Stuvia 2388851 Test Bank Nursing Leadership and Management 1st Canadian Edition Gaudine 2015 Chapter 1 14 All Chapters

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Management, 1st Canadian Edition (Gaudine,

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TEST BANK
Nursing Leadership and Management, Canadian Edition
Alice Gaudine, & Marianne Lamb

1st Edition

Table of Contents
Chapter 1 - Leadership in Health Care 1

Chapter 2 - Healthcare Management and the Canadian Context 10
Chapter 3 - Organizational Power and Politics 21
Chapter 4 - Change and Culture 34
Chapter 5 - Decision-making and Management of Work Flow 45
Chapter 6 - Nursing Workforce Issues Recruitment and Retention, Selection, Socialization, and
Transitioning 59
Chapter 7 - Motivation and Performance 70
Chapter 8 - Nursing Roles and Nurse Staffing 81
Chapter 9 - Quality of Work Life Issues 93
Chapter 10 - Team Building and Managing Conflict 101
Chapter 11 - Quality Improvement 113
Chapter 12 - Diversity in Health Care Organizations 122
Chapter 13 - Financial Leadership and Accountabilty in Nursing 132
Chapter 14 - Ethical Leadership and the Context for Ethical Practice in Health Care
Organizations 143

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Test Bank - Nursing Leadership and Management, 1st Canadian Edition (Gaudine, 2015)
Chapter 1 - Leadership in Health Care

Multiple Choice Questions
1) Which of the following would not be considered concepts related to leadership?

a. Leaders are change agents.
b. Leadership is relationship-based.
c. Leadership is focused on orderly steps and coordination of details.
d. Leadership involves influencing the thinking and actions of others.
Answer: c
Rationale for Correct Answer:
a. Incorrect: This concept is related to leadership.
b. Incorrect: This concept is related to leadership.
c. Correct: This is a description of management, not leadership.
d. Incorrect: This concept is related to leadership.
W W W . T B S M . W S
Client need per NCLEX: safe and effective care environment

Integrated Nursing Process: Assessment, Evaluation
Objective: 1—Distinguish between leadership and management
2) Examples of management activities would include __________.

a. coaching a soccer team
b. party planning
c. motivational speaking
d. teaching
Answer: b
a. Incorrect: This is a leadership activity.
b. Correct: Management involves directing activities.
c. Incorrect: This is a leadership activity.
d. Incorrect: This is a leadership activity.
Client need per NCLEX: safe and effective environment
3) Leadership theories developed out of management theories in what order?

a. great man and trait theories, behavioural theories, contingency theories, interactional
theories
b. transactional theory, great man theories, behavioural theory, contingency theory
c. transformational theory, great man theories, behavioural theory, contingency theory
d. contingency theories, great man theories, transactional theory, behavioural theories
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Answer: a
a. Correct: The theories were built one upon the other. Great man theory
included cultural and societal views that suggested that great leaders were
born with inherited traits. This was abandoned because it did little to
predict who would turn out to be a leader. In behavioural theories, leaders
were divided into those who were task-oriented vs. people-oriented. This
was determined to be unhelpful—no one style was better than another and
effectiveness was setting-dependent. Contingency theories were based on
the assumption that leadership varied based on the situation and there was
a need for innovation. Interactional theories look at leadership style but
focus on how it varies depending on characteristics of followers.
b. Incorrect: This does not reflect how leadership theories developed out of
management theories.
c. Incorrect: This does not reflect how leadership theories developed out of
d. Incorrect: This does not reflect how leadership theories developed out of
Objective: 2—Discuss the evolution of theories of leadership
4) Authoritarian style and a focus on performance and production would be behaviours

demonstrated by what team leader style?
a. participative
b. laissez-faire
c. autocratic
d. innovative
Answer: c
a. Incorrect: See Table 1.1 in the textbook (p. 5).
b. Incorrect: See Table 1.1 in the textbook (p. 5).
c. Correct: See Table 1.1 in the textbook (p. 5).
d. Incorrect: See Table 1.1 in the textbook (p. 5).
Objective: 2—Discuss the evolution of theories of leadership
5) The term “follower” has replaced which of the following terms?

a. superior
b. leader
c. Subordinate
d. participant
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Answer: c
C is correct: Superior is the term replaced by leader. Leader replaced the
previously used term superior. A participant can be both a follower and a
leader in various circumstances.

Objective: 3—Describe the role and behaviour of followers in an organization
6) Which of the following is not a basic tenet of active followership theory?

a. Followers and leaders share a common purpose.
b. Followers are active, not passive.
c. Followers and leaders are people with inherent characteristics.
d. Followers and leaders must be studied in the context of their relationship.
Answer: c
a. Incorrect: This is a basic tenet of followership theory.
b. Incorrect: This is a basic tenet of followership theory.
c. Correct: Followers and leaders are roles, not people with inherent
characteristics.
d. Incorrect: This is a basic tenet of followership theory.
7) Resonant leadership styles __________.

a. create conflict
b. build energy in the group
c. set pace
d. command followers
Answer: b
a. Incorrect: This is a dissonant leadership style.
b. Correct: This reflects a resonant leadership style.
c. Incorrect: This is a dissonant leadership style.
d. Incorrect: This is a dissonant leadership style.
Objective: 4—Debate the strengths and weaknesses of different styles of
leadership in various health care settings
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8) Which of the following aspects of authentic leadership is particularly relevant to

nursing leadership?
a. moral/ethical aspects
b. servant/leader
c. inspiring others
d. rewards in exchange for meeting objectives
Answer: a
a. Correct: Correct.
b. Incorrect: This is relevant to servant leadership.
c. Incorrect: This is relevant to charismatic leadership.
d. Incorrect: This is relevant to transactional leadership.
leadership in various health care settings
9) The health care field is interested in developing research related to emotional

intelligence because __________.
a. it directly improves patient satisfaction
b. it directly decreases mortality rates
c. it improves human performance
d. it directly improves working conditions
Answer: c
a. Incorrect: This answer is not substantiated in the literature (directly).
b. Incorrect: This answer is not substantiated in the literature (directly).
c. Correct: This fits with the view that human relations are central to
management and transformational leaders as those who inspire other to
achieve goals within organizations.
d. Incorrect: This answer is not substantiated in the literature (directly).
Objective: 5—Analyze the components of emotional intelligence
10) Goleman, Boyatis, and McKee (2002) identify the four domains of emotional
intelligence as __________.
a. relationship building, social awareness, self-reflection, and self-management
b. self-awareness, self-management, social awareness, and relationship management
c. social activism, self-awareness, self-management, and relationship management
d. social advocacy, self-awareness, relationship management, and self-management
Answer: b
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a. Incorrect: This answer is not a domain of emotional intelligence.
b. Correct: Correct.
c. Incorrect: This answer is not a domain of emotional intelligence.
d. Incorrect: This answer is not a domain of emotional intelligence.
11) Your clinical instructor has been described by others as collaborative, democratic,
and student-focused. Your instructor’s leadership style is __________.
a. autocratic
b. diplomatic
c. participative
d. laissez-faire
Answer: c
a. Incorrect: See Table 1.1 in your textbook (p. 5) for a breakdown of
leadership styles and behaviours.
b. Incorrect: See Table 1.1 in your textbook (p. 5) for a breakdown of
c. Correct: See Table 1.1 in your textbook (p. 5) for a breakdown of
d. Incorrect: See Table 1.1 in your textbook (p. 5) for a breakdown of
Objective: 6—Identify leadership behaviours in the various communities in
which you participate and identify characteristics of leadership styles
12) __________ is the type of emotionally intelligent leadership style used to help an
employee improve performance and build long-term abilities.
a. Visionary
b. Affiliative
c. Pace-setting
d. Coaching
Answer: d
a. Incorrect: See Table 1.3 in your text (p. 9) for a description of emotionally
intelligent leadership styles.
b. Incorrect: See Table 1.3 in your text (p. 9) for a description of emotionally
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c. Incorrect: See Table 1.3 in your text (p. 9) for a description of emotionally
d. Correct: See Table 1.3 in your text (p. 9) for a description of emotionally
13) Transformational leadership has shown what effects among staff nurses?
a. improved staff health
b. increased anxiety
c. emotional exhaustion
d. increased stress
Answer: a

b. Incorrect: This answer is an effect of dissonant leadership or management
by exception.
c. Incorrect: This answer is an effect of dissonant leadership or management
by exception.
d. Incorrect: This answer is an effect of dissonant leadership or management
by exception.
Client need per NCLEX: safe and effective care environment, psychological
integrity
Objective: 7—Discuss the potential effects of leadership behaviours on nurse and
on patient outcomes
14) High quality relationships between nurses and nurse leaders __________.
a. decrease medication errors
b. decrease retention of nurses
c. decrease patient safety outcomes
d. decrease patient satisfaction
Answer: a
a. Correct: Decreased medication errors were the outcome of the study
conducted by Squires et al in 2010.
b. Incorrect: Incorrect.
c. Incorrect: Incorrect.
d. Incorrect: Incorrect.
integrity
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Objective: 7—Discuss the potential effects of leadership behaviours on nurses
and on patient outcomes
Short Answer Questions
15) Compare and contrast the concepts of management and leadership.
Answer:
Correct answer should include the following points.
o Management is a process that involves directing activities within an

organization.
o Management refers to “handling;” leadership refers to “going places.”
o A person can be a leader without the formal authority of management.

16) Describe a situation in which you were a leader. What behavioural or emotionally
intelligent leadership styles did you use? Explain.
Answer: See Table 1.2 (p. 8) and Table 1.3 (p. 9) in the textbook for an
explanation of leadership behaviours and leadership styles.
Integrated Nursing Process: Evaluation
Objective: 2—Discuss the evolution theories of leadership
17) Provide examples of each of the following.

a. Followers becoming more powerful than a designated leader
b. Followers not designated as followers
Answer: An example for A would be a well-respected nurse in a clinical unit that

may have powerful influence on nurses in a unit (greater than the influence of the
manager).
An example for B would be members of a professional organization.
18) Describe three strengths and three weaknesses of the commanding leadership style.
Answer:
Correct answer should include the following points:
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o Strengths: useful in crisis to get a change in a situation; useful with

problem employees; useful in the short term to turn things around.
o Weaknesses: leads to dissonance; can be intimidating; is least
effective leadership style; commanding leaders may be out of
touch with staff

leadership in various health care settings.
19) Discuss emotional intelligence and its relationship to nursing.
Answer:
o It is believed that nurses ought to be emotionally intelligent because

nursing is a profession that deals with human emotion and understanding.

o Empathy and emotional understanding of others is seen as a nursing
competency or core skill of nurses.
integrity
Integrated Nursing Process: Planning, Implementation, Evaluation
20) Using your clinical practice area or educational institution as an example, identify
two different leadership behaviours you have seen and name two characteristics of each.
Answer:
Answers will vary according to student experience, but should include at least two
of the following:
o Autocratic behaviours (authoritarian; directive; focused on task or

production; focused on performance; control authority, power, and
decision-making)
o Participative behaviours (democratic; consultative; people-oriented;
employee-centred; involve group decision-making; share authority, power,
and control with followers)
o Laissez-faire behaviours (uninvolved in day-to-day activities; passive; not
visible)
integrity
Integrated Nursing Process: Assessment, Planning, Implementation, Evaluation
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21) Choose a leadership style and provide three examples of how it positively impacts
outcomes for staff nurses.
Answer:
o Positive outcomes such as job satisfaction, accountability, decreased job

tension, organizational commitment, trust, and perceived unit care-quality
is seen with transformational leadership and transactional leadership
(transformational in greater amount).
o Leadership styles that focus on people and relationships were associated
with higher nurse job satisfaction while the styles that focused on tasks
were associated with lower satisfaction.
Client need per NCLEX: safe and effective care environment,

Objective: 7—Discuss the potential effects of leadership behaviours on nurses
and patient outcomes
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Chapter 2 - Healthcare Management and the Canadian Context

1) Fayol’s principles of management that continue today include __________.

a. division of work, authority, hierarchy, and democracy
b. unity of command, scalar chain, centralization, and discipline
c. division of work, scalar chain, hierarchy, and discipline
d. unity of command, scalar chain, centralization, and democracy
Answer: b
a. Incorrect: Hierarchy and democracy are not included in Fayol’s principles
of management.
b. Correct: These principles, along with division of work, authority, and
subordination of interest, are all included in Fayol’s principles of
management.
c. Incorrect: Hierarchy is not included in Fayol’s principles of management.
d. Incorrect: Democracy is not included in Fayol’s principles of
management.
Integrated Nursing Process: Assessment, Planning, Implementation
Objective: 1—Discuss the evolution of theories of management and how they are
reflected in current health care organizations
2) Fayol’s categories of management functions include __________.

a. controlling, leading, staffing, organizing, and planning
b. controlling, leading, staffing, organizing and productivity
c. controlling, leading, staffing, organizing and promotion
d. controlling, leading, staffing, organizing and priority
Answer: a
a. Correct: These are all included in Fayol’s categories of management
functions.
b. Incorrect: Productivity, promotion, and priority are not included in Fayol’s
categories of management.
c. Incorrect: Productivity, promotion, and priority are not included in Fayol’s
d. Incorrect: Productivity, promotion, and priority are not included in Fayol’s
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3) Concerns of __________ include dealing with complexity and producing results,

quality and planning, and setting targets and goals while dealing with budgeting and
allocating resources.
a. management
b. administration
c. leadership
d. frontline staff
Answer: a
a. Correct: See Table 2.1 (p. 37) in your textbook for a list of management
functions.
b. Incorrect: See Table 2.1 (p. 37) in your textbook for a list of management
functions.
c. Incorrect: See Table 2.1 (p. 37) in your textbook for a list of management
functions.
d. Incorrect: See Table 2.1 (p. 37) in your textbook for a list of management
functions.
Objective: 2—Compare the focus and activities of leaders and managers
4) _________ includes motivating, inspiring, and empowering people to pursue change

and overcome barriers by coaching and role modelling.
a. Management
b. Administration
c. Leadership
d. frontline staff
Answer: c
a. Incorrect: See Table 2.1 (p. 37) in your textbook for a list of leadership
functions.
b. Incorrect: See Table 2.1 (p. 37) in your textbook for a list of leadership
functions.
c. Correct: See Table 2.1 (p. 37) in your textbook for a list of leadership
functions.
d. Incorrect: See Table 2.1 (p. 37) in your textbook for a list of leadership
functions.
Client need per NCLEX: Safe and effective care environment
Integrated Nursing Process: Assessment, Diagnosis, Planning, Implementation,
Evaluation
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5) A(n) __________ health care delivery system that has an evident private market and
provides public funding for the poor and/or elderly is:
a. universal and comprehensive
b. entrepreneurial and permissive
c. socialist and centrally planned
d. welfare-oriented
Answer: b
a. Incorrect: Universal and comprehensive services are publicly funded and
provide a full range of services for all citizens.
b. Correct: In entrepreneurial systems, individuals purchase health insurance
or work for employers that purchase such insurance for employees under
private insurance schemes, and most health care is paid for in this way.
Such systems often feature a mix of publicly funded services for the poor
and/or elderly, with most services being provided and paid for privately.
c. Incorrect: Socialistic and centrally planned services are ones that are
available to all citizens and are designed and delivered by government-

funded organizations.
d. Incorrect: In welfare-oriented health systems (such as Canada’s),
governments take on the role of funding only a portion of services, such as
hospitals and physicians, but not a full range of health care services.
Client need per NCLEX: safe and effective care environment, health promotion
and maintenance
Evaluation
Objective: 3—Identify the components of health systems and the factors
influencing the organization of health systems
6) Canada’s health care system is classified as __________.

a. universal and comprehensive
b. entrepreneurial and permissive
c. socialist and centrally planned
d. welfare-oriented
Answer: d
a. Incorrect: Sweden and the United Kingdom are examples of universal and
comprehensive health systems.
b. Incorrect: The United States is an example of an entrepreneurial and
permissive health system.
c. Incorrect: China and Cuba are examples of socialist and centrally-planned
health systems.
d. Correct: Canada and Japan are examples of welfare-oriented health
systems.
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and maintenance
Integrated Nursing Process: Planning
influencing the organization of health services
7) In Canada, the __________ level of government is responsible for the health care of
military members.
a. provincial
b. territorial
c. municipal
d. federal
Answer: d
a. Incorrect: Under the Constitution Act of 1982, Canada’s federal
government carries responsibility for a limited range of health services,

such as service for members of the military and for Aboriginal people on
reserves.
b. Incorrect: Under the Constitution Act of 1982, Canada’s federal
reserves.
c. Incorrect: Under the Constitution Act of 1982, Canada’s federal
reserves.
d. Correct: Under the Constitution Act of 1982, Canada’s federal government
carries responsibility for a limited range of health services, such as service
for members of the military and for Aboriginal people on reserves.
Client need per NCLEX: Health promotion and maintenance
Integrated Nursing Process: Planning, Implementation
8) In Canada, the ___________ level of government has no obligation to health care.

a. provincial
b. territorial
c. municipal
d. federal
Answer: c
a. Incorrect: This level of government all has some obligation with respect to
the provision of health care services.
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b. Incorrect: This level of government all has some obligation with respect to
c. Correct: Municipal governments are responsible for local matters in cities,
towns and smaller communities. Depending on the jurisdiction, the
government may have responsibilities with respect to health care by
having municipal representatives on boards of public health units. They do
not, however, have any obligation to health care.
d. Incorrect: This level of government all has some obligation with respect to
Client need per NCLEX: health promotion and maintenance
9) __________ is the comprehensive system of essential health care that is focused on

preventing illness and promoting health.
a. Secondary health care

b. Tertiary health care
c. Strategic initiative care
d. Primary health care
Answer: d
a. Incorrect: Secondary health care is a specialized level of care in a variety
of settings, such as community hospitals, home care, and long-term and
chronic care settings. Someone usually refers individuals here from a
primary health care level.
b. Incorrect: Tertiary care refers to the third level of care that provides more
specialized care than found in a general or community hospital.
c. Incorrect: This is not a level or system of health care.
d. Correct: This is the definition of primary health care.
Objective: 4—Distinguish among municipal, provincial/territorial, and federal
levels of responsibility and jurisdiction with respect to health care services and the
legislative framework governing health care and health care professionals.
10) __________ is most often funded by the provincial governments, governed by

community boards, and more specialized in a variety of settings. This level of health care
is where someone in a doctor’s office normally refers individuals.
a. Primary health care
b. Secondary health care
c. Tertiary health care
d. Quaternary health care
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Answer: b
a. Incorrect: Primary health care is the comprehensive system of essential
health care that is focused on preventing illness and promoting health.
b. Correct: Secondary health care is a specialized level of care in a variety of
settings, such as community hospitals, home care, and long-term and
chronic care settings. Someone usually refers individuals here from a
primary health care level.
c. Incorrect: Tertiary care refers to the third level of care, which provides
more specialized care than found in a general or community hospital.
d. Incorrect: Quaternary health care is a more specialized service that is only
available at limited locations.
Integrated Nursing Process: Planning
11) __________ is the organization and management of health services to enable people
to get the care they need when they need it in a user friendly way, provide value for
money, and achieve desired results.
a. Integrated service delivery
b. Quality service delivery
c. Value added delivery
d. Balanced scorecard delivery
Answer: a
a. Correct: This is the definition of integrated service delivery (as defined by
the WHO in 2008).
b. Incorrect: This is not the term for the definition provided.
c. Incorrect: This is not the term for the definition provided.
d. Incorrect: This is not the term for the definition provided.
and maintenance
Objective: 5—Describe the levels of health care and the range and types of health
care services in Canada
12) Canada uses data from the __________ to rank itself against other countries to
determine its effectiveness in the delivery of health care.
a. OECD
b. OCDE
c. ODEC
d. OCED
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Answer: a
a. Correct: OECD stands for the Organization for Economic Co-operation
and Development.
b. Incorrect: OECD stands for the Organization for Economic Co-operation
and Development.
c. Incorrect: OECD stands for the Organization for Economic Co-operation
and Development.
d. Incorrect: OECD stands for the Organization for Economic Co-operation
and Development.
and maintenance
Objective: 7—Identify trends and issues in health systems in Canada and how
performance of health systems might be evaluated
13) Describe how your current clinical placement exhibits characteristics of a classical
management theory or human relations theory. Provide at least three examples to support
your answer.
Answer:
o Classical Management Theories
i. Industrial revolution-stimulated a trend of mechanizing work to
more efficiently accomplish goals. Interested in design of
individual jobs to increase output and efficiency
ii. Other theorists were interested in the design of organizations as
a whole, such as administration, human relations, and
production efficiency.
iii. Fayol’s principles of management that continue today:
1. Division of work
2. Authority
3. Unity of command
4. Scalar chain
5. Subordination of interest
6. Centralization
7. Discipline
iv. Fayol’s categories of management functions:
1. Planning
2. Organizing
3. Staffing
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4. Leading
5. Controlling
o Human Relations Theories
v. Evolved through experimentation initiated as result of worker
unrest and interest in what motivated workers and performance
enhancement
vi. Realized that attention given to the workers improved attitude
and social relationships, which enhanced cooperation and
reduced work alienation
vii. Examined motivation AND hierarchy in organizations and
democratic approaches to management as alternatives to
autocratic or authoritarian approaches
viii. Focus ensured human aspect of organizations was considered,
not just the technical aspect or design of a job or organization

14) Compare management with leadership. Provide four differences between these two
roles.
Answer: See Table 2.1 (p. 37) in your textbook for a list of management and
leadership functions.
15) Identify two characteristics of each of the following types of health delivery systems
and indicate a country where the system of delivery is used.
A. Entrepreneurial and permissive
B. Welfare-oriented
C. Universal and comprehensive
D. Socialist and centrally planned
Answer:
A: Entrepreneurial and permissive
o Individuals/employers purchase health insurance

o Public funding for poor and/or elderly
o Private market is evident
o Government does not intervene to a great extent
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o Example: United States of America

B: Welfare-oriented
o Publically funded to great extent
o Dental and pharmaceuticals covered by insurance providers in many cases
o Governments take on a larger role, financing personal medical care and
provision of some direct service, especially in rural areas
o Examples: Canada, Japan
C: Universal and comprehensive

o Universal and publically funded
o Access to additional services outside what is funded by gov’t
o Examples: Sweden, United Kingdom
D: Socialist and centrally planned
o Available to all citizens and are designed and delivered by government-
funded organizations
o Government finances services, hires almost all who provide the services,
educates all healthcare professionals and produces pharmaceuticals
o Examples: China, Cuba
Client need per NCLEX: safe and effective care environment, health promotion and
maintenance
Objective: 3—Identify the components of health systems and the factors influencing
the organization of health services
16) Provide three examples of the responsibilities of the provinces and territories with
respect to the delivery of health services.
Answer:
Correct answer should include three of the following points:
o Major role in financing and organizing health services within their
jurisdictions
o Reference often made to Canada’s 13 health systems
o Substantial portion of resources for health care contributed by provincial
monies not allocated by federal government
o Per-capita spending
o Negotiation of physicians fees
o Planning and implementation of health promotion campaigns
o Administration of health insurance plans
o Allocation of funding for hospitals and other health agencies
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o In 2010, 34.9% of provincial budgets spent on health care
and maintenance
17) Your grandmother calls to tell you about her neighbour, Norma, who recently had a
stroke. She says the physician in the urgent care center at St. John’s hospital saw Norma
after she was brought in by a friend. Then Norma was transferred to a larger hospital
(Holy Oaks Regional Hospital) where she had to have a “coiling thing” done. Your
grandmother tells you that they don’t do this type of procedure at their local hospital,
“only in those big cities.” Norma spent a couple of days there and then was transferred
back to the hospital in the next town (Springfield Hospital) where they have special
“brain doctors.” Then they moved Norma back to the local hospital (St. John’s Hospital)
where they took care of her for two weeks. Now Norma is seeing Dr. Bradley in his
office every week and has home care every day. What level of health care did Norma
receive at each of the following places?
a) St. John’s Hospital
b) Holy Oaks Regional Hospital
c) Springfield Hospital
d) Dr. Bradley’s office
Answer:
a) St. John’s Hospital: Secondary Care
b) Holy Oaks Regional Hospital: Quaternary Care
c) Springfield Hospital: Tertiary Care
d) Dr. Bradley’s office: Primary Care
maintenance
Objective: 5—Describe the levels of health care and the range and types of health
care services in Canada
18) What are three aspects of a country’s health system performance that have been said
to need to be examined in greater detail?
Answer: 1) quality of care, 2) access to care, 3) cost/expenditure

and maintenance
Integrated Nursing Process: Implementation, Evaluation
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Objective: 7—Identify trends and issues in health systems in Canada and how
performance of health systems might be evaluated
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Chapter 3 - Organizational Power and Politics

