leadership 6+7

shared responsibility for implementing EBP

barriers = time, organ culture, lack of knowlege and skill in findings EBP inadequate access, poor admin support

Overdelegation

bc poor managers of time feel insecure in ability to perform task leads to overworked and tired ppl = decr productivity

sellouts

not usually a big event believe you should help someone, but you dont should apologize, but dont

what you must have for EBP

research, experience, pt preferences

provision 4.2

accountability for nursing judgements, decisions, actions follow code of ethical conduct, moral principles ex. fidelity, loyalty, veracity ,benefit, respect for dignity, worth, self determination, adhere to scope systems and tech assist w/ clinical practice are adjuncts not replacement for nurse's knowledge/skill nurse accountable even if systems or tech failure

Bandura's Social Learning Theory

anticipated reinforcement --> select and observe a model --> retention process <--> cog learning --> behavior is reproduced --> reinforcement of behavior continues --> new behavior --> behavior is internalized and attitude change occurs

building through socializing and edu staff in a learning org

assess edu needs, edu quality, fiscal accountability use EBP

provision 4.4

assignment and delegation of nursing activities or tasks must be consistent w/ state practice act, org policy, nursing standards of practice eval of knowledge, skill, experience of person to whom care is assigned, complexity of task, nursing care needs ot pt rn must monitor activities and eval quality/outcome cant delegate assessment, ecal may delegate some interventions according to state nurse practice act enviro = orientation, skills development, licensure, certification, continue edu, competency, verification, adequate/flexible staffing, policies protect pt and rn open communication w/o fear of reprisal, express concerns, refuse assignment which don't have skill

try that stupid little stunt one more time

attacking

plan ahead delegation

attempt to delegate before you are overwhelmed assess sit before delegating, clearly desired outcomes

provision 4.1

authority, accountability, responsibility independent direct nursing care activities, as ordered by provider, care coordination, eval of intervention, delegation of nursing intervention, teaching, research, admin authority, accountable and responsible for their quality of their practice comply w/ and adhere to state nursing practice acts, reg, standards of care, and ANA code of ethics for nursing w/ interpretive statements scope of practice continues to evolve exercise judgement in accepting respon, consulting, assisting APRNs prescriptive authority, not acts of delegation

speaking of ideas for cutting costs, what if diluted the coffee, or use both sides of our printer paper

avoiding meaning: if i offer trivial suggestions perhaps we can avoid talking about sensitive thinks like staff inefficenity

how does you new suit look? well you know that blues my fav color

avoiding meaning: what happened, did you buy your clothes at the circus

management roles w/ socializing and edu staff in learning org

aware and clarifies org and unit goals for workers clarifies role expectation for all ppl +/- sanctions appropriately to socialized new ppl select preceptors and encourages + role modeling by experience staff methods of meeting special orientation needs to new graduates, international nurses, experiences nursing changing roles workers w/ edu department to to delineate shared and ppl responsibility for staff development adequate resources for staff development and makes appropriate choices about allocation during periods of fiscal restraint responsibility for quality and fiscal control of staff development activities all staff competent for role assigned input formulating staff development policies org provides resources to promote EBP nursing practice

subordinates who are not delegated

become bored, nonproductive so delegation contributes to personal and prog development

Training vs Education

both componets of staff developemtn -Training-organized method of ensuring that people have knowledge and skills for a specific purpose and that they have acquired the necessary knowledge to perform the duties of the job -May require increased motor and cognitive skills. -Education-More formal and broader in scope than training -Develops individuals in a broader sense -Managers/leaders may be asked to teach classes\ -Managers are not solely responsible for the employee's formal education

Assessing Staff Development Needs

managers are responsible for identifying learning needs, getting resources

Adult Learning Theory

many managers use pedagogical learning strategies = fail = bc adults have special needs andragogy = adult learning = separate adult learning strategies from pedagogy = child learning adult learners = mature, life experience, focus on prob solving, need to know why they need to learn this before they learn it adults don't like to learn just for shits sake, more external obstacles to learning (time, energy, institutional barriers) than kids

