TEST BANK for Leadership and Nursing Care Management 7th Edition by Diane Huber, Lindell Joseph

Leadership and Nursing Care Management 7th Edition Huber Test Bank Chapter 01: Leadership and Management Principles Huber: Leadership & Nursing Care Management, 7th 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 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? a. Effective leadership b. Management involvement c. Mentoring d. Rewards and recognition 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 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? 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.”

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

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

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 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? a. Care provider b. Business principles c. Care coordination d. Change management 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 7. Interpersonal communication and the ability to apply

needs to enhance professional practice. a. vision

are two critical skills every nurse

b. supervision c. delegation d. problem solving 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 9. The personal leadership skill for nurses that consists of self-awareness, discipline, motivation,

social awareness, and relationship management is known as what? a. Leadership b. Management c. Emotional intelligence d. Vision 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 10.

are vital to good leaders because they are able to take the vision of the leader and achieve the determined goals. a. Managers b. Motivators c. Visionaries d. Followers

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 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? a. Planning b. Organizing c. Coordinating d. Controlling 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 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? a. Contingency theory b. Systems theory c. Complexity theory d. Chaos theory 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 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. a. nurse manager b. care provider c. nurse executive d. senior leader 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 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. a. authoritarian b. democratic c. laissez-faire d. servant 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 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? 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.”

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 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? a. Authoritarian b. Democratic c. Transformational d. Transactional 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 19. Which of the following are crucial leadership traits to exhibit in the nursing profession? 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 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 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.) a. feminist perspective. b. servant leadership. c. transactional leadership. d. transformational leadership. e. authoritarian leadership.

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 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.) 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.

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 4. To reach Magnet status the nursing service in a hospital must attain competency in which of

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

organization? (Select all that apply.) a. Sharing relevant information b. Encouraging competition via winners and losers c. Reducing controls d. Meeting expectations e. Avoiding discussion of sensitive issues 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 6. Which of the following traits describe a transactional leader? (Select all that apply.) 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.

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

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, 7th 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

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? a. Transforming care at the bedside b. Second-order change c. Emergent change d. Organizational change 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 5. How is the refreezing stage of change similar to the nursing process? 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.

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 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? a. Complexity b. Compatibility c. Trialability d. Relative advantage 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 7. According to the

people move through a series of states when modifying their behavior. a. Organizational Change-Readiness Scale (OCRS) b. Transtheoretical Stages of Change Model c. Rapid Cycle Change d. plan-do-study-act model 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 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? 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.”

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 10. a. b. c. d.

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

Depression Resistance Acceptance Denial

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 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? a. Early adopters b. Late majority c. Innovators d. Laggards 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

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? a. Budget-oriented change b. Transformation c. Resistance d. Emergent change 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 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? a. Storytelling b. E-mail c. Discussion d. Open 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 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? 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.

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 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? 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.

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

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.) 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.

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 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.) 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.

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 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.) 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.

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 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.) 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.

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

Chapter 03: Organizational Climate and Culture Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. Culture is best defined as (the) a. deviation from the majority. b. differences in likes and dislikes. c. shared beliefs and values. d. similar views and opinions.

ANS: C

Culture is described as shared beliefs and values. It provides a common belief system among its members but is not expected to hold similar views and opinions of its members.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. Climate is best defined as the a. health and well-being of the structure of a facility. b. perceptions that individuals have about an environment. c. style in which individuals treat each other. d. temperature in the nursing units of an institution.

ANS: B

Climate is defined as the perceptions that individuals have about a particular unit or environment.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. A professor at the local college of nursing is teaching at a new clinical site. She notes that the

nurses greet each other and their clients with warmth and a smile. She also notes that the policies and procedures encourage nursing autonomy. Nurses and physicians seem to have a collegial relationship. These observations best describe the of the unit. a. climate b. culture c. interactions d. operation ANS: A

Climate is the perception that individuals have about a particular unit or environment.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. Characteristics of a Magnet hospital include a. multidisciplinary collaboration. b. nursing leader authority.

c. physician control. d. social worker retention.

ANS: A

Characteristics of a Magnet hospital include nursing autonomy, practice control, and collaboration. Nursing support, collaborative partnerships with physicians, and nursing practice are other aspects.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. A process used to achieve and internalize knowledge, skills, and behaviors of professional

nursing in order to belong and participate is referred to as professional a. actions. b. conduct. c. ownership. d. insight.

ANS: D

Insight can be described as a process used to achieve knowledge, skills, and behaviors of a certain group to belong and participate. Nurses’ insight enables them to better understand behaviors, relationships, norms, change processes, expectations, and communication.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. The nursing manager wants to change the culture of the nursing unit. Some of the older nurses

are bullying the newer nurses, which seems to be affecting self-confidence in their new nursing roles. Which of the following strategies would be helpful in this endeavor? a. Assign mentors to the new nurses. b. Determine the roles of each nurse. c. Interview each nurse about his or her perspective. d. Suspend the bullying nurses for harassment.

ANS: C

Changing the culture requires the following to be done: (1) identify the desired change; (2) assess the current status of the group; (3) create a shared need and group commitment to change; (4) use appropriate communication skills and personal contact to establish open discussion; (5) identify shared values and mission so that the group knows where it is going; (6) determine strategies; and (7) develop an action plan for change. Interviewing each nurse would provide an opportunity for personal contact and attempt to establish open discussion.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Nursing Diagnosis MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. The nursing manager of a telemetry unit has developed a policy in which all nurses

automatically are scheduled to have a day off from work on their birthday unless they request to work on that day. He also gives a small gift to each nurse who becomes certified in his or her specialty area. This manager’s actions are positively affecting the of the unit.

a. b. c. d.

climate culture interactions operation

ANS: B

Key areas under the leader’s control in which culture can be affected are staff recruitment and retention, welcoming new staff, orientation, celebrating and recognizing staff accomplishments, facilitating change, and promoting a learning environment.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. A nurse is interviewing for a position at a prominent hospital in her community. She notes a

separate physicians’ dining room, but all other professionals and visitors eat in the same dining area. The physicians have a separate parking area. Nurse practitioners and physician assistants are asked to park in the staff lot. What might these observations suggest? a. The mission statement supports collaborative care. b. The philosophy of the organization depicts inequality. c. The values and actions may not be congruent. d. The vision for nursing is defined clearly.

ANS: C

The values drive the way that resources are distributed. In this case, the values of nursing and actions of the organization may not be congruent.

DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. Patient surveys reveal that patients do not know which caregiver is the registered nurse (RN).

A task force consisting of nursing staff is formed to develop a plan to address this issue. Many ideas are discussed to reinforce the role of the professional nurse and to make it easy for patients to recognize the RN, such as changing the dress code. Decisions resulting from this task force will mostly reflect the a. goals. b. mission. c. climate d. values.

ANS: C

The climate of the unit is evident in policies, unit norms, dress code and appearance, environment, communication, and teamwork.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. Determining the origin of errors with a focus on prevention is known as which of the

following? a. A civil investigation b. A voluntary reporting program

c. An administrative review d. A root cause analysis ANS: D

To change the culture from “who dunnit?” to an environment that is respectful and open to learning, it is necessary for the climate to change. It is essential to be able to discuss mistakes freely, with the intention of learning from them by doing a root cause analysis.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 11. The Institute of Medicine (IOM) report, Crossing the Quality Chasm, was useful in describing

the challenges related to moving from a. patient; provider b. provider; patient c. patient; facility d. provider; financially

-centered to

-centered care.

ANS: B

The IOM report, Crossing the Quality Chasm, describes challenges in care provision and details the shift of moving from provider-centered care to patient-centered care. The need for patient and family participation is a dominant force in treatment decisions.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. What is the purpose of culture in an organization? a. To provide a perception of what it feels like to work in the organization b. To provide an organization’s response to economic, social, and financial

challenges c. To provide a common bond so that members know how to relate to one another

and show others outside the organization what is valued d. To provide a small geographic area within the organization where nurses provide

care ANS: C

Culture is the set of values, beliefs, and assumptions that are shared by members of an organization. The purpose of culture is to provide a common bond so that members know how to relate to one another and to show others outside the organization what is valued.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. How is culture represented at the unit level, with an underlying belief in patient-centered care? a. Open visiting hours in the critical care unit (CCU) b. Strict visiting hours in the CCU c. Tape-recorded report d. Verbal handoff conducted at the nurses’ station ANS: A

Open visiting hours in the CCU convey the importance of family as partners in care delivery.

This is a representation of culture within a nursing unit where a relationship-based nursing care model is used, and it represents an underlying belief in patient-centered care.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. How is culture measured within an organization? a. Through the use of time-motion studies b. Through the use of quantitative instruments c. Through the use of qualitative instruments d. With a combination of qualitative and quantitative measures ANS: D

The choice of a measurement instrument would be directed by definition, purpose, and context for the cultural assessment. It is likely that a combination of qualitative and quantitative measures would be the best means of capturing the culture of an organization.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 15. A small geographic area within a larger hospital system, where nurses work interdependently

to care for a group of patients, is known as the a. nurses’ station. b. subculture. c. nursing work group. d. community.

ANS: C

The nursing unit, or nursing work group, is a small geographic area within a larger hospital system, where nurses work interdependently to care for a group of patients.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 16. What is the purpose of a mission statement? a. To provide a method of achieving success and a competitive advantage b. To aid recruitment c. To guide members on problem solving and relationship management d. To offer a snapshot of strategic priorities ANS: D

The mission statement for an organization offers a snapshot of strategic priorities and is an important way to get a sense of organizational values. A deeper understanding of cultural issues in an organization helps people understand how to improve outcomes.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

17. Organizational a. culture b. climate c. fiscal stability d. case mix

affects the quality of nursing care and patient outcomes.

ANS: A

Organizational culture affects the quality of nursing care and patient outcomes. The manner in which staff perceives culture, manages boundaries, and translates values has an impact on patient care.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 18. Which of the following exemplifies a safety climate within a nursing unit? a. Asking nursing staff to work a double shift b. Encouraging nurses to take the blame when a medication error occurs c. Asking staff to report medication errors only d. Asking staff to report near-misses of adverse events ANS: D

Safety climate refers to keeping both patients and nurses safe. Part of a safety culture encourages nurses to report adverse events as well as near-misses of adverse events. Factors that influence avoidance of errors include staffing levels, excess fatigue, education, and experience.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 19. Culture change within nursing homes was initiated by the a. Nursing Home Reform Act. b. National Citizens’ Coalition for Nursing Home Reform. c. Pioneer Network. d. Eden Alternative.

ANS: A

A series of quality improvement programs were implemented in nursing homes following the passage of the Nursing Home Reform Act legislation in 1987.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 20. The nurse manager of a medical-surgical unit realized that there are differences in dealing

with the varied generations of her nursing staff. How does the nurse manager communicate effectively with the Generation Y staff members (those born after 1980)? a. Typewritten memos b. Staff meetings held monthly for 2 hours c. E-mails or text messages d. Face-to-face interactions

ANS: C

A work environment supportive to each generation is an important retention strategy.

Tailoring the work environment to meet generational and life needs is a recurrent theme in being able to address staff retention.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. The IOM report, To Err Is Human: Building a Safer Health System, recommends building a

safety culture within an organization. This refers to keeping both patients and nurses safe. The organization supports nursing by (Select all that apply.) a. moving from a reactive culture to one that is fair and just. b. demonstrating authoritarian behaviors. c. mandating nurses to meet patient needs. d. providing a safe and efficient workspace.

ANS: A, D

Included in the concept of a safety climate is a focus on nurse’s health and safety. Nurses working in hospitals have one of the highest rates of work-related injuries, especially back injuries and needlesticks. One major shift in an organization’s safety climate is the move from a punitive and reactive culture to a fair and just culture. In a fair and just culture, expectations for system and individual learning and accountability are transparent.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. What drivers of change are impacting nursing care? (Select all that apply.) a. Transparent communication b. Overabundance of nursing staff c. Evidence-based practice d. Information technology e. Reduced acute care needs ANS: A, C, D

An explosion in information technology capacity is altering the speed and transparency of communication and information delivery. The impact of a nursing shortage, increased demand for nursing care, and the drive to incorporate evidence-based practice are changing the face of nursing care.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Why is it important for nursing staff to have insight into the culture of their unit? (Select all

that apply.) a. So they can understand religious practices b. To allow time for peers to access the Internet more often

c. To enable nurses to understand staff behaviors d. To improve staff communication e. To allow nursing staff insight into expectations and norms ANS: C, D, E

Nurses’ insight into culture enables them to better understand staff behaviors and relationships, norms, change processes, expectations, and communication.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. Researchers study organizational climate in order to examine how the work environment

influences behaviors. Which of the following characteristics are utilized to study climate?

(Select all that apply.) a. Supervisor support b. Unit staffing and its effect on incident reporting c. Autonomy d. Peer cohesion e. Rewards and recognition ANS: A, C, D, E

Some characteristics that are used to study climate are decision making, leadership, supervisor support, peer cohesion, autonomy, conflict, work pressure, rewards, feeling of warmth, and risk.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Nursing Diagnosis MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Hospitals and long-term care facilities wishing to achieve Magnet Recognition Program

must meet which of these components? (Select all that apply.) a. Transformational leadership b. Incident reporting c. New knowledge d. Actual staffing ratios e. Empirical outcomes ANS: A, C, E

Today, hospitals and long-term care facilities wanting to achieve Magnet Recognition Program status must meet five key components identified by the ANCC: transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovations, and improvements; and empirical outcomes.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. Which of the following statements reflects just culture within an organization? (Select all that

apply.) a. Just culture is a punitive reaction to patient errors. b. Just culture occurs when the organization is transparent about its mistakes.

c. Interpersonal learning is balanced with personal accountability and discipline. d. Expectations for system and individual learning are apparent. e. Serious safety events are reported to senior leadership and kept confidential.

ANS: B, C, D

In a just culture, organizational, individual, and interpersonal learning are balanced with personal accountability and discipline. In a fair and just culture, expectations for system and individual learning and accountability are transparent. The organization freely discusses mistakes with the intention of learning from them.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Chapter 04: Managerial Decision Making Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. What is the definition of the process of making choices that will provide maximum benefit? a. Critical thinking b. Problem solving c. Decision making d. Leading ANS: C

Decision making is the process of making choices that will provide maximum benefits.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. A patient has arrived at the critical care unit with a head injury. On admission, the patient is

talking and is a little drowsy but oriented. Two hours later, the nurse discovers that the patient is talking at a rapid pace and keeps repeating his words. When the nurse recognizes the change and deploys the rapid response team and physician, which skill is being demonstrated? a. Leadership b. Clinical judgment c. Clinical decision making d. Management ANS: B

The competent nurse uses the information about head injury, change in mental status from talking and drowsy but oriented to talking at a rapid pace, and the potential for the patient to deteriorate to discern that the patient is experiencing cerebral edema or increased intracranial pressure. The nurse is demonstrating clinical judgment, which is the interpretation of the information of patient problems and needs.

DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Which of these concepts is key to refining clinical judgment capabilities? a. Critical judgment b. Reflection c. Management experience d. Nursing expertise ANS: B

Reflection is key to refining the capabilities of clinical judgment. As a nurse gets more experience, the intuitive component of judgment follows. Nurses do not require management experience or nursing expertise to refine clinical judgment.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. A staff RN is leading a quality improvement team on the care of the total hip replacement

patient. The issue is an increased length of stay from 1 year ago. The nurse asks team members to reframe the problem statement from their perspective. Twenty different problem statements were developed. The team is focusing on four of the problem statements. This is an example of which of the following techniques? a. Decision making b. Evaluating the consequences c. Inclusive judgment d. Problem processing ANS: A

Decisions are made following the basic problem-solving process but also involve an evaluation of the effectiveness of outcomes that result from the decision-making process itself.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. How is decision making at the staff nurse level exemplified? a. The staff nurse adapts to a challenging patient assignment. b. The staff nurse refers issues to the performance improvement committee. c. The staff nurse accepts the status quo. d. The staff nurse questions current practice and refers to unit leadership for change.

ANS: A

Decision making is the process of making choices from several courses of action in order to solve problems. The process of selecting one course of action from alternatives forms the basic core of the definition of decision making. The staff nurse who adapts to a challenging patient assignment is using decision making to affect the quality of patient care delivered.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. What is the final step in the clinical reasoning process? a. The right cues b. The right patient c. The right reason d. The right time ANS: C

There are five steps for clinical reasoning, which involves five rights: the right cues or clinical data, the right patient or setting priorities, the right time or capability of identifying high risk patients, the right action or clinical decision that results from the clinical reasoning process, and the right reason. The right reason incorporates legal and ethical considerations.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

7. A nurse manager has ordered equipment for a new unit. The company has sent two notices

that the equipment is on back order. The nurse manager is debating whether to wait for the equipment on back order or to cancel the order and go with another company. She discusses this issue with another nurse manager and they determine that the equipment is urgent for patient safety in the new unit. The manager orders the necessary equipment from another company even though it is slightly more expensive. This is an example of a. clinical decision making. b. prioritization. c. triage decision. d. clinical reasoning.

ANS: B

Prioritization occurs not only in triage situations, but also across the care spectrum. Thus decisions have to be made regarding what care has to be delivered and when the care is to be delivered. All nurse managers and leaders need to consider the implications of their decisions.

Each decision made involves financial, ethical, and human resources. Furthermore, reimbursement and other regulations must be taken into account.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. The nurse in a medical-surgical unit is working short-staffed due to a sick call. Which of these

is an example of prioritization? a. Charting by exception b. Omitting personal hygiene in favor of timely medication administration c. Timely medication administration without scanning the patient armband d. Deploying a rapid response team when a patient condition changes ANS: B

Prioritization occurs not only in triage situations, but also across the care spectrum. Thus decisions have to be made regarding what care has to be delivered and when the care is to be delivered. For example, nurses implicitly make decisions to ration care when time and staffing are short. On a day-to-day basis nurses must decide if such things as routine hygiene activities are omitted in favor of administering critical treatments, including medications.

DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. A family member of a patient files a complaint that her mother’s dentures were lost when the

patient was transferred from one unit to another. The risk management department interviews the patient and the staff nurses who cared for the patient. Which of the following problem-solving techniques was used? a. Delegation b. Direct intervention c. Indirect intervention d. Purposeful inaction ANS: B

The focus of leadership and management decision making is more closely related to the nurse’s role as care coordinator and systems problem solver. Some decisions, such as those requiring disciplinary action, do require the manager’s direct intervention.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Basic Care and Comfort 10. Which of the following scenarios is an example of clinical reasoning? a. A nurse ignores a client’s requests to stop his dialysis. b. A nurse is scheduled to work over the weekend, and she has a family outing to

attend. c. A nurse is counseling a woman with breast cancer about terminating her pregnancy

and receiving chemotherapy or completing the pregnancy and possibly not surviving. d. A nurse has been offered an exciting new position with a dramatic increase in salary, but she would have to move out of state, away from her ailing parents.

ANS: C

Clinical reasoning is the process of analyzing and synthesizing both objective and subjective cues about patients. There are five defined steps for clinical reasoning. They stated that clinical reasoning involved five rights: the right cues or clinical data, the right patient or setting priorities, the right time or capability of identifying high risk patients, the right action or clinical decision that results from the clinical reasoning process, and the right reason. The right reason incorporates legal and ethical considerations. For example, the clinical process may lead a nurse to recommend that a patient needs respiratory support in the form of a ventilator. However, the patient may have an advance directive that would cause the clinician to make a different decision.

DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. Nurses working on the intermediate care unit have had many hours of overtime in the last 6

months. Before forming a team, the nurse manager gathers data about patient condition severity, staffing ratios, educational levels of staff, and personality mixes on each shift. What level of decision making is this process? a. Establishment of solution evaluation criteria b. Evaluation of the alternative solutions c. Identification of a problem, issue, or situation d. Search for alternative solutions or actions ANS: C

Data should be collected to identify properly the actual problem, issue, or situation. The five core elements to decision making are the following: (1) identification of a problem, issue, or situation; (2) establishment of the criteria to be used to evaluate potential solutions; (3) search for alternative solution or actions; (4) evaluation of the alternative; and (5) selection of a specific alternative.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. How is SBAR used in decision making? a. Prevents cognitive errors b. Data management tool c. Financial tool d. Effective communication technique ANS: D

SBAR is a communication technique that helps members of the health team communicate effectively so that appropriate decisions can be made. Because hands-off communication is so crucial to decision making about patient care, SBAR is used to clarify and organize essential but complex patient care information.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. The nursing education department is revising its orientation curriculum for nurse externs. The

curriculum includes a module on clinical reasoning skills. What is the expected time frame for mastery of clinical reasoning? a. Nurse externs should master clinical reasoning within 6 months. b. Clinical reasoning is mastered in nursing school. c. Clinical reasoning is never mastered. d. Clinical reasoning is a career-long process.

ANS: D

Clinical reasoning is a career-long development process. This process must carry over from skills learned during a nurse’s education to the workplace. Nurse residency programs are one way to help newly licensed nurses develop their clinical decision-making abilities.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. The decision support department has been asked to create balanced scorecards for each

nursing unit. Nurse managers work with decision support on the data elements which will be useful in assessing financial, quality, and other measures in order to improve what? a. Staff turnover b. Organizational performance c. Physician satisfaction d. Reimbursement ANS: B

Managers in particular can use the data to develop a balanced scorecard that assesses financial, quality, and other operational performance measures. This scorecard should be available to all staff so that organizational performance can improve.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care

15. An intravenous infusion center is considering switching intravenous pumps to another vendor.

A team of nurses is gathered to examine the benefits and uses and to conduct a cost analysis of various intravenous pumps. After thoroughly reviewing the data and piloting several intravenous pumps, the team votes to determine which pumps to use. The nurses selected the pump which provides them with the most safeguards for safe infusion delivery. Which type of decision-making tool was used in this process? a. Simulation b. Pilot project c. Data analytics d. Evidence informed ANS: D

All nurses are familiar with evidence-based practice for clinical standards of practice. In the management realm, using evidence to make decisions is as important as is using evidence for clinical decisions.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies 16. A long-term care facility has been busy for several months with patients who have a very high

acuity. Nurses have been working double shifts. The nurses have been given the task of determining whether they would like to implement an on-call program and determine guidelines for implementation, if most nurses believe that it is the best solution. This example depicts which type of decision-making tool? a. Pilot project b. Simulation c. Shared governance d. Data analytics ANS: C

Shared governance is an organizational structure that promotes empowerment and autonomous decision making at the point of care, accountability that is shared among all parties in a decision, and organizational processes that promote an egalitarian environment in decision-making processes.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 17. A multidisciplinary team makes a decision to develop a plan for the use of thrombolytics in

the emergency medical service system. Questions are asked such as, “Is the client a candidate for thrombolytic therapy? Does the client have a history of gastrointestinal bleeding? Has the client ever had a stroke? Does the client have any bleeding disorders?” Which of the following decision-making strategies would work best in this situation? a. Fishbone diagram b. Decision tree c. Flowchart d. Data analytics ANS: B

Diagrams such as decision trees can be invaluable in understanding complicated alternative solutions. These diagrams are useful in assessment and problem definition and in considering the available alternatives for dealing with a problem. Once the alternative is chosen, a plan must be formulated for implementing the approach chosen. The choice implemented must be evaluated.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 18. A team consisting of preoperative, operative, and postoperative health care professionals and

ancillary staff is examining the turnaround time from the preoperative area to discharge for patients having tonsillectomies. The goal is to decrease waiting times for clients. The team comes up with a solution and wants to test it on a small group of patients before rolling it out to the rest of the department. What type of decision-making tool is exhibited? a. Shared governance b. Evidence informed c. Pilot project d. Trial and error ANS: C

Pilot projects are critical for implementation for evidence-informed decision making. Pilot projects or carefully defined trials are used to experiment by trying out a solution alternative on a small or restricted basis to reduce risk and to see whether major problems will occur.

Pilot project strategies may resemble research projects, and these projects may also be linked to quality improvement initiatives.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 19. Which of these clinical decisions poses the greatest risk for committing an error? a. Verifying medication dose prior to administration b. Charting by exception c. Prioritizing patient care activities d. Independent interpretation of a medication order ANS: D

Medication administration involves many decisions. In order to protect the patient, the nurse must deliver medications safely while managing the environment in order to preserve safe medication administration. Medication administration involves decisions regarding managing distractions, interpreting orders, and documenting errors and near-misses.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 20. The nurse manager is dealing with a situation between two nurses who disagree on patient

assignments. The nurse manager decides to allow the two nurses to work out their differences between themselves because the patient needs and the needs of the unit are being met. After the situation is resolved, the nurse manager praises the two nurses for making autonomous decisions about staffing. What will be the likely outcome of praising the nurses in this situation? a. Higher job satisfaction

b. Lower job satisfaction c. Lower patient satisfaction d. Increased staff turnover ANS: A

A nurse manager’s leadership style may affect how decisions are made throughout the organization. Decisions about the safety culture are a part of a nurse manager’s role. A transformational leadership style contributed to a positive safety culture. Praising employees affects a nurse’s job satisfaction.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 21. Effective managers utilize a wide array of data in making decision. Which of these techniques

is used to build process improvement models? a. Incrementalism b. Scenario planning c. Six Sigma d. Budgetary model ANS: C

Six Sigma is a quality and decision support technique that uses data to build process improvement models. The goal is to eliminate defects in safety and quality in health care delivery (American Society for Quality Improvement, n.d.). Essentially Six Sigma is a variant of the plan-do-study-act (PDSA) cycle promoted by the Institute for Healthcare Improvement.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Nurse managers in patient care areas must manage staffing on a daily basis. The degree of

work needed for any patient is known as nursing intensity and includes which of these other variables? (Select all that apply.) a. Severity of illness b. Complexity of patient’s condition c. Amount of time needed with patient d. Complexity of care e. Patient’s dependency ANS: A, C, D, E

The degree of work needed for any patient is called nursing intensity and is a combination of the severity of illness, the patient’s dependency, the complexity of care, and the amount of time needed. The need-severity (physical and psychological) is called patient acuity, which is a rating of the complexity of the patient’s condition.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. Two cognitive processes that nurses use in clinical reasoning include (Select all that apply.)

a. b. c. d.

education. acuity. staffing ratios. experience.

ANS: A, D

Clinical reasoning is the process of analyzing and synthesizing both objective and subjective cues about patients. The nurse’s level of analysis is influenced by experience and education.

DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Utilizing the DECIDE acronym for the process of decision making, what are the first and final

steps in the process? (Select all that apply.) a. Develop and implement an action plan for problem solution. b. Establish criteria for what you want to accomplish. c. Define the problem and determine why anything should be done about it. d. Evaluate the decision through monitoring, troubleshooting, and feedback. e. Determine the best choice or alternative.

ANS: C, D

The first step in the decision-making process using DECIDE is to define the problem and determine why anything should be done about it and explore what could be happening. The final step in the process is to evaluate the decision through monitoring, troubleshooting, and feedback.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. A client becomes confused after surgery. He is in a room farthest away from the nurses’

station. The client tries to get out of bed several times during the shift. The nurse informs the physician and obtains an order for soft restraints. In addition she moves the client close to the station and assigns a sitter to watch him. Which of the following did the nurse utilize? (Select all that apply.) a. Clinical judgment b. Clinical decision making c. Autocratic decision d. Financial decision ANS: A, B

Clinical judgment and clinical decision making were utilized in determining the measures that would promote patient safety and prevent a fall.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 5. Which of the following are examples of formal decision-making tools? (Select all that apply.) a. Shared governance b. Anchoring c. Pilot projects

d. Evidence-informed decision making e. Simulation ANS: A, C, D, E

Examples of formal decision-making strategies include shared governance, the use of pilot projects, evidence-informed decision making, and the use of simulation.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Chapter 05: Managing Time and Stress Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. a. b. c. d.

is defined as the accomplishment of specified activities during the time available.

Stress Mismanagement of resources Time management Self-management

ANS: C

Time management is defined as the accomplishment of specified activities during the time available. It is the process of managing the things an individual does with his or her available time. At its core, time management is self-management.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. Nurses who are successful at time management a. display an ability to set measurable goals and objectives. b. frequently volunteer for new and creative projects. c. hesitate to delegate because of perfectionist characteristics. d. tend to accomplish specific activities within a time frame.

ANS: D

Time management is accomplishing specific activities during the time available. It is a process of managing the things an individual does with his or her available time.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Jay, a nurse in the intensive care unit, has been caring for a patient with end-stage renal

disease, congestive heart failure, and a stroke. The client has had four cardiac arrests in 4 days. Despite the grave prognosis, the client’s family continues to want resuscitation at all cost. Jay knows that further medical care is futile. Jay is at risk for a. confrontational conflict. b. resilience. c. burnout. d. moral distress.

ANS: D

Moral distress is linked to issues related to patient care, including ethical dilemmas that can put professionals in difficulty and give rise to feelings of unease. It occurs when an individual knows what ethical action should occur but is prevented from doing so by either internal or external barriers.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity: Physiological Adaptation

4. Nurses who must manage unplanned and regular responsibilities simultaneously may

experience a. complexity compression. b. resilience. c. moral distress. d. empowerment.

ANS: A

When unexpected conditions are added to regular responsibilities, nurses may experience what experts call complexity compression, which has been linked to burnout, turnover, and other types of work-related stress. Nurses experience this when they must manage unplanned (complexity) and regular responsibilities simultaneously (compression).

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Creating a safe, empowering, and satisfying work environment can be accomplished through

implementation of a. Institute of Medicine Coalitions. b. health care reform. c. the Troubled Asset Relief Program. d. Healthy Work Environment (HWE) standards.

ANS: D

A Healthy Work Environment (HWE) is one that is safe, empowering, and satisfying. The American Association of Critical-Care Nurses (AACN) has established six standards that support Healthy Work Environments. Although developed for nurses, they are applicable for all types of employees.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. A staff nurse has a concern about a co-worker who may be diverting medications. The staff

nurse would like to report the concern to a supervisor, but she is fearful of retaliation from her colleagues. The staff nurse knows that the ethical thing to do is report the concern for the sake of patient safety. This nurse is experiencing a. stress. b. procrastination. c. moral distress. d. burnout.

ANS: C

Moral distress occurs when clinicians know what is the ethical action to take, yet are prevented by either external or internal obstacles. Moral distress will contribute to stress and eventual burnout if the staff nurse does not take action.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential

7. An internal obstacle that may contribute to moral distress is a. lack of resources. b. lack of confidence. c. lack of structure. d. lack of processes.

ANS: B

Moral distress occurs when an individual knows what ethical action should occur but is prevented from doing so by either internal or external barriers. Internal obstacles include personal characteristics such as fear or lack of confidence. External obstacles include a lack of resources, structures, or processes that prevent taking the desired and right action.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. A new nurse manager is provided with a smartphone in order to efficiently manage her time.

What is the most effective method of managing stress related to e-mail? a. Create an auditory cue that alerts the manager to incoming messages so they can be processed immediately. b. Set aside time during meetings to read and respond to messages. c. Schedule blocks of time to tackle e-mail. d. Delete e-mails that require a lengthier response.

ANS: C

Time management will not be effective if the manager is expected to respond to messages as soon as they arrive. Managers can set a rule to check e-mails two to three times per day rather than constantly and should use a sorting a flagging methodology to effectively manage the need for follow-up. Managers should not utilize meetings in order to read and respond to messages.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. The first critical step in creating an environment to prevent and address work-related stress is a. delegation. b. motivation. c. innovation. d. intention.

ANS: D

To prevent and address work-related stress, creation and innovation are needed. A creation is something new that did not previously exist in that form and occurs in a multitude of fields.

Experts who study creativity may differ on the requisite attributes of creative individuals and exact steps in the creative process. However, most agree that intention is the critical first step.

Without intention, no action is ever taken.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Knowledge MSC: Client Needs: Safe and Effective Care Environment: Management of Care

10. Nurse managers are in a position of impacting the stress levels of employees through

improving work environments and creating a culture of enhanced staff satisfaction. Having structures and processes in place to prevent work-related stress from happening in the first place requires a. genuine intention and corresponding action. b. additional evidence about the human and financial costs of work-related stress. c. more stability in the health care industry. d. decreased demands from payers, consumers, and regulators.

ANS: A

It has always been challenging to secure the necessary resources for prevention, even for patient care. However, failure to do so puts employees at risk, which in turn can jeopardize the lives of patients. It is no longer possible to wait for more evidence about the human and financial costs of work-related stress. Waiting for more stability in the industry, which may never come, wastes precious time. Once that is embraced and there is genuine intention, then design and creation can begin in earnest.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. There is evidence of a link between

employees with higher productivity and more

satisfied customers. a. stressed b. empowered c. financially focused d. creative ANS: B

Employees who are empowered in their jobs are also more engaged and satisfied. Research indicates that structural empowerment leads to higher productivity and satisfaction for the employee, which translates to more satisfied customers.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. Nurses on the midnight shift are experiencing difficulty with receiving materials from the

central supply department. Last night a patient was admitted to the unit from the emergency department with a heart dysrhythmia. The nurse requested that a temporary pacemaker kit be placed in the unit as a standby in case the patient required its use. The central supply unit did not comply until the patient required its emergent use. The nurse was stressed. This is an example of which type of stress? a. Job stress b. Overload of role c. Moral distress d. Role conflict ANS: A

Job stress is a tension that arises related to the person-in-environment demands of a person’s role or job. Job stress, or “disquieting influences,” can accumulate into levels that are too high, reach the point of burnout, and manifest as emotional and/or physical exhaustion and lowered job productivity.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. When a nurse leader is able to fully embrace the American Association of Critical-Care

Nurses’ (AACN’s) Healthy Work Environment and engage others in its achievement, what is the leader demonstrating? a. Authentic leadership b. Meaningful recognition c. True collaboration d. Skilled communication ANS: A

The nurse leader is demonstrating authentic leadership when he or she is able to embrace and model the AACN’s Healthy Work Environment.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. A new nursing manager is falling behind on the staffing schedule, the monthly budget, and

employee evaluations. She says to her director, “I’m working 60 hours per week and I still don’t have enough time to do it all.” The nursing director suggests which of the following to her? a. Setting priorities b. Obtaining additional preceptoring c. Scheduling blocks of time for each activity to be accomplished d. Giving up management and returning as a regular staff nurse ANS: C

Time management involves a deliberative process of identifying, focusing, and completing activities needed to accomplish specific tasks and achieve goals. Blocking time to get tasks done is a strategy that can be used to for time management at work.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Nursing Diagnosis MSC: Client Needs: Safe and Effective Care Environment: Management of Care 15. In setting boundaries it is important to do which of the following? a. Set rigid boundaries. b. Set boundaries based on individual needs. c. Consider where one is in the lifespan when setting boundaries. d. Set boundaries even if it produces more stress than not having boundaries at all.

ANS: B

Boundaries need not be exceedingly rigid and may change over time. Boundaries should be set based on individual needs, not gender, stereotypes, or even where someone is on the lifespan. The most important thing is that setting them should not induce more stress on the individual than not having them at all.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 16. A nurse manager has several complaints from her staff that she is inaccessible during the day.

What is the best strategy the nurse manager takes to improve her staff satisfaction? a. Notify staff when she will be out of the office. b. Block time for daily rounds with staff. c. Set realistic follow-up deadlines for staff issues, questions, and concerns. d. Ask the staff to communicate with her through their supervisors.

ANS: B

Blocking time to round with staff is the best way the nurse manager can be on the unit and visible to her staff. Notifying staff when she is out of the office, setting realistic deadlines for following up with issues, and delegating certain activities to the supervisors are good time management strategies, however they don’t address the staff’s issue of not seeing her.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Definitions of stress are (Select all that apply.) a. a negative emotional experience that is associated with biological changes that

trigger the body to make adaptations. b. the accomplishment of specified activities during an available time period. c. a physical, mental, psychological, or spiritual response to an experience. d. a response that is evaluated by the individual as a threat to one’s sense of well-being.

