20 Jan Clinical incompetence is one

NUR 4827 Leadership and management in Healthcare

Week 1 Discussion

List four words that come to mind when you think of a leader. List four words that come to mind when you think of a follower. Analyze the difference between the two lists. Do you think of leaders in different ways than you think of followers? Discuss what is different and why?

NUR 4827 Leadership and management in Healthcare

Week 2 Discussion

DQ1 Are leaders born or made? If you think they are born, can anything be done to help someone who wants to lead but was not born a leader? If you think they are made, how are they made? What strategies can you use to improve your leadership skills?

DQ2 Nurses manage day to day challenges at the workplace. Consider the following scenario about violence in the workplace:

A young, husky male is brought to the Emergency Department because of his escalating angry behavior. As he is being interviewed, a 6-inch knife is found in his possession. When he is asked to surrender the knife, he refuses and becomes quite agitated. How can this situation best be handled? Provide a rationale for your selected strategies.

Call the code-green team for a show of force.

Push the panic button to summon the security guards.

Try to talk the patient into giving up the weapon.

Other responses

NUR 4827 Leadership and management in Healthcare

Week 3 Discussion

What can happen when the employer is held liable based solely on the actions of the staff member’s negligence and the employer pays monetary damages because of the employee’s negligent actions? Does the institution have the right to counter-sue the nurse for damages paid to an injured patient?

NUR 4827 Leadership and management in Healthcare

Week 6 Discussion

DQ1 Team building

Working in a team is an important strategy for accomplishing work. Understanding what is required of a strong teammate becomes clear as you are assigned team projects.

For this discussion question, Identify the 17 characteristics that make a good team. Select four of those characteristics and discuss why each of these is important.

DQ2 Managing Quality and Risk

How does the Magnet Recognition Program® relate to quality management?

NUR 4827 Leadership and management in Healthcare

Week 7 Discussion

DQ1 Managing Personal/Personnel Problems

Take a few moments to recall the past 2 to 3 weeks in the clinical setting or work location. How many times were they praised for a job well done? Was the praise or reward warranted? What are their strengths and weaknesses in praising others?

DQ2 Workplace Incivility

How can incivility impact patient care? Discuss how communication problems are at the heart of nearly 70% of events impacting patient care (TJC, 2008).

NUR 4827 Leadership and management in Healthcare

Week 9 Discussion

DQ1 This discussion can be found in your book, chapter 7 called Exercise 7-1.

Using the local phone directory, determine the types and numbers of primary care, secondary care, and tertiary care services available in our community. Table 7-2 provides an example of a format for collecting the data.

Review the list of your classmates, is there anything you can add to their list? Do you think this information is useful and why?

DQ2 A nurse on a medical/surgical unit has made the same medication error 2 days in a row. As the nursing manager, describe how you would decide whether this is a systems problem or a problem related to the individual nurse. In either case, explain how you (the manager) should correct the problem?

NUR 4827 Leadership and management in Healthcare

Week 10 Discussion

DQ1 Many nursing experts believe that evaluation is the most crucial part of employee development. Debate the pros and cons of this statement, and decide whether the statement is true. If it is not true, then what constitutes the most important part of employee development?

DQ2 Differentiate failure mode effects analysis (FMEA) from root cause analysis (RCA)?

NUR4827 Leadership and management in Healthcare

Week 12 Discussion

This question refers to Chapter 14 Exercise 14-3. It pertains to your place of work so it only needs the reference of the book and/or any other source you utilize. If you would like to provide an example, please ensure that all names have been removed for privacy.

Questions to determine the potential employer’s scheduling practices might include the following. Relate these questions to your place of business.

How many hours are included in each shift? Is there any flexibility in this?

Have minimum and maximum numbers of days been determined that an individual should work before he takes a day off?

What input does staff have in determining schedule practices?

What is the process for requesting specific time off?

What other questions might you ask about scheduling?

NUR4827 Leadership and management in Healthcare

Week 14 Discussion

DQ1 Bachelors prepared nurses are leaders in their fields. Making the transition and transformation into a management role is worth the effort.

Leading lives of integrity and commitment, nurse managers set examples, bringing out the best in direct care nurses and thereby multiplying their influence on quality patient care.

How can you set yourself up for success when transitioning between roles? or enhance your role as leader?

DQ2 Job stress can be defined as the physical and emotional responses that arise when the job requirements do not match the abilities, resources or needs of the worker.

External sources of stress include work-related stressors, and may be related to change, social pressures, position (role stress), and gender roles.

