Question 1

The nurse has been assigned to be a change agent for the facility's change to a computerized charting system. What type of planning will this require?

Accepted Answer

1. Strategic planning will not be necessary because changes will not be made to the organizations' departments or services provided.
2. This change probably will not change the value system, nor will laws and regulations be changing. Therefore, policy planning will not be necessary.
3. Since this change involves a specific time-limited initiative for the nursing department, this requires project planning.
4. Strategic planning will not be necessary because changes will not be made to the organizations' departments or services provided. Project planning will be required.

Question 2

The staff of a healthcare organization is burned out and apathetic, and the organization is stagnant. The newly employed leader is working to empower staff, improve the organization's vision, and alter the culture of accepting the status quo. According to Quinn, what is this leader trying to create?

Accepted Answer

1. This is part of Lewin's theory of change and is not applicable to this scenario.
2. This is what the organization is experiencing. The leader is trying to turn this situation around.
3. This is a strategy of Lewin's theory of change.
4. Quinn says that in order to avoid a "slow death" leaders must create a "deep change."

Question 3

The nurse manager is developing a staff education session on change in healthcare. Which concepts should be included in this information? Select all that apply.

Accepted Answer

1. This is certainly a pertinent topic in today's healthcare environment.
2. Important examples of change are related to the organization's structure, but change is also affecting roles and responsibilities, communication methods and systems, policies and standards, culture, leadership and management approaches, and competencies and attitudes.
3. This is certainly a pertinent topic in today's healthcare environment.
4. The equilibrium does become disturbed, so staff must learn to tolerate this equilibrium in order to be effective.
5. This is certainly a pertinent topic in today's healthcare environment.

Question 4

The nurse manager is coping with a staff member who is very resistant to change. Which strategy would be beneficial for this nurse manager?

Accepted Answer

1. Having an open and trusting relationship with staff will help to reduce resistance to change.
2. Focusing on parts and being unable to see the whole picture can result in territoriality.
3. Staff will not be innovative if managers over-direct, over-observe, or over-report.
4. Staff with hidden agendas or motives are barriers to change and should not be ignored.

Question 5

A new management company has acquired a hospital. Since the acquisition, the hospital's name has changed, a new vision statement has been distributed, the department structure has changed, and the staff's cafeteria discount has be eliminated. Management has plans for many additional changes. What should happen at this point?

Accepted Answer

1. This staff has experienced significant changes and may need a break from change for a few months.
2. This option would have the effect of keeping the staff out of equilibrium.
3. It is not necessary to abandon plans for the changes, but staff needs to be free of changes for a period of time.
4. This quick strike method may result in irretrievable disequilibrium in the staff, which could adversely impact patient care and safety.

Question 6

The nurse manager has repeatedly tried to convince a staff nurse that changing to a new scheduling format is necessary. The staff nurse continues to be negative and argumentative about the need to change. How should the nurse manager interpret this response? Select all that apply.

Accepted Answer

1. Some people are very threatened by the idea of change. This fear may make them respond negatively.
2. The change may go forward with or without this staff nurse's approval.
3. Generally, this is not the case if the nurse manager is genuinely trying to establish rapport with the staff nurse and explain why the change in necessary.
4. The change can go forward without terminating the nurse. If the nurse is indeed fearful of change, the nurse will probably not resign, as that is also a change.
5. Resisters to change are often fearful of losing something they value. Scheduling changes are a particular issue when nurses have established their personal schedules based upon a routine work schedule.

Question 7

Which option best describes a change agent that demonstrates a transformational style of leadership during the change process?

Accepted Answer

1. The charismatic change agent is an envisioning leader.
2. These actions describe an enabling change agent.
3. These actions describe a missionary change agent.
4. This is an instrumental or transactional change agent.

Question 8

In which situation would it be necessary to re-regulate practice? Select all that apply.

Accepted Answer

1. This is a redesign practice used by many organizations to compensate for the nursing shortage.
2. The use of telemedicine requires re-regulating professional practice because nurses can use this technology to provide care in situations in which the patient is in a different state from the one where the nurse is licensed and located.
3. This is a redesign practice used by many organizations to compensate for the nursing shortage.
4. This is an example of restructuring in which nursing education attempts to prepare nurses for the "real world."
5. This mobility would result in the nurses working in different states from where they live and are licensed.

Question 9

A patient's finger stick blood sugar registers

Accepted Answer

1. Programmed decision making is more repetitive and routine and typically related to a policy or procedure.
2. The situation is not a crisis.
3. This is not a time-limited situation.
4. Non-routine decision-making is not routine, can be crisis-oriented, and can require more time and consultation with others.

Question 10

The hospital would like to decrease the amount of medication errors made secondary to transcription errors. In order to accomplish this, it is hoped that all physicians will be trained in the use of computerized physician orders by the end of the fiscal year. This is an example of which stage of Lewin's model of change?

Accepted Answer

1. The refreezing stage is the implementing step in the model where change becomes a part of the work environment and its processes.
2. The unfreezing stage is the first step in Lewin's model of change and includes recognition of a problem.
3. This is an example of the moving stage, because the hospital has developed a goal and outcomes to help resolve the problem.
4. Working is not one of the stages of the model.

