Chapter 3, Twenty-First Century Thinking About Leadership and Management

1. What action by a nurse-manager best demonstrates servant leadership?

a. Prioritizing the interests of others over the manager's own interests

b. Cultivating a personal relationship with each subordinate

c. Making decisions on the basis of customer service

d. Communicating a clear vision for the future and asking subordinates to share it

ANS: A Feedback: Managers who are servant leaders put serving others, including employees, customers, and the community, as the number one priority. This attitude is not dependent, however, on having a personal relationship with every subordinate. Customer service is valued, but the servant leader also emphasizes the needs of employees and the community. Vision has a place in servant leadership, but this is not a specific characteristic of this type of leadership.

2. A nurse-manager who seeks to exemplify emotional intelligence should:

a. attempt to remove emotion from decision making.

b. prioritize emotion over reason when making decisions.

c. regulate their own emotions and those of others.

d. effectively manipulate the emotions of others to achieve goals.

ANS: C Feedback: Theorists studying emotional intelligence posit that the ability to regulate the emotions of self and others is key to effective leadership. Emotional intelligence does not involve removing emotion from decision making; conversely, it does not claim that emotion should trump reason. Management of emotions is not the same as manipulating the emotions of others, which is unethical.

3. A leader-manager provides oversight on a busy medical-surgical unit. There has recently been an incident where two nurses were not honest about neglecting a controversial new protocol and misled the leader. How can the leader-manager best prevent similar episodes?

a. Support employees' right to disagree with proposed changes. b. Ensure that employees know the consequences of misleading the manager.

c. Avoid making decisions that displease large numbers of employees.

d. Identify allies who can be trusted to report employees who may mislead the manager.

ANS: A Feedback: There is no guarantee that followers will not mislead leaders, but adhering to certain principles, such as making sure that followers are allowed to disagree, will guard against this from happening. The manager can often not avoid making unpopular decisions. Enacting punitive measures (consequences) has not been shown to encourage honesty. The use of "informants" is likely to cultivate mistrust and is likely to increase dishonesty.

4. Which statement regarding the characteristics of a good leader is true?

a. They are brave in all situations. b. They may have character flaws. c. They are by nature good intentioned.

d. Charisma is their strongest attribute.

ANS: B Feedback: Leaders may be deceitful and trustworthy, greedy and generous, and cowardly and brave. To assume that all good leaders are good people is foolhardy and makes us blind to the human condition. It is only when we recognize and manage failings that leaders can achieve greatness. No one can be brave in each and every situation. Many good leaders have strong charisma, but this is not always the case.

5. To decrease overtime, the manager of a surgical unit offers nurses who get their work finished on time for an entire 2-month period an extra day off with pay at regular time. The nurse is enacting what model of leadership?

a. Favoritism

b. Quantum leadership

c. Principal agent theory

d. Servant leadership

ANS: C

Feedback: Principal agent theory suggests that followers may have an informational (expertise or knowledge) advantage over the leader as well as their own preferences, which may deviate from that of the principal. This may lead to a misalignment of goals. To influence the agent, the principal offers an incentive that corrects excessive overtime. This action is performance-based, so it would be difficult to characterize it as favoritism. Servant leadership prioritizes the interests of others; creating incentives to address the misalignment of goals is not central to servant leadership. Quantum leadership is a holistic theory of leadership that does not mainly focus on the alignment of disparate goals.

6. A nurse has been hired to oversee a day surgery clinic. What action will best ensure good outcomes for this nurse, the clients, and the employees of the clinic?

a. Implement the principles of authoritative leadership.

b. Teach all employees about the financial considerations at the clinic.

c. Consciously develop the ability to be charismatic.

d. Integrate nursing management and nursing leadership roles and practices.

ANS: D Feedback: For managers and leaders to function at their greatest potential, the two roles must be integrated. This helps ensure positive outcomes for all. Authoritative leadership is generally not preferred in the 21st century because it has poorer results than more contemporary models. Charisma can be beneficial in a leadership position, but it is not among the major traits of successful leadership and management. A focus on finances with all employees is not normally necessary and is not linked to high-level outcomes.

7. A new leader-manager is planning to implement the principles of strengths-based leadership after being hired for a new position. What action will best facilitate this plan?

a. Creating a team with diverse abilities and talents

b. Identifying the leader's personal strengths and utilizing them

c. Appraising team members on a scale that runs from "weaker" to "stronger"

d. Organizing the flow of work to match the leader's strengths

ANS: A

Feedback: Strengths-based leadership posits that effective leaders surround themselves with people who have different strengths than they do. The leader should focus on addressing areas where they are weaker, not relying solely on existing strengths. This model does not rank people on a two-dimensional scale because there are diverse ways of being strong.

