Chapter 10: Power, Politics, and Influence


Chapter 10: Power, Politics, and Influence
Yoder-Wise: Leading and Managing in Nursing, 6th Edition


1. A nurse manager is experiencing poor staff morale on her unit. While participating in a baccalaureate course, the nurse manager had learned that one of the reasons nurses lack power today is probably because of the past. In the early decades of the profession, nurses lacked power because:
a. Nurses freely chose to defer to physicians and administrators with more education.
b. Women lacked legal, social, and political power because of legal and cultural barriers.
c. The first nursing licensure laws prohibited nurses from making most decisions.
d. Nurses astutely recognized the risks of grabbing too much power too soon.
Nursing mirrored the lack of legal, social, and political power that was prevalent in the early decades of the profession.

REF: Page 169 TOP: AONE competency: Leadership

2. Nurses who engage in in-fighting, seek physician support against nursing colleagues, and avoid political advocacy through membership in nursing organizations:
a. Refuse to believe that they are acting like members of groups that suffer socioeconomic oppression.
b. Do not understand how their failure to exercise power can limit the power of the whole profession.
c. Purposefully choose to exercise their power in the workplace through indirect means.
d. Suffer from learned helplessness as a result of abuse by powerful nurse executives.
Becoming an active, productive, collegial member of groups and teams within the workplace and in professional associations and community groups ensures that the nursing voice is heard on healthcare issues and problems and is an appropriate exercise of power.

REF: Page 176 | Page 177 TOP: AONE competency: Professionalism

3. A nurse belongs to several professional organizations, serving on a state-level committee of one group and on two task forces at work. The nurse is committed to a range of health issues and knows the state senator from the nurse’s district, as well as the name of the representative in Washington, DC. This nurse exemplifies which level of political activism in nursing?
a. Gladiator
b. Buy-in
c. Self-interest
d. Political astuteness
Political involvement is a professional responsibility and nurses’ perspectives of the critical issues for improving the healthcare system can shape the policy agenda of the nation’s political leadership. This nurse exemplifies several of the skills associated with political astuteness.

REF: Page 179 TOP: AONE competency: Professionalism

4. A manager relies on his director (immediate supervisor) for advice about enrolling in graduate school to prepare for a career as a nurse executive. The director may exercise what kinds of power in the relationship with the manager in this advisory situation?
a. Expert, coercive, and referent
b. Reward, connection, and information
c. Referent, expert, and information
d. Reward, referent, and information
Because the director is in a leadership role, he comes with knowledge or expertise that is required to assume a leadership role, and he has information that he is willing to share, which gives him the power of information. The employee sees him as credible and seeks his advice, which gives him referent power.

REF: Page 170 | Page 171 TOP: AONE competency: Business Skills

5. A nurse manager must implement a 2% budget cut on the nursing unit. Which approach should the manager use to most effectively empower the staff of the unit?
a. Discuss the guidelines for the budget cuts with the staff, making the decisions with those who participate.
b. Inform the staff of the budget cuts in a series of small group meetings and accept their ideas in writing only.
c. Provide the staff with handouts about the budget cuts and let them make recommendations in writing.
d. Hold a series of mandatory meetings on the budget cuts, asking staff for ideas on the cuts.
Empowerment is the process of exercising one’s own power to facilitate the participation of others in decision making and taking action so they are free to exercise power It means releasing authority and enabling others to have accountability, for participation and decisions.

REF: Page 171 TOP: AONE competency: Communication and Relationship-Building

6. During orientation of new nurse managers, the chief nursing officer stresses strategies that help nurse managers to achieve a powerful image. Which groups of behaviors best contribute to a powerful image for the nurse manager?
a. Greeting patients, families, and colleagues with a handshake and a smile; listening carefully when problems arise
b. For men, no facial hair, always wearing a suit and tie; for women, always wearing a suit and high-heeled shoes
c. Maintaining a soft voice during times of conflict; making unbroken eye contact during interactions
d. Smiling all the time; always wearing a suit, carrying a briefcase, and, if a woman, wearing no jewelry
A powerful and positive approach is communicated through confident behaviors such as greeting others, smiling, and showing respect for the opinions of others through listening. Grooming and dress need to be clean, neat, and appropriate to the situation. Speech needs to be firm and confident.