ANS: A, C, D

Stress is a negative emotional experience associated with biological changes that trigger the body to make adaptations. It can be a physical, mental, psychological, or spiritual response to an experience that is evaluated by the individual as a threat to one’s sense of well-being.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. Which of the following responses may occur related to stress? (Select all that apply.) a. Increased heart rate b. Decreased blood glucose levels c. Emotional exhaustion d. Burnout e. Chronic health conditions ANS: A, C, D, E

Stress has a variety of induced changes, including increases in heart rate and blood glucose levels, emotional changes, and burnout, and it can lead to acute and chronic health problems.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Which of the following statements are true regarding job stress? (Select all that apply.) a. Job stress is related more to external demands that are brought into the workplace. b. Job stress can lead to burnout. c. Job stress is manifested as emotional and/or physical exhaustion. d. Job stress increases productivity. e. Levels of job stress that are too low or too high decrease individual productivity.

ANS: B, C, E

Job stress is a tension that arises related to the environmental demands of a person’s role or job. Job stress can accumulate to levels that are too high, reach the point of burnout, and manifest as emotional and/or physical exhaustion. Levels of job stress that are too low or too high decrease individual productivity.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. What are some methods that nursing staff can use to manage personal stress levels? (Select all

that apply.) a. Take personal time each day. b. Take on extra shifts to keep the mind occupied. c. Get enough sleep. d. Pay attention to diet and exercise. e. Have a strong support network of friends and family.

ANS: A, C, D, E

While stress management is unique to each person, some of the tools that may be effective include taking personal downtime each day, getting enough sleep, eating right, exercising, and having a strong network of friends and family for support.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. What are some potential reasons that nurses experience higher levels of stress? (Select all that

apply.) a. Nurses are skilled at setting boundaries. b. Nurses often put others’ needs ahead of their own. c. Staff nurses are under pressure to do more with less. d. There are support staff cuts. e. There are fluctuations in staffing levels.

ANS: B, C, D, E

Staff nurses are under constant pressure to do more with less, and this can cause professional and personal stress for staff as well as managers. Support staff have been cut, jobs are fewer, and staffing levels fluctuate. Nurses may have a difficult time dealing with stress, because they often put others’ needs ahead of their own and need to be able to create healthy boundaries.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Nursing Diagnosis MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. Managers have a key role in mitigating stress in the workplace. Which strategies will assist

the manager in creating a more healthy work environment? (Select all that apply.) a. Recognize nurses for the value they bring to the organization. b. Partner with the nursing staff to make policies and lead organizational operations. c. Keep information confidential regarding safety concerns or initiatives. d. Ensure staffing is an effective match between patient needs and nurse competencies. e. Ensure that the manager maintains responsibility for all aspects of unit functioning.

ANS: A, B, D

A healthy work environment (HWE) is one that is safe, empowering, and satisfying. Nurse managers can foster an HWE by recognizing nurses for the value they bring to the organization, partnering with the nursing staff to make policies and lead organizational operations, and ensuring that staffing is an effective match between patient needs and nurse competencies.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. Conflict and stress in the workplace can be managed through building relationships.

Organizations can foster the building of relationships through (Select all that apply.) a. social media. b. informal social gatherings. c. mentoring. d. confidential meetings.

ANS: A, B, C

Building relationships can be fostered in organizations by formal and informal social gatherings, mentoring, social media, and deliberate culture creation. Perceived supportive work environments are characterized by perceptions that supervisors are supportive, there is fairness, and there is open communication. Stress is reduced when nurses feel that win-win solutions occur in the work environment.

DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Job stress can accumulate into (Select all that apply.) a. better time management skills. b. feelings of elation. c. burnout.

d. physical exhaustion.

ANS: C, D

Chronic stress can lead to acute and chronic health problems. Job stress is a tension that arises related to the person-in-environment demands of a person’s role or job. Job stress, or “disquieting influences,” can accumulate into levels that are too high, reach the point of burnout, and manifest as emotional and/or physical exhaustion and lowered job productivity.

Levels of job stress that are too low or too high decrease individual productivity.

DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 9. A staff RN is writing an article for a prestigious nursing journal. The deadline is in 1 week,

and she is feeling overwhelmed about completing her work. She is unable to keep up with home management, and she is beginning to procrastinate on the project. She also has other responsibilities, such as taking her elderly mother grocery shopping and to health care appointments. She is married to a busy executive and has three children, all of whom are active in high school sports. Which of the following stress management strategies would be helpful? (Select all that apply.) a. Schedule “think time” appointments at least once a week for a block of time; get out of the office for these times. b. Bring a water bottle to work and refill as needed to keep hydrated. c. Cut extra activities out of her schedule, such as her morning walk. d. Create a “getaway” place at work where she can spend a few minutes in silence and thought.

ANS: A, B, D

Scheduling “think time” appointments and spending a few minutes in silence can help her clear her mind and regroup. Keeping hydrated will help keep energy levels up. Exercise is important to help the nurse deal with stress and would not be wise to delete from her schedule, if possible.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. Max is a nurse on the 7 PM to 7 AM shift on the orthopedic floor. He is the most experienced

nurse on the unit during this shift, with 6 years of nursing experience. Max usually acts as charge nurse during his shift while caring for a group of patients. Recently there has been an influx of new graduates working on his shift. Some nights, he is expected to orient a new nurse, act as the charge nurse, and mentor other new nurses working on the floor. He is concerned that with all the new nurses, there are not enough mentors for all of them, resulting in less-than-optimal care delivery. Which factors have been shown to decrease stress for nurse leaders? (Select all that apply.) a. Support from others b. Autonomy c. Predictability d. Transparency ANS: A, B, C

High stress is experienced by nurse leaders and stems from the challenges of a multifaceted job with myriad sources of stress. Having support from others (e.g., supervisors, comanagers, and coworkers) is a factor that decreases stress. The amount of autonomy and predictability in the job mitigates the negative effects of stress as well.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Chapter 06: Role Management Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. The process for a nurse to direct another person to perform nursing tasks and activities is a. authorization. b. delegation. c. empowerment. d. supervision.

ANS: B

In their Joint Statement on Delegation (NCSBN, 2005b), the ANA and the NCSBN defined delegation in nursing as “the process for a nurse to direct another person to perform nursing tasks and activities.”

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. The provision of guidance or direction, evaluation, and follow-up by the licensed nurse for

accomplishment of a nursing task delegated to unlicensed assistive personnel (UAP) is a. authorization. b. delegation. c. observation. d. supervision.

ANS: D

Supervision is the provision of guidance or monitoring of a delegated nursing task. It may occur in a variety of ways, including written and verbal communication (such as giving or receiving reports), observation of the performance of the delegated task, or assessing the patient for evidence that the delegated task has been completed successfully.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Individuals who are trained to help the registered nurse (RN) in the provision of patient-client

care activities as delegated by and under the supervision of the RN are known as a. certified assistive personnel. b. health care assistive personnel. c. medical assistive personnel. d. unlicensed assistive personnel.

ANS: D

The NCSBN (2016) defined unlicensed assistive personnel (UAP) as any unlicensed personnel trained to function in a supportive role and to whom a nursing responsibility can be delegated.

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

MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. When considering whether to delegate a task, the nurse needs to assess the patient and a. how many nurses are available to supervise. b. how complex the delegated action is. c. the severity level of the patient population. d. the expiration date of the license.

ANS: B

When considering whether to delegate a task, the nurse needs to assess the patient and determine whether the action delegated is complex or if the plan of care of the patient could change rapidly (Catalano, 2015).

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. According to the American Association of Critical-Care Nurses, there are five factors that a

nurse should assess when making a decision to delegate nursing tasks. These factors are assessing the potential for harm, the complexity of the task, the amount of problem solving and innovation required, the unpredictability of the outcome, and the a. amount of time that the task will take. b. degree of comfort the delegatee has with the task. c. level of patient interaction. d. method of measuring outcomes.

ANS: C

The level of patient interaction is the fifth factor that nurses should assess when making delegation decisions.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. The five rights of delegation are right task, right circumstance, right person, right direction

and communication, and right a. interaction. b. outcome. c. supervision. d. time.

ANS: C

The delegation process, as outlined by the ANA/NCSBN joint statement and the NCSBN national guidelines, begins with the preparation/assessment phase and then goes on to outline a five-step process. These steps are (1) the right task, (2) under the right circumstance, (3) to the right person, (4) with the right directions and communication, (5) under the right supervision and evaluation.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

7. If an error occurs as a result of delegation, the nurse is accountable for supervision, follow-up,

intervention, and a. corrective action of the event. b. documentation of the event. c. evaluation of the process. d. summation of the occurrence.

ANS: A

The nurse is also responsible for corrective action in case of an error.

DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. The nurse has asked a nurse’s aide to greet a postoperative patient who has just arrived on the

unit and to determine whether he is in stable condition. This act of delegation is an example of a nurse inappropriately delegating a. assessment of the patient. b. evaluation of an intervention. c. nursing judgment. d. teaching to a delegate.

ANS: A

The RN is responsible for assessment, evaluation, and nursing judgment, and should not delegate these professional responsibilities.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. If a licensed practical/vocational nurse (LPN/LVN) provides discharge teaching as part of

routine role, who is ultimately responsible? a. Chief executive officer b. Institution where the LPN/LVN works c. Risk manager d. UAP ANS: B

Organizational leadership in building the skills related to delegation enhances individuals and builds high-performing teams, as well as enhancing team member awareness of roles and responsibilities and their individual capabilities and limitations. The organization is accountable for the delegation processes in place and for upholding values of safe patient care and staff development.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. Being answerable to oneself and others for one’s own choices, decisions, and actions as

measured against a standard is a. accountability. b. authority. c. supervision.

d. delegation.

ANS: A

The National Council of State Boards of Nursing defined accountability as being answerable to oneself and others for one’s own choices, decisions, and actions as measured against a standard.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. Which staff member should be assigned to a dying client who is experiencing symptoms of

emotional distress? a. UAP who can be spared to sit with the client b. LPN/LVN who has grown attached to the family c. RN who has experience as a hospice nurse d. Newly graduated RN ANS: C

The delegation process, as outlined by the ANA/NCSBN joint statement and the NCSBN national guidelines, begins with the preparation/assessment phase and then goes on to outline a five-step process. These steps are (1) the right task, (2) under the right circumstance, (3) to the right person, (4) with the right directions and communication, (5) under the right supervision and evaluation. The right person is the one who has the education and competency to perform the element of care. A hospice nurse has experience in managing symptoms associated with the dying process. This is the best nurse to care for this patient.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity: Physiological Adaptation 12. The charge nurse is making assignments on a surgical unit. Which client should be assigned to

the least experienced nurse? a. Client who had a vaginal hysterectomy and still has an indwelling catheter b. Client who had an open cholecystectomy and has gray drainage in the T-tube drainage tube and bag c. Client who had a hip replacement and stated that something popped while walking d. Client who had a Whipple procedure and is reporting being thirsty all the time ANS: A

The delegation process, as outlined by the ANA/NCSBN joint statement and the NCSBN national guidelines, begins with the preparation/assessment phase and then goes on to outline a five-step process. These steps are (1) the right task, (2) under the right circumstance, (3) to the right person, (4) with the right directions and communication, (5) under the right supervision and evaluation. The right person is the one who has the education and competency to perform the element of care. Options b, c, and d indicate the possibility of postoperative complications, but option a does not. The least experienced nurse should have the client who is not displaying the possibility of postoperative complications.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care

13. When determining that delegation of an element of patient care needs to occur, the nurse

delegates with a clear, concise description of the task, including its objectives, limits, and expectations. The nurse allows the delegate to clarify without fear of repercussion. Which of the following five rights of delegation is being demonstrated? a. Right task b. Right circumstance c. Right person d. Right direction/communication e. Right supervision/evaluation ANS: D

The right direction/communication of delegated elements of care will be a clear, concise description of the task, including its objective, limits, and expectations. The nurse allows for clarification without the fear of repercussions.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. Who is ultimately accountable for the appropriateness and supervision of the delegated task? a. The nurse who delegated the task b. The UAP who accepted the task c. The nursing manager d. The hospital CEO ANS: A

Accountability in delegation means being obligated to answer for one’s actions, including the act of supervision. The nurse is ultimately accountable for the appropriateness and supervision of the delegated task. Thus the nurse may be found liable if found negligent in the process of delegating and supervising. The delegatee is accountable for accepting the delegation and for the actions in carrying out the delegated task.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 15. Delegating requires clear and skillful a. negotiation b. communication c. corrective action d. planning

to avoid liability.

ANS: B

Delegating requires skillful written and verbal communication to avoid liability. If an activity is not documented, it is considered that it was not done. Clear documentation of assignments and additional clarification of the delegated tasks for each health care team member are required when delegating.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

16. The nurse manager determines that communication style is contributing to problems with

delegation on her unit. What tool is used to teach principles of communication, leadership, situation monitoring, and mutual support? a. American Nurses Association (ANA) b. Agency for Healthcare Quality and Research (AHRQ) c. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) d. Institute for Healthcare Improvement (IHI) ANS: C

Invariably there will be potential problems as the use of delegation expands in health care.

The nurse leader will need to be aware of techniques to address these potential problems. One such method is the TeamSTEPPS 2.0 (Team Strategies and Tools to Enhance Performance and Patient Safety) program. The framework followed is based on a foundation of team competencies including knowledge, attitudes, and performance. The principles the program abides by include team structure and the teachable principles of communication, leadership, situation monitoring, and mutual support.

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 colleagues would a nurse typically delegate to in the health care

setting? (Select all that apply.) a. Nurse apprentices b. Personal care attendants c. Family members at bedside d. Physicians e. Nursing assistants ANS: A, B, E

Nurses often delegate to unlicensed assistive personnel (UAPs). UAPs include a number of health care disciplines, such as nursing assistants, medical assistants, nurse apprentices, and personal care attendants. A nurse would not delegate to a family member or a physician.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. When making a decision to delegate a nursing task, which of the following factors are

assessed? (Select all that apply.) a. Potential for harm b. Complexity of the task c. Amount of problem solving required d. Predictability of the outcome e. Level of patient interaction ANS: A, B, C, E

In making a decision to delegate nursing tasks, the following five factors can be assessed: potential for harm, complexity of the task, amount of problem solving and innovation required, unpredictability of the outcome, and the level of patient interaction.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. When the licensed nurse makes a determination to delegate a task, which of the following

occurs in the process? (Select all that apply.) a. The nurse assesses the situation and need for delegation. b. A plan for specific task delegation is established. c. The needs of the nurse are considered. d. The nurse determines the available resources and patient safety. e. Accountability is transferred to the manager.

ANS: A, B, D

With the qualifications of both the delegator and the delegatee as a baseline in place, the licensed nurse enters the continuous process of delegation decision making. The situation is assessed, and a plan for specific task delegation is established, considering patient needs, available resources, and patient safety. The nurse needs to ensure accountability for the acts and process of delegation.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. With regard to delegation, what organizational principles are considered? (Select all that

apply.) a. Legal guidelines and policies b. Patient safety and accountability c. Relationship management and patient support d. Cost containment e. Knowledge and education ANS: A, B, E

At the core of the five rights of delegation and the roles of the UAP and nurse are three organizational principles that are present in many health care settings today. These principles include organizational and legal guidelines and policies, patient safety and accountability, and knowledge and education (Craftman et al., 2012).

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. The legal and ethical standards to consider when questioning if delegation is appropriate

include (Select all that apply.) a. accountability. b. good faith. c. cost efficiency. d. reasonable.

e. prudent.

ANS: B, D, E

Nurses are held to a standard of patient care in which they use their expertise, knowledge, and skill in decision making. When considering a questionable situation, the standards of “reasonable,” “prudent,” and “good faith” form the foundations for legal and ethical decision making.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. Which principles are important to consider when an RN delegates tasks to UAP? (Select all

that apply.) a. Tasks are delegated that will challenge the UAP to use critical thinking. b. Assess the condition and stability of the patient. c. Delegate tasks that are within the expertise of the RN, particularly if the UAP is a student. d. Evaluate the complexity of the task. e. Determine the potential for harm to the patient.

ANS: B, D, E

When considering whether to delegate a task, the nurse needs to assess the patient and determine whether the action delegated is complex or if the plan of care of the patient could change rapidly. In making a decision to delegate a nursing task, the following five factors should be assessed: 1. Potential for harm: The nurse must determine how much risk the activity carries for an individual patient.

2. Complexity of the task: The more complex the activity, the less desirable it is to delegate.

3. Amount of problem solving and innovation required: If an uncomplicated task requires special attention, adaptation, or an innovative approach, it should not be delegated.

4. Unpredictability of outcome: When a patient’s response to the activity is unknown or unpredictable it is not advisable to delegate that activity.

5. Level of patient interaction: It is not advisable to delegate so many tasks that the amount of time the nurse spends with the patient is decreased to the point that a therapeutic relationship cannot be established between the nurse and the patient (AACN, 2004, p.10).

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. A unit manager is utilizing her staff as a resource for educational presentations. An RN in her

unit has been requested to create a PowerPoint on delegation and supervision. What resources should she include for staff to obtain additional information on delegation and supervision?

(Select all that apply.) a. State nurse practice act b. Organization’s policies and procedures c. The Joint Commission (TJC)

d. American Nurses Association (ANA) e. Board of Registered Nursing ANS: A, B, D, E

Nurses are accountable for following their state nurse practice act, standards of professional practice, policies of the organization, and ethical-legal models of behavior. The ANA and each state’s board of nursing regulate nursing practice.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Which of the following are the responsibilities of the delegatee in a situation? (Select all that

apply.) a. Corrective action b. Own acts c. Accepting the delegation d. Appropriate notification and reporting e. Accomplishing the task ANS: B, C, D, E

The delegatee accepts accountability for his or her own acts, accepts the delegation, uses appropriate notification and reporting, and accomplishes the task.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. Leadership style may be a significant barrier to effective delegation. Which of the following

describes the “invincible” style? (Select all that apply.) a. Prefers to do everything themselves so as not to transfer control. b. Wants to be everyone’s friend. c. Comes across as a pushover. d. Often stays late to complete documentation. e. Micromanages the UAP. ANS: A, D

Many nurses fall into the “invincible” nurse style; they prefer to do everything themselves so as not to risk delegating to the UAP or transfer some control to someone else. This nurse often stays late after the shift completing documentation and may miss some cares that should have been completed due to trying to do everything him- or herself. The “pal” is the nurse who wants to be everyone’s friend. These nurses do not want to be viewed as pushy or demanding.

This type of delegator may come across as a pushover to the UAP. The “watchdog” nurse views delegation as a real risk and is constantly monitoring and micromanaging the UAP to the point that resentment may enter the nurse/UAP team and lead to poor teamwork and outcomes.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

10. The process of delegation may be undermined in the health care setting as one member of the

team moves work in a downward direction. What are some of the reasons for delegatees to resist responsibility? (Select all that apply.) a. Lack of ability to direct b. Fear of criticism for mistakes c. Overwhelming workload d. Lack of confidence e. Lack of resources ANS: B, C, D, E

The delegatee may resist responsibility for a number of reasons, including fear of criticism, overwhelming workload, lack of confidence, and lack of resources.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Chapter 07: Legal and Ethical Issues Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. A staff nurse is facing a dilemma between meeting clinical ethical standards and meeting

organizational goals. The nurse manager understands that the best way to assist staff members in resolving ethical dilemmas effectively is to focus on a. doing the right thing and taking the right action. b. meeting clinical standards before organizational goals. c. meeting organizational goals before clinical standards. d. referring indecisive staff members for additional training.

ANS: A

Although the domain of clinical ethics is the care of clients, the domain of organizational ethics is a facility’s business-related activities. Together, clinical and organizational ethics reflect a health care facility’s concern that, whether related to the continuum of care or the continuum of services related to that care, ethical dilemmas should be resolved based on values-centered principles that focus on doing the right thing and taking the right action.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control 2. One mechanism that ensures autonomy in the nursing profession is the a. American Nurses Association (ANA). b. Department of Health Professionals. c. Nursing Code of Ethics. d. Professional Regulatory Board.

ANS: C

American Nurses Association’s (ANA) Nursing’s Social Policy Statement: The Essence of the Profession indicates competence is foundational to autonomy, with the profession ensuring nursing competence through professional regulation of nursing practice via standards and ethical codes of practice, legal regulation of nursing practice via state licensure requirements and law pertaining to criminal and civil wrongdoing, and self-regulation in which all nurses retain personal accountability for their own practice.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. A nurse manager is evaluating the efficiency of a process on the nursing unit. The manager

believes that the unit could be more efficient if one aspect of this process were delegated to unlicensed personnel. To establish whether the delegation of this duty would be legal, he should check with the a. ANA. b. current federal defense attorney. c. state nurse practice act. d. policy and procedure manual of the unit.

ANS: C

Nurse practice acts exist for each state and govern the legal practice of nursing, including standard of care, delegation, and supervision.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. The major responsibility for upholding patient care standards belongs to the a. chief executive officer of the facility. b. nurse manager. c. on-call physician. d. staff nurse providing patient care.

ANS: B

Nurse managers carry the major responsibility for developing and upholding the standards of care for staff nurses.

DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. The nursing manager has assumed responsibility for ensuring that tasks within her department

are delegated legally and are performed appropriately. In so doing, she has accepted which of the following nursing roles? a. Ethical b. Ombudsman c. Paralegal d. Supervisor ANS: D

Supervision includes monitoring the tasks performed, ensuring that functions are performed in an appropriate fashion, and ensuring that assigned tasks and functions do not exceed competency or require a license to perform.

DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. The court has found that a registered nurse (RN) harmed a patient by violating his rights. The

nurse is ordered to pay the patient a large sum of money. The court has determined that the nurse has committed a a. civil act. b. criminal act. c. critical wrong. d. quality breach.

ANS: A

By definition, civil acts are wrongs that violate the rights of individuals by tort or breach of contract.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Evaluation

MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. The most common source of legal liability for nurse managers is a(n) a. medical malpractice suit. b. organizational nursing issue. c. tort. d. vicarious liability.

ANS: C

In nursing, harm related to clinical practice commonly arises from negligent acts or omissions (unintentional torts) and a variety of intentional acts (intentional torts), such as invasion of privacy or assault and battery.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. On admission, the patient was found to have a blood glucose level of 218. The RN knows that

except in emergency situations, it is hospital policy to obtain physician’s orders before administering any medication. Because the on-call physician did not return the page, the nurse administered insulin according to the common sliding scale. Four hours later, the patient was found nonresponsive in her bed and later died. According to the autopsy, the patient died from heart failure. Her postmortem blood glucose level was 22. The nurse’s actions are an example of a. breach of contract. b. common negligence. c. intentional malpractice. d. medical oversight.

ANS: B

Examples of common negligence allegations in nursing malpractice suits include patient falls, use of restraints, medication errors, burns, equipment injuries, retained foreign objects, failure to monitor, failure to ensure safety, failure to take appropriate nursing action, failure to confirm accuracy of physicians’ orders, improper technique or performance of treatments, failure to respond to a patient, failure to follow hospital procedure, and failure to supervise treatment.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 9. On admission, the patient was found to have a blood glucose level of 218. The RN knows that

except in emergency situations, it is hospital policy to obtain physician’s orders before administering any medication. Because the on-call physician did not return the page, the nurse administered insulin according to the common sliding scale. Four hours later, the patient was found nonresponsive in her bed and later died. According to the autopsy, the patient died from heart failure. Her postmortem blood glucose level was 22. Because of the nurse’s actions, the admitting hospital may be found to be a. a judicial risk. b. an ostensible authority. c. indemnified.

d. vicariously liable.

ANS: D

If a nurse negligently injured a client during the course of and within the scope of employment, not only would the nurse be directly liable for damages, but also the health care organization would be vicariously liable.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 10. On admission, the patient was found to have a blood glucose level of 218. The RN knows that

except in emergency situations, it is hospital policy to obtain physician’s orders before administering any medication. Because the on-call physician did not return the page, the nurse administered insulin according to the common sliding scale. Four hours later, the patient was found nonresponsive in her bed and later died. According to the autopsy, the patient died from heart failure. Her postmortem blood glucose level was 22. Being aware of the hospital policy for medication administration, the patient’s blood glucose level presented the nurse with a(n) a. assessment option. b. clinical choice. c. ethical dilemma. d. moral decision.

ANS: C

Ethical dilemmas require that decisions be made about what is right and wrong in situations in which an individual has to make a choice between equally unfavorable alternatives.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Physiological Adaptation 11. A patient who is not fully informed about his or her health status is an example of a violation

of which ethical principle? a. Autonomy b. Justice c. Utilitarianism d. Confidentiality ANS: A

Autonomy refers to the client’s right of self-determination and freedom of decision making. A patient who is not fully informed is denied the freedom and access to make a decision.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. Which ethical principle is violated when there are insufficient community resources to meet

the needs of low-income families? a. Nonmaleficence b. Autonomy c. Beneficence d. Justice

ANS: D

Justice is the norm of being fair and giving all equal treatment. When low-income families do not get the same community resources as others, justice is not being served.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. “To do good for others” is an example of which ethical principle? a. Nonmaleficence b. Fidelity c. Beneficence d. Confidentiality ANS: C

Beneficence means doing good for clients and providing benefit balanced against risk.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. A new RN is observed breaking sterile technique by the perioperative nurse. This is an

example of a violation of which ethical principle? a. Autonomy b. Justice c. Nonmaleficence d. Confidentiality ANS: C

Nonmaleficence means doing no harm to clients. A break in sterile technique could cause significant harm to a patient by causing an infection.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control 15. A staff nurse came in to work the 7 PM to 7 AM shift. She had met her friends for “happy

hour” earlier in the evening. Her breath smells of alcohol. If this nurse is allowed to provide care for patients, she may be at risk for a. maleficence. b. melange. c. nonmaleficence. d. nonmelange.

ANS: A

Maleficence is doing harm to the patient whether it is intentional or unintentional, such as an omission. If the nurse is intoxicated, she may fail to meet the standard of care.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control

16. The nurse on a medical unit is caring for a 19-year-old with complications from a congenital

heart defect. The client’s mother is consistently at the bedside asking questions and attempting to direct the treatment plan. Which of the following shows how the nurse should communicate with the mother? a. Discuss personal information that the client shared with the nurse in confidence. b. Provide the mother with any information required for continuity of care. c. Explain that client confidentiality prevents the nurse from disclosing information. d. Ask the client if he gives permission for the nurse to share information with the mother.

ANS: D

It is the nurse’s legal and ethical duty to protect the adult “child’s” autonomy and not simply accept a parent’s intervention, without lawful authority, just because it may seem easier at the moment. The nurse must obtain permission from the client before sharing information with the mother.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 17. The definition of veracity is a. being loyal and faithful to commitments and accountable for responsibilities. b. the norm of telling the truth and not intentionally deceiving or misleading clients. c. a prohibition of disclosure of information. d. a right of limited physical or informational inaccessibility.

ANS: B

Veracity is the norm of telling the truth and not intentionally deceiving or misleading clients.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 18. Nurse managers are able to respond better to ethical dilemmas when they have access to the

organization’s a. mission and vision. b. patient safety plan. c. medical staff bylaws. d. ethics committee.

ANS: D

It is critical that nurses and administrators have access to and inclusion on the health care organization’s ethics committee. Nursing professionals are ideal members because of their responsibilities and experiences associated with patient care.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE

1. Which ethical principle is violated when the RN tells the hospital accountant that the patient is

HIV-positive? (Select all that apply.) a. Beneficence b. Veracity c. Confidentiality d. Autonomy e. Fidelity ANS: A, C

Beneficence means “doing good for clients and providing benefit balanced against risk.” The hospital accountant had no need to know; therefore, there was no benefit for the patient for him to be told. Confidentiality prohibits disclosures of information gained in certain relationships to third parties without the consent of the original source of the information.

Without the patient giving express consent, the hospital accountant has no need for this information, and it is a breach of confidentiality.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. An elderly client becomes confused after surgery. He is in a room farthest away from the

nurse’s station. The client has been trying to get out of bed several times during the shift. The nurse documents this very well. The client falls out of bed and breaks his hip. Who can possibly be held negligent? (Select all that apply.) a. Client’s wife b. Nurse manager c. Pharmacist d. Staff RN ANS: B, D

It is possible that the nurse and nurse manager could be held negligent. The nurse could be held negligent for not moving the patient closer to the nurse’s station, calling the physician or nurse practitioner for medications or change in medications, or obtaining an order for a vest restraint. The nurse manager may be held negligent because of 24-hour accountability for the care of patients on his or her unit and possible lack of supervision.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 3. Which of the following are examples of intentional torts that may occur in the health care

field? (Select all that apply.) a. Slip and fall in the hospital cafeteria b. Patient restrained by the neck utilizing the nurse’s arm c. Ovary removal against the patient’s signed consent d. Restraining a patient without a physician’s order e. Hospital-acquired pressure ulcer ANS: B, C, D

Common intentional torts within the health care setting include assault and battery, medical battery, and false imprisonment.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. To establish legal liability on the grounds of malpractice, the injured party must prove which

of the following? (Select all that apply.) a. A duty of care was owed to the injured party. b. An agreement was made to assume another party’s liability. c. There was a breach of duty. d. Causation was present. e. Actual harm or damages were suffered by the plaintiff.

ANS: A, C, D, E

These four elements are required to establish legal liability on the grounds of malpractice.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Which of the following patient-related events may be considered as examples of common

negligence allegations in a nursing malpractice suit? (Select all that apply.) a. Staffing levels in the medical unit b. Patient fall with injury c. Heparin error d. Failure to utilize rapid response team with change in vital signs e. Failure to ensure telemetry monitor is on the correct patient ANS: B, C, D, E

Examples of common negligence allegations in nursing malpractice suits include patient falls, use of restraints, medication errors, burns, equipment injuries, retained foreign objects, failure to monitor, failure to ensure safety, failure to take appropriate nursing action, failure to confirm accuracy of physicians’ orders, improper technique or performance of treatments, failure to respond to a patient, failure to follow hospital procedure, and failure to supervise treatment.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 6. The nurse manager in a large emergency department utilizes agency nursing for staffing.

Which of the following should the nurse manager do to help the facility avoid corporate liability? (Select all that apply.) a. Assume that the agency has reviewed the license status of the individual. b. Ensure that those who report to them remain competent and qualified and have current licensure. c. Report incorrect mixes of staff for effectively meeting the health care needs of clients. d. Assign the staff members to the role of mentor and educator.

ANS: B, C

Nurse managers can help the facility avoid corporate liability by, among other things, ensuring that those who report to them remain competent and qualified and have current licensure. Nurse managers should also report dangerously low staffing levels, incorrect mixes of effective staff, and incompetent, illegal, or unethical practices.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. A Middle Eastern man has just been diagnosed with terminal cancer. The family has asked the

medical and nursing staff to keep this information from the patient because in their culture they are fearful of delivering bad news as it may cause the patient to give up hope. Which ethical principles and dilemmas might be faced by nursing staff? (Select all that apply.) a. Justice b. Autonomy c. Veracity d. Confidentiality ANS: B, C

Autonomy refers to the rights of the patient to participate in decision making. Veracity refers to telling the truth. The nurses caring for the patient may feel that they are not being truthful about the treatment plan and decision-making process in this case.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Professional safeguards that protect the nurse from being wrongfully accused of malpractice

include which of the following? (Select all that apply.) a. Code of Ethics b. Statute of Limitations c. Affidavit of Merit d. Standard of Proof e. Sources of Law ANS: B, C, E

Civil law controls those circumstances when an individual, the plaintiff, feels that he or she has been harmed by another. If the other person is a professional, the law provides for professional liability, also known as malpractice. Professionals are provided with many safeguards to avoid them being wrongfully accused of malpractice. The Statue of Limitations is a statutory time limit (most commonly 2 years) by which a plaintiff must file a lawsuit against a professional or lose that opportunity forever. An affidavit of merit is a sworn document by a like kind of professional (a doctor for a doctor defendant and a nurse for a nurse defendant) who reviews the injured patient’s chart, and, based upon the reviewer’s education and experience, makes a statement that the case has merit and should be permitted to go to trial. Laws are found in case books, as well as online in official reports and legal research services. A reported case is one that can be found in an official reporter. There are state as well as federal reporters. When entered into a reporter, the case is printed and becomes part of the ever-growing body of case law.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Chapter 08: Communication Leadership Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. The process in which information, perception, and understanding are transmitted from person

to person is a. articulation. b. communication. c. evaluation. d. pronunciation.

ANS: B

Communication is the process in which information, perception, and understanding are transmitted from person to person.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. Unspoken affective or expressive behaviors best describe which type of communication? a. Effective communication b. Ineffective communication c. Non-verbal communication d. Verbal communication ANS: C

Non-verbal communication is unspoken. It is composed of affective or expressive behaviors.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. A communication model that focuses on compassion, expression of emotion, and providing

validation via support is the a. validation, emotion, reassurance, activity (VERA) framework. b. situation, background, assessment, and recommendation (SBAR) Communication Theory. c. nonviolent communication (NVC) model. d. Human Relationship Model.

ANS: A

The VERA (validation, emotion, reassurance, activity) framework for communication was developed to meet a need for nursing students who were at a loss to communicate with persons with communication difficulties.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

4. A human communication activity designed to influence another to change attitudes or alter

behaviors by the use of techniques such as argument, reasoning, or pleading is known as a. advisement. b. consultation. c. persuasion. d. suggestion.

ANS: C

Persuasion is a human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Which of the following is true about negotiation? a. It commonly results in a win-lose situation. b. It is aimed at solving problems, conflicts, or disputes. c. It is used only in contract and labor union disputes. d. It is the exchanging of favors or trading activity.

ANS: B

Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue. It is used to solve problems, conflicts, or disputes.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. A nursing preceptor is giving feedback to a new nurse who currently is being oriented. Her

preceptor suggests a better method of interacting with a family member by saying, “You might want to be cognizant of your non-verbal behaviors when talking with clients. Rather than continuing to chart when you are talking with an American family, stop charting, move closer to the family and client, look at them during the conversation, and take time to let them share their concerns.” This preceptor is giving advice about a. interpersonal communication. b. clarity. c. image. d. intention.

ANS: A

If the verbal message is clear, but the non-verbal communication is not congruent, then listeners may misinterpret, distrust, or not even hear the intended message. In this situation, the nurse’s non-verbal behavior may suggest that she is not interested in interacting with the family.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. The transformational leader engages staff by a. punishing errors. b. sharing vision and decision making.

c. taking a top-down approach to leadership. d. making unilateral decisions for the team.

ANS: B

Effective transformational nurse leaders will engage their staff through role modeling and mentorship of inclusion behaviors such as developing rapport, sharing vision and decision making, providing constructive feedback, and communicating successful outcomes. The communication of transformational leaders is focused on positive interchanges, rather than punishment, and inclusion in decision making versus authoritarianism.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. An example of an external variable that may affect communication is a. circumstance. b. personality. c. thoughts. d. feelings.

ANS: A

Communication may be affected by the interaction of external variables (others, a situation) and internal variables (you). Internal factors are the only thing under our own control. We have little control over others or the situation, because those are external to us.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9.

communication patterns exist between colleagues and serve to contribute to a hostile work environment, high turnover, burnout, and job dissatisfaction. a. Defensive b. Disruptive c. Negotiating d. Humanizing ANS: B

Documentation in literature is extensive regarding disruptive and distracting communication interactions not only between nurses and colleagues but also between nurses and patients. The research indicates that nursing personnel experience high turnover rates, job dissatisfaction, and burnout; many registered nurses are leaving the profession. The work environment is described as hostile to nurses, and patient outcomes of increased severity of illness and mortality have been directly related to poor communication skills of the staff.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. Over lunch in the cafeteria, student nurses are sharing educational information about the

patients for whom they are caring. This is a(n) a. breach of beneficence. b. example of maleficence.

c. potential assault and battery charge. d. violation of the Health Insurance Portability and Accountability Act (HIPAA).

ANS: D

HIPAA provisions have heightened awareness about and encouraged strategies to protect a patient’s privacy in health care transactions. This is an example of breach of confidentiality.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. Interpersonal communication is defined as a. the conscious intent by one individual to modify the thoughts or behaviors of

others. b. a combination of written and spoken communication. c. a theory used to describe a manner of communicating. d. communication between two or more individuals involving face-to-face

interaction.

ANS: D

Interpersonal communication is defined as communication between two or more individuals involving face-to-face interaction while all parties are aware of the others on an ongoing basis.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. Organizational tones are based mostly on a. unspoken cultural norms. b. commitment to success. c. communication behavior. d. leadership styles.