1) A senior executive in a pharmaceutical company holds an employee meeting to discuss

its quarterly sales. Sales have decreased from the previous quarter and incentives have
been put in place to encourage employees to perform better. These incentives include pay
increases, promotions, and time off. In offering these incentives, the type of power the
senior executive is demonstrating __________ power.
a. legitimate
b. referent
c. expert
d. reward
Answer: d
Rational for correct answer:
a. Incorrect: Legitimate power is based on someone’s official or formal

position and the perception that this person has the right to exert influence
and expect compliance.
b. Incorrect: Referent power is based on personal attractive qualities.
c. Incorrect: Expert power is based on the perceived extent of a person’s
knowledge or expertise.
d. Correct: Reward power is based on the ability of the person in the senior
position to provide rewards, such as pay increases, promotions, special
privileges, and other benefits.
Objective: 1—Define power and politics and describe differing perspectives on
their use in organizations
2) Politics can be defined as

a. tactical activities a person takes to influence the decisions or actions of others.
b. the ability to exert actions that directly or indirectly cause change in the behaviour of
others.
c. a person’s ability to apply punishment or withhold rewards.
d. a person’s formal position and the perception that the person has a right to exert
influence.
Answer: a
a. Correct: Politics is defined as the tactical activities a person takes to
influence the decisions or actions of others.
b. Incorrect: This is the definition of power.
c. Incorrect: This is the definition of reward power.
d. Incorrect: This is the definition of legitimate power.
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______________________________________________________________________________________________

Objective: 1—Define power and politics and describe differing perspectives on
their use in organizations
3) The three groups of people that affect power relations in an organization are the
__________ groups.
a. naïve, cynics, and in between
b. politicians, cynics, and in between
c. unions, management, and cynics
d. management, cynics, and politicians
Answer: a
a. Correct: According to Kotter (1985), those who are naïve (believing that
power and influence don’t exist at all in organizations and that all is
harmonious), those who are cynics (believing that organizations are rife
with power struggles), and those who hold a middle view (in between
these two extremes) all affect power relations in organizations.
c. Incorrect: Incorrect.
Objective: 2—Analyze power relationships in the workplace and the sources of
power of the actors or units/departments of an organization
4) According to Kanter, the key source of power for productivity and accomplishment in
the workplace is __________.
a. the individual
b. a person’s position and power built into the position
c. the person’s ability to communicate
d. the person’s adaptability to change
Answer: b
a. Incorrect: The key source of power for productivity and accomplishment in the
workplace is a person’s position and the power that is built into that position.
b. Correct: The key source of power for productivity and accomplishment in the
c. Incorrect: The key source of power for productivity and accomplishment in the
d. Incorrect: The key source of power for productivity and accomplishment in the
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______________________________________________________________________________________________
Objective: 2—Analyze power relationships in the workplace and the sources of power of
the actors or units/departments of an organization
5) Positive perceptions of power in the workplace include __________.

a. dominance over others
b. the contribution to order and effectiveness
c. differing cultural views
d. differing psychological and behavioural consequences
Answer: b
a. Incorrect: This is a negative consequence/perception of power in the workplace.
b. Correct: Positive perceptions of power in the workplace include the contribution
to order and effectiveness.
c. Incorrect: This is a negative consequence/perception of power in the workplace.
d. Incorrect: This is a negative consequence/perception of power in the workplace.
maintenance
Objective: 3—Debate the positive and negative perceptions of power and politics in the
workplace
6) Negative perceptions of politics in the workplace include __________.

a. competing interests and goals
b. diverse interests can be sorted out in a just way
c. association between power and reward
d. organizational structure
Answer: a
a. Correct: Mintzberg’s (1983) negative view of politics in the workplace
describes politics as 1) behaviour outside of the legitimate systems of
influence, and often in opposition to them; 2) behaviour designed to
benefit the individual or group, ostensibly at the expense of the
organization at large; and 3) behaviour that is divisive or conflictive in
nature, pitting individuals or groups against the organization or against
each other.
b. Incorrect: This is not a description of politics in the workplace.
c. Incorrect: This is not a description of politics in the workplace.
d. Incorrect: This is not a description of politics in the workplace.
Objective: 3—Debate the positive and negative perceptions of power and politics
in the workplace
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______________________________________________________________________________________________
7) Which of the following workplace scenarios empowers employees?

a. There are many rules inherent in the job.
b. There is little publicity about job activities.
c. There is a high level of contact with senior officials.
d. There is little opportunity for advancement of subordinates.
Answer: c
a. Incorrect: This would limit the empowerment of employees.
b. Incorrect: This would limit the empowerment of employees.
c. Correct: Workplace scenarios in which employees are more likely to feel
empowered include workplaces where there is flexibility around the use of
people; where there is interpersonal contact in the job; where there is
contact with senior officials; where there is an opportunity to participate
in programs, conferences, and meetings; where there is participation in
problem-solving task forces; and where there are advancement prospects
for subordinates (see Table 3.1, p. 74, in your textbook). Options
d. Incorrect: This would limit the empowerment of employees.

integrity
Integrated Nursing Process: Implementation
Objective: 4—Discuss how an organization may be structured to empower
employees
8) When developing the strategic plan for an organization, the types of power that might
be articulated by organizations to empower employees would be __________.
a. reward, expert, and referent power
b. public, reward, and expert power
c. politics, expert, and reward power
d. salary, expert, and referent power
Answer: a
b. Incorrect: Public is not type of power.
c. Incorrect: Politics is not a type of power.
d. Incorrect: Salary is not a type of power.
Client need per NCLEX: safe and effective care environment, psychological integrity
Objective: 4—Discuss how an organization may be structured to empower employees
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______________________________________________________________________________________________
9) A board of directors and senior physician in a tertiary care centre are described as
being __________.
a. powerless in hospital decision-making
b. oppressed in the hospital decision-making process
c. influential in hospital decision-making
d. support staff to those who make decisions in hospitals
Answer: c
a. Incorrect: Incorrect.
c. Correct: Members of the board of directors and senior physicians in a
tertiary care centre fall under the system of authority, which gives formal
power and legitimate authority to the holder of an official position. As
such, they are influential in the decision-making process.
integrity
Objective: 5—Describe the groups in organizations who can exert power and
ways in which power can operate
10) Which system of influence in an organization involves a sense of mission and shared
goals, traditions, socialization, and loyalty?
a. the system of ideology
b. the system of authority
c. the system of expertise
d. the system of politics
Answer: a
a. Correct: The system of ideology refers to a system of beliefs about the
organization that integrates personal and institutional goals, so that this
ideology has an influence on the way members think and act.
b. Incorrect: The system of authority refers to the formal power that accrues
to the holder of an official position.
c. Incorrect: The system of expertise arises in organizations that rely on
professionals for the complex work required in the organization.
d. Incorrect: The system of politics arises in organizations because
employees have delegated power that gives them the discretion to make
decisions at some level.
integrity
Objective: 5—Describe the groups in organizations who can exert power and
ways in which power can operate
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______________________________________________________________________________________________
11) The local member of the legislative assembly has made a promise to decrease the
wait times for surgery in the hospital in his riding. There has not been an evaluation of
the methodology he has proposed. In fact, the proposed plan will cause budgetary
problems for other areas of the hospital. This is an example of a __________.
a. political action
b. political ploy
c. political game
d. political pattern
Answer: c
a. Incorrect: This terms does not describe this kind of political manoeuvre.
b. Incorrect: This terms does not describe this kind of political manoeuvre.
c. Correct: Political games are patterns of behaviours engaged in by political actors
who attempt to achieve their own ends, rather than the overall good of the whole
organization.
d. Incorrect: This terms does not describe this kind of political manoeuvre.

Objective: 6—Discuss how politics plays out in organizations and the strategies and
games that can be used in health care organizations
12) A ________ strategy is when a group of people are threatened or forced to change
their behaviour through assertiveness, sanctions, or blocking through non-cooperation.
a. push
b. pull
c. persuasion
d. preventive
Answer: a
a. Correct: Push strategies threaten or force others to change behaviour
through assertiveness, sanctions, or blocking through non-cooperation.
b. Incorrect: Pull strategies use positive motivation to influence behaviour
through recognition, benefits, or the satisfaction of needs and goals.
c. Incorrect: Persuasion strategies appeal to logical reasoning or convincing
others about behaviour in relation to goals.
d. Incorrect: Preventive strategies are intended to prevent an issue from
arising and may involve focusing attention elsewhere, avoiding a topic, or
leaving it off an agenda.
integrity
Objective: 6—Discuss how politics plays out in organizations and the strategies
and games that can be used in health care organizations
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______________________________________________________________________________________________
13) During an interview about her career, the local Director of Nursing identified
situations where power and politics were used in her career. One of situations she
identified might have been ________.
a. provision of patient care
b. leadership changes
c. educational opportunities
d. operating room efficiencies
Answer: b
a. Incorrect: While it is possible that power and politics could be at work in these
specific situations, leadership changes have been identified as an area where
power and politics will always be used.
b. Correct: Situations in which politics and power may be at work in an organization
include strategic planning processes, budgeting processes, capital planning
processes, periods of constrained resources in health care (e.g., downsizing),
leadership change, implementation of changes in work (e.g., reorganization, re-

engineering), and any process involving allocation of resources.
c. Incorrect: While it is possible that power and politics could be at work in these
d. Incorrect: While it is possible that power and politics could be at work in these
Client need per NCLEX: safe and effective care environment, psychological integrity
Objective: 7—Identify the types of situations in health care organizations that give rise
to use of power and politics
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______________________________________________________________________________________________
14) Provide an example of each of the following.
a) Reward power
b) Coercive power
c) Expert power
Answer: Correct answers should include:

a) Reward power—Ability of person in senior position to provide rewards (pay
increases, promotions, privileges, etc.)
b) Coercive power—Power to apply punishment or withhold rewards
(termination)
c) Expert power—Perceived extent of a person’s knowledge or expertise


Objective: 1—Define power and politics and describe differing perspectives on their
use in organizations
15) Match each of terms in column A with the correct corresponding statement from
column B.
Column A Column B
personal attribute anger
personal behaviour can accrue power
personal actions sphere of influence
control over resources person who allocates office space
ability to cope successful marketing
formal position being articulate
Answer:
personal attribute—being articulate
personal behaviour—anger
personal actions—successful marketing
control over resources—person who allocates office space
ability to cope—can accrue power
formal position—sphere of influence
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______________________________________________________________________________________________
integrity
Objective: 2—Analyze power relationships in the workplace and the sources of
power of the actors or units/departments of an organization
16) Discuss three positive and three negative perceptions of power in the workplace.
Answer: Points to include in correct answer:

 Negative perceptions
o dominance over others
o hold-over from pre-democratic periods where leader was cruel tyrant
o social inequality, abuse and rule by elites
o westerners showed a negative association between power and cooperation
o differing cultural views of power may lead to differing psychological and
behavioural consequences in the workplace
 Positive perceptions
o contribute to order and effectiveness
o Westerners showed positive association between power and reward
integrity
Objective: 3—Debate the positive and negative perceptions of power and politics in
the workplace
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______________________________________________________________________________________________
17) For each of the following tasks, indicate where the corresponding factor is high or
low. An example is provided.
Factor Generates power when the Generates powerlessness

factor is _____. when the factor is _____.
Task variety high low
Number of rules inherent to

the job
Number of established
routines
Contact with senior officials
Interpersonal contact in the

job
Answer:
Factor Generates power when the Generates powerlessness
factor is _____. when the factor is _____.
Task variety high low
Number of rules inherent to low high

the job
Number of established low high

routines
Contact with senior officials high low
Interpersonal contact in the high low

job
integrity
Objective: 4—Discuss how an organization may be structured to empower
employees
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______________________________________________________________________________________________
18) Explain each of the following:
a) Internal coalition
b) The system of authority
c) The system of ideology
d) The system of expertise
e) The system of politics
Answer:
Correct answer for A should include:
o top management
o operators
o line managers
o analysts
o support staff
Correct answer for B should include:

o formal power that accrues to the holder of an official position (e.g., CEO)
o they establish and design the hierarchy or chain of authority
Correct answer for C should include:

o beliefs about the organization that integrates personal and institutional
goals
o involves a sense of mission and shared goals, traditions, identification,
socialization, and loyalty
Correct answer for D should include:

o rely on professionals for the complex work required in organization
o relies on less bureaucratic form of organization
Correct answer for E should include:

o employees have delegated power that gives them discretion to make
decisions at some level
o discretion in work makes the use of political power possible
integrity
Objective: 5—Describe the groups in organizations and the strategies and games that
can be used in health care organizations
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______________________________________________________________________________________________
19) Provide an example of each of the following:
a) Push strategies
b) Pull strategies
c) Persuasion strategies
d) Preventive strategies
e) Preparatory strategies
Answer:
Correct answers should include:
a) Push strategies—threaten or force others to change behaviour through
assertiveness, sanctions, or blocking through non-cooperation
b) Pull strategies—positive motivation to influence behaviour through
recognition, benefits, or the satisfaction of needs and goals
c) Persuasion strategies—appeal to logical reasoning or convincing others about
behaviour in relation to goals
d) Preventive strategies—designed to prevent an issue from arising and may

involve focusing attention elsewhere, avoiding a topic, or leaving it off an
agenda
e) Preparatory strategies—aimed at preparing the ground or creating the
conditions favourable to other strategies and range from the way in which
someone dresses to create an impression, to ordering the agenda in a
favourable way, to simply pouring on the charm
integrity
Objective: 6—Discuss how politics plays out in organizations and the strategies and
games that can be used in health care organizations
20) Provide two examples of each level of the multi-level framework that reflects politics
in nursing.
Answer:
Correct answers should include at least two points from each of the following.
o Interpersonal Level
o relationships with patients
o relationships with colleagues
o negotiation
o power in interaction
o Organizational Level
o dominant groups and coalitions in organizations
o institutional policies
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______________________________________________________________________________________________
o power of the institution

o organizational hierarchy
o External Level
o national/governmental policies
o political action to influence policy
integrity
Objective: 7—Identify the types of situations in health care organizations that give
rise to use of power and politics
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______________________________________________________________________________________________
Chapter 4 - Change and Culture

1) The theory used to explain how innovation is adopted within a population depends
upon __________.
a. compatibility
b. connectivity
c. complacency
d. continuance
Answer: a
Rationale for correct answer:
a. Correct: Diffusion of innovations theory is a marketing theory that was
developed to explain how an innovation was adopted throughout a
population. According to this theory, innovation depends on five features:
relative change, compatibility, complexity, trialability, and observability.

b. Incorrect: This is not included in the five features of Diffusion of
Innovations theory.
c. Incorrect: This is not included in the five features of Diffusion of
Innovations theory.
d. Incorrect: This is not included in the five features of Diffusion of
Innovations theory.
Evaluation
Objective: 1—Analyze how change theories could be used to guide planned
change in health care settings
2) Eliminating the obstacles to change, adjusting systems, and encouraging risk taking
represent which part of the change process?
a. planning for and creating short-term wins
b. institutionalizing new approaches
c. creating a vision
d. empowering others to act on the vision
Answer: d
a. Incorrect: This phase within Kotter’s “Eight-Stage Change Process”
includes planning for visible performance improvements, creating those
improvements and recognizing and rewarding employees involved in the
improvements.
b. Incorrect: This phase within Kotter’s “Eight-Stage Change Process”
includes articulating the connections between the new behaviours and
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______________________________________________________________________________________________
corporate success, and developing the means to ensure leadership

development and succession.
c. Incorrect: This phase within Kotter’s “Eight-Stage Change Process”
includes creating a vision to help direct the change effort and developing
strategies for achieving that vision.
d. Correct: Within Kotter’s “Eight-Stage Change Process,” stage 5,
empowering others to act on a vision, includes getting rid of obstacles to
change; changing systems or structures that seriously undermine the
vision; and encouraging risk-taking and non-traditional ideas, activities,
and actions.
integrity
Objective: 1—Analyze how change theories could be used to guide planned
3) The medical-surgical unit in the local hospital has implemented a new closed drainage
suction dressing for wound care. The staff are resistant to this new equipment. What may
be one of the reasons for their resistance to the new method of wound care?
a. They know that there is a need for change.
b. They believe that they may not be able to do the things now required of them.
c. They received an in-service that prepared them to use the equipment.
d. Previous practices were acknowledged as having been well done.
Answer: b
a. Incorrect: This is a reason for accepting change, not resisting it.
b. Correct: Austin and Claassen (2008) identified six potential reasons for
resistance to change in the workplace: 1) fear that employees may be
unable to perform well; 2) belief that they may not be able to do things
now required; 3) sense of loss experienced about the former way of doing
things; 4) perception that this means previous practices were not good; 5)
not understanding or knowing how to do things differently; and 6) not
understanding the need for change.
c. Incorrect: This is a reason for accepting change, not resisting it.
d. Incorrect: This is a reason for accepting change, not resisting it.
integrity
Evaluation
Objective: 2—Discuss how employees might respond to change and how
resistance to change may be lessened.
4) The medical-surgical unit in the local hospital has implemented a new closed drainage
suction dressing for wound care. The staff are resistant to this new equipment. How
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______________________________________________________________________________________________
might the nurse manager or nurse educator on the unit assist the staff to lessen their
resistance to the change?
a. discourage discussion of their feelings toward the change
b. present the change as a continuation of their previous practice
c. explain that previous practices were deficient
d. ignore any negative comments about the change
Answer: b
a. Incorrect: This would increase employee resistance to change.
b. Correct: Austin and Claassen (2008) note, “If the change is presented as a
continuation of previous practice, the resistance can be decreased.” This
can prevent employees from feeling bad about their former practices and
also increase their confidence that they can do things differently because
the new ways have something in common with the old ways.
c. Incorrect: This would increase employee resistance to change.
d. Incorrect: This would increase employee resistance to change.
integrity
resistance to change may be lessened.
5) __________ is an emerging area of research that is largely invisible, has an impact on

outcomes, and is socially constructed.
a. Organizational identity
b. Organizational culture
c. Organizational competence
d. Organizational change
Answer: b
a. Incorrect: This is not an emerging area of research about organizational
culture and climate.
b. Correct: According to Bellot (2011), organizational culture is an emerging
area of research that exists but is largely invisible, has an impact on
outcomes, and is “socially constructed” because it is based on shared
experiences of its members.
c. Incorrect: This is not an emerging area of research about organizational
d. Incorrect: This is not an emerging area of research about organizational
Integrated Nursing Process: Assessment
Objective: 3—Define organizational culture and discuss aspects of the culture of
an organization where you have worked
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______________________________________________________________________________________________
6) Organizational culture __________.

a. guides employees’ interpretation of events and behaviour
b. guides employees’ reaction to events
c. refers to how employees feel in the workplace
d. is a temporary perception
Answer: a
a. Correct: According to Quinn (2011), organizational culture encompasses
the taken-for-granted values, underlying assumptions, expectations,
collective memories, and definitions present in an organization.
b. Incorrect: Organizational culture guides employees’ interpretation of
events, but not necessarily their reaction to events.
c. Incorrect: This is a definition of organizational climate, not organizational
culture.
d. Incorrect: Organizational culture evolves over time.

