Leadership and Management Exam II

How to calculate FTE

(hours per week X 52 weeks in a year) / 2,080

Examples of Mission statements

-"Our mission is to improve the health of the people and communities we serve" -Should they purchase a medical equipment company? How does it fit with the mission of the institution? -Baylor Scott & White Health exists to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. -As a comprehensive health science university, the mission of The University of Texas Health Science Center at Houston is to educate health science professionals, discover and translate advances in the biomedical and social sciences, and model the best practices in clinical care and public health. -We pursue this mission in order to advance the quality of human life by enhancing the diagnosis, treatment, and prevention of disease and injury, as well as promoting individual health and community well-being -Mayo Clinic Mission and Values Mission To inspire hope and contribute to health and well-being by providing the best care to every patient through integrated clinical practice, education and research. -Mayo Clinic Mission and Values Mission To inspire hope and contribute to health and well-being by providing the best care to every patient through integrated clinical practice, education and research.

Behavioral interview

-"provide the employer with information about how you have handled both negative and positive experiences in the past. Employers are seeking employees who are able to reflect on their past performance and learn from it." -The best predictor of future performance is past performance -Develop in advance answers to common behavioral interview questions—BE PREPARED!

Technology Implementation

-2004 President Bush formed Office of National Coordinator for Health Information Technology (ONC) -Charge: Implement interoperable, private and secure nationwide health information system and supporting the widespread, meaningful use technology (within 10 years) -Endorsed by President Obama as part of the American Recovery and Reinvestment Act (ARRA) and supported financially with $30 million -Health Information Technology for Economic and Clinical Health Act (HITECH)(CMS 2010) -Mandatory EHR by 2015 -Reduced reimbursement to nonparticipants -Dollars provided to physicians and hospitals -Requires Meaningful use = demonstrate improvement in quality on some level -Current state of Meaningful use -SAFER Guides -CMS latest ruling -Security provision tighten HIPAA

Managed Care

-A broad term used to describe strategies used in the health care delivery system that reduce the costs of health care -Client care is outcome driven and is managed by a case management process -emphasizes the promotion of health, client education and responsible self-care, early identification of disease, and the use of health care resources

Critical pathway

-A clinical management care plan for providing client-centered care and for planning and monitoring the client's progress within an established time frame -Interprofessional collaboration and teamwork ensure shared decision making and quality client care

Case management

-A health care delivery strategy that supports managed care -It uses an interprofessional health care delivery approach that provides comprehensive client care throughout the client's illness, using available resources to promote high-quality and cost-effective care -Includes assessment and development of a plan of care, coordination of all services, referral, and follow-up -Utilizes critical pathways and conducted variation analysis

Case Manager

-A professional nurse who assumes responsibility for coordinating the client's care at admission and after discharge -Establishes a plan of care with the client, coordinates any interprofessional consultations and referrals, and facilitates discharge

Nursing Care Plan

-A written guideline and communication tool that identifies the client's pertinent assessment data, problems and nursing diagnoses, goals, interventions, and expected outcomes -The plan enhances interprofessional continuity of care by identifying specific nursing actions necessary to achieve the goals of care -The client and family are involved in developing the plan of care, and the plan identifies short-term and long-term goals -Client problems, goals, interventions, and expected outcomes are documented in the care plan, which provides a framework for evaluation of the client's response to nursing actions

Operational budget

-Accounts for resources needed to make department operate or run -Budget is comprised of multiple accounts specific to department -Created for revenue producing and non revenue producing departments

Problem solving

-Active process that starts with problem and ends with solution -Some are simple and uncomplicated -Others may be complex and require more analysis by the nurse -Create resolution between the gap of "what is" and "what should be

Organizations demonstrate four cultural traits that can be measured by indices, each with it's own unique characteristics:

-Adaptability -Involvement -Consistency -Mission

Don'ts with a Cover letter

-Address to company -Exceed one page -Indent paragraphs -Add humorous anecdotes -Sloppy appearance -Bad mouth prior experiences or employers

Critical Need for Patient Education

-Adherence to prescribed regimens -Prevent complications -Promote self-care -Reduce admissions

Benefits of Transforming Care at the Bedside

-Adverse events are reduced to 1 (or less) per 1,000 patient days -25% reduction in deaths on the TCAB unit -95% compliance with all key clinical process measures (all-or-nothing measure) for the three top clinical conditions on the TCAB unit -95% of clinicians, students, and staff say, "I work within a supportive environment that nurtures my professional formation and development" -95% of clinicians, students, and staff say, "I am part of an effective work team that continuously strives for excellence even when the conditions are less than optimal" -95% of patients are willing to recommend and are satisfied with physical comfort, emotional support, and respect for their values and preferences -Clinicians spend 70% of their time in direct patient care Clinicians spend -90% of their time in value-added activities

Clinical Decision System Uses

-Alert -Interpretation -Assisting -Critiquing -Diagnosing -Managing

Service Line or Product Line Structure

-All functions needed to produce a product or service are grouped together in self-contained units -Decentralized decision-making based on product, service, geographical location or type of customer

Review of literature

-Allows projects to identify similar programs and structures and discover problems, pitfalls, and successes -Can help identify best practices or evidence based innovations

e-Portfolio

-An emerging trend is to develop and e-portfolio as a web page or to provide as a digital copy to perspective employers. -e-Portfolios can range from very simple web page delivery of the resume/curriculum vitae or more interactive and engaging

Five major steps of Methodology:

-Analysis -Design -Development -Implementation -Evaluation

Evaluation of Information Found on the Internet

-Ask "Am I PLEASED with the site?" -Purpose -Links -Editorial (site content) -Author -Site navigation -Ethical Disclosure -Date site last updated

Elements of an objective

-Audience -Behavior -Condition -Degree

Career planning/goal setting

-Being SMART will help you describe specifically what you want to accomplish with strategic planning for your career. -S-Specific -M-Measureable -A-Achievable -R-Realistic -T-Timely -Crucial for professional development & will be expected as part of your performance appraisal -You should develop goals that span your career over the next 6 years -Short-term career goals for 1-3years -Intermediate career goals for 3-5years -Long-term career goals for 5-6years -New grads typically set a shorter time line

Communication skills

-Both verbal and nonverbal communication skills essential to effective education -Must constantly watch and listen to patient -Looking for cues about patient's reaction to education -Body language says a lot about interest and motivation

External environment

-Broad based -Identifies trends and future issues -Assesses the impact of opportunities and threats within the environment

What is a budget variance?

-Budget can be used as a benchmark -A variance is the difference between what is budgeted and the actual result (may be positive or negative) -Allows comparison of actual performance against the expected -Can be impacted by unexpected events (natural disasters, epidemics, etc.) as well as staff generated (wasteful use of resources, incremental overtime, misuse of sick time, etc.)

Daily Staffing is influenced by multiple factors

-Budgeting -Resources to support staff -Regulatory requirements -Model of Care Delivery

Comparison of Personal to Business Budgets

-Business -New Hill-Rom Total -Care bed -Personal -new car -dishwasher

Advantages of Functional nursing

-Can deliver care to a large number of patients -Allows specialization

Types of Budgets

-Capital Budget-Ticket items above X dollars (X depends on organization) -Zero Based Budget: Each line item requires justification. -Operational Budget-Day to day functioning -Income and expenses over a specified period of time (yearly, monthly, etc.)

