leadership and management test 2

organizational culture

-"total of an organization's values, language, traditions, customs, and sacred cows...those few things present in an organization that are not open to discussion or change." -differs from organizational climate (how individuals perceive the organization) -The organizational culture is not in writing...the feelings, beliefs, and values must be shared so all employees understand the culture. -a system of symbols and interactions unique to each organization. It is the ways of thinking, behaving, and believing that members of a unit have in common

organization of patient care

-Organization of patient care is the coordination of resources and clinical processes that promote patient care delivery. -Organization of patient care utilizes the nursing process to assess, plan, implement, and evaluate the outcomes of care for populations of patients. -Successful organization of patient care requires governance structures, patient care delivery processes, and measures of the outcomes of care delivery

contemporary healthcare policy issues

-Patient Protection and Affordable Care Act (PPACA) -The Future of Nursing: Leading Change, advancing Health (Institute of Medicine Report) -Transition of Care Program -Advanced Practice Registered Nurse (APRN) Consensus Model -Informed Consent -Good Samaritan Laws -Health Insurance Portability and Accountability Act (HIPAA)

Benner's Model of Novice to Expert

-The model provides a framework that, when developed into a clinical or career promotion ladder, facilitates professional staff development by building on the skill sets and experience of each practitioner -The model acknowledges that there are tasks, competencies, and outcomes that practitioners can be expected to have acquired based on five levels of experience Five Stages of Benner's Model: -Novice: task oriented and focused on the rules; need a directing-telling style from a mentor; sees nursing as a list of tasks rather than seeing the big picture of patient goals ( nursing student) -Advanced Beginner: demonstrates marginally acceptable independent performance; learning to apply newly acquired knowledge and skills to many situations -Competent: 1 to 3 years experience and has developed the ability to see their actions as part of the long-ranged goals set for their patients -Proficient: Proficient nurses usually have 3 to 5 years experience and characteristically perceive the whole situation rather than a series of tasks -Expert: expert usually has 5 years experience or more and intuitively know what is going on with their patients; expertise is embedded in their practice.

types of nursing power

-Transformational power: the ability to assist clients to transform their self-image. -Integrative power: the ability to help clients return to normal lives. -Advocacy power: the ability to resolve obstacles. -Healing power: the ability to create a healing climate and nurse-client relationship. -Participative/affirmative power: the ability to draw strength from a caring interaction with a client. -Problem-solving power: the ability, through caring, to be sensitive to cues and search for solutions to problems.

unity of command

-concept described as one person/one boss in which employees have one manager to whom they report and are accountable so that there is less confusion and greater accountability; hard as healthcare advocates an interprofessional approach

Charismatic Theory

-inspirational quality: feelings and enthusiasm -self-confidence -communicate high expectations -emerge during a crisis -creates and communicates a vision -uses unconventional strategies -obtains emotional commitment and loyalty -Behaviors of Charismatic Leaders: -strong role models -show competence -articulate clear goals and strong values -communicate high expectations for followers -show confidence in followers -are an inspiration to others

change and planned change

Change: something new or different; change can be considered a predictable linear process or a complex, highly interrelated process Planned Change: the deliberate application of knowledge and skills by a leader to bring about change

differences in theories/ theories summarized

Differences in Theories? -Trait Approach: emphasizes that leaders should have certain traits -Situational: focuses on leader behavior in a situation based on the developmental level of follower and task -Contingency: (Fielder) leader effectiveness based on matching a leadership style to the right setting -Path Goal: fit between leader's behavior, characteristics of subordinates and the task -Transformational: process of how leaders are able to inspire followers to accomplish great things -Servant: puts followers first and supports their personal growth -Authentic: leaders are true to themselves and their values and act accordingly

internal and external forces to change

Internal forces might include obsolescence of production and service, new market opportunities, new strategic direction, and a shift in sociocultural values. They could also be: change in priorities, need for increased productivity, need for cost containment, staffing pattern changes, shifts in philosophy, work process changes, and need for better quality of work life. External forces might include regulators, competitors, market forces, customers, or technology. They could also be: health care economics, restructuring, diversity, and changing demographics.

level 5 leadership

Level 5 Leadership is characterized by knowledge, team building skills, the ability to help groups achieve goals, humility, and the empowerment of others through servant leadership.

havelocks six step change

Often used for educational change or cultural change -build relationship -diagnose problem -acquire resources -choose solution -gain acceptance -stabilize and self-renew.

1. Discuss the Joint Statement on Delegation by the American Nurses Association and the National Council of State Boards of Nursing.

The ANA and NCSBN both defined delegation as the process for a nurse to direct another person to perform nursing tasks and activities. NCSBN describes this as the nurse transferring authority while ANA calls this a transfer of responsibility. Both mean that a registered nurse (RN) can direct another individual to do something that that person would not normally be allowed to do. Both papers stress that the nurse retains accountability for the delegation.

the vision

The vision statement is a road map that describes what group members will accomplish; used to describe future goals or aims of an organization; it is a description in words of that conjures up a picture for all group members of what they want to accomplish together; the organization will never be greater than the vision that guides it

charismatic power

a personal type of power; versus referent power (association with other people in power).

Lippitt's Seven Phases of Change

built on Lewin's model, good for changing a process and general change "Unfreezing": -Diagnose the problem -Assess motivation and capacity for change -Assess motivation and resources of change agent "Movement": -Select change objective -Choose change agent -Maintain the change "Refreezing": -Terminate the helping relationship.

strategies for implementing change

empirical-rational, normative re-educative, power-coercive

win-win

focuses on goals of both parties consensus problem solving collaboration

informational power

individual has information that others need to accomplish their goal.

negligence

is the omission to do something that a reasonable person, guided by the considerations that ordinarily regulate human affairs, would do- or as doing something that a reasonable and prudent person would not do. Reasonable and prudent generally means the average judgement, foresight, intelligence, and skill that would be expected of a person with similar training and experience.

multicratic or continuum leadership

moving freely, flexible back & forth along the continuum of leader behavior as the situation demands -leader maintains a concern for people -incorporates the best of the three previously mentioned styles

organizational conflicts

multiples sources of organization conflict and may include conflicting goals, conflicts between groups, intergroup competition, inadequate leadership and failure

referent power

power a person has because others identify with the leader. Can occur when one gives another person, feelings of personal acceptance or approval. May be gained through association with an individual that has power. People may also develop referent power because others perceive them as powerful.

elements of empowered nurses

self-directed -knowledge-based -competent -fluid and flexible -fulfilling purpose and outcomes

information conflicts

sometimes information individuals receive is inaccurate or inadequate to support their position. Bias occurs when information travels through the perceptive and values filters of the person receiving the information

coercive power

the opposite of reward power. Based on fear of punishment if the manager's expectations are not met.The manager may obtain compliance through threats (often implied) of transfer, layoff, demotion, or dismissal

value based conflict

these conflicts are perhaps the most difficult conflicts to resolve in the workplace as they relate to personal values. These values are difficult to resolve because they relate to who people are and what they believe; differing cultures, ethnic groups, religious beliefs, personal values, political ideology, and economic and social status.

