TEST BANK for Human Resources in Healthcare: Managing for Success 5th Edition

Chapter 1 1. Why should healthcare organizations be concerned about integrating

business strategies and HR? a. To better align the business strategies with each other b. To determine which HR functions should be done in-house and

which should be outsourced *c. To enhance organizational outcomes d. To ensure the organization is included in various lists of “best places to work”

2. Which of the following is an HR metric? a. Market share

*b. Cost per hire c. Profitability d. Competitive advantage

3. The number of HR staff members in most organizations a. continues to increase. b. is remaining the same. c. cannot be determined.

*d. continues to decline.

4. Which of the following is NOT part of a balanced scorecard? a. Short-term and long-term objectives b. Internal and external performance perspective c. Financial and nonfinancial metrics

*d. Measures of the internal and external environments

5. Competitive advantage in the workforce is challenging to achievebecause a. it is enduring and difficult for competitors to duplicate. b. it requires alignment of all HR systems.

*c. it takes time to do so. d. HR practices’ impact on it is not clear.

6. Human resources management includes a. financial management. b. strategic management. c. marketing.

*d. informal management of employees by all administrators.

7. Effective HR practices for healthcare organizations do NOT include a. development of strategies to enhance employee work–life

balance. b. recognition of employees with monetary and nonmonetary rewards. *c. elevation of status distinctions and barriers. d. creation of a positive work environment.

8. Which of the following strategies constitutes the HR strategy? a. Compensation, planning, and staffing strategies b. Compensation, staffing, and marketing strategies c. Staffing, incremental, and compensation strategies

*d. Staffing, developmental, and compensation strategies

9. The HR scorecard is a. a measurement instrument and control system that looks at amix of

quantitative and qualitative factors to evaluate organizational performance. b. HR’s role as a strategic partner. *c. a modified version of the balanced scorecard. d. a lagging indicator of organizational performance.

10. High-performing healthcare organizations share all of the following

characteristics except a. agile and open culture. b. consistent and effective communication. c. employee selection based on fit.

*d. central focus on hierarchical organizational structure.

11. Environmental trends affecting healthcare organizations have resulted

in the following human resources management trends except a. Lean management structures. b. flexible work schedules.

*c. increased hiring activity. d. job redesign or restructuring.

12. Which of the following is an outdated HR practice?

a. Hiring decisions made by teams

*b. Uniform appraisal procedures c. Performance-based pay d. Employee responsible for career development 13. Investments in predictive HR analytics can help the organization a. develop competitive advantage. b. inform strategic HR decisions. c. identify possible causal factors for HR performance

indicators. *d. all of the above

14. Which of the following is NOT a persistent basic HR challenge? a. Managing employee stress and burnout

*b. Complying with federal, state, and local laws and regulations c. Creating a culture of equity and trust d. Developing the next generation of leaders

15. Successful strategic human resources management has been

problematic over the years due to *a. lack of implementation and assessment plans. b. nonacceptance of human resources management planning as a standard practice. c. poor environmental scanning. d. lack of strategic goals and objectives.

16. Understanding HR management’s significance is as relevant to line

managers as it is to HR managers. *a. True b. False

17. HR is moving from appraisals with multiple inputs to supervisorinput

only. a. True

*b. False

18. Implementation of an HR strategy requires management of internaland

external stakeholders. *a. True

b. False

19. The immediate goal of building a strong HR brand is to attract andretain the

best employees. *a. True b. False 20. HR practices are “lagging” performance indicators. a. True

*b. False

Chapter 2 1. What are three areas addressed by the original Fair Labor StandardsAct

passed in 1938? a. Overtime pay provisions, discriminatory hiring practices, timeoff for

family illness *b. Minimum wage, overtime pay provisions, child labor c. Discriminatory hiring practices, illegality of disparatetreatment, child labor d. Illegality of gender-based discrimination, child labor,employment at will

2. Which of the following was NOT a provision of the 2008 amendments tothe

Americans with Disabilities Act (ADA)? a. Expanded definition of major life activities

*b. Further limited episodic conditions for ADA coverage c. Expanded the scope of “substantially limiting” major life activities d. Included “reading” as a major life activity

4. Under the employment-at-will doctrine, a. an employer may fire an employee at any time but must give the

employee timely notice as defined under the employment contract. b. an employer may fire an employee only with written justification. c. an employer may not fire an employee for an immoral reason. *d. an employee may quit a job at any time.

5. What are the three provisions of the Family and Medical Leave Act? a. Up to 6 months of leave for several medical and family-relatedreasons,

continued compensation at a reduced rate during the leave period, guarantee of continuation of employer-paid health insurance during the leave period b. Up to 12 weeks of leave for several medical and family-relatedreasons, continued compensation at a reduced rate during the leave period, guarantee of continuation of employer-paid health insurance during the leave period c. Up to 6 months of leave for several medical and family-relatedreasons, guarantee of continuation of employer-paid health insurance during the leave period, guarantee of a return to work in the same or a similar position *d. Up to 12 weeks of leave for several medical and family- related

reasons, guarantee of continuation of employer-paid health insurance during the leave period, guarantee of a returnto work in the same or a similar position 7. Which of the following employment interview questions is/are illegalunder federal law? a. “Do you plan on having children?”

*b. “Are you disabled?” c. “What is your age?” d. All of the above are illegal.

8. The two main bases of employee discipline are a. employee behavior and insubordination. b. insubordination and absenteeism.

*c. job performance and employee behavior. d. absenteeism and failure to improve after a negative jobevaluation.

9. A privately owned nursing home hires mostly Hispanic women. The

hiring manager believes that only Hispanic women can “fit in” and therefore does not hire a non-Hispanic person who does not meet thisprofile. This is likely to be a. permissible because of the employment-at-will doctrine. b. permissible because most of the local residents are Hispanic.

*c. discrimination on the basis of national origin in violationof Title VII. d. permissible because the nursing home is a private company.

10. A state that protects whistleblowers is likely relying on what typeof

exception to at-will employment? a. Contractual employee exception b. Exception based on employees protected by federal employmentlaw c. Exception based on Title VII prohibitions against sexual

harassment *d. Public policy exception

11. The Civil Rights Act covers

*a. employers with 15 or more employees who worked more than 20 weeks in the current or previous year. b. all US employers. c. employers with more than 100 full-time employees in the current or previous year. d. all employers listed on the New York Stock Exchange.

12. In Title VII of the Civil Rights Act, “terms, conditions, orprivileges

of employment” refers to a. hiring. b. compensation. c. training. *d. all of the above.

13. An employee with a hearing disability asks the organization to provide her

with a device to help her communicate with other employeesand customers. In legal language, she is asking for a. flexible implementation of company policies. b. reduction of disparate impact.

*c. reasonable accommodation. d. reduction of undue hardship.

14. Under a strict employment-at-will doctrine, it is legal to fire anemployee a. only for grossly poor performance. b. for a reason that does not violate local employment law

statutes.

c. because of the employee’s race.

*d. for any or no reason.

15. An individual with 20/20 eyesight was denied a job as a school busdriver

because the interviewer perceived that the applicant had a vision disability. The individual is considering bringing a lawsuit against the school district. What would be your advice? *a. You are covered under the ADAAA and should bring a lawsuit. b. You should not bring a lawsuit because you do not have a disability. c. You should bring a lawsuit based on a Title VII violation. d. You should not bring a lawsuit because you were probably denied employment because of some other aspect of your application.

16. For a disparate impact discrimination case to succeed, a. it must be demonstrated that an employment practice was

intentionally discriminatory. b. it must be demonstrated that a hiring practice was designed to discriminate against a protected class.

*c. it is not necessary to prove that the intent of an employmentpractice was discriminatory. d. the case must not be brought in a right-to-work state.

17. The National Labor Relations Board has found that employees

discussing negative employment issues over social media a. provides a reasonable rationale for firing an employee. b. provides a reasonable rationale for disciplining but notfiring an employee. *c. is legal as a concerted activity covered by federal law. d. is legal under the Constitutional right to free speech.

18. In the amendments to the Americans with Disabilities Act, a. fewer conditions were qualified as disabling conditionsbecause

of abuse. b. obesity was removed as a disabling condition. c. drug addiction was added as a disabling condition.

*d. more disabling conditions were added.

19. A male employee in a privately owned factory was fired because he

protested ongoing sexual harassment of women in the company. Firing this employee *a. was likely illegal because the firing was a form ofretaliation. b. was likely illegal because he himself was not victim to the harassment. c. was likely illegal based on at-will employment. d. was likely illegal because it violated his Constitutionalright to free speech.

20. A clothing store targeting people in their twenties decided to terminate a

saleswoman who had just returned from maternity leave andhad reached her 40th birthday. This would likely be seen as a. legal because having a youthful appearance is a business

necessity. *b. illegal under the Age Discrimination in Employment Act. c. legal because being under the age of 40 is a bona fideoccupational qualification. d. illegal under the Pregnancy Discrimination Act.

21. Among the goals of employee discipline is/are

a. to motivate an employee to improve. b. to make sure the employee has the appropriate skills andtools. c. to make sure the employee is aware of the consequences ofless-

than-satisfactory performance. *d. all of the above.

22. Under the Family and Medical Leave Act, an employee may take leavein

small increments. This is known as a. for-cause leave. *b. intermittent leave. c. temporary leave. d. continuation leave.

23. Which of the following is true about states’ ability to restrict

off-duty conduct?