Evaluation
7) Organizational climate __________.

a. refers to how employees feel in the workplace
b. guides employees’ interpretation of events
c. is the same as organizational culture
d. is outlined in the strategic plan of the organization
Answer: a
a. Correct: A is the correct definition of organizational climate, which refers
to how employees feel in their workplace and their perception of different
aspects of the workplace (e.g., their perceptions about leadership, reward
systems, conflict, or safety practices).
b. Incorrect: Organizational culture, not organizational climate, guides
employees’
c. interpretation of events.
d. Incorrect: Organizational culture is not the same as organizational climate,
but overlaps with organizational climate.
e. Incorrect: Organizational climate is not part of an organization’s strategic
plan.
integrity
Evaluation
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______________________________________________________________________________________________
Objective: 4—Define organizational climate and discuss aspects of the climate of

8) When a new documentation tool is implemented in various units of the hospital, nurses
on the medical unit find the tool to be very user-friendly, yet nurses on the surgical unit
find it to be problematic. This is an example of ________.
a. organizational culture
b. organizational climate
c. change theory
d. trainability
Answer: b
a. Incorrect: This scenario is an aspect of organizational climate, not
organizational culture.
b. Correct: According to Rousseau (1988), organizational climate or
employees’ perceptions of their workplace are often described as positive

and negative; however, different persons viewing the same aspect of the
workplace may see it differently.
c. Incorrect: This scenario is an aspect of organizational climate, not change
theory.
d. Incorrect: This scenario is an aspect of organizational climate, not
trainability.
9) Nurses from a hemodialysis unit have been dissatisfied with their work environment
and a high turnover rate among new staff has been identified. During their exit interviews
nurses, identified horizontal violence as being endemic because of infighting. This
created a _________.
a. culture of bullying
b. culture of change
c. culture of empowerment
d. culture of sustainability
Answer: a
a. Correct: A culture of bullying is one where horizontal and/or vertical
violence is endemic.
b. Incorrect: Horizontal violence is not an aspect of a culture of change.
c. Incorrect: Horizontal violence is not an aspect of a culture of
empowerment.
d. Incorrect: Horizontal violence is not an aspect of a culture of
sustainability.
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______________________________________________________________________________________________

Objective: 5—Discuss what is meant by the terms safety culture, culture of
blame, culture of change, culture of continuous improvement, culture of
empowerment, and culture of bullying
10) When employees are treated fairly and respectfully, an organization may see
_________.
a. decreased employee productivity
b. increased rates of absenteeism
c. decreased rates of absenteeism
d. a decrease in helpful behaviours
Answer: c
a. Incorrect: In organizational cultures where employees are treated fairly
and respectfully, employee productivity is increased, not decreased.
b. Incorrect: In organizational cultures where employees are treated fairly

and respectfully, rates of employee absenteeism are decreased, not
increased.
c. Correct: Researchers have found that organizational cultures in which
employees are treated fairly and respectfully have been associated with
higher employee productivity and helpful behaviours, and lower rates of
absence from work.
d. Incorrect: In organizational cultures where employees are treated fairly
and respectfully, there is an increase, not a decrease, in helpful behaviours.
integrity
Evaluation
11) When an organization has a positive culture, patient care is impacted in which of the
following ways?
a. There is a decreased incidence of medication errors.
b. There is an increased length of hospital stay.
c. There is an increased incidence of nosocomial infections.
d. There is a decrease in reported satisfaction by patients and families.
Answer: a
a. Correct: In a positive organizational culture, impacts on patient care can
include decrease in medication errors and an increase in report patient
satisfaction.
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______________________________________________________________________________________________
b. Incorrect: This is an example of an outcome that can occur within a

negative organizational culture.
c. Incorrect: This is an example of an outcome that can occur within a
d. Incorrect: This is an example of an outcome that can occur within a
integrity
Evaluation
Objective: 6—Identify the impact of organizational culture on employees and
patients
12) Which of the following is an appropriate order of steps for the step-by-step process to
change an organization’s culture?
a. identify ways to communicate change; collect and reach agreement about culture; form
a group
b. collect and reach agreement about organization’s actual culture; identify discrepancies
between actual and ideal culture; develop a strategic action plan
c. develop an action plan; come to agreement on preferred culture of organization;
celebrate small changes
d. celebrate small changes; repeat the change; collect input and reach agreement about
success of change
Answer: b
a. Incorrect: The order of steps is incorrect.
b. Correct: In Cameron and Quinn’s nine-step process for changing an
organization’s culture, the steps occur in the following order: 1) form a
group of key employees in the organization, including those responsible
for implementing the change; 2) collect input and reach agreement about
organization’s current culture; 3) discuss what the organization’s ideal
culture would look like; 4) figure out what to keep and what to change to
shift the culture; 5) develop a strategic action plan; 6) celebrate small, easy
changes; 7) leaders develop their skills in leading change; 8) measure
progress in achieving cultural change by identifying measures and
milestones of change; 9) identify ways to communicate change to help
employees become aware of how things have changed.
c. Incorrect: The order of steps is incorrect.
d. Incorrect: The order of steps is incorrect.
Evaluation
Objective: 7—Suggest strategies for changing an organization’s culture
13) Why might making a change in an organization be challenging?
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______________________________________________________________________________________________
a. It is easy to change things that people are unaware of.

b. Culture is easily identified by employees and managers alike.
c. Culture is pervasive and largely hidden from employees and managers.
d. It is difficult to change things that people identify as problematic.
Answer: c
a. Incorrect: This option implies that change is easy, not challenging.
b. Incorrect: Culture is not easily visible to employees and managers.
c. Correct: Making change in an organization can be difficult because an
organization’s culture is pervasive and largely hidden from employees and
managers, and it is hard for anyone to change something they are unaware
of.
d. Incorrect: When problems are identified, this lessens the challenges to
making organizational changes.
Evaluation
Objective: 7—Suggest strategies for changing an organization’s culture
14) Draw Cooperrider’s theory of appreciative inquiry as a cycle. What questions would
be asked in each dimension?
Answer:
Points to include for correct answer:
o Discovery dimension—“What gives life?” (the best of what is;

appreciating)
o Dream dimension—“What might be?” (what is the world calling for;
envisioning results)
o Design dimension—“What should be the ideal?” (co-constructing)
o Destiny dimension—“How to empower, learn and adjust/improvise?”
(sustaining)
integrity
Evaluation
Objective: 1—Analyze how change theories could be used to help guide planned
15) Describe a situation (real or fictitious) where a change is made on a medical-surgical

nursing unit. Then, describe EITHER:
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a) a positive response by the staff members and four reasons for why the change was
received in a positive manner, OR
b) a negative response by the staff members and four reasons why the change was
resisted.
Answer:
Correct answers should include the following points.
a) Potential reasons for employee resistance to change:
o fear that they may be unable to perform as well
o belief that they may not be able to do things now required
o sense of loss experienced about the former way of doing things
o perception that previous practices were not good
o not understanding or knowing how to do things differently
o not understanding the need for change
b) Potential ways to lessen resistance to change:
o determine reasons for the resistance—may differ among
employees
o allow employees to work through their feelings related to the
change
o present change as a continuation of a previous practice
integrity
resistance to change may be lessened
16) Describe the four themes of Organizational Culture.
Answer:
o Organizational culture is largely invisible but it does exist and it does have
an impact on outcomes.
o Culture is largely invisible, intangible, and ambiguous, leading to
confusion about what it is and difficulties measuring it.
o Organizational culture is based on the shared experiences of its members
or is “socially constructed”—a group phenomenon that helps members of
the group make sense both of their workplace and their work experiences.
o Each organization has a unique culture that evolves over time.
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Evaluation
17) Explain the difference between organizational climate and organizational culture.
Provide at least three points.
Answer:
Correct answers should include the following points:
o Climate is how employees feel in their workplace and their perceptions of

different aspects of the workplace.
o Climate refers to a more temporary perception of the employee about
organizational routines and rewards.
o Different persons viewing the same aspect of the workplace may see the
aspect differently.
integrity
Evaluation
an organization where you have worked.
18) Define a culture of bullying and provide an example from your clinical practice area.
Answer:
Correct answers should include the following information.
o A culture of bullying is one in which horizontal and/or vertical violence is

endemic. Like other oppressed groups, the anger nurses experience
because of the control held by a powerful group is turned inward, toward
other members of their group, resulting in horizontal violence.
integrity, physiological integrity
Evaluation
19) What impact does a negative organizational culture have on employee productivity,
commitment, and morale?
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Answer:
Correct answers should include the following information.
o Organizational culture has an impact on employee productivity,

commitment, and morale. Where employees are treated fairly and
respectfully, there has been associated increased employee productivity,
increased helpful behaviours, and lower rates of absence from work.
integrity
Evaluation
Objective: 6—Identify the impact of organizational culture on employees and
patients
20) What are the steps to changing an organization’s culture?

Answer:
Correct answers should include all of the following steps.
1. A group of key employees is formed, including those responsible for

implementing change
2. Group collects input and reaches agreement about the current culture
3. Group comes to an agreement on a preferred future for culture of
organization
4. Discrepancies between the actual and the ideal culture are identified
5. Group determines what they would like to keep and what they would like
to change
6. Small changes are celebrated
7. Leaders develop their skills in leading change
8. Group develops a strategic action plan
9. Group identifies ways to communicate change

Evaluation
Objective: 7— Suggest strategies for changing an organization’s culture
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Chapter 5 - Decision-making and Management of Work Flow

1) When using an innovative decision-making model, in order to help reduce the potential
of group members’ reluctance to share their ideas with the group, the group leader will
__________.
a. credit the individual for their creativity with a reward
b. ask each group member to write their idea on a piece of paper, then read the ideas to
the group, identifying the member who developed the idea
c. Ask each group member to write their idea on a piece of paper, then read the ideas to
the group without identifying the member who developed the idea
d. credit the group with a reward, pointing out who the individual was who generated the
starting point
Answer: c

a. Incorrect: To help individuals share their ideas with their work group,
consideration must be made for giving a reward to the group, rather than
rewarding individual performance.
b. Incorrect: In order to help reduce the potential reluctance of group
members, this activity must be done anonymously to prevent individual
ideas from being judged.
c. Correct: When using an innovative decision-making model, in order to
help reduce the potential reluctance of group members to share their ideas,
the group leader might ask each group member to write one idea down on
a piece of paper, collect these ideas and read them to the group, and then
continue the process by having members write down another idea.
d. Incorrect: To help individuals share their ideas with their work group,
consideration must be made for giving reward to the group rather than the
individual performance. In order to help reduce the potential reluctance of
group members, this activity is done anonymously so as to prevent their
ideas being judged.
Objective: 1—Identify different models and tools of decision making
2) Which of the following represents the correct order of steps for rational decision
making?
a. identifying an issue, generating all potential solutions and their consequences, selecting
the optimal solution, and implementing the decision
b. implementing a decision, identifying an issue, generating possible solutions and their
consequences, and selecting the optimal solution
c. identifying an issue, generating all potential solutions and their consequences,
implementing the decision, and selecting the optimal solution from those implemented
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d. identifying an issue, selecting the optimal solution, generating possible solutions and
their consequences, and implementing a decision
Answer: a
a. Correct: Rational decision-making models are developed on the
assumption that a person determines the best course of action through
logically thinking about all possible options. The number of steps in
different models may vary, but in general these models include the
following sequence of steps: identifying an issue that needs a decision;
generating all potential solutions; generating all possible consequences for
each potential solution; selecting an optimal solution; and implementing
the decision.
b. Incorrect: These are steps in rational decision making, but the steps are in
the wrong sequence, thus altering the logical flow of the process.
c. Incorrect: These are steps in rational decision making, but the steps are in
d. Incorrect: These are steps in rational decision making, but the steps are in
Client need per NCLEX: safe and Effective Environment
Objective: 1—Identify different models and tools of decision making
3) The type of decision making where a manager makes a decision without any input
from others in the organization, and then implements the decision, is called __________.
a. participatory decision making
b. consultative decision making
c. collaborative decision making
d. autocratic decision making
Answer: d
a. Incorrect: Participatory decision making, sometimes referred to as
participatory management, refers to decision making where the manager
allows employees to share in the decision.
b. Incorrect: In consultative decision making, the manager consults with
employees, but after the consultation process, the manager makes the
decision.
c. Incorrect: Collaborative decision making is also known as group decision
making, and refers to when a decision is made by a group rather than an
individual.
d. Correct: This is the definition of autocratic decision making.
Client need per NCLEX: safe and effective environment, psychological integrity
Objective: 2—Identify a variety of styles of management decision-making
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4) A generous donor has provided funds to a nursing unit. The nurse manager requests
the input of the staff to determine how the funds will be spent. Options include
redecorating the staff lounge, registration for some staff to attend educational
conferences, or directing the funds towards the staff holiday party. The manager asks the
staff to vote on their preferred choice. In order to ensure the staff feel valued and not
betrayed, the manager indicates that not everyone will agree with the final decision, but
that when it is announced, the rationale for the decision will be transparent. The decision-
making style used in this scenario is __________.
a. transparency
b. consensus decision making
c. autocratic decision making
d. equity
Answer: b
a. Incorrect: Transparency means being open about what is occurring and
what decisions are made. It is not a decision-making style.

b. Correct: Consensus decision-making refers to the decision-making process
in which the group makes the decision and there is general agreement
about the decision. However, if group members believe a decision made
by consensus means that all are in agreement with the decision, then those
who are not in agreement may feel betrayed.
c. Incorrect: Autocratic decision making is the type of decision-making
where a manager makes a decision without any input from others in the
organization, and then implements the decision.
d. Incorrect: People may hold different views about what is fair and
equitable, but equity is not a decision-making style.
5) When developing strategic plans __________.

a. in small organizations, it may be possible for everyone in the building to be involved
b. in large organizations, it may be possible for everyone in the building to be involved
c. there is no link to financial and human resources required
d. in large organizations, it is considered the only plan to be followed at the
organizational and departmental levels
Answer: a
a. Correct: In small organizations, it may be possible for everyone in the
building to be involved in the organization’s strategic plan.
b. Incorrect: In large organizations, the senior executive group may do most
of the strategic planning, with input from managers and from all
employees.
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c. Incorrect: If an area is prioritized in the strategic plan, it needs to have the

financial and human resources required for it to be successful. The
strategic activities should be linked with the organization’s financial and
human resource plans.
d. Incorrect: After the overall strategic plan is developed, each department
may form its own strategic plan that flows from the overall strategy.
Objective: 3—Suggest how strategic planning could be used in the health care
organization at both the departmental and organizational levels
6) Strategic planning generally includes __________.

a. an organization’s mission, values and vision
b. an organization’s human resources, financial, and succession planning
c. an organization’s mission, values, and leadership
d. only an organization’s short-term goals
Answer: a
a. Correct: Strategic plans usually include the organization’s mission
statement (description of focus or purpose), values, and vision statement
(description of where the organization would like to be in the future).
b. Incorrect: An organization’s strategic plan should be linked to the human
resource and financial plans, but these are not included in the strategic
plan. Succession planning is often part of the human resource plan for an
organization.
c. Incorrect: Leadership is not usually included in a strategic plan.
d. Incorrect: A strategic plan includes both short-term and long-term goals
for the organization.
Objective: 3—Suggest how strategic planning could be used in the health care
7) Which of the following is a true statement about the core values of an organization?
a. They are not released to the public.
b. They are respect, equity, and transparency.
c. They assist with decision making in the organization.
d. They are different for each department in an organization.
Answer: c
a. Incorrect: Statements of an organization’s core values are shared with the
public and all other stakeholders.
b. Incorrect: While respect, equity, and transparency are often part of an
organization’s values, they are not the only values used.
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c. Correct: Most organizations have developed statements about their values,

and these are often posted on their websites along with their mission and
vision statements. Decisions made in the organization should be consistent
with these values.
d. Incorrect: The overarching core values of an organization must be upheld
within each department. Each department may add to the list but the core
values must be maintained.
Objective: 4—Discuss how core values can be used to guide decision making in
organizations
8) Employees and other onlookers consider decisions made by an organization’s

administrators or board of directors to be a(n) _________________of the organization’s
actual values.
a. mission statement
b. vision statement
c. reflection
d. pattern
Answer: c
a. Incorrect: A mission statement is a brief description of the focus or
purpose of the organization.
b. Incorrect: A vision statement is a description of where an organization
would like to be in the future.
c. Correct: Employees and other onlookers consider decisions made by an
organization’s administrators or board of directors to be reflections of the
organization’s actual values.
d. Incorrect: Patterns and cues are recognized by experts in practice to
support a recognition-primed decision making model.
organizations
9) In a shared governance structure, which of the following is true about nursing practice
councils?
a. They help with making decisions that have time constraints.
b. They help nurses understand the work being done in their own departments.
c. They allow for administrators to direct the work of nurses.
d. They empower nurses.
Answer: d
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a. Incorrect: When issues need to be brought forward to a nursing practice

council, this may take time and thus make it difficult or impossible to act
when a decision is needed immediately or an organization is large.
b. Incorrect: In a shared governance structure, nurses understand the “big
picture” of the organization, which includes understanding work done in
departments other than their own department.
c. Incorrect: Administrators and nurses are both involved in decision making
regarding the work of the nursing staff in a shared governance structure.
Nurse administrators do not direct the work of nurses within this structure.
d. Correct: Nursing practice councils, and shared governance in general,
involves nurses in the decision-making process, and therefore empowers
them.
Objective: 5—Discuss the roles of direct care nurses, their manager, and senior
administrators in decision making, and everyone’s accountability for their
decisions
10) Respect, equity, accountability, caring, participation, and collaboration are all
examples of _________.
a. key values
b. vision statement
c. mission statement
d. patterns
Answer: a
a. Correct: Along with collaboration, teamwork, and transparency, these are
all examples of key values an organization may identify.
b. Incorrect: A vision statement is an organization’s description of where it
would like to be in the future and does not necessarily include these
values.
c. Incorrect: A mission statement is a brief description of the focus or
purpose of the organization and does not necessarily include these values.
d. Incorrect: Patterns are identified by experts in their fields.
Objective: 5—Discuss the roles of direct care nurses, their manager, and senior
administrators in decision-making, and everyone’s accountability for their
decisions
11) Nurse managers often have a large span of control, which contributes to a heavy
workload and leaves little time to think about problems. What other factor compounds a
nurse manager’s ability to find or implement a good solution to a problem?
a. interprofessional team
b. shared governance
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c. “wicked” problems
d. vertical integration
Answer: c
a. Incorrect: This is the type of team that works together to assess the client’s
needs and care is provided by the practitioner whose expertise will most
benefit the client.
b. Incorrect: This refers to an organizational structure where decision making
is shared with staff.
c. Correct: “Wicked” problems is a term used to describe difficult problems
that have multiple causes, some of which may not be known and are
difficult to solve.
d. Incorrect: Vertical integration refers to an organization becoming larger by
joining with another organization that is the supplier or purchaser of
products or services of the organization.

Objective: 6—Be aware that rational decision-making models may have limited
use in “wicked’ contexts
12) Which of the following is true about “wicked” problems as they relate to decision-
making models?
a. They have multiple causes, all of which are understood, and one solution can fix them
all.
b. They have multiple causes, some of which may not be known, and they are difficult to
solve.
c. They have multiple causes, all of which are understood, and require multiple solutions.
d. They have a single cause, but it is not known, and they are difficult to solve.
Answer: b
a. Incorrect: In “wicked” problems, each cause is not always identified or
understood.
b. Correct: This is the definition of a “wicked” problem.
c. Incorrect: In “wicked” problems, all causes are not always identified.
d. Incorrect: There are usually multiple causes to a “wicked” problem.
Objective: 6—Be aware that rational decision-making models may have limited
use in “wicked’ contexts
13) Considering alternatives until one is found that will satisfy a problem is referred to as
__________.
a. safe
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b. emotionally derived decision-making

c. satisficing
d. satiating
Answer: c
a. Incorrect: This term does not relate to the definition in the question.
b. Incorrect: This term does not relate to the definition in the question.
c. Correct: “Satisficing” is a term coined by Herbert Simon in 1957 to
describe the selection of an alternative that is satisfactory without
spending additional time identifying the pros and cons of all possible
solutions.
d. Incorrect: This term does not relate to the definition in the question.
Objective: 7—Apply strategies for innovative decision-making
14) In order to encourage innovative solutions when making decisions, you should
__________.
a. offer suggestions only when asked
b. offer ideas with interest and curiosity
c. evaluate others ideas as they are presented to ensure yours is best
d. realize that if your initial reaction is that an idea is silly, it probably is
Answer: b
a. Incorrect: With an innovative decision-making process, team members
should feel comfortable contributing to the conversation, and not offer
suggestions only when asked.
b. Correct: Offering ideas with interest and curiosity encourages innovative
solutions.
c. Incorrect: In order to encourage everyone to give ideas, group members
are asked to not evaluate ideas as they are presented in brainstorming
sessions.
d. Incorrect: Even if your initial reaction is that an idea is silly or it has been
tried before, by allowing discussion of the idea, you foster a culture of
curiosity.
15) Which type of governance allows all nurses within an organization to be involved in
decision making related to their professional practice?
a. shared governance
b. program management
c. horizontal governance
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d. vertical governance
Answer: a
a. Correct: Shared governance refers to an organizational structure where
decision making is shared with staff.
b. Incorrect: Program management is a way of organizing health care
organizations by groups of patients, rather than by departments with
members of one professional group.
c. It does not relate to involving nurses in decision making.
d. Incorrect: Horizontal governance is not a type of governance.
e. Incorrect: Vertical governance is not a type of governance.
Objective: 8—Compare different organizational and reporting structures,
including shared governance, program management and interprofessional teams
16) Mr. Watkins is an 84-year-old who was admitted to hospital with pneumonia. He was
assessed in the emergency department by a physician, and was provided nursing care by
an RPN and an RN. A respiratory therapist then conducted pulmonary function tests and
social work has been consulted. A plan of care is developed for each of these
practitioners to be involved in different aspects of Mr. Watkin’s care while in hospital.
This is an example of implementation of which type of structure?
a. interprofessional team
b. intraprofessional team
c. hierarchical structure
d. consultative care
Answer: a
a. Correct: An interprofessional team works together to assess the client’s
needs and care is
b. provided by the professional(s) whose expertise will benefit the patient.
c. Incorrect: The intraprofessional team functions only within one discipline.
d. Incorrect: This type of structure has a number of layers of management.
e. Incorrect: Consultative care is not a structure within Canadian health care
organizations.
17) Ronee is a health care aide (unregulated care provider). Which of the following
scenarios will facilitate a safe and positive work environment for her in an acute care
area?
a. All nurses on the unit will delegate their work to Ronee.
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b. All nurses on the unit will work as a large team, with Ronee included.
c. All nurses and health care aides on the unit will work as a large team.
d. All nurses and Ronee will participate in change-of-shift reports.
Answer: d
a. Incorrect: It will be difficult for the unregulated care provider if all nurses
and licensed practical nurses on a unit can delegate their work to one
person.
b. Incorrect: It is preferable to create small health care teams, such as two
nurses working with one unregulated health worker, with responsibility for
the same group of patients.
c. Incorrect: It is preferable to create small health care teams, such as two
nurses working with one unregulated health worker, with responsibility for
the same group of patients.
d. Correct: Including unregulated care providers in change-of-shift reports
demonstrates to the care provider that he or she is a member of the team.
Objective: 9—Discuss what and how nursing care can be delegated (or assigned)
to other nurses and non-nurses
18) In which of the following situations could the care of a patient be transferred to an
unregulated care provider?
a. The patient’s condition is well-controlled or managed.
b. The patient’s condition is expected to change.
c. The patient is unresponsive.
d. The patient’s response to the procedure is unpredictable.
Answer: a
a. Correct: As per the CNO’s decision tree regarding decisions about
activities to be performed by unregulated care providers, this factor is
acceptable. It is appropriate to transfer a patient’s care to an unregulated
care provider if that patient’s condition is well-controlled.
b. Incorrect: In this situation it would not be appropriate to delegate patient
care to an unregulated care provider.
c. Incorrect: In this situation it would not be appropriate to delegate patient
d. Incorrect: In this situation it would not be appropriate to delegate patient
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19) Fill in the blanks with the appropriate term from the following list:
Intuitive decision-making
Rational decision-making
Innovative decision-making
A. __________ is the decision-making model that is a rational, cognitive process.
B. __________ is often described as a decision-making process that requires
“thinking outside the box.”
C. ___________ is the decision-making model based on patterns and cues.
Answer:
o Rational decision-making is the decision-making model that is a rational,
cognitive process.
o Innovative decision-making is often described as a decision-making
process that requires “thinking outside the box.”
o Intuitive decision-making is the decision-making model based on patterns
and cues.
Objective: 1—Identify models and tools of decision making
20) Name three styles of management decision making.
Answer:
Correct answers will include 3 items from the following list.
o autocratic decision-making
o consultative decision-making
o participatory decision-making
o collaborative decision-making
21) Name three things that should be included in an organization’s or department’s

strategic plan.
Answer:
Correct answers should include 3 of the following.
o mission statement
o values
o vision statement
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o goals and objectives and how they will be achieved
Objective: 3—Suggest how strategic planning could be used in a health care
22) Name two core values often used by organizations. Provide an example of how each
core value can be demonstrated.
Answer:
o Equity, e.g., communicating how decisions will be made

o Transparency, e.g., being open about what is occurring and what decisions
are being made
o Respect, e.g., communicating verbally and nonverbally in a civil way with
employees
o Collaboration, e.g., use of a shared governance model
organizations
23) Name three advantages of delegation.
Answer:
Correct answer should include the following.
o Decisions are made by persons who have the best information, thus the
quality of decisions should be improved.
o Decisions are not delayed by the need to take them to a higher level of
manager in the organization.
o Lower-level managers have the opportunity to develop their decision-
making skills.
Objective: 5—Discuss the roles of direct care nurses, their managers, and senior
administrators in decision making, and everyone’s accountability for their
decisions
24) Define a “wicked” problem and provide an example you have seen in clinical
practice. Explain why a rational decision-making process will not be effective for dealing
with this type of problem.
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Answer:
o A “wicked” problem cannot be solved using a rational decision-making
process because “wicked” problems are difficult problems that have
multiple causes, some of which may not be known, and are therefore
difficult to solve.
o Various examples of “wicked” problems will be provided.
Objective: 6—Be aware that the rational decision-making models may have
limited use in “wicked” contexts
25) Identify two strategies that can be used to engage group members who are involved
in the brainstorming stage of innovative decision making.
Answer:
o Encourage everyone to give ideas. Others in the group are asked to not
evaluate the ideas as they are presented.
o Give rewards for the whole group, rather than the individual.
o Have group members write one idea on a piece of paper and collect the
ideas to be read to the group.
26) Define one of the following.

a. shared governance
b. program management
c. interprofessional teams
Answer:
o Shared governance: An organizational structure in which decision making is
shared with staff
o Program management: A way of organizing health care organizations by
groups of patients rather than by departments with members of one
professional group
o Interprofessional teams: Teams that work together to assess the client’s needs
and care is provided by the various professional(s) whose expertise will
benefit the patient
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27) What are the three key categories of factors used in the decision-making process
about activities performed by unregulated care providers? Provide an example of each.
Answer:
Correct answers should include:
o Client Assessment
Examples:
o The client has established well-defined care needs, support
systems, and coping mechanisms.
o The client’s condition is well controlled/managed.
o The client’s condition is not excepted to change.
o The client or representative may direct his/her own care.
o Benefits and Risks Assessment
Examples:
o The activity and client response has been established over time.
o There are identifiable outcomes that are easily recognized.
o There are no negative systemic effects.
o The activity will be performed frequently enough for the UCP to
maintain competence.
o Environmental Supports
Examples
o There are clear policies.
o The appropriate resources are readily available for consultation or
intervention. In the community, this can mean by telephone.
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Chapter 6 - Nursing Workforce Issues: Recruitment and Retention,

Selection, Socialization, and Transitioning
1) Monica is a nurse practitioner who is interested in working in a rural community.