"i think your idea is uh brilliant. yeah thats it. i just worry that other wont catch the subtle nuances. some ideas come before their time so expect some uh minior resistance"

masking meaing: your idea is insane, ppl will fith it w/ their last breath

"oh yeah thatill work like a charm, offer ppl a discoutn and theyll drive all the way across town just to save 6 cents on soap

masking meaning: what a dumb idea

set deadlines and monitor progress for delegation

monitor through informal byt reg scheduled meetings provide feedback to incr competency in task performance final responsibility belongs to delegator, subordinate accepts responsibility for completing it appropriately and is accountable to person who delegated task

reward accomplishment in delegation

more recognition team members get, more recognition given to leader delegation is a high level skill managers = incr their impact, incr power subordinates = gain self esteem, incr job satisfaction, closer to goals

common tasks generally considered appropriate for delegation to NAP

noninvasive nonsterile tx ADLs socializing feeding, cutting food, placing meal trays personal hygiene, poop, vaginal irrigation, enemas transport ambulation, positioning, turing collect, report, doc data, VS, height, weight, I/O, cap blood and urine tests

provision 4

nurse has authority, accountability, responsibility for nursing practice; makes decisions; takes action consistent w/ obligation to promote health, to provide optimal care delegation

obstacles and assets of adult learning

obstacles to learning: institutional barriers time self confidence situational obstacles family reaction special individual obstacles assets for learning: heigh self motivation self directed proven learner knowledge experience reservior special ppl assets

resocialization of the experienced nurse

occurs when experience ppl forced to learn new values, skills, sttitudes, social rules as result of change in type of work they do, scope of responsibility or work setting transition from expert to novice = hard familiar to unfamiliar = new positions, new workers all this creates role strain = from MS to labor and delivery, dont know all the norms role stress = experienced nurse mores from from inpatient setting to community setting = powerless

who are stakeholders

manager, provider, nurses, ebp/resource office

common delegation errors

Under Delegating Over Delegating Improper delegating incr risk harm and malpractice, breach of duty

assignment

distributing work to qualified persons or persons for implementation of specific activity or set of activity w/i their job description

5 rights of delegation

1. Right task 2. Right circumstance 3. Right person 4. Right direction/communication 5. Right supervision/evaluation

subordinate resistance to delegation

* One of the most common causes of subordinate resistance to, or refusal of, delegated tasks is the failure of the delegator to see the subordinate's perspective. * Workloads assigned to NAP are generally highly challenging, both physically and mentally. In addition, NAP frequently must adapt rapidly to changing priorities, often imposed on him or her by more than one delegator. * If the subordinate is truly overwhelmed, additional delegation of tasks is inappropriate, and the RN should reexamine the necessity of completing the delegated task personally or finding someone else who is able to complete the task.

socialization and resocialization

-Learning of the behaviors that accompany each role by instruction, observation, and trial and error -Involves a sharing of the values and attitudes of the organization -*Creates a fit between new staff members and the unit by introducing them to the norms* of the group -The *first socialization to the nursing role occurs during nursing school* and continues after graduation -reality shock from gaps in academic and practice expectations - anticipatory socialization in edu setting, ease role transition for new grads role overload - managers should watch for this, help new grads cope prolonged orientation periods = wks to 6 months internships or nurse residencies transition pracice = TPP = incr outcomes for new grads in 1st yr, incr retention

meeting the edu needs of a culturally diverse staff

3 main types: ethnicity, gender, generational gender, age, english language proficiency, culture consider learning styles

Stages of the mentoring relationship

1. Finding and connecting 2. Learning and listening 3. Changing and shifting 4. Mentoring others

joint statement of delegation

ANA and NCSBN say delegation is a skill that must be taught and practiced

provision 7

Advance the profession through practice, education, administration and knowledge. contribution w/ scholarly contribution through practice standards policy development

