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Flashcards in Chapter 29 Deck (24):
1

You are a new nurse that is looking for your first nursing job. You are aware of some key elements to consider when choosing a first nursing job. Which is not necessarily one of those key elements?
a. patient fit c. scheduling
b. work environment d. orientation options

A: Patient fit would not be an element that you would consider. Some important considerations when choosing your first nursing position include patient type, work environment, scheduling, and orientation options. CHOOSING A POSITION

2

During your transition from student nurse to your first position as a staff nurse, your general an unit orientation are a key component of the transition. Which of the following questions would be most appropriate for you to ask about orientation?
a. How long should I expect to be in orientation?
b. How will I be paid for my time in orientation?
c. Do I have to attend every orientation session?
d. Will I be graded during the orientation?

A: It is appropriate for the new graduate to ask about the length of the orientation program. It would not be appropriate to ask about pay for orientation, grading of performance or whether the graduate should attend all sessions. Hospitals invest a great deal of funds in orientating new employees and it is expected that they will participate in the orientation fully. ORIENTATION CONSIDERATIONS

3

You are a new graduate and have been hired at the local hospital. Which of the following would be least likely to be included in this orientation?
a. validation of CPR
b. human resource policies
c. specific requirements for certain units
d. policies related to medication administration

C: General orientation usually includes information and skills measurement that all nurses new to the facility need to know regardless of their unit. Some examples are validation of CPR, human resource policies, policies related to medication administration, opportunities to hear from representatives from various departments, and patient safety concerns (per the Joint Commission). Specific requirements for certain units will come during the unit-specific orientation. GENERAL ORIENTATION

4

Your preceptor is providing you with a unit-specific orientation. Which of the following would be included in the unit-specific orientation?
a. benefits c. patient safety standards
b. IV pumps d. CPR

B: Unit-specific orientation focuses upon information and competencies that a new nurses needs to care for the diagnoses and ages of the patients on the assigned unit. Some elements in the unit-specific orientation include unit-specific policies and procedures such as IV pump usage and acquisition and paperwork needed for new admissions and discharges. Benefits, patient safety standards, and CPR validation are covered during general orientation. UNIT-SPECIFIC ORIENTATION

5

Utilizing the example of the unit-specific competency tool for the emergency department, there are a number of skills that are significant to any new nurse. Which of these is not necessarily correct?
a. monitor data so that I am up to date on evidence-based care for my patients
b. network primarily with other nurses
c. participate in professional committees at work
d. communicate pride in being a nurse

B; The unit-specific competency tool example of the Emergency Room provided in the text offers a number of useful skills and critical-thinking concepts that are valuable for new nurses. Some of these are to monitor data so that I am up to date on evidence based care for my patients, to network primarily with other professionals (not only nurses), to participate in professional committees at work, to communicate pride in being a nurse, to monitor data so that my patients are complication free and have no nurse-sensitive outcomes, and to give and receive professional respect to the health care team. CRITICAL THINKING 29-1

6

You tell a friend that one of the patients tried to intimidate you when the patient discovered that this was you first nursing position. You friend gives you several methods to prepare for such situations. Which method would your friend be least likely to suggest to you?
a. Keep your knowledge base up to date.
b. Look and act like a professional.
c. Demonstrate to your patients that you possess a body of nursing care knowledge.
d. When you are with your patient, don’t ask another nurse to help you, this can show the patient that you don’t know what you’re doing.

D: New nurses can often be surprised that their patients expect them to have the answers, hence may become intimidated. Your education and experiences give you a firm background in nursing process and patient care, but some other ways to help enhance one’s confidence are keeping your knowledge base up to date, looking and acting like a professional, demonstrating to your patients that you possess a body of nursing care knowledge, and demonstrating a sense of caring to your patients. If you are unsure about something or need advice do not be afraid to ask other nurses or professionals for advice or assistance. Completing a task correctly is better than proceeding with a task that not sure of. WORKING WITH PATIENTS

7

After completing a class on working collaboratively with other members of the health team, the nursing instructor asks the students to identify methods to implement collaboration as a new member of the team. Which comment by a student would indicate that additional teaching is needed?
a. establish rapport and introduce yourself
b. seek clarification if an order is unclear
c. do not be intimidated
d. be as assertive as possible, even aggressive if need be

