Chapter 28: Self-Management: Stress and Time


Chapter 28: Self-Management: Stress and Time
Yoder-Wise: Leading and Managing in Nursing, 6th Edition


1. As a nurse manager, you observe a staff nurse who over the past few weeks has become withdrawn and has had several absences due to minor ailments. Your best action would be to:
a. Ask the nurse if she is okay during report.
b. Refer the nurse to the employee assistance program.
c. Ask the nurse to meet with you for a few minutes before she leaves for the day.
d. Write a note to the nurse advising her that her work attendance must improve.
Stress can lead to emotional symptoms such as depression and a variety of ailments. Meeting with the nurse privately may assist in identifying stress and possible solutions.

REF: Page 526 | Page 527 TOP: AONE competency: Business Skills

2. The nurse manager of a unit has lost many staff members, and the unit is now staffed with a large number of agency and traveling nurses. She knows that the agency and traveling nurses are all contracted to stay on the unit for the next 3 months. One way to improve morale and decrease stress in the unit would be to:
a. Plan a social event and include the agency and traveling nurse staff members.
b. Plan unit-based social events for your remaining permanent staff members.
c. Request hospital-based “floating” nurses to substitute for the temporary staff.
d. Implement team nursing.
Social support, in the form of positive work relationships, can be an important way to buffer the effects of a stressful work environment. Including all staff in the social event enables those who are not normally part of the team to experience this support and provides an opportunity for the staff as a whole to develop supportive relationships.

REF: Page 528 TOP: AONE competency: Communication and Relationship-Building

3. As a nurse manager, the one activity you should not overlook is:
a. Posting the yearly rotation schedule.
b. Reviewing vacation requests.
c. Scheduling staffing for holidays 6 months in advance.
d. Anticipating staff sick days.
Free time and vacation time are needed for individuals to recharge. If time for work is more than 60% of wake time, or when self-time is less than 10% of wake time, stress levels increase.

REF: Page 527 TOP: AONE competency: Business Skills

4. A nurse manager has decided that she must institute some personal time management steps to survive work and home life. Her first step should be to:
a. Determine what takes up so much of her time and energy.
b. Organize her personal and work spaces.
c. Purchase a handheld personal digital assistant to help remind her of important meetings.
d. Determine her personal and professional goals.
Personal time management refers, in part, to “the knowing of self.” Self-awareness is a critical leadership skill, and being self-aware and setting goals helps managers determine how their time is best spent.

REF: Page 533 TOP: AONE competency: Leadership

5. A hospice nurse has been feeling very stressed at work because of both the physical strain and the emotional drain of working with clients with AIDS. She tries to walk 1 to 2 miles three times a week and to talk regularly with her husband about her work-related feelings. One reasonable stress management strategy would be to:
a. Start taking yoga lessons.
b. Make an appointment to meet with a psychiatrist.
c. Start jogging 5 to 6 miles every day.
d. Plan to go out for a drink with fellow nurses after work every day.
Stress relief techniques include 30 minutes of exercise five times a week, as well as techniques such as yoga that relieve mental stress.

REF: Page 530 TOP: AONE competency: Leadership

6. The nurse manager is implementing a shared governance model to help with communication and decision making. Although staff members like the concept, change is difficult. Staff nurses feel:
a. More empowered.
b. More communicative.
c. Less stressed.
d. More powerless and devalued.
Change can lead to feelings of being overwhelmed and powerless, especially if complexity compression or rapid, intense changes have been involved.

REF: Page 521 | Page 526 TOP: AONE competency: Business Skills

7. The chief nursing officer listens to nurse managers verbalize their feelings of internal stress. One common source of internal stress seems to be:
a. The death of a loved one.
b. Perfectionism.
c. Getting married.
d. Losing a job.
Losing a job, the death of a loved one, and getting married are examples of external stress.

REF: Page 523 | Page 524 TOP: AONE competency: Business Skills

8. The staff development educator presents a series of programs on stress management to the nurse managers. Research has indicated that an individual’s ability to deal with stress is moderated by psychological hardiness. Psychological hardiness is a composite of:
a. Commitment, control, and challenge.
b. Commitment, powerlessness, and passivity.
c. Commitment, control, and passivity.
d. Decreased isolation, challenge, and passivity.
Some people have the capacity to accept changes in life with good humor and resilience, which, in turn, influences behavior that prevents illness. Hardiness involves the capacity to manage time and stress, to reframe situations positively, and to commit.

