Week 2- Chapter 2-Managing, Leading and Following Flashcards
A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults. She is asked to assess and adapt the unit to better meet the unique needs of older adult patients. According to complexity principles, what would be the best approach to take in making this change?
a. Leverage the hierarchical management position to get unit staff involved in assessment and planning.
b. Engage involved staff at all levels in the decision-making process.
c. Focus the assessment on the unit, and omit the hospital and community
environment.
d. Hire a geriatric specialist to oversee and control the project.
ANS: B
Complexity theory suggests that systems interact and adapt and that decision making occurs throughout the systems, as opposed to being held in a hierarchy. In complexity theory, everybody’s opinion counts; therefore, all levels of staff would be involved in decision making.
A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who has called in sick five times in the past month. He tells the manager that he very much wants to come to work when scheduled, but must often care for his wife, who is undergoing treatment for breast cancer. In the practice of a strengths-based nursing leader, what would be the best approach to satisfying the needs of this nurse, other staff, and patients?
a. Line up agency nurses who can be called in to work on short notice.
b. Place the nurse on unpaid leave for the remainder of his wife’s treatment.
c. Sympathize with the nurse’s dilemma and let the charge nurse know that this nurse
may be calling in frequently in the future.
d. Work with the nurse, staffing office, and other nurses to arrange his scheduled
days off around his wife’s treatments.
ANS: D
Placing the nurse on unpaid leave may threaten physiologic needs and demotivate the nurse. Unsatisfactory coverage of shifts on short notice could affect patient care and threaten staff members’ sense of competence. Strengths-based nurse leaders honour the uniqueness of individuals, teams, systems, and organizations; therefore arranging the schedule around the wife’s needs would result in a win-win situation, also creating a work environment that promotes the health of all the nurses and facilitates their development.
A grievance brought by a staff nurse against the unit manager requires mediation. At the first mediation session, the staff nurse repeatedly calls the unit manager’s actions unfair, and the unit manager continues to reiterate the reasons for the actions. What would be the best course of action at this time?
a. Send the two disputants away to reach their own resolution.
b. Involve another staff nurse in the discussion so as to clarify issues.
c. Ask each party to examine her own motives and issues in the conflict.
d. Continue to listen as the parties repeat their thoughts and feelings about the
conflict.
ANS: C
Nurses and leaders must assess each situation as unique, determining appropriate actions accordingly. Leaders must adapt their styles to complement specific issues being faced, such as conflict. Examining motives and issues for the conflict in perceptions promotes equal representation of each point of view.
Shortly after being informed of fetal death, a labouring woman asks why she is not able to hear her baby’s heartbeat on the monitor anymore. Although the monitor volume had been turned off so that the patient would be able to sleep between contractions, the nurse responded that there was no heartbeat to hear because the baby had died in utero; then the nurse asked whether the patient would like to talk about how she was feeling. This response demonstrates:
a. Lack of empathy.
b. Ethical leadership.
c. Complexity science.
d. A coercive relationship.
ANS: B
Ethical leadership is based on a willingness to identify and act on complex problems in an ethical manner. Leadership can be misused when coercive relationships form, and information and true goals are withheld.
The manager of a surgical area envisions a future that requires the addition of registered nurse (RN) assistants or unlicensed persons to feed, bathe, and walk patients. The RNs on the staff have always practiced in a primary nursing-delivery system and are very resistant to this idea. The best initial strategy in this situation would include:
a. Exploring the values of the RNs in relation to this change.
b. Leaving the RNs alone for a time so they can think about the change before they
are approached again.
c. Dropping the idea and trying for the change in another year or so.
d. Hiring the assistants and allowing the RNs to see what good additions they are.
A
Leadership involves engaged decision making around a vision that is based on evidence and tacit knowledge. Influencing others requires emotional intelligence in domains such as empathy and handling relationships.
As the charge nurse on the night shift in a small long-term care facility, you have found that there is little turnover among your licensed practical nurse and nursing assistant (NA) staff members, but they are not very motivated to work beyond their job descriptions. Which of the following strategies might motivate the staff and lead to greater job satisfaction?
a. Ask the director of nursing to offer higher wages and bonuses for extra work for the night licensed practical nurses and NAs.
b. Allow the licensed practical nurses and NAs greater decision-making power within the scope of their positions in the institution.
c. Help the licensed practical nurses and NAs with their work, whenever possible.
d. Ask the director of nursing to increase job security for night staff by having them
sign contracts that guarantee work.
ANS: B
A nurse leader should provide an environment conducive to opinion sharing that involves staff in decision making at all levels. This approach is shown to increase job satisfaction. Decision making and the corresponding actions taken are core tasks performed in engagement with coworkers.
As the nurse manager, you want to increase motivation by providing motivating factors. Which action would you select?
a. Collaborate with the human resources/personnel department to develop on-site
daycare services.
b. Provide a hierarchical organizational structure.
c. Implement a model of shared governance.
d. Promote the development of a flexible benefits package.
ANS: C
Complexity theory suggests that systems interact and adapt and that decision making occurs throughout systems, as opposed to being made unilaterally by different levels of the organizational hierarchy. In complexity theory, every person’s opinion counts, and therefore all levels of staff would be involved in decision making. This principle underlies shared governance. Shared governance is an example of nurse decision making in which nurses at different organizational levels engage in shaping policy and practices.