Leadership Styles

Authoritative - makes decision for the group, motive by coercion, communication down the chain, work output is high, good for crisis, bureaucratic settings, effective employees w/ little.no formal edu Democratic - includes group when decisions are made, motivate by support achievements, comm up and down chain, good output, good when cooperation and collab needed Laissez-faire - makes very few decisions and does little planning, motive responsibility of ppl, communication up and down chain and b/w members, output low unless informal leader evolves, effective w/ professionals

identify necessary skills and education delegation

NPA - nurse practice act in each state not the same in all states so be careful unlicensed personnel can = ALD, vs, weight, pee/poop, safe enviro

Omnibus Budget Reconciliation Act (OBRA)

Federal law that regulates the education and testing of nursing assistants min 75 hrs of theory and practice pas exam no federal or community standards

informatics tree in class

HIPPA = personal hx = intern/extern/personal decr med errors decr pt care errors nurse/pt relationships = touch of RN database = EBP, data unbiased education = QSEN, TIGER, IOM health competency alarm fatigue, nursing application errors, broken technology

Best care at lower cost: the path to continuously learning healthcare in america

IOM 400 pages 2012 potential strategies to accelerate health care org capabilities for continuous learning and improvement reward for learning

learning organization

LO by senge 1994 who called organizations LO as a place where ppl continually expand their capacity to create the results they truly desire where new and expansive patterns of thinking are nutured, collective aspirations is set free, ppl continually learning to see the whole together 5 disciplines = system thinking, personal mastery, team learning, mental models, shared vision learning is key for ppl and organization

staff development

LO doesnt just meet licensure requirments for edu and training, but encourage ppl to growth and supports staff developement activities both $$ and philosophically staff knowledge level and capabilities determine # of staff neeed to carry out unit goals = better trained and more competent staff save orga $ by incr productivity and + outcomes is structured

Improper delegation

Wrong time, to the wrong person, or for the wrong reason Beyond the capability of the person, or something the manager should do Decision making without providing adequate information

Delegation as a Function of Professional Nursing

clearly defined structure where RN recognized as leaders of the health care team job description clearly defines roles/respon of all workers edu program help personnel learn roles/respon of coworkers training program foster development of leadership , delegation skills skills are not learned by trial and error teamwork, respect, communication

Implications of Knowles' Work for Trainers and Educators

climate of openness and respect will assist in identifying of what adult learner wants/needs to learn adults enjoy taking part in and planning their learning experiences adults should be involved in eval of their progress experiential tech work best w/ adults mistakes are opportunities for adult learning if value of adults experiences is rejected, adult will feel rejected adults readiness to learn is greatest when they recognize that there is need oto know adults need opportunity to apply what they have learned very quickly after leanring assess need imperative in adult learning

coaching as a teaching strategy

coaching is a teaching strategy rather than leaning theory one of the most important tools, hard to master one person helping another to reach optimum level of performance short term - effective as teaching tool, assist w/ socialization, short term probs long term - tool for cancer for career management, dealing w/ disciplinary pros

cultural phenomena to consider when delegating to a transcultural team

communication - dialect, volume, touch, eye contact space - interpersonal space differs social organization - fam unit of primary importance in some culture time - past, present, future oriented enviro control - internal or external locus of control biological variations - susceptibility to diseases, physiological differences (height, weight, skin)

be a role model and provide guidance in delegation

confidence and encouragement in person who has taken task if hard time completing be a role model and resources to help try to get them to solve prob themselves 1st answer their questions reassuming delegated task should be managers last resort bc actio fosters sense of failure to employee

violence

control, complet others to your point of vien name calling and monologuing to make threats controlling - coercing other to your way of thinking, forcing your views on others, dominating the convo, cutting off others, overstating your facts, speaking in absolute, changing subjects, directive questions to control convo labeling labling ppl or ideas so we can disscuss them under a general sterotype attacking - moved from winning the argument to making other suffer, belittling and threatening

theres not a person in the world who hasnt brought on of these things, they are the perfect gift

