Chapter 24: Managing Personal/Personnel Problems Nursing School Test Banks

Chapter 24: Managing Personal/Personnel Problems
Yoder-Wise: Leading and Managing in Nursing, 6th Edition

MULTIPLE CHOICE

1. The most important approach that a nurse manager can take with an emotionally troubled employee is to:
a. Act as a therapist for the employee.
b. Adjust the standard of care to assist the employee.
c. Assist the employee in obtaining professional help.
d. Adjust the employees work schedule to decrease stress.
ANS: C
Emotional difficulties are usually beyond the scope of skills that a nurse manager would normally employ. A referral needs to be made to a professional who is specifically prepared to deal with this kind of difficulty.

REF: Page 458 TOP: AONE competency: Communication and Relationship-Building

2. The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is that:
a. Using replacement personnel with new ideas may be beneficial.
b. Salary costs are lower because personnel are fewer, and outcome is favorable.
c. Absence on the part of the rest of the staff is decreased.
d. Unacceptable patient care may result.
ANS: D
Reduced staffing adversely affects patient care. Employee morale suffers, care standards may be lowered, and additional stress is placed on working staff.

REF: Page 451 TOP: AONE competency: Knowledge of the Health Care Environment

3. In keeping with guidelines of the organization, the nurse manager documents staff problems. Documentation of disciplinary problems should:
a. Include a plan to correct them and to prevent future occurrences.
b. State a detailed history of past problems that are related to the current one.
c. Be written at the convenience of the manager.
d. Not be discussed until the formal performance evaluation.
ANS: A
In documenting staff problems, it is important to identify the incident with an objective statement of facts and record actions taken to correct/prevent future problems.

REF: Page 459 | Page 462 TOP: AONE competency: Business Skills

4. Before terminating an employee, a nurse manager must:
a. Be an expert in all legal aspects of termination and discipline practices.
b. Follow the organizations specific policies for addressing disciplinary problems and termination.
c. Function as a counselor for problem employees.
d. Do everything to assist and protect the employee by adjusting standards and policies.
ANS: B
It is important to know the policies of the organization to address disciplinary issues fairly and equitably, as well as to know the model that is employed to address employee problems. Human resource departments and legal departments are important sources for consultation, advice, and support.

REF: Page 460 TOP: AONE competency: Business Skills

5. A nurse manager understands that the typical first step in handling an employee with a disciplinary problem is a:
a. Verbal reprimand.
b. Written reprimand.
c. Reminder of employment standards.
d. Day off without pay.
ANS: C
The progressive model of discipline advocates that the first step of the disciplinary process is the informal reprimand or verbal admonishment. The nonpunitive discipline model advocates reminding the employee of the employment policies and procedures of the agency.

REF: Page 460 TOP: AONE competency: Business Skills

6. The chief nursing officer understands that clinical incompetence is best prevented by a(n):
a. Flexible protocol for evaluating competency skills.
b. Standardized clinical skills checklist.
c. Administration of personality tests and competency assessments at point of hire.
d. Formalized competency program with established standards for practice.
ANS: D
The competency program with established standards of practice outlines what the nurse must do to achieve desired competencies in her current position. Competency assessment and goal-setting should help the nurse identify how to excel and which competencies the nurse wants to achieve in the future.

REF: Pages 454-456 TOP: AONE competency: Business Skills

7. A nurse manager understands that the second step in handling an employee with a disciplinary problem is to document the incident. Which of the following is best for documentation of personnel problems?
a. Use of the performance appraisal on an annual basis
b. Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up
c. A tally sheet of medication errors and other specific problems that will be used at annual review
d. Copies of reports, placed in his or her file, of all unusual occurrences involving the employee
ANS: B
In documenting staff problems, it is important to specifically indicate what rules were broken or violated, consequences if behavior is not altered, employees explanation of the incidents, and the plan of action to achieve and to reach new goals.

