Chapter 01: Leading, Managing, and Following
Waddell/Walton: Yoder-Wise’s Leading and Managing in Canadian Nursing, Second Edition

MULTIPLE CHOICE

	1.	A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults. She is asked to assess and adapt the unit to better meet the unique needs of older adult patients. According to complexity principles, what would be the best approach to take in making this change?
a.	Leverage the hierarchical management position to get unit staff involved in assessment and planning.	
b.	Engage involved staff at all levels in the decision-making process.	
c.	Focus the assessment on the unit, and omit the hospital and community environment.	
d.	Hire a geriatric specialist to oversee and control the project.	

ANS:	B
Complexity theory suggests that systems interact and adapt and that decision making occurs throughout the systems, as opposed to being held in a hierarchy. In complexity theory, everybody’s opinion counts; therefore, all levels of staff would be involved in decision making.

DIF:	Cognitive Level: Apply	REF:	Page 14	
TOP:	Nursing Process: Implementation

	2.	A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who has called in sick five times in the past month. He tells the manager that he very much wants to come to work when scheduled, but must often care for his wife, who is undergoing treatment for breast cancer. In the practice of a strengths-based nursing leader, what would be the best approach to satisfying the needs of this nurse, other staff, and patients?
a.	Line up agency nurses who can be called in to work on short notice.	
b.	Place the nurse on unpaid leave for the remainder of his wife’s treatment.	
c.	Sympathize with the nurse’s dilemma and let the charge nurse know that this nurse may be calling in frequently in the future.	
d.	Work with the nurse, staffing office, and other nurses to arrange his scheduled days off around his wife’s treatments.	

ANS:	D
Placing the nurse on unpaid leave may threaten physiologic needs and demotivate the nurse. Unsatisfactory coverage of shifts on short notice could affect patient care and threaten staff members’ sense of competence. Strengths-based nurse leaders honour the uniqueness of individuals, teams, systems, and organizations; therefore arranging the schedule around the wife’s needs would result in a win-win situation, also creating a work environment that promotes the health of all the nurses and facilitates their development.

DIF:	Cognitive Level: Analyze	REF:	Page 6	
TOP:	Nursing Process: Implementation

	3.	A grievance brought by a staff nurse against the unit manager requires mediation. At the first mediation session, the staff nurse repeatedly calls the unit manager’s actions unfair, and the unit manager continues to reiterate the reasons for the actions. What would be the best course of action at this time?
a.	Send the two disputants away to reach their own resolution.	
b.	Involve another staff nurse in the discussion so as to clarify issues.	
c.	Ask each party to examine her own motives and issues in the conflict.	
d.	Continue to listen as the parties repeat their thoughts and feelings about the conflict.	

ANS:	C
Nurses and leaders must assess each situation as unique, determining appropriate actions accordingly. Leaders must adapt their styles to complement specific issues being faced, such as conflict. Examining motives and issues for the conflict in perceptions promotes equal representation of each point of view.

DIF:	Cognitive Level: Apply	REF:	Pages 11–13	
TOP:	Nursing Process: Implementation

	4.	Shortly after being informed of fetal death, a labouring woman asks why she is not able to hear her baby’s heartbeat on the monitor anymore. Although the monitor volume had been turned off so that the patient would be able to sleep between contractions, the nurse responded that there was no heartbeat to hear because the baby had died in utero; then the nurse asked whether the patient would like to talk about how she was feeling. This response demonstrates:
a.	Lack of empathy.	
b.	Ethical leadership.	
c.	Complexity science.	
d.	A coercive relationship.	

ANS:	B
Ethical leadership is based on a willingness to identify and act on complex problems in an ethical manner. Leadership can be misused when coercive relationships form, and information and true goals are withheld.

