CNML & NE-BC STUDY QUESTIONS WITH GUARANTEED ACCURATE ANSWERS |VERIFIED, Exams of Nursing

Download CNML & NE-BC STUDY QUESTIONS WITH GUARANTEED ACCURATE ANSWERS |VERIFIED and more Exams Nursing in PDF only on Docsity! CNML & NE-BC STUDY QUESTIONS CNML & NE-BC STUDY QUESTIONS WITH GUARANTEED ACCURATE ANSWERS |VERIFIED What is the purpose of a job description? - ACCURATE ANSWERS✔✔ A job description outlines the job duties to a potential or new employee, explains the boundaries of the scope of practice, and provides direction for the new employee about what performance measures will be assessed at evaluation time. Why should you avoid starting new staff before they attend general orientation? - ACCURATE ANSWERS✔✔ Expediting an employee orientation is not a good idea because general orientation provides an opportunity to connect the employee with the mission, vision, and values of the larger organization. General orientation also provides safety topics and opportunities to make connections which can help them in the future. What is the best way to give feedback to an employee who tends to be defensive and confrontational? - ACCURATE ANSWERS✔✔ When giving feedback to an employee who tends to be defensive and confrontational it is best to review the employee performance guidelines, have the meeting in a safe location, perhaps include a witness, and focus specifically on the employee's performance issues. What are the challenges of communication in the workplace? - ACCURATE ANSWERS✔✔ The challenges of workplace communication are that people tend to look for differences rather than similarities. People tend to judge others based on what they assume is their intent, and people tend to avoid engaging in potentially tense interactions. Why is communication in the workplace so important? - ACCURATE ANSWERS✔✔ Good communication is important because 80% of patient errors are related to communication breakdowns (Institute of Medicine, 2004). People often know there is a problem but do not know how to communicate it to others who can resolve the situation. What is disruptive innovation? - ACCURATE ANSWERS✔✔ Disruptive innovation (Christensen, Bohmer, & Kenagy, 2000) is any action that disrupts an existing way of doing something. The term can be used to describe a problem but do not know how to communicate it to others who can resolve the situation. Why is it important how a candidate dresses for an interview? - ACCURATE ANSWERS✔✔ First impressions influence the interviewer when conducting an interview. Unprofessional and inappropriate attire may be an indication of poor judgement by the candidate however; there may be a reason, which you will not know them for suggested creative solutions where they both could be satisfied with the outcome. What are the dynamics that impact on physician-nurse relationships? - ACCURATE ANSWERS✔✔ Physician-nurse relationships are impacted by a variety of factors including: Gender differences, patterns in the organizational culture of how people relate too each other, and perceptions of hierarchy such as physicians should be in charge. What are ways of increasing dialogue in crucial communication situations? - ACCURATE ANSWERS✔✔ Crucial Conversations is a model for communication based upon the concept of increasing dialogue on a team (Patterson, et al, 2002) Dialogue is increased by creating a safe environment for communication; working toward mutual purpose and respect; and increasing the pool of shared meaning about the situation. What is the purpose of rounding for outcomes? - ACCURATE ANSWERS✔✔ Rounding for outcomes involves having staff go in the patient room at regular intervals and asking specific questions. It helps to provide a safe environment for patients and families by allowing them to provide feedback on their care experience. What is SBAR? - ACCURATE ANSWERS✔✔ SBAR is s communications tool primarily used to improve nurse-physician communication. The initials stand for: Situation: Who else is involved? What's going on? Background: Briefly explain everything leading up to the situation. Assessment: What do you think is going on? Recommendation: What do you think should be done and by when? What is the best way to address a nurse who refuses to float to another unit because she says she has no experience caring for that patient population and does not want to risk losing her license? - ACCURATE ANSWERS✔✔ The best response by the charge nurse to a nurse who refuses to float to another unit would be to talk to the nurse about her concerns. Then ask the other unit what types of support they will provide the nurse. Make sure the nurse will be working safely is she goes to the other unit. What would you do first if one of your nurses was uncooperative when she floated to another unit? - ACCURATE ANSWERS✔✔ The first thing for the manager to do if a nurse was uncooperative when floating to another unit would be to talk to the nurse and ask her version of what happened. What would be the