Chapter 07: Organizational Planning

1. A nurse is considering applying for employment at a new health-care facility. How should

the nurse best identify the aims and priorities of the organization?

a. Review the organization's mission statement.

b. Speak with as many front-line workers as possible.

c. Ask interviewers about recent responses to consumer satisfaction surveys.

d. Review the organization's policy and procedures documents.

ANS: A

Feedback: The purpose or mission statement is a brief statement identifying the reason that

an organization exists. The mission statement identifies the organization's position

regarding ethics, principles, and standards of practice. The nurse should be able to infer the

organization's aims and priorities from this statement. Consumer feedback will not

necessarily reveal the organization's aims and priorities. Similarly, workers are often unable

to identify these priorities. Policies and procedures identify the preferred ways of

completing tasks but not the organization's aims and priorities.

2. The nurse is participating in a planning process in a large health-care organization. The

nurse and the other members of the team should:

a. avoid specifics so that the plan can be applied in any health-care setting.

b. ensure that long-term priorities are always prioritized over short-term priorities.

c. ensure that evaluation occurs at several points during the process.

d. begin to engage employees in the process after the plan has been implemented.

ANS: C

Feedback: Planning can be short term or long term but should always include built-in

evaluation checkpoints so there can be a midcourse correction if unexpected events occur.

Excessive generalization (vagueness) can make a plan difficult to implement because of the

lack of specifics. Employee engagement should occur early in the process. Short-term and

long-term interests must be balanced; long-term priorities do not always supersede

short-term priorities.

3. Which is a true statement about planning?

a. All plans should be defined at the outset so that changes are not necessary.

b. Long- and short-range plans should be kept separate so priorities do not become

confused.

c. Objectives and goals must be established before the philosophy is written.

d. All plans should be flexible to accommodate changing circumstances.

ANS: D

Feedback: Every plan should be flexible because unexpected events are inevitable. It is

impossible to identify every aspect of the plan at the outset because circumstances are

always changing. Short- and long-range plans should be complementary and integrated, not

separate. The philosophy should form the foundation of objectives and goals.

4. A nurse is participating in the process of values clarification. What are the characteristics of

a true value? Select all that apply.

a. It is freely chosen from among alternatives.

b. It aligns with the dominant values of society.

c. It is prized and cherished.

d. It is positively affirmed.

e. It is acted upon.

ANS: A, C, D, E

Feedback: McNally identified the fact that a value is prized and cherished, positively

affirmed and acted on, and chosen freely from among alternatives. It is possible for a value

to be true while not aligning with the dominant values of the society

5. Which statement is an example of a process objective?

a. "Every nurse will screen newly admitted clients for alcohol abuse."

b. "The falls rate on the unit will decrease by 50% compared with 2016 rates."

c. "The health-care facility will achieve accreditation within the next 24 months."

d. "The new bowel care protocol will be fully implemented by the end of the calendar

year."

ANS: A

Feedback: Objectives can focus on either the desired process or the desired result. Process

objectives are written in terms of the method to be used, whereas result-focused objectives

specify the desired outcome. The statement "Every nurse will screen newly admitted clients

for alcohol abuse" states how (i.e., the process) each client will be screened. Each of the

other listed statements focuses on results or outcomes.

6. A leader has launched an organizational planning process that requires the development of

new policies. How should the leader utilize subordinates during this process?

a. Delegate the evaluation phase of organizational planning to subordinates.

b. Ask subordinates to brainstorm alternatives and then have industry experts

evaluate each alternative.

c. Limit the involvement of subordinates to developing unit-level policies and

procedures.

d. Include subordinates early in the process and include them in all aspects of policy

formation.

ANS: D

Feedback: The leader should encourage subordinates to be involved in policy formation,

including developing, implementing, and reviewing unit philosophy, goals, objectives,

policies, procedures, and rules. The leader should work alongside the subordinates, not just

delegate to them. Subordinates should contribute to evaluation rather than this role limited

to experts. The role of subordinates should not be limited to policies and procedures at a unit

level.

7. The manager is leading a team to develop a unit-level philosophy statement. What guideline

should the team use during this process?

a. The unit philosophy should align with the larger organization's philosophy.

b. The unit's philosophy should include a mission statement and vision statement.

c. The statement should reflect the values and priorities of the specific unit manager.

d. The statement should be consistent with that of other similar health-care agencies

ANS: A

Feedback: The unit philosophy will be congruent with the organizational philosophy. Vision

and mission are distinct from philosophy statements. The statement should transcend any

one particular manager and does not necessarily have to align with other organizations.

