Leadership Exam 1

Patient-Centered Focus

"Patients currently do not have a central role in determining their care, one that fosters a sense of responsibility for their own health" (Institute of Health Improvement, 2010). -A patient-centered focus requires that patients play a greater role in their care and in some instances, providers play less of a role

Key Features of the Affordable Care Act by Year: 2011- Increasing Access to Affordable Care

*Increasing Access to Services at Home and in the Community *Holding Insurance Companies Accountable *Bringing Down Healthcare Premiums *Addressing Overpayments to Big Insurance Companies and Strengthening Medicare Advantage

Key Features of the Affordable Care Act by Year: 2012- Improving Quality and Lowering Costs

*Linking Payment to Quality Outcomes *Encouraging Integrated Health Systems *Reducing Paperwork and Administrative Costs *Understanding and Fighting Health Disparities

Key Features of the Affordable Care Act by Year: 2011- Improving Quality and Lowering Costs

*Offering Prescription Drug Discounts *Providing Free Preventive Care for Seniors *Improving Healthcare Quality and Efficiency *Improving Care for Seniors After They Leave the Hospital *Introducing New Innovations to Bring Down Costs

Key Features of the Affordable Care Act by Year: 2014- New Consumer Protections

*Prohibiting Discrimination Due to Preexisting Conditions or Gender *Eliminating Annual Limits on Insurance Coverage *Ensuring Coverage for Individuals Participating in Clinical Trials

Key Features of the Affordable Care Act by Year: 2010- Increasing Access to Affordable Care

*Providing Access to Insurance for Uninsured Americans with Preexisting Conditions *Extending Coverage for Young Adults *Expanding Coverage for Early Retirees *Rebuilding the Primary Care Workforce *Holding Insurance Companies Accountable for Unreasonable Rate Hikes *Allowing States to Cover More People on Medicaid *Increasing Payments for Rural Healthcare Providers *Strengthening Community Health Centers

Key Features of the Affordable Care Act by Year: 2010- Improving Quality and Lowering Costs

*Providing Small Business Health Insurance Tax Credits *Offering Relief for 4 Million Seniors Who Hit the Medicare Prescription Drug "Doughnut Hole" *Providing Free Preventive Care *Preventing Disease and Illness *Cracking Down on Healthcare Fraud

Key Features of the Affordable Care Act by Year: 2010- New Consumer Protections

*Putting Information for Consumers Online *Prohibiting Denying Coverage of Children Based on Preexisting Conditions *Prohibiting Insurance Companies from Rescinding Coverage *Eliminating Lifetime Limits on Insurance Coverage *Regulating Annual Limits on Insurance Coverage *Appealing Insurance Company Decisions *Establishing Consumer Assistance Programs in the States

Nurse Leaders Need to Change

-"Step outside the box" -Apply modern leadership theories to practice *Remember: leadership can be learned.

What is view of nursing professional organizations of nursing leadership?

-ANA -AACN -AONE

Developing a Positive Work Environment: Caring and Trust

-Ability to care and trust staff -Interpersonal sensitivity -Use of consistency when authority used

Nurse Participation in the Policy-Making Process

-Active participation in professional organizations -Provide testimony and use lobbying -Serve on policy-making committees -Contact governmental representatives -Network and collaborate with other healthcare professionals -Hold elected office

Patient and Family Education

-All patient and family education needs to focus on the individual patient. -Understanding the patient's medical history, assessment data, needs, and home situation is important in developing patient-centered patient education. -This also requires patient engagement. *Asking the patient what the patient identifies as needs, problems, etc.

Assessing Problems to Get to Policies

-Cost-benefit analysis -Efficiency -Equity *Outcome must also be considered when developing policy. If the policy is not accepted (limited political support) it will fail.

Examples of Tools

-Disease management program -Clinical pathways -Clinical practice guidelines -Examples of development of clinical pathways and clinical practice guidelines follow.

Need for More Nursing Leadership

-Education about leadership *Staff education *As students (e.g., NSNA) *Career ladders *Nurse residencies -Education about leadership *Role of nursing organizations *New degrees (CNL, DNP) *Healthcare reform and its impact *Engagement vs. retention of nurse managers

Change and Nursing Leadership

-Engaging in changes and the change process in healthcare delivery system -Flexibility -Importance of collaboration and interprofessional teamwork -Collaboration key characteristic of effective leaders and managers

Implementation of Pathways and Guidelines

-Evaluation of the implementation of practice guidelines and pathways is important, to help ensure patients' needs are being met. -With the increasing emphasis on evidence-based practice, it is important that management tools, such as pathways and guidelines, are based on best practice.

Legislation: Impact on Healthcare Delivery

-Federal and state legislation has a major impact on healthcare. -Legislation offers many opportunities to pilot new nursing programs in education and delivery. -Difference between legislation and regulations -Examples *Social Security Act of 1935 *Public Health Act of 1944 *Affordable Care Act of 2010 **Legislation is law. Regulations describe how it will be implemented. These Acts are law.

Negligence

-General term that means conduct lacking in due care **It is a failure to do what an ordinary prudent person would do under similar circumstances. -To prove negligence, there are four elements that must be met.

Examples of Current Approaches to Patient-Centered Care

-HCO self-assessment to determine status of application of patient-centered care -Myths about patient-centered care -Planetree Model and implications for HCO patient-centered care -The Joint Commission and its view of patient-centered care

Key Features of the Affordable Care Act by Year: 2013- Improving Quality and Lowering Costs

-Improving Preventive Health Coverage -Expanding Authority to Bundle Payments

Examples of ACA Provisions Related to Nursing

-Increase nursing student loans to expand the profession -Increase geriatric education -Increase funding for advanced nursing education -Provide grants for nurse-managed health centers -Establish Accountable Care Organizations (ACOs) -Increase nursing faculty loans -Arrange for workforce diversity grants -Provide and expand prevention programs -Improve public health education and services -Expand primary care -Establish Patient-Centered Care Outcomes Research (PCORI) -Promote changes in home health services

Key Features of the Affordable Care Act by Year: 2013- Increasing Access to Affordable Care

-Increasing Medicaid Payments for Primary Care Doctors -Open Enrollment in the Health Insurance Marketplace Begins

Nurses Play a Role in Reducing Fraud and Abuse

-Know and use the Code for Nurses. -Recognize personal values and professional values. -Understand the decision-making process and how it applies to practice. -Recognize and understand the importance of policy and legal issues. -Be assertive.

