 Chapter 25 Managing Personal and Personnel Problems 1. The most important approach that a nurse manager can take with an emotionally troubled employee is to: a. act as a therapist for the employee. b. adjust the standard of care to assist the employee. c. assist the employee in obtaining professional help. d. adjust the employee’s work schedule to decrease stress. Emotional difficulties are usually beyond the scope of skills that a nurse manager would normally employ. A referral needs to be made to a professional who is specifically prepared to deal with this kind of difficulty. 2. The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is that: a. using replacement personnel with new ideas may be beneficial. b. salary costs are lower because personnel are fewer, and outcome is favorable. c. absence on the part of the rest of the staff is decreased. d. unacceptable patient care may result. Reduced staffing adversely affects patient care. Employee morale suffers, care standards may be lowered, and additional stress is placed on working staff. 3. In keeping with guidelines of the organization, the nurse manager documents staff problems. Documentation of disciplinary problems should: a. include a plan to correct them and to prevent future occurrences. b. state a detailed history of past problems that are related to the current one. c. be written at the convenience of the manager. d. not be discussed until the formal performance evaluation. In documenting staff problems, it is important to identify the incident with an objective statement of facts and record actions taken to correct/prevent future problems. 4. Before terminating an employee, a nurse manager must: a. be an expert in all legal aspects of termination and discipline practices. b. follow the organization’s specific policies for addressing disciplinary problems and termination. c. function as a counselor for problem employees. d. do everything to assist and protect the employee by adjusting standards and policies. It is important to know the policies of the organization to address disciplinary issues fairly and equitably, as well as to know the model that is employed to address employee problems. Human resource departments and legal departments are important sources for consultation, advice, and support. 5. A nurse manager understands that the typical first step in handling an employee with a disciplinary problem is a: a. verbal reprimand. b. written reprimand. c. reminder of employment standards. d. day off without pay. The most important approach that a nurse manager can take with an emotionally troubled employee is to: Assist the employee in obtaining professional help. The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is that: Unacceptable patient care may result. In keeping with guidelines of the organization, the nurse manager documents staff problems.
Documentation of disciplinary problems should: Include a plan to correct them and to prevent future
occurrences. Before terminating an employee, a nurse manger must: Know the organization's specific policies for addressing disciplinary problems and termination. A nurse manager understands that the typical first step in handling an employee with a disciplinary problem is a: Reminder of employment standards. The chief nursing officer understands that clinical incompetence is best prevented by a: Formalized competency program with established standards for practice. A nurse manager understands that the second step in handling an employee with a disciplinary problem is to
document the incident. Which of the following is best for documentation of personnel problems? Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up The nurse manager places a staff member on probation because of reports of chemical dependency. The nurse manager should be aware that which of the following statements is true
regarding chemical dependency? the chemically impaired nurse affects the entire healthcare organization. The chief nursing officer reviews the policy about “progressive discipline process.” The progressive discipline process includes which of the following? The manager: Should terminate the employee if the problem persists. A nurse manager must be familiar with the agency’s
policies regarding termination. Termination procedures include which of the following? Having adequate written documentation to support the action Nathan has been on the cardiac unit for 6 months and has found it difficult to adjust to the expectations of his team. Which of the following behaviors would mostlikely signal that Nathan is intending to resign from his position on the unit? Increased absenteeism over the past month All of the following are grounds for immediate dismissal except: Failing to pursue further medical help for a patient; patient dies. The unit manager on 4E is concerned about the performance of Jean, a staff nurse. She is not involved directly with Jean, so she has not been able to determine whether the problem is one of motivation, ability, or both. If Jean lacks ability, which of the following strategies might the head nurse use? Document all problem areas and then discuss with Jean. Nurses generally experience difficulty in identifying behaviors and actions that could signal chemical dependency in a co-worker. Which of