Internal sources of stress include personal triggers, unrealistic self-beliefs, and lifestyle choices. An individual’s ability to deal with stress may be moderated by psychological hardiness.

Initially, increased stress produces increased performance. However, when stress continues to increase or remains intense, performance decreases.

What is General Adaptation Syndrome? What are the stages of stress response in this theory?

NUR 4827 Leadership and management in Healthcare

Group Project Case Study

Case Study #1 for Team A and B

Mr. and Mrs. O. are from Sudan and are temporarily living in the United States while Mr. O. is a university graduate student. They have a daughter age 6 and a son age 10. Mrs. O. brings her daughter to the clinic requesting a modified female genital mutilation (FGM), a form of female circumcision. They plan to return to Sudan within 2 years. Dr. M., the pediatrician, is outraged and discusses this with K., his RN, and the clinic social worker, G. He emphatically stated that her request was unethical and a primitive practice. He tells the social worker (MSW) to call the Children’s Protective Service (CPS), because the parents are endangering their daughter’s health. They are in need of counseling, and to an extreme action of placing the daughter in a foster home temporarily until the situation is resolved.

The RN has cared for Mrs. O. during her clinic appointments. In the presence of the MSW, she tries to explain to Dr. M. that the parents are very concerned about their daughter’s “future.” The RN and the MSW are opposed to bringing in the CPS. They believe that the parents are good, responsible parents and are trying to do the best for their daughter. They think that Dr. M. doesn’t understand the cultural issues. They explain that FGM is commonly done in Sudan and the parents will need to have this surgery done or else their daughter will not be “marriageable” and will be forced to live as a prostitute or even a beggar on the streets. The parents desperately would like the surgical procedure to be done as a minimum, minor incision, rather than the major, more mutilating excision. If they return to Sudan without the daughter having surgery, the daughter will be subjected to a more invasive excision (infibulation). According to the mother, it most likely would be done by a nonmedical person under unsanitary conditions using a butcher knife. The dangers of these procedures are severe pain, hemorrhage, infection, damage to adjacent tissue, and poor healing. The long-term effects include recurrent urinary tract infections, infertility, serious complications with pregnancy, and development of excess scar tissue requiring additional procedures.

What are some of the cross-cultural ethical issues occurring with this case?

What should each healthcare professional (RN, MSW, pediatrician) do individually and/or collectively in managing this case?

What are the parents’ rights acting on behalf of their minor child in this situation?

What are the pediatrician’s rights in this situation?

Case Study #2 for Team C and D

Millicent, RN, MSN is a white, 40-ish certified therapist in “Healing Touch.” She has been offering this therapy to her hospitalized culturally diverse post-surgical patients with good responses from them. She is aware that that there is some research suggesting that the therapy lessens the need for pain medication, reduces anxiety, and induces better sleep. Dr. Jones becomes angry when he learns about her doing “touch therapy” on his patients, which he calls “the work of the devil.” He strongly tells Millicent that she cannot do anything to his or his partner’s patients without a physician’s order.

What facts should be known about the RN’s scope of practice?

What are the ethical issues in this case between the RN and the physician?

What should be considered by the RN in relationship to “research ethics”? Patient’s fully informed consent? Cultural beliefs about an alternative therapy?

Case Study #3 for Team E and F

Benito F. is a 66-year-old Latino/Hispanic male retired after 45 years as a lineman with the telephone company in a rural community. His wife died from cancer within the past year. He had been a significant caregiver in addition to neighbors. They were married for 42 years and have two grown sons who live out of state. Lately, he has spent a lot of time alone, no longer going hunting with a friend and becoming less involved in activities at the Catholic Church. A concerned neighbor, who was unable to reach Benito by telephone, went to his home to check on him. Subsequently, he drove him to a large public hospital in a city 50 miles from his home. Benito was admitted to the Emergency Room. The nurse’s assessment revealed that he was in a “stuperous state with a strong smell of alcohol on his breath.” His rambling speech included comments about his wife’s death and that life wasn’t worth living anymore.

What are common family beliefs/values of the Hispanic culture and how has Benito’s family structure changed based on these beliefs?

What factors about Benito’s lifestyle might have led to his health condition?

What might be potential medical and mental consequences of Benito’s current lifestyle?

What appropriate patient teaching should be given to Benito in writing on his discharge, and why?

Why should “health literacy” be considered in teaching Benito about his care?

