Chapter 01: Leading, Managing, and Following
n n n n n
Yoder-Wise: Leading and Managing in Nursing, 8th Edition
n n n n n n n
MULTIPLE CHOICE n
1. A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults.
n n n n n n n n n n n n n n n n
Sheis asked to assess and adapt the unit to better meet the unique needs of the older adult
n n n n n n n n n n n n n n n n n n n
patient.Using complexity principles, what would be the best approach to take for
n n n n n n n n n n n n n
implementation of this change?
n n n n
a. Leverage the hierarchical management position to get unit staff involved n n n n n n n n n
inassessment and planning.
n n n n
b. Engage involved staff at all levels in the decision-making process.
n n n n n n n n n
c. Focus the assessment on the unit and omit the hospital and
n n n n n n n n n n
communityenvironment.
n n
d. Hire a geriatric specialist to oversee and control the project.
n n n n n n n n n
ANS: B n
Complexity theory suggests that systems interact and adapt and that decision making
n n n n n n n n n n n
occurs throughout the systems, as opposed to being held in a hierarchy. In complexity
n n n n n n n n n n n n n n
theory, every voice counts, and therefore, all levels of staff would be involved in decision
n n n n n n n n n n n n n n n
making.
n
TOP: AONE competency: Communication and Relationship-Building
n n n n n
2. A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who
n n n n n n n n n n n n n n n
hascalled in sick five times in the past month. He tells the manager that he very much wants
n n n n n n n n n n n n n n n n n n n
to come to work when scheduled but must often care for his wife, who is undergoing
n n n n n n n n n n n n n n n n
treatmentfor breast cancer. According to Maslow‘s need hierarchy theory, what would be
n n n n n n n n n n n n n
the best approach to satisfying the needs of this nurse, other staff, and patients?
n n n n n n n n n n n n n n
a. Line up agency nurses who can be called in to work on short notice.
n n n n n n n n n n n n n
b. Place the nurse on unpaid leave for the remainder of his wife‘s treatment.
n n n n n n n n n n n n
c. Sympathize with the nurse‘s dilemma and let the charge nurse know that this n n n n n n n n n n n n
nursemay be calling in frequently in the future.
n n n n n n n n n
d. Work with the nurse, staffing office, and other nurses to arrange his
n n n n n n n n n n n
scheduleddays off around his wife‘s treatments.
n n n n n n n
ANS: D n
Placing the nurse on unpaid leave may threaten the nurse‘s capacity to meet physiologic
n n n n n n n n n n n n n
needsand demotivate the nurse. Unsatisfactory coverage of shifts on short notice could affect
n n n n n n n n n n n n n n
patient care and threaten the needs of staff to feel competent. Arranging the schedule around
n n n n n n n n n n n n n n n
the wife‘s needs meets the needs of the staff and of patients while satisfying the nurse‘s need
n n n n n n n n n n n n n n n n n
for affiliation.
n n
TOP: AONE competency: Communication and Relationship-Building
n n n n n
3. A grievance brought by a staff nurse against the unit manager requires mediation. At the
n n n n n n n n n n n n n n
firstmediation session, the staff nurse repeatedly calls the unit manager‘s actions unfair, and
n n n n n n n n n n n n n n
the unit manager continues to reiterate the reasons for the actions. What would be the best
n n n n n n n n n n n n n n n n
courseof action at this time?
n n n n n n
a. Send the two disputants away to reach their own resolution.
n n n n n n n n n
b. Involve another staff nurse in the discussion for clarity issues.
n n n n n n n n n
Want nto nearn
n$1.236
extra nper nyear?
, c. Ask each party to examine their own motives and issues in the conflict.
n n n n n n n n n n n n
d. Continue to listen as the parties repeat their thoughts and feelings about
n n n n n n n n n n n
theconflict.
n n
ANS: C n
For resolution of conflict, one should address the interests and involvement of participants
n n n n n n n n n n n n
inthe conflict by examining the real issues of all parties.
n n n n n n n n n n n
TOP: AONE competency: Communication and Relationship-Building
n n n n n
4. At a second negotiation session, the unit manager and staff nurse are unable to reach
n n n n n n n n n n n n n n
aresolution. What is the appropriate next step?
n n n n n n n n
a. Arrange another meeting in a week‘s time so as to allow a cooling-off period.
n n n n n n n n n n n n n
b. Elevate the next negation session to the next manager, one level above.
n n n n n n n n n n n
c. Insist that participants continue to talk until a resolution has been reached.
n n n n n n n n n n n
d. Back the unit manager‘s actions and end the dispute.
n n n n n n n n
ANS: B n
Part of leadership is understanding conflict resolution and ability to negotiate and manage
n n n n n n n n n n n n
forresolution of issues and concerns. This situation has failed a second negotiation session,
n n n n n n n n n n n n n n
elevation to a manager with additional training to facilitate conflict resolution is important at
n n n n n n n n n n n n n n
this point.
n n
TOP: AONE competency: Communication and Relationship-Building
n n n n n
5. The manager of a surgical area has a vision for the future that requires the addition of RN
n n n n n n n n n n n n n n n n n
assistants or unlicensed persons to feed, bathe, and ambulate patients. The RNs on the staff
n n n n n n n n n n n n n n n
have always practiced in a primary nursing-delivery system and are very resistant to this
n n n n n n n n n n n n n n
idea.What would be the best initial strategy for implementation of this change?