8. A new nurse on the unit has been criticized for deviated from the accepted model of

end-of-shift report, even though there is no written policy about the content or format for

report. Which term is used for this type of policy?

a. Implied policies

b. Expressed policies

c. Understood precedents

d. The organizational culture

ANS: A

Feedback: Implied policies are neither written nor stated verbally and have developed over

time. The other options fail to meet this description.

9. A health-care organization has adopted a new philosophy statement. What observation best

shows that the philosophy is being implemented?

a. The philosophy is displayed prominently in client care areas and staff areas.

b. The philosophy aligns with the organization's vision and mission.

c. The philosophy is reflected in the care that clients and families receive.

d. The philosophy was created by an interdisciplinary group that included nurses

ANS: C

Feedback: A philosophy is being implemented if it is evident in the care that clients and

families receive. Displaying the philosophy prominently, aligning it with vision and

mission, and collaboratively creating the philosophy do not guarantee that the philosophy is

actually being implemented.

10. A recent nursing graduate has not performed a dressing change on a central catheter for

several months and is unsure of how to correctly perform this. The nurse should refer to the:

a. documentation.

b. practice rules.

c. organization policy.

d. procedure manual.

ANS: D

Feedback: Procedures delineate a series of specific steps of a required action, such as

performing a specific type of dressing change. Policies are plans reduced to statements or

instructions that direct organizations in their decision making, not specific nursing actions.

Procedures are not synonymous with documentation of "practice rules."

11. A nurse-manager recognizes the role that individual values play on decision making. How

should the manager best address this fact during a period of organizational planning?

a. The manager should carefully reflect on his or her most important values.

b. The manager should make every attempt to set aside his or her values when

making decisions.

c. The manager should seek individuals who have similar values when creating a

decision-making team.

d. The manager should seek individuals who claim to have flexible values when

creating a decision-making team.

ANS: A

Feedback: All people should carefully examine their value system and recognize the role

that it plays in how they make decisions and resolve conflicts and even how they perceive

things. Therefore, the nurse-leader must be self-aware and provide subordinates with

learning opportunities or experiences that foster increased self-awareness. In most cases,

teams are not chosen on the basis of their personal values. It is unrealistic for a person to

expect that he or she can set aside values or alter them when making decision.

12. A nurse has been asked to join the health-care organization's strategic planning committee.

What actions should the committee perform in order to create an efficient and

evidence-based planning process? Select all that apply.

a. Enlist members with expertise in health-care economics.

b. Carefully consider political issues related to health care.

c. Prioritize the role of intuition in the planning process.

d. Identify and implement a planning theory.

e. Include as many stakeholders as possible in the planning process.

ANS: A, B, D, E

Feedback: Strategic planning requires managerial expertise in health-care economics,

human resource management, and political and legislative issues affecting health care, as

well as planning theory. Stakeholders should be engaged in the process. Intuition is not

assigned a high value in organizational planning processes and is not normally prioritized

over other decision-making processes

13. Which statement best describes an emerging paradigm that is likely to influence strategic

planning for health care in the 21st century?

a. Reduced emphasis on cost containment

b. Reduced regulatory oversight of health-care organizations

c. A shift from interdependence of health-care professionals to greater autonomy

d. Continued increases in the cost of pharmaceuticals

ANS: D

Feedback: The rising cost of pharmaceuticals and ongoing drug shortages will continue to

be a problem for US hospitals for at least the next 3 years. Cost containment, regulatory

oversight, and interdependence of health-care providers are predicted to continue.

14. Which element should influence the nurse executive most heavily when assessing the

organization's philosophy of nursing services for possible revision?

a. Consumer surveys

b. Input from other health disciplines

c. The organization's mission statement

d. Policy statements

ANS: C

Feedback: The philosophy flows from the mission statement, the highest priority in the

planning hierarchy. Each of the other sources may be considered, but none should be as

influential as the mission statement of the organization.

15. A nurse-manager can implement the principles of preactive planning by:

a. responding quickly to emergent problems.

b. using new technologies to accelerate change.

c. preferring the status quo as a stable environment.

d. directing planning in response to a crisis.

ANS: B

Feedback: Preactive planners utilize technology to accelerate change and are future oriented.

Unsatisfied with the past or present, preactivists do not value experience and believe that the

future is always preferable to the present. Their focus is not necessarily crisis response.

16. A manager has been experiencing challenges during a planning process and must implement

strategies to overcome barriers that impede planning. What is the manager's best action?

a. Reevaluate whether the goals and objectives are appropriate and achievable.

b. Establish a fixed goal that is unaffected by changes in the organization.

c. Limit membership in the planning team to administrators, leaders, and executives.

d. Make the goals of the plan more general so that they can be more easily achieved.

