Leadership & Management in Advanced Nursing Practice Exam, Exams of Nursing

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NURS

Leadership & Management in

Advanced Nursing Practice

LATEST EXAM

PART A:

1. A nurse manager is leading a team of nurses in a busy emergency department. She notices that some of the nurses are experiencing burnout and compassion fatigue due to the high workload and stress. Which of the following is the most appropriate leadership style for her to adopt in this situation? a) Autocratic b) Democratic c) Laissez-faire d) Transformational Answer: D. Transformational leadership is a style that inspires and motivates followers to achieve a shared vision and goals. It also fosters a positive work environment, encourages innovation and creativity, and provides support and feedback to the followers. This style can help reduce burnout and compassion fatigue by enhancing the nurses' sense of meaning, purpose, and empowerment.
2. A nurse leader is implementing a quality improvement project in a long-term care facility. He wants to involve the staff nurses in the planning and decision-making process. Which of the following is the most effective way for him to do so? a) Form a committee of staff nurses to represent their views and opinions b) Conduct a survey of staff nurses to collect their feedback and suggestions c) Hold regular meetings with staff nurses to discuss the project and solicit their input d) Delegate tasks and responsibilities to staff nurses according to their expertise and interests Answer: C. Holding regular meetings with staff nurses is the most effective way to involve them in the quality improvement project. This method allows for direct communication, collaboration, and participation among the nurse leader and the staff nurses. It also enables the nurse leader to address any concerns or issues that may arise, provide guidance and support, and acknowledge the contributions of the staff nurses.
3. A nurse educator is teaching a group of nursing students about evidence-based practice (EBP). She explains that EBP is the integration of the best available evidence, clinical expertise, and patient preferences and values in making clinical decisions. She

then asks the students to identify the sources of evidence that can be used in EBP. Which of the following is an incorrect answer? a) Systematic reviews b) Clinical practice guidelines c) Personal experience d) Randomized controlled trials Answer: C. Personal experience is not a source of evidence that can be used in EBP. Although personal experience can provide valuable insights and knowledge, it is not considered as reliable or valid as scientific evidence. Personal experience can also be influenced by biases, assumptions, and emotions that may affect the quality of clinical decisions.

4. A nurse administrator is responsible for managing the budget of a hospital unit. She has to allocate resources for staffing, equipment, supplies, education, and other expenses. She also has to ensure that the unit meets the quality and safety standards set by the accreditation body. Which of the following is a key skill that she needs to perform her role effectively? a) Negotiation b) Delegation c) Conflict resolution d) All of the above Answer: D. All of the above are key skills that a nurse administrator needs to manage the budget of a hospital unit. Negotiation is a skill that involves reaching an agreement or compromise with others who have different interests or perspectives. Delegation is a skill that involves assigning tasks or authority to others who are capable and willing to perform them. Conflict resolution is a skill that involves resolving disagreements or disputes among individuals or groups in a constructive way.
5. A nurse practitioner is working in a primary care clinic that serves a diverse population of patients from different cultural backgrounds. She recognizes that cultural competence is an essential component of providing quality care to her patients. Which of the following is an example of cultural competence? a) Asking patients about their cultural beliefs and practices related to health and illness b) Adapting her communication style and interventions to suit the patients' cultural preferences and needs c) Respecting and valuing the differences and similarities among patients from different cultures d) All of the above Answer: D. All of the above are examples of cultural competence. Cultural competence is defined as "the ability of health care providers and organizations to deliver services that meet the social, cultural, and linguistic needs of patients" (Betancourt et al., 2005). Cultural competence involves awareness, knowledge, skills, attitudes, and behaviors that enable health care providers to provide culturally appropriate care to their patients.
6. A nurse researcher is conducting a study on the effects of music therapy on pain management in patients with chronic pain. She has obtained informed consent from all the participants and has followed ethical principles throughout the study. However, she faces a dilemma when one of the participants requests to withdraw from the study after completing half of the sessions. How should she handle this situation? a) Respect the participant's right to withdraw and terminate his participation in the study

b) Persuade the participant to continue and complete the remaining sessions of the study c) Offer the participant an incentive or compensation for completing the study d) Report the participant to the ethics committee and exclude him from the study Answer: A. Respect the participant's right to withdraw and terminate his participation in the study. One of the ethical principles that guide research is respect for persons, which means that researchers should respect the autonomy, dignity, and rights of the participants. Participants have the right to withdraw from a study at any time without penalty or coercion. Researchers should honor this right and ensure that the participants are not harmed or disadvantaged by their decision.