*a. States have the freedom to regulate legal off-duty conduct. b. States do not have the freedom to regulate legal off-dutyconduct. c. States must appeal to the US Supreme Court to regulate legaloff-duty conduct. d. States can regulate off-duty smoking and alcohol use only.

24. Which of the following statements about the minimum wage is true? a. States may not raise the minimum wage above the federal

minimum. b. By statute, the minimum wage is raised every year. c. In some years, the minimum wage is reduced to increase employment. *d. States may raise the minimum wage above the federal minimum.

25. Public-sector employees tend to have more rights in the workplacethan

private sector employees because a. government agencies tend be more generous than private

employers. b. government employees tend to have more rights to unionize than employees of private organizations. *c. government employees are protected by Constitutionalprovisions. d. all of the above.

Chapter 3 1. The development of healthcare professionals is related to all butwhich of

the following? a. Supply and demand b. Healthcare financing and delivery

*c. Decreasing use of new technology due to cost d. Changes in disease and illness

2. Which of the following is NOT a primary role of a healthcare

administrator? a. Coordinate care

*b. Deliver care c. Manage care d. Organize care

3. According to the National Sample Survey of Registered Nurses,

approximately what percentage of registered nurses are NOT employed in healthcare organizations? a. 4 b. 11

*c. 17 d. 21

4. What are the five key roles of nursing? a. Diagnosis, prescribing, planning, strategic development,

evaluation b. Assessment, prescribing, planning, education, evaluation c. Assisting physicians, diagnosis, planning, strategic

development *d. Assessment, diagnosis, planning, implementation, evaluation

5. Interdisciplinary care teams include a. insurers, providers, and patients. b. providers, patients, and billing staff.

*c. practitioners/providers, patients, and family members. d. patients, administrators, and pharmacists.

6. Which of the following factors does NOT pose a threat to the supplyof

nursing professionals? a. The aging nursing workforce

*b. The decrease in nursing salaries c. The decline in educational resources d. The decline in nursing school enrollment

7. Which of the following is NOT a primary reason for the increasedsupply

and demand for healthcare professionals? a. Technological growth b. The aging population c. Increases in specialization

*d. Flexible work schedules

8. All of the following are indicators of demand for healthcare

professionals except a. vacancy data. b. turnover rates.

*c. number of students enrolled in programs. d. salary increases.

9. In 2018, what percentage of the registered nurse workforce held a

bachelor’s degree or higher? a. 32 b. 43 c. 49

*d. 64

10. Research suggests that the future supply of healthcare professionals is

threatened by all of the following factors except a. the aging of faculty. b. the shortage of faculty. c. limits on clinical placements.

*d. the shortage of qualified applicants.

11. Healthcare professional roles continue to emerge and evolve as aresult of

all of the following factors except a. the shift to outpatient care.

*b. the emphasis on fee-for-service reimbursement. c. the emphasis on population health management. d. the growth of healthcare consumerism.

12. A key factor that limits basic educational opportunities forregistered

nurses is *a. the lack of classroom space.

b. the oversupply of educational programs. c. the poor job prospects for registered nurse graduates. d. the preference for bachelor’s-prepared nurses.

13. An impaired practitioner is a healthcare professional who a. is able to carry out their duties with reasonable skills andsafety.

*b. is unable to carry out their duties with reasonable skillsand safety. c. is not accountable for maintaining high professionalstandards. d. is not at risk for affecting the quality of health services.

14. Career ladders allow healthcare organizations to

*a. identify healthcare professionals for advancement orpromotion. b. identify healthcare professionals for separation or retrenchment. c. identify educational programs for elimination. d. identify job categories.

15. Advanced practice registered nurses meet all the following criteriaexcept that a. they have advanced clinical knowledge and skills to providedirect

care to patients. b. they have completed an accredited graduate-level educational program. *c. they have the same competencies as registered nurses. d. they have developed the competencies for greater interventionsand data synthesis.

16. Healthcare organizations are increasingly reliant on nonphysicianLIPs to

provide services to their patients. LIPs are a. licensed individual practitioners. b. licensed independent providers. c. legal independent physicians.

*d. licensed independent practitioners.

17. When considering the duties of a nonphysician healthcare provider,

“scope of practice” refers to a. day-to-day services provided by the healthcare provider.

*b. services permitted to be provided by license. c. all services provided to patients when directed by a physician. d. services performed that are typically performed by aphysician.

18. Since 1993, the healthcare field has increasingly accepted the use of

complementary and alternative medicine (CAM) therapies. According toNahin, Barnes, and Stussman (2016), approximately what percentage of office-based physicians recommend CAM approaches to patients? a. 35

*b. 50 c. 60 d. 75

19. An electrocardiograph technician is an example of which category ofallied

healthcare professional? a. Radiograph services b. Clinical lab services

*c. Medical and surgical services d. Emergency medical services

20. A provider who demonstrates practiced response of definable tasks and

who can deal with unexpected events that may not conform to plans is said to be at which stage of skill development? *a. Competent

b. Proficient c. Advanced beginner d. Expert

21. Which of the following is most true of a functionally trained

healthcare provider? a. They may understand the theory but do not have practical

experience to complete healthcare tasks. *b. They have practical experience necessary to complete healthcare tasks but they may not understand the theory behindthe tasks they complete. c. They have both theoretical knowledge and practical experiencebut have only recently graduated and have less than one year experience in the field.

d. They have not received any formal training in their healthcarefield.

22. Which of the following does NOT apply to hospitalists? a. They are unlikely to run their own practice.

*b. They deliver specialized outpatient care. c. They are overseen by a chief medical officer. d. They are considered members of the hospital’s medical staff.

Chapter 4 1. Credentialing involves all but which of the following? a. Collection b. Verification c. Assessment

*d. Communication

2. How many states have adopted a legal cause of action, or the rightof the

patient to sue the healthcare facility, over negligent credentialing or privileging? a. More than 20 b. More than 25

*c. More than 30 d. More than 35

3. Which of the following professionals is NOT subsumed in the credentialing

and privileges of independent practitioners or those whopractice in hospitals under the guidance or supervision of physicians? a. Nurse anesthetist b. Midwife

*c. Physical therapist d. Psychologist

4. The origins of medical and surgical educational standards can betraced to

all but which of the following? a. American College of Surgeons b. American College of Physicians

*c. American Board of Medical Specialties d. American Medical Association

5. Which of the following is NOT reported to the National PractitionerData

Bank? *a. Actions related to new licensure b. Adverse actions related to hospital privileges c. Adverse actions related to participation in federal programs d. Professional liability settlements of at least $10,000

6. Which of the following is NOT an element of privileging?

a. Licensure

*b. Association membership c. Medical education d. Residency and training

7. Under the Health Care Quality Improvement Act (HCQIA), which of the

following does NOT apply to peer reviewers? a. Established

immunity of medical staff members engaged in peer review and credentialing matters b. Protection from lawsuits (i.e., legal actions) by physicians who are adversely affected by credentialing/privileging efforts as long as the peer reviewers acted in good faith c. Use reasonable efforts to obtain facts that pertain to thematter *d. Assure themselves that the action is unrelated to qualityhealthcare

8. The Ongoing Professional Practice Evaluation (OPPE) requires each

facility to *a. adopt a federal-specific process that continually monitors and evaluates a physician’s pattern of practice from an outcomesperspective. b. adopt a federal-specific process that continually monitors andevaluates a physician’s pattern of practice from a contextual perspective. c. evaluate practitioners without current performance documentation at the organization. d. develop an evaluation process without defined metrics.

10. Ultimate responsibility for the credentialing and privileging ofmedical

staff rests with the *a. governing board. b. chief medical officer. c. chief executive officer. d. quality improvement committee.

11. From a conceptual perspective, the healthcare facility is charged with

ensuring that its medical staff possess the requisite licensure, training, experience, certifications, and health status by all of thefollowing except a. the federal government. b. the state government. c. The Joint Commission.

*d. the community oversight board.

12. In the credentialing and privileging process, primary source

verification requires the healthcare organization to a. obtain this information from the medical staff.

*b. obtain this information directly from the information source. c. obtain this information from a clearinghouse. d. verify this information with the previous employer.

13. Future trends for credentialing committees include all thefollowing

except a. longer terms for members. b. appointment of members who are not physicians.

*c. shorter terms for members. d. consultation with external medical experts for new technologies.

14. In the credentialing and privileging process, review of the

practitioner’s experience and quality outcomes may include all thefollowing except a. morbidity and mortality. b. pathological reports. c. pending litigation and lawsuit settlements.

*d. health status.

15. Privileging is described as

*a. review of the clinical procedures and activities that the practitioner is verifiably able, and then approved, to perform. b. review of the clinical procedures and activities that the practitioner is able to perform. c. review of the clinical procedures and activities for which the practitioner is licensed. d. review of the clinical procedures and activities for which the practitioner has received training.

Chapter 5 1. Diversity efforts are often unsuccessful because a. they focus only on fixing the lack of diversity. b. they ignore the root problem of the combination of policies,practices,

and procedures that do not support fairness and respect. c. they make an effort only to recruit a small number from underrepresented groups to appear to be diverse. *d. all of the above.

2. All of the following are internal dimensions of diversity except a. age. b. gender.

*c. thinking patterns. d. sexual orientation.

3. All of the following are internal dimensions of diversity except a. ethnicity. b. race.

*c. communication style. d. language.

4. All of the following are external dimensions of diversity except

*a. physical ability.

b. appearance. c. religion. d. generation.

