Chapter 01: Leadership and Management Principles

Huber: Leadership & Nursing Care Management, 6th Edition

Multiple Choice

1. Leadership is best defined as: a. an interpersonal process of participating by encouraging fellowship. b. delegation of authority and responsibility and the coordination of activities. c. inspiring people to accomplish goals through support and confidence building. d. the integration of resources through planning, organizing, and directing.

ANS: C

Leadership is the process of influencing people to accomplish goals by inspiring confidence and support among followers.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Effective leadership b. Management involvement c. Mentoring d. Rewards and recognition

2. A medical-surgical unit reports higher rates of patient satisfaction coupled with high rates of staff satisfaction and productivity. Which of the following is attributed to the data findings?

ANS: A

Effective leadership is important in nursing because of the impact on nurses’ work lives, it being a stabilizing influence during change, and for nurses’ productivity and quality of care.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. “Nursing is responsible for pain control of the total knee replacement patient.” b. “Our pharmacist has provided some excellent pain control literature.” c. “Physical therapy’s expertise is in rehabilitation, not pain control.” d. “Total knee replacement patients require optimal pain control.”

3. A staff registered nurse (RN) is leading a multidisciplinary clinical pathway team in the development of care for patients with total knee replacement. Which of the following statements exemplifies leadership behaviors in a clinical pathway team meeting?

ANS: B

Leadership is the process of influencing people to accomplish goals by inspiring confidence and support among followers. The correct answer is supportive of a team member’s work and depicts some skill at interpersonal relationships.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies a. Inspiring a vision is a management function. b. Management is focused on task accomplishment. c. Management is more focused on human relationships. d. Management is more important than leadership.

4. Which of the following is true of management activities?

ANS: B

Management is focused on task accomplishment.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

5. During a staff meeting, a group of RNs has complained that medications are not arriving to the unit in a timely manner. The nurse manager suggests that the group resolve this issue through the development and work of a multidisciplinary team led by one of these RNs. This scenario demonstrates: a. adaptation. b. empowerment. c. flexibility. d. relationship management.

ANS: B

Empowerment is the giving of authority, responsibility, and the freedom to act. In this situation, the manager has given authority, responsibility, and the freedom to act in the investigation and resolution of this issue.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Care provider b. Business principles c. Care coordination d. Change management

6. A nurse is caring for an elderly patient who was admitted after sustaining a fall at home. When creating a care plan for the patient, she requests that the doctor order a home health visit to assess for home safety and medication compliance. In addition, the nurse is concerned about the nutrition of the patient and requests a dietitian evaluation. The nurse is demonstrating which of the following leadership skills?

ANS: C

Care coordination is the delivery of nursing services that involves the organization and coordination of complex activities. The nurse uses managerial and leadership skills to facilitate delivery of quality care.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential a. vision b. supervision c. delegation d. problem solving

7. Interpersonal communication and the ability to apply _____ are two critical skills every nurse needs to enhance professional practice.

ANS: D

Every nurse needs two critical skills to enhance professional practice. One is a skill at interpersonal relationships. This is fundamental to leadership and the work of nursing. The second skill is applying the problem-solving process. This involves critical thinking, problem identification, and the development of objectivity.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

8. Good leaders need to be able to demonstrate an intuitive skill of empathy and expressiveness when dealing with others in the workplace. This requires sensitivity and awareness of the emotions and moods of others and is known as: a. social awareness. b. self-awareness. c. self-management. d. relationship management.

ANS: A

Social awareness is an intuitive skill of empathy and expressiveness in being sensitive and aware of the emotions and moods of others.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Leadership. b. Management. c. Emotional intelligence d. Vision

9. The personal leadership skill for nurses that consists of self-awareness, discipline, motivation, social awareness, and relationship management is known as what?

ANS: C

Among the important personal leadership skills for nurses is emotional intelligence (EI). EI traits are emotional factors consisting of five defining attributes: self-awareness, self-regulation or discipline, motivation, social awareness, and relationship management.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Managers b. Motivators c. Visionaries d. Followers

10. _____ are vital to good leaders because they are able to take the vision of the leader and achieve the determined goals.