ANS: A

The entire tone of the organization is based mostly on unspoken cultural norms. Because nurses make up the bulk of the health care workforce, having nurse leaders at the helm of the organization can influence the culture and climate of the organization as a whole.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. Which communication technique is most effective when handling patient complaints? a. Persuasion b. Bargaining c. Negotiation d. Non-verbal cues ANS: C

Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. A communication system developed originally to address communication patterns in critical

situations is a. VERA framework. b. NVC model. c. crucial conversations. d. TeamSTEPPS. ANS: D

Communication effectiveness becomes crucial in times of emergency or disaster.

TeamSTEPPS was initially developed to address communication issues between nurses and providers during critical patient events.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 15. The number one cause of preventable medical errors is a. hostile work environments. b. poor communication. c. ineffective leadership. d. staff competency.

ANS: B

The Agency for Healthcare Research and Quality (AHRQ) has collected data regarding patient safety over many years. They discovered that poor communication was the number one cause of preventable medical errors. After discovering the staggering number of preventable medical errors and recognizing that communication problems were cited as the number one contributor, the AHRQ partnered with the Department of Defense (DOD) and developed the TeamSTEPPS program.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 16. Which communication format was developed to address the communication arm of the

TeamSTEPPS model? a. NVC (nonviolent communication) b. SBAR (situation, background, assessment, and recommendation) c. VERA (validation, emotion, reassurance, activity) d. MI (motivational interviewing) ANS: B

To address the “communication arm” of the TeamSTEPPS model strategies such as SBAR have been created to enhance teamwork communication. One of the strategies that has been well documented and is familiar to nurses is SBAR, which stands for situation, background, assessment, and recommendation.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Effective communication is fostered through which of the following ingredients? (Select all

that apply.) a. Trust b. Humility c. Respect d. Empathy e. Sympathy ANS: A, C, D

Trust, respect, and empathy are the three ingredients needed to create and foster effective communication.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. NVC communication processes are grounded in (Select all that apply.) a. confrontation. b. empathy. c. compassion. d. honesty. e. assertiveness.

ANS: B, C, D

NVC communication utilizes a four-part communication process grounded in compassion, empathy, and honesty. The four parts include making an observation, expressing a feeling, expressing a need, and making a request without demanding.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. A client’s wife is concerned about her husband’s declining health. He has been admitted with

an acute myocardial infarction and has had two myocardial infarctions before this admission.

He is not a candidate for surgery. She and her husband have discussed “no breathing machine” for long-standing care, but she is unsure of his wishes if he were to need a “breathing machine” for a short period. The nurse discusses his current condition and care with the client and his wife. She also organizes a team meeting consisting of the client’s physicians, social worker, pastoral care person, and nursing staff. During this meeting, the nurse helps the wife share her concerns and the client’s concerns with the rest of the team.

What type of communication technique is being utilized by the nurse? (Select all that apply.) a. Bargaining b. Negotiation c. Persuasion d. Spiritual assessment e. Collective action

ANS: B, C

Persuasion is the conscious intent by one individual to modify the thoughts or behaviors of others. Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue. Persuasion and negotiation are used to ensure that all members of the teamwork together in a co-operative manner. The nurse, the patient, and the spouse all communicate the wishes of the patient to convince the team to abide by the autonomous decisions of the patient and spouse.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. Which of the following are examples of patient privacy or security breaches? (Select all that

apply.) a. Encrypted e-mail communications b. Fax transmission sent to incorrect physician office c. Prescription given to patient with wrong label attached d. Case management coordinator obtaining information about a patient’s diagnosis e. Discharge summary given to patient’s spouse ANS: B, C

Fax transmissions sent to the incorrect physician’s office or prescriptions given to a patient with the wrong label attached are examples of privacy or security breaches under HIPAA. Electronic transmissions should be end-user encrypted for data security.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Which of the dimensions of spirituality should nurses assess for in care delivery? (Select all

that apply.) a. Culture b. Beliefs c. Values d. Social e. Religious ANS: B, C, D, E

Nurses need to assess for social, spiritual, religious, and cultural values and beliefs because they may affect individual patients’ health care decisions and preferences.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. Effectiveness and sustainability of change is based on the skilled communication of leadership

and stakeholders endorsing the change process. What are some barriers that can interfere with change? (Select all that apply.) a. Inwardly focused cultures b. Transformational leadership c. Fear of the unknown d. Arrogant attitudes

e. Safety culture ANS: A, C, D

Multiple factors are required to implement effective change: communicate the vision to employees, make structures compatible with the vision, provide the training employees need, align information and personnel systems, and confront supervisors who undercut needed change. Further, he suggested that structures, skills, systems, and supervisors are generally the four barriers to any transformational process.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. Transformational leadership focuses on engaging staff to become stakeholders in a shared

mission and vision. Which of the following are correct statements? (Select all that apply.) a. Transformational leaders have an authoritarian style of communication. b. Effective transformational nurse leaders engage their staff through role modeling and mentorship of inclusion behaviors. Communicating is a process competency. c. Transformational leaders have a rigid bureaucratic one-way communication network. d. The communication of transformational leaders is focused on positive interchanges. e. Effective transformational leaders listen more than they talk, are open to all new ideas, and create a culture of safety.

ANS: B, D, E

Effective transformational nurse leaders will engage their staff through role modeling and mentorship of inclusion behaviors such as developing rapport, sharing vision and decision making, providing constructive feedback, and communicating successful outcomes. The communication of transformational leaders is focused on positive interchanges, rather than punishment, and inclusion in decision making versus authoritarianism. Transformational leaders also know how to share vision and mission and how to motivate the workforce. This is accomplished by communicating the vision with passion and commitment that is contagious.

Transformational leaders need to listen more than they talk, be open to all new ideas, and create a culture of safety, transparency, and empathy.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Group readiness levels can be assessed in four stages. Which of the following statements is

accurate regarding group readiness? (Select all that apply.) a. Members are organized and secure about their roles in the forming stage. b. At the forming stage, the group needs direction in defining goals. c. During the storming period, there is more willingness to accept the group goals. d. The group becomes self-managing during the norming period. e. During the performing period, the members willingly perform the task.

ANS: B, C, E

At the forming readiness level, the group needs direction in defining task goals and objectives as opposed to personal goals. The members are uncertain and insecure about their role in the group. This initial period is chaotic. During the storming period, there is more willingness to accept the group goals and objectives but there are still differences of opinion, competition for recognition, and attempts to influence the group. During the norming period, there is greater agreement on the task goals as the group develops cohesiveness and adjusts to the group and task. Finally, during the performing period, the members are thinking as one and willingly performing the task. There is camaraderie and team spirit as the group becomes self-managing.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. E-mail is a great tool for communication. When should e-mail not be used? (Select all that

apply.) a. When you are mad b. When scheduling a meeting c. When you are canceling or apologizing d. If there is any chance your words could be misunderstood e. When rebuking or criticizing ANS: A, D, E

Electronic communication has assisted us to be better informed regarding our patients.

However, within the professional health care realm, there is a tendency to rely on these modes of communication when other methods would be preferable and more appropriate. For instance, there are definite times when a face-to-face conversation is preferred to an e-mail. In our busy professional lives, it is easier to send off a quick e-mail than to pick up the phone or walk down the hall; however, e-mail distances us from others and is really only the preferred means of communication when information is simply being conveyed.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Chapter 09: Team Building and Working with Effective Groups Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. Any collection of interconnected individuals working together for the same purpose is known

as a(n) a. club. b. group. c. meeting. d. organization.

ANS: B

Any collection of interconnected individuals working together for the same purpose is known as a group.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. A type of group that is stable, meets periodically, has an identified purpose, and is part of the

organizational structure is called a a. club. b. committee. c. group. d. meeting.

ANS: B

A committee is a type of group that is stable, meets periodically, has an identified purpose, and is part of the organizational structure. An example of a committee is a policy and procedure committee.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Team building is the process of a. forming b. identifying c. organizing d. unifying

a group.

ANS: D

Team building is the process of deliberately creating and unifying a group into a functioning work unit so that specific goals are accomplished.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

4. A small number of people with complementary skills who are committed to a common

purpose, performance goals, and approach for which they hold themselves mutually accountable and whose membership should be consistent is known as a a. committee. b. group. c. team. d. unit.

ANS: C

A team is a small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable and whose membership should be consistent.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. A collection of individuals who are led by a strong, clearly focused leader and who come

together to share information and ideas and possibly make decisions is known as a a. committee. b. pseudoteam. c. team. d. work group.

ANS: D

A collection of individuals who are led by a strong, clearly focused leader and who come together to share information and ideas and possibly to make decisions is known as a work group. In a work group, there is little or no collective accountability.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. In nursing, the reason groups form is a. monetary rewards. b. mandatory obligations. c. physical needs. d. professional socialization.

ANS: D

In nursing, the formation of groups occurs primarily for one of two reasons: (1) to provide a personal or professional socialization and exchange forum, or (2) to provide a mechanism for interdependent work accomplishment.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. Group problem solving is known to be more effective over individual problem solving

because of a larger knowledge and information base, increased acceptance of solutions, more approaches to a problem, lower economic costs, and the ability for a. group development.

b. individual expression. c. hierarchical bonding. d. organizational team building.

ANS: B

Individual expression is one of the major advantages of group problem solving.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Some of the major disadvantages to group decision making are negativity, individual focus,

and a. b. c. d.

autonomous conclusion. disruptive conflicts. group synergy. inaccurate data interpretation.

ANS: B

Six identified potential negative impacts groups can have on an organization, including negativity, passivity, individual focus, groupthink, vocal minority, and the ethical dark side. A seventh possible negative impact is disruptive conflicts.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. A group of tenured nursing faculty at a major university votes on whether a faculty member

should receive tenured status. This type of decision making is referred to as a. autocratic decision procedure. b. consultative decision procedure. c. delegated decision procedure. d. joint decision making.

ANS: D

Joint decision making occurs when the entire group makes the decision by two-thirds vote, a simple majority, consensus, or some other process. In this process, the group members have as much power as the leader.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. Group as well as individual accountability exists within a a. work group. b. true team. c. pseudoteam. d. committee.

ANS: B

A true team occurs when there is a collective entity in which leadership rotates and is shared by various members of the team. There is group as well as individual accountability.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. The hospital’s regulatory department is experiencing The Joint Commission survey. The

surveyors want to review hospital policies for infection control before they leave for the evening. The regulatory team leader states that she can stay past her regular hours to wait for them and acknowledges that there will be a need for a policy change before the surveyors return the following day. All of the department managers stay to assist the regulatory team leader with the required documentation. This is an example of a a. work group. b. committee. c. true team. d. group.

ANS: C

A true team is a group where there are collective work products. There is group as well as individual accountability. If one member is having a problem, it is not only that person’s problem but that of the whole team to resolve.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control 12. A temporary group of individuals formed to carry out a specific mission or project is known

as a a. club. b. group. c. meeting. d. task force.

ANS: D

A task force is a temporary group of individuals formed to carry out a specific mission or project. Task forces may solve a problem that requires a multidisciplinary approach.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. The stage of group development where control issues arise and disputes or disagreements

begin to emerge is the a. orientation b. adaptation c. emergence d. working

stage.

ANS: C

Emergence is the third stage of group development and occurs as control issues arise.

Disputes, disagreements, confrontations, alliances, and power struggles mark this stage of determining control over the group in order to emerge with a more consolidated identity.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. The nurse manager within a small department has requested that the staff decide department

coverage over the holidays. The department is not associated with patient care and serves as a supportive role to the organization. The staff is to present the manager with the coverage plan during the month of December. This is an example of which type of decision? a. Autocratic decision procedure b. Consultative decision procedure c. Joint decision making d. Delegated decision procedure ANS: D

A delegated decision procedure occurs when the leader allows participants to make the final decision. An autocratic decision procedure occurs when the leader makes all of the decisions.

A consultative decision procedure occurs when decisions involve employee participation but the leader still makes the decision. Joint decision making occurs when the entire group decides by vote or consensus.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 15. The critical care unit of a hospital utilizes team huddles at change of shift. This is an

opportunity for the clinical supervisors to connect with team members and review the upcoming shift or any quick topics that need to be communicated. This is an example of a(n) meeting. a. information-sharing b. opinion-seeking c. problem-solving d. strategy ANS: A

An information-sharing meeting occurs when a group is gathered to disseminate information.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 16. A multidisciplinary committee meets monthly to discuss medication safety issues within the

acute care areas. The quality director consistently arrives late for meetings and spends her time in the meeting answering e-mails on her smart phone. What type of disruptive behavior does this exhibit? a. Compulsive talker b. Interrupter c. Squasher d. Unreliable ANS: D

Unreliable members are not committed to the work of the group and frequently arrive late, leave early, spend time checking e-mail or texting, and simply want to show up for the purpose of appearance.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Why is an interdisciplinary, team-based approach essential in health care? (Select all that

apply.) a. Reimbursement protocols and government regulations require them. b. Diverse team’s enhanced ability to adapt to continuous or sudden change. c. A collective pool of thinking styles allows for greater exchange of information, ideas, and problem solving. d. Rapid information dissemination is most efficient with multidisciplinary teams. e. Engaging teams in this process allows for diverse points of view, creativity, and innovation.

ANS: B, C, E

Health care leaders recognize that an interdisciplinary, team-based approach is essential for high-quality, patient-centered, coordinated, and effective health care. Teamwork allows for greater exchange of information, ideas, and problem solving to address the complex issues of health care. Engaging teams in this process allows for diverse points of view, creativity, innovation, and an enhanced ability to adapt to continuous or sudden change.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. What are some of the positive aspects of utilizing teams in a professional setting such as

health care? (Select all that apply.) a. Teams have the potential to perform at higher levels than individuals on their own. b. Teams are a way to keep decision making at the management level. c. Teams may contribute to constraints within the budget. d. Teams can motivate individual members and provide encouragement, constructive criticism, and praise. e. Teams can make individuals feel more connected to the larger organization.

ANS: A, D, E

Groups have the potential for being a driving force for change in an organization. Potential positive impact groups can have on an organization: 1. Synergy: Groups have the potential to perform at higher levels than an individual would on his or her own.

2. Positive individual impacts: Groups have the potential to improve every member of the group or at least help each one reach his or her highest potential.

3. Motivation: Groups have the potential to motivate their individual members and provide encouragement, constructive criticism, and praise.

4. Diverse thinking: Groups have the potential to engage in diverse thinking, thereby identifying problems that might otherwise go unnoticed or ignored and exploring solutions.

5. Linkage to the larger organization: Groups have the potential to make individuals feel more connected to the larger organization.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. When teams are assigned, but not designed, dysfunction can occur. What are some

characteristics of a dysfunctional team? (Select all that apply.) a. Confusion over the purpose of the team b. Lacks real authority c. Effective interpersonal communication patterns d. Team needs placed above individual needs e. Lack of evaluation criteria ANS: A, B, E

Perils and pitfalls can occur when teams are assigned—not designed—including confusion about the team’s work, the team lacks real authority, structural team building is not done, dysfunctional behavior occurs and team members don’t know how to constructively deal with it, and team-based outcome measures and coaching are lacking.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. Group interactions are composed of which of the following elements? (Select all that apply.) a. The unique way the group interrelates and begins to work together b. The values and norms of each individual c. The process of problem solving d. The communication that occurs among group members e. The roles played by each member ANS: A, C, D, E

Group interactions are composed of the unique way the group interrelates and begins to work together, the standards that regulate the group’s behavior, the process of problem solving and decision making, the communication patterns that occur among group members, and the roles played by each member.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. A nursing professional practice council is being formulated within an organization. Nurses

from the three acute settings will meet monthly to discuss safety, policy, and practice needs within the organization. What are some of the reasons for this group formation? (Select all that apply.) a. To provide professional socialization b. To provide an exchange forum c. To provide a mechanism for independent work accomplishment d. To allow members to test a theory e. To create a sense of status and esteem ANS: A, B, E

In nursing, formation of groups occurs primarily to provide a personal or professional socialization and exchange forum, or to provide a mechanism for interdependent work accomplishment. Groups are established within organizations to create a sense of status and esteem, they allow an individual to test and establish reality, and they function as a mechanism for getting a job done.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control 6. Work group disruption has been shown to be linked to negative outcomes. What are some

factors that can contribute to work group disruptions? (Select all that apply.) a. Budget constraints b. Multidisciplinary attendance c. Reorganization d. Absenteeism e. Turnover ANS: C, D, E

Work groups can be disrupted by factors such as downsizing, reorganization, absenteeism, and turnover.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. What are some of the advantages to group work related to problem solving? (Select all that

apply.) a. There is greater sharing of knowledge and information. b. Individuals are less likely to accept a solution. c. Complex problems are more manageable in a group. d. Groups discourage individual expression. e. Group decision making is cost-effective.

ANS: A, C, E

The major advantages of group problem solving over individual problem solving are greater sharing of knowledge and information, increased acceptance of solutions, complex problems are more manageable, groups allow for individual expression, and group functioning is less expensive.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Team dynamics can become dysfunctional over time. What are some factors that can

contribute to team dysfunction? (Select all that apply.) a. Taking accountability b. Absence of trust c. Negotiating expectations d. Fear of conflict e. Lack of commitment

ANS: B, D, E

Dysfunctional team behaviors can occur related to an absence of trust, fear of conflict, lack of commitment, avoiding accountability, and inattention to results. Articulating and negotiating expectations for healthy interpersonal behavior benefits team development.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. Effective groups will have a variety of roles. Which of the following are examples of

group-building roles? (Select all that apply.) a. Encourager b. Listener c. Summarizer d. Compromiser e. Recorder ANS: A, B, C

Group-building roles include initiator, encourager, opinion giver, clarifier, listener, and summarizer.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. In planning for an effective committee meeting, what are some of the roles of the leader?

(Select all that apply.) a. Allowing the group to set the agenda during the meeting b. Speaking for every member to ensure all opinions are heard c. Identifying the purpose of the meeting d. Ensuring that the meeting starts and ends on time e. Keeping the meeting directed toward accomplishing objectives ANS: C, D, E

An effective meeting checklist for leaders includes preparing an agenda and related materials, listen carefully and summarize discussion and assignments at the end of the meeting, ensure balanced dialogue by all members, identifying the purpose of the meeting, ensuring that the meeting starts and ends on time, and keeping the meeting directed toward established goals.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Chapter 10: Power and Conflict Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. A nurse on a medical-surgical floor has been asked to join a research committee. She agrees to

this request because of her great admiration for the vice president of nursing. This is an example of dimension of power. a. dependence b. relational c. subversive d. tactical ANS: B

Relational dimension of power is a property of a social relationship. Many classic definitions indicate that power has to do with relationships between two or more actors in which the behavior of one is affected by the other.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. A staff nurse frequently is providing positive comments to get the manager in a good mood

before asking about additional vacation time. This influence tactic is known as a. consultation. b. ingratiation. c. inspiration appeals. d. rational persuasion.

ANS: B

Ingratiation occurs when the agent uses praise, flattery, friendly behavior, or helpful behavior to get the target in a good mood or to think favorably of him or her before asking for something.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Management offers a day of pampering at a spa if nurses agree to work 3 out of 4 weekends

over the summer. This type of power is known as a. coercive. b. expert. c. legitimate. d. reward.

ANS: D

French and Raven’s five sources of power (1959) include reward, coercive, expert, referent, and legitimate. When reward power is used, most people comply because of the positive benefits of doing so.

DIF: Cognitive Level: Understand (Comprehension)

TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. The nursing supervisor informs the staff that if they refuse to stay on the nursing unit and

work an additional 8-hour shift, they will be reported to the state for patient abandonment.

This type of power is known as a. coercive. b. expert. c. legitimate. d. reward.

ANS: A

French and Raven’s five sources of power (1959) include reward, coercive, expert, referent, and legitimate. When coercive power is used, an individual reacts to the fear of the negative consequences that might occur for failure to comply.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Subunit power is derived from a. being independent within the organization. b. providing resources on which the organization most depends. c. supplying multiple cross-trainable functions within the organization. d. voicing unique opinions and values within the organization.

ANS: B

Subunit power is derived from providing resources on which the organization most depends.

Subunit power also is derived from dependence, coping with uncertainty, being irreplaceable, having the ability to affect the decision process, and having shared consensus within the organizational subunit.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. A nursing manager is leading a recruitment and retention committee. She manages in a

laissez-faire style. Her co-leader is a staff nurse who is very detail oriented. The nurse manager usually leads the meetings. During the meeting, the staff nurse frequently needs to interject information that has not been presented. She also creates the agenda and communicates information with other team members. This scenario depicts which type of conflict? a. Competitive b. Disruptive c. Organizational d. Task ANS: D

Task conflict is an awareness of differences in viewpoints and opinions pertaining to a group task.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. A hospital nurse manager is involved in conflict management between two staff members.

The process of collaborating occurs when a. one person seeks to satisfy his/her own interests. b. both sides strive to meet the interests of both parties. c. a person chooses to withdraw from conflict. d. one party seeks to appease the other.

ANS: B

Collaborating ensues when the parties to conflict each desire to fully satisfy the concerns of all parties. The intention is to solve the problem by clarifying differences rather than by accommodating.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Nurses derive much of their power from being a. authority figures in emergent situations. b. central to the delivery of health care services. c. organized through public associations. d. the care coordinator of the health care team.

ANS: B

Professional nurses have a high degree of centrality within health care organizations. They are critical to the operation of most health care organizations, and without nurses, many health care facilities would not be able to offer services. Nursing maintains power by being central to the actual delivery of health care services, which is the core business function.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. A well-known talk show host presents information to a congressional committee to garner

support for cancer research. This type of power refers to a. coercive b. expert c. legitimate d. referent

power.

ANS: D

Referent power is based on admiration for a person who has desirable resources or personal traits.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10.

is an influence tactic where another person is given praise or sympathy in an effort to make the other person feel important.

a. b. c. d.

Assertiveness Ingratiation Rationality Upward appeal

ANS: B

Ingratiation means trying to make the other person feel important—giving praise or sympathizing. Ingratiation is attempting to advance oneself by trying to make another person feel important.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. Subunit or power refers to relationships across departments. a. vertical b. organizational c. horizontal d. exertional ANS: C

Subunit or horizontal power pertains to relationships across departments.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. A disagreement or differences between the members of two or more groups over authority,

territory, and resources is called a. intragroup b. intergroup c. interpersonal d. intrapersonal

conflict.

ANS: B

Intergroup conflict refers to disagreements or differences between the members of two or more groups or their representatives over authority, territory, and resources.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. a. b. c. d.

is a personal quality that is admired in the person with referent power.

Problem solving Authority Knowledge Coercive power

ANS: A

Referent power comes from the affinity other people have for someone. They admire the personal qualities, the problem-solving ability, the style, or the dedication the person brings to the work.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. A common source of conflict in nursing occurs when the nurse wants to perform patient

teaching or counseling, but there are competing priorities and the nurse has inadequate time to spend with the patient. This type of conflict is related to a. interpersonal conflict. b. intergroup conflict. c. intrapersonal conflict. d. intragroup conflict.

ANS: C

Intrapersonal conflict means discord, tension, or stress inside—or internal to—an individual that results from unmet needs, expectations, or goals. It often is manifested as a conflict over two competing roles. A nursing example occurs when the nurse determines that a patient needs teaching or counseling, but the organization’s assignment system is set up in a way that does not provide an adequate amount of time. When other priorities compete, an internal or intrapersonal conflict of roles exists.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Nurses must use which of these to facilitate change in health care organizations? (Select all

that apply.) a. Actualization b. Authorization c. Influence d. Ratification e. Power ANS: C, E

As the largest health care profession, nursing must use power and influence as a legitimate tool to facilitate change in health care organizations and the health care system.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. What are the consequences or outcomes of nurse empowerment? (Select all that apply.) a. Increased compensation and benefits b. Decreased burnout c. Decreased job strain d. Increased job satisfaction and work effectiveness e. Increased trust in the workplace ANS: B, C, D

The potential consequences or outcomes of nurse empowerment as (1) the potential for improved nurse and patient outcomes, (2) decreased burnout, (3) decreased job strain, (4) increased trust in the workplace, and (5) increased job satisfaction and work effectiveness.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. The Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine have assessed

progress made on recommendations for the future of nursing. What are the recommendations for nurses? (Select all that apply.) a. Remove barriers to practice and care. b. Maintain current leadership roles. c. Promote diversity. d. Transform education. e. Improve data.

ANS: A, D, E

In 2014 the Robert Wood Johnson Foundation asked the Institute of Medicine (IOM, now called the National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division) to convene a committee to assess progress made on implementing the recommendations of The Future of Nursing (IOM, 2010) and identify areas that should be emphasized over the next 5 years. This report outlines specific areas to accelerate implementation of the IOM recommendations for nurses: (1) removing barriers to practice and care, (2) transforming education, (3) collaborating and leading, (4) promoting diversity, and (5) improving data.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. Which of the following are the formal dimensions of power? (Select all that apply.) a. Social aspect b. Relational aspect c. Dependence aspect d. Independent aspect e. Sanctioning aspect ANS: B, C, E

The three formal dimensions of power are the relational, dependence, and sanctioning aspects of power. The relational aspect of power suggests that power is a property of a social relationship. The dependency aspect of power suggests that power resides implicitly in the other’s dependency. The sanctioning aspect of power is the active component of the power relationship, referring to the direct manipulations of the other’s outcomes.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

5. Empowerment for nurses may consist of three components. Which three of the following

components may help nurses become empowered to use their power for better patient care?

(Select all that apply.) a. A state in which a nurse has assumed control over his or her own practice b. A social relationship between two or more people c. A workplace that promotes opportunities for growth d. A nurse’s sense of meaning as expressed in values and work role e. Interdependence of personnel ANS: A, C, D

Nurse empowerment was defined as a state in which an individual nurse has assumed control over his or her practice, enabling him or her to successfully fulfill professional nursing responsibilities within an organization. Organizational antecedents to nurse empowerment include the “opportunities for mobility and growth and access to resources, support, and information provided within the nurse’s work environment.” The organizational and individual antecedents lead to psychological empowerment, including a nurse’s sense of meaning as expressed in values and work role.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. What are the two major content dimensions of power? (Select all that apply.) a. Influence b. Integrity c. Authority d. Dominance e. Control ANS: A, C

Authority and influence are two major content dimensions of power. Influence, dominance, and control may occur in separate dimensions.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. Which of the following statements accurately describe the varying mechanisms of power?

(Select all that apply.) a. Connection power is based on the perception that the influencer has access to powerful people or groups. b. Legitimate power is based on fear. c. Expert power results from expertise, special skill, or knowledge. d. Information power refers to skill in making rational appeals. e. Referent power is based on admiration for a person.

ANS: A, C, E

Connection power is based on another’s perception that the influencer has access to powerful people or groups. Expert power results from expertise, special skill, or knowledge. Referent power is based on admiration for a person.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Which of the following statements describe structural determinants of power within an

organization? (Select all that apply.) a. Power is derived from independence. b. Power is derived from providing resources. c. Power is derived from certainty. d. Power is derived from being irreplaceable. e. Power is derived from the ability to affect the decision process.

ANS: B, D, E

The following are structural determinants of power within organizations: Power is derived from dependence; power is derived from providing resources; power is derived from coping with uncertainty; power is derived from being irreplaceable; power is derived from the ability to affect the decision process; and power is derived if there is a shared consensus within the organizational subunit.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. Organizational change is associated with both direct and indirect costs for which leaders must

be prepared. Which of the following are examples of indirect costs associated with conflict?

(Select all that apply.) a. Loss of team morale b. Disrupted communication c. Disability or stress claims d. Decreased management productivity related to time spent resolving conflict e. Loss of motivation for achieving team goals ANS: A, B, E

Dysfunctional outcomes of conflict include development of discontent, reduced group effectiveness, disrupted communication, reduced group cohesiveness, and infighting among group members, which then overrides the focus on group goals.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. The main effects of conflict are individual effects, interpersonal relationships, and

organizational effects. What are some of the positive effects of conflict within an organization? (Select all that apply.) a. Absenteeism b. Team cohesiveness c. Disrupted communication d. Stimulation of creativity and innovation e. Improved quality of decisions ANS: B, D, E

Positive outcomes of conflict include stronger relationships and team cohesiveness, stimulation of creativity and innovation, and improved quality of decisions.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. Negotiation is a form of conflict resolution. Which of the following terms are associated with

negotiation? (Select all that apply.) a. Conciliation b. Distributive bargaining c. Arbitration d. Mediation e. Collective bargaining ANS: A, B, D

Conflict resolution involves eliminating all forms of conflict. Negotiation, mediation, and arbitration are often referred to in discussions of conflict resolution. These terms are also included under the umbrella of alternative dispute resolution (ADR). The resolution continuum includes negotiation, mediation, arbitration, and litigation as a spectrum of third-party dispute resolution. A conciliator is like a third friend who might attempt to intercede in an argument between two other friends. Conciliators attempt to diffuse the negative emotions that are often involved in the conflict, and they strive to establish more effective communications between the parties.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. Which of the following are factors that influence the way conflict is handled within an

organization? (Select all that apply.) a. Behavioral predispositions of individuals b. Bureaucratic hierarchy c. Social pressure in the environment d. Rules and procedures e. Position power ANS: A, C, D

A structural model of conflict exists that examines four factors that seem to influence the way conflict is handled in organizations: behavioral predispositions of individuals, social pressure in the environment, the organization’s incentive structure, and rules and procedures.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Chapter 11: Workplace Diversity and Inclusion Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. Which of these statements are true about culture? a. Culture remains consistent. b. Individuals identify with one culture during their lifetime. c. Culture is complex. d. Culture excludes religion.

ANS: C

Culture is dynamic in nature, and individuals may identify with multiple cultures over the course of their lifetimes. There is a complex nature to culture, which has been defined and studied across many disciplines.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Basic Care and Comfort 2. A client of Vietnamese background is admitted to the unit after a hysterectomy. She has an

order for clear liquids. When her tray is brought to her, she refuses the lime Jell-O. Which response by the nurse is most appropriate? a. “I don’t blame you. I don’t like lime Jell-O either.” b. “Tell me about your cultural beliefs to best help you.” c. “Why don’t you want to eat the lime Jell-O?” d. “It is important for you to eat so that you will heal.”

ANS: B

The first step toward multicultural competence is to recognize one’s own prejudices and learn about other people’s differences. The problem is that many Americans are afraid to ask people about their culture because of the idea that “we don’t want to offend anyone.” The challenge with this thinking is that if nurses do not ask about people’s differences, then the only option is to make assumptions.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Cultural diversity refers to the a. variety of cultural or ethnic groups within a society. b. belief that one’s own culture is similar to another’s culture. c. realization that all people in a particular culture have the same beliefs. d. view that individuals living in a country should speak the native language.

ANS: A

Cultural diversity is defined by the Oxford Dictionary as “The existence of a variety of cultural or ethnic groups within a society.”

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

MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. Which of these is the fastest growing minority group in the United States? a. Asians b. Caucasians c. Blacks d. Hispanics ANS: D

The U.S. Census Bureau (2014) estimates that minorities (anyone who is not a single-race non-Hispanic White) will be the majority in America by 2044 as a result of both immigration and growth rate. The nation’s racial and ethnic minority groups, especially Hispanics, are growing more rapidly than the non-Hispanic White population, fueled by both immigration and births.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Which of the following ethnic populations has seen the fastest growth? a. African Americans b. Iranians c. Hispanics d. Vietnamese ANS: C

Results from the 2010 census show that racial and ethnic minorities accounted for 91.7% of the nation’s growth since 2000. Most of that increase, from 2000 to 2010 (56%), was due to Hispanics.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. Equity is the absence of avoidable differences among groups of people, whether those groups

are defined socially, economically, demographically, or geographically. Which group formulated this definition? a. World Health Organization b. Affordable Care Act c. Centers for Disease Control d. Agency for Healthcare Research and Quality ANS: A

According to the World Health Organization, “Equity is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically.”

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

7. Recognizing one’s own prejudices and learning about other people’s differences is the first

step toward a. cultural diversity. b. multicultural competence. c. social change. d. valuing.

ANS: B

To reduce cross-cultural miscommunications and improve patient satisfaction, the multicultural competence of health care practitioners needs to be improved. The first step toward multicultural competence is to recognize one’s own prejudices and learn about other people’s differences.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. A nurse believes that she should provide optimal care to all clients, regardless of their cultural

background. She is struggling with her emotions when caring for a client with a violent criminal background. What would be the best course of action for this nurse? a. Avoiding the client as much as possible but providing care b. Identifying her biases but providing care c. Requesting another patient assignment d. Taking sick days while the patient is hospitalized ANS: B

The first step toward multicultural competence is to recognize one’s own prejudices and learn about other people’s differences. The problem is that many Americans are afraid to ask people about their culture because of the idea that “we don’t want to offend anyone.” The challenge with this thinking is that if nurses do not ask about people’s differences, then the only option is to make assumptions.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. Which of the following supports successful workplace diversity? a. Being a “devil’s advocate” b. Holding tight to one’s cultural values c. Respect for differences d. Withholding judgment of others ANS: C

To reduce cross-cultural miscommunications and improve patient satisfaction, the multicultural competence of health care practitioners needs to be improved. The first step toward multicultural competence is to recognize one’s own prejudices and learn about other people’s differences.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

10. According to the National Healthcare Quality and Disparities Report, which group has worse

access to health care in America, compared with Whites? a. Hispanics b. Asians c. Blacks d. American Indians ANS: A

According to the 2014 National Healthcare Quality and Disparities Report (Agency for Healthcare Research and Quality [AHRQ], 2015), “Historically, Americans have experienced variable access to care based on race, ethnicity, socioeconomic status, age, sex, disability status, sexual orientation, and residence location.” This study found that Blacks had worse access to health care than Whites for about half of measures of access, Hispanics had worse access to care than Whites for two-thirds of access measures, and Asians and American Indians and Alaska Natives had worse access to care than Whites for about one-third of access measures.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. The variation among groups of people with respect to habits, values, preferences, beliefs,

taboos, and rules for behavior determined to be appropriate for individual and societal interaction is known as a. bias. b. diversity. c. culture d. stereotyping.

ANS: B

Culture refers to the variation among groups of people with respect to habits, values, preferences, beliefs, taboos, and rules for behavior determined to be appropriate for individual and societal interaction.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. What is the most modifiable factor in the provision of equitable health care? a. Availability of services b. Socioeconomic status c. Care that is responsive to cultural needs d. Education level ANS: C

Health inequities are directly related to the existence of historical and current discrimination and social injustice, and one of the most modifiable factors is the lack of culturally and linguistically appropriate services, broadly defined as care and services that are respectful of and responsive to the cultural and linguistic needs of all individuals.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. When nurses portray an attitude that their cultural group is superior to another, it is known as

practicing the concept of cultural a. diversity. b. egocentrism. c. ethnocentrism. d. prejudice.

ANS: C

Ethnocentrism is characterized or based on an attitude that one’s own cultural group is superior to another.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. A White nurse from the United States is assigned to care for a Vietnamese woman who speaks

little English, had a baby 2 months ago, and is 1 day postoperative after fibroid removal. The nurse knows that traditional Vietnamese women will avoid drinking or eating “sour” foods such as lime Jell-O or other citrus types of liquids after surgery. She confirms her patient’s values and beliefs. The nurse is exhibiting characteristics of a. cultural competence. b. ethnic sensitivity. c. stereotyping. d. nonjudgmental behavior.

ANS: A

To reduce cross-cultural miscommunications and improve patient satisfaction, the multicultural competence of health care practitioners needs to be improved. The first step toward multicultural competence is to recognize one’s own prejudices and learn about other people’s differences.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity: Basic Care and Comfort 15. This generational cohort currently dominates the U.S. workforce. They have grown up with

little economic competition. Efficiency, teamwork, quality, and service have thrived under their leadership. This generational cohort is known as a. baby boomers. b. Generation X. c. Internet Generation. d. Mature Generation.

ANS: A

The baby boomers, born between 1946 and 1964, currently dominate the U.S. workforce.