Key Features of the Affordable Care Act by Year: 2014- Improving Quality and Lowering Costs

-Making Care More Affordable -Establishing the Health Insurance Marketplace -Increasing the Small Business Tax Credit

Practice Guidelines continued....

-Nurses who work in the community can make use of practice guidelines to help plan community health education and services that focus on specific problems.

Clinical Pathways

-Pathways provide direction in the coordination of care, and ensure that outcomes are met within a designated time frame, with efficient use of resources and cost control. -Nurses need to explain what a clinical pathway is to patients and how it is used. -They provide this explanation best because they interact more with patients and families.

Managers must be competent in these key management functions:

-Planning -Organizing -Leading -Controlling

Professional Ethics

-Professional ethics applies to both nursing management and clinical issues. -Some ethical dilemmas include: *Staffing levels and mix situations *Developing/maintaining standards of care *Allocating/rationing of scarce resources *Incompetent physicians and nurses *Demotion/termination of employees *Employee relations *Selection/hiring of employees *Treatment versus non-treatment *Promotion of employees *Diversification of services *Downsizing services *Access to care for the indigent

The IOM identifies four areas that need improvement and lead to effective programs:

-Providers communicate and reinforce patients' active and central role in managing their illness. -Practice teams make regular use of standardized patient assessments. -Evidence-based programs are used to provide ongoing support. -Collaborative care planning and patient-centered problem solving result in an individualized care plan for each patient and support from the team when problems are encountered.

Public Policy

-Reflects needs of the public -Developed by public organization or government -Influenced by politics -Two major types *Regulatory *Allocative **Regulatory involves regulations, allocative involves money.

The Future of Nursing Report

-Role of the Institute of Medicine and impact of the report -Emphasis on need for nursing leadership in a redesigned healthcare system -Impact of the Affordable Care Act of 2010 **Changed it's name to National Academies of Science (NAM) April 2015. There is a new video on the website that gives the progress on the report. (listed above). Bullets on bottom of page 5-6 are most critical points relevant to Leadership

States and Healthcare Policy

-States play an active role in healthcare policy, legislation, and regulation. -There are five typical healthcare areas in which the states have major input. *Public health and safety *Provision of indigent care *Purchase care *Regulation *Resource allocation **Page 41. As you can see when you read these areas in which states have input, that laws are enacted in response to a need. They can have long lasting effects, so they need to be developed responsibly.

Seven Attributes of Patient-Centered Care

-Superb access to care -Patient engagement in care -Clinical information systems that support high-quality care, practice-based learning, and quality improvement -Care coordination -Integrated and comprehensive team care -Routine patient feedback to doctors and other care providers -Publicly available information

Practice Guideline Definition

-Systematic statement that assists providers in making decisions about care for specific clinical conditions -Supports evidence-based practice -Developed by public and private sector

Patient Protection and Affordable Care Act of 2010

-The goal of the healthcare reform legislation of 2010 is to reduce the number of uninsured by 32 million by 2014. -Everyone will be required to have insurance or pay fee for not having coverage.

Whistleblowers

-There are protections for nurses and all employees who act as whistleblowers, those that reveal wrongdoing within an organization. -If the employee is fired, demoted, or discriminated against for these actions, the employee can bring a claim against the employer for unlawful retaliation

Healthcare Policy Determines:

-What services to provide -Who provides services -Who receives services -Reimbursement -Quality of care -Improvement -Requirements

Chronic Care Model Elements are:

1. Health system 2. Delivery system design 3. Decision support 4. Clinical information systems 5. Self-management support 6. The community

Report Recommendations

1. Remove scope of practice barriers. 2. Expand opportunities for nurses to lead and diffuse collaborative improvement efforts. 3. Implement nurse residency programs. 4. Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020. 5. Double the number of nurses with a doctorate by 2020. 6. Ensure that nurses engage in lifelong learning. 7. Prepare and enable nurses to lead change to advance health. 8. Build an infrastructure for the collection and analysis of interprofessional healthcare workforce data.

Justice

All patients should be treated fairly.

Policy process: identify possible solutions

Apply cost-benefit analysis of data to determine possible solutions; consider testimony from experts, lobbyists' input and pressure; arrive at list of possible solutions.

How Policy May Affect Ethical Decision Making

As changes occur in the healthcare environment, healthcare policy, legislation, and regulation, it is important for nurses to understand and participate in the legislative process and consider how policy may affect ethical decision making. *Active involvement by nurses must occur at local, state, and federal levels, page 37.

Autocratic

Authoritarian, directive The leader makes decisions for the group, typically by issuing orders or directions. The leader assumes people are externally motivated and incapable of independent decision making. External motivators might be salary and benefits or job security. Today this style is most effective in emergencies, when clear direction is required from one person. It is not as effective for long-term use.

_____ ______ should be developed by an interprofessional team with an emphasis on collaboration, coordination, and continuity of care that is patient-centered. Health literacy is important.

Care plans

Other Legal Issues Relevant to Nurses

Consent Living wills Durable power of attorney Do-not-resuscitate Assisted suicide Patient privacy and confidentiality Need to follow the law and the profession's Code of Ethics

Interdisciplinary Ethics Committees: Typical Issues

Cost containment End-of-life decisions Informed consent Incompetent, unethical, or illegal professional behavior Access to care

Board of Nursing (BON)

Each state board of nursing has the responsibility to protect the public health in its state. Nurses who are licensed in a state can and should make complaints to the board when they are concerned about patient health and safety.

Transformational Leadership and Empowerment

Empowerment is an important component of Transformational Leadership. *A leader will gain more power by giving more power to the staff. Very important point!! This also builds trust.