Product or Service Division of Labor

-Care delivery can be organized around product lines or service lines -Can lead to improved quality of care and decreased confusion

Team nursing

-Care for patient by several team members -RN as team leader

Common Sequencing Structures

-Chronological -Procedural -Categorical -Topical -Parts to whole; whole to parts -General to specific; specific to general -Problem to resolution -Known to unknown; unknown to known -Theoretical to practical; practical to theoretical -Simple to complex; complex to simple

Working Phase of Interview

-Clarification of cover letter and resume content -Use of behavioral interview strategy -Highlight specific personal and professional accomplishments -Utilize STAR strategy when answering questions (Table 27-4) -Specifics- provide details of what happened -Task- problem/issue -Action- what you did -Result- what happened/what you learned -Familiarize yourself with the legalities of interviewing

Clinical Decisions in Nursing Practice

-Clinical decision making requires critical thinking. -Clinical decision-making skills separate professional nurses from technical and ancillary staff. -Patients often have problems for which no textbook answers exist. -Nurses need to seek knowledge, act quickly, and make sound clinical decisions

Termination Phase of Interview

-Closing of interview -Employer will typically ask if you have any further questions -Opportunity for you to ask any remaining questions related to -Position -Benefits -Expectations -Concerns -Ask when to expect to hear back from the employer if not stated -Send a Thank You note for allowing you the opportunity to speak with them regarding potential employment

Patient and Staff Health care education

-Communication of facts, ideas, and skills to change knowledge, attitudes, values, behaviors, and skills of patients, families, and fellow health care workers

Top 10 things employers want

-Communication skills -Honesty & integrity -Teamwork skills -Interpersonal skills -Motivation initiative -Strong work ethic -Analytical skills -Flexibility/adaptability -Computer skills -Self-confidence

Self assessment

-Complete pre-interview assessment based on job description -Identify strengths and weaknesses -Should be completed annually along with establishing/re-evaluating goals

Enterprise Health Information Systems (EHISs)

-Comprehensive integrated system -Serves an entire population or region -Data is relational -Anonymity of health data

Information Processing

-Computer functions provide for effective retrieval and processing of data into useful information -Includes decision support tools -May provide consensus-driven and evidence-driven treatment guidelines and protocols

Elements of Nursing Informatics

-Computerized order entry (CPOE) -Electronic health records (EHR) -Patient decision support tools, clinical and business related -Laboratory and x-ray results reporting as well as picture retrieval and viewing systems (Diagnostic results) -Electronic prescribing, order entry, and medication administration systems, Including barcoding -Community and population health management and information -Communication using Internet, intranet, and email; staffing; and administrative systems, e.g., billing -Evidence-based knowledge and information retrieval systems with access to remote library and Internet resources -Quality improvement data collection/data summary systems/business intelligence -Documentation and care planning -Patient monitoring for vital signs and other measurements -Electronic bed boards to review bed status and availability -Data mining techniques for sifting through large amounts of data to discover knowledge -Disease surveillance systems -web pages to personalize information -Computer generated nursing care pans, critical pathways, and patient documentation such as discharge instruction and medication information -Staff reminders of planned nursing interventions and documentation prompts to ensure comprehensive charting -access to computer archived patient data from previous patient encounters -collaboration with patients, other nurses, and health care providers

Nurse Educator Qualities

-Content knowledge -Education experience -Communication -Intelligence -Adaptability -Patience -Self-confidence -Self-direction -Interactivity -Organization

Barriers to Implementation of IT

-Cost -Start up cost are very expensive -Controlled vocabulary needed -NANDA, NIC, NOC, SNOMED CT... -Interoperability issues -Security protection -Information presentation (interfacing)

The CARS Checklist (CARS)—another tool designed to help you evaluate a website

-Credibility—authoritative source? -Accuracy—correct today? -Reasonableness—engages subject thoughtfully, reasonably, truthfully? -Support—triangulated sources?

Critical thinking skills

-Critical reading -Critical listening -Critical writing -Critical speaking

Various demographic characteristics can influence learner's response, including:

-Cultural background -Language -Age -Education -Health literacy -Health care background -Physiological condition

Decision Making Strength

-Decision making improves with experience -Strategies to improve critical thinking and decision making: -Making only own decisions -Having all information needed to make decision -Ask "why," "what else," and "what if" -Anticipate questions and outcomes

Decision-Making Tools and Technology

-Decision-making grid may help separate multiple factors that surround situation or decide between two choices -Program Evaluation and Review Technique (PERT)

Telehealth

-Delivery of health related services and information for health promotion, disease prevention, diagnosis, consultation, education and therapy via telecommunication, satellite, videoconferencing, robotics, home monitoring to patients and providers at another location

Organizational chart

-Depicts and communicates organizational structure, how activities are arranged, how authority relationships are defined, and how communication channels are established -Roles and responsibilities within each level and division are not defined (see job descriptions)

Primary nursing (relationship-based practice)

-Designates RN as primary provider of care at the bedside; provides total direct care and goal planning -RN assumes 24 hour responsibility for planning care from admission to discharge; When primary RN is not on duty, an associate nurse follow the care plan established by the primary nurse -designates RN as primary provider of care and RN retains 24 hour accountability of care. Other staff member follow care plan created by primary RN. -Adv - trust relationships, accountability, continuity of care -Disadv - costly, may be inefficient

Conducting Internet purpose-focused-assessments (P-F-As)

-Determine Purpose -Why searching? -Determine Focus -Broad and general or narrow and technical -Purpose and focus together determine search approach -Brute force or quick-and-dirty

To achieve culture of safety, organizations must:

-Determine areas of high risk (e.g., monitor outcomes and use survey tools such as the DOCS and the NDNQI) -Develop action plans to improve performance in weak areas -Ask staff to speak up if they witness an unsafe practice -Learn from errors and near misses. Focus on analysis of system problems, not on blaming individuals -Evaluate culture of safety -Enhance teamwork skills. Consider use of TeamSTEPPS -Safeguard patients. Develop a culture of safety; use standardized approaches to common procedures; develop decision aids, e.g., an OR checklist, standing orders, etc.

Managerial Decision-Making Model

-Determine the decision and the desired outcome (set objectives). -Research and identify options. -Compare and contrast these options and their consequences. -Make a decision. -Implement an action plan. -Evaluate results.

Strategies for Promoting Evidence-Based Practice

-Develop and refine research-based policies and procedures -Build consensus from the interprofessional team through development of protocols, decision trees, standards of care, institutional clinical practice guidelines, etc -Make research findings accessible through libraries and computer resources -Provide organization support, such as time to do research and educational assistance to teach staff to interpret research statistics and use findings -Encourage cooperation among professionals -When possible, hire nurse researchers or consultants to assist staff

Need for Nursing Informatics

-Development of standards for EHR on national health care agenda -Interoperability -Centralized EHR -The Joint Commission has highlighted need for increased patient technology and nursing informatics

Disadvantages of Functional nursing

-Disjointed/fragmented care -Risk for impaired communication -Lack of accountability by team members

Functional Nursing

-Divides nursing work into functional roles, each member has specific duties or tasks; task-oriented approach to care -Team member focuses on the delegated task rather than the total client

Lesson Plan

-Document that provides blueprint for education session -Provides nurse information to conduct education session

Implementation

-During this phase, conduct education session -Various factors affect education session -Environment -Learner -Presentation -Content

Content analysis

-During this phase, identify specific information that education should address -Determine essential information to be shared -use PICO question to focus on EBP

Design

-During this phase, organize and structure content identified in analysis phase -Accomplished by establishing objectives and sequencing content

Advantages of Team Nursing

-Each team member works within scope of practice and is accountable for client care and outcomes of care -Requires excellent leadership, communication and delegation skills; requires more time for coordination

Critical Thinking and Delegation

-Effective communication is needed between registered nurses (RNs) and unlicensed assistive personnel (UAP) for giving feedback and clarifying tasks and patient status. -When patients' clinical conditions change, warranting attention by RNs, clear directions are necessary to avoid missed care. -Applying critical thinking can help an RN make the decision about when to appropriately delegate care.

Information Processing Theories

-Emphasize different styles of thinking -Kolb Experiential Learning Styles -Four major thinking styles -Sensing and Abstracting -Doing and Watching

Functional structure

-Employees are grouped in departments by specialty -Decision making is centralized -who reports to who -hospital is divided by function (labs, RT, PT, dietary, radiology, surgery) -person on top of this structure may be uninformed

developing a marking plan

-Ensures all stakeholders have needed information -Communication is essential for success

Critical Thinking

-Essential when making decisions and solving problems -Rapid changes in health care environment have expanded nurse's decision-making role -Stringent budgets -More complex patient care -Earlier discharge of patients

Staff Development

-Evaluation for: -Quality control -Fiscal accountability -Managers and education department staff have a shared responsibility for the education and training of staff.

