Chapter 01: Leading and Managing in Nursing
Chapter 01: Leading, Managing, and Following
Yoder-Wise: Leading and Managing in Nursing, 6th
Edition MULTIPLE CHOICE
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?
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.
REF: Page 8 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.
REF: Page 10 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 her 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 so as to clarify issues.
c. Ask each party to examine her own motives and issues in the conflict.
d. Continue to listen as the parties repeat their thoughts and feelings about
the conflict. ANS: C
,Ury, Brett, and Goldberg outline steps to restoring unity, the first of which is to address
the interests and involvement of participants in the conflict by examining the real issues
of all parties.
REF: Page 16 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. It would now be best to:
a. Arrange another meeting in a week’s time so as to allow a cooling-off period.
b. Turn the dispute over to the director of nursing.
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
According to the principles outlined by Ury, Brett, and Goldberg, a “cooling-off” period is
recommended if resolution fails.
REF: Page 16 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 walk patients. The RNs on
the staff have always practiced in a primary nursing–delivery system and are very
resistant to this idea. The best initial strategy in this situation would include:
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.
REF: Page 7 | Page 15
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.
REF: Page 9 | Page 10
TOP: AONE competency: Communication and Relationship-Building
7. As the nurse manager who wants to increase motivation by providing motivating
factors, which action would you select?
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.
REF: Pages 8-11 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 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?
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
Goleman suggests that emotional intelligence involves insight and being able to step
outside of the situation to envision the context of what is happening as well as being
able to manage emotions such as frustration effectively.
REF: Page 7 | Page 8 TOP: AONE competency: Leadership
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?
a. Disregard staff concerns and continue with development of the program.
b. Inform the nurses that this program is a requirement for JCAHO accreditation.
c. Schedule a meeting with the chief nurse executive to apprise her of the situation.
d. Facilitate a meeting so nurses can articulate their values and concerns about a
competency program.
ANS: D
, The manager role involves guiding others through a set of derived practices that are
evidence-based and known to satisfy preestablished outcomes such as participation in
a competency program. This involves engagement of staff through sharing of concerns
and ideas. A close analysis of the IOM report and the summary of the PPACA suggests
that no health reform can unfold without active nursing engagement. Each document
emphasizes that nurses must lead, manage, and behave as active collaborators with
other members of the health team and with those being served.
REF: Page 3 TOP: AONE competency: Communication and Relationship-Building
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?
a. The training modules are left in the staff room for times when staff are available.
b. The current approach is continued because it is also evidence-based and is more
familiar to staff.
c. You decide to implement the approach at a later date because of feedback from the
RNs that the new approach takes too much time.
d. A RN who is already familiar with the new approach volunteers to take the lead in
mentoring and teaching others how to implement it.
ANS: D
Followership occurs when there is acquiescence to a peer who is leading in a setting
where a team has gathered to ensure the best clinical decision making and actions are
taken to achieve clinical or organizational outcomes. Followership promotes good
clinical decisions and use of clinical resources.
REF: Page 4 | Page 5
TOP: AONE competency: Communication and Relationship-Building
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:
a. Is correct. Leadership is not the role of the staff nurse.
b. Would benefit from further understanding of her role as a professional, whose
influence may affect the decision making of patients, colleagues, and other
professionals.
c. Has been influenced by nurse leaders and managers who leave for other positions.
d. Is related to the general perception that nurse leaders and managers are not satisfied
in their jobs. ANS: B
Care coordination that involves the intersection of individual, family, and community-
based needs requires that nurses have self-confidence, knowledge of organizations and
health systems, and an inner desire to lead and manage. There is often a view that
leadership is isolated to those holding managerial positions and that a direct care nurse
is subject to following by adhering to the direction of others. Such views fail to
acknowledge that to be a nurse requires each licensed individual to lead, manage, and
follow when practicing at the point-of-care and beyond.