______ focuses on what ought to be done in relation to what is done. _______ is moral principles.

Ethics; Ethics

Policy process: select a solution

Federal (or state) written law will probably repeat some of the activities described as part of "identify possible solutions" to gather more data or clarify. Coalition building also continues throughout the process.

Policy process: Monitor outcomes (Evaluation)

Federal department or agency responsible for implementation develops evaluation plan and monitors outcomes. The department may have to report to Congress at specific times and may recommend and implement changes as long as they are within the framework of the law. Otherwise, the department will need to recommend legislative changes.

Management Grid Theory

Five styles that range from little interest in production and people to maximum interest in production and people

EI: Social-Awareness Cluster

Focuses on reading people and teams and groups accurately. Competencies: Empathy, service orientation, organizational awareness.

______ are to improve quality of life and prevent complications from disease. This is why we use disease management, we anticipate the progression of the disease and what treatment is available. It focuses on identification, intervention, and measurement, just like the QI process.

Goals

Healthcare Fraud Increases

Growth of healthcare corporations Current status of healthcare fraud and abuse Whistleblowing Strategies to address the fraud and abuse

_______ ________ is the ability to read, understand, and act on health care information

Health literacy

Healthcare Delivery Systems

Healthcare delivery systems need to be "carefully and consciously designed to provide care that is safe, effective, patient-centered, timely, efficient, and equitable. Such systems must be designed to serve the needs of patients, and to ensure that they are fully informed, retain control and participate in care delivery whenever possible, and receive care that is respectful of their values and preferences" (Institute of Medicine, 2001, p. 7).

Ethics: Impact on Decision-Making in Management and Practice

In health care, ethical decision making focuses on the right and just thing to do. It is guided by four principles. -Autonomy -Beneficence -Justice -Veracity

______ is the formal organization of societal values, demonstrated through laws that are passed and implemented _____ is a system of rules that are enforced through social institutions to govern behavior (Wikipedia).

Law; Law

Policy process: gather data about issue

Legislative staff gather data about the issue; some data may come from federal departments or agencies, which act as resources for legislative activity. Criteria are developed to evaluate the data. (e.g. cost, efficiency, equity, and political feasibility).

___________ is "the failure of a professional person to act in accordance with the prevailing professional standards or failure to foresee consequences that a professional person, having the necessary skills and education, should foresee"

Malpractice

Examine examples and key healthcare policy issues.

Most significant recently is the 2010 Patient Protection and Affordable Care Act

Bureaucratic

Organizational rules, structure Directly related to the autocratic style as the leader also presumes the group is externally motivated. The leader relies on organizational rules and policies, takes an inflexible approach, and gives directions, expecting them to be followed.

Chronic Care Model

Organizations must focus on these six fundamental areas and develop productive interactions between patients who take an active part in their care and providers backed up by resources and expertise.

Patient-Centered Care

Patient-centered care is the key competency around which the other four competencies are based. It requires health care organizations and nurses to place the focus on the individual, rather than the on the disease or medical problem. Effective patient-centered care requires that staff collaborate and coordinate care. **Patient preferences should be considered and the informed patient should be supported and making the decisions, not the HC provider making the decisions. Care planning is interprofessional and includes the patient.

Autonomy

Patients have the right to determine their own rights

Care Planning

Patients need to be as active in the care planning process. Planning that is done separately from the patient and then delivered as a final decision acts as a barrier to patient-centered care. *When the patient (or family if patient is unable) is involved in the care planning it will work much better because their individual needs and preferences are included.

Key Features of the Affordable Care Act by Year: 2015- Improving Quality and Lowering Costs

Paying Physicians Based on Value, Not Volume

________ __________ focus more on general treatment for a specific illness or condition, whereas _________ are more specific and unique to the health care organization in which they are used.

Practice guidelines; pathways

Key Features of the Affordable Care Act by Year: 2014- Increasing Access to Affordable Care

Promoting Individual Responsibility

Key Features of the Affordable Care Act by Year: 2012- Increasing Access to Affordable Care

Providing New, Voluntary Options for Long-Term Care Insurance

Examples of Healthcare Fraud and Abuse

Psychiatric Hospitals Operation Restore Trust Veterans Administration Greater need for organizational ethics

Nurses Described as Leaders Make a Difference

Recent Institute of Medicine reports related to the quality and safety of health care state that nurses who are described as leaders make a difference in the quality and safety of health care.

Policy process: implement policy

Rules and regulations are developed; staff receive feedback on rules and regulations and implement rules and regulations to apply the law.

______-___________ ________ is the "systematic provision of education and supportive interventions to increase patients' skills and confidence in managing their health problems, including regular assessment of progress and problems, goal setting, and problem-solving support"

Self-management support

Policy process: policy issue develops

Senator learns about consumer concern about a health issue and has staff work on the problem

Policy process: coalition building

Senator will form coalitions to back the legislation with other senators, representatives, and other stakeholders such as healthcare professional organizations.

Examples of Negligence

Some of the examples of potential risks for nurses: -Failure to adequately assess, monitor, and communicate -Failure to act as the patient's advocate *For example, not providing patient education to a patient who has diabetes *Failure to protect a patient when the patient is suicidal or at risk for falls

Scope of Practice

State Nurse Practice Act Scope of practice provides guidance and boundaries for practice.

Healthcare Fraud and Abuse Control Program

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a program to identify and prosecute healthcare fraud. - This program is called Health Care Fraud and Abuse Control Program (HCFAC).

Which Contingency Variables Are Advantageous?

The most advantageous situation occurs when there are positive leader-member relations, high task structure, and high position power.

Management Grid Theory: Authority-obedience leadership

This leader focuses on efficiency and getting the job done. This includes providing a work environment in which staff can be productive, but the leader has less concern for staff members as people.

Management Grid Theory: Organizational "man"

This style of leadership focuses on balancing the necessity to accomplish the task while maintaining morale.

Management Grid Theory: Country club leadership

This type of leader has an interest in people, and staff describes the leader as friendly and outgoing. Productivity, however, is not a major concern.

Veracity

Truth telling is critical for effective patient communication and developing trust with the patient. If incomplete information is not shared with a patient, then it has not been met.

