NURS 10060 ch. 09 + 13 + 16 notes + questions

if burnout is reduced by 10%, hospitals would same how much annually (including infections)?

$41 million

how much does the ACA provide annually to develop new training programs for each of the nurse practitioner roles?

$50 million

students in dr. reynolds's nursing fundamentals class routinely leave scathing reviews of him on a professor-rating website, refuse to participate in class activities, and complain to the dean about how strict dr. reynolds is. what activity are these students engaged in? 1. academic incivility 2. bullying 3. vertical violence 4. lateral violence

1. academic incivility

where should you post your resume?

1. linkedin 2. blogger.com 3. livecareer.com 4. wordpress.com

what are the warning signs of PTSD?

1. recurring nightmares 2. vivid flashbacks 3. depression 4. high anxiety 5. drug and alcohol abuse

of the four types of health-care systems, which is the oldest? 1. type 01 2. type 02 3. type 03 4. type 04

1. type 01

Incivility and intimidation in the academic and workplace environments are not new. However, technological developments have made them even more toxic, widely distributed, and damaging. Research indicates that cyber-harassment, vicious anonymous e-mails, hate text messages, harmful social media posts, acts of rudeness, and social rejection are forms of incivility that are on the rise. Often, students targeted in this way experience more fear, anxiety, and avoidant behaviors than if they were victims of an actual theft or physical assault.7 Incivility in the health-care setting is by no means an original problem. Over the years, it has been called by a number of names: nurses eating their young, the doctor-nurse game, assertive versus aggressive, passive-aggressive, lateral violence, and workplace violence, to mention a few. The ultimate consequence of incivility in this setting is that it jeopardizes quality of care and client safety.8 Incivility has been linked to increased medical errors and the creation of hostile academic and workplace environments. Such negative environments can create situations that end in decline of health or even loss of life. For example, a newly licensed nurse asks his preceptor how to properly place sequential compression devices (SCDs) on a postoperative client's legs. The experienced nurse "hazes" the trainee by telling him to "just figure it out." The trainee does his best, but the client later develops a deep vein thrombosis (DVT). Or what about a licensed practical nurse (LPN) in a nursing home who routinely treats her nurse aides and unlicensed assistive personnel (UAP) badly, telling them how stupid and lazy they are? The aides and UAPs respond to the LPN's incivility by not repositioning bedbound residents as frequently as ordered. These residents soon develop pressure injuries that require wound care. Could these incidents have been prevented by early recognition of the signs of severe incivility?

2

which factors will affect the evolution of healthcare delivery in the united states in the future? (select all that apply) 1. the elimination of contagious illnesses 2. an aging population 3. an increase in public wellness due to preventive care 4. an increase in morbidity due to shorter hospital stays 5. the increase in the number of people with chronic illnesses

2. an aging population 5. the increase in the number of people with chronic illnesses

mrs. vazquez had hip-replacement surgery yesterday at a large hospital. today, her case manager stops by to discuss her planned transfer to another facility for rehabilitation and physical therapy. what level of health-care delivery will the new facility provide? 1. primary care 2. secondary care 3. tertiary care 4. outpatient care

2. secondary care

in what way do the canadian and u.s. health-care systems differ? 1. in the united states, health insurance must be operated on a nonprofit basis. 2. the united states requires health-insurance coverage for all citizens; canada does not. 3. canadian health care is funded by federal tax dollars and administered by the provinces. 4. canada is a type 04 system; the united states is a modified type 01 system.

3. canadian health care is funded by federal tax dollars and administered by the provinces.

what is the world ranking of health-care for the united states?

37th out of 50 in infant mortality and chronic diseases

carli wants to include evidence of her people skills in her nursing portfolio. Which of the following is the BEST evidence for her to include? 1. a powerpoint presentation she gave on the importance of people skills. 2. a certificate showing completion of continuing education credits in psychology. 3. positive performance reviews from past supervisors. 4. thank-you letters from former clients or their family members praising carli's ability to care for and communicate with them.

4. thank-you letters from former clients or their family members praising carli's ability to care for and communicate with them.

after the APIN's completion, what was the increase in RN-BSN workforce?

4.2%

how many u.s. citizens were not insured by any type of health insurance in 2020?

47 million (25%)

what is the turnover rate for new nurses within the first year without residency programs?

75%

fewer than what percent of today's nurses are graduating from a bachelor's degree program?

<50%

what was the first step to developing a system that offered all u.s. residents the same type of health care distributed to members of the u.s. congress and the president's administration?

ACA

creating a positive work environment

Alertness is essential to defuse incivility in the work setting. Listening to fellow workers' accounts of incivility is a first step and should be followed by reflection and development of an action plan. Ignoring the problem never solves it and often escalates the frequency and intensity of the incivility. To break the cycle, it is necessary to be proactive about incivility incidents and to see them as signs of potentially more dangerous problems. "Nurses can break the cycle of incivility by looking at their own acceptance or participation in the negative behavior and using organizational structures and personal influence to change the organization's culture of horizontal violence." The Nursing Organizations Alliance recommends eight actions to help create a positive workplace environment and overcome incivility: 1. Building a collaborative culture that includes respectful communication and behavior 2. Establishing a communication-rich culture that emphasizes trust and respect 3. Making accountability central to the culture with clearly defined role expectations 4. Maintaining adequate staffing 5. Training leaders competent in cooperation and communication 6. Sharing decision-making with all those it will affect 7. Continuously developing employee skills and clinical knowledge 8. Recognizing and rewarding employees' contributions Other identified methods that help reverse horizontal violence include the following: 1. Recognizing and acknowledging that horizontal violence exists in the workplace 2. Adopting a continuous, consistent, integrated approach to promote a culture of cooperation and address instances of horizontal violence 3. Providing regular education for all staff on the subject of horizontal violence; for example, what it is, how to address it, and so on 4. Instituting mechanisms that enable and allow staff members to safely address issues of horizontal violence 5. Talking to all staff members about the phenomenon, breaking the silence31 Nurses can break the cycle of incivility by looking at their own acceptance of or participation in the negative behavior and using organizational structures and personal influence to change the organization's culture of horizontal violence.29 Some important actions nurses need to take individually to reduce the effects of lateral violence on their own careers and lives include the following: 1. Name the problem—refer to the situation as horizontal violence. 2. Raise the issue at staff meetings—bring the light of day to the problem. 3. Ask supervisors about developing a process for dealing with incivility in the workplace. 4. Learn from experience—keeping a journal raises self-awareness about personal values, beliefs, attitudes, and behavior, and it is a good source of documentation. 5. Pursue a path of personal growth—finding those things that create happiness and satisfaction and developing them goes a long way to counteract incivility. 6. Ensure the nurse is part of the solution, not part of the problem. 7. Maintain self-care behaviors—peer support, good nutrition, adequate sleep, time-outs, meditation, and exercise. 8. Speak up when horizontal violence is witnessed.31 Although horizontal violence is endemic in the workplace culture, it can be decreased and maybe even eliminated. It requires that all employees of every workplace work together to eliminate oppression and unhealthy behaviors from the environment. Nurses must be vigilant for acts of incivility that are less obvious but affect the work of nurses in all settings

Rural Primary Care

Clients living in rural areas face some different health issues than people who live in large cities. Access to health care can be difficult for clients located in a remote area. They might not be able to get to a hospital quickly in the event of an accident or emergency and have to travel long distances for basic checkups and assessments. Rural areas often have fewer family practice physicians and often no specialists at all. Health problems in rural residents tend to be more serious because of delayed diagnoses. Chronic disease rates are notably higher in clients who live in the rural areas of the United States

characteristics of PPO

Contractual agreement exists between a set of providers and one or more purchasers (self-insured employers or insurance plans). Comprehensive health services at a discount for companies under contract.

DAY-CARE CENTERS

Day-care centers can be used by any age group. Traditionally, "day-care" has referred to the care of children; however, during the past 12 years or so, adult day-care centers have become relatively common. Adult day-care centers provide services for elderly adults who cannot be left at home alone but do not require institutionalization. Services provided by adult day-care centers include health maintenance classes, socialization and exercise programs, physical or occupational therapy, rehabilitative services, and organized recreational activities. Nurses who are employed in adult day-care centers may administer medications, give treatments, provide counseling and teaching, and coordinate services between day care and home care.

medicare

Federally funded national health insurance program in the United States for people older than 65 years. Part A provides basic protection for medical, surgical, and psychiatric care costs based on diagnosis-related groups. Part B is a voluntary medical insurance plan that covers health-care provider and certain outpatient services. Part D is an unfunded insurance for medications.

medicaid

Federally funded, state-operated medical assistance program for people with low incomes. Individual states determine eligibility and benefits.

characteristics of EPO

Limited contractual agreement; less access to specialists.

solutions to horizontal violence in nursing

Nurses must try to prevent a situation from reaching the tipping point where incivility turns into violent actions. The importance of providing safety in practice needs to be continually reinforced to prevent negative outcomes from an unsafe work environment. The Quality and Safety Education for Nurse (QSEN) competencies developed by the AACN can be successful in reducing educational and workplace incivility when they are efficiently implemented into a facility or nursing program. The six QSEN areas for prelicensure and graduate nursing programs include client-centered care, teamwork and collaboration, evidence-based practice (EBP), quality improvement (QI), safety, and informatics.26 Although these areas are being addressed in the clinical setting, there is still a need to promote these competencies in education (see Chapter 4).

solutions to academic incivility

Once incivility has been identified and acknowledged in the academic and clinical settings, there are effective measures that can be taken to either decrease it or totally eliminate it. All the most effective measures to deal with lateral incivility are based on effective communication skills.

PPO

One that limits an enrollee's choice to a list of "preferred" hospitals, physicians, and other providers. An enrollee pays more out-of-pocket expenses for using a provider not on the list

EPO

One that limits an enrollee's choice to providers belonging to one organization. Enrollee may or may not be able to use outside providers at additional expense

characteristics of traditional private insurance

Policies typically expensive; most policies have deductibles that clients must meet before insurance pays

characteristics of medicare MCO

Premium generally less than supplemental plans.

medicare MCO

Program same as MCO but designated to cover health-care costs of senior citizens.

what is the largest single-budget item at most facilities?