REF: Page 459 | Page 462 TOP: AONE competency: Business Skills

8. The nurse manager places a staff member on probation because of reports of chemical dependency. The nurse manager should be aware that which of the following statements is true regarding chemical dependency?
a. The chemically dependent employee usually hides any changes in behavior.
b. When confronted with the issue, the affected employee is usually relieved to have someone to talk to about the problem.
c. The chemically impaired nurse affects the entire healthcare organization.
d. Hospital policy, state laws, and nurse practice acts address procedures for the chemically dependent employee in the most general terms.
ANS: C
A chemically impaired nurse jeopardizes patient care through impaired skills and judgment. She or he also compromises teamwork and continuity as peers attempt to cover deficiencies in work performance for their impaired team member.

REF: Page 457 | Page 458 TOP: AONE competency: Business Skills

9. The chief nursing officer reviews the policy about progressive discipline process. The progressive discipline process includes which of the following? The manager:
a. Is a counselor and friend to the employee.
b. Should reprimand and suspend the employee as a last resort.
c. Should rehire the employee after a reasonable length of time.
d. Should terminate the employee if the problem persists.
ANS: D
Termination can be defined as the discharge of an employee who is performing at an unsatisfactory level or who is not a good match for the organization. Termination is always considered the last resort when dealing with poor performance.

REF: Page 460 TOP: AONE competency: Business Skills

10. A nurse manager must be familiar with the agencys policies regarding termination. Termination procedures include which of the following?
a. Following specific procedures from other organizations
b. Having an attorney present at the termination meeting
c. Having adequate written documentation to support the action
d. Having a friend present during the termination meeting
ANS: C
All steps should be followed, including full appropriate detailed documentation and following the procedures of the organization.

REF: Page 460 TOP: AONE competency: Business Skills

11. Nathan has been on the cardiac unit for 6 months and has found it difficult to adjust to the expectations of his team. Which of the following behaviors would most likely signal that Nathan is intending to resign from his position on the unit?
a. Increased absenteeism over the past month
b. Increased attempts to discuss his concerns with his colleagues
c. Testing of workplace guidelines
d. Frequent defensiveness
ANS: A
Many employees increase their absenteeism just before submitting their resignation. If the healthcare worker is experiencing some form of role stress, it might be manifested through absenteeism. Role strain may be reflected by (1) withdrawal from interaction; (2) reduced involvement with colleagues and the organization; (3) decreased commitment to the mission and the team; and (4) job dissatisfaction. Testing of workplace guidelines and defensiveness are associated with immaturity.

REF: Page 452 TOP: AONE competency: Business Skills

12. All of the following are grounds for immediate dismissal except:
a. Failing to pursue further medical help for a patient; patient dies.
b. Selling narcotics obtained from the unit supply of narcotics.
c. Restraining a patient in bed for 7 hours, unsupervised, as punishment for hitting a staff member.
d. Grabbing the unit manager and threatening further physical harm after a poor performance appraisal.
ANS: A
Situations that may warrant immediate dismissal include theft, violence in the workplace, willful abuse of the patient, harassment, and chemical abuse.

REF: Page 460 TOP: AONE competency: Business Skills

13. The unit manager on 4E is concerned about the performance of Jean, a staff nurse. She is not involved directly with Jean, so she has not been able to determine whether the problem is one of motivation, ability, or both. If Jean lacks ability, which of the following strategies might the head nurse use?
a. Dismiss or transfer Jean.
b. Document all problem areas and then discuss them with Jean.
c. Develop appropriate solutions and make recommendations to Human Resources.
d. Smooth over the problems if they are minor in nature.
ANS: B
For the employee to change and grow, specific corrective measures need to be taken. Consultation with the employee is necessary, and documentation is key to determining the issues.

REF: Page 453 | Page 454 TOP: AONE competency: Business Skills

14. Nurses generally experience difficulty in identifying behaviors and actions that could signal chemical dependency in a co-worker. Which of the following is not a behavioral change that occurs with chemical dependency?
a. Personality and behavioral changes
b. Job performance changes
c. Changes in educational involvement and pursuit
d. Absenteeism
ANS: C
A manager needs to be alerted when suspicions of chemical dependency are raised by behavioral changes in the employee. These include mood swings, changes in hygiene and appearance, heightened interest in the pain control of patients, frequent changes in shifts, increases in absenteeism, and increases in tardiness.