Compare and contrast private and public policy.

Two types, private which is developed by private parties for their own purposes, whereas public policy is developed by the government.

Leadership Skills: Preparation and Development

Why would this be the case? -To cope with constant organizational and healthcare delivery changes and to empower others *Preparation and development help with recognition of self tendencies and responses of others to self, and helps acquire the skills and knowledge needed to lead and be effective.

Leadership Development: ANA states that leadership is....

a critical part of the nursing profession. -Every nurse needs to develop leadership qualities and competencies.

The nurse wants to become more involved in healthcare decision making. Which is the nurse's best strategy for achieving this goal? a. By active participation in nursing organizations b. By keeping up with new healthcare developments c. By electing officials with minimal interest in healthcare d. By charging for nursing care services

a. By active participation in nursing organizations Active participation in nursing organizations gives every nurse a voice because nursing organizations are often represented on committees that develop healthcare policy. This is the best way for an individual nurse to impact policy development. It is important for nurses to be aware of new healthcare developments, but simply being aware is not the best way to impact healthcare decision making. The nurse should try to elect officials that understand and are interested in healthcare. Nursing care services are a valuable commodity, and nurses should be reimbursed for delivering quality care. However, this is not the best strategy for impacting healthcare decision making.

The nurse is meeting with a state senator regarding healthcare policy issues in the state. How can this nurse best impact the development of healthcare policy during this meeting? a. By demonstrating that nurses provide cost-effective, high-quality, measurable care b. By suggesting the creation of new titles and licensure requirements to indicate various levels of preparation c. By encouraging the legislator to vote for laws that have nurses remaining at the bedside, giving total care to patients d. By suggesting legislation that requires the nurse to work longer under mandatory overtime requirements to meet patient care needs

a. By demonstrating that nurses provide cost-effective, high-quality, measurable care Legislators may have an unrealistic view of the role of the nurse. This nurse should explain how the profession provides cost-effective, high-quality, measurable care and why this is important. This is a suggestion that is still being debated within nursing and is not currently the best use of the nurse's influence. Bedside care is only one of the important types of work done by nurses. This suggestion limits the profession's impact on healthcare policy. Nurses should be working against mandatory overtime.

Which skills must be exhibited by non-manager nurses working in today's healthcare environment? Select all that apply. a. Exhibiting personal ethics b. Working alone c. Focusing on one area of care d. Focusing on chronic care and prevention e. Using technology

a. Exhibiting personal ethics; e. Using technology Personal ethics is a skill essential for nurses in today's healthcare environment. Today's nurse must have the skills needed to use technology in the provision of client care. Today's nurse must be able to work in a team. Today's nurse must be multi-skilled with focus on numerous areas of care. There is greater emphasis on understanding the impact of chronic care and prevention and health maintenance rather than on curing.

The clinical pathway committee wants to create pathways for the target population. What criteria should be used to identify the target population? a. High-volume, high-risk, and high-cost conditions b. Low-volume, low-risk, and low-cost conditions c. Conditions that meet the "norm" or benchmarks d. Conditions that are unusual for the patient population

a. High-volume, high-risk, and high-cost conditions High volume, high risk, complex care requirements, high cost, variations in length of stay compared with the "norm" or benchmarks, variations in practice patterns, payer request of interest in the illness or condition, and opportunity for improved care are criteria for choosing the target population. The committee should focus on high-volume, high-risk, and high-cost situations. Situations that meet the norm are not problematic. The committee should focus on high-volume situations, which are usual conditions, not unusual conditions.

During orientation to a new position, the new nurse receives a copy of the ANA's Code of Ethics. What is the significance of this code for nurses? a. It sets forth the primary goals, values, and obligations of the profession. b. It determines who can enter the profession of nursing. c. It sets forth the practice guidelines for developing clinical pathways. d. It differentiates between the practice of nursing and the practice of medicine.

a. It sets forth the primary goals, values, and obligations of the profession. A code of ethics makes explicit the primary goals, values, and obligations of the profession. Individuals who become nurses are expected not only to adhere to the ideals and moral norms of the profession, but also to embrace them as part of what it means to be a nurse. This is determined by law, not the ANA Code. This is not part of the ANA Code, but may be part of standards of practice of some specialties. This differentiation is a matter of law.

The nurse manager has determined that a system variance exists for one critical pathway being used on the care area. Which option is an example of this type of variance? a. Lack of supplies b. Misread orders c. Care provided by a nurse who is ill-prepared d. Mislabeled medications

a. Lack of supplies System or operational variances focus on hindrances in the system or the organization that prevent the achievement of client outcomes. Examples are delay in laboratory results, lack of bed space or hours of service, delayed transfers to a long-term care facility, and lack of supplies. Other choices are a provider variance.

The clinical pathway committee needs data to assist with the creation of the pathways. What is the most important type of data this committee will require? a. Length of stay, common admission diagnoses, laboratory tests, and incident data b. Infection control data and quality improvement records c. Average census data, staffing grids, and unit-specific diagnoses d. Frequency of admissions, medication error reports, and readmission data

a. Length of stay, common admission diagnoses, laboratory tests, and incident data The teams that develop the content for specific pathways need access to data such as length of stay, common admission diagnoses, laboratory tests, and incident data. Lists in other choices are not inclusive of all the types of data needed.

The quality improvement committee is reviewing practice guidelines and written standards of care. What is the difference between these two items? a. Practice guidelines provide information and options. b. Practice guidelines define treatment. c. Standards of care pull together research information from the literature. d. Standards of care save money for the healthcare system.

a. Practice guidelines provide information and options. Practice guidelines are different from standards of care in that guidelines do not define treatment but rather provide information and options. Standards of care define treatment. Both standards of care and practice guidelines use research information. Both practice guidelines and standards of care have the potential to save money for the system.

