Deck 14: Decentralization Shared Governance

Question 1

In 2005, the World Health Organization (WHO) declared the need for the health care workforce to:

A) reduce medical errors.
B) organize care around the patient.
C) provide a service-oriented delivery.
D) remain in individual scopes of practice.

Answer 1

organize care around the patient.

Question 2

The councilor model:

A) uses committees for structuring staff and governance.
B) functions autonomously using the democratic process.
C) uses elected representatives to make decisions.
D) works from a clinical and managerial focus.

Answer 2

uses committees for structuring staff and governance.

Question 3

To feel comfortable enough to practice autonomously and make effective decisions in an institution with a decentralized organizational philosophy, staff must be empowered with (select all that apply):

A) autonomy.
B) conflict resolution.
C) decision-making skills.
D) communication techniques.
E) human resources management.

Answer 3

autonomy.
conflict resolution.
decision-making skills.
communication techniques.

Question 4

Avenues of power provide for the sources of structural empowerment in an organization. Avenues of power for nurses include (select all that apply):

A) access to information.
B) frequent meetings with the chief executive officer.
C) having the opportunity to learn and grow.
D) access to resources required to do the job.
E) alliances with fellow nurses at all levels of the organization.

Question 5

At its start, shared governance requires the education and support of organizational executives, managers, and point-of-care staff. The challenge for administrators in creating a shared governance is (select all that apply):

A) implementing the philosophy of accountability.
B) relinquishing control of decision-making power.
C) creating the structure that supports shared governance.
D) developing a culture that supports, encourages, and maintains it.
E) justifying the cost in terms of personnel time, effort, and financial commitment.

Question 6

Which of the following statements best describes an organizational chart?

A) All job positions are displayed clearly in a two-dimensional drawing.
B) All outside organizations with relationships to the hospital are depicted.
C) Informal and formal structures within the organization are outlined.
D) It shows organizational positions and relationships in a visual representation.

Question 7

The purpose of an organization's philosophy is to:

A) influence the goals and objectives of an organization.
B) display how the parts of an organization are connected.
C) be an instrument that gives voice to the organization's mission.
D) serve as the institutional framework that shapes the direction of knowledge and skill acquisition.

Question 8

Decentralization occurs when:

A) equipment is being purchased from approved vendors.
B) hiring decisions are made at the executive level.
C) power is distributed to those closest to the work of caregiving.
D) supplies are distributed from one central supply area in the hospital.

Question 9

The nurse manager should use which of the following behaviors when implementing a shared governance structure?

A) Autocratic decision making of the manager
B) Coaching the staff to be successful
C) Harboring the vision within the team
D) Reimbursing the staff for overtime

Question 10

The instruments that give voice to the organization's philosophy include which of the following (select all that apply)?

A) Goals
B) Focus
C) Vision
D) Mission
E) Core values

Question 11

Shared governance is a model of organizational structure in which staff nurses are:

A) employed to establish mutual goals with clients.
B) empowered through autonomy and accountability.
C) engaged in problem-solving strategies and techniques.
D) equipped with evaluative thinking methodologies.

Question 12

A nurse works in the critical care unit (CCU). She enjoys being on the unit charge nurse team, the recruitment and retention team, and the peer evaluation team. The recruitment and retention team is responsible for hiring new employees into the CCU. The five-member team, consisting of three registered nurses (RNs), a unit clerk, and a nurse's aide, conduct the interviewing process with key questions that were developed by the team. This is an example of:

A) centralized power.
B) shared governance.
C) span of control.
D) vertical authority.

Question 13

In an organization that has a decentralized organizational philosophy, decision-making authority rests in levels closer to the point of service rather than in the executive levels. Benefits of a decentralized organizational philosophy include (select all that apply):

A) encouraging more input.
B) supporting greater innovation.
C) facilitating faster response times.
D) permitting a narrower span of control.
E) allowing for more levels of management.

Question 14

In institutions that practice shared governance, the responsibility for unit outcomes rests with the:

A) nursing team.
B) nurse manager.
C) individual nurse.
D) chief nursing officer (CNO).

Question 15

Using a philosophy of centralized decision making, power distribution usually results in a _____ span of control, with _____ levels of management.

A) narrower; fewer
B) narrower; more
C) wider; fewer
D) wider; more

Question 16

One obstacle in the implementation of a shared governance model is that nurses have:

A) empowered participation in committee meetings.
B) minimal experience with building consensus.
C) the same basic educational foundation.
D) traditionally worked in decentralized structures.

Question 17

Shared governance is a vehicle for engaging organizations and creating the necessary forums and intersections that assure the decisions and actions remain dynamic and as close to the point of service as possible. Shared governance promotes:

A) dependence.
B) nonpunitive culture.
C) horizontal relationships.
D) executive decision making.

Question 18

Traditionally, nurses have worked in strong, hierarchical institutions with centralized decision-making and clear authority structures, rigid approval mechanisms, and extensive policies and procedures that have resulted in barriers to creating a shared governance system. Such barriers include:

A) role clarity.
B) lack of time management.
C) poor time management skills.
D) inexperience with conflict resolution.

Question 19

Research about shared governance suggests that it is:

A) enhancing the role of the nurse's aide within the organization.
B) improving organizational and patient outcomes.
C) not a cost-effective program when examining all areas of care.
D) too much additional work for the already overwhelmed RN.

Question 20

Which of the following leadership styles is best suited for implementation of a shared governance structure?

A) Authoritarian
B) Autocratic
C) Democratic
D) Laissez faire

Question 21

Organizational benefits of a culture of shared governance include (select all that apply):

A) improved financial outcomes.
B) interdependence among staff nurses.
C) increased commitment of staff to the organization.
D) more senior leadership involvement at the point of service.
E) a more efficient model for point-of-service decision making.

Question 22

_____ refers to a process whereby nurses recognize that they have legitimate power and authority to make decisions regarding their practice.

Question 23

Shared governance has far-reaching implications for today's health care environment. Patients benefit due to (select all that apply):

A) quicker responses at the point of service.
B) more committed health care professionals.
C) a more stringent model of health care service.
D) better decisions being made by upper management.
E) nurses being more assured, confident patient advocates.

Question 24

In institutions that practice shared governance, the nurse manager's role is to (select all that apply):

A) hire new employees.
B) mentor the nursing staff.
C) train new nurses in patient care.
D) support the decisions of the nursing team.
E) enable the staff to become effective leaders.

Question 25

Decentralization and shared governance were strategies first introduced in the late 1970s. Shared governance is touted as a strategy to (select all that apply):

A) improve productivity.
B) empower staff nurses.
C) increase job satisfaction.
D) increase nursing turnover.
E) decrease staff nurse autonomy.

Question 26

Institutions organize and structure themselves by defining departmental function and authority to achieve a more coordinated effort. In institutions where the executive leader retains more decision-making authority, the operation takes on a more _____ philosophy.

Question 27

Education must be continually available to employees in institutions that practice shared governance. Educational programs should include (select all that apply):

A) conflict resolution.
B) successful budgeting.
C) behavioral management.
D) planning and conducting effective meetings.
E) collecting, aggregating, and displaying meaningful data.