5. Which of the following is NOT an inclusive action in organizations?

*a. Requiring that all employees assimilate to the workenvironment b. Advocating for fair treatment and accommodating differences c. Challenging prejudice and injustice d. Ensuring transparency and access to information and

opportunity

6. The business case for diversity includes all of the following except a. a positive impact on growth, innovation, performance, and

adaptability.

b. a rich pool of skills, backgrounds, and perspectives. c. competitive advantage.

*d. investment in employee development.

7. Interpersonal dimensions of inclusive action include all of thefollowing

except *a. networking. b. treating others as they wish to be treated. c. active listening. d. willingness to adapt behavior to meet the needs of others.

8. Diversity in an inclusive work environment supports superior organizational

performance and innovation in all of the following waysexcept a. providing diverse perspectives and cognitive styles to avoid

groupthink. b. enhancing creativity since diverse members can link ideas morefluidly. c. equipping high-performing teams with diverse lenses for creative problem solving. *d. considering a diverse talent pool for all open positions.

10. Which of the following is a good strategy to drive positive employee

engagement, recruitment, retention, and customer loyalty aspart of corporate social responsibility? *a. Using market demographics and employee and patient values todrive social responsibility activity b. Using employee demographics to develop corporate social responsibility strategies c. Using governing body experience to develop corporate social responsibility strategies d. Using social media to share corporate statements about plansfor inclusive actions

11. Personal habits are best characterized in what dimension of

diversity? *a. External

b. Organizational c. Internal d. Personality

12. Parental status is best characterized in what dimension of

diversity? *a. External

b. Organizational c. Internal d. Personality 13. The heightened experience of being different from peers at work because of

gender or race/ethnicity is associated with detrimental effects on health, wellbeing, and the ability to thrive at work. Thisis known as a. anxiety. b. stress. c. exclusion.

*d. emotional tax.

14. Organizations that continually recognize and evaluate structural,

institutional, systemic, and societal forms of injustices that createdisparities in the provision of healthcare and in health outcomes andconsider how organizations and individuals can meaningfully self- reflect on their roles in perpetuating them are known as a. culturally competent.

*b. culturally responsive. c. culturally sensitive. d. culturally reflective.

15. Which of the following is NOT part of a diversity strategy? a. Career development programs

*b. Maintaining the status quo c. Assessment of policies and practices d. Values blueprinting

16. As part of diversity strategy development, identifying necessaryskills and

inclusive actions includes all of the following except *a. evaluation of screening and hiring practices for bias.

b. definition of the behavior required of inclusive leaders. c. integration of inclusive skills in performance evaluationcriteria. d. evaluation of person fit with organizational values in the

recruitment process.

17. Which of the following is NOT an appropriate tactic to fill thegaps

identified in a diversity strategy?

a. Creation of affinity groups or employee resource groups b. Identification of diversity champions to lead initiatives andmodel

organizational values c. Mentorship and training opportunities for underrepresentedgroups *d. Identification of diversity champions without influence tolead initiatives 18. Inclusive practices can be embedded in the organization via all ofthe

following human resources activities except a. Recruitment and selection b. Promotion

*c. Credentialing d. Training and education

19. Which of the following is NOT an inclusive action for interactionswith

others? a. Providing multiple avenues to share ideas and input b. Respectfully calling attention to exclusionary behavior c. Rewarding new ideas

*d. Using colloquial language around individuals from differentcultures or regions

20. Which of the following is NOT an inclusive action for meetings andgroups? a. Ensuring the participation of each individual b. Sharing materials, information, and meeting agendas in advance c. Recognizing the original source of contributions and ideas

*d. Allowing the active participants to answer questions

Chapter 6 1. Which of the following is NOT usually included in a job

specification? a. Education b. Experience

*c. Job duties d. Physical demands

2. Which of the following is NOT usually included in a job description? a. Title

*b. Knowledge, skills, and abilities c. Performance criteria d. Responsibilities

3. A future-oriented job analysis a. reduces the number of job titles. b. emphasizes “any other duty that may be assigned.”

*c. requires managers to assess how duties and tasks may berestructured. d. develops more general job descriptions.

4. A competency-based approach to job analysis

*a. can help organizations hire employees who are a better fit. b. emphasizes the job duties and tasks. c. assumes a static job environment. d. reduces the number of job titles.

5. The process of job design includes a. acknowledgment of the employee’s unique skills.

*b. changing, eliminating, modifying, and enriching duties andtasks. c. appropriate professional guidelines. d. a reduction in the flexibility in how the job is done.

6. Challenges that may limit the impact and effectiveness of jobanalysis

include all of the following except a. only a single method of job analysis is deployed. b. current jobholders and managers are excluded from the job

analysis. *c. participants are encouraged to critique the current job, andmore job

functions than currently performed are included. d. participants in the job analysis process are not trained togenerate quality data.

7. Employee empowerment a. facilitates communication between employees. b. allows employees to achieve self-actualization.

*c. allows decisions to be made by those closest to the customer. d. encourages supervisors to listen to their subordinates.

8. Which of the following is NOT an obstacle to the effective

functioning of teams? a. Lack of power b. Overly high expectations

*c. Lack of communication from top management d. Lack of team member training

9. Which of the following is NOT a characteristic of a self-directedteam? a. Is accountable for a whole work product

*b. Is charged with improving quality c. Uses consensus decision-making d. Deals with customers

10. All of the following statements describe job crafting except

*a. employees must seek the manager’s approval. b. employees enhance their original job tasks to better fit theirevolving skills. c. employees enhance their original job tasks to better fit theirexisting skills. d. employees attain higher levels of engagement.

11. A cross-functional team

*a. is formed using a mix of specialists to accomplish a specificpurpose. b. has voluntary membership. c. has experienced employees charged with improving quality or

productivity for several departments.

d. may not operate beyond the scope of the team members’ typical

jobs.

12. Which of the following is NOT a work schedule innovation? a. Flextime b. Job sharing c. Compressed workweek

*d. Shift work

13. All of the following describe workers in the gig economy except a. they are self-employed. b. they are independent contractors or freelancers.

*c. they are part-time workers who qualify for benefits. d. they set their hours.

14. Which of the following is NOT a managerial challenge for contingent

employees? *a. Low relative compensation b. Low retention rates c. Inadequate orientation and training d. Variable work quality and attitudes

16. Which of the following is a disadvantage for telecommuting for

employees? *a. Excessive telework hours b. Greater autonomy c. Fewer unproductive meetings d. Greater flexibility

17. Flexibility in work scheduling a. is most relevant to patient care positions. b. may reduce customer service. c. is uncommon among employees.

*d. allows choice of daily start and end times.

18. Two part-time employees work a job that a full-time employee wouldhold.

This scenario is called *a. job sharing. b. contingency work. c. temporary work. d. flexible scheduling.

19. In healthcare, constraints on tasks that some employees may legallyperform,

or the level of supervision required, is called *a. scope of practice.

b. job design. c. job description.

d. job specification.

20. Which of the following is NOT a reason job descriptions can presentissues in

human resources management? a. Job duties are vague. b. Job duties are very specific and also include items unrelatedto job

performance. *c. Job duties do not limit the scope of activities of thejobholder as the environment changes rapidly. d. Job descriptions are not updated as duties or specificationschange.

Chapter 7 1. Which of the following is NOT an advantage of internal recruitment? a. The applicant is known to management.

*b. Internal applicants do not have existing dysfunctionalrelationships in the organization. c. Internal recruitment may be faster than external recruitment. d. Internal recruitment may be a good motivator for employeeperformance.

2. The primary purpose of a realistic job preview is to a. evaluate an applicant’s qualifications. b. highlight the positive aspects of the job.

*c. provide an applicant with a true picture of the job. d. provide information for current employees to encourage them torefer their peers to the organization.

3. Which of the following may be used to evaluate the effectiveness of

recruitment? a. Quantity of applicants b. Diversity of applicants c. Cost per applicant

*d. All of the above

4. In assessing person–job fit, one is interested in learning

*a. whether an applicant has the knowledge, skills, and abilitiesto do the job. b. whether an applicant’s beliefs align with those of the organization. c. whether an applicant will help the organization to achievediversity goals. d. whether an applicant’s method of work is consistent with the norms of the organization.

5. In hiring a physician practice office manager, a critical incidentsapproach to

selection is best used for a. understanding the financial skills required to do the job.

*b. understanding how the manager needs to communicate withstaff. c. checking references. d. none of the above.

6. Which of the following is true about the use of reference checks forjob

applicants? *a. Reliability tends to be low. b. Reliability tends to be high because previous employers havehad experience working with the applicant. c. Reference checks are generally good predictors of job performance. d. Reference checks are more valuable when the old and new jobsare different in content.

7. An applicant for a social work position in a hospital is asked bythe

interviewer to describe a time when he had to deliver difficult news to the family of a patient. This is known as what? a. A situational question

*b. An experience-based question c. An unstructured interview question d. A realistic job preview question

8. In hiring a nurse for a hospital position, which of the following questions

would be considered appropriate and likely defensible in a UScourt? a. What is your native language? b. When was your last physical exam? c. Will family responsibilities inhibit your ability to workdifferent

shifts? *d. Are you authorized to work in the United States?

10. Which of the following is likely to be included in an

organization’s recruiting message?

a. Location of the work site b. Compensation c. Career advancement opportunities

*d. All of the above

11. Which of the following statements is true about internal andexternal

recruitment? a. Today, about 90 percent of new hires are made internally

through promotions or lateral moves. *b. Only 28 percent of talent acquisition leaders value internalapplicants as a productive source of applicants. c. External hires require less time to perform as well asinternal hires do

in the same job. d. External hires require seven years, on average, to earn asmuch as internal hires are paid.