The Purpose of Strategic planning is twofold:

-Everyone needs to have same idea of vision for where the organization is headed -Planning helps ensure that the needed resources and budget are available to carry out the strategic initiatives that have been identified as important to the unit

Good critical thinkers

-Examine decisions from all sides and take into account varying points of view -Generate new ideas and alternatives when making decisions -Ask "why" questions about situation to arrive at best decision

Factors Influencing Organizational Structure

-Experiencing severe problems -Performance -External audits and reviews -Other reasons to rethink structure -New programs, services, or product lines -Change in leadership -Technology -Diversity -Size of an organization

Affective domain

-Expression of feelings, attitudes, opinions, values -Receiving, responding, valuing, organizing, characterizing

Strategies to Improve Patient Understanding

-Focus on "need-to-know" & "need-to-do" -Use Teach-Back Method -Demonstrate/draw pictures -Use clearly written education materials

Shared governance

-Framework for nursing grounded in decentralized leadership -Each does what "they" do best -Manager relinquishes clinical practice issues -Occurs at unit, division, or system level -Allows nurses significant control over nursing practice -Improves efficiency & accountability -Mitigates some the feelings of powerlessness common in nursing -Used by magnet hospitals

Red Flags for Low Literacy

-Frequently missed appointments -Incomplete registration forms -Non-compliance with medication -Unable to name medications, explain purpose or dosing -Identifies pills by looking at them, not reading label -Unable to give coherent, sequential history -Ask fewer questions -Lack of follow-through on tests or referrals

Overall Strategies

-Get & keep client's attention -Stick to basics -Make most of your time -Reinforce

Groupthink

-Goal is 100 percent agreement from everyone -Can cause disagreement -Can potentially have problems with members feeling invincible or stereotyping outsiders -Can come to one solution without considering all available options -To avoid, group leaders should encourage all members to think independently

Introductory Phase of Interview

-Greetings -Firm hand shake -Make eye contact -Maintain good posture -Provide copy of resume & portfolio -Employer should outline job and conditions of employment -Time to clarify any questions about the position

Delphi technique

-Group members do not meet face-to-face -Questionnaires distributed seeking opinions from group members -Summaries disseminated to group members -Process continues until group members reach consensus

Advisory board

-Group of people selected to reflect representation from variety of stakeholders & various areas of expertise -Can identify potential concerns and provide sound guidance

Characteristics of Strategic Planning

-Guides members of the organization -Develops procedures and operations to optimize future outcomes -Decreases costs and expands resources to serve community needs and interests -Adds efficient and effective programs -Establishes fruitful relationships

Health Information Systems

-Have far-ranging capabilities -Function as mechanisms to improve outcomes, reduce errors, control costs, and support move to HER -Clinical information system (CIS) -Administrative information system

Value in Health Care

-Health Information Systems (HIS) -"Meaningful use" -Improve quality, safety & efficiency -Enhanced patient safety -Advance evidence-based care

Group Problem Solving

-How have problems in nursing been traditionally handled in the past? -Was this a good practice? If not why not? -What methods have been implemented to improve problem solving?

Nurses need basic understanding of the following:

-How organizations are structured -How organizational systems work -How to engage in strategic planning process

Vision statement

-How the people of the organization plan to actualize the mission -Describes future goals or aims of the organization -Usually 3 to 5 years out -in health care, it describes a balance of addressing the needs of the providers, the patients, and the environment

Nominal group technique

-Ideas generated in writing without discussion -Ideas presented on flip chart by group members -Group discusses, clarifies, and evaluates ideas -Group votes privately on ideas

Problem solving with the Nursing process

-Identify a problem and collect data about the problem -Determine the exact nature of the problem -Decide on a plan of action -Carry out the plan -Evaluate the plan

Decision making is a 5 step process

-Identify need for decision -Determine goal -Identify alternatives -Determine which action to implement -Evaluate decision

The Traditional Problem-Solving Process

-Identify the problem. -Gather data to identify the causes and consequences of the problem. -Explore alternative solutions. -Evaluate each alternative -Select appropriate solution -Implement solution -Evaluate results.

Goals of Budgeting

-Improve operational efficiency -Make economically sound decisions -Meet operational objectives -Fulfill the mission and vision of the organization -Others?

Education

-Inherent part of nursing -Patient education -Legal component of nursing -Staff education -Attempt to increase staff proficiency -Goal is to have staff function at their highest level of competency

Intuitive thinking

-Innate feeling nurses develop that helps them act in certain situations -Described as gut feeling of something wrong -Results from unconscious assessment and analysis of data based on individual's past experiences

ANA Tenants on Safe Staffing

-Input from Direct Care RNs -Take into account experience of RNs and more... -Consider staffing recommendations made by specialty organizations -Ensure RNs not forced to "float" to units where they are not trained -Does not legislate ratios

Clinical reasoning

-Integrating and applying different types of knowledge to weigh evidence, critically think about arguments, and reflect on the process used to arrive at diagnosis -Collaborative and reflective process that involves content-specific knowledge, engagement of the patient and family in understanding the clinical problem, and incorporation of critical contextual factors -Leads to deliberative decision making and sound clinical judgment

Nursing informatics

-Integration of nursing, its information, and information management with information processing and communication technology to support health of people worldwide (International Medical Informatics Association, Nursing Informatics Special Interest Group (IMIA-NI), 1997) -Designed to analyze, formalize, and model nursing information processing and nursing knowledge for all nursing practice

Information Communication

-Interoperability of systems and linkages to be able to exchange data across systems -Identifier numbers for health care systems essential -Infrastructures must be in place so standard data communication can occur -Patient privacy must be maintained

The Joint Commission & The Safe Care Program

-Is a free offering developed to assist health care organizations in educating patients to help prevent medical errors -Utilizes free posters that hospitals can hang in patient rooms which allows patients and families to instantly access and watch safety videos by topic on their own smart phones by simply pointing a smart phone at a QR code on the poster, or texting the word "SAFE" to 411247 to receive a link to Safe Care's safety video library.

Key problem-solving questions

-Is it important? -Is it mine? -Am I qualified? -Do I have the authority? -Do I have the resources? -Can I delegate it? -What are the benefits of solving the problem?

Electronic health records

-Is patient-centered -Is a virtual way to maintain person's health data across lifetime -Contains multidisciplinary information -Documents patient's contact with health care organization -Includes health promotion, protection indicators, & illnesses

Transforming Care at the Bedside (TCAB)

-Is the result of the NAM (formerly IOM) reports -An effective initiative that provides multiple strategies for improving healthcare

Strategic planning

-It is the formal consideration of an organization's future course -Deals with at least one of three key questions: "What do we do?" "For whom do we do it?" "How do we excel?"

Actions negatively affecting decision making:

-Jumping to conclusions -Not gathering all information -Choosing too broad decisions -Failing to choose rational solution -Failing to intervene or evaluate

Interaction

-Learning works best when interaction between learner and teacher occurs -Can occur via constant discussion, incorporating activities, and questioning learner

Resume basics

-List jobs in reverse chronological order -Highlights education & career progression -List certifications & organizational membership -List societal contributions & volunteer work -Special skills such as languages spoken -Keep resume for internet uploads simple

Do's with a Cover Letter

-Market yourself -Highlight experience -Highlight accomplishments -Double check spelling and grammar -Emphasize behavior strengths

Group decision making

-May be necessary in some situations -People affected by decision often will be involved in decision -Involve people with information or resources that contribute to decision -Consider size of group and personalities of members

Consensus building

-Means all group members can live with and fully support decision regardless of whether they totally agree -Useful because all group members participate and realize contributions of each member to group -Requires more time -Should be reserved for important decisions that need strong support

Goals and Objectives

-Measurable activities specific to the development of designated services and problems of an organization -Part of strategic planning and growth of an organization -Goal=desired result toward which effort is directed -Development of SMART goals -Objectives=are explicit, measurable, observable or retrievable, and obtainable. One goal may have multiple objectives. Usually more specific than a goal as they identify how and when the goal is to be accomplished.

Personality

-Meyer-Briggs theory suggests personality is made up of four complementary traits: -Extroversion-introversion -Sensing-intuition -Thinking-feeling -Judging-perceiving -Sliding scale 1 - 10 is used -Example: 1 = extremely extroverted, 10 = extremely introverted, 5 = equally both -Individuals can be identified as 1 of 16 different personality types -Personality differences can affect the way individuals approach and engage in a learning experience

Currently

-Mobile Applications -Social Networking -Virtual Reality -Internet for clinical practice -Use trusted websites -Use precise terms -Refine internet searches with filters

Individual and Group Education

-Most patient and staff education occurs on individual basis -Nurse may be teaching patient or family -Nurses can provide group education by teaching community seminars and wellness classes -Need to include family in the learning process -Assess the patient's current level of knowledge

NHPPD and FTE Budget

-NHPPD = 6 Unit Average Daily Census = 20 patients -6 NHPPD X 20 patients = 120 hours ÷ 12 hour shifts = 10 shifts per 24 hours -5 Shifts on Days and 5 Shifts on Nights for 24 hour coverage for units with equal work distribution.

NHPPD/Units of Service

-NHPPD = Nursing hours per patient day -Number of hours of nursing care required/budgeted for each patient in a 24 hour period.