n n n n n n n n n n n n n
a. Exploring the values and feelings of the RN group in relationship to this change
n n n n n n n n n n n n n
b. Leaving the RNs alone for a time so they can think about the change before it
n n n n n n n n n n n n n n n
isimplemented
n n
c. Dropping the idea and trying for the change in a year or so when some of
n n n n n n n n n n n n n n n
thepresent RNs have retired
n n n n n
d. Hiring the assistants and allowing the RNs to see what good additions they are
n n n n n n n n n n n n n
ANS: A n
Influencing others requires emotional intelligence in domains such as empathy, handling
n n n n n n n n n n
nrelationships, deepening self-awareness in self and others, motivating others, and managing
n n n n n n n n n n
nemotions. Motivating others recognizes that values are powerful forces that influence
n n n n n n n n n n
nacceptance of change. Leaving the RNs alone for a period of time before implementation
n n n n n n n n n n n n n
ndoesnot provide opportunity to explore different perspectives and values. Avoiding
n n n n n n n n n n
ndiscussion until the team changes may not promote adoption of the change until there is
n n n n n n n n n n n n n n
nopportunity to explore perspectives and values related to the change. Hiring of the assistants
n n n n n n n n n n n n n
ndemonstrates lack of empathy for the perspectives of the RN staff. n n n n n n n n n n
TOP: AONE competency: Knowledge of the Health Care Environment
n n n n n n n n
Want nto nearn
n$1.236
extra nper nyear?
,6. As the RN charge nurse on the night shift in a small long-term care facility, you‘ve found
n n n n n n n n n n n n n n n n
thatthere is little turnover among your LPN and nursing assistant (NA) staff members, but
n n n n n n n n n n n n n n n
they are not very motivated to go beyond their job descriptions in their work. Which of the
n n n n n n n n n n n n n n n n n
following strategies might motivate the staff and lead to greater job satisfaction?
n n n n n n n n n n n n
a. Ask the director of nursing to offer higher wages and bonuses for extra work
n n n n n n n n n n n n n
forthe night LPNs and NAs.
n n n n n n
b. Allow the LPNs and NAs greater decision-making power within the scope of
n n n n n n n n n n n
theirpositions in the institution.
n n n n n
c. Hire additional staff so that there are more staff available for enhanced care,
n n n n n n n n n n n n
andindividual workloads are lessened.
n n n n n
d. Ask the director of nursing to increase job security for night staff by having
n n n n n n n n n n n n n
themsign contracts that guarantee work.
n n n n n n
ANS: B n
Hygiene factors such as salary, working conditions, and security are consistent with
n n n n n n n n n n n
Herzberg‘s two-factor theory of motivation; meeting these needs avoids job dissatisfaction.
n n n n n n n n n n n
Motivator factors such as recognition and satisfaction with work promote a satisfying and
n n n n n n n n n n n n n
enriched work environment. Transformational leaders use motivator factors liberally to
n n n n n n n n n n
inspirework performance and increase job satisfaction.
n n n n n n n
TOP: AONE competency: Communication and Relationship-Building
n n n n n
7. The nurse manager wants to increase motivation by providing motivating factors for
n n n n n n n n n n n
thenurseon the unit. What action would be appropriate to motivate the staff?
n n n n n n n n n n n n n
a. Collaborate with the human resource/personnel department to develop on- n n n n n n n n
sitedaycare services. n n
b. Provide a hierarchical organizational structure. n n n n
c. Implement a model of shared governance. n n n n n
d. Promote the development of a flexible benefits package. n n n n n n n
ANS: C n
Complexity theory suggests that systems interact and adapt and that decision making
n n n n n n n n n n n
occursthroughout systems, as opposed to being held in a hierarchy. In complexity theory,
n n n n n n n n n n n n n n
every voice counts, and therefore all levels of staff would be involved in decision making.
n n n n n n n n n n n n n n n
This principle is the foundation of shared governance.
n n n n n n n n
TOP: AONE competency: Communication and Relationship-Building
n n n n n
8. The nurse manager has been asked to implement an evidence-based approach to teach
n n n n n n n n n n n n
ostomy patients self-management skills postoperatively. The program is to be implemented
n n n n n n n n n n n
across theentire facility. What illustrates effective leadership in this situation?
n n n n n n n n n n n
a. The training modules are left in the staff room for times when staff are available.
n n n n n n n n n n n n n n
b. The current approach is continued because it is also evidence-based and is
n n n n n n n n n n n
morefamiliar to staff.
n n n n
c. You decide to implement the approach at a later date because of feedback from
n n n n n n n n n n n n n
theRNs that the new approach takes too much time.
n n n n n n n n n n
d. An RN who is already familiar with the new approach of volunteers to take
n n n n n n n n n n n n n
thelead in mentoring and teaching others how to implement it.
n n n n n n n n n n n
ANS: D n
Want nto nearn
n$1.236
extra nper nyear?
, Want nto nearn
n$1.236
extra nper nyear?