Identify the best method for delivering nursing care if there are all registered nurses on the unit at the start of the shift.

total patient care/ primary nursing

chain of command primary nursing

charge nurse- RN- patient The Charge Nurse: -assigns the primary and associate nurse -evaluates the primary nurse and associate nurse (nursing care plans, discharge planning etc.) -may function as a primary nurse or associate nurse -management responsibilities -coordinates units activities Primary nursing is also known as relationship-based nursing, uses some concepts of total patient care and brings the RN back to the bedside to provide clinical care. The primary nurse assumes 24-hour responsibility for planning the care of one or more patients from admission or the start of treatment to discharge of the treatment's end. During the work hours, the primary nurse provides total direct care for that patient, and when not on duty the associate nurse will follow the care plan. Although originally designed for hospital settings, primary nursing can lend itself well to home health nursing, hospice nursing, and other health-care delivery enterprises.

chain of command functional nursing

charge nurse- nurse, lvn, uap- patient The Charge Nurse is accountable for: -direction and supervision -major decision -coordinating care due to the division of labor -making rounds to evaluate nursing care and patient outcomes

chain of command in team nursing

charge nurse- team leader- RN, LVN, UAP- patient The Charge Nurse: -is knowledge of nursing care needed by the patients on the unit and team -delegates authority -serves as consultant, resource for the Team Leader -assigns a capable RN as Team Leader -assigns Team Members to the team Team Leader in Team Nursing: reports to the Charge Nurse -have knowledge of all patients on the team -delegates specific duties to the team members-what does the team leader consider in delegation? -plans, organizes and evaluates the work of the team -good communication skills -have human relation skills, organizational and leadership skills as well as technical skills Team Members: -accountable for patient care assigned -accountable for working with the team (communication and assisting others)

Balanced Scorecard (BSC)

collect and analyze metrics from four organizational perspectives: financial, customers, processes, growth; These measures align individual, departmental, and organizational goals and identify entirely new processes for meeting customer and shareholder objectives. Because all of the measures are considered to be related, and because all of the measures are assumed to eventually lead to outcomes, an overemphasis on financial measures is avoided. The scorecard then is "balanced" in that outcomes are in balance.

win lose

competing one party exerts dominance accommodating failure to respond majority rule

lose-lose

compromise bribes arbitration

relationship conflict

conflict based on interpersonal relationships know what the individuals feel; know what the individuals perceive about the conflict. Most common relationship conflict involves inaccurate perceptions based on what was said or heard. Filled with emotional content

reward power

derived from the ability to grant favors or reward others with something they value. Positive leadership through rewards tends to develop a great deal of loyalty and devotion to the leader.

legitimate power

derived from the title or position within an organization. It is inherent in the ability to create feelings of obligation or responsibility.

Identify the best method for delivering nursing care if there are RN's, LVN's, and patient care assistants on the unit at the start of the shift.

functional nursing/team nursing

expert power

gained through knowledge, expertise, or experience. This type of power is limited to a specialized area. Having critical knowledge allows a manager to gain power over others who need that knowledge.

shared governance

is an organizational framework grounded in a philosophy of decentralized leadership that fosters autonomous decision making and professional nursing practice. It implies the allocation of control, power, or authority among mutually interested vested parties. -Nursing shared governance structures are usually council models emphasizing the empowerment of staff nurses. -Typical Practice Councils include: Nursing Practice Quality/Performance Improvement Education/Professional Development Research Leadership

biggest reason for resistance to change

subordinates not trusting their manager/organization

advisory staff positions

-provides information and assistance to the manager but has limited organizational authority; enable the manager to handle more activities and interactions than would otherwise be possible; provide for specialization that would be impossible for any one manager to achieve alone; organizations can function without them

anecdotal notes ( critical incidents )

used for all methods documenting performance for the entire time period. Notes are maintained during the evaluation period. Serves to increase the accuracy of the performance appraisal. The major emphasis is on how the manager and employee can work together to improve performance during the next evaluation period.

things that CAN NOT be delegated

(1) physical, psychological, and social assessment, which requires professional nursing judgment, intervention, referral, or follow-up; (2) formulation of the nursing care plan and evaluation of the client's response to the care rendered; (3) specific tasks involved in the implementation of the care plan that require professional nursing judgment or intervention; (4) the responsibility and accountability for client or client's responsible adult health teaching and health counseling which promotes client or client's responsible adult education and involves the client's responsible adult in accomplishing health goals; and (5) administration of medications, including intravenous fluids, except by medication aides as permitted under §224.9 of this title (relating to The Medication Aide Permit Holder).

1. Discuss appropriate steps for a supervising registered nurse that should be followed when managing an error made by unlicensed assistive personnel (UAP).

- Assess the patient's condition -Notify the physician -Take corrective action

criteria for delegating

-Assess client's nursing needs -A task that a reasonable and prudent RN would find in the scope of sound nursing judgment to delegate -The task must be one that in the opinion of the delegating RN, can be properly and safely performed by the UAP without jeopardizing the client's welfare -The nursing task must not require the unlicensed person to exercise professional nursing judgment . -UAP to whom the nursing task is delegated must be adequately identified. -RN shall have instructed the UAP or verified competency perform the task. -RN shall adequately supervise and evaluate the delegation of tasks performance of the nursing task. -The RN shall be accountable and responsible for the delegated nursing task. The degree of supervision is dependent on the stability of the client, training and capability of the UAP, nature of the nursing task being delegated, and proximity and availability of the RN to the UAP when the task will be performed Consider the consequences and likely effects when delegating -Potential for harm -Task complexity -Problem solving/critical thinking required -Unpredictability of outcome -Level of caregiver-patient interaction -The practice setting

checklists

-Assess the presence or absence of a desired characteristic. Rates the performance against a set list of desirable job behaviors. -Behaviors to effective performance should be listed. -Desired behaviors are determined in advance and stated as measurable criteria. -Simple checklists: use words or phrases to describe behaviors -Forced checklists: requires evaluator to select a desirable and undesirable behavior for each employee -Weighted checklists: gives weighted scores for each behavior

resistance to change

-Because change disrupts the homeostasis or balance of the group, resistance should always be expected -Resistance is a natural and expected response to change. -Subordinates should speak openly so the options can be identified to overcome objections -Planned change must be collaborative. -Basic Causes of Resistance: economic factors inconvenience uncertainty fear of loss of job loss of prestige/status loss of job satisfaction -The greatest factor contributing to resistance encountered with change is a lack of trust between the employee and the manager/organization. Workers want security and predictability; trust erodes when the ground rules change. Managers must remember that subordinates will generally focus more on how a specific change will affect their lives and status than on how it will affect the organization.

competence to become a nurse political expert

-Build working relationship with policy committee members in your organization -Participate on committees focused on policy areas of interest -Participate in professional organizations of interest -Develop relationships with state agency leaders and provide input to legislators -Participate on legislative lobby days with nursing organizations -Get involved with a local political party; get involved with US legislators -Share your ideas with leaders and elected officials involved in policy work -Run for office

four common myths about change

-Change can be controlled. False because change can only be facilitated, not stopped or harnessed. -Change is painful. False because not everyone is reluctant or resistant to change. Some people readily embrace change as normative. -Change is always chaotic. False because it can be planned or unplanned, and the process can be managed. -The environment does not impact a well-thought-out process. False because the environment is dynamic and continually changing.

characteristics and outcomes to servant leadership

-Characteristics of Servant Leadership: -Listening: communicate by listening first, acknowledge the viewpoint of the follower and validate their perspective -Empathy: "Standing in their shoes" and see the world from their point of view, accepting what they are -Healing: make whole, caring about the personal well-being of the follower -Awareness: understanding oneself and the impact one has on others, step aside and view themselves in the situation -Persuasion: clear and persistent communication that convinces others to change (not coercion, not position power) -Conceptualization: a visionary for the organization, providing a clear sense of the goals and directions, the "big picture" -Foresight: ability to know the future based on what is occurring in the present and what has happened in the past -Stewardship: responsible for the leadership role entrusted to the leader, hold the organization in trust for the greater good, serving the needs of others -Commitment to Growth: helping people grow personally and professionally, views each person as "unique" with intrinsic value that goes beyond the tangible contributions to the organization -Building Community: development of people with shared interests and pursuits, allows followers to identify something greater than themselves, feel safe, connected -Advantages of Servant Leadership: -values people -enables others to develop and flourish -committed to personal and professional growth -shows commitment to the community -seeks to improve care through encouragement and facilitation -Outcomes of Servant Leadership: -Follower growth and performance: greater self-actualization, improved performance, becomes a servant leader -Organizational Performance: positive influence on organization performance, followers go beyond to help the overall functioning of the organization -Societal Impact: likely to have a positive impact on community...consider Mother Teresa's impact throughout the word

