Leadership & Management

What is healthy minds, healthy people?

A 10 year plan to address mental health and substance use in BC

What are the 5 stages in the conflict process?

*1. Latent conflict* - the existence of antecedent conditions (e.g. short staffing, rapid change) *2. Perceived conflict* - is intellectualized and often involves issues and roles *3. Felt conflict* - when the conflict is emotionalized. Emotions include hostility, fear, mistrust & anger *4. Manifest conflict* - action is taken *5. Conflict aftermath* - there is always aftermath whether positive or negative

According to Lewin (1951) who should be involved in planning for change?

*All individuals who may be affected by the change* should be involved in planning for the change

What are the 3 leadership styles?

*Authoritarian* - strong control is maintained, others are motivated by coercion, communication flows downward, decision making doesn't involve others, punitive criticism *Democratic* - less control is maintained, others are directed through suggestions and guidance, criticism is constructive, communication flows up and down *Laissez-faire* - permission with little or no control, little or no direction, decision making is dispersed through the group, no criticism

Define autonomy, beneficence, nonmaleficence, paternalism, utility

*Autonomy* - promotes self-determination and freedom of choice *Beneficence* - doing good *Nonmaleficence* - actions are taken in an effort to avoid harm (do no harm) *Paternalism* - one individual assumes the right to make decisions for another *Utility* - the good of the many outweighs the want or needs of the individual

Differentiate between constitutional, civil and statutory law

*Constitutional Law* - outlines the rights and powers of governments *Civil law* - rules and legal principles governing relations, rights, and obligations between individuals and institutions *Statutory Law* - created by an act or statute proclaimed after assent through government processes such as the Canada Health Act

What is the difference between organization culture and organizational climate?

*Culture* - a system of symbols and interactions, a sum total of values, language, past history of "sacred cows" *(wtf)*, formal and informal communication and the rituals and norms of an organization *Climate* - how employees *perceive* an organization; the perception may be accurate or inaccurate and people in the same organization may have different perceptions about the same organization

What is the difference between formal structure and informal structure?

*Formal structure* - provides a framework for defining managerial authority, responsibility and accountability (through departmentalization and work division). Roles and functions are defined and systematically arranged, different people have differing roles, and rank and hierarchy are evident *Informal structure* - a naturally forming social network of employees. Gaps are filled in with connections and relationships. Informal structure is typically based on mutual trust and friendship, and therefore result in a more immediate response from individuals, saving time and effort.

What are some examples of formal and informal leader positions?

*Formal* - e.g. a clinical nurse leader *Informal* - e.g. an advocate, leading a group

What is the difference between internal and external whistleblowing?

*Internal* - occurs within an organization, reporting up the chain of command *External* - reporting outside the organization such as the media and an elected official Leader-managers must be willing to advocate for whistler blowers

What are the 3 categories of conflict?

*Interpersonal* - happens between two or more people with differing values/goals/beliefs; bullying or horizontal violence, an area of increasing concern in the workplace *Intrapersonal* - an internal struggle with conflicting priorities or values *Intergroup* - may emerge between two or more groups of people, departments & organizations with differing interests or values (e.g. political groups)

Define justice, veracity, fidelity, confidentiality

*Justice* - fairness, equality *Veracity* - telling the truth *Fidelity* - keeping a promise *Confidentiality* - keep privileged information private

Left-brain thinkers vs. right brain thinkers

*Left brain thinkers* - typically better at processing language, logic, numbers and sequential ordering. Do well at mathematics, reading, planning and organizing. *Right brain thinkers * - creative, intuitive. Excel at nonverbal ideation and holistic synthesizing. Are better at handling images, music, colours and patterns.

Define legitimate power and expert power

*Legitimate power* - position power (e.g. authority). Power gained by a title of official position within an organization *Expert power* - gained through knowledge, expertise or experience

What are the different types of planners?

*Reactivists* - plan after a problem exists *Inactivists* - consider the status quo as the stable environment and they spend a great deal of energy preventing change and maintaining conformity *Preactive planners* - utilize technology to accelerate change and are future-oriented *Proactive planners* - are dynamic, look forward, and anticipate changes in the environment

Define referent power and informational power

*Referent power* - power that a person has because others identify with that leader or with what that leader symbolizes. Another way to get this is if others perceive you as powerful *Informational power* - obtained when people have information that others must have to accomplish their goals

Define reward power and coercive power

*Reward power* - obtained by the ability to grant favours or reward others with whatever they value *Coercive power* - the opposite of reward power. It is based on fear of punishment if the manager's expectations are not met. The manager may obtain compliance through threats of transfer, layoff or demotion

What does SWOT stand for?

