FMLA vs ADA, and the rest of Domain I

An RN asks not to be scheduled on Saturdays because of religious observance. Under Title VII, what is the nurse manager's obligation?

1. Accommodate only if a coworker volunteers to swap
   Voluntary swaps are one way to accommodate, but the employer's duty does not depend on a volunteer appearing.
2. Accommodate unless it would cause undue hardship
   Title VII requires reasonable accommodation of religious practice unless it would impose undue hardship, which since Groff v. DeJoy (2023) means substantial increased costs to the business.
3. Handle the request through the FMLA leave process
   The FMLA covers serious health conditions and family care, not religious observance.
4. Deny the request because schedules apply to everyone
   Applying a schedule uniformly is not a defense; Title VII requires the employer to look for an accommodation.

Several new graduates report that a senior RN repeatedly belittles them in front of patients. What is the nurse manager's MOST appropriate action?

1. Assign the new graduates to a different preceptor
   Moving the new graduates protects them for now but leaves the senior RN's behavior unchecked for the next group.
2. Enroll the new graduates in a resilience workshop
   Teaching the targets to cope puts the burden on them instead of stopping the behavior.
3. Address the conduct directly with that RN
   Repeated belittling is incivility the manager must address directly with the senior RN under the code of conduct, because it harms new nurses and patient safety.
4. Discuss respect at a staff meeting without naming anyone
   A general talk lets the offender avoid accountability; the conduct needs a direct conversation.

A unit has 40 budgeted RN FTEs, and 34 are currently filled. What is the unit's RN vacancy rate?

1. 15%
   Vacancy rate = vacant budgeted positions ÷ total budgeted positions = 6 ÷ 40 = 15%.
2. 17.6%
   This divides the 6 vacancies by the 34 filled positions instead of the 40 budgeted ones.
3. 6%
   This reports the number of vacant FTEs as if it were a percentage.
4. 85%
   85% is the fill rate (34 ÷ 40), not the vacancy rate.

A nurse manager wants to require staff to speak only English at all times on the unit, including during breaks. How is this rule viewed under Title VII?

1. Unlawful only once an employee complains
   A rule's legality does not depend on whether anyone complains about it.
2. Lawful, if staff are told about it in advance
   Advance notice is required for a lawful narrow rule, but it does not make a blanket rule lawful.
3. Lawful, because English is the language of care
   Patient-care communication can justify a rule for specific situations, not a ban that reaches breaks.
4. Presumed discriminatory as a blanket policy
   EEOC guidelines (29 CFR 1606.7) presume that an English-only rule applied at all times, breaks included, violates Title VII; a narrower rule needs a business necessity.

Which interview question is BEST for predicting how an RN candidate will handle conflict with a coworker?

1. 'What do you consider your greatest weakness?'
   A general weakness question draws rehearsed answers and says little about handling conflict.
2. 'Would you describe yourself as a team player?'
   A yes-or-no self-description is easy to answer favorably and gives no evidence.
3. 'Tell me about a time you disagreed with a colleague.'
   A behavioral question asks for a real past example, and past behavior is the best predictor of how a candidate will handle a similar situation.
4. 'How would you handle a conflict with a coworker here?'
   A hypothetical question invites an ideal answer instead of evidence of what the candidate has actually done.

An RN schedules elective knee surgery two months in advance and plans to use FMLA leave. What notice does the FMLA require?

1. At least 30 days' advance notice
   When leave is foreseeable, such as planned surgery, the employee must give at least 30 days' notice, or notice as soon as practicable if that is not possible (29 CFR 825.302).
2. At least 60 days' advance notice
   Sixty days is not an FMLA requirement; the rule is 30 days.
3. Notice within 2 business days of surgery
   A two-day window is not the FMLA standard for foreseeable leave; 30 days applies when the need is known in advance.
4. Notice only when certification is submitted
   Medical certification supports the leave after notice is given; it is not the notice itself.

Under the Fair Labor Standards Act (FLSA), which salaried employee on a nursing unit is generally entitled to overtime pay for hours worked over 40 in a workweek?