Case Study #4 for Team G and H

Mr. H. is a 59-year-old Arab business executive who lives in Saudi Arabia. His physicians have sent him to a large medical center hospital in the United States for evaluation of a potential heart-lung transplant. He speaks fluent English as do his wife and son, who accompanied him to the United States. On arrival at the hospital unit, Mr. H. stated that he was very tired from the long plane flight and was anxious about his condition. Because of his “status,” his attending physician transferred him to the Medical Intensive Care Unit. While undergoing extensive testing in preparation for a heart-lung transplant, Mr. H. has a lethal pulmonary embolus on Day 2 of hospitalization (physician diagnosis). Mr. H.’s wife and son were devastated.

What cultural information should the healthcare team know about Mr. H.’s beliefs/values about organ allographic transplant? Food practices? Spirituality/religious practice?

What is the general decision-making process in Arab family relationships?

What death care/rituals should be addressed with the family and by whom from the healthcare team? Consider care of the body at time of death, consent for autopsy, grief intervention, return of body to Saudi Arabia.

NUR 4827 Leadership and management in Healthcare

Week 16 Assignment Career Marketing Strategies

Even the steady-state or experienced nurse who is not seeking a new position needs to have a curriculum vitae (CV) or resume that can document continued development of expertise. Interviewing, which is a two-way process, also contributes to successful position choices and career development.

To begin data collection, especially if you have not kept records before, begin with where you are and think back. The important aspect of this phase is to begin the process and to save it electronically so that you can shape information for specific reasons.

A curriculum vitae (CV) is the documentation of one’s professional life.

Resumes are customized documents that relate to the qualifications of a specific organizational position and help create an image of you serving in that position.

During your career, you will need to communicate effectively through letters. The commonly used letters are a cover letter, a thank-you letter, and a resignation letter.

Develop your own curriculum vitae, resume, and cover letters. Sample resumes are included on the Evolve Website. Submit them as they would to actual employers, typed correctly and formatted appropriately.

NUR 4827 Leadership and management in Healthcare

Midterm Exam

Question 1

At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution. What is the best next action?

Arrange another meeting in a week’s time so as to allow a cooling-off period

Insist that participants continue to talk until a resolution has been reached

Turn the dispute over tot he direcxtor of nursing

Back the unit manager’s actions and end the dispute

Question 2

After assessing an older adult patient in long-term care who has been slowly deteriorating for weeks, the nurse manager calls the family and asks them to come in, as the patient is dying. What is the nurse manager’s decision based on?

Experience

Unit protocol

An established clinical pathway.

Confirmatory scientific evidence.

Question 3

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

Leader

Manager

Laissez-faire

Follower

Question 4

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

Contingency-based

Transformational

Trait-based

Situational

Question 5

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

Empowerment

Development of networks

Bottom-up interactions

Systematic thinking

Question 6

As a nurse manager on the West Surgery Unit, you are interested in increasing patient safety and reducing morbidity and mortality on your unit. Which of the following recommendations would be consistent with the IOM The Future of Nursing report?

Careful screening of nursing staff for substance use and abuse

Increase in the percentage of baccalaureate-prepared nurses to 80%

Salary and benefits that reflect nursing accountabilities

Increased RN staffing on the unit

Question 7

In preparation for re-designation as a Magnet Hospital, how would you prepare?

Commit staff resources over a 6-month period to updating procedure manuals.

Prepare a manual that outlines orientation procedures and ensure that all safety issues are addressed.

Educate staff through meetings and training sessions regarding appropriate answers to questions.

Ensure that there are empirical data to support review of patient outcomes, actions taken, and results of actions.

Question 8

The SBAR approach to patient safety encourages which of the following?

Continuing education.

Patient feedback.

Consistency in assessment and practices.

Multidisciplinary approaches.

Question 9

As the manager on an acute care medical unit, you note that the incidence of medication errors has increased since the implementation of staffing changes. As part of your strategy to reduce errors, it is important to do which of the following?

Re-visit reporting standards for medication errors in your organization.

Provide staff with additional education related to safe practice in medication administration.

Involve RN staff in determining reasons for errors and practice solutions to increase the safety of medication administration.

Ensure that medication errors are consistently reported.

Question 10

A nurse executive is hired to restore a unit’s productivity, which has decreased as the result of low staff morale. The nurse executive utilizes which of the following leadership principles?

If staff members increase productivity, then they are given opportunity to engage in learning events such as workshops and conferences. If the staff members are not satisfied, they will insist on a different leader, who will get them what they want.