common conflict resolution outcomes

-Compromising: may be a lose-lose situation as neither party gets what they want. Either or both parties may perceive they have given up more than the other -Competing: one party pursues what it wants at the expense of the others. May be a win loose or lose-lose situation if the outcome adversely affects the working relationship. -Cooperating/accommodating: one party sacrifices their beliefs and allows the other party to win. A win-lose situation. -Smoothing: one party attempts to pacify the other party or focus on agreements rather than differences. May be appropriate for minor disagreements, but rarely results in resolution of the actual conflict. Also called accommodating. -Avoiding: parties are aware of the conflict but choose not to acknowledge or attempt to resolve it. Most common strategy used by nurses. -Collaborating: an assertive and cooperative means of conflict resolution that results in a win-win solution

authoritarian leadership

-involves centralized decision-making: leader makes the decisions -communication downward -primary concern is for the job, the task -strong control over followers -uses directive behavior (gives orders and expect followers to respect and obey) -believes that people are motivated by external forces, such as power, authority, and need for approval -Outcomes of Authoritarian Leadership: -may foster hostility -more dependence on the leader -subtle kinds of discontent -followers may be aggressive or submissive -creativity, autonomy and self-motivation reduced -Theory X is very similar to autocratic or authoritarian leadership

constructive vs destructive conflict

-Discipline involves training or molding the mind or character to bring about desired behaviors. Although discipline can have negative consequences, it can be a powerful motivator for positive change because it has an educational component as well as a corrective one. -Punishment is an undesirable event that follows unacceptable behavior. -Destructive (Punishment): Scientific management theory viewed discipline as necessary means for controlling an unmotivated and self-centered workforce. Because of this traditional philosophy, managers primarily used threats and fear to control behavior. The approach focused on eliminating all behaviors that could be considered to conflict with organizational goals. Although it may succeed on a short-term basis, it is usually demotivating and reduces long-term productivity because people will achieve goals only up to the level that they believe is necessary to avoid punishment. This method is often arbitrarily administered and is unfair either in the application of rules or in the resulting punishment. -Constructive (Discipline): Assists employee growth; can be defined as training, educating, or molding; punishment may be applied for improper behavior, but it is carried out in a supportive and corrective manner. Employees are reassured that the punishment given is because of their actions and not because of who they are.

discipline

-Discipline: The action taken when a regulation has been violated. The basic prerequisite for effective discipline is that the employee was aware of the agency rules and regulations covering behavior -Discipline is administered promptly, privately, thoughtfully, consistently. -Discipline is progressive except in the most severe cases since discipline may have serious consequences for the employee. -Progressive Discipline: -oral warning (informal reprimand) -written warning (formal reprimand) -disciplinary layoff (suspension with or without pay) -involuntary termination or dismissal -The manager should investigate the episode to be sure that a rule was broken, the employee was informed of the rule, that the employee knew a rule was being violated and that there were no extenuating circumstances. -Principles of Disciplinary Action: -investigate carefully and have all of the facts -be prompt -protect privacy -enforce rules consistently -be flexible -advise the employee -take corrective, constructive action -follow up -Due Process in Discipline: -there is an agency rule or standard the governs behavior under consideration -employee was aware of the rule or standard governing the problem behavior -employee did in fact violate the agency rule or standard -penalty imposed is appropriate to the rule or standard violated -Due process insures that the discipline is not arbitrary, capricious, or discriminatory

hot stove policy

-Employee knows that if they touch a hot stove (break a rule), they will be burned (punished or discipline). They must know the rule beforehand and be aware of the punishment. Forewarning -If the employee touches the stove (breaks a rule), there will be immediate consequence (getting burned). All discipline must be administered after the rule is broken. Immediate consequences -If the employee touches the stove again, they will again be burned. There is consistent and immediate consequences. Consistency -If any other employee touches the hot stove, they will get burned. Discipline must be impartial.

mission statement

-Every organization has a vision and mission. The purpose and philosophy are explicitly stated and detailed in a formal mission statement -A mission statement or purpose is a formal expression of the purpose or reason for existence of the organization. It is the organization's declaration of its primary driving force or its vision of the manner in which it believes care should be delivered; brief statement (typically no more than 3 or 4 sentences); identifies the organization's constituency and addresses its position regarding ethics, principles, and standards of practice

power used for advocacy process

-Expert Power: nurses are clearly knowledgeable and are experts in their profession. Expert power allows nurse advocates to be effective team members in meetings with other powerful players. -Legitimate Power: the nurse license from the State Board grants legitimate power to nurses to be used as advocates for the public -Nurse policy advocates have access to referent power, Can be used to gain support from groups in the community -Reward power is available for nurse advocates. Reward power can be used to effectively reward policy makers as they seek votes to maintain their positions.

barriers to delegation

-Fear of being disliked -Inability to give up control -Fear of making a mistake -Inability to determine what to delegate and to who -Unpleasant past experience -Poor interpersonal communication skills -Lack of confidence -Lack of administrative support -tendency to isolate oneself -inability to prioritize -thinking of oneself as the only one capable -inability to communicate effectively -inability to develop working relationships with other team members -lack of knowledge of capabilities of staff

goal vs objective

-Goal: the desired result toward which effort is directed; it is the aim of the philosophy; a specific aim or target that the unit wishes to attain within the time span of 1 year; goals usually have multiple objectives -Objective: the measurable step to be taken to reach a goal; more specific and measurable than goals because they identify how and when the goal is to be accomplished -Setting a Realistic Timeline and Identifying Specific Responsibilities -Proactive and deliberate continuous process of establishing goals, defining problems and opportunities, setting objectives and developing strategies and tactics for action -Must have clear objectives for planning to take place

common errors in performance evaluations

-Leniency Error: overrating the RN's performance -Recency Effect: occurs when recent issues are weighed more heavily than past performance -Halo Effect: occurs when the appraiser lets one or two positive aspects of the assessment or behavior of the employee unduly influence all other aspects of the employee's performance -Horns Effect: occurs when the appraiser allows some negative aspects of the employee's performance to influence the assessment to such an extent that other levels of job performance are not accurately recorded -Central Tendency Effect: rating all traits same; small range -Mathew Effect: occurs when employees receive the same appraisal year after year

normative reeducation strategy

-provide a more holistic approach to change -Recognizes needs, feelings, values, attitudes on efforts toward change -Uses group process, group norms, and peer pressure to socialize and influence people so that change will occur. -Assumptions are: -assumes that people are social creatures -uses group process to effect the change -uses group norms and peer pressure to socialize and influence the change -education alone is not enough to implement change -people act according to their level of personal commitment to social norms -people are rational beings

evaluation principles

-Managers must be trained in the performance appraisal process -Appraisal in writing and completed at least once a year -Performance appraisal information is to be shared with the employee -Employee has the opportunity to respond in writing -Employee has the opportunity to appeal -Manager must have ample opportunity to observe a representative sample of the employee's job performance -Anecdotal notes are maintained during the entire evaluation period to avoid the recency effect -The performance appraisal must be valid; based on the job description for the position and on the performance standards -Assess the employee's performance in relation to behaviorally stated goals; Focus on employee behaviors rather than traits of the person -Observe a representative sampling of the employee's behavior; do not focus on isolated instances of extremely capable or inept behavior -Compare the employee's self-evaluations with the manager's evaluation -Every employee should be given a copy of the job description, and performance appraisal prior to the conference. (Should receive this at employment interview); This allows both the employee and supervisor to approach the discussion from the same perspective. -Cite specific examples of satisfactory and unsatisfactory behavior; with unsatisfactory behavior, indicate how to improve -Indicate which job areas have the highest priority for improvement -The tool must be reliable: inter-rater reliability -What should the employee expect? -Personnel and manager meet to review progress since either the previous evaluation or hire date -evaluation should be objective -evaluation should be based on the individual's job description -Problems associated with performance evaluations -time and energy factors: require time and effort to prepare and are frequently left to the last task -must be more than a one way process: the manager and employee must view the system as a mechanism to increase performance of the individual

team nursing

-Nursing unit has Charge Nurse, Team Leaders, and Team Members -Team leader must be an RN (not a technical nurse) providing leadership -Team Leader coordinates and supervises the nursing care delivered by the team members -Team has RNs, LVNs, UAPs -team member is assigned the total care of the patient to the extent that is within their knowledge and licensure -good open communication among team members (patient care conferences, reports, care plans, work assignments)... -corrects fragmentation associated with functional nursing Advantages of Team Nursing: -personnel of several levels are employed -more continuity and less fragmentation as fewer people are delivering patient care if there is communication -potential for building team spirit Disadvantages of Team Nursing: -family and the patient do not know their nurse -not cost effective -falls back to functional because the communication fails...fragmentation of care -increased likelihood of errors -LVNs are often made the Team Leader -no one considers the total patient