13. Hot-skill premiums refer to a. offering a prospective employee relocation assistance. b. signing bonuses.

*c. temporary pay supplements to pay for employees with in-demandskills. d. supplemental pay for employees working night shifts.

14. A dual career ladder is a. additional training for professional employees so they may

transition to a different professional role. *b. a method by which employees can advance in the organizationwithout having to assume management responsibilities. c. a form of outplacement for employees who must be downsized buthave a strong record of success in the organization. d. most commonly used to train middle managers to move intohigher levels of management.

is the process by which an organization communicates itsvalues to prospective employees.

15.

a. Advertising b. Word-of-mouth communication between employees and prospective

employees c. Employee training

*d. Signaling

16. All things being equal, a sole wage earner in a family of five would

consider which of the following the least important aspect of ajob? *a. Opportunities to travel

b. Advancement opportunities c. Compensation d. Health insurance

17. A rural hospital may need to consider which of the following

alternative ways to attract doctors? a. Offering competitive compensation b. Loan repayment programs c. Joint contracts between hospitals

*d. All of the above

18. In evaluating job applicants, artificial intelligence has been usedto do all of

the following except a. analyze applicants’ responses to questions. b. predict whether an employee is likely to leave a job to take anew job.

*c. identify manager bias in the employee hiring process. d. screen job applicants.

19. A potential advantage of external recruitment is that a. it is generally a quicker process.

*b. it may be less expensive than training internal applicants. c. it may reinforce employees’ sense of job security. d. it may maximize the potential of hiring employees who fit theculture and values of the organization.

20. The Peter Principle suggests that

*a. employees continue to be promoted until they reach a level atwhich they are not competent. b. as employees are promoted, they gain required skills to enablethem to function effectively at the new organizational level. c. employees who are successful at one level of the organizationare likely to experience the same level of success at higher levels of the organization. d. job applicants’ peers are in the best position to assess theirreadiness to be promoted.

21. Which of the following is NOT true about employee referrals? a. Yield ratios are higher with employee-referred applicants thanothers. b. Employee referrals may result in a more homogenous workforce.

*c. Individuals hired through employee referrals rarely stay longenough in the organization to warrant a monetary reward for the referring employee. d. Employee who make referrals are more productive than otheremployees.

22. Providing prospective employees with both positive and negative

information about a job is known as a a. cost–benefit job assessment.

*b. realistic job preview. c. ratio-referral factor.

d. diversity hire ratio.

23. Which of the following may be used to evaluate the effectiveness ofdifferent

recruitment sources? a. Number of hired candidates divided by the total number of

candidates b. Time between job requisition and first interview c. Number of new hires receiving a sign-on bonus *d. First-year resignation rate

25. In assessing human attributes in employee selection, which of thefollowing

has the highest level of reliability? a. Mechanical skills *b. Hearing c. Mathematical skills d. Verbal ability

Chapter 8 1. Which of the following factors related to turnover is generally NOTunder the

control of healthcare managers? a. The quality of supervisors in an organization

*b. The quantity of employment opportunities that job seekershave an opportunity to explore c. Peer relationships in the organization d. Lack of metrics to predict if a job applicant intends to stayin the position for a defined period of time

2. A successful employee retention program

*a. continuously evaluates retention efforts. b. focuses only on employee groups where there are shortages. c. recognizes that department managers have little control overthe

factors associated with retention. d. all of the above.

3. The Work Institute reported in its 2019 Retention Report that a. compensation/benefits was the most common reason for people

quitting their jobs. b. 30 percent of employees cited compensation as the root causefor leaving their jobs. *c. compensation/benefits was the fourth most common reason for people quitting their jobs. d. more than 50 percent of employees cited salary as the rootcause for leaving their jobs.

4. Which of the following is NOT considered a factor affecting the highdemand

for healthcare workers? a. Population growth b. Advances in technology

*c. Increased labor productivity d. Expansion in health insurance coverage

5. Data from the National Council of State Boards of Nursing reportedthat a. one-third of the registered nurse workforce is age 50 orolder.

*b. over 50 percent of the registered nurse workforce is age 50or older. c. the number of employed registered nurses will stabilize in thecoming decade.

d. the number of employed registered nurses will decrease in thecoming decade.

6. The monthly turnover rate percentage is calculated as a. number of employees voluntarily separated ÷ average number of

employees × 100. b. number of employees involuntarily separated ÷ average numberof employees × 100. c. number of employees terminated ÷ average number of employees × 100. *d. number of employees separated ÷ average number of employees ×100.

7. Which of the following is an indirect cost of turnover? a. Cost of recruitment b. Cost of training and onboarding new employees

*c. Decline in quality of care d. Cost of training new hires

8. Which of the following has been found to be a reason for nurse

dissatisfaction? a. Poor compensation b. Relocation c. Lack of training and development

*d. All of the above

9. Exit interviews can best be used for a. preventing employee turnover. b. finding new sources of recruitment.

*c. identifying root causes of turnover. d. helping a downsized employee find a new job.

10. A newly hired ICU nurse has expressed concern about the

availability of parking. This question is best addressed a. after the employee has worked for two weeks to determine the

individual’s need for parking. *b. during orientation. c. by the director of the medical staff. d. after the nurse has looked into public transportation options.

11. Employee orientation information that is employee centered includes

a. the organization’s safety regulations. b. grievance procedures.

*c. job responsibilities. d. all of the above.

12. The “eating the apple” approach to orientation features a. a quick, intensive full-day orientation. b. self-paced, online orientation sessions. c. a one-day orientation broken into brief, intensive educationalsessions.

*d. using multiple days or weeks to convey orientationinformation.

13. Employee assistance programs a. provide bridge funding for contracted employees moving fromone

project to another. b. provide specialized orientation for employees with mental orphysical disabilities. *c. address mental health concerns for employees. d. are required under the Affordable Care Act.

14. Mentorship programs seek to a. prepare the next generation’s workforce. b. develop leaders. c. build employee engagement.

*d. all of the above.

15. The first stage of succession planning is

*a. reviewing the organizational mission, goals, and objectives. b. providing professional development activities for current employees. c. forecasting gaps in administrative roles. d. identifying potential successors for key positions.

16. From a generational perspective,

*a. a lack of advancement opportunities is a key source ofdissatisfaction among millennials. b. career planning is key to the job satisfaction of babyboomers. c. both “a” and “b” are true. d. neither “a” nor “b” is true.

17. Which of the following has NOT been found to be an important reasonfor

turnover in healthcare? a. Excessive workload

*b. Danger of physical assault by dissatisfied patients andfamily members c. Inadequate compensation d. Lack of appreciation

18. Which of the following is a best practice for understanding thenature of

turnover in an organization? a. Using full-time equivalent measures rather than an employeehead

count b. Including temporary workers and independent contractors in thehead count c. Including only full-time employees in the head count *d. Including both voluntary and involuntary terminations inturnover data

19. Employee retention efforts should begin a. after the first 30 days of an individual’s employment. b. after orientation has been completed. c. after the first year of employment.

*d. during employee orientation.

20. Which of the following questions is appropriate to ask during anexit

interview? a. How did you feel about promotional opportunities in your

department? b. What prompted your resignation from the organization? c. What advice would you give to the person who will be replacingyou?

*d. All of the above 21. An organization’s volunteer activities can be used to a. extract extra work from an employee.

*b. improve the employer’s brand. c. improve relationships with labor unions representingemployees. d. evaluate the work done by prospective employees.

22. The set of processes that communicate an organization’s expectations

regarding attitudes, standards, values, and patterns ofbehavior is known as *a. onboarding.

b. employee discipline. c. performance management. d. job design.

23. Mechanisms for reporting discrimination and other illegal

activities should be provided a. during career planning sessions with employees. b. during discussion of employee compensation.

*c. during orientation. d. only after an allegedly illegal activity has occurred.

24. To retain employees, department managers should a. ensure that their pay rates are no greater than 85th

percentile. b. ensure that the organization is maintaining salaries at nomore than more than the 50th percentile. c. require employees to stay with the organization at least twoyears before their salaries are made competitive with market rates. *d. ensure that the organization is paying competitive rates.

25. The coming years will see increased demand for a. home health aides. b. physician assistants. c. nurse practitioners.

*d. all of the above.

26. A turnover report for a 600-bed teaching hospital found that the average

nurse turnover for the past two years stood at 10 percent, which is significantly less than similar hospitals in its market. Whatcan be concluded from these data? a. The nurse turnover rate is acceptable. No specific new actionsare

required. *b. Nurse turnover may be a significant problem for the hospital. c. Nurses are likely overpaid. d. None of the above.

27. A clinical ladder strategy may help reduce turnover by

*a. promoting career advancement.

b. encouraging clinicians to move into management positions. c. providing an incentive for employees to stay in their currentpositions. d. both “a” and “b.”

28. Which of the following is most likely to have a positive impact onemployee

retention? *a. Instituting a hiring-from-within policy b. Increasing the patient–nurse ratio c. Hiring a new chief executive officer d. Conducting a survey of employee satisfaction

Chapter 9 1. Which of the following is NOT an advantage of multisource appraisal?

*a. There is a high level of trust because many people areinvolved in providing information. b. It takes into consideration organizational goals and values. c. It contributes to team development and improvement. d. It recognizes the importance of customer focus.

2. Subordinate appraisal is most useful for a. evaluating the quality of performance data. b. learning about how peers perceive one’s performance. c. organizations that do not have many managers.

