Leadership exam 2

NCSBN defines delegation as

" transferring to a competent individual the authority to perform a selected nursing task in a selected situation"

E- extras

(any extra activities that promote patient comfort) • Providing a heated blanket • Getting water/ice/snacks

R- routine responsibilities

(makes up the bulk of the routine) • Standard daily nursing activities • Assessments • Administering medications

to supervise, nurse leaders and managers must

- Monitor the delegate's performance and assure compliance with standards of practice. - Adhere to organizational policies and procedures in place to support the nurse delegating the task.

barriers to effective delegation

- delegator, delegate and the leadership/ management

when assigning a task nurse leaders and managers must

- ensure the activity is within the individuals scope of practice

breaking down the barriers to delegation

- hold all staff accountable - provide feedback - focus efforts on creating a supportive environment that promotes effective communication and teamwork

Supervision

- to provide guidance or direction, oversight, evaluation and follow-up

what cannot be delegated

-Aspects of the nursing process -Performing an assessment -Formulating a nursing diagnosis -Developing and updating a plan of care -Evaluating the patient progress -Communicating with health-care providers (ex. change in patient status you wouldn't delegate someone else to tell them for you) -Implementing orders from health-care providers -Providing teaching to patient and/or family (initial teaching) -Evaluating patient status and triage

HITECH Act of 2009

-Provided incentive payments to hospitals and healthcare providers to adopt health IT. -"Meaningful Use"- criteria required to be met that demonstrated meaningful use of electronic health records (EHR). EHR technology must be used to achieve certain objectives.

Assessment and Planning step of delegation

-Specification of the knowledge and skills required to accomplish the task -*Development of a plan of care* with the patient and his or her family

right person

-assess and verify the competency of the team member -continually review the performance of the team member & determine competency of care -assess team member performance based on standards & remediate if needed RN can decide what to delegate at the bedside

leadership-management related barriers

-lack of guidelines that address who can delegate and what tasks can be delegated -lack of policies that protect nurses from inappropriate assignments and delegation of inappropriate nursing activities or responsibilities -poor staffing levels -absence of processes for validation of competencies for delegation

delegator-related barriers

-lack of willingness - lacking skill or comfort - feeling overworked - feel its an unfair assignment - feeling physically unable

UAP scope of practice

1. ADLs 2. hygiene 3. linen change 4. routine, stable vital signs 5. documenting input/output 6. positioning *patient must be stable*

Clinical Decision Support System

A special subcategory of clinical information systems that is designed to help healthcare providers make knowledge-based clinical decisions; warnings or reminders to provide nursing care, implement important task

Right circumstance

Appropriate patient setting, available resources, and other relevant factors considered

5 steps of budgeting process

Assess diagnosis plan implement evaluate

CURE

C= critical needs U = urgent needs R= routine responsibilities E= extras

variable expenses

Costs that vary in amount and type, depending on the choices you make. ex. fluctuating patient volume or acuity levels

prioritization

Deciding which patient needs or problems require immediate action and which are not urgent and can be addressed at a later time

electronic records

EHR- electronic health record EMR- Electronic medical record PHR- personal health record

overdelegation

Occurs when the delegator loses control of a situation by providing the delegate with too much authority or too much responsibility *RN feels uncomfortable performing the task*

Personnel Budget

Part of the operating budget that deals with personnel needed to deliver care; composed of salary and benefit costs; largest budget - a manager must monitor the personnel budget closely to prevent understaffing or overstaffing. - determine full time equivalents to determine the needed staff for the unit

delegator

Person, usually the RN, delegating the task Must have the appropriate qualifications, education, and authority to delegate per the state nurse practice act

Interface

The place at which independent and often unrelated systems meet and act on or communicate with each other ability to communicate among systems

LPN/LVN can delegate to

UAP if directed to do so by RN

Standardized language

a structured vocabulary that provides nurses with a common means of communication; enables understanding among disciplines and across information systems so that data can be analyzed

right task

a task that can be safely delegated to a specific delegate for a specific patient- under their scope of practice

evaluate step in budget

address any deviations in the budget perform variance analysis, including staff variances The budget must be reviewed periodically and modified as needed throughout the fiscal year.

CPOE (Computerized Provider Order Entry)

an EHR function that allows the physician to order medications and tests. reduces prescribing errors, delays and duplication, and simplify inventory and billing processes

LPN/LVN cannot delegate to

an RN

Information system (IS)

any system that stores, processes and manages information ex. laptop- harbors information

critical pathways

are a strategy for assessing, implementing, and evaluating the cost-effectiveness of patient care. - specific diagnosis might suggest an average length of stay of 4 days, with certain interventions completed by certain points on the pathway Patient progress that differs from the critical pathway prompts a variance analysis.

delegation process 4 steps

assessment and planning communication surveillance and supervision evaluation and feedback