ANS: D

Without followers, there is no leadership. Followers are vital because they accept or reject the leader and determine the leader’s personal power.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

11. The best leadership style for unfavorable conditions is: a. leader–member relations. b. task-oriented structure. c. position power. d. laissez-faire.

ANS: B

The need for task-oriented leaders occurs when the situation is extreme. The best leadership style for unfavorable conditions is task-oriented.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

12. Nursing management is defined as: a. delegation of authority and responsibility and the coordination of tasks. b. the integration of resources through planning, organizing, and directing. c. the process of influencing patients to accomplish goals. d. the coordination and integration of nursing resources by applying the management process to accomplish nursing care and service goals and objectives.

ANS: D

The coordination and integration of nursing resources by applying the management process to accomplish nursing care and service goals and objectives is the definition of nursing management.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Planning b. Organizing c. Coordinating d. Controlling

13. A nursing unit has demonstrated lower patient satisfaction scores during the last quarter. The manager of the unit has formed a small team to set long- and short-term goals for the unit with action plans to increase patient satisfaction. This is an example of which management process?

ANS: A

Planning is the managerial function of selecting priorities, results, and methods to achieve results.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Planning

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Contingency theory b. Systems theory c. Complexity theory d. Chaos theory

14. A nursing unit has discovered a series of medication errors with regard to a particular computerized physician order set and the calculation within the order. The unit manager has a theory on changes that should be made within the order to decrease the confusion for nursing staff. However, the nurse manager realizes that changes would need to be made with pharmacy input as well as other nursing units within the facility and the multihospital system. Which of the following management theories is exemplified when the nurse manager considers the impact of change on the organization as a whole?

ANS: B

Systems theory helps managers recognize their work as being embedded within a system. Managers use this theory to learn that changing one part of a system inevitably affects the whole system.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential a. nurse manager b. care provider c. nurse executive d. senior leader

15. The role of the _____ is to provide leadership and direction for all aspects of nursing services with a focus on integrating the system and building a culture.

ANS: C

The nurse executive’s role and functions concentrate on long-term administration of an institution or program that delivers nursing services, focusing on integrating the system and building a culture.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. authoritarian b. democratic c. laissez-faire d. servant

16. The postoperative patient with anterior cervical laminectomy is complaining of tightness in his throat. His voice is raspy. The staff nurse asks the unit secretary to page Dr. Julio stat. This is an example of _____ leadership.

ANS: A

Authoritarian leadership uses directive and controlling behaviors in which the leader determines policies and makes decisions in isolation. The leader orders subordinates to carry out the tasks or work. This style is helpful in crisis situations.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Implementation

MSC: Client Needs: Physiological Integrity: Physiological Adaptation a. “After the meeting today, each member on this team will be a role model of good communication techniques to other staff members.” b. “How would you describe an ideal collaborative practice environment?” c. “What do you think about sharing our opinions today in a mutually respectful manner as we move around the table?” d. “You folks are highly motivated and smart enough to develop a plan on your own. I’ll support you as needed.”

17. A quality improvement team is working to enhance teamwork among the staff in a newly developed Alzheimer’s program. Which of the following statements would be an expected behavior that illustrates quantum leadership?

ANS: B

Quantum leadership fosters an environment of curiosity, questioning, and exploration. Answer A depicts an authoritarian leadership style.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Evaluation

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Authoritarian b. Democratic c. Transformational d. Transactional

18. A nursing executive is leading a multidisciplinary team of professionals who have worked well together on prior initiatives. Which of the following leadership styles might work best in this situation?

ANS: B

Democratic leadership would work best in this situation. This approach implies a relationship and person orientation and policies are a matter of group discussion and decision.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Planning

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. The nurse leader needs to by dynamic b. The nurse leader shows good interpersonal skills c. The nurse leader is a visionary for the organization and the profession d. The nurse leader is able to inspire e. The nurse leader allows corporate executives to determine department goals

19. Which of the following are crucial leadership traits to exhibit in the nursing profession?

ANS: A

Leadership is considered key to the success of health care organizations. A nurse leader needs to be dynamic, show interpersonal skills, and be a visionary for the organization and the profession. The ability to inspire and motivate followers to carry out the vision is crucial. Effective nurse leaders set department goals without micromanaging.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Multiple Response

1. Which of the following behavioral aspects are present in the feminist perspective leadership style? (Select all that apply.)

a. Builds relationships.

b. Focuses on completing tasks and achieving goals.

c. Empowers others.

d. Fosters an environment of mothering.

e. Supports bargaining of tasks and roles.

f. Promotes personal growth.