They have grown up with little economic competition outside the United States. Efficiency, teamwork, quality, and service have thrived under their leadership.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

16. This generational cohort was the first generation of latchkey kids who had to be resourceful at

an early age. They are skeptical of traditional practices and beliefs. They strive for a balanced life. This group is known as a. baby boomers. b. Generation X. c. Internet Generation. d. Mature Generation.

ANS: B

Generation X members, born between 1965 and 1980, were the first generation of latchkey kids who had to be resourceful at an early age. They are skeptical of traditional practices and beliefs. They strive for a balanced life.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 17. A patient from the Philippines has been admitted to the ICU after a motor vehicle accident.

The patient has a very large group of family and friends wanting to visit, hold vigils, and provide meals to the visitors and staff. This is an example of a. inflexible attitude b. ambiguity c. ethnocentrism d. collectivism ANS: D

Collectivism is a tightly knit societal framework where people are integrated into cohesive and strong in-groups, often extended families, to look after them in exchange for unquestioning loyalty. Nurses from collectivist cultures tend to look to the team before taking action. The most collectivist culture on Hofstede’s scale is Guatemala at 6, China is 20, and the Philippines is 32. It’s not unusual with patients from collectivist cultures to have large groups of relatives and friends visit at the same time, which can create challenges for nursing staff to accommodate, especially in crowded shared rooms.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 18. Eliminating

can be accomplished through access to high-quality care, promoting patient-centered care and maintaining accurate data to monitor the quality of care provided. a. diversity b. cultural incompetence c. health disparities d. miscommunication ANS: C

Principles of eliminating racial and health disparities include providing insurance coverage and access to high-quality care, promoting a diverse health care workforce, delivering patient-centered care, maintaining accurate, complete race and ethnicity data to monitor disparities in care, and setting measurable goals for improvement of quality of care.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 19. Members of a generation who are linked through shared life experiences in their formative

years are known as a. baby boomers. b. generational markers. c. generation gaps. d. cohorts.

ANS: D

Generational groups are categorized into cohorts. These cohorts are members of a generation who are linked through shared life experiences in their formative years.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 20. A 17-year-old male has presented to the emergency department with appendicitis. He speaks

English, but his mother speaks Spanish. The mother needs to consent for the surgery since the patient is a minor. The doctor determines that the consent is not needed due to the emergent nature of the case. If the doctor proceeds without obtaining consent, he may face a. cultural competence. b. linguistic competence. c. miscommunication concerns. d. liability claims.

ANS: D

The National Center for Cultural Competence noted that health professionals who lack cultural and linguistic competency can be found liable under tort principles in several areas such as treatment in the absence of informed consent. In addition, providers may be presumed negligent if an individual is unable to follow guidelines because they conflict with his or her beliefs and the provider neglected to identify and try to accommodate the beliefs.

Additionally, if a provider proceeds with treatment or an intervention based on miscommunication due to poor quality language assistance, he or she and his or her organization may face increased civil liability exposure.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Culturally competent organizations benefit from meeting the diverse health care needs of the

population it serves. What are the social benefits to the organization? (Select all that apply.)

a. b. c. d. e.

Increases mutual respect.

Increases community participation.

Meets regulatory guidelines.

Assists patient and families in their care.

Increases cost savings.

ANS: A, B, D

Becoming culturally competent has social, health, and business benefits for health care organizations, according to a report from the Equity of Care initiative and the American Hospital Association’s Health Research & Educational Trust and Hospitals in Pursuit of Excellence. Becoming a Culturally Competent Health Care Organization (Health Research & Educational Trust, 2013) outlined 16 benefits of organizations’ ability to meet the health care needs of patients with diverse backgrounds, grouped into three broad categories of social, health, and business benefits. Social benefits include increases mutual respect and understanding between patient and organization, increases trust, promotes inclusion of all community members, increases community participation and involvement in health issues, assists patients and families in their care, and promotes patient and families responsibilities for health.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. When communicating health information with diverse populations, miscommunication and

misunderstanding can lead to (Select all that apply.) a. cultural competence. b. malpractice claims. c. informed consent. d. errors. e. increased cost.

ANS: B, C, D, E

The literature illustrates the vital role communication plays in avoiding cases of malpractice due to diagnostic and treatment errors. When communicating with culturally and linguistically diverse populations, the opportunity for miscommunication and misunderstanding increases, which subsequently increases the likelihood of errors. These errors, in turn, can cost millions of dollars in liability or malpractice claims.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. There are three major issues in cross-cultural communication. They are (Select all that apply.) a. ambiguity. b. ethnocentrism. c. inflexible attitude. d. collectivism. e. negotiation.

ANS: A, B, C

Research shows that there are three major issues in cross-cultural communication: ambiguity, inflexible attitude, and ethnocentrism.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. In order to make a positive contribution to care of patients, it is critical that nurses recognize

which of the following aspects of culture? (Select all that apply.) a. Culture of the clinician b. Culture of the patient and family c. Spiritual beliefs of the clinician d. Culture of co-workers e. Spiritual beliefs of the patient ANS: A, B, D

In order to make a positive contribution to the effective treatment of patients, it is critical that nurses or clinicians first recognize that they are dealing with a multiplicity of cultures. They include the clinician’s own culture, the culture of the patient and patient’s family, the culture of co-workers, and the health care institution’s culture.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Which of these are true regarding millennials in the work environment? (Select all that apply.) a. They need clear definitions of outcomes. b. They thrive on deadlines. c. Most enjoy working on their own. d. They struggle with multitasking. e. They lack problem-solving skills.

ANS: A, B, C

Millennials have astonishing multitasking skills. They are problem solvers who grew up in a flourishing economy. Most enjoy the liberty of working on their own in a style that favors their work ethic. Millennials have learned that their presence is in demand. To thrive, they need clear definitions of outcomes, resources to do what needs to be done, and a deadline.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 6. The nurse manager of a nursing unit is a White, female working with a high percentage of

Middle Eastern nursing staff. Which of these statements are true about the communication and leadership style of a low-context culture? (Select all that apply.) a. Rules are clear and tend to be followed. b. Low-context cultures require extensive, detailed explanations. c. Verbal communication is less explicit. d. Decisions are made in face-to-face conversations. e. Decisions are focused around tasks.

ANS: A, B, E

From a global perspective, the cultural context of the Western world is low context. In places such as North America and Western Europe, the explicit verbal or written message carries the meaning. Low-context cultures require extensive detailed explanations, information, and contracts because they are making up for the context that may be missing in a given situation.

Decisions are focused around tasks and activities that need to be accomplished. Rules are very clear and tend to be followed precisely.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Chapter 12: Organizational Structure Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. Which of the following factors influences the structure of an organization? a. Age of the building b. Brand of computer system c. Number of employees d. Square footage of the facility ANS: C

The number of employees influences the structure of an organization. Organizational structure is a consequence of both the division of and the coordination of labor, which results in a formal set of interrelated and interdependent roles and work groups.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. Within nursing practice, the use of advanced practice roles is an example of a. cross-training. b. departmentalization. c. fragmentation. d. specialization.

ANS: D

In health care, specialist roles have emerged to address the increasing complexities of care and technology. Within nursing, specialist roles have also evolved to address particular areas of nursing practice and include advanced practice roles such as clinical nurse educators, nurse practitioners, and nurse anesthetists.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. The nursing chief executive officer (CEO) works in a major rehabilitation and subacute

facility network. Her span of control refers to the number of a. miles in which the network resides. b. ancillary staff accountable to her. c. nurses and non-nurses reporting to her. d. inpatients that the facilities service.

ANS: C

Span of control refers to the number of nurses and non-nurses reporting to a manager.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

4. A nurse manager is responsible for a unit consisting of 40 nurses who report to two clinical

supervisors. In addition, there are 10 support staff who report to an administrative supervisor.

The subordinates reporting to this manager are known as which dimension of organizational design? a. Division of labor b. Hierarchy c. Span of control d. Decentralization ANS: C

Span of control is the number of subordinates a manager can efficiently and effectively direct.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. A staff nurse has been working in the neonatal critical care unit for 10 years. She believes that

a professional nurse is a lifelong learner. Many staff members come to her for clinical problem solving and advice. This nurse has a. decisional authority. b. formal power. c. informal power. d. quantum authority.

ANS: C

This nurse has informal power. She is a staff nurse with a great amount of expertise, with many relationships and alliances in the organization.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. An organizational chart with one line of management and one line of staff reflects which of

the following types of organizational structures? a. Authoritarian structure b. Flat structure c. Power structure d. Vertical structure ANS: B

A flat or horizontal structure has few administrative layers between management and employees. Employees have more decision-making power in this type of hierarchy.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. The phrase “the buck stops here” best describes which of the following terms? a. Accountability b. Authority c. Responsibility d. Trustworthiness

ANS: A

Accountability refers to the liability for task performance. Accountability means being answerable and liable. The assignment of responsibility and the granting of authority create accountability.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Patient surveys convey that they are uncertain about who is the registered nurse (RN). The

CEO makes a decision that mandates that white nursing caps will be worn by all RNs and blue nursing caps by all licensed practical nurses to differentiate professional nurses and occupational nurses from nurses’ aides and other ancillary staff. Which type of structure does this represent? a. Centralized b. Decentralized c. Nonparticipative d. Participative ANS: A

This is an example of centralized structure. The CEO makes a top-down decision, and lower-level managers and staff have little decision-making discretion.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. The patient is a 69-year-old woman who has a history of diabetes mellitus, peripheral vascular

disease, and myocardial infarctions. She was admitted to the hospital with a stroke and is being transferred to a subacute facility and then to a rehabilitation facility. At every transfer she must review her entire history, provide telephone numbers of family members, list all 30 of her medications, and list all home care and medical supply companies. Which of these processes could improve the fragmentation in work flow? a. Departmentalization b. Standardization c. Specialization d. Subdivision ANS: B

Subdividing work may create breaks or fragmentation in work flow, which can be addressed in organizations by integrating work processes across roles and subunits using coordination devices. At the work group level, coordination may involve specific roles, standardization (programming), groups, or feedback devices. For example, handoff communication and techniques such as situation, background, assessment, and recommendation (SBAR) are used to coordinate between units or providers in the delivery of care.

DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

10. The ways in which work is divided and coordinated among members and the resulting

network of relationships, roles, and work groups is the a. organization. b. organizational social structure. c. structure. d. formal relationship.

ANS: B

Organizational social structure is defined as the ways in which work is divided and coordinated among members and the resulting network of relationships, roles, and work groups (e.g., units, departments).

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. According to the

organizational approach, organizations are logical and predictable with identifiable and scientifically measurable characteristics that can be predicted, observed, or manipulated. a. objective b. subjective c. postmodern d. realistic ANS: A

According to the objective perspective, an organization exists as an external reality, independent of its social actors. Organizations are viewed as logical and predictable objects with identifiable and scientifically measurable characteristics (e.g., size) that can be predicted, observed, or manipulated.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. Which organizational theory emphasized the informal aspects of organization social structure

and was influenced by the Hawthorne experiments? a. Bureaucratic theory b. Scientific management school c. Classical management theory d. Human relations school ANS: D

Theorists in the human relations school emphasized the informal, rather than formal, aspects of organization social structure. Hawthorne experiments were influential in this school of thought.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. The division of work by occupation or function is a form of a. specialization.

b. interdependence. c. uncertainty. d. technology.

ANS: A

The division (or differentiation) of work by occupation or by function is a form of specialization. Specialization is the extent to which work is divided and assigned to positions and divisions.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. Standardization of

provides a uniform structure for information delivery and flow in order to facilitate exchange among those involved in common work processes. a. physician orders b. communication c. work processes d. work outputs ANS: B

Standardization of communication methods coordinates work by providing a uniform infrastructure of information to facilitate exchange among those involved in common work processes.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 15. A rapid response team within an acute care hospital is comprised of critical care physicians,

nurses, and respiratory therapists. The team assists staff throughout the hospital with detecting and managing imminent patient deterioration. This is an example of a _ organizational form. a. parallel b. functional c. modified program d. matrix ANS: A

To address the challenges of purely functional forms, mechanisms in the parallel form assist in coordinating across functional departments. These mechanisms can include teams, specialists, task forces, liaison roles, and standing committees.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity: Physiological Adaptation 16. The structure of authority in an organization is known as the a. authority. b. centralization. c. bureaucracy. d. hierarchy.

ANS: D

In bureaucratic and classical management theory, hierarchy is the structure of authority in an organization. Authority is equated with the enforcement of regulations.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 17. The network or pattern of social relationships and friendship circles within an organization is

known as the a. clique. b. formal structure. c. informal structure. d. hierarchy.

ANS: C

The informal structure is simply the network or pattern of social relationships and friendship circles that are outside the formal structure. It is an interconnected web of relationships that operate in and around the formally designated lines of communication.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. The nursing staff on a critical care unit thought that professional growth could be enhanced.

Which of the following interventions would support empowerment of the nursing staff?

(Select all that apply.) a. Eliminating computers and reverting back to paperwork b. Increasing pay wages for ancillary and professional staff c. Providing various methods for ongoing education and continuing education units d. Working to make equipment and medications readily available ANS: C, D

Social structures important to the growth of empowerment are having access to information, receiving support, having access to resources necessary to the job, and having the opportunity to learn and grow.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. According to organization theories, there are three perspectives regarding the nature of reality

and knowledge within an organization. Which of the following are those perspectives? (Select all that apply.) a. Objectivism b. Subjectivism c. Postmodernism d. Realism e. Idealism

ANS: A, B, C

The field of organization theory contains a variety of approaches to and assumptions about the phenomenon of organization. Objectivism, subjectivism, and postmodernism reflect three broad perspectives regarding the nature of reality and the nature of knowledge with respect to the concept of organization.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. According to the contingency theory of organizational performance, an organization must

structure and adapt its nursing units to complement which two factors? (Select all that apply.) a. Skill set b. Patient population c. Environment d. Technology e. Finances ANS: C, D

Mark and colleagues (1996) applied contingency theory to the evaluation of nursing care delivery system outcomes. The basic premise was that, to perform effectively and produce quality outcomes, an organization must structure and adapt its nursing units to complement the environment and technology.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. Which of the following statements describe the benefits of specialization in the health care

setting? (Select all that apply.) a. Improved work performance b. Increase in expertise c. Improved efficiency and outcomes d. Increased workload e. Increased error reporting ANS: A, B, C

The advantages of specialization include improved work performance and a critical mass of experts. In health care, specialist roles have emerged to address the increasing complexities of care and technology.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Dividing work by occupation leads to a functional organization where services are arranged

by the type of work performed. What are some benefits of the functional form within the health care organization? (Select all that apply.) a. Professional silo b. Fragmented care delivery c. Cost reduction d. Enhanced performance and quality

e. Promotion of professional development ANS: C, D, E

By dividing personnel according to the type of work performed, organizations can capitalize on the expertise, experience, efficiency, and professional standards that each discipline offers.

Other benefits include cost reduction through shared resources; enhanced monitoring of cost, performance, and quality; and promotion of professional development, identity, autonomy, advocacy, and career advancement. Disadvantages of the functional form are its potential to overemphasize professional silos, discourage informal relationships across disciplines, and fragment care delivery.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. An organizational chart is used to depict (Select all that apply.) a. a visual display of the organization s positions. b. the intentional relationships among positions. c. open positions within human resources. d. flow of authority. e. advisory committees.

ANS: A, B, D

Hierarchy reflects the formal structure of the organization, which can be identified on an organizational chart. An organizational chart is a visual display of the organization’s positions and the intentional relationships among positions. The organizational chart reflects the various positions and the formal relationships between and among the positions and, by extension, the people who are a part of the organization.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. Which of the following statements are accurate when describing responsibility and

accountability? (Select all that apply.) a. The assignment of responsibility assumes accountability. b. A manager is assigned responsibility by a subordinate. c. Accountability is the liability for task performance. d. The assignment of responsibility and the granting of authority create accountability. e. Accountability flows upward or outward.

ANS: C, D, E

Responsibility is the allocation and acceptance of a task. Responsibility is the obligation to take on and accomplish work and to secure the desired results. In accepting the obligation of an assigned task, the staff person is accepting responsibility to accomplish the task.

Accountability is the liability for task performance and is determined in a retrospective analysis of what occurred. The assignment of responsibility and the granting of authority create accountability. Accountability flows upward or outward: from staff to manager or from provider to client.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation

MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Managers apply their leadership skills to their reporting relationships to release energy and

talents of people in a manner that adds value to the work they perform. What are some examples of the effects of added value? (Select all that apply.) a. Increased compensation b. Improved productivity c. Organizational commitment d. Organizational citizenship behaviors ANS: B, C, D

Managers apply their leadership skills to reporting relationships to release the energy and talents of people in ways that add value to the work performed. Examples of added value include improved employee productivity, organizational commitment, and organizational citizenship behaviors.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. An organization with a flat structure has minimal layers of management. What are some of the

advantages of a flat organizational structure? (Select all that apply.) a. Fewer divisions facilitating streamlining of goals and problem solving b. Greater supervisory capability c. Greater innovation d. Layers of accountability for completion of work e. Enhanced responsiveness to consumers ANS: A, C, E

The advantages of a flat organizational structure include fewer divisions to facilitate streamlining of goals and problem solving, greater innovation, and enhanced responsiveness to consumers at the point of service.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Chapter 13: Decentralization and Governance Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. Shared governance is a model of organizational structure in which staff nurses are a. employed to establish mutual goals with clients. b. empowered through autonomy and accountability. c. engaged in problem-solving strategies and techniques. d. equipped with evaluative thinking methodologies.

ANS: B

Shared governance is a model of organizational structure in which staff nurses are empowered through autonomy and accountability.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. Decentralization occurs when a. equipment is being purchased from approved vendors. b. hiring decisions are made at the executive level. c. power is distributed to those closest to the work of caregiving. d. supplies are distributed from one central supply area in the hospital.

ANS: C

Decision-making authority rests at lower levels in the organizational framework, closer to the point of care, rather than being passed up through the chain of command to an executive.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3.

Which of the following statements best describes an organizational chart? a. All job positions are displayed clearly in a two-dimensional drawing. b. All outside organizations with relationships to the hospital are depicted. c. Informal and formal structures within the organization are outlined. d. It shows organizational positions and relationships in a visual representation.

ANS: D

The organizational chart is a diagrammatic representation that displays “the flow of authority, chain of command, titles, and functions.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. Nurses’ involvement in shared governance is an important component of a. practice models. b. Magnet recognition. c. increased reimbursement.

d. physician satisfaction.

ANS: B

Nurses’ involvement in governance is an important component of the American Nurses Credentialing Center’s Magnet Recognition Program.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. A nurse works in the critical care unit (CCU). She enjoys being on the unit charge nurse team,

the recruitment and retention team, and the peer evaluation team. The recruitment and retention team is responsible for hiring new employees into the CCU. The five-member team, consisting of three registered nurses (RNs), a unit clerk, and a nurse’s aide, conduct the interviewing process with key questions that were developed by the team. This is an example of a. centralized power. b. shared governance. c. span of control. d. vertical authority.

ANS: B

For shared governance to be effective, decision making must be shared by empowered staff at the point where patients receive care.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. Which of the following leadership styles is best suited for implementation of a shared

governance structure? a. Authoritarian b. Autocratic c. Participative d. Laissez-faire ANS: C

Participative leadership—the notion of leaders turning to their team for input and ideas—was first introduced to the business world in the 1970s. It was adapted by health care organizations and nursing leaders in the early 1980s, and formed the basis of shared governance, which today has evolved to define the role of nurses as well as to resolve issues related to patient care.

DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. One obstacle in the implementation of a shared governance model is that nurses have a. empowered participation in committee meetings. b. limited time to work on projects. c. the same basic educational foundation. d. traditionally worked in decentralized structures.

ANS: B

Implementing a shared governance structure can take years; it does not happen overnight. It takes commitment, ongoing education, transparency, time, and dedication. Shared Governance is not easy to develop. It takes time to be effective. Neither staff nor leaders/managers should assume that the approach relieves leaders and managers of their responsibility to do their jobs. The biggest barrier to shared governance is having dedicated time for meetings and for work on projects.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. The nurse manager should use which of the following behaviors when implementing a shared

governance structure? a. Autocratic decision making of the manager b. Coaching the staff to be successful c. Harboring the vision within the team d. Reimbursing the staff for overtime ANS: B

To be successful, shared governance structures need leaders who are role models and mentors.

Staff and management must be dedicated to coaching and continuous learning.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. Research about shared governance suggests that it is a. enhancing the role of the nurse’s aide within the organization. b. improving organizational and patient outcomes. c. not a cost-effective program when examining all areas of care. d. too much additional work for the already overwhelmed RN. ANS: B

Shared governance has far-reaching implications for leaders in today’s health care environment, in which the focus is to provide patient care safely, efficaciously, and efficiently. Organizational benefits include increased commitment of staff to the organization; accountability of the nurse; a new level of professional autonomy; a more efficient model for point-of-service decision making; more expert involvement at the point of service; a more assured, confident patient advocate; and improved financial outcomes. Patients benefit from a more efficient model of health care service, more committed health care professionals, quicker responses at the point of service, and a more assured, confident patient advocate.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Nursing Diagnosis MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. Shared governance is a vehicle for engaging organizations and creating the necessary forums

and intersections that assure the decisions and actions remain dynamic and as close to the point of service as possible. Shared governance promotes a. dependence.

b. non-punitive culture. c. collaboration. d. executive decision making.

ANS: C

Shared governance is an accountability-based model through which nurses actively engage in making decisions regarding nursing practice, quality of patient care, education, nursing peer issues, and issues in the work environment. In a shared governance environment, staff take ownership of decision making. This is a dynamic staff-leadership partnership that promotes collaboration, shared decision making, and accountability for improving quality of care, safety, and enhancing work life.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. Traditionally, nurses have worked in strong, hierarchical institutions with centralized decision

making and clear authority structures, rigid approval mechanisms, and extensive policies and procedures that have resulted in barriers to creating a shared governance system. One such barriers is a. lack of role clarity. b. lack of time management. c. poor time management skills. d. that development takes a long time.

ANS: D

Effective shared governance is an ongoing process. Both staff and unit managers need to become comfortable with how governance is shared. Development is gradual and time consuming. To be successful, shared governance structures need leaders who are role models and mentors. Staff and management must be dedicated to coaching and continuous learning.

DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. In organizations that practice shared governance, the responsibility for unit outcomes rests

with the a. nursing team. b. nurse manager. c. individual nurse. d. chief nursing officer (CNO).

ANS: A

In organizations that practice shared governance, staff as well as nurse managers and leaders are responsible for innovation. Innovation is considered crucial to safely and effectively solve complex care problems. The entire team is responsible for unit outcomes, not just the individual manager.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care

13. The local hospital has a new specialty unit for women and children. The nursing staff has

created a family advisory council to assist in reviewing educational materials used at discharge. This shared governance structure is an example of a. interprofessional education. b. whole-system integration. c. engagement. d. collaboration.

ANS: B

Some see the benefits of decentralization and the shared governance model extending beyond nurses and all care providers to all employees. “As for the future of Shared Governance, Susan Allen PhD, RN (assistant vice president, Cincinnati Children’s Hospital) says it would be ideal to see whole-system integration involving all hospital staff. Clearly, the next steps in this vision are to include patients and the community more deliberatively into the shared governance model. Allen says Cincinnati Children’s Hospital has a family advisory council and a teen council that get involved in projects, including reviewing potential educational materials and designing a new learning center.

DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. The purpose of an organization’s philosophy is to a. influence the goals and objectives of an organization. b. display how the parts of an organization are connected. c. be an instrument that gives voice to the organization s mission. d. serve as the institutional framework that shapes the direction of knowledge and

skill acquisition.

ANS: D

Hospitals are organized and their work is structured around a guiding philosophy. The philosophy serves as the institutional framework that shapes the direction of knowledge and skill acquisition. It is the pivotal factor in the long-term development of the institution.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 15. In Magnet organizations, shared governance needs to be manifested through what

mechanisms for nurses’ decision making? a. Unit practice councils b. Democratic leaders c. Authoritarian leaders d. System-wide practice councils ANS: A

In a national study of the nursing practice environment, it was found that in Magnet organizations, the primary governance structure was shared governance, which was significantly and positively related to an improved professional practice environment. To be real and make a difference for nurses, the shared governance needs to be manifested through point-of-care structures where direct-care nurses make decisions about patient care and unit operations. Unit practice councils (UPCs) are an example.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 16. An employee satisfaction survey is conducted annually and shows that nurses in a particular

unit are committed to their jobs and feel that they make positive contributions. These nurses are a. engaged. b. disengaged. c. unproductive. d. at retirement age.

ANS: A

An ongoing challenge among U.S. employers, including health care systems, is to keep employees engaged. A Gallup poll (2014) indicated that only 31.5% of employees in the United States report they are “engaged at work,” meaning they are committed to their job and making positive contributions. Fifty-one percent reported they are “not engaged at work,” meaning they are not likely to put effort into organizational goals. Seventeen and a half percent are “actively disengaged,” described as unhappy, unproductive, and likely to spread negativity. Shared governance is the gold standard for engaging nurses in solving problems at the point of care.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 17. Participative leadership was first introduced in the late 1970s. It was adapted by health care

organizations to form the basis of shared governance and has evolved to define the roles of nurses and resolve issues related to a. patient care. b. nursing liability. c. nursing salaries. d. nursing turnover.

ANS: A

Participative leadership—the notion of leaders turning to their team for input and ideas—was first introduced to the business world in the 1970s. It was adapted by health care organizations and nursing leaders in the early 1980s, and formed the basis of shared governance, which today has evolved to define the role of nurses as well as to resolve issues related to patient care.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

18. In organizations that practice shared governance, staff, managers, and leaders are responsible

for a. b. c. d.

technology. budgeting. education. innovation.

ANS: D

In organizations that practice shared governance, staff as well as nurse managers and leaders are responsible for innovation. Innovation is considered crucial to safely and effectively solve complex care problems. The entire team is responsible for unit outcomes, not just the individual manager. The manager is primarily responsible for mentoring, facilitating, enabling, and supporting.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 19. Institutions organize and structure themselves by defining departmental function and authority

to achieve a more coordinated effort. In institutions where the executive leader retains more decision-making authority, the operation takes on a more philosophy. a. centralized b. decentralized c. autocratic d. democratic ANS: A

Centralization and decentralization are organizational philosophies about power distribution that pertain to the hierarchical level of decision-making authority in the institution.

Centralization means that decisions are made at the top levels. Decentralization means that decision making is diffused throughout the organization.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 20. The

of an organization is the formulation of ideas, plans, or dreams that help shape the future and ability to persuade colleagues and associates to share those dreams. a. mission b. core values c. vision d. organizational chart ANS: C

The mission, core values, and vision are the instruments that give voice to the organization’s philosophy. The mission is a simple and direct expression of a company’s goals and objectives. It defines what a company stands for. The vision is the formulation of ideas, plans, or dreams that “help shape the future and ability to persuade colleagues and associates to share those dreams.”

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. In organizations that practice shared governance, the nurse manager’s role is to (Select all that

apply.) a. hire new employees. b. mentor the nursing staff. c. train new nurses in patient care. d. support the decisions of the nursing team. e. enable the staff to become effective leaders.

ANS: B, D, E

The nurse manager is primarily responsible for mentoring, facilitating, enabling, and supporting the staff personnel. Sustainable change can occur at the unit and organizational level if the nurse manager works within the framework of transformational leadership, shared governance, and action processes.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. Shared governance has far-reaching implications for today’s health care environment. Patients

benefit due to (Select all that apply.) a. quicker responses at the point of service. b. more committed health care professionals. c. a more stringent model of health care service. d. better decisions being made by upper management. e. nurses being more assured, confident patient advocates.

ANS: A, B, E

The focus of a health care environment that supports shared governance is to provide patient care safely, efficaciously, and efficiently. Patients benefit from a more efficient model of health care service; more committed health care professionals; quicker responses at the point of service; and a more assured, confident patient advocate.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Organizational benefits of a culture of shared governance include (Select all that apply.) a. improved financial outcomes. b. interdependence among staff nurses. c. increased commitment of staff to the organization. d. more senior leadership involvement at the point of service. e. a more efficient model for point-of-service decision making.

ANS: A, C, E

Organizational benefits include increased commitment of staff to the organization; accountability of the nurse; a new level of professional autonomy; a more efficient model for point-of-service decision making; more expert involvement at the point of service; a more assured, confident patient advocate; and improved financial outcomes.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. The primary purpose of unit practice committees in a health care organization is to improve

(Select all that apply.) a. practice. b. processes. c. outcomes. d. reimbursement. e. turnover.

ANS: A, B, C

The purpose of the unit practice council is described as being part of the shared governance structure to promote shared decision making at the unit/clinic/program of care level. To make and implement recommendations to improve practice, processes, and outcomes.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. The instruments that give voice to the organization’s philosophy include which of the

following? (Select all that apply.) a. Goals b. Focus c. Vision d. Mission e. Core values ANS: C, D, E

The mission, core values, and vision are the instruments that give voice to the organization’s philosophy. The mission is an aim to be accomplished. It influences the philosophy, goals, and objectives of an organization. The vision is a mental image or the power of imagination to see something that is not actually visible.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. In an organization that has a decentralized organizational philosophy, decision-making

authority rests in levels closer to the point of service rather than in the executive levels.

Benefits of a decentralized organizational philosophy include (Select all that apply.) a. encouraging more input. b. supporting greater innovation. c. facilitating faster response times. d. permitting a narrower span of control. e. allowing for more levels of management.

ANS: A, B, C

Decentralization encourages and facilitates greater innovation, more input, and faster response times. Centralized decision making results in a narrower span of control and more levels of management, while decentralized decision making generally means that the span of management is larger for each manager.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. At its start, shared governance requires the education and support of organizational

executives, managers, and point-of-care staff. Organizational benefits include (Select all that apply.) a. accountability of the nurse. b. reduction in liability claims. c. reduction in workers’ compensation claims. d. improved financial outcomes. e. more expert involvement at the point of care.

ANS: A, D, E

Shared governance has far-reaching implications for leaders in today’s health care environment, in which the focus is to provide patient care safely, efficaciously, and efficiently. Organizational benefits include increased commitment of staff to the organization; accountability of the nurse; a new level of professional autonomy; a more efficient model for point-of-service decision making; more expert involvement at the point of service; a more assured, confident patient advocate; and improved financial outcomes. Patients benefit from a more efficient model of health care service, more committed health care professionals, quicker responses at the point of service, and a more assured, confident patient advocate.

DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Chapter 14: Strategic Management Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. The concept of strategic management includes strategic planning and the implementation of a. core values. b. strategy. c. tactics. d. objectives.

ANS: B

The concept of strategic management includes strategic planning and strategy implementation.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. The guiding framework that describes the organization’s purpose and future direction is the a. futuristic guidelines. b. mission and vision. c. strategic plan. d. core purpose.

ANS: B

The organizational mission and vision collectively is a guiding framework that describes the organization’s purpose and future direction.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Objectives are a. bylaws used to govern the organization. b. financial minimums needed to operate. c. performance-based criteria for accreditation. d. targets that the organization wants to achieve.

ANS: D

Objectives are defined as the targets that an organization wants to achieve.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. A new cancer center is being built in the local hospital. A patient survey has revealed that

patients are not certain which caregiver is the registered nurse (RN) during their hospital stay.

A group is formed to recommend methods to help patients identify which caregiver is their RN for the new cancer center. Which of the following groups best represents those who should be involved in forming recommendations? a. Chief medical officer, public relations vice president, and human resources

b. Oncology clinical nurse specialist, nurse’s aides, and RNs c. Physicians, unit secretaries, and vice president of finance d. Vice president of nursing, decentralized pharmacist, and licensed

practical/vocational (LPN/LVN) nurses ANS: B

Involving individuals at all levels of the organization will ensure a variety of perspectives and more buy-in to the final product. Including the patient’s perspective may provide additional insight about the issue. Ideally, those involved in all levels of patient care, such as the vice president of nursing, nurse manager, oncology clinical nurse specialist, LPN/LVNs, and nurses’ aides, as well as patients of the RN, may need to be included to gain additional perspective.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. A highly respected staff RN on the medical-surgical unit has volunteered to be the champion

for the implementation of a new nursing protocol. What does champion mean in this situation? The staff nurse will a. accept an award on behalf of her unit regarding this protocol. b. display a winning attitude in support of the new protocol. c. educate others in continuous quality improvement protocols. d. passionately commit to the implementation of the process and inspire others.

ANS: D

A champion is an individual who is passionate and committed to the implementation process and who can inspire others. Often a champion appears as the strategic planning process unfolds; generally, this individual contributes freely, is engaged in the work groups, and expresses interest in the process. Champions can be selected as well, but those who volunteer are usually more enthusiastic about the work than those who are “drafted.”

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. SWOT is an acronym for a. stability, wealth, opportunistic, and timeliness. b. strategies, work ethic, oppositions, and team. c. strengths, weaknesses, opportunities, and threats. d. strong, worthy, oppositional, and tactical.

ANS: C

SWOT is an acronym for strengths, weaknesses, opportunities, and threats. SWOT analysis is used in developing strategic plans for an organization.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. An action plan a. breaks a strategic plan into manageable parts. b. details a futuristic view of the institution. c. outlines the steps in performing a procedure.

d. provides a strategic plan for actualizing the mission.

ANS: A

An action plan breaks a strategic plan into manageable parts.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. A nurse manager enjoys implementing new programs and beginning new projects. She is

beginning to find herself overwhelmed and needs to decrease her workload. Which of the following ideas might best help decrease her workload? a. Comparing her vision with that of the institution b. Following the strategic objectives and mission of the hospital c. Reviewing the action plan and vision of the hospital system d. Using her intuition to determine which project should continue ANS: B

Strategic objectives provide a way of converting the rather abstract mission of an organization into concrete terms. Following the mission of the hospital will help keep the nurse manager focused.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. Part of the evaluation design process when developing a strategic plan includes a. delineation of measures of success. b. designing a form to critique the guidelines. c. formulating an implementation outline. d. writing the vision and mission statement.

ANS: A

The final step in the strategic planning process is developing the evaluation design. Planning for evaluation is imperative to ensure that systems and measurements are in place to determine whether the strategic plan has been achieved. During the strategic planning process, measures of success are delineated, responsible individuals are identified, and frequency of evaluation and reporting of these measures is determined.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. A hospital with a large surgery department is concerned about surgeons starting their own

surgical centers. In relation to the environmental assessment process, this is an example of a. an economic monopoly. b. an external threat. c. marketplace competition. d. political strength.

ANS: B

The external components are described as opportunities and threats, and they are identified in the same manner as the internal factors. Opportunities and threats may include changes in industry, marketplace, economy, political climate, technology, and competition.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. Operational choices for action that are made to implement a strategy are called a. tactics. b. objectives. c. core values. d. strategic plans.

ANS: A

Tactics are operational choices for action that are made to implement a strategy.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. The first step of the strategic planning process is to a. develop strategic goals. b. survey the environment. c. implement the action plan. d. formulate the organization’s mission and vision.

ANS: D

The first step of the strategic planning process is to formulate or review and update as needed the organization’s mission and vision in alignment with the organization’s core purpose and values. The mission delineates what the organization does, while the vision articulates the preferred future state of the organization.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. The statement, “We will provide high-quality care and services to our patients. We are

committed to maintaining excellence, respect, and integrity in all aspects of our operations and our professional and business conduct,” is an example of a. a mission statement. b. the core values of an organization. c. a strategic plan. d. the core purpose of an organization.

ANS: A

The mission defines what the organization does; the core purpose delineates why.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. Answering questions such as “What business are we in?” and “What business do we want to

be in?” can lead the organization to define the a. mission. b. objectives.

c. core purpose. d. strategic plan.

ANS: C

The core purpose can be defined and refined by asking, “Why are we in business?” As a result, the initial response, “We are in the business of health care,” may be further refined to “We want to contribute to the community in which we exist.” Thus asking “why” may result in the core purpose of providing needed health care services to the community in which the organization is located.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 15. Addressing the strategic planning process questions involves considering environmental

factors. An example of an external environmental factor to be considered is a. financial factors. b. human resources. c. political climate. d. organizational culture.