REF: Page 172 | Page 173 TOP: AONE competency: Leadership

7. Two nurses approach their manager about a conflict regarding the next month’s schedule. The nurses are talking loudly and at the same time. The manager most effectively uses communication skills to resolve the conflict by:
a. Taking both nurses aside, separately and then together, and charging them with resolving the problem without her direct intervention.
b. Listening to each nurse speak to the other without interruption and asking clarifying questions to help them resolve the issue themselves.
c. Separating the nurses, instructing each to decide how the problem can be resolved, and meeting with them the next day.
d. Calling an emergency scheduling committee meeting and asking volunteers to resolve the conflict between the two nurses.
Negotiation involves the presentation of an opening position with each party, then moving on until they achieve a mutually agreeable result or until one or both move away from a failed negotiation. Negotiation occurs when one party has something that the other party values, such as a desired schedule.

REF: Page 178 TOP: AONE competency: Communication and Relationship-Building

8. A nurse manager recognizes the need to expand her professional network as she begins a job search for a middle-management position. Which of the following actions is least likely to expand her job-searching network?
a. Reviewing her address book or card file for names and phone numbers of former colleagues who are now in middle-management positions
b. Making an appointment to meet with a former instructor from her graduate program in nursing administration
c. Making a long overdue return call to a former colleague who is now a chief nurse executive
d. Attending a state-level conferences for nurse managers and executives and volunteering to help with professional organizations’ informal luncheons and receptions
Networking is the result of identifying, valuing, and maintaining relationships with a system of individuals who are sources of information, advice, and support. Many nurses have relatively limited networks within the organizations where they are employed. Active participation in nursing organizations is the most effective method of establishing a professional network outside one’s place of employment.

REF: Page 174 | Page 175 TOP: AONE competency: Professionalism

9. A staff nurse asks the nurse manager for a few days off for personal reasons. The nurse manager turns in the request to the human resources office with a note indicating that the staff nurse has demonstrated excellent working skills and is a valued employee. The nurse manager has used the influence of her position to help this staff member. Influence is the process of:
a. Using power.
b. Empowering others.
c. Understanding power.
d. Moving past apathy.
Influence involves the use of power to effect certain outcomes—in this situation, to arrange days off for a valued employee.

REF: Pages 168-169
TOP: AONE competency: Communication and Relationship-Building

10. A nurse is participating in a baccalaureate course. For the class, she has to attend the legislative session regarding the new role of medication assistants. Nurses should be involved in shaping public policy primarily because:
a. Involvement will enable nurses to take over the healthcare system at some point in the future.
b. Other healthcare professions are less concerned about the essential needs of clients.
c. Such activities are important career builders for nurses who seek top-level executive positions.
d. They are closest to the front line of health care and see how it affects clients and families.
Nurses can no longer be passive observers of the political world. Political involvement is a professional responsibility. Nurses’ perspectives of the critical issues for improving the healthcare system can shape the policy agenda of the nation’s political leadership.

REF: Page 179 TOP: AONE competency: Knowledge of the Health Care Environment

11. Sondra, a new graduate, recently began a position as a registered nurse in a rural hospital, where she is the youngest and newest staff member. Although she has limited experience, she has a strong knowledge base, is confident, and was considered to have strong entry-level skills on graduation. Sondra meets with her former instructor and confides that she is very frustrated that others do not seem to accept her leadership. What might you suggest that would help Sondra to understand what is happening in terms of power and influence?
a. As a new graduate, it is unlikely that she has acquired the experience and knowledge of other staff, including aides and practical nurses.
b. Rural settings tend to be closed systems and therefore are, not welcoming of those who are not from their community.
c. Morale on her unit can be improved by engaging in shared decision making.
d. Identify the informal leaders on her unit and how they affect care decisions.
Developing organizational savvy includes identifying the real decision makers and those persons who have a high level of influence with the decision makers. Recognize the informal leaders within any organization may have more power than the formal leader because of more knowledge of the organization, more informational power, or more expertise.

REF: Page 176 TOP: AONE competency: Knowledge of the Health Care Environment

12. Literature on oppression in nursing has:
a. Verified the presence of behaviors associated with oppression within nursing.
b. Suggested that oppression leads to bullying but has little or no effect on patient outcomes.
c. Failed to establish that oppression is present in nursing groups.
d. Indicated that nurses use oppression negatively.
Oppressed group behavior is apparent when a population is dominated by another group and begins to take on the characteristics of the dominant group (Roberts, 1993), often bullying and abusing their peers. In the twenty-first century, bullying and incivility have become epidemic in both nursing education and clinical settings.

