can adequately address patient needs in the twenty-first century.
Barriers to initiating interprofessional collaboration are many. Which of the following apply? (Select all that apply.)
a. Practice protection.
b. Regulatory mechanisms.
c. The concept is well accepted.
d. Outdated legislation.
ANS: A, B, D
Rationale: Despite the laudable benefits of interprofessional collaboration, it is a concept that can be difficult to implement and measure in practice. Barriers to collaboration include macro-level restrictions impacting micro-level processes such as outdated legislation, regulatory mechanisms, and practice protection.
The controlled acts model is structured so that those outside a particular profession are not necessarily restricted. The controlled acts model has several benefits over the licensure
model. Which of the following is not a benefit over the licensed manner? (Select all that apply.)
a. It allows professionals to perform to the range of their competency and abilities.
b. It places greater emphasis on standards and competence.
c. It increases flexibility in allowing patients more choice in providers.
d. Perform particular services or functions within professions.
ANS: A, B, C
Rationale: Perform particular services or functions within professions is part of the licensure system. Over time several provinces have replaced health professional licensing, which allowed only professions with a particular license to perform particular services or functions within regulation. Ontario, Alberta, and British Columbia have adopted a common framework known as a “restricted activities” or “controlled acts” model.
What is an intraprofessional team is composed of? (Select all that apply.)
a. A mix of same discipline with different levels of education.
b. Members of same discipline.
c. Members of different disciplines.
d. Members of different disciplines with extended levels of education.
ANS: A, B
Rationale: Nurses working in an intraprofessional team can registered practical nurses, degree nurses, advanced practice nurses, and nurses holding a doctoral degree.
The number of adverse events such as falls and pressure ulcers on your unit is increasing. An ideal staffing plan to address this issue would include which of the following?
a. Increasing the total number of staff on the unit.
b. Increasing the staff and registered nurse (RN) hours per patient.
c. Increasing the total number of staff and implementing 12-hour shifts.
d. Increasing the number of RNs and number of RNs with experience on the unit.
ANS: D
Rationale: A number of studies (for example, Dunton et al., 2007) have demonstrated that adverse events such as falls can be reduced by increasing the number of RNs on a unit (relative to other personnel), and the number of experienced RNs. Overtime and 12-hour shifts are linked to higher incidences of errors.
A small rural hospital has been designated as a critical access hospital. It has 40 beds and an average occupancy rate of 34 beds. To prepare the staffing, the chief nursing officer computes the occupancy as being;
a. 90%.
b. 85%.
c. 75%.
d. 60%.
ANS: B
Rationale: The occupancy level is calculated as 34/40, or 85%.
To prepare staffing schedules, a nurse manager needs to calculate paid nonproductive time. When calculating paid nonproductive time, the nurse manager considers:
a. Work time, educational time, and holiday time.
b. Paid hours minus worked hours.
c. Vacation time, holiday time, and sick time.
d. Paid hours minus meeting time.
ANS: C
Rationale: Nonproductive hours are hours of benefit time and include vacation, holiday, and personal or sick time.
An important aspect of managing the costs on a unit is to plan accurately for staffing needs. Nurse managers use staffing plans to:
a. Assign staff on the unit on a daily basis.
b. Ensure that days off are planned for the staff.
c. Outline the number of individuals by classification on a per-shift basis.
d. Predict the numbers and classifications of float staff needed to augment regular staff.
ANS: C
Rationale: Among the largest expenditures for a nursing unit are employee salaries and benefits. In
order to manage the costs on a unit, it is important that the nurse manager develop staffing plans that outline the number of individuals by classification that are needed on a per-shift basis, thus optimizing the management of financial resources.
A nurse manager must consider a number of external variables when preparing the personnel budget and projecting the unit’s staffing needs. An external consideration is:
a. Organizational staffing policies.
b. Staffing models.
c. Changes in services that will be offered.
d. Department of Health licensing standards.
ANS: D
Rationale: Internal considerations are staffing policies, regulations, or recommendations and how they can relate to the minimum number of regulated or professional nurses required on an acute care unit at a given time, or to the amount of minimum staffing in an ambulatory care program, a continuing care facility, or correctional facility. Licensing standards and staffing
recommendations by provincial and territorial professional association and regulatory bodies affect staffing plans and are considered to be external, or outside of the organization.
A nurse manager must also consider a number of internal variables that will affect staffing
patterns. Which of the following is an internal variable to be considered?
a. Organizational staffing policies.
b. Provincial/territorial licensing standards.
c. Canadian Nurses Association guidelines.
d. Consumer expectations.