ANS: A

Feedback: The organization can be more effective if movement within it is directed at

specified goals and objectives. Because a plan is a guide to reach a goal, it must be flexible

and allow for readjustment as unexpected events occur. Reevaluation is often necessary to

ensure this happens. The manager should include in the planning process all people and

units that could be affected by a plan, not just administrators and executives. A plan that is

too global or unrealistic discourages rather than motivates employees because attainment of

the goals can never be clearly determined.

17. A nurse-manager is creating an organizational plan. What characteristic of the plan is more

likely to promote success?

a. A midterm evaluation of the planning process

b. Several predefined evaluation checkpoints

c. The rejection of any earlier plans that did not succeed

d. Overplanning to accommodate predicted lapses in the planning process

ANS: B

Feedback: Good plans have several built-in evaluation checkpoints so that there can be a

midcourse correction if unexpected events occur. A single midterm evaluation is likely

insufficient. If goals were not met, the plan should be examined to determine why it failed.

However, this does not necessarily mean that similar plans cannot be reattempted.

Overplanning can result in an excessive and inefficient commitment to minor details.

18. At the unit level, what time frame may be considered long-range planning?

a. 3 months

b. 6 months

c. 12 months

d. 18 months

ANS: B, C, D

Feedback: At the unit level, any planning that is at least 6 months in the future may be

considered long-range planning.

19. The nurse-manager is on a team that is performing a SWOT analysis of the staffing system

at a community clinic. What should the manager do when addressing the "S" component of

the SWOT analysis?

a. Identify stakeholders in the current staffing system.

b. Examine the factors indicating that a change in the staffing system is necessary.

c. Identify any characteristics of the staffing system that currently help the clinic

meet its goals.

d. Strategize about ways that the staffing system could possibly be improved.

ANS: C

Feedback: After identifying the issue, SWOT analysis begins with identifying strengths,

which are the internal attributes that help an organization achieve its objectives. The "S"

does not denote stakeholders or strategizing. It is important to identify the rationale for a

change, but this is not a component of the SWOT model of analysis.

20. One of the most commonly used tools in health-care organizations is SWOT analysis. What

is the definition of the "O" component of this model?

a. Internal attributes that help an organization achieve its objectives

b. Internal attributes that challenge an organization in achieving its objectives

c. External conditions that promote achievement of organizational objectives

d. External conditions that challenge or threaten the achievement of organizational

objectives

ANS: C

Feedback: Opportunities are external conditions that promote achievement of organizational

objectives. Strengths are internal attributes that help an organization achieve its objectives.

Weaknesses are internal attributes that challenge an organization in achieving its objectives.

Threats are external conditions that challenge or threaten the achievement of organizational

objectives.

21. The nurse-manager is participating in organizational planning. Which factors should the

team consider when identifying variables that may complicate the planning process? Select

all that apply.

a. Government regulations

b. Rapidly changing technologies

c. Decreased acknowledgement of the importance of planning

d. Changing population demographics

e. Public mistrust of the nursing profession

ANS: A, B, D

Feedback: Because of the rapidly changing technology, increasing government regulatory

involvement in health care, changing population demographics, and reduced provider

autonomy, health-care organizations are finding it increasingly difficult to appropriately

identify long-term needs and plan accordingly. Nurses are generally well trusted by the

public, and there is acknowledgment that planning is important in health-care organizations

22. An organization is considering a revision to its philosophy. What characteristic of the

current philosophy would most clearly indicate a need for revision?

a. The philosophy is more than 5 years old.

b. Staff claim the stated unit philosophy is in contrast to the care that is being given.

c. The philosophy was appropriated from a different health-care facility.

d. The philosophy was created after the organization's vision and mission were

determined.

ANS: B

Feedback: An organizational philosophy that is not or cannot be implemented is useless. An

old philosophy is not necessarily obsolete, and it is possible to adopt a philosophy from

another facility if it is appropriate in a different setting. It is acceptable for an organization's

philosophy to flow from the vision and mission statements

23. Which statement regarding nursing policies and procedures is most important to their

successful application in achieving goals?

a. The policies and procedures are created by staff representatives.

b. All policies and practices are based on current evidence related to practice.

c. Policies and procedures are reviewed at fixed times, every 5 years.

d. One hundred percent of the staff adheres to established policies and procedures

100% of the time.

