Exam 4- Leadership,
a. "It is a nurse's professional responsibility to maintain quality control."
b. "All instances of clinical incompetence are to be reported."
c. "It is not considered being disloyal when one nurse reports another for poor care."
d. "Patient care is the number one concern. Meeting standards is mandatory and necessary."
The nurse leader must remind employees that professional responsibility is to maintain quality
care, and thus they are obligated to report instances of clinical incompetence, even when it
means reporting a co-worker. Ignoring safety violations or poor practice is unprofessional and
jeopardizes patient care. - ANS-1. Clinical incompetence is one of the more serious problems
facing a nurse manager. Joyce, the nurse manager, is not aware of the problems of Sarah, a
novice nurse. After she investigates, it is obvious that Sarah's peers are covering for her. Which
of the following might Joyce include in her meeting with the nurses? (Select all that apply.)
a. "It is a nurse's professional responsibility to maintain quality control."
b. "All instances of clinical incompetence are to be reported."
c. "It is not considered being disloyal when one nurse reports another for poor care."
d. "Patient care is the number one concern. Meeting standards is mandatory and necessary."
A. "It is frustrating to wait when you are in pain and when you are expecting to receive relief
right away."
Empathizing helps the other person to know and feel that he has been understood and is
powerful in de-escalating a situation that has potential for aggression and violence. - ANS-9. In
the Emergency Department waiting room, you notice a patient sitting, with his head in his
hands, who has been waiting for about 5 hours for relief of his headache. When you approach
him to ask him how he is doing, he says, "I can't believe that I have to wait this long for help! Do
you know what it is like to be in pain for 10 hours?" Your response to him would be:
a. "It is frustrating to wait when you are in pain and when you are expecting to receive relief right
away."
b. "Don't talk to me. If you are going to be rude, then you will not receive treatment here."
c. "We are very busy and don't have enough staff to deal with problems such as yours."
d. "Perhaps you should go elsewhere. We do not have time for you here, as many more sick
patients are waiting."
A. A private meeting with Gregory, a Human Resources representative, and you to deliver the
news and deliver the termination notice and all other documents that are related.
,Termination requires careful planning as to timing, privacy, safety, and how to preserve the
employee's dignity and avoid humiliation. Choosing a private location where colleagues are not
present, and organizing all documentation that is required to be given to Gregory, achieves
these goals and prevents his having to come to the organization at a future date. - ANS-2. You
need to terminate Gregory, who has had a long-standing history of conflict with you and the
staff, and who recently was charged with theft of patient belongings. You consult Human
Resources, and together, you develop a plan, which includes:
a. A private meeting with Gregory, a Human Resources representative, and you to deliver the
news and deliver the termination notice and all other documents that are related.
b. Planning an opportunity for Gregory to return and be recognized at a staff farewell.
c. Calling Gregory at home to tell him that he is fired and that his paperwork will be sent to him
at a future date.
d. Calling him into a meeting in your office on the ward, where assistance is available, should he
become upset or agitated.
A. Active listening and feedback
Active listening is a skill in listening in which one listens with the full intention of understanding
what is being communicated, listening to the degree that you are able to repeat exactly what
was said. Feedback helps to verify that the message you received was the one that was sent.
Paraphrasing and restating the message are important feedback skills ("What you meant
was...."). - ANS-The nurse educator was giving a workshop on team building. She noted that
effective communication is essential for team building. One of the key questions in the workshop
was, "What is the best way to check to see if what you have communicated to a team member
is understood the way you meant it to be understood?" The correct response is which of the
following options?
a. Active listening and feedback
b. Cues from nonverbal communications
c. Content and context clues
d. Reliance on paralanguage
A. allows nurses who meet specific criteria to continue to work. - ANS-An
alternative-to-discipline program (ADP):
A. allows nurses who meet specific criteria to continue to work.
B. requires that nurses change shifts.
C. has a longer investigation time compared to traditional discipline.
D. takes a punitive approach.
A. An adversarial relationship.
Collective bargaining encompasses management support of labor's initiative, a spirit of trust
between labor and management, and resolution of problems, and replaces the adversarial
,approach that has been associated with traditional trade unions. - ANS-The emergency
department staff decides to use a collective bargaining model for negotiation, rather than a
traditional trade union model. A traditional trade union model is characterized by:
a. An adversarial relationship.
b. Management support of labor's initiatives.
c. A spirit of trust between management and labor.
d. An ability to resolve complaints.