The National Quality Forum

-NQF is committed to helping our nation achieve better and affordable care, and improving the overall health of Americans. Specifically, NQF: -Sets standards. NQF endorsed measures are considered the gold standard for healthcare measurement in the United States. Expert committees made up of varied stakeholders, including patients, evaluate measures for NQF endorsement. The federal government and many private sector entities use NQF-endorsed measures above all others, given the rigor and consensus process behind them. -Nearly all NQF-endorsed measures are in use. -Recommends measures for use in payment and public reporting programs. By 2017, nine percent of all Medicare payments will be performance-based. Under legislated authority, the NQF-convened Measure Applications Partnership advises the federal government and private sector payers on the optimal measures for use in specific payment and accountability programs. MAP also bridges public and private sector use of measures to help the nation use measures efficiently and reduce burden. -Identifies and accelerates quality improvement priorities. We can only achieve a safe, value-driven healthcare system when all those involved work together with a shared vision, a common purpose, and a coordinated plan of action. Through NQF-convened partnerships, such as the National Priorities Partnership, NQF stakeholders help set and shape national healthcare improvement priorities, and then figure out the best courses of action to meet them. -Advances electronic measurement. Care can be safer, more affordable, and better coordinated when electronic health records capture data needed to measure performance, and when that data is easily shared between healthcare providers and their patients. NQF's health IT initiatives are designed to support the complex but important move toward electronic measurement. -Provides information and tools to help healthcare decision-makers. Healthcare is changing fast, and performance measurement is changing with it. NQF provides reports, tools, events, and information geared to help physicians and others on the frontlines of changing healthcare.

Why is the budget so important?

-Necessary for a entity to survive in today's healthcare environment -Budget planning is influenced by many factors

Reasons for purchasing equipment

-New, more efficient technology becomes available or older equipment becomes antiquated -Older equipment becomes too expensive to maintain or there is a lack of availability of replacement parts

Examples of fixed costs

-Nurse Manager salary -Rent/Mortgage -Others -building and equipment depreciation -utilities -fringe benefits -administrative salaries

Use of Technology in Decision Making

-Other tools: -Decision tree -Gantt chart -Technology can support decision- making process -But not take over

PICO stands for?

-P: patient/population/problem -I: intervention -C: comparison -O: outcome

Learning Styles

-Particular manner in which learner responds to and processes learning -Perception theories emphasize how people's senses affect learning -Information processing theories emphasize different styles of thinking -Personality theories emphasize how personality differences affect learning

Obstacles to effective decision making:

-Past life experience -Education -Previous decision making experience -Values -Gender -Personal biases -Preconceived ideas

Four P's of Marketing

-Patient -Product -Price -Placement

Calculating Skill Mix

-Percentage of RN staff compared to other direct care staff Example: Unit has 40 FTEs or 8 staff on duty RNs = 20 FTEs RNs = 4 LVNs = 10 FTES LVNs = 2 UAP = 10 FTEs UAP = 2 Example: #RNs / # of FTEs = skill mix % Skill Mix is 50 % RN (25% LVNs & 25% UAP)

formal education

-Planned, structured, and directed toward specific topics and goals -Contains evaluation, which measures the patient's success in retaining and applying information

Budget Planning

-Planning for next fiscal year typically begins 6 months into current fiscal year -Based on anticipated costs and revenue -Anticipated costs and revenue may begin with Historical Data -Adjust budget for anticipated new or reduced revenue or other changes

Budget preparation

-Planning meetings, start 6 mths ahead -Require nursing involvement -For a fiscal year as apposed to a calendar year. -Regulatory influences

Phases of an Interview

-Preparation Phase -Introductory Phase -Working Phase -Termination Phase

Repetition

-Preview information -Allows patient to understand what is to come and mentally prepare -Present information -Review information -Allows patient opportunity to organize information and reinforce learning

Marketing

-Process of creating a product or health care service for patients or consumers -The healthcare facility, the patient, & the community benefit

Learner analysis

-Process of identifying learner's unique characteristics and needs -And how these can influence education process -Understanding patient's unique characteristics may not guarantee success -But increases effectiveness -Reading level -Functional illiteracy (reading level below 5th grade) -The safety of patients cannot be assured without mitigating the negative effects of low health literacy and ineffective communications on patient care

Examples of Variable costs

-Productive wages -Floor stock supplies -Others -medical and surgical supplies -drugs -laundry -food costs

Advantages of Patient/Client-Focused Care (total care or case method)

-Provides high quality care and consistency; Establishes trusting relationship -Right person doing the right thing -Convenient and expedited care services -Care teams utilized - Interdisciplinary collaboration

Advantages of Primary nursing

-Provides holistic, high quality care; Establishes trusting relationship and continuity of care -High job satisfaction and professionally rewarding -Increased accountability and responsibility; autonomy

Capital budget items

-Purchase of new or replacement items that are costly -Plan ahead for these items -Budget (set aside) purchase dollars (next fiscal year). Large capital budgets may be spread over several fiscal years. -Need justification for expenditure -Sometimes justify emergency unplanned expenditure (defibrillator) -Compete with "other" department capital requests

Positive outcomes

-Reduces healthcare costs -Improves quality of care -Assists client in gaining optimal wellness & independence

Mission statement

-Reflects purpose or reason for existence of organization -Can include a description of the geographical area of service, the attitudes and beliefs of the organization, as well as the organization's values and what behavior and actions can be expected -it's the primary driving force or its vision of the manner in which it believes care should be delivered

Patient/Client-Focused Care (total care or case method)

-Registered nurse assumes total responsibility for planning and delivering care to a client -The client may have different nurses assigned during a 24 hour period; the nurse provides all necessary care needed for the assigned time period

Presentation, Performance, Practice

-Repetition and interaction can be incorporated through format of presentation, performance, and practice -Allows patient to repeat and reinforce learning while increasing patient's interaction with nurse

Disadvantages of Primary nursing

-Requires excellent communication, care coordination, and skills by primary nurse -Nurses and patients should be matched according to needs and abilities -May be costly, inefficient, and time-consuming

Preparation Phase of Interview

-Research -Know the job duties and complete self-assessment -Know about the facility/organization -Know the mission, vision, philosophy of the facility/organization -Develop questions you may have related to facility/unit/position -Develop a portfolio to showcase your experiences and accomplishments—skills -Prepare your resume -Practice interviewing -Plan wardrobe -Take to interview: copies of resume, portfolio, pen, notepaper and list of questions -Arrive shortly before the interview

Internal environment

-Reviews effectiveness of an organization -Assessment of assets and liabilities

Disadvantages of Team nursing

-Risk for RN dissatisfaction -Can cause blur lines of responsibility, lack of accountability, errors, and fragmented/depersonalized patient care

Perception Theories

-Rose's VAK Model

Expenses

-Salaries and benefits -Floor stock -Nourishment -Linen replacement -Others...

Strategic Planning and the Mission

-Set deadline for completion of strategic plan -Develop marketing plan

Culture linked to organizational effectiveness

-Shared sense of responsibility -Possessing consistent systems & procedures -Responsive to the market -Clear purpose & direction for the organization

Quality

-Shorter hospital stays - Teaching should begin upon admission! -Increased demands on nurses to provide quality education

Communication skills to increase your patient's understanding

-Slow down -Avoid abbreviations and idioms -Use visual aids and illustrations -Give "normals" (e.g. lab values in reference to their abnormal labs) -Limit the amount of information at each sessions and repeat, repeat, repeat -Use "teach back" (e.g. "show me", have them repeat in their own words) -Be an active listener -Clarify and address quizzical or confused looks -Be respectful, caring and sensitive

Focus groups and Interviews

-Small groups of individuals with common characteristic -Asked to meet in groups to answer related questions -usually time consuming and expensive to conduct than questionnaires or surveys. They work best when the topic is broad and the options are not clear

Reporting relationships in organizational chart

-Solid lines = formal reporting relationships -Dotted lines = dual or secondary reporting relationship

Staffing in Texas

-Staffing committees required by Law -Percentage of committee make-up must be direct RN providers

Disadvantages of Patient/Client-Focused Care (total care or case method)

-Staffing is determined by patient needs; negatively perceived by staff -Decentralized; May be costly and inefficient

SWOT analysis

-Strengths, Weaknesses, Opportunities, & Threats -Identifies strengths and weaknesses in internal environment and opportunities and threats in external environment -Useful for initial brainstorming and formal planning

Organizational structure

-Structure facilitates execution of mission -Illustrates lines of communication -Variations -Matrix -Flat versus tall -Decentralized

Community and Stakeholder assessment

-Systematic consideration of all potential stakeholders to ensure needs of each stakeholder are incorporated in planning phase -When stakeholders are not involved in planning, they do not gain sense of ownership -May not accept program or strategic goals -No sense of ownership

Possible listing of sources for jobs include:

-TNA website -Monster -Indeed -SoutheastTexas.com -Nurse.com -Job Fairs -Hospital websites

5 mistakes to avoid in an interview

-Talking too much -Knowing nothing about the company -Arrive late -Bring up salary expectations too early -Not professionally dressed -What is your verbal and nonverbal behavior saying about you as a professional?

