Chapter 01: Leading, Managing, and Following
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
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 for implementation of
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.
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 Maslow‘s 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 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 the nurse‘s 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 wife‘s needs meets the needs of the staff and of patients while satisfying the nurse‘s need
for affiliation.
TOP: AONE competency: Communication and Relationship-Building
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 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 for clarity issues.
, c. Ask each party to examine their own motives and issues in the conflict.
d. Continue to listen as the parties repeat their thoughts and feelings about the
conflict.
ANS: C
For resolution of conflict, one should address the interests and involvement of participants in
the conflict by examining the real issues of all parties.
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. What is the appropriate next step?
a. Arrange another meeting in a week‘s time so as to allow a cooling-off period.
b. Elevate the next negation session to the next manager, one level above.
c. Insist that participants continue to talk until a resolution has been reached.
d. Back the unit manager‘s actions and end the dispute.
ANS: B
Part of leadership is understanding conflict resolution and ability to negotiate and manage for
resolution of issues and concerns. This situation has failed a second negotiation session,
elevation to a manager with additional training to facilitate conflict resolution is important at
this point.
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 ambulate patients. The RNs on the staff
have always practiced in a primary nursing-delivery system and are very resistant to this idea.
What would be the best initial strategy for implementation of this change?
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.
TOP: AONE competency: Knowledge of the Health Care Environment
,6. As the RN charge nurse on the night shift in a small long-term care facility, you‘ve 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
Herzberg‘s 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.
TOP: AONE competency: Communication and Relationship-Building
7. The nurse manager wants to increase motivation by providing motivating factors for thenurse
on the unit. What action would be appropriate to motivate the staff?
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.
TOP: AONE competency: Communication and Relationship-Building
8. The nurse manager has been asked to implement an evidence-based approach to teach ostomy
patients self-management skills postoperatively. The program is to be implemented across the
entire facility. What illustrates effective leadership in this situation?
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. An RN who is already familiar with the new approach of 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.
TOP: AONE competency: Communication and Relationship-Building
9. You overhear a new graduate RN telling a nurse colleague that leadership and management
belong to the unit manager, not to her. As a nursing colleague, what do you know to be true in
regard to the statement?
a. The statement is correct. Leadership is not the role of the staff nurse.
b. The new graduate would benefit from further understanding of her role as a
professional, whose influence may affect the decision making of patients,
colleagues, and other professionals.
c. The new graduate has been influenced by nurse leaders and managers who leave
for other positions.
d. The general perception is that nurse leaders and managers are not satisfied in their
jobs.
ANS: B
Care coordination that involves the intersection of individual, family, and community-based
needs requires that nurses have self-confidence, knowledge of organizations and health
systems, and an inner desire to lead and manage. There is often a view that leadership is
isolated to those holding managerial positions, and that a direct care nurse is subject to
following by adhering to the direction of others. Such views fail to acknowledge that to be a
nurse requires each licensed individual to lead, manage, and follow when practicing at the
point-of-care and beyond.
TOP: AONE competency: Leadership
10. The charge nurse walks into Mr. Smith‘s room and finds him yelling at the LPN. He is
obviously very upset. The charge nurse determines that he has not slept for three nights
because of unrelieved pain levels. The LPN is very upset and calls Mr. Smith an ―ugly, old
man.‖ The charge nurse acknowledges the LPN‘s feelings and concerns and then suggests that
Mr. Smith‘s behavior was aggressive but was related to lack of sleep and to pain. The charge
nurse asks, ―Can you, together with Mr. Smith, determine triggers for the pain and effective
approaches to controlling his pain?‖ This situation is an example of what?
a. Lack of empathy and understanding for Miss Jones
b. Concern with placating Mr. Smith
c. Leadership behavior
d. Management behavior
ANS: C
The situation between Mr. Smith and Miss Jones is a complex situation involving unrelieved
patient symptoms and aggressiveness toward a staff member. Providing engaged,
collaborative guidance and decision making in a complex situation where there is no
standardized solution reflects leadership.
TOP: AONE competency: Leadership
,11. After assessing an older adult patient in long-term care who has been slowly deteriorating for
weeks, the nurse manager calls the family and asks them to come in, as the patient is dying.
