,Chapter 01: Leading, Managing, and Following
s s s s s
Yoder-Wise: Leading and Managing in Nursing, 8th Edition s s s s s s s
MULTIPLE CHOICE s
1. A nurse manager of a 20-
s s s s s
bed medical unit finds that 80% of the patients are older adults. She is asked to assess and adapt th
s s s s s s s s s s s s s s s s s s s
e unit to better meet the unique needs of the older adult patient. Using complexity principles, what
s s s s s s s s s s s s s s s s
would be the best approach to take for implementation of this change?
s s s s s s s s s s s s
a. Leverage the hierarchical management position to get unit staff involved in ass s s s s s s s s s s s
essment and planning. s s
b. Engage involved staff at all levels in the decision-making process. s s s s s s s s s
c. Focus the assessment on the unit and omit the hospital and community en s s s s s s s s s s s s
vironment.
d. Hire a geriatric specialist to oversee and control the project.
s s s s s s s s s
ANS: B s
Complexity theory suggests that systems interact and adapt and that decision making occurs thro
s s s s s s s s s s s s s
ughout the systems, as opposed to being held in a hierarchy. In complexity theory, every voice co
s s s s s s s s s s s s s s s s
unts, and therefore, all levels of staff would be involved in decision making.
s s s s s s s s s s s s
TOP: AONE competency: Communication and Relationship-Building
s s s s s
2. A unit manager of a 25-
s s s s s
bed medical/surgical area receives a phone call from a nurse whohas called in sick five times in t
s s s s s s s s s s s s s s s s s
he past month. He tells the manager that he very much wants to come to work when scheduled bu
s s s s s s s s s s s s s s s s s s
t must often care for his wife, who is undergoing treatment for breast cancer. According to Maslo
s s s s s s s s s s s s s s s s
w‘s need hierarchy theory, what would be the best approach to satisfying the needs of this nurse,
s s s s s s s s s s s s s s s s s
other staff, and patients? s s s
a. Line up agency nurses who can be called in to work on short notice.
s s s s s s s s s s s s s
b. Place the nurse on unpaid leave for the remainder of his wife‘s treatment.
s s s s s s s s s s s s
c. Sympathize with the nurse‘s dilemma and let the charge nurse know that thisnurse ma s s s s s s s s s s s s s s
y be calling in frequently in the future.
s s s s s s s
d. Work with the nurse, staffing office, and other nurses to arrange hisscheduled da
s s s s s s s s s s s s
ys off around his wife‘s treatments.s s s s s
ANS: D s
Placing the nurse on unpaid leave may threaten the nurse‘s capacity to meet physiologic needs and
s s s s s s s s s s s s s s s s
demotivate the nurse. Unsatisfactory coverage of shifts on short notice could affect patient care a
s s s s s s s s s s s s s s
nd threaten the needs of staff to feel competent. Arranging the schedule around the wife‘s needs m
s s s s s s s s s s s s s s s s
eets the needs of the staff and of patients while satisfying the nurse‘s need for affiliation.
s s s s s s s s s s s s s s s
TOP: AONE competency: Communication and Relationship-Building
s s s s s
3. A grievance brought by a staff nurse against the unit manager requires mediation. At the first med
s s s s s s s s s s s s s s s s
iation session, the staff nurse repeatedly calls the unit manager‘s actions unfair, and the unit man
s s s s s s s s s s s s s s s
ager continues to reiterate the reasons for the actions. What would be the best course of action at th
s s s s s s s s s s s s s s s s s s
is time? s
a. Send the two disputants away to reach their own resolution. s s s s s s s s s
b. Involve another staff nurse in the discussion for clarity issues. s s s s s s s s s
, c. Ask each party to examine their own motives and issues in the conflict.
s s s s s s s s s s s s
d. Continue to listen as the parties repeat their thoughts and feelings aboutthe con s s s s s s s s s s s s s
flict.
