Deck 19: Workforce Engagement and Collective Action

Question 1

The Emergency Department nurses' decision to organize for the purpose of collective bargaining is being driven by a desire to:

A)Establish the staffing pattern that will be used.
B)Determine the hours that one is willing to work.
C)Create a professional practice environment.
D)Protect against arbitrary discipline and termination.

Answer 1

Create a professional practice environment.

Question 2

Martin,the unit manager,receives complaints from community agencies that patients who have been discharged from his unit seem to lack understanding about their disorder and immediate strategies for managing elements of their care.Martin checks the patient teaching sheets and notes that the sheets are initialed by staff.He calls the agencies and indicates that teaching has been done.Martin's follow-up to complaints from the community is:

A)Appropriate and indicates that he has assumed accountability for the actions of his staff.
B)Indicative that he does not clearly understand the concept of accountability.
C)Indicative of strong support for his staff and their autonomy.
D)Important in clarifying the difference between his accountability and that of the community in patient care.

Answer 2

Indicative that he does not clearly understand the concept of accountability.

Question 3

Awareness and use of power have been challenging for nurses in general because of:

A)Incidences of punishment by authority figures.
B)Too little time in the workplace to collectively develop power strategies.
C)Lack of cohesiveness and unity among nurses.
D)A tradition of obedience to authority.

Answer 3

A tradition of obedience to authority.

Question 4

In accomplishing the goal of breakfast for children in elementary school,Leanne is particularly effective in approaching businesses with the needs that the group has determined and articulating the ways that the group has found for businesses to participate.Leanne is exemplifying:

A)Leadership.
B)Followership.
C)Professionalism.
D)Knowledge of context.

Question 5

In a nurse managers' meeting,strategies for ways to help retain staff are discussed.One strategy for assisting nurses in developing collective action skills is:

A)Accepting the practice of "going along to get along."
B)Attending as many workshops as practical.
C)Spending as much time as possible in clinical settings.
D)Taking the opportunity to work with a mentor.

Question 6

In looking at an organizational chart for her institution,Jennifer notes that nursing is led at the senior level by a non-nurse executive.Jennifer expresses concern that this is a reflection of how nursing is viewed within the organization.Jennifer's comments reflect:

A)A concern that resource allocation will be made on a business and not a professional model.
B)The dissatisfaction that occurs when lack of autonomy is given to nurses.
C)Concern with the nonadvancement of nursing practice in the institution.
D)An awareness of how organizational culture is reflected in organizational structure.

Question 7

Nurses on the dialysis unit notice that changes in labeling of fluids have meant several alarming near misses in terms of wrong administration of fluids.They take this concern to the unit manager.As an advocate of nurse autonomy,the most appropriate response in this situation would be to:

A)Ensure that the nurses are aware of the reasons for the change and how the decision was made about the new labels.
B)Discuss concerns about the labels and develop potential solutions that take into account changes that can be made at the local level and those that need system intervention.
C)Suggest that the staff wait until they have become more familiar with the labels before taking further action.
D)Tell the staff that you will notify the pharmacy about these concerns and leave it up to the pharmacy to decide what should be done.

Question 8

The Emergency Department staff members are concerned that working long hours without rest puts patient safety at risk.One staff member decides that she will risk her job and become a whistleblower.Whistle-blowing is an appropriate recourse when management:

A)Disregards due process when disciplining a nurse.
B)Delays responding to repeated efforts to provide safe care.
C)Hires nurses who are not a part of the union during a strike.
D)Refuses to bargain in good faith with the elected bargaining agent.

Question 9

Sarah determines,in partnership with her patient,that current medications are not enabling her patient,a married account executive with fibromyalgia,to continue with her employment and family responsibilities.After searching for additional information on fibromyalgia,Sarah finds nonpharmacologic interventions that are supported through credible evidence.Sarah suggests that the patient,her physician,and she meet to discuss the medications and possible options and a plan of care for the patient's discharge.This action exemplifies which of the four historical concepts identified by Lewis and Batey?

A)Authority
B)Responsibility
C)Communication of conflict
D)Autonomy

Question 10

In Hospital STV,senior administration is strongly oriented toward fiscal and social conservatism.The nursing department is deeply concerned with the provision of quality to the community,which includes a high number of poor and unemployed.To accomplish the goals of the nursing department,resources need to be allocated that administration is not able to allocate.Nursing and administration:

A)Are engaged in shared governance.
B)Are involved in an irreconcilable conflict of interests.
C)Represent separate subcultures in the institution.
D)Represent union and nonunion conflict.

Question 11

Government and third-party payers announce reduction of compensation for the delivery of patient services.Hospital STV has a flat organizational structure.After the funding announcements,senior officials at the hospital meet and make decisions regarding cost containment of new revenue streams.This action is consistent with:

A)The practice of leaving financial decisions with senior officials who understand the total context of funding.
B)A tendency to concentrate decision making during economic downturns at the top administrative level.
C)A need to make expedient decisions that are likely to be poorly received by staff.
D)Ensuring that decisions with regard to cost are made equitably across all departments.

Question 12

Collective action is effective in:

A)Ensuring that needs of nurses are placed ahead of other disciplines.
B)Defining nursing as a profession.
C)Advising patients of the needs of nurses.
D)Amplifying the influence of individuals.

Question 13

As a new nurse manager who has "inherited" a unit with high nurse turnover and complaints of patient dissatisfaction,your first course of action would be to:

A)Determine levels of nurse engagement on the unit.
B)Review the personnel files of nurses who have resigned.
C)Interview upper management about their vision for the unit.
D)Meet with your staff to clarify your vision for the unit.