Situational Leadership Theory

-Paul Hersey and Kenneth Blanchard focused on the "maturity" levels (developmental levels) of the followers -Maturity: defined as the follower's ability to set high, but attainable goals, their willingness & ability to take responsibility & their level of education and experience; determinants of maturity are job-related not emotional or age-related -Developmental level: the degree to which subordinates have the competence and commitment to accomplish a given task or activity -Theory based on three concepts: -Directive Style: helps members accomplish goals by giving directions, setting time lines...showing how the goals are to be achieved; "When a leader tells an individual what to do, when it needs to be done, where it should be done, and who is going to do it." -Supportive Style: "entails two-way communication, facilitating behavior, active listening, and socio-emotional support."; Helps the follower feel good about themselves, their colleagues, and the situation; includes asking for input, solving problems. -Developmental Level (Maturity): a follower with a high developmental level (maturity) is one that has the capacity, willingness, and capability to set individual goals and accomplish the task with minimal direction; a follower with low developmental level (immaturity) requires step by step instruction in order to accomplish a specific task; a person's developmental (maturity) level is not constant, but depends on a specific task; frequent assessments are required for the appropriate leadership style to be used -leadership style should be more directive with the lower developmental level employee (immature) and less directive with the high developmental level (mature) employee -supportive behavior should increase with the employee until the worker is fully mature (developed) where neither are needed

what competencies should nurses embrace to promote change

-Personal knowledge and accountability for strength and limitations specific to change innovations -Understanding the essence of change and innovation concepts as well as the tools of innovation -Ability to collaborate and fully engage team members -Competence in embracing vulnerability and risk taking.

SWOT analysis

-SWOT Analysis: a tool that is used to conduct the environmental assessment. It identifies the organization's strengths, weaknesses, opportunities, threats. -First step is to define the desired end state or objective. After the desired objective is defined, the SWOTs are discovered and listed. Decision makers must then decide if the objective can be achieved in view of the SWOTs. If no, a different objective is selected and the process repeats. Strengths are those internal attributes that help an organization to achieve its objectives Weaknesses are those internal attributes that challenge an organization in achieving its objectives Opportunities are the external conditions that promote achievement of organizational objectives Threats are external conditions that challenge or threaten the achievement of organizational objectives

horizontal, vertical, and dotted line positions

-Solid horizontal line positions - represent communication between people with similar spheres of responsibility and power but different functions -Solid vertical line positions - denote the official chain of command (authority at the top) -Dotted lines - staff or advisory positions; no inherent legitimate authority

philosophy

-The philosophy of an organization is typically embedded in the mission statement. It is a value statement of the principles and beliefs that direct the organization's behavior; a working philosophy is evident in a department's decision, in its priorities, and in its accomplishments

organizational chart

-a picture of the organization; can help identify roles and expectations; defines formal relationships within the institution Advantages: -shows formal lines of communication - chain of command, decision-making authority -facilitates the flow of information -shows formal (not informal) relationships - who you are accountable to... -useful for orienting new staff - how they fit in the organization Limitations: -does not show the informal structure of the organization -does not indicate the degree of authority held by each line position -may show things as they are supposed to be or used to be rather than as they are -may define roles too narrowly -possibility exists of confusing authority with status

stakeholder

-a stakeholder is any person, group, organization that has a vested interest in the project under view. -Stakeholders may be part of the organization or part of the community.

stakeholder assessment

-a stakeholder is any person, group, organization that has a vested interest in the project under view. -Stakeholders may be part of the organization or part of the community. Legal Considerations: -credentialing: the formal recognition of professional or technical competence -certification: the process by which a non-governmental agency or association grants recognition to an individual who has met certain predetermined, specified qualifications -licensure: the process by which an agency of the government grants permission to an individual to engage in a given occupation; this is granted after finding the applicant has attained a minimal degree of competence to ensure that the public health, safety and welfare will be reasonably protected Shared Governance: -Shared governance is an organizational framework grounded in a philosophy of decentralized leadership that fosters autonomous decision making and professional nursing practice. It implies the allocation of control, power, or authority among mutually interested vested parties. -Nursing shared governance structures are usually council models emphasizing the empowerment of staff nurses. -Typical Practice Councils include: Nursing Practice Quality/Performance Improvement Education/Professional Development Research Leadership

Contingency Leadership

-arose from the law of the situation, which said that the situation should determine the directives given after allowing everyone to know the problem -no one leadership style is ideal for every situation -interrelationships between the group's leader and its members were most influenced by the manager's ability to be a good leader -task to be accomplished and the power associated with the leader's position are key variables

Transaction Leadership

-concerned with day to day operations -focus is on tasks -sets goals, gives direction and uses rewards to reinforce behaviors that meet the goals -leaders strive to compromise, manipulate and control -rewards may be praise, recognition, merit increases... - maintains the status quo

credentialing, certification, licensure

-credentialing: the formal recognition of professional or technical competence -certification: the process by which a non-governmental agency or association grants recognition to an individual who has met certain predetermined, specified qualifications -licensure: the process by which an agency of the government grants permission to an individual to engage in a given occupation; this is granted after finding the applicant has attained a minimal degree of competence to ensure that the public health, safety and welfare will be reasonably protected

formal organizational structure

-defined by executive decision -emphasis is on organizational positions and formal power -highly planned and visible -diagrammed to show the relationships among people, tasks and their positions (accountability) -refers to what you see when you are looking at the organizational chart -through departmentalization and work division, provides a framework for defining managerial authority, responsibility, and accountability -roles and functions are defined and systematically arranged, different people have differing roles, and rank and hierarchy are evident

organizational structure and function

-depicts formal relationships, channels of communication, and authority through line-and-staff positions, scalar chains, and span of control -the way the group is formed, its lines of communication, and its means for channelling authority and making decisions -establishing a formal structure that provides the best possible coordination or use of resources to accomplish unit objectives; can impede or facilitate communication, flexibility, productivity, and job satisfaction -affects how people perceive their roles and the status given to them by other people in the organization

House and Mitchell's Path Goal Theory

-derived from expectancy theory: "followers will be motivated if they think they are capable of performing their work, if they believe their efforts will result in a certain outcome, and if they believe that the payoffs for doing their work are worthwhile." -Defines goals→clarifies path, removes obstacles→provides support: Leadership makes the path to the goal clear and easy to travel through -coaching and direction -removing obstacles and roadblocks to attaining the goal -making the work itself more personally satisfying -Result is higher performance and productivity -Behavior of the leader affects the employee's degree of motivation through the use of rewards, clarifying the link between the path, goal achievement, and the reward -the leaders structures the activities

purpose of performance appraisal

-determine job competence -provide feedback, direction and leadership -show support and encouragement (motivate) -initiate discussion about areas that need improvement -evaluate accomplishments and set goals -assist with promotion -requirement of accreditation (administer performance for each employee at regular intervals) -reinforce the agency vision, mission and goals

conflict manager

-does not take sides; has no vested interest in the outcome -asks questions to clarify the issues at hand (fact-finding) -listens to both parties -meets with parties privately as necessary -helps to identify solutions both parties can live with

Power-coercive strategies

-focus on overcoming resistance to change -Needs, values, feelings, and attitudes are recognized. -Features the application of power by legitimate authority, economic sanctions, or political clout of the change agent. -Assumptions are: -consensus cannot be reached through persuasive methods -When change is needed in the presence of resistance, power must be seized. -Appropriate when: -time is short -much resistance is anticipated -change is critical for organizational survival

strategies for managing conflict

-focus on the causes of the disagreement and not on personalities -try to arrive at solutions acceptable to everyone concerned -get all the information possible; differentiate between facts and opinions -listen carefully and do not prejudge -do not belabor how the conflict occurred. Instead, concentrate on what should be done to keep it from recurring -concentrate on understanding and not on agreement -confrontation -third-party consultation -behavior change -responsibility charting -structure change -soothing one party

chain of command

-formal path of authority and communication -the communication and order giving chain of superior-subordinate relationships in an organization -If you're unhappy with your work assignment, who do you talk to?