RNs

students (inciv)

Some nursing faculty are too embarrassed to admit that incivility exists in higher education, particularly in their own classrooms, despite a documented increase in student hostility, insubordination, and even intimidation.12 Although students are often considered subordinates in the classroom setting, they wield a considerable amount of power derived from their numbers and the policies of the institution. Students can exercise this type of bottom-up vertical violence in undeservedly poor teacher evaluations, low levels of attention, inadequate note-taking, and poor grades. Examples of student-to-faculty incivility typically include the following:5 • Harassing and threatening behaviors by students toward certain instructors over grades • Filing false complaints about inappropriate sexual behavior • Cutting classes because students consider them boring or the instructor stupid • Cheating on tests and homework assignments to get better grades • Refusing to participate in class activities • Being unprepared for classes by not doing reading assignments or written work • Distracting teachers and other students by asking irrelevant or confrontational questions • Complaining behind the teacher's back to the teacher's superiors Examples of student-to-student incivility include the following: • Obtaining study notes from the previous year's classes and using them as bargaining chips with their classmates • Ridiculing (bullying) students who are considered outcasts by their classmates because they do not fit the model of the majority in terms of weight, clothing, hairstyle, and disposable income • Two-faced behavior, where students act nice to a classmate's face but are nasty behind his or her back. These behaviors are found throughout higher education. It is critical for nursing faculty to deal constructively with disgruntled students in a timely manner. When students' rude and disruptive behavior is not addressed, it may turn into physical violence. Most nursing students recognize the importance of treating others respectfully, studying diligently, disagreeing graciously, and listening attentively. However, when stress levels are high, they may struggle to remain civil.1 Studies show a correlation between increased student stress and student incivility, resulting in some faculty doubting their abilities as educators or even having concerns for their personal safety. The key to effective education lies in the quality of the interpersonal relationship between student and teacher.12 What can nursing educators do to promote the positive interpersonal relationships that encourage civility? The National League for Nursing (NLN) faculty development program includes strategies to manage incivility and offers a program of co-sponsorship for those interested. Although many schools of nursing actively engage in curriculum and program improvement measures, few examine the impact of incivility on student learning. Examples of incivility in nursing education range from minor insults, delivered either electronically or face to face, to full-blown acts of physical violence.18,19 Regarding the rise of incivility in nursing education, two questions have dominated the literature in recent years: (1) What factors contribute to it? (2) What measures can be taken to minimize its impact on student learning?

Telehealth and E-Health

Telehealth, or telephone health, advice services have experienced major growth in Canada in recent years. These services are generally available 24 hours a day, 7 days a week. Nurses answer the phones, supply answers to health-related questions, and advise callers on how to handle nonurgent health situations.24 Although telehealth activities have grown significantly in the past 10 years, their full potential has not yet been reached. The success of telehealth rests on a full and seamless integration of the service as part of the health-care delivery system.24 Understanding and eliminating barriers to the use of telehealth while capitalizing on the opportunities it presents will eventually improve the acceptance and mainstreaming of telehealth technologies. Telehealth is discussed in detail in Chapter 27. E-health, or electronic health, advice takes the telephone into the computer age. Rather than calling a resource center for information, the client can use a computer, smartphone, or tablet to access any number of sites that provide health-care information. Unfortunately, some of the information available online may not be completely accurate. Persons who use these resources need to evaluate the quality and the accuracy of the information they find.

stop the spiral

The incivility spiral (Fig. 16.3) depicts uncivil behavior between two people or two groups. The behavior can escalate into violence, or those involved can let go of their resentment and stop the incivility from progressing. The path chosen depends largely on communication, both at the beginning of the conflict and during its progression. Conflict resolution interventions are essential to the process. The higher up the spiral the uncivil behavior advances, the more coercive behavior is displayed and the greater is the desire for violent revenge. The victim of the incivility experiences loss of face, increased anger, and a desire to fight back against the one creating the hostile environment. Once the tipping point is passed (i.e., the point in the spiral where neither party can back down), the potential for physical violence increases dramatically. Interrupting the spiral with positive interventions and communication before the tipping point is reached is essential in defusing the anger.

Long-Term Care Facilities

The majority of senior citizens in North America continue to live in their own homes. However, a growing group of seniors have health needs that require long-term care or extended care services. Some individuals may require rehabilitation or intermediate care, whereas others require extended, long-term care. These services are provided for both elderly and younger clients who have similar needs, such as clients with spinal cord injuries. The current trend in extended care facilities is to provide care in a homelike atmosphere and base programs on the needs and abilities of the clients, or residents, as they are commonly called, of the facility. Many of these residents require personal services such as bathing and assistance with activities of daily living. Others may require higher-level skilled nursing care such as tube feedings and catheter management or even occasional medical attention. Because of the range of needs of clients, some facilities will admit clients with specific needs to specific areas of the facility where the appropriate services are provided. In Canada, clients considered for admission to long-term care facilities must meet specific guidelines. Assessments of client needs and the nursing services available must be completed before the client is admitted to the facility. Frequently, there are waiting lists for admission to extended care facilities. In the United States, many long-term care facilities are for-profit institutions that rely heavily on Medicaid and Medicare reimbursements. However, major cuts to Medicare are being proposed in addition to the loosening of rules that help prevent abuse of the elderly in nursing homes.21 When Medicare coverage is limited, the resident must use private insurance or personal resources to pay the difference in cost.

targets

The victim of bullying, or any level of incivility, is often called the target. Elements that may make a person a target include his or her religion, gender, sexual orientation, race, physical characteristics such as weight, physical defects or differences, or a particular skill or ability a person may possess. Bullies perceive targets to be weak or timid. Targets may have a quieter, more self-conscious demeanor than that of the bully or of their peers, but that demeanor is not ultimately why a bully chooses them. In actuality, targets have attributes (1) that are foreign to the bullies or (2) that the bullies have—and despise—in themselves. Feeling threatened by the unfamiliar or by revulsion at themselves is what fuels bullies to attack. Targets usually feel helpless to stop the bullying and do not know how to defend themselves from it. Bullying usually involves elusive methods of coercion, such as making intimidating comments on social media (cyberbullying), ostracizing a person from the group, or making a person the butt of practical jokes. One-on-one bullying from peers is sometimes called peer abuse or lateral violence, but in groups, the primary bully may have co-conspirators that contribute to or prolong the bullying activities. Sometimes a bullying culture can develop in the workplace or educational setting, where it is accepted as part of the normal environment.

what is incivility?

This conversation between two experienced nurses was recently overheard at a major state nursing conference: Nurse 1: "I can't believe how impolite people are now. No one ever seems to say please or thank you or you're welcome anymore." Nurse 2: "I know, I had my arms full of packages when I arrived yesterday, and not even one of the three or four people standing by the door offered to help." Nurse 1: "I was almost hit in the hotel parking lot by some guy who tried to muscle into a space I was already pulling into!" Nurse 2: "I guess our society has just gotten a lot more rude over the years." Society in general and the nursing profession in particular seem to be filled with complaints about "incivility," both in academia and in the workplace. The simplest definition of incivility is the lack of civility. However, it is a very broad term that includes a wide range of what is considered unacceptable behavior in a civilized society. Incivility can be viewed as a continuum of impolite behaviors with a lot of overlap between them. All of the individual stages usually begin with some type of covert, subtle psychological behavior. However, incivility can lead to physical violence if taken to its extreme. As shown in Figure 16.1, on the right end of the scale are overt violent actions such as vandalism, physical assault, and battery. On the left end of the scale are more surreptitious and psychologically based behaviors such as discrimination, rudeness, verbal bullying, and psychological abuse. Between the extremes is a range of behaviors that are either more or less overtly violent with a great deal of overlap.7 In the academic or classroom setting, incivility is any type of human activity or interaction that creates an unpleasant or negative learning atmosphere. Examples of classroom incivility engaged in by students include inattentiveness (e.g., texting, side conversations), coming unprepared for class, not listening, interrupting others who are speaking, and tardiness. Examples of faculty incivility include not addressing students by their preferred name, belittling or demeaning students because of questions they ask or answers they give, and not keeping scheduled office hours. Classroom incivility can also arise due to grading procedures, faculty evaluations, and cheating or attempting to cheat. The end result is that students do not learn, and the stress levels of both students and faculty increase. In the health-care work setting, incivility takes on many forms, but they all produce a threatening and polarized work environment that reduces the quality of client care. Subsequently, nurses feel dissatisfied, angry, anxious, and unhappy. Stress levels are unnecessarily high, and turnover rates increase. Generally, incivility is a societal problem. Many professional psychologists, educators, and health-care providers agree that civility has declined in society, but they are hopeful that behavior and relationship education will result in more harmonious discourse while elevating expectations for appropriate behavior. People under stress can potentially lose their sense of civility, which can escalate, turning into outright violence if left unchecked.

characteristics of long-term care insurance (private)

Very expensive; good policy has a minimum waiting period for eligibility, payment for skilled nursing, intermediate or custodial care, and home care.

what should be sent in with every mailed resume?

a cover letter

in its extreme form, cyberbullying can be considered ____________________ punishable by law

a crime of harassment

what defines a nursing shortage?

a lack of qualified, staffed nurses in the health-care system

describe a preceptorship

a student is assigned one RN to work beside for most of the semester that works the same hours and on the same unit that the RN is assigned. the student absorbs the role expectations of the workplace and the perceived role of the student also changes.

how can you categorize tasks?

a, b, and c

what does APIN stand for?

academic progression in nursing

what does ACA stand for?

affordable care act (obamacare)

what are the two problems with demographics affecting health-care delivery?

age and chronicity

which of the following behaviors are characteristic of both bullying and lateral violence? (select all that apply) 1. can escalate to physical actions 2. intimidation 3. name calling 4. verbal sarcasm 5. use of social media to attack target

all of the above

category b tasks

baths, linen changes, lunch breaks, and charting

what is a great way to close an interview?

by asking the interviewer for a tour

how can you offset negative information about yourself?

by introducing as much positive information as possible

who spends less per person on healthcare? u.s. or canada

canada

category c tasks

cleaning up and organizing

what is a key element of the ACA?

clients must be evaluated by a primary health-care provider before being referred to a secondary health-care provider

most nurse practitioners are currently based in what kind of clinic?

community

between now and 2050, the number of people 65+ is expected to __________, one in __________ people will be elderly, and their numbers will reach __________ million.

double; five; eighty

describe how the roles change from nursing school to nursing practice

during nursing school, clinicals focus on a patient or two at a time and have more than enough time to focus on all of the needs, wants, and responsibilities of your patient(s). in nursing practice, there are six to eight clients assigned to you. this allows for the most brief, required care without much time leftover per client.