ANS: A
Rationale: Internal policies determine what a nurse may do in a particular setting—for example,
organizational staffing policies. External variables to consider are provincial/territorial licensing standards that outline what a nurse can do; the Canadian Nurses Association is a national regulatory organization; and consumer expectations fall within the public realm, which is also an external variable that affects staffing plans.
A nurse manager uses many sources of data when planning the unit’s workload for the year. Which of the following data must be considered in the planning?
a. Hours of operation of the unit.
b. Trends in the numbers of acutely ill patients on the unit.
c. Maximum work stretch for each employee.
d. Weekend requirements.
ANS: B
Rationale: The numbers of acutely ill patients are determined through classification systems, which determine the nursing resources required.
Scheduling is a function of implementing the staffing plan by assigning unit personnel to work specific hours and specific days of the week. To retain nursing staff, the nurse manager must schedule:
a. All weekends off.
b. All holidays off.
c. A variety of scheduling options.
d. Rotating shifts.
ANS: C
Rationale: It is important for staff retention to have a variety of scheduling options. Exact constraints regarding weekends and holidays are determined through contracts and policies.
The difference between staffing and scheduling is that staffing:
a. Puts the right person in the right position.
b. Puts the right person in the right time and place.
c. Refers to the number of nursing hours per patient per day.
d. Accounts for interpretation of benefits and compensation.
ANS: A
Rationale: Staffing is concerned with finding and assigning qualified individuals to care for a group of
patients. Scheduling assigns personnel to specific hours and days of the week.
A busy neurologic intensive care unit and a step-down unit are most likely to use which patient classification system?
a. Factor evaluation.
b. Prototype evaluation.
c. Canadian National Database of Nursing Quality Indicators.
d. Agency for Healthcare Research and Quality (AHRQ) system.
ANS: A
Rationale: In complex patient care areas, a factor evaluation system, in comparison with a prototype system, would be used. The AHRQ produces studies related to staffing and scheduling. As of yet, there is no National Database of Nursing Quality Indicators in Canada, although it does exist in the United States.
Factor evaluation systems involve classification systems in which:
a. Financial data are used to determine staff-to-patient ratios.
b. Diagnosis-related groups are used to determine the number of acutely ill patients on a unit.
c. Interventions and time required for interventions are combined to determine the levels that are required.
d. Financial resources and nursing interventions are combined to determine patient contact hours.
ANS: C
Rationale: In a factor evaluation system, tasks, thought processes, and patient care activities are considered and given a time or rating. These times or ratings are then used to determine the number of patient care hours required.
Staff members on your unit raise concern that the number of acutely ill patients on the unit is rising and responsiveness in addressing these needs through appropriate staffing is lacking. They point to increased incidences of adverse and sentinel events on the unit. To address this concern, the best action for your hospital organization is to:
a. Implement a patient classification system immediately.
b. Participate in databases that compare the outcomes and staffing levels versus those of institutions similar to yours.
c. Provide increased numbers of staff to the unit.
d. Ignore such concerns because the number of acutely ill patients is variable.
ANS: B
Rationale: Staff morale suffers both when models of acute illness indicate a gap between staffing and the number of acutely ill patients, and when there is no model but perceived acute illness that is not being addressed. A truer approach is to monitor patient outcomes and participate in national databases that measure staffing levels through comparison with similar institutions.
A particular classification system assigns revenue according to the functional capacity of patients and the progression of patients during their stay in rehabilitation units. More independent patient activities such as prompted voiding require higher staff utilization than do dependent activities but do not result in increased staff resources. This is an example of:
a. Bureaucracy.
b. Concern related to the validity of classification systems.
c. Inadequate reliability of classification systems.
d. Inappropriate subjectivity in making judgements about staffing.
ANS: B
Rationale: Validity of categories and implications for staffing levels are in question in this situation because staffing levels do not reflect the levels of activity required for patient care.
In the past year, you have noticed an increase in patient falls on your unit. In reading studies related to staffing and patient outcomes, you realize that you will need to plan for:
a. Higher patient care hours.
b. Safer facilities.
c. Institution of a patient classification system.
d. An increased number of RN positions.
ANS: D
Rationale: Lower fall rates are shown to be related to higher total nursing hours and a higher percentage of nursing hours supplied by RNs.