Which of the following factors would be a positive factor for her recruitment to this type
of work?
a. Rural characteristics
b. a friend who works in the rural community
c. the limiting nature of rural nursing structure
d. limited contact with support services
Answer: b
a. Incorrect: Rural characteristics (e.g., lack of services and resources, small

institution size, diminishing population, and isolation factors) would be a
deterrent to nursing in a rural community.
b. Correct: Facilitators for nursing recruitment and retention in rural areas
included connection to the community (e.g., family ties, social
networking, spousal employment) and a supportive work environment
(e.g., full-time employment, variety of experiences, professional
development opportunities, independent practice).
c. Incorrect: The limiting nature of rural nursing structure (e.g., scarcity of
full-time jobs, mainly float positions, decreased opportunities for
professional development, excessive overtime/workload, lack of nurses in
the system) would be a deterrent to nursing in a rural community.
d. Incorrect: Limited contact with support services would be a deterrent to
nursing in a rural community.
Evaluation
Objective: 1—Suggest ways health care employers can recruit nurses
2) The local primary care facility is looking to recruit nurses to their centre. Which venue
would be the best place to target nurses at the key point in their career in order to attract
them to this type of work?
a. local nursing school, three months prior to graduation
b. at a conference of critical care nurses
c. in a pediatric hospital cafeteria
d. at a conference of clinical nurse specialists for pain management
Answer: a
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a. Correct: One study of nursing recruitment found that in order to attract and
retain nurses prior to completing their nursing program, a good strategy is
to help nursing students learn about nursing roles in primary care and
allow them to provide nursing care in primary care settings.
b. Incorrect: This venue will have nurses who have already specialized in a
particular field; these nurses would not be the target staff for a primary
health centre.
c. Incorrect: This venue will have nurses who have already specialized in a
health centre.
d. Incorrect: This venue will have nurses who have already specialized in a
health centre.
Evaluation
3) Which of the following factors will have little effect on the recruitment of nurses?
a. going downstream
b. good interactions among colleagues
c. supporting nursing students when they are in clinical practice
d. methods of performance appraisals
Answer: d
a. Incorrect: This is a very effective factor in the recruitment of nurses.
b. Incorrect: This is a very effective factor in the recruitment of nurses.
c. Incorrect: This is a very effective factor in the recruitment of nurses.
d. Correct: Performance appraisals don’t have an effect on nursing
recruitment.
Evaluation
Objective: 2—Identify how direct care nurses play a role in recruiting nurses
4) Which type of organization has proven most successful in recruiting nurses?

a. primary care centres
b. tertiary care centres
c. magnet hospitals
d. rehabilitation hospitals
Answer: c
a. Incorrect: Magnet hospitals are known to be the most successful at
recruiting and retaining nurses.
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b. Incorrect: Magnet hospitals are known to be the most successful at

c. Correct: Magnet hospitals are known to be the most successful at
d. Incorrect: Magnet hospitals are known to be the most successful at
Evaluation
5) Jeremiah is a nurse with four years of experience on a cardiac sciences unit. He has
applied to the intensive care unit for a full-time job. Which of the following is the best
predictor of whether Jeremiah will be an asset to the ICU team?
a. past behaviour/work performance
b. information on his résumé
c. character references
d. his academic record
Answer: a
a. Correct: The best predictor of future behaviour is generally considered to
be past behaviour. If the nurse is not a new graduate, it is good to obtain a
reference from the nurse’s previous manager(s).
b. Incorrect: While the information on Jeremiah’s résumé is useful for the
interview process, this is not the best predictor of his practice as a front-
line nurse.
c. Incorrect: While character references are useful for the interview process,
they are not the best predictor of Jeremiah’s work.
d. Incorrect: Jeremiah’s academic record is not the best predictor of his
practice as a front-line nurse.
Integrated Nursing Process: Assessment, Implementation, Evaluation
Objective: 3—Propose how your work setting could select new nurses
6) Johanna is being interviewed for a primary care nursing position. The interviewer has
heard less-than-favourable things about Johanna from others. How could the interviewer
correct for bias during the interview?
a. Only use interview questions if the discussion gets out of hand.
b. Have a group of individuals interview Johanna and all of the other candidates.
c. Wait to meet Johanna to determine what the characteristics of the person to be hired
should be.
d. Ask Johanna why others are speaking poorly about her.
Answer: b
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a. Incorrect: This is not an effective interview method and would not help to
correct for bias during an interview.
b. Correct: Using a group interview process will correct for individual bias
created by hearsay.
c. Incorrect: This is not an effective interview method and would not help to
d. Incorrect: This is not an effective interview method and would not help to
integrity
Evaluation
Objective: 4—Develop an interview guide to hire nurses for your work setting
using behaviour-based questions
7) When creating an interview guide, which of the following would you include as a
behaviour-based question?
a. How many years of experience do you have?

b. Can you tell me about your educational preparation?
c. How do you feel that your previous clinical experience has prepared you for this role?
d. Can you explain how, in the past, you have managed to deal with multiple requests at
the same time?
Answer: d
a. Incorrect: This is not a behaviour-based interview question.
b. Incorrect: This is not a behaviour-based interview question.
c. Incorrect: This is not a behaviour-based interview question.
d. Correct: A behaviour-based interview question includes a description of
an event and asks how the candidate managed the situation.
Evaluation
8) When nurses are being socialized (or being “formed” into the profession), they may
find themselves feeling alienated. Alienation includes __________.
a. the importance of being accepted, being ignored, and being blamed for things
b. being spoken about in negative terms, being blamed for things, and being ignored
c. developing responsibility, being questioned, and being accepted
d. being accepted, being blamed, and then taking responsibility
Answer: b
a. Incorrect: This is an example of being accepted into the profession.
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b. Correct: Finding oneself in alienation reflects the idea that new nurses will
become outsiders on a unit if they do not assume the norms and
behaviours expected by the other nurses.
c. Incorrect: This is a combination of being accepted, being questioned, and
developing through responsibility.
d. Incorrect: This is a combination of developing through responsibility and
being alienated.
integrity
Evaluation
Objective: 5—Debate the pros and cons of socializing nurses to a work setting
9) Megan is a new graduate who has been hired onto a medical-surgical nursing unit at
the local hospital. She has discovered that her initial expectation of what nursing was
going to be like was very different from what she is experiencing in practice. What
Megan is experiencing is known as _________.
a. being accepted into the profession

b. being questioned in the profession
c. being alienated from the profession
d. being socialized into the profession
Answer: d
a. Incorrect: Megan’s experience is not a reflection of being accepted into
the nursing profession. Acceptance includes the importance of being
accepted by other nurses, which in part requires that the new nurses accept
the unit’s culture.
b. Incorrect: Being questioned in the profession consists of new nurses’
awareness that other professionals are questioning their education and
whether they are able to meet the requirements of a practising nurse.
c. Incorrect: Being alienated from the profession means that new nurses who
do not assume the norms and behaviours expected by the other nurses
become outsiders on the unit.
d. Correct: Megan’s experience reflects socialization into the nursing
profession.
integrity
Evaluation
10) What four phases can student nurses expect to go through when they transition to the
role of direct care nurses after graduation?
a. honeymoon, shock, recovery, resolution
b. denial, honeymoon, recovery, acceptance
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c. honeymoon, shock, recovery, transition

d. denial, honeymoon, recovery, transition
Answer: a
a. Correct: Kanter (1974) coined the term “reality shock” to describe the
reactions of nursing graduates to the realities of what was expected of
them in their first job. Reality shock consists of four phrases that nurses
move through over this transition period: honeymoon, shock, recovery,
and resolution.
b. Incorrect: These do not reflect Kanter’s four phases of “reality shock”
during the transition of nursing graduates into their first nursing job.
c. Incorrect: These do not reflect Kanter’s four phases of “reality shock”
d. Incorrect: These do not reflect Kanter’s four phases of “reality shock”
integrity
Objective: 6—Discuss issues related to transitioning from the role of nursing
student to direct care nurses
11) Mark is a new graduate. He was hired onto an oncology nursing unit at the local
hospital. He has discovered that the knowledge, skills, and values he learned in his
nursing program vary greatly from those he has seen demonstrated in the workplace.
Mark is experiencing __________.
a. honeymoon
b. reality shock
c. recovery
d. transition
Answer: b
a. Incorrect: This represents only one of the four phases of reality shock.
b. Correct: Kanter (1974) coined the term “reality shock” to describe the
reactions of nursing graduates to the realities of what they encountered in
their first nursing job. Reality shock is divided into four phases:
honeymoon, shock, recovery, and resolution.
c. Incorrect: This represents only one of the four phases of reality shock.
d. Incorrect: Mark is experiencing reality shock, which is a result of his
transition from nursing student to nurse.
integrity
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12) How might your school of nursing ease the transition of its graduates into the
workplace?
a. Provide a greater number of courses focus on transitioning.
b. Encourage cooperative education programs.
c. Eliminate any paid work terms from nursing education.
d. Discourage summer employment for nursing students.
Answer: b
a. Incorrect: This option would not help schools of nursing ease the
transition of nursing graduates into the workplace.
b. Correct: Strategies that many schools of nursing have used to ease the
transition into nursing include preceptored clinical courses, summer
externships, employment of nursing students by health agencies during the
summer, and cooperative education.
c. Incorrect: This option would not help schools of nursing ease the
d. Incorrect: This option would not help schools of nursing ease the
integrity
Objective: 7—Recommend how nurse educators, nurse managers, experienced
nurses, and transitioning nurses themselves can foster the transitioning of nurses
to the workplace
13) How might an employer ease the transition of nursing graduates into the workplace?
a. Allow for increased time to pass between graduation and employment.
b. Assign new graduate nurses to the same unit to increase comfort level.
c. Provide internships or residencies.
d. Eliminate new graduate positions in specialty units.
Answer: c
a. Incorrect: This would likely not ease the transition of nursing graduates
into the workplace.
b. Incorrect: This would likely not ease the transition of nursing graduates
into the workplace.
c. Correct: Employers can ease the transition of nursing graduates into the
workplace by offering orientation programs, mentorship programs,
internships or residencies, and clinical experiences either using patient
simulation or on a special education unit.
d. Incorrect: This would likely not ease the transition of nursing graduates
into the workplace.
integrity
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Evaluation
to the workplace
14) You have been asked to work with your employer to recruit nurses to your primary
care facility. You know that there are four key points in a nurse’s career when
recruitment will be most successful. What are these key points?
Answer:
Correct answers must include the following key points.
o prior to completing their nursing program

o upon graduation from a nursing program or during transition to primary

care position
o nurses experienced in primary care
o nurses at times of transition such as maternity leave or retirement

15) Fill in the blanks:

a) Creating interest in the nursing profession among high school or younger students
is and example of __________________.
b) Advocating for a __________ work environment and a good interactions among
colleagues is a way direct care nurses can assist with recruitment.
c) When __________ __________ are on the units, staff nurses recognizing their
work will promote recruitment.
Answer:
a) going downstream
b) positive
c) nursing students

Evaluation
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16) What type of reference would you want for each of the following potential candidates
for a staff nurse position?
a) a new graduate
b) a nurse employed for 10 years
Answer:
a) new graduate: academic record, clinical instructors, character references

b) if not a new graduate: apply a 360-degree process using references from
persons who have worked with the applicant in different capacities
integrity
Evaluation
Objective: 3—Propose how your work setting could select new nurses
17) Provide examples of what information you would like to see in an interview guide for
a nurse coming to a medical-surgical unit. Candidates may vary in their experience.
Answer:
Correct answers should include some of the following points:
o Where does the nurse want to be in five years?

o Ask the nurse to summarize his/her work experience, clinical experiences
o Ask the nurse why he/she has left previous positions
o Ask about challenges in previous employment
o Use behaviour-based interview questions—descriptions of an events and
how the candidate managed the situations (e.g., dealing with a complaint
from a family member; receiving multiple requests).
o Recruiting while interviewing: Sharing the hospital’s vision and values
with the candidate during the interview—this is only done with those who
present as potential employees, so as not to use the opportunity to discuss
the agency’s strategic plan as opposed to recruiting suitable candidates.

Evaluation
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18) Discuss the three main themes found in the literature regarding becoming socialized
to nursing.
Answer:
Correct answers should include the following points:
o Influence of ideals: nurses’ original ideals about nursing (i.e., the desire to
care for others and make a difference)
o Paradox: How the nurses’ view of their profession as caring was
challenged by seeing nurses who were uncaring. Also reflects the nurses’
ambivalence about being viewed only as caring and their desire to be seen
and knowledgeable and competent.
o Role of others: Desire to be accepted by others. Nurses not only assumed
the values and behaviours of other nurses but also behaved in ways the
public expected of their profession.
integrity
Evaluation
19) What are the four phases of reality shock that new nurses experience when
transitioning from academia to the workforce?
Answer:
Correct answers will include the following 4 points.
o honeymoon
o shock
o recovery
o resolution
integrity

Evaluation
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20) Name two ways that schools of nursing can ease the transition of nurses into the
workforce, and two ways that employers can ease the transition of nurses into the
workforce.
Answer:
Correct answers should include 2 points from each of the following categories.
o Schools of nursing can ease the transition of graduates through:

o preceptored clinical courses in the curriculum,
o summer externships,
o assistance for students in securing employment in health agencies
during summer months,
o cooperative education programs,
o integration of paid work terms into the nursing program, and
o explaining the use of teaching strategies such as nursing care plans
and clinical practice in community settings that do not hire nurses.
o Employers can ease the transition of the graduates through:

o orientation programs,
o mentorship programs,
o internships or residencies, and
o clinical experiences using patient simulation or on a special
education unit.
integrity
Evaluation
to the workplace
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Chapter 7 - Motivation and Performance

1) Bonnie has been a nurse on a medical-surgical unit for 6 months. Recently, there has
been mention of cutbacks in the hospital and she is sure she will be one of the nurses who
will be let go. She has been finding it increasingly difficult to find motivation to go to
work. This is an example of which theory of motivation?
a. social cognitive theory
b. Maslow’s hierarchy of needs
c. Herzberg’s motivation-hygiene theory
d. McClelland’s theory
Answer: b
a. Incorrect: Incorrect: In social cognitive theory, self-efficacy is an
important component, and is defined as the degree of confidence an

individual has that he or she can do a particular task. Job security is not a
motivating factor in this theory.
b. Correct: Correct. Maslow’s hierarchy of needs includes physiological,
safety, belonging (love), self-esteem, and self-actualization needs.
According to the safety tier of this theory, a person cannot feel motivated
in their job if they feel it is not secure.
c. Incorrect: Incorrect. In Hertzberg’s theory, the motivation factors are
personal achievement, status, recognition, challenging work,
responsibility, and advancement opportunities. Job security is not a
motivating factor in this theory.
d. Incorrect: Incorrect: McClelland’s theory deals with the need for
achievement, affiliation, and power, and motivation is tied to whether or
not a nurse is able to influence others, work on a team where he or she is
liked and feels part of the group, and where success is achieved through
recognition of achievement. Job security is not a motivating factor in this
theory.
integrity
Evaluation
Objective: 1—Analyze how different theories of work motivation can be applied
to the motivation of nurses in the workplace
2) Personal achievement, status, policies and administration, work/life balance, and

interpersonal relationships are all aspects of which motivation theory?
a. social cognitive theory
b. Maslow’s hierarchy of needs
c. Herzberg’s motivation-hygiene theory
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d. McClelland’s theory
Answer: c
a. Incorrect: The motivating needs that must be met according to social
cognitive theory are self-efficacy, cognitive factors, and behavioural
factors.
b. Incorrect: Maslow’s eight-stage needs hierarchy does not include these
categories.
c. Correct: Personal achievement, status, policies and administration,
work/life balance, and interpersonal relationships are all needs that need to
met within Herzberg’s motivation-hygiene theory.
d. Incorrect: McClelland’s theory deals with the need for achievement,
affiliation, and power.
integrity
Evaluation
3) Which of the following is true of the clinical ladders used by health care organizations
to motivate and reward the performance of nurses?
a. They are based on salary alone.
b. They vary among organizations in terms of the number and type of steps included.
c. They are professional purpose statements.
d. They are not supported by the International Council of Nurses (ICN).
Answer: b
a. Incorrect: Clinical ladders include various components, such as job title
and nursing role, and may or may not include a salary scale range.
b. Correct: Clinical ladders enable nurses to progress in their career while
remaining in direct patient care positions. New nurses start at the first step
on the ladder and are promoted to subsequent steps as they gain expertise.
However, there is variation among health care organizations in the number
of steps on the ladder, the position titles for each step, and whether there is
a different salary scale for each step.
c. Incorrect: Clinical ladders do not include professional purpose statements.
d. Incorrect: The ICN has supported the use of clinical ladders to promote
nurses who work in direct care.
Evaluation
Objective: 2—Discuss how career development plans can facilitate nurses’
motivation and performance
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4) Professional purpose is __________.

a. outlined by each regulatory body
b. included in the mission statement of many organizations
c. unique to each individual nurse
d. for unregulated health care providers
Answer: c
a. Incorrect: Professional purpose is unique to each individual nurse.
Professional purpose is not outlined by a regulatory body.
b. Incorrect: Professional purpose is unique to each individual nurse. It is not
included in an organization’s mission statement.
c. Correct: Professional purpose is each individual nurse’s unique reason for
why he or she practises nursing, and is intertwined with each nurse’s
unique capabilities and values.
d. Incorrect: Professional purpose is unique to each individual nurse. It
includes unregulated health care providers, but is not specific to only this
group.
integrity
Evaluation
5) Reductions in productivity, fostering fear and a lack of trust, and damaging morale and
motivation, are all said to be the _____________ of performance appraisals.
a. soft costs
b. hard costs
c. simple costs
d. complex costs
Answer: a
a. Correct: The benefits of performance appraisals are receiving feedback
about job performance, goal-setting, career management, objective
assessment, and legal protection. However, according to Nickols (2007),
the cost of performance appraisals outweighs these benefits and can be
divided into soft costs and hard costs. The soft costs identified include
reductions in productivity, erosion of performance, creation of emotional
anguish, damage to morale and motivation, emphasis on the individual
versus team and task versus process, fostering a short-term view, fostering
fear and lack of trust, and political gains.
b. Incorrect: The hard costs of performance appraisals have been identified
as direct financial expenses and indirect financial expenses.
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c. Incorrect: Simple costs were not identified by Nickols (2007) as costs of

the performance appraisal process.
d. Incorrect: Complex costs were not identified by Nickols (2007) as costs of
the performance appraisal process.
Evaluation
Objective: 3—Debate the pros and cons of performance appraisals
6) Performance appraisals are considered to have the following positive impacts on

employees:
a. goal setting, career management, and reductions in productivity.
b. legal protection, objective assessment, and feedback.
c. rewarding the team, career management, and feedback.
d. a long-term goal, career management, and goal setting.
Answer: b

a. Incorrect: Reduction in productivity is considered to be a negative impact
of performance appraisals, not a positive one.
b. Correct: The benefits of performance appraisals are receiving feedback
about job performance, goal-setting, career management, objective
assessment, and legal protection.
c. Incorrect: One of the negative impacts of performance appraisals is that
they reward the individual rather than rewarding the team.
d. Incorrect: One of the negative impacts of performance appraisals is that
they foster short-term goals rather than long-term goals.
Evaluation
7) Consider each of the following situations. In which one would the use of progressive
discipline not be appropriate?
a. when a nurse assaults a patient
b. when a medication error is made
c. when a second medication error is made
d. when a patient makes a complaint about a nurse’s behaviour
Answer: a
a. Correct: Progressive discipline is a contracture approach to discipline that
is based on the belief that employees should receive several warnings
regarding their performance or behaviour if it is problematic. It is based on
a manager’s belief that employees can learn, develop, and change.
However, in cases where the nurse’s action is extreme, such as stealing
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narcotics or intentionally harming a patient, progressive discipline would

not be used, and instead the nurse might be terminated or put on paid leave
until an investigation is completed.
b. Incorrect: Medication errors are a situation where progressive discipline
would be appropriate.
c. Incorrect: A second occurrence of a medication error is a situation where
progressive discipline would be appropriate.
d. Incorrect: A patient complaining about a nurse’s behaviour is a situation
where progressive discipline would be appropriate.
integrity
Evaluation
Objective: 4—Suggest situations when disciplinary procedures may help or hurt
nurses’ motivation and performance in the workplace
8) Honest mistakes should be reviewed in order to __________.

a. build a case for disciplinary action against a nurse

b. look for the root cause and analyze work processes
c. penalize nurses who are forgetful
d. discipline nurses who do not perform according to unit policy
Answer: b
a. Incorrect: The disciplinary process should not be used for nurses who
make an honest mistake. Using discipline in cases where nurses make
honest mistakes may reduce the reporting of errors, as well as demotivate
the nurse and cause all nurses who are aware of the nurse’s treatment to
experience anger.
b. Correct: The disciplinary process should not be used for nurses who make
an honest mistake. Honest mistakes should instead be reviewed to look for
root causes and analyze work processes to see how they can be improved
to reduce errors.
c. Incorrect: The disciplinary process should not be used for nurses who
experience anger.
d. Incorrect: The disciplinary process should not be used for nurses who
experience anger.
integrity
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Evaluation
9) While nexters and baby boomers differ in many ways, there are some similarities in
what motivates both groups in the workplace. These similarities include __________.
a. desire to help, caring, and salary
b. desire to help, caring, and scheduled time off
c. desire to help, caring, and sense of achievement
d. salary, caring, and self-validation
Answer: c
a. Incorrect: Salary was not a factor that was motivating to nurses across
different age groups.
b. Incorrect: Scheduled time off was not identified as a factor that was
motivating across different age groups in the workplace. Time off was has
been identified as a motivating factor specifically for Generation X

employees.
c. Correct: Similarities in what motivates both nexters and baby boomers in
the workplace include the desire to help, caring, a sense of achievement,
and self-validation.
d. Incorrect: Salary and self-validation are not factors that were identified as
motivating to nurses across different age groups.
integrity
Evaluation
Objective: 5—Identify how nexters, members of Generation X, and nurses
nearing retirement (baby boomers) may differ in what motivates them in the
workplace
10) It has been a busy night in the emergency room and there is now a trauma patient
coming in. Given what you know about the differences among generations of nurses,
which of the following would you expect to volunteer to participate in the care of the
trauma patient?
a. Marnie, aged 55
b. John, aged 28
c. Elizabeth, aged 42
d. Marilyn, aged 36
Answer: b
a. Incorrect: Research by Newton et al (2009) found that nurses 30 years of
age or younger were more motivated by exciting and challenging work
situations than nurses aged 40 to 50 years.
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b. Correct: Research by Newton et al (2009) found that nurses 30 years of

c. Incorrect: Research by Newton et al (2009) found that nurses 30 years of
d. Incorrect: Research by Newton et al (2009) found that nurses 30 years of
Evaluation
workplace
11) In which type of workplace would a nurse be more motivated to practice?

a. where there is a high level of autonomy
b. where there is no apparent collaboration among team members
c. where there are few opportunities to learn
d. where there are definite hierarchical relationships among the team
Answer: a
a. Correct: A review by Toode et al (2011) identified studies that showed
nurses were more motivated by good collaboration with other members of
the health care team, social support within the team, positive team spirit,
being an equally valued member of the team, high autonomy, a variety of
different work-related activities, manual work, opportunities to learn,
opportunities to share their knowledge with physicians, and receiving
supervision.
b. Incorrect: Nurses are motivated by collaboration with other team
members. A lack of collaboration would be demotivating.
c. Incorrect: Nurses are motivated by having opportunities to learn. A lack of
opportunities would be demotivating.
d. Incorrect: Nurses are motivated by being an equally valued member of the
team and having a high degree of autonomy. Working within a definite
hierarchical relationship would be demotivating.
Client need per NCLEX: safe and effective work environment, psychological
integrity
Evaluation
Objective: 6—Relate issues related to motivation and performance to your
practice setting(s)
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12) How will performance be affected by setting objectives that can be easily achieved?
a. It will be eroded.
b. It will improve.
c. It will lead to increased motivation.
d. It will eliminate the need for performance appraisals.
Answer: a
a. Correct: Erosion of performance might occur if employees are given
objectives that they can easily achieve.
b. Incorrect: If objectives are too easy to achieve, performance will be
eroded, not improved.
c. Incorrect: If objectives are too easy to achieve, motivation will decrease,
not increase.
d. Incorrect: Performance appraisals are required, regardless of performance
erosion/motivation.

