Chapter 26 Role Transition

1. The unit leader on an inpatient psychiatric unit of a large hospital has been in the
position for 3 months. The unit leader is frustrated by how little time is available to work
with clients and how few changes have been implemented in that time. The phase of role
transition being experienced is the role of:
a. acceptance.
b. negotiation.
c. discrepancy.
d. internalization.
Role discrepancy is an experience that includes a gap between what is expected and
what is occurring and can lead to disillusionment, discomfort, and frustration. If the
unit manager values the relationship and sees the differences between performance and
expectations as correctable, then the manager is likely to stay in the role.

2. An interviewee for a nurse manager position asks for a copy of the organizational
chart. Organizational charts provide information about the role component of:
a. expectations.
b. opportunities.
c. responsibilities.
d. lines of communication.
No matter what role an individual is in, multiple relationships exist with individuals
including supervisors and peers. Roles incorporate patterns of structured interactions
between the manager and people in these groups. Organizational charts provide
information about relationships and lines of communication in the organization.

3. During an employment interview for the manager’s position in a home health agency,
the applicant asks questions about the medical director and about retention of staff. The
nurse executive assures the applicant that the agency has few personnel problems and
receives excellent support from the medical director. The applicant knows that the
agency has a 50% turnover rate and has had three medical directors in the past year.
The nurse executive is:
a. unaware of the turnover rate and difficulties with the medical director.
b. lying about the problems and hoping to resolve them by hiring the applicant.
c. denying that the agency has a turnover problem with staff or medical directors.
d. minimizing the challenges of the position to make a positive impression
on the applicant.
During the dating phase or preview period in the role transition process, the potential
employer attempts to make a favorable impression, which may result in minimizing the
challenges of the position.

4. The new head nurse on telemetry has been in the position for 3 months. The head
nurse and the administrator disagree on how much time the head nurse should allot to
various aspects of the role. Staff members on the unit complain that the head nurse is
unavailable for clinical concerns because of being off the unit while attending meetings.
To facilitate the process of role transition, the head nurse should:
a. develop policies consistent with the head nurse’s prior workplace.
b. attend a workshop on how to deal with difficult people.
c. decide to give the position 3 more months and then leave if things do not improve.
d. schedule a series of meetings with staff and the administrator to clarify
expectations.
During role transition, it is important for the manager to negotiate the role by writing
down the manager’s expectations of the role and determining the expectations of others
(staff, supervisors) in order to clarify expectations and reduce or ameliorate role
ambiguity and role strain. It can take up to a year to understand the role, system, and
boundaries in a new job-role-position.

5. A nurse manager in one hospital values a colleague who is a few years older and has
more experience in nursing management. The colleague works in another hospital, but
they meet for lunch once a month. In these meetings, they share their feelings about
nursing management and their lives. The function of a mentor that is missing in the
relationship is:
a. sponsorship.
b. role modeling.
c. social interaction.
d. mutual positive regard.
Sponsorship involves building the competency of the mentee through exposure or by
creating opportunities for achievement in order for the mentee to develop a reputation
of competence.

6. The new nurse manager feels pulled between the expectations of staff, the demands of
hospital administrators, and family obligations. According to the theory by Hardy
(1978), unrelieved role stress and strain will lead to:
a. frustration and anger.
b. alienation of family and friends.
c. low productivity and performance.
d. physical symptoms and acute illness.
Unrelieved role stress and strain leads to focusing energy into negative thoughts and
feelings, which can leave the manager fatigued and therefore less likely to be productive
or to perform well.