what is a preceptor clinical experience?

during the senior year of nursing school, these are instituted clinical experiences that help the student feel more comfortable in the role of RN

nurses who do what will be the leaders that health-care requires?

educate themselves about policy changes and who find opportunities to shape them

tertiary care

emphasizes rehabilitative services, long-term care, and care of the dying. Nursing services are essential in all three levels of health care, in both the hospital and community settings.

health-care systems: type 02

hybrid of type 01 and type 03. egalitarian are high priority, but practitioner and client autonomy are important too. uses tax dollars to pay for health services through insurance available from non profit agency (government)

role conflict/ambiguity exists when a person is unable to integrate what three distinct aspects of a given role?

ideal, perceived, and performed role images

what are three types of roles?

ideal, performed, perceived

when client-to-nurse rations increase, so does the spread of __________.

infection

rodney, a new RN, just started training on a busy medical-surgical unit. he has been warned that the experienced nurses on the unit will probably expect him to "pay his dues" just as they had to. this type of initiation practice is commonly referred to as "____________________"

nurses eat their young

what are multiskilled practitioners?

nurses who can practice independently in several different settings (ex: a home-care, community, and hospice nurse)

reality shock is the transition of what?

nursing student to registered nurse

what was one of the most significant factors that influenced cost control?

prospective payment system (PPS) in 1983

what preventative care tactics can all americans receive with no out-of-pocket cost?

prostate exams, mammograms, annual physical exams, and immunizations

what is on the front lines of the influx of new clients?

public health

what do applicant tracking systems (ATS) and (RRR) do?

read the resume and search for key words, disqualifying statements, and more via AI.

____________________ is the transition from nursing student to registered nurse

reality shock

increasing the number of __________ they employ is the only way to increase the quality of care they provide

registered nurses

what do taxes cover?

some fund home care, provide coverage for prescription drugs, but it depends on the system type.

what strategies can help nursing graduates increase their chances of being hired?

take advantage of preceptor/intern/extern experiences and attempt to meet their clinical obligations in the institution where they want to be employed

what has made incivility and intimidation more toxic in the academic and workplace environments, causing them to be even more toxic, widely distributed, and damaging

technological developments (cyberbullying)

what does the angel of mercy do (is it practical)?

the angel of mercy is the ideal role of the nurse that can maintain all personal values, has very high intelligence, great decision-making, great people skills, and works well to communicate with patients. no, it is not practical and does not exist.

how can acts be perceived as civil or uncivil?

the context of a situation, the culture of an organization, and the power difference between the participants

what is cognitive dissonance?

the difference between expectation in reality produces this in many new graduate nurses

what differentiates professional nursing from medicine?

the goal of maintaining health and preventing disease

health-care systems: type 04

this keeps the general public healthy so that they can contribute to society and the economy. in this system, health-care is an essential service or "right" that does not really involve compassionate motives. providers are agents of the state who work to help others work efficiently

secondary care

the focus shifts toward emergency and acute care. Secondary services are frequently provided in hospitals and other acute care settings, with an emphasis on diagnosis and the treatment of complex disorders.

vertical violence

the inappropriate use of coercive power by a superior. less often, bottom-up vertical violence may be carried out by subordinates against a higher-ranking person

what is one reason for the nursing shortage?

the increasing demand for health-care

what did the ACA set the stage for?

the largest overhaul of the u.s. health-care system

name at least three other things that have contributed to the nursing shortage

unprofessional image of nurses in the media, long hours, multiple shifts, short staffing, low wages, and decreased number of university nursing applicant acceptance

community health-centers

use a team approach involving physicians, nurse practitioners, and community nurses working together to provide health services. Most centers have diagnostic and treatment facilities that provide medical, nursing, laboratory, and radiological services. Some centers may also provide outpatient minor surgical procedures that allow clients to remain at home while accessing health services as needed.

It is believed that a focus on __________ and a population living a healthier lifestyle will reduce the number of people who require expensive illness-care services

wellness

what is a performed role?

what the practitioner of the role actually does

what two things can lessen reality shock?

preceptorships and internships

what does burnout result from?

professional and personal dissatisfaction

nurses suffering burnout have also been linked to what?

malpractice, medication mistakes, missing treatments, and missing signs and symptoms of serious change in condition

what is the cost for losing and replacing a new RN?

$80,000

ethical prohibitions to incivility

(TJC, ANA, NLN) he Joint Commission notes: Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators, and managers to seek new positions in more professional environments. Safety and quality of patient care is dependent on teamwork, communication, and a collaborative work environment. To assure quality and to promote a culture of safety, health care organizations must address the problem of behaviors that threaten the performance of the health care team.26 The ANA Code of Ethics also has principles that support ethical, civil, and caring relationships. (For more information on the code, see Chapter 6.) It was developed as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession. The NLN website gives high priority to the Code of Ethics and to faculty responsibility as a way of dealing with student behavioral problems. The specific parts of the ANA Code of Ethics (2015) that relate to incivility are as follows: 1.0 "The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual...." 1.5 Principles of respect extend to all encounters, including colleagues. "This standard of conduct precludes any and all prejudicial actions, any form of harassment or threatening behavior, or disregard for the effect of one's actions on others." 3.5 "Nurse educators have a responsibility to ... promote a commitment to professional practice prior to entry of an individual into practice."27 The Joint Commission, the ANA, and the NLN make it clear that underlying attitudes of caring and respect are essential expectations of those who enter the profession of nursing. It is essential for nurses to learn and internalize these attitudes. A caring attitude is not transmitted from generation to generation by genes—it is transmitted by the culture of a society.3 The ANA's Task Force on Workplace Violence maintains a website that assists nurses in understanding more about this problem

thirteen qualities of transformational leaders

1. You hold a vision for the organization that is intellectually rich, stimulating, and rings true. 2. You are honest and empathic. People feel emotionally safe and trust that you have their interests at heart. 3. Your character is well developed, without the prominent dark side of ego power. 4. You set aside your own interests in looking good and getting strokes instead making others look good and giving others power and credit. 5. You evince a concern for the whole (not just your own organization), reflected in your passionate and ethical voice being heard when necessary. 6. Your natural tendency is to help others engage, deepen their perspectives, and be effective. 7. You can share power with others—you believe sharing power is the best way to tap talent, engage others, and get work done in optimal fashion. 8. You risk, experiment, and learn. Information is never complete. 9. You have a true passion for work and the vision. It shows in your time commitment, attention to detail, and ability to renew your energy. 10. You communicate effectively both in listening and in speaking. 11. You understand and appreciate management and administration. They appreciate that you move toward shared success without sacrifice. 12. You celebrate the now. At meetings or anywhere else, you sincerely acknowledge accomplishment, staying in the moment before moving on. 13. You persist in hard times. That means you have the courage to move ahead when you are tired, conflicted, and getting mixed signals.

which of the following behaviors would be considered civil in both the classroom and the clinical setting? (select all that apply) 1. assume goodwill. 2. listen to and respect others. 3. be on time. 4. do not ask questions. 5. do not share information.

1. assume goodwill. 2. listen to and respect others. 3. be on time.

which elements of a job search can you work on while you are in nursing school? (select all that apply) 1. creating a résumé 2. building a portfolio 3. writing a cover letter 4. arranging an interview 5. following up

1. creating a résumé 2. building a portfolio

what are some ways that can help with PTSD? (name a few)

1. do not watch constant replays 2. friends and family! 3. eat healthy regularly 4. exercise often 5. no drug/alcohol abuse 6. get back in a routine 7. be able to seek help if needed

a nursing instructor has just finished lecturing on the topic of the job-search process and is taking questions from the class. Which comment by a student indicates the need for clarification? 1. employers can't see what i post on social media as long i use appropriate privacy settings. 2. i like the idea of a website portfolio rather than a heavy physical one you have to carry around. 3. even though I'll wear scrubs at work, it's important to dress up for the job interview. 4. after an interview, it's a good idea to send a letter or e-mail thanking the interviewer

1. employers can't see what i post on social media as long i use appropriate privacy settings.

what are the symptoms of burnout (name at least 5)

1. extreme fatigue 2. exhaustion 3. fequent illness 4. overeating 5. headaches 6. sleeping problems 7. physical complaints 8. alcohol and/or drug abuse 9. mood swings 10. emotional displays 11. anxiety 12. poor-quality work 13. anger 14. guilt 15. depression

what should a resume include (name four or five)

1. full name, address, telephone number, and email address 2. educational background, naming institution, location, year(s), and degree(s). no high school necessary 3. former employers, year(s), title, supervisor's full name and telephone number, and job description (basic non-healthcare jobs could be omitted) if needed, then supervision of other employees or demonstrated some higher degree of responsibility such as developing budgets, handling money, or preparing work schedules, it should be included and described. 4. escribe any scholarships, achievements, awards, or honors that you have received, along with any professional development activities or certifications (e.g., BLS, ACLS) in which you participated, starting with the most recent. 5. professional memberships, offices held, and date of memberships. 6. list any publications. if both books and journal articles were published, list the books separately, starting with the most recent. 7. list any military service, including name of branch, location, and years. 8. include an "Other" category to describe any unpublished materials produced (e.g., an internal hospital booklet for use by clients), research projects, fellowships, grants, and so forth.

sue, a charge nurse on a mother-baby unit, goes to see her primary care physician. sue reports that she feels exhausted all the time, has difficulty sleeping, experiences frequent headaches, and feels anxious and overly emotional. her healthcare provider orders laboratory tests to rule out physical ailments. which of the following questions would BEST help the provider assess if sue is feeling burned out? 1. how are things going at work? at home? 2. What have you tried doing to feeling better? 3. What do you think is going on? 4. Are you feeling burned out at work?

1. how are things going at work? at home?

which statement about incivility in the educational setting is true? (select all that apply) 1. incivility in the educational setting may involve administrators, faculty, and students. 2. in the nursing classroom, instructors are responsible for policing uncivil behavior. 3. incivility among nursing educators is sometimes related to differences in educational backgrounds and professional preparation. 4. students are typically uncivil to one another, not to instructors. 5. there is a correlation between increased student stress and student incivility

1. incivility in the educational setting may involve administrators, faculty, and students. 3. incivility among nursing educators is sometimes related to differences in educational backgrounds and professional preparation. 5. there is a correlation between increased student stress and student incivility

what are the skilled needs?