REF: Page 3 | Page 4 TOP: AONE competency: Leadership
12.You walk into Mr. Smith’s 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. Smith’s behavior was aggressive
Chapter 01: Leading, Managing, and Following
Yoder-Wise: Leading and Managing in Nursing, 6th
Edition MULTIPLE CHOICE
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?
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.
REF: Page 8 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.
REF: Page 10 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 her 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 so as to clarify issues.
c. Ask each party to examine her own motives and issues in the conflict.
d. Continue to listen as the parties repeat their thoughts and feelings about
the conflict. ANS: C
,Ury, Brett, and Goldberg outline steps to restoring unity, the first of which is to address
the interests and involvement of participants in the conflict by examining the real issues
of all parties.
REF: Page 16 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. It would now be best to:
a. Arrange another meeting in a week’s time so as to allow a cooling-off period.
b. Turn the dispute over to the director of nursing.
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
According to the principles outlined by Ury, Brett, and Goldberg, a “cooling-off” period is
recommended if resolution fails.
REF: Page 16 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 walk patients. The RNs on
the staff have always practiced in a primary nursing–delivery system and are very
resistant to this idea. The best initial strategy in this situation would include:
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.
REF: Page 7 | Page 15
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.
REF: Page 9 | Page 10
TOP: AONE competency: Communication and Relationship-Building
7. As the nurse manager who wants to increase motivation by providing motivating
factors, which action would you select?
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.
REF: Pages 8-11 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 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?
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
Goleman suggests that emotional intelligence involves insight and being able to step
outside of the situation to envision the context of what is happening as well as being
able to manage emotions such as frustration effectively.
REF: Page 7 | Page 8 TOP: AONE competency: Leadership
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?
a. Disregard staff concerns and continue with development of the program.
b. Inform the nurses that this program is a requirement for JCAHO accreditation.
c. Schedule a meeting with the chief nurse executive to apprise her of the situation.
d. Facilitate a meeting so nurses can articulate their values and concerns about a
competency program.
ANS: D
, The manager role involves guiding others through a set of derived practices that are
evidence-based and known to satisfy preestablished outcomes such as participation in
a competency program. This involves engagement of staff through sharing of concerns
and ideas. A close analysis of the IOM report and the summary of the PPACA suggests
that no health reform can unfold without active nursing engagement. Each document
emphasizes that nurses must lead, manage, and behave as active collaborators with
other members of the health team and with those being served.
REF: Page 3 TOP: AONE competency: Communication and Relationship-Building
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?
a. The training modules are left in the staff room for times when staff are available.
b. The current approach is continued because it is also evidence-based and is more
familiar to staff.
c. You decide to implement the approach at a later date because of feedback from the
RNs that the new approach takes too much time.
d. A RN who is already familiar with the new approach volunteers to take the lead in
mentoring and teaching others how to implement it.
ANS: D
Followership occurs when there is acquiescence to a peer who is leading in a setting
where a team has gathered to ensure the best clinical decision making and actions are
taken to achieve clinical or organizational outcomes. Followership promotes good
clinical decisions and use of clinical resources.
REF: Page 4 | Page 5
TOP: AONE competency: Communication and Relationship-Building
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:
a. Is correct. Leadership is not the role of the staff nurse.
b. Would benefit from further understanding of her role as a professional, whose
influence may affect the decision making of patients, colleagues, and other
professionals.
c. Has been influenced by nurse leaders and managers who leave for other positions.
d. Is related to the general perception that nurse leaders and managers are not satisfied
in their jobs. ANS: B
Care coordination that involves the intersection of individual, family, and community-
based needs requires that nurses have self-confidence, knowledge of organizations and
health systems, and an inner desire to lead and manage. There is often a view that
leadership is isolated to those holding managerial positions and that a direct care nurse
is subject to following by adhering to the direction of others. Such views fail to
acknowledge that to be a nurse requires each licensed individual to lead, manage, and
follow when practicing at the point-of-care and beyond.
REF: Page 3 | Page 4 TOP: AONE competency: Leadership
12.You walk into Mr. Smith’s 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. Smith’s behavior was aggressive
