Chapter 5- The World of Healthcare Employment My Nursing Test Banks

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Information Field: Client Needs

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Information Field: Integrated Process

Information Field: Objective

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Highest Answer Letter: D

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Chapter: Chapter 5: The World of Healthcare Employment

Multiple Choice

1. What is the basic tenet of shared governance?

A) It allows nursing staff and management to be involved in decision-making.

B) It establishes the control of the institution over the actions of the nursing staff.

C) It allows the administrative decision area to be controlled by management.

D) It supports the traditional role of the supervisor as one who hires, evaluates, promotes, and fires.

Ans: A

Client Needs: A-1

Cognitive Level: Comprehension

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 3

Page and Header: 166, Shared Governance Model

Feedback: Shared governance may be viewed as a system in which nurses have organizational autonomy as reflected in control over their practice, and have input into decision relating to patient care. It is a professional practice model in which both the nursing staff and the nursing management are involved in decision-making, as opposed to the administrative decision area being controlled by management. In this way, it is an alternative to traditional supervision models and hierarchies.

2. A nurse is assigned for the care of each patient from the time the patient is admitted to the hospital until that patients discharge. What system of care delivery is most likely in place?

A) Functional care

B) Primary care

C) Modular care

D) Team care

Ans: B

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 5

Page and Header: 171, Primary Care Nursing

Feedback: In a pattern of primary care, one nurse was assigned the responsibility for the care of each patient from patient admission until that patients discharge. The primary nurse was responsible for initiating and updating the nursing care plan, patient teaching, and discharge planning. An associate nurse worked with this same patient on other shifts and on the primary nurses day off, carrying out the plan of care developed by the primary nurse.

3. Nurses working in a hospital initiate a negotiating session in which they offer to take a pay cut to allow management to provide job security and to hire more nurses to alleviate understaffing. What is the term for this type of session?

A) Interest-based bargaining

B) Collective action bargaining

C) Concession bargaining

D) Good faith bargaining

Ans: C

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 6

Page and Header: 177, Bargaining and Negotiating

Feedback: Concession bargaining is a process in which there is an explicit exchange of reduced labor costs for improvements in job security. This specific tradeoff is not a characteristic of interest-based bargaining, collective action bargaining, or good faith bargaining.

4. Nurses decide to go on strike to try to force improvement in the quality of patient care in their facility. Once the strike is resolved, what are their options for being rehired by the facility under the reinstatement privilege that is in effect in their contract?

A) They will be rehired after the strike whether or not it is decided that the strike was lawful.

B) They will be rehired after the strike as positions become available provided they have not engaged in unfair labor practices.

C) They will be rehired to replace nurses hired during the strike who were hired to replace them.

D) They will be rehired at their former job as soon as the strike is resolved.

Ans: B

Client Needs: A-1

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Communication and Documentation

Objective: 7

Page and Header: 181, Reinstatement Privilege

Feedback: A reinstatement privilege is a guarantee offered to striking employees that they will be rehired after the strike as positions become available, provided that they have not engaged in any unfair labor practices during the strike, and provided that the strike itself is lawful.

5. Which of the following statements accurately reflects the general use of the grievance process by nurses?

A) Grievances usually are related to interpretations of a contract or to policies and procedures.

B) Although either the management or an employee can file grievances, in most instances it is management that initiates the case.

C) A grievance involves informal talk between the management and the employee until the issue is resolved.

D) Employees may have grievances about the contract negotiation process itself.

Ans: A

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 9

Page and Header: 173, Grievance Process

Feedback: A grievance is a circumstance or action believed to be in violation of a contract (or of policies of an institution if a contract is not in place). Grievances usually are related to interpretations of a contract or policies and procedures and they are usually initiated by employees. Although resolution may begin with an informal talk, this proceeds to a formal process if resolution is not achieved.

6. As part of the development of a new inner-city clinic, a group of nurses and members of other health disciplines have drafted a mission statement for the clinic. This statement will most likely specify

A) the priorities for the health of the identified population.