REF: Page 523 | Page 524 TOP: AONE competency: Leadership

9. The chief nursing officer understands that a nurse manager can exhibit stress that is related to trying to keep up with the number of electronic messages that arrive, as well as trying to remain accessible to staff. What is a strategy that would assist the manager to manage the information overload effectively?
a. Ignore messages unless they are labeled as important.
b. Determine who is most likely to send useful or important information or requests.
c. Check e-mail messages once a day.
d. Encourage face-to-face meetings rather than e-mail.
Reduction of stress related to information overload requires the development of information-receiving and information-sending skills. Information-sending skills include determining most common sources of useful data, labeling files and folders to which e-mail messages can be directed, deletion of e-mails, and focusing on the most important pieces. Information-sending skills include keeping e-mail messages short (and calling if the message needs to be long) and considering the most appropriate medium for messages (telephone, fax, face-to-face).

REF: Page 537 | Page 538 TOP: AONE competency: Professionalism

10. In helping nurse managers to manage their time, the chief nursing officer suggests that they:
a. Maintain a perfectionistic attitude.
b. Set up a complaint list.
c. Have good negotiation skills.
d. Have good information literacy skills.
Time can be saved by using information technology effectively, as it assists with effective data retrieval and information gathering and with communication related to a variety of needs in the management setting.

REF: Page 535 TOP: AONE competency: Business Skills

11. Which of the following statements would best define stress? Stress is:
a. The comfortable gap between how we like our life to be and how it actually is.
b. Everyday life, both the highs and the lows.
c. A consequence or response to an event or stimulus that can be positive or negative.
d. Identical to distress.
Stress is defined as a gap between how we would like our lives to be and how they actually are and as a consequence or response to an event or stimulus. It is not inherently bad (distress), and whether highs and lows are seen as distress or eustress is dependent on each individual’s interpretation of the event.

REF: Page 520 TOP: AONE competency: Business Skills

12. In a job interview for a nursing position, Marley can be assured that which of the following will occur?
a. Both eustress and distress
b. Only eustress
c. Only distress
d. Neither eustress nor distress
Eustress is defined as stress that is pleasant in nature, and distress is defined as stress of an unpleasant nature. One can assume that every interview has both of these stresses.

REF: Page 520 TOP: AONE competency: Business Skills

13. Which one of the following statements has been proven to be true?
a. Recent research has found that women do not have a unique physiologic response to stress.
b. Both men and women interpret the same stressor in the same manner without regard to past experiences.
c. Stress influences the immune system in one complex manner.
d. Stressors that are identical do not necessarily have similar effects on each individual.
Stressors may be unique to certain environments, situations, and persons or groups, and individuals may respond to the same stressor in different ways.

REF: Page 524 TOP: AONE competency: Business Skills

14. An example of role stress occurs when:
a. The director of the ICU and the manager of the surgical unit wish to hire the same new employee.
b. Two part-time staff members are hired to work in a unit, but the job expectations for them are not clear, and the head nurse expresses disappointment in their performance.
c. The nurse manager for the ICU wants to advocate for more staff and finds it difficult to find data to substantiate his proposal.
d. Line managers believe that support staff use their technical knowledge to intrude on their authority.
Role stress is an additional stressor for nurses. Viewed as the incongruence between perceived role expectations and achievement, role stress is particularly acute for new graduates. Failure to comply with expectations can lead to role conflict. Role conflict and role ambiguity are major sources of conflict for nurses.

REF: Page 522 TOP: AONE competency: Business Skills

15. A staff nurse approaches the unit manager and indicates to her that because of her father’s death in the previous month, she is now finding it very difficult to do her work effectively. This would be considered a(n) ________ stress.
a. Internal source
b. Familial
c. Burnout
d. External
External stress is outside and removed from the work setting, but it is considered work-related stress because of the impact it has on the worker.

REF: Page 521 TOP: AONE competency: Business Skills

16. Sources of occupational stress in nursing include all except which of the following?
a. Authoritarian leadership
b. Concern about moral wrongdoing by colleagues
c. Multiple changes in a short time
d. Rotating shifts
Ethical distress, complexity compression, rotating shifts, high acuity levels, rotating shifts, and workload are all sources of work-related stress for nurses.

REF: Page 520 TOP: AONE competency: Business Skills

17. Mr. T. Jones and Mr. R. Smith are both going to become residents in Sunny Haven Lodge. Mr. Jones views it as an opportunity to socialize and meet new friends. Mr. Smith views this as abandonment by his family and is worried that the care will be inadequate. Each senior perceives the situation differently. This is a good example of stress that is:
a. Both a positive stressor and a negative stressor.
b. Occurring only because of age.
c. Positive in both cases.
d. Harmful in both cases.
Some researchers have determined that stress is a person-environment process in which the person appraises the situation as taxing or not. Appraisal is an important concept that explains why two people react in different ways to the same situation. Stress can be viewed as positive (eustress) or negative (distress).