7. The nurse manager of a unit was demoted to staff nurse 6 months ago. Because of
being near retirement, the former nurse manager wanted to be employed at the hospital
and was offered a position on the same unit. The former nurse manager complains often
about how infrequently the current nurse manager is available on the unit and argues
with physicians and co-workers. Clients have complained about the attitude of the
nurse. The behavior of the former nurse manager can be best explained as being caused
by:
a. overwork in the staff nurse position.
b. inadequate mentoring in the new role.
c. anger as a stage of the grieving process.
d. demotion as a threat to personal identity.
When an employment relationship ends or changes unexpectedly, grieving occurs. One
of the phases in grieving is anger.
8. A nurse is interviewing for a manager’s position. Which of the following actions is
considered a role preview?
a. Formal commitment of the employment contract
b. Improving role performance
c. Touring the unit
d. Disillusionment about the expectations of the job
Touring the unit enables the candidate to assess further whether this organization will
assist in growth and also to make a positive impression on the potential employer.

9. The chief nursing officer develops a mentoring program to help new staff members
adjust to their new jobs. The main purpose of mentoring is:
a. promoting staff retention.
b. promoting staff attrition.
c. developing new role expectations.
d. promoting staff supervision.
Mentoring has been identified as important to staff retention.

10. A nurse manager notices that Nathan, an RN who has been on the unit for
approximately 3 years, has an interest in health technology and seems to be very
enthused about working with software and hardware at home. She speaks with Nathan
and asks him if he would lead investigation of software applications on the unit. This is
an example of:
a. opportunity.
b. delegation.
c. role negotiation.
d. role transition.
Nathan’s nurse manager recognizes Nathan’s interest in technology as an opportunity
for the unit and as an untapped resource that can be used to meet unit goals.

11. Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She
has taken some certificate courses in leadership and management and has considered
beginning a graduate degree with this focus. She is excited about being able to use her
knowledge and interest by being hired as a nurse manager. Before beginning her new
position, Sarah spends time with her nurse executive to clarify the executive’s
expectations of her and of the unit that she has been hired to manage. Sarah’s actions
are important in avoiding role:
a. ambiguity.
b. transition.
c. development.
d. negotiation.
Clarification of implicit and explicit expectations regarding the role assists in avoiding
role ambiguity and role strain.

12. Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She
has taken some certificate courses in leadership and management and has considered
beginning a graduate degree with this focus. She is excited about being able to use her
knowledge and interest by being hired as a nurse manager. Before beginning her new
position, Sarah spends time with her nurse executive to clarify the executive’s
expectations of her and of the unit that she has been hired to manage. After beginning
her new position, Sarah finds that she spends a great deal of time in direct patient care.
Her staff begins to complain that they are never able to find her when they need her, and
that some aspects of her responsibilities fall behind, such as scheduling. Sarah is most
likely:
a. lacking an understanding of the nurse management role.
b. attempting to prove her clinical skills to the nursing staff.
c. experiencing difficulty in unlearning old roles.
d. lacking enjoyment in her new role.
Role transition involves transforming one’s identity. Although any of the answers listed
might be correct, as a new manager, her confidence in her clinical skills suggests that
she is having difficulty in the transformation process and in unlearning her role as a
clinician.

13. Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She
has taken some certificate courses in leadership and management and has considered
beginning a graduate degree with this focus. She is excited about being able to use her
knowledge and interest by being hired as a nurse manager. Before beginning her new
position, Sarah spends time with her nurse executive to clarify the executive’s
expectations of her and of the unit that she has been hired to manage. A strategy that
may help to make the transition to her management role and to respond to relationships
and situations in her new position is:
a. avoiding discussion of her personal beliefs with staff until she is ready to do so.
b. finding a network of clinicians with interests similar to her own.
c. researching clinical literature to maintain her clinical assessment skills for the unit.
d. recognizing her strong commitment to care in the management process
through journaling.
During the transition period, it is important to recognize, use, and strengthen values
and beliefs, translate these for staff, and adapt behaviors to the situation. Understanding
personal and professional beliefs and values assists in helping the manager respond to
situations and relationships.

14. Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She
has taken some certificate courses in leadership and management and has considered
beginning a graduate degree with this focus. She is excited about being able to use her
knowledge and interest by being hired as a nurse manager. Before beginning her new
position, Sarah spends time with her nurse executive to clarify the executive’s
expectations of her and of the unit that she has been hired to manage. Sarah finds that
she has begun to think negatively about the way nursing care is delivered on her nursing
unit. She often wishes that she was back on her old unit and in her familiar staff nurse
role. This behavior:
a. is natural when assuming a new position.
b. diverts energy from internalization of Sarah’s new role.
c. is justified if practices are deficient on the new unit.
d. reflects Sarah’s astuteness as a clinician.
By focusing on the weaknesses of the unit, Sarah may lack the energy to internalize the
new role—a step that is critical to being an effective leader. As a new manager, Sarah
must learn how to access resources in the organization. Approaching the organization as
a foreign culture, Sarah can keenly observe the rituals, accepted practices, and patterns
of communication within the organization. This ongoing assessment promotes a
speedier transition into the role of manager.

15. Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She
has taken some certificate courses in leadership and management and has considered
beginning a graduate degree with this focus. She is excited about being able to use her
knowledge and interest by being hired as a nurse manager. Before beginning her new
position, Sarah spends time with her nurse executive to clarify the executive’s
expectations of her and of the unit that she has been hired to manage. Sarah finds a
mentor, Amy, who has been in the role of unit manager for 3 years and has a similar
interest in clinical excellence. During their frequent meetings, Amy provides assistance
with learning aspects of the manager’s role, including technical aspects, such as how to
interpret budget printouts and to achieve budget outcomes. The success of Amy’s
coaching depends on:
a. clarity of Amy’s information.
b. organizational support for the mentor relationship.
c. the congruence of Amy’s beliefs with Sarah’s beliefs.
d. willingness of Sarah to receive feedback.
Coaching provides information about how to improve performance and learning aspects
of the
role. Coaching requires willingness on the part of the mentee to accept feedback.

16. In addition to providing coaching, a nurse mentor may provide counseling to the
mentee. For counseling to be successful, the mentor must:
a. provide a quiet environment away from the unit.
b. keep the focus on technical and management responsibilities.
c. assure confidentiality.
d. present assignments that stretch the intellectual and technical ability of the mentee.
Counseling provides opportunity for the mentee to share personal concerns. For
counseling to be successful, confidentiality must be assured.

17. Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She
has taken some certificate courses in leadership and management and has considered
beginning a graduate degree with this focus. She is excited about being able to use her
knowledge and interest by being hired as a nurse manager. Before beginning her new
position, Sarah spends time with her nurse executive to clarify the executive’s
expectations of her and of the unit that she has been hired to manage. After a year,
Sarah successfully transitions into the nurse manager role and considers taking the
examination to become a certified nurse executive. Amy advises her that this is not
possible because Sarah will need:
a. a graduate degree.
b. at least a nursing diploma.
c. 24 months of experience.
d. 5 years of successful experience.
Nurses with baccalaureate preparation and holding a nurse executive position with at
least 24 months of experience can take the examination to become a certified nurse
executive.

18. Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She
has taken some certificate courses in leadership and management and has considered
beginning a graduate degree with this focus. She is excited about being able to use her
knowledge and interest by being hired as a nurse manager. Before beginning her new
position, Sarah spends time with her nurse executive to clarify the executive’s
expectations of her and of the unit that she has been hired to manage. Sarah finds that
she is comfortable with the expectations of staff and her supervisor regarding her
management role and responsibilities and has been able to effect a strong commitment
to quality clinical care on the unit. At this point, Sarah has
likely attained this role:
a. development.
b. acceptance.
c. symmetry.
d. internalization.
Role internalization is achieved when the manager experiences performance of the role
as being congruent with his or her own beliefs. Role acceptance refers to accepting the
contract and making a public announcement of the acceptance.

19. As a new manager, you reflect on what professional development would be most
valuable to assist you in taking on this role. Which of the following would you most
likely identify?
a. Opportunities to hone clinical skills that are used most often on the unit that you will
manage
b. A workshop on conflict management and communication skills
c. Attendance at a conference on global healthcare economics
d. Attendance at a workshop on survey tool development and statistical measurement
In a qualitative descriptive study that explored the professional development needs of
nursing leaders, a number of recommendations that were based on what charge nurses
indicated about their needs. The recommendations included education and orientation
to the role, managing performance and development of staff, and communication skills.
Additional education should be focused on unit finances and patient relations.
Leadership support was found to be pivotal for charge nurses to feel successful or hinder
their work.