ANS: A, C, F

Leaders using the feminist perspective build connections, empower others, and support personal growth to promote teamwork and to accomplish goals.

DIF: Cognitive Level: Understand (Comprehension)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. feminist perspective. b. servant leadership. c. transactional leadership. d. transformational leadership. e. authoritarian leadership.

2. A nurse manager at Great Lakes Hospital is meeting with the dean of a well-recognized university who is the keynote speaker today at the nursing conference. He remembers that one of the RNs is interested in attending a well-known university to obtain a doctorate. The nurse manager arranges for the RN to meet with this dean. The nurse manager is exhibiting leadership behaviors consistent with: (Select all that apply.)

ANS: A, B, D

This behavior nurtures personal growth (servant leadership) and assists the RN to attain his or her fullest potential (transformational leadership). This behavior also helps the RN build a connection with the dean, a representative of the university (feminist perspective).

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Knows the personnel and addresses them by name. b. Intervenes when she receives complaints. c. Has a consistent style that never varies. d. Is visible on the nursing unit by all shifts on a frequent basis. e. Evaluates a number of aspects of problems prior to making decisions. f. Uses decision by consensus to resolve conflicts. g. Fosters collaboration.

3. A nurse manager at Morgan Hill Community Hospital is known to be an excellent nursing manager by the personnel working on her nursing unit. The nurse manager exhibits which of the following behaviors? (Select all that apply.)

ANS: A, D, E, G

These behaviors foster teamwork and positive morale.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Professionalism b. Use of critical thinking skills c. Business skills and principles d. Leadership e. Communication and relationship management f. Knowledge of the health care environment g. Implementation of an acuity-based staffing system

4. To reach Magnet status the nursing service in a hospital must attain competency in which of the following areas? (Select all that apply.)

ANS: A, C, D, E, F Magnet hospitals are recognized for the nurse’s critical role in the business of health care. Professionalism, leadership, communication, and the ability to work with others as well as understanding the business and principles of running a hospital business and health care environment are required.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Evaluation

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Sharing relevant information b. Encouraging competition via winners and losers c. Reducing controls d. Meeting expectations e. Avoiding discussion of sensitive issues

5. Which of the following behaviors build trust between leaders and employees in an organization? (Select all that apply.)

ANS: A, C, D

Leadership is founded on trust. Behaviors that build trust include sharing relevant information, reducing controls, and meeting expectations. Trust-destroying behaviors include being insensitive to beliefs and values, avoiding discussion of sensitive issues, and encouraging competition.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Evaluation

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Functions in a caregiver role. b. Surveys their followers’ needs and sets goals for them. c. Uses charisma to produce greater effort in followers. d. Focuses on the maintenance and management of ongoing and routine work. e. Motivates followers to perform to their full potential.

6. Which of the following traits describe a transactional leader? (Select all that apply.)

ANS: A, B, D

A transactional leader is a leader or manager who functions in a caregiver role and is focused on day-to-day operations. Such leaders survey their followers’ needs and set goals for them based on expectations. They are also leaders who are focused on maintenance and management of ongoing and routine work. Transformational leaders use charisma to produce greater effort and are able to motivate followers to perform to their full potential over time.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. It is a process of inspiring people to accomplish goals through support and confidence building. b. It is the process of coordination and integration of resources to accomplish specific goals. c. It includes the activities of planning, organizing, coordinating, directing, and controlling. d. It is a process of planning and directing human effort to achieve established objectives. e. It is the directing of the organizations’ money, facilities, and supplies to achieve results.

