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Programming that stresses discipline-based research: While discipline-specific research contributes to knowledge, it does not directly address quality and safety concerns in everyday practice. Research alone does not equip students with the teamwork and systems-based skills.

A strong professional identity is valuable for role clarity, but focusing only on discipline-specific training may limit interprofessional collaboration. Addressing safety requires breaking down silos and working across professions rather than reinforcing separation.

Developing reporting tools can improve error tracking, but software alone cannot create the cultural and educational changes needed for sustained improvements in safety and quality. Broader collaboration and team-based approaches are more effective.

Consumer expectations: Consumer or patient expectations are considered an external variable because they originate outside the organization and influence how care services are delivered. While important, they are not controlled directly within the staffing structure of the facility.

State licensing standards: Licensing regulations set by state boards of nursing are external requirements that health care organizations must follow. These standards provide minimum legal guidelines but are not internal organizational variables.

American Nurses Association: The ANA provides professional standards and guidelines that influence practice, but these are external to the individual health care organization. They serve as a framework rather than an internal factor that determines daily staffing.

Determine what takes up so much of her time and energy: Assessing time drains is helpful, but it is not the very first step. Without first clarifying goals, the nurse manager cannot distinguish between high-priority and low-priority activities when evaluating time use.

Organize her personal and work spaces: Organizing the environment can improve efficiency, but it should follow after identifying goals. Without goal direction, organization efforts may not target the areas that most affect time management.

Purchase a handheld personal digital assistant to help remind her of important meetings: Technology tools can support time management, but they are aids rather than the starting point. Using such tools without defined goals and priorities may simply reinforce poor time-use habits.

Paid hours minus worked hours: While this equation could describe non-productive time in general, it does not specify the types of paid non-productive hours a manager must consider. Staffing schedules require a more concrete breakdown of specific categories of leave.

Work time, educational time, and holiday time: Work time is considered productive, not non-productive. Educational time may sometimes be counted as productive depending on organizational policies, but vacation and sick leave are the standard inclusions under non-productive time.

Paid hours minus meeting time: Meetings are generally considered part of productive or required work duties, not non-productive time. Therefore, subtracting meeting time does not accurately capture the paid non-productive hours a nurse manager needs to calculate.

An ability to resolve complaints: Both collective bargaining and trade union models include mechanisms to address staff complaints. This is not the defining feature of the traditional trade union model, as grievance resolution is expected in either approach.

Spirit of trust between management and labor: A spirit of trust is more closely associated with collaborative or interest-based bargaining models. Traditional trade union approaches typically involve more adversarial relationships rather than mutual trust.

Management support of labor's initiatives: In a traditional trade union model, management and labor are often in opposition, and management does not generally endorse labor’s initiatives outright. Support of labor’s goals is more characteristic of cooperative or partnership models.

Ask the nurse if she is okay during report: Asking during report does not allow for privacy or adequate discussion. Sensitive issues should be addressed in a confidential setting where the nurse feels comfortable sharing concerns.

Refer the nurse to the employee assistance program: Referring immediately without first having a private discussion may appear abrupt and unsupportive. The nurse manager should first assess the situation through direct conversation before recommending further resources.

Write a note to the nurse advising her that her work attendance must improve: Written communication about attendance is formal and corrective in tone. This should not be the first approach when early signs of withdrawal and absenteeism appear, as it may discourage open communication.

Do not make assumptions: One of Don Miguel Ruiz’s Four Agreements emphasizes avoiding assumptions because they often lead to misunderstandings and conflict. By seeking clarity instead of assuming, individuals can improve relationships and self-awareness.

Be impeccable with your word: This agreement highlights the power of language and encourages using words truthfully and constructively. It fosters integrity and accountability, supporting both personal growth and trust with others.

Always do your best: Doing one’s best at any given moment, within current abilities and circumstances, promotes self-acceptance and reduces regret. This principle encourages continuous effort without self-criticism, making it a core agreement.

Provide education to the staff of the unit: Education is an important managerial responsibility that supports staff development and competency. However, it is a secondary role compared to ensuring that the overall quality of patient care remains the central focus.

Assess staff for contentment on unit: Staff satisfaction can influence retention and morale, but it is not the primary goal when evaluating care delivery. Contentment should be balanced with the overarching responsibility to ensure patient safety and high-quality outcomes.

Focus on cost outcomes: While cost management is important in health care administration, financial outcomes should not take precedence over patient care quality. Prioritizing cost over quality can compromise safety and effectiveness of care on the unit.

Director leadership: This term refers to a role level, such as a director of nursing, but it is not the correct description of the type of leadership being described. The question focuses on how the leadership authority is established, not the job title itself.

Personal leadership: Personal leadership refers to an individual’s ability to influence and guide themselves or others through personal qualities and behaviors. It is not dependent on an official position and therefore does not apply to an appointed CNO.

Informal leadership: Informal leaders gain influence through respect, expertise, or personality rather than an assigned role. The CNO’s appointment makes the position official, so this cannot be considered informal leadership.

Less stressed: Shared governance does not directly reduce stress levels. Stress is influenced by workload, staffing, and individual coping, and while involvement in decisions may improve satisfaction, it is not primarily associated with decreased stress.

More communicative: Although shared governance encourages open dialogue among staff and leadership, communication alone is not the defining outcome. It is a means to achieve greater engagement rather than the central feeling staff experience.

More powerless and devalued: In traditional hierarchical models, staff may feel powerless or undervalued due to limited input in decisions. Shared governance is designed to address this problem by giving nurses a greater voice in practice-related decisions.