REF: Page 457 TOP: AONE competency: Business Skills

15. Nurse Stacey is a self-admitted drug addict and has been a heavy abuser of codeine. Stacey and the unit manager decide that changes have to occur. Stacey enrolls in an addiction program, and the manager has her transferred to a drug-free area. What other strategies might be appropriate?
a. The manager could refer Stacey to the Human Resources Department.
b. The manager could assist in monitoring Staceys progress.
c. The manager could counsel Stacey if Stacey has formed a trusting relationship with her.
d. Stacey needs to be asked not to involve her family in the recovery program because this is a work-related situation.
ANS: B
Effective management demands that the organization take an active role in helping employees with special needs. Humanistic strategies that counsel and assist employees are cost-effective and necessary.

REF: Page 458 TOP: AONE competency: Business Skills

16. Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety. The manager can implement steps that help to alleviate uncivil behavior on a unit. Which of the following would not be an appropriate first step?
a. Suspending the staff member from work
b. Providing written admonishment that is discussed and placed in the employees file
c. Providing verbal admonishment
d. Terminating the staff member
ANS: D
Dismissal does not enable the present organization to attempt remediation of the behavior and is not consistent with first steps in progressive discipline.

REF: Page 458 TOP: AONE competency: Business Skills

17. Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety. The manager can implement the following steps that help to alleviate uncivil behavior on a unit. A) Suspending the staff member from work, B) Providing written admonishment that is discussed and placed in the employees file, C) Providing verbal admonishment, D) Terminating the staff member
a. A, B, C, D
b. B, A, C, D
c. C, B, A, D
d. C, A, B, D
ANS: C
The steps in progressive discipline are followed from the least severe (counseling the employee) to the most severe (termination). Studies have shown that following this sequence provides a fair and effective plan for discipline and remediation.

REF: Page 460 TOP: AONE competency: Business Skills

18. When progressive discipline is used, the steps are followed progressively only for repeated infractions of the same rule. On some occasions, rules that are broken are so serious that the employee is:
a. Transferred to another unit.
b. Suspended indefinitely.
c. Asked to attend a union grievance meeting.
d. Terminated after the first infraction.
ANS: D
Behaviors that include violence, theft, and purposeful abuse of a client are sufficiently serious to warrant immediate dismissal with the first incident.

REF: Page 460 TOP: AONE competency: Business Skills

19. During unit staff meetings, you observe that Marg rolls her eyes and snorts whenever Julia makes a comment. Your first response as a unit manager is to:
a. Discuss what you have observed with Marg.
b. File immediate documentation in Margs personnel file.
c. Ask Julie to monitor Margs behavior during meetings.
d. Ignore the behavior, as Marg is one of your strongest nurses.
ANS: A
Incivility must be addressed. The initial step in addressing it is discussion with Marg, and if the behavior continues, then written documentation should be filed in Margs personnel file. Monitoring and follow-up are your responsibility as the unit manager.

REF: Page 460 TOP: AONE competency: Business Skills

20. Ellen is a novice nurse on your unit. Even though she has come to you highly recommended, as her supervisor, you have noticed some knowledge and skill deficiencies. These deficiencies have been noticed by her peers as well, who cover for her because she is new and they like her. Which of the following is likely to be the greatest asset to Ellen in improving her performance?
a. Ignore Ellens errors until she has more experience.
b. Instruct staff to avoid working with Ellen until she learns to how do things herself.
c. Ask Ellen to complete a self-assessment, using a standard skills checklist.
d. Encourage staff to report every behavior of Ellens that is different from theirs.
ANS: D
When other employees are engaged in enabling behavior by covering for the mistakes of one of their peers, the nurse leader may be surprised to discover that the employee does not know or cannot do what is expected of him or her. The nurse leader must remind employees that part of professional responsibility is to maintain quality care and thus they are obligated to report instances of clinical incompetence, even when it means reporting a co-worker. Ignoring violations of a safety rule or poor practice is unprofessional and cannot be tolerated. The employee may be asked to do a self-assessment of the listed skills or competencies and then have performance of the skills validated by a peer or co-worker. This is a very effective method for the leader to assess the skill level of employees and to determine whether additional education and training may be necessary.