7. A nurse consultant is hired by a health care organization to evaluate and improve its performance and outcomes. She uses a framework that consists of four components: structure, process, outcome, and balance. What is the name of this framework? a) Donabedian model b) Kirkpatrick model c) Logic model d) Balanced scorecard Answer: A. Donabedian model. The Donabedian model is a widely used framework for evaluating and improving health care quality. It was developed by Avedis Donabedian, a pioneer in health care quality research. The model proposes that health care quality can be assessed by examining three aspects: structure (the physical and organizational characteristics of the health care setting), process (the activities and interactions that occur in the delivery of care), and outcome (the results or effects of care on patients' health status). The model also suggests that balance (the trade-offs or costs associated with care) should be considered in evaluating quality.
8. A nurse mentor is assigned to a new graduate nurse who is working in a surgical ward. She provides orientation, guidance, feedback, and support to the new nurse as she transitions from student to professional nurse. She also helps the new nurse develop her clinical skills, confidence, and competence. Which of the following is a benefit of mentoring for the new nurse? a) Increased job satisfaction and retention b) Enhanced professional growth and development c) Reduced stress and anxiety d) All of the above Answer: D. All of the above are benefits of mentoring for the new nurse. Mentoring is a relationship between an experienced and a novice nurse that facilitates learning, development, and socialization in the nursing profession. Mentoring can help new nurses overcome the challenges and difficulties they face in their first year of practice, such as role ambiguity, role conflict, role overload, and reality shock. Mentoring can also foster a sense of belonging, commitment, and loyalty to the nursing profession.
9. A nurse advocate is working for a non-governmental organization that promotes human rights and social justice in health care. She campaigns for better access to health care services for marginalized and vulnerable populations, such as refugees, immigrants, indigenous people, and people living with HIV/AIDS. She also educates and empowers these populations to voice their needs and concerns and to participate in decision-making processes that affect their health and well-being. Which of the following is a challenge that she faces in her role as a nurse advocate? a) Lack of resources and funding

b) Resistance and opposition from powerful stakeholders c) Ethical dilemmas and conflicts of interest d) All of the above Answer: D. All of the above are challenges that a nurse advocate faces in her role. Nurse advocacy is defined as "the act or process of supporting a cause or proposal; it encompasses actions designed to influence or change health policy on behalf of patients or groups" (Stanhope & Lancaster, 2016). Nurse advocacy can be rewarding but also challenging, as it involves dealing with complex and controversial issues, competing interests, political pressures, and resource constraints.

10. A nurse manager is responsible for supervising a team of nurses in a pediatric unit. She uses various methods to monitor and evaluate the performance of her team members, such as observation, feedback, appraisal, coaching, and mentoring. She also uses various tools to measure and document the performance of her team members, such as checklists, rating scales, portfolios, and self-assessments. Which of the following is a purpose of performance measurement in nursing? a) To identify strengths and weaknesses of individual nurses b) To provide feedback and recognition to individual nurses c) To facilitate professional development and improvement of individual nurses d) All of the above Answer: D. All of the above are purposes of performance measurement in nursing. Performance measurement is defined as "the process of collecting, analyzing, and reporting information regarding the performance of an individual, group, organization, system, or component" (Joint Commission on Accreditation of Healthcare Organizations [JCAHO], 2002). Performance measurement can help nurses assess their current level of competence, identify their learning needs, set their goals, and plan their strategies for achieving them. Performance measurement can also help nurses receive constructive feedback, praise, and recognition for their achievements, which can enhance their motivation, satisfaction, and retention. PART B: Case Study: The Role of Leadership in Improving Patient Outcomes Mr. Wilson, a 65-year-old patient with multiple comorbidities, has been admitted to the acute care unit. His condition deteriorates rapidly, and the care team is struggling to provide optimal care. Discuss how effective leadership and management can contribute to improving patient outcomes in this scenario. Answer with rationale:

Effective leadership and management are crucial in ensuring optimal patient outcomes. Leaders can promote a culture of continuous quality improvement, facilitate interdisciplinary collaboration, and allocate resources effectively to meet patient needs. By fostering a sense of teamwork and accountability, leaders can create an environment where all staff members are motivated to provide high-quality care, leading to improved patient outcomes.

1. Case Study: The Role of Managerial Skills in Conflict Resolution Two nurses on the medical-surgical unit, Sarah and Emily, have been experiencing frequent conflicts, leading to decreased team morale and compromised patient care. Explain how effective leadership and management can help resolve conflicts in this situation. Answer with rationale: Effective leadership and management skills are important in conflict resolution. Leaders can employ active listening skills, gather all relevant information, and encourage open communication to understand the root causes of the conflict between Sarah and Emily.

By promoting empathy, creating a safe environment for discussion, and facilitating open dialogues, leaders can help both nurses find common ground and establish effective strategies for collaboration, ultimately improving team dynamics and patient care.

2. Case Study: Developing Effective Communication Strategies in Nursing Leadership The medical-surgical unit is composed of several staff members from different cultural backgrounds, leading to communication challenges and misunderstandings. Discuss the strategies that nursing leaders can employ to overcome these communication barriers. Answer with rationale: Nursing leaders play a vital role in developing effective communication strategies. They can initiate cultural awareness training, implement translation services, and encourage open dialogue to address communication barriers caused by different cultural backgrounds. By promoting cross-cultural understanding and emphasizing the importance of effective communication, nursing leaders can foster an inclusive work environment that enhances team cohesiveness and ultimately improves patient care.
3. Case Study: Leadership Styles and Their Impact on Team Performance The intensive care unit (ICU) is experiencing low staff morale, decreased job satisfaction, and burnout due to a disengaged leadership style. Discuss the impact of different leadership styles on team performance and propose an effective leadership approach in this situation. Answer with rationale: Different leadership styles impact team performance differently. A disengaged leadership style can lead to decreased job satisfaction and burnout, negatively affecting team performance and patient outcomes. In contrast, transformational leadership, which emphasizes inspiration, motivation, and intellectual stimulation, enhances team engagement and fosters a positive work environment. Therefore, in the given scenario, adopting a transformational leadership approach can help improve staff morale, job satisfaction, and ultimately enhance team performance in the ICU.
4. Case Study: Ethical Decision Making in Nursing Leadership The nursing manager is faced with a dilemma involving limited resources and the need to prioritize patient care. How can nursing leaders employ ethical decision-making frameworks to navigate this situation effectively? Answer with rationale: Ethical decision-making frameworks can guide nursing leaders in making difficult

choices. Leaders can utilize frameworks such as the ANA Code of Ethics or principles of beneficence, non-maleficence, autonomy, and justice to evaluate the situation and make fair and equitable decisions. By involving the interdisciplinary team in the decision-making process and ensuring transparency, leaders can foster understanding and support, leading to ethical and efficient resource allocation while prioritizing patient care.