A. An autocratic perspective
A team approach involves collaboration, which is not the approach that an autocratic leader
would typically use. If team members work in an authoritarian environment, they may be
hesitant to make decisions for themselves and may fully depend upon the authoritarian leader. -
ANS-Which of the following would not be a characteristic of an effective team nurse leader?
a. An autocratic perspective
b. Excellent communication skills
c. Awareness of everyone's abilities
d. A genuine interest in team members
A. Assess your situation and your surroundings.
The behavior of the individual (flushed appearance, furtive glances, speed of speech) and the
hand in his pocket suggest the potential for violence or aggression. The first step is to quickly
assess your surroundings for others who might assist and for safety alarms. - ANS-10. At 3 AM,
a man walks into your emergency department. He paces back and forth in the waiting area
before he approaches staff to ask if he can see his wife, who is a patient on another floor. He
speaks rapidly, his face is flushed, he glances around often, and he keeps his hand in his jacket
pocket. A best initial response would be to:
a. Assess your situation and your surroundings.
b. Ask two or three staff to assist in confronting the individual.
c. Ask what floor his wife is on and remind him that visiting hours are closed.
d. Remain calm as there is no potential for violence here.
A. Authority
Authority refers to the use of professional status and power to act in the patient's best interests.
In this example, Sarah is using her professional status and power to set up a conference in
which her patient, the prescribing physician, and she can discuss what is not working for the
patient and potential options. - ANS-Sarah determines, in partnership with her patient, that
current medications are not enabling her patient, a married account executive with fibromyalgia,
to continue with her employment and family responsibilities. After searching for additional
, information on fibromyalgia, Sarah finds nonpharmacologic interventions that are supported
through credible evidence. Sarah suggests that the patient, her physician, and she meet to
discuss the medications and possible options and a plan of care for the patient's discharge. This
action exemplifies which of the four historical concepts identified by Lewis and Batey?
a. Authority
b. Responsibility
c. Communication of conflict
d. Autonomy
A. Autonomy.
In this situation, Sandra is exemplifying autonomy, which is the act of making independent
decisions in the best interests of the patient, based on her knowledge and experience. This is
analogous to the example in the text where the workers on the manufacturing floor have the
independence to say "Stop the line" when something is wrong. Key to the concept of autonomy
is decision making and the level of independence that is given. Accountability refers to
achievement of outcomes, and authority refers to the capacity to make decisions. -
ANS-Sandra, an RN on the surgery unit, is assisting with a procedure in the patient examination
room. The physician orders a medication to be given through IV. Sandra questions the order,
based on her knowledge of the patient's history and of other medications that the patient has
been given. The physician reiterates the order and Sandra refuses to give it. In this instance,
Sandra is demonstrating:
a. Autonomy.
b. Accountability.
c. Authority.
d. Best practice.
A. Becky
Healthcare workers, especially nurses, experience a disproportionately high rate of violence,
compared to personnel in other industries. Nurses are the primary target of violence in
healthcare settings, especially those who work in emergency room, mental health, and
geriatrics. Hader (2008) found that nurses experienced their colleagues as primary targets of
violence 79.7% of the time. - ANS-19. Becky, RN, works as a staff nurse in mental health;
Sharon works as a data entry clerk in Admissions; Sarah is an emergency room physician; and
Donna is a housekeeper in geriatrics. Which of these four is most at risk for violence and
aggression?
a. Becky
b. Sarah
c. Sharon
d. Donna
a. "It is a nurse's professional responsibility to maintain quality control."
b. "All instances of clinical incompetence are to be reported."
c. "It is not considered being disloyal when one nurse reports another for poor care."
d. "Patient care is the number one concern. Meeting standards is mandatory and necessary."