1. A clinical nurse specialist
   An advanced-practice nurse with specialized education meets the learned professional test and is exempt when paid on a salary basis.
2. A licensed practical nurse
   DOL guidance (Fact Sheet 17N) says LPNs generally do not meet the learned professional duties test, so they are owed overtime even when salaried.
3. A staff registered nurse
   Registered nurses generally meet the learned professional duties test, so a salaried RN above the salary threshold is usually exempt; hourly RNs are owed overtime.
4. A unit nurse manager
   A salaried manager who directs staff typically meets the executive exemption.

A director has formed a new team of unit managers who have not worked together before. Using Tuckman's model, what should the director focus on FIRST?

1. Celebrating results and closing out the team's work
   Celebrating and closing out belong to adjourning, the end of a team's life cycle.
2. Delegating full decision-making authority to the team
   Full delegation fits a performing team; a new team that has not yet settled its roles is not ready for it.
3. Encouraging open debate of differing work styles
   Working through clashes over style is the storming stage, which comes once roles are clear.
4. Clarifying the team's purpose and each member's role
   In the forming stage members are uncertain and depend on the leader, so a clear purpose, roles and expectations come first.

A unionized nurse is called to an investigatory meeting that could lead to discipline and asks for a union representative. What is the employer's obligation?

1. Refer the nurse directly to human resources for handling
   Sending the matter to HR does not answer the request; the right applies whoever conducts the interview.
2. Let a steward attend before questioning continues
   Under Weingarten, an employee who reasonably fears discipline from an investigatory interview may ask for a union representative, and the employer must allow one or stop the interview.
3. Postpone all discipline until the next scheduled review
   The right concerns representation at the interview, not a delay of discipline.
4. Proceed now because attendance is mandatory
   Continuing the interview after a valid request denies the employee's Weingarten right and is an unfair labor practice.

An RN has used all 12 weeks of FMLA leave for a back injury and reports needing more time off before returning. What should the nurse manager do NEXT?

1. Work with HR on an ADA interactive process review
   When FMLA leave runs out, the ADA can still require more leave or another reasonable accommodation, worked out through the interactive process.
2. Grant 12 more weeks of FMLA leave to the nurse
   The FMLA provides 12 weeks per 12-month period; there is no second block, though more leave can come through the ADA.
3. Require a full-duty release before any return to work
   A blanket full-duty rule can violate the ADA by refusing accommodations such as light duty or a modified schedule.
4. Begin separation because FMLA protection has ended
   Ending employment when FMLA leave expires ignores ADA duties and is a common source of disability claims.

An RN returns from 18 months of active military duty and applies for reemployment on time. Under USERRA, where must the hospital place the nurse?

1. In any open RN position at the nurse's former pay rate
   An arbitrary open position at the old pay ignores the seniority and raises the nurse would have earned.
2. In the job the nurse would have held without the absence
   USERRA's escalator principle restores a returning service member to the position, seniority and pay continuous employment would have brought; after more than 90 days of service, that job or one of like seniority, status and pay.
3. In the nurse's former position at the former pay rate
   The old job at the old pay misses the escalator: the nurse is owed what continuous service would have brought.
4. In a probationary role until skills are revalidated
   USERRA bars treating the returning employee as a new hire; the employer must make reasonable efforts, such as refresher training, to qualify the nurse.

A hospital is launching an employee wellness program with a health risk assessment (HRA). Under the Genetic Information Nondiscrimination Act (GINA), which design is permissible?

1. A bonus for employees who complete genetic screening
   A reward for genetic test results is an inducement to hand over genetic information, which GINA prohibits.
2. Higher premiums for staff who skip the family-history section
   A penalty for declining is the mirror image of a reward; either one makes the disclosure involuntary.
3. A voluntary HRA with no incentive tied to family history
   GINA treats family medical history as genetic information; a wellness program may ask for it only when participation is voluntary and no reward or penalty depends on answering (29 CFR 1635.8(b)(2)).
4. A required HRA that includes family medical history
   Requiring family medical history makes the request involuntary, an unlawful acquisition of genetic information.

Which leave request by an eligible RN qualifies for FMLA protection?