1. management of care: For example, injections, IV lines, wound care, diabetes or its complications, urinary catheters, rehabilitation, respiratory therapies 2. client evaluation: For example, unstable conditions, pain, response to medications, neurological functioning, environment 3. client education: For example, medications, glucose monitoring, disease management, prevention measures, activities of daily living

how does burnout syndrome happen?

1. nurses know what/how they should take care of their patients 2. when they cannot, high apprehension is produced 3. high levels of anxiety and apprehension lead to physical and emotional symptoms 4. when these symptoms are high enough, this becomes burnout syndrome

how has the profession of nursing in the united states affected and been affected by health-care reform? (select all that apply) 1. nurses participated in the planning of the affordable care act (aca). 2. nurses were vital to the initial implementation of the aca. 3. thousands of new nurses have been recruited to ease the nursing shortage. 4. nursing's historic commitment to health maintenance and disease prevention are reflected in the preventive-care provisions of the aca. 5. because of the aca, nurse practitioners play an increasingly important role as primary care providers

1. nurses participated in the planning of the affordable care act (aca). 2. nurses were vital to the initial implementation of the aca. 4. nursing's historic commitment to health maintenance and disease prevention are reflected in the preventive-care provisions of the aca. 5. because of the aca, nurse practitioners play an increasingly important role as primary care providers

federal transfer payments in the canadian government

1. per capita payments were made on the basis of previous expenditures and adjusted regularly in relation to the gross national product. 2. tax points were transferred by the federal government, allowing provinces to reduce their tax contribution to the government and at the same time increase the portion of tax collected at the provincial level. 3. equalization of tax points was distributed among poorer provinces. 4. additional per capita payments were indexed to help pay for nursing home, residential home, and ambulatory care (1977)

carol is listing examples of civil classroom behavior for the nursing students in her study group. which example should the other members of the study group question? 1. play computer games quietly so as not to disturb others. 2. turn cell phones on silent. 3. do not allow the door to slam shut. 4. be present and on time

1. play computer games quietly so as not to disturb others.

what are the criteria for the canada health and social transfer? (CSHT)

1. public administration: The health insurance plan must be administered and operated on a nonprofit basis by a public authority, responsible to the provincial government, and subject to audit of its accounts and financial transactions. 2. Comprehensiveness: The plan must cover all insured health services provided by hospitals, medical practitioners, dentists, and, where permitted, services rendered by other health-care practitioners. 3. Universality: One hundred percent of the insured population of a province must be entitled to the insured health services provided for by the plan on uniform terms and conditions. 4. Portability: Residents moving to another province must continue to be covered for insured health services by the home province during any minimum waiting period, not to exceed 3 months, imposed by the new province of residence. For insured persons, insured health services must be made available while they are temporarily absent from their own provinces on the following basis: • Insured services received out of province but still in Canada are to be paid for by the home province at host province rates unless another arrangement for the payment of costs exists between the provinces. Prior approval may be required for elective services. • Out-of-country services received are to be paid, as a minimum, on the basis of the amount that would have been paid by the home province for similar services rendered in the province. Prior approval may be required for elective services. 5. Accessibility: The health insurance plan of a province must provide for the following: • Insured health services on uniform terms and conditions and reasonable access by insured persons to insured health services not precluded and unimpeded, either directly or indirectly, by charges or other means. • Reasonable compensation to physicians and dentists for all insured health services rendered. • Payments to hospitals in respect to the cost of insured health services. Although discussion and debate continue surrounding the federal and provincial responsibilities for health-care funding and the escalating costs associated with health care, the CHA continues to be the operating model for the Canadian health-care system

what are the steps in fighting workplace cyberbullying?

1. save evidence 2. present, in a private conversation, the evidence to the person who made the comments 3. document the conversation and outcome 4. if the bullying continues, report to the nurse manager with evidence 5. if behavior continues, report to CNO

united states has the highest rate of what things?

1. the highest rate of death by gun violence, by a huge margin 2 The highest rate of death by car accidents 3 The highest chance that a child will die before age 5 4 The second-highest rate of death by coronary heart disease 5 The second-highest rate of death by lung cancer and COPD 6 The highest teen pregnancy rate 7 The highest rate of women dying due to complications of pregnancy and childbirth This disparity is attributed in large part to the lack of access to and prohibitive cost of health-care services, not the quality of the services available. With the weakening of the ACA, these trends are anticipated to continue

brian's unit manager suspects that brian may be starting to experience burnout. what factors would lead the manager to this conclusion? (select all that apply) 1. they work in a neonatal intensive care unit. 2. brian has always been a hard worker and a perfectionist. 3. brian is a team player and assists other staff when he is able to. 4. the manager overhears Brian asking for another nurse's advice about a client. 5. the hospital has had to freeze staff salaries and cancel bonuses due to financial problems. 6. brian requests additional training to improve his skills

1. they work in a neonatal intensive care unit. 2. brian has always been a hard worker and a perfectionist. 5. the hospital has had to freeze staff salaries and cancel bonuses due to financial problems.

why is it important to reduce the number of uninsured people in the united states? (select all that apply) 1. to make health care more affordable for all citizens 2. to reduce costs passed on to hospitals and taxpayers when uninsured people receive care in the emergency department 3. to encourage those currently uninsured to take more accountability for their health 4. to improve public health by ensuring access to preventive care 5. to reverse the trend of rising costs for inpatient care and pharmaceuticals

1. to make health care more affordable for all citizens 2. to reduce costs passed on to hospitals and taxpayers when uninsured people receive care in the emergency department 3. to encourage those currently uninsured to take more accountability for their health 4. to improve public health by ensuring access to preventive care

what are the five steps to assembling a portfolio?

1. use a binder 2. ask yourself questions 3. interview a professional 4. showcase your education 5. use the internet (web version)

how much exercise is essential to prevent burnout?

1.5 hours a week

from 2012 to 2016, the number of students in RN-to-BSN programs increased by how much?

10%

how many home care agencies care for how many clients?

12,400 agencies : 4.9 million clients

how many people will lose their health insurance if the ACA mandate of insurance is repealed?

15 million

in 2016, how many first-time NCLEX-RN testers were there?

165,299 (165,000)

health accounted for what percent of the GDP in the u.s. in 2014?

17.9%

khadija, a nursing student, wants to improve her time-management skills. which is the first step she must take to better manage her time? 1. learn how to multitask. 2. set priorities. 3. delegate household duties to her roommates. 4. overcome her tendency to procrastinate.

2. set priorities

the influx of some __ million new clients into the health-care system offered new challenges and opportunities for nurses to expand their profession and practice to the levels for which they were educated

22

what percent of americans have no health insurance and are limited in their ability to access health-care?

25%

in what way does improving one's time management help to prevent nursing burnout? 1. effective time management allows the nurse to complete all the necessary activities of patient care and have time to relax a little, too. 2. effective time management allows the nurse to do less work by delegating to an LVN/LPN or to unlicensed assistive personnel. 3. effective time management allows nurses to do what must be done and use the remaining time to do the nursing activities that bring them the most professional and personal satisfaction. 4. effective time management allows the nurse to complete client care early in the shift and then focus on professional-development activities, such as pursuing an advanced degree.

3. effective time management allows nurses to do what must be done and use the remaining time to do the nursing activities that bring them the most professional and personal satisfaction.

which statement best describes the relationship between caring and civility in nursing? 1. giving care that exactly follows facility policies and procedures is how nurses show civility. 2. it is easier to assess a nurse's caring than it is to assess his or her civility. 3. engaging in civil behavior is a way to demonstrate caring for clients, coworkers, and others. 4. focusing on civility takes time and attention away from caring in nursing practice

3. engaging in civil behavior is a way to demonstrate caring for clients, coworkers, and others.

marla, a medical-surgical nurse for 10 years, is giving jerome, a new graduate RN, advice on self-care behaviors he can use to prevent burnout. which statement by jerome indicates that he has understood marla's teaching? 1. i will decompress after a difficult shift by having a few beers with friends. 2. i get all the exercise I need during a busy shift. 3. i will make sure to get 8 hours of sleep each night. 4. i can postpone my annual wellness examination because I'm a health professional.

3. i will make sure to get 8 hours of sleep each night

how does medicare encourage facilities to provide high-quality, cost-effective health care? 1. it pays more if a client is discharged sooner than expected. 2. it limits the number of diagnostic tests and procedures a facility can provide. 3. it offers facilities incentives for shorter-than-expected hospital stays and penalizes them for longer-than-expected stays 4. the greater availability of family members nowadays to care for clients at home

3. it offers facilities incentives for shorter-than-expected hospital stays and penalizes them for longer-than-expected stays

what is the main difference between bullying and lateral violence? 1. bullying can result in physical violence; lateral violence does not. 2. lateral violence is a response to vertical violence; bullying is not. 3. lateral violence occurs primarily in the work setting. 4. targets of bullying are chosen because they have attributes that are foreign to the bullies; targets of lateral violence are chosen because the bullies see their own despised attributes in the target.

3. lateral violence occurs primarily in the work setting.

the insurance industry has tried to manage healthcare costs in a variety of ways. what do these plans have in common? 1. they require facilities providing services to medicare clients to be reimbursed using a fixed-rate system and include monetary incentives to reduce the length of hospital stays. 2. they require participants to pay a flat rate, usually through their employer, to belong to a managed care organization for a specified period of time. 3. they seek to provide services to the maximum number of people at the lowest possible cost. 4. they set lifetime spending caps on individuals.

3. they seek to provide services to the maximum number of people at the lowest possible cost.

mara is reviewing her class notes on incivility and nursing ethics. which of the following notes should she request clarification about? 1. in 2016, the joint commission developed guidelines to address lateral violence. 2. the joint commission noted that lateral violence contributes to medical errors, patient dissatisfaction, and adverse outcomes. 3. the ANA code of ethics has principles that support civility. 4. the ANA code of ethics mentions extending respect to all encounters, except for colleagues

4. the ANA code of ethics mentions extending respect to all encounters, except for colleagues

how many people enrolled in the ACA as their primary insurance in 2017-2018?

8.2 million

what does the department of health and human services project the nursing shortage to be in 2025?

808,000 RNs

what is the retention rate for new nurses that have completed the nursing residency program?