The nurse leader must remind employees that professional responsibility is to maintain quality
care, and thus they are obligated to report instances of clinical incompetence, even when it
means reporting a co-worker. Ignoring safety violations or poor practice is unprofessional and
jeopardizes patient care. - ANS-1. Clinical incompetence is one of the more serious problems
facing a nurse manager. Joyce, the nurse manager, is not aware of the problems of Sarah, a
novice nurse. After she investigates, it is obvious that Sarah's peers are covering for her. Which
of the following might Joyce include in her meeting with the nurses? (Select all that apply.)
a. "It is a nurse's professional responsibility to maintain quality control."
b. "All instances of clinical incompetence are to be reported."
c. "It is not considered being disloyal when one nurse reports another for poor care."
d. "Patient care is the number one concern. Meeting standards is mandatory and necessary."
A. "It is frustrating to wait when you are in pain and when you are expecting to receive relief
right away."
Empathizing helps the other person to know and feel that he has been understood and is
powerful in de-escalating a situation that has potential for aggression and violence. - ANS-9. In
the Emergency Department waiting room, you notice a patient sitting, with his head in his
hands, who has been waiting for about 5 hours for relief of his headache. When you approach
him to ask him how he is doing, he says, "I can't believe that I have to wait this long for help! Do
you know what it is like to be in pain for 10 hours?" Your response to him would be:
a. "It is frustrating to wait when you are in pain and when you are expecting to receive relief right
away."
b. "Don't talk to me. If you are going to be rude, then you will not receive treatment here."
c. "We are very busy and don't have enough staff to deal with problems such as yours."
d. "Perhaps you should go elsewhere. We do not have time for you here, as many more sick
patients are waiting."
A. A private meeting with Gregory, a Human Resources representative, and you to deliver the
news and deliver the termination notice and all other documents that are related.
,Termination requires careful planning as to timing, privacy, safety, and how to preserve the
employee's dignity and avoid humiliation. Choosing a private location where colleagues are not
present, and organizing all documentation that is required to be given to Gregory, achieves
these goals and prevents his having to come to the organization at a future date. - ANS-2. You
need to terminate Gregory, who has had a long-standing history of conflict with you and the
staff, and who recently was charged with theft of patient belongings. You consult Human
Resources, and together, you develop a plan, which includes:
a. A private meeting with Gregory, a Human Resources representative, and you to deliver the
news and deliver the termination notice and all other documents that are related.
b. Planning an opportunity for Gregory to return and be recognized at a staff farewell.
c. Calling Gregory at home to tell him that he is fired and that his paperwork will be sent to him
at a future date.
d. Calling him into a meeting in your office on the ward, where assistance is available, should he
become upset or agitated.
A. Active listening and feedback
Active listening is a skill in listening in which one listens with the full intention of understanding
what is being communicated, listening to the degree that you are able to repeat exactly what
was said. Feedback helps to verify that the message you received was the one that was sent.
Paraphrasing and restating the message are important feedback skills ("What you meant
was...."). - ANS-The nurse educator was giving a workshop on team building. She noted that
effective communication is essential for team building. One of the key questions in the workshop
was, "What is the best way to check to see if what you have communicated to a team member
is understood the way you meant it to be understood?" The correct response is which of the
following options?
a. Active listening and feedback
b. Cues from nonverbal communications
c. Content and context clues
d. Reliance on paralanguage
A. allows nurses who meet specific criteria to continue to work. - ANS-An
alternative-to-discipline program (ADP):
A. allows nurses who meet specific criteria to continue to work.
B. requires that nurses change shifts.
C. has a longer investigation time compared to traditional discipline.
D. takes a punitive approach.
A. An adversarial relationship.
Collective bargaining encompasses management support of labor's initiative, a spirit of trust
between labor and management, and resolution of problems, and replaces the adversarial
,approach that has been associated with traditional trade unions. - ANS-The emergency
department staff decides to use a collective bargaining model for negotiation, rather than a
traditional trade union model. A traditional trade union model is characterized by:
a. An adversarial relationship.
b. Management support of labor's initiatives.
c. A spirit of trust between management and labor.
d. An ability to resolve complaints.
