Test bank for leading and managing in nursing revised reprint 5th edition by yoder wise

Leading and Managing in Nursing: 5th Edition Test Bank – Yoder-Wise
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Yoder-Wise: Leading and Managing in Nursing, 5th Edition

Chapter 08: Understanding and Designing Organizational Structures

Test Bank

MULTIPLE CHOICE

1. A hospital and a nursing education program form a partnership to recruit
more nurses to the region. This organizational structure is:
a.
b.
c.
d.

Being responsive to changes in the environment.
Being bureaucratic.
Creating permanent professional boundaries.
Delineating structures for all decision making.

ANS: A
Shared decision making across organizations can lead to growth and
responsiveness in meeting emergent needs.


REF: Pages 141, 142, 153
TOP: AONE competency: Communication and Relationship-Building

2. A hospital is working toward becoming a Magnet™ hospital. The chief
nursing officer is aware that professional nursing departments of the future
will:
a.
b.
c.
d.

Not be directed by nurses.
Be virtual organizations.
Be designed to maintain nursing standards of practice.
Be entitled to have client care departments.

ANS: C
Professional nursing departments of the future will be focused on patient care
outcomes and delivery of services.

REF: Pages 150, 151
TOP: AONE competency: Knowledge of Healthcare Environment

3. The chief nursing officer and the dean of the School of Nursing believe that
by establishing rules and regulations and controlling the environment, this
partnership will:
a.
b.
c.
d.

Promote professional medical authority, autonomy, and responsibility.
Need a degree of flexibility to engender success.

Be essential for self-governance.
Provide for the establishment of medical committees.


ANS: B
Centralized decision-making structures that emphasize high control and rules and
regulations that lay out expectations can be slow to respond to emergent trends.

REF: Page 144

TOP: AONE competency: Leadership

4. In matrix organizational structures, a nurse manager understands that this
type of structure:
a.
b.
c.
d.

Is a simplified organizational structure.
Has both a functional manager and a service or product-line manager.
Arranges departments strictly according to function.
Promotes harmony in organizational decision making.

ANS: B
Matrix structures are complex, integrated organizational structures that involve
both functional and service or product-line managers. In this structure, team
members or teams from various functional departments may combine to complete
a project or program, thereby becoming responsible to both their functional
department manager and their product-line manager. Harmony or disharmony

cannot be assumed.

REF: Pages 147-149

TOP: AONE competency: Business Skills

5. Collaborative partnerships between hospitals and schools of nursing are
examples of hybrid organizational structures. A hybrid organizational
structure:
a. Has many divisions of labor.


b. Best fits long-term care units.
c. Has a mixture of the characteristics of various organizational types.
Places the authority for decision making closest to the places where
d.
workers perform.

ANS: C
Hybrid structures include characteristics of various organizational types and reflect
the needs of the situation and the environment.

REF: Page 150
TOP: AONE competency: Communication and Relationship-Building

6. In opening a new dialysis unit, the nurse manager has to develop a
philosophy for the unit. This philosophy needs to:
a.
b.
c.

d.

Reflect the culture of the unit and its values.
Be developed by the nursing manager on the unit.
Identify the clients that will be served on the unit.
Replicate the organization’s philosophy.

ANS: A
The philosophy needs to state what the nurse manager and staff believe is the
vision for nursing management and practice and sets the stage for establishing
goals to make the vision a reality. It is complementary to the organizational
philosophy but reflects the values of nursing. Shared governance enables staff and
management to develop a vision and is congruent with contemporary views of
management. The identification of clients to be served reflects a mission statement.


REF: Page 138
Environment

TOP: AONE competency: Knowledge of Healthcare

7. The hospital administration gives approval to the chief nursing officer to hire
clinical nurse specialists in staff positions rather than in administrative
positions. A clinical specialist who has staff authority but no line authority
typically is able to:
a. Function through influence.
b. Take complete responsibility for the care of clients.
c. Interview and hire staff nurses for designated nursing units.
Be granted functional authority to determine standards of nursing care
d.

and enforce them.

ANS: A
Staff positions provide support to line positions but have no direct accountability
for staff or patient outcomes and therefore, function through influence.

REF: Page 146
TOP: AONE competency: Knowledge of the Healthcare Environment

8. A new director of nursing in a small rural hospital wants to make changes
from the traditional model of governance to a shared-governance model.
Select the characteristic below that best describes the traditional
organizational structure in which a staff nurse is assigned to carry out
nursing tasks for clients but is not given the chance to provide input into
forming the policies and procedures by which care is delivered or the
standards by which care is evaluated:
a. Bureaucratic


b. Decentralized
c. Delegated authority and responsibility
d. Delegated responsibility but no authority

ANS: D
In traditional structures, decision making authority is held by a centralized
decision-making body, so that staff members have responsibility for certain
functions but do not participate in decisions related to those functions.