the following is not a behavioral change that occurs with chemical dependency? Changes in educational involvement and pursuit Nurse Stacey
is a self-admitted drug addict and has been a heavy abuser of codeine. Stacey and the unit manager decide that changes have to occur. Stacey enrolls in an addiction program, and the manager has her transferred to a drug-free area. What other strategies might be appropriate? The manager could assist in monitoring Stacey's progress. Incivility is a disruptive behavior or communication that creates a negative environment and
interferes with quality patient care and safety. The manager can implement steps that help to alleviate uncivil behavior on a unit. Which of the following would not be an appropriate first step? Terminating the staff member Arrange the strategies from Question 16 in the order in which they should occur in progressive discipline. When progressive discipline is used, the steps are followed progressively only for
repeated infractions of the same rule. On some occasions, rules that are broken are so serious that the employee is: Terminated after the first infraction. During unit staff meetings, you observe that Marg rolls her eyes and snorts whenever Julia makes a comment. Your first response as a unit manager is to: Discuss what you have observed with Marg. 20 Ellen is a novice nurse on your unit. Even though she has come to you highly recommended, as her supervisor, you have noticed some knowledge and skill deficiencies. These deficiencies have been noticed by her peers as well. Which of the following is likely to be the greatest asset to Ellen
in improving her performance? Making arrangements for practice time for her in the hospital's skills lab Susan, a new graduate, is upset that so many staff have been absent lately from the unit. She declares to you that all absenteeism could be eliminated with proper management. Your response is based on understanding that: Not all absenteeism is voluntary. The nursing director calls a meeting with one of the new unit managers. She is very concerned about a report of substance abuse on the manager’s unit, and she reviews the procedures involved in dealing with
chemically dependent staff. Which of the following statements would not be included in the discussion? “As a manager, you: Should realize that the nurse is a professional embarrassment and should be kept out of sight of other staff." The education consultant for the hospital is presenting a workshop on “Documentation: A Manager’s Responsibility.” Which of the following points would she not include in her PowerPoint presentation?
Documentation: Should avoid discussion of the problem. The unit manager discusses absenteeism with the unit clerk. She indicates that it is a serious problem on the unit. Which of the following points would they have likely discussed? (Select all that apply.) Care will suffer and standards will be lowered. Clinical incompetence is one of the more serious problems facing a nurse manager. Joyce, the nurse manager, is not aware of the problems of Sarah, a novice nurse. After she investigates, it is obvious that Sarah’s peers are covering for her. Which of
the following might Joyce include in her meeting with the nurses? (Select all that apply.) "It is a nurse's professional responsibility to maintain quality control." Your healthcare
organization places a high value on workplace safety and integrates this into all aspects of administrative and patient care processes. As a unit manager, you thoroughly endorse this direction, and during the selection and hiring of new staff, you consistently: Thoroughly follow up with all references before offering a position. history of conflict with you and the staff, and who recently was charged with theft of patient belongings. You consult Human Resources, and together,
you develop a plan, which includes: A private meeting with Gregory, a Human Resources representative, and you to deliver the news and deliver the termination notice and all other documents that are related. In which of the following situations would you, as the head
nurse, be concerned about potential safety issues? Carla, RN, has just ended a relationship with Jake, RN, and he will not leave her alone. You are meeting with Jake today because colleagues on nights have reported that Jake seems to have been intoxicated last night and the previous night. Delaney, one of your staff nurses, confides that Marjorie, another nurse, has been actively telling others that you are incompetent and do not know what you are doing in relation to patient care, and that you lie to the staff about attempts to get more staffing.
