NEA-BC, the exam for system nurse executives

A health system expanding telehealth finds that video visit use is lowest among older, rural, and low-income patients. Which strategy best advances equitable access?

1. Offer audio-only visits and digital navigation support
   Audio-only visits and help with the technology remove the device, broadband, and skill barriers that keep these groups from video care.
2. Market the patient portal app more widely online
   Marketing the portal app online reaches people who are already connected, so it widens the gap for older, rural, and low-income patients.
3. Prioritize telehealth for patients who already use the portal
   Prioritizing patients who already use the portal rewards existing access and pushes the excluded groups further behind.
4. Require video for all visits to ensure clinical quality
   Requiring video for every visit locks out the very patients with the lowest video use, trading equity for a quality claim.

A hospital's RN workforce is 58% BSN-prepared, below the 80% goal set in the Institute of Medicine's 2010 Future of Nursing report, and many associate-degree RNs cite cost as their barrier to further study. Which program best raises BSN attainment while retaining the nurses supported?

1. Reimbursement paid only after three years' employment
   Reimbursement delayed for three years leaves the up-front cost barrier in place, so few nurses can start.
2. Prepaid tuition tied to a later service commitment
   Paying tuition up front removes the cost barrier nurses named, and the later service commitment keeps the newly prepared nurses in the organization.
3. A rule that all current RNs earn a BSN within one year
   A one-year mandate is unrealistic for working nurses and pushes experienced associate-degree RNs to leave.
4. A one-time bonus on finishing, with no commitment
   A one-time bonus on finishing arrives after the nurse has already paid, and with no commitment it does nothing to keep the nurse afterward.

During contract talks, hospital and union negotiators are deadlocked over mandatory overtime: the union demands a total ban and management insists on full discretion. Which approach reflects interest-based (principled) negotiation?

1. Split the difference between the two positions
   Splitting the difference is compromise between fixed positions, which leaves both sides' real worries about overtime unresolved.
2. Explore the concerns behind the two positions
   Exploring the interests behind each position (rest and safety for nurses, coverage flexibility for management) opens options neither side's opening stance allowed.
3. Trade the overtime ban for a smaller wage increase
   Trading the overtime ban for a smaller raise is classic horse-trading of positions; the concerns behind each demand stay unexamined.
4. Present a final offer directly to the staff for a vote
   Taking a final offer straight to the staff bypasses the union's negotiators and is a positional pressure move, not interest-based bargaining.

A monthly run chart of the hospital's fall rate is presented to the board quality committee. Which pattern signals a non-random shift that warrants action?

1. Any month that exceeds the prior year's average
   Comparing a month with last year's average ignores the run-chart rules and turns ordinary variation into a false alarm.
2. One month that is higher than any previous month
   A single record-high month can occur by chance and is not one of the run-chart rules for a non-random signal.
3. Two points falling on opposite sides of the median
   Points alternating across the median are expected random variation, not a signal.
4. Six or more consecutive points above the median
   Six or more consecutive points on the same side of the median meet the run-chart rule for a shift, signaling real change rather than noise.

A Joint Commission survey issues a Requirement for Improvement for inconsistent handoff documentation. What must the organization submit, and when?

1. Evidence of Standards Compliance within 10 days
   A 10-day window does not apply to a Requirement for Improvement; the Evidence of Standards Compliance is due within 60 days.
2. A root cause analysis at the next triennial survey
   A root cause analysis held until the next triennial survey confuses a sentinel-event response with the follow-up to an ordinary finding, and the timing is far too late.
3. Evidence of Standards Compliance within 60 days
   A Requirement for Improvement is closed with Evidence of Standards Compliance submitted within 60 days of the final report.
4. An RCA and action plan within 45 business days
   An RCA and action plan within 45 business days is the Joint Commission's sentinel event expectation, not the response to a documentation finding.