Effective Leadership And Management in Nursing 9th Edition – Test Bank

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Effective Leadership & Management in Nursing, 9e (Sullivan)

Chapter 5   Initiating and Managing Change

 

1) The new chairperson of the nursing department has determined that the faculty’s teaching is stagnant and outmoded. The chairperson would like to encourage the faculty to adopt more innovative teaching strategies. According to Lewin, what is the first step in initiating this plan?

  1. Bring an expert on innovative teaching strategies to campus for a meeting with faculty.
  2. Include the staff in identifying problems related to teaching strategies.
  3. Ask staff to assist in the development of a plan for implementing new teaching strategies.
  4. Implement interventions to improve the teaching strategies currently used.

Answer:  2

Explanation:  1. Bringing in an expert to talk to the faculty would be ineffective until the faculty is beginning to “unfreeze” their current beliefs about teaching. Introducing an expert at this time might do more harm than good.

  1. The first step is to unfreeze the existing equilibrium by asking staff to become part of the process of change, particularly in the first phase.
  2. Asking the staff to assist in developing a plan is incorrect because the planning part of the process occurs after the problem areas have been identified.
  3. The faculty will likely not be receptive to new strategies until they have identified a need to change.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Quality of Practice

Learning Outcome:  5-2: Describe how different theorists explain change.

 

2) The nursing supervisor identifies ineffective communication as a problem among the managers. According to Lippitt’s phases of change, which action by the supervisor reflects the final stage of improving this issue?

  1. The supervisor uses outcome data to evaluate the amount of change that has occurred.
  2. The supervisor has gradually withdrawn from the role of change agent.
  3. The supervisor has developed strategies to maintain the change.
  4. The supervisor has determined if anyone in the group is sabotaging change efforts.

Answer:  2

Explanation:  1. Evaluating the amount of change would occur before the final stage.

  1. According to Lippitt’s phases of change, the final stage is terminating the helping relationship.
  2. Maintaining the change is the next to last of Lippitt’s stages.
  3. Looking for persons who may be sabotaging change efforts is not the last of Lippitt’s stages.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Implementation/Communication

Learning Outcome:  5-2: Describe how different theorists explain change.

 

3) The nurse manager is planning to initiate new policies in the department and is reviewing several change theories. Which step of Havelock’s model will the nurse find most closely resembles Lewin’s moving stage?

  1. Self-renewal occurs among all participants.
  2. Solutions are identified to create change.
  3. Resources are acquired to facilitate change.
  4. Relationships are formed among all participants.

Answer:  2

Explanation:  1. Self-renewal and stabilization occur during the final stage and are most like Lewin’s refreezing stage of change.

  1. Choosing a solution and gaining acceptance are most like Lewin’s moving stage. Previous to this stage in both models, the work is to convince participants that change is necessary and to secure resources for the change. After solutions are identified and implemented, the final stage begins.
  2. The first three steps of Havelock’s theory are building a relationship, diagnosing the problem, and acquiring resources. These three steps are most like Lewin’s unfreezing stage.
  3. The first step of Havelock’s model is building relationships among participants. This is one of the steps that are equivalent to Lewin’s unfreezing stage.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Leadership

Learning Outcome:  5-2: Describe how different theorists explain change.

 

4) A new IV pump has just been purchased by the facility. Which statement by the nurse manager reflects Rogers’ first step in making the change to this new equipment?

  1. “The nursing staff will have the final decision on whether to change to this IV pump.”
  2. “Before we make the final decision, we will do a three-month ‘test run’ of the equipment to make sure we like it.”
  3. “I have looked at the pump and I like it.”
  4. “I have information to share with you about the new IV pump we are considering for the unit.”

Answer:  4

Explanation:  1. Telling the staff that they have the final decision is a way of persuading.

  1. The decision to adopt or reject a change occurs after the knowledge and persuasion steps.
  2. Giving a personal endorsement of the change would be persuasion.
  3. The first step of the diffusion of innovation occurs when the decision-making unit is introduced to the innovation and knowledge is gained.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Communication

Learning Outcome:  5-2: Describe how different theorists explain change.

 

5) The nurse manager feels that changing the unit’s method of assigning break times would benefit the flow of client care. What should be the manager’s first action associated with this idea?

  1. Tell the staff that a change is coming, but that it is positive and they should not be worried.
  2. Collect and analyze information about how the current system is working.
  3. Mention in a staff meeting that the current system is causing a lot of trouble.
  4. Identify how the manager would know if the change is benefiting the unit.

Answer:  2

Explanation:  1. It is not a good idea to indicate that a change is coming until further planning is completed.

  1. Assessment is the first step of the change process, just as it is the first step of the nursing process.
  2. Planting the seed of discontent with the status quo occurs after the problem has been assessed.
  3. Operational indicators of success are developed when the planning phase is near completion.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Implementation/Quality of Practice

Learning Outcome:  5-3: Delineate steps in the change process.

 

6) A nursing administrator overhears nurses conversing during a break in a seminar on change. The administrator would interpret which statement as meaning that the nurse who made it is ready to become a change agent?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

  1. “I know that suggesting this change may backfire on me.”
  2. “I don’t expect too much conflict or resistance to this change.”
  3. “I see an opportunity to make a difference in the way this facility provides nursing care.”
  4. “I think the status quo is just fine for now.”
  5. “This change is certainly going to be a challenge, but that’s okay.”

Answer:  1, 3, 4

Explanation:  1. This statement exemplifies the willingness to take risks that is necessary to become a change agent.

  1. The nurse should always expect that change will be met with resistance and possible conflict.
  2. Nurses should always look for ways to improve client outcomes.
  3. Change occurs when people become uncomfortable with the status quo.
  4. Accepting that change is challenging is part of being a change agent.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Evaluation/Collegiality

Learning Outcome:  5-1: Explain why nurses have the opportunity to be change agents.

 

7) Computerized charting will be initiated on select units of the hospital. Orientation to this new system will be provided to each nurse by a team of nurses educated in nursing informatics. This is an example of which type of change strategy?

  1. Normative-reeducative strategies
  2. Lippitt’s phases
  3. Empirical-rational model
  4. Power-coercive strategies

Answer:  3

Explanation:  1. Normative-reeducative strategies focus on people’s roles and relationships, perceptual orientations, and attitudes that influence their acceptance of change.

  1. Lippitt’s phases of change are a seven-step process of change that involves participants in every step of the process.
  2. The assumption of the empirical-rational model is that people are rational and will follow their rational self-interest if that self-interest is made clear to them. In this instance, when the nurses have the knowledge to use the charting system and have a chance to try it, it will become clear that it is in their best interest to adopt the new system.
  3. Power-coercive strategies are based on the application of power by legitimate authority, economic sanctions, or political influence.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Implementation/Education

Learning Outcome:  5-4: Differentiate among change strategies.

 

8) Hospital administrators are considering changing from the traditional method of creating work schedules to a system in which the nurses will choose their own workdays. Choices will be made according to seniority. Which change strategy would likely be best for this endeavor?