controlling

key concepts in ch 20, delegation

delegation not option for manager it is necessity delegation used for assigning routine tasks and task which manager doesn't have time, tool for prob solving, changes in managers own job emphasis, building capability in subordinates prof nursing organ and reg bodies are actively engages in clarify scope of practice for unlicensed worker and delegation parameters of RN managers must delegate the authority and responsibility needed to complete the tasks manages must clearly communicate what they want done and purpose of doing so, limits, qualifications trans cultural sensitivity in delegation needed for productive multicultural work team ubord resist, delegator must say why delegated task needed most errors avoided avoided if 5 rights by ANA and NCSBN rn who asked to assume role of supervisor and delegator need prep to assume leadership tasks NAP incr scope of liability for RN, NAP some responsibility for their action, does not negate accountability for RN RN always bear ultimate responsibility for care omnibus budget reconciliation act 1987 = reg for ecu and certification for CNA - 75 hrs, no fed or community standards for NAP

strategies for promoting ebp decision making in establishing clinical best practice

develop and refine research based policies and procedures build consensus from interdisciplinary team through develop of protocols, decisions trees, standards of care, institutional clinical practice guidelines research findings accessible through lib and computers support time to do research and edu assistance in showing staff how ti interpret data cooperation among professionals hire nurse researchers

when safety is at risk

dual processing = watch for topic under discussion and what people are doing in response longer it takes to notice not in dialogue, the harder it is to get back and higher the costs watch for moment the convo turns crucial, signs that ppl dont feel safe (silence or violence), your own style under stress

refuse fools choice

either/or choices --> turn them into a search for all important and AND require your brain to solve the more complex problem, more often than not, it does just that clarify what you want, break out of fools choice, claridy what you really dont want, present your brain w/ more complex prob, combine this into an AND question "is there a way to talk to husband about how youre spending money AND not get into an argument?

eval performance in delegation

eval after performance + and - feedback were outcome achieves? hat could have done differently?

delegating to UAP/NAP

ex = nurse extenders, care partners, nurses aides, orderlies, assistances, attendants, health care assistants, techs use them bc of cost RN --> RN = less legal obligation to superives work RN --> NAP = job description, knowledge base, demonstrate skill, NAP must agree they are the right person for task RN is always accountable NAP can refuse if wrong skills, knowledge, experience if not something normally do or have not done in long time = supervision NAP vary by states

delegating effectively

explain how to do task, tain someone else to do it, monitor that person

Hospital Organization competencies

fire pulls emergencies disaster planning hospital determines these = staff development every year do skills fair department and job competenties

learn to spot crucial convo

further you stray off track, harder to get back on pay attention to signs that suggest youre in crucial convo physical signs = stomach tight, eyes dry emotions = scared, hurt, angry behavioral = raising voice, pointing fingers, being quiet

delegating to multicultural work team

generational, gender, cultural, ethnic asians - told not to ask for help = longer to get delegation skills 6 cultural phenomena to be considered: communication, space, social organization, time, enviro control, biologic variations communication - gestures, stance, eye movements, speech, kinesics, tone space - distance and intimacy social organization - group or unit for social support, values time - past = preserving past and maintaining tradition, present = maintaining status quo and daily operations, future = goals and approaches to probs enviro control - perception of control over enviro (internal locus of control), fate, luck, chance = more likely creative and autonomous in decision making biologic variations - b/w racial, ethnic groups, suscep to diseases, physiological effects

delegation

getting work done through others or as directing the performance of one or more ppl to accomplish organizational goals transfer of authoriity

your style under stress test

high score = 1 or 2 checked boxes per categorie = use this technique often 2-3 checked =already quite skilled in thie area 0-1 = pay attention to these chapters

negative sanction

like rewards, provide cues that enable ppl to eval their performance consciously to modify behavior needed must result in role leaner internalizing values of org very subtle and cover ex. making fun of new grads awkwardness, but should be told when behavior is inappropriate

