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Leading and Managing in Canadian Nursing Patricia
Yoder-Wise - Chapter 02
Health Policy, Health Care Organizations, Change Management (University of Alberta)
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Chapter 02: Developing the Role of Leader
Waddell/Walton: Yoder-Wise’s Leading and Managing in Canadian Nursing, Second Edition
MULTIPLE CHOICE
1. Change in health care must occur at the micro, meso, and macro policy levels. Which of the following addresses the meso level of
change?
a. Emergency room
b. Clinic
c. Ministry of Health
d. College of Nurses
ANS: D
Emergency room and Clinic is at the micro level. Ministry of health is at the macro level and College of Nurses is at the meso level
as a professional organization.
DIF: Cognitive Level: Understand REF: Page 27
TOP: Nursing Process: Assessment
2. Nursing leaders require several competencies for successful leadership. Which of the following descriptions encompass the best
candidate for Director of Nursing in a large urban hospital?
a. Graduate degree in Nursing, social skills, communication skills
b. Legal knowledge, philanthropy knowledge, undergraduate degree in nursing
c. Finance knowledge, graduate degree in nursing, excellent communication skills
d. Undergraduate degree in nursing, communication skills, social skills
ANS: C
All are required to be in a leadership position. For a director of nursing a graduate degree in nursing, finance knowledge, and
excellent communication skills are the minimum needed. In addition legal and philanthropic experience would enhance the leader
chosen.
DIF: Cognitive Level: Apply REF: Page 28
TOP: Nursing Process: Implementation
3. Self-doubt in novice nurses is a common issue and is known as which of the following?
a. Insecurity
b. Imposter syndrome
c. Lack of confidence
d. Lack of knowledge
ANS: B
Imposter syndrome is self-doubt is one’s ability to function adequately in one’s role and may prevent nurses from taking leadership
roles.
DIF: Cognitive Level: Understand REF: Page 28
TOP: Nursing Process: Assessment
4. Two areas nurses must take leadership in developing knowledge and skills in consideration for the future is?
a. Health informatics and social media
b. Research and technology
c. Social media and research
d. Publications and social media
ANS: A
Nursing informatics competencies is one method to support nurses globally in addressing new health care challenges globally into
the future. Appropriate use of social media is part of health informatics.
DIF: Cognitive Level: Apply REF: Page 28
TOP: Nursing Process: Implementation
5. Which of the following is a relational leadership approach?
a. Transactional
b. Laissez-faire
c. Transformational
d. Instrumental
ANS: C
Transactional, Laissez-faire, and instrumental are task focused. Transformational, resonant, and participatory leadership are
relational leadership approaches.
DIF: Cognitive Level: Understand REF: Page 29
TOP: Nursing Process: Assessment
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6. The nurse manager in the emergency department needs to implement new staffing patterns. As a transformational leader, the nurse
manager should:
a. Explain in detail how well the new idea will work.
b. Make staff members think the idea was theirs in the first place.
c. Reason with staff members that the new idea will save money and allow more
free time.
d. Imply that raises will be smaller than anticipated if the new idea is not accepted.
ANS: B
Transformational leadership inspires and motivates other people through influence and persuasion rather than through rewards
(e.g., free time) and punishment (e.g., smaller raises).
DIF: Cognitive Level: Understand REF: Page 31 TOP: Nursing Process: Planning
7. Which relational leadership approach is based on mindfulness and emotional intelligence?
a. Resonant
b. Instrumental
c. Participatory
d. Transactional
ANS: A
Instrumental and transactional are task focused. Participatory is based on respect and aims to optimize peoples’ strengths. Resonant
is based on mindfulness, emotional intelligence, and openness and responsiveness without judgment.
DIF: Cognitive Level: Understand REF: Page 29
TOP: Nursing Process: Implementation
8. Systematic reviews related to patient outcomes in nursing homes identified patients and families responded to this leadership style.
a. Resonant
b. Transactional
c. Instrumental
d. Participatory
ANS: B
The transactional style was identified as being more directional and clear cut in providing resident care.
DIF: Cognitive Level: Analyze REF: Page 31 TOP: Nursing Process: Planning
9. Nurse outcomes were identified to be predicated on which leadership styles?
a. Participatory and instrumental
b. Resonant and transformational
c. Laissez-faire and transformational
d. Transactional and instrumental
ANS: B
Relational leadership approaches were described as influencing positive nurse outcomes. Transactional, laissez-faire, instrumental
are task focused.
DIF: Cognitive Level: Understand REF: Page 31 TOP: Nursing Process: Planning
10. Hospital beds may be closed because of a nursing shortage and the increased amount of overtime required to care for patients. For
you as the nurse leader on the unit, which of the following leadership approach is most effective to address this issue?
a. Transactional
b. Laissez-faire
c. Autocratic
d. Instrumental
ANS: D
Instrumental leadership focuses on choosing strategy and resources to solve a problem. Leaders with this style strive to maintain
productivity and complete tasks that are in line with the organization’s strategic direction.
