Question 1

Pharmacy reports that the medication records of a unit have begun to show frequent corrections. What other signs of diversion would the manager look for on the unit?
A) Chart review on effectiveness of pain control
B) Increase in clients with conditions requiring pain medications
C) Increase in use of doses of as-needed narcotics that results in wastage
D) Chart review that reveals that clients require much more narcotic pain medication on one shift than on others
E) Narcotic containers that look as if they have been altered

Accepted Answer

The answer of Pharmacy reports that the medication records of...

Question 2

A nurse manager has had issues with a marginal employee. Staff members have complained several times to the manager regarding this employee's competence. Which action by the manager would be appropriate?
A) Discuss the issues at a staff meeting and elicit methods to improve morale.
B) Use progressive discipline to manage the employee.
C) Monitor the staff's performance to determine the lack of civility.
D) Terminate the employee.

Accepted Answer

Using progressive discipline to manage the employee is the most appropriate action, as it allows the manager to address the employee's performance issues while also providing opportunities for improvement. Terminating the employee should only be the last resort after all efforts to improve performance have failed. Discussing the issues at a staff meeting may help improve morale, but it does not directly address the employee's performance issues. Monitoring the staff's performance to determine the lack of civility assumes that the issue is with the entire team and not with the specific employee in question.

Question 3

A nurse is suspected of abusing narcotics. A thorough investigation has been performed, and the nurse will now be notified of the suspicion and investigation. How should this notification be handled?
A) A certified letter outlining the accusation and investigation should be sent to the nurse's home.
B) A certified letter outlining the accusation and investigation should be sent to the nurse at work.
C) The nurse should be contacted and asked to make an appointment with the nurse executive without giving cause.
D) The nurse should be approached at work with no prior notice and asked to come to the nurse executive's office.

Accepted Answer

1. Sending a letter to the nurse's home will give the nurse opportunity to rationalize the abuse, to create a "story," or to develop denial.
2. Sending a letter to the nurse at work will give the nurse opportunity to rationalize the abuse, to create a "story," or to develop denial.
3. If a request to make an appointment with the nurse executive is made, a nurse who is abusing narcotics would likely be suspicious that administration had found out about the abuse.
4. This surprise approach minimizes the amount of time the nurse has to create a story or to rationalize the abuse of narcotics.

Question 4

A nurse constantly complains about employee policies and procedures and frequently mentions how "they" are "out to get us." The nurse is surprised when referred to by the manager as "disgruntled" during a discussion of this behavior. What information should the manager provide this nurse?
A) "People who are constantly complaining decrease the morale of the rest of the unit."
B) "You have complained so long, it will be impossible to change your behavior."
C) "Being a complainer is a character trait."
D) "Your attitude problem makes everyone else in the unit miserable."

Accepted Answer

The manager should explain to the nurse that constantly complaining and talking negatively about policies and procedures can decrease the morale of the rest of the unit, which is not productive or helpful for the team. Using the term "disgruntled" accurately describes this behavior and helps the nurse understand the impact of their actions.

Question 5

A nurse admits to diverting narcotic drugs while working. The manager says, "All nurses who admit diverting narcotics have to be reported to the state board of nursing." How should the nurse interpret this statement?
A) As true, because any nurse who admits diversion must be reported to the state's board of nursing
B) As false, because in some states reporting depends on other factors
C) As beneficial, because the state board of nursing will help the nurse find a substance abuse program
D) As career ending, because the state board of nursing is required to suspend the license of any nurse who admits to diverting drugs

Accepted Answer

Reporting requirements for nurses who admit to diverting narcotics vary by state. While some states may require reporting to the board of nursing, others may have different reporting requirements or may take other factors into consideration before making a report. Therefore, the manager's statement cannot be universally true.

Question 6

A nurse who has been abusing narcotics is in the nurse executive's office discussing the charges. The nurse executive is trying to convince the nurse to seek treatment for the abuse. Which statement should the nurse executive make?
A) "Health insurances generally pay 100 percent of treatment charges for medical professionals who are seeking help."
B) "If you go to treatment, the state board will never know you were abusing."
C) "Treatment is your best chance at returning to practice."
D) "We will be able to follow your progress through reports from your treatment team."

Accepted Answer

This statement provides the nurse with a reason why seeking treatment is important - it is their best chance at returning to practice. It also shows empathy and support for the nurse's situation. While the other options may be true, they may not be the best choice to say to the nurse in this particular situation. A is true but may come across as unsympathetic, B is not necessarily true, and D may sound more like a threat than a supportive statement.