ANS: C

A key component of the strategic planning process is to assess the environment. This assessment, called environmental scanning, consists of analyzing both internal and external environmental factors. External opportunities and threats may include changes in industry, marketplace, economy, political climate, technology, and competition.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 16. The statement, “We will increase our profit by 8% each year,” is an example of a(n) a. strategic plan. b. mission statement. c. organization objective. d. implementation strategy.

ANS: C

Objectives are defined as the targets an organization wants to achieve. These can be financial or performance based with short-range or long-range targets.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 17. The 2011 Future of Nursing report published by the Institute of Medicine (IOM), calls for a. an improved educational system that promotes seamless academic progression. b. the baccalaureate in nursing to be established as the minimal educational level for

entry into practice. c. the master’s degree to be established as the minimal requirement for a leadership position in nursing. d. increased participation in leadership among nurses.

ANS: D

The leadership role of nurses has become an area of increasing focus since the Institute of Medicine (IOM, now called the National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division), in its 2011 Future of Nursing report, called for increased leadership development and participation in leadership among nurses.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Strategic management, long used in business to ensure a competitive advantage over similar

enterprises, involves (Select all that apply.) a. setting targets. b. establishing goals. c. evaluating success. d. developing an action plan. e. defining the core purpose. f. conducting an environmental scan.

ANS: A, B, C, D, F

Strategic management involves conducting an environmental scan, knowing the competition, establishing goals, setting targets, developing an action plan, implementing the plan, and evaluating success. This approach has long been used in business to ensure a competitive advantage over similar enterprises. The core purpose is the reason the organization is in business.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. The purpose of strategic management is to (Select all that apply.) a. ensure customer satisfaction. b. establish a competitive position. c. reach strategic objectives or goals. d. develop the organizational mission. e. provide a blueprint for operating a business.

ANS: A, B, C, E

Strategic management involves strategic planning and implementation. It provides a blueprint for operating a business, establishing a competitive position, ensuring customer satisfaction, and reaching strategic objectives or goals.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Characteristics of strategic management include (Select all that apply.) a. alignment with the external environment. b. helps identify best practices on the nursing unit.

c. d. e. f.

future orientation. engagement of the entire workforce in organizational leadership. use of change management strategies to achieve performance goals. facilitation of decision making with well-communicated decisions.

ANS: A, C, D, E, F

Five characteristics of strategic management are engagement of the entire workforce in organizational leadership, alignment with the external environment, future orientation, use of change management strategies to achieve performance goals, and facilitation of decision making with well-communicated decisions.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. For organizational strategy to be implemented successfully it must be (Select all that apply.) a. specific and inflexible. b. applied in a timely manner. c. agreed upon by all stakeholders. d. executed proficiently and efficiently. e. aligned with the organizational culture.

ANS: B, D, E

Strategy must be implemented proficiently and efficiently, as well as in a timely manner, if it is to be effective. For this to occur, the organization must attend to its capabilities, the reward structure, available support systems, and the organizational culture. If any of these characteristics are not in place, implementation of the strategy will surely fail.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Most strategic plans result in a written document. Strategic plan documents generally contain

which of the following sections? (Select all that apply.) a. Forward b. Glossary c. Goals and strategies d. Executive summary e. Mission, vision, and values ANS: C, D, E

Generally, strategic plan documents contain an executive summary; background; mission, vision, and values; goals and strategies; and appendixes.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. Strategic management is useful for nursing leaders and managers because it (Select all that

apply.) a. helps identify best practices on the nursing unit. b. rewards those who carry out strategy successfully. c. can be used to set measurable, achievable goals and plans.

d. can be used to analyze the environment for opportunities and threats. e. can help determine the future of the nursing area, such as a department or unit.

ANS: C, D, E

Strategic management is useful for nursing leaders and managers because it can be used to analyze the environment for opportunities and threats; to set measurable, achievable goals and plans; and to help determine the future of the nursing area, such as a department or unit.

Success in strategic planning and implementing that strategic plan will position nursing well in an institution. The process provides an opportunity for nursing to shine, because the similarities between the nursing process and the strategic planning process allow nurses to shortcut the learning curve and begin to move forward with the implementation phase while others may still be grappling with the planning process.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care COMPLETION 1. A(n)

is a two- to three-page synopsis of the strategic plan, written in language understandable by all potential readers.

ANS:

executive summary An executive summary is a two- to three-page synopsis of the strategic plan, written in language understandable by all potential readers.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. A competitive move or business approach designed to produce a successful outcome is called

.

ANS:

strategy Strategy is a competitive move or business approach designed to produce a successful outcome.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. In a written strategic plan, the

contains all the documentation related to the strategic planning process so that the reader obtains a sense of the background information used by the strategic planners in order to arrive at the strategic plan.

ANS:

appendix

The appendix contains all the documentation related to the strategic planning process so that the reader obtains a sense of the background information used by the strategic planners in order to arrive at the strategic plan.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care OTHER 1. A key component of the strategic planning process is to assess the environment. Place the

steps of the assessment process in order a. Identify strengths and weaknesses internal to the organization. b. Shape strategies into a strategic plan on which strategic management is based. c. Establish priorities for the critical issues so that strategies are based on the priority issues. d. Analyze strengths, weaknesses, opportunities, and threats for their impact on the organization. e. Analyze internal components for the purpose of drafting a picture of the critical features of the organization.

ANS:

A, E, D, C, B Environmental analysis incorporates an internal analysis such as a review of the mission statement and value system, as well as an external analysis. The analysis needs to review four areas: strengths, weaknesses, opportunities, and threats. In this approach, strengths and weaknesses internal to the organization are identified. Once identified, these components are analyzed for the purpose of drafting a picture of the critical features of the organization, its achievements and failures, and its good points and bad points. Next, priorities must be established for the critical issues so that strategies are based on the priority issues. The strategies identified through the SWOT analysis can be shaped into a strategic plan on which strategic management is based. The more carefully the analysis is done, the more reliable the strategic plan.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Chapter 15: Professional Practice Models Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. A professional practice model is a a. conceptual framework and philosophy of nursing within an organization. b. staffing grid that outlines nursing unit work schedules. c. mechanism by which care is actually provided to patients and families. d. blueprint for developing specific measurable objectives and actions.

ANS: A

Professional practice models (PPMs) refer to the conceptual framework and philosophy of nursing within an organization.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. Which nursing care model was prominent before the Great Depression? a. Functional nursing b. Group nursing c. Hospital staffing d. Private duty nursing ANS: D

Private duty nursing is the oldest care model in the United States. Between 1890 and 1929 in the United States, graduate nurses acted as private duty nurses, caring for patients in their homes.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. An example of a traditional nursing care delivery model is a. case management. b. patient- and family-centered care. c. transitional care. d. patient-centered medical home.

ANS: A

There are five traditional nursing models of care: (1) private duty, (2) functional, (3) team, (4) primary, and (5) case management. Of these, functional, team, primary, and case management were and are currently associated with hospital nursing practice. Private duty and case management were associated with public health, home health care, and community health but have been adapted to the inpatient setting.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care

4. Functional nursing a. divided and distributed nursing tasks. b. enhanced client-oriented care. c. provided a smooth care delivery system. d. was expensive once implemented.

ANS: A

Functional nursing focused on task accomplishment rather than individualized and holistic care. The division of labor was assigned according to specific tasks and technical aspects of the job, such as medication administration and taking vital signs.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Primary nursing is a type of care delivery in which the nurse a. cares for a patient 24 hours a day. b. is responsible for the client’s daily care. c. monitors care from admission to discharge. d. provides total care for the patient.

ANS: C

In the primary nursing model, the primary nurse has 24-hour-per-day accountability for the patient’s plan of care from admission to discharge. Associate nurses oversee patient care delivery when the primary nurse is not on shift, although associate nurses are expected to follow the primary nurse’s plan of care.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. Critical paths a. are designed only for critical care or trauma patients. b. determine lifesaving interventions for a specific population. c. outline optimal care and time milestones for the routine patient. d. provide a list of supplies and equipment needed for care.

ANS: C

A critical path is a written plan that identifies key, critical, or predictable incidents that must occur at set times to achieve client outcomes during an appropriate length of stay in a hospital setting.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. A patient is admitted with congestive heart failure, diabetes mellitus, and dementia. He has a

new dark spot on the top of his toes on his right foot. The nurse contacts the primary care physician, consults with the wound care specialist nurse, writes a nursing order for a referral to the diabetic educator, and contacts the discharge planner to facilitate future discharge plans.

Which of the following care delivery models best describes how the nurse is providing care? a. Case management b. Group nursing

c. Functional nursing d. Private duty nursing ANS: A

The Case Management Society of America (CMSA) definition of case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Nursing Diagnosis MSC: Client Needs: Physiological Integrity: Physiological Adaptation 8. Which of the following is true about team nursing? a. It includes only registered nurses (RNs) and licensed practical/vocational nurses

(LPN/LVNs). b. Each team member has his or her own patient assignments. c. Team members must have dual degrees. d. The nurse with a bachelor’s of science in nursing degree is the leader of the team.

ANS: B

Team nursing is a delivery approach that provides care to a group of patients by coordinating a team of RNs, licensed practical nurses, and care aides under the supervision of one nurse, called the team leader. Each team member has his or her own patient assignments, and team members are expected to assist and support each other as needed.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. The conceptual framework and philosophy under which the method of delivery of nursing

care is a component is known as a. core values. b. mission statement. c. care delivery model. d. professional practice model (PPM).

ANS: D

PPMs refer to the conceptual framework and philosophy under which the method of delivery of nursing care is a component. PPMs describe the environment and serve as a framework to align the elements of care delivery. The PPM can be thought of as a link between the problems presented by client populations, the purposes of professional occupations, and the purposes of health care organizations.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. The responsibility for making decisions about and designing strategies to create a climate and

environmental context around the provision of nursing and health care services lies with a. staff nurses. b. care councils. c. the nurse manager.

d. executive leadership.

ANS: D

Executive leadership is responsible for making decisions about and designing strategies to create a climate and environmental context around the provision of nursing and health care services.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. Stakeholders are informed of an organization’s key goals through its a. vision. b. values statement. c. mission statement. d. organizational philosophy.

ANS: C

Publicly posted mission statements inform key stakeholder groups, such as the public and employees, of the organization’s key goals.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. Lilly, an RN, works full time in her client’s home providing total care for him. She bathes and

dresses him, provides tracheostomy care and wound care, and feeds him. She is paid directly by her client. This type of nursing care is commonly known as a. primary nursing. b. functional nursing. c. case management. d. private duty nursing.

ANS: D

Private duty nursing, sometimes called case nursing, is the oldest care model in the United States. Private duty nursing is defined as one nurse caring for one client. In this model, complete and total care is provided by one nurse, but the nurse carries only one client assignment.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity: Physiological Adaptation 13. Mary Lou is a nurse in the critical care unit. She works 12-hour shifts. Each shift she is

assigned to one or two critical care patients. She is responsible for planning and delivering the care and treatment for each one of the patients she is assigned to. This is an example of which nursing model? a. Team nursing b. Managed care c. Total patient care d. Functional nursing ANS: C

The term total patient care has come to mean the assignment of each client to a nurse who plans and delivers care during a work shift.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity: Physiological Adaptation 14. Janice is assigned to pass medications this shift. Mary is assigned to do wound care, Jennifer

will give all the baths, and Jim will take all the vital signs. This model of nursing care is called nursing. a. team b. primary c. modular d. functional ANS: D

In functional nursing the division of labor is assigned according to specific tasks and technical aspects of the job. It has been defined as work allocation by functions or tasks, such as passing medicine, changing dressings, giving baths, or taking vital signs. Under functional nursing, the nurse identifies the tasks to be done for a shift. The work is divided and assigned to personnel, who focus on completing the assigned tasks.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity: Physiological Adaptation MULTIPLE RESPONSE 1. The presence of a nurse professional practice model (PPM) is the nurse’s (Select all that

apply.) a. control over practice. b. career focus. c. job satisfaction. d. psychological needs.

ANS: A, C

One important predictor of RN job satisfaction is the presence of a nurse professional practice model (PPM). Nurse job satisfaction is directly associated with nurse turnover, a significant human resource challenge for management. Professional practice models consist of structures, processes, and values that support nurse control over practice and enhance job satisfaction and retention.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. Which of the following nursing care models are hospital based? (Select all that apply.) a. Case management b. Functional c. Private duty d. Team

ANS: A, B, D

Case management, functional, primary, and team are nursing care models that are hospital based.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. The determination of a care delivery model or system of care delivery depends on (Select all

that apply.) a. fiscal responsibility. b. accountability to the consumer. c. government reimbursement. d. the organization’s philosophy. e. quality and safety considerations.

ANS: A, B, E

Care delivery model redesign is influenced by fiscal responsibility, accountability to the consumer, available resources, and quality and safety considerations. The appropriate care delivery model is the one that maximizes existing resources while meeting organizational goals and objectives (i.e., the mission).

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. Positive work environments are often found in Magnet-designated organizations.

Organizational structures associated with Magnet-like healthy work environments are (Select all that apply.) a. professional development opportunities. b. interdisciplinary collaboration. c. top-down approach to governance. d. decreased workloads. e. culture of safety.

ANS: A, B, E

Organizational structures associated with Magnet-like healthy work environments include effective leaders at all levels of the organization, professional development opportunities, staffing structures that consider nurse competencies, patient needs, and teamwork; interdisciplinary collaboration; empowered, shared decision making; patient-centered culture/culture of safety; quality improvement infrastructure; evidence-based practice; and a visible acknowledgment of nursing’s unique, valued contributions (e.g., professional practice model, vision/mission/philosophy statements).

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Professional practice models (PPMs) refer to the conceptual framework and philosophy of

nursing within an organization. The core elements of a PPM include (Select all that apply.) a. goals. b. values. c. leadership.

d. collaborative relationships. e. care delivery model.

ANS: B, C, D, E

The core elements of a PPM include nursing values, leadership, the care delivery model, collaborative relationships and decision making, and professional development opportunities.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. A well-known conceptual framework by Donabedian (1988) is used to promote positive

outcomes in an organization. The framework is composed of concepts related to (Select all that apply.) a. structure. b. outcomes. c. processes. d. values. e. quality.

ANS: A, B, C

One well-known conceptual framework by Donabedian (1988) frequently is used to “map” or determine what structures and processes promote positive outcomes. The three-concept framework is composed of structures, processes, and outcomes (S-P-O), and these three components are causally linked.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. Policies and procedures are two functional elements of an organization that are extensions of

the mission statements. The similarities between policies and procedures include (Select all that apply.) a. a need for regular, periodic reviews. b. a means for accomplishing goals and objectives. c. general guidelines for decision making about actions. d. a need for the smooth functioning of any work group or organization. e. a need to be very detailed as to how to perform a specific procedure on a specific unit.

ANS: A, B, D

The similarities between policies and procedures are that both need regular, periodic reviews and that both are a means for accomplishing goals and objectives. Both are necessary for the smooth functioning of any work group or organization.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Nurses still struggle to create a healthy work environment. The standards of a healthy work

environment include (Select all that apply.) a. staffing ratios.

b. c. d. e.

true collaboration. powerful leadership. meaningful recognition. skilled communication.

ANS: B, D, E

The six standards of a healthy work environment are skilled communication, true collaboration, effective decision making, meaningful recognition, appropriate staffing, and authentic leadership. They have direct relevance to PPMs. DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. Disadvantages of private duty nursing include (Select all that apply.) a. private duty nurses have a great degree of autonomy. b. private duty being a costly model. c. job security being tenuous and irregular. d. the nurse’s focus being entirely on one client’s needs. e. nurses maintaining close relationships with colleagues.

ANS: B, C

One disadvantage was that private duty is a costly model because of its low efficiency.

Furthermore, job security was tenuous and irregular. Other disadvantages were that nurses had little job mobility and were relatively isolated from colleagues.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care COMPLETION 1. A(n)

is the operational mechanism by which care is actually provided to patients and

families.

ANS:

care delivery model Care delivery models are the operational mechanisms by which care is actually provided to patients and families. Well-designed models maximize the quality and safety of nursing care.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. Organizations need to integrate the behaviors of employees to avoid random chaos and

maintain some order, function, and structure. A(n) is a guideline that has been formalized. It directs the action for thinking about and solving recurring problems related to the objectives of the organization.

ANS:

policy

A policy is a guideline that has been formalized. It directs the action for thinking about and solving recurring problems related to the objectives of the organization.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. A(n)

is a written plan that identifies key, critical, or predictable incidents that must occur at set times to achieve client outcomes within an appropriate length of stay in a hospital setting.

ANS:

critical path A critical path is a written plan that identifies key, critical, or predictable incidents that must occur at set times to achieve client outcomes within an appropriate length of stay in a hospital setting. As a pathway, it is a tracking system for the timing of treatments and interventions, health outcomes, complications, activity, and teaching/learning.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Chapter 16: Case and Population Health Management Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. The core element common to all provider interventions in case management (CM), disease

management (DM), and population health management (PHM) is a. disease preventative care. b. care coordination. c. client-centered. d. population-focused.

ANS: B

Care coordination is the core element common to all provider interventions in CM, DM, and PHM. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. The nurse who uses collaboration to coordinate care for an individual’s and family’s

comprehensive health needs through communication and available resources to promote patient safety and quality, cost-effective outcomes is performing a. population health management. b. managed care. c. disease management. d. case management.

ANS: D

Case management (CM) is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality cost-effective outcomes.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. The brokerage model and the comprehensive service center model are examples of which type

of care model? a. Collaborate b. Inter-professional c. Interdisciplinary d. Social work ANS: D

The brokerage model, the primary therapist model, the interdisciplinary team model, and the comprehensive service center model are all examples of social work models.

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

MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. A concept involving a system that guides and tracks patients over time through a

comprehensive array of health services to span all levels of intensity of care is known as a. transition of care. b. continuum of care. c. rounds. d. disease management strategies.

ANS: B

Continuum of care is a concept involving a system that guides and tracks patients over time through a comprehensive array of health services to span all levels and intensity of care. The services incorporated in each patient’s unique continuum vary based on the individualized health and/or behavioral health needs of each person.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5.

has garnered considerable attention in health care in part because of the publication Crossing the Quality Chasm, a health care quality initiative of the Institute of Medicine (IOM, now called the National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division). a. Disease management b. Development research groups c. Case management d. Diagnosis-related groups ANS: A

Two major forces triggered the rise of a DM perspective: (1) the abundance of managed care systems as a prevailing form of organized health care delivery (the influence of health plans), and (2) the national attention generated by Crossing the Quality Chasm, a health care quality initiative of the Institute of Medicine (IOM, now called the National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division).

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. A disease management program usually focuses on patients with a. chronic conditions. b. mental health issues. c. outpatient procedures. d. surgical diagnoses.

ANS: A

While CM programs serve a smaller percentage of the overall population, enrollees are complex from a medical-behavioral, health-social vulnerability perspective. DM programs serve a larger percentage of patients whose main problem is one or more chronic condition(s).

These individuals generally have similar primary needs regarding health condition education and accommodation strategies.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. Nursing outreach programs are the core element of a. population health management. b. disease management. c. case management. d. care management.

ANS: A

The newest generation of PHM programs involves proactive outreach. Nursing outreach programs are the core element. Personal communications (usually via telephone) between an expert nurse and the health plan participant build a personal relationship, help identify knowledge deficits and counseling needs, facilitate close monitoring and progress toward goals, enhance treatment adherence, and promote clinical and cost stabilization.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Which of the following statements is true about the New England Medical Center (NEMC)

case management model? a. It has a client-centered approach instituted during episodes of acute illness. b. It is known as a beyond-the-walls, medical-social, across-the-continuum of care model. c. It emphasizes the case manager’s traditional linkage function. d. CM functions are undertaken as a part or an extension of therapeutic intervention.

ANS: A

The NEMC model is a client-centered approach instituted during episodes of acute illness. It focuses on resource utilization, nursing accountability, and outcomes.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. The hospital’s disease management program has gathered data collected from health

assessments in order to categorize patients into like groups with the intention of providing population management interventions. This practice or strategy is referred to as a. analogizing. b. stratification. c. comparing. d. data exchanging.

ANS: B

In population health management, stratification has two meanings: a method of randomization and a process for sorting a population of eligible members into groups relating to their relative need for total population management interventions. The stratification process harvests information that can be used to divide the patient population into different levels to ensure a return on investment (ROI) based on resources allowed.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. A patient has a history of diabetes mellitus, myocardial infarctions, and hypertension. His

HgbA1c level dropped from 7.8% to 6.2% 2 months after he began a walking exercise program. The nurse case manager had provided diabetic education and suggested ways to enhance his cardiac reserve. This is an example of a. nursing empowerment. b. nursing knowledge. c. patient expertise. d. patient participation in care.

ANS: D

The scenario depicts an example of a case manager’s intervention resulting in a positive clinical outcome. This is the result of the patient’s participation in his own care.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity: Physiological Adaptation 11. Which of the following scenarios would require disease management? a. A blood pressure screening clinic is started at the senior citizen center. b. A person with multiple chronic illnesses is admitted to the hospital. c. A program is started to address diabetes in the Native American population. d. An initiative is developed to promote fluoride treatments in schools.

ANS: B

DM programs serve a larger percentage of patients whose main problem is one or more chronic condition(s). These individuals generally have similar primary needs regarding health condition education and accommodation strategies. Assessments focus on health condition– specific issues, and programs take a more standardized approach to education and resources.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. Which of the following collaborative processes assesses, plans, facilitates, coordinates,

advocates, and evaluates options and services required to meet an individual’s comprehensive health needs? a. Care management b. Case management c. Disease management d. Population health management ANS: B

Case management (CM) is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality cost-effective outcomes.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. Which of the following factors best suggests an individual is motivated to engage in a disease

management program? a. Mistrust of insurance companies b. Enrollment at initial contact c. Can afford the cost of enrollment d. Has a need that would benefit from the program ANS: D

Factors driving engagement suggest that individuals most motivated to engage are those who are well informed of the program benefits and have a perceived need that would benefit from said program (e.g., living alone, needing a supportive person to discuss ideas).

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. A health care management continuum a. deals strictly with health promotion. b. controls problems at the population level. c. is a linkage of health services across settings. d. provides another health care option for the homeless.

ANS: B

The health care management continuum is better known as population health management (PHM). One definition of population health management is the process of addressing population health needs and controlling problems at a population level.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 15. A population health approach a. aims to improve the health of the entire population. b. is funded by local, state, and national governments. c. strives to care for people who already exhibit optimal health. d. treats community-acquired diseases in area clinics.

ANS: A

Population health is an approach to health that aims to improve the health of the entire population and reduce health inequities among population groups.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 16. To be effective at population care management, both CM and DM need to a. assess and plan health initiatives within an area. b. implement and evaluate health programs within a community.

c. assess and define the populations to be served. d. organize and regulate health professions across the country.

ANS: C

To be effective at individual and population-based care management, both CM and DM programs need to identify, assess, and define the populations to be served early in the program planning effort.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 17. Community health means meeting the a. collective needs of a group by identifying problems and managing interactions. b. needs of an individual within the community by identifying problems and

managing interactions. c. needs of the health care system within a population or area. d. needs of a population by identifying problems and managing interactions.

ANS: A

Community health means meeting the collective needs of a group by identifying problems and managing interactions within the community and between the community and larger society.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 18. The Collaborative Care Model of CM is best used for a. patients with co-occurring physical and mental health needs. b. individuals and small systems. c. hospital-based case management programs focusing on episodic care. d. the transition of high-risk clients from acute care to community or long-term care

settings.

ANS: A

In the Collaborative Care Model, dedicated team members address the needs of patients through a comprehensive and strategic care delivery process. Included in the team are a primary care provider, a case manager who is trained in behavioral health, and psychiatric consultants and/or behavioral health specialists. This comprehensive approach to care serves as a proactive means to screen and track mental health conditions within the primary care setting.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 19. The first step in the development of a case management program is a. to identify high-volume or high-risk case types. b. to develop a pilot program. c. to assess the organization and the client population served. d. to form an interdisciplinary care team.

ANS: C

The general process for the development of a case management is to assess the organization and the client population served; identify high-volume or high-risk case types; determine the usual client care problems, issues, or difficulties related to the high-volume or high-risk case types, with desired goals; form an interdisciplinary care team of the interrelated care providers who will be involved with the case types; develop and design an interdisciplinary critical pathway for each selected case type; develop a pilot program or trial site; and then evaluate the pilot program and consider system-wide implementation.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 20. According to the Centers for Disease Control (CDC), chronic diseases account for

% of

deaths in the United States. a. 20 b. 40 c. 50 d. 70 ANS: D

Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability in the United States. Chronic diseases account for 70% of all deaths in the United States, which is 1.7 million each year. These diseases also cause major limitations in daily living for almost 1 out of 10 Americans, a total of about 25 million people.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance MULTIPLE RESPONSE 1. Which of the following components are common to all case management models? (Select all

that apply.) a. Client identification and outreach b. Population management c. Monitoring service delivery d. Individual assessment and diagnosis e. Evaluation f. Environmental management ANS: A, C, D, E

There are eight main service components common to all case management models. They are client identification and outreach; individual assessment and diagnosis; service planning and resource identification; linking clients to needed services; service implementation and coordination; monitoring service delivery; advocacy; and evaluation.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 2. Which of the following statements accurately describe disease management? (Select all that

apply.) a. Disease management is care coordination that is organized to achieve specific client outcomes, given fiscal and other resource constraints.

b. Disease management is a system of coordinated health care interventions and

communications for populations with conditions in which patient self-care efforts are significant. c. Disease management relies on a structured system of interventions that focus on a specific condition. d. Disease management program content and interventions are evidence and guideline based. e. Disease management is the medical management of chronic disease.

ANS: B, C, D

Disease management is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant. DM programs usually focus on a single condition, rely on a structured system of interventions that focus on a single condition; and program content and interventions are evidence and guideline based.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 3. Case management and disease management are similar because both are interventions

designed to coordinate care for better outcomes and lowered costs. Which statements are true regarding the differences between the two terms? (Select all that apply.) a. Disease management is client focused. b. Case management focuses on coordinating care of individuals and families. c. Disease management is more population-based than client-centered. d. Disease management is more episodic in its approach. e. Case management is more population-focused.

ANS: B, C

Case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality cost-effective outcomes. Disease management is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 4. Which of the following governmental agencies tracks population and health trends? (Select all

that apply.) a. U.S. Census Bureau b. The Joint Commission c. CDC d. Bureau of Labor Statistics (BLS) e. Health Resources and Services Administration (HRSA) ANS: A, C, D, E

Population and health trends are tracked by governmental agencies such as the U.S. Census Bureau, CDC, BLS, and HRSA, as well as private foundations and organizations.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. The CM dyad team model—composed of a nurse case manager and social worker—has been

widely adopted in hospitals. Through its unique structure, the nurse and social work dyad provides the implementation of collaborative interventions that focus on (Select all that apply.) a. minimization of inpatient transitions. b. promotion of patient and family satisfaction through efforts of advocacy. c. maximization of health care benefits. d. reduction of cost by decreasing the length of stay. e. enhanced discharge planning.

ANS: A, B, D, E

Through its unique structure, the nurse and social work dyad provides the implementation of collaborative interventions that focus on (1) minimization of inpatient transitions, (2) reduction of cost by decreasing the length of stay, (3) promotion of patient and family satisfaction through efforts of advocacy, and (4) enhanced discharge planning.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 6. Population health management (PHM) is viewed as a major health care strategy to improve

health outcomes. This is because effective population health management programs (Select all that apply.) a. have proactive interventions. b. promote client satisfaction through advocacy. c. coordinate care for chronic conditions. d. have consistency of care for at-risk populations. e. customize care support. f. encourage adherence to treatment.

ANS: A, C, D, E, F

PHM is now being viewed as a major health care strategy to improve health outcomes across multiple populations while lowering costs and improving patient satisfaction. PHM has demonstrated effectiveness across disease states, including integrated behavioral health, chronic illness (e.g., diabetes, congestive heart failure), and assorted payers (e.g., Medicare, Medicaid, third-party populations). Attractive features include effective population management, coordination of care for chronic conditions, consistency of care for at-risk populations, customization of care support, encouragement of adherence to treatment, and proactive interventions.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

Chapter 17: Nursing Leadership for Evidence-Based Practice Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. Evidence-based practice includes a. collaborative practice dynamics between health care professionals. b. documentation of patient care as evidence of nursing practice. c. integration of research with clinical expertise and patient values. d. mutual goal setting and application in the clinical setting.

ANS: C

Evidence-based practice is a process of shared decision making in a partnership between patients and providers that involves the integration of research and other best evidence with clinical expertise and patient values in health care decision making.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. Components of a systematic review include a. publication of study data. b. assessment of a study. c. determination of statistical tests. d. development of research guidelines.

ANS: B

Standard components of a systematic review are processes for (1) initiating, (2) finding and assessing individual studies, (3) synthesizing the body of evidence, and (4) reporting using a standard format.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. A team has formed to determine which methods have worked best and which factors influence

the implementation of an evidence-based practice program. This is known as a. authoritarian b. autocratic c. transformational d. translational

research.

ANS: D

Translational research includes testing the effect of interventions aimed at promoting the rate and extent of adoption of evidence-based practices by nurses, physicians, and other health care providers and describing organizational, unit, and individual variables that affect the use of evidence in clinical and operational decision making.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

4. Opinion leaders are a. formal leaders who lead evidence-based practice development teams. b. formal leaders who write new evidence-based practice guidelines. c. informal leaders who influence peers by evaluating innovations for use in certain

settings and promoting clinicians use of evidence in clinical decision making. d. informal leaders who gather data about nursing practice changes.

ANS: C

Informal leaders who influence peers by evaluating innovations for use in certain settings and promoting clinicians’ use of evidence in clinical decision making are referred to as opinion leaders. Opinion leaders are likeable, trustworthy, informative, and influential.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. A clinical nurse specialist is meeting one on one with staff nurses while they are working to

discuss data about the evidence-based practice. This is known as a. academic detailing. b. champion coaching. c. individual instruction. d. professional mentoring.

ANS: A

Academic detailing is a marketing strategy in which a trained individual meets one on one with practitioners in their setting to provide information about the evidence-based practice.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. A communication strategy used in the promotion of adopting evidence-based practice

recommendations is a. best practice evaluation. b. knowledge translation. c. shared governance. d. academic detailing.

ANS: D

Academic detailing involves a strategic approach to communication and discussions with clinicians. Clinicians tend to buy into the need for the practice change when there is a strong evidence base, the topic addresses an identified need, data demonstrate an opportunity for practice improvement within the clinical area, and the practice change offers a relative advantage.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control 7. Which of the following will positively influence the sustainability of a practice change? a. Audit and feedback of key indicators. b. Incremental implementation of practice changes. c. Adhering to a strict action plan for implementation. d. The new practice is much different from current practice.

ANS: A

The sustainability step in implementation is one of the most difficult in the EBP process.

Audit and feedback of key indicators remains a necessary component of an integration plan.

Key indicators to monitor are drawn from the pilot data and include process (i.e., knowledge, attitudes, and practices) and outcomes.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. The chief executive nursing officer has discussed implementation of evidence-based practice

at hospital-wide nursing meetings. She is leading a team to incorporate evidence-based practice terminology into the vision and mission of the institution. She also is advising the multidisciplinary leadership team to incorporate evidence-based practice expectations into the performance appraisals of all staff members. The chief executive nursing officer is modeling a. continuous quality improvement methodology and techniques. b. marketing tactics that will help familiarize the staff with new terminology. c. professional duties for new protocol acceptance throughout the institution. d. strategies for incorporation of evidence-based practice into the infrastructure of the organization.

ANS: D

Strategies for integration of evidence-based practice into the infrastructure of the organization include the following: incorporation of evidence-based practice into the mission, vision, strategic plan, and performance appraisals of staff; integration of work into nursing governance structure; and demonstration of valuing evidence-based practice through the behaviors of leadership.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. Once a new practice has been implemented on a unit, scaling up needs to be evaluated. What

is scaling up? a. A method used to implement the previous practice if the new practice has been found to be detrimental to patient care b. A process used to expand the reach of effective clinical interventions in new settings c. Recruitment of new nurses from different institutions who can help with role modeling and communication of the new practice d. A tactic used to invigorate leaders to continue to communicate better with staff nurses and ancillary personnel ANS: B

A reinfusion or reinforcement plan is a strategy for ongoing communication about the new practice until it becomes fully integrated into daily care.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. The responsibility to articulate the business case for evidence-based practice to senior

leadership lies with a. the staff nurse.

b. nursing leadership. c. the governing board. d. the quality improvement committee.

ANS: B

Nursing leaders have a responsibility to clearly articulate EBP work in a way that will be heard by decision makers. Sharing results with senior leaders helps them recognize great work while reporting the business case for evidence-based care to governing boards.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. The responsibility of developing the unit culture for evidence-based practice belongs to the a. staff nurses. b. unit manager. c. medical director. d. chief executive officer.

ANS: B

Nurse leaders are in key positions responsible for developing and sustaining an organizational infrastructure and creating an environment that affects adoption of EBPs and improves patient outcomes.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. The role of the project director is to a. take meeting minutes. b. maintain the action plan. c. set the expectations for the unit. d. report project progress to the governing body.

ANS: B

The project director is responsible for establishing meeting schedules and time lines with the group, running the meetings, maintaining the action plan, delegating work assignments, and overseeing the process and progress. The focus of the project director must always be on moving the project forward, despite challenges, as a key strategy for success. The project director may orchestrate discussions for identifying potential challenges, addressing those that cannot be avoided but continuing to move forward despite distractions.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. The

Act provides incentives for adoption and implementation of electronic health records (EHRs) while enhancing privacy and security for patients and providing incentives for practitioners and hospitals to engage in meaningful use. a. Stark b. HIPAA c. HITECH d. Anti-kickback

ANS: C

The HITECH Act provides incentives for adoption and implementation of EHRs while enhancing privacy and security for patients and providing incentives for practitioners and hospitals to engage in meaningful use.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. A rigorous scientific process used to combine findings from research (usually randomized

controlled trials) into a powerful and clinically useful report to guide practice is known as a systematic review. Standard components of a systematic review to consider are (Select all that apply.) a. process for initiating. b. standard reporting format. c. reliability and validity of data. d. process for synthesizing the body of evidence. e. process for finding and assessing individual studies.

ANS: A, B, D, E

Standard components of a systematic review to consider are: (1) process for initiating; (2) process for finding and assessing individual studies; (3) process for synthesizing the body of evidence; and (4) standard reporting format. Rigor used in development varies considerably among reports.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. Clinicians tend to buy into the need for practice change when (Select all that apply.) a. there is a strong evidence base. b. the topic addresses an identified need. c. the practice change offers a relative advantage. d. the practice change is endorsed by organizational executive leadership. e. data demonstrate an opportunity for practice improvement within the clinical area.

ANS: A, B, C, E

Clinicians tend to buy into the need for the practice change when there is a strong evidence base, the topic addresses an identified need, data demonstrate an opportunity for practice improvement within the clinical area, and the practice change offers a relative advantage.

Localizing or adapting practice recommendations to fit the local setting and culture is an essential step in the process, often using the role of the opinion leader and team of local experts.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

3. The cardiac care unit is putting together a shared governance committee. To develop expertise

in evidence-based practice processes, the members of the committee should have skills that include the ability to (Select all that apply.) a. report results. b. perform research. c. critique and synthesize evidence. d. statistically analyze quality improvement. e. develop an implementation and evaluation plan.

ANS: A, C, D, E

Critical skills for shared governance committee members who supplement point-of-care clinical experts include appraisal and synthesis of the evidence, development of an implementation and evaluation plan, statistical analysis for quality improvement, and reporting of results.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. To promote an organizational culture that embraces evidence-based practice, an organization

must (Select all that apply.) a. recognize and reward the work. b. adopt an evidence-based practice model. c. provide education about evidence-based practice. d. discourage nurses from questioning their practice. e. recruit nurses with interest in evidence-based practice.