  1. A power-coercive strategy
  2. A normative-reeducative strategy
  3. An empirical-rational model
  4. A driving force

Answer:  2

Explanation:  1. Power-coercive strategies are used when much resistance is anticipated, time is short, and the change is critical for organizational survival. This strategy may meet with resistance from the nursing staff.

  1. In most cases, the normative-reeducative approach to change is effective in reducing resistance and stimulating personal and organizational creativity.
  2. The empirical-rational strategies are most often effective when little resistance to the proposed change is expected, and the change is perceived as reasonable. This is likely not the case with the change described.
  3. A driving force is a behavior that facilitates change by pushing participants in the desired direction in spite of restraining forces.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Quality of Practice

Learning Outcome:  5-4: Differentiate among change strategies.

9) Which factor best represents a driving force in the process of change?

  1. An ineffective nurse manager
  2. An administration composed of long-term employees
  3. A staff composed of long-term employees
  4. A financial deficit of millions of dollars

Answer:  4

Explanation:  1. An ineffective nurse manager is a restraining force that impedes change by discouraging participants from making specified changes.

  1. An administration of long-term employees can be a restraining force that impedes change by discouraging participants from making specified changes.
  2. A staff of long-term employees can be a restraining force that impedes change by discouraging participants from making specified changes.
  3. A budget in the red necessitates change and pushes participants in the desired direction.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Assessment/Leadership

Learning Outcome:  5-2: Describe how different theorists explain change.

 

10) When faced with the prospect of change, the nurse states, “We have always done it this way and never had any problems.” A few weeks later, the same nurse remarks, “This new way seems to work better than the old way did.” This statement is characteristic of which type of change response?

  1. Laggards
  2. Early adopters
  3. Early majority
  4. Innovators

Answer:  3

Explanation:  1. Laggards dislike change and are openly antagonistic.

  1. Early adopters are not as eager to change as are innovators but are still receptive to change.
  2. The early majority prefers the status quo but eventually accepts change.
  3. Innovators love change and thrive on it.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Evaluation/Quality of Practice

Learning Outcome:  5-5: Evaluate ways to handle resistance to change.

 

11) Which statements by the nurse manager would demonstrate effective change management?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

  1. “If this approach doesn’t work, at least we can say we’ve tried.”
  2. “Let’s wait until the administration has completed their reorganization before we implement change.”
  3. “In order for this plan to work, everyone must agree to participate.”
  4. “We cannot lose sight of the mission and values of our institution as we begin to integrate these changes.”
  5. “Although this task is going to be difficult, we have the full support of our hospital administration.”

Answer:  4, 5

Explanation:  1. This statement suggests that the manager is not completely behind the projected change. This lack of decisiveness may confuse supporters of the change and encourage resisters to keep resisting.

  1. This statement suggests that the manager may not be completely in favor of the change. In some cases, the staunchest resister is the manager.
  2. If the nurse manager waits until everyone agrees to be a participant in change, change will never occur.
  3. All changes and actions that occur within an organization should flow from the mission and values.
  4. It is important to acknowledge that change is difficult. Full support of the administration makes change easier.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Implementation/Quality of Practice

Learning Outcome:  5-6: Describe the nurse’s role in planned and unplanned change.

 

12) The nurse administrator has been asked to work with other administrators to make a change in a long-standing hospital policy. What should be the nurse’s first action?

  1. Research the options that will work best for the nursing staff and the hospital.
  2. Speak positively of the change to ensure the most “buy-in” from the nurses.
  3. Encourage the other administrators to choose the option that is easiest for the nurses.
  4. Ensure that each nurse is aware of the change and why it is necessary.

Answer:  1

Explanation:  1. Assessment is always the first action for a nurse in any situation.

  1. This constitutes an intervention and is not the first action.
  2. This constitutes an intervention and is not the first action.
  3. This constitutes an intervention and is not the first action.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Assessment/Quality of Practice

Learning Outcome:  5-3: Delineate steps in the change process.

 

13) The nursing committee is planning a change in the unit’s organization. Which statement reflects the priority expected outcome of these change agents’ work?

  1. The nurses involved will demonstrate management skills.
  2. The nurses will agree with the change and present a united front for its adoption.
  3. The change will guide nursing practice on the unit.
  4. The change will lead to improved client care on the unit.

Answer:  4

Explanation:  1. Demonstration of management skills is not the priority expected outcome.

  1. Agreement and presentation of a united front is not the priority expected outcome.
  2. It is hoped that the changes will guide nursing practice, but this is not the priority expected outcome.
  3. All nursing responsibilities and changes have the expected outcome of improving client care.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Evaluation/Quality of Practice

Learning Outcome:  5-3: Delineate steps in the change process.

 

14) The CEO of the hospital approaches the chief nurse with a request that the nurse act as the primary change agent in the implementation of a new hospital-wide policy. Why would the nurse be a good choice for this assignment?

  1. Nurses thrive on transition and work best in such circumstances.
  2. Nurses are role models for reacting positively to change.
  3. Nurses routinely interact with multiple disciplines.
  4. Nurses are always acting in the client’s best interest.

Answer:  3

Explanation:  1. It is hard to prove that nurses thrive on transition.

  1. Nurses have not always reacted positively to change.
  2. Nurses are client advocates who routinely interact with multiple disciplines in the provision of quality care.
  3. Nurses do act in the client’s best interest, but this option is not as strong as another.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Implementation/Quality of Practice

Learning Outcome:  5-1: Explain why nurses have the opportunity to be change agents.

 

15) The nurse is working on a committee tasked with making a major organizational change. Which comments by the nurse would help to advance the work of this committee?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

  1. “I would like to focus on completing this process so we can move on.”
  2. “Have we looked at all available data in order to make an informed decision?”
  3. “What are the obstacles to implementing this change within the organization?”
  4. “Are we including the opinions of all stakeholders in this decision?”
  5. “I think it does not really matter when we institute this change, as long as it is over quickly.”

Answer:  2, 3, 4

Explanation:  1. Completing the process is not the major focus of the work.

  1. Those involved in change should be certain that sufficient data are present to make an informed decision.
  2. Persons working on this committee should be aware of obstacles they may face.
  3. It is important to consider the opinions of the organization’s stakeholders.
  4. Getting the change instituted quickly is not the focus of committee work.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Implementation/Quality of Practice

Learning Outcome:  5-6: Describe the nurse’s role in planned and unplanned change.

 

16) Which action will have the greatest impact on the successful implementation of a planned change?

  1. Disciplining individuals who continue to be resisters to the change
  2. Ensuring there are no remaining pockets of disagreement when the change occurs
  3. Continually rewarding those working toward the change and ignoring those who are not
  4. Creating a supportive environment for those undergoing the change

Answer:  4

Explanation:  1. It is true that in some cases resisters are so disruptive that they must be disciplined. This is not the best method of assuring successful implementation of a change.

