Chapter 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 in making this change?

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 Maslows need hierarchy theory, what would be the best approach to satisfying the needs of this nurse, other staff, and patients?

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 managers actions unfair, and the unit manager continues to reiterate the reasons for her actions. What would be the best course of action at this time?

4. At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution. It would now be best to:

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 walk patients. The RNs on the staff have always practiced in a primary nursingdelivery system and are very resistant to this idea. The best initial strategy in this situation would include:

6. As the RN charge nurse on the night shift in a small long-term care facility, youve 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?

7. As the nurse manager who wants to increase motivation by providing motivating factors, which action would you select?

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 rejects any attempt to intervene therapeutically to resolve the issue. He 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?

9. The chief nursing officer has asked the staff development coordinator to facilitate the development of a clinical competency program for the facility. While making rounds on the units, the staff development coordinator overhears RN staff complaining that they feel it is insulting to be required to participate in a competency program. Which behavior by the staff development coordinator is most appropriate in this situation?

10. As the manager, you have been asked to implement an evidence-based approach to teach ostomy patients self-management skills postoperatively that is being operationalized throughout your organization. Which of the following illustrates effective leadership?

11. You overhear a newly graduated RN telling one of your colleagues that leadership and management belong to the unit manager and not to her. As a nursing colleague, you respond by demonstrating understanding that the perception of the new graduate:

12. You walk into Mr. Smiths room and find him yelling at the LPN, Miss Jones. He is obviously very upset and after you speak with him regarding his behavior, you determine that he has not slept for three nights because of unrelieved pain levels. The LPN is very upset with Mr. Smith and calls him an ugly, old man. You acknowledge her feelings and concerns and then suggest that Mr. Smiths behavior was aggressive but is related to lack of sleep and to pain. You say to Miss Jones, Can you both, together with Mr. Smith, determine triggers for the pain and effective approaches to controlling his pain? This approach demonstrates:

13. After assessing an older adult patient in long-term care who has been slowly deteriorating for weeks, the nurse manager calls the family and asks them to come in, as the patient is dying. The nurse managers decision and actions are based on:

14. Chart audits have revealed significant omissions of data that could have legal and funding guidelines ramifications. As the unit manager, you meet with the staff to discuss audit findings and to find approaches that will address the gaps in charting and achieve desired goals. This is an example of:

15. A family is keeping vigil at a critically ill patients bedside. Other, distant family members, not yet able to come, call the unit continuously, asking for updates and wanting to express concern. You speak with the distant family members and suggest that you are going to refer them to the hospital social worker, whose role is to work with people in such situations. What role are you assuming through this action?

16. A family is keeping vigil at a critically ill patients bedside. Other, distant family members, not yet able to come, call the unit continuously, asking for updates and wanting to express concern. You speak with the distant family members and suggest that you are going to refer them to the hospital social worker, whose role is to work with people in such situations. In response to this situation, you approach the unit manager to apprise her of your concerns that the family dynamics of the patient involved may lead to staff-family and patient-family conflicts. You suggest that the physician may need to discuss the treatment plan with the family. The unit manager advises that he will arrange this discussion. If, after the meeting with family members, this is identified as a desired approach, you support the managers decision. Your actions indicate that you are acting in what role?

17. You pull staff together to assess a situation in which the family of a seriously ill patient is anxious and is absorbing a great deal of staff time in consultation, discussion, and questioning of treatment decisions. Staff members are becoming distanced from the family. After inviting the concerns of staff, you explain that the organization values patient-centered care and that evidence supports that acting as an advocate and a listener is helpful to families. You ask the staff for ideas as to strategies that are effectively patient-centered in these situations. In this situation, you are taking on which role?

18. Joan, the nursing unit manager, finds it difficult to work with Thomas, a new graduate. Thomas has many ideas, and his manner of presenting them irks Joan. After reflection and discussion with others, Joan recognizes that she also feels threatened by his behavior. She comes to understand that Thomas is trying to establish his own role on the unit, is not trying to challenge her, and needs guidance, coaching, and affirmation. Joan is demonstrating:

19. As the head of a nursing program, you consistently invite the ideas of your team about innovations in teaching, community partnerships, and curriculum design and invite participation in decisions. Many of these ideas have been implemented successfully, and your staff members are keen to try on other ideas. You are employing _____ leadership.

20. As a leader on a rehab unit, you encourage all staff members to see themselves as having a role in decision making and quality care. You see your role as involving particular responsibilities in decision making but not as a hierarchal role. This view of decision making and leadership is consistent with:

21. You recently acquired a position as a unit manager. During your time on the unit, you have formed a strong social network among your staff, have promoted the development of relationships between your staff and workers in other areas of the organization, and have formed relationships that generate ideas from patient organizations and the local nursing education program. According to complexity theory, you are engaging which principle?

22. According to the complexity theory, which of the following should be the focus of measurement?

23. During a staff meeting held to discuss developing a mission statement for the unit, the idea of placing patient needs first is:

24. A dispute arises between an RN staff member and an LPN over a patient issue. The tension between the two begins to affect other staff members, who are drawn into the conflict; eventually, the team becomes polarized toward either the RN or the LPN. This situation might have been prevented through:

25. The unit is shifting from primary nursing to a team model in an effort to contain costs. Staff members are angry and ask for a meeting to discuss the change. After hearing their concerns related to reduction in professional autonomy and care quality, you:

1. Sarah wonders about the direction that you have given regarding management of incontinent, confused patients. She brings you evidence that she has found regarding incontinence interventions and asks you if she and you could talk about the guidance that you have given after you have had an opportunity to read the articles she has given you. This is an example of (select all that apply):