Workplace satisfaction depends on staffing ratios, adequate pay, and tuition reimbursement, and these are things the leader can control.

Leaders at the national level who are seeking relief for nurses in the workplace are seen as the solution to the nursing shortage.

The leader declares the intent and goals to enhance productivity and assumes that the unit also wishes to increase productivity, which allows nurses to feel in control of the environment.

Question 11

After being interviewed for the unit manager position, the staff nurse reflects on the interview process. The staff nurse is aware that leadership begins:

Through a relationship with a mentor.

With the chief nursing officer of the organization.

Within.

With the job description.

Question 12

The nurse manager in the Emergency Department needs to implement new staffing patterns. As a transformational leader, the nurse manager shoulddo which of the following?

Explain in detail how well the new idea will work.

Reason with staff members that the new idea will save money and allow more free time.

Imply that raises will be smaller than anticipated if the new idea is not accepted.

Reinforce how this change will respond to the ideas and solutions generated by staff members.

Question 13

Recruiting among the emerging workforce (18- to 35-year-olds) is a challenge for healthcare agencies. Marketing brochures should address the leadership and vision of the healthcare agency. Which of the following workplace environments will attract applicants in the emerging workforce?

An environment highlighted by lots of meetings, so staff members can have lots of input

A nurturing and receptive environment

A totally online environment, so staff members will not have to interface with uncaring colleagues

A highly professional environment

Question 14

The Sunny Long-Term Care Facility has experienced numerous difficulties with staff relationships, despite its success in maintaining financial viability and judicious use of resources. Staff members complain that the primary concerns of the facility include applying policy, saving money, and ensuring that lawsuits are avoided. There is little trust in, and involvement of, staff members. This facility may be:

Well managed and well led.

Overly led and overly managed.

Poorly managed and well led.

Overly managed and not well led.

Question 15

The adage “leaders are born and not made” reflects which of the following ideas around leadership?

Leadership is a natural skill that cannot be refined or developed.

Succession planning and formal education related to leadership are ineffective.

Mentorship is important in developing innate skills of leaders.

Management can be taught; leadership depends on abilities.

Question 16

A nurse manager in a hospital is deeply concerned that senior administration makes decisions about budgetary directions that affect staffing and other resources without sharing the rationale for changes or demonstrating concern as to how these changes may affect patients or staff. She says she does not feel respected and is emotionally tired as a result. This situation represents:

Negative organizational culture.

Quantum leadership.

Realities of current health care.

Bureaucratic organization.

Question 17

As a nurse manager, you embrace the usefulness of resources such as Smart Bed. This behavior is important to do which of the following?

Succession planning.

A manager’s role.

Budget development.

Encouragement of staff utilization of technology.

Question 18

To reduce the incidence of falls in a skilled nursing unit, the nurse manager contacts the risk manager. Risk management is a process that attempts to identify potential hazards and:

Supersede the need for staff members to file incident reports.

Compensate for previous injuries.

Eliminate these risks before anyone else is harmed.

Discipline staff members who have been involved in previous incident reports.

Question 19

The risk manager informs the nurse manager of an orthopedic unit that her unit has had an increase in incident reports about patients falling during the 11-7 shift. What is the best way for the nurse manager to resolve the problem?

Identify the problem.

Obtain support from the 7-3 shift.

Use institutional research.

Use creativity.

Question 20

A clinic nurse has observed another nurse deviating from agency policy in performing wound care. What is the best approach for the clinic nurse to take?

Assess the risk to the client and the agency before proceeding.

Stay out of it.

Fill out a notification form (incident report).

Inform the nursing supervisor.

Question 21

John Smith, one of three managers at BSG Labs, drafted a policy that would allow his department to do more testing in his lab. This policy included the times for regular collection as well as a new process for emergency laboratory testing. The policy and procedures were never followed. What is the reason for this?

The policy was too lengthy and inundated readers with too much detail.

The policy made decisions for other departments in the company.

Testing should not be done in the lab.

The staff did not believe that the new policy would be effective.

Question 22

Jane, an experienced head nurse, is given the task of completing the summer vacation schedule for the pediatric unit. She is fully aware of the hospital’s restrictions on time off and the number of staff on vacation at any given time, as well as its issues regarding seniority. She weighs the options of allowing staff choice, such as it takes more time but gives employees options. However, if choice is allowed, this could cause arguments. Which of the following is the best alternative?

Post a tentative schedule, and request feedback.

Ask for requests for vacation time in advance, and post the times.

Post the completed vacation schedule.