REF: Page 520 | Page 524 TOP: AONE competency: Business Skills

18. Jeff, an RN in his 30s, has lost a parent, just purchased a new home, and is laid off with 6 months’ severance pay. At the same time, Jerry, an RN in his 50s, is financially secure and is asked to take early retirement with a buyout. How will the two men react to the emotional and physical influences and the sequence of stress?
a. The younger man will feel more stress.
b. The two men may or may not feel the same amount of stress.
c. The older man will feel more stress.
d. Neither man will experience any stress.
The response to similar stressors does not always result in a similar experience of stress in individuals. Responses are mediated by the appraisal of the event as well as by factors such as gender, personality, lifestyle, and age.

REF: Page 524 | Page 525 TOP: AONE competency: Business Skills

19. Social stressors are considered a major factor in the stress nurses experience in the healthcare system. Which of the following is not considered to be a social stressor?
a. High amounts of stress in the nursing home environment
b. Changes in the current healthcare system such as nursing strategies
c. Disruptive behavior coming from physicians and other healthcare workers
d. Stress triggers such as self-criticism and overanalyzing
Personal stress triggers such as self-criticism are considered intrapersonal stressors; environmental factors such as change, work environment, and interactions with others are considered social stressors.

REF: Page 521 TOP: AONE competency: Business Skills

20. After several months of heavy patient loads in the Emergency Department and inability to secure sufficient and experienced staff, the department is especially taxed by a train accident that brings in many seriously injured individuals. You observe that Rama ignores the requests of several of the injured, even when time is available to care for them and is rude to two elderly patients. You are concerned that Rama is evidencing which state?
a. Hardiness
b. Depression
c. Role ambiguity
d. Depersonalization
A characteristic of burnout is depersonalization, a state characterized by distancing oneself from the work itself and developing negative attitudes toward work in general (Greenglass et al., 2001). Depersonalization is commonly described as a feeling of being outside one’s body, feeling as if one is a machine or robot, an “unreal” feeling that one is in a dream or that one “is on automatic pilot.” Generally, subjective symptoms of unreality make the nurse uneasy and anxious. Nurses pushed to do too much in too little time may distance themselves from patients as a means of dealing with emotional exhaustion.

REF: Page 529 TOP: AONE competency: Business Skills

21. “Stress-buffering” behaviors can be elicited to reduce stress. All of the following behavioral coping responses can be used by nurse managers to reduce and manage stress except:
a. Distancing oneself from work.
b. Using cognitive reframing to change irrational thoughts.
c. Refusing a request to sit on a committee to evaluate scheduling software.
d. Exercising regularly.
Achieving balance between work and leisure is a useful strategy for stress reduction. Distancing, however, can be a sign of depersonalization that includes negative attitudes as well and is a characteristic of burnout.

REF: Pages 526-529 TOP: AONE competency: Business Skills

22. The education consultant at St. Joseph’s Hospital is giving a workshop on cognitive reframing. The consultant explains that cognitive reframing reduces stress by:
a. Aiding individuals in identifying positive stressors.
b. Helping people realize that negative thinking causes emotional distress.
c. Eliminating negative stressors.
d. Replacing positive self-statements with negative irrational beliefs.
Cognitive reframing is a therapy that aids individuals in discovering that their irrational thoughts can be replaced with responses that are more rational. It enables individuals to gain a sense of control over the situation and can change “I’ll never …” to “I can …” or “She always …” to “Sometimes she … .” It is an approach that allows individuals to replace negative thoughts and statements with others that are more realistic and helpful.

REF: Page 526 | Page 527 TOP: AONE competency: Business Skills

23. Time management is very essential for the nurse manager. Which of the following is not a good time-management technique?
a. Decide what not to do.
b. Learn to say “No.”
c. Learn to delegate.
d. Break down your workload into large manageable tasks.
To manage time successfully, it is important to break down your workload into smaller, manageable tasks. Developing PERT and Gantt charts will aid in dealing with larger, complex projects. Both charts can be used to outline how an individual will approach a large project.

REF: Page 533 | Page 534 TOP: AONE competency: Leadership

24. As a unit manager, you chair the unit meetings. For each meeting, you consider and establish the purpose of the meeting. Second, you prepare an agenda. Arrange the following steps in an order that would make the meetings productive and successful.
1. Distribute an agenda.
2. Distribute minutes.
3. Select team members.
4. Start on time.
5. Keep the meeting focused and directed toward accomplishing the set objectives.
Select the correct order from the following options:
a. 1, 2, 4, 5, 3
b. 4, 1, 2, 5, 3
c. 3, 1, 4, 5, 2
d. 3, 4, 2, 1, 5
Planning, organizing, and keeping the group on task are critical in ensuring that meetings are productive and that time is managed well.

REF: Page 541 TOP: AONE competency: Leadership


1. High levels of work-related stress affect all but which of the following? (Select all that apply.)
a. Job satisfaction
b. Absenteeism and turnover
c. Nurses’ health
d. Client welfare
ANS: A, B, C, D
Many writers and researchers have found that these work-related areas are adversely affected by stress.

REF: Page 519 | Page 525 TOP: AONE competency: Business Skills