What is the most likely basis for the nurse manager‘s request?
a. An established clinical pathway
b. Confirmatory scientific evidence
c. Unit protocol
d. Experience
ANS: D
The nurse manager is employing knowledge and experience in determining that the patient is
dying, because the course of dying is not standardized and cannot be determined by clinical
pathways.
TOP: AONE competency: Knowledge of the Health Care Environment
12. Chart audits have revealed significant omissions of data that could have legal and financial
guideline ramifications. The unit manager meets with the staff to discuss audit findings and to
find approaches that will address the gaps in charting and achieve desired goals. What is the
manager demonstrating?
a. Leadership
b. Management
c. Decision making
d. Vision
ANS: B
The process of guiding others 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.
TOP: AONE competency: Knowledge of the Health Care Environment
13. A family is keeping vigil at a critically ill patient‘s bedside. Distant family members call the
unit continuously asking for updates and expressing concern. The nurse speaks with the
distant family members and states she is referring them to the hospital social worker, whose
role is to work with family in this situation. What role is the nurse assuming through this
action?
a. Manager
b. Leader
c. Follower
d. Laissez-faire
ANS: A
As a manager, you are concerned with managing and coordinating resources to achieve
outcomes in accordance with established clinical processes. Referral to a social worker
alleviates demand on staff time and is consistent with hospital procedures.
TOP: AONE competency: Communication and Relationship-Building
,14. A family is keeping vigil at a critically ill patient‘s bedside. The nurse approaches the unit
manager with concern over the family dynamics for the patient concerned there are
patient-family conflicts based on patient‘s wishes. The nurse suggests that the patient‘s
provider may need to discuss the treatment plan with the family. The unit manager states he
will arrange a discussion with the patient‘s provider and ask the nurse to support the
provider‘s decisions. What is the role of the nurse in this situation?
a. Leadership
b. Management
c. Follower
d. Evidence-based
ANS: C
In the followership role, you bring to the manager your concerns about concerns for patients
and the outcomes and accept the direction given by the manager in response to your concerns.
TOP: AONE competency: Knowledge of the Health Care Environment
15. The manager calls the staff together to assess a situation in which the family of a seriouslyill
patient is anxious and is absorbing a great deal of staff time in consultation, discussion, and
questioning of treatment decisions. Staff members are becoming distanced from the family.
After inviting the concerns of staff, the manager explains that the organization values
patient-centered care and that evidence supports that acting as an advocate and a listener is
helpful to families. The manager asks the staff for ideas and strategies that are effectively
patient-centered in dealing with families in similar situations. What is the role of the nurse
manager in this situation?
a. Leadership
b. Management
c. Follower
d. Visionary
ANS: A
As a leader, the manager is providing and communicating vision and direction based on
evidence and experience. The manager is engaging others in decision making that moves them
toward the vision with a reasonable level of risk taking.
TOP: AONE competency: Leadership
16. The manager of a unit is finding it difficult to work with a new graduate nurse. The new nurse
has many ideas; however, his manner of presenting them irritates the manager. After
reflection and discussion with others, the manager recognizes that she feels threatened by his
behavior. She comes to understand that the new nurse is trying to establish his own role on the
unit; is not trying to challenge her; and needs guidance, coaching, and affirmation. What is the
nurse manager demonstrating in this situation?
a. A positive self-concept
b. Deepening self-awareness
c. Leadership
d. Acquiescence
ANS: B
, Stepping outside oneself to envision the situation while assuming ownership is a component
of emotional intelligence. This is an example of self-awareness to identify the resolve to
self-conflict in this situation.
TOP: AONE competency: Professionalism
17. As the head of a nursing program, you consistently invite the ideas of your team about
innovations in teaching, community partnerships, and curriculum design and invite
participation in decisions. Many of these ideas have been implemented successfully, and your
staff members are keen to try on other ideas. What is the leadership you are employing?
a. Situational
b. Trait-based
c. Contingency-based
d. Transformational
ANS: D
Transformational leadership involves attending to the needs and motives of followers, which
results in creativity, improvement, and employee development.
TOP: AONE competency: Professionalism
18. As a leader on a rehab unit, the manager encourages all staff members to see themselves as
having a role in decision making and quality care. The manager sees their role as involving
particular responsibilities in decision making but not as a hierarchal role. What is this view of
the role consistent with in this situation?
a. Trait theories
b. Complexity theory
c. Situated theory
d. Emotional intelligence
ANS: B
Complexity theory involves envisioning each member of the team involved in decision
making, management, and leadership, with the leader not seen in a hierarchal relationship to
other team members.
