Question 1

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?
A)Use of the performance appraisal on an annual basis
B)Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up
C)A tally sheet of medication errors and other specific problems that will be used at annual review
D)Copies of reports, placed in his or her file, of all unusual occurrences involving the employee

Accepted Answer

In documenting staff problems, it is important to specifically indicate what rules were broken or violated, consequences if behavior is not altered, employee's explanation of the incidents, and the plan of action to achieve and to reach new goals.

Question 2

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?
A)The manager could refer Stacey to the human resources department.
B)The manager could assist in monitoring Stacey's progress.
C)The manager could counsel Stacey if Stacey has formed a trusting relationship with her.
D)Stacey needs to be asked not to involve her family in the recovery program because this is a work-related situation.

Accepted Answer

Effective management demands that the organization take an active role in helping employees with special needs.Humanistic strategies that counsel and assist employees are cost-effective and necessary.

Question 3

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.

Accepted Answer

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.

Question 4

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?
A)Personality and behavioral changes
B)Job performance changes
C)Changes in educational involvement and pursuit
D)Absenteeism

Accepted Answer

A manager needs to be alerted when suspicions of chemical dependency are raised by behavioral changes in the employee.These include mood swings, changes in hygiene and appearance, heightened interest in the pain control of patients, frequent changes in shifts, increases in absenteeism, and increases in tardiness.

Question 5

Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety.The manager can implement the following steps that help to alleviate uncivil behavior on a unit.(A) Suspending the staff member from work, (B) Providing written admonishment that is discussed and placed in the employee's file, (C) Providing verbal admonishment, (D) Terminating the staff member
A)A, B, C, D
B)B, A, C, D
C)C, B, A, D
D)C, A, B, D

Accepted Answer

The steps in progressive discipline are followed from the least severe (counseling the employee) to the most severe (termination).Studies have shown that following this sequence provides a fair and effective plan for discipline and remediation.

Question 6

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, who cover for her because she is new and they like her.Which of the following is likely to be the greatest asset to Ellen in improving her performance?
A)Ignore Ellen's errors until she has more experience.
B)Instruct staff to avoid working with Ellen until she learns to how do things herself.
C)Ask Ellen to complete a self-assessment, using a standard skills checklist.
D)Encourage staff to report every behavior of Ellen's that is different from theirs.

Accepted Answer

When other employees are engaged in enabling behavior by covering for the mistakes of one of their peers, the nurse leader may be surprised to discover that the employee does not know or cannot do what is expected of him or her.The nurse leader must remind employees that part of professional responsibility is to maintain quality care and thus they are obligated to report instances of clinical incompetence, even when it means reporting a co-worker.Ignoring violations of a safety rule or poor practice is unprofessional and cannot be tolerated.The employee may be asked to do a self-assessment of the listed skills or competencies and then have performance of the skills validated by a peer or co-worker.This is a very effective method for the leader to assess the skill level of employees and to determine whether additional education and training may be necessary.

Question 7

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?
A)Suspending the staff member from work
B)Providing written admonishment that is discussed and placed in the employee's file
C)Providing verbal admonishment
D)Terminating the staff member

Accepted Answer

Dismissal does not enable the present organization to attempt remediation of the behavior and is not consistent with first steps in progressive discipline.

Question 8

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:
A)transferred to another unit.
B)suspended indefinitely.
C)asked to attend a union grievance meeting.
D)terminated after the first infraction.

Accepted Answer

Behaviors that include violence, theft, and purposeful abuse of a client are sufficiently serious to warrant immediate dismissal with the first incident.

Question 9

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:
A)discuss what you have observed with Marg.
B)file immediate documentation in Marg's personnel file.
C)ask Julie to monitor Marg's behavior during meetings.
D)ignore the behavior, as Marg is one of your strongest nurses.

Accepted Answer

Incivility must be addressed.The initial step in addressing it is discussion with Marg, and if the behavior continues, then written documentation should be filed in Marg's personnel file.Monitoring and follow-up are your responsibility as the unit manager.

Question 10

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.

Accepted Answer

The progressive model of discipline advocates that the first step of the disciplinary process is the informal reprimand or verbal admonishment.The nonpunitive discipline model advocates reminding the employee of the employment policies and procedures of the agency.