5. Case Study: The Impact of Emotional Intelligence on Nursing Leadership Nurse Kelly, a unit manager, struggles with managing her emotions during stressful situations, leading to ineffective communication and decreased team morale. Discuss how emotional intelligence can influence nursing leadership and propose strategies for Nurse Kelly to enhance her emotional intelligence. Answer with rationale: Emotional intelligence plays a crucial role in effective nursing leadership. Emotionally intelligent leaders can manage their emotions, empathize with others, and effectively communicate during stressful situations. Strategies for Nurse Kelly to enhance her emotional intelligence may include self-reflection to identify triggers, seeking feedback from peers, and attending emotional intelligence workshops or coaching. By improving her emotional intelligence, Nurse Kelly can develop more meaningful relationships with her team, improve communication, and ultimately foster a positive work environment.
6. Case Study: Implementing Change in Nursing Practice The hospital has decided to introduce a new electronic documentation system. Discuss how leadership and management can facilitate successful change implementation and address staff resistance. Answer with rationale: Leadership and management play a critical role in successful change implementation. Leaders should communicate the need for change effectively, provide opportunities for staff input, and address any concerns or resistance. By involving staff in the decision- making process, providing comprehensive training, and ensuring ongoing support, leaders can foster a sense of ownership and empower staff during the transition. This approach enhances the likelihood of successful change implementation, improves staff acceptance, and ultimately optimizes patient care outcomes.
7. Case Study: Leading Interprofessional Teams in Complex Healthcare Environments The emergency department (ED) is experiencing difficulties in maintaining effective collaboration and communication among various healthcare professionals. Discuss the role of nursing leaders in leading interprofessional teams and propose strategies to improve teamwork in the ED.

Answer with rationale: Nursing leaders play a crucial role in leading interprofessional teams and promoting effective teamwork. They can foster interdisciplinary collaboration by facilitating regular team meetings, enhancing communication channels, and promoting mutual respect and understanding. Implementing interprofessional education programs, assigning shared responsibilities, and encouraging professional development opportunities can also foster a sense of teamwork and enhance collaboration among healthcare professionals in the ED.

8. Case Study: Managing Conflict Between Different Generations in Nursing Leadership The nursing unit is comprised of staff members from different generations, leading to conflicts and communication challenges. Discuss strategies that nursing leaders can employ to manage and leverage the diversity of generations effectively. Answer with rationale: Nursing leaders should adopt strategies to manage the diversity of generations effectively. By promoting an inclusive work environment that values all generations, leaders can foster collaboration by encouraging open discussions, sharing knowledge, and leveraging the strengths of each generation. Implementing mentorship or reverse mentoring programs can facilitate intergenerational relationship building, leading to improved team dynamics and a positive work environment.
9. Case Study: Effective Time Management in Nursing Leadership Ms. Johnson, a nurse manager, struggles with time management, resulting in missed deadlines and decreased productivity. Discuss the importance of effective time management for nursing leaders and propose strategies for Ms. Johnson to improve her time management skills. Answer with rationale: Effective time management is vital for nursing leaders to meet deadlines, ensure optimal task allocation, and enhance team productivity. Strategies for Ms. Johnson to improve time management may include prioritizing tasks, delegating responsibilities, utilizing effective time management tools or software, and setting realistic goals and deadlines. By enhancing her time management skills, Ms. Johnson can lead by example, ensure tasks are completed efficiently, and create a productive work environment for her team.
10. Case Study: Leadership in Crisis Management A natural disaster strikes the community, resulting in a mass casualty incident overwhelming the hospital's capacity. Discuss the role of nursing leaders in crisis management and propose strategies to ensure effective leadership during a disaster.

Answer with rationale: Nursing leaders play a critical role in crisis management. They should ensure clear communication and coordination among various departments, allocate resources effectively, and provide emotional support to the healthcare team. Strategies for effective leadership during a disaster may include establishing an incident command system, conducting regular drills and simulations, and developing a comprehensive disaster response plan. By demonstrating strong leadership and effective crisis management skills, nursing leaders can guide their team through challenging situations, optimize patient care, and ensure the safety of staff and patients.

