Chapter 12: Leadership and Management

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Processes used in management parallel the nursing process. Which sentence describes a nurse using a management principle paralleled with the nursing process? a. Planning is demonstrated when the nurse motivates others. b. Directing is demonstrated when the nurse plans care for the patient. c. Organizing is demonstrated when the nurse coordinates care for patients. d. Controlling is demonstrated when the nurse tells other staff members what to do.
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Answer: c According to Fayol, the functions of managers are planning, organizing, directing, and controlling. The nurse demonstrates organizing by coordinating the care delivered to patients. Planning involves goal setting, assessment, and setting the plan and acting on it. Direction involves the ability to motivate others toward a common goal and includes good communication skills. Controlling involves comparing expected results of the planned work with actual results.
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Which statement most closely reflects the differences between nurse leaders and managers? a. Nurse leaders are always in formal positions of authority. b. Nurse managers use transactional principles to accomplish goals. c. Nurse leaders rely primarily on interpersonal skills to accomplish goals. d. Nurse managers rely on supervisors for accountability and responsibility.
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Answer: c Leaders influence others to effect change. They rely on personal characteristics to convince others that what they envision is worthwhile. Managers get their power from formal positions. Leaders may or may not be in formal positions of authority. Transactional leadership employs reward and punishment to gain the cooperation. Nurse leaders use a variety of leadership and management styles. Nurse managers maintain accountability and responsibility for their decisions.
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The nurse manager is monitoring overtime for the unit. She closely monitors staff hours and does not allow staff to come in for extra hours if they are over their allotted time per week. This is an example of which of Mintzberg’s decisional roles of the manager? a. Entrepreneur b. Disturbance handler c. Negotiator d. Resource handler
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Answer: d The resource handler function of the decisional role of the manager includes monitoring the budget and regulating the use of personnel time. In the entrepreneur role, the manager is the problem solver. The disturbance handler responds to unplanned change. The negotiator works within and outside of the organization to intercede for resources and help.
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A nurse manager is trying to improve patient satisfaction ratings for her area of responsibility. The manager meets with the staff and forms an ad hoc committee to address the issues around the problem. This is an example of what style of leadership? a. Bureaucratic b. Democratic c. Laissez-faire d. Autocratic
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Answer: b The nurse manager fits the description of the democratic style because the staff members have input into the solution of the problem. A bureaucratic manager develops policies and procedures to follow or reinforces existing policies and procedures. A laissez-faire manager presents the problem to the employees, but rather than offering a plan for addressing it, he or she asks employees to solve the problem on their own. An autocratic manager uses the threat of punishment or promise of rewards to solve the problem.
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A nurse is volunteering in the community to educate parents to increase the number of children in the school district who are immunized. The nurse oversees the activities of a group of volunteers. Which role best describes the nurse’s activity in this situation? a. Management b. Leadership c. Volunteerism d. Activism
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Answer: b The nurse meets the criteria for leadership because the nurse is acting in an informal role, not as part of a managerial structure in an organization. Volunteerism and activism are not defined as management or leadership functions.
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Which statement is an example of the use of situational leadership? a. The emergency room manager takes a vote on holiday coverage and then responds to a Code Blue by directing orders at the nursing staff. b. The manager in surgery uses the vacation policy to grant time off and then performs a surgical count in an operating room using a checklist. c. A vice president of nursing allows the department directors to make a decision about a hospital policy on holiday time and then sides with a nurse who does not want to work the required time. d. The CEO of the hospital instructs the nursing senate to develop a dress code and then changes the dress code after determining he does not like it.
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Answer: a Situational leadership adjusts leadership styles to fit the situation. In the correct option, the manager moved from a democratic to an authoritarian leadership style to fit the change in situation. The manager in surgery follows a bureaucratic style by strictly following policy and procedure. The vice president of nursing is following a laissez-faire style, because responsibility for the decision is abdicated, and he or she does not support the policy when needed. The CEO of the hospital is following an authoritarian style of leadership because input of the staff is not valued.
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To be effective, nurse managers should focus on which area? a. Cost-effective operation of the unit b. Motivation of staff c. Accomplishing organizational goals d. The patients and their needs
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Answer: d All of the options are considerations of an effective manager. However, at the core of all nursing management actions must be the benefit of the patient or patient population that is served.
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A nurse states she believes in the dignity of each patient. At break, she is overheard talking about a patient in a persistent vegetative state as a “lump.” This represents an inconsistency in which quality of an effective leader? a. Dedication b. Magnanimity c. Integrity d. Humility
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Answer: c Integrity refers to the alignment of stated values and actions. Dedication is the ability to spend the time to accomplish the task. Magnanimity means giving credit where credit is due. Humility is the ability to recognize that no one person is superior to another.
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A nurse delegates a bed bath to unlicensed assistive personnel (UAP). After lunch, the patient rings for the nurse and complains that he has not yet been cleaned up. He is very upset and angry. What should the nurse’s next action be? a. Assist the patient in getting cleaned up. b. Write up the UAP for not carrying out the assignment. c. Report the UAP to the unit manager. d. Go find the UAP, and tell her to complete the bath immediately.
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Answer: a The goal of delegation of any assignment is to provide efficient, patient-centered care. In this case, the patient is angry and upset, and the nurse should first see to the patient’s needs and address the issue with the UAP after the situation is resolved.