95.6%

a model for civility

Administrators in colleges and universities have an important role in building a proper workplace environment. This begins with the first interview of the hiring process. Applicants need to be asked specific questions about civility. Following are some samples of these questions: • What things about the people you are working with really irk you? • What do you do when you become angry or irritated with another employee or supervisor? • On a scale of 1 to 10, with 10 being the best possible, how would you rate your abilities in the areas of collaboration, collegiality, and civility? Explain your answers.23 The positive or negative attitudes of administrators can determine whether stressful situations are addressed or ignored. Unaddressed, the culture of incivility permeates all aspects of the organization, but when constructive problem-solving and respectful encounters are the norm, a culture of civility can prevail. A civil climate enhances both teaching and learning. A recently developed model allows faculty and students to promote civility in the academic setting. Although the model does not include administrators, their responsibilities, or their perceptions about incivility, it emphasizes the critical importance of the climate and infrastructure established by administrators. It is called the conceptual model for fostering civility in nursing education (Fig. 16.2). The model depicts how, as stress levels increase for both students and faculty, student attitudes of entitlement and faculty attitudes of condescending superiority can lead to incivility. The conceptual model provides a basis for creating a culture of civility by focusing on the levels of stress for nursing faculty and students. Possible research questions include the following: 1. What do you perceive to be the biggest stressors for nursing students? 2. What uncivil behaviors do you see nursing students displaying? 3. What do you perceive to be the biggest stressors for nursing faculty? 4. What uncivil behaviors do you see nursing faculty displaying? 5. What should be the nursing administration's role in addressing incivility?

what is civility?

Although almost everyone has a basic understanding of what civility is and is not, it is more difficult to actually define. The word civility is derived from the Latin word for citizen. It appears that to be a good Roman citizen, a person had to be polite and helpful to their fellow citizens. In a global context, civility is often thought of as good manners; however, its meaning is much broader. Civility is based on recognizing that all human beings have value. A simple definition of civility is for people to treat others as they would wish to be treated (the Golden Rule). Empathy is key to recognizing how others might want to be treated and what they may perceive as unpleasant actions by others. A more activist view of civility sees it as taking positive actions that fight injustice and oppression while at the same time respecting the rights of others. The Civil Rights Act of 1964 requires that all individuals have equal protection under the law, regardless of race, color, religion, gender, national origin, or disability. An analysis of existing research shows that even perceived discrimination can produce negative mental and physical health outcomes such as elevated stress levels and self-destructive behaviors. Protection from discrimination can be found in social support, active coping styles, and group identification.

vicious circle

Another negative outcome of vertical violence is the "bullying vicious circle" that is perpetuated in the organization. This phenomenon is particularly evident in organizations such as health-care facilities and educational settings, where the persons who are bullied when they first start are likely to move into positions of power later. An example is when a new faculty member who was bullied when he or she first started now has several years of experience and becomes the bully to newly hired faculty. The same cycle often occurs on nursing units in a hospital, where new nurses who were bullied become the charge nurses and bully other new nurses. It becomes part of the culture where it may not even be recognized as bullying. Often, there is an attitude of "I went through it, so now it's time for you to pay your dues."

Retirement and Assisted Living Centers

As the population continues to age, assisted living centers are increasing in popularity because they allow clients, or residents, to maintain the greatest amount of independence possible in a partially controlled and supervised living environment. These centers consist of separate apartments or condominiums for the residents and provide amenities such as meal preparation and laundry services. Many centers work closely with home care and other social services to provide the resources required for residents to maintain a degree of independence. Case coordinators, often nurses, help residents navigate their way through the complex paperwork involved in obtaining required services. Some assisted living centers are attached to long-term care facilities. According to the level of care required, residents may be transferred to various facilities as their care needs change. The goal of the Gold Standards Framework program, started in the United Kingdom, is to ensure that quality of care persists up to the time of death

Vertical Violence

Bullying from a superior, or vertical violence, is a type of harassment that can permeate the entire organization and have a detrimental effect on its effectiveness. The concept of inappropriate use of coercive power becomes a key element in vertical violence. When bullies are in a position of power or are perceived to have power, they can do a lot of damage to the organization and the people who work for them. The people they supervise are in a constant state of fear and work in a defensive mode, avoiding contact with the bully or anything that may bring attention from the bully. They feel anger toward the bully and have lower self-esteem because they do not know what to do about the bullying. As a result of this type of atmosphere, productivity and innovation decrease, morale suffers, and the best workers seek employment elsewhere. However, superiors usually forget that vertical violence can move in both directions, and they themselves may become the targets of bottom-up vertical violence. Although subordinates may seem to be powerless in the face of a bullying superior, they actually do have considerable power both as a collective and as individuals (see Chapter 1). The superior's position is often dependent on the productivity of the people being supervised. Some extremely disgruntled employees may devise subtle, passive-aggressive ways to decrease productivity, sabotaging the boss and the organization. When they lower productivity enough, the boss is going to be confronted by his or her superior to see what the problem is and may get fired as a result. In the extreme, bottom-up vertical violence may result in the employee "going postal" and causing physical injury or even death to those he or she holds responsible for causing distress. (See "Workplace Violence" later in the chapter.)

bullying

Bullying is a type of incivility that is one step beyond impoliteness. It can be defined as any behavior that could reasonably be considered humiliating, intimidating, threatening, or demeaning to an individual or group of individuals. It can occur anywhere and at times becomes habitual, being repeated over and over.9 Although almost everyone has experienced some type of bullying during their lives, bullying is a complex concept that includes a number of elements. In the U.S. legal system, physical abuse, emotional abuse, verbal abuse, or any combination of the three are considered bullying and may be punished by fines in the civil system or jail time in the criminal system (see Chapter 8). The goal of bullying is usually to coerce or intimidate another person or group of people into doing something that they do not want to do. However, sometimes the goal is to merely humiliate a person or group because of some perceived difference or weakness. Hazing and initiation rites are also a form of bullying. Most people who bully others have low self-esteem along with a poor self-image and a lack of empathy, and they use bullying to make themselves feel more powerful.6

faculty (inciv)

Conflicts are common within groups of highly educated and extremely motivated individuals such as are found in nursing faculty. These conflicts generally occur as collegial differences and intellectual debates and are a natural phenomenon within intellectual communities. These types of purely academic differences, if expressed in a positive way, can contribute to a constructive learning environment. However, if the differences get out of hand or are ignored, they can, over time, lead to incivility or even become full-blown battles. Faculty-to-faculty incivility is not uncommon in the higher education setting and is frequently left unaddressed and unresolved. Friction among faculty can stem from personality conflicts, extreme self-interest, a high need for control or power, jealousy, spite, or even revenge. In some cases, faculty may be oblivious to how their behaviors affect others. Faculty incivility increases in the presence of heavy workloads, unclear role expectations, pressure to publish, evolving technological demands, the lack of skills to manage conflicts with other faculty, and envy of the achievements of others such as promotion or being granted tenure. An uncivil culture or environment in the nursing program can lead to psychological and physical stress conditions such as sleep disorders and depression among faculty. Faculty incivility also affects the students in the program who are sensitive to any type of stress or strife. Faculty will sometimes complain to students about other faculty, which puts the students in an uncomfortable position. It is essential that there be increased awareness by faculty and administrators about the variety and frequency of faculty-to-faculty incivility and how it impacts everyone in the nursing program. Faculty must be educated in how to treat one another with civility and respect and how to recognize incivility when it is in its early stages so that it can be stopped.11 Some faculty report being the target of negative remarks, insinuations, and harassment from their faculty peers, all of which are counterproductive to their work and their credibility. Some faculty dismiss this type of lateral violence as "part of the job" and look the other way. Others note the rise in incivility and report feelings of anger, disappointment, and embarrassment as the result of colleagues' actions.13 Expressed in many different forms, workplace incivility can include a toxic work environment, workplace violence, and bullying. Faculty themselves experience psychological pain as well as anger, fear, anxiety, feelings of being devalued, and decreased self-esteem. These emotions may prompt competent teachers to resign rather than confront the incivility.10 But avoiding confrontation is not a suitable response for a professional educator. In the words of Dr. Martin Luther King Jr., "Our lives begin to end the day we become silent about things that matter.

professional standards

Ethical behaviors in nursing school correlate with ethical behaviors in professional practice.26 The American Association of Colleges of Nursing (AACN) notes the importance of professional standards, including the development and acquisition of an appropriate set of values and an ethical framework. It stresses that incivility is unethical and notes that nursing faculty have a "moral imperative" to deter incivility.15 Early identification of incivility in a culture of violence is very important in preventing severe physical harm (see Figure 16.3). The AACN strongly suggests that educators try to determine the presence of incivility before students enter a program.26

characteristics of medicare

Finances a large portion of maternal and child care for the poor; reimburses for nurse midwifery and other advanced practice nursing (varies by state); reimburses long-term care facility funding.

characteristics of medicaid

Finances a large portion of maternal and child care for the poor; reimburses for nurse midwifery and other advanced practice nursing (varies by state); reimburses long-term care facility funding. HEALTH-CARE LEVELS AND SETTINGS

leadership for job satisfaction

Healthy workplace environments that empower nurses are critical to the success of the profession. It is critical to develop a healthy workplace environment to decrease absenteeism, increase productivity, and dramatically reduce turnover rates.28 Mentoring has been shown to lower incivility in the workplace. Mentoring partnerships, along with updated educational models, increase cultural competence and enhance job satisfaction for both the new person and the mentor.29 It eases the new nurse's transition into his or her new role and helps the mentor to better understand the problems the new nurse is having in completing the role transition. It also helps make the new person a genuine member of the group much more quickly than if he or she were learning by trial and error. Transformational leadership (TL) is a key element in reversing incivility in the academic or workplace environment. TL acts as a lens through which leaders can see themselves and the workplace inequalities that need to be changed.30 As an intervention, TL requires an extraordinary capacity for self-restraint, self-reflection, and deep consciousness of the inner sense of responsibility. In addition, TL plays an important role in implementing needed changes in present and future practices.30 Box 16.4 lists 13 transformational leadership qualities that can work toward increasing civility in the workplace.

mentoring (inciv)

High-quality mentoring for new faculty members helps to build healthy relationships between students and educators. Constructive mentor relationships require respectful listening, focused thinking, maturity, wisdom, and positive energy, all of which help those being mentored correct mistakes and accomplish goals.