B) the main goals and functions that the organizers envision for the clinic.

C) the philosophies and beliefs that underlie the existence and functioning of the clinic.

D) the health outcomes that the organizers see as currently lacking in the community.

Ans: B

Client Needs: A-1

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Communication and Documentation

Objective: 1

Page and Header: 156, Mission Statement and Philosophy

Feedback: The purpose of an organization is often expressed in the form of a mission statement, which outlines what the organization plans to accomplish, including its goals and function. This may or may not identify the philosophy of the organization, specific health outcomes, or priorities for the health of residents.

7. Which of the following conditions must be met in order to ensure the efficient and effective operation of a healthcare organization?

A) Span of control must be kept as narrow as possible.

B) The chain of command must be explicitly and clearly delineated.

C) The formal organizational structure must closely mimic the informal relationships that exist (the grapevine).

D) Registered nurses must occupy positions in employee, middle management, and executive roles.

Ans: B

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 2

Page and Header: 162, Chain of Command

Feedback: The effective operation of a healthcare organization requires a detailed and clear chain of command. A narrow span of control is not always preferable to broader spans of control and formal structure does not necessarily have to replicate informal structures, though each should be acknowledged and recognized. It is certainly possible, and potentially beneficial, for nurses to occupy a variety of roles in the organizational hierarchy but this is not a precondition for successful organization.

8. A nurse has concerns about some of the practices on the hospital unit and met with the unit manager to explain these concerns. After the meeting, the nurse felt misunderstood and rebuffed by the manager. How should the nurse determine who in the organization to meet with next?

A) Consult with the hospital bureaucracy

B) Enlist the help of a union representative

C) Ask colleagues about who is most influential in the organization

D) Refer to the hospitals chain of command

Ans: D

Client Needs: A-1

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 2

Page and Header: 162, Chain of Command

Feedback: The chain of command represents the path of authority and accountability from individuals at the top of the organization to those at the base of the organization. The nurse should most likely meet with the person who is above the manager in the chain of command. The hospital bureaucracy, the union, and the persons who are informally influential are less likely to help the nurse identify the appropriate person with whom to meet.

9. There is general agreement on a postsurgical unit that the admission assessment template that is used is lengthy, unwieldy, and includes many parameters that are not relevant to the care of the patient population on the unit. Which of following aspects of amending the assessment template best exemplifies the concept of shared governance?

A) Managers and nurses cooperatively make a change and share accountability for the outcomes.

B) The unit manager consults with nurses and members of other disciplines prior to changing the document.

C) The decision-making process reflects the chain of command that exists at the hospital.

D) Nurses collectively present the change in practice to the manager, who is then accountable for the outcomes of the change.

Ans: A

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 3

Page and Header: 166, Shared Governance Model

Feedback: Shared governance encompasses a collaborative model of decision-making and shared accountability for the outcomes of these decisions. It does not involve nurses announcing an independent change to management or management being solely accountable for the decisions of others. Shared governance is not necessarily linked to the chain of command in an organization.

10. The staff, the administrators, and the executives of a large, urban hospital are currently celebrating the fact that the hospital has recently been granted Magnet Recognition by the American Nurses Credentialing Center (ANCC). This designation suggests that the hospital

A) pays nurses higher wages than the national median.

B) has lower staff turnover than most hospitals.

C) integrates the principles of evidence-based practice into care.

D) has a committed and responsive bureaucracy.

Ans: B

Client Needs: A-1

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Communication and Documentation

Objective: 4

Page and Header: 168, Magnet Hospitals

Feedback: While all of the given options may underlie or contribute to a hospitals Magnet designation, low staff turnover is one of the key attributes of such a hospital. Magnet Recognition is not explicitly based on high wages, effective bureaucracy, or evidence-based practice.

11. A nurse who has a baccalaureate degree in nursing has begun working at a hospital in which the principles of primary care nursing are used to organize care. Which of the following actions should the nurse anticipate?