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The registered nurse on an inpatient medical unit delegates vital signs and morning care to the unlicensed assistive personnel (UAP) for five stable patients. The nurse asks the UAP to document the vital signs and report any abnormal results immediately. Which rights of delegation is the nurse demonstrating? (Select all that apply.) a. Right person b. Right circumstance c. Right time d. Right supervision e. Right patient
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Answers: a, b, d The nurse is demonstrating all of the rights of delegation. Right time and right patient are not part of the Five Rights of Delegation. They are a part of the Rights of Medication Administration. The Five Rights of Delegation are 1. Right task 2. Right person 3. Right circumstance 4. Right communication 5. Right supervision
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According to Mintzberg’s 1994 model, what are the three levels of management? a. Thinking, feeling, and doing b. Informing, directing, and controlling c. Autocratic, democratic, and laissez-faire d. Information, people, and action
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ANS: D Mintzberg’s contemporary model lists three levels of management: information, people, and action.
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The nurse manager of a nursing unit monitors the actual number of missed medications on her unit each month and compares this number with the expected results. This is an example of which function of management? a. Planning b. Organizing c. Directing d. Controlling
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ANS: D Controlling involves comparing expected against actual results of planned work. The other answers are all examples of the management process but do not involve comparing results of the work against the plan.
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Your patient is preparing for discharge. In discussing one of the discharge medications ordered, he mentions that he doesn’t know how he will pay for such an expensive drug. What is your best course of action as the patient’s advocate? a. Explain to the patient that he must have the medication as ordered for his own benefit. b. Get the names of local pharmacies that offer discounted prescriptions. c. Contact the physician to schedule a follow-up appointment to be sure the patient is taking the medication as prescribed. d. Contact the social worker to assist with checking prescription benefits and applications for subsidized prescription programs.
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ANS: D The best way to advocate for the patient in this case is to enlist the aid of those equipped to help the patient find additional resources to obtain the medication. Discounted pharmacies may be one component of the solution, but discounts may not apply to drugs not yet available as generic.
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The nurse is speaking to UAP about Mr. Seo, an Asian immigrant for whom they are caring. The UAP states, “I don’t trust him. He never looks you in the eye. He must be lying about something.” What must the nurse recognize in order to effectively manage the situation? a. The UAP is unaware of the cultural tradition of Mr. Seo, who views eye contact as disrespect. b. The UAP most likely has some good insight into Mr. Seo’s behavior. c. The UAP requires much closer social space than does Mr. Seo and is probably making him uncomfortable. d. Mr. Seo most likely does not feel well and is avoiding eye contact because he wants to rest.
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ANS: A Many individuals from Asian cultures do not make direct eye contact when speaking with others, as this is a sign of disrespect. The UAP likely does not understand this.
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You are the nurse in charge of a care team consisting of a new graduate, a male UAP, and an LPN. You are caring for Mr. P, a patient with renal failure and congestive heart failure. Mr. P is bedridden and weighs 227 kilograms. He must be turned every 2 hours. In making out assignments, what is your best approach? a. Assign Mr. P to the new nurse so she can get experience with a large patient. b. Assign Mr. P to the UAP because he is a male and is stronger. c. Assign Mr. P to the LPN and the new RN so the new RN can perform assessments. d. Take Mr. P as your own assignment and assign the other staff to assist with turns every 2 hours.
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ANS: D Due to his medical diagnoses, Mr. P. will likely need frequent assessment of all systems, which requires the assessment skills of an experienced RN. In addition, it is likely that more than one or two people will be needed to turn Mr. P. Assigning the team to assist with turns every 2 hours meets the criteria for appropriate delegation. The new RN likely does not yet have the experience to care for someone in Mr. P.’s condition.
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Bob is a staff nurse in the critical care unit. He routinely assists with calling staff to find coverage for the next shift and volunteers to coordinate policy and procedure revision and development on the unit. Which type of leadership is Bob demonstrating? a. Formal b. Informal c. Laissez-faire d. Democratic
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ANS: B Informal leadership occurs outside the expectations of the position, and Bob is volunteering for extra duties. Formal leadership occurs within the expectations of an appointed position in an organization. Laissez-faire and democratic are styles of management.
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A nurse manager receives two vacation requests from staff for the same days off. Unit policy states that only one person may be off at a time. The manager decides to allow the staff the time off anyway. What type of leadership is the manager demonstrating? a. Democratic b. Bureaucratic c. Laissez-faire d. Autocratic
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ANS: C The nurse manager is not intervening and is allowing the staff to take control. This is an example of laissez-faire style. It is not democratic because there is no input of staff into solving the issue. A bureaucratic manager would follow the policy. An autocratic manager would still follow policy but make an arbitrary decision about which employee to allow time off.
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A nurse is making outpatient assignments for the day. One of the LPNs is newly returned from a medical leave due to a back injury. Which patient would be most appropriate to assign to this nurse? a. Mr. D., a confused patient who is ambulatory and requires assistance with feeding. b. Mr. J., a recent postoperative patient who received a total knee replacement who has not yet been out of bed. c. Mrs. K., an elderly woman requiring one-person assistance for bed-to-chair transfers. d. Miss L., a cerebral palsy patient with pneumonia who uses a wheelchair.
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ANS: A In considering the LPN’s recent injury, the only patient appropriate to assign is Mr. D. The other patients would not be appropriate due to the risk of re-injury. Even though Mr. D is confused, he is ambulatory and can get up to use the bathroom, lessening the risk of possible harm to the LPN.
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A nurse in an oncology unit has used the available resources. She has also considered other relevant factors such as specific isolation requirements when determining who can care for this patient. This is a demonstration of what right of delegation? a. Right task b. Right person c. Right circumstance d. Right supervision
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ANS: C The nurse has considered the specific circumstance and setting of the patient with all relevant factors.
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Which of the following are examples of the planning function of management? (Select all that apply.) a. Taking action b. Goal setting c. Assessing the present situation d. Setting the plan
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ANS: B, C, D Goal setting, assessing the present situation, and converting the plan into an action statement are all part of the planning function of management. Taking action is part of a manager’s role, but it occurs as a part of the directing function.

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