D: Cardillo (2001) provides some tips for new nurses on working with health care practitioners. Some of these include establishing rapport and introducing yourself, seeking clarification if an order is unclear and repeating the order and clarifying it, not being intimidated, and being assertive but sincere (not possibly aggressive if need be). WORKING WITH DOCTORS

8

A nursing instructor asks a group of students if they know the traits that a successful preceptor would possess. Which trait identified by a student, would indicate to the instructor that further teaching is needed?
a. assertive/aggressive in clinical expertise
b. clinically prepared
c. enjoys teaching
d. committed to the role

A: Nurses are generally assigned the role as preceptor due to their expertise, experience, and knowledge of the unit and facility. Some important characteristics of effective preceptors: clinically prepared/experienced, enjoy teaching, committed to the role as preceptor, familiar with the organization’s policies and procedures, and willing to share knowledge and model behaviors for their orientees. Being assertive and/or aggressive related to clinical expertise may make a preceptor difficult to work with for new nurses, and this behavior is not conducive to effective precepting or to successful orientation. PRECEPTORS

9

As a nurse you are exposed to many performance feedback mechanisms. Which one of the following is not one of these mechanisms?
a. 365-degree feedback c. formal performance feedback
b. preceptor feedback d. informal performance feedback

A: Performance feedback can take many forms. Some formats that new nurses may encounter are 360-degree feedback (not 365-degree feedback), preceptor feedback (feedback from one’s preceptor during the orientation period), formal performance feedback (regular formalized performance evaluation to maintain accreditation (for new nurses, generally after the orientation process or first 3 months, and then at 6- and 12-month intervals for the first year), and informal performance feedback (feedback from nurses and professional you work with such as “good job,” or “your IV placement technique is really nice”). PERFORMANCE FEEDBACK

10

You are the nurse manager and must conduct a performance evaluation on a nurse that you hired this year. Which aspect of your evaluation would indicate that improvement is needed?
a. demonstrates competency in knowledge base, skill level, and psychomotor skills
b. organizes and coordinates delivery of patient care in an efficient and cost-effective manner
c. participates in unit and service quality management activities
d. performs an ongoing and systematic assessment, focusing only on physiological status

D: Performance evaluations are based upon the nurse’s performance measured against the job description. Some examples of what may be covered during a performance evaluation include demonstrates competency in knowledge base, skill level, and psychomotor skills, organizes and coordinates delivery of patient care in an efficient and cost-effective manner, participates in unit and service quality management activities, performs an ongoing and systematic assessment focusing on physiological, psychological, and cognitive status (not only physiological), and demonstrates ability to identify, plan, implement, and evaluate patient’s educational needs. FIGURE 29-3 ALBANY MEDICAL CENTER HOSPITAL PATIENT CARE SERVICES JOB DESCRIPTION FOR REGISTERED PROFESSIONAL NURSES

11

A nursing instructor quizzes students on the 360-degree feedback evaluation tool. Which comment by a student would indicate that further clarification is needed?
a. potentially provides a broader more balanced assessment
b. is time consuming
c. does not include patient interviews or assessments
d. includes peer reviews

C: The 360-degree evaluation tool is used by some health care organizations where an individual is assessed by a variety of people in order to provide a broader perspective. Some other aspects of this evaluation tool include peer reviews, evaluation by the nurse’s immediate supervisor, and patient interviews, and it is time consuming yet yields valuable information from a number of different sources. 360-DEGREE FEEDBACK

12

A new nurse is beginning to establish short term goal to be addressed in the nurse’s performance appraisal. The nurse recognizes that part of the goal setting process would include which of the following?
a. goals should be developed by the nurse in collaboration with the nurse’s manager
b. one goal would be to successfully complete an advanced practice certificate
c. goals should be vague and general
d. goals do not have to be measurable but they must be achievable

A: The establishment of performance goals (short term) are an essential part of any performance appraisal. They are especially important for new nurses as they provide opportunities for mentorship and guidance from one’s immediate supervisor for attainable goal setting. Some aspects of effective goals setting: they are developed by the nurse and the nurse’s manager, are clearly articulated, are measurable, and are attainable. The goal of successfully completing an advance practice degree is not a sound short-term or initial goal for a new nurse graduate. However, it can be a long-term goal. The initial goals set by the new nurse and the nurse’s manager should be short term and attainable within a short period of time, such as “become an active participant in a unit-based or hospital wide committee.” GOAL SETTING

