leadership exam 3 combo

227 flashcards

In an ICU, you order new devices to measure heart rhythm and rate, respiratory rate, oxygen levels, and intracranial pressure. These devices involve:: a. biomedical technology.
Because it is not possible to visit Mrs. Baker in person every day and see all of the other clients, the nurse gives her a laptop computer with net meeting software installed. Each morning, both dial in at an agreed-upon time and discuss her progress. This type of technology is called:: telecommunications
A nurse manager was orienting new staff members to computerized charting. To understand computerized charting, staff members must understand informatics. The three core concepts in informatics are:: Data, information, and knowledge
Nurses need to know how to operate a computer, compare data across time, and look for patterns in client responses to treatments. These are examples of:: Informatics competencies
As the head nurse involved in leading determination of which patient surveillance systems to acquire for your unit, one of your aims is to avoid adverse events through the implementation of appropriate technology. This particular aim recognizes that:: Physiologic monitoring systems enable detection of early changes before an adverse event occurs.
Leaders in nursing must advocate for information and knowledge systems that support nursing practice. This is best accomplished by:: Participating in organizational information technology committees.
As artificial intelligence devices emerge, it is important that at least a core of nurses engaged in the work that leads to improvement of AI-related devices to ensure that:: d. they can contact the manufacture about complaints.
The nurse in a large hospital working in the emergency room is caring for a patient having a myocardial infarction. The hospital has recently implemented an order entry system that uses artificial intelligence (AI). The nurse should be aware that AI should never take the place of:: a. knowledge and wisdom.
Medication errors which directly resulted from the redevelopment of processes and workflow brought about by the implementation of BCMA are considered:: a. unintended consequences related to technology.
The cascading continuum that is extremely important when exploring digital health technology, especially with some of the modern technologies present today is:: a. data-information-knowledge-wisdom
The term data refers to the smallest unit of insight, commonly presented without background context, and possesses little meaning in isolation:: a. data.
Information that could be conceived as data that has been further contextualized to possess meaning, ―data plus meaning‖, is:: b. information
Information that has been synthesized so that relationships are identified and formalized‖ is referred to as:: c. knowledge.
Actualized knowledge that uses insight to ―manage and solve human problems‖ is:: d. wisdom.
After a major flu vaccination campaign, an agency bills a private insurance company for allowable costs for administration of each vaccination according to the schedule established by the insurance company for reimbursement. This is an example of which major payment method?: Cost-based reimbursement
The chief nursing office continues to seek ways to improve healthcare services to clients and to save the hospital money. Capitation provides incentives for healthcare providers to control costs by:: Using fewer services per client
During the budgeting process, nurse managers are typically responsible for which of the following? (Select all that apply.): 1. Developing unit operation objectives 2. Justifying capital equipment requests 3. Negotiating budget with other managers and administration
The chief nursing officer works with her nurse managers by helping them understand how to develop and implement a budget. A nurse manager can best describe a budget as a:: Financial plan.
In preparing her budget, a nurse manager determines that she needs to budget for six FTE RN positions in the upcoming year. Based on a 40-hour week, this means that the nurse manager has determined that the budget will provide for _____ hours.: 12,480 paid
A staff nurse regularly works two 12-hour shifts each week and one 8-hour shift every other week. How many FTEs is this position?: 0.7
Because of the complexity of reimbursement systems and its implications for the services available to patients, the nurse has a key role in:: Advocacy for patients with regard to services required and services utilized.
Of the following, which is the most effective strategy that a nurse manager could employ to reduce unnecessary costs in specific healthcare settings?: Training nurses on accurate documentation of supplies used for patient care.
In a nurse managers' meeting, the chief nursing officer encourages the managers to brainstorm ways to reduce costs. Nurse managers have the greatest impact on reducing costs by managing:: Staffing.
An example of an initiative that may reduce total healthcare costs would be:: Offering nurse practitioner-led clinics that educate parents about nonpharmacologic strategies for managing ear infections.
As a manager, you are interested in developing behavioral questions for an interview. Knowing that there is team conflict at times on your unit, which of the following questions would satisfy your interest in behavioral questions?: c. "Tell me about a time you were involved in a conflict related to a project. What was your role in the conflict? In the resolution of the conflict?"
In determining the fit of a candidate with the culture on your unit, which of the following interview questions might be asked?: c. "We have a number of older adult patients on this unit. If you noticed another staff member addressing one of these patients impatiently, how would you respond?"
The biggest challenge in the recruitment of staff is:: a. Finding well-qualified candidates who can function well within your particular work culture.
The turnover rate for RNs in the ICU is high. You discuss this situation with existing staff, and you find out that because of the rapid turnover, new staff are frequently required to assume full responsibilities soon into the position and before training is completed. In considering approaches that will reduce turnover rates, the staff and you decide to implement:: d. A committed orientation and training program.
The nurse manager schedules evaluations of staff members using a newly developed performance appraisal tool. The development of a performance appraisal tool should include:: a. Organizational mission, philosophy, and position requirements.
Sue, a nurse manager, discusses her concerns about the hospital's employee appraisal system with her work group, noting that it includes only one rating scale and that it means nothing unless the manager has effective relationship skills. Sue's concerns reflect which best practices associated with performance appraisal?: b. The effectiveness of appraisal is enhanced by a combination of methods and effective communication skills.
The most important approach that a nurse manager can take with an emotionally troubled employee is to:: c. assist the employee in obtaining professional help.
The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is that:: d. Unacceptable patient care may result.
The unit manager discusses absenteeism with the unit clerk. She indicates that it is a serious problem on the unit. Which of the following points would they have likely discussed? (Select all that apply.): b. Care will suffer, and standards will be lowered.
Before terminating an employee, a nurse manger must:: b. Know the organization's specific policies for addressing disciplinary problems and termination.
A nurse manager must be familiar with the agency's policies regarding termination. Termination procedures include which of the following?: c. Having adequate written documentation to support the action
Nathan has been on the cardiac unit for 6 months and has found it difficult to adjust to the expectations of his team. Which of the following behaviors would most likely signal that Nathan is intending to resign from his position on the unit?: a. Increased absenteeism over the past month
The chief nursing officer understands that clinical incompetence is best prevented by a:: d. Formalized competency program with established standards for practice.
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.): ALL THE ABOVE
The chief nursing officer develops a mentoring program to help new staff members adjust to their new jobs. The main purpose of mentoring is:: a. Promoting staff retention.
Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. Sarah finds a mentor, Amy, who has been in the role of unit manager for 3 years and has a similar interest in clinical excellence. During their frequent meetings, Amy provides assistance with learning aspects of the manager's role, including technical aspects, such as how to interpret budget printouts and to achieve budget outcomes. The success of Amy's coaching depends on:: d. Willingness of Sarah to receive feedback.
The unit leader on an inpatient psychiatric unit of a large hospital has been in the position for 3 months. The unit leader is frustrated by how little time is available to work with clients and how few changes have been implemented in that time. The phase of role transition being experienced is the role of:: c. Discrepancy.
After several months in the role of manager of a dialysis unit, Maryanne finds herself still questioning the gap in expectations between her and her staff and management and is also questioning if she can reconcile her concerns about quality care with the strong cost containment orientation of the facility. At this point, Maryanne is in which stage of role transition?: d. Discrepancy
An interviewee for a nurse manager position asks for a copy of the organizational chart. Organizational charts provide information about the role component of:: d. Lines of communication.
During an employment interview for the manager's position in a home health agency, the applicant asks questions about the medical director and about retention of staff. The nurse executive assures the applicant that the agency has few personnel problems and receives excellent support from the medical director. The applicant knows that the agency has a 50% turnover rate and has had three medical directors in the past year. The nurse executive is:: d. Minimizing the challenges of the position to make a positive impression on the applicant.
As a new manager, you reflect on what professional development would be most valuable to assist you in taking on this role. Which of the following would you most likely identify?: b. A workshop on conflict management and communication skills.
The department manager makes a list of interview questions for a new position. Which of the following questions are inappropriate?: b. Do you have any disabilities we need to know about?
A cover letter should be included with your resume when applying for a position. A cover letter is the key to:: a. getting your resume read and into the interview process
A new graduate is seeking a position in nursing and wants to ―sell‖ herself effectively. The best strategy is to:: a. create a résumé.
A functional résumé focuses on:: a. experience and skills gained in positions.
A unit manager recently graduated as a clinical nurse specialist with a focus ingerontology. She applied to take a certification exam. Certification is designed to recognize:: c. special knowledge beyond basic licensure.
An example of a career is: (Select all that apply.): c. continuous employment in the same position and the same arrangement for 20 years. d. moving into and out of nursing positions in various cities while pursuing travel and education that develop understanding of global health.
The hospital administrator approves a case management position for a new rehabilitation unit to help reduce costs. In developing the job description, the nurse manager understands that a key element of case management is:: b. coordination of resources for effective outcomes.
Nurses in the CCU are unhappy and frustrated with their nurse manager. They complain that ―nothing is ever good enough for him. These statements suggest that the nurse manager's goals may be:: b. unrealistic.
The director of nursing has been observing staff interactions in a 20-bed coronary care unit. Based on her observations, which of the following staff members is an obvious leader?: d. The staff nurse who persuades other staff members to practice by making evidence-based decisions
While interviewing for a nurse manager position, Ann is asked to give an example of a situation in which she demonstrated leadership. Which of the following examples exemplifies leadership?: a. Through research and investigation of best practice and practice-based evidence, she proposed a change in the management of incontinence in older adult patients.