first thing for a charge nurse to do if a nursing assistant was accused of sleeping on the night shift? - ACCURATE ANSWERS✔✔ If the charge nurse was told a nursing assistant was sleeping when she was suppose to be doing a 1:1 observation she or he should remove the employee from the situation. The place them on administrative leave pending an investigation as to what happened. What is the best way to handle a new employee who feels uncomfortable with the relationship with their orientation preceptor who they describe as harsh and overly critical? - ACCURATE ANSWERS✔✔ When questioned about a preceptor the manager should ask the orientee for specific feedback about what is going on and then make some suggestions for how he or she can address these with the preceptor. They may also offer to meet with them together, if that would help. If the situation cannot be resolved a new preceptor should be assigned. What would be the best response to an orientee on your Medical- Surgical unit who says she would like to work in the ICU some day? - ACCURATE ANSWERS✔✔ The best response to an orientee on your Medical-Surgical unit who says she would like to work in the ICU some day would be to explain to the nurse that Medical-Surgical nurses often transfer to the ICU after they have a year or two of experience and you will design her orientation and work assignments to help achieve her goal. What is the best way to address a crisis? - ACCURATE ANSWERS✔✔ According to crisis management theories, the best way to address a crisis is to make sure the front-line employees know what to do in an emergency (Mitroff, 2005). According to the principals of Crisis Management, what do front line workers need? - ACCURATE ANSWERS✔✔ Front line workers need training, empowerment, and support after the crisis. Work is not a popularity contest. You are there to do a job, not be everyone's friend, right? - ACCURATE ANSWERS✔✔ Research has shown that a lack of teamwork can negatively affect patient outcomes (Aiken, et al, 2002). Rath (2006) found that friendships had a positive impact on teamwork, morale, and employee engagement. performance as possible, and should be meaningful to the employee. While a nurse's week gift is a nice gesture, it is hard to find a gift that everyone finds meaningful and will appreciate. It is not necessarily motivating, as it is not tied to any specific behavior by the individual nurse. What is the best way to include an employee's self-evaluation in the review process? - ACCURATE ANSWERS✔✔ The best way to involve an employee's self-evaluation when doing an employee review is to have the employee do a self-evaluation and read it before the review. Then discuss and compare your impressions vs. theirs before writing up your review. Why is it important to set specific goals with the employee during the annual evaluation process? - ACCURATE ANSWERS✔✔ It is important for the supervisor and employee to mutually agree upon goals to provide the employee with the direction for being successful in the coming year. How can bias effect the manager when performing an employee annual evaluation? - ACCURATE ANSWERS✔✔ Some examples of bias by the rater during an annual evaluation would be: Allowing an employee's positive personality to influence your scoring; having one bad recent experience that influence your view of the whole year of performance; and giving credit good or bad this year for something they did in previous years. What factors may influence low employee performance? - ACCURATE ANSWERS✔✔ In looking at employee performance, the nurse manager should consider the possible reason, in order to determine a course of action. Some possible reasons for lower performance may include a knowledge or skill deficit requiring further education or coaching. The employee may also be experiencing personal stress such as a family situation or illness. Another factor may be the directions for the task or job description were unclear. What is a root cause analysis? - ACCURATE ANSWERS✔✔ Root cause analysis is a process used to define the basic fundamental causal factor(s), which if corrected will reduce the likelihood of an error occurring in the future. Who should be on a root cause analysis team? - ACCURATE ANSWERS✔✔ The root cause analysis team should include: Staff who work closest to the problem, a leader, and a facilitator to insure the people feel safe to give honest feedback without being punished. The department manager, person who wrote the policy, Risk Management department, and any other technical experts may be included as determined by the leaders of the root cause analysis team. How do you create a safe environment for a cause analysis project? - ACCURATE ANSWERS✔✔ The way to create a safe environment for a root cause analysis team is to have a skilled facilitator who sets ground rules and creates a safe environment where everyone can speak honestly. Leadership must also make a commitment not to punish employees who give honest