major leadership traits

-intelligence: complex problem solving skills -self-confidence: self-esteem, belief that they can make a difference -determination: initiative, persistence, drive -integrity: honesty and trustworthy -sociability: friendly, outgoing, diplomatic

global leader traits

-need to understand how cultural differences affect leadership performance -leaders must be competent in cross cultural awareness and practice -most important trend of the 21st century Five cross cultural competencies: -understand business, political and cultural environments world wide -learn and incorporate the perspectives, tastes, trends, and technologies of other cultures -work simultaneously with people from many cultures -adapt to living and communicating in other cultures -relate to people from other cultures from a position of equality rather than cultural superiority Additional cultural competencies: -develop skill in creating transcultural visions -develop communication competencies that will enable them to articulate and implement their vision in a diverse setting

informal organizational structure

-not defined by organizational structure/chart -unplanned and often hidden -focus is on the employees, their relationships, and the informal power that is inherent within those relationships -a naturally forming social network of employees (provides stability to work groups) -consists of the unwritten rules, norms, social systems (could influence the behavior of group/individuals) -communication channel often referred to as "the grapevine"; social media sites and electronic communication used to facilitate communication among informal group members

rating scales ( traditional )

-oldest and most often used form -manager indicates the quality of the employee's performance on each activity by checking the appropriate point on a scale or by selecting the appropriate phrase -common example is the instructor evaluation filled out at the end of each semester disadvantages: -manager avoids using the high and low extremes of the scale and clusters all ratings around the center (central tendency effect) -managers differ in their interpretation of outstanding, etc.; poor inter-rater reliability -manager may give everyone the best mark (leniency effect) -possible subjectivity of the rater -Halo and Horns Effect more common -not used as frequently due to multiple disadvantages -Behaviorally Anchored Rating Scale: -Employees doing the same job identify critical incidents that reflect superior and inferior job behaviors. The critical incidents are stated as measurable or quantifiable behaviors. -Employee can easily understand the behavior needed to improve. Advantages: -forms are developed by the employees, so there is commitment -cover all aspects of the job -refer to observable job performance -can be used to develop the subordinate as they can see what they need to do to improve -high inter-rater reliability -Forced Distribution Scale: -assumes that individuals conform to a normal frequency distribution -like grading on a curve -staff members would be compared to each other rather than a standard -no provision to recognize two outstanding employees

total patient care case method

-oldest mode of organizing patient care -patient's total care done by an RN -RN is accountable for total care of assigned patient -works well in specialized units -patient could receive three different approaches to care (3 shifts-3 nurses etc.) Advantages of Total Patient Care: -continuous nursing care for the shift -RN accountable for the care the patient receives during the shift -continuity of care for the shift -increase communication with patient, family, physician, and other departments Disadvantages of Total Patient Care: -not cost effective as RNs are doing tasks which could be done by lesser-skilled personnel -What if the nurse is not prepared to provide total patient care? -no guarantee of the same nurse with the same patient each day -2-3 RNs per day with different approaches to patient care (confusion for the patient)

democratic leadership

-participatory, works with their followers -authority delegated -uses expert power -draws and welcomes new ideas -involves followers in decisions: two-way communication -believes that people are motivated by internal drives and impulses -Outcomes of Democratic Leadership: -takes more time and is not as efficient -more cohesive, friendlier and more group minded -motivation and originality were higher than the autocratic style -higher job satisfaction, commitment and cohesiveness -more creative and greater motivation -Theory Y is very similar to the democratic or participative style of leadership

Laizzez-faire leadership

-passive and permissive with little or no content -leader defers decision making to the group -discussion with a minimum of leader participation/control: nondirective -decision making dispersed throughout the group -"nonleadership" -Outcomes of Laissez Faire Leadership: -little is accomplished -followers find chaos -poor motivation -greater employee frustration -decreased satisfaction -becomes unmotivated and disheartened -productivity decreases

peer review

-peer review has great potential for developing professional accountability, but is often difficult to effectively implement -managers review of the employee is not considered complete unless some type of peer review is implemented -staff are often not oriented to peer review -may be viewed as very threatening without time devoted to orientation of the process -peers feel uncomfortable sharing feedback with people they work closely with the result of the leniency effect (wanting to avoid conflict)

sources of conflict

-poor communication -inadequately defined organizational structure -individual behavior (incompatibilities or disagreements based on differences of temperament or attitudes) -unclear expectations -individual or group conflicts of interest -operational or staffing changes -diversity in gender, culture, or age

emperical-rational strategies

-power ingredient is knowledge -Assumptions are that the change agent, being knowledgeable, has the expert power to persuade people to accept a rationally justified change that will benefit them (example-new technology) -Appropriate when there is little anticipated resistance or when the change is perceived as reasonable.

self appraisal

-promotes dignity and self-respect -ensures that the person is prepared for the discussion-very important -difficult to accurately rate one's own performance (tend to be overly positive or overly negative) -RNs may undervalue their achievements or feel uncomfortable giving themselves high ratings

basic rules on managing conflict

-protect party's self-respect -do not affix blame on parties -allow open and complete discussion -maintain equity in frequency of presentation between parties -encourage full expression of positive and negative feelings -assure both parties listening to each other -identify key themes in discussion and restate them -encourage parties to provide feedback to each other's comments -help parties develop alternative solutions -follow-up on progress of plan

trait theroy

-some sources call this "Great Man" theory -correlates with the personality traits of the leader -research was directed toward identifying intellectual, personality, physical abilities...of effective leaders -no set of traits was definitive and reliable in determining leadership -New Interest in the Trait Approach: -began with identifying qualities of great people, shift to include the situation, and now focuses on critical role of traits in effective leadership -new research focusing on visionary and charismatic leaders and the impact of social intelligence major leadership traits: -intelligence: complex problem solving skills -self-confidence: self-esteem, belief that they can make a difference -determination: initiative, persistence, drive -integrity: honesty and trustworthy -sociability: friendly, outgoing, diplomatic

Authentic (Congruent) Leadership

-suggests that in order to lead, leaders must be true to themselves and their values and act accordingly -leader's principles and their conviction to act accordingly inspires the followers -takes great courage to be true to one's convictions when external forces or peer pressure encourages the leader to do something morally inappropriate -Authenticity: "to thine own self be true" -the authentic leader acts with integrity -leaders who are hopeful, optimistic, resilient, and transparent -They operate consistently with values visible to others, focus on ethical or right things to do, take the lead even at personal risk... -Characteristics of the Authentic Leader: -Purpose: understand their own purposes and passions as a result of ongoing self-reflection and self-awareness -Values: link between purpose and passion by having congruence in beliefs and actions -Heart: care for themselves and the people they lead, and their compassion is genuine -Relationships: value building relationships and establishing connections with others, not to receive rewards but rather to strengthen the human connection -Self-discipline: practice self-discipline by incorporating balance into their personal/professional lives

power

-the authority and ability to get things accomplished -the capacity or potential to get others to do something one wants then to do that they would not ordinarily do otherwise -the potential of an individual or group to influence the behavior of others -gives one the potential to change the attitudes and behaviors of individual people and groups

span of control

-the number of subordinates who report directly to the manager -implies a limited number of employees can be effectively supervised by one manager -many healthcare organizations have reduced the number of administrative levels due to financial concerns (flattening the organization) -too many people reporting to a single manager delays decision making; too few results in an inefficient, top-heavy organization

methods of delivering patient care

-total patient care-case method -functional -team -primary -interdisciplinary collaboration

Transformational Leadership

-transformational leaders, "...often have a strong set of internal values and ideals, and they are effective at motivating followers to act in ways that support the greater good rather than their own self interests." -Leaders: -move followers beyond own self-interest to exert effort on behalf of the organization -stimulates commitment to a shared vision and goals -prefers to coach rather than control -becomes the role model for the follower -provides a sense of direction -encourages self-management