Master My Stories how to stay in dialogue when youre angry, scared or hurt

how to control your own emotions emotions dont just happen, other dont make you mad, you make yourself mad feel hurt = act in cheap shots/silence = NO think out your emotions retrace your path - notice your behavior, if you find yourself moving away from dialogue, ask yourself what you're really doing am I in some form of silence or violence get in touch w/ your feelings, learn to accurately identify emotions behind your story people use the wrong emotion to describe how they feel what emotions are encouraging me to act this way analyze your stories, question your conclusion and look for other possible explanations behind your story are you feeling the right emotion path to action = see and hear, tell a story, feel, act how our emo, thoughts, experiences lead to our actions take control of our stories so they dont control us what story is creating these emotions get back to the facts, abandon your absolute certainty by distinguishing b/w hard facts and your invention story what evidence do i have to support this story what for clever stories, victim, villain, helpless stories sit at the top of the list victim - its not my fault, you ignore the position you played in the story villain - its all your fault, exaggerate our own innocence , watch for double standard helpless - theres nothing else i could do, clever stores - they match reality, gets us off the hook, keep us from acknowledging our own sellouts tell the rest of the story: ask am i pretending not to notice my role in the prob why would reasonable, rational decent person do this (turn villains into humans) what do i really want what would i do right now if i really wanted these results separate facts from story w/ emo

Sequence for developing an educational program

identify desire knowledge or skills that staff should have identify present level of knowledge or skill determine deficit of desire knowlesge identify resources avaliable make max use of resources eval and test outcomes after use of resources

communicate goals clearly in delegation

identify limitations, qualifications what is being delegated, purpose, goals of tasks, limitations for task completion, timeline, expectations for reporting

socialization and orientation of new managers

if old manager still there, they should orient the new one = 1wk allows fast gain of control of unit if no manager, should appoint someone to help learn unit, manager from another unit, supervisor new managers immediate superior - unit supervisor if new manager is charge nurse or chief nursing executive if new manager is unit supervisor, have reg scheduled sessions w/ new manager to continue ongoing orientation process group of new managers peers - management group in org w/ which new manager can consult, new manager should be encouraged to use group as resource mentor - in org decides to mentor the new manager, will undoubtedly benefit org, mentors cannot be assigned, org encourage experienced managers to seek out ppl to mentor

characteristics of leaders

initiative inspiration energy positive attitude communication skills respect problem solving & critical thinking skills great leaders = thought to be born w/ skills that could not be acquired contemporary leadership theory supports belief leaders can develop needed skills leaders influence willing followers to move to goal leaders have goals that might not reflect those of organization transformational - empowers follower to assume responsibility for communal vision, personal development s 2nd outcome transactional leaders - focus on immediate prob, maintaining status quo, use rewards to motivate followers

positive sanctions

interactional or edu process of socialization is deliberately planned = become educational reference group sets norms of behavior and applies sanction to ensure new members adopt group norms before acceptance into group

youre not going to listem to them are you, for crying out loud first theyre from headquarters, theyere enginneers, need i saym more

labeling meaning - if i pretent that all ppl from headquaters and all engineers are shomehow bad and wrong, i wont have to explain anything

leadership and management

leadership and management = concepts that are integral to effective management, motivation of staff and pt management = process of planning, org, directing, coordinate work w/i org, good leadership skills, formal positions of power and authority leadership = ability to inspire others to achieve a desired outcome, informal power by peers cannot be leader w/o followers many theories about leaders behavior = leadership styles transac/transform = 2 types effective leaders are not always in management positions

leadership roles and management function w/ delegation

leadership: guidelines are current, best practice role model, supported, resource person use delegation as time management/team building identify situations for delegation communicate clearly pt safety as min criteria when deciding right person plan ahead, dont wait for emergency feel confident in person taking task informed in local, state, national guidelines for nurisng assistive personnel scope of practice (NAP) sensitive to culture affect transcultural delegation delegation as stretching/empowering workers trust, teamwork, open comm management: create job description, scope of practice, NAP legal liabilities assess subordinates skills, motivation delegates level of authority needed for task accountability for task see subordinates perspective to decr resistance periodic review process for delegated tasks permission to refuse disciples when fail to carry out delegation reward for completion formal edu/train on delegation