8. A leader is applying the principles of emotional intelligence (EI). What outcome indicates successful application of these principles?

a. Emotions are held in check.

b. Emotions are used effectively. c. Emotions dominate decision making.

d. Expression of emotion indicates success.

ANS: B Feedback: EI refers to the ability to use emotions effectively and is required by leader-managers in order to enhance their success. Holding one's emotions in check can be unhealthy; EI does not demand this. EI does not require that emotions dominate decision making or that the expression of emotion is the marker of success.

9. A manager has proposed to the hospital board that it hire someone to teach management and leadership classes and that head nurses are paid to attend the classes. What is this an example of?

a. Using emotional intelligence b. Transformational leadership

c. Building human capital

d. Using quantum leadership

ANS: C Feedback: By providing classes in leadership, the manager is investing in the potential of the head nurse staff to become better leaders and managers. Human capital refers to the attributes of a person that are productive in some economic context, although it is normally measured and conceived of as a private return to the individual as well as a social return. There is no mention of the role of emotions or emotional intelligence. Quantum leadership focuses on the dynamic and multifactorial nature of leadership, but this is not evident in the scenario. Transformational leadership focuses on influencing and promoting vision; these are not evident in the scenario.

10. An organization has hired six RNs who are recent immigrants. The manager has noticed they interact very little with other staff, often speaking in their own language during their breaks, although they speak English while on duty. Which intervention would be the most helpful action for the manager to help these new RNs better assimilate? a. Explain to the new nurses the problem their isolation is causing. b. Arrange to send them to an English language course at the local adult school.

c. Ask the established RNs to make an effort to include the new nurses in after-work activities.

d. Hold a sharing session so all RNs can share information about their cultures and differences in client care.

ANS: D Feedback: This situation has varied nuances that require the manager to address many factors. Providing an opportunity for both groups of nurses to share their cultural heritage and differences in nursing care is an opportunity to promote acceptance among all members of the staff. It has been established that speaking the language is not a problem because they do so while on duty. Including them in after-work activities may demonstrate willingness on the staff's part but will not address work-related isolation. Merely presenting the problem to the new nurses does not show managing initiative.

11. A nurse-manager will soon be introducing a significant change in the way overtime shifts are allocated on a hospital floor. What action by the manager will best demonstrate the principles of thought leadership?

a. Convincing employees that the change will be beneficial and innovative

b. Relating the change to the fact that the floor has been required to cut costs

c. Delegating the implementation of the change to the nurses themselves

d. Describing clear expectations for nurses' adherence to the new policy

ANS: A Feedback: Thought leadership refers to any situation in which one individual convinces another to consider a new idea, product, or way of looking at things. Thought leadership does not emphasize financial realities, delegation, or the need for rigid adherence.

12. When applying the principles of quantum leadership, the nurse-manager should prioritize: a. carefully managing emotions. b. being true to their own values, beliefs, and moral character.

c. distinguishing between personal goals and organizational goals.

d. understanding the fact that workplaces are complex and dynamic.

ANS: D Feedback: Quantum leadership suggests that the environment and context in which people work is complex and dynamic and that this has a direct impact on organizational productivity required by leader-managers in order to enhance their success. Authentic leadership suggests that in order to lead, leaders must be true to themselves and their values and act accordingly. Quantum leadership does not prioritize the difference between personal and organizational goals or the management of emotions.

13. Twenty-first-century leadership models generally emphasize the importance of:

a. relationships.

b. incentives.

c. motivation.

d. consequences.

ANS: A Feedback: A transition has occurred in the 21st century from industrial age leadership to relationship age leadership. Most of the contemporary models of leadership have some form of emphasis on relationships. Incentives, consequences, and motivation are not ignored, but relationships are highly prioritized.

14. There are current and future paradigm shifts in health care that affect the leadership skills needed by nurses in the 21st century. What issue at the organizational and unit levels are nurse-leaders being directed to address?

a. Active involvement in greatly needed health care reform

b. Persistent and growing international nursing shortage

c. Increasing disparities between health outcomes for wealthy clients and poorer clients

d. High turnover rates by staff nurses

ANS: D Feedback: At the organizational and unit levels, nurse-leaders are being directed to address high turnover rates by staff, an emerging shortage of qualified top-level nursing administrators, growing trends toward unionization, and intensified efforts to legislate minimum staffing ratios and eliminate mandatory overtime while maintaining cohesive and productive work environments. At the national level, nurse-leaders and nurse-managers are actively involved in greatly needed health care reform and in addressing a persistent, and likely growing, international nursing shortage. Healthy disparities exist at regional and national levels, not organizational levels.

