TEST BANK
Leading and Managing in Nursing
Patricia S. Yoder-Wise
7th Edition Table of Contents
Chapter 01 Leading, Managing, and Following 1
Chapter 02 Clinical Safety The Core of Leading, Managing, and Following 11
Chapter 03 Legal and Ethical Issues 19
Chapter 04 Cultural Diversity and Inclusion in Health Care 27
Chapter 05 Gaining Personal Insight The Beginning of Being a Leader 36
Chapter 06 Being an Effective Follower 43
Chapter 07 Managing Self Stress and Time 47
Chapter 08 Communication and Conflict 55
Chapter 09 Power, Politics, and Influence 64
Chapter 10 Healthcare Organizations 73
Chapter 11 Organizational Structures 82
Chapter 12 Care Delivery Strategies 91
Chapter 13 Staffing and Scheduling 100
Chapter 14 Work force Engagement through Collective Action and Governance 108
Chapter 15 Making Decisions and Solving Problems 118
Chapter 16 The Impact of Technology 127
Chapter 17 Delegating Authority, Accountability, Responsibility in Delegation Decisions 136
Chapter 18 Leading Change 145
Chapter 19 Building Effective Teams 154
Chapter 20 Managing Costs and Budgets 162
Chapter 21 Selecting, Developing, and Evaluating Staff 171
Chapter 22 Person-Centered Care 179
Chapter 23 Managing Quality and Risk 188
Chapter 24 Translating Research into Practice 196
Chapter 25 Managing Personal and Personnel Problems 205
Chapter 26 Role Transition 214
Chapter 27 Managing Your Career 223
Chapter 28 Developing the Role of Leader 231
Chapter 29 Developing the Role of Manager 241
Chapter 30 The Strategic Planning Process 250
Chapter 31 Thriving for the Future 258 WWW.TBSM.WSChapter 01: Leading, Managing, and Following Yoder-Wise: Leading and Managing in Nursing, 7th Ed ition 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 ho spital and community environment. d. Hire a geriatric specialist to oversee and control the project. ANS: B Complexity theory suggests that systems interact an d 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 wo uld be involved in decision making. TOP: AONE competency: Communication and Relationshi p-Building 2. A unit manager of a 25-bed medical/surgical are a 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 n urse, 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 o f his wife’s treatment. c. Sympathize with the nurse’s dilemma and let the charge nurse know that this nurse may be calling in frequ ently 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 cove rage 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 staf f and of patients while satisfying the nurse’s need for affiliation. TOP: AONE competency: Communication and Relationshi p-Building 3. A grievance brought by a staff nurse against th e 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 res olution. ______________________________________________________________________________________________
______________________________________________________________________________________________Test Bank - Leading and Managing in Nursing, 7th Edition (Yoder-Wise, 2019)
1 | P a g e WWW.TBSM.WSb. Involve another staff nurse in the discussion for c larity issues. c. Ask each party to examine their own motives and iss ues in the conflict. d. Continue to listen as the parties repeat their t houghts 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 Relationshi p-Building 4. At a second negotiation session, the unit manag er 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 a llow 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 r esolution has been reached. d. Back the unit manager’s actions and end the dispute . ANS: B Part of leadership is understanding conflict resolu tion and ability to negotiate and manage for resolution of issues and concerns. This situati on 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 Relationshi p-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, an d 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 i mplementation 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 thi nk 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 w hat 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 p eriod of time before implementation does not provide opportunity to explore different p erspectives and values. Avoiding discussion until the team changes may not promote a doption of the change until there is opportunity to explore perspectives and values rela ted to the change. Hiring of the assistants demonstrates lack of empathy for the perspectives o f the RN staff. TOP: AONE competency: Knowledge of the Health Care Environment ______________________________________________________________________________________________
______________________________________________________________________________________________Test Bank - Leading and Managing in Nursing, 7th Edition (Yoder-Wise, 2019)
2 | P a g e WWW.TBSM.WS 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 nu rsing 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 l ead to greater job satisfaction? a. Ask the director of nursing to offer higher wage s and bonuses for extra work for the night LPNs and NAs. b. Allow the LPNs and NAs greater decision-making p ower within the scope of their positions in the institution. c. Hire additional staff so that there are more sta ff available for enhanced care, and individual workloads are lessened. d. Ask the director of nursing to increase job secu rity 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 satisfact ion with work promote a satisfying and enriched work environment. Transformational leaders use motivator factors liberally to inspire work performance and increase job satisfact ion. TOP: AONE competency: Communication and Relationshi p-Building 7. The nurse manager wants to increase motivation by providing motivating factors for the nurse on the unit. What action would be appropriate to motivate the staff? a. Collaborate with the human resource/personnel de partment 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 pack age. ANS: C Complexity theory suggests that systems interact an d adapt and that decision making occurs throughout systems, as opposed to being held in a h ierarchy. In complexity theory, every voice counts, and therefore all levels of staff wou ld be involved in decision making. This principle is the foundation of shared governance. TOP: AONE competency: Communication and Relationshi p-Building 8. A charge nurse on a busy 40-bed medical/surgica l 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 s taff, physicians, and other visitors. The family member leaves the unit abruptly, and the nur se is left feeling frustrated. Which behavior by the charge nurse best illustrates refin ed leadership skills in an emotionally intelligent practitioner? a. Reflect to gain insight into how the situation c ould be handled differently in the future. b. Try to catch up with the angry family member to res olve the concern. c. Discuss the concern with the patient after the fami ly member has left. d. Notify nursing administration of the situation. ______________________________________________________________________________________________
