Leadership And Management In Nursing 4th Edition By Grohar Murray – Test Bank

Grohar-Murray

Chapter 11: Monitoring and Improving Performance

Learning Objective 1

Describe the appraisal system.

1. The nurse manager is conducting a performance appraisal interview with the nurse.  Which of the following questions posed by the nurse manager yields the most information about the strength of their health care organization?
2. “Where do you see yourself in five years?”
3. “How does the work of our department contribute to the organization’s mission?”
4. “Do you have any ideas about some possible research that our unit could perform?”
5. “How are you getting along with the other members of this department?

Answer: 2

Rationale: All of these questions are appropriate for the nurse manager to ask during a performance appraisal interview. The nurse manager must understand the nurse’s future goals to discover the best ways to reward the nurse. Ideas for research opportunities can be developed during a performance appraisal. It is important to promote team cohesion. However, the best way to evaluate the overall strength of the organization is to evaluate the nurse’s contribution to and understanding about the overall mission of the organization. This information from the nurse helps ensure that organizational goals are being met by individuals and departments.

Nursing Process: Evaluation

Category of Client Need: Safe, Effective Care Environment

Cognitive Level: Application

2. The nurse and the nurse manager are discussing Sigma Theta Tau’s “8 Skills for a Healthy Career.” Which of the following statements by the nurse indicates the nurse is implementing or intends to implement one of these skills? Select all that apply.
3. “I enrolled in a new class about personal finances.”
4. “I made an appointment to talk to the education department about these new cardiac monitors. I’m tired of new things being forced down our throats every time we turn around.”
5. “After I retire, I’m going to take a Spanish class.”
6. “Have you read about the new research about pain control for surgical patients? We should see if we could try some of the principles here.”
7. “I volunteer as a parish nurse at our church.”

Answer: 1; 3; 4; 5

Rationale:

• “I enrolled in a new class about personal finances.” According to the “8 Skills for a Healthy Career,” nurses must continue to perform self-development activities, be able to locate resources, and learn financial principles. Nurses need to study current information from professional organizations, develop leadership skills, and identify their mentors.  Learning a second language is advised. Nurses must educate themselves about new technological advances, and position themselves for recognition in the community and in their profession. It is important to remain active professionally during retirement. It is advisable to enroll in a class about finances.
• “I made an appointment to talk to the education department about these new cardiac monitors. I’m tired of new things being forced down our throats every time we turn around.” It is important to remain flexible. Opportunities for learning about new technology, equipment, or skills should be welcomed.
• “After I retire, I’m going to take a Spanish class.” It is advisable to learn a second language.
• “Have you read about the new research about pain control for surgical patients? We should see if we could try some of the principles here.” It is important to stay current about new professional research.
• “I volunteer as a parish nurse at our church.” Volunteering within the community is advised, and puts nurses in a position for recognition.

Nursing Process: Evaluation

Category of Client Need: Safe, Effective Care Environment

Cognitive Level: Application

3. The hospitalized client is having a discussion with the physician. Which of the following client issues will the physician typically focus on?
4. The client’s lack of compliance with coughing and deep-breathing exercises after major abdominal surgery.
5. The client’s estrangement from her daughter.
6. The client’s perceived issues with financial insecurity.
7. Pathophysiological principles, treatment, and diagnostic testing related to the client’s new diagnosis of colon cancer.

Answer: 4

Rationale: Physicians typically approach clients with an application of pathophysiological principles and the desire to cure or treat the client. Social workers approach clients as individuals. They can assist with finances, food, clothing, and shelter. Nurses have been taught to use a holistic view of the client. Their focus would be to encourage coughing and deep-breathing exercises following surgery to prevent complications. The nurse may discuss the client’s estrangement with her daughter. The nurse might determine that the client feels financially insecure. Social workers are the best resources to help clients deal with their issues regarding financial insecurity.

Nursing Process: Assessment

Category of Client Need: Health Promotion and Maintenance

Cognitive Level: Application

Learning Objective 2

Identify criteria used to evaluate staff.