360 degree feedback

: a multisource system of assessment looking at how the employee is perceived by multiple layers of people including: -more accurate perspective of the employee's work performance -may include physicians, patients, peers, employees from other departments who interact with the individual on a regular basis -ideally completed on an online format

competence

: the ongoing ability of a nurse to integrate and apply knowledge, skills, judgment, and personal attitudes required to practice safely and ethically in a designated role and setting. Competence can be insured through credentialing or a clinical ladder framework

bureaucratic organizational structure

A pyramid-shaped organizational structure that consists of hierarchies with many levels of management The hierarchical model is the most popular organizational chart type. There are a few models that are derived from this model. In a hierarchical organization structure, employees are grouped with every employee having one clear supervisor. The grouping is done based on a few factors, hence many models derived from this. Below are few of those factors

strategic planning

A strategic plan can be defined as the sum total or outcome of the processes by which an organization engages in environmental analysis, goal formulation, and strategy development with the purpose of organization growth and renewal. (Book def.): typically examines an organization's purpose, mission, philosophy, and goals in the context of its external environment; forecasts the future success of an organization by matching and aligning an organization's capabilities with its external opportunities -Planning is a proactive function required of all nurses; a plan is a guide for action in reaching a goal and must be flexible; plans should be specific, simple, and realistic, all planning must include an evaluation step and required periodic reevaluation and prioritization -Healthcare systems are in chaos and are particularly vulnerable to external social, economic, and political forces -Long-term planning must address these changing dynamics -managers easily become focused on short-term planning because change is occurring so rapidly -Methods of assessment: SWOT Analysis, Balanced Scorecard, Surveys and Questionnaires, Focus groups and interviews, Advisory Boards, Review of Literature on Similar Programs, Best Practices

Authority Accountability Responsibility Delegation

Authority: -is delegated when decision-making power is vested in a subordinate. -is the official power to act. It is the power given by the organization to direct the work of others. -The RN who assigns care to an LVN or PCA retains accountability for the patient care. -the right to delegate and the ability to provide formal rewards for successful completion of delegated tasks are a reflection of the legitimate authority inherent in the management role Accountability: is being responsible and answerable for actions or inactions of self or others in the context of delegation. Responsibility: involves reliability, dependability, and obligation to accomplish work when an assignment is accepted. DELEGATION: Authorizing an unlicensed person to provide nursing services while retaining accountability for how the unlicensed person performs the task. It does not include situations in which an unlicensed person is directly assisting a RN by carrying out nursing tasks in the presence of a RN.

Centralized vs. Decentralized Decision Making

Centrality: refers to the degree of communication of a particular management position Centralized: -few managers at the top of the hierarchy make the decisions and the emphasis is on top-down control -the vision of one or a few individuals in the organization guides the organization's goals and how the goals are accomplished -execution of decision making is fairly rapid Decentralized: -diffuses decision making throughout the organization and allows problems to be solved by the lowest practical managerial level -problems can be solved at the level at which they occur, although some delays may occur in decision making if the problem must be transmitted through several levels to reach the appropriate individual to solve the problem -larger organizations benefit from decentralized decision making

common causes of professional nursing license suspensions

Common causes of professional nursing license suspension or revocation: - Profesional negligence - Practicing medicine or nursing without a licence - Obtaining a nursing license by fraud or allowing others to use your licence - Felony conviction for any offense substantially related to the function of duties of an RN - Participating professionally in criminal abortions - Not reporting substandard medical or nursing care - Providing patient care while under the influence or drugs or alcohol - Giving narcotic drugs without an order - Falsely holding oneself out to the public or to any health-care practitioner as a "nurse practitioner"

interest based conflict

Competition over needs and goods that the other desires or holds onto Parties come to the table with different interests. The leader works to specify and name the critical part of the conflict identifying shared interests or common ground.

origin of law

Constitution highest law in the U.S., interpreted by the Supreme Court; gives authority to the other three sources of the law Little direct involvement in the area of malpractice Statutes also called statutory law or legislative law; laws that are passed by the state or federal legislators and that must be signed by the president or governor Before 1970s, very few state or federal laws dealt with malpractice. Since the malpractice crisis, many statutes affect malpractice Administrative Agencies The rules and regulations established by appointed agencies of the executive branch of the government (governor or president) Some of the agencies, such as the National Labor Relations Board and health and safety boards, can affect nursing practice Court Decisions Also called tort law; this is court mode law and the courts interpret the statutes and set precedents; in the U.S., there are two levels: trial court and appellate court Most malpractice law is addressed by the courts

strategic vs operational planning

Long-range or Strategic Planning: -extends 3 to 5 years into the future -reviews external opportunities and threats so realistic goals can be set Short-range or Operational Planning: -done in conjunction with budgeting -develops departmental maintenance and improvement goals

steps in the change process

Contemporary Model of Lewin's (The Stages of Change Model) -Precontemplation: no current intention to change -Contemplation: considers making a change but does not make a commitment (unfreezing would occur in Stage 2) -Preparation: intent to make a change in short-term future (Stage 3 is a transition from Unfreezing to Movement) -Action: modifies behavior (Stage 4 is Movement) -Maintenance: change is maintained; prevention of relapse (Stage 5 is Refreezing)

direct vs indirect pt care

Direct Patient Care: includes activities such as assisting a patient with feeding, drinking, ambulating, grooming, toileting, socializing, collecting, reporting, and documenting. Do not delegate health teaching, or activities requiring independent judgment. Indirect Patient Care: includes activities such as assisting in providing a clean, efficient, and safe environment, companion care, housekeeping, transporting, clerical, stocking, and maintenance tasks.

direct and indirect ways to influence policy

Direct strategies include lobbying legislators either in person or by letter. Political action committees (PACs) of the Congress of Industrial Organizations attempt to persuade legislators to vote in a particular way. Professional organizations generally impose higher standard of care than the law requires. Voluntary controls often are forerunners of legal controls. What nursing is and should be depends on nurses taking an active part in their professional organization. Legislators and policy makers are more willing to deal with nurses as a group rather than individuals; thus joining and supporting professional organizations allow nurses to become active in lobbying for a stronger nurse practice act or for the creation or expansion of advancing nursing roles. Other nurses may choose to monitor the progress of legislation, count congressional votes, and track a specific legislator's voting intents as well as past voting records. Another option is is to join network groups, where colleagues meet to discuss professional issues and pending legislation. For a more indirect approach to professional advocacy, the nurse can influence and educate the public about nursing and the nursing agenda to reform health care. This can be done by speaking to professional and community groups about healthcare and nursing issues and by interacting with the media.

traits/ qualities of followers

Effective followers share essential qualities: -manage themselves: ability to think for oneself, exercise control and independence -committed to the organization and goals -build competence and focus their efforts - hold higher performance standards than required and continuing education is second nature -courage - credible, honest, independent thinkers, give credit where credit is due, admit mistakes

culture and leadership

Ethnocentrism: the tendency of an individual to view their own culture as better or more natural than the culture of others. -failure to recognize the unique perspective of others -each of us is ethnocentric to some degree -our tendency to think our own cultural values and ways of doing things are right Obstacle to effective leadership because it prevents people from fully understanding or respecting the world of others -one person's culture values individual achievement, hard to understand another person whose culture emphasizes working together as a whole -one person's culture values respecting authority, hard to understand a person who challenges authority Leaders need to promote and be confident in their way of accomplishing a task, but must be sensitive to the legitimacy of the ways of other cultures.

filleys conflict process model

Five Stages of Conflict: -Antecedent Conditions or Latent Conflict: no conflict has actually occurred -Perceived Conflict: antecedent conditions lead to frustrations and the felt conflict is born. Each party's perceptions; felt refers to the negative feelings between two or more parties -Felt Conflict (affective): conflict is emotionalized; felt emotions include hostility, fear, mistrust, and anger -Manifest Conflict (overt): action is taken conflict resolution or conflict management -Conflict Aftermath: hopefully both parties see themselves as winners; may be more significant than the original conflict if the conflict has not been handled constructively

types of responses ppl have to change

INNOVATORS embrace change and enjoy the challenge. EARLY ADOPTERS are respected by their peers and are sought out for advice. EARLY MAJORITY enjoys and prefers the status quo but will accept new ideas. LATE MAJORITY are openly negative and agree to change only after it is accepted by others. LAGGARDS are the last group to adopt a change, prefer tradition and stability, suspicious of change. REJECTORS openly oppose and reject change and can interfere with the success of the change process.