*S*trengths *W*eaknesses *O*pportunities *T*hreats A tool to help with strategic planning

What is the difference between tall/hierarchical and flat organizational structures?

*Tall* - decision making takes place at upper levels of the organization, narrow span of control for the leader, many level of management between the top level and bottom *Flat* -decision making at the level of the related work; less hierarchy evident, broader span of control for the leader, less managerial levels between top and bottom

Differentiate between underdelegating and overdelegation

*Underdelegating* - frequently stems from the individual's false assumption that delegation may be interpreted as a lack of ability on his or her part to do the job correctly or completely; lack of trust in subordinates *(Overburdens the manager)* *Overdelegating* - *burdening your subordinates.* Done by poor managers of time. Overdelegation may be done because managers feel insecure in their ability to perform a task

What are some reasons that subordinates resist delegation?

-Failure of the delegator to see the subordinates perspective -They believe that they are incapable of completed the delegated task -Inherent resistance to authority -Tasks are over delegated in terms of specificity

What are the benefits of involving others (subordinates from all levels of the organization) in planning?

-Increases the likelihood of successful implementation -"Buy-in" helps to reduce the likelihood of resistance of the implementation

What is the purpose of law and legislation?

-Protect the patient and the nurse -Define the scope of acceptable practice -Protect individual rights Nurses who are aware of their rights and duties in legal matters are better able to protect themselves against liability or loss of professional licensure

What are the 2 common errors in performance appraisals?

-Tendency to be lenient -Inadequate record keeping

What are the 2 most common errors made by novice managers?

-Underestimating the importance of a daily plan -Not allowing adequate time for planning

The performance appraisal is more likely to have a positive outcome if...

...The appraiser is viewed with trust and professional respect

What are the 3 steps to quality control?

1. Criterion/standard is determined 2. Info is collected to determine whether the standard is being met 3. Education or corrective action is taken if the criterion has not been met

What are the 3 stages of transition?

1. Ending 2. Neutral zone 3. Beginning

What are the 4 steps in progressive discipline?

1. Informal reprimand or verbal admonishment. 2. Formal or written reprimand in a disciplinary conference (signed by the employee and the manager). 3. Suspension from work without pay. 4. Termination.

When was the mental health commission of Canada established?

2007 Its focus is on recovery

What does the change theory consist of (3 phases)?

3 phases: unfreezing, movement and refreezing *Unfreezing* - when the change agent convinces members of the group to change or when guilt, anxiety or concern can be elicited *Movement* - the change agent identifies plans and implements appropriate strategies, ensuring that driving forces exceed restraining forces *Refreezing* - the change agent assists in stabilizing the system so that it becomes integrated in the status quo

What is the 80/20 principle?

80% of the conflicts in your life are probably with 20% of the people in your life, and 20% of those conflicts are causing 80% of the negative consequences in your life, so Because you can't resolve all the conflicts, you have to pick the ones that matter. Concentrate on the 20% that are causing 80% of your problems.

What are the different components of workplace violence?

>Bullying - repeated, offensive, abusive, intimidating >Incivility - behaviour lacking authentic respect for others >Mobbing - when employees "gang up" on an individual

What is the greatest factor contributing to resistance to change?

A lack of trust between the employee and the manager or the employee and the organization

What did the Kirby Report establish?

A mental health commission - for all mental health

Define prudent

Acting with or showing care and thought for the future

When is the only time that informed consent can be given?

After the patient has received a complete explanation of the surgery, procedure, or treatment and indicates that he or she understands the risks and benefits related to it. The information must be presented in a language that the patient can understand and patients must be invited to ask questions and have a clear understanding of the options as well. *Only a competent adult can legally sign the form*

Define destructive discipline

Use of threats and fear to control behavior. Employee always alert to impending penalty or termination. Arbitrarily administered and either unfair in the application of rules or in the resulting punishment.

Which acts are relevant to RPN nursing practice?

Health Profession's Act B.C. Mental Health Act Freedom of Information and Protection of Privacy

Which types of nurses are most commonly victimized (workplace violence)?

New graduate nurses

Can incident reports be subpoenaed?

No (in most states) because attorneys use incident reports to defend the health agency against lawsuits brought by clients

What is situational or contingency theory?

No one leadership style is suitable for all situations. The situation dictates the leadership approach Different for each scenario

What are the different conflict resolution strategies?

Avoiding Compromising Competing Accommodating Smoothing Collaborating

What are the different types of organizational structures?