*d. identifying managers’ blind spots.

3. A primary care physician practice has decided to base its evaluationof

physician performance solely on the volume of patients seen. What problem is most likely to result from such an approach? a. Halo effect

*b. Criterion deficiency c. Contrast effect d. Rating errors

4. In relation to performance management and performance measures,

“reliability” refers to

a. whether an employee can be counted on to perform at a highlevel.

*b. consistency with which two or more managers rate performancewhen presented with comparable information. c. whether a performance metric measures what it is intended tomeasure. d. the extent to which factors out of the employee’s controlaffect performance.

5. The free-rider syndrome is likely to be associated with a. multisource appraisal.

*b. team-based compensation. c. self-appraisals. d. graphic rating scales.

6. On a five-point rating form, a manager is asked to respond to the following

question: “How flexible is this person?” This is likely partof which type of

performance management process? *a. Graphic rating scale b. Management by objectives c. Behavioral anchored rating scale d. None of the above

7. Which of the following is NOT an example of a rating error in

performance management? *a. Forced ranking

b. Halo effect c. Central tendency d. Contrast effect

8. Which of the following is NOT a characteristic of management by

objectives? a. It establishes specific and measurable goals. b. It involves setting goals with employee input. c. It provides the opportunity to give objective feedback to

employees. *d. The method is robust and equally applicable to all types ofjobs.

9. Which of the following performance appraisal methods is associatedwith

reduced employee defensiveness and conflict? a. Ranking methods b. Graphic rating scales c. Stack ranking

*d. Behavioral anchored rating scale

10. Which of the following actions is NOT recommended as part of the

annual performance review? a. Addressing employee strengths and weaknesses b. Planning for additional training

*c. Raising major performance concerns not addressed earlier inthe year d. Discussing possibilities for promotion

11. Forced ranking systems a. evaluate employees on the basis of measures independent of the

performance of other employees. b. provide supervisors with the latitude to evaluate an employee’s performance without concern for their department’sdistribution of performance ratings.

*c. require supervisors to distribute employee ratings accordingto a predefined distribution. d. require that poorly rated employees be terminated if theirperformance does not measurably improve in one year.

12. A manager who consistently rates all employees around the centralpoint of

a rating scale is exhibiting *a. distributional error. b. leniency error. c. personal bias. d. temporal error.

13. A multisource appraisal system may a. improve teamwork. b. take into consideration the perspective of customers. c. provide a wholistic view of an employee’s performance.

*d. all of the above.

14. Graphic rating scales are a. time-consuming to develop because each scale must be tailoredto a

particular job. b. more specific in their measures than behaviorally anchoredrating scales. *c. relatively simple to administer. d. only recently developed and used only rarely.

15. Three supervisors evaluating the same employee using the same

criteria provide vastly different performance evaluations. This islikely because of problems with *a. reliability.

b. calibration. c. criterion contamination. d. validity.

16. Which of the following is a characteristic of multisource

appraisal? a. It is relatively simple to administer. b. Personal bias is minimized. c. It is particularly useful in organizations of 15–20 employees.

*d. It may be used for purposes of retribution.

17. Behaviorally anchored rating scales

*a. provide raters with specific response categories. b. are less acceptable to employees than graphic rating scales. c. increase defensiveness among employees because of the

subjectivity of ratings. d. all of the above.

18. Management by objectives focuses on a. specific desirable employee behaviors.

*b. achievement of goals. c. employee traits. d. evaluating both behaviors and employee traits.

19. A nurse supervisor gave a nurse a negative evaluation primarilybecause

he showed up late for a night shift on one occasion. The supervisor is likely engaging in a rating error known as a. contrast effect. b. halo effect.

*c. recency effect. d. all of the above.

20. Which of the following is an activity associated with performance

management? a. Establishing performance goals b. Obtaining performance information c. Providing ongoing feedback

*d. All of the above

21. Ensuring that managers rate their employees according to definedcriteria

is known as *a. calibration.

b. alignment. c. validity. d. reliability.

22. Self-appraisals are most appropriate for

a. making decisions about compensation.

*b. employee development. c. decisions related to employee promotion. d. all of the above.

23. Subordinate appraisal is used

*a. to evaluate a manager’s performance.

b. to evaluate the performance of one’s subordinates. c. to provide an avenue for individuals to voice grievances. d. to evaluate a team’s performance.

24. Optimally, managers should provide feedback to employees a. once a year or once every two years. b. as needed by employees.

*c. on an ongoing basis. d. after a positive or negative employee action.

25. A behavioral observation scale a. provides a framework for determining the objectives of one’s

work. *b. requires raters to indicate the frequency with which anemployee exhibits certain behaviors. c. is an elaborate version of a graphic rating scale. d. provides a basis for management by objectives.

Chapter 10 1. A hospital in a rural community is having difficulty attracting radiation

therapists. In an effort to attract young, newly trained therapists, the hospital has decided to pay these newly graduated therapists at a pay rate equivalent to that of radiation therapists whohave been with the hospital for up to ten years. What compensation issue is relevant to this scenario? *a. Internal equity

b. External competitiveness c. Extrinsic rewards d. Intrinsic rewards

2. Using a point system of job evaluation, which of the following isleast

likely to be used as a compensable factor? a. Educational requirements

*b. Age and experience c. Supervisory responsibilities d. Mental stress

3. Which of the following is NOT a common criticism of pay-for-

performance systems? *a. Because peers evaluate an employee’s performance in most pay-forperformance programs, bias is likely to be present. b. There is a tendency to please the manager rather than toplease the patient. c. Some goals may be rewarded at the expense of other valued goals. d. Pay-for-performance systems may inhibit innovation.

4. Which of the following influence(s) the pay structure of a

particular organization? a. The presence of a union in a competitor organization b. Prevailing wage rates in the local market c. The organization’s financial status

*d. All of the above

5. Which of the following is true about physician compensation? a. Quality-focused pay for performance is the most common methodof

compensation. b. There is strong evidence that quality-focused pay for

performance has been effective in improving quality. *c. Productivity-based compensation is the most common method of compensation. d. Research shows that implementing pay for performance forphysicians has reduced costs because unnecessary tests and procedures are avoided.

6. According to equity theory, a. employees use objective data in determining the fairness of areward

system. *b. if an employee perceives inequity in a reward system, theperson will seek to restore equity. c. managers are the best source of information about theperceived equity in an organization. d. equity theory is more applicable to blue collar thanprofessional employees.

7. Broadbanding allows for a. managers to pay employees based on employee characteristicsand

performance. b. greater decentralization of decisions about salaries. c. managers to more easily change an individual’s compensation. *d. all of the above.

8. The major challenge in compensation for an organization is a. balancing employee needs with compensation. b. responding to labor union demands for higher compensation.

*c. balancing internal equity with external competitiveness. d. ensuring that information about employee pay is not madepublic.

10. Competency-based pay is an approach to compensation that

*a. rewards employees who develop new skills.

b. bases employees’ compensation on the competency they have

demonstrated on the job.

c. is most appropriate in stable work environments. d. rewards an employee’s loyalty to the organization.

11. Among the criticisms of reimbursing organizations on the basis of

performance is that a. insurance companies find this unaffordable.

b. organizations rarely achieve sufficiently high levels of

performance to warrant rewards. *c. high levels of performance may be attributable to factorsoutside of the control of the organization. d. all of the above.

12. The positive sense of accomplishment an employee feels after

completing a project is considered a. a compensable factor. b. an extrinsic reward. c. a noncompensable factor.

*d. an intrinsic reward.

13. According to

, employees tend to compare their ratio of outcomes to inputs with that of other employees. a. Maslow’s hierarchy of needs

*b. equity theory c. the strategic role of compensation d. performance-based compensation

14. In a tight labor market for a particular position, an organizationmay have to

*a. sacrifice internal equity. b. sacrifice external competitiveness. c. promote people from within to fill a position. d. all of the above.

15. Using job evaluation, a job is priced based on a. the experience of the job holder. b. the job’s value in the marketplace. c. the performance of the job holder.

*d. the job’s relative importance to the organization.

16. In an organization using a point system of compensation, a wagecurve is

used to determine a. the job’s average wage in the local market.

*b. the relationship between points and current salaries. c. the variation in wages among all jobs in the organization. d. how a job’s wages have changed over time.

17. Wage compression may result from

a. keeping wages low to maintain financial solvency. b. the higher cost of paying for employee benefits.

*c. pressure to pay wages that are externally competitive. d. efforts to maintain internal equity.

18. Quality-focused pay-for-performance programs in healthcare organizations have consistently been shown to have a. positive impacts on quality. b. sustained impacts on quality. c. negligible impacts on quality.

*d. none of the above.

19. A physician payment method that requires physicians to assume

responsibility for a population is commonly referred to as a. fee-for-service. b. piecework payment. c. solo practice.

*d. capitation.

20. Temporarily employed physicians who are paid a fixed amount for

providing services are known as a. members of a faculty practice plan.

*b. locum tenens physicians. c. medical group–based physicians. d. office practice physicians.

21. Fee-for-service payment methods for physicians have a tendency to

encourage *a. the use of more services.

b. the use of more preventive services. c. physicians to be financially at risk for a population ofpatients. d. provision of services within the confines of a set amount ofmoney.

22. Which of the following characterizes recent trends in physician-owned

office practices? a. The number of physician-owned office practices has increased. b. The number of physician-owned office practices has remained

stable. *c. The number of physician-owned office practices has decreased. d. The number of physician-owned office practices has increasedamong primary care physicians.

