Question 1

A nurse manager is faced with the task of introducing an unpopular change to a staff that includes several nurses who have acted as rejecters to previous changes. The manager expects resistance but hopes to identify these rejecters early in the process. The manager should be particularly alert to which statements?

Accepted Answer

A)   "I don't care what they say; I'm not giving care that way."
B)   "I don't think this is going to work, but I'll probably come around to it sooner or later."
C)   "I'm not crazy about this idea, but we do need to change how we are providing care."
D)   "I bet I can make it very difficult for this change to occur."
E)   "It won't be so bad. I like change." A,D

Question 2

Computerized charting will be initiated on select units of the hospital. Orientation to this new system will be provided to each nurse by a team of nurses educated in nursing informatics. This is an example of which type of change strategy?

Accepted Answer

A)   Normative-reeducative strategies
B)   Lippitt's phases
C)   Empirical-rational model
D)   Power-coercive strategies C

Question 3

Which factor best represents a driving force in the process of change?

Accepted Answer

A)   An ineffective nurse manager
B)   An administration composed of long-term employees
C)   A staff composed of long-term employees
D)   A financial deficit of millions of dollars D

Question 4

The nurse manager feels that changing the unit's method of assigning break times would benefit the flow of client care. What should be the manager's first action associated with this idea?

Accepted Answer

A)   Tell the staff that a change is coming, but that it is positive and they should not be worried.
B)   Collect and analyze information about how the current system is working.
C)   Mention in a staff meeting that the current system is causing a lot of trouble.
D)   Identify how the manager would know if the change is benefiting the unit.

Question 5

The nurse manager knows that maximum power will be needed to achieve a desired change and has identified a key person on the organizational chart who will be affected by the change. What is important for the nurse manager to do?

Accepted Answer

A)   Try to minimize the impact of the change when talking to this person.
B)   Bypass this person and talk to the administrator who supervises him or her.
C)   Pay attention to the people above and below this person on the organizational chart.
D)   Try to find some information against this person to use as leverage.

Question 6

The nurse manager is facilitating change to a new documentation system in the unit. If the manager wants to use the most common method to overcome resistance to the change, which strategy would be chosen?

Accepted Answer

A)   The manager distributes a handout explaining the new system and how to use it.
B)   The manager creates a "quick tip" sheet about how to use the system and schedules practice sessions for each nurse.
C)   The manager identifies a key supporter of the change and has that nurse act as mentor to the remaining staff.
D)   The manager threatens to transfer anyone who resists the change.

Question 7

The new chairperson of the nursing department has determined that the faculty's teaching is stagnant and outmoded. The chairperson would like to encourage the faculty to adopt more innovative teaching strategies. According to Lewin, what is the first step in initiating this plan?

Accepted Answer

A)   Bring an expert on innovative teaching strategies to campus for a meeting with faculty.
B)   Include the staff in identifying problems related to teaching strategies.
C)   Ask staff to assist in the development of a plan for implementing new teaching strategies.
D)   Implement interventions to improve the teaching strategies currently used.

Question 8

The nurse administrator has been asked to work with other administrators to make a change in a long-standing hospital policy. What should be the nurse's first action?

Accepted Answer

A)   Research the options that will work best for the nursing staff and the hospital.
B)   Speak positively of the change to ensure the most "buy-in" from the nurses.
C)   Encourage the other administrators to choose the option that is easiest for the nurses.
D)   Ensure that each nurse is aware of the change and why it is necessary.

Question 9

The staff is transitioning to a major change in the provision of nursing care in a large hospital. Which behaviors should the nurse manager watch for that would indicate possible problems?

Accepted Answer

A)   Nurses are discussing the change at breaks and meals.
B)   Nurses are doing both the old work and the new work.
C)   A nurse says, "I guess everything we've done for years is wrong."
D)   The provision of care with the new system takes longer than expected.
E)   Nurses are doing parts of the old procedure and parts of the new procedure.

Question 10

A nursing supervisor has introduced a needed change in policy to the nurse managers. The managers have met maximum resistance when attempting to gain support for the change. Which options reflect valid strategies for the nurse managers?