Through telephone calls and conversations during breaks, she is recruiting other staff to her position. Delaney confides that most of the staff find you fair, honest, and knowledgeable. Marjorie’s behavior can best be characterized as: During coffee and other breaks, Rosalie, the new RN, is shut out of conversations with the
other staff. When she approaches other staff on the unit to ask questions, they turn and walk off in the other direction. The behavior of the staff is characteristic of: While working with an aggressive patient, it is important for the nurse to: Place herself between the patient and the door. Caroline asks family members to leave while she cares for the 16-year-old victim of a recent car accident. The father screams at her and
tells her that she has no right to ask his family to leave, and that if she continues to do so, he will “throw her out of the room.” Caroline is shaken and tells her head nurse, who tells her that this kind of thing is just part of the job. The guidance of the head nurse: Is related to why statistics on violence in health care are likely underreported. You are part of a multidisciplinary team that is charged with designing a workplace safety plan for your healthcare organization. This team has been established in response to
increases in reports of violence and aggression. You begin by: Surveying staff about levels of satisfaction with the workplace and management, collegial, and patient relations. In the Emergency Department waiting room, you notice a patient sitting, with his head in his hands, who has been waiting for about 5 hours for relief of his headache. When you approach him to ask him how he is doing, he says “I can’t believe that I have to
wait this long for help! Do you know what it is like to be in pain for 10 hours?” Your response to him would be: "It is frustrating to wait when you are in pain and when you are expecting to receive relief right away." At 3 AM, a man walks into your emergency department. He paces back and forth in the waiting area before he approaches staff to ask if he can see his
wife, who is a patient on another floor. He speaks rapidly, his face is flushed, he glances around often, and he keeps his hand in his jacket pocket. A best initial response would be to: Assess your situation and your surroundings. Linda, a staff nurse on nights, yells at Ali, another RN, and tells Ali that she is stupid and can’t get anything right. In responding to this situation as head nurse, it is critical that you: Respond to Linda in a way that is consistent with organizational processes and with similar situations. Residents in a new long-term care facility attend a large dining hall for meals. In reviewing reports of aggression and violence, you note that behaviors such as hitting, or attempting, to hit staff are increasing. Further investigation suggests that this behavior occurs most often at mealtimes. A possible intervention would be to: Establish a smaller dining area that is away from the main area that is for residents who have potential for aggression/violence. You note that Unit 64 has had a high turnover rate of staff during the past year. In investigating this situation, an important source of data might include: Exit interviews with staff. In selecting the appropriate action in Question 13, it is important that: Confidentiality is assured. In addressing the staff turnover rate in Question 13, you are: Demonstrating awareness that workplace violence, if present, has significant costs. A patient who has a history of involvement with drugs and weapons comes up to you in the hallway and asks you a question
regarding directions in treatment. When you respond, he moves closer in to you and puts both hands up on either side of your neck. No one else is in the hallway. Your best response at this point is to: Calmly ask the patient to remove his hands. Jenny tells you that she is always able to tell when others are about to become violent because they yell. Your response to Jenny is based on your understanding that: Violence is signaled by a variety of behaviors. Joe and Carol, two of the RNs on Unit 22, are discussing recent incidents on the unit that have involved patients and visitors uttering threats or making demeaning remarks to staff during evening hours. Joe observes that unless someone shoots at him, he is not
concerned because “words can’t hurt you.” Joe’s remarks: Illustrate common misperceptions about the nature of violence. Becky, RN, works as a staff nurse in mental health; Sharon works as a data entry clerk in Admissions; Sarah is an emergency room physician; and Donna is a housekeeper in geriatrics. Which of these four is most at risk for violence and aggression?
In Question 19, which of the four is most likely to be a perpetrator of violence? A safety and security plan is important to a healthcare organization because it: Establishes policies and practices that guide prevention of violence and expectations in the workplace. Sarah is involved in intervening when a patient
attempts to harm herself on the unit. During the interaction, the patient slaps Sarah across the face. As a head nurse, it is important that you: Assist with follow-up documentation and offer access to counseling. In designing a new healthcare facility, it is particularly important to pay close attention to safety elements related to violence and aggression in which of the following settings? (Select all that apply.) Emergency, Psychiatry, Gerontology A clinic nurse has observed another nurse deviating from agency policy in performing wound care. The best approach for the clinic nurse to take is to: Assess the risk to the client and the agency before proceeding. A good nursing decision maker is one who: Uses various models to guide the process based on the circumstances of the situation. After the nurses who work on an adolescent
