Question 1

A client who is being discharged from the hospital will need follow-up for wound care. The client's spouse is not capable of providing bed baths for the client. The nurse case manager who is planning care for this client should contact which agency?

Accepted Answer

1. Long-term care facilities are used for rehabilitation and care needed for extended periods. There is no evidence that this client will be unable to care for self after recovery.
2. The public health department's focus is usually community health, not individual primary care.
3. Temporary service agencies are used to provide healthcare organizations with professional and nonprofessional personnel when the latter are short staffed.
4. With shorter hospital stays, home health agencies are frequently used to provide clients with intermittent or temporary follow-up care such as wound care and bathing.

Question 2

A nurse practitioner and a physician are considering establishing a medical home. For this venture to be successful, these healthcare providers should ensure which resources are available? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Accepted Answer

1. For medical homes to be most effective, EMR should be implemented.
2. A medical home is not the same as a long-term care facility.
3. One of the challenges in developing a medical home is the multiple needs of clients who have chronic conditions.
4. The medical home is not a bricks-and-mortar facility.
5. Problems with electronic delivery of data and information and compensation for primary care are challenges associated with developing a medical home.

Question 3

Which situation is an example of organizational culture?

Accepted Answer

1. As this is a system-wide condition initiated by the administrator, it is an example of organizational environment.
2. These are set rules published for everyone, including visitors, and make up part of the organizational environment.
3. This is a system-wide "rule" established by administration and is part of the organizational environment.
4. The nurses have created this system of coverage informally as part of their daily work. This is an example of organizational culture and may vary from unit to unit.

Question 4

"We want to be the hospital of choice in the Midwest" is which type of statement?

Accepted Answer

1. The value statement concerns the beliefs or attitudes esteemed by the organization's leaders.
2. The mission statement is a broad statement of the organization's reason for existence. An example is "Our mission is to improve the health of the people of the Midwest."
3. A vision statement describes the goal to which the organization aspires-in this case, to be the hospital of choice in the Midwest.
4. A philosophy statement reflects the organization's values, vision, and mission, so it is all-inclusive.

Question 5

The nurse manager has established a program that recognizes a different staff member each month for contributions to client care. As a result, overall staff productivity and the number of client compliments have increased. This is an example of which concept of organizational theory?

Accepted Answer

1. Span of control is the number of individuals a manager can effectively supervise.
2. Line authority is a linear hierarchy through which activity is directed.
3. The Hawthorne effect is the tendency of people to perform as expected because of special attention.
4. Adhocracy is a fluid structure in which management, staff, and experts work together on teams.

Question 6

The nurse applying for a position is told, "This hospital has a very traditional organizational structure." The nurse would expect the organization to use which structure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Accepted Answer

1. A functional structure is a traditional organizational structure.
2. Shared governance is a new, more relationship-based organizational structure.
3. A service-line structure is a new, more relationship-based organizational structure.
4. A parallel structure is a traditional structure, even though it is more modern than a functional structure.
5. Matrix is a traditional structure.

Question 7

During a nurse's interview for a new job, the health benefits are described as being provided by a health maintenance organization (HMO). What should the nurse expect from this coverage?

Accepted Answer

1. An HMO is a geographically organized system that provides an agreed-upon package of health maintenance and treatment services. Providers must be chosen from those in the HMO.
2. The HMO system will not pay for services provided "out of network."
3. The ability to choose a provider who is "out of network" for an additional premium is a feature of point-of-service plans.
4. The HMO provides an agreed-upon package of health maintenance and treatment services. Treatment and services are not unlimited.

Question 8

The nurse's friend says, "I've been thinking about going to that healthcare clinic in the grocery store so someone can look at my daughter's rash. What do you think?" Which response by the nurse is appropriate?

Accepted Answer

1. Studies on the quality of care provided by these clinics have shown it to be comparable to care provided elsewhere.
2. Most retail clinics are less expensive than physician offices or emergency departments.
3. Care in these clinics is provided by nurse practitioners with physician backup. If the nurse practitioner believes additional studies or assessment should be done, referrals are made.
4. There is no indication that the clinic is not appropriate for children.

Question 9

A long-term care facility's organization reflects a functional structure. Which facility practice reflects a basic weakness in this organizational strategy?

Accepted Answer

1. In functional structure, individual departments are grouped and responsible for specific tasks. A weakness of the functional structure is that coordination of services across departments is poor. Nursing would find it difficult to write a comprehensive care plan without input from other departments.
2. In functional structure, individual departments are grouped and responsible for specific tasks. The dietary department would be responsible for nutritional assessment in this structure, so this is not a weakness.
3. In functional structure, individual departments are grouped and responsible for specific tasks. All nursing tasks would be grouped under the nursing department, so this is not a weakness.
4. In functional structure, individual departments are grouped and responsible for specific tasks. Physical and occupational therapy would logically coordinate and evaluate activities of daily living, so this is not a weakness.

Question 10

A community-owned hospital has been purchased by a healthcare conglomerate. The staff is aware that the organizational theory governing the hospital is likely to change. Which statement indicates a lack of understanding of organizational theory on the part of a staff nurse?