Hospice Services

Hospice care originated in Great Britain and has changed the way end-of-life care is delivered. Disillusioned with health-care services that focused on technology and the preservation of life at all costs, the hospice movement gained momentum in the 1970s. Hospice care emphasizes physiological and psychological support for clients who have terminal diseases. Hospice care provides a variety of services in a caring and supportive environment to terminally ill clients, their families, and other support persons. The central concept of hospice care is not saving life but improving or maintaining the quality of life until death occurs. With the recent development of the Gold Standards Framework, nurses working with hospice have a defined process to improve the quality of life through communication, collaboration, support, and coordination of care

Hospitals

Hospitals, the traditional provider of health-care services, are still an essential part of the health-care system and still employ the majority of nurses. Hospitals range in size from small, rural facilities with as few as 15 to 20 beds to large urban centers that may exceed a bed capacity of several thousand. However, with recent changes in health-care funding, rural hospitals are closing at an alarming rate. Depending on the services they provide, hospitals have varying classifications. General hospitals offer a variety of services, such as medical, surgical, obstetric, pediatric, and psychiatric care. Other hospitals may offer specialized services, such as pediatric care. Hospitals can be further classified as acute care or chronic care, depending on the length of stay of the client and the services available. Large hospitals may be designated as specific centers for treatment, such as a trauma or cardiac center, because they can offer specialized services.

communication and civility

In Watson's model of human caring (Chapter 3), caring can be demonstrated and practiced through interpersonal interactions (Box 16.1). Similarly, the consideration of others within interpersonal relationships is a fundamental part of being civil.3 Incivility in nursing today contradicts the primary requirement that nurses be caring professionals. The reasons for incivility can be uncovered by a closer examination of the interpersonal relationships found in toxic work and learning environments. The health and well-being of clients are predicated on excellence in communication and a culture of civility in the workplace. The Institute of Medicine report Crossing the Quality Chasm: A New Health System for the 21st Century notes that finding new strategies to improve communication is critical in promoting a culture of civility. Furthermore, intimidation, even when subtle, results in harmful outcomes of psychological abuse, horizontal and lateral violence, bullying, relationship aggression, workplace incivility, and mobbing when a group is involved. Ethical codes and values in society affirm civility as the antidote to incivility.4

incivility in nursing education

In its broadest sense, academic incivility is any speech or action that disrupts the harmony of the teaching or learning environment.9 Incivility exists in education as it does in the clinical setting. It takes the form of lateral violence when faculty, students, and staff are demeaning to their peers. Incivility is destructive to the emotional and physical well-being of those affected.10 Significant financial costs result from a fear-based environment due to missed work, legal fees for lawsuits, rehiring, and decreased work output. Although data about the costs of bullying in higher education is limited, it is estimated that it may cost large educational institutions more than $90,000 per year.11 The classroom experience reflects the larger society, with inequities as well as humanitarian qualities such as caring. Academic incivility is an interactive and dynamic process in which individuals or groups make the choice to behave uncivilly. Within nursing education, the three parties or groups who need to take primary responsibility for incivility are administrators, faculty, and students

Rehabilitation Centers

In many acute care facilities, discharge planning and rehabilitative needs are discussed at the time of admission. Rehabilitation centers or units are similar to some extended care facilities, where the client goal is to restore health and function at an optimum level. Often, clients are admitted to rehabilitation units after recuperating from the acute stage of an injury or illness. The rehabilitation unit then provides services to complete the recovery and restore a high degree of independence. Some common types of rehabilitation units include geriatric, chemical dependency, stroke, and spinal cord injury units. Nurses who work on these units have the responsibility of coordinating healthcare services, providing skilled care when required, supervising less qualified personnel, and ensuring client compliance with treatment regimens.

civility in nursing

In nursing, civility is one of the underpinnings of caring and can even be considered a moral imperative (i.e., a rule or principle originating in a person's mind that forces the person to act in a certain manner).3 For most people entering the profession, the motivation to be a nurse stems from the moral values of helping and caring coupled with a deep desire to make a positive impact in the lives of individuals.4 Civility in the profession enables nurses to make caring the focal point of their practice. Being civil to each other, to students, to colleagues, and to clients promotes emotional health and creates a positive environment for learning and for the promotion of healing. It also develops emotional intelligence and empathy in nurses.1 Emotional intelligence, which is the ability to be aware of feelings and thoughts of others by using behavioral cues, promotes the nurse's personal growth. It also transforms negative actions and attitudes into positive responses to health-care issues and is considered critical to the foundation of nursing practice

conclusion

Incivility violates trust and undermines the nurse's obligation to care. It creates insecurity and hostility and degrades learning, collaboration, and performance in all institutions where it is found. In all settings, relationships are adversely affected by incivility. Research and active efforts to deal with the problem will help to ensure better client care. TL qualities can transform incivility into civility and caring. TL can stop upward-spiraling incivility and help with spotting, intervening in, and overcoming incivility. Constructive mentor-mentee rather than tormentor-tormentee relationships will promote professional growth in nurses and improve both the academic environment and the health-care setting. Emotional intelligence arising from the practice of civility is essential and basic to the practice of nursing.

alternatives to incivility (stai)

It is a well-known psychological principle that all behavior has meaning. (See Chapter 12 for more detail.) An individual's behavior also expresses his or her intrinsic values, including whether or not he or she treats others with respect and dignity or in a way that disrespects them and drags down their self-esteem. An individual who helps in a soup kitchen, provides pro bono nursing care at a free clinic, or drops a few coins in a homeless person's cup is displaying behavior that indicates a fundamental belief that all human beings are valuable and deserve basic respect.24 As noted in the later discussion of the ANA Code of Ethics and civility, disrespectful and poor treatment of others, whether they be coworkers, clients, family members, or strangers, is inconsistent with the basic tenets of nursing. Because every action toward others, whether conscious or reflex, contributes to a culture of either civility or incivility, it is essential that every individual be committed to eliminating negative, uncivil thoughts and behaviors. For example, simple negative actions that should be eliminated include groaning out loud when a classmate in the front row asks another a complicated question, gossiping about a classmate during break times, disparaging the instructor's clothing, making cynical comments about a classmate's presentation, and so forth. Instead, it is much more productive to use positive actions such as saying "good morning," "please," and "thank you" to everyone, even individuals who are not well liked; opening doors for people; putting your phone away when someone is trying to talk to you; complimenting people when they do a good job; asking people if they need help; and so forth. A culture of civility is based on respecting everyone's dignity all the timeOver time and with the accumulation of life experiences, many people become cynical. Cynicism develops when people have been hurt, no longer trust the motives of others, and try to keep people from hurting them again. This distrust is just the opposite of what is required for civility. The ability to assume that the intentions of others are positive and good (or at least neutral) is key to establishing a culture of civility. Another method to decrease incivility is to avoid escalating uncivil behavior. It is a natural tendency that when someone is uncivil to us, we respond with similar behavior. This creates a cycle of incivility that escalates until the cycle is broken by one of the individuals. Would it not be better to break the cycle at the beginning? However, breaking the cycle does not mean ignoring another person's inappropriate words or actions. Dealing with conflict and the difficult behavior of individuals is a skill that all nurses must master.24 For a more detailed discussion of dealing with difficult behavior, see

contributing factors

It is common knowledge that attending nursing school increases students' stress levels. Identified stressors include juggling multiple roles, such as meeting the demands of work, study, and family responsibilities; financial pressures; time management; lack of family support; demanding faculty; and the student's own emotional issues.20 Students automatically find themselves in a dependent and relatively powerless position as compared to the instructor or institution. Recent research indicates that the clinical setting is also vulnerable to incivility due to rapid technological changes, staff shortages, and poor staff-to-staff interpersonal communication and relationships. There is a need for ongoing research into the negative consequences of the clinical environment on students and faculty.21 One study reported that other contributing factors to incivility include student developmental issues caused by isolation from high-quality professional role models and reduced exposure to the faculty's decision-making process. Other nursing students did not believe in the hierarchical social structure of nursing school but rather felt that everyone was a peer. For these students, the chain of command did not exist, and there were no boundaries in the lines of communication between students and faculty.9,20 Ignoring incivility does not make it go away. Rather, disregarding incivility sends the message that uncivil behavior is part of the norm and something to be tolerated. Denial of problems often leads to bigger and more severe problems down the road. It is far better to take measures to prevent incivility and stop it as soon as it starts. Once incivility becomes a common occurrence, it is almost impossible to stop without radical intervention.

parish nurses

It is estimated that approximately 2,000 parish nurses throughout the United States are attempting to meet the needs of individuals who are without adequate primary care or who are experiencing escalating health-care costs.23 Many of these nurses work part time or are volunteers, and some work in conjunction with community-based programs. Churches engage parish nurses to • serve as health educators and counselors. • do health assessments and referrals. • organize support groups. • visit parishioners who are sick or elderly. • serve as client advocates or case managers. • organize and manage parish health clinics. Parish nurses are in a unique position to exercise their skills as case managers. As nurses, they possess clinical knowledge and skills, understand the healthcare delivery system in their communities, and know many of the key health-care providers. As members of their parish, they are intimately familiar with their communities, understand the cultural climate of their clientele, and are familiar with the services that are available. Moreover, as members of the church community they serve, they are likely to be familiar with the spiritual, psychosocial, and financial needs of their clients.23 However, direct reimbursement is not yet available for most parish nurse services.

lateral violence (p)

Lateral violence, also known as horizontal violence, has many of the same characteristics as bullying except that it takes place almost exclusively in the work setting. It has been recognized by the National Institute for Occupational Safety and Health (NIOSH) as one of the leading causes of poor staff morale, excessive sick days, turnover of staff, nurses leaving the profession, poor quality of care, and physical symptoms such as insomnia, hypertension, depression, and gastrointestinal upset. The American Nurses Association (ANA), over the past several years, has produced many position papers that discuss lateral violence as a major problem for practicing nurses. Lateral violence can be either covert or overt. Overt lateral violence can include name calling; threatening body language; physical hazing; bickering; fault finding; negative criticism; intimidation; gossip; shouting; blaming; put-downs; raised eyebrows; rolling of the eyes; verbally abusive sarcasm; or physical acts such as pounding on a table, throwing objects, or shoving a chair against a wall. Covert lateral violence is initially more difficult to identify and includes unfair assignments, marginalizing a person, refusing to help someone, ignoring someone, making faces behind someone's back, refusing to work with certain people, whining, sabotage, exclusion, and fabrication