ANS: C s
For resolution of conflict, one should address the interests and involvement of participants in the c
s s s s s s s s s s s s s s s
onflict by examining the real issues of all parties.
s s s s s s s s
TOP: AONE competency: Communication and Relationship-Building
s s s s s
4. At a second negotiation session, the unit manager and staff nurse are unable to reach a reso
s s s s s s s s s s s s s s s s
lution. What is the appropriate next step?
s s s s s s
a. Arrange another meeting in a week‘s time so as to allow a cooling-off period.
s s s s s s s s s s s s s
b. Elevate the next negation session to the next manager, one level above.
s s s s s s s s s s s
c. Insist that participants continue to talk until a resolution has been reached.
s s s s s s s s s s s
d. Back the unit manager‘s actions and end the dispute.
s s s s s s s s
ANS: B s
Part of leadership is understanding conflict resolution and ability to negotiate and manage for resol
s s s s s s s s s s s s s s
ution of issues and concerns. This situation has failed a second negotiation session, elevation to a
s s s s s s s s s s s s s s s s
manager with additional training to facilitate conflict resolution is important at this point.
s s s s s s s s s s s s
TOP: AONE competency: Communication and Relationship-Building
s s s s s
5. The manager of a surgical area has a vision for the future that requires the addition of RN assistant
s s s s s s s s s s s s s s s s s s
s or unlicensed persons to feed, bathe, and ambulate patients. The RNs on the staff have always pr
s s s s s s s s s s s s s s s s s
acticed in a primary nursing- s s s s
delivery system and are very resistant to this idea. What would be the best initial strategy for imple
s s s s s s s s s s s s s s s s s
mentation of this change? s s s
a. Exploring the values and feelings of the RN group in relationship to this change s s s s s s s s s s s s s
b. Leaving the RNs alone for a time so they can think about the change before it is impl
s s s s s s s s s s s s s s s s s
emented
c. Dropping the idea and trying for the change in a year or so when some of the pres s s s s s s s s s s s s s s s s s
ent RNs have retired s s s
d. Hiring the assistants and allowing the RNs to see what good additions they are
s s s s s s s s s s s s s
ANS: A s
Influencing others requires emotional intelligence in domains such as empathy, handling relation
s s s s s s s s s s s
ships, deepening self- s s
awareness in self and others, motivating others, and managing emotions. Motivating others recog
s s s s s s s s s s s s
nizes that values are powerful forces that influence acceptance of change. Leaving the RNs alone f
s s s s s s s s s s s s s s s
or a period of time before implementation does not provide opportunity to explore different perspe
s s s s s s s s s s s s s s
ctives and values. Avoiding discussion until the team changes may not promote adoption of the ch
s s s s s s s s s s s s s s s
ange until there is opportunity to explore perspectives and values related to the change. Hiring of t
s s s s s s s s s s s s s s s s
he assistants demonstrates lack of empathy for the perspectives of the RN staff.
s s s s s s s s s s s s
TOP: AONE competency: Knowledge of the Health Care Environment
s s s s s s s s
, 6. As the RN charge nurse on the night shift in a small long-
s s s s s s s s s s s s
term care facility, you‘ve found that there is little turnover among your LPN and nursing assistant
s s s s s s s s s s s s s s s
(NA) staff members, but they are not very motivated to go beyond their job descriptions in their
s s s s s s s s s s s s s s s s s s
work. Which of the following strategies might motivate the staff and lead to greater job satisfacti
s s s s s s s s s s s s s s s
on?
a. Ask the director of nursing to offer higher wages and bonuses for extra work for the
s s s s s s s s s s s s s s s s
night LPNs and NAs. s s s
b. Allow the LPNs and NAs greater decision- s s s s s s
making power within the scope oftheir positions in the institution. s s s s s s s s s s
c. Hire additional staff so that there are more staff available for enhanced care,and indi
s s s s s s s s s s s s s s
vidual workloads are lessened. s s s
d. Ask the director of nursing to increase job security for night staff by having them sign
s s s s s s s s s s s s s s s
contracts that guarantee work.
s s s s
ANS: B s
Hygiene factors such as salary, working conditions, and security are consistent with Herzberg‘s t
s s s s s s s s s s s s s
wo-
factor theory of motivation; meeting these needs avoids job dissatisfaction. Motivator factors suc
s s s s s s s s s s s s
h as recognition and satisfaction with work promote a satisfying and enriched work environment.