"Right To Know" A Patient's Bill Of Rights

-Teaching allows client/family to make informed decisions -Teaching helps prevent preventable disease -Education empowers the patient to become active in his or her own health care

Team Nursing

-Team leader usually led by a Registered Nurse (RN) is responsible for assessing client, analyzing client data, planning, and evaluating each client's plan of care; RN then determines the work assignment and delegates to supporting staff -teams responsible for patient care, usually led by an RN that may delegate -Adv - need delegation and supervision skills -Disadv - fragmented-depersonalized care, lack of accountability, can contribute to RN dissatisfaction

Technology in Health Care

-The National Academy of Medicine formerly Institute of Medicine (IOM) -Patient Outcomes -Computers -Internet -Intravenous pumps -Spreadsheets -Databases -Electronic Health Record -mHealth -Self service kiosks -Remote monitoring tools -Sensors & wearable technology -Wireless communication -Real time locating services

Nursing Leadership in HIT

-The Technology Informatics Guiding Education Reform (TIGER) Initiative -Vision -Mission -Activities -Information literacy -Set of skills needed to find, retrieve, analyze and use information

Direct Patient Care

-Time spent on activities that are done directly to the patient -Medication administration, assessment, interventions, etc.

Indirect Patient Care

-Time spent on patient related activities, but do not require direct contact with the patient -Documentation, patient hand-off, traveling, reviewing orders, etc. -Nurses can spend up to 25% of their shift on indirect activities

Vision Statement Examples

-To be the most trusted name in giving and receiving safe, quality, compassionate health care. -Excellence above all in the quest to be an acknowledged leader in the collaboration to treat, cure and prevent the most common diseases of our time through education, research and clinical practice.

Reasons for Staff Development

-To establish competence -To meet new learning needs -To satisfy interests the staff may have in learning in specific areas

Daily Staffing: Patient Classification Systems

-Tools are typically proprietary and purchased by system -Measures workload requirements of patients over time -Best tools are reliable and valid -May be used to staff shift and or calculate NHPPD for budgeting

Joint Commission and Campaign to Reduce Readmissions

-Two new resources -Speak Up campaign -Quick Safety newsletter

Budget Monitoring

-Typically monitored monthly through Monthly Ledgers with Details -Reports typically show current month and Year to Date (YTD) -There is frequently a comparison of year/year profit and expenses -Net effect is shown in dollars, percent or both -Negative results or losses below budget are expressed as ( ) -Variances must be explained -Negative results require corrective action or plan

Supervisor assessment

-Typically occurs annually -Determines if you are meeting job expectations -Establishes goals for improvement or professional growth for upcoming year -Typically based on job description and observation -Can determine eligibility for merit increase

Matrix Structure

-Unique and complex integrating both product and functional structures into one overlapping structure. Managers may report to different bosses (i.e. oncology clinic manager may report to VP nursing service and to VP for outpatient services.) -Matrices develop when there are strong outside pressures for dual organization focus on product and function.

Initiatives for Transforming Care at the Bedside

-Use of rapid response teams to "rescue" patients before a crisis occurs -Specific communication models -Professional support programs -Liberalized diet plans & meals schedules for patients -Redesigned workspace that enhances efficiency & reduce wastes

Literacy & Foreign Languages

-Use pictures, models, video on demand and other learning aids as appropriate -Other than Spanish, few commercial vendors provide patient education materials in foreign languages -Ensure that translated print documents are readable by population served

Surveys and questionnaires

-Used with large groups of stakeholders and only when a general idea of options available -Ex. Polling staff

Philosophy of an organization

-Value statement of principles and beliefs that direct organization's behavior -Typically embedded in mission statement

Gardner's Multiple Intelligence

-Verbal-linguistic -Logical-mathematical -Musical -Spatial -Bodily-Kinesthetic -Interpersonal -Intrapersonal -Naturalist

Rose's VAK model suggests

-Visual learners learn best when they see -Auditory learners learn best when they hear and say -Kinesthetic learners learn best when they touch and move

Salaries and Benefits

-Wages paid to all department members or by category (Licensed, UAP) -Includes productive paid time and non productive paid time -Vacation dollars -Sick dollars -Education and training dollars

Reflective thinking

-Watching or observing oneself as one performs task or makes decision about certain situation -Two selves: -Reflective -Acts as observer and offers suggestions -Active -Active participation

Division of Labor

-Way labor force is divided or organized has impact on how mission is accomplished -Span of control designates number of individuals who will report to one person

Questions while assessing the environment

-What is your opinion about the economic situation in the city in which you live? -What are the demographics of the area? -What are the educational resources? -What are the healthcare resources?

Peer assessment

-Will occur during your orientation and annually -Provides you with another perspective of your strengths and weaknesses

personal health record

-a health record that is initiated and maintained by an individual. Provide a complete and accurate summary of the health and medical history of an individual by gathering data from many sources and making this information accessible online to anyone who has the necessary electronic credentials to view the information -Electronic record of an individual's health information by which the individual controls access to the information.... (HHS.gov, n.d.) -Real-time data (i.e., blood glucose monitoring, pulse, BP) sent directly from device to patient's EMR

Nurse intensity

-a measure of the amount and complexity of nursing care needed by a patient -is dependent upon many factors that are difficult to measure

Dress like a pro: for women

-a neutral colored suit (navy or another dark color) with a skirt -skirt length should be a little below the knee and never shorter than above the knee -blouses should be cotton or silk (white or light pastel color) -basic pumps with 1-2 inch heels (no scrappy sandals or platforms) -simple accessories only earrings (no nose rings or eyebrow rings) -make up should be minimal and conservative -minimal perfume or fragrances

National Quality Forum

-a not-for-profit membership organization created to develop and implement a national strategy for health care quality measurement and reporting

Self-scheduling

-a process in which unit staff take leadership in creating and monitoring the work schedule while working within defined guidelines -allows flexibility for staff -all personnel must also be committed to providing safe staffing on all shifts for their patients

variance

-a tool used to identify when categories are out of line and to identify the need for corrective action -the difference between what was budget and the actual result

The Leapfrog Group

-a voluntary program aimed at using employer purchasing power to alert America's health industry that big leaps in health care safety, quality, and customer value will be recognized and rewarded -Also advocating for increased technology -Encourages transparency and easy access to health care information as well as rewards for hospitals that have a proven record of high quality care

Stage 3

-access comprehensive patient data -automated real-time surveillance

Unproductive time

-also calculated into a budget, because there has to be staff coverage when nurses or other staff members are not working -includes sick, vacation, personal, holiday, and education time

Adaptation

-alters performance to adapt to new situations -adapt, alter, change, rearrange, reorganize, revise, vary

E-Health

-an emerging field in the intersection of medical informatics, public health, and business, referring to health services and information delivered or enhanced -Delivery and enhancement of information or services through the internet or related technologies -Electronic prescription (e-prescription)

Fixed costs

-are expenses that are constant and not related to productivity or volume,

Average Daily Census

-calculated by taking the total numbers of patients at census time, usually midnight over a period of time -Daily census added together for specific period of time (i.e.. Month) ÷ days in specific period (i.e. 30 for month of June)

Decision tree

-can be useful in making the alternatives visible -these help the nurse review the alternatives with the consequences and benefits of each other

Cognitive domain

-centered on knowledge, or what the learner knows -Includes intellectual behaviors & requires thinking

Psychomotor domain

-centered on skill, or what the learner does -Acquiring skills that require mental & muscular integration -Perception, set, guided response, mechanism, complex overt response, adaptation, origination

Dress like a pro: for men

-clean, pressed and wrinkle free clothes -collared shirt with an undershirt -clean, polished and conservative dress shoes -well groomed hair -clean and trimmed fingernails -brushed teeth and fresh breath -wear a belt that matches your shoe color -wear socks that match your slacks (save the white one for the gym) -no gum or candy -no strong cologne, fragrances, or body odor

Learning domains

-cognitive -Bloom's taxonomy

Threats in the External environment

-competition -staffing shortages -increased legislative regulations -unionization -cuts in funding of nursing/medical education -revenue loss for caring for the uninsured -decreased reimbursement

A strategic plan consists of:

-core values -a vision -a mission -a philosophy -goals -action steps -results

Origination

-creates an original skill -arrange, build, compose, construct, create, design, initiate, make, originate

Set

-demonstrates readiness to perform; understands steps in a task, adopts physical posture to perform the task -begin, display, explain, move, proceed, react, show, state