11. Case Study: Leadership in Quality Improvement Initiatives In the pediatric unit, there is a concern about the increasing incidence of medication errors. Discuss how nursing leaders can lead quality improvement initiatives to address this issue and propose strategies for sustained improvement. Answer with rationale: Nursing leaders play a vital role in leading quality improvement initiatives. They should initiate a root cause analysis to identify the underlying factors contributing to medication errors and gather input from frontline staff for potential solutions. Leaders can implement strategies like barcode scanning, standardized medication administration protocols, and ongoing education and training to address the issue. By promoting a culture of safety, monitoring outcomes, and engaging staff in continuous quality improvement, nursing leaders can sustainably reduce medication errors and enhance patient safety.
12. Case Study: Leadership in Staff Recruitment and Retention The critical care unit is experiencing high staff turnover and difficulty in recruiting qualified nurses. Discuss the role of nursing leaders in staff recruitment and retention and propose strategies to address this issue. Answer with rationale: Nursing leaders are essential in staff recruitment and retention. They can ensure a positive work environment that values and recognizes staff contributions, offers professional development opportunities, and provides competitive compensation and benefits. Strategies to address the issue may include conducting exit interviews to identify reasons for turnover, implementing mentorship programs, and promoting a healthy work-life balance. By fostering a supportive work environment, nursing leaders can enhance staff satisfaction, reduce turnover, and promote continuity of care, ultimately improving patient outcomes.
13. Case Study: Leading Change in Nursing Education

The nursing education program wants to introduce a new curriculum focused on evidence-based practice. Discuss the role of nursing leaders in leading educational change and propose strategies for successful curriculum implementation. Answer with rationale: Nursing leaders play a crucial role in leading educational change. They can engage faculty members in the decision-making process, provide support and resources for curriculum development, and facilitate ongoing faculty development opportunities. Strategies for successful curriculum implementation may include piloting the new curriculum, conducting regular program evaluations, and seeking feedback from students and faculty to identify areas for improvement. By demonstrating effective leadership, nursing leaders can ensure the successful implementation of evidence- based practice curricula, resulting in a competent nursing workforce equipped with the latest knowledge and skills.

14. Case Study: Ensuring Patient Safety Through Effective Leadership The surgical unit experiences a high rate of surgical site infections (SSIs). Discuss how effective leadership and management can contribute to improving patient safety in the surgical unit and propose strategies to reduce SSIs. Answer with rationale: Effective leadership and management are crucial in ensuring patient safety. Leaders can promote a culture of safety by implementing evidence-based infection prevention protocols, ensuring compliance with best practices, and monitoring surgical outcomes. Strategies to reduce SSIs may include implementing pre-operative antibiotic prophylaxis, improving hand hygiene compliance, and conducting regular audits and educational sessions Describe the traditional organizational structure - answer- Tall and narrow chain of command - Employees ranked top to bottom with the number on bottom greater than the top, authority is at the top only, power is distributed, communication is a challenge because of all of the layers of power What are the differences between mission statement, vision and philosophy of an organization - answer- Mission - reason for existence, Vision-goals/ambitions for future, Philosophy-value of principles/beliefs/behaviors What is the purpose of a mission statement? - answer- To show purpose/reason for existence, outlines aim of organization, critical in strategic planning and guides planning What impact do ineffective nurse managers have on others? - answer- Can harm employees, clients and the organization for which they work

3 quality behaviors of effective nurse managers? - answer- Interpersonal, decisional and informational behaviors along with leadership, business sense and clinical expertise What are some roles of the nurse manager? - answer- Customer service, team building and motivation, decisions/mediation, evaluations, delegation, change agent, clinical consults, staff development, corporate supplier What are some informational behaviors of nurse managers? - answer- Spokesperson for staff and the organization, monitor activities of units/work groups, dissemination of information What are some decisional behaviors of nurse managers? - answer- Employee evals, resource allocation, planning, job analysis and redesign What is the difference between Theory X and Theory Y (McGregor) - answer- Theory X - Work is avoided, people want to do as little as possible, control and punishment is needed. Theory Y - Work itself can be motivating/rewarding, people actually want to do their job well, guidance and development with rewards are needed Explain the differences between management and leadership - answer- Management- Assigned formal position, budgets, hires/fires. Leadership - Achieved informal position, part of every RN's responsibility This is the act of getting work done through others by planning, organizing and commanding employees - answer- Management True or False, good management skills ensure good leadership skills? - answer- False List the 5 dimensions of followership - answer- Courage to assume leadership/responsibility as needed, courage to serve, courage to challenge, courage to participate in change/transformation, courage to leave What do followers expect from good leadership? - answer- Respect, tools to do the job, guidelines/input into the decision and how it will affect them as followers, openness to change, quality relationships with supervision, rewards/recognition, balance of life, professional development opportunities List 3 qualities a leader must develop - answer- 1. Ability to diagnose or understand the situation you want to influence or change 2. Adaptation in order to allow your behaviors to close the gap between the current situation and what needs to be changed 3. Communication List some behaviors characteristic of a leaders - answer- Critical thinking, problem solving, respect people, communicates skillfully, sets goals, shares a vision, develops self and others What are the qualities of a good leader? - answer- Integrity, courage, initiative, energy, optimism, perseverance, balance, ability to handle stress, self awareness This is leadership exercised by a person with no official power but influences others (can be positive or negative influence) - answer- Informal leadership

This is a type of leadership in which the nurse is acting in an approved/appointed management role - answer- Formal leadership 2 ways to be an emotionally stable leader - answer- 1. Recognize and understand your own emotions, learn to manage them, stay calm and clear headed. 2. Listen to others, perceive unspoken concerns, acknowledge others perspectives, helpful This type of leader makes no attempt to motivate or move the group in any direction