In evaluating mortality rates, the head nurse on the cardiac unit is surprised to find that they are higher on the weekend than on weekdays. In exploring the reasons for this apparent anomaly, the head nurse focuses on:
a. Availability of diagnostic personnel.
b. Availability of physicians.
c. Communication with on-call providers.
d. Numbers of acutely ill patients.
ANS: C
Rationale: Studies of off-peak hours (weekends and nights) are limited to date, but those that have been done indicate that mortality increases during weekends and nights, when staff work with fewer and often less experienced staff, and when communication among on-call healthcare providers may be strained.
What does a nurse staffing plan take into account?
a. Specific nurse-to-patient ratios per shift.
b. Participation of nurses in projecting staffing needs.
c. Compensation and benefits for each level of staff.
d. The occupancy load of a unit.
ANS: B
Rationale: Nurse staffing plans employ nursing judgement and flexibility that is based on the number of acutely ill patients, nurse experience, and unit configuration rather than set nurse-to-patient ratios.
As the unit manager you post the staffing plan and compliance reports. This initiative is aimed at:
a. Maintaining unit morale.
b. Complying with national requirements.
c. Demonstrating patient outcomes.
d. Inviting staff participation in decision making.
ANS: A
Rationale: Adequate staffing, as demonstrated through a staffing plan and compliance reports, contributes to staff morale.
To maintain patient safety, studies suggest that scheduling should avoid which of the following?
a. Rotating shifts.
b. Weekends.
c. Eight-hour shifts.
d. Mandatory overtime.
ANS: A
Rationale: Rotating shifts and overtime past 12 hours (mandatory or not) are being shown to increase
nurse error and jeopardize patient safety.
In a job interview for a staff position, which of the following indicates your knowledge of patient safety?
a. “Will I be able to get overtime hours on your unit?”
b. “If there is an opportunity to work extra shifts, I would really like that.”
c. “Is there a strategy in place to reduce the number of overtime hours on the unit?”
d. “I see no reason why I wouldn’t be able to work overtime.”
ANS: C
Rationale: Strategies to reduce overtime increase patient safety. Studies suggest that every additional 10% of overtime hours worked contributes to a 1.3% increase in hospital-related mortality.
To reduce reliance on overtime hours, an organization develops a strategy for floating nurses during staff shortages. To maximize patient safety and reduce costs, the health care organization:
a. Develops a centralized pool of float nurses.
b. Assigns nurses from less busy units to ones with increased numbers of acutely ill patients.
c. Floats nurses only between units on which the nurses have been cross-trained.
d. Assigns float nurses to basic care only.
ANS: A
Rationale: A centralized pool usually includes experienced nurses who maintain a broad range of competencies. Other approaches are less satisfying for nurses, are less efficient, and may be less safe.
To project staffing needs and to avoid understaffing, it is important that nurse managers consider which of the following?
a. Maximum productive hours.
b. Average nonproductive hours.
c. Minimum benefit hours.
d. Maximum vacation time.
ANS: B
Rationale: To avoid understaffing, average nonproductive or benefit hours need to be considered, so that the unit is properly staffed when staff members are off.
Your health care organization has a decentralized system for scheduling. As part of this process, after you have developed a draft schedule, you may need to:
a. Seek budgetary approval.
b. Balance personal schedules against institutional needs.
c. Negotiate the schedule with unit staff.
d. Submit the schedule to a centralized staffing office for review.
ANS: D
Rationale: In a decentralized model, you may be completely responsible for approving all schedule changes and for development of the schedule, or you may need to submit a draft to a centralized office for review and determination of supplemental staff. Balancing personal schedules and negotiation are characteristics of staff self scheduling models.
Patient classification systems have been developed in an effort to give nurse managers the tools and language to describe the acuity of patients. “Sicker” patients receive higher classification scores, indicating that more nursing resources are required to provide patient care. Which of the following describes a factor evaluation system?
a. Subjective and descriptive.
b. More objective.
c. Uses broad categories to predict patient-care needs.
d. Patient-care needs based on diagnosis-related groups.
ANS: B
Rationale: Factor evaluation system is more objective and gives each task, thought process, and patient-care activity a time or rating. These indicators are then summed to determine the hours of direct care required, or they are weighted for each patient. Used for patients with more complex care needs and a less predictable disease course.
Which of the following increase the risk of patient mortality rates? (Select all that apply.)
a. Staff burnout.
b. Positive leadership support.
c. Increase of casual or temporary positions.
d. Staffing numbers and levels.