ANS: A, B, C, E

An organizational culture that promotes use of evidence values nurses questioning their practice, provides education about evidence-based practice, adopts an evidence-based practice model, and recognizes and rewards the work. Recruiting and hiring nurses with interest in EBP will help build the desired culture and capacity.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Strategies for building a strong organizational context of evidence-based practice include

(Select all that apply.) a. linking quality improvement and patient safety. b. periodically evaluate the infrastructure and context for EBP in their organization. c. development of a mission, vision, and strategic plan inclusive of EBP language. d. inclusion of EBP components in performance appraisals across all job classifications. e. incorporating evidence-based practice into organizational information systems.

ANS: B, C, D, E

When working to sustain evidence-based practice, strategies are needed to hardwire the work into the organizational system. Nurse leaders should periodically evaluate the infrastructure and context for EBP in their organization. Linking quality improvement and EBP is another strategy for building a strong organizational context. Development of a mission, vision, and strategic plan inclusive of EBP language provides a sturdy foundation for this work at all levels of the organization and begins the process of building a culture in which evidence-based health care is the expected norm. Inclusion of EBP components in performance appraisals across all job classifications—from top executives to all levels throughout the system—promotes positive reinforcement and priority setting in the busy work environment. Organizational information systems must be designed to incorporate EBPs into clinical work flow if adoption is to occur and best outcomes achieved.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. When articulating the business case for evidence-based practice to governing boards, key

messages to share with board members include (Select all that apply.) a. reporting of patient safety events. b. reporting of anticipated outcomes. c. reporting only projects that have cost savings. d. functional responsibility of committees within the organizational and nursing infrastructure. e. reporting the linkages between evidence-based practice and the organization’s mission, values, and strategic plan.

ANS: B, D, E

Key messages to share with board members include reporting the linkages between evidence-based practice and the organization’s mission, values, strategic plan, and committee’s functional responsibility within the organizational and nursing infrastructure.

Reporting of project results is essential to garner continued support and recognition for the program. Reports will best capture attention when addressing three to five key talking points or takeaway messages with clear links to organizational priorities and infrastructure.

Reporting anticipated outcomes can be helpful early in the process. Cost savings or cost avoidance may not be achieved with every project but should be calculated whenever possible.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. Nurse managers are responsible for developing the unit culture supporting innovation and

evidence-based care. The nurse manager can facilitate and support EBP work by (Select all that apply.) a. set the staffing schedule. b. allocate resources as needed. c. set the expectations for the unit. d. promote staff questioning practice. e. encourage and respond to new ideas.

ANS: B, C, D, E

Nurse managers are responsible, parallel to the nurse executive, for developing the unit culture supporting innovation and evidence-based care. Nurse managers can facilitate and support EBP work in the following ways: set unit expectations, discuss importance of EBP with unit nurses and inter-professional team members, encourage and respond to new ideas, promote staff questioning practice, support the team with project work time, promote the project’s importance, track progress, facilitate movement of the project through the institutional shared governance approval process, and allocate resources.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Jenny is an advanced practice nurse on the telemetry unit. How might Jenny’s skills be used to

contribute to a culture of evidence-based practice? (Select all that apply.) a. She can facilitate meetings. b. She can function as team leader. c. She can assist with problem solving. d. She can identify potential roadblocks. e. She can increase her patient load.

ANS: A, B, C, D

Advanced practice registered nurses can function as opinion leaders and facilitators. They have the ability to take on the most challenging steps in the process by leading a team, identifying potential roadblocks, facilitating problem solving during implementation and evaluation, reporting results, and providing expertise throughout the evidence-based practice process. Critique and synthesis of the evidence, development of an evaluation plan, and analysis of results are steps that utilize this expertise. Strong skills are needed for the facilitator to keep a team focused and moving forward. Increasing patient load does not contribute to a culture of evidence-based practice.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. The functions of staff nurses in a culture of evidence-based practice include (Select all that

apply.) a. functioning as change champions. b. facilitating adoption of practice change. c. facilitating use of research findings in practice. d. overseeing the process and progress of projects as project director. e. identifying important and clinically relevant topics to develop into evidence-based practice improvements.

ANS: A, B, D, E

Staff nurses are ideally positioned to identify important and clinically relevant topics to develop into evidence-based practice improvements. Staff nurses are expert clinicians who have the skills to collaborate and problem solve, finding many creative solutions. They are critical to providing quality care through implementation of evidence-based practices. Staff nurses can function as change champions and core group members within their current functions. With appropriate coaching and support staff, nurses also can function as an opinion leader or even project director. Advanced practice nurses usually have the responsibility of facilitating use of research findings in practice.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care OTHER 1. The CNO at Mercy Hospital is implementing a new evidence-based practice for fall

prevention. List the steps in order she should take to advance stakeholders (both people and systems) through the process of diffusion. a. Integrating and sustaining use b. Creating awareness and interest c. Promoting action and adaptation d. Building knowledge and commitment ANS:

B, D, C, A The evidence-based practice implementation guide was developed to assist nurse leaders with planning and use of effective implementation strategies that advance stakeholders (both people and systems) through a process of diffusion creating awareness and interest, building knowledge and commitment, promoting action and adaptation, and integrating and sustaining use.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Chapter 18: Quality and Safety Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. The degree to which health services for individuals and populations increases the likelihood of

desired health outcomes that are consistent with current professional knowledge is known as the a. care delivery quotient. b. excellence index. c. quality of health care. d. standard of care.

ANS: C

Quality of health care is defined as the degree to which health services for individuals and populations increases the likelihood of desired health outcomes that are consistent with current professional knowledge.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. A nursing quality improvement supervisor is proposing to enhance the current quality

improvement program. One of the most important themes that a nursing quality improvement supervisor should consider is a. budgetary considerations. b. collaboration between health care teams. c. regular staff training programs. d. suggestions from patients.

ANS: B

Collaborative partnerships are part of this imperative and shape the way professional nurses act clinically and how they participate in performance and quality improvement efforts. As the complexity of care increases, multidisciplinary and inter-professional teamwork is used to solve complex problems in practice.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. To provide the best care to every patient every day through integrated clinical practice,

education, and research is an example of a(n) a. accountability agreement. b. mission statement. c. organizational standard. d. vision and value proposal.

ANS: B

The mission statement of an organization is a concise statement that answers the question: What business are we in today?

DIF: Cognitive Level: Understand (Comprehension)

TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. Hospitals must submit specific quality performance data regarding Medicare patients or risk a. an increase in federal tax. b. decreased payments. c. fewer physician referrals. d. sanctions by The Joint Commission (TJC).

ANS: B

In 2011, CMS developed the Hospital Value-Based Purchasing Program, which applied to payments beginning in fiscal year 2013 for discharges occurring on or after October 1, 2012.

Under the program, CMS makes value-based incentive payments to 3500 acute care hospitals based either on how well the hospitals perform on certain quality measures or how much the hospitals’ performance improves on certain quality measures from their performance during a baseline period. Reimbursement is based on quality of care, not quantity. The higher a hospital’s performance or improvement during the performance period for a fiscal year, the higher the hospital’s value-based incentive payment for the fiscal year would be (CMS, 2015).

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Responding to a code called in the psychiatric unit where she works, a staff nurse finds that a

patient has committed suicide. The staff nurse correctly identifies this as a a. benchmark incident. b. quality improvement issue. c. performance breach. d. sentinel event.

ANS: D

Specific sentinel event outcomes are considered “reviewable” by TJC. Reviewable sentinel events are events that have resulted in an unanticipated death, permanent harm, or severe temporary harm and include suicide of any patient receiving care, treatment, and services in a staffed around-the-clock care setting.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 6. Which comment by the nurse manager would indicate that the hospital places a high value on

patient safety? a. We have safety posters throughout the hospital that encourage people to report problems. b. We have monthly safety in-services. c. We encourage patients and families to participate in their care. d. All employees are required to update their knowledge of safety practices each year.

ANS: C

Nurse leaders will continue to play an important role in designing care delivery systems that promote patient and family engagement. Various toolkits have been developed to assist staff nurses and managers who desire to engage patients and their families in hospitals and ambulatory and primary care.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 7. Which of the following responses from the nurse manager is consistent with a culture that

promotes patient safety? a. We make sure that we don’t have any errors on this unit. b. We identify who made the error and take corrective action. c. We provide remedial training for all staff on the unit when there is an error. d. We report any medical error or near-miss to help us find the root cause of the problem.

ANS: D

Health care organizations that embrace a fair and just culture identify and correct the systems or processes of care that contributed to the medical error or near-miss. Managers believe that more health care professionals will report more errors and near-misses when they are protected by a non-punitive culture of medical error reporting, and this will further improve patient safety through opportunities for improvement and lessons learned. The American Nurses Association has endorsed just culture as a means of ensuring safe care.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 8. Sentinel Event Alerts are published by TJC to do which of the following? a. Allow facilities to learn from sentinel events that have occurred in other facilities

and incorporate recommendations for prevention into their policies. b. Notify hospitals that if a sentinel event occurs during an alert, the hospital will be

subject to withdrawal of Medicare and Medicaid certification and reimbursement. c. Prevent a near-miss from occurring. d. Assist hospitals to find national standardized performance measures to benchmark themselves against other similar hospitals.

ANS: A

Sentinel Event Alerts are published by TJC to review the lessons learned from those facilities that had experienced these sentinel events. The hope is that other hospitals will incorporate the recommendations into their policy to avoid making similar errors.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 9. Mercy Hospital compares its surgical site infection rate to General Heart Hospital, which is

known as a best-in-class hospital for its surgical site infection rates. Mercy Hospital studies General Heart Hospital’s methods for reducing surgical site infection rates and uses that information to improve its own performance. This quality performance method is called a. benchmarking. b. evidence-based practice. c. enterprise risk management. d. continuous quality improvement.

ANS: A

In ambulatory care (and other settings), benchmarking is the process of comparing a practice’s performance with an external standard. Benchmarking is an important tool that facilitators can use to motivate a practice to engage in improvement work and to help members of a practice understand where their performance falls in comparison to others.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control 10. A clearly recognizable process of providing care that has an evidence base demonstrating that

it reduces the likelihood of harm is a. risk adjustment. b. a sentinel event. c. a patient safety practice. d. a performance measure.

ANS: C

Patient safety practices are discrete and clearly recognizable processes or manners of providing care that have an evidence base demonstrating that they reduce the likelihood of harm due to the systems, processes, or environments of care.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 11. The industry-based model for quality management and measurement whose premise is that

operational waste needs to be eliminated is a. Six Sigma. b. ISO 9000. c. Lean Enterprise. d. Baldrige National Quality Award Program.

ANS: C

Lean Enterprise is a model of quality measurement that was originally associated with Deming but reintroduced to the United States by Womack in the mid-1990s. The premise of this model is that operational waste in an organization needs to be eliminated.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. Which of the following is an example of a nurse-sensitive indicator? a. Cardiac patient mortality b. Hospital-acquired pressure ulcers c. Pulmonary embolus after knee surgery d. Iatrogenic pneumothorax after central line placement ANS: B

Nurse-sensitive indicators refer to the structure, process, and outcomes of professional nursing care. These include falls and falls with injury, hospital-acquired pressure ulcers, health care– associated infections, nursing care hours per patient day, nursing care hours, nursing turnover, physical restraints, RN survey, and skill mix.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Evaluation

MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 13. The purpose of a root cause analysis (RCA) is to a. discipline the staff involved in the patient safety event. b. disclose the medical error to the patient/patient s family. c. identify the person(s) responsible for committing the error. d. identify the systems issues that led to a sentinel event.

ANS: D

The purpose of the RCA is to drill down to the most common cause(s) for the event and determine what process improvements can be made to prevent the sentinel event from occurring in the future.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 14. The risk manager wants to illustrate the causes that have been leading to an increase in patient

misidentification. The most appropriate tool to use is a a. Pareto chart. b. control chart. c. fishbone diagram. d. detailed flowchart.

ANS: C

The fishbone diagram resembles diagramming sentences. The effect is illustrated in a box at the end of a midline (or head of the fish). The causes are generally four or five categories of elements that might contribute to the effect (e.g., machines, methods, people, materials, and measurements) and the specific activities. Under each of these category headings, individual items that might lead to the effect are listed. By diagramming all of the possible contributors, the predominant or root causes may be found more readily.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential MULTIPLE RESPONSE 1. Which of the following are never events? (Select all that apply.) a. A minor medication error b. A foreign object left in the body during surgery c. Surgery on the wrong body part d. A mismatched blood transfusion e. Hip fracture acquired in the hospital f. Pressure ulcer acquired in the home g. Catheter-associated urinary tract infection h. Surgical site infection ANS: B, C, D, E, G, H

A never event is an event that should never happen. The insurer will never pay. Insurers will no longer pay for never events. A pressure ulcer will be covered if it was not acquired in the hospital facility. A minor medication error that causes no harm to the patient will not cause an insurer to withhold payment.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 2. A successful enterprise risk management (ERM) program will (Select all that apply.) a. identify risks. b. improve quality. c. prevent damage. d. control occurrences. e. control legal liability.

ANS: A, C, D, E

ERM program is defined as an organization-wide program to identify risks, control occurrences, prevent damage, and control legal liability; it is a process whereby risks to the institution are evaluated and controlled.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 3. Tenets embraced by health care professionals and promoted by health care leaders and

organizations such as TJC and the IOM include which of the following? (Select all that apply.) a. People and systems are the problems, not processes. b. Quality measurement and monitoring is everyone’s job. c. Quality cannot be enhanced by non-punitive work cultures. d. Standardization of processes is key to managing work and people. e. The impetus for quality monitoring is not primarily for accreditation or regulatory compliance.

ANS: B, D, E

Tenets embraced by health care professionals and promoted by health care leaders and organizations such as TJC and the IOM include the following: processes and systems are the problems, not people; standardization of processes is key to managing work and people; quality can be enhanced only in safe, non-punitive work cultures; quality measurement and monitoring is everyone’s job; the impetus for quality monitoring is not primarily for accreditation or regulatory compliance, but rather as a planned part of an organization’s culture to continuously enhance and improve its services; based on continuous feedback from employees and customers, consumers and stakeholders must be included in all phases of quality improvement planning; consensus among all stakeholders must be gained to have an impact on quality and safety; and health policy should include a focus on continuous enhancement of quality and safety.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential

4. A framework for understanding health care improvement has been proposed by the IOM

Committee on Quality of Health Care in America. The aims for health care quality improvement propose that health care systems ensure that care is (Select all that apply.) a. safe. b. timely. c. efficient. d. cost-controlled. e. patient-centered.

ANS: A, B, C, E

A framework for understanding health care improvement has been proposed by the IOM Committee on Quality of Health Care in America. These six aims for health care quality improvement propose that health care systems ensure that care is safe, effective, patient-centered, timely, efficient, and equitable.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 5. The Baldrige National Quality Award (BNQA) establishes a set of performance standards that

define a total quality organization. The standards in areas of excellence include (Select all that apply.) a. leadership. b. strategic planning. c. environment of care. d. human resource focus. e. medication management.

ANS: A, B, D

The standards in seven areas of excellence established by the BNQA are: (1) leadership, (2) strategic planning, (3) customer and market focus (focus on patients, other customers, and markets), (4) information and analysis, (5) human resource focus, (6) process management, and (7) business results (organizational performance results).

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. Attributes of a total quality organization according to BNQA include (Select all that apply.) a. accreditation by TJC. b. a commitment to obtaining Magnet designation. c. strategic planning. d. focus on patients, other customers, and markets. e. organizational performance results.

ANS: C, D, E

The Baldrige National Quality Award (BNQA) establishes a set of performance standards that define a total quality organization. Named after the Secretary of Commerce, the BNQA was established by Congress in 1987 to enhance the competitiveness and performance of U.S. businesses. The standards in seven areas of excellence are: (1) leadership, (2) strategic planning, (3) customer and market focus (focus on patients, other customers, and markets), (4) information and analysis, (5) human resource focus, (6) process management, and (7) business results (organizational performance results). Organizations committed to quality improvement choose to adopt the BNQA approach as another means of defining and improving their organizational processes to achieve quality outcomes.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. TJC requires accredited organizations to participate in their core measure initiative. The

current core measure sets include (Select all that apply.) a. stroke. b. tobacco treatment. c. pneumonia measures. d. iatrogenic pneumothorax. e. venous thromboembolism. f. acute myocardial infarction.

ANS: A, B, C, E, F

The current core measure sets include perinatal care, stroke, venous thromboembolism, substance use, tobacco treatment, hospital outpatient department, pneumonia measures, heart failure, acute myocardial infarction, surgical care improvement project, hospital-based inpatient psychiatric services, emergency department, children’s asthma care, and immunization.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Principles of a fair and just culture include (Select all that apply.) a. zero-tolerance for reckless behavior. b. reduction of personal accountability and discipline. c. recognition that competent professionals make mistakes. d. errors and unintended events being reported unless no patient harm occurs. e. acknowledgment that even competent professionals develop unhealthy norms.

ANS: A, C, E

A fair and just culture is an approach to medical event reporting that emphasizes learning and accountability over blame and punishment. Everyone throughout the organization is aware that medical errors are inevitable, but all errors and unintended events are reported—even when the events may not cause patient injury. This culture can make the system safer as it recognizes that competent professionals make mistakes and acknowledges that even competent professionals develop unhealthy norms (shortcuts or routine rule violations), but it has zero-tolerance for reckless behavior.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 9. Nurse managers can create an environment that is devoted to health care safety by doing

which of the following? (Select all that apply.) a. Adopting and embracing the concept of disciplining staff who commit errors b. Learning the concepts and tools related to quality improvement and quality assurance c. Becoming a role model for staff and peers in practicing health care safety concepts d. Encouraging staff to be constantly vigilant in identifying potential risks in the care environment e. Creating a sense of partnership with patients and families to promote communication about safety concerns and soliciting their suggestions to correct and prevent potential risks ANS: C, D, E

Nurse managers can personally create an environment that is devoted to health care safety by doing the following: learning the concepts and tools related to risk identification, analysis, and error reduction; adopting and embracing the concept of non-punitive error reporting; advocating for the establishment of a non-punitive culture if it is not currently a strong ideal within the organization; encouraging staff to be constantly vigilant in identifying potential risks in the care environment; creating a sense of partnership with patients and families to promote communication about safety concerns and soliciting their suggestions to correct and prevent potential risks; and becoming a role model for staff and peers in practicing health care safety concepts.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential COMPLETION 1. The improvement process in which an organization measures its strategies, operations, or

internal process performance against that of best-in-class organizations within or outside its industry determines how those organizations achieved their performance levels, and uses that information to improve its own performance is known as _.

ANS:

benchmarking Benchmarking is the process of comparing a practice’s performance with an external standard.

Benchmarking is an important tool that facilitators can use to motivate a practice to engage in improvement work and to help members of a practice understand where their performance falls in comparison to others.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2.

is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.

ANS:

Evidence-based practice Evidence-based practice is defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care OTHER 1. A Healthcare Failure Modes and Effects Analysis (HFMEA) for a new bar-coding system is

being conducted by an interdisciplinary team. List the steps of the HFMEA in the correct order. a. Identifying prevention strategies b. Endorsing action plans for implementation c. Assessing risk points within the process steps d. Flowcharting the steps of the process being studied e. Designing out the most critical of the potential failures f. Recommending process improvements for prevention of the failures g. Ranking key risk points in terms of their impact on the potential failure of the system h. Reporting action plans for implementing prevention strategies to the enterprise leaders ANS:

D, C, G, E, F, A, H, B The HFMEA is conducted by an interdisciplinary team of professionals who own the process being studied and is facilitated by someone with knowledge and skills in quality improvement tools. The HFMEA begins with flowcharting the steps of the process being studied. The team assesses risk points within the process steps, and these key risk points are ranked in terms of their impact on the potential failure of the system. Scores for severity and probability are calculated to give a hazard score to the identified breakdown, and detectability of the failure mode is factored into the analysis of its impact on the overall process. The team then designs out the most critical of the potential failures and recommends process improvements for prevention of the failures. Once these prevention strategies are identified, action plans for implementing them are reported to the enterprise leaders and endorsed for implementation.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 2. Quality planning establishes the design of a product, service, or process that will meet

customer, business, and operational needs to produce the product before it is produced.

Quality planning follows a universal sequence of steps. List the universal sequence of steps in order. a. Identify customers and target markets. b. Discover hidden and unmet customer needs.

c. Develop a service or product that exceeds customer’s needs. d. Transfer these designs to the organization and the operating forces to be carried out. e. Translate these needs into product or service requirements: a means to meet their needs. f. Develop the processes that will provide the service, or create the product, in the most efficient way.

ANS:

A, B, E, C, F, D Quality planning follows a universal sequence of steps, as follows: Identify customers and target markets. Discover hidden and unmet customer needs.

Translate these needs into product or service requirements: a means to meet their needs (new standards, specifications, etc.). Develop a service or product that exceeds customer’s needs. Develop the processes that will provide the service or create the product in the most efficient way. Transfer these designs to the organization and the operating forces to be carried out.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Chapter 19: Measuring and Managing Outcomes Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. The results people care about most when seeking treatment is known as a(n) a. achieved benefit. b. benchmark. c. expected response. d. outcome.

ANS: D

Simply put, an outcome is the result or results obtained from the efforts to accomplish a goal.

A patient-focused definition of outcomes considers them “the results people care about most when seeking treatment, including functional improvement and the ability to live normal, productive lives” that are “inherently condition-specific and multidimensional.”

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. To determine whether her patient has responded favorably to a nursing intervention, a staff

nurse should observe the client for a. improved health. b. increased complaints. c. outcome indicators. d. signs and symptoms.

ANS: C

Indicators are valid and reliable measures related to performance. They are specific markers used that make quality and quality differences visible to stakeholders in health care.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. The outcomes concept that emphasizes the multidisciplinary process of providing health care

is known as outcomes a. maintenance. b. management. c. measurement. d. monitoring.

ANS: B

Outcomes management is defined as a multidisciplinary process designed to provide quality health care, decrease fragmentation, enhance outcomes, and constrain costs.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. Outcomes measurement is complex because a. budgets are unable to allocate sufficient funds. b. health care is multidimensional.

c. patients may not cooperate. d. treatments are not always necessary.

ANS: B

A patient-focused definition of outcomes considers them “the results people care about most when seeking treatment, including functional improvement and the ability to live normal, productive lives” that are “inherently condition-specific and multidimensional” (International Consortium for Health Outcomes Measurement [ICHOM], 2016).

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. The field in health care that aims at a better understanding of the end results of health care

practices and interventions is called a. patient safety. b. risk management. c. outcomes research. d. quality management.

ANS: C

Outcomes research aims at a better understanding of the end results of health care practices and interventions, such as the impacts of care that are most important to patients, families, payers, and society.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. The specific tools used to make quality visible to stakeholders in health care are called a. indicators. b. outcomes. c. variable selections. d. quality measures.

ANS: A

Indicators are valid and reliable measures related to performance. They are the specific tools used to make quality visible to stakeholders in health care.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. Mary Lou is studying the 48-hour readmission rate of cardiac patients whose care was

provided by nurses with associate degrees versus nurses with bachelor’s degrees. The type of research Mary Lou is performing is called research. a. quality b. patient outcomes c. nursing outcomes d. outcomes management ANS: C

Nursing outcomes research is a subspecialty within the larger field of health outcomes research that focuses on determining the effect of different contexts and conditions, related specifically to nurses and nursing care, on the health status of patients. Nursing outcomes researchers are interested in the structures or management strategies for nursing care delivery, as well as the mix of health care workers best equipped to care for them.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Outcome indicators such as nurse burnout, turnover, and job satisfaction are examples of

which type of indicator? a. Patient-focused b. Provider-focused c. Organizational-focused d. Nursing-focused ANS: B

Provider-focused outcomes include phenomena such as nurse burnout, turnover, and job satisfaction.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. Key examples of patient-focused outcome indicators are (Select all that apply.) a. patient satisfaction. b. birth rates. c. health status. d. quality of life. e. ability to function.

ANS: A, C, D, E

Patient-focused outcomes can include indicators such as disease status, symptom experience, or pain. Other outcomes indicators incorporate a broader impact of disease and its management on clients’ lives. These outcomes, often measured through surveys of patient perceptions and experiences, include quality of life, functional status, health status, and patient satisfaction.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. The Agency for Healthcare Research and Quality (AHRQ) developed a set of categories of

desirable attributes of a quality indicator. The categories include (Select all that apply.) a. feasibility. b. efficiency. c. importance. d. cost-effectiveness. e. scientific soundness.

ANS: A, C, E

Recently, the AHRQ developed a set of three broad categories of desirable attributes of a quality indicator: (1) importance; (2) scientific soundness, including clinical logic and measurement properties; and (3) feasibility.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Donabedian’s aspects of quality include (Select all that apply.) a. goals. b. process. c. policies. d. structure. e. outcomes.

ANS: B, D, E

Indicators are used to measure all three of Donabedian’s (1985) aspects of quality: structure, process, and outcomes. Donabedian’s framework is useful to understand the relationship between outcomes and the structure and processes that have produced them.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. Areas of data evaluation on a balanced scorecard include (Select all that apply.) a. metrics. b. key performance indicators. c. environmental. d. turnover rates e. benchmarks ANS: A, B, E

Metrics (specific measurement standards like operating room start time), key performance indicators (a metric with a performance indicator such as revenue by year end), and benchmarks (the gold standard or best practices such as the pulse should be between 50 and 80 beats per minute) are the specific elements for collecting, monitoring, and analyzing quality improvement and decision-making data.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Implementation of the Transitional Care Model (TCM) has been associated with which of the

following favorable outcomes? (Select all that apply.) a. Decreased length of stay b. Reductions in total health care costs c. Reductions in preventable hospital readmissions d. Increased overall satisfaction with the care experience e. Long-term improvements in physical health, functional status, and quality of life ANS: B, C, D

The TCM is a delivery system innovation that is designed to increase the alignment of the care system with the preferences, needs, and values of high-risk individuals and their family caregivers and achieve higher-quality outcomes while reducing health care costs (Naylor, 2012). Implementation of the TCM has been associated with the following favorable outcomes: (1) reductions in preventable hospital readmissions; (2) short-term improvements in physical health, functional status, and quality of life; (3) increased overall satisfaction with the care experience; and (4) reductions in total health care costs.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care COMPLETION 1. A(n)

is the result or results obtained from the efforts to accomplish a goal.

ANS:

outcome An outcome is the result or results obtained from the efforts to accomplish a goal. The term outcomes has also been defined as the conditions in patients and others that health care delivery aims to achieve.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2.

involves accounting for patient factors, the intrinsic risks that a patient brings to the health care encounter in the form of clinical and/or demographic factors, before drawing conclusions about the meaning of different values for indicators.

ANS:

Risk adjustment Risk adjustment involves accounting for patient factors, the intrinsic risks that a patient brings to the health care encounter in the form of clinical and/or demographic factors, before drawing conclusions about the meaning of different values for indicators. Comparisons of outcomes across settings or time periods are meaningful only when potentially important differences in the characteristics of patients involved are taken into account.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care OTHER 1. The process of managing outcomes includes five steps. List the five steps below in the correct

order. a. Variances are investigated. b. Data are collected about outcomes.

c. Trends are identified from data analysis. d. Changes are implemented and reevaluated. e. Appropriate service delivery changes are determined.

ANS:

B, C, A, E, D In managing outcomes, the information derived from measuring client outcomes is collected, trends are identified, variances are examined, and appropriate care needs are determined to improve care to an individual, group, or population.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Chapter 20: Workplace Violence and Incivility Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. What is the range of change a health worker is likely to endure physical violence at work? a. 5% to 10% b. 10% to 40% c. 50% to 75% d. >75% ANS: B

Health workers all over the world are subject to workplace violence. Between 8% and 38% of health workers are likely to endure physical violence at work. This percentage does not include those who are intimidated or subjected to verbal assault. Most violence is committed by patients and visitors.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 2. A long-standing mental health nursing tool may be used in an aggressive or violent situation.

The use of verbal and physical expressions of empathy, alliance, and non-confrontational limit setting is known as a. de-escalation. b. chemical restraint. c. stress management. d. emergency assistance programs.

ANS: A

De-escalation is a long-standing mental health nursing tool. De-escalation is defined as a gradual resolution of a potentially violent and/or aggressive situation through the use of verbal and physical expressions of empathy, alliance and non-confrontational limit setting that is based on respect.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 3. The chief operations officer of a local hospital has issued a memorandum indicating that the

modular waiting room furnishings will be replaced with stationary units. This is an example of which type of strategy for preventing workplace violence? a. Administrative controls b. Behavior modification c. Environmental design d. Fixture adaptation ANS: C

NIOSH recognizes that workplace violence is a particular issue in the health care industry and recommends the following violence prevention strategies for employers: environmental designs, administrative controls, and behavior modifications. Environmental designs include signaling systems, alarm systems, monitoring systems, security devices, security escorts, lighting, and architectural and furniture modifications to improve worker safety.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 4. A nurse executive is a member of a collaborative committee assigned to revise the violence

prevention program. After reviewing the program, the committee has determined that the following components already were included in the existing program: a written plan available to all employees, a system for tracking work-related assaults, and specific strategies for reducing the severity of violent injuries. A primary revision recommended by the committee should be the inclusion of a a. detailed description of last year’s injuries. b. list of preferred work injury health care providers. c. method for evaluating the effectiveness of the program. d. way to determine whether an employee is at fault.

ANS: C

According to the Occupational Safety and Health Administration (OSHA), the main components in a violence prevention program are a written plan, a worksite analysis, hazard prevention and control, safety and health training, and record keeping and evaluation of the program.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 5. Staff nurses may be able to avoid bullying behavior through a. increasing time spent with patients at the bedside. b. ignoring the assaults. c. filing a grievance. d. cognitive rehearsal training.

ANS: D

On an individual level, cognitive rehearsal training can help nurses avoid bullying behavior. It can also teach nurses how to intervene in situations where they see others bullying and is reported to improve staff satisfaction.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 6. Employee assistance programs a. allow employers to place staff into anger management programs designed to help

control potentially violent behavior. b. encourage employees to provide assistance to co-workers experiencing workplace

violence. c. provide services to help employees cope with stressors that occur at home or work.

d. train employees to deescalate violent situations.

ANS: C

Employee assistance programs provide a range of services to help employees cope with stressors that occur at home and at work.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 7. An important role of the human resources department in limiting workplace violence is a. allowing the local police force to control violence within the facility. b. delegating the control of workplace violence to individual unit managers. c. enforcing comprehensive violence prevention policies and procedures. d. empowering each nurse to assess each situation and react accordingly.

ANS: C

Human resource management in collaboration with the C-Suite should work to develop policies addressing hiring, discipline, counseling, training, threat assessment, threat management, and reporting are essential for the prevention and/or mitigation of violence from current or former workers in health care organizations. HR in addition should enforce the policies.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 8. One of the several legal issues surrounding workplace violence is a. an employer may be subject to liability claims. b. maintaining mandatory security ratios. c. Department of Labor laws requiring employers to report each incidence of

workplace violence. d. the patient’s right to unrestricted visitation.

ANS: A

To date, 30 states have introduced legislation related to workplace bullying, often referred to as the Healthy Workplace Bill (HWB) or some version thereof. Basic provisions of the model HWB legislation, developed and introduced include a clear definition of an “abusive work environment,” a legal right for those harmed by workplace bullying to seek recourse, and decreased employer liability when prevention and corrective policies and plans are implemented.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 9. The most prevalent source of violence against nurses is from a. a current or former employee. b. customers, clients, or patients. c. criminals with no other connection to the workplace but who simply intend to

commit a crime. d. someone who is not employed at the workplace but has a personal relationship

with an employee.

ANS: B

Customers, clients, and patients, are regarded as the most prevalent source of violence against nurses.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 10. Jeff, the manager of security at Methodist Hospital, has required that all of his security guards

attend de-escalation training. The workplace violence prevention strategy Jeff is promoting is a. hazard prevention. b. environmental designs. c. behavior modification. d. administrative control.

ANS: C

Behavior modifications provide all workers with training in recognizing and managing assaults, resolving conflicts, and maintaining hazard awareness.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 11. A common-sense look at the workplace to find existing or potential hazards for workplace

violence is a. worksite analysis. b. risk management. c. administrative rounds. d. hazard prevention and control.

ANS: A

Worksite analysis is a needs assessment to gauge an organization’s susceptibility to violence.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 12. Employee assistance programs can be especially useful when mitigating which source of

violence? a. Patients b. Former facility employee c. Family members only from the facility d. Current employee to assist with stressors ANS: D

Employee assistance programs (EAPs) provide a range of services to help employees cope with stressors that occur at home and at work. Family counseling might be useful in reducing domestic violence that can spill over into the workplace. Programs that counsel both the victim and the abuser could be instrumental in initiating needed interventions to defuse domestic violence situations that could affect the worksite. Furthermore, individual counseling can help employees cope with personal stressors that might contribute to unpredictable or violent behaviors.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 13. An integrated effort across all disciplines and functional areas to protect the financial assets of

an organization from loss by focusing on the prevention of problems that can lead to untoward events and lawsuits is called management. a. risk b. threat c. total quality d. human resources ANS: A

Risk management is an integrated effort across all disciplines and functional areas to protect the financial assets of an organization from loss by focusing on the prevention of problems that can lead to untoward events and lawsuits.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 14. A large rural hospital has purchased a computerized reporting system for reporting incidents,

including acts of violence. Violence reports are aggregated, trended, and used to mitigate future incidences of workplace violence. This type of management framework is management. a. risk b. threat c. total quality d. human resources ANS: C

In a systems approach, organizational culture is also considered an aspect of environment. A worksite analysis conducted by a task force is among the recommendations by OSHA and is consistent with a total quality management approach. Such an effort analyzes records, trends, workplace security, physical characteristics, operating policies, and screening surveys of staff to provide an overview of the work environment.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential

15. Health workers are at risk for workplace violence from a multitude of types and sources.

Which of the following is the act or threat of violence, ranging from verbal abuse to physical assaults directed toward persons at work or on duty? a. Workplace incivility b. Workplace violence c. Workplace bullying d. Violence ANS: B

Workplace Violence is the act or threat of violence, ranging from verbal abuse to physical assaults directed toward persons at work or on duty.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 16. The agency that oversees the safety and health of health care workers is a. The Joint Commission (TJC). b. the Department of Public Health (DPH). c. OSHA. d. CMS. ANS: C

OSHA is the agency that provides health and safety programs for health care workers, through the U.S. Department of Labor.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 17. One of the staff registered nurses (RN), has been accused of gossiping and bullying a new

graduate RN on the unit. This type of workplace violence is called a. horizontal b. co-worker c. threatening d. nurse-to-nurse

violence.

ANS: A

A major source of violence against nurses is bullying from other nurses, also referred to as lateral or horizontal violence. There is much speculation as to why this occurs. Analysis of data from nurses in hospitals found that incidents are often sparked by unprofessional behavior resulting from disagreement over responsibilities for work tasks or methods of patient care and dissatisfaction with a co-worker’s performance. Incidents also result from conflicts or aggression arising from failure to follow protocol, patient assignments, limited resources, and high workload.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 18. What is the primary component of a violence prevention program? a. Regulatory guidelines

b. Employee commitment c. Financial commitment d. Management commitment ANS: D

Violence prevention written plans demonstrate management commitment by disseminating a policy that violence will not be tolerated, ensuring that no reprisals are taken against employees who report or experience workplace violence, encouraging prompt reporting of all violent incidents, and establishing a plan for maintaining security in the workplace.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 19.

may be useful in preventing loss caused by domestic violence that extends to the workplace. a. Employee assistance programs b. Stress leave for up to 6 weeks c. Termination of the perpetrator d. Arrest and conviction of the perpetrator ANS: A

Employee assistance programs can be very useful in preventing or mitigating loss caused by domestic violence that extends to the workplace.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential MULTIPLE RESPONSE 1. Administrative controls that may affect workplace violence include (Select all that apply.) a. adequate staffing levels. b. controlled access. c. development of systems to alert security personnel to threats of violence. d. conflict resolution. e. architectural modifications.

ANS: A, B, C

NIOSH recognizes that workplace violence is a particular issue in the health care industry and recommends the following violence prevention strategies for employers: environmental designs, administrative controls, and behavior modifications. Administrative controls include (1) adequate staffing patterns to prevent personnel from working alone and to reduce waiting times, (2) controlled access, and (3) development of systems to alert security personnel when violence is threatened.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 2. The main components in a violence prevention program are (Select all that apply.)

a. b. c. d. e.

a written plan. worksite analysis. criminal control. security staff training. record keeping and evaluation of the program.