  1. It is unlikely that everyone affected by the change will see it as positive. Attempts to ensure that everyone is happy with the change are generally a waste of energy and resources.
  2. Rewards can be positive, but ignoring resisters is dangerous.
  3. A supportive work environment for those experiencing the change is the strategy most likely to result in an easier transition.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Implementation/Quality of Practice

Learning Outcome:  5-5: Evaluate ways to handle resistance to change.

 

17) A proposed change in a healthcare organization is controversial and will require cooperation from all parties involved. Which change strategy should the change agent use?

  1. Empirical-rational
  2. Normative-reeducative
  3. Power-coercive
  4. Empirical-reeducative

Answer:  2

Explanation:  1. Empirical-rational strategy is used when little resistance to the proposed change is expected.

  1. Normative-reeducative strategy uses collaboration as its primary decision-making technique. It is most likely to result in the greatest number of people being happy with the decisions made.
  2. Power-coercive strategy is the least likely to result in everyone agreeing with the change.
  3. This is not one of the change strategies.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Quality of Practice

Learning Outcome:  5-4: Differentiate among change strategies.

 

18) The healthcare facility has elected to make a significant change in organization strategy. The change has been thoroughly researched and all levels of leadership have been included in the decision. Which roles are commonly undertaken by the nurse manager when such a change is necessary?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

  1. Disciplinarian
  2. Resister
  3. Fact manager
  4. Liaison
  5. Support person
  6. Discussion leader

Answer:  1, 3, 4, 5, 6

Explanation:  1. The nurse manager may be placed in the role of disciplining staff members who are impeding the work of the organization.

  1. Once the decision to make a change has been made, the nurse manager should not act as a resister.
  2. The nurse manager may be in the role of one who supplies information about the needed change.
  3. The nurse manager may act as a liaison between the committee and the staff.
  4. The nurse manager fulfills the role of support person for staff adapting to the change.
  5. The nurse manager may act as discussion leader, both in formal and informal discussions.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Implementation/Quality of Practice

Learning Outcome:  5-5: Evaluate ways to handle resistance to change.

19) The nurse manager knows that maximum power will be needed to achieve a desired change and has identified a key person on the organizational chart who will be affected by the change. What is important for the nurse manager to do?

  1. Try to minimize the impact of the change when talking to this person.
  2. Bypass this person and talk to the administrator who supervises him or her.
  3. Pay attention to the people above and below this person on the organizational chart.
  4. Try to find some information against this person to use as leverage.

Answer:  3

Explanation:  1. The nurse manager should always be honest when discussing the change.

  1. The nurse manager should not “jump” the chain of command to speak to this person’s supervisor.
  2. The people just above and just below this person will be important to the way this key player reacts to the change.
  3. This tactic would not be ethical.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Quality of Practice

Learning Outcome:  5-6: Describe the nurse’s role in planned and unplanned change.

 

20) The novice nurse manager is acting in the role of change agent for the unit. Which statement indicates that this manager needs further training in regard to change?

  1. “I must not get so bogged down in details that I lose focus on the ultimate goal.”
  2. “As we go through this process, I think I need to be flexible but persistent.”
  3. “Those who are resistant will probably accept it sooner or later with my support.”
  4. “I think the implementation will go much better if I stay available the whole time.”

Answer:  4

Explanation:  1. The ability to retain a big-picture focus while dealing with each part of the change is a desirable trait for a change agent.

  1. The change agent must have sufficient flexibility to modify ideas when this will improve the change, but enough persistence to resist nonproductive tampering with the planned change.
  2. It is likely that those who are resistant will adapt to the change if given enough time and support.
  3. Staying available the whole time is not realistic and will make it difficult for the change agent to maintain the energy it will take to make the change more successful.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Evaluation/Quality of Practice

Learning Outcome:  5-6: Describe the nurse’s role in planned and unplanned change.

 

21) The staff is transitioning to a major change in the provision of nursing care in a large hospital. Which behaviors should the nurse manager watch for that would indicate possible problems?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

  1. Nurses are discussing the change at breaks and meals.
  2. Nurses are doing both the old work and the new work.
  3. A nurse says, “I guess everything we’ve done for years is wrong.”
  4. The provision of care with the new system takes longer than expected.
  5. Nurses are doing parts of the old procedure and parts of the new procedure.

Answer:  2, 3, 5

Explanation:  1. It is natural that the staff would discuss the change and its implications.

  1. Adding the new work to the old work is a sign that the transition is not healthy.
  2. This attitude is a sign that the transition is not healthy.
  3. It is natural for the transition to a new process to take time. The nurse manager should be on the alert if this continues.
  4. Making individual decisions about what parts of the old method to retain and what parts of the new method to adopt is a sign that the transition is not healthy.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Evaluation/Quality of Practice

Learning Outcome:  5-5: Evaluate ways to handle resistance to change.

 

22) The nurse manager is facing resistance to change from many staff nurses. Why should the manager work hard to address this resistance?

  1. Resistance will keep the change from occurring at all.
  2. Resistance from the late majority can keep others from accepting the change.
  3. Resistance can negatively impact future client care.
  4. Resistance allows others to take power from managers.

Answer:  3

Explanation:  1. Resistance generally does not completely prevent change, but it may stall or delay it.

  1. The late majority eventually does accept the change.
  2. Client care is always the most important reason that nurses do what they do. If the change does not improve client care in some respect, is it worth the effort? If resisters interrupt the work of the unit or refuse to provide care as directed by the change, the quality of care may suffer.
  3. Resistance is a normal part of change and does not mean that power has been diverted to the resisters.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Assessment/Quality of Practice

Learning Outcome:  5-3: Delineate steps in the change process.

 

23) The nurse manager has determined that changes are necessary in the way holiday shifts are assigned. When assessing the political climate surrounding this potential change, the nurse manager would ask which questions?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

  1. Who is in control of the way holiday shifts are being assigned?
  2. What communication technology is available to distribute information about the change in holiday shift assignments?
  3. Who will lose when holiday shift assignments are changed?
  4. Will changing holiday shift assignments affect the budget?
  5. Who is benefiting the most from the way holiday shifts are currently assigned?

Answer:  1, 3, 5

Explanation:  1. It is important to identify who is in control of the way things are being done currently.

  1. Communication technology may be helpful in completing the change but is not assessed as part of the political climate surrounding the change.
  2. Early knowledge of who will lose in the change is essential to preparation.
  3. Costs and benefits of the change should be assessed but are not a part of the political climate.
  4. Political climate involves power, benefits, and losses.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Assessment/Quality of Practice

Learning Outcome:  5-5: Evaluate ways to handle resistance to change.

 

 

24) The nurse manager is facilitating change to a new documentation system in the unit. If the manager wants to use the most common method to overcome resistance to the change, which strategy would be chosen?