Bureaucratic, ad hoc, matrix and flat

What is the main difference between the traditional problem solving process and the harrison's problem solving model?

Traditional starts with identifying the problem Harrison's starts with setting the objective* and then identifying the problem second

Which type of decision making is more beneficial in larger organizations?

Decentralized

Define decentralized decision making

Decision making is diffused throughout the organization, and problems are solved by the lowest practical managerial level. Usually, this means that problems can be solved at the level at which they occur.

Define improper delegation

Delegating at the wrong time, to the wrong person or for the wrong reason

What are the 3 categories of prioritizing what needs to be accomplished?

Don't do Do later Do now

Define vicarious liability

Employers being held liable for the nurse's acts

Define utilitarianism (aka teleological)

Encourages decision making on what provides the *greatest good for the greatest number of people* Outcome focused

What is a common cause of procrastination?

Failure to break large tasks down into smaller ones so that the manager can set short-term, intermediate and long-term goals

Kohlberg's Moral Development Theory

Focuses on how children's develop moral reasoning and has 6 different stages in 3 different levels. He proposed that moral development is a continual process that occurs throughout the lifespan *1) Preconventional - punishment and reward* -stage 1 - obedience orientation -stage 2 - instrumental orientation *2) Conventional level - social norms* -stage 3 - interpersonal norms -stage 4 - social system morality *3) Postconventional - moral codes* -stage 5 - social contract orientation -stage 6 - universal ethical principles

What are driving forces of change?

Forces driving to reach the goal of supporting staff in further education: -Advancement at work -More earning possibility -Increased self-esteem -Agency provide some funding for education -Improved knowledge in staff as a resource so improved quality of work

What are restraining forces of change?

Forces restraining from supporting staff in further education: -Not enough staff to cover absences -Not enough money -Not enough interest -Not enough room for advancement

What are the benefits of turnover?

Fresh, new ideas Reduces the probability of "group think" - where everyone shares similar thought process, vision and goals

Define advocacy

Helping others to grow and self-actualize. Protecting and defending what one believes in for both self and others. Is a critically important leadership role

What is primary health care?

Ideals for basic everyday health care E.g. preventing people from becoming ill or being injured, managing chronic illness and making the most of health care resources and expertise Improving the quality of health care and the access to health care Includes: accessibility, public participation, health promotion, appropriate technology, inter-sectoral cooperation

Define centralized decision making

In organizations with centralized decision making, a few managers at the top of the hierarchy make most of the decisions. Execution of decision making if fairly rapid

Define chain of command

Indicates the formal paths of authority and communication in an organization vertical (from top-down management to front-line staff) and horizontal (across departments) varying in complexity with the organizational structure Status and power is often reflected in the chain of command within the organization

Define time inventory

It allows you to compare what you planned to do, as outlined by your appointments and "to do" entries, with what you actually did

What is the relation between span of control and number of levels in a hierarchy in organizations?

It is an inverse relationship. The narrower the span, the greater the number of levels in an organization

Define deontological

Judges whether the action is right or wrong, regardless of the consequences Duty focused, centred on rules

What is the difference between managers and leaders regarding change?

Managers strive to maintain equilibrium and leaders embrace change

MORAL decision making model

Model for ethical decision making incorporating the nursing process and principles of biomedical ethics, Useful in clarifying ethical problems that result from conflicting obligations. *M*assage the dilemma (collect data) *O*utline options (identify alternatives & analyze the causes and consequences of each) *R*eview criteria and resolve (weigh options) *A*ffirm position and act (develop the implementation strategy) *L*ook back (evaluate the decision making)

Define competing (conflict resolution strategy)

One party pursues what it wants, regardless of the cost to others The reason for not backing down may be legitimate due to more information about the situation or ethical considerations or as a form of advocacy

Define accommodating (conflict resolution strategy)

One party sacrifices his or her beliefs and wants to allow the other party to win Cooperating or accommodating are more likely to occur when the stakes are not high for the party "backing down"

Define smoothing (conflict resolution strategy)

One person attempts to smooth or reduce the emotional component of the conflict Rarely results in actual conflict resolution, more likely to have just a short term resolution

Who invented the 80/20 principle?

Pareto

What is the management process?

Planning Organizing Staffing Directing Controlling POSDC

What is primary nursing?

Primary nurse assumes 24-hour responsibility for planning the care. When the primary nurse is not on duty, associate nurses provide are as per the care plan that the primary nurse made

What are the pro's and con's of the nursing process?

Pro - multiple venues for feedback Con - objectives are not clearly stated

What are clinical practice guildelines/standardized clinical guidelines?