Budgeting and protection of revenues is a function of:: b. management.
In developing an orientation program, the hospital educator breaks essential organizational information down into chunks, which she develops as online modules. This is an application of which of Drucker's functions of management?: d. Organization of activities into manageable tasks
In an ICU, you order new devices to measure heart rhythm and rate, respiratory rate, oxygen levels, and intracranial pressure. These devices involve: A. biomedical technology. B. telecommunications. C. retrieval of patient history information. D. Internet.: ANS: A
Medication errors that directly resulted from the redevelopment of processes and workflow brought about by the implementation of BCMA are considered: A. intended response to change. B. reasons to return to paper-based medication administration processes. C. unintended consequences related to technology. D. an expected response to technology-based nursing.: ANS: C
The chief nursing officer works with her nurse managers by helping them understand how to develop and implement a budget. A nurse manager can best describe a budget as a: A. day-to-day plan for operations. B. unit of service. C. statement of revenues and services. D. financial plan.: ANS: D
As a manager, you are interested in developing behavioral questions for an interview. Knowing that there is team conflict at times on your unit, which of the following questions would satisfy your interest in behavioral questions? A. "If you were to employ one strategy for managing conflict, what would it be?" B. "What is your preferred style of conflict resolution?" C. "Tell me about a time you were involved in a conflict related to a project. What was your role in the conflict? In the resolution of the conflict?" D. "How effective are you in working in a group? In dealing with conflict?": ANS: C
The most important approach that a nurse manager can take with an emotionally troubled employee is to: A. act as a therapist for the employee. B. adjust the standard of care to assist the employee. C. assist the employee in obtaining professional help. D. adjust the employee's work schedule to decrease stress.: ANS: C
The unit leader on a psychiatric unit of a large hospital has been in the position for 3 months. The unit leader is frustrated by how little time is available to work with clients and how few changes have been implemented in that time. The phase of role transition being experienced is the role of: A. acceptance. B. negotiation. C. discrepancy. D. internalization.: ANS: C
The department manager makes a list of interview questions for a new position. Which of the following questions are inappropriate? A. What are your short-term and long-term goals? B. Do you have any disabilities we need to know about? C. Will you be able to meet our attendance expectations? D. Do you understand our philosophy and mission?: ANS: B
The director of nursing has been observing staff interactions in a 20-bed coronary care unit. Based on her observations, which of the following staff members is an obvious leader? A. The unit secretary who knows everyone's business B. The CNO who is in charge and is responsible for nursing services C. The chief cardiologist who admits the largest number of patients and brings in more revenue than any other physician D. The staff nurse who persuades other staff members to practice by making evidence-based decisions: ANS: D
A nurse manager was orienting new staff members to computerized charting. To understand computerized charting, staff members must understand informatics. The three core concepts in informatics are: A. hardware, software, and printers. B. data, information, and knowledge. C. decision making, data gathering, and reporting. D. wireless technology, voice recognition, and handheld devices.: ANS: B
The nursing manager of a surgical unit has been asked by administration to evaluate client outcomes post heart cath. Using data about client outcomes post heart cath for the past 6 months in order to modify practice is an example of: A. information. B. cost-effective care. C. meeting standards. D. evidence-based practice.: ANS: D
The clinic nurse has just accessed a client's chart on the computer. The resident comes over and asks her to stay logged on because he needs to add a note to that client's chart. She should say: a. No problem. Just log me off when you're done. b. I'll put the note in for you. What do you want to say? c. Just make sure that you sign your note because it's under my password. d. I'm sorry, but you will have to enter the information using your own password.: ANS: D
A home health nurse has been assigned to cover remote Montana. Mrs. Baker has just been discharged home following bowel surgery and has a new colostomy. She will need daily contacts for at least 2 weeks and then regular weekly contact following that week. Because it is not possible to visit Mrs. Baker in person every day and see all of the other clients, the nurse gives her a laptop computer with software installed. Each morning, both dial in and discuss her progress. The home health nurse assesses whether or not the client needs to be seen that day and is able to view the colostomy site. This type of technology is called: a. distance learning. b. knowledge software. c. telecommunications. d. biomedical technology.: ANS: C
Nurses need to know how to operate a computer, compare data across time, and look for patterns in client responses to treatments. These are examples of: a. JCAHO standards. b. information systems. c. informatics competencies. d. requirements for nursing licensure.: ANS: C
As the head nurse involved in leading determination of which patient surveillance systems to acquire for your unit, one of your aims is to avoid adverse events through the implementation of appropriate technology. This particular aim recognizes that: a. human error is significant in contributing to adverse events. b. documentation of patient data is often illegible and therefore, misinterpreted. c. data systems provide backup documentation with adverse events that staff cannot provide. d. physiologic monitoring systems enable detection of early changes before an adverse event occurs.: ANS: D
Leaders in nursing must advocate for information and knowledge systems that support nursing practice. This is best accomplished by: a. participating in organizational information technology committees. b. submitting written requests for needed information systems. c. requesting budgetary funds needed for systems. d. sending staff nurses to conferences that discuss cutting-edge technologies.: ANS: A
When assessing the appropriateness of adopting WL COWs for a nursing unit, you need to consider the advantages, which include: a. mobility of the carts. b. small display screen. c. font size. d. speed of operation.: ANS: A
Nurses need to prepare for the eventual infusion of systems that possess knowledge-generating capabilities such: a. artificial intelligence. b. data, information, and knowledge. c. contemporary digital health technologies. d. wireless technology, voice recognition, and handheld devices.: ANS: A
Technology can influence human social systems and humans can reciprocally influence technology. This relationship is known as: a. knowledge. b. informatics. c. wisdom. d. sociotechnical: ANS: B
The cascading continuum that is extremely important when exploring digital health technology, especially with some of the modern technologies present today is: a. data-information-knowledge-wisdom b. tools-technology-intelligence-response c. illness-symptoms-treatment-nursing care d. automation-task-ability-hybridized: ANS: A
The nurse can identify various apparatuses, processes, or systems that have experienced some form of automation. Tasks and processes undertaken by nurses that introduce some level of automation include: a. electronic medical records (EMR). b. point-of-care devices. c. telecommunications. d. barcode medication administration (BCMA).: ANS: C
The nurse in a large hospital working in the emergency room is caring for a patient having a MI. The hospital has recently implemented an order entry system that uses Al. The nurse should be aware that AI should never take the place of: a. knowledge and wisdom. b. nurses notes. c. nursing experience. d. tasks and procedures.: ANS: A
Values that could be conceived as data that has been further contextualized to possess meaning is: a. data. b. information. c. knowledge. d. wisdom: ANS: B
Information that has been synthesized so that relationships are identified and formalized is referred to as: a. data. b. information. c. knowledge. d. wisdom.: ANS: C
Actualized knowledge that uses insight to manage and solve human problems is: a. data. b. information. c. knowledge. d. wisdom.: ANS: D
The use of AI in healthcare is to help nurses: a. see more patients in a shorter amount of time. b. decrease the need for nurses to further their education c. provide data to assist the nurses to make decisions. d. make patient decisions: ANS: C
As a nurse manager, one challenge is to orient new staff to your agency's policies and procedures, as well as to provide training across various shifts. A cost-effective and effective learning strategy would be: A. development of new learning modules and software to support document retrieval. B. e-mail distribution to staff home e-mail addresses regarding important policies. C. preparation of DVDs that can be viewed on computers at the nursing station during down times. D. linking policies and procedures to the network for access when required at the point-of-care.: ANS: D
The chief nursing office of a Magnet® hospital has conducted a study of ways to improve healthcare services. Healthcare services that add value for clients: a. accomplish healthcare goals. b. minimize costs. c. decrease the number of services used. d. use high-technology treatments.: ANS: B
In a nurse managers' meeting, the chief nursing officer encourages the managers to brainstorm ways to reduce costs. Nurse managers have the greatest impact on reducing costs by managing: a. supplies. b. staffing. c. fixed costs. d. medication costs.: ANS: B
A nurse manager approves two staff nurses to attend a national conference. When reviewing the budget, the nurse manager looks at which line item? a. Cash budget b. Capital budget c. Operating budget d. Supply and expense budget: ANS: C
An example of an initiative that may reduce total healthcare costs would be: A. offering nurse practitioner-led clinics that educate parents about nonpharmacologic strategies for managing ear infections. B. educating seniors about the comparative costs of medications that are prescribed to them. C. lowering copayments for prescription drugs for seniors. D. advocating for more readily available MRI services to ensure early diagnosis.: ANS: A
Which of the following factors is not implicated in rising healthcare costs? a. Rising expectations of consumers for cure and care b. Marketing of drugs to consumers c. Large administrative staffs to process medical billings d. Rising Medicare costs: ANS: D
Within a healthcare environment, where the gap between revenues and costs can mean the difference between sustainability of an organization and nonsustainability of an organization or services, it is critical for nurse managers to: a. maintain a clear vision of how to trim healthcare costs. b. balance value-added services against costs and revenues. c. consistently delete programs that are of high cost. d. implement programs that bring in additional revenues.: ANS: B
Because of the complexity of reimbursement systems and its implications for the services available to patients, the nurse has a key role in: a. advocacy for patients with regard to services required and services utilized. b. increasing the volume of services and decreasing the number of patients served. c. accomplishing more with each visit and decreasing the volume of services used. d. decreasing the volume of services used and the number of return visits.: ANS: A
Of the following, which is the most effective strategy that a nurse manager could employ to reduce unnecessary costs in specific healthcare settings? a. Training nurses on accurate documentation of supplies used for patient care b. Reducing the number of overtime hours worked by staff c. Reducing the number of staff on a unit d. Making decisions for patients about which care is important to their health: ANS: A