ANS: A, D
Rationale: Leadership support ensuring adequate staffing levels and appropriate skill, education, and experience of staff including staff mix decreases mortality rates. An increase in staff burnout and casual or temporary positions has been demonstrated to increase mortality rates.
The growth in evidence on nursing sensitive indicators has been accompanied by significant controversy regarding the level of nurse staffing required for various groups of patients, primarily in acute-care hospitals. Two major approaches to sufficient staffing have been put forward in Canada. These are? (Select all that apply.)
a. Mandated nurse-patient ratios
b. Increased numbers of registered nurses
c. Development of a staffing plan for a period of time
d. Better staff mix
ANS: A, C
Rationale: Although an increase in the number of registered nurses and a better staff mix will support
better patient care and decreased mortality rates. It is more important that, in Canada, mandated nurse-patient ratios and development of a staffing plan for a period of time, usually a budget cycle, will provide consistency and ensure the nurse-patient ratio is appropriate based on evidence.
Eschiti and Hamilton (2011) learned that support services and numbers of nonnurse staff are greatly diminished on off-peak shifts leading to increased mortality rates. Which of the following factors influence the risk to patients in off-peak times (weekends and evenings
and night shifts)? (Select all that apply.)
a. Rotating shifts
b. Mandatory overtime hours
c. Good staff mix
d. Nurse fatigue
ANS: B, D
Rationale: Research demonstrates that mandatory overtime hours and resulting nurse fatigue are primary factors for increasing mortality rates in off peak hours. Rotating shifts may have a minor influence and a good staff mix increases mortality rates.
In reviewing the job description of a nurse manager, the staff members become aware that a nurse manager’s role is complex. Which of the following duties are required of a nurse manager? (Select all that apply.)
a. Responsibility for nursing benchmarks.
b. No responsibility for knowledge of staffing benchmarks.
c. Responsibility for planning staffing of unlicensed assistive personnel only.
d. Preparing a unit budget.
e. Changing staffing plans on the basis of service needs.
ANS: A, D, E
Rationale: A nurse manager manages financial resources by developing business and staffing plans. They also prepare nursing benchmarks and change staffing plans according to their unit’s needs.
The nurse manager schedules evaluations of staff members by using a newly developed performance appraisal tool. The development of a performance appraisal tool should include:
a. The organizational mission and philosophy and the position requirements.
b. A generalized overview of the duties of a position.
c. A skills checklist and accreditation requirements.
d. An ordinal scale that ranks all employees.
ANS: A
Rationale: Performance appraisal tools and processes should reflect the organizational mission and philosophy, and also position requirements.
Joshua, a new graduate, reviews the employee evaluation for his new position. The first section requires that he list his own specific objectives to be accomplished. This is an example of:
a. The traditional rating scale.
b. Learning goals or management by objectives.
c. A forced distribution scale.
d. A behaviourally anchored rating scale (BARS).
ANS: B
Rationale: In management by objectives, the employer and the employee jointly establish clear and
measurable objectives for the next performance period.
Joshua notes that the next section of the evaluation tool is specific to the organizational philosophy and has a four-point ordinal scale that describes performance from “always meets expectations” to “does not meet expectations.” This type of evaluation is most commonly known as:
a. A BARS.
b. Management by objectives/learning goals.
c. The forced distribution scale.
d. A traditional rating scale.
ANS: D
Rationale: Traditional rating scales are commonly used in evaluation and reflect generalizations rather than specific behaviours.
On your unit, despite efforts to build a strong sense of team, conflict between some of the staff is ongoing. Nonetheless, you want to proceed with developing a systematic and effective performance appraisal system. Which of the following approaches would be most appropriate for you to implement?
a. Peer review.
b. A combination of tools.
c. Anecdotal notes.
d. Rating scale.
ANS: B
Rationale: A combination of tools is probably superior to any one method in any situation. Peer review would not be recommended alone or in combination because it is not useful in an environment characterized by a high degree of mistrust or conflict.
Which of the following is a strategy that clinical nurse educators can use to ensure understanding and retention of information in newly hired staff nurses?
a. Provide written information of all orientation topics.
b. Evaluate whether there is fit between learner and organizational values.
c. Develop a range of strategies that cover a variety of learning styles.
d. Organize group sessions for orientation to increase cost effectiveness.
ANS: C
Rationale: Preceptors teach newly hired nurses in the clinical setting. Clinical nurse educators can assist
in developing strategies that cover a variety of learning styles of new employees. This allows the preceptor to ensure uptake and retention of information in the newly hired staff member.