feedback. What are the most common root causes of medical errors? - ACCURATE ANSWERS✔✔ The most likely root causes of medical errors are written procedures that are not followed due to complicated processes or ones with too many unnecessary steps. What is a potential problem with a policy requiring two nurses to check all blood before it is administered? - ACCURATE ANSWERS✔✔ One potential flaw in two nurses checking blood is that each one assumes the other is doing it and neither one really checks. What is Group Think? - ACCURATE ANSWERS✔✔ Group Think is a process where a group falls into a pattern of dong something because they think everyone else believes it is an acceptable behavior. It can lead to dangerous safety situations. What is diffusion of responsibility? - ACCURATE ANSWERS✔✔ Diffusion of responsibility is a form of group-think in which people perform differently in a group, then they would individually. The dynamic involves a combination of feeling somewhat anonymous, dispersing the responsibility to the group rather than you individually, and a certain element of excitement regarding the situation (Gerrig, & Zimbardo, 2009). People's behavior in a group may differ from their individual behavior, because being in a group provides a certain element of anonymity and protection (Lacks, Gordon, and McCue, 2005). What is a workaround? - ACCURATE ANSWERS✔✔ Workarounds are a common problem when staff feel a process is too complicated and it appears easier to take a short cut, than to follow a process with too many steps. Unfortunately, workarounds are a common cause of errors. What is a flow chart? - ACCURATE ANSWERS✔✔ A flow chart is used in a process improvement project to provide a visual representation of the steps in a process. What is a Gantt chart? - ACCURATE ANSWERS✔✔ A Gantt chart is used to show a projects schedule timeline. What is a scattergram? - ACCURATE ANSWERS✔✔ A scattergram is used to show variation between items based on the frequency they occur. What is a pareto diagram? - ACCURATE ANSWERS✔✔ A pareto diagram displays the frequency of occurrences in order of appearance or frequency. What is a bar graph? - ACCURATE ANSWERS✔✔ A bar graph shows values of a number of different items. What does PDSA stand for? - ACCURATE ANSWERS✔✔ The PDSA cycle stands for Plan, Do, Study, Act. What are the stages in Thompson (2000) theory of change? - ACCURATE ANSWERS✔✔ Thompson, et al (2000) identified the stages of change as: Forming, Storming, Norming, Performing. What happens in the forming stage of a change process? - ACCURATE ANSWERS✔✔ In the forming stage people get along fairly well leading to a sense of optimism about the project. Senior staff refusing to work night shifts because they have seniority is an example of which stage of the change process? - ACCURATE ANSWERS✔✔ Senior staff refusing to work night shifts because they have seniority is an example of Storming. How should you handle a team in the storming stage? - ACCURATE ANSWERS✔✔ In the storming stage conflict is high, so as leader your best response would be to accept that storming is a normal stage of development and remind the team of their mission. Then create a safe environment for staff to share their feelings and move toward an acceptable solution based on the common vision. What should the facilitator do if a committee seems to be in the storming stage? - ACCURATE ANSWERS✔✔ If a committee seems to be in the storming stage, the facilitator should work with the team to identify the conflicts and help them to work through this stage. How can you avoid the storming stage? - ACCURATE ANSWERS✔✔ It actually is not a good idea to try and avoid the storming stage. Storming is a normal part of change and helps the individuals to understand the details of the mission. The emotional intensity of the storming dialogue can be improved by recognizing that conflict is a healthy part of change and brings potential issues to the forefront. Avoiding the issues could hinder long-term success. A way to improve the dynamics is to develop ground rules for effective dialogue with the group early on. What should the manager's role be in assigning an experienced nurse to perform a new task she has never done before? - ACCURATE ANSWERS✔✔ According to Situational Leadership Theory (Blanchard, & Zigarmi, 1999) the managers role should be highly directive. Despite the fact the employee has years of experience, she or he is still a novice in this particular situation and therefore needs a high level of direction. What is situation leadership? - ACCURATE ANSWERS✔✔ Situational Leadership (Blanchard & Zigarmi, 1999) is a management theory based on every situation is different and the supervisor needs to customize an approach that considers the employee's skill and experience in that situation. What is the most important reason for using Situation Leadership as an approach to a challenging situation on the unit? - ACCURATE ANSWERS✔✔ Situational Leadership involves