In preparing her budget, a nurse manager determines that she needs to budget for six full time RN positions in the upcoming year. Based on a 40-hour week, this means that the nurse manager has determined that the budget will provide for ___ hours. a. 12,480 productive b. 10,820 productive c. 12,480 paid d. 10,800 patient care: ANS: C
A nurse manager is planning to request three new infusion pumps at a cost of approximately $1500 each. This item would typically be included in which budget? a. operating b. strategic c. unit of service d. capital: ANS: D
As an experienced nurse manager who is new to an organization, it would be important to: a. know the difference between operating and capital budgets. b. understand the budget timetable and level of involvement expected of individual managers in budget preparation. c. know why a budget is essential to the well-being of an organization. d. understand what factors drive up healthcare costs in the healthcare system.: ANS: B
The nurse manager schedules evaluations of staff members using a newly developed performance appraisal tool. The development of a performance appraisal tool should include: a. organizational mission, philosophy, and position requirements. b. a generalized overview of the duties of a position c. a skills checklist and accreditation requirements. d. an ordinal scale that ranks all employees.: ANS: A
As part of orientation to your unit, you decide to assign the new nurse to a preceptor. The most likely reason for your decision is that the use of preceptors: a. reduces the cost of orientation. b. determines if there is fit between learner and organizational values. c. develops the strengths of the new staff member. d. can impact the retention rate.: ANS: D
In determining the fit of a candidate with the culture on your unit, which of the following interview questions might be asked? a. Could you review your résumé for us, highlighting your certifications and experience b. If we were to ask your references, what would they list as your strengths? weaknesses?| c. We have a number of older adult patients on this unit. If you noticed another staff member addressing one of these patients impatiently, how would you respond?! d. Tell us about your work and academic experiences and qualifications.: ANS: C
The biggest challenge in the recruitment of staff is: a. finding well-qualified candidates who can function well within your particular work culture. b. recruiting individuals with the appropriate qualifications and experience. c. screening out candidates who are unable to function well within a team. d. determining if candidates have had previous negative experiences in a work environment.: ANS: A
The turnover rate for RNs in the ICU is high. You discuss this situation with existing staff and you find out that because of the rapid turnover, new staff are frequently required to assume full responsibilities soon into the position and before training is completed. In considering approaches that will reduce turnover rates, the staff and you decide to implement: a. an employee recognition program. b. coaching for new staff. c. a new performance appraisal system. d. a committed orientation and training program.: ANS: D
Sue, a nurse manager, discusses her concerns about the hospital's employee appraisal system with her work group, noting that it includes only one rating scale and that it means nothing unless the manager has effective relationship skills. Sue's concerns reflect which best practices associated with performance appraisal? a. Rating scales are too generalized to be considered valid or reliable. b. The effectiveness of appraisal is enhanced by a combination of methods and effective communication skills. c. BARS is considered superior to simple rating scales in terms of performance appraisal. d. Rating scales need to be designed by users to be well accepted.: ANS: B
During a performance appraisal, Joanne, the nurse manager, indicates that Alysha has difficulty mentoring students on the unit. Alysha responds that this is not her responsibility. In responding to Alysha, Joanne needs to consider: a. Alysha's level of confidence. b. whether mentoring is included in the position description. c. whether mentoring is an essential component of the position description. d. whether mentoring can be accurately observed and measured.: ANS: B
The final section of a performance appraisal is a rating scale. This scale is very detailed and relates to competency standards specific to surgical clients. The scale is a summary of performance directly observed or documentation reviewed and is specific to client care situations in which the employee has been involved. This type of evaluation is most commonly known as: a. a traditional rating scale. b. management by objectives/learning goals. c. a forced distribution scale. d. a behaviorally anchored rating scale.: ANS: D
An outpatient clinic advertised for RN positions. Before authorizing an open position, the nurse manager should: a. review the position description and performance expectations for the opening. b. place an ad in the local newspaper and on the telephone job line. c. review all current applications on file. d. look for employees within the system who might best fill the position.: ANS: A
The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is that: a. using replacement personnel with new ideas may be beneficial. b. salary costs are lower because personnel are fewer, and outcome is favorable. c. absence on the part of the rest of the staff is decreased. d. unacceptable patient care may result.: ANS: D
Before terminating an employee, a nurse manager must: a. be an expert in all legal aspects of termination and discipline practices. b. follow the organization's specific policies for addressing disciplinary problems and termination. c. function as a counselor for problem employees. d. do everything to assist and protect the employee by adjusting standards and policies.: ANS: B
A nurse manager understands that the typical first step in handling an employee with a disciplinary problem is a: a. verbal reprimand. b. written reprimand. c. reminder of employment standards. d. day off without pay.: ANS: C
The chief nursing officer understands that clinical incompetence is best prevented by an: a. flexible protocol for evaluating competency skills. b. standardized clinical skills checklist. c. administration of personality tests and competency assessments at point of hire. d. formalized competency program with established standards for practice.: ANS: D
The chief nursing officer reviews the policy about progressive discipline process. The progressive discipline process includes which of the following? The manager: a. acts as a counselor and friend to the employee. b. should reprimand and suspend the employee as a last resort. c. should rehire the employee after a reasonable length of time. d. should terminate the employee if the problem persists.: ANS: D
A nurse manager must be familiar with the agency's policies regarding termination. Termination procedures include which of the following? a. Following specific procedures from other organizations b. Having an attorney present at the termination meeting c. Having adequate written documentation to support the action d. Having a friend present during the termination meeting: ANS: C
Nathan has been on the cardiac unit for 6 months and has found it difficult to adjust to the expectations of his team. Which of the following behaviors would most likely signal that Nathan is intending to resign from his position on the unit? a. Increased absenteeism over the past month b. Increased attempts to discuss his concerns with his colleagues c. Testing of workplace guidelines d. Frequent defensivenes: ANS: A
Susan, a new graduate, is upset that so many staff have been absent lately from the unit. She declares to you that all absenteeism could be eliminated with proper management. Your response is based on understanding that: a. not all absenteeism is voluntary. b. high personal control contributes to absenteeism. c. direct discussions with employees who have high levels of absenteeism are not recommended. d. all absenteeism is related to personal issues and needs.: ANS: A
An interviewee for a nurse manager position asks for a copy of the organizational chart. Organizational charts provide information about the role component of: a. expectations. b. opportunities. c. responsibilities. d. lines of communication: ANS: D
During an employment interview for the manager's position in a home health agency, the applicant asks questions about the medical director and about retention of staff. The nurse executive assures the applicant that the agency has few personnel problems and receives excellent support from the medical director. The applicant knows that the agency has a 50% turnover rate and has had three medical directors in the past year. The nurse executive is: a. unaware of the turnover rate and difficulties with the medical director. b. lying about the problems and hoping to resolve them by hiring the applicant. c. denying that the agency has a turnover problem with staff or medical directors d. minimizing the challenges of the position to make a positive impression on the applicant.: ANS: D
The new head nurse on telemetry has been in the position for 3 months. The head nurse and the administrator disagree on how much time the head nurse should allot to various aspects of the role. Staff members on the unit complain that the head nurse is unavailable for clinical concerns because of being off the unit while attending meetings. To facilitate the process of role transition, the head nurse should: a. develop policies consistent with the head nurse's prior workplace. b. attend a workshop on how to deal with difficult people. c. decide to give the position 3 more months and then leave if things do not improve. d. schedule a series of meetings with staff and the administrator to clarify expectations.: ANS: D
A nurse manager values a colleague who is a few years older and has more experience in nursing management. The colleague works in another hospital, but they meet for lunch once a month. In these meetings, they share their feelings about nursing management and their lives. The function of a mentor that is missing in the relationship is: a. sponsorship. b. role modeling. c. social interaction. d. mutual positive regard.: ANS: A
The chief nursing officer develops a mentoring program to help new staff members adjust to their new jobs. The main purpose of mentoring is: a. promoting staff retention. b. promoting staff attrition. c. developing new role expectations. d. promoting staff supervision.: ANS: A
A strategy that may help to make transition to a new management role and to respond to relationships and situations in the new position is: a. avoiding discussion of personal beliefs with staff until ready to do so. b. finding a network of clinicians with interests similar to their own. c. researching clinical literature to maintain clinical assessment skills for the unit. d. recognizing a strong commitment to care in the management process: ANS: D
In addition to providing coaching, a nurse mentor may provide counseling to the mentee. For counseling to be successful, the mentor must: a provide a quiet environment away from the unit. b. keep the focus on technical and management responsibilities. c. assure confidentiality. d. present assignments that stretch the intellectual and technical ability of the mentee.: ANS: C
A new nurse manager finds that she is now comfortable with the expectations of staff and her supervisor regarding her management role and responsibilities and has been able to effect a strong commitment to quality clinical care on the unit. At this point, she has likely attained this role: a. development. b. acceptance. c. symmetry. d. internalization.: ANS: D
As a new manager, you reflect on what professional development would be most valuable to assist you in taking on this role. Which of the following would you most likely identify? a. Opportunities to hone clinical skills that are used most often on the unit that you will manage b. A workshop on conflict management and communication skills c. Attendance at a conference on surobal heal thecae contanes d. Attendance at a workshop on survey tool development and statistical measurement: ANS: B