Matrix organizational structure

In a Matrix organizational structure, the reporting relationships are set up as a grid, or matrix, rather than in the traditional hierarchy. It is a type of organizational management in which people with similar skills are pooled for work assignments, resulting in more than one manager to report to (sometimes referred to as solid line and dotted line reports, in reference to traditional business organization charts). For example, all engineers may be in one engineering department and report to an engineering manager. But these same engineers may be assigned to different projects and might be reporting to those project managers as well. Therefore some engineers might have to work with multiple managers in their job role.

guidelines for informed consent

Informed consent can only 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 client can understand and should be conveyed by the individual who will be performing the procedure. The person giving consent must fully comprehend: -the procedure to be performed -the risk involved -expected desired outcomes -expected complications or side effects that may occur as a result of treatment -alternative treatments that are available Consent may be given by: -a competent adult (must be capable of understanding the nature and consequences of the decision and be able to communicate their decision) -a legal guardian or individual holding durable power of attorney -an emancipated or married minor -mature minor (varies by state) -parent of a minor child -court order During an emergency physicians can invoke implied consent, in which the physician states in the progress note that the patient is unable to sign but that the treatment is in the best interest of the patient. Usually this must be validated by another physician. Nurses frequently seek expressed consent from patients by witnessing patients sign a standard consent form. The role of the nurse is to be sure that the patient has received informed consent and to seek remedy if he or she has not.

interdisciplinary collaboration

Interdisciplinary vs. Multidisciplinary: -multidisciplinary teams share information and work in tandem with other disciplines, functioning independently of the other. Each discipline is responsible for different areas of care for the client. -Interdisciplinary...a partnership between health team members and the client in a participatory, collaborative and coordinated approach to share decision making... -A new vision of team nursing! Interdisciplinary Collaboration: -Interdisciplinary: the sum of the effort is greater than how each discipline might interpret a situation or what each discipline might produce individually. -Breaks down professional silos...enhancing collaborative non-hierarchical relationships Interdisciplinary team members: -meet regularly to discuss and collaboratively set treatment goals -jointly carry out the treatment plan -non-hierarchical relationships -high degree of communication and cooperation -sharing of power -increased professional satisfaction and stimulation -diversity of clinical expertise Advantages of Interdisciplinary Collaboration for the Client: -patient and family-centered care -enhanced patient compliance -superior clinical outcomes -greater patient satisfaction -increased efficiency and reduced costs -fewer hospitalizations -decreased lengths of stay -holistic care

Malpractice (professional negligence)

Malpractice is the failure of a person with professional training to act in a reasonable and prudent manner, also called professional negligence. There are five components of professional negligence: 1. Duty to use due care (defined by the standard of care)- The care that should be given under the circumstances (what a reasonably prudent nurse would have done). (ex. A nurse should give medications accurately, completely, and on time) 2. Failure to meet standard of care ( breach of duty)- Not giving the care that should be given under the circumstances. (ex. A nurse fails to give medications accurately, completely, or on time) 3. Foreseeability of harm- The nurse must have reasonable access to information about whether the possibility of harm exists. (ex. The drug handbook specifies that the wrong dosage or route may cause injury) 4. A direct relationship between failure to meet the standard of care (breach) and injury can be proved- Patient is harmed because proper care is not given. (ex. wrong dosage causes the patient to have a convulsion) 5. Injury- actual harm results to the patient. (ex. convulsion or other serious complication occurs)

responsibilities of a change agent

Must have knowledge of the organization, knowledge of the change process, knowledge of the participants in the change, and understanding of the feelings of the people in the group. Should possess these characteristics: trust, respect, ability to maintain and communicate the vision of the change, ability to communicate, good interpersonal skills, ability to empower others.

primary nursing

Primary Nursing: -designed to provide the patient with comprehensive, non-fragmented nursing care -increases the accountability of the professional nurse -all professional staff (RNs) -brings the RN back to the bedside to provide basic nursing care -patient is assigned to the primary nurse on admission -24-hour accountability for care for duration of stay -plans transition to follow-up care -when not on duty, associate nurses follow the plan of care established by the primary nurse Advantages: -improved continuity and coordination of care as the primary nurse is the primary provider of care (holistic approach) -patient and family knows who their nurse is resulting in increased patient satisfaction and trust -cost effective (decrease turnover) -promotes RN accountability and decision making -decreased errors -job satisfaction Disadvantages: -expensive -difficulty in hiring all RN staff -improper implementation -requires excellent communication between the patient, associate nurses and physicians

GLOBE research program

Purpose: to increase the understanding of cross cultural interactions and the impact of culture on leadership Findings: -help leaders understand their own cultural biases and preferences (first step in understanding other cultures and preferences) -what it means to be a good leader (different cultures have different ideas about what they want from their leader) -leaders can become more emphatic and accurate in communicating with individuals from other cultures

servant leadership

Servant leaders put serving others, including employee, customers, and the community as the number one priority. -Listen on a deep level and truly understand -Keep an open mind and hear without judgment -Able to deal with ambiguity, paradoxes, and complex issues -Believe that sharing critical challenges and asking for input is more important than personally providing solutions -clear on goals and good at pointing the direction toward goal achievement without giving orders -able to be a servant, helper, teacher, and then a leader -thinks before reacting -chooses words carefully -uses foresight and intuition -sees things whole and sensing relationships and connections

nurse recovery program

State of Texas' program to assist nurses that have addictions (TPAPN-Texas Peer Assistance Program for Nurses) -Is the program voluntary? Yes -What types of monitoring mechanisms are in place? TPAPN monitors a participant's recovery via their adherence with treatment recommendations, return-to-work restrictions, attendance at self-help meetings, and random drug tests. -What is the duration of the program? The length of program is one (1) to five (5) years. 1. Any extensions, exceptions or modifications to the length of participation are handled on an individual basis following a formal review by TPAPN. 2. In the event of any nonadherence with the terms of the contract TPAPN will notify the nurse's employer and may require the nurse to cease practice. The participant's length and terms of participation may be extended and/or modified. 10.B. The following could result in program extension: 1. Failure by nurse participant to demonstrate incident-free, safe nursing practice for a minimum of 64 hours per month for twelve (12) consecutive months. -Can the nurse continue practicing? Yes -Are there practice restrictions? Participants agree NOT TO: 1. Function in an autonomous or unsupervised role. 2. Work shifts longer than twelve (12) hours. 3. Work for multiple employers or to engage in self-employed practice. 4. Accept employment with short-term staffing agencies. 5. Work as a traveler. 6. Take on-call assignments during the first six months after returning to work in nursing. 7. Float to other units. a. Nurse will only work a pre-determined area for the first year of work; thereafter, the floating restriction may be modified given certain conditions. 8. Work at multiple practice sites without BON approval. 9. Have access to controlled substances during the first six months of work in nursing. No access includes: a. Not counting or administering controlled substances. b. Not witnessing wastage, signing pharmacy receipts for controlled substances, or having the ability to access storage areas for controlled substances. c. Not calling, faxing, or otherwise electronically authorizing prescriptions for controlled substances. 10. Work more than 96 hours per two-week pay period. 11. The controlled substance restriction may be waived by TPAPN Case Managers for nurses participating under a psychiatric disorder agreement.