  1. The manager distributes a handout explaining the new system and how to use it.
  2. The manager creates a “quick tip” sheet about how to use the system and schedules practice sessions for each nurse.
  3. The manager identifies a key supporter of the change and has that nurse act as mentor to the remaining staff.
  4. The manager threatens to transfer anyone who resists the change.

Answer:  1

Explanation:  1. Giving information is the most common method of changing individuals’ perceptions, attitudes, and values.

  1. Providing information and an opportunity to practice is called training. Training is not the most common method of changing perceptions, attitudes, and values.
  2. While having a mentor may be a desirable method for the learner, it is not the most common method of changing perceptions, attitudes, and values.
  3. Transferring or terminating those who resist change is a method of changing the perceptions, attitudes, and values of the remaining staff. It is not the most common method.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Implementation/Quality of Practice

Learning Outcome:  5-5: Evaluate ways to handle resistance to change.

 

25) Which statements by a hospital executive reflect power-coercive strategies to implement change?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

  1. “We must follow the federal guidelines in the way we bill for our services.”
  2. “If we don’t reduce our nosocomial infection rate, Medicare won’t reimburse us.”
  3. “Administration has to make this change or our accreditation status will be at risk.”
  4. “This change is the only logical action we can take.”
  5. “All our sister institutions in the association have already made this change.”

Answer:  1, 2, 3

Explanation:  1. Power-coercive strategies are based on the application of power by a legitimate authority-in this case, the federal government.

  1. Power-coercive strategies are based on the application of power by a legitimate authority-in this case, Medicare.
  2. Power-coercive strategies are based on the application of power by a legitimate authority-in this case, the accrediting body.
  3. The empirical-rational model of change focuses on logical actions.
  4. Normative-reeducative strategies rest on the assumption that people act in accordance with social norms and values.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Implementation/Leadership

Learning Outcome:  5-6: Describe the nurse’s role in planned and unplanned change.

 

26) A nurse manager is faced with the task of introducing an unpopular change to a staff that includes several nurses who have acted as rejecters to previous changes. The manager expects resistance but hopes to identify these rejecters early in the process. The manager should be particularly alert to which statements?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

  1. “I don’t care what they say; I’m not giving care that way.”
  2. “I don’t think this is going to work, but I’ll probably come around to it sooner or later.”
  3. “I’m not crazy about this idea, but we do need to change how we are providing care.”
  4. “I bet I can make it very difficult for this change to occur.”
  5. “It won’t be so bad. I like change.”

Answer:  1, 4

Explanation:  1. Rejecters often respond with active opposition.

  1. This statement is characteristic of an early or late majority resister.
  2. Acknowledging that change is necessary is characteristic of an early adopter.
  3. Making the change more difficult is a form of sabotage, which is characteristic of a rejecter.
  4. Innovators love change and thrive on it.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Assessment/Quality of Practice

Learning Outcome:  5-5: Evaluate ways to handle resistance to change.

27) A nursing supervisor would like the nurse manager to serve as change agent for a needed revision to unit policy. Which statements would alert the supervisor that this manager is not the best choice for this assignment?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

  1. “Well, we don’t want to rock the boat too much.”
  2. “Do you think we can get enough support from the nurses to make this change?”
  3. “We tried making a change like this before and it didn’t work out well.”
  4. “To make this big change, we need to start making smaller changes now.”
  5. “There is going to be resistance, but I think it can be overcome.”

Answer:  1, 2, 3

Explanation:  1. Fear of “rocking the boat” may prevent the manager from effectively leading the change.

  1. Fear that no one will support the change may prevent the manager from effectively leading the change.
  2. Recalling that previous efforts at change have failed may prevent the manager from effectively leading the change.
  3. The ability to see the end result and what it will take to make the plan work is a sign that the manager could be an effective change agent.
  4. The ability to handle resistance and a display of confidence are signs that the manager could be an effective change agent.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Assessment/Quality of Practice

Learning Outcome:  5-6: Describe the nurse’s role in planned and unplanned change.

 

 

28) A nursing supervisor has introduced a needed change in policy to the nurse managers. The managers have met maximum resistance when attempting to gain support for the change. Which options reflect valid strategies for the nurse managers?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

  1. Meet with the supervisor and discuss modifications of the proposed change.
  2. Slow down the change process.
  3. Meet with the supervisor and suggest abandoning the change.
  4. Work together to identify strategies to overcome resistance.
  5. Proceed with the change.

Answer:  1, 2, 4, 5

Explanation:  1. Modifying the change and compromising with resisters is a valid strategy.

  1. Trying to change too much too fast can escalate resistance.
  2. Abandoning the change is not a viable offer, as the supervisor has indicated that change is needed.
  3. Overcoming resistance is often necessary for change to occur.
  4. In some cases, change must proceed despite resistance. Those who can live with the change stay, and those who cannot leave.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Quality of Practice

Learning Outcome:  5-6: Describe the nurse’s role in planned and unplanned change.

29) A major change has occurred in the governance of the hospital. How can the nurse manager help staff cope with this change?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

  1. Disperse information about the change as quickly as possible.
  2. Discourage any negative discussion about the change.
  3. Remind staff that change is part of the healthcare environment.
  4. Talk about the change in positive terms.
  5. Withdraw slightly from those who oppose the change.

Answer:  1, 3, 4

Explanation:  1. Communicating openly and honestly with those who support the change and those who oppose the change is the best strategy.

  1. The pros and cons of the change should be openly discussed.
  2. Change is constant in healthcare.
  3. Emphasizing the positive outcomes of the change is a strategy to reduce resistance.
  4. The nurse manager should maintain support for and confidence in all staff.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Implementation/Quality of Practice

Learning Outcome:  5-6: Describe the nurse’s role in planned and unplanned change.

 

 

30) Hospital administration is working with a university school of nursing to establish a nursing residency program. Why is this a desired action?

  1. A residency program eliminates the hospital’s liability if a novice nurse makes an error.
  2. A residency program is established to make nursing education more like physician education.
  3. The Institute of Medicine (IOM) has proposed residency programs for nurses.
  4. A residency program ensures that nurses participate in lifelong learning.

Answer:  3

Explanation:  1. There is no reduction of the hospital’s liability for errors.

  1. Residency programs for nurses are not being established to mimic physician education.
  2. The IOM has made this proposal.
  3. There is no assurance that nurses who participate in residency programs will engage in lifelong learning.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Collegiality

Learning Outcome:  5-1: Explain why nurses have the opportunity to be change agents.

31) A nurse leader is contemplating change on the unit. Which is the first step in the change process?

  1. Defining costs/benefits
  2. The problem has been clearly defined
  3. Identify driving and restraining forces
  4. Select and analyze data
  5. Develop a plan for change

Answer:  2

Explanation:  1. Defining costs/benefits are part of the second step.

  1. The first step in the change process is to clearly define the problem.
  2. Identify driving and restraining forces is part of the second step.
  3. Selecting and analyzing data are part of the third step.
  4. Developing a plan for change is a part of step four.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Diagnosis/Leadership

Learning Outcome:  5-3: Delineate steps in the change process.