After several months in the role of manager of a dialysis unit, Maryanne finds herself still questioning the gap in expectations between her and her staff and management and is also questioning if she can reconcile her concerns about quality care with the strong cost-containment orientation of the facility. At this point, Maryanne is in which stage of role transition? a. Internalization b. Acceptance c. Development d. Discrepancy: ANS: D
Who of the following might be the most appropriate mentor for Becky, a new nurse manager on the cardiac unit who has 4 years of previous clinical experience? a. Sam, near retirement. He has 20 years of clinical nursing and recently assumed role of head nurse in an interim capacity because of the incumbent's illness. b. Leslie, who has been a clinical educator at the institution for a number of years. She has tired of her role and aspires to become a nurse manager. She looks at mentorship as an opportunity to understand the role better. c. Courtney, who has been a nurse manager for 3 years. Her staff and supervisor value her skills and her leadership acumen and championship of innovation. d. Ben, who was nurse manager for 3 years, soon after graduation. He left the role because he was uncomfortable with the expectations and has been a team leader on surgery for 15 years.: ANS: C
A cover letter should be included with your resume when applying for a position. A cover letter is the key to: a. getting your resume read and into the interview process b. asking questions about the position. c. listing all of the positions you have held in the past. d. revealing information about your personal life..: ANS: A
A new graduate is seeking a position in nursing and wants to -sell herself effectively. The best strategy is to: a. create a résumé. b. practice interviewing c. call the personnel offices d. create a curriculum vitae: ANS: A
According to the ANA, -systematic professional learning experiences designed to augment nurses' knowledge, skill, and attitudes, thereby enriching the nurses contributions to quality health care and their pursuit of professional career goals is known as: a. accreditation. b. endorsement. c. continuing education d. entrepreneurialship.: ANS: C
Thomas has been a nurse in your ICU for 10 years. In facilitating Thomas' professional development, the nurse manager would focus on: a. certification for the ICU environment b. discussions about how Thomas can fit with role expectations and relationships c. possible changes to other ICU environments. d. encouraging him to lead changes that leave long-term impacts after his retirement.: ANS: D
A unit manager recently graduated as a clinical nurse specialist with a focus in gerontology. She applied to take a certification exam. Certification is designed to recognize: a. basic knowledge in a specified area. b. advanced practice in functional roles. c. special knowledge beyond basic licensure. d. continued competence as a registered nurse.: ANS: C
A nurse is applying for a new position. This position is one in which she will serve as a liaison between a hospital and a school of nursing. The nurse must update her résumé to include her teaching experience. The goal of creating a curriculum vitae is to: a. have a listing of facts about your professional life. b. provide potential employers with information about where you are in your career. c. respond quickly whenever a position becomes available. d. be certain you can recall facts for a prospective position.: ANS: B
You are offered an opportunity to take a temporary leave from your position as a nurse manager to lead a technology implementation project. Which of the following reasons for accepting the opportunity is most consistent with developing a solid career path? a. You are pressured to do so by your supervisor. b. The organization has no other suitable candidate for the position. c. You have limited knowledge of information technology and no real interest, but this will increase your knowledge. d. Accepting a position outside of your established skill set may establish you organizationally as an innovative, adaptable leader.: ANS: D
The primary difference between a résumé and a CV is that a résumé: a. reflects your skills, knowledge, and background in relation to a specific position. b. offers a detailed listing of positions held and where positions were held. c. includes a long and detailed explanation of academic and work experience. d. provides contact information and focuses on your background, in general.: ANS: A
A functional résumé focuses on: a. experience and skills gained in positions. b. positions held and specific roles in the positions. c. academic qualifications and achievements. d. relating skills and experience to qualifications in a specific position.: ANS: A
Professional associations: a. set regulatory requirements and establish entry requirements for nursing. b. offer graduate programs for clinical and career advancement. c. provide opportunities for career networking and support. d. are open to all individuals who meet the criteria for membership.: ANS: C
The nurse manager, as the leader of the unit's customer (client) first, has asked the staff nurses to develop and administer a survey to every client before discharge. In asking the count to accomplish this task, the nurse manager is demonstrating a. accountability. b. shared leadership. c. a common purpose. d. independence in the nursing manager's role.: ANS: B
A nurse manager's responsibility for financial management involves making budgetary decisions. Budgets that allow the nurse manager to allocate resources at the unit level allow: a. minimal nurse manager input. b. limited rationale for budgetary requests. c. budgetary allocations at the executive nurse leve d. budgetary decision making at the point-of-service (POS: ANS: D
The hospital administrator approves a case management position for a new rehabilitation unit to help reduce costs. In developing the job description, the nurse manager understands that a key element of case management is: a. managing of care by nurse managers. b. coordination of resources for effective outcomes. c. rapid discharge of clients to decrease costs. d. managing of care for outpatient clients only.: ANS: B
Nurses in the CCU are unhappy and frustrated with their nurse manager. They complain that nothing is ever good enough for him. Il These statements suggest that the nurse manager's goals may be: a. measurable. b. unrealistic. c. attainable. d. too low.: ANS: B
Budgeting and protection of revenues is a function of: a. leadership. b. management. c. team leadership. d. followers.: ANS: B
As the clinical director of 24 employees, you have been asked to explain to staff members why they are not getting a raise this year, even though they have been working short-handed for many months and patient satisfaction scores have never been higher. Because you believe yourself to be a transformational leader, you will approach this problem by: a. telling the assistant clinical director and asking her to share the bad news with the other staff members. b. posting a note on the bulletin board that includes the phone number of the chief nursing officer, so anyone who has complaints may express them. c. showing staff members the budget and asking for input about how to cut costs so that raises will be possible in the future. d. meeting with a small group of seasoned staff members and asking them how to break the news.: ANS: C
Kari, a head nurse on the dialysis unit, has been informed during budget planning meetings that budget cuts are likely. She discusses this at the next unit meeting and tells staff members that unless they do their jobs well, their positions may be terminated, and there will be no replacement. Kari is enacting which management style? a. Transformational b. Transactional c. Trusting d. Truthful: ANS: B
The nurse manager plays a unique role in institutional management in that the nurse manager: a encourages shared decision making. b. models professional nursing behavior. c. interprets healthcare trends and their impact on revenues. d. coordinates care and allocates resources.: ANS: B
In developing an orientation program, the hospital educator breaks essential organizational information down into chunks, which she develops as online modules. This is an application of which of Drucker's functions of management? a. Establishment of goals and objectives b. Motivation and communication c. Analysis and interpretation of performance d. Organization of activities into manageable tasks: ANS: D
A nurse manager was orienting new staff members to computerized charting. To understand computerized charting, staff members must understand informatics. The three core concepts in informatics are: A) hardware, software, and printers. B) data, information, and knowledge. C) decision making, data gathering, and reporting. D) wireless technology, voice recognition, and handheld devices.: B) data, information, & knowledge Informatics is the application of technology to all fields of nursing to facilitate and extend nurses' decision-making abilities and to support nurses in the use, storage, and linkage of clinical information to provide effective and efficient patient care.
Nurses need to know how to operate a computer, compare data across time, and look for patterns in client responses to treatments. These are examples of: a. JCAHO standards b. Information systems c. Informatics competencies d. Requirements for nursing licensure: c. Informatics competencies The Quality and Safety Education for Nurses (QSEN) project identified informatics competency as a necessary component of the knowledge, skills, and attitudes for quality patient care. Nurses are anticipated to be able to use information and technology to communicate, manage knowledge, mitigate error, and support decision making. Nurses must utilize hospital database management, decision support, and expert system programs to access information and analyze data from disparate sources for use in planning for patient care processes and systems.
You are in the process of designing a patient education program that will provide education and monitoring for patients with hypertension. To support your planning, you draw out and present patient data from: a. A clinical database. b. Biomedical technologies. c. E-mail. d. Internet sources.: a. A clinical database Clinical databases are collections of elements organized and structured for the processing, organization, and presentation of data for interpretation as information, which, in this particular instance, includes outpatient data.
You document your patient's vital signs into a bedside documentation device and are able to compare your patient's vital signs with patients who have similar diagnoses and similar medications, and who are of a similar age. You are accessing: a. E-mail b. Telecommunications c. A database d. Technology: c. A database A database is a collection of data elements stored and organized together for the purposes of interpreting information such as vital signs.
Despite the implementation of bar-code medication administration (BCMA) on your busy medical unit, you notice that the number of medication errors has not significantly decreased. Which of the following reasons might explain the lack of change in errors? a. A number of new medications have been introduced into the hospital pharmacy that are not yet recognized in the CDS. b. There have been an unusually high number of patients on the unit who have been unable to confirm their identity at the time of medication administration. c. Lack of staff understanding and support for BCMA has led to overrides or failures to scan bar codes during busy times. d. Clinical data that have been entered into the system to guide administration of the medications are outdated.: c. Lack of staff understanding and support for BCMA has led to overrides or failures to scan bar codes during busy times Most errors related to technology involve mislabeled bar codes on medications, mistakes at order entry because of confusing computer screens, or issues with management of information. Errors also are related to dispensing devices and human factors, such as failure to scan bar codes or overrides of bar-code warnings.