customizing the approach depending on the employee's needs in the particular situation. What happens in the second stage of Situational Leadership? - ACCURATE ANSWERS✔✔ During the second stage of situational Leadership (Blanchard & Zigarmi, 1999) the employee experiences frustration as the tasks become more challenging. What are the key qualities to a good meeting? - ACCURATE ANSWERS✔✔ A good meeting has an agenda with clear objectives and What are the advantages of using e-mail to communicate information? - ACCURATE ANSWERS✔✔ E-mail provides a way to send one message to a large audience in a timely way. There is an electronic record that the message was received and read, which may be easier than trying to assemble a large group of people for a face-to-face meeting on an important topic. Unfortunately, the negative aspect of e-mail is you do not know if staff understand the information from just reading the e- mail. What is CQI? - ACCURATE ANSWERS✔✔ CQI is Continuous Quality Improvement. What does TQM stand for? - ACCURATE ANSWERS✔✔ TQM is Total Quality Management. Describe Total Quality Management (TQM)? - ACCURATE ANSWERS✔✔ TQM originated in the 1950's in factories as a process for quality, which focused on doing things right the first time rather than checking for mistakes. TQM was based on the concept that faulty systems primarily cause failures, not people (Deming, 1989). What is Lean Six Sigma? - ACCURATE ANSWERS✔✔ Lean Six Sigma is an approach to quality based on getting as close to possibility of having no errors. What is the best way to measure patient satisfaction? - ACCURATE ANSWERS✔✔ The best way to measure patient satisfaction is to work with the shared governance councils to develop a comprehensive program to solicit patient feedback on an on-going basis. What is the purpose of hourly rounding? - ACCURATE ANSWERS✔✔ The purpose of hourly rounding for outcomes is to ask patients about their care needs, to assess the safety of the environment, and to let patient's know you are accessible. What are examples of Proactive Teamwork? - ACCURATE ANSWERS✔✔ Examples of Proactive Teamwork include staff helping each other during surges, participating on quality focus projects, and discussing patient care options. What is the purpose of an incident report? - ACCURATE ANSWERS✔✔ Incident reports provide a detailed report of what happened in a particular situation. The report provides data for tracking the nature and pattern of incidents, which can be used to identify systems breakdowns for correction. Incident reports also provide certain information to the Risk Management department, which you may not want to document in the chart. What should staff document when writing an incident report? - ACCURATE ANSWERS✔✔ An incident report should contain the time the incident occurred, who was present, and a detailed description of everything that occurred. What is the first thing a nurse manager should do if she or he found three medication errors? - ACCURATE ANSWERS✔✔ The first thing a nurse manager should do related to multiple medication errors is talk to the charge nurse and ask if there was anything unusual about the shift that could have contributed to the medication errors. How do you create a zero tolerance policy for safety related to patient falls? - ACCURATE ANSWERS✔✔ To create a zero tolerance policy for patient falls the nurse manager should talk to the shared governance quality chair and ask them to explore with staff what the issues are related to patient falls on their unit. Based on staff feedback the approach could include evidence based practices related to patients falls; hiring more staff, including sitters to watch the high risk patients; and instituting hourly rounding to include documenting patient fall prevention checks. What is benchmarking? - ACCURATE ANSWERS✔✔ Benchmarking is a process for identifying the best practices within and outside the organization. The comparative benchmarks can be used to set targets for meeting strategic goals. What is evidence based practice information? - ACCURATE ANSWERS✔✔ Evidence based practice information comes from scholarly peer reviewed sources based on research showing that something is effective. What is the purpose of qualitative research? - ACCURATE ANSWERS✔✔ Qualitative research is used to looks at a phenomenon that there is not a lot of information about, by asking open-ended questions. What are the attributes of a good change agent? - ACCURATE ANSWERS✔✔ Being a successful change agent requires goof listening skills, patience to allow people to adopt the change at their own pace, the ability to facilitate groups effectively, and good communication skills. What is the Neutral Zone in a change? - ACCURATE ANSWERS✔✔ During a transition, the Neutral Zone (Bridges, 2004) is time of uncertainty between the ending and the beginning of the new thing. the neutral zone is a good time to experiment with different approaches and different roles. What is wrong with