DIF: Cognitive Level: Analyze REF: Page 29
TOP: Nursing Process: Implementation
11. Miles is interested in leadership positions within his nursing organization. Although he has been on the same unit for 10 years, he
has attended two workshops during that time and has steadfastly refused opportunities to engage in leadership development
opportunities or other learning offered as part of the hospital’s succession planning strategy. He says that he is interested in a
leadership role primarily because it will give him a more stable work schedule and will enable him to spend more time with his
family. Miles is demonstrating attributes of which leadership style?
a. Transformational
b. Laissez-faire
c. Participatory
d. Transactional
ANS: B
Laissez-faire leadership uses a hands off approach allowing others to do the leading. They usually let things happen and do not
address problems or assist others to make improvements.
DIF: Cognitive Level: Understand REF: Page 29
TOP: Nursing Process: Assessment
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12. Akash graduated 5 years ago and is keenly interested in pursuing leadership opportunities. She has been active in learning about
leadership through workshops and Internet research and recently began a graduate degree program with a focus on nursing
administration. She has excellent clinical skills and eagerly accepts responsibility for various projects on the unit. Her sarcastic and
sometimes aggressive behaviour tends to alienate other staff members on the unit. Akash is demonstrating which leadership style?
a. Transformational
b. Participatory
c. Transactional
d. Resonant
ANS: A
Leadership involves radiating positive energy and the ability to inspire and motivate others. Transactional leaders are closed
minded and controlling and exhibit negative behaviours using blame and punishment. Transactional leaders do not consider input
from others.
DIF: Cognitive Level: Understand REF: Page 29
TOP: Nursing Process: Assessment
13. To achieve strategic priorities the most important activity health care organizations need to address is?
a. Providing education
b. Nurturing future nurse leaders
c. Engaging patients
d. Increasing number of nurses
ANS: B
Organizations must also recognize and nurture the development of future nurse leaders. By doing so, they will be rewarded with
leaders who can motivate, inspire change, and work with interprofessional colleagues in a shared vision of an environment of
empowerment (Scully, 2015). If organizations identity and nurture future leaders, excellence in patient and family-centred care can
be achieved.
DIF: Cognitive Level: Understand REF: Page 33
TOP: Nursing Process: Implementation
14. Which of the following LEADS in a Caring Environment is not one of the five capacities?
a. Achieves results
b. Develops coalitions
c. Engages others
d. Focuses on leaders
ANS: D DIF: Cognitive Level: Understand REF: Page 33
TOP: Nursing Process: Implementation
15. Which of the following nurses is most likely to inspire other professionals to do their best?
a. Nayla, RN, is an individual who enjoys details and organization. She regularly
leaves notes for the next shift about what has been done incorrectly or omitted.
b. Roger, RN, has been involved in nursing for several years and is well liked by
patients and families. He continually searches for new knowledge and skills, and
his sense of humour and optimism are infectious.
c. Clara has been the head nurse on Unit 3Y for years. She is quiet but enjoys
patients and their families. She has not been to a conference in years because the
unit is her entire life.
d. Katrin is a team leader. She is extraordinarily vigilant about ensuring that
everyone is treated fairly in assignments. She is also very conscientious about
care and regularly checks up on what everyone is doing to ensure that it is done
correctly.
ANS: B
To be inspired, people must have a positive leader who radiates energy, a zest for learning, and an interest in the common good and
who is engaged in self-renewal. This leader is hopeful and optimistic. Leaders, not managers, inspire other professionals to achieve
their highest level.
DIF: Cognitive Level: Apply REF: Page 34
TOP: Nursing Process: Assessment
16. The adage “leaders are born and not made” reflects which of the following ideas about leadership?
a. Management can be taught; leadership depends on abilities.
b. Mentorship is important in developing innate skills of leaders.
c. Leadership is a natural skill that cannot be refined and developed.
d. Succession planning and formal education related to leadership are ineffective.
ANS: A
Leadership is an abilities-dependent role that can be developed and refined through such strategies as coaching, mentorship, and
reflection. Management can be taught and learned through traditional teaching techniques. Similarly, leadership is a learnable set of
practices that requires continued opportunity for application and feedback.
DIF: Cognitive Level: Understand REF: Page 28
TOP: Nursing Process: Assessment
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17. Kari, a head nurse on the dialysis unit, has been informed during budget planning meetings that budget cuts are likely. She
discusses this at the next unit meeting and tells staff members that unless they do their jobs well, their positions may be terminated,
and there will be no replacement. Kari is enacting which management style?
a. Transformational
b. Transactional
c. Trusting
d. Truthful
ANS: B
Transactional leaders tend to rely on position, power, and reward and punish according to performance and conformity with
expectations.