Question 11

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 most likely signal that Nathan is intending to resign from his position on the unit?
A)Increased absenteeism over the past month
B)Increased attempts to discuss his concerns with his colleagues
C)Testing of workplace guidelines
D)Frequent defensiveness

Accepted Answer

Many employees increase their absenteeism just before submitting their resignation.If the healthcare worker is experiencing some form of role stress, it might be manifested through absenteeism.Role strain may be reflected by (1) withdrawal from interaction; (2) reduced involvement with colleagues and the organization; (3) decreased commitment to the mission and the team; and (4) job dissatisfaction.Testing of workplace guidelines and defensiveness are associated with immaturity.

Question 12

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.

Accepted Answer

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.

Question 13

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.

Accepted Answer

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.

Question 14

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?
A)The chemically dependent employee usually hides any changes in behavior.
B)When confronted with the issue, the affected employee is usually relieved to have someone to talk to about the problem.
C)The chemically impaired nurse affects the entire healthcare organization.
D)Hospital policy, state laws, and nurse practice acts address procedures for the chemically dependent employee in the most general terms.

Accepted Answer

A chemically impaired nurse jeopardizes patient care through impaired skills and judgment.She or he also compromises teamwork and continuity as peers attempt to cover deficiencies in work performance for their impaired team member.

Question 15

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?
A)Dismiss or transfer Jean.
B)Document all problem areas and then discuss them with Jean.
C)Develop appropriate solutions and make recommendations to human resources.
D)Smooth over the problems if they are minor in nature.

Accepted Answer

For the employee to change and grow, specific corrective measures need to be taken.Consultation with the employee is necessary, and documentation is key to determining the issues.

Question 16

The chief nursing officer reviews the policy about "progressive discipline process." The progressive discipline process includes which of the following? The manager:
A)acts as a counselor and friend to the employee.
B)should reprimand and suspend the employee as a last resort.
C)should rehire the employee after a reasonable length of time.
D)should terminate the employee if the problem persists.

Accepted Answer

Termination can be defined as the discharge of an employee who is performing at an unsatisfactory level or who is not a good match for the organization.Termination is always considered the last resort when dealing with poor performance.

Question 17

A nurse manager must be familiar with the agency's policies regarding termination.Termination procedures include which of the following?
A)Following specific procedures from other organizations
B)Having an attorney present at the termination meeting
C)Having adequate written documentation to support the action
D)Having a friend present during the termination meeting

Accepted Answer

All steps should be followed, including full appropriate detailed documentation and following the procedures of the organization.

Question 18

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.

Accepted Answer

Reduced staffing adversely affects patient care.Employee morale suffers, care standards may be lowered, and additional stress is placed on working staff.

Question 19

The chief nursing officer understands that clinical incompetence is best prevented by a(n):
A)flexible protocol for evaluating competency skills.
B)standardized clinical skills checklist.
C)administration of personality tests and competency assessments at point of hire.
D)formalized competency program with established standards for practice.

Accepted Answer

The competency program with established standards of practice outlines what the nurse must do to achieve desired competencies in her current position.Competency assessment and goal-setting should help the nurse identify how to excel and which competencies the nurse wants to achieve in the future.

Question 20

All of the following are grounds for immediate dismissal except:
A)failing to pursue further medical help for a patient; patient dies.
B)selling narcotics obtained from the unit supply of narcotics.
C)restraining a patient in bed for 7 hours, unsupervised, as punishment for hitting a staff member.
D)grabbing the unit manager and threatening further physical harm after a poor performance appraisal.

Accepted Answer

Situations that may warrant immediate dismissal include theft, violence in the workplace, willful abuse of the patient, harassment, and chemical abuse.

Quiz 25: Managing Personal and Personnel Problems

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?

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 most important approach that a nurse manager can take with an emotionally troubled employee is to:

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?

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?

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:

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:

A nurse manager understands that the typical first step in handling an employee with a disciplinary problem is a:

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 most likely signal that Nathan is intending to resign from his position on the unit?

Before terminating an employee, a nurse manager must:

In keeping with guidelines of the organization, the nurse manager documents staff problems.Documentation of disciplinary problems should:

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 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?

The chief nursing officer reviews the policy about "progressive discipline process." The progressive discipline process includes which of the following? The manager:

A nurse manager must be familiar with the agency's policies regarding termination.Termination procedures include which of the following?

The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is that:

The chief nursing officer understands that clinical incompetence is best prevented by a(n) :

All of the following are grounds for immediate dismissal except: