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A nurse erroneously administered two tablets of acetaminophen totaling 650 mg to their patient. When reporting this to the nurse manager, the nurse states, 'there are two tablets in a package labeled '325 mg, acetaminophen.' The prescription reads 'administer 325 mg of acetaminophen;' therefore, I administered what was in the package.' Based on a philosophy of just culture, what should happen next?
- A. The nurse should be found at fault for not clarifying the order.
- B. The package labeling should be reviewed with the pharmacy.
- C. The nurse should be disciplined.
- D. No follow-up is needed as the medication is over the counter.
Correct Answer: B
Rationale: A just culture is committed to accountability and safety. Nurses are encouraged to disclose clinical errors and potential error situations without the fear of punitive actions, allowing others to learn from this experience. Health care workers within the organization discuss concerns and challenges related to patient care, turning them into opportunities for improvement. Reviewing the package labeling with the pharmacy addresses the root cause of the error, which is unclear labeling, rather than solely blaming the nurse.
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Nursing students enrolled in a leadership and management course attend clinical on a surgical unit. As they are planning their day, they note one student has a complex patient with multiple medications and the need for frequent turning, pressure injury wound care, and tube feedings. Which action by the group best reflects effective teamwork and coordination?
- A. Asking patients to prioritize what they want to accomplish each day
- B. Including a 'nice to do' for every 'need to do' task on the list
- C. Front loading' their schedules with 'must do' priorities
- D. Scheduling times to assist the student with the complex patient
Correct Answer: D
Rationale: The students use teamwork and collaboration to appropriately coordinate patient care; this is the best response. By asking the patient to prioritize what they want to accomplish each day, the nurse is demonstrating an effective time management technique. To manage time, the nurse should establish goals and priorities for each day, differentiating 'need to do' from 'nice to do' tasks; the nurse should include the patient in this process. The nurse should also establish a time line, allocating priorities to hours in the workday in to keep track of falling behind and correct the problem before the day is lost.
A nursing student is actively working toward strengthening their leadership skills. What action will best assist the student to meet this goal?
- A. Being self-reliant in solving problems
- B. Being self-directed and asking for assistance when needed
- C. Using written communication instead of face-to-face communication
- D. Reporting nurses who do not follow policies to the nurse manager
Correct Answer: B
Rationale: Leader behavior includes being self-directed and knowing your limitations; demonstrating a commitment to excellence; having a clear vision and strategic focus that allow movement forward toward a creative solution; showing commitment to and passion for your work; and displaying problem-solving skills, trustworthiness and integrity, respectfulness, accessibility, empathy and caring, desire to be of service, and responsibility to enhance the personal growth of all staff.
A nurse who is considered a servant leader is working in an economically depressed community setting up a free mobile health clinic. Which actions best exemplify a servant leader? Select all that apply.
- A. Motivating coworkers to solicit funding to set up the clinic
- B. Setting only realistic goals that are present oriented and easily achieved
- C. Forming an autocratic governing body to keep the project on track
- D. Spending time with supporters to help them grow in their roles
- E. Ensuring that other's lowest priority needs are served
- F. Prizing leadership because of the need to serve others
Correct Answer: A,D,F
Rationale: To serve as servant leaders, nurses need to invest in those who support the organization's values, show passion, can play to their strengths, and demonstrate a positive attitude. They should develop their vision to see the future related to a current anticipated need and motivate others to follow and engage. They also need to provide ongoing opportunities for collaborations, sharing, reflection, encouragement, and celebration as well as hard work. The servant leader allows others to have a voice, to exercise control, and to practice leading themselves. The servant first makes sure that other people's highest priority needs are being served.
A chief nursing officer with a transformational leadership style is developing a plan for success to obtain Magnet status. What are the most appropriate strategies for the leader to use? Select all that apply.
- A. Sharing their vision of excellence in patient care and high-level education
- B. Encouraging nurses to incorporate evidence-based practice through hospital committees and to join nursing organizations
- C. Promoting compliance by reminding subordinates that they have a good salary and working conditions
- D. Ensuring employees are kept abreast of new developments in their department and the larger organization
- E. Writing the Magnet application and supporting documentation with limited input from the nursing staff
- F. Encouraging nurse managers and nurses to self-schedule as long as proper coverage is maintained
Correct Answer: A,B
Rationale: Transformational leaders inspire, motivate, create intellectually stimulating practice environments, and challenge themselves and others to grow personally and professionally. They demonstrate caring and vulnerability, communicating honestly and openly. They are risk takers and pay attention to process as well as outcomes. Instituting a reward program and reminding workers that they have a good salary and working conditions are examples of transactional leadership, which is based on a task-and-reward orientation. Ensuring that employees keep abreast of new developments in nursing care is a characteristic of quantum leadership. The group and leader work together to accomplish mutually set goals and outcomes with the democratic leadership style, and the laissez-faire style encourages independent activity by group members, such as setting their own schedules and work activities.
An RN on a telemetry unit is falling behind while performing assessments and administering medications. Which task can the nurse safely delegate to the AP?
- A. Assessing a patient who has just arrived on the unit
- B. Teaching a patient with newly diagnosed diabetes about foot care
- C. Documenting a patient's I & O in the electronic health record
- D. Helping a postoperative patient out of bed for the first time
Correct Answer: C
Rationale: Documenting a patient's I & O on a flow chart does not require professional judgment and can be delegated to AP. Professional nurses are responsible for the initial patient assessment, discharge planning, health education, care planning, triage, interpretation of patient data, care of invasive lines, administering parenteral medications. What they can delegate are assistance with basic care activities (bathing, grooming, ambulation, feeding) and things like taking vital signs, measuring intake and output, weighing, simple dressing changes, transfers, and postmortem care.