20. John, a new nurse manager, complains to his colleague that he feels very
uncomfortable with the conflict between what he thinks he should be doing as the
manager and what his supervisor thinks he should be doing. According to Hardy’s role
theory, John is experiencing:
a. stress.
b. role stress.
c. role strain.
d. role exploration.
According to Hardy’s role theory, role strain is the subjective feeling of distress that
occurs when role stress or a social condition of conflicting demands or difficult
conditions is present.

21. Seth is hired as the nurse manager for a surgical unit. After a year, the hospital
reorganizes, and his position is lost. In leaving the unit, it is important for Seth to:
a. engage in clarifying why the hospital did not state its expectations for the unit at the
time of hiring.
b. hire a lawyer to represent his interests during this unexpected role transition.
c. seek counseling to deal with his shock and anger.
d. negotiate a reasonable settlement.
When role transition occurs as a result of restructuring, the unit manager should request
and negotiate reasonable compensation and assistance, even if it is not offered initially
by the employer.

22. After several months in the role of manager of a dialysis unit, Maryanne finds herself
still questioning the gap in expectations between her and her staff and management and
is also questioning if she can reconcile her concerns about quality care with the strong
cost-containment orientation of the facility. At this point, Maryanne is in which stage of
role transition?
a. Internalization
b. Acceptance
c. Development
d. Discrepancy
At this point, Maryanne is still experiencing discomfort and disillusionment with the
gap between what she expected and what others expect of her in the performance of her
role as manager. She is considering the significance and fit of the relationship for her,
which is consistent with role discrepancy.

23. In assisting new graduates to make the role transition to graduate nurse, Ted, the
unit manager initiates which of the following?
a. Self-check list to assess competencies that have been strengthened
b. Discussions that focus on what the new graduates have yet to learn
c. Fixed target dates for acquisition of competency and transition to RN role
d. Frequent formal meetings to provide feedback on performance and areas to be
strengthened
Transition to the new role is facilitated through reflection and ongoing development of
awareness of strengths (as compared with a focus on weaknesses) and of weaknesses.
The value of the employee may not depend on quickness in making the role transition.

24. Who of the following might be the most appropriate mentor for Becky, a new nurse
manager on the cardiac unit who has 4 years of previous clinical experience?
a. Sam, near retirement. He has 20 years of clinical nursing and recently assumed role of
head nurse in an interim capacity because of the incumbent’s illness.
b. Leslie, who has been a clinical educator at the institution for a number of years. She
has tired of her role and aspires to become a nurse manager. She looks at mentorship as
an opportunity to understand the role better.
c. Courtney, who has been a nurse manager for 3 years. Her staff and
supervisor value her skills and her leadership acumen and championship of
innovation.
d. Ben, who was nurse manager for 3 years, soon after graduation. He left the role
because he was uncomfortable with the expectations and has been a team leader on
surgery for 15 years.
A mentor needs to have sufficient professional experience and organizational authority
so that he or she can mentor the career of the mentee. Mentors need competencies that
include interpersonal and communication effectiveness, risk taking and creativity, and
ability to inspire change.

25. As a result of Amy’s coaching, Sarah, a nursing graduate of 5 years, completes a

ROLES assessment. This assessment is helpful in: (Select all that apply.)
a. identifying her clinical knowledge.
b. role development.
c. areas of conflict in expectations.
d. expected work time commitments.
A ROLES assessment is useful in identifying, confirming, and visualizing
responsibilities, opportunities, lines of communication, expectations of self and others
for the position, and support. This is particularly useful in identifying areas of conflict in
expectations, including conflict between the manager’s own expectations and those of
staff and supervisors and in negotiating role expectations.