Provide diagnosis-based step-by-step interventions for providers to follow in an effort to promote quality care

What was the Romanow Report (2002)

Provided renewed support for primary healthcare a priority for Canada's health care delivery Proposed changes to to ensure the long-term sustainability of Canada's health care system The future of healthcare in Canada

What is the difference between quality assurance and quality improvement?

Quality assurance - target currently existing quality Quality improvement - target ongoing and continually improving quality

Define centrality

Refers to the location of a position on an organization chart where frequent and various types of communication occur. The middle manager generally has the largest degree of centrality because information is relayed upward, downward, horizontally, and diagonally.

Define span of control

Refers to the number of people directly reporting to any one manager and determines the number of interactions expected of him or her. Too many people reporting to a single manager delays decision making, whereas too few results in an inefficient, top-heavy organization.

What is the key to adequate staffing in the long term?

Retention

What are some strategies for successful planning?

Start planning at the top of the organization. Don't bypass levels of people/management. Have short- and long-range plans and goals. Evaluate ongoing with realistic dates and goals. Gather data appropriately and thoroughly. Be sure objectives are clear for all involved. Remember, interpersonal relationships are important.

_____ _______ forecasts the future success of an organization

Strategic planning

What is team nursing?

Support personnel collaborate in providing care to a group of patients under the direction of a professional nurse Requires excellent communication and coordination skills or else can result in blurred lines of responsibility, errors and fragmented patient care Requires a strong team leader

What is functional nursing?

Task oriented (e.g. checking BP, administering medication, changing linens...etc). Smaller number of RN's and increased number of, for example, care aids and LPNs. *Assigning tasks to workers* Advantage - efficient and economical

What is a contemporary adaptation of Lewin's change model?

The 5 stages of change Stage 1 - pre contemplation - no current intention to change Stage 2 - contemplation - individual considers making a change Stage 3 - preparation - there is intent to make a change in the near future Stage 4 - action - individual modifies his or her behaviour Stage 5 - maintenance - change is maintained and relapse is avoided PCPAM

Define retention

The act or power of remembering things; memory; the continued possession, use, or control of something *Retention occurs when the organization is able to create a work environment that makes staff want to stay*

What did Kurt Lewin develop?

The change theory

In which phase of the management process is delegation the most essential?

The directing phase

Define malpractice

The failure of a person with professional training to act in a reasonable and prudent manner

What is authentic leadership theory?

The focus is on finding one's personal passion and expressing it in the workplace Willingness to stick to one's values even in the face of pressure (transparency) Encouraging others to do their best, rewarding actions to install hope, coach and celebrate excellence, build relationships, exemplify authenticity

Define critical thinking

The mental process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and evaluating information to reach an answer or conclusion

What is the highest priority in the planning hierarchy and why?

The mission statement because it influences the development of an organization's philosophy, goals, objectives, policies, procedures and rules

What is total patient care?

The nurse assumes total responsibility during their time on duty for meeting all the needs of assigned patient(s). Still widely used in hospitals and home health agencies. This structure provides nurses with high autonomy and responsibility. The patient theoretically receives holistic and unfragmented care during the nurse's time on duty. Downfalls - inconsistency with care as every nurse is different

Which theoretical system is most commonly used in nursing for decision making and problem solving?

The nursing process Assessment Diagnosis Planning Implementation Evaluation

Define indoctrination

The planned, guided adjustment of an employee to the organization and the work environment Includes 3 phases: induction, orientation, socialization Effective indoctrination results in higher productivity, fewer rule violations, reduced attrition and greater employee satisfaction

Define recruitment

The process of actively seeking out or attracting applicants for existing positions and should be an ongoing process

Productivity is directly related to what?

The quality of an organization's personnel

What is TQM?

Total quality management AKA continuous quality improvement (CQI) A philosophy which assumes that production and service focus on the individual and that quality can always be better

What is the recognition-primed decision model?

Used for intuitive decision making. Explains how people can make effective decisions under time pressure and uncertainty. It is considered part of naturalistic decision making. It *attempts to understand how humans make decisions in complex, real-world settings such as firefighting and critical care nursing without having to compare options*

What's the difference between a vision statement vs. a purpose or mission statement?

Vision - describes the future goals or aims of an organization Purpose/mission - identifies that reason that an organization exists and addresses its position regarding ethics, principles and standards of practice.

When is informal structure relied on?

When the formal structure has stopped being effective, which often happens as an organization grows or changes but does not reevaluate its hierarchy or work groups

When are lower level managers more involved in recruiting new employees?

When the nursing management is more decentralized