Question 14

While making rounds,a night supervisor finds a unit with a low census and too many staff members.The night supervisor is performing as a statutory supervisor when he or she:

A)Assigns nurses to care for specific clients.
B)Develops a protocol for unlicensed personnel.
C)Recommends transferring a nurse to another service.
D)Teaches a nurse to use a new piece of equipment.

Question 15

In an inner-city area,a group of nurses meet and develop a plan to negotiate with local businesses to support a breakfast program for young elementary schoolchildren.This is an example of:

A)Community development.
B)Collective bargaining.
C)Collective action.
D)Shared governance.

Question 16

The staff members in a local Emergency Department are experiencing stress and burnout as the result of excessive overtime.The staff decides to unionize to negotiate for better working conditions.The increase in unionization within health care may be attributed to the:

A)Movement from being "blue-collar workers" to being "knowledge workers."
B)Excess profits in health care.
C)Level of risk that exists for health care.
D)Number of people who are involved in health care.

Question 17

The chief nursing officer utilizes the hospital's workplace advocacy to help the overwhelmed Emergency Department staff.Workplace Advocacy is designed to assist nurses by:

A)Creating professional practice climates in their institutions.
B)Equipping them to practice in a rapidly changing environment.
C)Negotiating employment contracts.
D)Representing them in labor-management disputes.

Question 18

A Magnet™ hospital surveys the staff about job satisfaction.This type of environment,in which nurses have authority and autonomy,is linked with:

A)Client satisfaction with the healthcare organization.
B)Organizations with a limited number of nurse managers.
C)Private, specialty organizations in urban areas.
D)Sophisticated academic health sciences universities.

Question 19

Nursing labor management partnerships:

A)Engage nurses at all levels in problem solving for better patient care.
B)Require unions and management to negotiate in good faith regarding hours of work and wages.
C)Have been shown to have negligible effects on nurse turnover and patient outcomes.
D)Have typically resulted in increased polarization of nurses and management, leading to formation of collective bargaining units.

Question 20

The Emergency Department staff decides to use a collective bargaining model for negotiation rather than a traditional trade union model.A traditional trade union model is characterized by:

A)Positional conflict.
B)Management support of labor's initiatives.
C)A spirit of trust between management and labor.
D)An ability to resolve complaints.

Question 21

You are hired as a new manager.When the offer of employment is made,you agree to at-will employment.Later,you become very concerned about the policies and practices of your organization and their impact on patient care.You speak with your supervisor several times about your concerns,but no action is taken.In considering your next steps,you:

A)Consider your increased vulnerability under the terms of your employment.
B)Recognize that your supervisor is more vulnerable than you are because of her more senior position.
C)Are more likely as a leader to take action because you are well protected from repercussions by federal and state regulations.
D)Contact your union to discuss your concerns and review your options.

Question 22

On Unit 62,the nurses and the unit manager have been involved in shared decision making related to the model of nursing care delivery that the unit will adopt.All individuals have participated and been involved in decision making and implementation of changes.When issues arise during implementation,it is expected that:

A)Accountability resides entirely with the unit manager.
B)Individual expertise will be utilized to provide solutions, but that responsibility for the change is shared.
C)No one really has any accountability or responsibility for the changes.
D)This will contribute to widespread skepticism among the staff about the probability of success.

Question 23

Senior executives at Hospital A determine that the hospital will engage in a strategic planning process after changes in healthcare funding and concerns expressed in the community about care that is being delivered at the hospital.The senior executives decide on a participatory process in which staff are widely consulted regarding input about the organization and the external environment and are actively invited to be part of decisions related to the mission statement,goals,and objectives.For true shared governance to be seen as part of this approach:

A)It must be evident in the outcomes of the process that staff and senior executives have partnered on the decisions.
B)Stakeholders must be assured of the value of their input even though final decisions rest with senior executives.
C)Publications must clearly outline how staff input was solicited and obtained.
D)Staff must be reassured that significant concerns will be kept in mind even if they have not been addressed in planning documents.

Question 24

Nurses in an Emergency Department,in an inner-city neighborhood characterized by high levels of violence,are concerned with low levels of security presence in their department.Security levels have recently been decreased and the nurses question why this has occurred.An appropriate action would be to:

A)Provide nurses with information about rationale for recent changes in security staffing.
B)Refer the matter to the head of security and let her deal with it.
C)Provide mentors who can help nurses diffuse aggressiveness.
D)Accept the security levels as a consequence of funding realities.

Question 25

Martin,the unit manager,receives complaints from community agencies that patients who have been discharged from his unit seem to lack understanding about their disorder and immediate strategies for managing elements of their care.Martin checks the patient teaching sheets and notes that the sheets are initialed by staff.He calls the agencies and indicates that teaching has been done.Potential outcomes of Martin's actions include (select all that apply):

A)Poor morale on the unit.
B)Disruption in community relationships.
C)Corruption of patient-staff relationships.
D)Patient outcomes for quality care are met.

Question 26

Sandra,an RN on the surgery unit,is assisting with a procedure in the patient examination room.The physician orders a medication to be given through IV.Sandra questions the order,based on her knowledge of the patient's history and of other medications that the patient has been given.The physician reiterates the order and Sandra refuses to give it.In this instance,Sandra is demonstrating:

A)Autonomy.
B)Accountability.
C)Authority.
D)Best practice.