 

 

32) The Institute of Medicine (IOM), has made recommendations for the nursing profession in its report “The future of nursing: Leading change, advancing health.” Which recommendations will help nurses lead change?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

  1. Engage in lifelong learning
  2. Remove scope of Practice barriers
  3. Implement nurse residency programs
  4. Change the structure of the organization
  5. Lead change to advance health

Answer:  1, 2, 3, 5

Explanation:  1. Engaging in lifelong learning is an IOM recommendation that will help nursing lead change.

  1. Removing scope of Practice barriers is an IOM recommendation that will help nursing lead change.
  2. Implementing nurse residency programs is an IOM recommendation that will help nursing lead change.
  3. Changing the structure of the organization is not an IOM recommendation that will help nursing lead change.
  4. Leading change to advance health is an IOM recommendation that will help nursing lead change.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Implementation/Leadership

Learning Outcome:  5-6: Describe the nurse’s role in planned and unplanned change.

 

 

 

 

Effective Leadership & Management in Nursing, 9e (Sullivan)

Chapter 17   Staffing and Scheduling

 

1) A unit requires a great deal of staffing flexibility. To fill this need, the manager should use which strategy?

  1. Maximizing the availability of nursing staff
  2. Good communication among staff
  3. A high RN-skill mix
  4. Overlap between shifts

Answer:  3

Explanation:  1. Maximizing the availability of nursing allows for more nurses but does not take into account the staffing mix. If the RN number is low, flexibility is lower.

  1. Good communication among staff is very important but does not create the greatest flexibility.
  2. A high RN-skill mix allows for more flexibility to meet client needs. An RN is educated and licensed to provide care that an assistant or LPN cannot provide.
  3. Overlap between shifts may provide more staff, but if the staff members are not RNs, flexibility is not appreciably increased.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Resource Utilization

Learning Outcome:  17-3: Describe the various ways to schedule staff.

 

2) The nurse manager is determining the day’s nursing care hours (NCHs) by analyzing the client workload. The unit census is 30 and there is a total of 220 nursing care hours. The average nursing hours per patient per day (NHPPD) figured to the nearest hundredth decimal point is ________.

Answer:  7.33

Explanation:  Nursing hours per patient per day (NHPPD) is calculated by dividing the total nursing care hours (220) by the total census (30).

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Leadership

Learning Outcome:  17-1: Determine staffing needs using evidence-based tools.

 

3) The administration of a healthcare organization has proposed a new client care area staffing system. Which components of this system do not meet the American Nurses Association (ANA) requirements?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

  1. RNs from across the facility were included on the committee that developed the system.
  2. RNs will be required to accept flexible schedules that might require the nurse to practice on any unit in the facility.
  3. The nurse’s level of educational preparation will be considered in staffing decisions.
  4. The number of clients and their acuity will be considered for staffing purposes.
  5. When low census occurs the unlicensed assistant category will be first to be furloughed.

Answer:  2, 5

Explanation:  1. The ANA requires that staffing systems be developed with input from direct-care RNs.

  1. The ANA requirements state that the RN cannot be forced to work on a unit without “having established that he or she is able to provide professional care on such a unit.”
  2. The ANA requirements state that staffing will “reflect the level of preparation and experience of those providing care.”
  3. The ANA requirements state that staffing will be “based on the number of clients and client-acuity level.”
  4. There is no mention of low census furlough in the ANA requirements for staffing systems.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Evaluation/Leadership

Learning Outcome:  17-1: Determine staffing needs using evidence-based tools.

 

 

4) The nurse manager is explaining the organizational staffing policy to a newly hired nurse. The nurse will be scheduled on an as-needed basis. The manager explains this policy is a supplemental scheduling policy. Which staffing strategies would be included in this policy?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

  1. Contracting with outside agency nurses
  2. A decentralized float pool
  3. Using non-licensed personnel as substitutes for nurses
  4. Establishing an internal float pool of nurses who are cross-trained
  5. Developing a float pool of nurses shared with another hospital in the system

Answer:  1, 2, 4, 5

Explanation:  1. Agency nurses can be used as supplements, but their cost can be significant.

  1. A decentralized float pool provides personnel who usually work only for one nurse manager or only on one unit.
  2. Non-licensed personnel cannot be used as substitutes for nurses.
  3. This can be an effective way to provide supplementary staff.
  4. This is an innovative idea that creates a system-wide internal float pool.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Resource Utilization

Learning Outcome:  17-4: Explain how to supplement staff when needed.

5) A nurse manager needs to supplement the staff for the next schedule. Which option would be the most significant drain on the unit’s staffing budget?

  1. PRN nurse
  2. Internal float nurse
  3. Part-time nurse
  4. Agency nurse

Answer:  4

Explanation:  1. PRN nurses are part of an internal float that provides supplemental staffing at a substantially lower cost than using agency nurses.

  1. Internal float nurses are part of an internal pool that provides supplemental staffing at a substantially lower cost than using agency nurses.
  2. Part-time nurses may work independently of organized supplement pools but still be assigned throughout the facility. Their salary typically is the same as or only slightly higher than that of regular staff.
  3. Agency nurses used for supplemental staffing often earn two to three times the salary of in-house nurses.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Resource Utilization

Learning Outcome:  17-4: Explain how to supplement staff when needed.

 

 

6) The hospital has elected to use the demand management staffing system instead of the client classification system. Because of this decision, the nurse manager who is staffing must focus on which of the following?

  1. Immediate client needs
  2. Historical data of expected client outcomes
  3. Using hospital-wide data to staff individual units
  4. Reduction of nursing care hours

Answer:  2

Explanation:  1. Client classification systems focus on immediate client needs.

  1. Demand management uses unit-specific historical data to determine client outcomes and nursing hours needed to meet these outcomes.
  2. The data used to staff are client outcome data.
  3. The goal is appropriate use of nursing care hours, not reduction.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Leadership

Learning Outcome:  17-3: Describe the various ways to schedule staff.

7) Which group determines the level of nursing care and hours of care necessary to meet the needs of the hospitalized client?

  1. American Nurses Association (ANA)
  2. The Joint Commission
  3. Nurse managers
  4. Hospital administrators

Answer:  3

Explanation:  1. The American Nurses Association (ANA) has developed principles for nurse staffing, and the nurse managers follow these guidelines.

  1. The Joint Commission does not identify specific levels of nursing care hours for specific client populations.
  2. Staffing and scheduling is the responsibility of the nurse manager.
  3. Although the hospital administration must ensure that the right number of competent staff is provided to meet client needs, the responsibility of staffing has been delegated to the nurse manager or charge nurse.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Implementation/Leadership

Learning Outcome:  17-1: Determine staffing needs using evidence-based tools.

 

 

8) The unpredictability of the labor and delivery area requires a set staff mix for every shift. Which type of staffing pattern should the manager use to ensure this mix?