13

A variety of different organizational responses to performance exist. Some of these may be in response to positive feedback and others to negative feedback. Which of the following actions should the nurse manager implement when giving negative feedback?
a. 360-degree feedback c. punishment
b. ignoring the problem d. progressive discipline

D: When an individual’s appraisal feedback indicates a need for further improvement, the organization will use a corrective action program to help rectify the situation and guide the individual towards significant performance improvement. Progressive discipline is a form of corrective action where the employee’s and manager’s mutual goal is to correct the performance to an acceptable level. The 360-degree feedback evaluation tool may be used to initially identify the problem. Ignoring the problem and punishment are not effective means of dealing with problems. CORRECTIVE ACTION PROGRAMS

14

The nurse manager has implemented the process of progressive discipline with a nurse who has violated hospital policy. The nurse manager recognizes that two criteria for corrective actions to be effective are that the actions are:
a. consistent and impartial
b. very assertive and pertinent
c. pejorative and sound
d. measurable and administered by HR

A: Corrective action programs have certain criteria that make them effective. Two of these criteria are that they are consistent and impartial. Assertiveness can be construed as aggression, especially when an individual’s performance has been questioned, and pejorative measures are derogatory and should never be considered for any type of corrective action. Corrective action programs do not need to be administered by HR, but they are generally notified because a copy of any corrective action is placed in the individual’s HR file as well as the unit manager’s file. CORRECTIVE ACTION PROGRAMS

15

A nurse manager may encounter behaviors from staff that may necessitate corrective action. Which of the following is not one of those behaviors?
a. excessive absenteeism
b. failing to comply with policies or procedures
c. inability to complete assignments in a timely manner
d. a union complaint

D: Behaviors that result in corrective action measures can be categorized into developmental or a failure to follow policies and procedures. The nurse’s inability to complete assignments in a timely manner most likely does not have to do with the nurse’s inability to understand the rules, but shows that the nurse may need some guidance and coaching on time management from their manager. Excessive absenteeism is a form of failing to comply with policies and procedures, which necessitates disciplinary corrective action. A union complaint does not necessarily require corrective action unless it occurs as a result of a corrective or disciplinary action, such as a verbal warning. CORRECTIVE ACTION PROGRAMS

16

You are delegating a task to another RN on your team. Which of the following would be the most appropriate instruction for the RN?
a. “Please teach the patient how to do ostomy care at home.”
b. “Please teach the patient and the family the correct method for ostomy care when the patient is discharged.”
c. “Please assess the patient’s understanding of how to care for the ostomy while at home and report back to me when you finish.”s
d. "Please construct a teaching plan for this patient's ostomy care today. Be sure that the patient and his wife will be able to perform effective ostomy care at home."

D: When delegating to another RN, the instructions should be clear and thorough. In this situation stating, “Please construct a teaching plan for this patient's ostomy care today. Be sure that the patient and his wife will be able to perform effective ostomy care at home." DELEGATION TO A TEAM MEMBER

17

You are a nurse manager supervising an excellent team of nurses, whose members you want to keep with you as long as possible. You know that data has shown that nurses tend to stay in their positions longer if they are challenged and have opportunities to enhance their professional growth. Which of the following strategies will not necessarily challenge these nurses and enhance their professional growth?
a. educational opportunities c. increased benefits
b. cross training d. mentorship

C: A number of strategies exist to enhance professional growth for nurses. Educational opportunities such as taking an EKG course or obtaining PALS or ACLS certification are some ways of contributing to professional growth. Cross training is another effective way to enhance one’s skills and abilities to work in different situations and units. Forming a mentorship relationship with a more experienced nurse can be a benefit for both the mentee and mentor. Increasing benefits offered to employees may be a positive action, but does not necessarily contribute to one’s growth professionally. STRATEGIES FOR PROFESSIONAL GROWTH

18

You have been a nurse for three years and want to significantly enhance your long-term professional growth. Your best strategy would be through which of the following?
a. fishbone diagrams c. 365-degree feedback
b. clinical ladder d. patient feedback