DIF: Cognitive Level: Analyze REF: Page 29 TOP: Nursing Process: Evaluation
18. Siwan, a new graduate on the dialysis unit, appears to take the nurse manager’s remarks about possible position terminations very
seriously and works even harder, often volunteering for extra assignments. She also is often in the unit manager’s office, advising
of successes with her patients and of the extra effort that she is committing. This behaviour suggests that Siwan:
a. Is fearful of losing her job.
b. Lacks understanding of Kari’s leadership style.
c. Is not intimidated by Kari’s leadership style.
d. Knows how to “play the game.”
ANS: D
Followers under transactional leadership feel secure about what will happen next or what they must do to be rewarded; therefore
they learn to do what they think they must do (“play the game”).
DIF: Cognitive Level: Apply REF: Page 33
TOP: Nursing Process: Implementation
19. The style of leadership that is exhibited by a nursing manager that indicates to staff that with all of the budget cuts there may be lost
positions is likely to:
a. Ensure that the organization is financially stable.
b. Stifle innovative thinking about ways to move out of financial jeopardy.
c. Lead to apathy and disinterest in the organizational goals.
d. Lead to decreased attrition of staff on her unit.
ANS: B
Whether the organization achieves financial stability is a function of financial envisioning and planning, but the style of leadership
(transactional) that is demonstrated is likely maintaining the status quo within the organization, without an opportunity to generate
more creative and innovative ideas to address the financial issues. Lower staff turnover is associated with transformational
leadership.
DIF: Cognitive Level: Analyze REF: Pages 32-33 TOP: Nursing Process: Evaluation
MULTIPLE RESPONSE
1. Future nursing leaders must consider which of the following concepts? (Select all that apply)
a. Leadership is a skill built over time.
b. Need to develop ongoing reflective practice.
c. Assume everyone has inherent leadership abilities.
d. To develop an intentional action plan.
ANS: A, B, D
Nurse leaders of the future must have skills and knowledge related to population trends, and have competencies, which may expand
what has traditionally been in nursing curricula. The knowledge, skills and attributes required for effective leadership are
multifaceted and complex. As such, leadership is a skill that does not simply involve formal education but is developed over time.
DIF: Cognitive Level: Apply REF: Pages 32-33
TOP: Nursing Process: Implementation
2. A nurse manager is conducting yearly assessments of staff nurses. One nurse who stands out as being well-liked and receives
positive feedback from patients, staff, and families, possesses a high degree of emotional intelligence. Which of the following
characteristics indicates emotional intelligence? (Select all that apply).
a. Has confidence dealing with difficult situations.
b. Promotes interprofessional teamwork.
c. Increases staff retention.
d. Develops trust among staff.
ANS: A, B, C, D
They are very good at dealing with conflict, can manage the emotional aspects of patient care and staffing, and display confidence
when challenging situations arise. Evidence shows that emotionally intelligent nursing leaders can assist with retaining top talent,
intraprofessional teamwork, use of resources and time, increase team motivation and innovation, and develop trust among nurses.
DIF: Cognitive Level: Apply REF: Page 29
TOP: Nursing Process: Implementation
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3. The LEADS framework for leadership is being used to strengthen leadership in many hospitals. Which of the following are
considered elements of the LEAD framework when initiating change? (Select all that apply).
a. Does engage others.
b. Does lead self.
c. Does not pursue building coalitions.
d. Does achieve results.
e. Does not seek system transformation.
ANS: A, B, D
Engages others: Without willing, energized, and engaged followers, a leader is unable to accomplish results on any significant
scale. Leads self: Effective leadership is associated with capabilities that can be learned by conscious and intentional effort.
Achieves results: Leaders are accountable for managing the resources of the organization to achieve results.
DIF: Cognitive Level: Understand REF: Page 33 TOP: Nursing Process: Planning
4. Nurses are becoming engaged professionally through social media. They are able to share expertise, ideas, and evidence, to become
social media leaders at the micro to macro levels. Which of the following are outcomes of nurses’ engagement in social media?
(Select all that apply).
a. Brings innovation to health care.
b. Shapes expert nurse leadership.
c. Engages nurses and patients.
d. Makes nurses more visible in health care.
ANS: A, B, C, D
Social media is allowing more engagement between nurses, patients, and other health care providers, as it facilitates engagement of
ideas, and allows for the evidence, opinions, expertise, and resources to be shared globally. It is important that student and
registered nurses alike focus on developing their digital and interpersonal skills in order to become social media leaders. Through
the use of data and social media listening tools, nurses can begin to understand and gain insight into a variety of issues. By using
social media, nurses become visible and accessible role models.
DIF: Cognitive Level: Apply REF: Page 28
TOP: Nursing Process: Implementation
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