TOP: AONE competency: Leadership
19. A staff nurse has been recently promoted to unit manager. During the time on the unit, the
nurse formed a strong social network among staff, has promoted the development of
relationships between staff and workers in other areas of the organization, and has formed
relationships that generate ideas from patient organizations and the local nursingeducation
program. According to complexity theory, what principle is being engaged?
a. Empowerment
b. Systematic thinking
c. Development of networks
d. Bottom-up interactions
ANS: C
According to complexity theory, social networks evolve around areas of common interest and
are able to respond to problems in creative and novel ways.
, TOP: AONE competency: Knowledge of the Health Care Environment
20. According to the complexity theory, what would be the focus of measurement?
a. Cost per hospital day
b. Bed utilization
c. Infection rates
d. Staff morale and budgets
ANS: D
According to complexity theory and the principle ―Think systematically,‖ one cannot ignore
objective data or nonmeasurable data, as both inform decisions.
TOP: AONE competency: Business Skills
21. During a staff meeting held to discuss developing a mission statement for the unit, the ideaof
placing patient needs first is discussed. What is considered when the suggestion by the
manager is for the unit mission to be derived from the organization mission?
a. Empowering
b. A leadership task
c. A symbol
d. A management task
ANS: B
According to complexity theory, leadership task, which are similar to values, reflect the
patient-centered philosophies and values-driven characteristics that define an organization and
give it personality.
TOP: AONE competency: Knowledge of the Health Care Environment
22. A dispute arises between an RN and an LPN over a patient issue. The tension continues
between the two and begins to affect other staff members, who are drawn into the conflict.
Over time, the team becomes polarized toward either the RN or the LPN. How might this
situation be prevented?
a. Expediency in responding to the initial dispute, once it became apparent that it
could not be resolved by the two parties themselves
b. Asking other staff members what the real issues were in the dispute between the
RN and the LPN
c. Reassigning one of the parties to another unit when it became apparent that the two
individuals could not resolve the dispute themselves
d. Calling a staff meeting at the onset of the dispute to allow the team and the RN and
LPN to discuss the initial dispute
ANS: A
The initial step in conflict resolution should have involved an expedient response to the issues
and putting a focus on the issues involved in the dispute between the LPN and RN through
negotiation involving the two parties, before the dispute involved others.
TOP: AONE competency: Communication and Relationship-Building
, 23. The unit is shifting from primary nursing to a team model in an effort to contain costs. Staff
members are upset about the change and ask for a meeting to discuss the new model. After
hearing their concerns related to reduction in professional autonomy, what is the initial
response by the manager to address the concerns?
a. Acknowledge the loss.
b. Explain the reasons for change, emphasizing the need to reduce costs.
c. Repeat the information several times, giving detailed budget overviews.
d. Adjourn the meeting and provide explanation through e-mail.
ANS: A
Visioning involves engaging with others to assess the current reality, specify the end point,
and then strategize to reduce differences. This requires trusting relationships thatacknowledge
the differences in values and ideas. When done well, the nurse manager and the nurses within
a unit experience creative tension that inspires working in concert to achieve desired goals.
TOP: AONE competency: Communication and Relationship-Building
MULTIPLE RESPONSE
1. A new graduate nurse wonders about the directions that her preceptor has given her regarding
management of incontinent, confused patients. The new nurse brings the preceptor
evidence-based information she located regarding incontinence interventions for confused
patients and asks to talk about the guidance that given after the preceptor reviews the
information in the article. What is the new nurse demonstrating in this situation? (Select all
that apply.)
a. Assertiveness
b. Followership
c. Management
d. Insubordination
ANS: A, B
This is an example of followership in which a staff nurse is demonstrating assertive behavior
and presenting evidence that may influence the decision making of her nurse leader and
manager.
TOP: AONE competency: Knowledge of the Health Care Environment
Chapter 02: Quality and Safety
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
MULTIPLE CHOICE
1. In an effort to control costs and maximize revenues, the Rehabilitation Unit at Cross Hospital
reduced the number of its managers and increased the number of units for which each
manager was responsible. Within a year, the number of adverse events on the units had
doubled. How do the increase in adverse events relate to decreased managers?
a. The overload of staff nurse duties
b. Resistance to change by staff
c. A change in reporting system for everyone