psychiatric unit have had a brainstorming session, they are ready to resolve the problem of teenagers who are unmanageable. To maximize group effectiveness in decision making and problem solving, the nurse manager has: Encouraged equal participation among members. An outpatient surgery manager is evaluating infusion pumps for the operating room. The manager should: Use a decision-making tool to evaluate brands. Decision making is described by the nursing educator as the process one uses to: Choose between alternatives. During a fire drill, several psychiatric patients become agitated. The nurse manager quickly assigns a staff member to each patient. This autocratic decision style is most appropriate for: From the information supplied in this chapter, which statements best defines critical thinking? Critical thinking is a: High-level cognitive process that includes creativity, problem solving, and decision making. High-quality decisions are most likely to be made in nursing situations when: Group size is neither too small nor too large. ane, an experienced head nurse, is given the task of completing the summer vacation schedule for the pediatric unit. She is fully aware of the
hospital's restrictions on time off and the number of staff on vacation at any given time, as well as its issues regarding seniority. She weighs the options of allowing staff choice, such as it takes more time but gives employees options. However, if choice is allowed, this could cause arguments. Which of the following is the best alternative? Post a blank schedule, and ask staff members to fill in their times by a given date. John Smith, one of three managers at BSG Labs, drafted a policy that would allow his
department to do more testing in his lab. This policy included the times for regular collection as well as a new process for emergency laboratory testing. The policy and procedures were never followed. The reason was that: The policy made decisions for other departments in the company. Justin is a nurse manager in a rehabilitation unit in a small urban center. There is a high turnover rate among rehab-assistants because of the heavy work assignments. Justin decides to hire new staff in the order that applications are
received until all vacant positions are filled. Which of the following decision-making models did Justin use in making his decision? Knowing when to have the entire team participate in the decision-making process or when to have only the team leader make the decisions depends upon the situation and the desired
outcomes. The autocratic process is used in which of the following situations? The task and the outcome are relatively simple. Select the statement that best defines the difference between problem solving and decision making: Decision making is a goal-directed effort, problem solving is focused on solving an immediate problem. Several nurses on an adolescent psychiatric unit complain that the teens are becoming unmanageable on the 11-7 shift. To
resolve this problem, the nurse manager decides that the staff should have a brainstorming session. The goal of brainstorming is to: Generate as many solutions as possible. Sue, a nurse manager, has a staff nurse that has been absent a great deal for the past three months. A whistleblower gives some information to Sue indicating that the staff nurse will be resigning and returning to school. Because of this, Sue decides to do which of the following? The clinic nurse understands that problem solving is best defined as: Identifying the gap between "what is" and "what should be." The maintenance department wishes to have the nursing lounge renovated, so the lounge will be more "user-friendly." The department asks the nursing staff to make a wish list of everything that they would like to see in the new lounge. This process is an example of which part of the decision-making
process? Assessment/Data collection The nurse manager of a rehab unit wants to purchase a new anti-embolic stocking. To make a high-quality decision, the nurse manager
would: Involve the rehab staff in the decision. The risk manager informs the nurse manager of an orthopedic unit that her unit
has had an increase in incident reports about patients falling during the 11-7 shift. The nurse manager knows that the best way to resolve the problem is to: The risk manager wants to evaluate the reasons for an increased number of falls on the rehab unit. The risk manager devises a
fishbone diagram. A fishbone diagram is a useful tool to: Identify the root causes of problems. To solve
a problem, the nurse manager understands that the most important problem-solving step is: Accurate identification of the problem. When confronted with the controversy and the apparent poor morale of the evening staff, the unit manager decided the staff needed to take some time off. He scheduled holidays for the staff without consulting them. A couple of the staff nurses approached the manager and indicated that the problem was not scheduling, but rather the team leader and her patient assignments. What was the unit manager's first missed step in problem solving? Incorrect problem identification When decision making, critical thinking, and problem solving are considered, which of the following
statements are accurate and valid points? Many models aid the nurse in improving his or her decision-making skills. Which of the following decision-making solutions should Justin (Question 17) consider to have a more efficient department? Consider all the options listed. What should be the first thing considered before delegating a specific task?Before delegating a task, a nurse manager should: Assess the amount of guidance and support needed in a particular situation. A key advantage that a nurse manager has in terms of delegating is that: Team skills can be used more effectively.
Which task should the nurse delegate to the experienced unlicensed assistive personnel?Routine tasks, such as taking vital signs, supervising ambulation, bed making, assisting with hygiene, and activities of daily living, can be delegated to an experienced UAP.
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Which is the most important approach that a nurse manager can take with an emotionally troubled employee?
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