• answer- Laissez-Fare This type of leader tries to move the group toward their own (the leaders) goals
• answer- Autocratic/authoritarian This type of leader tries to move the group toward the groups goals - Shared responsibility (Somewhat efficient overall) - answer- Democratic This type of leader leads people to feeling confused, without goals or guidance and is often ineffective with little control or responsibility for the leader (not efficient) - answer- Laissez-Fare This type of leader is usually characterized by guidance from the leaders, rather than control by - answer- Democratic This type of leader is directive an controlling and can damped the creativity and inhibit motivation of the group (Very efficient) - answer- Autocratic/ authoritarian Name the three types of leadership styles - answer- Authoritarian/autocratic, Democratic, laissez fare Good empowers others - answer- Leadership True or false, effective leadership ensures good management skills - answer- False This is the ability to influence the beliefs, opinions or behaviors of a person or group toward overall goal acheivement - answer- Leadership What are some methods used to organize nursing care? - answer- - critical pathways, computerized information sheets, personalized worksheets, delegation trees These are activities that an RN may NOT delegate - answer- Initial and follow up assessments, decisions and judgements about client plan of care, interventions that require professional RN knowledge or skills, decisions/judgements needed to evaluate care List some ways RNs organize their work - answer- Set long and short term goals, use lists, ticker files, time blocks, filing systems

How much actual time does an RN spend on pt care? - answer- 35% List four types of nursing care delivery methods - answer- Team nursing, Functional nursing, Primary nursing, total care nursing In this nursing care delivery model the nurse is responsible for planning, organizing, and delivering all care. It is the oldest method of organizing care. - answer- Total Patient Care Nursing In this nursing care delivery model the staff members are assigned to complete tasks for a specific group of patients and unskilled workers are trained to perform routine simple tasks, evolved during WWII as a result of the nursing shortage. - answer- Functional Nursing In this nursing care delivery model the RN acts as a leader and coordinates all care for a group of patients. Was formed in the 50's to improve pt satisfaction and reduce fragmented care - answer- Team Nursing (RN team A LPN team A PCA team A delivers care for the group of pts assigned to team A; RN teamb, LPN team B PCA team B delivers care for the group of pts assigned to team B) In this nursing care delivery model, the RN is the main caregiver and responsible for planning, directing and evaluating all care. Created in the 70's for promoting RN autonomy. - answer- Primary Nursing What are some common areas for Total Patient Care Nursing delivery? - answer- ICU, PACU, and Nursing students often provide total patient care. :D What are some common areas for Functional nursing delivery? - answer- Operating Room What are some common areas for team nursing delivery? - answer- Inpatient and outpatient care settings (Med/Surg, Pine Rest Inpatient units etc) What are some common areas for primary care nursing delivery? - answer- Hospice, Home Health, Long Term Care, (my sub-acute detox facility I work on) What are some advantages to total patient care nursing? - answer- High degree of autonomy, Lines of responsibility and accountability are clear, patient receives holistic unfragmented care What are some advantages of functional nursing care - answer- Care is provided economically and efficiently, minimum number of RNs required, tasks are completed quickly

What are some advantages of team nursing care? - answer- High quality, comprehensive care with a high proportion of subordinate staff, each team member participates in care decision making and contributes their own expertise What are some advantages of primary nursing care? - answer- High quality holistic patient care, Establish good rapport with RN, the RN feels challenged and rewarded What are some disadvantages of total patient care nursing? - answer- Inconsistency- each RN may have different approach to care, not cost effective, Lack of RN availability What are some disadvantages of functional nursing care? - answer- Care can be fragmented, Pt may become confused with so many different care providers, caregivers feel unchallenged What are some disadvantages of team nursing care? - answer- Continuity suffers if daily team assignments vary, team leaders must have good leadership skills, There may be inefficient time for planning and communication between team members and teams What are some disadvantages of primary nursing care? - answer- Primary nurse must be able to practice with a high degree of autonomy, RN must accept 24 hour responsibility, more RN's are needed so it is not cost effective This skill is a prerequisite for good delegation skills? - answer- Good organizational skills What are some common errors of delegation? - answer- Overloading self by not delegating, old patterns of behavior, unclear communication, release of control, pressure to delegate in appropriately List some barriers to effective delegation - answer- lack of experience, lack of licensure, quality of care, assigning work to others, poor communication or follow through/follow up, lack of trust What are some factors the RN should consider when delegating tasks? - answer- Is there potential for harm?, Complexity of the RN activity/task, what problem solving/innovation is required, how predictable is the outcome? What are some RN only tasks that should not be delegated? - answer- Initial teaching, nursing diagnoses, assessments, delegation to others What are some reasons delegation is necessary? - answer- RN shortage, health care reform, increased need for nursing services, cost containment, time management, demographic trends, use of UAP Things an RN should do when evaluating the delegation process - answer- Oversees the care, determine if pt care needs have been met, allow for feedback

What should the nurse consider when implementing delegation to staff (assignments)