As a nurse manager, you want to institute point-of-care devices on your unit. The rationale that you provide to support the POC devices include: (select all that apply) A) reduction in incidents of medication error B) immediate documentation of care C) comparison of patient data with previous data D) immediate access to staffing schedules: A) reduction in incidents of medication error B) immediate documentation of care C) comparison of patient data with previous data Point-of-care devices that allow documentation of assessment, care, and teaching at the bedside reduce the gap in time between care and documentation, thereby reducing error, increasing accuracy, and improving communication of care. Medication devices and patient databases enable accurate clinical decision making.
When administering medications to a patient utilizing bar-code technology, what is the most important first step? A) Scan patient's identification band. B) Scan medication. C) Administer medication. D) Check the five rights.: D) Check the five rights Although all steps are imperative in the medication administration process, it is most important to remember technology does not replace standard nursing practice (five rights) and safely caring for the patient.
What observation by the charge nurse indicates a new nurse needs additional education regarding the safe use of the electronic health record? A) The nurse logs off the computer before walking away. B) The nurse using a computer outside of the patient room minimizes the screen when a family member approaches. C) Before leaving the patient's room, the nurse minimizes her documentation on the computer screen. D) The care assistant needs to document and asks to use the nurse's computer; before the care assistant begins documentation, the nurse logs out of the system.: C) Before leaving the patient's room, the nurse minimizes her documentation on the computer screen While minimizing the documentation removes it from immediate view, it is not a secure method to lock down patient information. Logging off or password-locking the system is the best process for securing patient information.
When goals/outcomes are somewhat unclear in early preparation for a complex change, the manager and the change management team develop several acceptable goals/outcomes. This change in management approach is termed: a. Unfreezing. b. Nonlinear. c. Cybernetic. d. Linear.: ANS: B While Lewin's theory was designed to describe planned or first-order changes, many scholars think the theory is too simplistic to address how unplanned or second-order change occurs. In complex situations with an uncertain change environment, a nonlinear approach that involves flexibility improves overall outcomes. Linear change is appropriate to stable, less complex, and more predictable situations
The home health agency hired an expert in financial management to evaluate and propose a plan for reversing growing expenses and decreasing revenues. The expert is well respected, both personally and professionally, by members living in this small community. To be effective, staff will need to perceive this change agent as: a. Trusted, quiet. b. Flexible, informal. c. Credible, enthusiastic d. Communicative, personable.: ANS: C To influence the decision, the expert must be seen as having knowledge of what matters to the people that they lead and of the change area itself. The expert also must be enthusiastic and communicative and have referent power.
The clinical coordinator expects the position description of the new wound care specialist to change nurses' responsibilities in caring for clients with skin integrity problems. The best approach to address this need for change, yet to have the best outcomes for clients, staff nurses, and the organization, is to: a. Select one of the change models. b. Use Lewin's model and principles of change c. Apply both planned and complexity theory approaches. d. Form a task force of nursing staff and wound care specialists.: ANS: C In the second stage, the moving or changing stage of Lewin's theory, planned interventions and strategies, such as education, vision building, and incremental steps towards the change, are executed to support the implementation of the change. This situation potentially also involves complexity theories that recognize that change involves engagement of individuals and subsystems throughout the unit and organization.
To effectively achieve a change goal/outcome in a change situation, the wound care specialist will: a. Preserve the status quo. b. Diminish facilitators and reinforce barriers. c. Weigh the strength of forces. d. Strengthen facilitating forces.: ANS: D For change to be effective, the facilitators must exceed the force of the barriers; thus, strengthening the facilitating forces would achieve this aim.
The wound care nurse decided to involve those to be affected by change early in the change management process. This can positively result in: a. Coordination. b. Resistance. c. Anticipation. d. Participation.: ANS: D Successful change means persistence and advancement of the change, which requires the undivided focus of all team members. Early involvement and participation are critical to capturing the undivided focus of team members.
The oncology clinic manager and the educational coordinator asked nursing staff to complete a brief written survey to assess their attitudes and knowledge related to having used the new infusion equipment for 6 weeks. The stage of change in this situation is: a. Developing awareness. b. Experiencing the change. c. Integrating the change. d. Perceiving awareness.: ANS: C This particular initiative assesses the success with which the change has been integrated into everyday practice after it has been experienced, or the degree to which staff members have accepted using the new infusion equipment.
An example of one strategy to improve participation in the change process by staff fitting the behavioral descriptions of laggards, early majority, late majority, and rejecters is to: a. Encourage teamwork. b. Transfer to a different unit. c. Require attendance at staff meetings. d. Delegate the roles and tasks of change.: ANS: D According to Rogers's work, the individual's decision-making actions pass through five sequential stages. The decision to not accept the new idea may occur at any stage. However, peer change agents and formal change managers can facilitate movement through these stages by encouraging the use of the idea and providing information about its benefits and disadvantages.
An example of one strategy used to improve participation in the change process by staff fitting the behavioral description of innovators and early adopters is to: a. Repeat the benefits of the change. b. Share change experiences early in the process. c. Initiate frequent interactions among staff. d. Provide select information to the staff.: ANS: B Connecting innovators and early adopters to new ideas and with new peers keeps them at the cutting edge.
As a new manager, you are shocked to learn that your unit is still using heparin in heparin locks. You are aware of evidence related to this practice and want to change this practice as quickly as possible on your unit. You are in which stage of Lewin's stages of change? a. Unfreezing b. Experiencing the change c. Moving d. Refreezing: ANS: A Although you may be at a higher level of change in relation to your individual practice and knowledge of the use of change, in this situation, you are recognizing the need for change in relation to practice on the unit that you are managing. This phase is the initial phase in first-order change and will involve listening to staff to see if they perceive a similar problem.
To engage your staff in awareness of their current practice and how it is affirmed or not by evidence, you plan a short series of learning presentations on evidence and use of heparin and saline to maintain IV patency. You meet with the educator to plan out the goals for each session with the overall purpose of increasing knowledge and awareness of staff in readiness to consider questions related to the IV practice. This learning approach is an example of which change management approach? a. Linear b. First-order c. Facilitative d. Integrative: ANS: A In the second stage, the moving or changing stage of Lewin's first-order, planned change process, planned interventions and strategies are executed to support the implementation of the change. One commonly used method is educating staff about the need for the change.
Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." According to Havelock (1973), this comment may originate from failure in which phase of the six phases of planned change? a. Generating self-renewal b. Choosing the solution c. Diagnosing the problem d. Building a relationship: ANS: D The first phase of this model of planned change involves building a relationship as a basis for later phases, which include diagnosing the problem and choosing the solution. At this point, as a new manager, the relationship may not have yet developed sufficiently with Elizabeth.
Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." You follow up with Elizabeth and discover that she is really quite angry about the information sessions because she feels that you are implying that "what she has been doing all these years means that she is incompetent and doesn't care about her patients." Which of the following would be the most effective response to Elizabeth? a. "I understand how you feel, but you are going to have to change." b. "It is unfortunate that you feel this way. Others seem quite excited about the new information." c. "It is difficult sometimes to change what we know very well. Sometimes it can be frightening." d. "Perhaps I can: ANS: C Dialogue can reveal areas where individuals feel inept or overwhelmed, providing the leader with an understanding of what programs need to be developed to increase personal ability to change and what educational initiatives need to be implemented to support change. To promote dialogue, leaders must serve as facilitators, promoting the sharing of ideas, fears, and honest reactions to the change proposal.
Elizabeth is an example of a(n): a. Early adopter. b. Late majority. c. Laggard. d. Resister.: ANS: C Laggards prefer keeping traditions alive ("We have always done it this way") and openly express their resistance to ideas (speaking out against the change). Late majority individuals are openly negative but will engage with new ideas when most others adopt the change.
Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." You follow up with Elizabeth and discover that she is really quite angry about the information sessions because she feels that you are implying that "what she has been doing all these years means that she is incompetent and doesn't care about her patients." After speaking with Elizabeth a few days later you discover that she is now fine with the change but is concerned that other areas of the organization might resist the change because of perceptions related to patient safety and cost. She suggests that it is important to bring pharmacy on board as they have had previous concerns about the use of heparin. In: ANS: A Senge's complexity theory, Bevan's Seven Change Factors, and general systems theory all highlight connectivity and the idea that changes are not isolated events.
Based on Elizabeth's insights and suggestions, you involve pharmacy, only to discover that the change in practice involves practice committees, a medical practice committee, and concerns from administration about potential costs and safety of the proposed change to the IV protocols. The change process at this point is: a. Linear. b. Nonlinear. c. Sabotaged. d. Neutralized.: ANS: B Complex change involves nonlinear processes and a variety of strategies to negotiate influences on change. Complexity theories alter the traditional systems thinking approach by asserting that system behavior is unpredictable. This theory views change as emergent, nonlinear, and highly influenced by all individuals and subsystems in an organization
Resistance is most likely when change: a. Is not well understood .b. Involves many layers in an organization. c. Involves nonprofessional workers. d. Threatens personal security.: ANS: D Resistance and reluctance commonly occur when personal security is threatened and may involve loss of confidence in abilities or loss of job or financial security.
As the unit manager on the unit that is leading changes to heparin locks, you find that Elizabeth is very valuable in terms of her observations about other units and her knowledge of organizational processes, and now in discussing the new procedure with others. Elizabeth might be considered an: a. Engager. b. Innovator. c. Informal change agent. d. Informant.: ANS: C Informal change agents are those who do not have formal, positional power but who have credibility through expertise and can model the new way of thinking, or who offer suggestions, ideas, and concerns
Planned change: Deliberate and organized and has the goal of improvement. Change expected and deliberatively prepared beforehand by using systematic directional processes to develop and carry out activities to accomplish a desired outcome.