Responding

-displays active participation, willingness, motivation -answer, assist, aid, comply, conform, discuss, help, label, perform, practice, present, read, recite, report, select, tell, write

Receiving/attending

-displays attention, willingness to listen -ask, choose, describe, follow, give, identify, locate, name, select, use

Pragmatists

-doing: look for practical, physical applications of learning -abstraction/generalization: prefer theory and systematic analysis; want structured learning experience; more oriented toward things, less toward people

Weaknesses of Matrix

-dual reporting authority -frustrating -time consuming -confusing

Weaknesses of Service line

-duplication of services -lack of training or in depth specialization

Stage 1

-ePrescribing -lab results into EHRs -send clinical summary to providers and patient -public health reporting -quality reporting (2012)

Advantages of Group Decision making

-easy and inexpensive way to share information -opportunities for face-to-face communication -opportunity to become connected with a social unit -promotion of cohesiveness and loyalty -access to a larger resource base -forum for constructive problem solving -support group -facilitation of esprit de corps -promotion of ownership of problems and solutions

Characterization

-exhibits a value system that drives the individual's behavior -act, discriminate, display, influence, modify, perform, practice, propose, qualify, question, revise, serve, solve, verify

Direct expenses

-expenses directly associated with the patient -Examples: Medical and surgical supplies, drugs, etc.

Indirect expenses

-expenses for items that are not directly related to patient care -Examples: Utilities, housekeeping, maintenance, etc.

teach back

-explain -assess -clarify -understanding

Strengths in the Internal environment

-financial status/cash flow -supporting practitioners/nurses alumni -programs and services -employee suggestion program -equipment/technology -administrative team -expertise of staff -staff satisfaction -location -marketing -patient satisfaction

Advantages of Tall structure

-focus is on chain of command -narrow -clear lines of responsibility

Tiger Initiative and Quality and Safety Education for Nurses (QSEN)

-focused on using informatics tools, principles, theories, and practices to enable nurses to make health care safer, more effective, efficient, patient centered, timely, and equitable

nonproductive hours

-hours not available for patient care activity -Benefit time (vacation, sick time, holiday)

Productive hours

-hours worked and available for patient care -Full time employees typically work 2080 (1 FTE) productive hours in one year

Guided response

-imitates performance and refines it through trial and error, practice -copy, trace, follow, react, reproduce, respond

Revenue

-income generated through variety of means, including type of service: patient days, procedures, minutes or occurrence of service -Typically expressed in dollars earned

Disadvantages of group decision making

-individual opinions influenced by others -individual identity obscured -formal and informal role and status positions evolve--hierarchies -dependency fostered -time consuming -inequity of time given to share individual information -existence of nonfunctional roles -personality conflicts

Advantages of Flat structure

-more flexible and adaptable -better communication -less costly, quicker

Examples of Opportunities of the External environment

-new programs and services -advanced technology -population growth -legislative changes -practitioner/nurse recruitment/retention -new markets -managed care -prestige in the community

Perception

-observes behaviors involved in a performance -choose, describe, detect, differentiate, distinguish, identify, isolate, relate, select

Organization

-organizes and prioritizes values through contrasting them, resolving value conflicts, and developing a personal value system -adhere, alter, arrange, comine, complete, defend, explain, formulate, generalize, identify, integrate, modify, order, organize, propose, relate, synthesize

Stage 2

-patient PHR access -ePrescribing refills -electronic summary record -receive health alerts -immunization information

Steps in Strategic Planning

-perform environmental assessment, SWOT analysis -conduct stakeholder analysis -review literature for evidence based best practices -determine congruence with organizational mission -identify planning goals and objectives -estimate resources required for the plan -prioritize according to available resources -identify timelines and responsibilities -develop a marketing plan -write and communicate the business plan/strategic plan -evaluate

The Basic Performance Pyramid

-performance measures (how will you measure how well you are doing?) -succes drivers (what do you need to do well?) -strategies (how will you achieve your goals/objectives?) -goals/objectives (what do we want to achieve?) -vision (where are we going?) -mission (what are we in business for?)

Mechanism

-performs task comfortably -assemble, calibrate, construct, dismantle, fasten, fix, manipulate, measure, mend, mix, organize

Complex overt response

-performs task skillfully and automatically (increased proficiency, accuracy, and coordination) -same as for mechanism level, but adverbs/adjectives indicate increase in speed or accuracy of performance

Auditory learners

-present material verbally -include verbal preview and review of material -involve learner through verbal questions and answers, discussion -include verbal activities such as brainstorming, discussion, and quiz show activities that require verbal response

Three important terms are used when discussing security

-privacy -confidentiality -security

Ways hospitals earn money

-procedures -labs -revenues -based on facilities billing process

Key issues to consider in developing the strategic plan:

-quality -access -cost

Instructional context

-refers to the conditions in which education will occur -When education will occur -Time frame for nurse

Bloom's taxonomy consists of

-remember -understand -apply -analyze -evaluate -create

Naturalist

-responds to intricacies and subtleties of patterns and relationships in nature -prefers activities that provide involvement in the natural world (plants, animals, other natural phenomena)

Intrapersonal

-responds to personal, inner emotions to understand self and others -prefers activities that use introspection, processing emotions, reflection

Bodily-kinesthetic

-responds to physical movement and activity (sports, dancing) -prefers activities involving physical movement and gestures

Musical

-responds to pitch, melody, rhythm, and tone -prefers activities that involve audio, musical rhythms, tonal patterns, melodic sound

Logical-Mathematical

-responds to reasoning, logic, and recognition of patterns and structures -prefers activities that involve abstract symbols, formulas, numbers, problem solving

Verbal-linguistic

-responds to rhythms and patterns of words, whether written or oral -prefers activities that involve listening, speaking, writing

Interpersonal

-responds to social interactions and relationships -prefers group activities or other situations that involve human interaction or collaboration

Spatial

-responds to two and three dimensional visual representations -prefers using or creating graphics and models, "visualizing" abstract information

Limited Health Literacy affects people's ability to:

-search for and use health information -adopt health behaviors (could be healthy eating, exercise, preventive measures) -act on important public health alerts (vaccines)

Activists

-sensing/feeling: perceive information in concrete rather than theoretical ways; peer oriented, social -doing: look for practical, physical applications of learning

Reflectors

-sensing/feeling: perceive information in concrete rather than theoretical ways; peer oriented, social -watching: want to observe, reflect, and establish objective interpretations of information; judge own performance by external, objective measures rather than persona, subjective judgment

Factors affecting Nurse intensity

-severity of illness -patient dependency for activities of daily living -complexity of care -amount of time needed for care

Valuing

-shows acceptance, preference, and commitment for the value -complete, demonstrate, differentiate, explain, follow, form, initiate, invite, join, justify, propose, read, report, select, share, study

Context Analysis consists of

-situational context -instructional context

SMART goal acronym

-specific and clear -measurable -achievable -relevant or reasonable -time bound

The 9 Topic Areas of the TIGER initiative include

-standards and interoperability -national health information technology (IT) agenda -informatics competencies -education and faculty development -staff development -usability and clinical application design -virtual demonstration center -leadership development -consumer empowerment and personal health records

Other Methods of Assessment

-surveys and questionnaires -focus groups and interviews -advisory board -review of literature on similar programs -best practices

Evaluation

-the process of determining effectiveness of education -Learner evaluation -Education evaluation -Can take many forms: -Ask patient to recall information -Answer questions -Perform procedures -Solve relevant problems -Analyze situation -Construct plan of action -Education evaluation concerned with whether educational event was effectively constructed and presented -Involves feedback from nurse-educator, patient, and/or third party observers -Measurement can be verbal or written feedback

information literacy

-the understanding of the architecture of information; the ability to navigate among a variety of print and electronic tools to effectively access, search, and critically evaluate appropriate resources; and the ability to synthesize accumulated information into an existing body of knowledge and practice -Set of skills needed to find, retrieve, analyze and use information

Flat structure

-there are a few layers in the reporting structure -Focus on the delegation of decision making to the professionals doing the work -They have full authority to take action without seeking input from others.