Post a blank schedule, and ask staff members to fill in their times by a given date.

Question 23

A 66-year-old native Chinese patient, hospitalized for a myocardial infarction, asks the nurse manager about seeing his “acupuncture doctor” for treatment of his migraine headache. What is the best response to this patient?

“Do you think acupuncture relieves your pain satisfactorily?”

“Have you tried nonprescription pain medication or been given a prescription drug for your headaches?”

“How long have you been using acupuncture treatment?”

“What have you told your heart specialist about your migraines and treatment?”

Question 24

Because an increasing number of Hispanic patients are being admitted, a nurse manager designs a staff-development program to help her staff understand the Hispanic culture. A nurse should understand that culture is determined by which of the following?

Behavior

Genetic predisposition

Shared vision

love for people

Question 25

During managers’ meetings, Lindsay is surprised by the forthrightness of male managers. She finds that, during discussions, she would be more likely to say which of the following?

“I wonder if we should consider changing our policy on performance appraisals? What do you think?”

“Forget about change in this policy. It is fine as it is.”

“Sean, your approach to appraisal is completely off track and does not reflect available evidence.”

“The system that has been developed needs to be implemented. We have already spent enough time in discussion.”

Question 26

The nurse manager used a mediator to help resolve conflicts on the unit. During the mediation process, the nurse manager saw signs of potential team-building. One key concept of an effective team is which of the following?

Conflict

Commitment

Task clarity

A designated leader

Question 27

A mediator suggested that the nurse manager and staff members decide on a method to resolve conflicts. It is important to have agreements about how team members will work together because:

If there are no agreements, each member will make up rules about how to handle disagreements and relationships.

A way to eliminate nonproductive team members must be available.

People are naturally difficult and will not work well together without such agreements.

People will naturally ask for agreements about how to be together.

Question 28

The staff development educator developed strategies to help nurse managers actively listen. Guidelines for active listening include which of the following?

Speed up your internal processes so that you can process more data.

Realize that the first words of the sender are the most important.

Cultivate a desire to learn about the other person.

Be prepared to make an effective judgment of the communication sender.

Question 29

You are charged with developing a new nursing curriculum and are committed to developing a curriculum that reflects the needs of the profession and of the workplace. To address deficits that may already be present in nursing curricula related to the workplace, you include more content and skills development related to which of the following?

Generational differences in communication.

Therapeutic communication with patients.

Increased emphasis on sender-receiver dyads.

Effective communication in the workplace.

Question 30

Hospital ABCD is a Magnet™ hospital. This designation has been applied to Hospital ABCD because it:

Is establishing career ladders for nurses.

Has implemented a graduate nurse orientation program.

Facilitates active staff participation in decision making related to quality nursing care.

Espouses commitment to excellence in patient care.

Question 31

As a nurse manager, you know that the satisfaction of patients is critical in making QI decisions. You propose to circulate a questionnaire to discharged patients, asking about their experiences on your unit. Why does your supervisor cautions you to also consider other sources of data for decisions?

The return rate on patient questionnaires is frequently low.

Patients are reliable sources about their own experiences but are limited in their ability to gauge clinical competence of staff.

Hospital experiences are frequently obscured by pain, analgesics, and other factors affecting awareness.

Patients are rarely reliable sources about their own hospital experiences.

Question 32

Through the QI process, the need to transform and change the admissions process across administrative and patient care units is identified. In this particular situation, what method of data organization will be most effective?

Flowchart

Line graphs

Histogram

Narrative

Question 33

The outcome statement “Patients will experience a ten percent reduction in urinary tract infections as a result of enhanced staff training related to catheterization and prompted voiding” is:

Physician-sensitive and nonmeasurable.

Patient care–centered and nonmeasurable.

Precise, measurable, and physician-sensitive.

Measurable and nursing-sensitive.

Question 34

Your institution has identified a recent rise in postsurgical infection rates. As part of your QI analysis, you are interested in determining how your infection rates compare with those of institutions of similar size and patient demographics. What is this known as?

Quality assurance

Benchmarking

Statistical analysis

Sentinel data

Question 35

At Hospital Ajax, there has been a 20% increase in instruments and sponges being left in patients during surgery and surgeries on the wrong limbs. What are these are known as?

Medically sensitive events.

Never events.

Sentinel events.

Nurse-sensitive events.

Question 36

The chief nursing officer at a local hospital seeking Magnet™ status creates staff development classes about incorporating evidence-based practice in nursing. What best describes evidence-based practice?

