Deck 2: Change and Innovation

Question 1

The charge nurse of a small nursing unit would like to gain staff acceptance of a time-intensive, budget-imposed change required by the hospital administration. She plans to emphasize several evidence-based research projects that have shown improved patient health outcomes as a result of implementing this change. This is an example of which of the following organizational change concepts?

A) Budget-oriented change
B) Transformation
C) Resistance
D) Emergent change

Answer 1

Transformation

Question 2

According to the ___________ people move through a series of states when modifying their behavior.

A) Organizational Change-Readiness Scale (OCRS)
B) Transtheoretical Stages of Change Model
C) Rapid Cycle Change
D) plan-do-study-act model

Answer 2

Transtheoretical Stages of Change Model

Question 3

An organization has encountered a serious patient safety event that was reported to the state, The Joint Commission, and the Centers for Medicare & Medicaid Services (CMS). An extensive plan of correction was received, and the organization had to make some immediate changes in practice. Additionally the organization anticipates a costly lawsuit. What is the best method of educating staff about the practice changes that were issued?

A) "These changes need to be made because the state and CMS require it."
B) "We understand this is a knee-jerk reaction, but please change the practice while the surveyors are in the building."
C) "We need to make this change because it will help our lawsuit."
D) "This change is being made so that there is no further harm to another patient."

Answer 3

"This change is being made so that there is no further harm to another patient."

Question 4

_____ is an expected part of change and is often related to fear and anxiety.

A) Depression
B) Resistance
C) Acceptance
D) Denial

Question 5

The chief nursing officer (CNO) of a hospital system works with senior leadership for approval to initiate an electronic health system. He recruits a nursing informaticist and a chief medical informatics officer to begin the process of planning the education and rollout of the new electronic system. The CNO could be viewed as the:

A) resister.
B) innovator.
C) change agent.
D) strategist.

Question 6

Almost all changes encounter:

A) attitudes.
B) resistance.
C) knowledge.
D) communication.

Question 7

The development of new practices in response to new evidence is called:

A) altered direction.
B) organizational flux.
C) planned change.
D) status revision.

Question 8

The use of a new idea or method is the definition of:

A) change.
B) innovation.
C) resistance.
D) stereotyping.

Question 9

A nursing manager recognizes that the changes that she is expected by administration to implement will be met with staff resistance. She is committed to determining the root of the resistance and communicating positively with her staff. The nurse manager's actions characterize her as a(n):

A) change agent.
B) implementation expert.
C) restructuring motivator.
D) supervisory threat.

Question 10

A memo sent to the unit nurse manager reads that beginning next week; all nursing staff will be expected to conform to a new dress code selected by the hospital board of directors. The nurse manager understands that change will be more effective through which manner of communication?

A) Storytelling
B) E-mail
C) Discussion
D) Open communication

Question 11

The identification of forces that drive and restrain change is called a(n):

A) equilibrium evaluation.
B) force field analysis.
C) status quo analysis.
D) refreezing system.

Question 12

How is the refreezing stage of change similar to the nursing process?

A) Refreezing is similar to the assessment phase of the nursing process.
B) Refreezing is similar to the problem identification phase of the nursing process.
C) Refreezing is like the planning and implementation phase of the nursing process.
D) Refreezing is like evaluation in the nursing process.

Question 13

Individual members of a group will adapt to change at different rates. Which of the following groups would take the longest to accept change?

A) Early adopters
B) Late majority
C) Innovators
D) Laggards

Question 14

An experienced nurse has recently taken a position on a telemetry unit in the local hospital. After 2 weeks on the job, he finds that the staffing is not what was discussed during his employment interview with the nurse manager. Which approach would be most appropriate for the nurse to take?

A) Give 2 weeks' notice and begin seeking employment at another hospital.
B) Discuss the situation with the nursing manager who interviewed him.
C) Talk to other employees about the staffing situation.
D) Notify the charge nurse that this was not what was explained to him prior to employment.