Formula for calculating NHPPD

-total hours of care daily / # of patients -NHPPD X # of patients = total hours -6 NHPPD X 20 patients = 120 hours -Total hours / hours in shift = # of shifts total -120 hours ÷ 12 hour shifts = 10 shifts -5 Nurses on Days and 5 Nurses on Nights -Each Nurse may be assigned 4 patients -*Depends on acuity

Weakness in the Internal environment

-union demands/relations -lag time for management information system -escalating costs for benefits/salaries -unprofitable services

Kinesthetic learners

-use activities to get learners up and moving -use music and color during presentation (these stimulate senses) -whenever possible, physically demonstrate learning and have learner physically practice it -provide frequent breaks during presentation so learners can get up and move around -provide toys, models, equipment, or other objects learners can touch -for complex tasks, have learners visualize physically performing the task

Visual learners

-use charts, graphs, pictures, diagrams, and so on -includes outlines, handouts, and other material for reading and note taking -allow plenty of empty space in materials for learner to take notes, draw diagrams, and so on -preview and review teaching content visually through flip charts, outlines, or other visual means -include both textual and graphic versions of information within material

Theorists

-watching: want to observe, reflect, and establish objective interpretations of information; judge own performance by external, objective measures rather than personal, subjective judgment -abstraction/generalization: prefer theory and systematic analysis; want structured learning experience; more oriented toward things, less toward people

Philosophies begin with

-with phrases such as without consideration for ability to pay, with respect for the dignity of each elderly resident, a brighter future for all children, or vigorous rehabilitation to maximize each individual's utmost potential, which provide clues to the type of service that you would expect from an organization

7 things to avoid with your cover letter

1) Not using a standard business letter format 2) It's not all about you 3) Typos and grammatical errors 4) Unsupported claims 5) Writing a novel 6) Using same cover letter for every job and company 7) Not sending a real cover letter "Here's my resume is not sufficient"

1 FTE

2,080 hours of work time (MAGIC NUMBER)

Strategic planning for organizations is for how long?

3-5 years ahead of time

Grand Total FTE

= Productive FTEs + Nonproductive FTE -Nonproductive FTEs are calculated by averaging for the unit from historical data.

Critical Pathway utilizes variation analysis

A continuous process that the case manager and other caregivers conduct by comparing the specific client outcomes with the expected outcomes described on the critical pathway

A

Adapt and require more credibility and evidence for stronger claims—be skeptical of information

Primary nursing

Assume responsibility from time of admission to discharge, 24 hrs/day

Total patient care

Assume total accountability while on shift

procedures

Based on policy and define methods for tasks; establish customary or acceptable ways of accomplishing a specific task or delineate a sequence of steps of required action

Establishing Behavioral Objectives

Behavioral objective -States specific and measureable behavior that should result from educational session -Defines what nurse will teach -Provides basis for evaluation

Use of Technology in Decision making

Best source of clinical decision making and judgment still professional practitioner

C

Challenge information and demand accountability

Decision making

Considering and selecting interventions from repertoire of actions that facilitate achievement of desired outcome

Organizational culture

Consists of deep underlying assumptions, beliefs, behaviors, and values that are shared by members of organization and typically operate unconsciously

Examples of Clinical information system (CIS)

EHR, clinical decision support systems, bedside medication administration, using positive patient identification, computerized prescribing practitioner order entry, patient surveillance, and clinical data warehouses

Functional nursing

Each member has specific duties or tasks

E

Evaluate and reevaluate regularly—recognize dynamic, fluid nature of information

Evidence-Based Practice

Facilitating evidence-based practice is a shared responsibility of the professional nurse, the organization, leader-managers, and the education or staff development department.

F

File new information in your mind rather than immediately believing or disbelieving

policy

Guidelines that define the organization's standpoint on courses of actions; direct organization's in their decision making; direct behavior towards the mission and define broad limits and desired outcomes of commonly recurring situations.

Terminal objective

Identifies major behavior that contributes to achievement of overall session goal

Enabling objective

Identifies secondary behavior that contributes to, or enables, achievement of terminal objectives

High Reliability Organization - Culture of Safety

Involves mutual trust, agreement on importance of safety, and confidence to prevent errors

informal education

May be as basic as exchanging information during conversation with patient such as explaining a medication, procedure, or laboratory result.

NHPPD and ADC

NHPPD X ADC = # of total hours # of total hours / hours in shift = # of total shifts

Difference between Operational budget and Personal budget

Operational budget -revenue/department earnings -RN salaries -Non chargeable floor stock -Office supplies Personal budget -Bi monthly pay -monthly house payment/rent -groceries -cell phone bill

Critical competency for nurses in current health care organizations:

Planning for continuous improvement of quality, service, and cost-effectiveness

protocols

Prescribe a specific course of action for a specific type of client or problem; based in policy and procedure

Strategic planning

Processes by which organization engages in environmental analysis, goal formulation, and strategy development for purpose of organizational growth and development

Evaluate an Internet Resource

Remember CAFE—advice for dealing with information obtained from Internet:

cost

Sample result oriented Goal: "Increase the accuracy of billing for supplies by 5%"

access

Sample result oriented Goal: "Provide care to 15% more patients than we did last year"

quality

Sample result oriented Goal: "To reduce medication administration errors by 10%"

Understanding the Health Care Organization

Strategic goals and objectives need to be prioritized according to strategic importance, resources required, and time & effort involved

Methodology

Structured, standardized approach for educational process

Goal of Critical pathways

To anticipate and recognize negative variance (client problems) early so that appropriate action can be taken and positive client outcomes can result

Goal for Transforming Care at the Bedside

To make fundamental improvements in healthcare delivery system that will result in safe & reliable care, vitality & teamwork, patient-centered care & value added care processes

Strategic Planning in a Clinical Setting

You are a nurse chosen to be on the board of a major county hospital, the board has begun the strategic planning process for the year...

electronic health record systems (EHR)

a digital record of an individual's health information across settings and over time, it's a replacement for the paper medical record as the primary source of information for health care, meeting all clinical, legal, and administrative requirements

lesson plan

a document that provides the blueprint for the education session; they provide necessary information for the nurse or other educator to conduct the education session

mission statement

a formal expression of the purpose or reason for existence of the organization; the primary driving force or its vision of the manner in which it believes care should be delivered

full time equivalent

a measure of the work commitment of an employee who works five days a week or 40 hours per week for 52 weeks a year (2,080 hours of work time)

Patient turn over

a measure reflecting patient admission, transfer, and discharge, all of which entail RN intensive procedures

patient classification system

a measurement tool used to articulate the nursing workload for a specific patient or group of patients over a specific period of time

learning style

a particular manner in which a learner responds to and processes learning

stakeholder assessment

a systematic consideration of all potential stakeholders to ensure that the needs of each of these stakeholders are incorporated in the planning phase

SWOT analysis

a tool that is frequently used to conduct these environmental assessments. Stands for strengths, weaknesses, opportunities, and threats; It identifies both strengths and weaknesses in the internal environment and opportunities and threats in the external environment. It is useful both for initial brainstorming and for a more formal planning document

variance report

a tool used to identify when categories are out of line and to identify the need for corrective action

intuitive thinking

a type of discernment or insight that nurses develop that helps them to act in certain situation

GANTT chart

a type of graph that shows the relationships between activities representing the phase of a project

"To provide a responsive healing environment for patients and their families, and to improve the quality of life for all members of our community" is an example of a: a) Mission statement b) Vision statement c) Goal statement d) Statement of Philosophy

a) Mission statement

The nurse identifies which characteristics as part of the case management approach to health care delivery? SELECT ALL THAT APPLY: a) Provides an individualized plan of care for the client b) Represents an interprofessional health care delivery system c) Involves one nurse who supervises all other health care providers d) A comprehensive approach that promotes quality and cost-effective care e) Requires only a case manager to implement the care for all of the clients in the facility

a) Provides an individualized plan of care for the client b) Represents an interprofessional health care delivery system d) A comprehensive approach that promotes quality and cost-effective care

Centralized EHR

accessible wherever you are

operational budget

accounts for the income and expenses associated with day-to-day activity within a department or organization

capital budget

accounts for the purchase of major new or replacement equipment

Security

address the confidentiality of private health information and the integrity of the data. Must be designed to ensure compliance with applicable laws, regulations, and standards.

Information processing includes decision support tools such as?

alerts and alarms for drug interactions, allergies, and abnormal laboratory results. Reminders can be provided for appointments, critical pathway actions, medication administration, and other activities

consensus

all group members can live with and fully support the decision regardless of whether they totally agree

Social network Sites

also invading care. They have been growing in popularity across brad segments of Internet users and are a convenient means to exchange information and support

problem solving

an active process that starts with a problem and ends with a solution

stakeholder

any person, group, or organization that has a vested interest in the program or project under review

staffing plan

articulates how many and what kind of staff are needed by shift and day to staff a unit or department

reflective thinking

as watching or observing ourselves as we perform a task, or make a decision about a particular situation.