Occupational Health Clinics

Maintaining the health of workers in their workplaces to increase productivity has long been recognized as an important role for nurses. In response to rising health insurance costs, today's employers are increasingly supportive of workplace health promotion, illness prevention, and safety programs. Many companies provide wellness programs and encourage or even require their employees to participate. These services range from providing exercise facilities and fitness programs to health screenings and referrals. Illness prevention focuses on topics such as smoking cessation, stress management, and nutrition. Although some companies may hire health educators to manage their clinics, community health nurses often provide these services. In Canada, occupational health nurses are registered nurses (RNs) holding a minimum of a diploma or a bachelor of science degree in nursing. Many may also have an occupational health certification or a degree in occupational health and safety from a community college or university. Nurses who are certified in occupational health nursing must meet eligibility requirements, pass a written examination, and be recognized as having achieved a level of competency in occupational health. The certification is granted by the Canadian Nurses Association.

workplace violence

More than 2 million workers are targets of workplace abuse each year, and it is blamed for the deaths of more than 1,000 people a year in the United States. When uncivil behavior is directed toward causing someone bodily harm, it becomes workplace violence. The cost of violence in hospitals in 2016 (most recent data at press time) was estimated at $2.7 billion, according to an American Hospital Association study.29 Hospitals and related providers spend a tremendous amount of money in planning for and reacting to violent events. The cost includes paying for uninsured care, enhanced security measures, and injuries to hospital personnel. The healthcare professionals at highest risk for workplace violence are nurses. However, health-care workers tend to underreport violence often because of the multiple requirements and reams of paperwork that go into reporting incidents. Whether in the form of workplace incivility or full-blown workplace violence, these behaviors result in negative outcomes for clients as well as employees, administrators, and facilities. Workplace violence in the health-care setting is a growing problem. It is important to be able to recognize characteristics that may indicate escalating cycles of violence in nurses, health-care providers, clients, family members, visitors, or others. A survey conducted in 2013 of 550 nurses' perceptions of how workplace hostility affected client safety revealed several major concerns. In the survey, a large number of the nurses indicated the following actions could occur in an environment of horizontal hostility leading to the compromise of client safety and quality of care: • Failing to clarify an unreadable order because of fear of the health-care provider • Lifting or ambulating heavy or debilitated clients without assistance rather than asking for help • Using an unfamiliar piece of equipment without asking for instructions first • Carrying out orders that the nurse did not believe were correct30 Institutions need a comprehensive plan to deal with violence, including client violence toward health-care workers. Without appropriate interventions, disrespect and unresolved conflict can quickly spiral out of control and eventually lead to physical violence. The Occupational Safety and Health Administration (OSHA) has developed a set of guidelines for limiting workplace violence and stopping it once it gets started. This document is an appropriate place to start developing an institutional plan. It is comprehensive yet flexible and can be modified to fit almost any workplace environment.

school-based services

Nurses provide a variety of services within local school systems. These services include screenings, health promotion and illness prevention programs, and treatment of minor health problems. Emphasis is placed on physical, social, and psychological well-being. Concerns relating to self-esteem, stress, drug abuse, and adolescent pregnancy are frequently addressed by the school nurse. In addition, children and adolescents with long-term health problems often attend school, and it is not uncommon for the nurse to be consulted about such issues as seizure management, colostomy care, or gastric tube feedings. Students who have health concerns are frequently referred to providers within the community, and an important role of the school nurse is that of community liaison. For this reason, the nurse must be knowledgeable about community resources and adept at getting clients into the system in a timely and efficient manner.

independent nurse-run health centers

Similar to community health centers, nurse-run health centers tend to focus on health promotion and disease prevention. Historically, they have been service rather than profit oriented and remain so today. Nurses who are interested in autonomous practice often work in these settings. Several types of nurse-run health centers have been identified. Among these are community health and institutional outreach centers. These facilities may be freestanding or sponsored by a larger institution, such as a university or public health agency. Primary care services are generally offered to the medically underserved, and these centers are typically funded by public and private sources.25 Wellness and health-promotion clinics are another type of nurse-run clinic and offer services at work sites, schools, churches, and homeless shelters. Many of these centers are affiliated with schools of nursing, providing health-care services while offering educational experiences for nursing students. A final type of nursing center includes faculty practice, independent practice, and nurse entrepreneurship models. These facilities are owned and operated by nurses and may be solo or multidisciplinary practices. Services are typically reimbursed through fee-for-service plans, grants, and insurance. The ability of nurses in these centers to secure payments through the newly emergent and complex health-care reimbursement network will largely determine the future financial viability of these types of clinics.

Voluntary Health Agencies

Since their inception in 1892, voluntary health agencies have experienced steady growth and now number more than 100,000. The first voluntary health agency was the Anti-Tuberculosis Society of Philadelphia. Some of the more well-known agencies that exist today include the American Cancer Society, American Heart Association, National Foundation for the March of Dimes, Easterseals, and National Alliance on Mental Illness. These agencies provide many valuable services, including fund-raising in support of cutting-edge research and public education. Some, such as the American Cancer Society, which has a strong emphasis on education and research, also help individuals secure special equipment, such as hospital beds for the home and wigs for chemotherapy clients. The National Alliance on Mental Illness is politically active and organizes support groups for the mentally ill and their families. These groups are not-for-profit organizations; all revenue in excess of cost goes toward improving services.

codes of conduct

Some universities and colleges have instituted honor codes. Studies have shown that academic settings with an honor code have less cheating. One type of honor code for students and faculty is called HIRRE, which stands for "honesty, integrity, respect, responsibility, and ethics." In HIRRE, students sign a pledge promising not to cheat or plagiarize. Faculty and students can use a reporting system to identify violations of the honor code. Enforcement by faculty, directors, or the dean can include expulsion for honor code infractions.28

long-term care insurance

Supplemental insurance for coverage of long-term care services. Policies provide a set number of dollars for an unlimited time or for as little as 2 years.

cause and effect (inciv)

The increase in incivility among nursing faculty has several causes. The academic culture is often controlling and driven by faculty insecurities and competitiveness. It is historically based on a rather inflexible hierarchical management structure (see Box 16.2). Many nursing faculty, who may have been excellent clinical practitioners, entered the teaching profession with little preparation in the basics of higher education. On-the-job training became the norm as nursing faculty adapted to the academic setting with its triple requirements of teaching, research, and service. Being unprepared, they often found themselves victims of lateral violence through unequal relationships or discrepancies in faculty status and rank.15 Normally, nursing faculty work in a highly interactive social system. Most of the day-to-day operations of classes and committees require working closely with other nursing faculty. In some cases, when faculty disagree strongly with policies, procedures, or lines of authority, they may develop feelings of exclusion or alienation. Although nursing educators recognize that challenging the status quo is essential for the growth of the profession, it is still often resisted. Faculty who challenge the system can be silenced and sometimes even shunned by colleagues when they attempt to take a contradictory stance on an important decision.16 This is most noticeable when a new faculty member with many years of experience in the clinical setting, but none in education, is hired and then is expected to blend seamlessly into the academic realm.

Health-Care Providers' Offices and General Clinics

The office continues to be the location where most North Americans access primary health care. The majority of health-care providers in North America continue to work either in their own offices or with other providers in a group practice. Services range from routine health screening to illness diagnosis and treatment and even some minor surgical procedures. The responsibilities of nurses who work in offices or in general clinics include obtaining personal health information and histories of current illness and preparing the client for examination. Nurses also assist with procedures and obtain specimens for laboratory analysis. Teaching clients basic health information and home management of treatments and medications is also a responsibility of the clinic nurse.

dont eat your young (stai)

The ritual of "eating your young" is seen both in the classroom and the clinical settings. It is a form of vertical violence, since it is based on an inequality of power between the experienced nurse or faculty member and the new nurse or nursing student. There has long been a practice of having the new members of a profession undergo a rite of initiation, or "hazing." These initiation rites often involve intimidating and belittling the student or the new nurse to help them "learn their place" in the organizational chain. Common "eating the young" activities include punishing, shaming, or ridiculing students or new nurses for their lack of knowledge. Using caustic humor or sarcasm or setting up victims by placing them in a situation in which they will likely fail also contribute to the demoralization of students and new nurses. Although this initiation process has diminished to some degree in recent years, it still exists in many institutions.17 As an alternative to on-the-job training in nursing education, universities are now offering master's degrees in nursing education; these programs teach students how to teach and explore the political ins and outs of the academic setting. Graduates of nursing education programs enter their teaching careers with an understanding of curriculum development, evaluation, testing, course preparation, and many other aspects of surviving in higher education, such as yearly evaluations, the rank and promotion system, and the need to publish. They are taught to be more assertive and to express their opinions without trepidation. Nowadays, senior nursing educators are much more sensitive to the needs of new faculty and have a strong incentive to nurture them and help them develop into high-quality educators.22 They realize that this new generation of instructors will replace them as they retire in large numbers over the next few years. Preceptor and mentoring programs for new nurses have been developed in clinical facilities as a result of the IOM's report The Future of Nursing: Leading Change and Advancing Health Care.23 Box 16.3 provides examples of classroom and clinical behavioral norms for nursing students. These have been co-created with colleagues and clinical-setting partners so that everyone clearly understands the expectations for appropriate behavior.

administrators (inciv)

The term administrator includes several levels of persons who are responsible for the running of an organization or unit of that organization. The role of administrators is to oversee the operations within their organization, coordinate with other managers in the organization, initiate planning for the organization, and provide guidance for employees. The administration sets the tone and creates the atmosphere for the entire organization. The efficiency and success of an organization is directly linked to the administrator's skills in communicating well, promoting staff development, finding solutions to problems, and creating a positive work environment. However, administrators are human and are sometimes responsible for incivility in their organization. Some administrators can be uncivil and can even be bullies. The very characteristics that helped them rise to a position of power may also contribute to a personality that tends to be uncivil. Administrators who are uncivil are likely to be self-centered and have problems feeling empathy with others. They may not have much concern over the consequences of their actions and seem to feel good about themselves most of the time. However, they have a brittle self-ego and retaliate against negative comments by belittling others. This behavior "trickles down" and actually promotes a culture of incivility throughout the organization. When complaints of bullying from employees about other employees or supervisors are sent up the chain of command, they often are dismissed outright or placed in the system where they tend to become lost.10

traditional private insurance

Traditional fee-for-service plan. Payment, computed after services are provided, is based on the number of services used.

workplace incivility

Workplace incivility is a broad term that includes workplace hostility, bullying, lateral violence, vertical violence, and workplace violence. It is the threat of violence or the actual causing of physical harm to workers either inside or outside the workplace. Workplace incivility runs along the continuum, ranging from verbal abuse to physical violence and homicide.

what is the most expensive personnel?

a registered nurse

what is the most important skill in conflict management?