Question 11

A nurse manager is collecting staff views about a current unit problem to make a decision about actions to take. Which style of decision-making is this manager employ?

Accepted Answer

1. This style depends on a small amount of data, but arrives at one decision.
2. This style focuses on individuals.
3. This style tells the staff what will be done with the manager making the decision.
4. This style engages the staff to arrive at a consensus.

Question 12

What are the common external factors that drive change in a healthcare organization? Select all that apply.

Accepted Answer

1. This is a common external factor causing change to be necessary.
2. This is an internal change.
3. Any changes in these laws acts as an external force necessitating change in the organization.
4. Changes in these standards will require change in the way the organization provides care.
5. This is an internal change.

Question 13

Which activities represent the eight-step process for organizational change? Select all that apply.

Accepted Answer

1. The eight steps are create a sense of urgency; create a guiding coalition and mobilize commitment; form strategic vision and initiatives; enlist volunteer army; enable action by removing barriers; generate short-term wins; sustain acceleration; and institute change.
2. The eight steps are create a sense of urgency; create a guiding coalition and mobilize commitment; form strategic vision and initiatives; enlist volunteer army; enable action by removing barriers; generate short-term wins; sustain acceleration; and institute change.
3. The eight steps are create a sense of urgency; create a guiding coalition and mobilize commitment; form strategic vision and initiatives; enlist volunteer army; enable action by removing barriers; generate short-term wins; sustain acceleration; and institute change.
4. This is not part of the eight steps. This is a coping strategy for what Quinn describes as "slow death."
5. The eight steps are create a sense of urgency; create a guiding coalition and mobilize commitment; form strategic vision and initiatives; enlist volunteer army; enable action by removing barriers; generate short-term wins; sustain acceleration; and institute change.

Question 14

The manager of a maternal-child health unit announces that the unit will be redesigned to help meet the Institute of Medicine healthcare competencies. What scenario is one that the staff of this unit might expect?

Accepted Answer

1. Cross-training is an example of redesign or re-engineering of healthcare.
2. This would require re-regulating professional practice.
3. This is an example of rightsizing.
4. This is not what is meant by redesign in this case.

Question 15

What is the first step in coping with changes that occur in the healthcare environment?

Accepted Answer

1. Some people have an immediate negative response to change. Other people are invigorated by change, whether the change is positive or negative. The nurse must understand personal response to the idea of change so that response to a particular change can be unbiased.
2. While this is important information, the nurse must first identify personal response to the concept of change.
3. While this is important information, the nurse must first identify personal response to the concept of change.
4. While this is important information, the nurse must first identify personal response to the concept of change.

Question 16

The nurse manager is aware of a significant change that will occur sometime in the next six months. How can this manager begin to prepare the staff for this change? Select all that apply.

Accepted Answer

1. Fear of the unknown is a primary reason people resist change.
2. Stability will help the staff cope with the idea of a change.
3. All discussions should be respectful and professional.
4. Being upfront with information will prevent staff from believing the manager is trying to hide the change.
5. Focusing on what the staff will lose (having to work harder) will likely increase resistance.

Question 17

The nurse is working in a facility that is considering a major change by incorporating interprofessional teams in all departments and units. Which type of planning is required?

Accepted Answer

1. Policy planning is required, but strategic planning is also required.
2. Strategic planning is required, but policy planning is also required.
3. This proposed change requires planning at levels above project planning.
4. Both strategic planning and project planning are required, because the move toward an interprofessional approach rather than a single discipline-run unit requires a change to the organization's components (departments) and operational matters within the organization.

Question 18

Management has called a meeting to discuss the increase in negative patient satisfaction surveys. Which stage of Lewin's model of change does this represent?

Accepted Answer

1. The moving stage is the planning phase of the model and focuses on the development of goals and outcomes.
2. The refreezing stage is the implementing step in the model where change becomes a part of the work environment and its processes.
3. The unfreezing stage is the first step in Lewin's model of change and includes recognition of a problem.
4. Working is not a stage of Lewin's model.

Question 19

During the change process to implement an electronic medical record, a nurse manager says, "We are experiencing a 'slow death'." What evidence would the manager have to support this conclusion?

Accepted Answer

1. Inability to do work effectively is a sign of 'slow death.'
2. Staff burnout is a sign of 'slow death.'
3. Using a detailed plan is a positive step and should not lead to 'slow death' during change.
4. Staff who are less enthusiastic is a sign of 'slow death.'

Question 20

A problem has been identified in the healthcare facility. What should the nurse who has been assigned the task of change agent do next?

Accepted Answer

1. Developing alternative plans is done after a diagnosis is made.
2. After the first step of the change process of acknowledging problem, then it is necessary to gather the data necessary to be able to define the problem and develop a plan of action.
3. Collaborating and empowering staff takes place throughout the change process after data is collected in the assessment phase.
4. Collaborating and empowering staff takes place throughout the change process after data is collected in the assessment phase.

Quiz 3: Operational and Strategic Planning: Change, Innovation, and Decision Making