trying to add structure, policies, and procedures to try and slow down the change process? - ACCURATE ANSWERS✔✔ It is challenging to try to slow down change by adding structure, policies, and procedures during the change process. Adding more structure can actually make things even more chaotic and confusing as the staff are bombarded with too many changes at once. What is the most important step to introducing new technology in the workplace? - ACCURATE ANSWERS✔✔ The most important step to introducing new technology is allowing staff time to reflect on what they are losing, so they are ready to accept the need for the new changes. What should a nurse manager do if the hospital is considering new communication technology for nurses? - ACCURATE ANSWERS✔✔ If the manager knows the hospital is considering new communication technology they should explore the different technology options at the vendor exhibits at the next national conference they attend and talk to colleagues from other organizations who have already purchased new technology so they are ready to provide informed input into the hospitals upcoming decision. What would you do if the hospital made a decision to use a vendor for the Electronic Medical Record (EMR) system and your nurses voiced strong opposition to the choice? - ACCURATE ANSWERS✔✔ If you found your nurses resisting a particular choice the hospital made your best action would be to talk with as many staff as possible and find out specifically what they did not like about this EMR product. If the decision is final, you can then help the staff to explore how they can adjust to the decision. What would you do if your staff were not attending the orientation workshops for a new technology being introduced? - ACCURATE ANSWERS✔✔ Your best response as a nurse manager if your staff were not attending mandatory orientation workshops for a new technology would be to talk to your shared governance council chair and ask for ideas on why staff are not attending. Then work with your staff to design times and formats that would work for them. What are the stages of change according to Lewin? - ACCURATE ANSWERS✔✔ Kurt Lewin (1997) described the stages of change as unfreeze, change, refreeze. What happens during the unfreeze stage of change? - ACCURATE ANSWERS✔✔ During the unfreeze stage of change the team becomes motivated to make the change by understanding there is a need to change, which motivates them to move into the transition period (Lewin, 1997). What happens during the refreeze stage of change? - ACCURATE ANSWERS✔✔ When teams reach the refreeze stage of change, the changes have been accepted and are now the new norm. This process takes time as people move into comfortable new routines, which can be described as refreezing (Lewin, 1997). Given the chaotic times we live in the refreeze period may be short lived and the team quickly moves into another unfreezing stage. What is force field analysis? - ACCURATE ANSWERS✔✔ Lewin (1997) referred to the force field analysis as the combination of factors for or against making a change. People make an analysis of these factors and when the factors in favor of the change are greater than the factors against the change they become motivated to change. If people are pushed too aggressively to change they often react with resistance. What is the best way to address nurses not wanting to participate in rounding for outcomes? - ACCURATE ANSWERS✔✔ The best approach to staff resistance is to provide staff the opportunity to express their frustration, remind them of the corporate mission, and draw a connection to how rounding impacts on patient satisfaction. What is the most important stage for a manger to focus on in Bridges (2004) transitions model? - ACCURATE ANSWERS✔✔ The most important stage of transition for a manager to be concerned about it endings. People need time to express their feelings about what they are losing before they can appreciate the benefits of the new beginning. leaders teaching them the facts. It is a solution focus based on expanding the number of supporters beyond the stakeholders directly involved with the problem. What are the characteristics of high performance teams? - ACCURATE ANSWERS✔✔ High performance teams trust each other, they put the team ahead of the individual, they do not fear conflict, they hold each other accountable, and focus on results, according to Lencioni (2002). What is the best way to help staff deal with multiple changes happening simultaneously? - ACCURATE ANSWERS✔✔ The best way to help staff cope with multiple changes happening simultaneously is to create a transition team of staff who focus on the emotional response of their co- workers to the change. Allow the transition team to make suggestions and implement them. How can a nurse manager create an environment where creativity, innovation, and change are embraced by the staff? - ACCURATE ANSWERS✔✔ The best way for a nurse manager to create an environment where