First-order change: Evolutionary change that occurs in planned and small steps. Often referenced as continuous improvement.
Second-order change: Change that is revolutionary, episodic, and that requires radical differences form what exists. May be unanticipated or expected.
Five organizational disciplines to support change and evolution: Shared vision, mental models, personal mastery, team learning, systems thinking.
The difference between a nurse practitioner's charge of $45 for an office visit & the insurance company's payment of $34 is: a. A contractual allowance b. A profit c. A flat rate d. Revenue: a. A contractual allowance
A staff nurse regularly works two 12-hour shifts each week and one 8-hour shift every other week. How many FTEs is this position? a) 0.6 b) 0.7 c) 0.8 d) 1: b) 0.7 Assuming that a full-time RN works 2080 hrs/yr (40 hrs X 52 weeks), the nurse works (24 hrs x 52 weeks + 8 hrs x 26 weeks)/2080 = 0.7 FTE
In preparing her budget, a nurse manager determines that she needs to budget for six FTE RN positions in the upcoming year. Based on a 40-hour week, this means that the nurse manager has determined that the budget will provide for _____ hours. a. 12,480 productive b. 10,820 productive c. 12,480 paid d. 10,800 patient care: c. 12,480 paid From the information given, it is not possible to determine how many non-productive hours (vacation, holiday, sick time, education) the nurse manager has accounted for in her budget calculations and therefore whether the total # of hours (40 hrs × 52 weeks × 6 staff = 12,480 paid hrs) is productive (paid time that is worked) or non-productive hrs. 12,480 accurately reflects the total number of hours of work paid per year.
After reviewing her monthly budget report, the nurse manager sees that she has a negative variance, which prompts her to change the staffing schedule. A negative or unfavorable variance in a monthly expense report may result from: a. Overestimation of inflation b. Higher than expected client acuity c. Net revenue exceeding net expenses d. Not replacing staff who called in sick: b. Higher than expected client acuity Variance reflects the difference between what was projected and the actual performance in a budget. When the variance is negative or unfavorable, the amount spent is more than what was budgeted (expenses exceed revenue); this may be a result of higher acuity. To help managers interpret and use variance information better, some institutions use flexible budgets that automatically account for census variances.
The primary reason for calculating productive hours paid instead of simply calculating work paid per year is that productive hours enable the manager to: a. Anticipate total costs for patient care. b. Know how much time staff will likely be unavailable because of illness .c. Determine when orientation needs to occur for new staff. d. Determine the number of hours available for patient care.: d. Determine the number of hours available for patient care Total hours are critical for determining the total number of hours that need to be paid for the year. Productive hours are needed to determine what hours are actually available for patient care. The number of FTEs required is determined by dividing the total patient care hours required by the number of productive hou
A nurse manager is planning to request three new infusion pumps at a cost of approximately $1500 each. What would BEST support the capital request? a. Number of patient care hours anticipated for the year b. Cost comparisons; how much and how often infusion pumps are used; condition of existing pumps c. Outline of cost for each pump d. Estimation of total cost; no further details: b. Cost comparisons; how much and how often infusion pumps are used; condition of existing pumps Complete well-documented justifications are needed because the competition for limited resources is stiff. Justifications should be developed using the principle of any business case and should include, at minimum, projected amount of use; services duplicated or replaced; safety considerations; need for space, personnel, or building renovation; effect on operational revenues and expenses; and contribution to the strategic plan.
A nurse manager is planning to request three new infusion pumps at a cost of approximately $1500 each. This item would typically be included in which budget? a. Operating b. Strategic c. Unit of service d. Capital: d. Capital Items that have a useful life of longer than a year, which is likely with the pumps, and that have a cost that usually exceeds $300 to $1000 (specific amount is set by the organization) are considered capital items. Operating budget items include what is used on a day-to-day basis, such as staffing.
Which of the following are considered variable costs? (Select all that apply) a. Salaries for the minimum number of staff b. Utilities and rent c. Managed care d. Supplies e. Medication and treatment supplies: d. Supplies e. Medication and treatment supplies The total fixed costs in a unit are those costs that do not change as the volume of patients changes. In other words, with either a high or a low patient census, expenses related to rent, utilities, loan payments, administrative salaries, and salaries of the minimum number of staff to keep a unit open must be paid. Variable costs are costs that vary in direct proportion to patient volume or acuity. Examples include nursing personnel, supplies, and medications.
The chief nursing officer decides to establish a client advocacy position in an oncology unit. Advocacy is best represented by: a. Establishing private and professional networking systems. b. Asking social services to handle clients' concerns. c. Identifying community support groups. d. Empowering others by promoting self-determination.: d. Empowering others by promoting self-determination. Advocacy involves empowering and promoting self-determination in others.
The nurse manager has to develop a patient satisfaction survey. What is one of the critical elements in selecting a patient satisfaction instrument? a. Being able to use the same instrument for all clinical units b. Including items that are important from the patient's perspective c. Being able to administer the instrument before a patient's discharge from the hospital d. Being sure that the reading level is no higher than third grade: b. Including items that are important from the patient's perspective
In writing the patient satisfaction survey, the nurse manager is aware of the education levels of the families. What is the most critical element in the concept of health literacy? a. Providing instructional materials at appropriate reading levels b. Facilitating access to translators for persons with language barriers c. Obtaining, processing, and understanding basic health information so appropriate decisions can be made d. Knowing that most people have limited health literacy skills: c. Obtaining, processing, and understanding basic health information so appropriate decisions can be made
The chief nursing officer is pleased with the nurse manager's strategy of improving patient satisfaction in the pediatric intensive care unit. She decides to implement these changes throughout the hospital. What would be important to consider in implementing a new program focused on improving relationships with consumers? a. Recognition of the nursing staff for excellence in promoting consumer relationships b. Holding the staff accountable for resolving patient complaints c. Selecting a staff nurse leader to implement the program d. Identifying key staff members who have already demonstrated excellence in consumer relationships: a. Recognition of the nursing staff for excellence in promoting consumer relationships
John is an older adult patient who comes regularly to the multigroup practice in which you are a nurse practitioner. He says that he doesn't understand what he is supposed to be doing about his medications, because every time he comes to the clinic, he sees someone else who has different ideas. John's experience represents what aspect of the current consumer experience? a. Nurses are well-trusted members of the healthcare team. b. Fragmentation of care results in lack of respect and trust. c. Care providers often have conflicting ideas about care. d. The public does not trust care providers other than nurses.: b. Fragmentation of care results in lack of respect and trust When consumers visit a multigroup practice, they do not have the option of selecting a specific healthcare provider, and thus, there is less opportunity to build a trusting relationship with a provider.
Corrine, a student nurse, often hears that nurses are gatekeepers and wonders what that term means. As a nurse leader, you explain that this is a reference to the: a. Assessment and admission of patients into care. b. Orientation of patients to services once they are admitted. c. Function of controlling which patients see the physician and which do not. d. Coordination of care, services, advocacy, and access for patients within the healthcare system.: d. Coordination of care, services, advocacy, & access for patients within the healthcare system. As gatekeepers to the system, nurses advocate for and coordinate care, services, and access for patients across all providers, settings, and levels of care.
You are involved in designing a clinic for women in an inner-city neighborhood. A goal of this clinic might be: a. Development of services that are identified in various studies as important for this target group. b. Partnership with area city councilors and health professionals to provide services that are consistent with their vision and funding sources. c. Provision of immunization and addictions services and health screening services for women in the area. d. Development of services that have been identified by the women and neighborhood advocates as necessary for their health care.: d. Development of services that have been identified by the women and neighborhood advocates as necessary for their health care.
As a nurse manager, you see an opportunity for patients to be well serviced through the medical home concept. You recognize that the concept of medical homes: a. Currently does not include nurses in its vision of multifaceted primary care. b. Includes nurses as part of an interdisciplinary and multidisciplinary team. c. Restricts nurses to services related to direct care and procedures. d. Cannot encompass nurses within this framework.: a. Currently does not include nurses in its vision of multifaceted primary care. The concept of medical homes encompasses the idea of multifaceted medical homes that provide a usual source of health care. Current discussions have focused on physician-directed care even though nurses in advanced practice are well suited to lead teams in this model.
Technology is integral to a cardiac ICU. Sue, the nurse manager, implements a patient-centered approach that focuses on the meaning of the experience for the patient and family, primary nursing, and a health literacy approach. Sue is: a. Using high-tech-low-touch approaches. b. Using high-tech-high-touch approaches. c. Providing products. d. Providing tangible products of satisfaction.: b. Using high-tech-high-touch approaches The provision of humanistic care within a high-tech environment is characteristic of high tech-high touch approaches and reflects the idea that the more that high-tech is used, the more patients also desire high-touch.
Which of the following activities would represent a customer-friendly approach in a healthcare setting? (Select all that apply) a. Using a local anesthetic before inserting a needle into a child's arm b. Repeating patient history information to the admitting clerk, the admitting nurse, and the ultrasound technician c. Ensuring that birthing preferences are on file and available when a laboring mother comes in d. Providing support to families when a family member is brought into trauma: a. Using a local anesthetic before inserting a needle into a child's arm c. Ensuring that birthing preferences are on file and available when a laboring mother comes in d. Providing support to families when a family member is brought into trauma A service orientation means delivering services in a manner that is least disruptive. When possible, services should come to the patient and should be as easy, comfortable, pleasant, and effective as possible. Meeting the emotional, psychosocial, and spiritual needs of the patient is important.