  1. Block staffing
  2. Creative scheduling
  3. Flexible scheduling
  4. Self-staffing

Answer:  1

Explanation:  1. Block staffing is scheduling a set staff mix for every shift so that adequate staff is available at all times. This staffing is commonly used in areas such as labor and delivery and the emergency care unit.

  1. Staffing for this unit is likely to be rather repetitive and predictable rather than creative.
  2. Flexible scheduling combines shifts of differing lengths and presents a challenge to nurse managers. It is not as predictable and set as block scheduling.
  3. Self-staffing and scheduling is a staffing model whereby managers and their staff completely manage staffing and schedules. This could potentially be done following a block staffing outline but can follow other staffing schedules as well.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Resource Utilization

Learning Outcome:  17-3: Describe the various ways to schedule staff.

9) A critical care nurse has reported off because of an illness. Which choice of replacement for this nurse would provide the best continuity of quality nursing care?

  1. A nurse from an outside agency
  2. A nurse from a hospital unit that has a low census today
  3. A nurse from a decentralized internal float pool
  4. A nurse from the centralized internal float pool

Answer:  3

Explanation:  1. Nurses from outside agencies may be unfamiliar with the routine in the unit, and their services are substantially more expensive. They may be used as supplemental staff, but continuity of care may be compromised.

  1. Nurses from another unit may not have the expertise needed to care for clients on a highly specialized unit.
  2. In decentralized pools, a staff member works for one unit manager or on only one unit. Highly specialized units tend to rely on decentralized internal float pool nurses.
  3. A nurse from the centralized internal float pool would likely be familiar with facility policy, layout, and culture, but may not be skilled in caring for critically ill clients.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Implementation/Resource Utilization

Learning Outcome:  17-4: Explain how to supplement staff when needed.

 

 

10) A newly hired nurse manager is being mentored in this new role. How should the mentor advise this manager regarding staffing for the next shift?

  1. “First you must determine the nursing care hours needed.”
  2. “First you must become familiar with the classification system we use.”
  3. “First consider how to modify the schedule to meet client needs.”
  4. “First consider the need to supplement the current nursing staff so that arrangements can be made.”

Answer:  2

Explanation:  1. Nursing care hours can be determined after the nurse manager has become familiar with the current client classification.

  1. The individual responsible for staffing should first become familiar with the staffing method used.
  2. Modification of the schedule is part of the implementation process. Supplementing staff as needed is part of the implementation process.
  3. Supplementing staff as needed is part of the implementation process.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning

Learning Outcome:  17-1: Determine staffing needs using evidence-based tools.

11) The medical-surgical unit’s census has decreased since the previous shift. The manager is reviewing the staffing grid. Which factor is used to determine staffing mix?

  1. Average daily census of the hospital
  2. Client care needs
  3. Number of staff on vacation
  4. Financial productivity of the unit

Answer:  2

Explanation:  1. The average daily census of the hospital probably will not have a direct bearing on the staffing mix of this unit.

  1. The staffing mix should be based on the needs of the clients currently on the unit. A higher need for assessment, education, or discharge planning requires more RNs.
  2. The number of staff on vacation is not an issue, as the clients still need care.
  3. The financial productivity of the unit should not be an issue as that is historical data, not current client care need data.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Resource Utilization

Learning Outcome:  17-3: Describe the various ways to schedule staff.

 

 

12) The nurse manager is explaining her staffing budget to the hospital administration. The manager has developed a flexible staffing pattern. The administration questions the manager as to why this pattern was developed. Which answer is most correct?

  1. Staff members would prefer to make out their own schedules.
  2. Nursing shortages and salary constraints have affected staffing patterns.
  3. Lower client acuity has contributed to the need for more flexibility.
  4. Flexible pattern staffing is the easiest method available.

Answer:  2

Explanation:  1. The fact that staff members like to make out their own schedule is not pertinent to a flexible pattern.

  1. Nursing shortages and wage constraints have necessitated an innovative approach to using the staff available to cover client care needs. A flexible staffing pattern can help fill this need.
  2. Client acuity has risen, not lowered.
  3. Flexible staffing can be very complex from a management standpoint.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Resource Utilization

Learning Outcome:  17-3: Describe the various ways to schedule staff.

13) On two recent occasions, the experienced nurse manager has found it nearly impossible to discuss upcoming events with all the staff on the unit. What is a common reason for this problem?

  1. The hospital is experiencing a nursing shortage, so staff members are very busy.
  2. The client mix on the unit is much more varied.
  3. The unit has just adopted combined staffing patterns.
  4. There is a 1-hour overlap of staff between shifts.

Answer:  3

Explanation:  1. A nursing shortage and a busy staff should not impact the manager’s ability to communicate information to staff.

  1. The amount of variation in client mix should not adversely affect the manager’s ability to provide information to the staff.
  2. A combined staffing pattern allows for such variation in shifts that the manager may not come into contact with all of the staff during the manager’s work hours.
  3. An overlap of staff should make communication easier for the manager.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Evaluation/Leadership

Learning Outcome:  17-3: Describe the various ways to schedule staff.

 

 

14) The nursing staff of a medical-surgical unit would like to work four 10-hour shifts each week. For which reason would the unit nurse manager probably deny this request?

  1. There is no overlap of staff.
  2. There are not enough nurses working during a 24-hour period.
  3. This would create discord and confusion with other healthcare departments.
  4. This staffing pattern would not be cost-efficient.

Answer:  4

Explanation:  1. With 10-hour shifts, there is an overlap of staff.

  1. In order to cover 24 hours, three nurses are needed. In order to cover 24 hours with 12-hour shifts, two nurses are needed.
  2. There is no evidence that 10-hour shifts for nurses would adversely affect other departments.
  3. Since there is substantial overlap when covering 24 hours with 10-hour shifts, this staffing pattern is generally not cost-efficient.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Evaluation/Leadership

Learning Outcome:  17-3: Describe the various ways to schedule staff.

15) The nurse manager of an intensive care unit has several open shifts that require an RN to fill. Several nurses have taken overtime shifts but there are still several uncovered shifts. The chief nurse officer (CNO) decides to fill these vacancies with agency nurses. The CNO realizes that agency personnel must have which requirements prior to working in the facility?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

  1. Current licensure to practice within the state
  2. Orientation to the facility and the unit
  3. Certification as an agency nurse
  4. Documentation of malpractice insurance
  5. Documentation of ability to work unsupervised in the environment

Answer:  1, 2, 4

Explanation:  1. An agency nurse must have a current licensure to practice in the state in which the requesting organization resides.

  1. The agency nurse must be oriented to both the facility and the agency.
  2. There is not a certification for agency nurses.
  3. Either the nurse or the supplying agency must have documentation of malpractice insurance that covers the nurse.
  4. The nurse must be supervised by an in-house nurse and cannot work unsupervised.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Resource Utilization

Learning Outcome:  17-4: Explain how to supplement staff when needed.