Accepted Answer

1. Classical organizational theory focuses on structure with a strong hierarchy.
2. Those who support chaos theory believe that organizational function and integrity must be guided by flexibility, fluidity, speedy adaptability, and cultural sensitivity. Change is inevitable and embraced.
3. Systems theory focuses on "input" or resources, "throughput" or the work done, and "output" or the product of the work.
4. Contingency theory posits that organization performance can be enhanced by matching an organization's structure to its environment.

Question 11

The healthcare institution has organized a committee to review and revise the strategic plan. As part of this work, committee members have been asked to submit a philosophy statement for consideration. Which statement meets the requirements of a philosophy?

Accepted Answer

1. This statement specifies an outcome to be achieved. This is a goal.
2. This statement is specific to a particular unit and is an objective.
3. This is a statement of the organization's values.
4. The philosophy is a written statement that reflects the organization's values, vision, and mission. It is broader than a value statement.

Question 12

What is occurring as the traditional parallel structure found in hospitals is being replaced by service-line structure?

Accepted Answer

1. Service-line structure is appropriate when environmental uncertainty is high and the organization requires frequent adaptation and innovation.
2. The medical staff is autonomous from the organization in parallel structure. This autonomy is reduced by service-line structure.
3. Parallel structure exists when there are two lines of authority in an organization.
4. Organizational structure is much clearer in a parallel structure.

Question 13

During a performance evaluation the nurse manager states, "My span of control is just too large." How should the unit supervisor interpret this statement?

Accepted Answer

1. Span of control is not directly related to the number of duties expected.
2. Span of control addresses the number of employees a manager can effectively supervise.
3. Span of control issues may result in burnout, but there is no indication from this scenario that this is the case.
4. There is no indication that the nurse manager's level of education is insufficient for the role.

Question 14

Which structure is reflected by the statement, "Nursing practice is best determined by nurses"?

Accepted Answer

1. Hybrid structure is typical of a growing institution and consists of both self-contained units and functional units. Top administrators still make many of the decisions for the organization.
2. Shared governance is a form of participative decision making. Nurses gain control over practice, are more accountable, and feel empowered.
3. Matrix structure combines functional structure and product structure into one overlapping structure. The dual authority created can be frustrating and confusing. Managers and administrators make many of the organizational decisions.
4. Functional structure is a traditional structure in which employees are grouped in departments by specialty. Most decisions are made by senior managers.

Question 15

A hospitalized client is complaining of abdominal pain that has developed since admission. The nurse says, "I am going to call the hospitalist." How should the client interpret this statement?

Accepted Answer

1. The medical intern is not a hospitalist.
2. The physician's on-call group is likely a group of physicians from the same office or organization of physicians with office practices. They are not hospitalists.
3. A hospitalist provides care only to hospital inpatients.
4. Emergency department physicians are not the same as hospitalists.

Question 16

A nurse practitioner and a physician have opened an office together. The nurse regularly collaborates with the physician in client care and is a general partner in the business of the office. This is an example of which diversification method?

Accepted Answer

1. Concentric diversification is expansion of services into new markets.
2. Conglomerate diversification is expansion into areas that differ from the original service.
3. Capitation is a fixed fee paid per enrollee for services in an HMO.
4. A joint venture is a partnership in which each partner contributes different areas of expertise or resources to create a product or service.

Question 17

What is the best example of a pediatric unit's organizational culture?
1)
1) All client rooms are private.
2) Nurses wear colorful scrubs.
3) The nurse-to-client ratio is 4 to
4) The primary nursing model is used for care.

Accepted Answer

The answer of What is the best example of a...

Question 18

A nurse has accepted the position of vice-president in charge of nursing in an organization that has a functional structure. What issues should the nurse be alert for? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Accepted Answer

1. Coordination across functions can be complex and poor in a functional structure.
2. Because so many day-to-day operation decisions are made by senior managers in this structure, these people may become overloaded and unable to be efficient in their work.
3. Typically, in a functional structure, promotion occurs from within.
4. Typically, response to changes in the external environment is very slow in organizations with functional structure.
5. Many managers in functionally structured organizations rise "up the ranks" to their position; there is often very little formal management training.

Question 19

A nurse manager encourages nursing staff members to assist in developing a new creative staffing pattern that can respond quickly when staff resign or go back to school. This is an example of the use of which organizational theory?

Accepted Answer

1. Contingency theorists study the environment in which the organization will exist and create the structure to match that environment.
2. Closed systems are self-contained and do not exist in organizations dependent on the interplay of people. Examples can be found in the physical sciences.
3. Classical leadership theory focuses on developing a well-structured and stable environment where chain of command and control are valued.
4. Chaos theory posits that an organization is dependent on its adaptability and response to change in its environment. Nurse managers must create an environment that accepts change, tolerates conflict, and promotes creative solutions.

Question 20

The nurse works in a school clinic that is part of an integrated healthcare network. How would this nurse explain to parents and teachers the focus of care provided in the clinic?

Accepted Answer

1. The goal of an integrated healthcare network is to keep clients healthy and out of the hospital.
2. Primary care is the focus of integrated healthcare networks.
3. The goal of an integrated healthcare network is to keep clients healthy, thereby minimizing the need for specialty care visits.
4. The goal of an integrated healthcare system is to keep clients healthy so that more expensive options, like home care, are not needed.

Quiz 2: Designing Organizations