15. A nurse-manager demonstrates Level 5 leadership by performing what action?

a. Keeping emotions in check

b. Accepting nothing less than perfection from subordinates

c. Taking responsibility for their own errors

d. Avoiding conflict unless absolutely necessary

ANS: C Feedback: Level 5 leaders know when to ask for help, accept responsibility for the errors they or their team make, and are incredibly disciplined in their work. This model does not have a particular emphasis on avoiding conflict or keeping emotions in check. Rejecting anything short of perfection is unrealistic and is not cited as a characteristic of a Level 5 leader.

16. A subordinate has accused a manager of favoritism after the manager created the work assignment for the day. How should the manager best apply the principles of emotional intelligence?

a. Identify and reflect on their own feelings after being accused.

b. Recognize that the subordinate's statement was likely based on emotion rather than evidence.

c. Involve a colleague in the situation who has no emotional investment in the situation.

d. Choose a response that will diffuse the subordinate's emotions.

ANS: A Feedback: Self-awareness is a key component of emotional intelligence that involves the ability to recognize and understand one's moods, emotions, and drives as well as their effects on others. The manager should apply this aspect of emotional intelligence by self-reflection. This self-awareness can often help the manager address a challenging situation without having to involve an impartial third party. Emotional intelligence requires a manager to empathize with others' emotions, but this does not mean that decisions should be made with the sole goal of diffusing people's emotions. The manager must acknowledge the role of emotion but should not assume tha

17. A nurse-manager has been attending several conferences and workshops in order to network with colleagues and build relationships with people outside the organization. How should a nurse best interpret this manager's actions?

a. The manager is building on their own strengths.

b. The manager's self-regulation is likely to grow because of this activity.

c. The manager is demonstrating servant leadership, which will ultimately benefit the whole organization.

d. The manager is applying the social skills necessary for emotional intelligence.

ANS: D Feedback: Social skills are a component of emotional intelligence and involve proficiency in handling relationships and building networks in an effort to find common ground. Servant leadership is characterized by selfless acts, which are not evident in this scenario. Similarly, there is no obvious evidence of the manager building on their strengths. Self-regulation is a component of emotional intelligence, but it involves controlling or redirecting disruptive impulses or moods; there is no indication that the manager is doing this.

18. Two nurses have approached the manager and have asked the manager to speak to a nurse on the unit who has a reputation for being difficult to get along with. How can the manager best implement authentic leadership? a. Meet with the "difficult" nurse to assess emotions.

b. Analyze the facts of the situation before making a decision.

c. Encourage all three nurses to meet without the manager present.

d. Encourage all three nurses to disregard their emotions.

ANS: B Feedback: Four factors cover the components of authentic leadership. One of these is balanced processing, which involves analyzing data rationally before making decisions. This model acknowledges the salience of emotions, and it would not be appropriate or realistic to ask people to ignore them. Authentic leadership focuses on affective ways of being and does not prescribe specific actions like arranging meetings.

19. A new nurse-manager has set a goal of implementing authentic leadership. What is the manager's best initial action?

a. Identify and reflect on their own principles.

b. Examine the source of their own power in the organization. c. Differentiate colleagues who are allies from those who are potential threats.

d. Delegate management activities so that they can focus on leadership.

ANS: A Feedback: In authentic leadership, the leader's principles and values are paramount. Identifying these is a logical starting point for implementing authentic leadership. Separating people into allies and enemies is likely to result in conflict and authoritarianism. Authentic leadership does not require that all management activities must be delegated; authentic leadership can occur in a blended leadership-management role. Examining sources of power may be a necessary practical concern, but this is not a focus of authentic leadership and its focus on principles and values.

20. An organization is facing budget cuts and the manager has openly shared the details, rationale, and implications of the cuts with staff. The manager has also expressed feelings of disappointment about the cuts. What component of authentic leadership has the manager demonstrated?

a. Balanced processing

b. Internalized moral perspective

c. Relational transparency

d. Self-awareness

ANS: C Feedback: Relational transparency refers to openly sharing feelings and information appropriate to a situation, as this manager has done. Balanced processing refers to analyzing data rationally before making decisions. Internalized moral perspective suggests that the authentic leader is guided by internal moral standards, which then guide their behavior, and self-awareness alludes to a knowing of self so as to make sense of the world.