active listening It is essential for the nurse to listen to clients' fears, concerns, and anger about their condition and their families' reactions and actions. The nurse must also be on the lookout for signs of elder abuse and neglect. It is not uncommon for family caregivers, either intentionally or unintentionally, to harm the client through threats, withholding care and medications, or negative communication. The future of home health care is full of opportunity. As the population ages, home health care will allow individuals to stay at home while receiving the same treatments and technology as they would receive in the acute care setting. Health-care reform has placed a brighter spotlight on the areas of quality and cost. Home health care allows for increased continuity of care and enhanced quality of care, while significantly reducing its cost.

the chief nursing officer (CNO) at a large hospital is concerned about nurse burnout. the CNO announces that a new hospital-wide initiative, the Stamp Out Burnout Campaign, will be developed by a committee of hospital employees. which of the following would help this campaign be effective? (select all that apply) 1. include nurses in the campaign committee. 2. make safe, adequate staffing levels a priority. 3. update the hospital policy and procedures documents to clarify roles and responsibilities of nursing and other personnel. 4. extend the preceptorship program for new graduate nurses from 3 months to 6 months. 5. ensure that communication from management is clear and timely. 6. make sure that staff nurses know they can share concerns and ideas with management, including the CNO.

all of the above

what is an internship?

allows students to work in a hospital setting as nurse aide's while allowed to practice at their level of education

what is a perceived role?

an individual's own definition of the role, often more realistic than the ideal role

bullying (def)

any behavior that could reasonably be considered humiliating, intimidating, threatening, or demeaning to an individual or group of individuals

academic incivility

any speech or action that disrupts the harmony of the teaching or learning environment.

public health departments

are government agencies that are established at the local, provincial or state, and federal levels to provide health services.the goal of early public health departments was to prevent/control communicable diseases in the 18th and 19th centuries, producing epidemics that killed millions of people. modern-day epidemics, such as the Ebola outbreak in western Africa, still remain a threat, and public health nurses continue their role as the first line of defense against pandemics that can potentially kill thousands of citizens. However, today, the scope of public health, while retaining its contagious disease control and prevention mission, has expanded to areas such as child health, pregnancy care, and, more recently, early detection and treatment of terrorist acts, particularly bioterrorism

what types of contact rank high on the burnout list?

constant contact of customers, clients, students, and/or criminals

what were PSROs designed to do?

contain health-care costs, and to review the quality, quantity, and cost of hospital care through medicare

what does CISD stand for?

critical incident stress debriefing

after a shift, what should a nurse do?

decompress and release tension before it explodes

what were the secondary goals of the ACA?

eliminating disproportionate control for the insurance agencies, addressing inequities in current coverage, and helping senior citizens pay medical bills (despite medicare)

what was the capitated payment system introduced to do?

encourage cost-effectiveness in a growing health-care system. the goal is to have a payment plan for selected diseases or procedures that provides the highest quality of care, including essential diagnostic and treatment procedures, at the lowest cost possible

what are some additional concerns of the aging population?

environmental and occupational safety, drug abuse, and mother and child health care

what is the purpose of the CHA?

establish criteria and conditions in respect of insured health services and extended health-care services provided under provincial law that must be met before a full cash contribution may be made (revised 2012)

true or false: health-care providers, both physicians and nurses, were consulted on the (new) changes that weakened the ACA.

false, they were not. neither

a graduate from a nursing program needs to do what? (name at least 3)

have the ability to access information, be competent in health policy at multiple levels, develop system improvements, use research and ebp, build teamwork, make complex decisions, and demonstrate leadership

primary care

health promotion and preventive care, including programs such as immunization campaigns. Primary care focuses on health education and on early detection and treatment. Maintaining and improving optimal health is the overriding goal.

what is the canada health act (CHA)?

health-care services are provided under this. collects taxes and gives the responsibility of administering health-care to the provinces. insurance premiums became a burden and improved services were promised to all canadians

although significant strides have been made in treating some acute infectious diseases, many challenges still exist in the management of health concerns such as cancer, ____________________, alzheimer's disease, diabetes, __________, and HIV

heart disease; COPD

what do nursing residency programs do?

help develop new nursing skills, increase knowledge, and aid the new nurses in providing safer care

what was the CISD designed to do?

help health-care staff process, cope, and treat acts of terrorism, violence, trauma, death, and/or natural disasters.

health-care systems: type 03

hybrid of type 01 and 04: funded and operated by government (old britain) and state-operated and funded health services were egalitarian. public management is important!

how (if repealed) would the ACA affect the nursing shortage?

it would likely lead to a reduction of the RNs needed in the long-term (hard to predict)

a nurse manager is concerned about incivility on her unit. the nurses on day shift gossip about the night nurses; unlicensed assistive personnel complain that the nurses refuse to help them turn morbidly obese clients; and during staff meetings, everyone looks at their phones. when the nurse manager shares her concerns with her supervisor, she identifies the specific problem as ___________

lateral (horizontal) violence

what type of violence is cyberbullying?

lateral (nurse-on-nurse) violence

what can help reduce and prevent burnout?

managing stress, time, setting personal goals, exercising, self-diagnosis, etc.

category a tasks

medications, assessments, treatments, and dressing changes

what is compassion fatigue?

no longer caring about the client's that you are assigned

is the sink-or-swim (new grad on same existing nurse level) approach still acceptable?

no!

what are the three key evaluation criteria of the nurse residency programs?

nurse retention, nurse knowledge/competency, and improved client satisfaction

has the transition from illness and disease emphasis to prevention and health promotion been easier for nurses or physicians?

nurses

who led the way for implementing the ACA?

nurses

who were the leaders in developing new systems and models to accommodate changes in health-care?

nurses

what are medicare clients classified as?

one of 467 DRG (diagnosis-related groups)

how long does it take for new graduates to master the skills necessary to be successful in their position?

one year

in its purest form, the type 01 system would not offer any option other than to

pay for a service

what role does the nursing student graduate with?

perceived (measured against ideal role)

what does the ACA have increased emphasis on?

preventative care

what do third-world countries focus their health-care systems on (not any of the 04 types)?

preventative, first point of contact, and continuing care

mr. nguyen takes his toddler to a facility that provides __________ care services to receive her scheduled immunizations.

primary

what practice shows the effects of the illness/disease/health transition?

primary care

the canadian healthcare system places a higher benefit on what?

primary care > specialist care, procedures

what are the levels of service?

primary, secondary, and tertiary

health-care systems: type 01

private approaches to health services predominate. physicians, caregivers, and clients have maximum autonomy. those who can afford private insurance, or who can pay for healthcare, choose their providers and services. if you cannot pay, you have no choice or benefit (u.s. with some publicly funded for old and poor)

what is the ideal role?

project's society's expectations of a nurse that delineates obligations, responsibilities, rights, and privileged

what was the PRIMARY goal of PSROs?

review the care provided by health-care providers to determine whether the best diagnostic and treatment approaches were being used

what is the institution's first contact with the nurse seeking employment?

the resume

what does the effectives ness of the MCO rely on (cps related)?

the theory that health-care costs can be reduced by decreasing the number of hospitalizations, shortening LoS, providing less expensive home care, and health promotion and illness prevention to keep people healthy

how many references do most institutions require?

three (nursing program directors, nursing faculty, supervisory-level personnel, and health-care providers are good examples)

when should you call the hospital to follow up on an interview?

three weeks

what is one thing that can prevent or lessen burnout during a shift?

time management (fulfillment, delegation and anti-procrastination)

what three things are the priority when including time management?

timely medications, client comfort, and accidental injury prevention

what was the APIN program developed for?

to conduct research into the education of nurses with higher degrees (also how and where they are employed)

what was the goal of the APIN?

to develop new ways to increase the number of higher-educated nurses by removing obstacles in education while forming hospital partnerships

what was the primary goal of the ACA?

to provide affordable health-care to u.s. citizens who, before its passage, were unable to pay for or obtain health insurance

what specialty areas have a high burnout rate?

transplant, ICU, neonatal, oncology, and burn units

what health-care system is opposite of type 01?

type 04

when does reality shock occur (in terms of roles)?

when the ideal or perceived role do not match the performed role

how will age work into the nursing shortage?

with an aging population, the need for qualified nurses is going to increase with their increased health needs

how does the nursing shortage cycle?

with the changes in the health-care system and regional availability

lateral violence

workplace bullying carried out against persons of approximately the same rank

should the nurse ask the interviewer about a written nurse's contract?

yes

can health-care reform be a double-edged sword? if so, how?

yes, for professional nursing. they can either mark success or become overrun by the system and be just a footnote

what are the steps to making a text-only resume? (for reference)

• Change to a nonproportional font (i.e., a font where all the letters take up the same amount of line space, such as Courier Brougham, Letter Gothic, Orator, Lucida Sans Typewriter, MonoTxt, Isocteur, Lucida Console, Courier, and Monospace 821). These fonts prevent the lines of text from varying in width across the page. • Do not indent by using tabs. Some Web browsers don't recognize them and might move the text around on the page. • Keep all lines justified to the left side of the page, and use line breaks (Enter key) to separate headings and sections. Using the spacebar to indent or center text has unpredictable results when read by another browser. • Use ALL CAPS rather than boldface or italic to emphasize a word or words or when starting a new section of the résumé. • Never use accent marks, quotation marks (" "), asterisks (***), or other special characters ($#). These almost never come out like they were in the original document. • Write the résumé in the third person. Avoid "I" statements. • Target your résumé to the specific position. Do this by reading job descriptions and selecting keywords noted in the descriptions—competencies, skills set, education, and experience. Use these keywords wherever they fit logically in your résumé. • Match individual experiences to key words/key skills found within the job posting. • Research the employer and target the résumé based on the facility values and culture. • Include a professional summary if you are an experienced nurse. • Make sure your skills and knowledge are a 100 percent match for the qualifications that are required for the position. For example, if a job listing says "BSN required" and you have an ADN, do not apply for the position—you do not meet the required qualifications for the position. • Use standard, simple section headers such as "Work History" and "Education." Avoid section headings such as "Where I Went to School." The ATS does not understand it. • List specific skills clearly. • If you use acronyms and abbreviations, make sure to spell out the entire name or phrase followed by the shortened version. • Do not put information in the document header or footer. ATS will not "see" it there. • Never use tables, graphs, diagrams, clip art, graphics, special fonts, photos, colored fonts, PDFs, or bullets. ATS are not programmed to read them.