Effective Leadership & Management in Nursing, 9e (Sullivan) Chapter 1 Introducing Nursing Management 1) A nurse manager is participating in the healthcare organization's strategic planning committee. Which factor is the primary driving force and controlling factor in new initiatives this committee might recommend? 1. Cost of care 2. Access to care 3. Availability of care 4. Quality of care Answer: 1 Explanation: 1. While all of the options given are driving forces in today's healthcare environment, the cost of providing care is still the primary issue. Cost of care controls access, availability, and quality. 2. Access to care is controlled by the ability to pay. 3. Care will not be available if it cannot be funded. 4. Healthcare providers do not like to correlate quality with cost, but the economic reality is that quality care must also be funded care. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology. 2) A nurse has been invited to discuss healthcare costs at a senior citizens' club. What information should the nurse plan to include in this discussion? 1. While healthcare costs continue to rise, the percentage of the United States (U.S.) economy spent on healthcare has slowly declined to less than 12%. 2. Regulations brought about by the Patient Protection and Affordable Care Act (PPACA) should bring financial relief to healthcare consumers. 3. The United States spends more money on healthcare than any other country. 4. Healthcare spending in the United States is slowly declining due to passage of bills such as the Patient Protection and Affordable Care Act (PPACA). Answer: 2 Explanation: 1. In 2009, healthcare costs consumed more than 17% of the country's gross domestic product. 2. Implementation of PPACA and its regulations have not been formulated. 3. The United States spends more than $2.5 trillion on healthcare annually, more than any other country. 4. While this act has been passed, it is not operationalized. Healthcare spending continues to rise. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology. 3) A 70-year-old client develops a catheter-induced urinary tract infection. Which statement by the nurse would indicate to the nurse manager a need for additional understanding of this situation? 1. "I wonder if there was a break of sterility when this catheter was inserted." 2. "Thankfully we can treat this with an antibiotic." 3. "This could potentially cost the hospital a lot of money." 4. "I will talk to my unlicensed assistants about proper urinary catheter care." Answer: 2 Explanation: 1. Wondering about a break in sterility indicates that the nurse is concerned about the process that might have contributed to this infection. 2. The nurse who focuses on taking care of the results of a potential medical mistake is not accepting the seriousness of the situation. 3. The Centers for Medicare and Medicaid Services no longer cover the costs incurred by medical mistakes. This urinary tract infection could cost the hospital the cost of treatment, including increased length of stay. 4. The nurse has identified that improper care may result in poor outcomes for the client. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Education Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology. 4) Which healthcare situations reflect the philosophy of quality management as designed by Deming? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A nurse asks visitors to leave because it is after visiting hours. 2. At 2:00 p.m. the nurse orders a lunch tray for a client who has just been removed from nothing by mouth (NPO) status. 3. A nurse tells the manager that a housekeeper's work is not up to standards. 4. A nurse volunteers to take a Spanish language class to be able to communicate with clients. 5. A nurse who has not made a medication error in two years asks for a salary increase. Answer: 2, 3, 4 Explanation: 1. The philosophy of quality management is focus on the needs of the client. If there is no reason for the visitors to leave other than it is after visiting hours, this is not focused on client need. 2. Even though 2:00 p.m. is after "lunchtime," this nurse is focused on the client's needs. This is an example of quality management. 3. Quality management empowers the employee to evaluate quality. 4. This nurse has seen a need and is working to improve the quality of service. This is quality management. 5. Salary increases can be tied to quality improvement initiatives, but just asking for an increase is not quality management. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology. 5) A client who was discharged yesterday is very upset about the quality of care received during hospitalization for gastric surgery. What options for reporting concerns does this client have? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. There is no mechanism for complaint because the client is no longer hospitalized. 2. The client can indicate dissatisfaction on the survey often sent to clients after discharge. 3. The client can call the hospital administration. 4. The client can make a formal complaint through the American Nursing Association (ANA). 5. The client can make a public report through the Agency for Healthcare Research and Quality (AHRQ). Answer: 2, 3, 5 Explanation: 1. The client can still voice concerns even after discharge. 2. These client satisfaction surveys are a good mechanism for discussing care issues. 3. Telephone calls are a means of discussing client care issues. 4. ANA is not a forum for complaints about care in a specific hospitalization. 5. The AHRQ has a mechanism for reporting care issues. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology. 6) A client needs a high-risk surgical procedure. According to the Leapfrog Group, the client should choose which hospital for care during this procedure? 1. The hospital closest to the client's home 2. The hospital that has done the greatest number of these surgeries in the last two years 3. The hospital chosen by the client's primary healthcare provider 4. The hospital with the highest performance ratings for this procedure Answer: 4 Explanation: 1. This may or may not be the best choice of hospital for this procedure. 2. Just because a hospital is high volume does not mean it is high quality. 3. This may or may not be the best hospital for this procedure. 4. The Leapfrog Group focuses on quality indicators including the use of higher-performing hospitals for high-risk procedures. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Coordination of Care Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology