Leading and Managing in Nursing

Testbank

Chapter 01: Leading, Managing, and Following

Yoder-Wise: Leading and Managing in Nursing

MULTIPLE CHOICE

1. 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 the older adult

patient. Using 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, every voice counts, and therefore, all levels of staff would be involved in decision

making.

REF: Page 8 TOP: AONE competency: Communication and Relationship-Building

2. 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. According to Maslows need hierarchy theory, 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 wifes treatment.

c. Sympathize with the nurses 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 wifes treatments.

ANS: D

Placing the nurse on unpaid leave may threaten the nurses capacity to meet physiologic

needs and demotivate the nurse. Unsatisfactory coverage of shifts on short notice could

affect patient care and threaten the needs of staff to feel competent. Arranging the schedule

around the wifes needs meets the needs of the staff and of patients while satisfying the

nurses need for affiliation.

REF: Page 10 TOP: AONE competency: Communication and Relationship-Building

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3. 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 managers actions unfair,

and the unit manager continues to reiterate the reasons for her 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

Ury, Brett, and Goldberg outline steps to restoring unity, the first of which is to address the

interests and involvement of participants in the conflict by examining the real issues of all

parties.

REF: Page 16 TOP: AONE competency: Communication and Relationship-Building

4. At a second negotiation session, the unit manager and staff nurse are unable to reach a

resolution. It would now be best to:

a. Arrange another meeting in a weeks time so as to allow a cooling-off period.

b. Turn the dispute over to the director of nursing.

c. Insist that participants continue to talk until a resolution has been reached.

d. Back the unit managers actions and end the dispute.

ANS: B

According to the principles outlined by Ury, Brett, and Goldberg, a cooling-off period is

recommended if resolution fails.

REF: Page 16 TOP: AONE competency: Communication and Relationship-Building

5. The manager of a surgical area has a vision for the future that requires the addition of RN

assistants or unlicensed persons to feed, bathe, and walk patients. The RNs on the staff

have always practiced in a primary nursingdelivery system and are very resistant to this

idea. The best initial strategy in this situation would include:

a. Exploring the values and feelings of the RN group in relationship to this change.

b. Leaving the RNs alone for a time so they can think about the change before it is

implemented.

c. Dropping the idea and trying for the change in a year or so when some of the present

RNs have retired.

d. Hiring the assistants and allowing the RNs to see what good additions they are.

ANS: A

Influencing others requires emotional intelligence in domains such as empathy, handling

relationships, deepening self-awareness in self and others, motivating others, and

managing emotions. Motivating others recognizes that values are powerful forces that

influence acceptance of change. Leaving the RNs alone for a period of time before

implementation does not provide opportunity to explore different perspectives and values.

Avoiding discussion until the team changes may not promote adoption of the change until

there is opportunity to explore perspectives and values related to the change. Hiring of the

assistants demonstrates lack of empathy for the perspectives of the RN staff.

REF: Page 7 | Page 15

TOP: AONE competency: Knowledge of the Health Care Environment

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6. As the RN charge nurse on the night shift in a small long-term care facility, youve found

that there is little turnover among your LPN and nursing assistant (NA) staff members, but

they are not very motivated to go beyond their job descriptions in their work. 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

LPNs and NAs.

b. Allow the LPNs and NAs greater decision-making power within the scope of their

positions in the institution.

c. Hire additional staff so that there are more staff available for enhanced care and

individual workloads are lessened.

d. Ask the director of nursing to increase job security for night staff by having them sign

contracts that guarantee work.

ANS: B

Hygiene factors such as salary, working conditions, and security are consistent with

Herzbergs two-factor theory of motivation; meeting these needs avoids job dissatisfaction.

Motivator factors such as recognition and satisfaction with work promote a satisfying and

enriched work environment. Transformational leaders use motivator factors liberally to

inspire work performance and increase job satisfaction.

REF: Page 9 | Page 10

TOP: AONE competency: Communication and Relationship-Building

7. As the nurse manager who wants to increase motivation by providing motivating factors,

which action would you select?

a. Collaborate with the human resource/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 held in a hierarchy. In complexity theory,

every voice counts, and therefore all levels of staff would be involved in decision making.

This principle is the foundation of shared governance.

REF: Pages 8-11 TOP: AONE competency: Communication and Relationship-Building

8. A charge nurse on a busy 40-bed medical/surgical unit is approached by a family

member who begins to complain loudly about the quality of care his mother is receiving. His

behavior 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 behavior by the

charge nurse best illustrates refined leadership skills in an emotionally intelligent

practitioner?

a. Reflect to gain insight into how the situation could be handled differently in the future.

b. Try to catch up with the angry family member to resolve the concern.

c. Discuss the concern with the patient after the family member has left.

d. Notify nursing administration of the situation.

ANS: A

Goleman suggests that emotional intelligence involves insight and being able to step

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outside of the situation to envision the context of what is happening as well as being able to

manage emotions such as frustration effectively.

REF: Page 7 | Page 8 TOP: AONE competency: Leadership

9. 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 feel it is

insulting to be required to participate in a competency program. Which behavior 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 JCAHO accreditation.

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 others through a set of derived practices that are

evidence-based and known to satisfy preestablished outcomes such as participation in a

competency program. This involves engagement of staff through sharing of concerns and

ideas. A close analysis of the IOM report and the summary of the PPACA suggests that no

health reform can unfold without active nursing engagement. Each document emphasizes

that nurses must lead, manage, and behave as active collaborators with other members of

the health team and with those being served.

REF: Page 3 TOP: AONE competency: Communication and Relationship-Building

10. As the manager, you have been asked to implement an evidence-based approach to

teach ostomy patients self-management skills postoperatively that is being operationalized

throughout your organization. Which of the following illustrates effective leadership?

a. The training modules are left in the staff room for times when staff are available.

b. The current approach is continued because it is also evidence-based and is more familiar

to staff.

c. You decide to implement the approach at a later date because of feedback from the RNs

that the new approach takes too much time.

d. A RN who is already familiar with the new approach volunteers to take the lead in

mentoring and teaching others how to implement it.

ANS: D

Followership occurs when there is acquiescence to a peer who is leading in a setting where

a team has gathered to ensure the best clinical decision making and actions are taken to

achieve clinical or organizational outcomes. Followership promotes good clinical decisions

and use of clinical resources.

REF: Page 4 | Page 5

TOP: AONE competency: Communication and Relationship-Building

11. You overhear a newly graduated RN telling one of your colleagues that leadership and

management belong to the unit manager and not to her. As a nursing colleague, you

respond by demonstrating understanding that the perception of the new graduate:

a. Is correct. Leadership is not the role of the staff nurse.

b. Would benefit from further understanding of her role as a professional, whose influence

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