1. A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults. She is asked to assess and adapt the unit to better meet the unique needs of the older adult patient. Using complexity principl
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1. A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults. She is asked to assess and adapt the unit to better meet the unique needs of the older adult patient. Using complexity principles, what would be the best approach to take for implementation of this change?
a. Leverage the hierarchical management position to get unit staff involved in assessment and planning.
b. Engage involved staff at all levels in the decision-making process.
c. Focus the assessment on the unit and omit the hospital and community environment.
d. Hire a geriatric specialist to oversee and control the project.
ANS: B
Complexity theory suggests that systems interact and adapt and that decision making occurs throughout the systems, as opposed to being held in a hierarchy. In complexity theory, every voice counts, and therefore, all levels of staff would be involved in decision making.
TOP: AONE competency: Communication and Relationship-Building
2. A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who has called in sick five times in the past month. He tells the manager that he very much wants to come to work when scheduled but must often care for his wife, who is undergoing treatment
for breast cancer. According to Maslow’s need hierarchy theory, what would be the best approach to satisfying the needs of this nurse, other staff, and patients?
a. Line up agency nurses who can be called in to work on short notice.
b. Place the nurse on unpaid leave for the remainder of his wife’s treatment.
c. Sympathize with the nurse’s dilemma and let the charge nurse know that this nurse may be calling in frequently in the future.
d. Work with the nurse, staffing office, and other nurses to arrange his scheduled days off around his wife’s treatments.
ANS: D
Placing the nurse on unpaid leave may threaten the nurse’s capacity to meet physiologic needs and demotivate the nurse. Unsatisfactory coverage of shifts on short notice could affect
patient care and threaten the needs of staff to feel competent. Arranging the schedule around the wife’s needs meets the needs of the staff and of patients while satisfying the nurse’s need for affiliation.
TOP: AONE competency: Communication and Relationship-Building
3. A grievance brought by a staff nurse against the unit manager requires mediation. At the first mediation session, the staff nurse repeatedly calls the unit manager’s actions unfair, and the unit manager continues to reiterate the reasons for the actions. What would be the best course of action at this time?
a. Send the two disputants away to reach their own resolution.
b. Involve another staff nurse in the discussion for clarity issues.
c. Ask each party to examine their own motives and issues in the conflict.
d. Continue to listen as the parties repeat their thoughts and feelings about the conflict.
ANS: C
For resolution of conflict, one should address the interests and involvement of participants in the conflict by examining the real issues of all parties.
TOP: AONE competency: Communication and Relationship-Building
4. At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution. What is the appropriate next step?
a. Arrange another meeting in a week’s time so as to allow a cooling-off period.
b. Elevate the next negation session to the next manager, one level above.
c. Insist that participants continue to talk until a resolution has been reached.
d. Back the unit manager’s actions and end the dispute.
ANS: B
Part of leadership is understanding conflict resolution and ability to negotiate and manage for resolution of issues and concerns. This situation has failed a second negotiation session, elevation to a manager with additional training to facilitate conflict resolution is important at this point.
TOP: AONE competency: Communication and Relationship-Building
5. The manager of a surgical area has a vision for the future that requires the addition of RN
assistants or unlicensed persons to feed, bathe, and ambulate patients. The RNs on the staff have always practiced in a primary nursing delivery system and are very resistant to this idea. What would be the best initial strategy for implementation of this change?
a. Exploring the values and feelings of the RN group in relationship to this change
b. Leaving the RNs alone for a time so they can think about the change before it is implemented
c. Dropping the idea and trying for the change in a year or so when some of the present RNs have retired
d. Hiring the assistants and allowing the RNs to see what good additions they are
ANS: A
Influencing others requires emotional intelligence in domains such as empathy, handling relationships, deepening self-awareness in self and others, motivating others, and managing emotions. Motivating others recognizes that values are powerful forces that influence acceptance of change. Leaving the RNs alone for a period of time before implementation does not provide opportunity to explore different perspectives and values. Avoiding discussion until the team changes may not promote adoption of the change until there is opportunity to explore perspectives and values related to the change. Hiring of the assistants demonstrates lack of empathy for the perspectives of the RN staff.
TOP: AONE competency: Knowledge of the Health Care Environment
6. As the RN charge nurse on the night shift in a small long-term care facility, you’ve found that there is little turnover among your LPN and nursing assistant (NA) staff members, but they are not very motivated to go beyond their job descriptions in their work. Which of the following strategies might motivate the staff and lead to greater job satisfaction?
a. Ask the director of nursing to offer higher wages and bonuses for extra work for the night LPNs and NAs.
b. Allow the LPNs and NAs greater decision-making power within the scope of their positions in the institution.
c. Hire additional staff so that there are more staff available for enhanced care, and individual workloads are lessened.
d. Ask the director of nursing to increase job security for night staff by having them sign contracts that guarantee work.
ANS: B
Hygiene factors such as salary, working conditions, and security are consistent with Herzberg’s two-factor theory of motivation; meeting these needs avoids job dissatisfaction. Motivator factors such as recognition and satisfaction with work promote a satisfying and
enriched work environment. Transformational leaders use motivator factors liberally to inspire work performance and increase job satisfaction.
TOP: AONE competency: Communication and Relationship-Building
7. The nurse manager wants to increase motivation by providing motivating factors for the nurse on the unit. What action would be appropriate to motivate the staff?
a. Collaborate with the human resource/personnel department to develop on-site daycare services.
b. Provide a hierarchical organizational structure.
c.
Implement a model of shared governance.
d. Promote the development of a flexible benefits package.
ANS: C
Complexity theory suggests that systems interact and adapt and that decision making occurs throughout systems, as opposed to being held in a hierarchy. In complexity theory, every voice counts, and therefore all levels of staff would be involved in decision making. This principle is the foundation of shared governance.
TOP: AONE competency: Communication and Relationship-Building
8. A charge nurse on a busy 40-bed medical/surgical unit is approached by a family member who begins to complain loudly about the quality of care his mother is receiving. His behavior is so disruptive that it is overheard by staff, physicians, and other visitors. The family member leaves the unit abruptly, and the nurse is left feeling frustrated. Which behavior by the charge nurse best illustrates refined leadership skills in an emotionally intelligent practitioner?
a. Reflect to gain insight into how the situation could be handled differently in the future.
b. Try to catch up with the angry family member to resolve the concern.
c. Discuss the concern with the patient after the family member has left.
d. Notify nursing administration of the situation.
ANS: A
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