Evaluation
practice setting(s)
13) Name three motivation factors and three hygiene factors in Herzberg’s motivation-
hygiene theory.
Answer: Correct answers should include three points from each of the following
categories:
o Motivation factors: personal achievement, status, recognition, challenging
work, responsibility, advancement opportunities
o Hygiene factors: salaries and benefits, employer policies and
administration, interpersonal relationships, supervision, job security,
working conditions, work/life balance

Evaluation
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14) Discuss how a professional purpose statement can facilitate a nurse’s motivation and
performance.
Answer: Correct answers should include some of the following points.

o Professional purpose statements involve nurses in writing their view of
their own professional purpose and values.
o Through reflection and articulating their purpose and values, nurses can
increase their motivation to fulfill their desired purposes and act in
accordance with their professional values
o Professional purpose is each individual nurse’s unique reason for
practising nursing and is intertwined with each nurse’s unique capabilities
and values. The nurse’s reason for choosing to become a nurse and to
continue to practise are articulated, and help motivate the nurse to direct
his or her practice and self-development in congruence with his or her
professional purpose.
o In challenging clinical or workplace situations, reflecting on your
professional purpose statements can help guide your decisions and

behaviours, enabling you to be the type of nurse you want to be.

Evaluation
15) Discuss four pros and four cons of performance appraisals
Answer: Correct answers will include four points from each of the following
categories.
o Pros:
o use of self-reflection may be mandated by regulatory body
o feedback
o goal setting
o career management
o objective assessment
o legal protection
o facilitates communication between nurse manager and health care
worker
o Cons:
o time-consuming
o may focus on brief encounters
o reductions in productivity
o rewards the individual, not the team
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o fosters a short-term view

o may foster fear and lack of trust in management
o cost

Evaluation
16) When might discipline procedures hinder or hurt a nurse’s performance and
motivation?
Answer: Correct answers will include at least one of the following points.
o When discipline is not progressive (e.g., it is not constructive or based on
the belief that employees should receive several warnings regarding
problematic performance or behaviour)
o When discipline is used to punish an honest mistake made by the nurse.
Honest mistakes should be reviewed to look for root causes and analyze
work process; the disciplinary process should not be used in such
instances because it may reduce the reporting of errors, demotivate the
nurse, and cause other nurses who are aware of the disciplined nurse’s
treatment to experience anger.
o When a nurse manager and organization does not practice according to the
philosophy they are asking the nurse being disciplined to practice within
integrity
Evaluation
17) What are four motivators that are common to nurses in all age groups?
Answer: Correct answers should include the following four points.

o desire to help
o caring
o sense of achievement
o self-validation

Evaluation
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workplace
18) Select three motivators from the following list that you have witnessed in your
workplace. Describe their effect on your own motivation and/or performance.
a. good collaboration with other members of the health care team
b. social support within the team
c. positive team spirit
d. being an equally valued member of the team
e. high autonomy
f. variety of different work-related activities
g. manual work
h. opportunities to learn
i. opportunities to share knowledge with physicians
Answer: Responses will vary according to personal experience.

Evaluation
practice setting(s)
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Chapter 8 - Nursing Roles and Nurse Staffing

1) Which of the following health care workers have some duties related to the direct care
of patients/clients, but do not report to a regulatory body?
a. registered nurses
b. registered psychiatric nurses
c. licensed practical nurses
d. health care aides
Answer: d
a. Incorrect: Registered nurses are regulated health professionals who report
to a regulatory body.
b. Incorrect: Registered psychiatric nurses are regulated health professionals
who report to a regulatory body.

c. Incorrect: Licensed practical nurses are regulated health professionals who
report to a regulatory body.
d. Correct: Health care aides are unregulated care providers, and do not
report to a regulatory body.
Evaluation
Objective: 1—Describe regulated and unregulated nursing categories in Canadian
health care organizations
2) Which of the following is a correct statement about regulated health care professions?
a. The regulated scope of practice will differ between hospitals.
b. Members of a regulated health profession are responsible for recognizing the limits of
their scope of practice.
c. It is the responsibility of the hospital to assign the scope of practice.
d. The scope of practice is not important if you have unregulated workers.
Answer: b
a. Incorrect: The scope of practice for nurses is regulated by the provincial
regulatory body and is applicable to all nurses working in that
province/territory.
b. Correct: Members of a regulated health profession are accountable for the
standards of practice set by their registering/licensing body. They are
educated to work within their scope and recognize the limits of their scope
of practice within health care.
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c. Incorrect: The scope of practice for nurses is regulated by the provincial

regulatory body, not by hospitals, and is applicable to all nurses working
in that province/territory.
d. Incorrect: It is the responsibility of the regulated health care professional
to understand their scope of practice, regardless of their work with other
health care disciplines.
Evaluation
3) Direct care nurses include all of the following, except __________.

a. patient care assistants
b. telenurses
c. pain nurse specialists
d. nurse educators
Answer: a
a. Correct: Patient care assistants are not direct care nurses, but may assist
direct care nurses. B, C, and D are
b. Incorrect: This a role that direct care nurses can participate in.
c. Incorrect: This a role that direct care nurses can participate in.
d. Incorrect: This a role that direct care nurses can participate in.
Evaluation
Objective: 2—Identify direct care nursing roles and categories of personnel
involved in nursing care in Canadian health care
4) A clinical nurse specialist __________.

a. is part of a specific regulated group
b. specializes in working in clinics
c. works in an advanced practice role
d. has only a baccalaureate education
Answer: c
a. Incorrect: A clinical nurse specialists may not be part of a specific
regulated group.
b. Incorrect: Clinical nurse specialists work in a variety of settings including
hospitals, not only in clinics.
c. Correct: A clinical nurse specialist is a registered nurse in an advanced
nursing practice role.
d. Incorrect: Clinical nurse specialists have a graduate level education.
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Evaluation
5) The type of decision making used for staffing a nursing unit that includes decisions
relating to normal staffing levels, methods of replacing staff, and scheduling methods, is
called _________.
a. strategic nursing decision making
b. logistical nursing decision making
c. tactical nursing decision making
d. standard nursing decision making
Answer: b
a. Incorrect: Strategic nursing decision making is the level that includes
decisions that guide the approach to nursing care delivery in an

organization, including decisions such as what the skill mix will be, staff
status mix, staffing levels, model of care/philosophy, and organization of
care delivery.
b. Correct: Logistical decision making generates directions on staffing for a
team or unit within an organization. Decisions relate to normal staffing
levels, replacement staffing methods (e.g., float, pool, agency staffing),
and scheduling approaches and methods.
c. Incorrect: Tactical nursing decisions involve making day-to-day, shift-to-
shift decisions to adjust to changing patient needs or changes in staff
availability.
d. Incorrect: This is not a type of nursing decision making.
Evaluation
Objective: 3—Discuss a variety of approaches to nurse staffing and the factors to
be considered in establishing a staffing plan
6) Patient classification systems are used __________.

a. to predict workforce trends
b. to predict the demand for supplies
c. to calculate staffing requirements
d. as the most consistent method of determining nursing workload
Answer: c
a. Incorrect: Patient classification systems provide information about trends
in patient acuity, but not about workforce trends.
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b. Incorrect: Patient classification systems predict the demand for nursing

care, not for supplies.
c. Correct: Patient classification systems group patients based on the amount
of direct nursing care they require, and use a classification scheme to
predict the demand for nursing care. They are used to calculate staffing
requirements.
d. Incorrect: Patient classification systems are not considered to be
consistent, reliable, or useful by many, because they show trends in patient
acuity, but not in nursing workload.
Evaluation
7) The nursing staffing mix—more specifically, a higher RN-to-RPN ratio—has been

associated with which following outcome?
a. lower mortality rates

b. higher rates of nosocomial infection
c. poor nurse–physician collaboration
d. higher rates of adverse events
Answer: a
a. Correct: An Alberta study of hospital nursing characteristics and patient
mortality at 49 acute care hospitals found that a higher RN to non-RN
skills mix was associated with lower patient mortality, better nurse–
physician relationships, and less use of casual and temporary employees.
b. Incorrect: A higher RN-to-RPN ratio has been associated with lower rates
of nosocomial infection, not higher rates.
c. Incorrect: A higher RN-to-RPN ratio has been associated with better
nurse–physician collaboration.
d. Incorrect: A higher RN-to-RPN ratio has been associated with lower rates
of adverse events in hospitals, such as mortality, hospital-acquired
pneumonia, and cardiac arrest.
Client need per NCLEX: safe and effective care environment, physiological
integrity
Evaluation
8) Which of the following is an incorrect statement about nursing outcomes related to

staffing?
a. Nursing shortages have led to burnout.
b. Nursing shortages have led to fatigue and exhaustion.
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c. Nursing shortages do not affect absenteeism.

d. Nursing shortages cause moral and psychological distress.
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Answer: c
a. Incorrect: This is an accurate statement about nursing outcomes related to
staffing.
b. Incorrect: This is an accurate statement about nursing outcomes related to
staffing.
c. Correct: Nursing shortages result in pressure on regular staff to work
overtime, leading to burnout and absenteeism.
d. Incorrect: This is an accurate statement about nursing outcomes related to
staffing.
Evaluation
Objective: 4—Discuss the relationship between nurse staffing and outcomes for
patients/clients, nurses, and the organization
9) Which statement is correct regarding the role of the nurse manager with respect to
scheduling and staffing a nursing unit?

a. The nurse manager does not play any role in the staffing of a unit where self-
scheduling is implemented.
b. The nurse manager must follow the organization’s direction for staffing, not that of the
collective agreement.
c. The nurse manager sets the parameters for all scheduling.
d. The nurse manager follows broad parameters that are set at an executive level.
Answer: d
a. Incorrect: Self-scheduling systems still require parameters and guidelines
for making requests so that the system is fair to all involved. This process
is still overseen by nurse managers.
b. Incorrect: The collective agreement must also be adhered to in considering
scheduling and staffing on a nursing unit.
c. Incorrect: Both the organization and the collective agreement will set
some of the parameters for scheduling, which the nurse manager needs to
follow.
d. Correct: In most health care organizations of considerable size, there are at
least two kinds of nurse managers involved in or playing a leadership role
in these decisions: nurse executives, who are key in strategic decision
making about staffing; and nurse managers, who are usually key in
logistical processes and tactical decision making.
Evaluation
Objective: 5—Identify the range of staffing and scheduling policies that might be
required in a health care organization and discuss the factors that must be
considered in establishing such policies
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10) The budget for staffing on a unit is established in terms of which type of
employment?
a. casual staffing
b. agency staffing
c. part-time equivalents
d. full-time equivalents
Answer: d
a. Incorrect: Nurse managers are required to establish a staffing budget based
on a staffing plan, and the budget for each unit is established in terms of
full-time equivalents (FTEs).
b. Incorrect: Nurse managers are required to establish a staffing budget based
c. Incorrect: Nurse managers are required to establish a staffing budget based
d. Correct: Nurse managers are required to establish a staffing budget based
full-time equivalents (FTEs). The unit`s staffing budget is expressed in
terms of FTEs paid for the standard work week, for example 35 hours per
week.
11) Which of the following is not an option used to increase the flexibility of scheduling
and to enhance the work-life balance for nurses?
a. assigning different shift lengths
b. permanent staffing for weekends
c. having a schedule that is variable, depending on the time of year
d. finding a scheduling pattern that is consistent throughout the year
Answer: c
a. Incorrect: This is an effective strategy used to enhance the work-life
balance for nurses.
b. Incorrect: This is an effective strategy used to enhance the work-life
balance for nurses.
c. Correct: Having a schedule that varies depending on the time of year is not
an option that is used to increase flexibility in scheduling and enhance
work-life balance for nurses.
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d. Incorrect: This is an effective strategy used to enhance the work-life

balance for nurses.
integrity
Evaluation
Objective: 6—Discuss the benefits, challenges, and considerations in establishing
a system of self-scheduling
12) Parameters to consider in self-scheduling for nurses include which of the following?
a. Equal access to preferred shifts is not required if a collective agreement exists.
b. Staffing guidelines are not necessary if a collective agreement exists.
c. Weekend staffing time periods will vary according to the time of year.
d. Guidelines on reaching consensus and negotiation should be developed and
understood.
Answer: d

a. Incorrect: Equal access to preferred shifts is required if a collective
agreement exists.
b. Incorrect: Staffing guidelines are important for ensuring fairness for all
involved.
c. Incorrect: When self-scheduling, weekend time periods must be clearly
defined and consistent throughout the year.
d. Correct: Self-scheduling systems require guidelines and parameters for
making requests, so that the system is fair to all involved.
integrity
Evaluation
13) Describe the regulated and unregulated nursing categories found in Canadian health
care organizations.
Answer: Correct answers should include some of the following points for each
category.
o Regulated nurses:
o As a member of a regulatory group, they are accountable for the
standards of practice set by their registering/licensing body.
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o Members are educated to work within their scope and to recognize

the limits of their scope of practice within health care.
o Include the following categories of nurses: registered nurses, nurse
practitioners, registered psychiatric nurses (in Alberta, BC,
Manitoba, Saskatchewan, Yukon), registered practical nurses (in
Ontario), infirmières et infirmiers auxiliaires/nursing auxiliaries in
Quebec, and licensed practical nurses in the rest of Canada.
o Unregulated care providers:
o May have some duties related to the direct care of patients/clients
o Job titles might reflect their role in direct care: e.g., personal
support worker, health care assistant, health care aide

Evaluation
14) What is a direct care nurse? Provide two examples of the roles of direct care nurses.

o Direct care roles of registered nurses:
o We usually think of the roles requiring direct physical contact with
the patients, but others may be considered direct care without
physical contact (e.g., telenurses who engage in assessment
activities and provide advice over the phone; or nurses who use
teleconferencing, videoconferencing, or Internet in their delivery
of care)
o Examples of direct care nursing roles:
o Staff nurses—in hospitals, public health units, clinics, long-term
care facilities. Also known as front-line or bedside nurses.
o Nurse practitioners—may be registered in different fields
depending on the province (primary health care, adult acute care,
pediatric acute care, etc.). Role involves education, consultation,
leadership and research.
o Clinical nurse specialists—in an advanced practice role but not
part of a specific regulated group. Have graduate nursing education
that gives them a greater depth of knowledge and skill in a
specialized area of nursing.
o Nurse educators—provide educational support to nurses in
healthcare organizations.
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Evaluation
15) Name and describe two methods/approaches to the staffing of nurses in an acute care
hospital.
Answer: Correct answers should include two of the following points.

o Reliance on professional judgement and expertise to identify staffing
requirements (e.g., when a workload becomes too great, identify the need
for more staff when there are temporary changes or upward trends in
patient acuity that require adjustment)
o Patient classification systems and workload measurement systems
o classification scheme to predict the demand for care
o classified into groups such as acuity of illness or critical elements

required
o established hours of care for the types of patients in the setting
o calculate the staffing requirements
o not considered consistent, reliable, or useful by many, since they
show trends in acuity but not in workload
o Decision frameworks used to formulate staff mix and staffing plans
o Use of standardized ratios: nurse-to-patient
o While ratios may be used as a general guideline in facilities,
mandatory ratios have not yet been established in Canada.
o In acute care hospitals there are a variety of specialty units that
have needs for more nursing hours per patient than general
medical/surgical units.
o Many believe that mandatory ratios do not allow for flexibility in
responding to shortages.
o Dynamic and shared decision making
o involve front-line nurses working in collaboration with nurse
managers to make decisions based on characteristics of patients
and nurse competencies or characteristics
o decisions made based on the group of patients/clients and the
nurses available

Evaluation
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16) List three outcomes for patients and three outcomes for nurses for a unit where there
is a higher RN to non-RN ratio.
Answer: Correct answers should include three points from each following
categories.
o Patient/Client Outcomes
o most research has been conducted in acute care hospital setting, is
recently expanded to home care and long term care
o nursing staff mix is a significant predictor of functional
independence, pain, social functioning, and satisfaction with
obstetrical care
o higher number of medication errors and wound infections was
noted on units with lower proportion of RNs to RPNs; on units
with less experienced nurses, wound infection rates were higher

o lower patient mortality was associated with higher nurse education
levels, a higher RN to non-RN skill mix, better nurse–physician
relationships, and less use of casual and temporary employees
o higher proportion of RNs demonstrated positive effect on patient
outcomes for ICUs and surgical units (lower mortality, failure to
rescue, cardiac arrest, hospital-acquired pneumonia, and other
adverse events)
o Nurse Outcomes
o nursing shortages have historically led to burnout, moral and
psychological distress, fatigue and exhaustion, and absenteeism
o the higher the perceived level of care, the greater the job
satisfaction of nurses
o the lower the perceived level of care, the higher the level of job
pressure, job threat, and role tension
o high turnover rates were associated with higher levels of role
ambiguity and role conflict and lower job satisfaction
o a study exploring fatigue among nurses revealed that “relentless
and excessive workloads, ongoing staffing issues, and sicker
patients as the key reasons for their fatigue”

Evaluation
Objective: 4—Discuss the relationship between nurse staffing and outcomes for
patients/clients, nurses, and the organization
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17) Fill in the blanks:

a) One of the roles of front-line nurses in larger organizations is _________ and
staffing.
b) The budget for a unit is established in terms of ____ _____-equivalents.
c) Two policies that a human resources department might be responsible for
are_________ and _________.
d) _________ parameters will be set at the executive level.
Answer: Correct answers:
a) scheduling
b) full-time
c) absenteeism, orientation (other answer options may work here as well)
d) Broad

Evaluation
18) Name three parameters to consider when implementing self-scheduling on a unit.
Answer: Correct answers should include 3 points from the following list.
o Assign shifts to maximize continuity of care and caregiver.
o Use visual cues on draft schedules to guide appropriate assignment of
staffing levels, including knowledge and skill, on a shift-to-shift basis.
o Self-scheduling occurs against a master schedule with a predetermined
number of shifts to be filled on a daily and shift-by-shift basis.
o Weekend time periods are clearly defined.
o Full-time and part-time staff must work their budgeted complement and
their required percentage of weekend and shift.
o Staff will have equal access to preferred tours on a rotational basis.
o Written scheduling guidelines include a process to reach consensus on the
length of time available to each rotational group to choose preferred shifts
and negotiate changes.

Evaluation
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Chapter 9 - Quality of Work Life Issues

1) Which type of health care organization has demonstrated fewer hierarchical levels,
more autonomy for nurses, and effective leadership?
a. tertiary care centre
b. primary care centre
c. magnet hospital
d. tertiary care hospital
Answer: c
a. Incorrect: Tertiary care centres are health care settings where more
specialized services are found than in general or community hospitals.
However, they do not necessarily demonstrate the characteristics outlined
in the question.
b. Incorrect: Primary care centres are a comprehensive system of essential
health care that is focused on preventing illness and promoting health.
They do not necessarily demonstrate the characteristics outlined in the
question.
c. Correct: Some characteristics of magnet hospitals that help them to attract
nurses are fewer hierarchical levels, more autonomy for nurses, more
control in decision making, support from supervisors and co-workers,
effective leadership, and manageable workloads.
d. Incorrect: A tertiary care hospital is a term used interchangeably with
tertiary care centre. This is a health care setting where more specialized
services are found than in general or community hospitals. However, they
do not necessarily demonstrate the characteristics outlined in the question.
Evaluation
Objective: 1—Describe the characteristics of magnet hospitals
2) Studies of magnet hospitals have found that __________.

a. they were not able to retain or attract nurses during times of nursing shortage
b. they have limited professional practice opportunities
c. they have a great number of nurses experiencing burnout
d. they often have primary care in their delivery model
Answer: d
a. Incorrect: Magnet hospitals have characteristics that made them successful
in retaining and attracting nurses during times of nursing shortages.
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b. Incorrect: Magnet hospitals offer multiple professional practice

opportunities.
c. Incorrect: Magnet hospitals tend to have fewer numbers of nurses with
burnout than non-magnet hospitals.
d. Correct: Studies of magnet hospitals have found that they provide more
autonomy for nurses. Nurses had increased discretion in making decisions
about the care they provided patients, and primary care nursing was often
the delivery care model.
Evaluation
3) Last week you overheard a nurse named Jimmy comments like “We don’t have the
tools we need to do this job;” “There isn’t a point to any of this, patients are better off
going somewhere else;” and “I just don’t have it in me to do this today.” Another nurse
stated that Jimmy has been like this for a few months now. You suspect that Jimmy is
suffering from __________.

a. motivation
b. poor mental health
c. burnout
d. criticism
Answer: c
a. Incorrect: Jimmy is unmotivated, because he is suffering from burnout.
b. Incorrect: Jimmy is suffering from burnout.
c. Correct: Burnout consists of three outcomes: emotional exhaustion,
cynicism, detachment, and fear of being ineffective, all of which are
illustrated by Jimmy’s comments.
d. Incorrect: Jimmy is experiencing cynicism, not criticism, which has been
identified as one of the components of burnout.
integrity
Evaluation
Objective: 2—Describe theoretical models of work stress and burnout
4) A person who is experiencing burnout would demonstrate which of the following

characteristics?
a. high emotional exhaustion, low personal accomplishment, and high depersonalization
b. high emotional exhaustion, high personal accomplishment, and low depersonalization
c. high emotional exhaustion, high personal accomplishment, and high depersonalization
d. high emotional exhaustion, low personal accomplishment, and low depersonalization
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Answer: a
a. Correct: A person who is experiencing burnout is high on emotional
exhaustion and depersonalization, and low on personal accomplishment.
b. Incorrect: A person who is experiencing burnout feels low personal
accomplishment and high depersonalization.
c. Incorrect: A person who is experiencing burnout feels low personal
accomplishment, not high.
d. Incorrect: A person who is experiencing burnout feels high
depersonalization, not low.
integrity
Evaluation
5) Kanter’s theory of organizational empowerment suggests that __________.