DIF:	Cognitive Level: Analyze	REF:	Page 7	
TOP:	Nursing Process: Implementation

	5.	The manager of a surgical area envisions a future that requires the addition of registered nurse (RN) assistants or unlicensed persons to feed, bathe, and walk patients. The RNs on the staff have always practiced in a primary nursing-delivery system and are very resistant to this idea. 
The best initial strategy in this situation would include:
a.	Exploring the values of the RNs in relation to this change.	
b.	Leaving the RNs alone for a time so they can think about the change before they are approached again.	
c.	Dropping the idea and trying for the change in another year or so.	
d.	Hiring the assistants and allowing the RNs to see what good additions they are.	

ANS:	A
Leadership involves engaged decision making around a vision that is based on evidence and tacit knowledge. Influencing others requires emotional intelligence in domains such as empathy and handling relationships.

DIF:	Cognitive Level: Apply	REF:	Page 5	
TOP:	Nursing Process: Implementation

	6.	As the charge nurse on the night shift in a small long-term care facility, you have found that there is little turnover among your licensed practical nurse and nursing assistant (NA) staff members, but they are not very motivated to work beyond their job descriptions. Which of the following strategies might motivate the staff and lead to greater job satisfaction?
a.	Ask the director of nursing to offer higher wages and bonuses for extra work for the night licensed practical nurses and NAs.	
b.	Allow the licensed practical nurses and NAs greater decision-making power within the scope of their positions in the institution.	
c.	Help the licensed practical nurses and NAs with their work, whenever possible.	
d.	Ask the director of nursing to increase job security for night staff by having them sign contracts that guarantee work.	

ANS:	B
A nurse leader should provide an environment conducive to opinion sharing that involves staff in decision making at all levels. This approach is shown to increase job satisfaction. Decision making and the corresponding actions taken are core tasks performed in engagement with coworkers.

DIF:	Cognitive Level: Apply	REF:	Page 7	
TOP:	Nursing Process: Implementation

	7.	As the nurse manager, you want to increase motivation by providing motivating factors. Which action would you select?
a.	Collaborate with the human resources/personnel department to develop on-site daycare services.	
b.	Provide a hierarchical organizational structure.	
c.	Implement a model of shared governance.	
d.	Promote the development of a flexible benefits package.	

ANS:	C
Complexity theory suggests that systems interact and adapt and that decision making occurs throughout systems, as opposed to being made unilaterally by different levels of the organizational hierarchy. In complexity theory, every person’s opinion counts, and therefore all levels of staff would be involved in decision making. This principle underlies shared governance. Shared governance is an example of nurse decision making in which nurses at different organizational levels engage in shaping policy and practices.

DIF:	Cognitive Level: Apply	REF:	Page 5	
TOP:	Nursing Process: Implementation

	8.	A charge nurse on a busy 40-bed medical/surgical unit is approached by a patient’s son, who begins to complain loudly about the quality of care his mother is receiving. His behaviour is so disruptive that it is overheard by staff, physicians, and other visitors. The family member rejects any attempt to intervene therapeutically to resolve the issue. He leaves the unit abruptly, and the nurse is left feeling frustrated. Which behaviour by the charge nurse best illustrates refined leadership skills in an emotionally intelligent practitioner?
a.	Reflection to obtain insight into how the situation could be handled differently in the future	
b.	Trying to catch up with the angry family member to resolve the concern	
c.	Discussing the concern with the patient after the family member has left	
d.	Notifying nursing administration of the situation	

ANS:	A
Emotional intelligence is closely aligned with individuals’ capacity to know themselves and others. Reflecting to obtain insight and being able to “step” outside the situation to envision the context of what is happening is an example of the actions of an emotionally intelligent practitioner.

DIF:	Cognitive Level: Apply	REF:	Page 8	
TOP:	Nursing Process: Implementation

	9.	The chief nursing officer has asked the staff development coordinator to facilitate the development of a clinical competency program for the facility. While making rounds on the units, the staff development coordinator overhears RN staff complaining that they believe it is insulting to be required to participate in a competency program. Which behaviour by the staff development coordinator is most appropriate in this situation?
a.	Disregard staff concerns and continue with development of the program.	
b.	Inform the nurses that this program is a requirement for accreditation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).	
c.	Schedule a meeting with the chief nurse executive to apprise her of the situation.	
d.	Facilitate a meeting so nurses can articulate their values and concerns about a competency program.	