"To set the standard in the new century for health, healing and comfort" is an example of a: a) Mission statement b) Vision statement c) Goal statement d) Statement of Philosophy

b) Vision statement

Simple to complex; complex to simple

begins with information that is easier to present or easier for the patient to learn and then moves to more difficult information, or presents the most complex material first and then progresses to easier information

affective domain

centered on attitude, or what the learner feels/believes

cognitive domain

centered on knowledge or what the learner knows

psychomotor domain

centered on skill, or what the learner does

clinical information system (CIS)

computerized system which manages clinical data with subsystems, such as electronic health records, clinical decision support systems, bedside medication administration using positive patient identification, computerized prescribing practitioner order entry, patient surveillance, and clinical data warehouses

decision making

considering and selecting interventions from a repertoire of actions that facilitate the achievement of a desired outcome

Staged Approach

consists of 3 stages

organizational culture

consists of the deep underlying assumptions, beliefs, and values that are shared by members of the organization and typically operate unconsciously

"We believe that health care is a human right, and that patients have the right and are encouraged to participate in their own care, whether the goal is quality of life or dignity of death" is an example of a: a) Mission statement b) Vision statement c) Goal statement d) Statement of Philosophy

d) Statement of Philosophy

profit

determined by the relationship of income to expenses. Profitability results when the income is higher than the expenses

indirect expenses

expenses for items such as utilities---gas, electric, and phones---that are not directly related to patient care

variable costs

fluctuate depending upon the volume or census and types of care required

Variable costs

fluctuate up or down according to services provided, or depending upon the volume or census and types of care required

available productive time

full time hours - benefit time

diagnostic related groups (DRGs)

have been used as groupings of patients to which a nursing acuity is assigned based on past organizational experience

cost centers

hospital systems are frequently divided into sections, departments, or units to compartmentalize them for organizational purposes, which are created to track financial data

terminal objective

identifies a major behavior that contributes to achievement of the overall session goal

enabling objective

identifies a secondary behavior that contributes to, or enables, achievement of terminal objectives

The Strategic Plan

identifies the direction for the budget of the organization

Environmental assessment

includes an assessment of the internal and external environment

revenue

income generated through a variety of means, including billable patient services, investments, and donations to the organizations. Can also be generated through the delivery of multiple services over time

consistency

indices of core values, agreement, and coordination and integration

involvement

indices of empowerment, team orientation, and capability development

mission

indices of strategic direction and intent, goals and objectives, and vision

Chronological

information is arranged in time sequence, based on the sequential occurrence of events. Typically used for teaching history

Categorical

information is organized into categories that are related to the primary topic. Allows the nurse to develop an arbitrary but logical structure when the information does not fit any of the other structures described here.

dashboard

is a documentation tool providing a snapshot image of pertinent information and activity at a particular point in time

zero based budget

is a process used to drill down into expenses by detailing every supply item and the quantity of items typically used

construction budget

is developed when renovation or new structures are planned; it typically includes labor, materials, building permits, inspections, equipment, etc.

PERT (program evaluation and review technique)

is useful in determining the timing of decisions. The flowchart provides a visual picture of the sequence of tasks that must take place to complete a project

Known to unknown; unknown to known

known to unknown begins with patient's existing information/experience and uses it as a bridge to new, unknown information. Unknown to known presents unfamiliar information, later showing its connecting to what the patient already knows

learning domains

learning theory suggests that learning can be classified into taxonomies, which are each based on the major type of learning involved

Disadvantages of Tall structure

longer communication, less flexible

Tall structure

may layers in the chain of command

The root cause of the variance

needs to be identified so that effective action plans for improvement can be developed

If you spend more than you make, then what is the NET?

negative

Topical

patient is immediately placed in the middle of a topical problem or issue. Education may then address how the issue originated and the concerns surrounding its resolution

If you make more than you spend, then what is the NET?

positive

Problem to resolution

presents a problem/situation and then presents the topics involved in its resolution

Parts to whole; whole to parts

presents the parts and then shows how they relate to the whole, or presents the whole and then talks about each part

Procedural (step by step)

presents the steps in a procedure in the order in which they are performed

Theoretical to practical; practical to theoretical

presents the theory and then demonstrates how it is used, or shows practical applications of information and then presents the theory

virtual reality

puts people inside a computer-generated world. A person can see, move through, and react to computer simulated items or environments

Set Deadline for completion of strategic plan

realistic times and individual responsibilities must be developed, specified, clarified, and communicated to all stakeholders

Confidentiality

refers to the act of limiting disclosure of private matters. After a patient has disclosed private information of a health care provider, the provider has a responsibility to maintain the confidentiality of that information

health literacy

refers to the learner's ability to read, understand, and act on health information

Security

refers to the means to controlling access and protecting information from accidental or intentional disclosure to unauthorized persons and from alteration, destruction, or loss. When private information is placed in a confidential EHR, the system must have controls in place to maintain the security of the system and not allow unauthorized personal access to the data.

Privacy

refers to the right of individuals to keep information about themselves from being disclosed to anyone. If a patient had an abortion and chose not to tell a health care provider this fact, the patient would be keeping that information private

Disadvantages of flat structure

role confusion

50-60% of operations are what?

salary

Examples of Administrative information system

scheduling matrix, something to order supplies, something to keep up with payroll, furniture

Modular nursing

similar to Team Nursing but takes into account unit structure/geographical area

General to specific; specific to general

similar to preceding; presents the "big picture" first and then presents details, or presents details first and then shows how they fit into the big picture

focus groups

small groups of individuals selected because of a common characteristic; invited to meet in a group and respond to questions about a topic in which they are expected to have interest or expertise

asset

something you own

behavioral objective

states a specific and measurable behavior that should result from the education session

vision

tells us how the people of the organization plan to actualize the mission; describes a balance of addressing the needs of the providers, the patients, and the environment

Interoperability

the ability of a computer to connect with other computers in various settings in a secure, accurate and efficient way without special effort on the part of the user and without any restricted access or implementation

benchmarking

the continuous measurement of a process, product, or service compared to that of the toughest competitor, those considered industry leaders, or similar activities in the organization in order to find and implement ways to improve the product, process, or service

methodology

the education process is more effective when it follows a structured, standardized approach

adaptability

the indices of creating change, customer focus, and organizational learning

nursing informatics

the integration of nursing, its information, and information management with information processing and communication technology to support the health of people

computer literacy

the knowledge and understanding of computers, combined with the ability to use them effectively

patient acuity

the measure of nursing workload that is generated for each patient

content knowledge

the nurse may not be an expert on a topic but must be able to demonstrate reasonable knowledge to the patient

adaptability

the nurse must be able to adapt to changes in the education content and format and to unforeseen changes in the education session

self direction

the nurse must be able to assume initiative, identify needs, and solve problems. The nurse must be able to work independently without supervision.

communication

the nurse must be able to communicate clearly and at a professional level

organization

the nurse must be able to organize and prioritize tasks and information to work efficiently

intelligence

the nurse must be intelligent and able to grasp the complexities of the content

patience

the nurse must be patient and caring with learners

education experience

the nurse must demonstrate experience and professionalism

interactive

the nurse must enjoy people and interacting with them and be able to work with difficult people

self confidence

the nurse must maintain a poised and professional manner when interacting with learners

skill mix

the percentage of RN staff compared to other direct care staff

marketing

the process of creating a product or health care service for patients, and uses the 4 Ps of marketing---patient, product, price, and placement.

evaluation

the process of determining the effectiveness of education

learner analysis

the process of identifying the learner's unique characteristics and needs and the ways in which these can influence the education process

Mobile Applications

the rapid uptake of the iPhone, iPad, BlackBerry, HP, Android phones, etc., by both consumers and providers for health care purposes is astounding compared to the slower adoption of health information technology (HIT). These are software programs for smartphones and other handheld computing devices

culture of safety

the result of shared values and behaviors that demonstrate communications based on mutual trust, agreement on the importance of safety, and confidence in the ability to prevent errors through the use of known safety practices

Situational context

the situation that creates the need for education

strategic plan

the sum total or outcome of the process by which an organization engages in environmental analysis, goal formulation, and strategy development with the purpose of organizational growth and renewal

liability

things you owe

critical thinking

thinking about your thinking while you're thinking in order to make your thinking better

direct expenses

those expenses directly associated with the patient, such as medical and surgical supplies and drugs

fixed costs

those expenses that are constant and are not related to productivity or volume

philosophy of an organization

typically embedded in the mission statement. It is, in essence, a value statement of the principles and beliefs that direct the organization's behavior.

Span of control

used to designate the number of individuals that report to one person

Confirm patient understanding

"Tell me what you've understood." "I want to make sure I explained your medicine clearly. Can you tell me how you will take your medicine?"