s s s s s s s s s s s s s s
Transformational leaders use motivator factors liberally to inspire work performance and increase s s s s s s s s s s s s
job satisfaction.
s
TOP: AONE competency: Communication and Relationship-Building
s s s s s
7. The nurse manager wants to increase motivation by providing motivating factors for thenurse on t
s s s s s s s s s s s s s s
he unit. What action would be appropriate to motivate the staff?
s s s s s s s s s s
a. Collaborate with the human resource/personnel department to develop on- s s s s s s s s
site daycare services. s s
b. Provide a hierarchical organizational structure. s s s s
c. Implement a model of shared governance. s s s s s
d. Promote the development of a flexible benefits package. s s s s s s s
ANS: C s
Complexity theory suggests that systems interact and adapt and that decision making occurs throu
s s s s s s s s s s s s s
ghout systems, as opposed to being held in a hierarchy. In complexity theory, every voice counts,
s s s s s s s s s s s s s s s s
and therefore all levels of staff would be involved in decision making. This principle is the founda
s s s s s s s s s s s s s s s s
tion of shared governance.
s s s
TOP: AONE competency: Communication and Relationship-Building
s s s s s
8. The nurse manager has been asked to implement an evidence-
s s s s s s s s s
based approach to teach ostomy patients self-
s s s s s s
management skills postoperatively. The program is to be implemented across the entire facility.
s s s s s s s s s s s s s
What illustrates effective leadership in this situation?
s s s s s s
a. The training modules are left in the staff room for times when staff are available.
s s s s s s s s s s s s s s
b. The current approach is continued because it is also evidence-
s s s s s s s s s
based and is more familiar to staff. s s s s s s
c. You decide to implement the approach at a later date because of feedback from the RN
s s s s s s s s s s s s s s s
s that the new approach takes too much time.
s s s s s s s s
d. An RN who is already familiar with the new approach of volunteers to takethe lead
s s s s s s s s s s s s s s s
in mentoring and teaching others how to implement it.
s s s s s s s s s
ANS: D s
s s s s s
Yoder-Wise: Leading and Managing in Nursing, 8th Edition s s s s s s s
MULTIPLE CHOICE s
1. A nurse manager of a 20-
s s s s s
bed medical unit finds that 80% of the patients are older adults. She is asked to assess and adapt th
s s s s s s s s s s s s s s s s s s s
e unit to better meet the unique needs of the older adult patient. Using complexity principles, what
s s s s s s s s s s s s s s s s
would be the best approach to take for implementation of this change?
s s s s s s s s s s s s
a. Leverage the hierarchical management position to get unit staff involved in ass s s s s s s s s s s s
essment and planning. s s
b. Engage involved staff at all levels in the decision-making process. s s s s s s s s s
c. Focus the assessment on the unit and omit the hospital and community en s s s s s s s s s s s s
vironment.
d. Hire a geriatric specialist to oversee and control the project.
s s s s s s s s s
ANS: B s
Complexity theory suggests that systems interact and adapt and that decision making occurs thro
s s s s s s s s s s s s s
ughout the systems, as opposed to being held in a hierarchy. In complexity theory, every voice co
s s s s s s s s s s s s s s s s
unts, and therefore, all levels of staff would be involved in decision making.
s s s s s s s s s s s s
TOP: AONE competency: Communication and Relationship-Building
s s s s s
2. A unit manager of a 25-
s s s s s
bed medical/surgical area receives a phone call from a nurse whohas called in sick five times in t
s s s s s s s s s s s s s s s s s
he past month. He tells the manager that he very much wants to come to work when scheduled bu
s s s s s s s s s s s s s s s s s s
t must often care for his wife, who is undergoing treatment for breast cancer. According to Maslo
s s s s s s s s s s s s s s s s
w‘s need hierarchy theory, what would be the best approach to satisfying the needs of this nurse,
s s s s s s s s s s s s s s s s s
other staff, and patients? s s s
a. Line up agency nurses who can be called in to work on short notice.
s s s s s s s s s s s s s
b. Place the nurse on unpaid leave for the remainder of his wife‘s treatment.