A. An autocratic perspective
A team approach involves collaboration, which is not the approach that an autocratic leader
would typically use. If team members work in an authoritarian environment, they may be
hesitant to make decisions for themselves and may fully depend upon the authoritarian leader. -
ANS-Which of the following would not be a characteristic of an effective team nurse leader?
a. An autocratic perspective
b. Excellent communication skills
c. Awareness of everyone's abilities
d. A genuine interest in team members
A. Assess your situation and your surroundings.
The behavior of the individual (flushed appearance, furtive glances, speed of speech) and the
hand in his pocket suggest the potential for violence or aggression. The first step is to quickly
assess your surroundings for others who might assist and for safety alarms. - ANS-10. At 3 AM,
a man walks into your emergency department. He paces back and forth in the waiting area
before he approaches staff to ask if he can see his wife, who is a patient on another floor. He
speaks rapidly, his face is flushed, he glances around often, and he keeps his hand in his jacket
pocket. A best initial response would be to:
a. Assess your situation and your surroundings.
b. Ask two or three staff to assist in confronting the individual.
c. Ask what floor his wife is on and remind him that visiting hours are closed.
d. Remain calm as there is no potential for violence here.
A. Authority
Authority refers to the use of professional status and power to act in the patient's best interests.
In this example, Sarah is using her professional status and power to set up a conference in
which her patient, the prescribing physician, and she can discuss what is not working for the
patient and potential options. - ANS-Sarah determines, in partnership with her patient, that
current medications are not enabling her patient, a married account executive with fibromyalgia,
to continue with her employment and family responsibilities. After searching for additional
, information on fibromyalgia, Sarah finds nonpharmacologic interventions that are supported
through credible evidence. Sarah suggests that the patient, her physician, and she meet to
discuss the medications and possible options and a plan of care for the patient's discharge. This
action exemplifies which of the four historical concepts identified by Lewis and Batey?
a. Authority
b. Responsibility
c. Communication of conflict
d. Autonomy
A. Autonomy.
In this situation, Sandra is exemplifying autonomy, which is the act of making independent
decisions in the best interests of the patient, based on her knowledge and experience. This is
analogous to the example in the text where the workers on the manufacturing floor have the
independence to say "Stop the line" when something is wrong. Key to the concept of autonomy
is decision making and the level of independence that is given. Accountability refers to
achievement of outcomes, and authority refers to the capacity to make decisions. -
ANS-Sandra, an RN on the surgery unit, is assisting with a procedure in the patient examination
room. The physician orders a medication to be given through IV. Sandra questions the order,
based on her knowledge of the patient's history and of other medications that the patient has
been given. The physician reiterates the order and Sandra refuses to give it. In this instance,
Sandra is demonstrating:
a. Autonomy.
b. Accountability.
c. Authority.
d. Best practice.
A. Becky
Healthcare workers, especially nurses, experience a disproportionately high rate of violence,
compared to personnel in other industries. Nurses are the primary target of violence in
healthcare settings, especially those who work in emergency room, mental health, and
geriatrics. Hader (2008) found that nurses experienced their colleagues as primary targets of
violence 79.7% of the time. - ANS-19. Becky, RN, works as a staff nurse in mental health;
Sharon works as a data entry clerk in Admissions; Sarah is an emergency room physician; and
Donna is a housekeeper in geriatrics. Which of these four is most at risk for violence and
aggression?
a. Becky
b. Sarah
c. Sharon
d. Donna