7. Which of the following definitions apply to management? (Select all that apply.)

ANS: B, C, D, E

Management is defined as the process of coordination and integration of resources through planning, organizing, coordinating, directing, and controlling to accomplish specific goals. Management is a process of planning and directing human effort to achieve established objectives while ensuring that the organizations’ money, facilities, and supplies are directed in a manner that achieves the best results.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Evaluation

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Chapter 02: Change and Innovation

Huber: Leadership & Nursing Care Management, 6th Edition

Multiple Choice

1. A hospital system is implementing an electronic health record. The facility conducts education and training for nursing staff, medical staff, and ancillary staff over a period of 6 months. This is an example of: a. emergent change. b. planned change. c. transformation. d. innovation.

ANS: B

Planned change is a decision to make a deliberate effort to improve a system.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Planning

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

2. The use of a new idea or method is the definition of: a. change. b. innovation. c. resistance. d. stereotyping.

ANS: B

Innovation is the use of a new idea or method.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

3. The chief nursing officer (CNO) of a hospital system works with senior leadership for approval to initiate an electronic health system. He recruits a nursing informaticist and a chief medical informatics officer to begin the process of planning the education and rollout of the new electronic system. The CNO could be viewed as the: a. resister. b. innovator. c. change agent. d. strategist.

ANS: C

The change agent is a person or thing that produces a particular effect or change. The change agent can be a person who functions as a change facilitator.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Planning

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Transforming care at the bedside b. Second-order change c. Emergent change d. Organizational change

4. A small critical care unit forms a team of nurses to implement bedside rounds at shift change. The nurses have researched the efficacy of bedside rounds and have determined that this evidence-based practice will lead to improved communication of patient status. Which type of change does this demonstrate?

ANS: A

Transforming care at the bedside was an initiative created to improve quality and safety on medical-surgical acute care units by engaging in changes to improve practice.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Implementation

MSC: Client Needs: Physiological Integrity: Physiological Adaptation a. Refreezing is similar to the assessment phase of the nursing process. b. Refreezing is similar to the problem identification phase of the nursing process. c. Refreezing is like the planning and implementation phase of the nursing process. d. Refreezing is like evaluation in the nursing process.

5. How is the refreezing stage of change similar to the nursing process?

ANS: D

Refreezing is like evaluation in the nursing process.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Evaluation

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Complexity b. Compatibility c. Trialability d. Relative advantage

6. Which of the following factors is used to describe the degree to which successful planned change is thought to be better than the status quo?

ANS: D

Relative advantage is one of the factors that helps determine successful planned change. It is the degree to which the change is thought to be better than the status quo.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Planning

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Organizational Change-Readiness Scale (OCRS) b. Transtheoretical Stages of Change Model c. Rapid Cycle Change d. plan-do-study-act model

7. According to the ___________ people move through a series of states when modifying their behavior.

ANS: B

The Transtheoretical Stages of Change Model used research to show that people move through a series of stages when modifying their behavior. Readiness to change is a key aspect.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

8. A medical-surgical unit utilizes a group of nurses and patient care assistants to determine ways to reduce the number of falls in the unit. They conduct Internet research to locate best practice interventions. They create fall risk alerts in the unit, and they implement hourly rounding to assess the need for toileting. After putting these small changes into place, they will evaluate the data to determine effectiveness. This project is an example of: a. rapid response teams. b. Failure Modes and Effects Analysis. c. root cause analysis. d. Rapid Cycle Change.

ANS: D

Rapid Cycle Change is used in health care to improve patient safety and quality. It is based on the idea that changes are tried on a small scale to see how they work.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Evaluation

MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential a. “These changes need to be made because the state and CMS require it.” b. “We understand this is a knee-jerk reaction, but please change the practice while the surveyors are in the building.” c. “We need to make this change because it will help our lawsuit.” d. “This change is being made so that there is no further harm to another patient.”

9. An organization has encountered a serious patient safety event that was reported to the state, The Joint Commission, and the Centers for Medicare & Medicaid Services (CMS). An extensive plan of correction was received, and the organization had to make some immediate changes in practice. Additionally the organization anticipates a costly lawsuit. What is the best method of educating staff about the practice changes that were issued?