Patient Self-Determination Act (PSDA)

The PSDA was enacted in 1991, requiring healthcare organizations that receive federal funding (Medicare and Medicaid) to provide education for staff and patients on issues concerning treatment and end-of-life issues. The education must include the use of advanced directives, written instructions regarding the end of life care. The PSDA requires acute care facilities to document on the medical record whether a patient has an advanced directive. The completion rate for advanced directives remains low, and many patients do not understand what information is included in an advanced directive.

the five rights of delegation

The RN uses critical thinking and professional judgment when following the Five Rights of Delegation, to be sure that the delegation or assignment is: 1. The right task: one that is delegable for a specific patient 2. Under the right circumstances: appropriate patient setting, available resources, and other relevant factors considered 3. To the right person-right person is delegating the right task to the right person to be performed on the right person 4. With the right directions and communication: clear, concise description of the task, including its objective, limits, expectations 5. Under the right supervision and evaluation: appropriate monitoring, evaluation, intervention, as needed, and feedback

Six Driving Forces to Increase Nursing's Power Base

The timing is right- the errors reported in our medical system, the number of uninsured, and the shortcomings of our current healthcare system are all reasons that consumers and legislators are willing to listen to nurses as an attempt is made to fix the healthcare crisis. The size of the nursing profession- numbers are very important in politics, and the nursing profession's size is its greatest asset. There are about 3 million RNs in the US. Nursing's referent power- the nursing profession has a great deal of referent power as a result of the high degree of trust and credibility the public places in them. Increasing knowledge base and education for nurses- there are more nurses gaining master's and doctoral degrees, as well as advanced practice degrees. If knowledge is power, then those having knowledge can influence others, gain credibility, and gain power. Nursing's unique perspective- nursing has long been recognized as having a strong caring component. Combine that with nursing's recent surge in scientific knowledge and critical thinking, and there is a science that brings a unique perspective to the healthcare arena. Desire of consumers and providers for change- healthcare restructuring as downsizing have sparked increasing concern among consumers. The public cares about who is taking care of them, and wants quality care.

types of law

There are three types of courts criminal, civil, and administrative. In CRIMINAL COURT the individual faces charges generally filed by the state or federal attorney general for crimes committed against an individual or society. Nurses found guilty of intentionally administering fatal doses of drugs to patients would be charged in criminal court.beyond a reasonable doubt incarceration, probation, fines In CIVIL COURT one individual sues another for money to compensate for a perceived loss. The burden of proof required to be found guilty in a civil case is described as a preponderance of the evidence (it is more likely than not that the accused individual was responsible for the injuries of the complainant). Most malpractice cases are tried in civil court. preponderance of the evidence monetary damages In ADMINISTRATIVE COURT, an individual is sued by a state or federal government agency assigned the responsibility of implementing government programs. State BON are one such agency. When an individual violates the state nurse practice act, the BON may seek to revoke licensure or institute some form of discipline. The burden of proof varies from state to state, but when the clear and convincing standard is not used, the preponderance of the evidence standard may be used. Clear and convincing is a higher standard of the two. clear and convincing suspension or loss of license

Driving vs. Restraining forces

These forces are part of Lewin's idea of Force-Field Analysis which happens in every stage. Driving forces push the system toward the change. Examples: strong support from CEO, incentive program, help from vendors, customer demands, legislative sanctions. Restraining forces impede change because they push the participants away from the change. They may come from the system itself or from individuals within the system. In order to neutralize these forces, the change agent needs to cultivate the assistance of the acceptors, persuade the uncommitted and identify/neutralize the rejectors. It is not the change itself which causes resistance, but the meaning of the change for the individual involved. Examples: mistrust amongst employees, "worn out" by constant change, staff reluctance to use new technology, union resistance, poor communication channels, low resources.

functional nursing

This method came about because of the increasing need for nurses and increasing technology. -small numbers of nurses available -RNs are used with other levels of personnel -tasks assigned based on knowledge and licensure -personnel were assigned to complete certain tasks rather than care for specific patients -RNs became managers of care rather than direct care providers -grew out of a need to provide care to large numbers of patients -goal was efficient management of time, task, energy and efficient use of staff -personnel evaluated based on what they were assigned for the shift -Scientific Management!! UAPs and LPNs/LVNs: am care/feeding patients etc., checking BP, some treatments, comfort measures RNs: assessments, medications, complicated treatments, managers of care Advantages of the Functional Method: -useful when there is a high ratio of nonprofessional staff to professional nurses -efficient way of completing "tasks" for a large number of patients -everyone knows what they are expected to do and are assigned based on knowledge and licensure Disadvantages of Functional Method -fragmentation of the care-no continuity -patient dissatisfaction-who is their nurse? -increased possibility of an omission of care due to lack of communication -absence of holistic view of patient -decrease registered nurse satisfaction -R.N.'s have no authority to supervise aides -decision making at the level of the charge nurse -individualized patient care may be jeopardized

transnational vs transformational leadership

Transactional vs. Transformational: Management theorists offer caution about transformational leadership -must be combined with the traditional transactional qualities of the day to day managerial role -both need to be present in the leader in varying degrees -leaders will not be successful without the traditional management skills

flat vs tall organizational structure

Types of organizational structure: -bureaucratic (line): Weber (division of labor, hierarchy of authority, impersonality of interpersonal relationships, system of procedures/rules, selection based on competence) -Ad Hoc: utilizes a project team or task approach often disbanded after project complete -Matrix: designed to focus on both product and function, think project managers -Service Line: service line decides on processes to be used to achieve goals -Flat: removes hierarchical layers by flattening the chain of command; decentralized structure; a single manager or supervisor would oversee a large number of subordinates and have a wide span of control; more authority and decision making can occur where the work is being carried out -Tall: centralized structure -Shared governance: empowers employees within the decision-making system; organization's governance is shared between board members, nurses, physicians, and management; often difficult to implement due to expense and a paradigm shift in roles

followership

ability to follow with candor, intelligence, commitment; often confused with indecisiveness -role: for every role, there is a complementary role that completes it; the complementary role for leadership is followership -authority: ideal organizational situation is to combine: Formal Authority Theory (authority of position)-authority results from the position the individual holds in the organization Acceptance Theory (authority of leadership)-when a person's skills are such that others will follow regardless of the formal position in the organizational structure; inspires and encourages respect, creating a desire to follow -moral leadership: -followership: unity -communication: induces acceptance by followers -Nursing's struggle: to become accepted as a contributor on the health care team; followership in the position of change agent, followers complement leaders

clinical ladder

acknowledges that staff members have varying skill sets based on their education and experience. Staff may be rewarded differently and carry differing responsibilities for patient care and professional practice on a unit. -Ongoing professional staff development is part of the regular performance feedback that staff can expect to receive from the patient career manager.

policies

are plans reduced to statements or instructions that direct organizations in their decision making; derived from the organization's philosophy, goals, and objectives -Purpose of policies: -serves as a basis for future decisions and actions -helps coordinate planning -means for delegation of authority -increases consistency among managers

rules and regulations

are plans that define specific action or nonaction. Generally included as part of policy and procedure statements, rules describe situations that allow only one choice of action. Rules are fairly inflexible, so the fewer rules, the better. Existing rules, however, should be enforced to keep morale from breaking down and to allow organizational structure.

procedures

are plans that establish customary or acceptable ways of accomplishing a specific task and delineate a sequence of steps of required action -Purpose of Procedures: -Guide to action and outlines the sequence of definite acts (how to perform) -chronological order for acts to be performed -specific instruction to direct action

Lewin's Force-Field Theory of Change

general model for most situations and organizations -3 simple steps--unfreezing, movement, and refreezing. The change agent proceeds through these phases before the planned change becomes part of the system. -Unfreezing occurs when the change agent convinces members of the group to change or when guilt, anxiety, or concern can be elicited. Thus, people become discontent and aware of a need to change. This discontent can be the result of internal or external forces. Simply comforting the stress/discontent prolongs the problem because motivation declines when discomfort is removed. -Movement occurs when the change agent identifies, plans, and implements appropriate strategies, ensuring that driving forces exceed restraining forces (see question 10 below). This takes time, and requires high level leadership skills, but it should not be delayed solely because of a fear of the unknown or because ambiguity exists. -Refreezing occurs when the change agent assists in stabilizing the system change so that it becomes integrated into the status quo. If this stage is left incomplete, the change will be ineffective and the prechange behaviors will be resumed. Change needs 3-6 months, at least, before it will be accepted as part of the system, so the change agent must remain involved. Measuring the impact of change should always be part of refreezing.