ANS: A, B, E

The main components in a violence prevention program are: (1) management commitment and worker participation, (2) worksite analysis and hazard identification, (3) hazard prevention and control, (4) safety and health training, and (5) record keeping and program evaluation. Violence prevention written plans demonstrate management commitment by disseminating a policy that violence will not be tolerated, ensuring that no reprisals are taken against employees who report or experience workplace violence, encouraging prompt reporting of all violent incidents, and establishing a plan for maintaining security in the workplace.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential 3. Examples of environmental designs that can improve worker safety include (Select all that

apply.) a. well-lit parking lots. b. critical incident debriefing. c. de-escalation training for all staff. d. metal detectors at hospital entrances. e. posting security guards in the main lobby.

ANS: A, D, E

NIOSH recognizes that workplace violence is a particular issue in the health care industry and recommends the following violence prevention strategies for employers: environmental designs, administrative controls, and behavior modifications. Environmental designs include signaling systems, alarm systems, monitoring systems, security devices, security escorts, lighting, and architectural and furniture modifications to improve worker safety.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential COMPLETION 1. Regulatory guidelines for the prevention of workplace violence are derived from

under the U.S. Department of Labor.

ANS:

OSHA

The Occupational Safety and Health Act of 1970 created the Occupational Safety and Health Administration (OSHA) in the U.S. Department of Labor. This legislation declared that employers had a general duty to provide safe and healthy working condition. Regulatory guidelines for the prevention of workplace violence are derived from OSHA. OSHA establishes that leaders have a general responsibility to create an awareness, take measures to prevent workplace violence, and promote safety and health in the work environment.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential

Chapter 21: Nursing Workforce Staffing and Management Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. The provision of quality nursing care to clients, wherever delivered, depends on the a. appropriate nursing diagnoses. b. current wage scale. c. number of nurse leaders. d. right skill mix.

ANS: D

The major goal of staffing management is to provide the right number of nursing staff with the right qualifications to deliver safe, high-quality, and cost-effective nursing care to a group of patients and their families as evidenced by positive clinical outcomes, satisfaction with care, and progression across the care continuum. Appropriate safe nurse staffing and skill mix levels are essential to optimize quality of care and this determination is challenging yet essential.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. Staffing management is one of the most critical activities for nurse leaders at every level of

the health care organization today because it affects a. delegation and supervision. b. unit leadership productivity. c. organizational outcomes. d. professional development and quality control.

ANS: C

Staffing management is one of the most critical yet highly complex and time-consuming activities for nurse leaders at every level of the health care organization today. How well or poorly nursing leaders execute staff management impacts the safety and quality of patient care, financial results, and organizational outcomes, such as job satisfaction and retention of registered nurses (RNs).

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Evaluation of the effect of nurse staffing on quality patient, financial, and organizational

outcomes is known as a. patient acuity. b. staffing effectiveness. c. nurse-to-patient ratio. d. nursing workload.

ANS: B

Staffing effectiveness is the evaluation of the effect of nurse staffing on quality patient, financial, and organizational outcomes.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. The nursing manager of a general medical-surgical unit in a large hospital has gathered data

reflecting the average length of time that it takes to provide nursing care to broad categories of client groups with typical characteristics. The patient classification system that the nursing manager has used is criticized for its a. lack of reliability. b. medical elements. c. stereotyping of patients. d. subjective basis.

ANS: A

Patient classification systems aimed at adjusting staffing for acuity have been plagued with an inability to accurately and reliably measure patient care variability. Further, they have lacked organizational credibility and added documentation burden to the direct-care nurse.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. The nursing manager of a general medical-surgical unit in a large hospital has gathered data

reflecting the average length of time that it takes to provide nursing care to broad categories of client groups with typical characteristics. The nursing manager will most likely use the patient classification data he collected to a. avoid management layoffs. b. change professional nursing roles. c. obtain staffing reimbursement. d. staff his nursing unit appropriately.

ANS: D

The nurse manager who is accountable for a patient care unit or area executes staffing management strategies to yield an optimal health experience and clinical outcomes for patients and their families; a healthy, satisfying work environment; and cost-effective staffing model for the organization.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. A(n)

provides logic and order to complex processes for administrators and scientists to consider. a. staffing plan b. organizational chart c. conceptual framework d. nursing care delivery model ANS: C

A conceptual framework provides logic and order to complex processes for administrators and scientists to consider (Edwardson, 2007).

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. A common element among nursing care delivery models is the a. ratio of nurses to patients. b. manager is the frontline leader. c. value of the nurse and patient/family relationship. d. needs of the patients drive the competency of the nurse.

ANS: C

One common element among care models is the value of the nurse and patient/family relationship. Patient assignment technology offers charge nurses access to real-time data in order to match the right nurse (i.e., competency, expertise) with the right patient and provide continuity of care during an episode of care. A second common trend is the evolving role of the charge nurse as the frontline leader with responsibility to coordinate patient flow with expert communication among health care team members.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. Relationship-based care (RBC) is a common model used in care delivery. The RBC model

articulates that is/are central nursing care delivery models. a. continuity of care b. case management c. coordination of care d. the needs or characteristics of the patients ANS: A

The RBC model identifies fundamental elements of continuity of nursing care delivery model as central to the core of the model and is one identified in working toward Magnet status for facilities.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. The core concept of the synergy model for patient care is based on the nurse-patient

relationship and acknowledges a. frontline charge nurses make informed patient care assignment decisions. b. organizing and delivering nursing care achieves desired patient outcomes. c. the needs or characteristics of the patients and families drive the competencies of the nurse. d. the clinical nurse leader champions innovations that improve patient outcomes, ensures quality care, and reduces health care costs.

ANS: C

The synergy model for patient care is presented by the American Association of Critical-Care Nurses. The core concept of the model is based on the nurse-patient relationship and acknowledges that the needs or characteristics of the patients and families drive the competencies of the nurse. Synergy, or optimum outcomes, results when the needs and characteristics of the patient clinical unit, or system, are matched with a nurse’s competencies.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. The Joint Commission’s (TJC’s) staffing regulation states a. staffing ratios are recommended in perinatal and critical care areas. b. nurse managers may determine the nurse-to-patient ratio as long as the patient’s

needs are being met. c. hospitals must also provide the right number of competent staff and appropriate staffing mix to meet the patient’s needs. d. hospitals may limit the number of admissions to ensure there are an adequate number of staff members to meet patient needs.

ANS: C

TJC standards include the human resources function of verifying that nurses are qualified and competent to ensure that the hospital determines the qualifications and competencies for staff positions based on its mission, populations, care, treatment, and services. Hospitals must also provide the right number of competent staff members and appropriate staffing mix to meet the patients’ needs.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. An approach for decreasing nursing RN skill mix was implemented in a one size fits all

approach across organizations in the 1990s. These changes in skill mix led to a. decreases in RN workload. b. increased nursing satisfaction. c. decreased patient satisfaction. d. decreased patient safety concerns.

ANS: C

The approach for decreasing nursing RN skill mix was implemented in a one size fits all approach across organizations and often lacked evaluation of the skill mix change and other changes on the quality of care and nurse job satisfaction and retention. This was most apparent in California where a leaner RN skill mix was tried by Kaiser Permanente Northern California in the early 1990s. Skill mix was reduced from 55% RNs to 30% RNs in 1995. The changes in skill mix led to widespread real and perceived increases in RN workload, patient safety concerns, and nurse and consumer complaints.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. A forecasted workload and a recommended care standard determine the a. staffing pattern. b. skill mix of the unit. c. nurse-to-patient ratios. d. staffing management plan.

ANS: A

The staffing management plan provides the structured processes to identify patient needs and then to deliver the staff resources as efficiently and effectively as possible. An effective plan first focuses on stabilizing the unit core staffing. A staffing pattern, or core coverage, is determined through a forecasted workload and a recommended care standard (e.g., hours per patient day).

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. The workload standard commonly used in nursing when calculating staffing patterns is a. patient days. b. patient acuity system. c. average length of stay. d. nursing care hours per patient day.

ANS: D

The amount of work performed by a unit is referred to as its workload, and workload volume is measured in terms of units of service. The workload standard commonly used is nursing care hours per patient day, although the validity of this measure is disputed.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. The staffing method used when units are staffed below maximum workload conditions and

staff is then supplemented when needed is called a. fixed staffing. b. variable staffing. c. strategic staffing. d. staffing by acuity.

ANS: B

With variable staffing, units are staffed below maximum workload conditions and staff is then supplemented when needed.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 15. The process of providing and measuring the correct full-time equivalent (FTE), or

complement, to adequately staff a given area is known as a. scheduling. b. position control. c. forecasted workload. d. demand management.

ANS: B

Position control is the process of providing and measuring the correct FTE, or complement, to adequately staff a given area.

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

MSC: Client Needs: Safe and Effective Care Environment: Management of Care 16. Key to effective staffing are protocols and processes for daily staffing decision support that

are aligned with a budget-sensitive variable staffing plan. In a decentralized model, the responsibility of daily staffing allocation belongs to the a. float pool. b. staffing office. c. department manager. d. chief nursing officer.

ANS: C

In a decentralized model, individual department managers and directors are responsible for daily staffing allocation.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 17. Assigning individual personnel to work specific hours, days, or shifts and in a specific unit or

area over a specified period of time is known as a. scheduling. b. staffing effectiveness. c. nursing direct-care hours. d. human resources staffing strategy.

ANS: A

Scheduling is the process of assigning individual personnel to work specific hours, days, or shifts and in a specific unit or area over a specified period of time (Barnum & Mallard, 1989).

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 18. The new nursing care model, developed by the American Association of Critical-Care Nurses

(2016), focuses on the needs of the patient and the competencies of the nurse. It is known as the a. Synergy Model for Patient Care. b. Case Management Model. c. Primary Nursing Model. d. Clinical Nurse Leader Model.

ANS: A

The Synergy Model for Patient Care was developed by the American Association of Critical-Care Nurses (2016) and is a patient-centered model focused on the needs of the patient, the competencies of the nurse, and the synergy created when the needs and competencies match. Synergy—or optimum patient outcomes—results when the needs and characteristics of the patient and clinical unit or system are matched with a nurse’s competencies. Patient assignment technology may assist in defining—and thereby aligning—patient needs with the nurse’s abilities, a concept that is central to the model.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. An RN is relocating and is seeking employment at a hospital that focuses on patient safety.

Which staffing issues have a negative impact on patient safety? (Select all that apply.) a. Eight-hour shifts b. Twelve-hour shifts c. Mandatory overtime d. Student nurses on the unit e. Unplanned overtime ANS: B, C, E

Evidence has grown supporting the link between adequate nurse staffing and better patient outcomes. Under principles related to the practice environment, the ANA has stated “Registered nurses should be provided a professional nursing practice environment in which they have control over nursing practice and autonomy in their workplace,” and “routine mandatory overtime is an unacceptable solution to achieve appropriate nurse staffing. Policies on length of shifts; management of meal and rest periods; and overtime should be in place to ensure the health and stamina of nurses and prevent fatigue-related errors.”

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. The hospital units most likely to employ a decentralized staffing model include (Select all that

apply.) a. the telemetry unit. b. labor and delivery. c. the medical-surgical unit. d. the emergency department. e. the neonatal critical care unit.

ANS: B, D, E

In a decentralized model, individual department managers and directors are responsible for daily staffing allocation. Units with decentralized staffing are typically units whereby volume and/or acuity may be most unpredictable, and the nursing competencies are unique to that area (e.g., emergency department, labor and delivery, critical care).

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Community Hospital is having a transient nursing shortage due to a high number of sick calls.

The staffing office utilizes the staffing pool to obtain the required number of nurses. The staffing pool may include what types of nurses? (Select all that apply.) a. Travel nurses b. Foreign nurses c. Seasonal nurses d. Per diem nurses e. Full-time nurses

ANS: A, C, D

Access to nurses outside the unit to cover transient shortages is critical to meet last-minute, unplanned nurse shortages, such as sick calls and high patient demand. Supplemental staffing resources, frequently referred to as the staffing pool, are defined as a group of nurses who supplement the core unit staffing. This includes per diem nurses, float pool nurses, part-time nurses desiring additional hours, seasonal nurses, agency nurses, and traveling nurses.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care COMPLETION 1. When the needs and characteristics of the patient clinical unit, or system, are matched with a

nurse’s competencies,

results.

ANS:

synergy Synergy—or optimum patient outcomes—results when the needs and characteristics of the patient and clinical unit or system are matched with a nurse’s competencies. Patient assignment technology may assist in defining—and thereby aligning—patient needs with the nurse’s abilities, a concept that is central to the model.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. The amount of work performed by a unit is referred to as its

.

ANS:

workload The amount of work performed by a unit is referred to as its workload, and workload volume is measured in terms of units of service. The unit of service is specific to the type of unit, such as the number of patients, patient days, deliveries, visits, treatments, encounters, or procedures.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. The manager is calculating the total patient days on the unit. The unit average daily census is

35 with an average length of stay is 2.4 days. In numerals, the total patient days on this unit is days.

ANS:

84 Total patient days are commonly used in inpatient hospital areas. This is calculated by multiplying the average length of stay and the average daily census.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. The proportion of direct-care RNs to total direct-care nursing staff, expressed as a percentage

of RNs to total nursing staff, is called

.

ANS:

skill mix Skill mix is the proportion of direct-care RNs to total direct-care nursing staff, expressed as a percentage of RNs to total nursing staff.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Chapter 22: Budgeting, Productivity, and Costing Out Nursing Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. The process of identifying the specific costs related to the delivery of nursing care to each

client so that nurses have data to identify the actual amount of services received is a. personnel budget development. b. evaluating budget expenditures. c. costing out nursing services. d. strategic financial planning.

ANS: C

Costing out nursing services is defined as the determination of the costs of the services provided by nurses. By identifying the specific costs related to the delivery of nursing care to each client, nurses have data to identify the actual amount of services received.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. Revenues minus expenses equals a. cash flow. b. expense incurred. c. income. d. total reimbursement.

ANS: C

Income (or profit) is defined as the excess of revenues over expenses, or revenues minus expenses.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. A(n) is the difference between the budgeted and actual amounts. a. expense b. margin c. revenue d. variance ANS: D

A variance is the difference between the budgeted and the actual amounts. A variance may be favorable or unfavorable relative to the budget amount.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. Staff nurses involvement in budgeting is essential because they a. have the final authority on the annual budget.

b. have the ability to contain costs at the unit level. c. have a unique perspective on the budgetary process. d. are the largest user of the budgeted funds for the unit.

ANS: B

In many organizations, staff nurses are expected to be aware of their unit’s financial performance and the impact their decisions may have on it. Staff nurses involvement is essential to the ability to contain costs at the unit level, because they make many decisions about supply and resource use.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. The costs or prices of activities undertaken in the organization’s operations are called a. budget. b. income. c. expenses. d. revenue.

ANS: C

Expenses are defined as the costs or prices of activities undertaken in the organization’s operations.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. The critical care unit manager would like to hire a wound care nurse for the unit. The type of

organizational budget the manager would use to ensure ability to hire the new nurse is called the budget. a. capital b. personnel c. operating d. expense ANS: B

The personnel budget is the staffing budget of the cost center.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. The manager of a rural, thriving, nurse-managed clinic is considering purchasing equipment

to furnish two additional examination rooms. The resource the manager must consider is the budget. a. capital b. expense c. operating d. product line ANS: A

The capital budget is the plan for the purchase of major equipment or assets.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. The operating budget covers a specific period, called a a. fiscal b. budget c. calendar d. federal government

year.

ANS: A

The operating budget covers a specific period, called a fiscal year. The fiscal year may begin July 1, may correspond to the calendar year beginning January 1, or may follow the federal government year that starts on October 1.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. The relationship between output and the goods and services used to produce them is called a. acuity. b. revenue. c. variability. d. productivity.

ANS: D

Productivity is defined as the relationship between output and the goods and services used to produce them.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. A budget functions as a a. capital constraint. b. employee management tool. c. human resource tool. d. planning instrument.

ANS: D

A budget is defined as a written financial plan aimed at controlling the allocation of resources.

It functions as both a planning instrument and an evaluation tool useful for financial management.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. A staff nurse’s accurate recording of all services and supplies used to provide care to each

client in the patient assignment is necessary for determining calculations used in which of the following budgets? a. Expense b. Gross c. Inpatient d. Revenue

ANS: D

Revenue is defined as income or amounts owed for purchased services or goods. Total operating expenses are the result of summing the costs of all resources (e.g., labor, patient consumable supplies, small medical equipment, utilities, office supplies, and other related miscellaneous fees and materials) used to produce services.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. In the past, health care organizations viewed nursing services as primarily a(n) a. acute care asset. b. expense. c. reimbursement tool. d. revenue generator.

ANS: B

Nursing has historically been seen as a cost center but not a revenue generator.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. The management team of a large hospital is attempting to identify the specific cost of

providing nursing services. This process is known as a. costing out services. b. fee-for-service care provision. c. priority nursing management. d. quality versus cost balance.

ANS: A

Costing out nursing services was defined as the determination of the costs of services provided by nurses.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. Using resources to maximize health benefits while simultaneously using resources to

maximize cost-effectiveness is a. costing out nursing services. b. fiscal responsibility. c. priority nursing management. d. capital constraint.

ANS: B

Fiscal responsibility is defined as using the resources of the patient to maximize health benefit while simultaneously using the resources of the institution to maximize cost-effectiveness.

Fiscal responsibility is essential when trying to improve client care by improving managerial and clinical decisions in nursing.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care 15. The incorporation of economic evaluation into clinical practice is important to productivity

because a. rationing must occur. b. health care resources are limited. c. providers may not turn away clients. d. uninsured clients get the same health care as insured clients.

ANS: B

The incorporation of economic evaluation into clinical practice is important to productivity, because health care resources are limited and choices must, and will, be made.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 16. The key advantage of activity-based costing is a. workload is determined based on the required hours of nursing care. b. it reflects what it costs to provide services and identifies why costs were incurred. c. data can be used in constructing a personnel budget because it is linked to the

volume indicator of patient days. d. the judgment of an expert nurse clinician must override an empirical system and be

based on patient’s needs in real time.

ANS: B

The key advantage of activity-based costing is that it reflects what it costs to provide services and identifies why costs were incurred.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 17. The RN is preparing to bathe a patient. The RN has the option of using prepackaged bathing

wipes or a bath basin and washcloths. The RN chooses the bath basin and washcloths because the nurse knows the performance is the same but they are less expensive. This choice is an example of a. rationing. b. fiscal responsibility. c. costing out services. d. activity-based costing.

ANS: B

Fiscal responsibility is defined as using the resources of the patient to maximize health benefit while simultaneously utilizing the resources of the institution to maximize cost-effectiveness.

Being fiscally responsible means making responsible resource allocation decisions.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity: Basic Care and Comfort 18. Supply budgets are a major component of the operating budget. Items such as office supplies,

intravenous solutions, instruments, linen, gloves, and other personal protective equipment are examples of costs.

a. b. c. d.

fixed flexible variable resource

ANS: C

Supply items such as office supplies, intravenous solutions, instruments, linen, gloves and other personal protective equipment, medical/surgical supplies, and drugs are examples of supplies that would vary with a higher volume of patient days. These supply items are variable (the amount used will vary based on the volume of service provided).

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. The phases of the budget process are (Select all that apply.) a. preparation. b. completing the forms. c. auditing and monitoring. d. revision and submission. e. selection and evaluation.

ANS: A, B, D

The budget process consists of three time periods. During preparation, the manager reviews the organization’s strategic plan and the last year’s budget for the cost center. The manager will then be given budget documents to use in preparing the cost center budget. As budget documents go through review by senior management, requests tend to exceed the available resources. This necessitates review, adjustment, and appeal.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care COMPLETION 1. A(n)

is a written financial plan aimed at controlling the allocation of resources.

ANS:

budget A budget is defined as a written financial plan aimed at controlling the allocation of resources.

It functions as both a planning instrument and an evaluation tool useful for financial management.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. A(n) ANS:

is the difference between the budgeted and the actual amounts.

variance A variance is the difference between the budgeted and the actual amounts. A variance may be favorable or unfavorable relative to the budget amount.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. A measure of the severity of illness of an individual patient or the aggregate patient

population on a unit is called

.

ANS:

acuity Acuity is defined as a measure of the severity of illness of an individual patient or the aggregate patient population on a unit.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Chapter 23: Performance Appraisal Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. A tool used to facilitate conversation in the form of constructive discussion between a staff

member and his or her manager/supervisor in order to clarify work performance and needed improvements is a a. performance improvement plan. b. performance appraisal. c. peer review. d. self-evaluation.

ANS: A

A performance improvement plan (PIP) is defined as a formal performance action plan that is used as a tool to facilitate conversation in the form of constructive discussion between a staff member and his or her manager/supervisor in order to clarify work performance and needed improvements. A PIP outlines specific goals to work toward and specific improvement steps to take.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. The prevailing purpose of performance appraisal is to a. Meet compliance standards and organizational goals. b. address the abilities of staff. c. address the needs of the institution. d. mentor staff.

ANS: A

Performance appraisals serve several administrative functions to meet compliance standards and organizational goals. These functions include helping to strengthen the appraisal process, improving employee performance, meeting compliance standards, and assisting with Human Resources (HR) workforce planning, such as recruiting, compensation, and succession planning.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. A newer focus of performance appraisal that has the ability to engage high-performing nurses

and motivate people toward even higher levels of performance is a. coaching. b. remedial learning. c. feedback. d. peer review.

ANS: C

Although the focus of performance appraisals has been on remedial learning or correcting weaknesses, researchers have more recently called for a reframing of performance development after feedback. A focus on building strengths has the potential to reorient the conversation, engage high-performing nurses, and motivate people toward even higher levels of performance.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. Performance appraisals provide information that is critical to human resources planning.

Having a sense of the current skills of the workforce is crucial for a. compensation administration. b. job analysis. c. being prepared for future needs. d. structuring educational programs for staff.

ANS: C

Performance appraisals provide data that are used to make a series of administrative and management decisions. Individual ratings can be used to inform compensation, promotion, and layoff decisions. More broadly, evaluations provide information that is critical to human resources (HR) planning. Having a sense of the current skills of the workforce is critical to being prepared for future needs, including skill gaps, new areas of specialization, and treatment needs.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. A nurse is receiving their annual performance appraisal. To evaluate the nurse’s performance,

the manager considers feedback about the nurse’s performance from the nurse’s peers, subordinates, and patients. This type of evaluation is a a. feedforward technique. b. self-report rating. c. 360-degree feedback review. d. peer review.

ANS: C

In a 360-degree feedback review, managers, peers, subordinates, and patients all provide feedback. The 360-degree process is intended to give the reviewer a fuller and more robust picture of the individual’s performance.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. A nursing manager is evaluating an employee’s dependability, responsibility, and

decision-making ability on a scale of 1 to 5. This is an example of what type of rating system? a. Behaviors b. Competencies c. Results d. Traits ANS: D

Under trait rating systems, workers are measured according to the extent to which they possess a given personal characteristic. Traits that could be measured include dependability, conscientiousness, responsibility, self-management, responsiveness, and decision-making ability. When using a trait method, a supervisor might be asked to rate to what extent an employee exhibits a certain trait.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. A performance appraisal criterion that measures the ability to perform a skill successfully is a. attitudes. b. behaviors. c. competencies. d. teamwork.

ANS: C

A competency is the ability to perform a skill successfully. Competencies are more adaptable than behaviors because they describe the capability that underlies the behaviors. Although there is still some subjectivity and bias in rating competencies, these types of scales have been shown to have acceptable levels of validity and reliability.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. An experienced critical care nurse left a CCU staff nurse position to finish a master’s degree.

Periodically, the nurse would return to work as a per diem nurse in the CCU. The staff was impressed with the nurse’s performance; however, one staff member complained that the RN was unfamiliar with the new telemetry monitors when they first returned to work several months ago. This comment showed up in the annual evaluation, resulting in a poorer overall evaluation from the nurse manager compared with previous evaluations. This is an example of a. contrast bias. b. a horn effect. c. recent behavior bias. d. similar-to-me effect.

ANS: B

A horn effect occurs when a manager perceives one negative aspect about an employee or that employee’s performance and generalizes it into an overall poor appraisal rating.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. This management technique is used to help employees improve performance in a

service-oriented profession. This technique, in which the manager empowers employees to exceed their performance is known as a. coaching. b. counseling. c. goal setting. d. mentoring.

ANS: A

Managerial coaching can be described as empowering employees to exceed their performance and providing the tools and resources that allows them to do so.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. The ability to measure performance is challenging, and despite significant advancements,

measurements continue to be imperfect. Inaccuracy in measurement in favor of or against a group is known as a. validity. b. objectivity. c. reliability. d. bias.

ANS: D

Accurately assessing and rating someone according to a predetermined scale is a challenging task. There is a tremendous amount of bias in a performance rating. Bias refers to inaccuracy in the measurement in favor of or against a person or group, typically in a way that is unfair.

Bias occurs for a wide range of reasons.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. The process by which a manager examines and evaluates an employee’s work behavior by

comparing it with pre-set standards, documents the results of the comparison, and uses the results to provide feedback to the employee is a. coaching. b. peer review. c. self-evaluation. d. performance appraisal.

ANS: D

Performance appraisal means evaluating the work of others. It is the process by which a manager examines and evaluates an employee’s work behavior by comparing it with pre-set standards, documents the results of the comparison, and uses the results to provide feedback to the employee to show where improvements are needed and why.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. A new RN is evaluating her own performance over the past year and comparing it to the

standards set by the organization. This nurse is performing a(n) a. peer review. b. intervention. c. self-evaluation. d. performance appraisal.

ANS: C

Self-evaluation is the aspect of performance appraisal whereby employees do self-assessments of their own perceptions about their performance as compared with stated objectives and expectations.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. The ability to perform a skill successfully is a. competency. b. acuity. c. aptitude. d. motivation.

ANS: A

A competency is the ability to perform a skill successfully. Competencies are more adaptable than behaviors because they describe the capability that underlies the behaviors.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. The medical-surgical nurse manager is conducting performance appraisals by observing each

nurse for a day and basing the evaluation on that day’s performance. This type of bias is known as a. halo. b. leniency. c. recency. d. contrast.

ANS: C

Recency bias occurs when the most recent events are the focus of the review rather than a cumulative evaluation since the last appraisal.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 15. A nurse has reported to work late four times in the last 3 months. The unit manager brings this

to the attention of the nurse and asks to meet and discuss the issue. At their meeting, the nurse is given an opportunity to explain repeated tardiness and corrective action is determined. A tool the manager can use to monitor the nurse’s future performance is a a. performance review. b. clinical ladder. c. written warning. d. performance improvement plan.

ANS: D

A performance improvement plan (PIP) is a formal action plan that addresses work performance and needed improvements using identified goals and specific improvement plans. A PIP can be used as a coaching device for personal professional improvement or as a way of tracking and monitoring the performance of a staff member who may be a cause for concern.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care

16. The nurse manager is evaluating a staff nurse in the emergency department (ED). The

manager obtains input about the nurse’s performance from another nurse in the ED, one of the ED physicians, a patient-care assistant, and self-eval from the nurse. The type of performance evaluation the nurse manager utilizes is a. just culture. b. peer review. c. 360-degree feedback review. d. management by objectives.

ANS: C

The 360-degree feedback review can be obtained by seeking input from managers, peers, subordinates, and patients. A self-report rating is often part of a 360-degree feedback process.

Once all the input is obtained, the evaluating manager adds his or her input and merges the feedback to develop the final score.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 17. The nurse manager of the pediatric floor is being evaluated by the unit director. The manager

set goals last year such as increasing patient satisfaction on the unit by 20% and decreasing staff turnover by 10%. The manager’s performance appraisal today is based on how well the goals were achieved. This type of performance appraisal measures a. traits. b. behaviors. c. competencies. d. results.

ANS: D

In an effort to reduce as much bias as possible in performance ratings, some evaluators look to results-based measures of performance. This type of measurement asks the question “what will be the outcome of high performance?” Although these types of measurements allow for objectivity in the rating, there are some clear limitations as the ratings do not capture everything that is important to performance for a job well done.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 18. A performance appraisal bias that occurs when all members of the team receive the same

satisfactory rating is a. halo. b. recency. c. similar-to-me. d. leniency.

ANS: D

Leniency is a type of bias that occurs when all members of the team receive the same satisfactory rating.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care

MULTIPLE RESPONSE 1. The effectiveness of the performance review process can be improved when the manager and

the employee can collaboratively (Select all that apply.) a. set goals. b. discuss merit raises. c. make developmental plans. d. determine performance corrections. e. talk about future prospects.

ANS: A, C, E

The performance review meeting needs to be seen as an opportunity. A reframing of the performance review as a meeting where the manager and the nurse can collaboratively set goals, make developmental plans, and talk about future prospects has the potential to shift the effectiveness of the entire performance review process. If performance corrections are given on the job as the need arises, then the review meeting can be refocused on meaningful development.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. A successful performance review system must be (Select all that apply.) a. in line with the organization’s strategic objectives. b. fair and transparent. c. free from bias. d. administratively practical. e. effectively administered.

ANS: A, B, D, E

The performance review process needs to be in line with the organization’s strategic objectives. An effective review system should be fair, transparent, and perceived as just by both those who administer the process and those who are evaluated. The review system needs to be administratively practical. If the system is too onerous, too time consuming, or too taxing on anyone, it can easily fall apart. It is important to understand that there is likely to be some bias in performance appraisals.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Stakeholders who might be represented within the employment review process of a CCU

nurse include (Select all that apply.) a. patients/patient families. b. physicians. c. the chief financial officer. d. organizational board members. e. nurses in the CCU. ANS: A, B, E

Historically, the manager has been at the center of the employment review process. Although this is still the case today, others are often involved in providing feedback. This can be an important part of the process. Anyone who has the opportunity to observe the individual under review has something to offer. This might include peers, physicians, and patients. In team environments, it is useful to have team members provide feedback.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. A self-report rating is an important component in the appraisal process. The self-report

promotes (Select all that apply.) a. relationships among peers. b. perceptions of fairness. c. heightened awareness of performance deficits. d. individual accountability in the performance review process. e. an opportunity to reflect on disagreements with ratings from others.

ANS: B, C, E

A self-report rating can be quite useful for two key reasons. First, the rater then has an opportunity to reflect on the disagreement between their self-rating and the ratings given by others. These discrepancies have been shown to heighten awareness of performance deficits and motivate performance change. Second, self-reports increase perceptions of fairness on the part of the person being reviewed. If the employee has an opportunity to have input in the process, then they feel that they have a voice and are actively participating in the process.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. The goals of a performance improvement plan should include (Select all that apply.) a. education of the employee. b. support in making improvements. c. punishing negative behavior. d. promotion of successful performance. e. providing a raise if earned through positive behavior.

ANS: A, B, D

In the case of a poor performance appraisal, the nurse needs to look for a formal PIP with goals, strategies, expected outcomes, and deadlines. The optimum outcome is that the PIP becomes an opportunity to educate the employee, provide support in making improvements, and promote successful performance that benefits the employee and the organization.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care COMPLETION 1. The definition of

is the execution of an action; something accomplished; or the fulfillment of a promise, claim, or request.

ANS:

performance Performance is defined as the execution of an action; something accomplished; or the fulfillment of a promise, claim, or request (Merriam-Webster.com, 2012).

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. The process by which nurses systematically evaluate the quality of nursing care provided by

peers as measured against professional standards is called

.

ANS:

peer review Peer review in nursing (defined in 1988 by the American Nurses Association and still applicable today) is the process by which nurses systematically evaluate the quality of nursing care provided by peers as measured against professional standards (American Nurses Association, 1988, p. 3).

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3.

is a type of bias that occurs when individuals who are similar to the rater in some way are rated more favorably.

ANS:

Similar-to-me Similar-to-me is a type of bias that occurs when individuals who are similar to the rater in some way are rated more favorably.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. The term

refers to the inaccuracy in the measurement in favor of or against a person or group, typically in a way that is unfair.

ANS:

bias Bias refers to inaccuracy in the measurement in favor of or against a person or group, typically in a way that is unfair. Bias occurs for a wide range of reasons.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Chapter 24: Emergency Management and Preparedness Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. All-hazards disaster is best defined as a. all types of natural and human terrorist events. b. an event involving floods, tornadoes, hurricanes, and earthquakes. c. an unforeseen and often unplanned event causing great damage. d. any type of biological, chemical, radiological, or nuclear event.

ANS: A

An all-hazards disaster includes all types of natural acts such as earthquakes, forest fires, floods, and hurricanes, or terrorist events such as biological, chemical, radiological, and nuclear attacks. A disaster is an unforeseen and often sudden event that causes great damage, destruction, and human suffering.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 2. An example of a cyber disaster is a catastrophic event caused by a. the use of military weapons. b. an exposure to toxic materials. c. an outbreak of a pathogen. d. an attack initiated from one computer against another.

ANS: D

A cyber disaster is a catastrophic event that results from an attack initiated from one computer against another computer with the purpose of compromising the information stored on it.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 3. Which combination of leadership is recommended for chairing an emergency management

committee? a. Chief executive officer and internal medicine physician b. Chief financial officer and emergency care nurse liaison c. Representative chief nurse officer and emergency care physician d. Representative chief information technology officer and critical care physician ANS: C

In health care systems, system-wide executive administrators need to be part of the emergency management committee. Having a senior executive administrator of the health care system serve as the chairperson of the committee will provide the leadership needed to communicate the importance of emergency preparedness as a system priority. A representative CNO and emergency medicine physician, serving as co-chairs with the senior executive administrator, can create a dynamic team that is uniquely prepared to tackle any issues that arise.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care

4. The system-wide emergency management plan should conduct a gap analysis. What should be

evaluated? a. Differences between standards and policies and procedures b. Differences between pieces of the program that are and are not in place c. Similarities between standards and policies and procedures d. Similarities between pieces of the program that are and are not in place ANS: B

The guiding principle for creating a hospital-specific all-hazards gap analysis is to keep it simple. One example of a simple way to assess the current state is to create an emergency preparedness survey that is easy to read and requires the department directors to answer in simple checklists one of two ways: (1) “Yes, we have it,” or (2) “No, we don’t have it.”

Survey questions need to be concise and clear. The goal is to begin by identifying the areas where there are gaps in the facility’s preparedness plans.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. What is the role of the project facilitator in the emergency management committee? a. Creating key components of disaster protocols b. Keeping the plan current and in the forefront of strategic planning c. Establishing guidelines for policy and procedures d. Improving care by developing patient care plans.

ANS: B

A project facilitator is helpful in getting the committee started and operational. The project facilitator can also serve in a pivotal maintenance role, keeping the emergency management plan current and in the forefront of the administration’s strategic planning over time.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. The nursing leadership role once the all-hazards preparedness plan is completed is to a. confirm that resources are allocated appropriately. b. ensure that every facility department understands their role is a disaster situation. c. establish goals for all-hazards preparedness. d. provide rewards for the committee’s accomplishments.

ANS: B

Nursing leadership needs to ensure that all facility departments understand their role in a disaster situation. Nurse leaders are the coordinators in synchronizing department plans so that everything fits together to meet the essential needs of the staff, patients, hospital, and community. Once the comprehensive emergency management plans are complete, every department should understand their identified written role.

DIF: Cognitive Level: Understand (Comprehension) MSC: Client Needs: Health Promotion and Maintenance 7. In a disaster, it is most important that the a. clients are sent home quickly. b. medications and supplies are secure.

TOP: Nursing Process: Planning

c. nurses and their families feel safe. d. security department increases its workforce.

ANS: C

It is most important that the staff members feel safe. In a disaster, the paradigm of keeping the patient safe first needs to change its focus so that staff members and their families feel as safe as possible. This way, staff members are best able to meet their patients’ needs.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 8. All-hazard preparedness plan drills should occur at least a. annually. b. biannually. c. monthly. d. quarterly.

ANS: B

The benefits of conducting biannual emergency drills, both announced and unannounced, include being able to test the EOP, the command center, and staff roles and responsibilities.