Accepted Answer

A)   Meet with the supervisor and discuss modification of the proposed change.
B)   Slow down the change process.
C)   Meet with the supervisor and suggest abandoning the change.
D)   Work together to identify strategies to overcome resistance.
E)   Proceed with the change.

Question 11

Which action will have the greatest impact on the successful implementation of a planned change?

Accepted Answer

A)   Disciplining individuals who continue to be resisters to the change
B)   Ensuring there are no remaining pockets of disagreement when the change occurs
C)   Continually rewarding those working toward the change and ignoring those who are not
D)   Creating a supportive environment for those undergoing the change

Question 12

The nursing committee is planning a change in the unit's organization. Which statement reflects the priority expected outcome of these change agents' work?

Accepted Answer

A)   The nurses involved will demonstrate management skills.
B)   The nurses will agree with the change and present a united front for its adoption.
C)   The change will guide nursing practice on the unit.
D)   The change will lead to improved client care on the unit.

Question 13

A major change has occurred in the governance of the hospital. How can the nurse manager help staff cope with this change?

Accepted Answer

A)   Disperse information about the change as quickly as possible.
B)   Discourage any negative discussion about the change.
C)   Remind staff that change is part of the health care environment.
D)   Talk about the change in positive terms.
E)   Withdraw slightly from those who oppose the change.

Question 14

Which statements by a hospital executive reflect power-coercive strategies to implement change?

Accepted Answer

A)   "We must follow the federal guidelines in the way we bill for our services."
B)   "If we don't reduce our nosocomial infection rate, Medicare won't reimburse us."
C)   "Administration has to make this change or our accreditation status will be at risk."
D)   "This change is the only logical action we can take."
E)   "All our sister institutions in the association have already made this change."

Question 15

A proposed change in a health care organization is controversial and will require cooperation from all parties involved. Which change strategy should the change agent use?

Accepted Answer

A)   Empirical-rational
B)   Normative-reeducative
C)   Power-coercive
D)   Empirical-reeducative

Question 16

A new IV pump has just been purchased by the facility. Which statement by the nurse manager reflects Rogers' first step in making the change to this new equipment?

Accepted Answer

A)   "The nursing staff will have the final decision on whether to change to this IV pump."
B)   "Before we make the final decision, we will do a 3-month 'test run' of the equipment to make sure we like it."
C)   "I have looked at the pump and I like it."
D)   "I have information to share with you about the new IV pump we are considering for the unit."

Question 17

The novice nurse manager is acting in the role of change agent for the unit. Which statement indicates that this manager needs further training in regard to change?

Accepted Answer

A)   "I must not get so bogged down in details that I lose focus on the ultimate goal."
B)   "As we go through this process, I think I need to be flexible but persistent."
C)   "Those who are resistant will probably accept it sooner or later with my support."
D)   "I think the implementation will go much better if I stay available the whole time."

Question 18

The nurse is working on a committee tasked with making a major organizational change. Which comments by the nurse would help to advance the work of this committee?

Accepted Answer

A)   "I would like to focus on completing this process so we can move on."
B)   "Have we looked at all available data in order to make an informed decision?"
C)   "What are the obstacles to implementing this change within the organization?"
D)   "Are we including the opinions of all stakeholders in this decision?"
E)   "I think it does not really matter when we institute this change, as long as it is over quickly."

Question 19

Hospital administration is working with a university school of nursing to establish a nursing residency program. Why is this a desired action?

Accepted Answer

A)   A residency program eliminates the hospital's liability if a novice nurse makes an error.
B)   A residency program is established to make nursing education more like physician education.
C)   The Institute of Medicine has proposed residency programs for nurses.
D)   A residency program ensures that nurses participate in lifelong learning.

Question 20

Hospital administrators are considering changing from the traditional method of creating work schedules to a system in which the nurses will choose their own workdays. Choices will be made according to seniority. Which change strategy would likely be best for this endeavor?

Accepted Answer

A)   A power-coercive strategy
B)   A normative-reeducative strategy
C)   An empirical-rational model
D)   A driving force

Exam 5: Initiating and Managing Change