23. Which activity best supports the principles of strengths-based leadership in a health care organization?

a. Funding for staff to become educated in areas where they are naturally talented

b. Providing remedial services to staff who have committed a medication error

c. Mental-health counseling for staff who have depression or anxiety

d. Smoking-cessation support classes

ANS: A Feedback: Strengths-based leadership, which grew out of the positive psychology movement (began in the late 1990s), focuses on the development or empowerment of workers' strengths as opposed to identifying problems, improving underperformance, and addressing weaknesses and obstacles. Investing in staff to develop areas where they are naturally talented is an example of this. Remedial learning, counselling, and treatment address problems or vulnerabilities, not strengths.

25. Which response is most characteristic of a servant leader?

a. "I don't think you have the skills necessary to be effective." b. "Let me think about that request for 24 hours and get back to you."

c. "Do whatever it takes to get it done fast."

d. "I'll personally handle this situation."

ANS: B Feedback: A servant leader always thinks before reacting. This leader also chooses words carefully so as to not damage those being led, provides directions toward goal achievement, and finds asking for input more important than personally providing solutions. Speed is not a priority within servant leadership.

26. A nurse has recently begun a leadership-management role and is most likely to face challenges in:

a. resolving tensions between baccalaureate-educated nurses and nurses without a degree.

b. promoting best outcomes for clients while reducing costs.

c. educating nurses about their legal scope of practice.

d. marketing the organization to members of the community.

ANS: B Feedback: The fiscal realities of nursing and health care are known to make great demands on managers and leaders, regardless of their setting. For this reason, this challenge is more likely than intraprofessional tensions, which are more likely to be isolated. Marketing is not normally the responsibility of the nurse manager-leader. Scope of practice affects what nurse can and cannot do, but it is not the manager's responsibility to educate them about this; most professionals have a grasp of this before beginning a job.

27. The leaders of a health care organization ascribe to human capital theory and are planning the budget for the next year. What activity should the team prioritize in the budget to promote the goals of this theory?

a. Signing bonuses for nurses who are hired from outside the region

b. Incentives for staff members who provide exemplary care and who make no errors

c. Community outreach activities that will increase engagement between staff and residents

d. Reimbursement of tuition to nurses who are upgrading their education

ANS: D Feedback: Human capital theory prioritizes the long-term benefits of investing in training and education. Incentives, signing bonuses, and community outreach do not run contrary to this theory, but these actions are not direct examples of prioritizing skills acquisition and educational development.

28. A chief nursing officer is assembling a leadership team. The nurse is ensuring that the team is made up of people who have a diverse range of natural talents and skills. This leader is most clearly exemplifying what theory of leadership?

a. Level 5 leadership

b. Emotional intelligence

c. Strengths-based leadership d. Authentic leadership

ANS: C Feedback: Strengths-based leadership emphasizes the need to not only identify one's own strengths but also to surround oneself with people who have different strengths. Emotional intelligence prioritizes the importance of values, emotions, and feelings. Level 5 leadership focuses on the affective traits of strong leaders. Authentic leadership is a holistic model that encompasses many more variables than just strengths.

29. A nurse manager-leader is experiencing many challenges overseeing the care in a health care organization. What statement most clearly indicates a need to apply quantum leadership principles?

a. "There's a lot of conflict, not just between nurses but also between members of other disciplines."

b. "Our workplace is in a constant state of change. Each part of our work is unpredictable and always shifting."

c. "Historically, many decisions seem to have been made on the basis of emotion, and I'd really like to change that."

d. "There's a rift between management and employees and it affects communication."

ANS: B Feedback: Quantum leadership posits that today's workplace is a highly fluid, flexible, and mobile environment, and this calls for an entirely innovative form of leadership. Quantum leadership encompasses varied aspects of this uncertainty, such as conflict and emotion, but these are not the central focuses of this theory.

30. A nurse-manager has proposed a change in the skills mix in a hospital unit, with fewer registered nurses and more nursing assistants. What outcome best demonstrates that the nurse is applying the principles of thought leadership?

a. Skeptics of the plan have begun to see it as innovative and beneficial.

b. Individuals who oppose the plan have become isolated by their peers.

c. Nurses and nursing assistants will both participate in the operations planning.

d. The ultimate decision on the matter will be based on rational ideas rather than emotions.

ANS: A Feedback: Thought leadership refers to any situation in which one individual convinces another to consider a new idea, product, or way of looking at things. The theory does not advocate achieving this through ostracizing dissenters. Inclusive leadership groups are beneficial, but this is not a particular characteristic of thought leadership. Thought leadership does not imply a rejection of emotion.