The organization is reviewing the private and public healthcare policies. How do these two types of policies differ? a. Private policy is healthcare policy that is developed by either healthcare organizations or a profession. b. Private policy provides the greatest good for the greatest number of people. c. Private policy is developed by politicians. d. Private policy has no input from healthcare organizations.

a. Private policy is healthcare policy that is developed by either healthcare organizations or a profession. Private policy is healthcare policy that is developed by either healthcare organizations or a profession, such as nursing. Public policy should reflect the needs of the public, but often is influenced by politics. Public policy should provide the greatest good for the greatest number of people. Public policy is developed by politicians. Healthcare organizations have strong influence on the development and implementation of private policy.

During a seminar, health care executives discuss the high-priority ethical dilemmas that they face in their organizations. Which are the highest-priority ethical dilemmas? a. Staffing levels and mix situations, developing/maintaining standards of care, and allocating/rationing of scarce resources b. Incompetent physicians, demotion/termination of employees, and employee relations c. Incompetent nurses, selection/hiring of employees, and treatment versus nontreatment d. Promotion of employees, diversification of services, and downsizing services

a. Staffing levels and mix situations, developing/maintaining standards of care, and allocating/rationing of scarce resources The top three ethical dilemmas identified by nursing administrators are staffing levels and mix situations, developing/maintaining standards of care, and allocating/rationing of scarce resources. While others are important factors, they are not the top three ethical dilemmas today.

A staff nurse provides patient care under the ethical principle of beneficence. How does this principle affect nursing practice and ethical decision making? a. The patient is discharged at the time expected and has no complications. b. Patients have the right to determine their own rights. c. Patients have the right to be treated fairly. d. Patients have the right to be told the truth.

a. The patient is discharged at the time expected and has no complications. The ethical principle of beneficence, or doing something good, is interpreted to mean that nurses inflict no harm and are to safeguard the patient. A patient who is able to be discharged with no complications probably has received quality care. (b) is the ethical principle of autonomy. (c) is the ethical principle of justice. (d) is the ethical principle of veracity.

Several staff nurses are disappointed to learn that their patient care area will begin using clinical pathways. What are the disadvantages of clinical pathways? a. They are costly to develop and implement, in both time and money. b. They are highly individual for each patient. c. They do not give direction to the staff for implementation. d. They are used to identify staff performance problems.

a. They are costly to develop and implement, in both time and money. They are costly to develop and implement, in both time and money. Staff may have a negative attitude toward them and not implement them as intended. Clinical pathways are written in a general form and must be individualized to each patient. The purpose of the clinical pathway is to provide direction in the care of the patient. This is not the intention of clinical pathways. Variances are tracked to help improve system performance.

Beneficence

doing something good. Nurses are to inflict no harm and to safeguard the patient.

Managers maintain ___________.

equilibrium

Expert

has an in-depth understanding of a particular topic or function. Will strive toward the best performance.

Leadership Development: The AACN recognizes the need to....

incorporate more leadership development in graduate and undergraduate nursing programs. -Leadership is required for all nursing positions

Leaders gain their authority from their ability to __________ others to get the work done.

influence

Policy

is a course of action that affects a large number of people, and it is stimulated by a need. May include a mixture of laws, regulations, interpretations, court decisions, and other information relevant to the policy content.

Throughout the care process nurses need to actively use the following: -Clinical reasoning

is the "practitioner's ability to assess patient problems or needs and analyze data to accurately identify and frame problems within the context of a patient's environment"

When nurses assume a ___________ role in policy development, this better ensures that both nurses' and patients' needs are included in critical healthcare policies, legislation, and regulation, all of which are directly connected to ethical decision-making in the healthcare environment.

leadership

Several studies have indicated that the use of _________ seems to increase patient satisfaction.

pathways

Patient-centered care is one of the 5 core competencies identified by the IOM. The 5 core competencies are:

patient-centered care, work in Intraprofessional teams, employ evidence based practice, apply quality improvement, utilize informatics. The definition of pt-centered care can be found in the paragraph on p. 245, "identify, respect, and care about patients' differences, values, preferences, expressed needs; etc..."

Throughout the care process nurses need to actively use the following: -Clinical judgement

requires that a nurse apply, analyze, and synthesize knowledge considering the context. -If done effectively, it should allow the nurse to reflect on the patient, communicate effectively, respond to uncertainty, and to avoid snap judgments.

Transformational Leadership Theory

-Most accepted theory today *Recognized by IOM as most effective theory Includes recognition and motivation of staff -Leaders need to embrace change and empower staff. -Critical qualities of the transformational leader

Knowledge Management Theory

-Accountability for those who do the work -Recognizes the importance of the knowledgeable worker and knowledge to the organization -Drucker first recognized the "knowledge worker" *Nurses as assets *HCOs are knowledge intense organizations; knowledge based managers must be facilitators and integrators

Key skills and competencies that make for effective managers and leaders include the following:

-Critical-thinking and communication skills -Ability to guide staff in using clinical resources and judgment -Team-building, flexibility, collaboration -Delegating, and ability to evaluate effectively

Leadership 2.0

-Current view of leadership -Integrates elements from many of the earlier theories -Difficult to describe leadership, but you know it when you see it. *These skills are: Emotional intelligence, organizational justice, character, and development

Private Policy

-Developed by either healthcare organizations or a profession examples: The Joint Commission, American Hospital Association, American Nurse Association

Myths of Leadership

-Everyone can be a leader. -Leaders deliver business results. -Leaders are great coaches.

Key Leader Roles

-Expert -Administrator -People person -Strategist

Drucker's Theory

-Father of modern management -Participatory management -Leadership can be learned. -Leaders are not born, but rather staff can be nurtured to gain greater leadership competency. *When staff participate in core functions of management, organization is more effective

Connective Leadership Theory

-Focuses on interconnectedness and collaboration -Emotional intelligence -Emotional competencies -Self-awareness -Nurturing work environment can lead to improved work performance.

Key Healthcare Policy Issues

-Healthcare Reform Act of 2010 -Disparity in healthcare delivery -Commercialization of health care -Consumers *"Inefficiency and the need to improve quality of care are key concerns" page 31 Disparity is related to the number of uninsured or underinsured: disparity can be major factors in HC when providers use bias, prejudice and stereotyping when planning care. Commericialization: HC has changed from a social good to a product. Consumers: concerns listed on page 33, all the changes can cause distress.