• answer- Assign appropriate personnel who have the level of expertise necessary to deliver the care or carry out the activities. How is the nursing process used while delegating care? - answer- Use Assessment to assess needs of pts, set specific goals, match the right personnel with the appropriate skills care for the pt, Use Planning to mentally identify who is best suited for the task, and prevent later problems, Use implementation to assign appropriate personnel who have the right level of expertise for the pt to deliver the care, and use Evaluation to oversee the care and determine if the pt care needs have been met and allow for feedback. What are the 5 rights of delegation a nurse must remember? - answer- Right task, Right circumstance, Right person, Right direction/communication, Right supervision/evaluation What is horizontal delegation" - answer- RN to RN (transfer of responsibility and accountability) Transfer to person of same expertise level. What is vertical delegation? - answer- From Rn to less qualified or UAP (RN is still accountable) What is the difference between delegating and assigning? - answer- Delegate- RN remains accountable (verticle RN to UAP), Assign-Transfer of responsibility (Horizontal RN to RN) (verticle - responsibility of the task if transferred to the delegatee, accountability remains with the delegator) This is the negative phenomenon that occurs in highly cohesive groups similar prejudices suppress open discussion. It often interferes with critical thinking and increases pressure to conform. - answer- Group Think Strategies for groups to decide on changes - answer- Brainstorm, nominal group techniques, focus groups, delphi technique(Panel of professionals to educate) Strategies for group decision making - answer- Increase acceptance, increase time, more ideas generated the better, increase team building, all members need knowledge, some members may dominate, competition can develop Phases of decision making - answer- Define objectives, generate options, identify advantages and disadvantages, rank options and select one, implement option selected, evaluate the results Steps to solving a problem - answer- Gather data, analyze data, establish outcome, implement, evaluate

Common mistakes made during change implementation - answer- Failure to make need for change clear, unclear goals, too little time, poor leadership, insufficient coordination of the change process, insufficient education, dismissing complaints list the 4 phases of unplanned change? - answer- Design the change, plan implementation, implement the change, integrate the change List 4 points about grapevine communication - answer- It always exists, it travels rapidly, spontaneous, may lack accuracy What are some good team communication guidelines? - answer- Active listening, communicate genuine concern and interest, provide the employee with adequate information, use team members ideas in the plan of action, maximize feelings of self respect, focus on the team members ability to help themselves, don't minimize value of time allowed to learn, seek alternatives, respect values and dignity, depresonalize potential conflict situations What are the key things that should be included in shift change report? - answer- Pt ID, Pt Dx, Where the pt is, Treatment plan, Responses to treatments, omit personal opinion and judgement Tips for a successful Team conference - answer- Present the info in a clear concise manner According to JCAHO what is the reason for a large number of sentinel events that occur? - answer- Communication deficits among health care providers What is the safety goal of JCAHO? - answer- Improve communication among health care providers Do's of feedback - answer- Include positive comments, be objective, be specific, treat everyone the same, correct people privately Dont's of feedback - answer- Focus on negatives, let personalities intrude, be vague, play favorites, correct people publicly Advice for giving feedback - answer- Give both negative and positive, give immediately, give frequently, give negative feedback in private, base it on observed behavior, include suggestions for change. True or False, it is more difficult to provide positive feedback than to provide negative feedback? - answer- false, it is more difficult to provide "good negative feedback" Than positive feedback. #1 thing to remember about negative feedback - answer- Unsatisfactory work must be acknowledged and discussed

What is the purpose of peer review? - answer- To provide the individual with feedback from those best acquainted with the requirements and demands of the position. What are some potential conflict generators in the workplace? - answer- Competition, increased workload, multiple role demands, threats to safety/security, scarce resources, cultural differences, invasion of personal space List the conflict resolution process - answer- Identify the problem, generate possible solutions, evaluate suggested solutions, choose the best solutions, implement the solution chosen, is the problem solved?, if yes end process if not repeat. Choices to resolve conflict - answer- Avoid it, accommodate, compete, compromise, collaborate True or false, conflict is inevitable in large groups - answer- True True or false, conflict is always a negative experience - answer- False, not necessarily 2 types of change - answer- Planned/Managed, Unplanned/Reactive 3 stages of lewins theory of change - answer- Unfreeze(take out of comfort zone), Change(discomfort), Refreeze(new comfort zone) Two things (Forces) that can happen during change (according to Lewin) - answer- 1. Driving forces and 2. Resisting forces What are driving forces for change? - answer- They call for the change, enable it. It must increase in order for the change to occur What are restraining forces of change? - answer- Resistance to change. They must decrease for the change to occur What are some ways to lower resistance to change (Restraining forces) - answer- Information dissemination (give as much info as possible for better understanding), Disconfirm currently held beliefs(risks if a change does happen), Psychological safety must be ensured, Command (usually commanding doesn't work) 2 types of resistance to change - answer- Active resistance and passive resistance This type of resistance to change attacks the idea, refuses to change, argues, organizes resistance of other people - answer- Active resistance This type of resistance to change avoids discussion, ignores the change, refuses to commit, and agress but doesn't act on the change - answer- Passive resistance