ANS:	D
The manager role involves guiding other people through a set of derived practices that are evidence-informed and known to satisfy pre-established outcomes such as participation in a competency program. This involves engagement of staff through sharing of concerns and ideas. This type of leader can instill hope and trust in followers, which influence their behaviours and attitudes (such as engagement and satisfaction) and cause work environments to become more positive.

DIF:	Cognitive Level: Apply	REF:	Pages 11–13	
TOP:	Nursing Process: Implementation

	10.	Which category is unique to leadership but is not part of management?
a.	Initiating change	
b.	Personal qualities	
c.	Developing people	
d.	Information management	

ANS:	C
Developing people—coaching, mentoring, succession planning—is a category of solely leadership, not management. Initiating change and personal qualities are categories of both management and leadership. Information management is a category of management only.

DIF:	Cognitive Level: Understand	REF:	Page 17	
TOP:	Nursing Process: Assessment

	11.	You overhear a newly graduated RN telling one of your colleagues that leadership and management belong to the unit manager and not to her. Because you are a nursing colleague, your response demonstrates understanding that the perception of the new graduate:
a.	Is accurately reflected in the new graduate’s statement.	
b.	Would benefit from further understanding of her role as a professional in relation to decision-making.	
c.	Has been influenced by nurse leaders and managers who leave for other positions.	
d.	Is related to the general perception that nurse leaders and managers are not satisfied in their jobs.	

ANS:	B
Decision making and the corresponding actions taken are the core work performed in engagement with co-workers. This core work requires that nurses be leaders, managers, and followers at the point-of-care, unit, institutional, and even societal levels.

DIF:	Cognitive Level: Understand	REF:	Page 7	TOP:	Nursing Process: Evaluation

	12.	You walk into a patient’s room and find him yelling at the licensed practical nurse. The patient is obviously very upset, and after you speak with him regarding his behaviour, you determine that he has not slept for three nights because of unrelieved pain levels. The licensed practical nurse is very upset with him and calls him an “ugly, old man.” You acknowledge her feelings and concerns and then suggest that the patient’s behaviour was aggressive but is related to lack of sleep and to pain. You ask, “Can both you and the patient together determine triggers for the pain and effective approaches to controlling his pain?” This approach demonstrates:
a.	Lack of empathy and understanding for the licensed practical nurse.	
b.	Concern with placating the patient.	
c.	Leadership behaviour.	
d.	Management behaviour.	

ANS:	C
The situation between the patient and the licensed practical nurse is complex, involving unrelieved symptoms and aggressiveness toward a staff member. Health care is now delivered in a collaborative, and most often, an interdisciplinary manner, whereby select leadership/management roles (e.g., first-line nurse leaders) serve as conduits for information and care coordination. Providing engaged, collaborative guidance and decision making in a complex situation for which there is no standardized solution reflects leadership.

DIF:	Cognitive Level: Apply	REF:	Page 7	
TOP:	Nursing Process: Implementation

	13.	Which category is unique to management but is not part of leadership?
a.	Initiating change	
b.	Personal qualities	
c.	Developing people	
d.	Information management	

ANS:	D
Information management is a category of management only. Developing people is a category of solely leadership, not management. Initiating change and personal qualities are categories of both management and leadership.

DIF:	Cognitive Level: Understand	REF:	Page 15	
TOP:	Nursing Process: Assessment

	14.	Chart audits have revealed significant omissions of data that could have legal and funding guidelines. As the unit manager, you meet with the staff to discuss audit findings and to find approaches that will address the gaps in charting and achieve desired goals. This is an example of:
a.	Leadership.	
b.	Management.	
c.	Decision making.	
d.	Vision.	