REF: Page 144
TOP: AONE competency: Knowledge of the Healthcare Environment

9. The chief nursing officer is given the task of reviewing and revising the
organization’s mission, philosophy, and technology. In reviewing them, the
chief nursing officer understands that they should be reflected in:
a.
b.
c.
d.

The organizational structure.
Line and staff responsibilities.
The policies and procedures.
Government regulations.

ANS: A
The mission statement is an important foundation for the organizational structure
and defines technology and human resources required for the organization.

REF: Pages 139, 140


TOP: AONE competency: Knowledge of the Healthcare Environment

10.The facilities department is experiencing some challenges and is undergoing
reorganization. Because of your familiarity with systems theory, you:
Know that this challenge is their issue and that it has nothing to do with
your unit.
Understand that such events are localized and do not have an impact on
b.
the organizational culture.

Know that the nature of challenges and reorganization in facilities will
c.
have an impact on other areas.
Anticipate that your prior experiences with facilities have no effect on
d.
the current situation.
a.

ANS: C
By nature, a system such as an organization is an interacting collection of parts that
together make up the whole. Changes to one part will affect other parts and the
system as a whole.

REF: Page 138

TOP: AONE competency: Leadership

11.“Georgia Hospital will provide care that is a national example of consumer
service” is a:
a.
b.
c.
d.

Vision statement.
Statement of philosophy.
Mission statement.
Rationale for care.

ANS: A
A vision statement is an articulated goal that provides an inspirational target to
which the organization aspires.

REF: Page 140
Environment

TOP: AONE competency: Knowledge of Healthcare

12.“At Thoroughcare, we provide healthcare for women and children in
transition” is an example of a:
a.
b.
c.
d.

Vision statement.
Mission statement.
Goal statement.
Statement of philosophy.

ANS: B
Mission statements provide a reason or rationale for the existence of the
organization and are indicative of the structure of the organization and of who
consumes the services provided.

REF: Pages 139, 140
TOP: AONE competency: Knowledge of the Healthcare Environment

13.Which of the following would be the most appropriate mission statement for

a nursing center?
“At Plentyville, we provide rehabilitative services for addicted
adolescents.”
b. “Georgiatown provides treatment and prevention services for county
a.


residents.”
“At Heart, our aim is to provide services that lead the nation in health
c.
education and research.”
“At Coeur, we strive to achieve optimal pain management with patients
d.
who are experiencing chronic pain.”

ANS: D
The mission statements of nursing centers are oriented toward achieving optimal
health status for a defined group of patients or consumers.

REF: Pages 139, 140
TOP: AONE competency: Knowledge of the Healthcare Environment

14.Which of the following most influences the organizational structure of the
organization?
a.
b.
c.
d.

Mission statement

Statement of philosophy
Vision statement
Goal statement

ANS: A
Mission statements lay out the reasons for the organization and include the
population served and services offered, which, in turn, influence the technologies
and human resources that will be required.

REF: Pages 139, 140


TOP: AONE competency: Knowledge of the Healthcare Environment
15.In which of the following situations would you expect low morale and
frustration?

a.

b.

c.

d.

Statement of philosophy indicates “We value our staff.” When staff
members leave, careful evaluation is done to determine whether staff
should be replaced by full- or part-time employees.
Practices include annual staff recognition celebrations. During times of
change, staff members are actively included in issue identification and
solution finding.

Recruitment ads promise opportunities for advancement for everyone.
Promotions are given only to individuals with long-standing service
and entrenched relationships.
The vision indicates that there is strong commitment to lead in
research. The organization has tried to implement a strong campaign to
attract leading nurse researchers but has experienced difficulty in doing
so.

ANS: C
Although frustration may occur with external factors that affect ability to act on
values and aspirations, lack of congruence between what is espoused as a value
within the organization, such as promising advancement as an incentive to join the
organization, and what is actually done, such as restricting advancement to internal
candidates with much organizational history, can cause low morale and confusion.

REF: Pages 140, 141
TOP: AONE competency: Communication and Relationship-Building

16.At Orangetown Hospital, the nursing department is developing a mission
statement for nursing. Which would be a suitable mission statement?


“Nursing provides services for patients admitted to Orangetown
Hospital.”
“To participate fully in the professional services offered by
b.
Orangetown Hospital.”
c. “To lead by the lamp; services for seniors.”
“At Orangetown, the nursing department provides caring services that
recognize the diversity of clients and promote optimal health with

d.
clients through partnership and education and in close partnership with
other disciplines.”
a.

ANS: D
A nursing mission statement within an organization needs to establish the reason
for nursing within the organization and lays out relationships with clients, the
community, and other disciplines.