Research priorities noted in the report to transform nursing leadership require the following:

-Identification of personal and professional characteristics most critical to leadership of HCOs such as accountable care organizations/healthcare homes/medical homes/clinics. -Identification of the skills and knowledge most critical to leaders of HCOs such as accountable care organizations/healthcare homes/medical homes/clinics. -Identification of the personal and professional characteristics most important to leaders of QI initiatives in hospitals and other settings. -Identification of mentors that have been (or could be) most successful in recruiting and training diverse nurses and nurse faculty. -Identification of the influence of nursing on important healthcare decisions at all levels. -Identification of the unique contributions nurses make in healthcare committees or boards.

How Does a Nurse Become a Leader?

-Identification of potential candidates -Setting goals -Providing mentorship -Additional education *We have discovered that to be effective, nurses need training and education to be good leaders. Critical competencies needed to accomplish the work are found on the bottom of page18-19.

The Political Process

-Impact on policies -Impact of legislation -Influenced by groups and organizations *Nurses should influence the political process that develop health policy (page 37). They can do this by understanding the process, getting involved, contacting elected officials, becoming an elected official, and supporting those involved either financially, by joining organizations that influence the process or by educating others.

Deming's Theory

-Importance of staff interaction -Develop trust -Increase communication -Importance of groups and teams *Teamwork and team ownership of work is focus of this theory, still uses centralized decision making

Where Does Authority Originate?

-Manager *Position held -Leader *Ability to influence others

Current Status of the Image of Nursing

-More women than men in the profession -Issue of the "virtue script" and how it impacts the image and the nursing profession

Healthcare Policy

-Nurses contribute to healthcare policy as patient advocates. -As leaders, nurses: *Protect patient rights. *Ensure patient needs are met. *Ensure that nursing profession retains its strength. **As Advocates, we can affect policy that affects patient rights, patient needs, and strengthen nursing's position.

Qualities that have been identified in Transformational Leaders are as follows:

-Self-confidence and self-direction -Honesty and loyalty -Commitment -Ability to develop and implement a vision

EI (Emotional Intelligence): Clusters of Competencies

-Self-management cluster -Social awareness cluster -Relationship management cluster *Emotional Intelligence is applied to leadership style; including self-confidence, empathy, change catalyst, and vision, and EI leaders are able to use good "people skills" such as ability to talk with others, develop trust, be transparent, and engage staff in progress

Contingency Theory

-Situational variables affect leadership. -Leader-member relationship -Task structure -Position power *This might also be called situational leadership.

Servant Leadership and Others

-Three related current theories *Servant, collaborative, and complexity -Integration of earlier theories and Transformational Leadership -Engaging and recognizing staff -Staff development and learning -Complex work environment -Adaptation *Servant: focuses on leader's need to serve; collaborative focuses on working together; complexity leadership recognizes that the work environment is complex, requires collaboration, direction, and commitment, plus tolerance for uncertainty

Report Research Priorities

-Transforming Nursing Practice *Scope of practice, residencies, teamwork, technology, value -Transforming Nursing Education -Transforming Nursing Leadership **These are the RESEARCH priorities of the report. Notice the last one.

Nursing Management: Summary of Key Competencies Today

-Use of information management skills -Outcomes emphasis -Delegation and facilitation -Consumer focus -Decreased emphasis on control -Increased emphasis on partnership with staff

Nursing Leadership Affects Staff Retention and Productivity

Adopting a transformational leadership style will help nurses cope with change, increase staff retention, and will improve staff's performance.

Peter Principle

Occurs when staff members are promoted but do not possess the competencies to successfully fill the new position. *Have you ever worked in a place where the person in charge is in charge because they have been there the longest? They may or may not be good at being in charge.

EI: Relationship-Management Cluster

Focuses on inducing desirable responses. Competencies: Developing others, influence, communication, conflict management, visionary leadership, change catalyst, building bonds, and collaboration and teamwork.

EI: Self-management cluster

Focuses on managing internal emotions, impulses, and resources. Competencies: Emotional self-control, trustworthiness, conscientiousness, adaptability, achievement drive, and initiative.

Explain why nurses should beinvolved in healthcare policy and the political process.

HC policy impacts nursing practice, education, staffing, roles, and responsibilities. Effected by legislation on both federal and state levels. Policy decides what services, who provides and who can receive services.

Management Grid Theory: impoverished leadership

In this style the leader has limited interest in production or people. Work requirements are established at a minimum level.

Who Is a Leader?

Leader might or might not be a manager. Manager might or might not be a leader. *Can you think of examples where either of these was true? You have probably seen leaders who were great visionaries but poor managers of the day to day tasks; or managers who were excellent detail people but poor people managers.

Laissez-faire

Nondirective, permissive, ultraliberal The leader assumes the group is internally motivated by recognition, achievement, increased responsibility, and so on and needs autonomy and self-regulation. The leader uses a hands-off approach. Leader allows staff to do as they please rather than giving implicit instructions.

Strategist or planner for the future

The leader also takes on the role of change agent and facilitator. The leader strives to make the most of change to improve the organization, even taking risks to accomplish effective change, engaging staff in the process.

People person

The leader ensures that the staff has the training and education to meet the performance requirements. The leader strives to provide work environment in which the staff feel comfortable to share information and opinions and work as a team.

Administrator

The leader needs to ensure that the organization, unit, or service operates effectively. The leader looks for ways to improve efficiency and provides the framework for practice, such as policies and procedures, guidelines, values, systems, and other necessary rules to get the job done. Is the most closely aligned role to nurse manager functions.

Management Grid Theory: Team leadership

This type of leader is very concerned about productivity and about the impact of staff morale and satisfaction.

Transformational Leadership and Change

To cope with change, healthcare organizations need transformational leaders that express vision, creativity, and empower staff.