ANS:	B
The process of guiding other people to meet established goals, outcomes, and procedures is management. This can require collaborative decision making to determine how best to reach predetermined goals and follow established practices.

DIF:	Cognitive Level: Apply	REF:	Pages 6–7	
TOP:	Nursing Process: Implementation

	15.	A family is keeping vigil at a critically ill patient’s bedside. Other distant family members, not yet able to come, call the unit continuously, asking for updates and wanting to express concern. You speak with the distant family members and suggest that you are going to refer them to the hospital social worker, whose role is to work with such situations. What role are you assuming through this action?
a.	Manager	
b.	Leader	
c.	Follower	
d.	Laissez faire	

ANS:	A
Management is the process of getting the job done and ensuring that people have the necessary resources to get the job done. Referral to a social worker alleviates demand on nurse staff time and is consistent with hospital procedures.

DIF:	Cognitive Level: Apply	REF:	Page 6	
TOP:	Nursing Process: Implementation

	16.	After a meeting with members of the family of a dying patient, the nursing manager discusses with you the family’s desired approach to care, and you support the manager’s decision. Your actions indicate that you are acting in what role?
a.	Leadership	
b.	Management	
c.	Followership	
d.	Evidence-informed	

ANS:	C
Followership is engaging with other people who are leading or managing by contributing to the work that needs to be done. By accepting and implementing the desired approach to care direction given by the manager in response to your concerns, you are demonstrating followership.

DIF:	Cognitive Level: Analyze	REF:	Page 7	
TOP:	Nursing Process: Implementation

	17.	You pull staff together to assess a situation in which the family of a seriously ill patient is anxious and is absorbing a great deal of staff time in consultation, discussion, and questioning of treatment decisions. Staff members are beginning to distance themselves from the family. After inviting the concerns of staff, you explain that the organization values patient-centred care and suggest that evidence indicates that acting as an advocate and a listener is helpful to families. You ask the staff for ideas as to strategies that are effectively patient-centred in these situations. In this situation, you are taking on which role?
a.	Leadership	
b.	Management	
c.	Follower	
d.	Visionary	

ANS:	A
Leadership is the process of engaging and influencing others. Strong leaders are associated with words such as visionary, energetic, inspirational, and innovative; they go beyond the status quo to make a difference for others. As a leader, you engage other people in decision making that moves them toward a goal with a reasonable level of risk taking.

DIF:	Cognitive Level: Apply	REF:	Page 7	
TOP:	Nursing Process: Implementation

	18.	Marie-Claire, the nursing unit manager, finds it difficult to work with Thomas, a new graduate. Thomas has many ideas and his manner of presenting them irks Marie-Claire. After reflection and discussion with others, Marie-Claire recognizes that she also feels threatened by his behaviour. She comes to understand that Thomas is trying to establish his own role on the unit, is not trying to challenge her, and needs guidance, coaching, and affirmation. Marie-Claire is demonstrating
a.	A positive self-concept.	
b.	Deepening self-awareness.	
c.	Leadership.	
d.	Acquiescence.	

ANS:	B
Individuals demonstrate emotional intelligence by raising their self-awareness and better regulating their emotions. Being empathetic and showing sensitivity to the experiences of others help nurse leaders develop their emotional intelligence.

DIF:	Cognitive Level: Apply	REF:	Page 11	
TOP:	Nursing Process: Implementation

	19.	As the head of a nursing program, you consistently invite your team to develop ideas about innovations in teaching, community partnerships, and curriculum design and invite participation in decisions. Many of these ideas have been implemented successfully, and your staff members are keen to try other ideas. You are employing _____ leadership.
a.	Situational	
b.	Trait-based	
c.	Contingency-based	
d.	Transformational	

ANS:	D
Transformational leadership involves attending to the needs and motives of followers, which results in creativity, improvement, and employee development.