 

 

16) The unit has open shifts even after staff members have signed up for overtime. The chief nurse officer (CNO) does not want to hire agency nurses to cover these shifts. The nurse manager does not understand why the CNO is offering staff an incentive versus hiring agency nurses. Which would be a reasonable conclusion?

  1. It takes a significant amount of time to orient agency nurses.
  2. The agency nurses are costly.
  3. There is a significant amount of documentation required for agency nurses.
  4. The physicians are not comfortable with agency nurses.

Answer:  2

Explanation:  1. Although it does take time and a significant amount of documentation to orient the agency this is not as big a problem as the cost.

  1. Agency nurses are a considerable cost to an organization and their use may cause staff resentment since agency nurses may be making two or three times the salary of the in-house nurse. Usually it is more cost-effective to offer an incentive and overtime to the current nursing staff.
  2. Although it does take time and a significant amount of documentation to orient the agency this is not as big a problem as the cost.
  3. The physicians may not know that the nurse is from an agency. Their primary interest is that their client’s needs are met.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Resource Utilization

Learning Outcome:  17-4: Explain how to supplement staff when needed.

17) A hospital has open shifts on its medical-surgical unit. The manager has listed open shifts on the hospital’s intranet. This is an example of which type of scheduling?

  1. External pools
  2. Internal pools
  3. Open shift management
  4. Float pools

Answer:  3

Explanation:  1. External pools are nurses employed from outside the organization, such as agency nurses.

  1. Internal pools are pools of nurses within the organization from which the unit manager may assign supplemental staff as needed.
  2. Open shift management is a technique in which a nurse may self-schedule by monitoring open shifts on the hospital intranet.
  3. Float pools are pools of nurses within an organization who work on units in which there is a need. They are typically assigned that day or within 24 hours of their shift.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Resource Utilization

Learning Outcome:  17-3: Describe the various ways to schedule staff.

 

 

18) The State Board of Health requests the employee file of all agency nurses employed within the past year. At the end of the review, the organization receives a sanction associated with these nurses. What is the most likely cause of this sanction?

  1. No current address on file for the nurse
  2. Past employment history not documented in file
  3. Evaluation of the nurse’s performance missing from file
  4. No documentation of past certifications in file

Answer:  3

Explanation:  1. The agency employing the nurse is required to maintain a file of the nurse’s current address, past employment history, and past certifications.

  1. The agency employing the nurse is required to maintain a file of the nurse’s current address, past employment history, and past certifications.
  2. The hiring organization must have a mechanism in place to evaluate agency nurses’ performance.
  3. The hiring organization is most interested in current certifications, not past certifications.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Evaluation/Resource Utilization

Learning Outcome:  17-4: Explain how to supplement staff when needed.

19) The medical-surgical unit is at capacity and the clients have a high acuity, requiring care such as turning, bathing, toileting, and feeding. Which level of supplementary staff would be cost-effective?

  1. Additional RNs
  2. Additional unit clerks
  3. Additional licensed practical nurses
  4. Additional unlicensed assistive personnel

Answer:  4

Explanation:  1. Additional RN staff would not be cost-effective for these tasks.

  1. Additional unit clerks are not likely to alleviate this staffing issue.
  2. Additional LPN staff would be less expensive than additional RN staff but are not the least expensive choice.
  3. Additional unlicensed assistive personnel could provide the care needed if supervised.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Resource Utilization

Learning Outcome:  17-3: Describe the various ways to schedule staff.

 

 

20) A new nurse manager asks to see the Joint Commission manual in order to determine adequate staffing for the next shift. How should the supervisor respond to this request?

  1. “The Joint Commission manual is kept with the other unit manuals.”
  2. “For that information you will need to refer to the human resources department’s policy on employment manual.”
  3. “You need to look at the policy and procedure manual for the organization, not the Joint Commission manual.”
  4. “Before you look any further, refer to the unit’s current schedule.”

Answer:  3

Explanation:  1. While this is likely a true statement, it does not get to the problem with the manager’s statement.

  1. Human resources policy on employment will refer to general employment guidelines for all employees, not guidelines on staffing ratios.
  2. The policy and procedures of the organization will set staffing criteria. The Joint Commission only determines if the organization is following its own policy.
  3. The current schedule will list vacancies but not the staffing guidelines for the unit.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Evaluation/Leadership

Learning Outcome:  17-3: Describe the various ways to schedule staff.

21) The nurse manager of a postsurgical unit is preparing the next month’s schedule. The manager has reviewed the surgery schedule for the corresponding month and notes there are several high-acuity surgeries. Which staffing adjustment would the manager make to best provide the care needed by these postoperative clients?

  1. Increase the number of unlicensed assistive personnel (UAP).
  2. Increase the number of licensed practical nurses (LPN).
  3. Increase the number of nonnursing support personnel.
  4. Increase the number of RNs.

Answer:  4

Explanation:  1. While UAPs would be needed for some nursing care, these surgeries are high acuity. UAPs are not the most critical employee for their care.

  1. LPNs could be helpful in caring for these clients, but since these are high-acuity surgeries, this employee classification is not the most helpful.
  2. Nonnursing support personnel are important to client care, but adding this classification of employee is not the most helpful choice.
  3. Since these are high-acuity clients, critical thinking and clinical judgment will be important. The employees best prepared to care for these clients are RNs.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Resource Utilization

Learning Outcome:  17-1: Determine staffing needs using evidence-based tools.

 

 

22) A nursing supervisor is setting up a new unit and must make a blanket decision about whether the unit will be staffed on 12-hour shifts or 8-hour shifts. What should this supervisor keep in mind when making this decision?

  1. Staffing 8-hour shifts uses slightly more full-time equivalents (FTEs).
  2. Staffing 12-hour shifts uses more full-time equivalents (FTEs).
  3. Staffing 12-hour shifts uses significantly fewer full-time equivalents (FTEs).
  4. There is no difference in the full-time equivalents (FTEs) required.

Answer:  4

Explanation:  1. Staffing 8-hour shifts does not use more FTEs.

  1. Staffing 12-hour shifts does not use more FTEs.
  2. Staffing 12-hour shifts does not use fewer FTEs.
  3. There is no difference in FTEs required.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Evaluation/Coordination of Care

Learning Outcome:  17-2: Plan workforce full-time equivalents (FTEs).

23) The OB manager is looking at staffing for the night shift. The postpartum unit is busy and the labor-delivery unit has four clients in labor. The manager collects data from the nursing staff regarding the acuity of their clients. These data assist the manager in determining the staff for the next shift. This is an example of which type of system?

  1. Demand management
  2. Block scheduling
  3. Organizational related
  4. Client classification

Answer:  4

Explanation:  1. Demand management predicts needs over the next few days, not the next shift.

  1. In block scheduling, a set number of nurses would work during the shift and client acuity would not be as big a factor.
  2. Organizational related refers to the principles for nurse staffing, not a staffing system.
  3. Client classification systems focus on the client’s acuity as it is currently occurring.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Resource Utilization

Learning Outcome:  17-1: Determine staffing needs using evidence-based tools.