eval of staff development activities

learners reaction - how did learner receive orientations, class, training, preceptor behavior change - behavior in result of learning, testing does not confirm these organizational impact - hard to measure, but try, med errors, accident, turnover, productivity cost effectiveness - quantified, quality control, cost effective

lean to look for safety probs

pay attention to content, watch for s/s of ppl being fearful forcing opinions into pool, purposefully keeping ideas out of pool when its safe you can say anything when you fear ppl arent buying your ideas, you push harder prob isnt content of message, but condition of convo when it is unsafe, you start to go blind dont let safety prob lead you astray = when feel unsafe, ppl act in annoying ways, so you should make them feel safe again

characteristics and learning enviro of pedagogy and andragogy

peds characteristics learner is dependant, needs external rewards and punishment, experiences is inconsequential or limited, subject centered, teacher directed peds learning enviro climate is authoritative, competition is encouraged, teacher sets goals, choices made by teacher, teacher lectures, teacher evals adult characteritis leander is self directed, internally motivated, experience are values and varied, task or prob centered, self directed adult learning enviro climate is relaxed and informal, collab is encouraged, teacher and class set goals, choices made by teachers and students, students process activities and inquire about projectes, teacher, self, peers eval

underdelegating

ppl false assumption that delegation interpret as lack of ability on their part to do job correctly/complete leaders should delegate some of their most difficult tasks lack of trust = get over this by frequent communication remember workers will make mistakes not enough time to delegate = must explain, tach lack of experience in job or in delegation need to be incontrol, perfectionist fail to anticipate the help they will need clinical nurse under delegate bc difficult to assume manager role

clinical ladder

programs encouraging nurses to earn promotion, gain recognition, and to increase pay by meeting specific requirements pay associated w/ it what committee - practice issues, recruitment, ect

other learning concepts

readiness to learn = maturational and experiential factors in learner background that influence learning, not same as motivation learn maturation = leader has received the prerequisites for next stage of learning, could be behaviors prior to learning experiential factors - skills previously learned that are needed for next stage in learning motivation to learn - benefits of learning specific content more likely to attend training session, why/how specific edu or training will benefit them personally is important reinforcement - learners 1st attempts are often unsuccessful, good preceptors are needed to reinforce desire behavior, once behavior or skill learned, needs continual reinforcement until internalized task learning - learning complex task is facilitated when tasks are broken into parts, beginning w/ simplest and continuing to hardest transferring of learning - goal is transfer new learning to work setting, training must be similar to work setting, practice and overlearning, variety of situations, identify important steps, span of memory - effectiveness of staff development activities depends on extent on ability of participants to retain info, repeated rehersal, grouping items, well presented material chunking - 2 independant items of info presented and grouped into one unit knowledge of results - ppl learn faster when informed of thier progress

provision 4.3

responsibility for nursing judgement, decisions, actions in some circumstances, response may be borne by noth nurse and institution nurse accept/reject role demands, assignments based on edu, knowledge, competence, experience, assessment of level of risk for pt safety nurses not in direct care of pt still responsible for care to those whom they supervise/teach define, implement, maintain stands of professional practice plan, establish, implement, eval mechanisms to safeguard pt, rn, colleagues, enviro safeguards = peer review, staffing plans, credentialing, QI nurse must seek consultation and collab for qualified nurses, professionals if beyond competence/qualifications

clarifying role expectations through role models preceptors and mentors

role model - someone who is unusually effective or inspiring in some social role, job, experienced relationship b/w role model and new hire = passive not all modeled behavior is positive preceptor - experienced nurse who gives knowledge and emo support, clarification of role expectations, 1:1 basis, adjust to learners needs preceptorship - careful hire process, only ppl w/ strong role model, formal classes for learning, growth for both, good communications, goal setting, ASSIGNED mentors - use edu as means for role in using edu as means for role clarifications, relation b/w 2 ppl in professional setting, CHOICE