s s s s s s s s s s s s
c. Sympathize with the nurse‘s dilemma and let the charge nurse know that thisnurse ma s s s s s s s s s s s s s s
y be calling in frequently in the future.
s s s s s s s
d. Work with the nurse, staffing office, and other nurses to arrange hisscheduled da
s s s s s s s s s s s s
ys off around his wife‘s treatments.s s s s s
ANS: D s
Placing the nurse on unpaid leave may threaten the nurse‘s capacity to meet physiologic needs and
s s s s s s s s s s s s s s s s
demotivate the nurse. Unsatisfactory coverage of shifts on short notice could affect patient care a
s s s s s s s s s s s s s s
nd threaten the needs of staff to feel competent. Arranging the schedule around the wife‘s needs m
s s s s s s s s s s s s s s s s
eets the needs of the staff and of patients while satisfying the nurse‘s need for affiliation.
s s s s s s s s s s s s s s s
TOP: AONE competency: Communication and Relationship-Building
s s s s s
3. A grievance brought by a staff nurse against the unit manager requires mediation. At the first med
s s s s s s s s s s s s s s s s
iation session, the staff nurse repeatedly calls the unit manager‘s actions unfair, and the unit man
s s s s s s s s s s s s s s s
ager continues to reiterate the reasons for the actions. What would be the best course of action at th
s s s s s s s s s s s s s s s s s s
is time? s
a. Send the two disputants away to reach their own resolution. s s s s s s s s s
b. Involve another staff nurse in the discussion for clarity issues. s s s s s s s s s
, c. Ask each party to examine their own motives and issues in the conflict.
s s s s s s s s s s s s
d. Continue to listen as the parties repeat their thoughts and feelings aboutthe con s s s s s s s s s s s s s
flict.
ANS: C s
For resolution of conflict, one should address the interests and involvement of participants in the c
s s s s s s s s s s s s s s s
onflict by examining the real issues of all parties.
s s s s s s s s
TOP: AONE competency: Communication and Relationship-Building
s s s s s
4. At a second negotiation session, the unit manager and staff nurse are unable to reach a reso
s s s s s s s s s s s s s s s s
lution. What is the appropriate next step?
s s s s s s
a. Arrange another meeting in a week‘s time so as to allow a cooling-off period.
s s s s s s s s s s s s s
b. Elevate the next negation session to the next manager, one level above.
s s s s s s s s s s s
c. Insist that participants continue to talk until a resolution has been reached.
s s s s s s s s s s s
d. Back the unit manager‘s actions and end the dispute.
s s s s s s s s
ANS: B s
Part of leadership is understanding conflict resolution and ability to negotiate and manage for resol
s s s s s s s s s s s s s s
ution of issues and concerns. This situation has failed a second negotiation session, elevation to a
s s s s s s s s s s s s s s s s
manager with additional training to facilitate conflict resolution is important at this point.
s s s s s s s s s s s s
TOP: AONE competency: Communication and Relationship-Building
s s s s s
5. The manager of a surgical area has a vision for the future that requires the addition of RN assistant
s s s s s s s s s s s s s s s s s s
s or unlicensed persons to feed, bathe, and ambulate patients. The RNs on the staff have always pr
s s s s s s s s s s s s s s s s s
acticed in a primary nursing- s s s s
delivery system and are very resistant to this idea. What would be the best initial strategy for imple
s s s s s s s s s s s s s s s s s
mentation of this change? s s s
a. Exploring the values and feelings of the RN group in relationship to this change s s s s s s s s s s s s s
b. Leaving the RNs alone for a time so they can think about the change before it is impl
s s s s s s s s s s s s s s s s s
emented
c. Dropping the idea and trying for the change in a year or so when some of the pres s s s s s s s s s s s s s s s s s
ent RNs have retired s s s
d. Hiring the assistants and allowing the RNs to see what good additions they are
s s s s s s s s s s s s s
ANS: A s
Influencing others requires emotional intelligence in domains such as empathy, handling relation
s s s s s s s s s s s
ships, deepening self- s s
awareness in self and others, motivating others, and managing emotions. Motivating others recog
s s s s s s s s s s s s
nizes that values are powerful forces that influence acceptance of change. Leaving the RNs alone f
s s s s s s s s s s s s s s s
or a period of time before implementation does not provide opportunity to explore different perspe
s s s s s s s s s s s s s s
ctives and values. Avoiding discussion until the team changes may not promote adoption of the ch
s s s s s s s s s s s s s s s
ange until there is opportunity to explore perspectives and values related to the change. Hiring of t
s s s s s s s s s s s s s s s s
he assistants demonstrates lack of empathy for the perspectives of the RN staff.