 

 

24) The hospital is caring for more high-acuity clients due to the recent flu endemic. The chief nurse officer (CNO) reviews the census from last year’s flu season and instructs the manager to schedule more RNs for the weekend. Which system has the CNO used?

  1. Client classification systems management
  2. Demand management system
  3. The Baylor plan
  4. Automated staffing

Answer:  2

Explanation:  1. Client classification systems focus on client acuity in which data are collected on the current census.

  1. Demand management system focuses on predicting and controlling the demand for nurses and uses historical data.
  2. The Baylor plan is a method for weekend staffing.
  3. Automated staffing matches client demand to nurse staffing on a more individual level. It does not use historical data.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Assessment/Leadership

Learning Outcome:  17-1: Determine staffing needs using evidence-based tools.

25) An emergency department manager is looking over the next month’s schedule and decides to supplement the schedule due to vacations. The manager decides to use decentralized pool staffing to lower costs and provide quality care. Which group of nurses is a part of this manager’s decentralized staffing?

  1. PRN staff from the external pool of nurses
  2. Agency nurses
  3. PRN staff from the emergency department nurses
  4. PRN staff from the nurses who work on medical-surgical units

Answer:  3

Explanation:  1. External pool nurses are generally more expensive to employ.

  1. Agency nurses are from the external pool.
  2. PRN emergency department nurses are decentralized or from the same department and/or manager.
  3. PRN staff composed of nurses who work on medical-surgical units make up centralized internal float pools.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Resource Utilization

Learning Outcome:  17-3: Describe the various ways to schedule staff.

 

 

26) A nurse has agreed to work on the Baylor plan. The nurse should arrange day care for which shifts?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

  1. A 12-hour shift on Saturday
  2. An 8-hour shift on Monday
  3. An 8-hour shift on Sunday
  4. A Thursday shift once a month
  5. Shifts every weekend

Answer:  1, 5

Explanation:  1. Twelve-hour weekend shifts are part of the Baylor plan.

  1. Weekday shifts are not included in the Baylor plan.
  2. In the Baylor plan, weekend shifts are 12 hours.
  3. Weekday shifts are not included in the Baylor plan.
  4. Under the Baylor plan, the nurse works 12-hour shifts every weekend and is paid for a standard work week.

Cognitive Level:  Applying

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Resource Utilization

Learning Outcome:  17-3: Describe the various ways to schedule staff.

 

27) Two nurses have agreed to share a schedule in which each will work 4 hours each day for a total of 20 hours a week. In 2 weeks, ________ FTEs will be generated by these nurses.

Answer:  80

Explanation:  In a 2-week pay period, one FTE equals 80 hours. These two nurses are working 4 hours each per day for 10 days: 4 × 2 × 10 = 80 hours.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Collaboration

Learning Outcome:  17-2: Plan workforce full-time equivalents (FTEs).

 

28) A healthcare facility has adopted automated scheduling across all client care areas. When presenting this decision to nursing staff, the nurse executive should include which information?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

  1. “This system will allow nurses to spend more time with those clients who need us the most.”
  2. “We expect that using this system will help us improve client outcomes.”
  3. “There will be little financial gain to the institution, but we are committed to improving our scheduling.”
  4. “Using this Baylor plan will help us improve client outcomes.”
  5. “This system will allow nurses to choose shifts and clients.”

Answer:  1, 2

Explanation:  1. Automated systems match nursing time to client need more effectively. This allows the nursing care to match the amount of care needed.

  1. Automated scheduling systems do improve client outcomes.
  2. Automated scheduling often results in improved financial outcomes.
  3. The Baylor plan is not an automated scheduling system.
  4. The automated system does not allow nurses to choose shifts or clients.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Implementation/Resource Utilization

Learning Outcome:  17-3: Describe the various ways to schedule staff.

 

29) A nursing supervisor requests information technology support for posting all nursing scheduling online. What justification can the supervisor provide for this request?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

  1. If schedules are posted online, they are open for all to see.
  2. Posting schedules online will promote fairness in shift assignments.
  3. It is easier to change the schedule if it is posted online.
  4. If the schedule is posted online, all shifts must be 12-hour shifts.
  5. Open shift scheduling is easier to maintain if all schedules are online.

Answer:  1, 2, 5

Explanation:  1. Posting schedules improves transparency.

  1. If everyone can see the schedule, it is more likely that shift assignments will be fair. Favoritism would be difficult to hide.
  2. There is little difference between a written schedule and an online schedule in ease of change.
  3. There is no requirement that all shifts must be 12-hour shifts.
  4. If schedules are online it is easier for nurses to see open shifts that they might wish to work.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Implementation/Resource Utilization

Learning Outcome:  17-3: Describe the various ways to schedule staff.

 

30) An acute care nursing unit has determined that an acuity level III client requires 6 hours of nursing care per shift while a level IV client requires 8 hours. Today the unit has seven level III clients and nine level IV clients. The manager should staff for ________ hours of nursing care for the next shift.

Answer:  114

Explanation:  To determine nursing care hours, multiply the number of hours per client by the number of clients in that category and add up the results. Category III = 7 clients × 6 hours of care = 42. Category IV = 9 clients × 8 hours of care = 72.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Coordination of Care

Learning Outcome:  17-1: Determine staffing needs using evidence-based tools.

 

31) The manager has appointed a nurse to complete staffing. The nurse knows that the goal of staffing is to provide what?

  1. Effective/efficient nursing care
  2. Appropriate numbers/mix of nursing staff
  3. Client assessment data
  4. Opportunities/chances for measuring nursing expertise
  5. Matched actual/projected client needs

Answer:  1, 2, 5

Explanation:  1. The goal of staffing is to provide effective, efficient nursing care; appropriate numbers; mix of nursing staff; and matched actual, projected client care needs.

  1. The goal of staffing is to provide effective, efficient nursing care; appropriate numbers; mix of nursing staff; and matched actual, projected client care needs.
  2. The goal of staffing is to provide effective, efficient nursing care; appropriate numbers; mix of nursing staff; and matched actual, projected client care needs.
  3. The goal of staffing is to provide effective, efficient nursing care; appropriate numbers; mix of nursing staff; and matched actual, projected client care needs.
  4. The goal of staffing is to provide effective, efficient nursing care; appropriate numbers; mix of nursing staff; and matched actual, projected client care needs.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Evaluation/Leadership

Learning Outcome:  17-1: Determine staffing needs using evidence-based tools.

 

 

32) A full-time equivalent (FTE) equals ________ hours/year.

Answer:  2,080

Explanation:  Answer is computed as follows: 40 hours per week times 52 weeks equals 2,080 hours.

Cognitive Level:  Analyzing

Client Need:  Safe Effective Care Environment

Client Need Sub:  Management of Care

Nursing/Int Conc:  Nursing Process: Planning/Coordination of Care

Learning Outcome:  17-1: Determine staffing needs using evidence-based tools.

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