The nurses are concerned that clinical pathways will lead to more malpractice issues. What are the legal issues surrounding the use of clinical pathways? a. Clinical pathways can be introduced as evidence in court to demonstrate a standard of care or what the outcomes should be for a patient. b. Clinical pathways can conflict with each other, thus relieving the provider of responsibility. c. Clinical pathways prevent negligent care. d. Clinical pathways cannot be applied incorrectly.

a. Clinical pathways can be introduced as evidence in court to demonstrate a standard of care or what the outcomes should be for a patient. Clinical pathways can be introduced as evidence in court to demonstrate a standard of care or what the outcomes should be for a patient. The provider is never relieved of the responsibility of using clinical judgment and reasoning. Even if the provider follows the clinical pathway, the provider can still be guilty of negligence. Even though the clinical pathway should be clearly understandable, it is possible to apply it incorrectly.

What are the primary concerns of patient consumers regarding healthcare services? a. Increased costs, decreased access and quality, and lack of competence of caregivers b. Increased communication with healthcare providers, improved trust in the system, and increased quality of care c. Increased access to care, decreased costs, and improved communication with providers d. Better communication with third-party payers, improved quality of care, and decreased costs

a. Increased costs, decreased access and quality, and lack of competence of caregivers Consumers are particularly concerned with increasing access problems, increasing costs, decreasing quality, confusion over the role of third-party payers, caregiver competence and ethics, impersonal care, and decreased communication. They are losing their trust in the healthcare system and its providers. Consumers are concerned about losing the ability to communicate with their selected healthcare provider and are losing trust in the system and its ability to provide quality care. The concern is that access to care will be more difficult, that care will cost more, and that it will be more difficult to communicate with a chosen provider. Better communication with third-party payers, improved quality of care, and decreased costs.

Which is the rationale for why nurses should participate in healthcare policy discussion? a. It determines what health care services are provided, who receives them, and who pays for them. b. It allows legislators to control healthcare. c. It keeps the cost of healthcare down. d. It keeps healthcare from becoming a monopoly.

a. It determines what healthcare services are provided, who receives them, and who pays for them. Healthcare policy is critical because it determines what healthcare services are provided, who provides the services, who can receive the services, reimbursement, quality care, improvements, and requirements. Legislators are voted for by the public and their input into healthcare policy should reflect the public's wishes. Policy is not written to allow legislators to control healthcare. Changes in healthcare policy may, in fact, cause an increase in the cost of healthcare. If healthcare policy is not written correctly, it might encourage the development of monopolies.

The documentation committee at an organization is planning to create clinical pathways. What is the purpose of these pathways? a. Pathways provide direction in the coordination of care and ensure that outcomes are met within a designated time frame. b. They do not restrict timelines for interventions. c. They increase cost without increasing quality of service. d. They do not take into account the use of new technology.

a. Pathways provide direction in the coordination of care and ensure that outcomes are met within a designated time frame. Pathways provide for efficient use of resources and controlling cost. Pathways set specific timelines for interventions and evaluation. Pathways have been shown to help control cost and to increase quality. New technology is considered when creating pathways.

The nurse manager is trying to find critical pathways to use for the patient care area but is unsuccessful. Why are pathways difficult to share between institutions? a. They are often individualized for a specific HCO to meet the practice concerns of the provider, the HCOs and patient populations. b. They focus on the general treatment for a specific illness or condition. c. They are not comprehensive because of their lack of emphasis on interdisciplinary care. d. They do not use case management.

a. They are often individualized for a specific HCO to meet the practice concerns of the provider, the HCOs and patient populations. Pathways are specific and unique to the healthcare agency or managed care organization in which they are used. One of the primary benefits of pathways is that they are interdisciplinary. Case managers often use clinical pathways to coordinate care.

The nursing student does not understand why each state has a separate Board of Nursing. Which is the primary mission of the Board of Nursing in each state? a. To protect the public b. To determine criteria for admission to schools of nursing c. To determine where nurses should practice d. To lobby for nursing rights

a. To protect the public Each state's Board of Nursing has the responsibility to protect the public in its state. State Boards of Nursing do not determine criteria for admission of schools of nursing, determine where nurses should practice, or lobby for nursing rights.

An attorney for a healthcare organization is sponsoring an educational seminar about legal issues affecting nurses. What type of cases involving nurses fall under the category of criminal law? a. Negligence, personal injury, and medical malpractice b. Assault and battery, murder, robbery, and rape c. Informed consent, confidentiality, and DNR d. Living wills and durable power of attorney for healthcare

b. Assault and battery, murder, robbery, and rape Civil law concerns the rights of individuals, usually involving payment of money or some type of compensation. Of most concern to nurses is tort law because it includes negligence, personal injury, and medical malpractice. Choices in option (b) are criminal offenses. Choices in option (c) are personal rights issues that could result in civil suits if not followed. Choices in option (d) are personal rights issues that could result in civil suits if not followed.

The nurse manager for the emergency department (ED) is preparing the staff for the arrival of multiple trauma patients. Which type of leadership will the nurse manager implement? a. Laissez-faire b. Autocratic c. Democratic d. Bureaucratic

b. Autocratic Different situations call for different types of managing style. An emergency is best handled with one person in control, delegating activities, which describes an autocratic style. The "laissez-faire" approach would be ineffective in this situation. There would be little or no direction to the staff. In an emergency, leading by majority rule would be ineffective. The bureaucratic leader strictly follows rules and regulations. This would not be an effective means of leading in an emergency.

An RN staff nurse in the intensive care unit has acquired a significant amount of personal power within the hospital organization. This acquisition of power is due in part to regularly attending local meetings of the Association of Critical Care Nurses and reading the American Journal of Critical Care. Which factor is increased for this nurse based on the participation in these activities? a. Communication network b. Credibility c. Interpersonal relations d. Persuasion

b. Credibility Credibility is gained through hard work, gaining skill and becoming competent in your work, and being very honest in your relationships with other people. This credibility gives the nurse expert power on the unit. While this nurse's communication network has likely increased, this is not the most likely factor to increase power on the unit. The nurse has likely improved interpersonal relations through this work, but this is not the most likely factor to increase power on the unit. The nurse may have learned persuasion strategies during this work, but this is not the factor most likely to increase power on the unit.