4. The nurse manager is conducting a performance appraisal interview with the nurse. Which of the following statements or questions indicate that the nurse might be receiving a “one-way” evaluation?
5. The nurse manager states, “Here is your performance evaluation. You can read it when you get a chance, sign it, and put it back on my desk.”
6. The nurse states, “What do you think I need to improve upon?”
7. The nurse manager states, “I think you’re becoming more assertive.”
8. The nurse states, “I’ve got to work on becoming more flexible.”

Answer: 1

Rationale: One-way evaluations occur when supervisors or staff members ignore the performance appraisal process. It is important to include the nurse in the process. The supervisor and the nurse have roles within the performance appraisal process. The process must be “two-way” to ensure that the evaluation has meaningful outcomes for the nurse and the organization. The supervisor and employee must arrange a time to sit down together to perform the evaluation interview. The nurse employee can expect guidance and direction from the supervisor. They will discuss the nurse’s goals for the future and clarify expectations. During a two-way evaluation, the nurse should ask the supervisor about specific ways to improve. The supervisor can praise the nurse for positive behaviors. The nurse can discuss areas where the nurse needs to grow and improve.

Nursing Process: Assessment

Category of Client Need: Health Promotion and Maintenance

Cognitive Level: Application

Learning Objective 3

Describe the process of an objective evaluation.

5. A nurse manager has discussed the nurse’s unprofessional behaviors with the nurse during the performance appraisal interview. Which of the following is the nurse manager’s best next course of action?
6. Encourage the nurse to change a behavior prior to the next annual evaluation.
7. Schedule a follow-up interim evaluation with the nurse to monitor the nurse’s progress.
8. Speak to the nurse’s peers about the nurse’s negative evaluation and request that they monitor the nurse for progress.
9. Terminate the nurse from the organization.

Answer: 2

Rationale: The nurse manager should encourage the nurse to change their behavior prior to an evaluation, however the evaluation should be scheduled much sooner than the annual evaluation. The nurse manager should monitor the nurse’s progress and evaluate the nurse at an agreed-upon interim performance appraisal interview. The nurse manager should not share information about the negative evaluation with the nurse’s peers. This information should be held privately. Unless the nurse has committed something that the organization has deemed as termination-worthy, the nurse should be encouraged to change their behaviors, continue to be monitored, and evaluated again in several months.

Nursing Process: Implementation

Category of Client Need: Health Promotion and Maintenance

Cognitive Level: Application

Learning Objective 4

List the elements of the performance appraisal system.

6. The nurse manager is conducting a performance appraisal interview with a nurse. Which of the following might occur during this process? Select all that apply.
7. The nurse learns that their position has been terminated due to budgeting constraints.
8. The nurse is in charge of conducting the meeting with the nurse manager.
9. The nurse manager learns that the nurse speaks fluent Spanish.
10. The nurse manager dictates specific goals for the nurse.
11. The nurse manager learns that the nurse does not feel comfortable using the new patient controlled analgesic pumps.

Answer: 3; 5

Rationale:

• “The nurse learns that their position has been terminated due to budgeting constraints.”

The nurse should not learn that their position has been terminated during the performance appraisal interview. This sort of information should be shared in a separate, private meeting.

• “The nurse is in charge of conducting the meeting with the nurse manager.” The nursing manager is in charge of conducting the meeting with the nurse, not the other way around.
• “The nurse manager learns that the nurse speaks fluent Spanish.” The nurse manager might learn about unrecognized resources, talents, or skills within the nurse.
• “The nurse manager dictates specific goals for the nurse.”  The nurse should create a list of future goals and share them with the nurse manager. The nurse manager can assist the nurse with fine-tuning some goals to meet department or organizational needs.
• “The nurse manager learns that the nurse does not feel comfortable using the new patient controlled analgesic pumps.” The nurse manager can expect to identify staff training needs during this interview.