Question 7

A nurse comes to a mandatory education session wearing a shirt with a picture and slogan that is degrading to nursing. What should the manager do first?
A) Tell the employee to go home and change.
B) Check the human resources policies regarding appropriate dress.
C) Ask the employee why the shirt was worn to this event.
D) Bring the employee a scrub shirt from surgery to change into.

Accepted Answer

Checking the human resources policies regarding appropriate dress would allow the manager to address the situation in a way that is consistent with organizational policies and procedures. This will also provide guidance for how to handle similar situations in the future. Option A and D are not appropriate solutions as it could potentially embarrass the employee, and option C is not necessary at this stage.

Question 8

A nurse who is a chronic complainer comes back from lunch 20 minutes late. When confronted by the manager the nurse says, "The nurses who smoke always take longer lunches. No one says anything to them." What is the manager's major consideration before replying to this statement?
A) Policies must be consistently applied to all employees.
B) Since the hospital is smoke free, those nurses who wish to smoke must leave campus for lunch.
C) This nurse complains about everything.
D) The human resources policy is that nurses get 60 minutes for lunch.

Accepted Answer

The manager's major consideration should be that workplace policies must be consistently applied to all employees, regardless of whether they smoke or not. All employees should be held accountable for adhering to the policies and rules of the workplace, including taking only the allotted amount of time for lunch breaks.

Question 9

A nurse has been discovered using drugs on the unit. Investigation reveals the nurse has likely been diverting and abusing narcotics for some time. What is the likely the worst outcome for this nurse?
A) Administration reports the nurse to the state board of nursing.
B) The nurse is counseled and asked to participate in a treatment center plan.
C) The nurse is allowed to continue supervised practice while a treatment plan is being devised.
D) The nurse is terminated with no report made.

Accepted Answer

Termination without reporting to the state board of nursing is the worst outcome as it fails to address the underlying issue, potentially endangers future patients, and does not provide the nurse with an opportunity for rehabilitation or accountability.

Question 10

A nurse manager has been working with a disgruntled employee for several weeks. Today the employee comes to the manager's office with yet another complaint about a new hospital policy. The manager says, "I am sick of your complaining. Leave me alone so I can get some work done." What should the manager do now?
A) Firmly shut the office door.
B) Tell the employee to go to human resources with complaints about the policy change.
C) Apologize to the employee for being unprofessional and ask what the issue with the policy is.
D) Tell the employee to go back to work.

Accepted Answer

The manager should apologize for their unprofessional behavior and ask what the issue with the policy is. This shows respect for the employee and allows them to express their concerns in a constructive manner. It also allows the manager to address any potential issues with the new policy. Shutting the door, telling the employee to go to human resources, or telling them to go back to work only dismisses the employee's concerns and can further escalate the situation.

Quiz 21: Dealing With Staff Problems

Pharmacy reports that the medication records of a unit have begun to show frequent corrections. What other signs of diversion would the manager look for on the unit?

A nurse manager has had issues with a marginal employee. Staff members have complained several times to the manager regarding this employee's competence. Which action by the manager would be appropriate?

A nurse is suspected of abusing narcotics. A thorough investigation has been performed, and the nurse will now be notified of the suspicion and investigation. How should this notification be handled?

A nurse constantly complains about employee policies and procedures and frequently mentions how "they" are "out to get us." The nurse is surprised when referred to by the manager as "disgruntled" during a discussion of this behavior. What information should the manager provide this nurse?

A nurse admits to diverting narcotic drugs while working. The manager says, "All nurses who admit diverting narcotics have to be reported to the state board of nursing." How should the nurse interpret this statement?

A nurse who has been abusing narcotics is in the nurse executive's office discussing the charges. The nurse executive is trying to convince the nurse to seek treatment for the abuse. Which statement should the nurse executive make?

A nurse comes to a mandatory education session wearing a shirt with a picture and slogan that is degrading to nursing. What should the manager do first?

A nurse who is a chronic complainer comes back from lunch 20 minutes late. When confronted by the manager the nurse says, "The nurses who smoke always take longer lunches. No one says anything to them." What is the manager's major consideration before replying to this statement?

A nurse has been discovered using drugs on the unit. Investigation reveals the nurse has likely been diverting and abusing narcotics for some time. What is the likely the worst outcome for this nurse?