1. Caring for an adult sibling during chemotherapy
   Siblings are not covered family members under the FMLA.
2. Caring for a grandparent recovering from a stroke
   A grandparent is covered only if they stood in loco parentis to the employee, which the item does not state.
3. Caring for a parent-in-law after hip surgery
   Parents-in-law are excluded; only the employee's own parent, or someone who stood in loco parentis, counts.
4. Caring for a parent recovering after hip fracture surgery
   The FMLA covers care for a spouse, son or daughter, or parent with a serious health condition, and recovery from surgery qualifies.

An RN with a hearing impairment asks for an amplified stethoscope and phone, which cost about $600. What should the nurse manager do?

1. Deny the request unless the RN's hearing loss worsens
   The ADA does not wait for a condition to worsen; the need for accommodation exists now.
2. Arrange the equipment as a reasonable accommodation
   Inexpensive equipment that lets a qualified nurse perform essential functions is a standard reasonable accommodation, and $600 is far from undue hardship.
3. Transfer the RN to a role that needs less auscultation
   Reassignment is a last-resort accommodation, used only when the current job cannot be accommodated.
4. Require the RN to buy the devices as personal equipment
   Making the employee pay for an accommodation shifts the employer's ADA duty onto the employee.

An RN reports that female nurses on the unit receive written warnings for lateness while male nurses with similar lateness receive only verbal reminders. What should the nurse executive do FIRST?

1. Retrain the unit manager on progressive discipline
   Retraining assumes the manager is the cause before the facts are known; corrective action follows the review.
2. Rescind all recent warnings issued on the unit
   Rescinding every warning before any review treats them all as tainted without evidence and can undo warnings that were justified.
3. Tell the RN to file a charge with the EEOC
   Pointing the RN to the EEOC sidesteps the employer's own duty to investigate; an external charge is the employee's right, not the employer's response.
4. Review the discipline records impartially
   A credible report that discipline differs by sex calls for a prompt, impartial review of the records first; Title VII requires the employer to investigate and correct disparate treatment.

A competent patient asks the charge nurse not to assign any Black nurses to their care. What should the nurse manager do?

1. Let the charge nurse decide each request case by case
   Case-by-case judgment allows the same discriminatory assignments and hands the employer's duty to the charge nurse.
2. Note the preference in the care plan for every shift
   Writing the preference into the plan turns one request into a standing race-based staffing rule.
3. Refuse and explain the hospital's nondiscrimination policy
   Title VII bars making work assignments by race, and honoring a patient's racial preference is exactly that (Chaney v. Plainfield Healthcare Center, 2010); the manager explains the policy and addresses the patient's other concerns.
4. Reassign the nurse to honor the patient's preference
   Granting the request makes race the basis of the assignment, which discriminates against the nurse even though a patient asked for it.

An RN assumes that a newly admitted patient from an Asian background will want family members to make care decisions. Which response by the nurse manager BEST models cultural humility?

1. Coach the RN to ask how the patient wants decisions made
   Cultural humility starts from asking the person instead of assuming from group membership; the patient decides how much the family takes part.
2. Ask the family to choose a spokesperson for decisions
   Asking the family to pick a decision-maker accepts the assumption and can bypass a patient who wants to decide.
3. Give the RN a fact sheet on Asian cultural norms of care
   A list of group norms reinforces the stereotype the RN already applied instead of finding out what this patient wants.
4. Refer the question to the hospital's diversity and inclusion office
   Sending the matter elsewhere avoids coaching at the point of care, where the RN's assumption needs correcting.

Union nurses begin wearing buttons that support a staffing campaign. Under the NLRA, where may the hospital restrict the buttons?

1. Nowhere, because union insignia can never be limited
   The right is not absolute; restrictions in immediate patient care areas are presumptively valid in hospitals.
2. Anywhere on hospital property during work time
   A facility-wide ban reaches non-patient areas such as hallways and break rooms, where the restriction is presumptively unlawful.
3. Only in the cafeteria and other public areas
   This reverses the rule: public and non-care areas are where restrictions are hardest to justify, and patient care areas are where they are allowed.
4. Only in immediate patient care areas, with a valid reason
   Wearing union insignia is protected Section 7 activity; hospitals may restrict it in immediate patient care areas to avoid disrupting care, but not across the whole facility.