23. The cost of malpractice insurance, decreasing reimbursements, and

overhead costs have resulted in *a. almost half of all physicians being employed by hospitals ormedical groups. b. an increase in physicians going into academic medicine. c. physicians seeking out risk contracts. d. all of the above.

24. A group practice composed of members of the medical staff of an

academic medical center is known as a. an independent practice association. b. an academic office-based practice. c. a multidisciplinary medical practice.

*d. a faculty practice plan.

25. An organization that employs a first-quartile strategy a. may have insufficient funds to pay at market rates. b. may face an abundance of potential applicants. c. may face difficulties attracting applicants.

*d. all of the above.

Chapter 11 1. Benefits provide additional compensatory value through all of the

following except a. leave time. b. insurance.

*c. training and development. d. tuition reimbursement.

2. The average cost of fringe benefits in many healthcare systems is

*a. between 20 percent and 35 percent of salary.

b. between 5 percent and 15 percent of salary. c. less than 5 percent of salary. d. greater than 35 percent of salary.

3. Human resources is responsible for the following when developing

compensation packages. a. Design b. Communication c. Monitoring of benefits

*d. All of the above

4. The rise in

led to the creation of disability insurance.

a. mining b. lumber industries

*c. industrialization d. railroads

5. Which of the following events led to the passage of the Social

Security Act and the government’s involvement in retirement protection? a. Military retirement protection b. Baylor University’s prepayment plan

*c. The Great Depression d. The wage freeze during World War II

6. All of the following are federal laws that affect benefits coverageand

administration except the a. Employee Retirement Income Security Act. b. Consolidated Omnibus Budget Reconciliation Act. c. Health Insurance Portability and Accountability Act.

*d. National Right to Work Act. 7. Which of the following is an employer-funded account for medical

expenses? a. Health savings account

*b. Health reimbursement account c. Flexible spending account d. All of the above

8. Flexible spending accounts a. are tax-advantaged medical savings accounts. b. are funded by employers only. c. hold funds that do not expire.

*d. allow employees to defer tax via payroll deduction.

9. Which of the following is NOT a type of life insurance plan? a. Permanent b. Universal

*c. Accumulated d. Split dollar

10. Experienced professionals qualified to design benefits are skilledin

*a. accounting, audits, and tax filing. b. generational differences, demographic and economic trends, and budgeting. c. negotiating, laws and regulations, and organizing. d. communication, budgets, and quality.

during World War II encouraged companies to offer benefitsto their employees.

11.

a. Inflation b. Injured and disabled soldiers c. The expansion of Social Security

*d. The wage freeze

12. The federal legislation that allows employees and their families tocontinue to

participate in their employer-sponsored health plan is known as the a. Affordable Care Act.

*b. Consolidated Omnibus Budget Reconciliation Act. c. Health Insurance Portability and Accountability Act.

d. Pension Protection Act of 2006.

13. The Health Insurance Portability and Accountability Act does notprotect

employees against a. disclosure of preexisting medical conditions. b. disclosure of medical claims data. c. disclosure of computerized protected health information.

*d. accidental disclosure of protected health information.

14. The term “total compensation” refers to

*a. the value of an employee’s base salary plus the value of thebenefits package. b. the value of an employee’s base salary plus the value of tips. c. the value of an employee’s base salary plus the value of employer contributions to health insurance. d. the value of an employee’s base salary after taxes plus thevalue of employer contributions to health insurance.

15. Workers’ compensation and unemployment compensation systems a. were developed as part of the Social Security system. b. are identical from state to state.

*c. vary from state to state. d. are financed mainly through employee contributions.

16. Stop-loss coverage a. protects patients from incurring large medical expenses.

*b. protects employers against catastrophic claim amounts. c. allows insurance companies to limit the amount they pay formedical expenses. d. both “a” and “b.”

17. A disadvantage of a flexible savings account is that a. contributions are not deducted pre-tax from the employee’s

paycheck. b. money in the account can be used only for health-related expenses. c. the organization determines the amount that each employee may contribute. *d. unused money in the account is forfeited to the InternalRevenue Service.

18. An employer that self-insures is likely to

*a. have greater flexibility in plan design. b. have minimal ability to handle fluctuations in expenses. c. both provide insurance and manage the administration of theplan. d. all of the above.

19. An employee assistance program typically provides employees with a. short-term assistance with mortgage or rent payments. b. outplacement assistance for employees who have been laid off.

*c. a limited number of counseling or therapy sessions. d. low-cost, temporary inpatient care for psychiatric conditions.

20. Wellness programs may be easier to implement in healthcare

organizations than in organizations in other industries because a. healthcare organizations frequently have pre-employment health

assessments. b. healthcare organizations typically have on-site wellnessexperts. c. healthcare workers are often more sophisticated consumers of wellness and preventive services. *d. all of the above.

21. The

determines maximum contributions that may be made toa flexible spending account. a. US Department of Labor b. US Department of Health and Human Services

*c. Internal Revenue Service d. individual organization

provides employees with income in the event that they become disabled and are unable to work.

22.

*a. Long-term disability

b. Workers’ compensation c. Long-term care insurance d. Unemployment compensation

23. The two main types of retirement plans are

a. term and supplemental term. b. defined contribution and supplemental term.

*c. defined contribution and defined benefit. d. defined supplemental and defined term.

24. A cafeteria plan allows employees to a. reduce their overall tax liability. b. pay for benefits on a pretax basis through payroll deductions. c. select from among a list of benefit programs.

*d. all of the above.

25. Under the Family and Medical Leave Act, a. employers must offer up to 12 weeks of paid leave for

maternity or other medical needs. b. employers must offer up to 16 weeks of unpaid leave for maternity or other medical needs. *c. employers must offer up to 12 weeks of unpaid leave formaternity or other medical needs. d. employers must offer up to 16 weeks of paid leave formaternity or other medical needs.

Chapter 12 1. In collective bargaining under the National Labor Relations Act,what are

the three types of bargaining issues? a. Recognition, union organizing, negotiation b. Union organizing, employer resistance, negotiation c. Union organizing, negotiation, bargaining

*d. Recognition, negotiation, administration

2. In 1989, a National Labor Relations Board ruling established

units for the purpose of collective bargaining in acute care hospitals. a. six

*b. eight c. five d. ten

3. Which of the following is considered a mandatory bargaining issueunder

the National Labor Relations Act? a. Pension plan b. Hours of work c. Sick leave

*d. All of the above

4. The primary intent of the Taft-Hartley amendments to the NationalLabor

Relations Act was a. to expand coverage of the NLRA to acute care hospitals.

*b. to enhance the rights of employers in union–management relations. c. to eliminate right-to-work laws. d. all of the above.

5. The grievance procedure is a mechanism that allows for a. identifying mandatory issues for negotiation. b. determining whether the employer used unfair labor practicesduring

the unionization drive. *c. implementing and interpreting the contract. d. employees to protest the contract signed by the employer andthe union.

6. Nurses helped to pass state legislation in California mandating

a. time off for nurses in highly stressful positions. b. ratios of physicians to nurses. c. special care units for patients with COVID-19.

*d. nurse-to-patient staffing ratios.

7. Physicians who practice as independent contractors are restrictedfrom

participating in collective bargaining by the *a. Sherman Antitrust Act of 1890

b. Hippocratic Oath c. boards of most acute care hospitals d. American Medical Association

8. Distributive bargaining is characterized by a. a “winner takes all” outcome. b. a “win–win” outcome. c. concessionary bargaining.

*d. a “win some, lose some” outcome.

10. The primary role of the National Labor Relations Board is to a. work with the US Department of Labor to implement the National

Labor Relations Act. *b. oversee implementation of the National Labor Relations Act. c. work with Congress to suggest changes to the National LaborRelations Act. d. ensure that companies abide by the provisions of the FairLabor Standards Act.

11. Where a union and employer cannot agree on the terms of a contract, a. an arbitrator must be brought in to resolve the outstandingissues. b. a mediator must be brought in to resolve the outstandingissues. c. mediators and arbitrators must be brought in to resolve

outstanding issues. *d. none of the above

12. An important principle of negotiation is to

*a. focus on people’s interests, not positions.

b. focus on people’s positions, not interests. c. focus solely on people’s final positions, not their opening

positions.

d. focus solely on people’s final interests, not their opening

interests.

13. In the past 20 years, a. unions have been more successful in organizing workers in theprivate

sector than in the public sector. b. unions have had a steady decrease in their ability to organizeworkers in both the public and private sectors. c. unions have had greater success organizing workers in stateswith right-to-work laws than in states without such laws. *d. unions have been more successful in organizing workers in thepublic sector than in the public sector.

14. Certification of union elections is carried out by a. the US Department of Labor b. the US Department of Health and Human Services c. state licensing boards

*d. the National Labor Relations Board

15. Managerial or supervisory employees may be a member of a bargainingunit a. if they supervise nonprofessional employees.

*b. under no circumstances. c. if they supervise fewer than five employees. d. if they were members of a union prior to being promoted intomanagement.

16. For a union to be certified, it must win

*a. 50 percent plus 1 of those voting. b. 50 percent plus 1 of those workers in the bargaining unit. c. a majority of workers in the bargaining unit after beingapproved

by management. d. a majority and gain the support of both workers and managersin the bargaining unit.

17. Bargaining issues are classified as a. legal, mandatory, and voluntary. b. mandatory, optional, and selective.

*c. illegal, mandatory, and voluntary. d. permissive, voluntary, and legal.