REF: Page 169 TOP: AONE competency: Knowledge of the Health Care Environment

13. Politics is usually:
a. Confined to legislatures.
b. Seen in dysfunctional workplaces.
c. Found in all social organizations.
d. A representation of self-interest.
Politics involves social interaction among organizations and as such, politics permeates in all organizations, workplaces, legislatures, professions, and even families.

REF: Page 169 | Page 170
TOP: AONE competency: Knowledge of the Health Care Environment

14. Your colleague Mary, a recent graduate, announces one day that she intends to leave nursing in 3 to 4 months to pursue a position in marketing. While at your agency, she plans to give patients excellent care and to learn as much as she can, because “Who knows? Nursing is a great job with a great pay and I may return someday.” Mary’s statements most accurately exemplify which orientation to the concept of nursing? Nursing as a(n):
a. Profession.
b. Occupation.
c. Flexible discipline.
d. Career with off and on ramps.
Concern with nursing as potentially one in a series of possibly well-paid jobs reflects a view of nursing as an occupation.

REF: Page 174 TOP: AONE competency: Professionalism

15. Lucy, head nurse on the surgical unit, works with her staff to find ways in which they can work together with other disciplines to provide more effective care for patients on the unit. Lucy likely knows her power is:
a. Limited, thereby necessitating involvement of others in implementing ideas.
b. Restricted, which necessitates finding alternative means to achieve strong patient outcomes.
c. Directed primarily toward those who are subordinate to her.
d. Of unlimited capacity when shared with others.
Those like Lucy, who share power, tend to be the strong collaborators and see power as an unlimited quantity when shared. Empowered nurses make professional practice possible, creating a culture that satisfies all nurses.

REF: Page 172 TOP: AONE competency: Leadership

16. One day, at coffee, your co-worker suggests that you and she sit with unit members of the hospital research committee. She suggests that this would be an excellent way to get to know people who share her interest in research. Her actions are an example of:
a. Mentorship.
b. Politics.
c. Networking.
d. Empowerment.
Meeting individuals outside the normal workgroup to share ideas and gain support and encouragement is an example of networking.

REF: Page 174 | Page 175 TOP: AONE competency: Leadership

17. The workgroup on NU 23 is marked by apathy toward the ward’s patients, high absenteeism, open conflict among team members, and high turnover of personnel, including managers. The underlying behavior in this situation may be characterized as:
a. Powerlessness.
b. Anger.
c. Apathy.
d. Oppression.
Emotions such as anger and apathy result from a workplace in which powerlessness is exhibited.

REF: Page 169 | Page 171 | Page 172 TOP: AONE competency: Leadership

18. During a unit meeting, you notice that Vivian listens attentively when Mary is speaking and offers support and advice when Mary presents ideas to the group. You are surprised because Vivian has often confided that she does not like Mary. Vivian’s behavior is best described as:
a. Insincere.
b. Networking.
c. Politically sophisticated.
d. Collegial.
Collegial behavior requires respect, not friendship.

REF: Page 177 TOP: AONE competency: Communication and Relationship-Building

19. Which of the following interactions is MOST consistent with the idea of networking?
a. Meet with the same colleagues daily to have coffee and share concerns about the workplace and stories about colleagues.
b. Join an online workplace forum to gain ideas about how to handle workplace conflict.
c. Suggest that you and a new team member meet after work for coffee to review unit guidelines.
d. Join a nurse executive interest group to meet other executives for support and for sharing ideas of expertise.
Networking is the result of identifying, valuing, and maintaining relationships with a system of individuals who are sources of information, advice, and support. Many nurses have relatively limited networks within the organizations where they are employed. Active participation in nursing organizations is the most effective method of establishing a professional network outside one’s place of employment. Successful networking involves sharing similar ideas and maintaining relationships within a system of individuals who serve as sources of information, advice, and support.

REF: Page 174 | Page 175
TOP: AONE competency: Communication and Relationship-Building

20. The institution where you are a nurse manager has resisted the adoption of a new document management software, citing cost as a concern. You meet with other nurse managers who are in favor of the software and prepare a proposal to take to the senior executive with the goal of persuading the executive to adopt the software. This is an example of:
a. Collaboration.
b. A coalition.
c. Networking.
d. Policy building.
The formation of temporary groups to achieve particular goals involves the development of coalitions.