a. work environment is not related to empowerment

b. employees respond to how their work environment is structured
c. empowered employees seek out the tools they require for their work
d. empowered employees are driven and do not require support
Answer: b
a. Incorrect: Kanter’s theory suggests that work environment is directly
related to employee empowerment.
b. Correct: According to Kanter’s theory, how the work environment is
structured has an effect on employees.
c. Incorrect: According to Kanter’s theory, employees are empowered when
their organization provides them with the resources they need to do their
work. They should not have to seek out those tools.
d. Incorrect: Empowered employees may be driven, but according to
Kanter’s theory, receiving support from their organization promotes
employee empowerment.
integrity
Evaluation
Objective: 3—Discuss the relationship of empowerment to outcomes for nurses
and patient safety
6) Judy has recently received a very positive performance appraisal. She was able to
provide her own comments on the document and wrote “the work environment is very
supportive. Management provides the staff on the unit with the tools they require, support
in difficult situations, and a positive work and learning environment”. Judy feels very
positive about her job and demonstrates __________.
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a. organizational empowerment
b. psychological empowerment
c. structural empowerment
d. collaborative empowerment
Answer: b
a. Incorrect: Judy demonstrates psychological empowerment, not
organizational empowerment.
b. Correct: Psychological empowerment is what employees feel as a result of
organizational empowerment. Judy’s perceptions of her work environment
enable her to feel this psychological empowerment.
c. Incorrect: Judy demonstrates psychological empowerment, not
d. Incorrect: Judy demonstrates psychological empowerment, not
integrity
Evaluation
and patient safety
7) During the initial consultation meeting with your preceptor, you learn that she
appreciates a balance between her work and non-work life, prefers a collaborative
approach instead of a competitive one, and has worked in a couple of different locations
in Canada as well as one abroad. You suspect that your preceptor was born __________.
a. between 1956 and 1966
b. before 1976
c. after 1981
d. between 1966 and 1976
Answer: c
a. Incorrect: The description of the preceptor indicates that she is a nexter
(born after 1981), not a baby boomer (born between 1956 and 1966).
b. Incorrect: The description of the preceptor indicates that she is a nexter
(born after 1981), not Generation X (born between 1966 and 1976).
c. Correct: C Correct: This description of the preceptor indicates that her
preferences are those of a ‘nexter’ (born after 1981).
d. Incorrect: The description of the preceptor indicates that she is a nexter
(born after 1981), not Generation X (born between 1966 and 1976).
Client need per NCLEX: psychological integrity
Evaluation
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Objective: 4—Identify how the values and needs of nexters and nurses nearing
retirement may differ from those of other nurses
8) Baby boomers are more likely than nurses from other generations to be motivated by
__________.
a. salary
b. time off
c. collaborative work environments
d. ability to change work environments
Answer: a
a. Correct: Salary is a motivator for baby boomers.
b. Incorrect: This is a motivator for Generation X and nexters, not baby
boomers.
c. Incorrect: This is a motivator for Generation X and nexters, not baby
boomers.
d. Incorrect: This is a motivator for Generation X and nexters, not baby

boomers.
Client need per NCLEX: psychological integrity
Evaluation
9) Name five characteristics of magnet hospitals.
Answer: Correct answers should include five of the following points.

o Magnet hospitals attract and retain nurses despite a shortage of nurses in
nearby hospitals.
o Nurses in magnet hospitals have higher levels of job satisfaction and less
burnout.
o Magnet hospitals have stronger professional practice environments for
nurses.
o Magnet hospitals have fewer hierarchical levels (fewer levels of
management, which facilitates the concerns of clinical nurses reaching
senior administrative nurses).
o Magnet hospitals offer more autonomy for nurses (increased discretion in
making decisions about the care they provide patients; primary care often
in the care delivery model).
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o Magnet hospitals offer more control in decision making (nurses have input
into decisions affecting how care is provided in their department; in some
cases shared governance is in place).
o Magnet hospitals feature support from supervisors and coworkers (direct
care nurses are encouraged to continue formal education; schedules are
adjusted to support attendance at in-services and committee meetings;
nurses are engaged in more collaboration with physicians).
o Magnet hospitals demonstrate effective leadership (nurses feel trusted and
valued; a chief nurse executive is included on the senior executive team;
scheduling systems are flexible)

Evaluation
10) What are the three outcomes of burnout? Provide an example of how a staff member
would demonstrate each of these.
Answer: Correct answers should include the following points.

o emotional exhaustion
o feelings of cynicism and detachment from work
o feelings of being ineffective at work
Examples of how a staff member would demonstrate these will vary.

integrity
Evaluation
11) Describe the theory of organizational empowerment and how it relates to quality of
work life for nurses.

o Employees respond to how the work environment is structured/conditions
of work environment.
o Empowered employees have the information and resources they need to
do their work.
o Empowered employees have opportunities to learn and receive support.
integrity
Evaluation
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and patient safety
12) Identify how the values of nexters and nurses nearing retirement may differ from
those of other nurses.

o nexters (persons born around 1981 and after, also known as Generation Y)
and Generation X (persons born between 1966 and 1980)
o appreciate balance between their work and non-work lives

o prefer collaborative approaches to work rather than competitive
ones
o will probably change their place of work much more frequently
o baby boomers (persons born between 1946 and 1966)
o motivated by salary as opposed to time off
o service oriented—may prioritize work before non-work life
o may wish to retire before age 65 because of decreased job

satisfaction related to the increased workload and psychological
stress that come from physical nature of work
o to delay retirement allow for more flexible work hours, reduced
work hours, or return to clinical work instead of working as a
charge nurse
integrity
Evaluation
13) Using your current clinical practice area, describe one issue that will lessen the
quality of life of nurses and one issue that will improve the quality of life of nurses.
Answer: Responses will vary, depending on the nurse’s personal experiences.

integrity
Evaluation
Objective: 5—Relate issues related to quality of work life to your practice
setting(s)
14) Suggest three ways nurses can work together to improve the quality of work life.
Answer: Responses will vary.
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integrity
Evaluation
Objective: 6—Suggest ways nurses can work together to improve the quality of
work life
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Chapter 10 - Team Building and Managing Conflict

1) Your clinical group has decided to write a letter of appreciation to the nurse manager
on the unit where you are currently practising. You would like to mention the
characteristics that make the staff on the unit an effective team. What might you include?
a. reference to the vertical leadership style
b. reference the fact that there did not appear to be any role bending
c. reference to the horizontal leadership style
d. reference the fact that there did not appear to be any role overlap
Answer: c
a. Incorrect: Vertical leadership is a leadership style where the leader uses
his or her power to direct other team members. Vertical leadership is not
one of the characteristics of successful teams.

b. Incorrect: Role-bending and role overlap are both characteristics of
effective teams.
c. Correct: Horizontal leadership refers to a leadership style in which the
leader does not dictate to other team members, but guides team members
to discuss their ideas to reach consensus and to attain goals. It has been
identified as one of the characteristics of successful teams.
d. Incorrect: Role-bending and role overlap are both characteristics of
effective teams.
integrity
Evaluation
Objective: 1—Discuss how effective and ineffective teams develop
2) You have been offered an opportunity for employment in a different area and you’ve
decided to leave your current job. You really enjoyed working with your team, but you
are also excited about the new opportunity. You wish to include in your letter of
resignation some mention of the characteristics and skills the nurse manager has
demonstrated that make the team you are leaving very successful. You mention the nurse
manager’s __________.
a. ability to make the decisions regarding unit management without having to bother the
staff for their input
b. not bothering with performance appraisals or unnecessary feedback
c. ability to motivate employees to engage in continuing education opportunities
d. allowing staff members to deviate from formal policy and procedures
Answer: c
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a. Incorrect: Managers of successful teams involve employees in decision

making.
b. Incorrect: Managers of effective teams coach employees, engage in
appropriate communication with employees, and facilitate employees’
growth and development.
c. Correct: Characteristics of successful teams include having managers who
are skilled in coaching, motivating, communicating, engaging team
members in decision making, and developing team members.
d. Incorrect: Allowing staff members to deviate from formal policy and
procedures has not been identified as a characteristic of managers of
successful teams.
integrity
Evaluation
3) Which of the following are competencies/skills of team members that lend to

successful teams?
a. conflict resolution, problem solving, goal setting
b. communication, task completion, problem solving
c. conflict resolution, task completion, goal setting
d. problem solving, conflict resolution, task completion
Answer: a
a. Correct: Competencies possessed by team members on effective teams
include conflict resolution, problems solving, communication, decision-
making skills, goal-setting and performance management skills, and
planning and task coordination.
b. Incorrect: While task completion is a desired outcome, it is not one of the
competencies required for team members of effective teams.
c. Incorrect: While task completion is a desired outcome, it is not one of the
d. Incorrect: While task completion is a desired outcome, it is not one of the
Evaluation
Objective: 2—Suggest ways nurses can promote team building in their own work
setting
4) A member of an effective/successful team does all of the following, except

__________.
a. collaborating and identifying win–win solutions
b. selecting alternatives to help the team meet its goals
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c. planning and coordinating tasks

d. taking on the majority of the work to support other team members
Answer: d
a. Incorrect: This is an action of an effective team member.
b. Incorrect: This is an action of an effective team member.
c. Incorrect: This is an action of an effective team member.
d. Correct: D Correct: Taking on the majority of the work is not an effective
way of working with a team.
Evaluation
setting
5) A(n) __________ is when a disagreement about how to manage a difficult situation in

the workplace involves a win–lose solution, a high level of assertiveness, a low level of
cooperation, and both individuals focusing on winning.
a. competition
b. compromise
c. avoidance
d. accommodation
Answer: a
a. Correct: One approach to dealing with conflict is competition, which
occurs when both individuals focus on winning. Both parties are high in
assertiveness and low in cooperation as they both focus on arguing for
their desired outcomes.
b. Incorrect: Compromise results in lose–lose solutions, in which neither
party ends up with a solution that he or she would consider ideal. Both
parties use medium assertion and medium cooperation.
c. Incorrect: Avoidance occurs when both individuals decide not to deal with
the conflict. Both individuals are low in assertiveness and cooperation, and
because the conflict is not dealt with, there is no solution and the result is a
lose–lose situation.
d. Incorrect: With accommodation, one individuals decides to allow the other
individual to have what the other person wants. The individuals are low on
assertiveness but high in cooperation, resulting in a win–lose solution.
Evaluation
Objective: 3—Discuss strategies for effectively managing conflict in the
workplace
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6) The clinical educator on a unit has attempted to implement a “lunch and learn” in-
service for the staff, but employees have been reluctant to participate. Which of the
following opening statements demonstrates an assertive approach to communication?
a. You have to participate in the in-service sessions at least once before you can say that
you won’t like them.
b. You need to participate in these in-services, or you will be seen as uncooperative.
c. I’d really appreciate your attendance at one in-service, at least so that you can provide
feedback about their value.
d. You have to participate in the in-services because they ultimately help the patients.
Answer: c
a. Incorrect: Suggesting that someone MUST do something is seen as being
uncooperative
b. and aggressive, not assertive.
c. Incorrect: Suggesting that someone MUST do something is seen as being
uncooperative and aggressive, not assertive.
d. Correct: Assertive behaviour is associated with saying no, asking for what
you want, expressing negative and positive comments, and initiating,
continuing, and ending an interaction. This answer demonstrates
assertiveness because the clinical instructor asked for exactly what she
wanted.
e. Incorrect: Suggesting that someone MUST do something is seen as being
uncooperative and aggressive, not assertive.
safety
Evaluation
workplace
7) Conflict can be positive because __________.

a. it can engage people in aggressive discussion
b. it can lead to innovation and creative decisions
c. it identifies the stronger members of the team
d. it fosters competition
Answer: b
a. Incorrect: Engaging people in aggressive discussion is a negative, not
positive, aspect of conflict.
b. Correct: Much conflict in the workplace is the result of real individual
differences in what different employees believe is the best decision or
course of action, how objectives should be met, and so on. In such cases,
conflict can be good because it can lead to innovation and creative
decisions.
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c. Incorrect: Identifying stronger members of the team is not necessarily a

positive aspect of conflict, as it may lead to competition.
d. Incorrect: Fostering competition is not necessarily a positive aspect of
conflict, since this usually results in win–lose solutions to a problem.
integrity
Evaluation
Objective: 4—Debate the pros and cons of conflict in the workplace
8) A dangerous outcome of avoiding conflict is __________.

a. groupthink
b. group work
c. team building
d. sabotage
Answer: a

a. Correct: Groupthink results when a group does not bring up and evaluate
divergent opinions because they want to remain cohesive. When group
members decide they will not bring up their contrary views about a
decision, the group proceeds without critically evaluating divergent
opinions. The group is harmonious, but their work may be faulty.
b. Incorrect: Groupthink, not group work, is an outcome of avoiding conflict.
c. Incorrect: Team building is not a result of avoiding conflict.
d. Incorrect: Sabotage is not an outcome of avoiding conflict.
integrity
Evaluation
9) As a nurse working in a unionized environment, the appropriate process for you to

follow if you have an issue of concern is to __________.
a. file a grievance; meet with your manager to discuss; and attend arbitration, if needed
b. file a grievance; speak with your union representative; and speak with your manager
c. speak with your manager; speak with administration; and file a grievance
d. speak with your manager; file a grievance; and attend arbitration, if needed
Answer: d
a. Incorrect: This is an incorrect sequence of the procedures required for
raising an issue of concern within a unionized environment.
b. Incorrect: This is an incorrect sequence of the procedures required for
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c. Incorrect: This is an incorrect sequence of the procedures required for

d. Correct: In a unionized environment, the appropriate process for raising an
issue of concern is first speaking with your manager, then filing a
grievance, and then attending arbitration if it is required.
integrity
Evaluation
Objective: 5—Suggest how health care organizations with and without unions
can resolve disputes
10) When resolving a dispute in a non-unionized health care environment, a mediator

would be involved when __________.
a. assistance is needed in working toward a resolution between parties
b. the organization wishes to reprimand the employee
c. the employee has threatened to report the organization to the labour board
d. an outside partner has made the final decision on the issue
Answer: a
a. Correct: In a non-unionized organization, if the dispute cannot be resolved
through early discussions, mediation may be employed. Mediation
consists of two disputing parties working to find a solution that they both
agree on. They do this in the presence of a mediator who facilitates the
process but does not identify the solution.
b. Incorrect: A mediator facilitates the dispute process; he or she does not
reprimand employees.
c. Incorrect: Mediation is employed when a resolution between two parties
can’t be reached, not when an employee threatens to report the
organization to a labour board.
d. Incorrect: Mediation involves a mediator facilitating the dispute process
between two people; the mediator does not make a final decision on the
issue but helps the two people come to a mutually acceptable decision.
integrity
Evaluation
11) When a nurse who is nearing retirement overhears a young nurse say “I’m not going
to work until I’m that slow, she can barely move” in reference to her own work, the nurse
is a victim of __________.
a. horizontal violence
b. vertical violence
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c. grievance
d. upward violence
Answer: a
a. Correct: Horizontal violence is the physical or emotional abuse toward
another person in a similar position.
b. Incorrect: This is horizontal, not vertical violence. Vertical violence is the
emotional or physical abuse of a person in a higher position of power or
authority towards a person in a lower position.
c. Incorrect: This is an example of horizontall violence. Grievance is a
process for conflict resolution.
d. Incorrect: This is horizontal violence. Upward violence is the emotional or
physical abuse by a person in a lower position of power or authority
toward someone in a higher position.
integrity

Evaluation
Objective: 6—Identify how nexters and nurses nearing retirement may be
engaged in lateral violence (perhaps unknowingly) with their own and the other
age cohorts
12) An experienced nurse has moved to a different area of the hospital to work. When she
asks questions about how to manage a patient’s care, the clinical educator and charge
manager belittle her and ask, “What did you do in that other unit, anyway?” This nurse
has been a victim of __________.
a. horizontal violence
b. vertical violence
c. grievance
d. upward violence
Answer: b
a. Incorrect: This is an example of vertical, not horizontal, violence.
Horizontal violence is the physical or emotional abuse of someone toward
a person in a similar position.
b. Correct: Vertical violence is the emotional or physical abuse by a person
in a higher position of power or authority towards a person in a lower
position.
c. Incorrect: This is an example of vertical violence. Grievance is a process
for conflict resolution.
d. Incorrect: This is an example of vertical violence. Upward violence is the
emotional or physical abuse by a person in a lower position of power or
authority toward someone in a higher position.
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integrity
Evaluation
age cohorts
13) A telemetry unit is in need of a new monitoring system. A working group has been
assigned to evaluate monitors that will be trialled on the unit. After narrowing the choices
to three, the monitors are each trialled for a one-week period. The nursing staff is asked
to vote on which monitor they feel is most appropriate for their unit. The monitor with
the greatest number of votes will be the one chosen. This is an example of __________.
a. transparency
b. participative democracy
c. authoritative decision-making
d. democratic decision-making
Answer: b
a. Incorrect: This is an example of participative democracy. Transparency is
the expectation of today’s workers to know what decisions are made by
managers, as well as how those decisions are made.
b. Correct: In participative democracy, clinicians participate in decisions
made in the workplace.
c. Incorrect: This is an example of participative democracy, not authoritative
decision-making.
d. Incorrect: This is an example of participative democracy, not democratic
decision-making.
integrity
Evaluation
Objective: 7—Discuss how the nurses’ values related to decision making in
organizations might lead to nurses’ conflict with hospitals
14) One of the major challenges with a shared governance model is _________.
a. time constraints for decision making
b. hierarchical models of decision making
c. government influence in decision making
d. committees making all the decisions
Answer: a
a. Correct: In shared governance, committees that include administrators and
direct care nurses focus on decisions related to the standard of nursing
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practice, and this committee structure operates concurrently with the

hierarchical hospital and nursing administration structures. However, the
rapid time frame required for many decisions can mean that these
decisions are made by administration rather than through committees,
because shared governance involves a longer decision-making process.
b. Incorrect: Shared governance is not a hierarchical model of decision
making.
c. Incorrect: Shared governance does not involve government influence in
decision making.
d. Incorrect: In shared governance, decisions are made by committees, so this
is not a major challenge. The challenge is that this type of decision-
making process takes time, and may not work well when there are time
constraints on decision making.
Evaluation
15) Managers of successful teams have been shown to have specific characteristics.
Name three of these characteristics.
Answer:
Correct answers should include three of the following points.
o coaching employees (guiding team members in their work; providing

skills, knowledge and support to do their work)
o motivating
o communicating (conveying enthusiasm about the work and goals of the
team; providing feedback about progress to goals)
o engaging team members in decision making
o developing team members

Evaluation
16) Discuss an example for each of the following skills that members of a successful
team will display.
a) conflict resolution
b) problem solving
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c) communication
d) decision-making skills
e) goal setting and performance management skills
f) planning and task coordination
Answer: Correct answers may include the following points for each category.
 conflict resolution
o recognizing conflict that can lead to new ideas and positive changes
o distinguishing useful types of conflict from undesirable conflict
between members
o collaborating and identifying win–win solutions
 problem solving
o identifyingn and determining methods to attain goals
 communication
o among members
o good presentation and writing skills
o respectful listening to the ideas of others

 decision-making skills
o properly evaluating and considering all alternatives
o selecting alternatives that help team meet goals
 goal setting and performance management skills
o properly evaluating and considering all alternatives
 planning and task coordination
o dividing and coordinating work among members
o balancing workload among members with different work task roles

Evaluation
setting
17)
Using the table provided, indicate whether each of the following methods of conflict resolution results in
win, lose–lose, or win–lose solutions, and indicate whether assertiveness and cooperation are high or low.
Solution Assertiveness Cooperation
Competition
Collaboration
Compromise
Avoidance
Accommodation
Answer:
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Points to include for correct answer:
Solution Assertiveness Cooperation

Competition win–lose high low
Collaboration win–win high high
Compromise lose–lose medium medium
Avoidance lose–lose n/a n/a
Accommodation win–lose low high

Evaluation
workplace
18) Provide an example of how a conflict in the workplace will have an effect on the
nursing team and patient care. How might this example lead to a positive effect on the
nursing team and patient care?

integrity
Evaluation
19) Outline the process for resolving disputes in a non-unionized organization.
Answer: Correct answers will include the following points.

 The organization will have a policy for dispute resolution.
 The policy may involve discussion at many levels of the organization.
 Final review/decision will be made by a senior executive or panel of
employees from within the organization (could also be an outside partner
hired for the meeting).
 Mediation may be employed—a mediator assists both disputing parties in
finding a solution that they can both agree upon. Both parties have to want
to resolve the conflict.

Evaluation
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20) Name and provide an example of four different kinds of subtle aggression that may
appear with lateral violence.
Answer: Correct answers will include four of the following.