The chief nursing officer at a local hospital seeking Magnet™ status creates staff development classes concerning translation of research into practice (TRIP). What best describes TRIP? a. Conducting an integrative review of the literature b. Searching the literature for a systematic review c. Providing the results of research studies to practitioners d. Applying strategies that aid in adoption of research in practice: d. Applying strategies that aid in adoption of research in practice The science of how research is adopted is known as translation science, the science of translating research into practice (TRIP). The primary aim of research utilization is to activate the change process to move research findings into practice to improve patient outcomes.
The nurse manager wants to use evidence-based recommendations to prevent ventilator-associated pneumonia. In order to effectively gather evidence to guide practice, what is the critical first step? a. Develop the clinical question b. Identify the databases to be used. c. Appraise the evidence. d. Integrate available evidence with unit expertise.: a. Develop the clinical question Identifying the question may be the most challenging part of the process. Once the clinical question has been identified, writing it down will help in moving on to the next step of gathering evidence
To help staff nurses adjust to using research in practice, what strategy would the nurse manager use? a. Attendance at a regional research conference b. Formal classes in electronic search techniques c. Establishing a journal club d. Issuing reports on the adverse consequences of outdated practices: c. Establishing a journal club Journal clubs provide opportunities for engagement in reading research and considering how it might be applied to clinical practice problems, which is considered very effective in behavioral change.
After searching the literature, Tara, the unit manager develops a table that outlines the findings of studies on management of incontinence. She then examines the studies in terms of risk and whether the findings fit within her practice context and for her population of moderately to severely cognitively impaired patients. This is which phase of Stetler's research utilization model? a. Preparatory b. Validation c. Evaluation d. Application: c. Evaluation The third phase, comparative evaluation and decision making, involves making a decision about the applicability of the studies by synthesizing cumulative findings; evaluating the degree and nature of other criteria, such as risk, feasibility, and readiness of the finding; and actually making a recommendation about using the findings of the studies.
Within a multisite healthcare system, the most appropriate strategy for translation of research would be: a. Widespread development of protocols using EBP at unit levels. b. Dissemination of EBP and recommendations to individuals, units, and the organization. c. Development of the skills of individual managers on how to build guidelines based on EBP. d. Establishment of an interdisciplinary center to guide and lead the translation of research findings into practice.: d. Establishment of an interdisciplinary center to guide & lead the translation of research findings into practice At a systems level, the most appropriate approach would be establishing a center that leads in, guides, and promotes EDP across and at various levels.
Which of the following is a meta-analysis? a. Review of 35 studies on nurse work satisfaction to determine the significance of the aggregated research findings b. Review of multiple chart audits to determine which errors are being reduced through implementation of evidence-based guidelines c. RCT comparing the effectiveness of a local anesthetic in reducing the pain of venipuncture in young children d. Analysis of factors contributing to nurse burnout and dissatisfaction at emergency room sites: a. Review of 35 studies on nurse work satisfaction to determine the significance of the aggregated research findings Meta-analysis statistically combines the results of several similar studies to determine whether aggregate findings are significant.
Volunteers in a study are assigned randomly to groups. Some of the volunteers receive an herbal supplement that is reputed to control nausea, and some of the volunteers are assigned to a control group where a placebo is administered. This is an example of a(n): a. Longitudinal study b. RCT c. Meta-analysis d. Appraisal tool: b. RCT RCTs, or randomized controlled trials, always involve testing of a treatment through the random assignment of subjects in the study to an experimental or treatment group or to a control group that receives a placebo.
The nurses at a community hospital are selecting research articles to use for the development of a new protocol for the removal of indwelling urinary catheters in surgical patients. How is this be characterized in the translation of research? A) Research B) Review of the literature C) Evidence-based practice D) Implementation science: B) Review of the literature A review of the literature includes seeking and analyzing information by identifying and selecting articles for review. Research involves the generation of new knowledge. Evidence-based practice involves the synthesis of best available evidence along with patient preferences. Implementation science involves identifying scientifically based strategies for implementing a practice cha
A nurse manager wants to highlight the accomplishments of the nurses who are providing high-quality care on a medical unit in a tertiary care medical center. What is an example of a nurse-sensitive outcome that could be used for this project? A) Pressure ulcer rate compared with a national benchmark rate B) Patient satisfaction scores compared with other hospitals C) Nurse satisfaction scores compared with other hospitals D) Percentage of patients with heart failure who are prescribed an angiotensin-converting enzyme (ACE) inhibitor on hospital discharge: A) Pressure ulcer rate compared with a national benchmark rate Nurse-sensitive outcomes are patient outcomes that are primarily dependent on the quality of nursing care rather than a multidisciplinary team effort. Although patient satisfaction is an important measure, it may not necessarily be linked to the quality of care. The prescription of an ACE inhibitor is an outcome measure dependent on medical care.
The most important approach that a nurse manager can take with an emotionally troubled employee is to: a. Act as a therapist for the employee. b. Adjust the standard of care to assist the employee. c. Assist the employee in obtaining professional help. d. Adjust the employee's work schedule to decrease stress: c) Assist the employee in obtaining professional help Emotional difficulties are usually beyond the scope of skills that a nurse manager would normally employ. A referral needs to be made to a professional who is specifically prepared to deal with this kind of difficulty.
The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is that: a. Using replacement personnel with new ideas may be beneficial. b. Salary costs are lower because personnel are fewer, and outcome is favorable. c. Absence on the part of the rest of the staff is decreased. d. Unacceptable patient care may result.: d) Unacceptable patient care may result Reduced staffing adversely affects patient care. Employee morale suffers, care standards may be lowered, and additional stress is placed on working staff
In keeping with guidelines of the organization, the nurse manager documents staff problems. Documentation of disciplinary problems should: a. Include a plan to correct them and to prevent future occurrences. b. State a detailed history of past problems that are related to the current one. c. Be written at the convenience of the manager. d. Accumulate until the evaluation period begins: a) Include a plan to correct them and to prevent future occurrences In documenting staff problems, it is important to specifically indicate what rules were broken or violated, consequences if behavior is not altered, employee's explanation of the incidents, and the plan of action to achieve and to reach new goals.
Before terminating an employee, a nurse manager must: a. Be an expert in all legal aspects of termination and discipline practices. b. Know the organization's specific policies for addressing disciplinary problems and termination. c. Function as a counselor for problem employees. d. Do everything to assist and protect the employee by adjusting standards and policies.: b) Know the organization's specific policies for addressing disciplinary problems and termination It is important to know the policies of the organization to address disciplinary issues fairly and equitably, as well as to know the model that is employed to address employee problems.
A nurse manager understands that the typical first step in handling an employee with a disciplinary problem is a: a. Verbal reprimand. b. Written reprimand. c. Reminder of employment standards. d. Day off without pay.: Reminder of employment standards The progressive model of discipline advocates that the first step of the disciplinary process is the informal reprimand or verbal admonishment. The nonpunitive discipline model advocates reminding the employee of the employment policies and procedures of the agency.
The chief nursing officer understands that clinical incompetence is best prevented by a: a. Flexible protocol for evaluating competency skills. b. Standardized clinical skills checklist. c. Administration of personality tests and competency assessments at point of hire. d. Formalized competency program with established standards for practice.: d) Formalized competency program with established standards for practice The competency program with established standards of practice outlines what the nurse must do to achieve desired competencies in her current position. Competency assessment and goal-setting should help the nurse identify how to excel and which competencies the nurse wants to achieve in the future.
he chief nursing officer reviews the policy about "progressive discipline process." The progressive discipline process includes which of the following? The manager: a. Is a counselor and friend to the employee. b. Should reprimand and suspend the employee as a last resort. c. Should rehire the employee after a reasonable length of time. d. Should terminate the employee if the problem persists.: d) Should terminate the employee if the problem persists Termination can be defined as the discharge of an employee who is performing at an unsatisfactory level or who is not a good match for the organization. Termination is always considered to be the last resort when dealing with poor performance.
A nurse manager must be familiar with the agency's policies regarding termination. Termination procedures include which of the following? a. Following specific procedures from other organizations b. Having an attorney present at the termination meeting c. Having adequate written documentation to support the action d. Having a friend present during the termination meeting: c) Having adequate written documentation to support the action All steps should be followed, including full appropriate detailed documentation and following the procedures of the organization.
Nathan has been on the cardiac unit for 6 months and has found it difficult to adjust to the expectations of his team. Which of the following behaviors would most likely signal that Nathan is intending to resign from his position on the unit? a. Increased absenteeism over the past month b. Increased attempts to discuss his concerns with his colleagues c. Testing of workplace guidelines d. Frequent defensiveness: a) Increased absenteeism over the past month
Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety. The manager can implement steps that help to alleviate uncivil behavior on a unit. Which of the following would NOT be an appropriate first step? a. Suspending the staff member from work b. Providing written admonishment that is discussed and placed in the employee's file c. Providing verbal admonishment d. Terminating the staff member Arrange the strategies from Question 16 in the order in which they should occur in progressive discipline. a) A, B, C, D b) B, A, C, D c) C, B, A, D d) C, A, B, D: d) Terminating the staff member Dismissal does not enable the present organization to attempt remediation of the behavior and is not consistent with first steps in progressive discipline. c) C, B, A, D
When progressive discipline is used, the steps are followed progressively only for repeated infractions of the same rule. On some occasions, rules that are broken are so serious that the employee is: a. Transferred to another unit b. Suspended indefinitely c. Asked to attend a union grievance meeting d. Terminated after the first infraction: d) Terminated after the first infraction Behaviors that include violence, theft, and purposeful abuse of a client are sufficiently serious to warrant immediate dismissal with the first incident
During unit staff meetings, you observe that Marg rolls her eyes and snorts whenever Julia makes a comment. Your first response as a unit manager is to: a. Discuss what you have observed with Marg. b. File immediate documentation in Marg's personnel file. c. Ask Julie to monitor Marg's behavior during meetings. d. Ignore the behavior, as Marg is one of your strongest nurses.: a) Discuss what you have observed with Marg Incivility must be addressed. The initial step in addressing it is discussion with Marg, and if the behavior continues, then written documentation should be filed in Marg's personnel file. Monitoring and follow-up are your responsibility as the unit manager.