DIF:	Cognitive Level: Apply	REF:	Pages 11–12	
TOP:	Nursing Process: Implementation

	20.	As a leader on a rehabilitation unit, you encourage all staff members to see themselves as having a role in decision making and quality care. You see your role as involving particular responsibilities in decision making, but not as a hierarchal role. This view of decision-making and leadership is consistent with:
a.	Trait theories.	
b.	Complexity science.	
c.	Situated theory.	
d.	Emotional intelligence.	

ANS:	B
Complexity science involves decision making distributed among the human assets within an organization, without regard to hierarchy.

DIF:	Cognitive Level: Understand	REF:	Page 14	
TOP:	Nursing Process: Assessment

	21.	You recently acquired a position as a unit manager. During your time on the unit, you have formed a strong social network among your staff, have promoted the development of relationships between your staff and workers in other areas of the organization, and have formed relationships that generate ideas from patient organizations and the local nursing education program. According to complexity science, you are engaging which principle?
a.	Empowerment.	
b.	Systematic thinking.	
c.	Development of networks.	
d.	Bottom-up interactions.	

ANS:	C
According to complexity science, networks evolve around areas of common interest and can respond to problems in creative and novel ways.

DIF:	Cognitive Level: Apply	REF:	Page 14	
TOP:	Nursing Process: Implementation

	22.	According to complexity science, which of the following should be the focus of measurement?
a.	Cost per hospital day.	
b.	Bed utilization.	
c.	Infection rates.	
d.	Staff morale and budgets.	

ANS:	D
In complexity science, principles to better understand the nature of relationships within complex social systems, objective data, and non-measurable data cannot be ignored because both inform decisions.

DIF:	Cognitive Level: Analyze	REF:	Pages 14–15	
TOP:	Nursing Process: Assessment

	23.	During a staff meeting held to discuss developing a mission statement for the unit, the idea of placing patient needs first is:
a.	Empowering.	
b.	A leadership tag.	
c.	A symbol.	
d.	A management task.	

ANS:	B
The term tag references the philosophic, patient-centred, and values-driven characteristics that give an organization its personality; they are sometimes called attractors or hallmarks of culture.

DIF:	Cognitive Level: Understand	REF:	Page 13	
TOP:	Nursing Process: Assessment

	24.	An RN staff member had to inform a licensed practical nurse on the unit nursing team that the care that she was providing needed improvement. The RN provided her with some practical examples of ways to improve her nursing care. After the discussion, the licensed practical nurse thanked the RN for the constructive criticism, and the two nurses proceeded to the cafeteria to have a coffee break together. Which follower characteristic did the RN display during this encounter?
a.	Being a team player.	
b.	Willingness to learn.	
c.	Active participation.	
d.	Being an effective communicator.	

ANS:	D
In this situation, the RN staff member demonstrated the ability to deliver negative news to a team member in an appropriate way. This is not an easy task; it requires experience, courage, and skill. Being a team player, willingness to learn, and active participation are all follower characteristics; however, the best answer for this situation is effective communicator.

DIF:	Cognitive Level: Analyze	REF:	Page 16, Table 1.3	
TOP:	Nursing Process: Evaluation

	25.	The unit is shifting from primary nursing to a team model in an effort to contain costs. Staff members are angry and ask for a meeting to discuss the change. After hearing their concerns related to reduction in professional autonomy and care quality, you do the following:
a.	Acknowledge the loss.	
b.	Explain the reasons for change, emphasizing the need to reduce costs.	
c.	Repeat the information several times, giving detailed budget overviews.	
d.	Adjourn the meeting and provide explanation through e-mail.	

ANS:	A
In providing an explanation for the change, it is important to acknowledge the loss and to provide enough detail to inform but not to paralyze, while you keep in mind the background of the listeners. In this situation, reasons for the change can still be addressed and should be explained in the context of how values are related to quality.