key concepts of ch 16

social learning theory = ppl learn most behavior by direct experience and observation socialization of ppl into role happens w/ all professional and is normal sociological process socialization and resocialization often neglected areas of indoctrination process new grads, international nurses, new managers, experienced nurses in new roles have unique socialization needs difficulties w/ socialization usually center on unclear role expectations (role ambiguity) an inability to meet job demands, deficiencies in motivation, role strain an role overload contribution to prob role model, preceptor, mentor are no s/s, all play important role in assisting w/ socialization of employees ppl form different cultures and age groups have different socialization and learning needs theories of learning and principles of teaching must be considered in staff development activities are to be successful promote and use of ebp nursing practice is an org wide responsibility training, edu, indoctrination are important parts of staff development and should be eval for pruose, quality control, fiscal accountability learner is role model of the lifelong learner and seeks to encourage lifelong learning in others managers and edu depart staff have shared resp for edu, training, indoctrination of staff roles that each play must be clearly delineated and communicated for staff development activities to be successful

responsibility of the education department

staff development is done by education department = bc have staff or advisory authority rather than line authority little or no formal authority over those for whom they are giving educ progams

Summary

start w/ heart (how ppl who are skilled at dialogue stay focused on goals) work on me first, us second (only person you can directly control is yourself) focus on what you really want (pay attention to your moves, what do i want for myself, others, relationship, how would i behave if this is what I wanted) refuse the fools choices (dont choose between things, add AND, clarify what you dont want, do what, healthy options)

start with heart how to get results we really want

start w/ your own heart get yourself right before the dialogue problem is not that motives degenerates, our motives do, we usually miss "if we fix those losers, we will have it better" best way to look at us, is to look at me "me first, us second" we are the only person we can work on anyhow = become skilled in dialog most talented want to improve dialog skills, not the least we try to win (prove others wrong), punish, keep the peace choice peace over conflict what do i really want for myself what do i really want for others what do i really want for the relationship how would i behave if i really wanted these results help remind us of our goal, keep focused

state NPA elements of delegation

states NPA definition of delegation items that cannot be delegated items that cannot be routinely delegated tasks RN can delegated description of profession nursing practice description of RN, LPN/LVN, UAP scope degree of supervision needed for task guidelines for lowering delegation risks warnings about inappropriate delegation if restriction use of work "nurse" to licensed staff

make it safe how to make it safe to talk about almost anything

step out - when others move to silence or violence, step out of the conversation and make it safe, when safety is restored, go back to the issues at hand and continue the convo decide which condition of safety is at risk: mutual purpose = do others believe you are about their goals in this convo, do they trust your motives (if at risk = defensiveness, hidden agendas, accusations, circling the same topic) mutual respect = do others think you respect them ( if ppl dont respect you = unsafe convo, convo stops), find ways ppl are similar to gain back both respects above do these 3 things: apologize when appropriate - your motives must change, give up part of your ego, contrast to fix misunderstanding - when others misunderstand either your purpose or your intent use contrasting, start with what you don't intent or mean, then explain what you do intend or mean (contracting is a don't/do statement that address others concerns that you dont respect them or that you have a malicious purpose = dont, confirms your respect or clarifies our real purpose = do), dont is more important part create a mutual purpose - not a misunderstanding, when at different purposes, use four skills to get back to mutual purpose - CRIB = commit to seek mutual purpose (stay open minded) recognize purpose behind the strategy(why do they want it like that?) invent a mutual purpose (if cant discover a mutual purpose, invent one) brainstorm new strategies