Which are examples of modern leadership theories and/or styles? Select all that apply. a. Personal quality leadership b. Knowledge management theory c. Contingency theory d. Transformational leadership e. Emotional intelligence leadership

b. Knowledge management theory; d. Transformational leadership; e. Emotional intelligence leadership The knowledge management theory is evolving as nurses are identified as knowledge workers. Transformational leadership is an important leadership theory today. Emotional Intelligence leadership is a modern theory. Personal quality leadership was a style in the 1940s and has since been replaced. Contingency theory is an older theory of leadership, but components of it exist in some modern theories.

Which statement regarding the major difference between managers and leaders will the nurse include in a presentation to fellow nurses regarding management of care? a. "Managers are seldom leaders." b. "Leaders do not make good managers." c. "Managers have legitimate power within the organization." d. "Leaders are tasked with accomplishing the work of the organization."

c. "Managers have legitimate power within the organization." Managers always will have legitimate power that belongs to them from holding the manager position. Managers are often also leaders. Some leaders are excellent managers. Managers, not leaders, are tasked with accomplishing the work of the organization.

The nurse manager is talking with the unlicensed assistive personnel (UAP) about time management. Which statement exemplifies the nurse manager in the role of coach? a. "You must get the vital signs taken on time or you will be disciplined." b. "You never report AM blood sugar levels on time." c. "Your timely response to patients' call lights is exemplary." d. "Your appearance is seldom professional."

c. "Your timely response to patients' call lights is exemplary." Telling the UAP that his or her timely response to the patients' call lights is exemplary is an example of the nurse manager as coach. Telling the UAP that he or she must get the vital signs taken on time or there will be disciplinary measures is a nurse manager who is punishment-reward driven. Telling the UAP that he or she never reports morning blood sugar levels on time is accusatory and does not provide coaching. In order for the statement regarding the UAP's appearance to reflect coaching, the manager should provide suggestions to the nursing assistant.

The nurse's neighbor asks, "Who do you think is a good pediatrician for my new baby?" The nurse replies, "Here is a website that will give you information on many pediatricians to help you choose." This is an example of which attribute of patient-centered care? a. Superb access to care b. Patient engagement in care c. Publicly available information d. Integrated and comprehensive team care

c. Publically available information Superb access to care is focused on being able to make appointments easily with short wait times, the provision of e-mail and telephone consultation, and availability of off-hours service. Patient engagement in care focuses on provision of information on treatment options, access to medical records, assistance with self-care, and counseling. Publicly available information focuses on patients' having accurate, standardized information on physicians to help them choose a practice that will meet their needs. Integrated and comprehensive team care focuses on a free flow of communication among physicians, nurses, and other health professionals with avoidance of duplication of tests and procedures.

Leaders manage _________.

change

Leadership Development: AONE states that nursing leadership play a very important role in.....

creating the work environment that attracts and keeps nurses. -Leaders need to empower their staff and exemplify leadership.

What is the central purpose of cost-effectiveness analysis (CEA) as it pertains to provision of healthcare services? a. To save money b. To understand the costs associated with new technologies c. To choose intervention for a specific patient d. Creating better health and longer life

d. Creating better health and longer life Cost savings is not the primary purpose of CEA, nor are choices (b) or (c). All of the components and other benefits of CEA are directed toward creating better health and longer life.

The unit manager of a 32-bed medical-surgical unit allows the staff nurses to do self-governance for scheduling, client care assignments, and committee work. This sometimes leads to confusion, which the staff must correct. Which type of leader would the nurse manager be considered? a. Bureaucratic b. Autocratic c. Democratic d. Laissez-fair

d. Laissez-faire The laissez-faire type of manager exerts very little control. Bureaucratic leadership is a leadership style that assumes that individuals are motivated by external forces; the leader trusts neither followers nor self to make decisions, and therefore relies on organizational policies and rules. Autocratic leadership is a leadership style that assumes that individuals are motivated by external forces; therefore, the leader makes all the decisions and directs the followers' behavior. Democratic leadership is a leadership style that assumes that individuals are motivated by internal forces; the leader uses participation and majority rule to get work done.

Which concept related to transformational leadership allows the nurse manager to change staff attitudes and behaviors towards meeting an expected outcome? a. Vision b. Influence c. Values d. Power

d. Power Power enables the leader to influence others, and by doing this, the leader can change staff attitudes and behavior, preferably moving toward meeting expected outcomes. A vision is a view of the organization in the future. Leaders use influence, which is the informal strategy of cooperation combined with formal authority of a position to develop trust. The leader needs to be persuasive and use productive communication. Values, the importance that is attached to something that guides action, are more important today in understanding effective leadership.

The complexities of the current healthcare delivery system require a variety of leadership styles. Which leadership style is the one that has emerged in response to these changes? a. Autocratic b. Democratic c. Consultative d. Transformational

d. Transformational The transformational leadership theory has emerged in response to the complexities of today's healthcare systems. Autocratic leadership follows an old theory. Democratic leadership emerged from an old leadership theory. Consultative leadership is an approach often followed by new managers until they develop confidence in their abilities.

The nurse manager is aware of the changing healthcare environment. Which situation is an important emerging challenge to changes in healthcare? Select all that apply. a. Nursing staff shortages b. Increased surgical procedures c. Decrease in immigration d. Use of advanced practice nurses e. Need to create a culture of safety

d. Use of advanced practice nurses; e. Need to create a culture of safety Use of advanced practice nurses is an emerging challenge to changes in healthcare. This need for a culture of safety is a recommendation of the Institute of Medicine. Nursing staff shortages have been prominent in health care for many years. The simple increase in surgical procedures is not a driving force for changes in healthcare. Immigration is increasing, which will change the demographics of the patient population and will present a challenge.

Collaboration, as described by the American Nurses Association....

requires understanding of the importance of expertise from within the profession and from other healthcare professionals. Requiring nurses to work across professional boundaries, which has been difficult for some nurses. They need to function with physicians, social workers, pharmacists, physical therapists, admission staff, and many more. Implies the ability to be flexible, listen to and include others, share information and ideas, work toward the best solution to a problem, and most of all be comfortable in the collaborative environment.