creativity, innovation, and change are embraced by the staff is to form an innovation task force and solicit suggestions. The manager must also reward staff who demonstrate creativity and innovation in whatever way the individual staff would appreciate it. According to Lewin you must first unfreeze the team to create enthusiasm for a change. What is the best way for a manager to do that? - ACCURATE ANSWERS✔✔ A nurse manager can create momentum for a change by providing staff with opportunities to articulate their dissatisfaction with the current state and make suggestions for how to improve the existing system. What is the best way to communicate information in today's environment as a nurse manager? - ACCURATE ANSWERS✔✔ We are working in a culturally diverse world with multiple generations who have a variety of preferences for how they like to receive and deliver information. Rather than trying to identify a best approach, the manager should use a variety of approaches including face-to-face meetings, e- mail, walking around and being visible, and using traditional methods such as newsletters. How can a manager run an effective meeting when the staff are too busy with patient care to leave the unit? - ACCURATE ANSWERS✔✔ In today's environment not all staff can attend face-to-face meetings because of work and personal responsibilities that impact their availability. Nurse manager need to be creative in finding other ways to deliver information including on-line meetings, teleconferences, blogs, electronic discussion groups, and shared governance councils. What is the most important thing a nurse manager can do to prepare her staff for a potential disaster? - ACCURATE ANSWERS✔✔ The most important aspect of disaster planning is making sure staff are aware of their role in various scenarios. Disaster manuals should be available for electronic viewing and hard copies should be centrally located on the nursing unit in case the computer is not available during the disaster. What is the first responsibility of a charge nurse when an internal disaster is announced? - ACCURATE ANSWERS✔✔ The first thing the charge nurse should do when an internal disaster is announced is to await further orders and review the procedures. During the alert stage she can also begin to alert staff using the phone tree, but not call in additional staff until the extent of the disaster is known. What is the first thing a medical surgical nurse manager should do if she is told to activate the external disaster plan as there has been an earthquake and 50 victims are being sent to the Emergency Department? - ACCURATE ANSWERS✔✔ If the external disaster plan has been activated the nurse manager should alert the charge nurse to begin to identify patients for discharge to make room for victims. The phone tree should be activated and staff identified who can come in to work. As many employees as possible should be sent to the personnel pool to be redeployed as needed to help with victims. Why is debriefing conducted after a disaster drill? - ACCURATE ANSWERS✔✔ A debriefing after a disaster drill provides an opportunity to identify what worked well or not so well for application to the disaster plan for real events. Minutes from the debriefing can be distribute to those who were not present and provide documentation for regulatory agencies that drills are taking place routinely to test the systems. What is SWOT? - ACCURATE ANSWERS✔✔ A SWOT analysis is part of the strategic planning process and includes a look at Strengths, Weaknesses, Opportunities, and Threats. What are some ways a good change agent transforms an organization? - ACCURATE ANSWERS✔✔ A good change agent is well educated on Why should evidence based practice literature be included in a change project discussion? - ACCURATE ANSWERS✔✔ Evidence based practice literature provides credibility to your project though justifications from scholarly sources. People may be willing to change once they hear the scholarly evidence for why change is needed. According to Bridges, what are the components of transitions? - ACCURATE ANSWERS✔✔ ~Three overlapping stages ~Endings more significant than beginnings ~Tendency to focus on benefits of the beginning ~Emotions are strongest around loss ~When endings are not addressed the repressed feelings emerge in other ways When facilitating change, how should endings be handled? - ACCURATE ANSWERS✔✔ Give plenty of information Define what's over and what's not Mark the ending symbolically Treat the past with respect Let people take a piece of the past with them Show how previous endings have led to success Don't drag it out What is wrong with the nurse manager trying to make everyone on her staff happy? - ACCURATE ANSWERS✔✔ It is impossible to make everyone happy. While employee satisfaction is a priority, the nurse manager cannot fix every possible problem herself. The staff should be in the process of identifying approaches to job satisfaction, not just the manager.