According to Rogers what are typical responses to change? - answer- innovators, early adapters, early majority, late majority, laggards and rejectors. Name four types of costs incurred by businesses - answer- Direct, indirect, fixed and variable This budget used by businesses is used for day to day expenses - answer- Operating Budget This budget used by businesses is to purchase equipment - answer- Capital Expenditure budget This budget is a plan for monthly bills and receipts - answer- Cash Budget (Petty cash) What is the role of the staff nurse pertaining to budget? - answer- Control spending /cost on the unit without compromising patient safety Name some ways that healthcare is financed - answer- Insurance companies, Government insurance, managed care organizations This is created as an attempt to demand lower health care prices by consumers and employers. (the strongest movement in healthcare) - answer- Managed Health Care organizations This is a health care delivery system that uses financial incentives and management controls to direct efficient and appropriate health outcomes (capitated system) - answer- Managed Care How do managed health care organizations control costs? - answer- By providing incentives to consider lower cost treatment alternatives Goals of managed healthcare organizations - answer- Decrease cost, promote health, provide seamless healthcare How do managed healthcare organizations promote health? - answer- Education, early diagnosis, self-care, prevention, reduce duplication Name 3 types of managed healthcare - answer- HMO, PPO, POS In this type of managed health care organization, the primary care provider controls access to services - answer- HMO This managed healthcare organization is when the physician and health services are contracted with the insurance company to provide services at discounted fees - answer- PPO

This managed healthcare organization type allows choice of providers but cost may be higher - answer- POS What are some fiscal responsibilities of RN's? - answer- Understand that budgeting drives healthcare, achieve patient outcomes in a safe/cost efficient manner, judicious use of equipment and supplies List 3 sources that laws come from - answer- Constitution, statutes, Administrative Types of law - answer- Criminal, Civil These are offenses committed against state laws - answer- Criminal acts List 3 levels of criminal law offenses - answer- Felony, Misdemeanor, Juvenile This is the law that involves the violation of one persons rights against anothers

• answer- Civil law Types of Civil Law - answer- Tort, Quasi-Intentional Tort, Negligence, Malpractice What type of law states that nurses have a duty to deliver care in such a manner that pts will not be harmed? (civil law) - answer- Tort This type of civil law is a legal duty of care (Duty to not harm) - answer- Tort This type of civil law involves damage to a persons reputation with words, defamation of character, invasion of privacy, or breech of confidentiality - answer- Quasi-Intentional Tort This is the unintentional tort of acting or failing to act, resulting in harm to the person owed care - answer- Negligence This is the term used for professional negligence - answer- Malpractice This states that the supervisor that gives an order can be sued if the person below them fails to follow it. - answer- Malpractice - (respondeat superior) List some examples of professional negligence - answer- Duty owed, duty breached, forseeability(Knowingly fails to meet standards), causation, injury, damages 3 types of liability - answer- Personal, vicarious, employer/corporate This liability is your individual responsibility for action or inaction - answer- Personal liability This type of liability is employers being held accountable for negligence of employees
• answer- Vicarious liability

This type of liability is dependent on hiring of quality staff, in a safe environment

• answer- Employer/Corporate liability Laws relevant to Nursing - answer- Good samaritan, confidentiality, slander/libel, false imprisonment, assault and battery, malpractice, liability, and negligence These are established guidelines for the nursing profession to ensure quality of care
• answer- Nursing Standards Name some types of Standards nurses must follow - answer- Internal, organizational, accepted state and national standards, nurse practice acts, patient care partnerships These standards are maintained in policy and procedure manuals/online access. Developed by institutions - answer- Internal standards True or False, the courts uphold the authority of boards of nursing to regulate standards
• answer- True This prevents some medical practices from being considered battery - answer- Informed consent Requirements for informed consent - answer- Mentally competent adult - voluntary, client understands exactly what they are consenting to, Consent includes risks alternative treatments available and outcomes, consent is written This drives healthcare, (QSEN standards also) - answer- IOM- Institute of Medicine What are the requirements of the patient self determination act - answer- Advanced directives - (Each person must be provided with information regarding them, documentation must be made, education necessary, respect pts rights, demonstrate cultural humility) Tips for prevention of malpractice - answer- Keep informed about new information r/t your practice (CEU's), Insist on employer keeping personnel informed of all changes in policy/procedure and new technology, follow standards of care, ID at risk clients for problems, maintain safe environment, document precisely, write detailed incident reports, file incident reports, recognize client behaviors that might be a problem Common causes of negligence - answer- Client falls, equipment injuries, failure to monitor, failure to communicate, medication errors, medical errors 2 biggest/worst actions that lead to malpractice lawsuits - answer- Altering/falsifying a medical record, violation of an internal or external standard of practice

Common actions leading to malpractice lawsuits - answer- Fail to assess properly, fail to report changes in pt status, fail to document, fail to obtain informed consent, fail to report co-worker negligence, fail to provide adequate education ** TWO BIGGEST** Altering/falsifying a medical record and Violation of an internal or external standard of practice Steps to follow if possible lawsuit is pending - answer- Immediately seek legal counsel, never sign documents without legal counsel, notify your malpractice carrier if covered and employer, keep all correspondence (written and verbal) Steps of a lawsuit - answer- Complaint, discovery, deposition, and trial How to prepare for a trial deposition - answer- Don't volunteer information, be familiar with the case, clarify questions, don't assume, don't exaggerate, allow 5 seconds before answering (Practice this), tell the truth always, speak slow and clear, eye contact, bring resume, request a break/rest, think before answering, avoid anger/absolutes, read deposition ahead of time, if asked the same question twice- ask them to play back or repeat your previous answer. Types of ethical values - answer- Intrinsic, extrinsic, personal and professional These ethical concepts are learned and change with maturity and experience - answer- Values (The amount of values a person holds, isn't as important as "which" values they consider important) These are organized thoughts about why people exist in the universe - answer- Beliefs What is the purpose of belief systems - answer- To explain concepts such as life and health, good and evil, and health and illness This is a persons own code for what is acceptable behavior (conscience) this is learned