18. “Integrative bargaining” refers to bargaining that is

a. win some, lose some. b. winner takes all. c. win–lose.

*d. win–win.

19. The heart of administering a collective bargaining agreement is a. good-faith bargaining. b. arbitration.

*c. the grievance procedure. d. disciplinary measures.

20. The intention of the Taft-Hartley amendments to the National Labor

Relations Act was a. to provide a way for workers to increase their leverageagainst

management. *b. to extend greater protections to management in itsrelationship with unions. c. to provide union members with protections against unioncorruption. d. all of the above.

21. The 1974 Health Care Amendments to the Taft-Hartley Act a. make it illegal for healthcare workers to strike. b. exempt healthcare organizations from the National Labor

Relations Act. *c. seek to protect patients from work stoppages. d. make it illegal for physicians to strike.

22. Social media has become particularly important to unions during

*a. union-organizing campaigns. b. collective bargaining. c. grievance procedures. d. all of the above.

23. With a union contract in place, there is disagreement between the union and

management about the length of the lunch break. This type ofdispute would likely be addressed during which phase of the labor relations process? a. Recognition phase

*b. Administration phase c. Negotiation phase d. Union-organizing phase

24. Which of the following represents a three-decade-long trend in the

employment of physicians? a. Employment of physicians is decreasing. b. There is no change in the proportion of physicians who are

employed. *c. Employment of physicians is increasing. d. Employment is decreasing, but only among female physicians.

25. From the perspective of a union seeking to organize a union in an

organization, it is generally advantageous to have bargaining units that a. contain several different occupational groups.

*b. consist of a single occupational group. c. are smaller and multidisciplinary. d. are larger and multidisciplinary.

Chapter 13 1. Which of the following factors may affect future healthcare

workforce needs? a. Changes in health insurance coverage b. Changes in how patients seek healthcare services c. Demographic changes in the population

*d. Changes in physician supply

2. Which of the following is an important factor in finding data on thecurrent

workforce? a. The larger the geographic area, the more difficult it is tofind reliable

data. *b. The smaller the geographic area, the more difficult it is tofind reliable data. c. Finding regional data is easier than finding national data. d. National data are superior to state-level data becausenational data can be extrapolated to multiple states.

3. Which of the following is NOT a challenge related to workforce

research data? a. The number of practitioners could be known, but the data donot

indicate if they are actively practicing. b. The number of practitioners could be known, but the settingsin which they work could be unclear. *c. The number of licensed practitioners is unknown. d. The number of licensed practitioners per geographic area depends on the addresses associated with the practitioners’licenses.

4. Because health professionals work different hours at differentpoints in

their careers, a. counting by head count is the most accurate way to determine

workforce supply. b. healthcare organizations need to standardize working hours. c. we can accurately predict changes in work hours in different

professions and use this information for planning. *d. using full-time equivalent data is more accurate than headcounts for planning purposes.

5. Which of the following is NOT true about retirements from healthcarecareers?

a. Practitioners delay retirement when the economy is strong

because wages are higher. b. Data are limited on retirements from the profession. *c. Practitioners delay retirement when the economy is weak. d. Serial retirement makes it difficult to project futureworkforce supply.

6. To deal with the uncertainty related to retirement, it is helpful tomodel the

future under at least three different sets of assumptions. Which of the following is NOT one suggested assumption? a. The workforce will retire at later ages than previous

generations did. b. The workforce will retire at the same rate as previous generations. *c. The workforce will retire from full-time employment and startpart-time work. d. The workforce will retire at earlier ages than previousgenerations did.

7. Health professionals

professionals

are more likely to move than health .

*a. with higher levels of education; from community colleges

b. from community colleges; with more specialized training c. from community colleges; with higher levels of education d. who enter the workforce directly from high school; with more

specialized training

8. The following are all main drivers in the complex task of estimatinghealthcare

workforce demand except a. epidemiology. b. healthcare delivery models. c. technology.

*d. reflecting patients’ need for care.

9. Which of the following factors may have an impact on workforce

projections? a. Changes in clinical practice b. Changes in technology c. Use of electronic health records

*d. All of the above

10. Which of the following workforce planning methods considers who

provides specific services in a particular area? *a. Plasticity b. Benchmarking c. Population-based methods d. Key informant surveys

11. A healthcare organization would logically consider increasing the number

of hours worked by a particular professional group in responseto a. a surplus of that professional group.

*b. a shortage of that professional group. c. a surplus or shortage of that professional group. d. its status as a highly specialized professional groupregardless of a surplus or shortage situation.

12. In healthcare workforce planning, a “backcast” is used to a. make mid-course corrections in planning strategies. b. look into the future to determine healthcare workforce supply. c. determine projections for future demand for health workers.

*d. compare what happened with what was projected.

13. Health professional shortage areas could be designated by all ofthe

following ratios except a. one FTE primary care physician for every 3,500 people as an

indicator of need. *b. one FTE primary care physician for every 3,000 people as anindicator of need. c. one physician to 3,000 people accompanied by high infantmortality in a rational service area. d. one physician to 3,000 people accompanied by a high proportionof people older than 65 years, in a rational service area.

14. One example of workforce vertical integration is a. shifting tasks from a nurse practitioner to physicianassistant.

*b. shifting tasks from a physician to a nurse practitioner. c. shifting tasks from a medical assistant to a certified medicalassistant. d. shifting tasks from a general practitioner to a specialist.

15. Which of the following may result in more immediate changes in

workforce supply? a. Increasing training capacity.

*b. Modifying the behavior of providers c. Reducing training time d. Reducing hours worked by providers 16. Under the assumption that not all healthcare workers will work fulltime, it can be concluded that more healthcare workers will beneeded than would be indicated by a. full-time equivalents.

*b. head count. c. census. d. forecast of hours worked.

17. Policy makers and planners have great uncertainty in workforce

modeling because of all of the following factors except a. widespread adoption of patient-centered care reforms in thehealth

system. b. recession. c. technology adoption. *d. backcasts.

18. The approach to modeling healthcare workforce supply includes allof the

following except a. training pipeline. b. attrition. c. workforce participation.

*d. healthcare delivery models.

19. Projecting the need for healthcare workers is more complex than inother

industries because of all of the following factors except a. long training periods.

*b. retirement age. c. scope-of-practice restrictions. d. task shifting.

20. Which of the following is NOT true about developing an

organizational workforce plan? a. It is an iterative process.

*b. It is a linear process.

c. It requires a continuous scan of workforce policy developments. d. It requires in-depth knowledge of the characteristics of thecurrent workforce.

Chapter 14 1. Which of the following is NOT part of the physical work of nursing? a. Monitoring patients b. Educating families

*c. Managing the flow of patients d. Documenting patient care

2. Which of the following statements is NOT true about the cognitivework of

nursing? a. Nursing is complicated by providing care to multiple patients. b. Nurses must make several judgments under pressure. c. Nursing requires frequent task and attention shifting.

*d. Nurses must track quality and safety indicators.

3. Which of the following types of nurses are not required to pass astate

examination? *a. Nursing assistants

b. Practical nurses c. Registered nurses d. Advanced practice nurses

4. Insurers are among the stakeholders interested in managing nursing

workload, because increases in nursing workload *a. increase the cost of care, which increases the cost ofcoverage. b. decrease the cost of care, which decreases the cost of coverage. c. increase access to care, which increases the cost of coverage. d. decrease the quality of care, which decreases the cost ofcoverage.

5. Which of the following is NOT a primary reason for measuring nurse

workload? a. To evaluate nurse staffing plans b. To prepare the operating budget c. To meet Joint Commission standards

*d. To evaluate nurse management effectiveness

7. Anna is the nurse manager at Max Memorial Hospital. To determinenurse

staffing, she uses GRASP to help her determinations. Anna is using a

*a. timed-task approach. b. patient classification systems approach. c. indicator approach. d. benchmarking approach.

8. Kenyatta has been a nurse for 35 years. She worked as a senior nursemanager

at a number of different facilities, has a master of science innursing degree, and is part-time nurse faculty. She has returned from retirement as a nurse management consultant at Max Memorial Hospital. Based on her observations at Max, she makes recommendations for changesto the nurse staffing requirements in the intensive care unit. Which approach is Kenyatta most likely using for her determinations? a. Benchmarking approach

*b. Professional judgment approach c. Indicator approach d. Volume-based approach

9. Daniela is the chief nursing officer for a health system in NorthernCalifornia.

Since nursing costs represent a significant portion of her organization’s expenses, she consults a professional organization and apeer health system to understand and compare their nursing staffing requirements. Based on her findings, which nurse staffing approach is she obligated to follow? a. Benchmarking approach b. Professional judgment approach c. Indicator approach

*d. Volume-based approach

10. Which of the following is NOT an outcome if nurse staffing is toolow? a. Higher costs in the long term

*b. Lower absenteeism c. Increased nursing errors d. Lower costs in the short term

11. Which of the following is NOT an outcome of higher nurse turnover? a. Negative effect on quality of care and patient safety

*b. Higher-quality nursing staff c. Cost of advertising for a replacement d. Costs 1.3 times the departing nurse’s salary

12. Which of the following is NOT counted as indirect care hours?

*a. Education leave b. Committee meeting time c. Quality improvement project work d. Orientation

13. Hours worked by the clinical nurse specialist or nurse manager areincluded

in the budget as a. indirect care hours.

*b. fixed hours. c. direct care hours. d. nonproductive hours.

14. Call-back time is included in the nursing budget as

*a. productive hours. b. nonproductive hours. c. premium hours. d. overtime.