ANS: D

Rapid Cycle Changes or those that are emergent are put into place to improve patient care, with the emphasis on patient safety and quality goals. Staff should not be educated that the changes are made based upon regulatory requirements or the avoidance of litigation. Misconceptions or inaccurate information can create resistance to change.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Implementation

MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential a. Depression b. Resistance c. Acceptance d. Denial

10. _____ is an expected part of change and is often related to fear and anxiety.

ANS: B

Resistance to change should be expected as integral to the process of change. It may be rooted in anxiety or fear.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Early adopters b. Late majority c. Innovators d. Laggards

11. Individual members of a group will adapt to change at different rates. Which of the following groups would take the longest to accept change?

ANS: D

Nurse leaders need to recognize that change will be accepted at varying rates and target interventions accordingly. The five categories in order are innovators, early adopters, early majority, late majority, and laggards.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

12. The development of new practices in response to new evidence is called: a. altered direction. b. organizational flux. c. planned change. d. status revision.

ANS: C

The development of new practices in response to new evidence or best practices occurs regularly and falls under planned change. One example is the broad adoption of evidence-based protocols and practices as a way of making sure that desirable outcomes are achieved.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

13. Almost all changes encounter: a. attitudes. b. resistance. c. knowledge. d. communication.

ANS: B

Almost all changes encounter some resistance as a natural phenomenon. Resistance may be rooted in anxiety or fear.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Budget-oriented change b. Transformation c. Resistance d. Emergent change

14. The charge nurse of a small nursing unit would like to gain staff acceptance of a time-intensive, budget-imposed change required by the hospital administration. She plans to emphasize several evidence-based research projects that have shown improved patient health outcomes as a result of implementing this change. This is an example of which of the following organizational change concepts?

ANS: B

Transformation is the use of new ideas, innovation, and creativity to change fundamental properties of the state of a system.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Planning

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

15. The first stage of planned change involves: a. accepting the need for change. b. cognitive redefinition. c. integration and stabilization. d. problem solving.

ANS: A

Change must begin with an awareness of the need for change and end with a general acceptance of the necessity of change.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

16. The identification of forces that drive and restrain change is called a(n): a. equilibrium evaluation. b. force field analysis. c. status quo analysis. d. refreezing system.

ANS: B

Driving and restraining forces influence any situation. A force field analysis facilitates the identification and analysis of driving and restraining forces in any situation.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

17. A nursing manager recognizes that the changes that she is expected by administration to implement will be met with staff resistance. She is committed to determining the root of the resistance and communicating positively with her staff. The nurse manager’s actions characterize her as a(n): a. change agent. b. implementation expert. c. restructuring motivator. d. supervisory threat.

ANS: A

The change agent needs to anticipate resistance, determine why it is occurring, and try to determine what the person who is resisting is trying to protect.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

18. A nurse manager recognizes that her staff’s emotional responses to organizational change are similar to: a. adaptation techniques. b. integrative tactics. c. symptoms of mental illness. d. the grief model.

ANS: D

The grief model is the most accurate, because change produces a longing for what is familiar, even if it is not what is best or realistic.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Storytelling b. E-mail c. Discussion d. Open communication

19. A memo sent to the unit nurse manager reads that beginning next week; all nursing staff will be expected to conform to a new dress code selected by the hospital board of directors. The nurse manager understands that change will be more effective through which manner of communication?

ANS: D

Open communication within the change process, early involvement of staff, listening to their input and concerns, and engaging them in the change may be the most effective means to assess readiness for change.

DIF: Cognitive Level: Understand (Comprehension)

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Give 2 weeks’ notice and begin seeking employment at another hospital. b. Discuss the situation with the nursing manager who interviewed him. c. Talk to other employees about the staffing situation. d. Notify the charge nurse that this was not what was explained to him prior to employment.

20. An experienced nurse has recently taken a position on a telemetry unit in the local hospital. After 2 weeks on the job, he finds that the staffing is not what was discussed during his employment interview with the nurse manager. Which approach would be most appropriate for the nurse to take?