A charge nurse on a busy 40-bed medical/surgical unit is approached by a patient’s son, who begins to complain loudly about the quality of care his mother is receiving. His behaviour is so disruptive that it is overheard by staff, physicians, and other visitors. The family member rejects any attempt to intervene therapeutically to resolve the issue. He leaves the unit abruptly, and the nurse is left feeling frustrated. Which behaviour by the charge nurse best illustrates refined leadership skills in an emotionally intelligent practitioner?
a. Reflection to obtain insight into how the situation could be handled differently in the future
b. Trying to catch up with the angry family member to resolve the concern
c. Discussing the concern with the patient after the family member has left
d. Notifying nursing administration of the situation
ANS: A
Emotional intelligence is closely aligned with individuals’ capacity to know themselves and others. Reflecting to obtain insight and being able to “step” outside the situation to envision the context of what is happening is an example of the actions of an emotionally intelligent practitioner.
The chief nursing officer has asked the staff development coordinator to facilitate the
development of a clinical competency program for the facility. While making rounds on the units, the staff development coordinator overhears RN staff complaining that they believe it is insulting to be required to participate in a competency program. Which behaviour by the staff development coordinator is most appropriate in this situation?
a. Disregard staff concerns and continue with development of the program.
b. Inform the nurses that this program is a requirement for accreditation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
c. Schedule a meeting with the chief nurse executive to apprise her of the situation.
d. Facilitate a meeting so nurses can articulate their values and concerns about a
competency program.
ANS: D
The manager role involves guiding other people through a set of derived practices that are evidence-informed and known to satisfy pre-established outcomes such as participation in a competency program. This involves engagement of staff through sharing of concerns and ideas. This type of leader can instill hope and trust in followers, which influence their behaviours and attitudes (such as engagement and satisfaction) and cause work environments to become more positive.
Which category is unique to leadership but is not part of management?
a. Initiating change
b. Personal qualities
c. Developing people
d. Information management
ANS: C
Developing people—coaching, mentoring, succession planning—is a category of solely leadership, not management. Initiating change and personal qualities are categories of both management and leadership. Information management is a category of management only.
You overhear a newly graduated RN telling one of your colleagues that leadership and management belong to the unit manager and not to her. Because you are a nursing colleague, your response demonstrates understanding that the perception of the new graduate:
a. Is accurately reflected in the new graduate’s statement.
b. Would benefit from further understanding of her role as a professional in relation
to decision-making.
c. Has been influenced by nurse leaders and managers who leave for other positions.
d. Is related to the general perception that nurse leaders and managers are not
satisfied in their jobs.
ANS: B
Decision making and the corresponding actions taken are the core work performed in engagement with co-workers. This core work requires that nurses be leaders, managers, and followers at the point-of-care, unit, institutional, and even societal levels.
You walk into a patient’s room and find him yelling at the licensed practical nurse. The
patient is obviously very upset, and after you speak with him regarding his behaviour, you
determine that he has not slept for three nights because of unrelieved pain levels. The licensed practical nurse is very upset with him and calls him an “ugly, old man.” You acknowledge her feelings and concerns and then suggest that the patient’s behaviour was aggressive but is related to lack of sleep and to pain. You ask, “Can both you and the patient together determine triggers for the pain and effective approaches to controlling his pain?” This approach demonstrates:
a. Lack of empathy and understanding for the licensed practical nurse.
b. Concern with placating the patient.
c. Leadership behaviour.
d. Management behaviour.
ANS: C
The situation between the patient and the licensed practical nurse is complex, involving unrelieved symptoms and aggressiveness toward a staff member. Health care is now delivered in a collaborative, and most often, an interdisciplinary manner, whereby select leadership/management roles (e.g., first-line nurse leaders) serve as conduits for information and care coordination. Providing engaged, collaborative guidance and decision making in a complex situation for which there is no standardized solution reflects leadership.
Which category is unique to management but is not part of leadership?
a. Initiating change
b. Personal qualities
c. Developing people
d. Information management
ANS: D
Information management is a category of management only. Developing people is a category of solely leadership, not management. Initiating change and personal qualities are categories of both management and leadership.
Chart audits have revealed significant omissions of data that could have legal and funding guidelines. As the unit manager, you meet with the staff to discuss audit findings and to find approaches that will address the gaps in charting and achieve desired goals. This is an example of:
a. Leadership.
b. Management.
c. Decision making.
d. Vision.
ANS: B
The process of guiding other people to meet established goals, outcomes, and procedures is management. This can require collaborative decision making to determine how best to reach predetermined goals and follow established practices.
A family is keeping vigil at a critically ill patient’s bedside. Other distant family members, not yet able to come, call the unit continuously, asking for updates and wanting to express concern. You speak with the distant family members and suggest that you are going to refer them to the hospital social worker, whose role is to work with such situations. What role are you assuming through this action?
a. Manager
b. Leader
c. Follower
d. Laissez faire
ANS: A
Management is the process of getting the job done and ensuring that people have the necessary resources to get the job done. Referral to a social worker alleviates demand on nurse staff time and is consistent with hospital procedures.