______________________________________________________________________________________________Test Bank - Leading and Managing in Nursing, 7th Edition (Yoder-Wise, 2019)
3 | P a g e WWW.TBSM.WSANS: A Goleman suggests that emotional intelligence involv es insight and being able to step outside of the situation to envision the context of what is happening as well as being able to manage emotions such as frustration effectively. TOP: AONE competency: Leadership 9. The chief nursing officer has asked the staff d evelopment coordinator to facilitate the development of a clinical competency program for th e 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 compet ency program. What behavior by the staff development coordinator is most appropriate in this situation? a. Disregard staff concerns and continue with developm ent of the program. b. Inform the nurses that this program is a requiremen t for JCAHO accreditation. c. Schedule a meeting with the chief nurse executive t o apprise her of the situation. d. Facilitate a meeting so nurses can articulate th eir 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 sta ff through sharing of concerns and ideas. A close analysis of the IOM report and the s ummary of the PPACA suggests that no health reform can unfold without active nursing eng agement. 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. TOP: AONE competency: Communication and Relationshi p-Building 10. The nurse manager has been asked to implement an evidence-based approach to teach ostomy patients self-management skills postoperativ ely. The program is to be implemented across the entire facility. What illustrates effect ive 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 appro ach of volunteers to take the lead in mentoring and teaching others how to implem ent 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 decis ion making, and actions are taken to achieve clinical or organizational outcomes. Follow ership promotes good clinical decisions and use of clinical resources. TOP: AONE competency: Communication and Relationshi p-Building ______________________________________________________________________________________________
______________________________________________________________________________________________Test Bank - Leading and Managing in Nursing, 7th Edition (Yoder-Wise, 2019)
4 | P a g e WWW.TBSM.WS 11. You overhear a new graduate RN telling a nurse colleague that leadership and management belong to the unit manager, not to her. As a nursin g colleague, what do you know to be true in regard to the statement? a. The statement is correct. Leadership is not the rol e of the staff nurse. b. The new graduate would benefit from further unde rstanding of her role as a professional, whose influence may affect the decisi on making of patients, colleagues, and other professionals. c. The new graduate has been influenced by nurse le aders 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, kn owledge of organizations and health systems, and an inner desire to lead and manage. Th ere 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. S uch views fail to acknowledge that to be a nurse requires each licensed individual to lead, ma nage, and follow when practicing at the point-of-care and beyond. TOP: AONE competency: Leadership 12. The charge nurse walks into Mr. Smith’s room a nd finds him yelling at the LPN. He is obviously very upset. The charge nurse determines t hat 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 feeli ngs and concerns and then suggests that Mr. Smith’s behavior was aggressive but was re lated to lack of sleep and to pain. The charge nurse asks, “Can you, together with Mr. Smit h, 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 com plex situation where there is no standardized solution reflects leadership. TOP: AONE competency: Leadership 13. After assessing an older adult patient in long -term care who has been slowly deteriorating for weeks, the nurse manager calls the family and a sks 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 ______________________________________________________________________________________________
______________________________________________________________________________________________Test Bank - Leading and Managing in Nursing, 7th Edition (Yoder-Wise, 2019)
5 | P a g e WWW.TBSM.WS ANS: D The nurse manager is employing knowledge and experi ence in determining that the patient is dying, because the course of dying is not standa rdized and cannot be determined by clinical pathways. TOP: AONE competency: Knowledge of the Health Care Environment 14. Chart audits have revealed significant omissio ns of data that could have legal and financial guideline ramifications. The unit manager meets wit h the staff to discuss audit findings and to find approaches that will address the gaps in ch arting 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 g oals, outcomes, and procedures is management. This can require collaborative decision making to determine how best to reach predetermined goals and follow established practice s. TOP: AONE competency: Knowledge of the Health Care Environment 15. 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 c oordinating resources to achieve outcomes in accordance with established clinical pr ocesses. Referral to a social worker alleviates demand on staff time and is consistent w ith hospital procedures. TOP: AONE competency: Communication and Relationshi p-Building 16. 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 t he 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 wit h the family. The unit manager states he will arrange a discussion with the patient’s provid er 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 ______________________________________________________________________________________________
______________________________________________________________________________________________Test Bank - Leading and Managing in Nursing, 7th Edition (Yoder-Wise, 2019)
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