A) Performing the most complex nursing tasks on the unit for all of the patients

B) Taking action to ensure that neither too much nor too little care is provided for each patient

C) Directing a team of practical (vocational) nurses and unlicensed care providers

D) Being responsible for specific patients from the time of their admission to the time of discharge

Ans: D

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 5

Page and Header: 171, Primary Care Nursing

Feedback: In a pattern of primary care, one nurse is assigned the responsibility for the care of each patient from patient admission until that patients discharge. Patient care is not fragmented according to complexity, as in functional nursing. Collaboration of a group of RNs, PNs. and UAPs is characteristic of team nursing. Tight control of the amount of care a patient receives is a key characteristic of case management.

12. Collective bargaining has a long history in nursing. Which of the following milestones in the history of collective bargaining resulted from the 1974 amendment of the Taft-Hartley Act (Labor Management Relations Act)?

A) Nurses were granted the right to form unions and engage in collective bargaining.

B) The maximum length of a work week and the minimum nursing wage were established.

C) Nursing was formally recognized as a professional occupation.

D) Nonprofit hospitals were obliged to bargain with nurses around wages and working conditions.

Ans: D

Client Needs: A-1

Cognitive Level: Knowledge

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 8

Page and Header: 176, Table 5.1

Feedback: Under the 1974 amendment of the Taft-Hartley Act, nonprofit hospitals were required to bargain with nurses for better salaries and working conditions. The formation of unions and the recognition of nursing as a profession predated this act. The 1974 amendment did not specify wages and hours of work.

13. Contracts are essential to the maintenance of high quality care in healthcare institutions. As well, they are necessary to protect the interests of nurses who provide this care. Which of the following issues is most likely to be addressed in a contract for nurses?

A) The process that should be followed when distributing overtime work

B) The obligation of nurses to participate in nursing research

C) The details of the organizational structure of a hospital

D) The relationships among nurses, physicians and members of other health disciplines

Ans: A

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 9

Page and Header: 182, Issues Negotiated in Contracts

Feedback: Contracts commonly address such issues as overtime work. Relationships between care providers, participation in research, and organizational structure of a hospital are issues that are normally outside the purview of a nursing contract.

14. Despite the long history of collective bargaining in the nursing profession, many nurses have concerns regarding membership in a collective bargaining unit. Which of the following statements by nurses best conveys one of the primary concerns that are prevalent among nurses?

A) I think that physicians recognize our value and sufficiently advocate for our best interests.

B) I think that a collaborative model results in higher wages than a confrontational model such as collective bargaining.

C) Im not sure that joining a union is congruent with the philosophy of the nursing profession.

D) In the end, I think that the costs of being in bargaining unit outweigh the potential benefits.

Ans: C

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Difficult

Integrated Process: Communication and Documentation

Objective: 10

Page and Header: 184, Issues Related to Collective Bargaining and Nursing

Feedback: Among the major issues of collective bargaining that affect the nursing profession is the fact that some nurses see collective bargaining as unprofessional. The other most common concerns involve the matter of which bargaining group will represent nursing when nurses participate in collective bargaining, the question of whether to join a union when one exists, and the issue of the role of the supervisor.

15. Nurses, as well as individuals outside the profession, have sometimes expressed concern around the involvement of state nurses associations in collective bargaining. What factor most often underlies such concerns?

A) State nurses associations lack the legal authority to engage in bargaining though this has been their traditional role.

B) State nurses associations tend to be unaware of many of the issues that nurses face when providing care.

C) It can be difficult to reconcile the professional obligations of nurses associations with their role in bargaining.

D) Few practicing nurses participate in the activities of state nurses associations.

Ans: C

Client Needs: A-1

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Communication and Documentation

Objective: 11

Page and Header: 185, Activity of the ANA

Feedback: Some individuals contend that it is not realistic for state nurses associations to work with the professionalism aspect of nursing as well as with the issues of wages, benefits, and working conditions. State nurses associations do not lack the legal right to bargain and participation of nurses in the operations of state nurses associations does not directly affect their right or ability to bargain.

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