ANS: B

Feedback: Policies and procedures should be evidence-based. It is unrealistic to expect

100% compliance, 100% of the time. A policy that is created by staff representatives but

which is not evidence-based is not appropriate because it may be unsafe. Ongoing, cyclical

review should be implemented

24. The nurse-manager is reviewing the rules that the previous manager had put into place.

When reviewing these rules, what principles should guide the manager's actions? Select all

that apply.

a. Rules should be flexible.

b. The number of rules should be kept to a minimum.

c. Rules should be changed on a regular basis.

d. Enforcement of the rules supports staff morale.

e. Consistent rule enforcement supports organizational structure.

ANS: A, B, D, E

Feedback: Rules are fairly inflexible, so the fewer rules, the better. Existing rules, however,

should be enforced to keep morale from breaking down and to allow organizational

structure. It is neither reasonable nor necessary for all involved parties to agree with the

rules but all must follow them. Rules require regular evaluation, but change may not be

warranted.

25. Which statements concerning the role of the leader-manager in organizational planning are

true? Select all that apply.

a. The leader-manager must be future-oriented.

b. The leader-manager has to be willing to take risks.

c. The leader-manager should possess human resource management skills.

d. The leader-manager must evaluate the social climate that affects the organization.

e. The leader-manager must be the most experienced clinician in the organization.

ANS: A, B, C, D

Feedback: Planning requires managerial expertise in health-care economics, human resource

management, political and legislative issues affecting health care, and planning theory.

Planning also requires the leadership skills of being sensitive to the environment, being able

to appraise accurately the social and political climate, and being willing to take risks. A

leader-manager can give effective oversight without being the most experienced clinician on

the unit.

26. The manager of a clinic is considering a change in the scheduling of vacation time in which

nurses would self-schedule their vacation rather than having the manager respond to their

submitted requests. A nurse has pointed out that it is possible that newer nurses may feel

intimidated by more experienced nurses on the unit when scheduling their vacation. This

observation constitutes what component of a SWOT analysis?

a. S

b. W

c. O

d. T

ANS: B

Feedback: Weaknesses are those internal attributes that challenge an organization in

achieving its objectives. In this case, possible intimidation within the culture of the unit

would be considered an internal attribute that could complicate the proposed system.

Threats are also potential confounding factors, but these are external, not internal, factors.

Strengths and opportunities are positive attributes.

27. A nurse-manager is on a strategic planning team that is applying the balanced scorecard

while strategic planning. The team should specifically consider what variables when

creating the scorecard? Select all that apply.

a. Legislation that governs the organization's operations

b. The health-care organization's budget

c. Goals identified by similar organizations

d. The existing processes that are in place

e. Opportunities for learning and growth

f. Feedback that clients and families have provided

ANS: B, D, E, F

Feedback: Strategic planners using a balanced scorecard develop metrics, collect data, and

analyze that data from four organizational perspectives: financial, customers, internal

business processes (or simply processes), and learning and growth. This particular model

does not explicitly include other organizations' goals or legislation as major components of

planning.

28. A nurse-manager has been asked for the first time to join the health-care facility's strategic

planning committee. What action should the manager take first?

a. Approach potential mentors on the committee.

b. Perform a SWOT analysis of the issues facing the committee.

c. Identify and examine his or her own planning style.

d. Review the committee's most recent Balanced Scorecard

ANS: C

Feedback: Self-reflection is a necessary first step when a nurse is becoming involved in

strategic planning. This should precede efforts such as finding mentors. Performing SWOT

analysis and creating balanced scorecards constitute the work of the committee.

29. A society that highly values social equity and equality is likely to support a health-care

system which:

a. prioritizes the role of the free market in providing health-care services.

b. entitles all citizens to similar levels of health-care services.

c. relies on the private sector to organize and provide health care.

d. is cost-effective and efficient.

ANS: B

Feedback: Values strongly influence the formation of health-care policy. A society that

values equality of access and social equity is likely to create a health-care system in which

each citizen has similar access to services. In many cases, the roles of the free market and

the private sector are eclipsed by government, which provides or coordinates services

accessible to all. This type of system may or may not be cost-effective, depending on

numerous variables.

30. A nurse-manager has identified the following objective for the care on the unit: "At least

95% of new clients' health records will contain a completed assessment for intimate partner

violence." How should the manager improve this objective?

a. Increase the objective to 100% of health records.

b. Include the rationale for the objective.

c. Focus on client actions rather than documentation.

d. Include a time frame in the statement.

ANS: D

Feedback: For objectives to be measurable, they should have certain criteria. There should

be a specific time frame in which the objectives are to be completed, and the objectives

should be stated in behavioral terms, be objectively evaluated, and identify positive

outcomes rather than negative outcomes. It is appropriate for an objective to include

references to documentation and it may or may not be appropriate to expect 100%

compliance, depending on many factors. The rationale is not normally included in an

objective statement.