REF: Pages 139, 140
TOP: AONE competency: Knowledge of Healthcare Environment

17.At Hospital XYZ, staff members on Y3 have dealt with the third head nurse
in three years. Donna, the current head nurse, lacks confidence in patientnurse relationships, and scheduling and other processes are routinely left to
the last minute. Staff members approached Donna first and then
administration with their concerns about Donna’s effectiveness as a leader.
The staff was told that the problem is likely staff related, that it is simply an
unhappy group, and that there is nothing that will be done further about their
concerns. The philosophy of the organization indicates that “open,
transparent communication between staff and management is desired and
supported,” and that “innovation and creative thinking are the foundation of
the organization’s progress.” In assessing this situation as a newly hired
senior executive, you anticipate that:
a. Staff members will resolve the conflict on their own.


b. The situation will lead to ongoing disgruntlement and attrition.
c. No further discussion or concerns will come out of the situation.
d. The head nurse will be able to resolve the conflict on her own.

ANS: B
Lack of congruence between the stated philosophy of the hospital and the
experienced organizational culture does not support either the staff or the head
nurse and likely will result in ongoing frustration and increased attrition.

REF: Page 140
Environment

TOP: AONE competency: Knowledge of Healthcare

18.In Valley Hospital, there is a great deal of discussion about the balance
between hospital-wide budget decision making and unit-based decision
making. This discussion represents:
a. A search for the “sweet spot.”
Conflict between the values of nursing and those of the healthcare
b.
organization.
c. Traditional organizational values.
d. Differences between bureaucratic and nonlinear thinking.

ANS: A
The important point for an organization, the balance between centralization and
decentralization of authority and decision making, is known as the “sweet spot.”

REF: Page 142
Environment

TOP: AONE competency: Knowledge of Healthcare

19.With revenue reductions and cost saving measures, the number of managers
has been reduced, which has increased the number of team leaders
supervised by managers by as many as three. This change may result in:
a.
b.
c.
d.

Decreased patient satisfaction.
Increased efficiency in costs.
A more positive perception of managers.
Little change to manager-staff relationships.

ANS: A
When a span of control becomes too large, supervision can become less effective,
which can have a negative effect on staff-manager relationships and on the overall
quality of patient care.

REF: Page 143
Environment

TOP: AONE competency: Knowledge of Healthcare

20.Taylor Hospital has well-defined organizational units that provide
maintenance, financial services, care for cardiac patients, care for surgical
patients, and so on. The organizational chart indicates that surgical units
report to a surgical manager, and that all nursing units report to a vice
president of nursing; financial services to an accountant and then to a
business executive; and so on. The primary disadvantage of this

organizational structure is:
a.
b.
c.
d.

Breakdown in function and communication across specialties.
Lack of congruence in culture and organizational values.
Highly centralized decision making and authority.
Wide span of control.


ANS: A
In a functional organizational structure, departments and services function
according to specialty. This model supports professional expertise but can lead to
silos in communication and decision making and discontinuity in patient services.

REF: Pages 146, 147
TOP: AONE competency: Knowledge of Healthcare Environment

21.In the Unity Healthcare organization, decisions, including those at the unit
level, are made by a group of senior executives. Rules for employees are
clear, and nursing care is delineated by procedures and protocols. This
exemplifies:
a.
b.
c.
d.

Transformational leadership.

Transactional leadership.
Bureaucratic organization.
Chaos theory.

ANS: C
Organizational structure refers to the organization of a work group, rather than to
its leadership, and includes where decisions are made and relationships between
groups. In the example given, power is centrally located, with all decisions
regarding policies and procedures flowing from this central location, which is
characteristic of bureaucratic organizations. In organizations where chaos theory is
exemplified, decision making and accountability are decentralized.

REF: Pages 144-146
TOP: AONE competency: Knowledge of Healthcare Environment


22.In the Unity Healthcare organization, communication flows:
a.
b.
c.
d.

Laterally.
Bottom to top.
Top to bottom.
Intermittently.

ANS: C
In a bureaucratic organization, communication flows vertically top to bottom.

REF: Pages 144-146
TOP: AONE competency: Knowledge of Healthcare Environment

23.Sarah is a clinical nurse educator in the dialysis unit at Pines Health Center
and provides education, consultation, and training support. Sarah has:
a.
b.
c.
d.

Direct responsibility for patient care.
Direct accountability for patient outcomes.
An authority relationship to staff.
An influence over patient outcomes.

ANS: D
In a staff position, Sarah supports line positions in accomplishing the primary goals
and objectives of the unit and provides support, counsel, and advice, but she has
limited or no authority for decision making.


REF: Page 146
Environment

TOP: AONE competency: Knowledge of Healthcare

24.A statement such as “We believe in the right of patients to make choices and
to have care that is sensitive to their preferences and needs” is a _____
statement.
a.

b.
c.
d.

Mission
Goal
Vision
Philosophy

ANS: D
Philosophy statements capture significant beliefs and values of the organization.

REF: Page 140
Environment

TOP: AONE competency: Knowledge of Healthcare

MULTIPLE RESPONSE

1. Organizational culture includes (select all that apply):
a.
b.
c.
d.

Norms.
Traditions.
Behaviors.
Values.

ANS: A, B, C, D
Organizational culture, the reflection of the norms or traditions of the organization,
is exemplified in behaviors that illustrate values and beliefs.