Susan, a new graduate, is upset that so many staff have been absent lately from the unit. She declares to you that all absenteeism could be eliminated with proper management. Your response is based on understanding that: a. Not all absenteeism is voluntary. b. High personal control contributes to absenteeism. c. Direct discussions with employees who have high levels of absenteeism are not recommended. d. All absenteeism is related to personal issues and needs.: a) Not all absenteeism is voluntary Not all absenteeism is voluntary or preventable, which means that absenteeism can never be fully eliminated. Absenteeism can result from personal issues and needs, work dissatisfaction, and involuntary reasons such as jury duty.
The unit manager discusses absenteeism with the unit clerk. She indicates that it is a serious problem on the unit. Which of the following points would they have likely discussed? (Select all that apply.) a. Employee morale is at a high level b. Care will suffer and standards will be lowered c. Existing staff have experienced little effect from the absenteeism d. Replacement staff usually needs little supervision: b) Care will suffer and standards will be lowered e) Unit costs have increased because of staff replacements and overtime
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, b, c, d
Planning is a process designed to achieve goals in dynamic, competitive environments. As a new manager, what is the first step you will undertake to develop a strategic plan of action for a congestive heart failure program? a. Search the environment to determine changes that may affect the organization. b. Appraise the organization's strengths and weaknesses. c. Identify the major opportunities for and threats to the organization. d. Identify and evaluate the various strategies available to the organization.: ANS: A Assessment of the external environment is the first step in the strategic planning process.
A community-based pain management program is being planned for your region. As a coordinator of a home care agency, you have been requested to develop a conceptual framework, mission statement, philosophy, and objectives for the program. In what order will you pursue this endeavor? a. Objectives, philosophy, and mission statement b. Philosophy, objectives, and mission statement c. Philosophy, mission statement, and objectives d. Mission statement, philosophy, and objectives: ANS: D The development of the mission statement is the first step in defining the purpose and direction of the organization after an assessment has been completed.
Northwestern Hospital has decided to implement peer review. As a clinical leader in the Emergency Department, you have overall responsibility for ensuring that this is in place by next month. The most important step in this process is to: a. provide an educational session for staff on peer review. b. revise the mission statement, objectives, and performance standards. c. develop objectives and performance standards with employees. d. implement objectives and performance standards.: ANS: A Once a strategic plan has been developed, the next step is open communication and execution of the specific plan, which, in this instance, is peer review.
The chief nursing officer has to write a strategic plan. The most difficult stage in the strategic planning process is: a. assessment of the external and internal environment. b. review of mission statement, goals, and objectives. c. identification of strategies. d. implementation of strategies: ANS: A Determination of strengths, weaknesses, opportunities, and threats requires openness to what is being said and observed and is critical to setting the stage for relevant responses in the latter phases of strategic planning.
From your observation of planning activities in the organization, you have noticed that planning and decision making occur at various levels of the organization. The nurse manager has overall responsibility for which of the following? a. Sending out postcards b. Organizing a telephone follow-up c. Monitoring ongoing activities and projects d. Listing the patient population: ANS: C The nurse manager should articulate organizational decision making for the criteria model adopted by the organization and monitor ongoing implementation of the plan.
Which of the following represents a well-written objective? a. Hospital-acquired infections are reduced, and procedures to reduce infections are implemented. b. To increase staff satisfaction and to decrease burnout. c. To increase the health of the community. d. To implement evidence-based practice on nursing units, as evidenced by adoption of evidence-based processes, by June 1.: ANS: D Objectives are specific (begin with word to followed by an action word; specify single result to be achieved; and specify a target date for attainment) and measurable (provide level of accomplishment at th
Pacific Hospital's team develops a process to include staff in development of the mission statement. Which of the following statements would indicate that the staff has been able to develop an effective mission statement? a. Pacific Hospital will increase its sustainability by increasing revenue streams within the next 3 years. Revenue streams are important to our hospital and are a driving force in our sustainability in the face of insurer and government funding changes. b. Pacific Hospital has a desire to relate to its community to enable appropriate identification of programming needs by July. c. Pacific Hospital will provide family-centered care to the community of Pacific Rim. It is committed to delivering a full spectrum of services that foster collaborative partnerships among clients, families, and the hospital, and it utilizes evidence-based practice to guide planning and interventions. d. To provide health p: ANS: C An effective mission statement reflects the values and direction of the organization. Included in the statement are beliefs about individuals, health, practitioners, and the relationship of the organization to practice, research, professionalism, and/or education.
At the beginning of the strategic planning processes, Pacific Hospital learns that nursing staff members are uncomfortable with utilizing evidence-based practice, and that staff perceives that only limited resources are available to support translation of evidence into their usual practice. Because this issue has been identified, the management team determines that a plan of action is required to address the issue. Who should be involved at this point? a. Nursing unit managers b. Staff nurses c. All staff d. Administration: ANS: C The first phase in planning is conducting an assessment of the external and internal environments. Assessment of the internal environment should include all levels of staff and facilitates feedback on effectiveness of strengths and weaknesses of systems and processes within the institution.
In implementing the strategic plan for effective utilization of evidence to guide nursing practice at Pacific Hospital, the nursing unit managers take the next step, which is the implementation. Implementation most likely would involve: a. revisiting the mission statement and objectives. b. reevaluating external and internal factors affecting evidence-based practice. c. preparing a budget to support implementation. d. developing unit-based objectives related to the plan.: ANS: D The previous planning (assessment of internal and external environments, development of a mission and plan, and allocation of resources) has already been completed. The next step involves adapting the strategic plan to the nursing units.
Assessment of the needs of the consumer or client (in developing a strategic marketing plan) focuses on: a. present needs only. b. present and future needs. c. the development of surveys. d. secondary analysis of existing data.: ANS: B Assessment of needs takes into account needs of the consumer now and for the future, using a variety of data-gathering techniques. Future orientation aids in anticipating how marketing and programs will need to shift to meet those needs.
To meet the social and human needs of a target market, it is critical to: a. assess the needs and priorities of the target market. b. revise the organization's mission statement to reflect external needs. c. assess the internal culture and needs. d. develop highly sophisticated media.: ANS: A Marketing emphasizes the identification and meeting of human and social needs, which can only be known through assessment of the needs of the consumer (as opposed to the needs of the organization).
A clinic nurse developed objectives for a diabetic education program. The characteristics of well-written objectives include that they should be what? (Select all that apply.) a. Achievable b. Understandable and specific c. People-oriented d. Manager-oriented e. Means-oriented f. Measurable: ANS: A, B, F The S.M.A.R.T. acronym describes the attributes of objectives: specific, measurable, agreed-upon, reasonable (achievable), and time-bound.
As a nurse manager, you trial a new pain scale on your unit that is supported by numerous research studies. You compare the patient outcomes with the new scale against the existing scale. Feedback from staff suggests that the new scale is too difficult for patients who have limited language skills and who are already under duress to understand. The difficulty in implementing the new scale refers to testing:a. Efficacyb. Effectivenessc. Practice failured. Comparative error: b. Effectiveness Comparing the effectiveness of interventions can help to address the needs of clinicians in determining best practices for their patients. Comparative effectiveness research (CER) is the "generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care" (Institute of Medicine, 2009, p. 29). Efficacy is testing an intervention or treatment in a traditional randomized clinical trial under carefully controlled conditions and is used to determine whether an intervention or treatment works, whereas effectiveness is testing whether the intervention or treatment works in the real world of practice.
A nurse manager understands that the second step in handling an employee with a disciplinary problem is to document the incident. Which of the following is best for documentation of personnel problems?a. Use of the performance appraisal on an annual basisb. Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-upc. A tally sheet of medication errors and other specific problems that will be used at annual reviewd. Copies of reports, placed in his or her file, of all unusual occurrences involving the employee: b) Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up In documenting staff problems, it is important to specifically indicate what rules were broken or violated, consequences if behavior is not altered, employee's explanation of the incidents, and the plan of action to achieve and to reach new goals.
The nursing director calls a meeting with one of the new unit managers. She is very concerned about a report of substance abuse on the manager's unit, and she reviews the procedures involved in dealing with chemically dependent staff. Which of the following statements would not be included in the discussion? "As a manager, you: a. Need to be aware of ADA issues." b. Should check with Human Resources regarding chemically dependent employees and employment practices." c. Check the nurse practice acts for the state in which the nurse resides." d. Should realize that the nurse is a professional embarrassment and should be kept out of sight of other staff.": d. Should realize that the nurse is a professional embarrassment and should be kept out of sight of other staff" As a manager, you need to be familiar with state and professional regulatory and reporting requirements regarding chemical use and abuse, as well with Human Resource practices and guidelines