• answer- Morals This is the "right" or "wrong" of human behavior, and the motivation behind it - answer- Ethics This takes the value of right/wrong and applies it to life/death issues - answer- Bioethics Name some ethical principles - answer- Autonomy, nonmaleficence, beneficence, justice, fidelity, confidentiality, veracity, accountablity This is the freedom to make ones own decisions - answer- Autonomy This is "do no harm" ethical principle - answer- nonmaleficence This ethical principle means "doing good" for others - answer- Beneficence

How do nurses practice autonomy for pts? - answer- Respecting the pts right to make their own choices about healthcare How do nurses practice nonmaleficence for their pts? - answer- Requires nurse to protect pts who can not protect themselves How do nurses practice beneficence for pt care? - answer- They need to assist pts in meeting all of their needs (Biological, psychological, social) This is the ethical belief that each person must be treated equally - answer- Justice How do nurses treat pts with justice? - answer- They must be nonjudgmental to every patient This ethical principle is loyalty and a promise to fulfill all commitments. (accountability)

• answer- Fidelity What are the 2 times in which confidentiality may be violated? - answer- If the pt is indicating they may harm themselves or others, if the pt gives permission for the information to be shared Name the ethical principle meaning truthfulness. It also builds trust - answer- Veracity This ethical principle means being responsible for your own action to self and other collegues - answer- accountability Formal statements of behavior rules for a group - answer- Ethical Codes This is a problem in which conflicts of belief exist making decisions difficult - answer- Ethical dilemma What are some examples of ethical dilemmas - answer- Assisted Suicide, technology issues, gene therapies, designer babies, organizational climate What are 4 things that the Institute of Medicine states about quality of care - answer- 1. quality can be defined and measured 2. quality problems are serious and extensive 3. current approaches are inadequate to improve quality 4. there is an urgent need for rapid change The role of this group is to provide unbiased, expert advice to improve health. (they drive healthcare) - answer- Institute of medicine (qsen, quality and safety - we teach to the IOM)

This was a group of recommendations by the institute of medicine to enhance safety, encourage learning from errors, sets standards for safety and safety systems - answer- "To Err is Human" recommendation This is a health care initiative by the institute of medicine that states the gaps in actual care and high quality care can be attributed to key inter-related areas within healthcare

• answer- "Crossing the quality chasm" What were some reasons for the crossing the quality chasm initiative from the institute of medicine? - answer- Growing complexity of science and technology, increase in chronic medical conditions, poorly organized delivery of care system, constraints on exploiting the revolution in information technology Ten rules to govern healthcare reform for the 21st century as published/recommended by the institute of medicine - answer- 1. care is based on a continuous healing relationship 2. care is provided based on pt needs/values 3. pt is a source of control of care 4. knowledge is shared and free. 5. Evidence based decisions 6. safety as a system is a priority 7. secrecy is harmful, transparency is necessary 8. anticipate pt needs 9. decrease waste continually 10. cooperation needed between the healthcare providers Six aims for quality improvement in healthcare - (Institute of Medicine) - answer- Healthcare should be 1. safe 2. effective 3. pt centered 4. timely 5. efficient 6. equitable QI vs CQI - answer- QI - Nightengale began, structured/organized, evidence based CQI- Purpose, Identify and collect data, analyze, evaluate and change, responsibility, evaluate structure process and outcome This is a measure of the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current and professional knowledge - answer- Quality Why are clinical pathways used? - answer- To decrease cost (save money) Top 3 types of quality errors that can happen in an institution - answer- 1. Service occurrences 2. serious incident 3. sentinel event What are some types of errors that can occur in healthcare delivery - answer- Diagnostic, treatment, preventative How are error events in health care categorized? - answer- Near miss, adverse event, accident, never event This type of error event is when no harm or minimal harm is done - answer- Near miss

This type of error event is when serious injury occurs, very concerning, major mistake

• answer- Sentinel event This type of error event shouldn't have happened. Ever. - answer- Never Event This approach to error resolution addresses a problem and goes deeper, and deeper and deeper to find out "why" - answer- Root cause analysis This process includes data information collection and knowledge. It is the infrastructure for Evidence based practice, and collects data for standardized nursing practice, Hospital information data and administrative database maintenance (collection of private, secure data) - answer- Informatics These are clinical protocols involving all disciplines - answer- Critical pathways The CQI program evaluates what 3 things? - answer- 1.Structure within which care is given, 2. the process of giving the care 3. the outcome of that care What are some trends in informatics today? - answer- EMR/Smartcards, telehealth, email help, health websites and evaluation of web resources To keep a current license RN's complete CEU's. At least one of these CEU's must be about. - answer- Pain or pain management 3 qualifications for RN licensure in the USA - answer- Graduate from an approved RN program, english language proficiency, disclosure of criminal convictions When must the NCLEX be taken - answer- within two years of graduation What happens if a student doesn't pass NCLEX after 3 x in one year - answer- Must have to repeat an RN program. Then gets 3 more chances in 12 months to pass (this may vary state to state)