social learning theory

suggests we learn from our interacts w/ others in social context part of teamwork and mental model development in LO albert bandura in 1970s direct reinforcement could not account for all types of learning, most ppl learn their behaviors by direct experience and observation = observational learning = modeling ppl learn as result of direct experience of effects of their actions knowledge is frequently obtained through vicarious experience (like seeing someone else's actions) ppl learn by judgements voiced by others, when vicarious experience is limited ppl eval t soundness of new info by reasoning through inductive and deductive logic

senge's five disciplines of a learning organization

system thinking - organ have staff see themselves as connected to whole org, work activities are seen as having impact beyond personal = sense of community, builds a commitment on part of individual workers, main goal of LO is construct organ culture of learning personal master - each member has commitment to improve personal abilities, personal and prof learning is integrated into team and org team learning - through collaboration of team that LOs achieve their goals, values, trust, openness, commitment to one another's learning, acknowledgement that mistakes part of learning process are important charactivies of LO mental models - goal in LO is foster organ development through diverse thinking, assumptions held by ppl then challenged bc releases ppl from traditional thinking, promotes full potential of ppl to learn shared vision - when all workers of LO share common vision, more willing to put personal goals and needs aside and instead focus on teamwork and collaboration

criteria for delegation to UAP

tasks may be delegated to NAP only if they meet ALL the following: allowed by agency policy dont engager health or well being of pt performed w/ predictable outcome little.no modification from 1 pt to another performed according to standard steps recur in daily care of pt or group of pt don't inherently involve ongoing assessment, interpretation, decision making which cannot be logically separated from procedures itself

socialization international nurses

to fix shortages = ge them from overseas sponsoring country must do whatever to make migrant nurse assimilated into work neviro ex - language skills, slang, abbreviations

training vs education

training = organized method, knowledge and skills for specific purpose, to perform duties of job edu = formal, broader scope, managers not solely responsible for workers formal edu managers/leaders asked to teach classes high risk, low volume = deathly, but doesn't happen often, but need to know what to do

leadership roles w/ socializing and edu staff in learning org

unit norms and values to all new hires infuses team spirit role model to all workers, mentor to some ppl encourages mentorship b/w all levels of staff signs of knowledge or skill deficit in new hires assist developing personal strategies to cope apply adult learning principles when helping employee learn new skills or info coaches workers spontaneously regarding regarding knowledge and skills deficit sensitive to unique socialization and edu needs of culturally and ethnically diverse staff promote aspects of learning org to workers assists nursing staff in overcoming org barriers to effective EBP encourages and support workers as they pursue lifelong learning ppl and collect

look for your style under stress

watch your own behavior = hardest thing to do lower self monitors - monitor own behavior become a vigilant self monitor - pay close attention to what youre doing and impact its having, alter your strategy is needed

silence is violence

when feel unsafe either turn silence (withholding means form the pool) or violence (force meaning in the pool) silence examples: masking = understanding or selectivly showing our true opinions, sarscam, sugarcoating, couching avoiding = steering completely away from sensitive subjects, talking but w/o addressing real issue withdrawing = pulling out of a conversation altogether, exit convo or exit room

role ambiguity

when role expectations are not clearly understood how to overcome: edu dept. ensure all ppl involved in indoctrination edu, training of nursing staff understand and do their roles non-nursing admin is responsible for staff development dept, must be input from nursing dept. in formulating staff development policies and delineating duties aduc advisory committee should be formal w/ representatives form top-middle, and 1st level management, staff development, HR, resps from all class of employees getting training or edu should be part of committee accountable for each area of staff development programs clearly communicated, follow up on process is essential method of seeing cost and benefits of various programs should be used

select and empower capable personnel

who can do it leadership role to stretch new and capable workers ask if person is capable of doing tasks validate capability w/ direct observation must have access to info, tech, tools, budget, informing support staff to do task

sorry im not going to talk about how to split up the phone bill again. im not sure our friendship can stand another subtle *exits*

withdrawing meaning: we cant talk about even sompletes topics w/o arguing

excuse me, iv got to take this call

withdrawling meaning: id rather gnow off my own arm than talk to you

NCSBN decision tree for delegation

yes or no questions and follow it step by step