ANS: B

The nurse should discuss the situation with the nursing manager who interviewed him before quitting. Perhaps there is a temporary problem affecting staffing that could explain the situation. If after this discussion it is believed that the staffing is not now or ever will be as it was relayed to him in the interview, then he should seek employment elsewhere.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Planning

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Inform all shifts that there have been some lapses in communication regarding patient needs and that involving the patient in the report will help alleviate this. b. Inform all nurses that to reach Magnet status, this type of change of shift report is required. c. Ask the nurses to participate in the planning and implementation of the change. d. Ask the nurses to try this type of change of shift report for 1 week and then have them evaluate it.

21. The nurse manager on a medical-surgical unit wants to change to “walking rounds” in the patients’ rooms for change of shift report. In the past, it has been “face to face” at the nurses’ station. The nurse manager is meeting resistance from the staff, because they think that it will take longer, and the nurses will not finish their shift on time. What could the manager do to increase the nurses’ acceptance of this change?

ANS: C

Change is always difficult, especially when it has been forced on people, threatens their security, or seems unnecessary. Change is more palatable when nurses participate in the planning and implementation and see that it is worthwhile.

DIF: Cognitive Level: Analyze (Analysis)

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Multiple Response

1. Which of the following statements are accurate descriptors regarding change? (Select all that apply.)

a. Organization-wide change is more sustainable when leadership imposes the change.

b. Change within an organization is often externally imposed.

c. Change within an organization may originate internally.

d. Nurses do not need to participate actively in the organizational changes.

e. Change is often complex and irrational.

ANS: B, C, E

Changes within an organization may be necessary due to external or internal demands. Change is seldom easy and may be complex and irrational.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Learning is conducted in individual parts rather than in groups. b. Viewing the organization as an interrelated system is known as systems thinking. c. Individuals utilize mental models to understand how their vision affects their decisions and actions. d. Shared vision is conducted within a group to determine plans to get to the preferred future. e. Personal mastery encourages individuals to create results as they see fit.

2. Learning organizations adapt to change through their ability to be open, dynamic, and responsive to changes in the environment. Which of the following learning disciplines are true of these types of organizations? (Select all that apply.)

ANS: B, C, D

Mental models allow individuals to develop, create, and project a personal vision and understand how these views affect their decisions and actions. Shared vision is encouraged within a group for development of plans. A sharing of learning skills is encouraged as a group so that learning can occur as a group. The organization is viewed as an interrelated system, rather than in unrelated parts, in systems thinking.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Reframe difficult questions. b. Communicate facts through e-mail. c. Provide active listening. d. Promote action steps and solutions. e. Keep staff informed of decisions. f. Communicate with participation.

3. During periods of stress and change, which of the following strategies should managers use to provide emotional support to staff members? (Select all that apply.)

ANS: A, C, D, E, F

Emotional responses are an expected part of change, and managers need to be able to provide emotional support to staff during periods of stress. Some of the effective strategies are active listening, promoting action steps and solutions, keeping staff informed of decisions, soliciting input, encouraging participation, and reframing difficult questions.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Evaluation

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Explain the rationale for a change so that individuals understand it. b. Simply announce the change without laying a foundation. c. Give participants all the information they need. d. Rely only on formal authority in implementing change. e. Help individuals cope with change.

4. The probability of effectiveness of the change process can be increased through several techniques. Which of the following actions will likely increase effectiveness? (Select all that apply.)

ANS: A, C, E

Announcing the change without laying a foundation and relying only on formal authority in implementing change are actions to be avoided when implementing change within an organization.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Use persuasion. b. Give the nurses adequate notice of change. c. Avoid discussion. d. Explain the rationale and patient impact. e. Inform staff that senior leadership made the decision.

5. A group of nurses is showing resistance to changes the manager is making with regard to staffing. Which of the following ways can the manager deal with the emotionality of the situation? (Select all that apply.)

ANS: B, D

A factor in determining how change is accepted depends upon how it is managed. The way to deal with emotionality is to avoid persuasion and to allow people to express their feelings. Staff should be given as much notice as possible when making changes in staffing or scheduling, and discussion is encouraged. Staff should be informed about the rationale for the decision as well as patient impact. Effective managers possess self-confidence to explain the change without blaming.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Evaluation

MSC: Client Needs: Safe and Effective Care Environment: Management of Care