Question 15

A nurse manager recognizes that her staff's emotional responses to organizational change are similar to:

A) adaptation techniques.
B) integrative tactics.
C) symptoms of mental illness.
D) the grief model.

Question 16

The first stage of planned change involves:

A) accepting the need for change.
B) cognitive redefinition.
C) integration and stabilization.
D) problem solving.

Question 17

A small critical care unit forms a team of nurses to implement bedside rounds at shift change. The nurses have researched the efficacy of bedside rounds and have determined that this evidence-based practice will lead to improved communication of patient status. Which type of change does this demonstrate?

A) Transforming care at the bedside
B) Second-order change
C) Emergent change
D) Organizational change

Question 18

Which of the following factors is used to describe the degree to which successful planned change is thought to be better than the status quo?

A) Complexity
B) Compatibility
C) Trialability
D) Relative advantage

Question 19

A medical-surgical unit utilizes a group of nurses and patient care assistants to determine ways to reduce the number of falls in the unit. They conduct Internet research to locate best practice interventions. They create fall risk alerts in the unit, and they implement hourly rounding to assess the need for toileting. After putting these small changes into place, they will evaluate the data to determine effectiveness. This project is an example of:

A) rapid response teams.
B) Failure Modes and Effects Analysis.
C) root cause analysis.
D) Rapid Cycle Change.

Question 20

A hospital system is implementing an electronic health record. The facility conducts education and training for nursing staff, medical staff, and ancillary staff over a period of 6 months. This is an example of:

A) emergent change.
B) planned change.
C) transformation.
D) innovation.

Question 21

Which of the following statements are accurate descriptors regarding change? (Select all that apply.)

A) Organization-wide change is more sustainable when leadership imposes the change.
B) Change within an organization is often externally imposed.
C) Change within an organization may originate internally.
D) Nurses do not need to participate actively in the organizational changes.
E) Change is often complex and irrational.

Question 22

During periods of stress and change, which of the following strategies should managers use to provide emotional support to staff members? (Select all that apply.)

A) Reframe difficult questions.
B) Communicate facts through e-mail.
C) Provide active listening.
D) Promote action steps and solutions.
E) Keep staff informed of decisions.
F) Communicate with participation.

Question 23

The nurse manager on a medical-surgical unit wants to change to "walking rounds" in the patients' rooms for change of shift report. In the past, it has been "face to face" at the nurses' station. The nurse manager is meeting resistance from the staff, because they think that it will take longer, and the nurses will not finish their shift on time. What could the manager do to increase the nurses' acceptance of this change?

A) Inform all shifts that there have been some lapses in communication regarding patient needs and that involving the patient in the report will help alleviate this.
B) Inform all nurses that to reach Magnet status, this type of change of shift report is required.
C) Ask the nurses to participate in the planning and implementation of the change.
D) Ask the nurses to try this type of change of shift report for 1 week and then have them evaluate it.

Question 24

Learning organizations adapt to change through their ability to be open, dynamic, and responsive to changes in the environment. Which of the following learning disciplines are true of these types of organizations? (Select all that apply.)

A) Learning is conducted in individual parts rather than in groups.
B) Viewing the organization as an interrelated system is known as systems thinking.
C) Individuals utilize mental models to understand how their vision affects their decisions and actions.
D) Shared vision is conducted within a group to determine plans to get to the preferred future.
E) Personal mastery encourages individuals to create results as they see fit.

Question 25

A group of nurses is showing resistance to changes the manager is making with regard to staffing. Which of the following ways can the manager deal with the emotionality of the situation? (Select all that apply.)

A) Use persuasion.
B) Give the nurses adequate notice of change.
C) Avoid discussion.
D) Explain the rationale and patient impact.
E) Inform staff that senior leadership made the decision.

Question 26

The probability of effectiveness of the change process can be increased through several techniques. Which of the following actions will likely increase effectiveness? (Select all that apply.)

A) Explain the rationale for a change so that individuals understand it.
B) Simply announce the change without laying a foundation.
C) Give participants all the information they need.
D) Rely only on formal authority in implementing change.
E) Help individuals cope with change.