Chapter 01: Leading, Managing, and
Following Yoder-Wise: Leading and
Managing in Nursing, 8th Edition
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. - ✔✔-b. Engage involved staff at
all levels in the decision-making process.
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.
A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse whohas
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. - ✔✔-d. Work with the nurse, staffing office, and other nurses to
arrange his scheduled days off around his wife's treatments.
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.
, 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. - ✔✔-c.
Ask each party to examine their own motives and issues in the conflict.
For resolution of conflict, one should address the interests and involvement of participants in the
conflict by examining the real issues of all parties.
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. - ✔✔-b. Elevate the next negation
session to the next manager, one level above.
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
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 - ✔✔-a.
Exploring the values and feelings of the RN group in relationship to this change
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