DIF:	Cognitive Level: Apply	REF:	Page 18	
TOP:	Nursing Process: Implementation

	26.	The Canadian government identifies the first point of care for Canadian residents.
a.	Hospitalization	
b.	Acute care	
c.	Primary care	
d.	Specialized services	

ANS:	C
The Government of Canada website states primary health care services should be every Canadian resident’s first point of contact with our publicly funded health care system. Primary health care providers also coordinate patients’ health services from “diagnosis to recovery” and access to specialized services and hospitalization.

DIF:	Cognitive Level: Apply	REF:	Page 4	
TOP:	Nursing Process: Assessment

MULTIPLE RESPONSE

	1.	A nurse manager on a busy rehabilitation unit recognizes that a new nurse graduate has potential to become a leader in mentoring and supporting other nurse graduates. The manager considers this nurse to possess characteristics of high emotional intelligence. Which of the following characteristics manifest in emotional intelligence? (Select all that apply.)
a.	Enhanced communication skills.	
b.	Showing sensitivity to the experience of others.	
c.	Taking an advanced leadership course.	
d.	Mentoring new nurses.	

ANS:	A, B
Researchers in the United States found positive associations between nurse leaders with transformational leadership styles and their levels of emotional intelligence (EI), indicating how emotional self-awareness and other awareness, along with regulation of emotions, are important attributes for building and sustaining positive workplace relationships with followers.

DIF:	Cognitive Level: Apply	REF:	Page 8	
TOP:	Nursing Process: Assessment

	2.	Sarah is concerned about your direction regarding management of incontinent, confused patients. She brings you evidence that she has found regarding incontinence interventions and asks you whether you both could talk about the guidance that you have given after you have had an opportunity to read the articles. This is an example of (Select all that apply.)
a.	Leadership.	
b.	Followership.	
c.	Management.	
d.	Insubordination.	

ANS:	A, B
This is an example of followership. Followers can promote team effectiveness, for instance, by maintaining collaborative work relationships, offering constructive criticism, and sharing leadership and management responsibilities. In addition, Sarah demonstrated leadership in seeking and presenting evidence that may influence the decision making of her nurse leader and manager.

DIF:	Cognitive Level: Apply	REF:	Page 7	
TOP:	Nursing Process: Implementation

	3.	An experienced nurse is exhibiting signs of stress associated with workload issues and has been abrupt with co-workers. The manager requests a meeting with the nurse to determine how to best support her. What aspect of mindfulness supports the nurse learning this technique? (Select all that apply.)
a.	Dampens negative thoughts.	
b.	Prevents mental drift.	
c.	Enhances authentic thinking.	
d.	Causes knee jerk reactions.	

ANS:	A, B, C
Mindfulness buffers against mental drift and it can also guard against ‘knee jerk’ reactions. Rather than immediately evaluating and labelling emotions in a situation, the mindful person creates a neutral space for reflection. Mindfulness practice enhances positive and authentic thinking.

DIF:	Cognitive Level: Apply	REF:	Page 9	
TOP:	Nursing Process: Implementation

	4.	When attending a clinical rotation in a geriatric setting a group of student nurses, Ashley observed all staff worked seamlessly, morale was high, and resident and family satisfaction rates are high. Upon discussing with the nurse manager their observations, the term “authentic leadership” was identified as the primary reason. What characteristics of authentic leadership support this observation? (Select all that apply.)
a.	Awareness of the people around them.	
b.	Apply balanced processing.	
c.	Align words to match beliefs.	
d.	Are swayed by external pressures.	

ANS:	A, B, C
Authentic leaders have heightened awareness of themselves in relation to others around them; they have an internalized moral perspective, and they align their words and actions to match their underlying values and beliefs—they are not swayed by external pressures; they apply balanced processing or the thoughtful consideration of all.

DIF:	Cognitive Level: Apply	REF:	Page 11	TOP:	Nursing Process: Evaluation