 Types of subtle aggression
o withholding information
o gossiping
o intimidating
o belittling achievements
o excessive surveillance
o exclusion
Examples will vary.

integrity
Evaluation

age cohorts
21) Name and describe the two things health care workers can expect in their workplace
with respect to decision making.

o Transparency—the expectation of today’s workers to know what decisions
are made by managers as well as how these decisions are made
o Participative democracy—clinicians participate in decisions made in the
workplace
integrity
Evaluation
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Chapter 11 - Quality Improvement

1) The term “quality assurance” has been replaced with: __________.

a. quality improvement
b. quality management
c. risk management
d. patient safety
Answer: a
a. Correct: In health care, the term “quality assurance” has been replaced by
the term “quality improvement” because quality assurance suggests we
can assure quality and, while we cannot do this, we can improve it.
b. Incorrect: In health care, the term “quality assurance” has been replaced
by the term “quality improvement,” not “quality management.”

c. Incorrect: In health care, the term “quality assurance” has been replaced
by the term “quality improvement,” not “risk management.”
d. Incorrect: In health care, the term “quality assurance” has been replaced
by the term “quality improvement,” not “patient safety.”
Evaluation
Objective: 1—Compare quality improvement, patient safety, and risk
management programs
2) Risk management programs __________.

a. identify potential risks to patients
b. measure quality indicators
c. develop and implement strategies to improve quality
d. are not suitable for community health care settings
Answer: a
a. Correct: Risk management programs identify potential risks to patients,
staff, or property such as injuries, loss, or damage. Once potential risks are
identified, actions are taken to reduce the risks.
b. Incorrect: Measuring quality indicators is part of total quality
management, not risk management.
c. Incorrect: Developing and implementing strategies to improve quality is
part of total quality management, not risk management.
d. Incorrect: Risk management programs are very important in all health care
settings, including community health care.
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Evaluation
Objective: 1—Compare quality improvement, patient safety, and risk
management programs
3) The nurse manager has decided to investigate why an increased number of medication
errors are being reported on the unit. A root cause analysis method is used because
__________.
a. there is no barrier to its use with respect to time
b. it allows for a variety of analysis techniques to be used
c. it does not require any meetings
d. only those involved in the incidents need to participate in the analysis
Answer: b
a. Incorrect: One barrier to the use of root cause analysis is time, because this
process requires a number of meetings. Other barriers are that persons
with relevant knowledge may not be available or may refuse to participate,

one person may dominate the discussion, or some may stick to using only
timeline method and limit the discussion.
b. Correct: Root cause analysis is used to investigate the causes of near
misses, incidents, and sentinel events in health care. After the incident to
be analyzed has been identified, a team of people who have relevant
knowledge is assembled to review how the incident occurred and to take
action. A variety of techniques, such as timelines, cause and effect charts,
brainstorming, and re-enactment of an incident can be used in root cause
analysis.
c. Incorrect: A number of meetings are required for root cause analysis.
d. Incorrect: More people than only those involved in the incident should
participate in the root cause analysis.
integrity
Evaluation
Objective: 2—Debate the pros and cons of different quality improvement
approaches such as structure, process and outcome indicators, Total Quality
Management, root cause analysis, and nursing sensitive outcomes
4) Staff in a newly restructured facility are participating in a learning session on Total

Quality Management. At first they are troubled by this method, but then they become
encouraged when they hear that this method is going to be used in the organization
because __________.
a. it will allow them to go focus on the current way of doing things
b. it includes performance appraisals at all levels
c. it has been known to be very easy to implement in other health care environments
d. it reduces the barriers between departments
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Answer: d
a. Incorrect: TQM is a method that encourages a change in the current way
of doing things to improve processes and customer service.
b. Incorrect: Performance appraisals are not a focus of TQM because
performance appraisals are viewed as focusing on individuals, instead of
the entire team.
c. Incorrect: TQM is difficult to implement in some health care structures,
such as those with vertical hierarchies that may require first talking with
the department head before moving an issue forward.
d. Correct: An important aspect of TQM is the reduction of barriers between
departments. To continuously improve quality, members of different work
groups need to be able to talk with each other.
Evaluation

5) You are working on an orthopedic floor and receive a call from the RN in the post-
anaesthetic recovery unit who gives you a report on a patient you will be receiving. The
nurse tells you the following information:
“Mr. Levine is a 70-year-old patient who had a laparoscopic appendectomy today, after a
three-day history of abdominal pain. The appendix was intact; it had not ruptured. His
vital signs are stable (the values are provided) and he had minimal blood loss during the
procedure. He is well pain controlled and his laparoscopic sites are dry and intact. He is
comfortable currently, but was nauseated when he first came out of the operating room. I
would suggest that he have another dose of the antiemetic when it’s due; he says this
always happens post-op.”
This is an example of __________.
a. a debriefing
b. SBAR communication
c. a huddle
d. a call-out
Answer: b
a. Incorrect: Debriefings are used to identify what happened in specific
circumstances, what was learned, and what can be done better next time.
This method of communication would not be appropriate for conveying
information about a patient during a change of shift or move from one unit
of a hospital to another.
b. Correct: SBAR stands for Situation, Background, Assessment, and
Recommendation, and is a communication strategy that was by designed
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by the military, adapted by the aviation industry, and more recently by

health care. It can serve as a checklist for nurses when they are
communicating important information about a patient.
c. Incorrect: In a huddle, all team members come together for a short,
structured communication to review what their next steps should be.
Huddles can be used at routine times, such as the beginning of a shift, or
when team members feel they need to regroup to think about an issue or a
patient. A huddle would likely include more than two nurses involved in
patient care.
d. Incorrect: Call outs are used particularly in the OR, to confirm the phase
of a process. This communication method would not be used for
discussing patient care after a procedure.
Evaluation
Objective: 3—Identify methods of communication to improve patient safety,
including SBAR, huddles, checklists, briefings, time out, and handout process
6) SBAR communication stands for __________.

a. situation, breathing, airway, and respirations
b. situation, background, assessment, and recommendation
c. situation, background, action, and recommendation
d. situation, breathing, assessment, and recommendation
Answer: b
a. Incorrect: SBAR stands for situation, background, assessment, and
recommendation.
b. Correct: SBAR stands for situation, background, assessment, and
recommendation.
c. Incorrect: SBAR stands for situation, background, assessment, and
recommendation.
d. Incorrect: SBAR stands for situation, background, assessment, and
recommendation.
integrity
Evaluation
7) Required Organizational Practices __________.

a. should be implemented three months before an accreditation process
b. should be implemented six months before an accreditation process
c. are evidence-based
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d. are required for an accreditation process only
Answer: c
a. Incorrect: Organizational practices are evidence-based and should be
implemented and adhered to continuously, not only in relation to the
accreditation process.
b. Incorrect: Organizational practices are evidence-based and should be
c. Correct: Required Organizational Practice (ROP) is a term developed by
Accreditation Canada for practices identified as essential for safe patient
care. These practices are evidence-based.
d. Incorrect: Organizational practices are evidence-based and should be

Evaluation
Objective: 4—Discuss how the accreditation of health care organizations can
improve quality
8) Accreditation improves the quality of a health care organization by __________.

a. developing a quality improvement plan that is implemented for the duration of the
accreditation process
b. providing standards for governance but not for leadership
c. providing standards for both governance and patient care delivery
d. providing standards for governance but not for patient care delivery
Answer: c
a. Incorrect: The quality improvement plan should be implemented and
adhered to before, during, and after the accreditation process.
b. Incorrect: Accreditation provides standards for governance, leadership,
and client care delivery.
c. Correct: Accreditation programs are built on standards for governance,
leadership, and client care delivery such as critical care, cancer care, home
care, hospice palliative care, etc. The standards are standards of
excellence, and their purpose is for an organization to use them to identify
areas where they are doing well and areas within which they can improve.
d. Incorrect: Accreditation provides standards for governance, leadership,
and client care delivery.
Evaluation
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improve quality
9) A nurse who is considering retirement has been asked to develop a quality

improvement initiative as part of a late career initiative in order to improve quality in her
practice setting (the emergency room). She has decided to improve quality by promoting
a culture of safety. Which one of following ideas is best suited for her plan?
a. One person should be assigned the task of completing all documentation required for
accreditation.
b. The nurse manager should now inform the charge nurses that they are responsible for
safety in the department.
c. When incident reports are completed, a team of front-line care providers should review
them and a root cause analysis should be completed.
d. When incident reports are completed, the nurse manager should review them and meet
with the staff involved.
Answer: c

a. Incorrect: All people involved in the accreditation process should be
involved in documentation.
b. Incorrect: Telling charge nurses that they are responsible for safety does
not necessarily promote a culture of safety; all team members must be
involved in the process.
c. Correct: Health care teams use root cause analysis to investigate the
causes of near misses, incidents, and sentinel events. This process
improves patient safety because with root cause analysis, the underlying
causes of incidents can be identified, allowing the team to learn from the
incidents and take actions to avoid similar incidents.
d. Incorrect: A culture of safety embraces the identification of process issues
related to incident reports, not penalizing staff members.
Evaluation
Objective: 5—Develop a quality improvement initiative to improve quality in
your practice setting(s)
10) In order to improve the quality of patient care, which of the following is not required?
a. risk management programs
b. patient safety programs
c. quality improvement programs
d. quality assurance programs
Answer: d
a. Incorrect: Risk management programs are an important aspect of
improving the quality of patient care.
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b. Incorrect: Patient safety programs are integral to improving the quality of

patient care.
c. Incorrect: Quality improvement programs improve the quality of patient
care.
d. Correct: The term “quality assurance” has been replaced with “quality
improvement” because quality can be improved, but not assured.
Evaluation
Objective: 5—Develop a quality improvement initiative to improve quality in
your practice setting(s)
11) Name the type of program that identifies potential risks to patients, staff, or property,
and provide three examples of those risks.

o Risk management programs identify potential risks to patients, staff, or

property.
o Three potential risks to patients, staff, or property are injuries, loss, and
damage.
o All can result in financial costs to the organization.

Evaluation
Objective: 1—Compare quality improvement, patient safety and risk
management programs
12) Choose one of the following quality management methods, and discuss the pros and
cons of using this method:
a) Total Quality Management (TQM)
b) Root cause analysis
Answer: Correct answers should include the following points for the method
chosen:
o Total Quality Management
o Pros
 reduction of barriers between departments
 continuous improvement of quality
 encourages modern methods of doing things
 encourages communication
o Cons
 does not include performance appraisals of individuals
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
difficult to apply in health care organizational structure due
to historical vertical hierarchy
o Root Cause Analysis
o Pros
 investigates the causes of near misses, incidents and
sentinel events
 allows for a variety of techniques to be used (timelines,
cause and effect charts, brainstorming, re-enactment)
o Cons
 requires a number of meetings
 time is considered a barrier to its use
 persons with relevant knowledge may not be available or
refuse to participate
 one person may dominate the discussion
 some may stick to using only timeline method and limit the
discovery

Evaluation
13) Choose one of your patients from clinical practice. While ensuring confidentiality
(change the patient’s name), write an SBAR report that you would give to the incoming
RN.
Answer: Answers will vary.

integrity, psychological integrity
Evaluation
14) Explain how the accreditation of health care organizations can improve quality.
Answer:
Correct answers may include the following points.
o It is an external process of peer review to determine how the organization

compares with developed standards.
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o It ensures an ongoing, coordinated quality improvement plan.

o It provides standards for governance, leadership, and patient care delivery.
o In addition to the standards, there are required organizational practices
(ROPs) that are evidence-based practices. Patients are at risk if these
practices are not in place.

Evaluation
improve quality
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Chapter 12 - Diversity in Health Care Organizations

1) Organizational dimensions of cultural diversity include __________.

a. management status, union membership, and seniority
b. management status, union membership, and education level
c. work experience, union membership, and seniority
d. work experience, union membership, and education level
Answer: a
a. Correct: The four layers of diversity, as identified by Gardenswartz and
Rowe (1998), and their accompanying dimensions, are as follows:
personality dimension (individual differences); internal dimensions (e.g.,
race, gender, sexual orientation, and physical ability); external dimensions
(e.g., income, education level, religion, work experience); and

organizational dimensions (e.g., management status, union membership,
seniority).
b. Incorrect: The organizational dimensions of cultural diversity include
management status, union membership, and seniority. Education level is
an external dimension of cultural diversity, not an organizational
dimension.
c. Incorrect: The organizational dimensions of cultural diversity include
management status, union membership, and seniority. Work experience is
an external dimension of cultural diversity, not an organizational
dimension.
d. Incorrect: The organizational dimensions of cultural diversity include
management status, union membership, and seniority. Work experience
and education level are external dimensions of cultural diversity, not
organizational dimensions.
Evaluation
Objective: 1—Discuss cultural diversity and the ways in which the people you
work with may differ from you and from each other
2) Age, physical ability, and gender are examples of which layer of diversity?
a. personality
b. internal dimensions
c. external dimensions
d. organizational dimensions
Answer: b
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a. Incorrect: The personality dimension includes individual differences. Age,

physical ability and gender are internal dimensions of cultural diversity.
b. Correct: The four layers of diversity, as identified by Gardenswartz and
Rowe (1998), and their accompanying dimensions, are as follows:
personality dimension (individual differences); internal dimensions (e.g.,
race, gender, sexual orientation, and physical ability); external dimensions
(e.g., income, education level, religion, work experience); and
organizational dimensions (e.g., management status, union membership,
seniority).
c. Incorrect: External dimensions of cultural diversity include income,
education level, religion, and work experience. Age, physical ability, and
gender are internal dimensions of cultural diversity.
d. Incorrect: Organizational dimensions of cultural diversity include
management status, union membership, and seniority. Age, physical
ability and gender are internal dimensions of cultural diversity.
integrity

Evaluation
3) The recent accreditation report for a health care organization commented that
“decisions appear to include a wide range of perspectives and include an exceptional
level of cultural competence.” This organization has shown that their diversity in
employees has provided a __________.
a. diversity challenge
b. diversity competence
c. diversity advantage
d. diversity awareness
Answer: c
a. Incorrect: Organizational diversity in employees provides a diversity
advantage, not a diversity challenge.
b. Incorrect: Organizational diversity in employees provides a diversity
advantage, not a diversity competence.
c. Correct: The growing reality of global diversity has brought about an
emphasis on the “business case” for increasing ethnic and gender
diversity. Business organizations, in particular, make the case that there is
a diversity advantage for an organization in that diversity in employees
brings about better decisions due to a wider range of perspectives, and the
fact that a diverse workforce better understands a diverse customer base.
d. Incorrect: Organizational diversity in employees provides a diversity
advantage, not diversity awareness.
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integrity
Evaluation
Objective: 2—Discuss the implications of diversity in health care organizations
for nursing staff members, clients/patients, visitors and family members, and
nurse leaders
4) Misunderstandings, misperceptions, and conflict can result from __________.

a. diversity competence
b. cultural competence
c. diversity
d. moral distress
Answer: c
a. Incorrect: Misunderstandings, misperceptions, and conflict can result from
mismanaged diversity in the workplace, not from diversity competence.

b. Incorrect: Misunderstandings, misperceptions, and conflict can result from
mismanaged diversity in the workplace, not from cultural competence.
c. Correct: While the positive side given for a diverse workforce is that it
brings more perspectives to decisions and improves decision making, there
is also a concern about a downside to diversity if it is not managed
effectively. Some concerns are that diversity in an organization may bring
with it miscommunication, conflict due to misunderstandings, and
differing values and beliefs that affect team functioning.
d. Incorrect: Misunderstandings, misperceptions and conflict can result from
mismanaged diversity in the workplace, not from moral distress.
integrity
Evaluation
Objective: 2—Discuss the implications of diversity in health care organizations
for nursing staff members, clients/patients, visitors and family members, and
nurse leaders
5) In order to develop communication skills that promote culturally diverse settings, a

nurse would _________.
a. teach others how to communicate using the accepted methods of communication
b. seek out and participate in learning opportunities that include a focus on
communication and diversity
c. ask yes/no questions when communication is not effective
d. identify colleagues who are best suited to working with clients who are culturally
diverse and suggest they care for that patient population
Answer: b
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a. Incorrect: Nurses should seek feedback from clients and colleagues, and
participate in communication validation exercises (e.g., role-playing
exercises; case studies).
b. Correct: According to the RNAO Best Practice Guidelines, one
recommendation for developing communication skills that promote
culturally diverse settings is to seek and participate in learning
opportunities that include a focus on communication and diversity.
c. Incorrect: Nurses should use a range of communication skills (not only
yes/no questions) to effectively communicate with clients and colleagues
(including empathetic listening, reflecting, non-judgemental open-ended
questioning).
d. Incorrect: All nurses should develop an awareness of different
communication styles and the influence of culture on communication.
integrity, health promotion and maintenance
Evaluation
Objective: 3—Examine your attitudes and experiences in working with others
who differ in age, culture, gender, profession, experience, education, and
hierarchical position
6) Acknowledging one’s own feelings and behaviours toward working with patients,
families, and colleagues who have different cultural backgrounds, health behaviours,
belief systems, and work practices is an example of __________.
a. learning to embrace diversity in individuals
b. assessing an organization’s level of cultural competence
c. a workplace policy on diversity
d. institutional racism
Answer: a
a. Correct: This is one of the aspects of self-awareness within the RNAO’s
individual recommendations for developing cultural competencies and
behaviours.
b. Incorrect: Acknowledging one’s own feelings and behaviours toward
working with patients, families, and colleagues who have different cultural
backgrounds, health behaviours, and belief systems is an individual
behaviour, and not part of assessing an organization’s level of cultural
competence.
c. Incorrect: Acknowledging one’s own feelings and behaviours toward
backgrounds, health behaviours, and belief systems is an individual
behaviour, and not necessarily part of a workplace policy on diversity.
d. Incorrect: Acknowledging one’s own feelings and behaviours toward
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backgrounds, health behaviours, and belief systems is one of the aspects of

self-awareness within the RNAO’s individual recommendations for
developing cultural competencies and behaviours. It is not a definition of
institutional racism.
Evaluation
7) An organization that moves along the continuum towards becoming culturally

competent works on which three aspects?
a. aptitude, policies, and practices
b. aptitude, procedures, and practices
c. attitudes, policies, and practices
d. attitudes, policies, and procedures
Answer: c
a. Incorrect: The three aspects involved in attaining cultural competence are
attitudes, policies, and practices.
b. Incorrect: The three aspects involved in attaining cultural competence are
c. Correct: Organizations that wish to move along the continuum to become
culturally proficient must work on three aspects: attitudes, policies, and
practices. There must be congruence between valuing differences, and the
policies and practices that reflect such values.
d. Incorrect: The three aspects involved in attaining cultural competence are
and maintenance
Evaluation
Objective: 4—Identify the continuum of cultural competence in an organization
and characteristics of organizations that embrace diversity in the workplace
8) A health care organization would be considered to have cultural blindness if it has

which of the following characteristics?
a. It seeks cultural assimilation of clients and employees.
b. It adopts policies that destroy cultural links.
c. It supports staff in expressing differing perspectives and beliefs.
d. It seeks consultation from cultural groups.
Answer: b
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a. Incorrect: This is a policy that would promote cultural competence, not
cultural blindness.
b. Correct: A culturally blind organization would adopt policies that
inadvertently destroy cultural links.
c. Incorrect: This is a policy that would promote cultural competence, not
cultural blindness.
d. Incorrect: This is a policy that would promote cultural competence, not
cultural blindness.
and maintenance
Evaluation
9) When preparing for a performance appraisal, a nurse is asked to reflect upon how he
has demonstrated respect for cultural diversity in his practice. Which statement reflects a
good understanding of cultural competence in his practice?
a. He says he is respectful of his colleagues and does not identify when they are
discriminatory, as this is up to them to determine.
b. He says he is respectful of patients when they are not of the same cultural background
as he is, but refuses to care for the patient.
c. He says he has participated in a learning session on communication skills and cultural
norms.
d. He says he has read about learning sessions on communication skills and cultural
norms.
Answer: c
a. Incorrect: This is not one of the aspects of self-awareness identified in the
RNAO’s individual recommendations for developing cultural
competencies and behaviours.
b. Incorrect: This is not one of the aspects of self-awareness identified in the
c. Correct: Participating in learning opportunities that include a focus on
communication and diversity is one of the aspects of self-awareness within
the RNAO’s individual recommendations for developing cultural
d. Incorrect: This is not one of the aspects of self-awareness identified in the
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Evaluation
Objective: 5—Describe the role of individual team members in a health care
workplace with respect to cultural diversity
10) An organization that is said to be stagnant in their movement toward becoming a

culturally safe environment might __________.
a. dedicate funding in the budget to implement and evaluate strategies to strengthen
diversity in the workplace
b. not recognize that there have been any issues with cultural diversity in the past and, as
such, may not include cultural diversity in their strategic plan
c. develop policies, guidelines, and processes to address change and conflict in the
workplace
d. develop educational strategies to address the diversity of preferred learning styles and
behaviours within employee groups
Answer: b

a. Incorrect: This is a policy that would move the organization forward in
becoming culturally safe; it is not an example of stagnation in this process.
b. Correct: In order to move forward in an environment of cultural safety,
organizations must articulate, implement, and evaluate the effectiveness of
their mission statement, values, and corporate strategic plans that
emphasize the value of cultural diversity and competence.
c. Incorrect: This is a policy that would move the organization forward in
d. Incorrect: This is a policy that would move the organization forward in
Evaluation
Objective: 5—Describe the role of individual team members in a health care
workplace with respect to cultural diversity
11) The key categories of cultural competence of an organization include __________.

a. organizational norms, boards of directors, and ethics committees
b. asset identification, translation services, and boards of directors
c. boards of directors, human resources, and community consultation
d. human resources, community consultation, and organizational norms
Answer: d
a. Incorrect: Olavarria et al (2009) identified five key categories for
consideration of standards of cultural competence in organizations: 1)
organizational norms, principles, and policies; 2) asset and need
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identification; 3) human resources and management; 4) services and

service delivery; and 5) community consultation, partnership, and
information exchange.
b. Incorrect: Olavarria et al (2009) identified five key categories for
c. Incorrect: Olavarria et al (2009) identified five key categories for
d. Correct: Olavarria et al (2009) identified five key categories for

Evaluation
Objective: 6—Describe responsibilities of nurse managers and health care
organizations with respect to diversity in health care organizations
12) Describe each of the four layers of cultural diversity and how a colleague may differ
from you.
Answer: Correct answers may include the following points.

o personality (individual differences)
o internal dimensions (race, age, gender, sexual orientation, physical ability)
o external dimensions (income, education level, religion, work experience)
o organizational dimensions (management status, union membership,
seniority)
integrity
Evaluation
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13) As a nursing student, what actions can you take to be more self-aware in your
attempts to embrace diversity in individuals?

o Perform self-reflection of one’s own values/beliefs, incorporating
feedback from peers.
o Express an awareness of one’s own views of differences among people
(e.g., different opinions, different world views, different races, different
values, and different views of society).
o State and continually explore through reflection and feedback how one’s
own biases, personal values, and beliefs affect others.
o Identify cultural differences among clients and colleagues in the practice
setting.
o Acknowledge one’s own feelings and behaviours toward working with
clients, families, and colleagues who have different cultural backgrounds,

health behaviours, belief systems, and work practices.
o Explore one’s strategies for resolving conflicts that arise between self and
colleagues and/or clients from diverse groups.
o Identify and seek guidance, support, knowledge, and skills from role
models who demonstrate cultural proficiency
o Recognize and address inequitable, discriminatory, and/or racist
behaviours or institutional practices when they occur.
o Acknowledge the presence or absence of individuals from diverse cultural
backgrounds at all levels in the workplace, reflecting the cultural makeup
of the clients or community being served.
o Reflect and act on ways to be inclusive in all aspects of one’s practice.
integrity
Evaluation
14) As a nursing student, what actions can you take to develop communication skills that
promote a culturally diverse setting?

o Be aware of different communication styles and the influence of culture
on communication.
o Be aware of one’s preferred communication style, its strengths and
limitations, and how it affects colleagues and recipients of care.
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o Seek feedback from clients and colleagues and participate in

communication validation exercises (e.g. role-playing exercises, case
studies).
o Use a range of communication skills to effectively communicate with
clients and colleagues (e.g., empathetic listening, reflecting, non-
judgmental open-ended questioning).
o Seek and participate in learning opportunities that include a focus on
communication and diversity.
Evaluation
15) What three aspects must an organization that is working toward cultural competence
work on in order to embrace diversity in the workplace?
Answer: Correct answer:

o Organizations that wish to move along the continuum to become culturally
proficient must work on three aspects: attitudes, policies, and practices.
integrity
Evaluation
16) What are five key categories of cultural competence of an organization?

o organizational norms, principles and policies (e.g., cultural competence is
an item in the organization’s budget)
o asset and need identification
o human resources and management
o services and service delivery (e.g., translation and interpretation services)
o community consultation, partnership, and information exchange
Evaluation
Objective: 6—Describe responsibilities of nurse managers and health care
organizations with respect to diversity in health care organizations
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Chapter 13 - Financial Leadership and Accountabilty in Nursing

1) The requirement to account for action, establish a relationship, and evaluate

performance are __________.
a. elements of performance
b. elements of practice
c. elements of accountability
d. elements of character
Answer: c
a. Incorrect: The element of performance refers to the requirement to account
for action, which involves judgement about performance.
b. Incorrect: Practice is not one of the six elements of accountability
identified by Fooks & Maslove (2004), which are establishment of a

relationship (between those making decision and those affected); agreed-
upon defined responsibility; delegation or conferring of authority;
answerability; performance; and sanction/correction.
c. Correct: The six elements of accountability, according to Fooks &
Maslove (2004), include: establishment of a relationship (between those
making decision and those affected); agreed-upon defined responsibility;
delegation or conferring of authority; answerability; performance; and
sanction/correction.
d. Incorrect: Character is not one of the six elements of accountability
identified by Fooks & Maslove (2004), which are establishment of a
relationship (between those making decision and those affected); agreed-
upon defined responsibility; delegation or conferring of authority;
answerability; performance; and sanction/correction.
Evaluation
Objective: 1—Discuss the meaning of accountability and the types of
accountabilities that health professionals and health care organizations have
2) Accountability in health care includes __________.