Conducting a randomized control trial to determine effectiveness of handwashing techniques

Developing standards for practice

Using research-based information to develop practice guidelines

Applying best research evidence to care of patients

Question 37

Before implementation of the new policy and procedure on central line catheter care, the nurse manager uses an appraisal system to evaluate the evidence. What is important in using an appraisal system to evaluate the evidence gathered in preparation for development of a new protocol?

Using only pre-processed evidence

Eliminating qualitative research studies

Limiting the search to randomized clinical trials

Matching the appraisal tool to the type of evidence

Question 38

Tara, the unit manager, is telling her colleague about her recent project, which involves seeking the most effective approaches to incontinence care, with the intention of adopting evidence-supported approaches on her dementia care unit. Her colleague suggests that translation of research into practice is which of the following?

Characterized by lack of knowledge about how to use evidence to guide practice.

A priority of all healthcare practitioners to improve patient care.

Less important than knowledge-generating research, which is required to advance the nursing profession.

So difficult that it is useless to begin the query in the first place.

Question 39

The clinical guidelines for management of incontinence developed by the Registered Nurses Association of Ontario (RNAO):

Are intended to increase awareness of issues in incontinence management.

Reflect practice that is fiscally directed and sound.

Articulate practice recommendations developed from synthesis and review of evidence.

Reflect a compilation of information from a variety and range of sources related to incontinence.

Question 40

Once evidence related to the use of prompted voiding in patients with cognitive impairment has been appraised and integrated with practice, it is important to:

Search large databases such as CINAHL to amass further evidence.

Solicit input regarding integration with practice.

Clarify the clinical practice question.

Consider whether patients’ families see this as necessary for the well-being of family members.

Question 41

A nurse manager must be familiar with the agency’s policies regarding termination. Termination procedures include which of the following?

Having a friend present during the termination meeting

Having adequate written documentation to support the action

Following specific procedures from other organizations

Having an attorney present at the termination meeting

Question 42

All of the following are grounds for immediate dismissal except:

Restraining a patient in bed for 7 hours, unsupervised, as punishment for hitting a staff member.

Grabbing the unit manager and threatening further physical harm after a poor performance appraisal.

Selling narcotics obtained from the unit supply of narcotics.

Failing to pursue further medical help for a patient; patient dies.

Question 43

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:

Asked to attend a union grievance meeting.

Transferred to another unit.

Suspended indefinitely.

Terminated after the first infraction.

Question 44

Jenny tells you that she is always able to tell when others are about to become violent because they yell. Your response to Jenny is based on your understanding of which of the following?

Violence is signaled by a variety of behaviors.

Her perception is accurate.

Yelling is more likely associated with aggression.

She is mostly accurate in her thinking.

Question 45

Becky, RN, works as a staff nurse in mental health; Sharon works as a data entry clerk in Admissions; Sarah is an emergency room physician; and Donna is a housekeeper in geriatrics. Which of these four is most at risk for violence and aggression?

Becky

Sarah

Donna

Sharon

Question 46

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

Assertiveness

Management

Followership

Insubordination

Question 47

With regard to nursing practice, nurse managers are held responsible for (select all that apply):

Ensuring that physicians are properly licensed to provide care on patient care units.

Referring all errors in nursing judgment to state discipline boards.

Practicing within legal guidelines established under state law and nurse practice acts.

Ensuring that nursing staff under their supervision are currently licensed to practice.

Question 48

Examples of sentinel events include which of the following: (select all that apply)

Administration of morphine overdose.

Forceps left in an abdominal cavity.

Patient fall, with injury.

Death of patient related to postpartum hemorrhage

Short staffing.

Question 49

A nurse manager introduces prompted voiding into nursing practice on a unit, which is supported by clinical guidelines based on evidence-based practice. The nurses on the unit resist implementation, indicating that the bathroom facilities are too far away for efficient implementation of the guidelines, and that resources are too few to accomplish the initial voiding observations. For the nurse manager in this situation, it is important to have further discussion with the staff regarding (select all that apply):

Feasibility of the program with respect to unit design.

Compatibility of this intervention with the values of staff on the unit.

Usefulness of prompted voiding with the particular population of patients on the unit.

Advantages of prompted voiding over incontinence products and catheterizations.

Question 50

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.)

“It is a nurse’s professional responsibility to maintain quality control.”

“Patient care is the number one concern. Meeting standards is mandatory and necessary.”

“It is not considered being disloyal when one nurse reports another for poor care.”

“All instances of clinical incompetence are to be reported.”