15. Which of the following nursing challenges is NOT a current issuefor

senior executives? a. Retention and turnover b. Nurse–nurse conflict c. Workload stress and burnout

*d. Work–family conflict

16. Which of the following is NOT a problem for healthcare managers? a. Recurring nurse shortages b. Nurse morale and turnover

*c. Increasing the supply of nursing personnel d. Best way to employ nurses considering quality and costs

17. Nurse workload is defined as the a. number of nurses employed. b. average hours per week worked by nurses.

*c. volume of work required to deliver care for the unit. d. process by which appropriate numbers of nursing personnel are deployed.

18. Implications for nursing in value-based healthcare include all ofthe

following except *a. decreasing patient education.

b. increasing team-based care. c. scope-of-practice considerations. d. health information technology.

19. Which of the following is NOT a key component of team-based care in

value-based care? a. It promotes enhanced communication. b. It allows every member of the team to use all of theirtraining

and experience. c. It requires the use of health information technology.

*d. It reduces productivity.

20. Which of the following is NOT a role for nurses in populationhealth

improvement? a. Community education b. Care coordination c. Case management

*d. Home visits

Chapter 15 1. According to the Institute of Medicine, a. high-quality care will follow naturally from an environment inwhich

patients are safe. *b. patient safety is indistinguishable from the delivery ofhighquality care. c. quality is a universal construct irrespective of one’s role in the organization. d. the most important quality metric is the patient’s belief about the quality of care received.

2. What is the major rationale for using teams in quality improvementefforts? a. Teams are empowering and can motivate employees to take

responsibility for quality. b. Teams are an important source of job satisfaction.

*c. Employees frequently have the best insights into problemcausation and the feasibility of alternative solutions. d. Teams form naturally in healthcare organizations and maytherefore be delegated responsibility for quality.

3. Plan-Do-Study-Act (PDSA) is most closely associated with

*a. the Model for Improvement.

b. Six Sigma. c. Lean. d. the Institute of Medicine.

4. The Toyota Production System provided the foundation for a. Six Sigma.

*b. Lean. c. total quality management. d. all of the above.

5. Which of the following is true of psychological safety in

organizations and teams? a. Managers can provide the most accurate perspective on

psychological safety. b. Psychological safety is ideally assessed through a cause-and-effect diagram. *c. Psychological safety is a subjective phenomenon.

d. A lower level of psychological safety is always associatedwith power differentials in organizations.

6. Antecedents of team effectiveness occur at *a. the individual, team, and organizational levels.

b. the behavioral, social, and psychological levels. c. the team and organizational levels. d. the behavioral, social, and macro-organizational levels.

7. Which of the following statements is true about quality improvementteam

leaders? a. Team leaders must ensure that team discussions always flow ina

logical, data-driven direction. b. Team leaders are responsible for conducting quality improvement training for team members. *c. Team leaders may lack formal authority over team members. d. All of the above

8. Organizations may adopt a quality improvement model a. to achieve process improvements. b. to gain a competitive advantage in the marketplace. c. to conform to regulations and requirements.

*d. All of the above

10. Which of the following may be associated with patient safety andquality? a. Overuse of procedures b. Underuse of procedures c. Misuse of procedures

*d. All of the above

11. The primary reason teams play a critical role in quality

improvement efforts is that a. involvement in teams increases staff morale. b. involvement in teams helps improve overall team functioning inthe

organization. *c. healthcare problems are complex and require input frommultiple people. d. healthcare managers have insufficient time to deal withprocess problems and must delegate this work to others.

12. A diverse team is helpful in quality improvement efforts because a. it helps the organization as a whole meet diversity andinclusion

efforts. b. diverse teams provide leadership opportunities for people from underrepresented groups. c. diversity reinforces the value of people from different backgrounds. *d. diverse teams can generate a broad range of perspectives on aproblem.

13. A key quality improvement role for a hospital CEO is to

*a. provide support to quality improvement teams.

b. lead quality improvement teams. c. provide training for quality improvement team members. d. monitor the compliance of quality improvement team members

with team norms.

14. Training is often required to carry out quality improvement activities.

Which of the following topics would be LEAST relevant fortraining quality improvement team members? a. Organizational change

*b. Principles of personal financial management c. Statistical concepts d. Decision-making

15. Which of the following is most likely to inhibit the empowerment ofquality

improvement team members? *a. Status differences among team members b. Lack of material rewards for team members c. Differences in personalities among team members d. Differences in gender among team members

16. The term used to describe a work environment in which individualsare

able to take risks without being chastised for failure is a. empowerment. b. job enlargement. c. job enrichment.

*d. psychological safety.

17.

uses different levels of “belts” as a credentialing

mechanism for individuals involved in quality improvement. a. The Model for Improvement b. Total quality management

*c. Six Sigma d. Lean 18. According to the Donabedian model of quality, which of the following is an example of a measure of process in a hospital nursingunit? a. Adequacy of staffing

*b. Mode of communication among staff between shift changes c. Number of patients with bedsores d. Number of non-nursing support staff

19. The role of a quality improvement team leader is a. to ensure engagement of team members. b. to ensure that all team members contribute to the discussion. c. to ensure that relevant areas of expertise are represented byteam

members. *d. all of the above.

20. The most appropriate initial response to a quality improvement team member

who repeatedly arrives late to a meeting is to a. ask team members why they think this individual arrives late. b. establish an improvement program for the team member. c. ask the team member’s supervisor or colleague to reinforce the

importance of being on time. *d. none of the above.

22. In the report Crossing the Quality Chasm, the following were amongthe six

characteristics of a high-quality health system. a. Safe, patient centered, cost-effective b. Efficient, timely, cost-effective

*c. Patient centered, effective, equitable d. Timely, efficacious, equitable

23. Organizations may adopt quality improvement to a. gain an advantage in the marketplace. b. conform to regulations. c. improve quality.

*d. all of the above.

24. A key way to emphasize the importance of employees participating inquality

improvement efforts is to a. pay people bonuses for their participation in quality

improvement work. *b. include participation in quality improvement efforts in thejob description. c. offer employees continuing education credits for the qualityimprovement work. d. assign employees to lead quality improvement teams.

25. The

quality improvement approach emphasizes a trial-and-

learning approach. *a. Model for Improvement

b. CQI c. Lean d. DMAIC

Chapter 16 1. Which of the following is NOT a stage of burnout? a. Depersonalization b. Depression c. Displacement of conflicts

*d. Acceptance of emerging problems

2. According to the World Health Organization, burnout syndrome is

characterized by all of the following except a. feelings of exhaustion. b. feelings of cynicism toward the job.

*c. feelings of inner emptiness. d. reduced professional efficacy.

3. Which of the following is NOT an administrative risk factor forburnout? a. Increased work demands b. Increased computerization of practice c. Increased external documentation requirements

*d. Increased patient load

4. Arlene is the chief human resources officer at ABC Health System.She is

launching a series of initiatives to build a positive work environment for employees. Which of the following initiatives shouldshe recommend as the best option to reach all existing employees? *a. Establishing several communication channels to listen toemployee concerns b. Hiring the right fit c. Giving meaningful recognition d. Having effective decision-making

5. Arlene is the chief human resources officer at ABC Health System. She is

launching a series of initiatives to build a positive work environment. Which of the following initiatives should she recommend asthe best option to embed in performance management processes? a. Applying solutions to improve workflow b. Implementing authentic leadership c. Having effective decision-making

*d. Providing ongoing feedback and communication

6. Arlene is the chief human resources officer at ABC Health System.She is

launching a series of initiatives to build a positive work environment. Which of the following initiatives aligns best with thestrategic objective to invest in human capital? a. Aligning values and expectations

*b. Developing employees c. Applying solutions to improve workflow d. Having effective decision-making

7. For organizations, stress and burnout are linked to all thefollowing

outcomes except a. lower patient satisfaction scores.

*b. better patient care quality. c. worsening provider shortages. d. lower staff morale.

8. Employee outcomes linked to stress and burnout include all of the

following except a. lower job satisfaction. b. decreases in intent to leave the profession. c. increased turnover.

*d. increased productivity.

9. The primary impacts of burnout on patients include all of the

following except a. increased medical errors. b. poor quality and patient safety outcomes. c. healthcare-acquired infections.

*d. longer wait times.

10. Which of the following recommendations to reduce technological

burnout also supports value-based care initiatives such as care coordination? a. Interface designed to reduce mundane tasks b. Simple navigation c. Intuitive data presentation

*d. Smooth transfer of information to other organizations andclinicians

11. Which of the following dimensions is NOT assessed by the Maslach

Burnout Inventory? *a. Problems with colleagues

b. Emotional exhaustion c. Disengagement d. Decreased sense of personal accomplishment

12. Which of the following is NOT true about the adoption of health

information technology (HIT)? a. HIT adoption has caused an information overload. b. HIT adoption has increased cognitive workload.

*c. HIT adoption has decreased overall job growth. d. HIT adoption has changed provider–patient interactions.

13. Which of the following is an internal factor for burnout risk forhealthcare

executives? *a. Management of care transitions along the continuum b. Consumerism c. Retail incursion into healthcare d. Changes in worker and patient ethnic and cultural demographics

14. From a 2018 online survey of C-suite healthcare executives, what

percentage indicated that executive burnout was affecting their organization? a. 90

*b. 79 c. 34 d. 43

15. The benefits of creating a positive work environment include all ofthe

following except a. reduced risk of burnout. b. improved quality of care.

*c. increased administrative burden. d. enhanced professional well-being.