REF: Page 178 TOP: AONE competency: Leadership

21. Which of the following is the best example of skilled negotiation?
a. Linda, the manager on pediatrics, takes a proposal to her supervisor, outlining the benefits of a walk-in preoperative area for children.
b. Kim, RN, asks for leave to pursue a semester of full-time study in her graduate program. She proposes to accept less popular rotations during peak vacation time, in return.
c. George, the head nurse in ER, asks for additional staff for his department and points out the benefits of being able to keep patients for longer periods.
d. Jerry speaks with his supervisor about his supervisor’s concerns related to bedside reporting before presenting a proposal to change this process.
Successful negotiators are well informed about not only their own positions but also those of the opposing side. Negotiators must be able to discuss the pros and cons of both positions. They can assist the other party in recognizing the costs versus the benefits of each position.

REF: Page 178 TOP: AONE competency: Leadership

22. Amy has worked in the dialysis unit on staff for about 12 years. She is frequently consulted by other nursing staff regarding protocols and policies on the unit. What type of power is Amy using?
a. Position power
b. Expert power
c. Personal power
d. Competency power
According to the types of power outlined in the text, Amy is most likely evidencing expert power in that she is being consulted regarding areas of knowledge and competency on the unit and is at the same level, potentially, in the hierarchy as her colleagues.

REF: Page 170 | Page 171 TOP: AONE competency: Leadership

23. Despite repeated invitations by his colleagues to become involved in regional and state nursing practice committees, Tom refuses. His reason is that “nursing committees rarely get anything worthwhile done because of politics and conflicts.” According to the text, Tom’s view of involvement:
a. Is rare in nursing today.
b. Reflects a fear of power.
c. Reflects the essential process of power.
d. Reflects empowerment and capacity to make his own decisions.
Tom’s response reflects a distancing from other nurses related to discomfort with conflict associated with human interactions. The text defines human interactions within organizations as politics, a component of which is the essential process of power.

REF: Page 169 | Page 170 TOP: AONE competency: Professionalism

24. A unit manager watches a new RN graduate interacting with a patient. When the RN comes out of the room, the unit manager says, “I don’t know what they taught you in your nursing program, but if I see you do that again, I will write you up.” This example demonstrates:
a. Coercive use of power.
b. Appropriate application of control.
c. Use of informatory power.
d. Use of power to provide coaching.
Influence is the process of using power. Influence can involve the punitive power of coercion, as is used in this example.

REF: Page 171 TOP: AONE competency: Communication and Relationship-Building

25. Susan, an RN in the ED, would like to pursue leadership roles in her career. She is frustrated that others in her working environment seem to pay little attention to her creative ideas or place her in informal leadership positions. As her colleague, you want to provide her with helpful feedback. Which of the following statements will provide feedback as to how she might communicate power and demonstrate that she is capable of handling other leadership responsibilities?
a. “I find your soft voice and manners very reassuring and calming to patients.”
b. “Try using a wider vocabulary and big words so that people will think that you are knowledgeable.”
c. “At times, you tend to slump and avoid eye contact when you are talking with colleagues and families.”
d. “Don’t worry about what others think of you. If you feel like saying something, say it, even if it hurts other people’s feelings.”
A powerful image comes from thinking of oneself as powerful and effective, and this is communicated through posture, maintaining eye contact, treating others with courtesy and respect, and using a firm, confident voice with vocabulary that is appropriate (which does not necessarily involve using big-sounding words).

REF: Page 173 TOP: AONE competency: Leadership


1. As a new manager in the ED, you meet with each of the staff to ask about their priorities and what they think is going well in the department or what is of concern to them. Almost all of the staff express frustration and distress at being treated rudely or disrespectfully by patients, staff from other departments, and physicians and complain that they feel that nurses in the ED are not valued. With the staff, you brainstorm to raise the profile of nurses. Which of the following strategies would be most effective? (Select all that apply.)
a. Requesting increased compensation
b. Speaking positively about one’s work
c. Dressing and grooming in a clean and neat manner
d. Using titles (e.g., Mr., Mrs., Ms.) and last names
e. Submitting a written complaint to senior administration regarding rude behaviors
f. Developing a code of conduct for the ED staff.
ANS: B, C, D, F
Demonstrating a positive and professional attitude about being a nurse to nursing colleagues, patients and their families, other colleagues in the workplace, and the public facilitates the exercise of power among colleagues while educating others about nurses and nursing. A powerful image is an important aspect of demonstrating this positive professional attitude and includes how we identify ourselves, how we dress, whether we are punctual for commitments, and whether we speak positively about our work. Bullying and incivility are negative expressions of power that can affect patient outcomes. The Joint Commission standard demands that leaders ensure that a code of conduct is implemented to ensure patient safety and a culture of quality.

REF: Page 169 | Page 177
TOP: AONE competency: Communication and Relationship-Building