This may be planned with community drills to improve effectiveness.

DIF: Cognitive Level: Remember (Knowledge) MSC: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

9. An all-hazards command center usually a. facilitates planning meetings. b. provides a place for the commander to sleep. c. is operated by an emergency department triage nurse. d. is located near the security department.

ANS: D

The command center usually is located near the security department and is commanded by the administrator on call, along with the chief nurse officer, emergency department–air care medical director, and safety and security director.

DIF: Cognitive Level: Understand (Comprehension) MSC: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

10. Which of the following warnings is used to alert the American people about credible terrorist

threats? a. Imminent threat b. Elevated threat c. Unlikely threat d. Likely threat ANS: B

In April 2011, the federal government implemented a new alert system, the National Terrorism Advisory System (NTAS), which replaced the color-coded system implemented by Homeland Security. The new two-level system will warn the American public about elevated threats, which warns of a credible terrorist threat, or imminent threat, warning the public that a credible and specific terrorist threat is imminent (U.S. Department of Homeland Security, 2012).

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 11. A 50-car pileup occurs on a major freeway in California’s Central Valley as a result of heavy

fog. There are major injuries, and victims are expected to be transported to local emergency departments. Which type of disaster is this classified as? a. Mass casualty event b. Conventional disaster c. Biological disaster d. Radiological disaster ANS: A

A mass casualty event is a natural or manmade event generating large numbers of patients requiring medical care and that overwhelms a health care facility and prevents it from delivering medical services that are consistent with accepted standards (Agency for Healthcare Research and Quality [AHRQ], 2012).

DIF: Cognitive Level: Apply (Application) MSC: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

12. When working with the community, recognizable nomenclature is important for a. response. b. education. c. reporting. d. communication.

ANS: D

When working with the community, using common language becomes especially important for promoting interagency communication in crisis situations. After September 11, 2001 the National Incident Management System (NIMS) was created by the U.S. Department of Homeland Security Secretary to further standardize and integrate response practices nationally.

DIF: Cognitive Level: Remember (Knowledge) MSC: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

13. A health care system’s ability to rapidly expand beyond normal capacity to meet an increased

demand for qualified personnel, beds, and medical care services in the event of a large-scale emergency or disaster is known as a. acuity. b. surge capacity. c. mass casualty. d. natural disaster.

ANS: B

Surge capacity is a measurable representation of the ability to manage a sudden influx of patients (American College of Emergency Physicians [ACEP], 2011). In addition to the overall all-hazards preparedness plans, the hospital will need to define procedures regarding what will be done in any biological, chemical, nuclear/radiological, or conventional disaster, and the surge capacity needs related to any of the events.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 14. The Joint Commission’s (TJC’s) emergency management accreditation standards call for

hospitals to sustain disaster operations for at least a. 24 b. 48 c. 72 d. 96

hours.

ANS: D

TJC’s emergency management accreditation standards call for hospitals to sustain disaster operations for at least 96 hours should an external disaster occur that impacts the local area or region (TJC, 2012). Lessons learned from Hurricane Katrina illustrate just how long it can take before assistance is available.

DIF: Cognitive Level: Remember (Knowledge) MSC: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

15. In the event of a chemical, biological, radiological, nuclear, or explosives (CBRNE) threats

who would have primary responsibility for serving as spokesperson for emergency physician needs with regard to disaster preparedness? a. Chief nursing officer b. Marketing director c. Department medical director d. Chief information technology officer ANS: C

The emergency department medical chair would represent all aspects of emergency medicine and physician needs related to all-hazards preparedness.

DIF: Cognitive Level: Remember (Knowledge) MSC: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

MULTIPLE RESPONSE 1. Which two of the following require all health care facilities to have detailed all-hazard

preparedness plans? (Select all that apply.) a. Patient Protection and Affordable Care Act b. Health Insurance Portability and Accountability Act c. The Joint Commission d. National Response Plan ANS: B, C

Health care executives across the country understand the need to dedicate resources to support effective all-hazards preparedness. The Health Insurance Portability and Accountability Act (HIPAA) and The Joint Commission (TJC) require all health care facilities to have detailed all-hazard preparedness plans. Nursing leaders are an integral part of the planning process and should have knowledge of the national response plan and state and local disaster response plans.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 2. A disaster is a sudden event that can cause great destruction and human suffering and often

requires external assistance. Which of the following statements are accurate depictions of various types of disasters or disaster-related definitions? (Select all that apply.) a. A cyber disaster is a catastrophic event that results from the use of information technology systems. b. A catastrophic event caused by the use of weapons is a radiological disaster. c. A biological disaster occurs when there is a deliberate or unintentional release of biological materials that may affect the health of those exposed. d. A chemical disaster occurs when there is deliberate or unintentional release of biological materials that may adversely affect the health of those exposed. e. A hazard vulnerability analysis is an exercise that identifies an organization’s potential emergencies.

ANS: A, C, E

A cyber disaster is a catastrophic event that results from the use of information technology systems to control or disrupt critical infrastructure systems. A biological disaster occurs when there is a deliberate or unintentional release of biological materials that may affect the health of those exposed. A hazard vulnerability analysis is an exercise that identifies an organization’s potential emergencies, the likelihood of the event occurring, and the impact it would have on the organization.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. When planning for Emergency Management Committee for a facility, which of the following

entities could be utilized as external ad hoc members? (Select all that apply.) a. Facility engineering b. Public health department representatives c. Community physicians d. Vendor representatives e. Chaplain services ANS: B, C, D

As the emergency management committee evolves in its work, ad hoc members can be added as needed. Internal ad hoc members might include radiology, facility engineering, telecommunications, volunteer support, chaplain services, physician chairs, social work, case management, dietary, respiratory, and laboratory services. External ad hoc members might include representatives from the local public health department; government liaisons; police; fire and rescue; public school systems; representatives from the faith community; community physicians; and even vendor representatives, who can be contracted to provide things such as oxygen, ice, food, cots, and linens in the event of a disaster.

DIF: Cognitive Level: Apply (Application) MSC: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

4. In a hospital’s emergency operations plan, what would be the expected roles of the security

department? (Select all that apply.) a. Overseeing facility security b. Lockdown of the facility as necessary c. Managing people entering and leaving the hospital d. Developing or refining the hospital’s emergency operations plan e. Being the primary source of communication to nursing staff ANS: A, B, C, D

The primary responsibility for the safety and security department, in conjunction with nursing leadership, is to develop or refine the hospital’s EOP for incidents based on the HVA. The safety and security department needs to have assigned oversight for facility security, quick lockdown or controlled access, and management of people flowing into and out of the hospital.

DIF: Cognitive Level: Apply (Application) MSC: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

5. What are the major roles of nursing leadership in disaster planning? (Select all that apply.) a. Providing clearly defined roles for staff nurses in a disaster situation b. Ensuring the synchronization of department plans c. Encouraging staff to stay at home in the event of a disaster to decrease confusion d. Ensuring that the community is synchronizing internal department plans in the

event of a disaster e. Developing or refining the hospital’s emergency operations plan ANS: A, B, E

Nursing leadership needs to ensure that all facility departments understand their role in a disaster situation. Nurse leaders are the coordinators in synchronizing department plans so that everything fits together to meet the essential needs of the staff, patients, hospital, and community. Once the comprehensive emergency management plans are complete, every department should understand their identified written role. Nursing leadership, in conjunction with security, develops or refines the hospital’s EOP for incidents based on the HVA. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care

6. Testing the all-hazards preparedness plan requires drilling to identify and work through

problems. Which of the following are examples of internal drills that can be used to test specific departments and/or hospital responses? (Select all that apply.) a. Surge capacity drills b. Lockdown of hospital entrances c. Prioritization of police response to biological events d. Simulating decontamination processes e. Setting up the command center ANS: B, D, E

Having comprehensive all-hazards preparedness plans requires frequent (at least biannual) drills to work through problems. Internal drills test specific department and/or hospital responses (e.g., setting up and operating the command center; recognizing a biological event both in the emergency department and on the units; lockdown of the hospital entrances; simulating decontamination processes; operating using downtime procedures during a communications or cyber disaster event; handling various surge capacity situations).

DIF: Cognitive Level: Remember (Knowledge) MSC: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Evaluation

7. The hospital plays an important role in the community in the case of a disaster. What are some

of the expected roles of the hospital? (Select all that apply.) a. Stockpiling emergency equipment b. Purchasing personal protective equipment (PPE) c. Providing additional security for the community d. Educating staff on all-hazards preparedness e. Providing emergency shelter to community members ANS: A, B, D

The hospital will play an important role in the community in the case of a disaster. The materials, equipment, and training required for hospitals to prepare adequately for their role in responding to disasters are very expensive. Capital expenditures will be required to create decontamination facilities; purchase PPE; train and educate staff on effective all-hazards preparedness; stockpile emergency equipment, supplies, and pharmaceuticals; ensure adequate isolation rooms; and outfit a hospital command center. Hospitals need financial assistance to do this well, and the AHPTF members can be advocates for federal and state funding.

DIF: Cognitive Level: Apply (Application) MSC: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

8. Nursing leadership competencies in disaster planning and crisis management encompass

which of the following domains? (Select all that apply.) a. Assessment of the disaster scene b. Technical skills c. Budget and resource allocation d. Risk communication e. Critical thinking ANS: A, B, D, E

Nursing leadership competencies in disaster planning and crisis management are invaluable, and fortunately they have been developed by a collaborative group led by the U.S. Department of Veterans Affairs, Office of Nursing Services. These disaster competencies are categorized into four domains: assessment of the disaster scene, technical skills, risk communication, and critical thinking.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 9. Hospital leadership should consider which of the following ethical dilemmas prior to

experiencing an actual disaster? (Select all that apply.) a. Which clinical leader will make the decision about distribution of scarce resources? b. Criteria to determine which patients receive aggressive treatment and which will receive palliative care? c. Which nursing staff will be the first to report to the hospital in the event of a disaster? d. How prophylactic pharmaceuticals will be distributed to protect staff and their families? e. Who will be primarily responsible for external communication?

ANS: A, B, D

An emerging issue that challenges care during a disaster is allocation of scarce resources when the system is overwhelmed. Implementing periodic tabletop discussions regarding how to allocate resources in a time of scarcity will prove to be a powerful tool in setting the stage for what to do if such an event occurs. Collaborative professional staff and hospital leadership discussions about scarce resource allocation will present ethical dilemmas that need to be thoughtfully considered in a planning time that is devoid of emotion. Questions to be discussed at the tabletop include which hospital and/or clinical leader will make the final decision about ventilator allocation and other scarce resource distribution; the criteria used to determine which patients receive aggressive treatment and which will receive palliative care, both imminently and long term, as other life-threatening complications ensue; and how prophylactic pharmaceutical dissemination plans are going to be activated to protect staff and their families.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 10. Which of the following questions should be considered in the hospital gap analysis survey of

safety and security readiness in the event of a disaster? (Select all that apply.) a. Does the facility have a lockdown plan in case of emergency? b. Does the facility have procedures in place for use of PPE? c. Does the facility have a mechanism of tracking costs associated with the event? d. Do you have a plan for allowing staff entry into the facility during an emergency? e. Does the facility have emergency-powered phones in case of a disaster?

ANS: A, D, E

Assessing the readiness of safety and security in the gap analysis survey can be answered by asking some of the following questions: Does the facility have a lockdown plan in case of emergency? Do you have a plan for allowing staff entry into the facility during an emergency?

Does the facility have emergency-powered phones in case of a disaster?

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 11. Which of the following questions should be considered in the hospital gap analysis survey of

clinical operations readiness in the event of a disaster? (Select all that apply.) a. Does the facility have procedures in place to maximize staff safety in a disaster? b. Does the facility have procedures in place for use of PPE? c. Can the facility track patients until discharge or death while maintaining confidentiality? d. Does the facility have a lockdown plan in case of emergency? e. Does the facility have a mechanism of tracking costs associated with the event?

ANS: A, B, C

Assessing the clinical operations readiness in the gap analysis survey can be answered by asking some of the following questions: Does the facility have procedures in place to maximize staff safety in a disaster? Does the facility have procedures in place for use of PPE? Can the facility track patients until discharge or death while maintaining confidentiality?

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

Chapter 25: Nursing Informatics for Leaders in Clinical Nursing Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. Nursing informatics includes the a. coding and billing of hospital and physician services. b. management and communication of data, information, knowledge, and wisdom in

nursing practice. c. organization and selection of quality medical information. d. support and troubleshooting of computer software issues.

ANS: B

Nursing informatics is a specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage and communicate data, information, knowledge, and wisdom in nursing practice.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. Management information systems describe a broad scope of activities that includes but is not

limited to the management of a. decision support systems. b. merchandise. c. products. d. nursing services.

ANS: A

Management information systems (MIS) describe a broad scope of activities that includes but is not limited to managing: decision support systems, resource and people management applications, project management, and database retrieval applications.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Which of the following statements best describes a desirable characteristic of a good

management information system? a. Data should be sorted and labeled within 2 weeks. b. For accurate interpretation, data should reflect a health bias. c. Information gathering should be comprehensive and cost-effective. d. The management information system operating system should be Windows-based.

ANS: C

Ten criteria or desirable characteristics for a good management information system are the following: (1) informative, (2) relevant, (3) sensitive, (4) unbiased, (5) comprehensive, (6) timely, (7) action-oriented, (8) uniform, (9) performance-targeted, and (10) cost-effective.

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

MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. Nursing data need to include which of the following domains? a. Fiduciary data b. Outcome data c. Patient data d. Tertiary data ANS: C

Nursing’s data needs fall in four domains: patient care, provider competencies and staffing, administration of care and sustainability of the organization, and knowledge-based research for evidence-based practice.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5.

was recognized by the American Nurses Association (ANA) as a nursing specialty in 1992 and is one of the fastest growing practice areas in health care. a. Nurse anesthesia b. Nursing informatics c. Nurse-midwifery d. Clinical nurse specialist ANS: B

Nursing informatics is one of the fastest growing practice areas in health care.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. The implementation of an electronic health record (EHR) could enhance patient care by

facilitating a. communication across the health care continuum. b. diabetes mellitus education and ongoing care delivery. c. one-on-one counseling between the provider and the client. d. physical and occupational therapy dispensing errors.

ANS: A

The purpose of an EHR is to document patient care in a single repository as a clinical, financial, and legal record. The electronic digital format supports the storage and exchange of the clinical data from the record that is accessible and available among health care members regardless of their location. The EHR is a virtual record of retrospective, concurrent, and prospective information to support continuous, efficient, and integrated health care.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. The first person to analyze patient outcomes associated with nursing care delivery was a. Clara Barton. b. Dorothea Dix.

c. Florence Nightingale. d. Luther Christman.

ANS: C

Florence Nightingale was the first person to analyze patient outcomes associated with nursing care delivery. This occurred in the nineteenth century.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. The Nursing Minimum Data Set (NMDS) was designed to a. determine differences in care delivery between the holder of an associate degree in

nursing and a bachelor’s of science in nursing. b. evaluate the nursing language of NANDA, Nursing Interventions Classification,

and Nursing Outcomes Classification. c. provide data for leaders to make decisions about staffing patterns. d. standardize the collection of nursing data across populations.

ANS: D

The formulation of the NMDS was an effort to standardize the collection of essential nursing information for comparison of nursing data across patient populations.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. Nursing outcome databases are critical because nurses must be able to a. assess the differences between an associate degree in nursing and a bachelor’s of

science degree in nursing. b. compare interventional care strategies between physicians. c. evaluate nurse’s aide– and licensed practical/vocational nurse–sensitive outcomes. d. measure how nurses influence patient outcomes.

ANS: D

Nursing outcome databases are critical for two reasons: (1) nurses are able to measure and document how nurses influence patient outcomes across care providers for populations of patients, and (2) the study of nursing-sensitive outcomes allows comparisons among interventional strategies and advances the science of nursing care delivery.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. The collection of data to measure performance is required by a. the Health Insurance Portability and Accountability Act (HIPAA). b. the Centers for Medicare & Medicaid Services. c. The Joint Commission (TJC). d. Health Information Technology.

ANS: C

The collection of data to measure performance is a requirement of TJC.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. The data analysts within a health care organization pull core measure data from patient

records on a quarterly basis. This data is then analyzed and collated into a report that is for analysis of adherence to core measure requirements. This is an example of a. health information exchange (HIE). b. effectiveness research. c. health information management. d. management information systems.

ANS: A

Health information exchange (HIE) is defined as the electronic movement of health-related information among organizations according to nationally recognized standards that allow health care providers to access and securely share vital medical information electronically.

The HIE is a process within either a state health information network or a regional health information organization (RHIO), often for a geographic area.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. The formal process of using patient data for providing evidence for the design of care

protocols is termed a. evidence-based practice. b. practice-based evidence. c. data analysis. d. effectiveness research.

ANS: B

Collecting and extracting data that describe the processes and outcomes of nursing care electronically has provided evidence for the design of care protocols and delivery models. The formal process of using these patient data for providing this evidence is termed practice-based evidence.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. Nurses utilize

through critical thinking and clinical reasoning skills to determine when and how to apply evidence-based knowledge. a. orders b. data c. information d. wisdom ANS: D

Wisdom is the appropriate use of knowledge in managing and solving patient problems, risks, and needs for health enhancement. Wisdom is knowing when and how to apply the evidence-based knowledge with client information, which nurses exercise through critical thinking and clinical reasoning skills.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Nursing Diagnosis MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. The Office of National Coordinator for Health Information Technology (HIT) was created by a. President Barack Obama. b. President George W. Bush. c. Hillary Clinton. d. President Bill Clinton.

ANS: B

In 2004, President George W. Bush created the position of Office of National Coordinator for HIT within the U.S. Department of Health and Human Services. The coordinator’s role involved leadership to develop the standards and interoperability framework and establish the infrastructure necessary to harness the use of information technology and exchange of health information nationwide to improve patient care and reduce health care costs.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. What are some of the expected outcomes in the client domain of nursing data? (Select all that

apply.) a. Patient satisfaction b. Achieved care outcomes c. Continuity of care d. Level of dependency e. Intensity of nursing care ANS: A, B, C

In the client domain, the cost and continuity of care for the client are important because data are now shared among providers within the HIE to manage care. Patient satisfaction and the achievement of care outcomes are also expected within the client domain. Some of the variables include diagnosis, age, gender, marital status, level of dependency, and intensity of nursing care.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. In the provider domain, what are some of the variables that are used to measure variability in

nursing? (Select all that apply.) a. Certification b. Hours of work c. Education level d. Years of experience e. Attitudes and beliefs ANS: C, D, E

In the provider domain, professional skills/knowledge and intensity of nursing care are variables that may be measured to monitor variability and to control workforce capacity. The quality and types of services are dependent on the competencies of the professional workforce.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. Which of the following statements are true regarding health information technology (HIT)

applications in nursing services? (Select all that apply.) a. HIT involves nursing administration, clinical informatics, and effectiveness research. b. Health information data allow nursing leaders to make informed decisions regarding patient care. c. HIT is used primarily for financial decision making. d. Clinical decision support utilizes tools for downloading, collecting, organizing, and analyzing data. e. HIT is used by senior leaders only.

ANS: A, B, D

HIT applications in nursing services arise from the intersection of three areas: nursing administration; clinical informatics; and effectiveness research, including research on client outcomes. The technologies are tools for downloading, collecting, organizing, and analyzing vast amounts of complex data, and clinical decision support. Having these data in an accessible format increases nursing leaders’, managers’, and administrators’ ability to make informed decisions regarding the organization and delivery of patient care.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 4. Nursing’s data needs fall into four domains. Which of the following statements accurately

describe the sources for data in each of the domains? (Select all that apply.) a. Client data is located in the client’s health care record. b. Provider data refers to physicians and is located within the medical board. c. Administrative data is located in registry and regulatory performance data. d. Research data is only available with informed consent. e. Existing and newly gathered data can be a source of obtaining research information.

ANS: A, C, E

The sources of client data are the client’s health care record, their personal health record, and patient-provider messages. Administrative data is located in administrative, fiscal, population, registry, and regulatory performance data. Existing and newly gathered data, relational databases, and common data elements are sources of research data.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

5. According to the ANA, what elements are viewed as a relationship continuum as nurses apply

them in decision making? (Select all that apply.) a. Data b. Technology c. Information d. Knowledge e. Wisdom ANS: A, C, D, E

As defined by the ANA, the practice of nursing informatics views the relationship of data, information, knowledge, and wisdom as a continuum with increasing complexity and interrelations as nurses aggregate and apply them in decision making.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. What are the roles of nursing informatics specialists? (Select all that apply.) a. Data analysis and reporting to governmental agencies b. Participation in education of nursing staff c. Providing direct patient care d. Providing information and evidence-based knowledge e. Supporting clinical decision making ANS: B, D, E

Nursing informatics specialists assist practitioners by providing information and evidence-based knowledge to support clinical decision making and delivery of safe patient care. Although these specialists may not be directly involved with care delivery, their effort is integrally related to reengineering work flow for clinical and administrative practice. Nursing informatics specialists participate in analysis, design, and implementation of information and communication systems; effectiveness and informatics research; and education of nurses in informatics and information technology.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. The goals of meaningful use include (Select all that apply.) a. improve quality of care and safety. b. engage patients and their families in care. c. improve population health. d. reduce costs associated with health care. e. improve care coordination.

ANS: A, B, C, E

Meaningful use of HIT brought with it four goals: improve quality of care and safety, engage patients and their families in care, improve care coordination, and improve population health.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. What are the primary purposes and benefits of EHRs? (Select all that apply.)

a. b. c. d. e.

Single source of clinical, financial, and legal record Electronic format supports the storage and exchange of continuity of care Available within the health care facility to ensure confidentiality Originate from a single place Virtual record of retrospective, concurrent, and prospective information

ANS: A, B, E

The purpose of an EHR is to document patient care in a single repository as a clinical, financial, and legal record. The electronic digital format supports the storage and exchange of the continuity of care document from the record that is accessible and available among health care members regardless of their location. The EHR is a virtual record of retrospective, concurrent, and prospective information to support continuous, efficient, and integrated health care.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. Nurse managers utilize outcomes data to make decisions about nursing care effectiveness.

Which NMMDS data elements would be most effective in evaluating nursing care? (Select all that apply.) a. Nursing diagnosis b. Turnover c. Population served d. Client accessibility e. Intensity of nursing care ANS: A, B, E

The NMMDS was developed to meet the need for “sharable and comparable” data, especially regarding the nursing workforce and the processes of patient care (Garcia et al., 2015). Such data are crucial for nurses to have in order to compare nursing practice and evaluate costs of care. Three categories of data elements are included in the NMDS: nursing care, demographic, and service. Data elements related to nursing care include nursing diagnosis, turnover, intervention, outcome, and intensity of nursing care.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Evaluation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. Successful implementation of a health information system requires a great deal of time,

education, and support. The process will require which of the following expertise within the organization? (Select all that apply.) a. Quality experts b. Marketing specialists c. Clinical nurse leaders d. Nurse informaticians e. Nurse managers ANS: A, C, D, E

Nurse managers are being asked to participate in the selection, design, and implementation of institutional information systems. Managers and clinical nursing leaders will serve as change agents to overcome resistance. Successful implementation and sustainability of these systems will require nurse managers, nurse informaticians, clinical nurse leaders, and quality experts to have leadership, vision, and commitment.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Chapter 26: Marketing Huber: Leadership & Nursing Care Management, 7th Edition MULTIPLE CHOICE 1. Which of the following phrases best describes the focus of health care marketing? a. Delivery of high-quality patient care b. Pursuing a high level of patient satisfaction c. Recruitment and retention of nurses d. Creating and delivering superior customer value ANS: D

The focus in health care marketing is not only on developing a brand and attracting customers but also on “creating and delivering superior customer value.” More simply, marketing is focused on establishing customer relationships and satisfying customer needs and wants.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. The marketing mix of an organization is a. an individualized blend of tactics used to achieve goals. b. guidelines that outline plans to market specific services. c. patient education materials that also highlight services. d. various television commercials used to advertise goods.

ANS: A

Marketing mix is the individual blend of tools and tactics used to achieve the goals of an organization.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. A hospital organizational culture that assumes customer needs and wants should determine the

quality, price, and availability of a product. This type of orientation is a. product. b. selling. c. marketing. d. holistic.

ANS: C

Marketing orientation is an organizational culture that assumes the customer’s needs and wants should determine the quality, price, and availability of the product.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

4. A registered nurse wants to start a primary care clinic in a rural area. Determining the segment

of the population that is most likely to use this business is important to consider before establishing a new clinic. This is an example of a. positioning. b. targeting. c. competition. d. marketing.

ANS: B

Targeting is identifying which segment is most relevant or presents the greatest opportunity for a given business.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. The process of obtaining and analyzing data, which will be used to refine strategic or

operational plans, is known as market a. exchange. b. mix. c. research. d. study.

ANS: C

Market research applies a scientific approach to ascertain insights in and information about customers and potential target markets. Steps in this approach begin with defining the problem and research objectives, proceeding to data collection and analysis, and ending with interpretation of findings relevant to a specific marketing situation or decision making.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. Target audiences for health care organizations are a. nurses and physicians. b. clients, physicians, payer, and employees. c. regulatory agencies such as The Joint Commission (TJC) and the Centers for

Medicare & Medicaid Services (CMS). d. insurance companies.

ANS: B

Clients, physicians, payers, and the employees are the target audiences for health care organizations.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. A patient with pulmonary fibrosis is visiting a large metropolitan institution for treatment of

the disease. An employee with a wheelchair and tank of oxygen greets the patient at the door and provides instructions on how to find the pulmonology clinic. This is an example of a. client courtesy. b. patient-centeredness.

c. patient advocacy. d. strategic service.

ANS: B

Attributes in patient-centeredness include patient satisfaction, the patient experience of care, patient engagement, and shared decision making.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8.

Marketing mix from a seller’s point of view includes client service, charges, comfort, and connecting. customer solution, cost, convenience, and communication. patient, physicians, perfection, and publicity. product, price, place, and promotion.

a. b. c. d.

ANS: D

Product, price, place, and promotion are the four Ps of the marketing mix that apply to the seller when a good or service is being marketed.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. Nursing leaders and managers participate in marketing by promoting the value nursing brings

to the organization. This level of market planning is a. corporate strategic planning. b. strategic marketing. c. strategic service. d. marketing management.

ANS: D

Nursing executive leadership generally would be involved in corporate strategic planning and strategic marketing. Nurse leaders and managers then implement corporate strategies at the marketing management level by promoting the value nursing brings to the organization and managing the implementation of the marketing mix.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. Nurses and other health care professionals tend to gravitate toward hospitals that showcase the

positive aspects of the hospital to differentiate themselves from their competitors. Some of the most enticing marketing plans include showcasing a. competitive hourly reimbursement for services. b. profitability margins and payer ratios. c. receipt of nationally recognized awards. d. vacation and holiday benefits.

ANS: C

Receipt of nationally recognized awards such as the American Nurses Credentialing Center Magnet Recognition Program or the marketing of high accreditation scores from The Joint Commission (TJC) often is used as part of a marketing plan to differentiate hospitals from their competitors. This tends to attract nurses, physicians, patients, and other health care professionals.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. A patient calls into the customer service department to complain about the long wait times

they have experienced in the emergency department. The patient feels that the charges were excessive compared with the time that it took to receive attention. What is the primary focus of this complaint? a. Product b. Place c. Price d. Promotion ANS: C

Price is described as the amount of money customers pay to obtain the product. Customers consider the cost in terms of reasonableness. However, in a broader sense, cost is more than the money that is exchanged. Customers place value on products and services not only according to financial issues, but also according to psychosocial and emotional concerns.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 12. The presence of

on the hospital’s website will promote nursing to current staff and

prospective new hires. a. distinctions b. nursing c. physicians d. services ANS: B

Advertising messages (promotion) about nurses and nursing care can reinforce a positive image of nursing to internal and external markets. One opportunity for promotion of nursing to all markets is to have a nursing focus on the hospital’s website. Nurse leaders can ensure the promotion of nursing and nursing roles in as many venues as possible to communicate the importance of nursing, nursing practice, or nursing care to potential target markets.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 13. Which model of patient care is based on a strong philosophy of patient-centeredness? a. TJC b. Thomson Reuters c. Beacon

d. Planetree ANS: D

Planetree is a designation that differentiates a hospital on the basis of excellence in patientand person-centered care. The Planetree philosophy reveals a simple view of what it means to be patient-centered: “Care should be organized first and foremost around the needs of patients.”

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 14. A center of excellence for geriatric care is put in place in a large retirement community. This

is an example of which of the following marketing concepts? a. Segmentation b. Targeting c. Product differentiation d. Positioning ANS: C

Product differentiation occurs when the market offers to create superior customer value.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment: Management of Care 15. The primary hospital a. product b. price c. place d. promotion

is the care that is delivered by nursing staff.

ANS: A

The primary hospital product is the care delivered by nurses. A product is the basis of any business and is the focus of exchange between the provider and customer.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care MULTIPLE RESPONSE 1. What are the overarching goals of marketing? (Select all that apply.) a. Attracting new customers b. Satisfying customer needs and wants c. Growing current customers d. Creative advertising techniques e. Delivering something of value ANS: A, B, C, E

Marketing goals are incorporated in the organizational strategic plan. These goals focus on satisfying and creating value with respect to customers. They also may be focused on attracting new customers or increasing volume to enhance financial viability. Nursing is affected by such strategies and also can have an impact on goal achievement.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 2. What unique challenges in the health care setting can be promoted through marketing? (Select

all that apply.) a. High-quality patient-centered care b. Hospital mortality rates c. Design of a healthy work environment d. Hiring and retention of new graduate nurses e. Practices aimed at patient satisfaction ANS: A, C, E

Not only are nurses at the center of care delivery, but nurse leaders are accountable for the workforce who provide that service. Marketing initiatives that focus on care delivery, customer satisfaction, and recruitment and retention of the nursing workforce are not uncommon in hospitals. Marketing initiatives can be designed and implemented to help meet the challenges of the delivery of high-quality patient-centered care; recruitment and retention of a culturally diverse, competent workforce; promotion of a positive and inspiring image of nursing; design of a healthy work environment; and practices to satisfy patients and improve outcomes.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care 3. How is the business of health care different from the practice of health care? (Select all that

apply.) a. The practice of health care is an exchange relationship. b. The business of health care is transactional. c. The business of health care is based on mutual caring and support. d. The practice of health care is based on trade for mutual benefit. e. The practice of health care is like a communal relationship.

ANS: B, E

Expectations and satisfaction depend significantly on the quality of the relationship between the brand and its customers. Social psychologists describe two broad categories of human relationships: exchange relationships in which we trade for mutual benefit and communal relationships, which are based on mutual caring and support. Health care is caught between these two kinds of relationships. In its strictest sense, the business of health care is transactional and is an exchange relationship. However, the practice of health care is more like a communal relationship.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care

4. What value propositions are important to offer when nurse leaders market to increase nursing

retention and recruitment? (Select all that apply.) a. Competitive salary b. Efficient work flow c. Uniform allowances d. Professional development opportunities e. Flexible work hours ANS: A, B, D

When considering nurse retention and recruitment, leaders consider what value proposition (product) the nursing department or unit offers to nurses. Highlighting department or unit characteristics deemed important, such as shared governance and professional development opportunities, provides details about the product. Leaders can give attention to the unit (place) where nurses provide service. Consideration of the physical layout and whether the unit design is conducive to an efficient and effective work flow is important. Nurse leaders can ensure that nurse salaries are competitive and that nurses do not feel underpaid and undervalued.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Nursing Diagnosis MSC: Client Needs: Safe and Effective Care Environment: Management of Care 5. Which of the following marketing strategies are examples of niche marketing? (Select all that

apply.) a. Full-service community hospital b. Children’s hospital c. Center for bariatric excellence d. University hospital e. Cancer specialty center ANS: B, C, E

Marketing strategy is based on how target markets are defined. Markets are both broad and narrow. Niche marketing is a narrower view and focuses on capturing a small but important part of the market. A children’s hospital and those specializing in bariatrics or cancer treatment are considered to be targeting very specific customers.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 6. What are four critical concepts that are essential to understanding and becoming fluent in the

language of marketing? (Select all that apply.) a. Segmentation and targeting clarify how customers will be served. b. Segmentation breaks down the mass market into submarkets. c. Targeting takes into account the whole market that can be considered in terms of smaller market segments. d. Differentiation calls for the creation of superior value. e. Positioning the product is completed in a manner where customers perceive it to be distinctive and desirable.

ANS: B, C, D, E

Segmentation and targeting are the means of decision making about which customers will be served. Differentiation and positioning clarify how customers will be served. Segmentation involves identifying pieces of the total market that contain potential customers with distinguishable characteristics such as age, gender, geographic location, or ethnicity.

Targeting takes into account the whole market that can then be considered in terms of attractive smaller market segments. A product offering’s differentiation calls for the creation of superior customer value and is typically what strengthens its position in the market against competitors. Positioning the product such that customers perceive it to be distinctive and desirable is the foundation of the marketing program.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 7. Which of the following distinctions may be utilized in the marketing of a health care

organization? (Select all that apply.) a. TJC accreditation for meeting performance standards b. Malcolm Baldridge National Quality Award for performance excellence c. Beacon Award for Excellence in critical care nursing d. Truven Health Analytics 100 Top Hospitals Award e. Four-star ranking on internal survey ANS: A, B, C, D

Heightened patient and regulatory scrutiny, fueled by more frequent accounts in the media of medical errors, has motivated hospitals to refocus on patient care excellence and seek ways to promote this excellence to the public to gain a competitive advantage. Logos depicting the following designations may be displayed for marketing purposes: TJC accreditation for meeting performance standards, Malcolm Baldridge National Quality Award for performance excellence, Beacon Award for Excellence in critical care nursing, and Truven Health Analytics 100 Top Hospitals Award.

DIF: Cognitive Level: Remember (Knowledge) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 8. What terms are considered to be the four As that influence a buyer’s decision to purchase a

product or service? (Select all that apply.) a. Acceptability b. Accreditation c. Affordability d. Accessibility e. Awareness ANS: A, C, D, E

The specific tools in the mix are custom-designed to influence the buyer’s decision to purchase the product or service and to be the basis for operational marketing activities. From the customer’s point of view, the marketing mix emerges from the four As of (1) acceptability, (2) affordability, (3) accessibility, and (4) awareness.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care 9. What are the attributes of patient-centeredness in health care? (Select all that apply.) a. Patient satisfaction b. Cost and transparency of care c. Patient engagement d. Patient experience of care e. Shared decision making ANS: A, C, D, E

Attributes in patient-centeredness include patient satisfaction, the patient experience of care, patient engagement, and shared decision making. Evidence supports the view that patient-centered care improves patient outcomes and is one approach to addressing racial, ethnic, and socioeconomic disparities in health care and health care outcomes.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 10. Hospitals in recent years have become more motivated to focus their marketing strategies on

patient care excellence. What are some of the drivers of this focus? (Select all that apply.) a. Heightened patient scrutiny b. Heightened media scrutiny c. Organizational transparency about error reporting d. Frequent media accounts of medical errors e. Increased litigation ANS: A, B, D

Heightened patient and regulatory scrutiny, fueled by more frequent accounts in the media of medical errors, has motivated hospitals to refocus on patient care excellence and seek ways to promote this excellence to the public to gain a competitive advantage. Logos depicting designations of excellence are displayed on the organization’s website homepage and are used to promote differentiating distinctions.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment: Management of Care 11. A nurse leader is attempting to attract experienced nurses to her unit. Which of the following

marketing strategies should she use? (Select all that apply.) a. Disciplinary actions b. Professional development opportunities c. Workplace engagement d. Shared governance e. Physician champions ANS: B, C, D

A marketing application for nurse leaders and managers relates to workforce characteristics.

Nurses who are employed make up an internal market, and the pool of nurses who are potential new hires make up an external market. In these instances, nurses are the customers.

Nurse leaders can use marketing to increase customer retention and attraction. Highlighting department or unit characteristics deemed important, such as shared governance, professional development opportunities, and workplace engagement provide details about the product.

DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment: Management of Care