Nursing Process: Implementation

Category of Client Need: Health Promotion and Maintenance

Cognitive Level: Application

7. The nurse has been selected to act as a member of an interdisciplinary care team. Which of the following statements by the nurse is most reflective of this nurse’s role on the team?
8. “It is important to remember that I’m a member of a team. We have to put our professional values aside.”
9. “As always, the bottom line is fiscal responsibility.”
10. “I just need to ensure that the other team members understand nursing’s view surrounding these issues”
11. “Client safety is the number one concern.”

Answer: 3

Rationale: When nurses act as members of interdisciplinary committees, they must remember that they are obligated to model and articulate the nurse’s core values and nursing principles to other team members.  The team must have a unified approach, but the team members represent their profession.  Fiscal responsibility and client safety issues are important but are not at the root of every problem explored by interdisciplinary committees.

Nursing Process: Planning

Category of Client Need: Safe, Effective Care Environment

Cognitive Level: Application

Learning Objective 5

Explain the phases in the performance appraisal system

8. The nurse manager is interviewing a nurse candidate for a staff position on the unit. Which of the following questions should be included in this interview?

1. 1. “What year were you born?”
   2. “What church do you attend?”
   3. “Where were your parents born?”
   4. “What kinds of skills were needed for your last position?”

Answer: 4

Rationale: During an interview, it is appropriate and important to determine experiences and skills that the candidate possesses. The interviewer should discuss what the new position entails and determine the candidate’s level of motivation to ensure a good fit on the unit. It is inappropriate to inquire about the candidate’s age, date of birth, race, religion, ethnicity, or culture.

Nursing Process: Implementation

Category of Client Need: Safe, Effective Care Environment

Cognitive Level: Comprehension

1. Place the following activities in order according to the performance appraisal process.

_____ The nurse manager shares the results of the evaluation process with the nurse’s immediate supervisor, per the organization’s policies.

_____ The nurse manager includes specific ways for the nurse to achieve more success.

_____ The staff nurse creates a summary of goals that the nurse has achieved since the last evaluation.

_____  The nurse manager praises the nurse for successes that have occurred since the last evaluation.

Answer:

1. The staff nurse creates a summary of goals that the nurse has achieved since the last evaluation.
2. The nurse manager praises the nurse for successes that have occurred since the last evaluation.
3. The nurse manager includes specific ways for the nurse to achieve more success.
4. The nurse manager shares the results of the evaluation process with the nurse’s immediate supervisor, per the organization’s policies.

Rationale:

The two-way performance appraisal process includes planning by the nurse manager (supervisor) and by the nurse who is being evaluated. It is important for the nurse to write down the goals that have been achieved and future goals. During the interview, the nurse manager should begin with praising the employee and later include suggestions for improvement. Following the evaluation, the nurse manager should share information about the evaluations with the nurse’s immediate supervisor. This step should be included in the organizational policy because data that are not shared cannot be used to improve processes.

Nursing Process: Implementation

Category of Client Need: Safe, Effective Care Environment

Cognitive Level: Analysis

1. The nurse manager discovers that the nurse has been arriving late to work frequently. This practice has been disruptive to the other staff members. Which of the following is the nursing manager’s best course of action?

1. The nurse manager meets with the nurse and praises the nurse’s desirable behavior.
2. The nurse manager meets with the nurse and provides information about the organization’s termination process.
3. The nurse manager meets with the nurse and provides constructive criticism about how to avoid future late arrivals.
4. The nurse manager meets with the unit’s immediate supervisor to brainstorm about methods to prevent the nurse from filing a grievance against the nurse manager.

Answer: 3

Rationale: It is important for the nurse manager to counsel with a nurse about undesirable behavior. This meeting should include constructive criticism, ways to correct the problem, and a look to the future with a positive attitude. The nurse manager should share information with the nurse about desirable behaviors, as well as the current problem. The nurse manager can brainstorm with the nurse about ways to prevent the problem from occurring. The nurse manager should seek information from the nurse to understand why the problem is occurring. Following the steps outlined when counseling the nurse will help protect the rights of the nurse and the facility.