a. private enterprise accountability
b. managerial accountability
c. corporate accountability
d. executive accountability
Answer: b
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a. Incorrect: Types of accountability within health care include financial

accountability (by those who receive public resources for health care),
managerial accountability (for effective and efficient use of resources),
political accountability (elected officials need to respond to citizens and
make good on commitments), and professional accountability (for
maintaining professional standards).
b. Correct: Types of accountability within health care include financial
c. Incorrect: Types of accountability within health care include financial

d. Incorrect: Types of accountability within health care include financial
Evaluation
3) A patient has been on a nursing unit for a few weeks. He is being administered one
medication that is delivered twice daily and costs $750 per dose. Dealing with this cost
would fall under which of the following responsibilities of the nurse manager?
a. human resource management
b. asset management
c. time management
d. supplies management
Answer: d
a. Incorrect: This is an example of supplies management. Human resource
management refers to working with people and managing human
resources in a way that is cost-effective in achieving organizational goals.
b. Incorrect: This is an example of supplies management. Asset management
refers to the assessment, planning, and purchase of equipment for
facilities, as well as the upgrade or maintenance and care of these.
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c. Incorrect: This is an example of supplies management. Time management

is not an element of resource management, which includes human
resource management, asset management, and supplies management.
d. Correct: Supplies management includes such things as food, drugs,
cleaning materials, and one-use products.
Evaluation
Objective: 2—Describe the responsibilities that nurse leaders have in managing
resources of all types
4) Determining the staffing numbers for each shift and assessing how much training the
staff will require are part of which aspect of management?
a. human resource management
b. asset management
c. time management
d. supplies management
Answer: b
a. Incorrect: This is an example of asset management. Human resource
management refers to working with people and managing human
resources in a way that is cost-effective in achieving organizational goals.
b. Correct: Asset management refers to the assessment, planning, and
purchase of equipment for facilities, as well as the upgrade or maintenance
and care of these.
c. Incorrect: This is an example of asset management. Time management is
not an element of resource management, which includes human resource
management, asset management, and supplies management.
d. Incorrect: This is an example of asset management. Supplies management
includes such things as food, drugs, cleaning materials, and one-use
products.
Evaluation
5) The __________ budget includes the normal operating expenses expected in the daily
functioning of the organization and has fairly detailed categories.
a. operating
b. capital
c. program
d. asset
Answer: a
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a. Correct: The operating budget refers to the budget of estimated revenues
and expenses for the daily operation of an organization over a period of
time, normally a one-year period. It includes the normal operating
expenses expected in the daily functioning of the organization and has
fairly detailed categories.
b. Incorrect: The capital budget refers to budgets developed for purchase of
items that endure (e.g., equipment that lasts a number of years).
c. Incorrect: The program budget is a financial plan for a specific area of
activity, a planned new activity or service, or a special project.
d. Incorrect: This is not one of the three budgets commonly referred to in
discussions of organizational budgets in health care.
Evaluation
Objective: 3—Differentiate between operating budgets and capital budgets, and
identify different approaches to budgeting
6) __________ has been said to lead to bloated budgets and fails to scrutinize costs in
depth.
a. Balanced scorecard
b. Incremental budgeting
c. Zero-based budgeting
d. Timeline budgeting
Answer: b
a. Incorrect: Balanced scorecard is not a form of budgeting, but refers to
collecting and reporting on data from several perspectives.
b. Correct: In incremental budgeting, most of the change in an operating
budget from one year to the next is based on how much the budget should
increase based on the assumption that the only change required is a cost-
of-living increase. There are concerns that this type of budgeting leads to
bloated budgets, because the focus of discussions is about relatively minor
adjustments and there may be a failure to scrutinize costs in depth.
c. Incorrect: Zero-based budgeting is a methodology that requires beginning
from zero for each cost and building the budget from the ground up.
d. Incorrect: Timeline budgeting is not an approach used by health care
organizations.
and maintenance
Evaluation
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7) Mortgage payments for a long-term care facility are a __________.

a. fixed indirect cost
b. fixed direct cost
c. variable indirect cost
d. variable direct cost
Answer: a
a. Correct: Mortgage payments for a long-term care facility are an example
of a fixed (do not vary with volume) indirect (general) cost.
b. Incorrect: Mortgage payments are not a direct (service) cost but an indirect
(general) cost.
c. Incorrect: Mortgage payments are not variable (i.e., they are not an
expense that varies with volume).
d. Incorrect: Mortgage payments are not variable (i.e., they are not an
expense that varies with volume).

Evaluation
Objective: 4—Differentiate between and identify fixed, variable, direct, and
indirect costs in your workplace
8) Vaccinations for H1N1 are considered a __________.

a. fixed indirect cost
b. fixed direct cost
c. variable indirect cost
d. variable direct cost
Answer: d
a. Incorrect: Vaccine costs are variable (the expense varies with volume) and
direct (a service), not indirect (general) costs.
b. Incorrect: Vaccine costs are variable (the expense varies with volume).
c. Incorrect: Vaccine costs are direct (a service), not indirect (general) costs.
d. Correct: Vaccine costs are variable (the expense varies with volume) and
direct (a service).
Evaluation
9) The process of operational budgeting in a health care organization begins __________.

a. many months before the budget is submitted for approval
b. the first day of the fiscal year
c. the last day of the fiscal year
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d. once input is received from external stakeholders
Answer: a
a. Correct: The budgeting process begins in large health care organizations
many months before the budget is submitted for approval to a governing
body.
b. Incorrect: The budgeting process begins in large health care organizations
body, not on a specific day of fiscal the year.
c. Incorrect: The budgeting process begins in large health care organizations
body, not on a specific day of fiscal the year.
d. Incorrect: In the budgeting process for health care organizations, input is
received from both internal and external stakeholders.
and maintenance

Evaluation
Objective: 5—Describe the process of operational budgeting in a health care
organization
10) Finance departments in large health care organizations __________.

a. provide guidance, timelines, and templates to nursing units
b. complete the budget for all nursing units
c. collate information from various templates provided by nursing units
d. manage payroll and organizational expenses only
Answer: a
a. Correct: In large organizations, a finance department prepares guidelines,
a timeline, and financial expertise to managers of nursing units as they
prepare and develop their budgets.
b. Incorrect: The finance department provides guidelines, timelines, and
financial expertise, but does not actually prepare the budgets for nursing
units.
c. Incorrect: The finance department may provide templates to nursing units,
but does not collate information provided by nursing units. It collates
budgets provided by various units into a total budget for the organization.
d. Incorrect: The finance department collects budgets related to all expenses
in a health care organization. These may include, but are not limited to,
payroll and organizational expenses.
and maintenance
Evaluation
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Objective: 5—Describe the process of operational budgeting in a health care

organization
11) A balanced scorecard collects and reports on data from the following perspectives:
__________.
a. external processes, innovation, supply chain, and financial
b. customer, internal processes, innovation, and financial
c. length of stay, medical procedures, and clinical outcomes
d. clinical outcomes, customer, financial, and innovation
Answer: b
a. Incorrect: A balanced scorecard refers to collecting and reporting data
from several perspectives—the customer, the core business or internal
processes, learning and innovation for improvement, and the financial or
shareholder perspective.
b. Correct: A balanced scorecard is an approach developed for the business
sector to examine performance and refers to collecting and reporting data

c. Incorrect: A balanced scorecard refers to collecting and reporting data
d. Incorrect: A balanced scorecard refers to collecting and reporting data
and maintenance
Evaluation
Objective: 6—Discuss the challenge of balancing financial performance and
quality improvement in nursing
12) Which kind of analysis would be used to compare the costs of renal dialysis for a
patient for 10 years to the costs of renal transplantation?
a. cost-minimization analysis
b. cost-effective analysis
c. cost-utility analysis
d. cost-benefit analysis
Answer: a
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a. Correct: Cost-minimization analysis is used when two approaches or

programs are known to have essentially the same results or outcomes. This
form of evaluation is done to compare the costs and determine the
approach that uses the fewest health care resources.
b. Incorrect: Cost-effective analysis can be used when approaches or
programs have the same kind of outcome of interest.
c. Incorrect: Cost-utility analysis examines outcomes using a generic
measure that enables comparison between alternative approaches to a
health program.
d. Incorrect: Cost-benefit analysis involves comparing costs and benefits in
monetary units. The results of the analysis may be expressed as a ratio of
costs to benefits, or as a net benefit or net loss sum from choosing one
program over another.
and maintenance
Evaluation

13) What are the six elements of accountability? Provide an example for each.

o establishment of a relationship (e.g., a relationship is required between
those making decisions and those affected)
o agreed-upon defined responsibility (defined responsibilities are decided
between the parties so that decisions and actions can be taken by the one
who is accountable)
o delegate or confer authority (those with the authority to take action can
delegate to others)
o answerability (those who are accountable, answer for decisions and
actions, and justify and explain them; answers may be public ones)
o performance (the requirement to account for action; involves judgement
about performance)
o sanction/correction (requirement for correcting for unmet standard of
performance)
Examples of each element will vary.
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Evaluation
14) Provide an example of each of the following types of management.
a) asset management
b) human resource management
c) supplies management

o asset management
o planning and purchase of equipment or facilities
o upgrade or maintenance and care of equipment/facilities
o assessment of new technologies
o planning new facilities or upgrading current facilities
o purchasing or upgrading equipment

o determining priority expenditure
o determining staffing and training requirements
o human resource management
o working with people and managing human resources in a way that
is cost-effective in achieving the organizational goals
o use all of their knowledge and skill to make wise decisions
o influence other decision makers in the organization
o supplies management
o food, drugs, cleaning materials, and one-use products
o analyze financial and inventory control reports to ensure the
appropriate use of materials

Evaluation
15) Indicate whether each of the following would fall under an operating, capital, or
program budget:
a) supplies for the operating room

b) a new monitoring system for the operating room
c) new stretchers for the entire hospital
d) the development of a new family support program
e) construction of a new waiting room
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a) supplies for the operating room—operating budget
b) a new monitoring system for the operating room—capital budget
c) new stretchers for the entire hospital—capital budget
d) the development of a new family support program—program budget
e) construction of a new waiting room—capital budget
and maintenance
Evaluation
16) Define and provide an example of each of the following.
a) fixed costs
b) variable costs
c) direct costs
d) indirect costs

o fixed costs—costs that do not vary with changes in volume of services
(examples: rent or mortgage payments; maintenance and security; salaries
and benefits; repairs; insurance; hydro; snow removal and landscaping;
telecommunications; office printing; office staff training)
o variable costs—costs that change as volume of services increases or
decreases (examples: cleaning services; travel expenses; home care;
medical supplies; medications and vaccines; diagnostic supplies)
o direct costs—costs that are attributable to the provision of care (examples:
direct care nursing salaries; transportation; vehicle repair and
maintenance; linen supplies; professional consultation)
o indirect costs—costs that support direct care but do not directly involve
care to patients; sometimes referred to as overhead costs (examples:
human resources office; housekeeping repairs; insurance; rent or mortgage
payments; computers; office training)
and maintenance
Evaluation
17) Discuss the concept of balanced scorecard budgeting.
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Answer: Correct answer should mention the following.

 Balanced scorecard budgeting is collecting and reporting on data from
several perspectives—the customer, the core business or internal
and maintenance
Evaluation
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Chapter 14 - Ethical Leadership and the Context for Ethical Practice

in Health Care Organizations
1) A nurse in a long-term care facility is aware that a patient’s death is imminent. The
patient does not have any family and there is no one with the patient. They are short-
staffed on the night shift and the nurse knows that the patient is frightened of dying alone.
The patient is unconscious and appears comfortable when the nurse checks on him, but a
short time later she realizes he has died alone. This is an example of __________.
a. moral agency
b. moral distress
c. power imbalance
d. character flaw
Answer: b
a. Incorrect: This is an example of moral distress. Moral agency is the
capacity or power of a nurse to direct his/her motives and actions to some
ethical end.
b. Correct: Moral distress occurs when one knows the right thing to do, but
institutional constraints make it nearly impossible to pursue the right
course of action.
c. Incorrect: Power imbalance is not a concept related to ethics in the
workplace.
d. Incorrect: Character flaw is not a concept related to ethics in the
workplace.
integrity
Evaluation
Objective: 1—Discuss the concepts of moral agency, moral distress, and moral
climate
2) A nurse in a long-term care facility is aware that a patient’s death is imminent. The
patient does not have any family and there is no one with the patient. They are short-
staffed on the night shift and the nurse knows that the patient is frightened of dying alone.
The patient is unconscious and appears comfortable when the nurse checks on him, but a
short time later she realizes he has died alone. The nurse is unable to sleep for many days
after this patient’s death and is anxious about returning to work, fearing this situation
may repeat itself. This is an example of __________.
a. moral agency
b. moral distress
c. moral residue
______________________________________________________________________________________________
143 | P a g e

______________________________________________________________________________________________
d. power imbalance
Answer: c
a. Incorrect: Moral agency refers to the ability to deliberate, choose, express,
and act upon moral responsibilities.
b. Incorrect: Moral distress occurs when one knows the right thing to do, but
institutional constraints make it nearly impossible to pursue the right
course of action.
c. Correct: Moral residue refers to the lingering guilt or feelings that persist
with unresolved moral distress, or from acting in a way that is inconsistent
with moral values due to choice or external constraints.
d. Incorrect: Power imbalance is not a concept related to ethics in the
workplace.
integrity
Evaluation
climate
3) A nurse manager who influences his staff through role-modelling and communicating
the importance of ethical standards can be described as __________.
a. ethically efficient
b. an ethical follower
c. an ethical leader
d. ethically sound
Answer: c
a. Incorrect: Ethical efficiency is not a concept related to ethical leadership
and ethics in the workplace.
b. Incorrect: This is an example of an ethical leader, not an ethical follower.
c. Correct: Ethical leadership theory proposes that ethical leaders influence
the conduct of followers and the ethical decision making of these
employees through role-modelling and communicating the importance of
ethical standards.
d. Incorrect: Ethically sound is not a characteristic of a nurse manager. This
nurse manager is demonstrating ethical leadership.
integrity
Evaluation
Objective: 2—Discuss the concept of character and the characteristics of ethical
leadership
______________________________________________________________________________________________
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______________________________________________________________________________________________
4) Character is __________.
a. a moral component that is the same as values and personality
b. not important for leadership
c. affected by context
d. cannot be developed
Answer: c
a. Incorrect: Character is a moral component that is distinct from values and
from personality.
b. Incorrect: Character is an important component of effective leadership.
Character-based leadership is focused on qualities aimed at the betterment
of society, as well as personal qualities aimed at improvement of
individuals.
c. Correct: Character refers to a multidimensional concept that includes
moral discipline, moral attachment, and moral autonomy. Character
implies habitual quality to act in moral way, but is affected by context.
d. Incorrect: Character can be developed over time, as it resides within the

leader.
integrity
Evaluation
leadership
5) In a health care setting, the issue of informed consent for patients participating in a
study post-surgery is considered to be a matter of __________.
a. organizational ethics
b. clinical ethics
c. bioethics
d. research ethics
Answer: d
a. Incorrect: Organizational ethics generally refers to administrative and
management ethical issues.
b. Incorrect: Clinical ethics focuses on issues that arise for patients and
health care providers in the provision of health care.
c. Incorrect: Bioethics refers to the ethics of biological and medical research
and practice.
d. Correct: Research ethics refers to the policies on ethical review and
monitoring of health care studies that are conducted within a health care
organization. Some system of review of research proposals is established
by organizations to ensure that such issues as consent, considerations of
______________________________________________________________________________________________
145 | P a g e

______________________________________________________________________________________________
benefits and burdens, and scientific merit are addressed before approval to
proceed with research is provided by an organization.
Evaluation
Objective: 3—Describe qualities of a workplace that would promote a positive
ethical climate
6) A workplace that promotes a positive ethical climate has __________.

a. an ethics framework and an ethics committee in place that works so well that there is
no need for monitoring its activities
b. an ethics framework in place and all matters related to ethics are managed by the
bioethicist on staff
c. developed and implemented an ethics framework and has an assigned person to
monitor the processes for ethics
d. developed and implemented an ethics framework and has improved the knowledge of
all health care providers in the organization
Answer: c
a. Incorrect: There is always a need to monitor a workplace environment to
ensure that its activities are ethical.
b. Incorrect: Either a clinical ethicist or bioethicist may be on staff to work
with health care professionals, patients, and families to address issues and
provide support for decision making in difficult situations.
c. Correct: A workplace that promotes a positive ethical climate has an
ethical framework in place that defines the formal processes for managing
ethical issues, and includes a process for reviewing the ethics of research
conducted in the organization.
d. Incorrect: An ethics framework is important in the workplace, but this is
only one of the aspects required in providing a positive ethical climate for
employees, in addition to having a Code of Ethics, ethics committees,
ethics education, and a clinical ethicist on staff.
Evaluation
ethical climate
7) Nurses in a recovery room have reported to their manager that the aging bedside
monitors are unreliable and they are concerned that patient care is being compromised as
a result. The nurse manager draws on the nursing code of ethics and standards to argue to
the administration that funding for new monitors is required immediately. What has the
nurse manager promoted?
a. more complaints about all the equipment that the nurses would like to see improved
______________________________________________________________________________________________
146 | P a g e

______________________________________________________________________________________________
b. ethical practice in the workplace

c. standard of practice in the workplace
d. a capital budget request
Answer: b
a. Incorrect: The nurse has not promoted a scenario in which nurses will
continue to complain about all of the equipment they would like to see
improved. She has demonstrated ethical practice because she has reported
a situation in which patient care could be compromised if the faulty
equipment is not replaced.
b. Correct: The nurse manager has demonstrated ethical practice in the
workplace.
c. Incorrect: The nurse has promoted ethical behaviour to ensure patient
safety.
d. Incorrect: The nurse has promoted ethical behaviour to ensure patient
safety. In this case, the request may impact the capital budget, but that is
not what the nurse is promoting directly.

Evaluation
Objective: 4—Discuss ways in which nursing leaders can promote ethical
practice in the workplace
8) Ethics debriefings, patient safety projects, ethics research, and integration of ethics
works are all examples of __________.
a. promoting ethics in the workplace
b. promoting scholarship in the workplace
c. promoting communication in the workplace
d. promoting research in the workplace
Answer: a
a. Correct: These are all examples of promoting ethics in the workplace.
b. Incorrect: These are example of promoting ethics in the workplace.
c. Incorrect: These are example of promoting ethics in the workplace.
d. Incorrect: These are example of promoting ethics in the workplace.
and maintenance
Evaluation
9) An ethics committee typically __________.

a. plans and organizes ethics education
______________________________________________________________________________________________
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______________________________________________________________________________________________
b. includes only front-line care providers

c. is always consulted in acute care hospitals when a dilemma arises
d. is only available for consultation to patients and their families
Answer: a
a. Correct: Ethics committees are advisory in nature. One of the roles of an
ethics committee is to organize ethics education.
b. Incorrect: A clinical ethicist, not an ethics committee, provides front-line
care to health care workers, patients, and their families.
c. Incorrect: A clinical ethicist, not an ethics committee, may be consulted in
an acute care hospital when a dilemma arises.
d. Incorrect: An ethics committee provides consultation to those who work or
volunteer in health care settings, not to patients and families.
and maintenance
Evaluation
10) When a hospital has a Code of Conduct and/or a Patient Bill of Rights, __________.
a. nurses are to follow these guidelines and not the code of ethics from their regulatory
body
b. nurses are to be familiar with them and endeavor to adhere to these, as well as the code
of ethics or standards from their regulatory body
c. nurses need not know about them because their regulatory body sets their standards of
ethics
d. nurses should examine both documents and choose which they prefer to follow in their
practice
Answer: b
a. Incorrect: Nurses must follow both the ethical guidelines of the
organization in which they work and the ethical guidelines put forth by
their regulatory body.
b. Correct: Nurses must be familiar with their hospital’s code of ethics or
patient bill of rights, as well as the code of ethics or nursing standards
document put forth by their regulatory body.
c. Incorrect: Nurses must follow both the ethical guidelines of the
their regulatory body.
d. Incorrect: Nurses must follow both the ethical guidelines of the
their regulatory body. They do not have the option to follow only one set
of guidelines over the other.
______________________________________________________________________________________________
148 | P a g e

______________________________________________________________________________________________
Evaluation
Objective: 5—Identify resources for ethics in the workplace and discuss their use
in supporting ethical practice
11) Identify three internal and three external constraints that can lead to moral distress.
Answer: Correct answers may include the following points.

o External constraints: physicians; law; nursing administration; hospital
administration/policy
o Internal constraints: fear of job loss; self-doubt; sense of futility based on
previous experience
integrity
Evaluation
climate
12) Provide some examples ethical leadership.

o Ethical leaders emphasize altruism, integrity, and role modelling.
o Ethical leaders focus on moral management and awareness of others.
o Ethical leaders emphasize ethical standards.
o Ethical leaders influence the conduct of followers and the ethical decision
making of these employees through role modelling and communicating
the importance of ethical standards.
Client need per NCLEX: safe and effective care management

Evaluation
leadership
13) Provide an example of an ethical dilemma in each of the following areas.
a) clinical ethics
b) organizational ethics
______________________________________________________________________________________________
149 | P a g e

______________________________________________________________________________________________
c) research ethics

Client need per NCLEX: safe and effective environment, psychological
Evaluation
ethical climate
14) What should the membership of an ethics committee look like? What will their role
be in the organization?

o typically interdisciplinary (nursing, medicine, administration, law, ethics,
clergy, board members, etc.)
o plan and organize ethics education
o consult health professionals and/or patients and families with respect to

clinical ethical issues
o some evidence shows that health professionals do not consult ethics
committees when they are dealing with an ethical issue

Evaluation
15) What is the role of a clinical ethicist? What academic preparation would you expect a
clinical ethicist to have?

o A clinical ethicist is a position found in most large teaching hospitals.
o A clinical ethicist is an individual with graduate preparation in philosophy,
ethics, bioethics, or health care ethics. Typically, part of preparation for
role is a placement or internship in a health care setting dealing with
clinical or health care consultation.

Evaluation
______________________________________________________________________________________________
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Test Bank - Nursing Leadership and

Management, 1st Canadian Edition (Gaudine,

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Alice Gaudine, & Marianne Lamb

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Chapter 1 - Leadership in Health Care 1

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Chapter 1 - Leadership in Health Care

1) Which of the following would not be considered concepts related to leadership?

Client need per NCLEX: safe and effective care environment

2) Examples of management activities would include __________.

3) Leadership theories developed out of management theories in what order?

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4) Authoritarian style and a focus on performance and production would be behaviours

5) The term “follower” has replaced which of the following terms?

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Client need per NCLEX: safe and effective care environment

6) Which of the following is not a basic tenet of active followership theory?

7) Resonant leadership styles __________.

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8) Which of the following aspects of authentic leadership is particularly relevant to

9) The health care field is interested in developing research related to emotional

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Rationale for Correct Answer:

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Rationale for Correct Answer:

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Integrated Nursing Process: Assessment, Evaluation

Short Answer Questions

15) Compare and contrast the concepts of management and leadership.

o Management is a process that involves directing activities within an

Integrated Nursing Process: Assessment, Evaluation

17) Provide examples of each of the following.

Answer: An example for A would be a well-respected nurse in a clinical unit that

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o Strengths: useful in crisis to get a change in a situation; useful with

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19) Discuss emotional intelligence and its relationship to nursing.

o It is believed that nurses ought to be emotionally intelligent because

nursing is a profession that deals with human emotion and understanding.

o Autocratic behaviours (authoritarian; directive; focused on task or

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Objective: 6—Identify leadership behaviours in the various communities in

o Positive outcomes such as job satisfaction, accountability, decreased job

Client need per NCLEX: safe and effective care environment,

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Chapter 2 - Healthcare Management and the Canadian Context

1) Fayol’s principles of management that continue today include __________.

2) Fayol’s categories of management functions include __________.

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3) Concerns of __________ include dealing with complexity and producing results,

4) _________ includes motivating, inspiring, and empowering people to pursue change

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available to all citizens and are designed and delivered by government-

6) Canada’s health care system is classified as __________.

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government carries responsibility for a limited range of health services,

8) In Canada, the ___________ level of government has no obligation to health care.

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9) __________ is the comprehensive system of essential health care that is focused on

a. Secondary health care

10) __________ is most often funded by the provincial governments, governed by