B: Professional growth opportunities pertain to occasions where an individual can enhance their current professional knowledge base and skill set. The use of a clinical ladder can assist a nurse in enhancing their professional and career goals by providing a framework for promotion in a specific track within a clinical, educational, or managerial focus. 360-degree feedback (not 365 degree) and patient feedback provide information regarding a nurse’s immediate performance but do not necessarily help to enhance the long-term professional growth in a significant manner. Fishbone diagrams are often used in quality improvement initiatives. DEVELOPING PROFESSIONAL GOALS

19

A nursing instructor is coaching students on methods to approach salary issues during a job interview. When asked what type of question they might ask the nurse recruiter, the students identified several questions. Which question posed by one of the students, would indicate to the instructor that further clarification is needed?
a. Is there a raise after passing the NCLEX-RN exam?
b. Are nurses paid extra for having a nursing degree?
c. What are the shift differentials?
d. Are nurses paid for orientation shifts and required courses?

B: There are different types of degrees in nursing such as the ADN. The instructor would need to clarify that the question should focus on whether nurses are paid more if they have a BSN. The other questions posed by the students would be appropriate. WORK ENVIRONMENT

20

You are very excited about your new job but you have been late for work several times because of the traffic. At this time you believe the nurse manager will implement a disciplinary action. Which action will the nurse manager most likely take first?
a. written warning c. verbal warning
b. suspension d. termination

C: In general, the first action that a nurse manager would take related to tardiness would be a verbal warning. If the pattern continues then a written warning would most likely be given. Continued violations may result in suspension and finally termination. CORRECTIVE ACTION PROGRAMS

21

A new graduate nurse has been absent from work on numerous occasions. Each time the unit has been left short staffed, requiring the nurse manager to request a float nurse for the unit. The nurse manager has met with the new graduate nurse regarding the persistent absences and provided the new graduate nurse with both verbal and written warnings. If the behavior continues which action should the nurse manager take next?
a. terminate the new graduate nurse
b. suspend the new graduate nurse
c. dock the new graduate nurse’s pay check
d. ask the union representative to talk with the new graduate nurse

B: Because the behavior has continued without correction, the nurse manager must take further action. Since both verbal and written warnings have been given the most likely next step for the nurse manager to take would be to suspend the new graduate nurse. CORRECTIVE ACTION PROGRAMS

22

As a novice nurse, you recognize that which of the following individuals would be most likely to serve as a support when you are met with ethical issues, provide you with networking opportunities, and assist you in identifying the direction that your career should take?
a. preceptor c. supervisor
b. mentor d. best friend

B: The mentor helps the novice develop skills and career direction. A mentor may introduce the younger nurse to professional networking opportunities. The mentor is also a good person to assist the new nurse in a workplace ethical dilemma. An experienced preceptor may serve as an informal mentor in some situations. IDENTIFYING A MENTOR

23

While the national turn-over rate for first-year nurses was 27.1%, the year-long UHC/AACN Nurse Residency Program™ (NRP) developed by the University Health System Consortium (UHC), was able to reduce the turn-over rate to which of the following?
a. 4.4% c. 14.0%
b. 7.7% d. 16.4%

A: The year-long UHC/AACN Nurse Residency Program™ (NRP) developed by the University Health System Consortium (UHC), an alliance of 107 academic medical centers and 232 of their affiliated hospitals helped members achieve an astounding 4.4% turnover rate among first-year nurses. This figure compares with a national turnover rate of 27.1%, according to the Pricewaterhouse Coopers’ Health Research Institute. CHOOSING A POSITION

24

You have been identified as a Millennial Generation nurse. You are working with a team of three LPNs two of whom are Baby Boomers and one is a Generation X nurse. You also are working with two NAP both are from the Baby Boom Generation. What should you focus on when working with your team?
a. All of the staff members will resent you because you are much younger and more educated than any of them.
b. Communication and teamwork among staff of all generations is critical in assuring a positive work milieu that can affect safe patient care and good working relationships.
c. Providing the LPNs with additional responsibilities and have them supervise the NAPs in what ever manner they choose.
d. Your reputation is dependent on whether the team members acknowledge your authority and provide you with respect even if you are the youngest person on the team.

B: Your major focus should be on the fact that communication and teamwork among staff of all generations is critical in assuring a positive work milieu that can affect safe patient care and good working relationships. DELEGATION TO TEAM MEMBERS