s s s s s s s s s s s s
TOP: AONE competency: Knowledge of the Health Care Environment
s s s s s s s s
, 6. As the RN charge nurse on the night shift in a small long-
s s s s s s s s s s s s
term care facility, you‘ve found that there is little turnover among your LPN and nursing assistant
s s s s s s s s s s s s s s s
(NA) staff members, but they are not very motivated to go beyond their job descriptions in their
s s s s s s s s s s s s s s s s s s
work. Which of the following strategies might motivate the staff and lead to greater job satisfacti
s s s s s s s s s s s s s s s
on?
a. Ask the director of nursing to offer higher wages and bonuses for extra work for the
s s s s s s s s s s s s s s s s
night LPNs and NAs. s s s
b. Allow the LPNs and NAs greater decision- s s s s s s
making power within the scope oftheir positions in the institution. s s s s s s s s s s
c. Hire additional staff so that there are more staff available for enhanced care,and indi
s s s s s s s s s s s s s s
vidual workloads are lessened. s s s
d. Ask the director of nursing to increase job security for night staff by having them sign
s s s s s s s s s s s s s s s
contracts that guarantee work.
s s s s
ANS: B s
Hygiene factors such as salary, working conditions, and security are consistent with Herzberg‘s t
s s s s s s s s s s s s s
wo-
factor theory of motivation; meeting these needs avoids job dissatisfaction. Motivator factors suc
s s s s s s s s s s s s
h as recognition and satisfaction with work promote a satisfying and enriched work environment.
s s s s s s s s s s s s s s
Transformational leaders use motivator factors liberally to inspire work performance and increase s s s s s s s s s s s s
job satisfaction.
s
TOP: AONE competency: Communication and Relationship-Building
s s s s s
7. The nurse manager wants to increase motivation by providing motivating factors for thenurse on t
s s s s s s s s s s s s s s
he unit. What action would be appropriate to motivate the staff?
s s s s s s s s s s
a. Collaborate with the human resource/personnel department to develop on- s s s s s s s s
site daycare services. s s
b. Provide a hierarchical organizational structure. s s s s
c. Implement a model of shared governance. s s s s s
d. Promote the development of a flexible benefits package. s s s s s s s
ANS: C s
Complexity theory suggests that systems interact and adapt and that decision making occurs throu
s s s s s s s s s s s s s
ghout systems, as opposed to being held in a hierarchy. In complexity theory, every voice counts,
s s s s s s s s s s s s s s s s
and therefore all levels of staff would be involved in decision making. This principle is the founda
s s s s s s s s s s s s s s s s
tion of shared governance.
s s s
TOP: AONE competency: Communication and Relationship-Building
s s s s s
8. The nurse manager has been asked to implement an evidence-
s s s s s s s s s
based approach to teach ostomy patients self-
s s s s s s
management skills postoperatively. The program is to be implemented across the entire facility.
s s s s s s s s s s s s s
What illustrates effective leadership in this situation?
s s s s s s
a. The training modules are left in the staff room for times when staff are available.
s s s s s s s s s s s s s s
b. The current approach is continued because it is also evidence-
s s s s s s s s s
based and is more familiar to staff. s s s s s s
c. You decide to implement the approach at a later date because of feedback from the RN
s s s s s s s s s s s s s s s
s that the new approach takes too much time.
s s s s s s s s
d. An RN who is already familiar with the new approach of volunteers to takethe lead
s s s s s s s s s s s s s s s
in mentoring and teaching others how to implement it.
s s s s s s s s s
ANS: D s