REF: Pages 454-456
TOP: AONE competency: Communication and Relationship-Building

21. Susan, a new graduate, is upset that so many staff have been absent lately from the unit. She declares to you that all absenteeism could be eliminated with proper management. Your response is based on understanding that:
a. Not all absenteeism is voluntary.
b. High personal control contributes to absenteeism.
c. Direct discussions with employees who have high levels of absenteeism are not recommended.
d. All absenteeism is related to personal issues and needs.
ANS: A
Not all absenteeism is voluntary or preventable, which means that absenteeism can never be fully eliminated. Absenteeism can result from personal issues and needs, work dissatisfaction, and involuntary reasons such as jury duty.

REF: Page 452 TOP: AONE competency: Business Skills

22. The nursing director calls a meeting with one of the new unit managers. She is very concerned about a report of substance abuse on the managers unit, and she reviews the procedures involved in dealing with chemically dependent staff. Which of the following statements would NOT be included in the discussion? As a manager, you:
a. Need to be aware of ADA issues.
b. Should check with Human Resources regarding chemically dependent employees and employment practices.
c. Check the nurse practice acts for the state in which the nurse resides.
d. Should realize that the nurse is a professional embarrassment and should be kept out of sight of other staff.
ANS: D
As a manager, you need to be familiar with state and professional regulatory and reporting requirements regarding chemical use and abuse, as well with Human Resource practices and guidelines.

REF: Page 457 | Page 458 TOP: AONE competency: Business Skills

23. The education consultant for the hospital is presenting a workshop titled Documentation: A Managers Responsibility. Which of the following points would she not include in her PowerPoint presentation? Documentation:
a. Cannot be left to memory. A notation must be placed in the personnel file.
b. Should avoid discussion of the problem.
c. Should include what was done about the problem when it occurred.
d. Needs to include date, time, and place.
ANS: B
Documentation of personnel problems is one of the most important aspects of the nursing managers role. Through carefully detailed and timely documentation of the problem and plan, the manager decreases the burdensome problems that can ensue from improper or inadequate documentation.

REF: Page 459 | Page 462 TOP: AONE competency: Business Skills

MULTIPLE RESPONSE

1. The unit manager discusses absenteeism with the unit clerk. She indicates that it is a serious problem on the unit. Which of the following points would they have likely discussed? (Select all that apply.)
a. Employee morale is at a high level.
b. Care will suffer and standards will be lowered.
c. Existing staff have experienced little effect from the absenteeism.
d. Replacement staff usually needs little supervision.
e. Unit costs have increased because of staff replacements and overtime.
ANS: B, E
Absenteeism puts a strain on staff, produces morale problems, can jeopardize patient safety, and increases unit costs.

REF: Page 451 TOP: AONE competency: Business Skills

2. Clinical incompetence is one of the more serious problems facing a nurse manager. Joyce, the nurse manager, is not aware of the problems of Sarah, a novice nurse. After she investigates, it is obvious that Sarahs peers are covering for her. Which of the following might Joyce include in her meeting with the nurses? (Select all that apply.)
a. It is a nurses professional responsibility to maintain quality control.
b. All instances of clinical incompetence are to be reported.
c. It is not considered being disloyal when one nurse reports another for poor care.
d. Patient care is the number one concern. Meeting standards is mandatory and necessary.
ANS: A, B, C, D
The nurse leader must remind employees that professional responsibility is to maintain quality care, and thus they are obligated to report instances of clinical incompetence, even when it means reporting a co-worker. Ignoring safety violations or poor practice is unprofessional and jeopardizes patient care.

REF: Pages 454-456 TOP: AONE competency: Professionalism

Leave a Reply