Evaluation step of delegation

assessment of the effectiveness of the delegation the outcome and the potential need to modify the plan of care; should occur throughout the delegation process

performance budgeting style

based on outcomes and results manager budgets as needed to achieve a certain outcome and reevaluates each time - helps determine the amount of money needed to provide value-added nursing care, non-value added and quality - provides a picture of where resources are being used and their relationship with goals

operating budget

budget for day-to-day expenses for a fiscal year includes all unit expenses and revenues reflects expenses that change in response to the volume of service, such as the cost of electricity, repairs and maintenance, and supplies.

effectiveness

can i do it or does it work value-added care activities - these direct care activities performed by RN that do benefit that patient and are necessary to delivering care ex. assessment, taking vital signs, wound care and communication with the patient

database

central place that stores data

right communication

clear directions given, what to report back, safety precautions, verify understanding that they know what to do - clear concise description DONT say excessive or a lot

data

collection of information, facts and numbers

Information Technology (IT)

combines computer technology with data and telecommunication technologies (tech guy; help you utilize the computer)

direct expense

cost of providing patient care

direct cost

costs that can be attributed to a specific source, such as medications and treatments; costs that are clearly identifiable with goods or service

indirect cost

costs that cannot be directly attributed to a specific area. These are hidden costs and are usually spread among different departments. Housekeeping services are considered indirect costs.

fixed cost

costs that do not vary according to volume. Examples of fixed costs are mortgage or loan payments.

controllable cost

costs—costs that can be controlled or that vary. An example would be the number of personnel employed, the level of skill required, wage levels, and quality of materials.

plan step of budget

determine the effective use of human and material resources, nursing services and the management of the environment perform budget worksheets and break- even analysis

ONC- National health information technology coordinator

developed EHR within 10 years

assignment

distribution of work that each staff member is responsible for during a given time period

Non-Value-Added Activities

do not benefit the patient and are not necessary - looking for equipment for people, waiting for phone calls, waiting for patient transportation

fixed expenses

do not change over the budget period, regardless of volume or activity level

medicare A

employer payroll- funded by social security and federal taxes

data mining

extracting data or knowledge from the EHR

Medicaid

federally assisted and state-administered program to pay for medical services on behalf of certain groups of low-income individuals. Generally, these individuals are not covered by Social Security. Certain groups of people (e.g., older adults, blind, disabled, members of families with dependent children, and certain other children and pregnant women) also qualify for coverage if their incomes and resources are sufficiently low.

incremental budgeting style

flat percentage- simplest method- doesn't include last minute expenses that might occur - By multiplying current-year expenses by a certain figure, usually the inflation rate or consumer price index, the budget for the coming year may be projected. - little expertise and generally inefficient

Network

framework of an IS that allows electronic devices to transfer information

Assessment step of budget

gather data and assess the needs for upcoming year examine the present nursing activities as well as those planned for the future

Preferred Provider Organization (PPO)

health-care financing and delivery program with a group of providers, such as physicians and hospitals, who contract to give services on an FFS basis. This provides financial incentives to consumers to use a select group of preferred providers and pay less for services. Insurance companies usually promise the PPO a certain volume of patients and prompt payment in exchange for fee discounts. **more flexible and broad*

U- urgent needs

high potential for harm or discomfort) • Administering PRN analgesics • Responding to a bed alarm • Clarifying MD's order before carrying out

Health Maintenance Organization (HMO)

historically, a prepaid organization that provided health care to voluntarily enrolled members in return for a preset amount of money on a per-person, per- month basis; often referred to as a managed care organization (MCO); require a lot of referrals

capital budget

includes equipment, furniture, technology hardware and software and building renovations - major purchases (over 5,000 dollars) that last about 5-7 years -occurs separate from operating and personnel budget

organizational accountability

involves providing sufficient resources for nurses to effectively and safely provide nursing care

professional accountability

is an obligation not to abuse trust and to be able to justify professional actions

authority

is the legal right of an RN to delegate specific tasks to other RN or a competent LPN/LVN

implement step of budget

keep the unit functioning within the budget plan engage all staff in the process and motivate them to work within the constraints of the budget meet with staff early to explain and discuss variances encourage input

health insurance marketplaces

malls online that allow those that don't have insurance or have a small business - to find insurance at a competitive rate

Cost effectiveness

means producing good results for the amount of money spent; in other words, the product is worth the price then must take into account factors such as anticipated length of service, need for such a service, and availability of other alternatives.

supervision step of delegation

monitoring of the task and of compliance with standards of practice and polices and procedures

efficient

most with time you have while still doing a good job ex. necessary care activities - essential needs for patient care but do not directly benefit the patient - ex. transcribing orders and documenting medication administration

Medicare

nationwide health insurance program authorized under Title 18 of the Social Security Act that provides benefits to people aged 65 years or older. Medicare coverage also is available to certain groups of people with catastrophic or chronic illness, such as patients with renal failure requiring hemodialysis, regardless of age.

indirect expense

necessary for daily operation but doesnt affect patient care

responsibility

obligation one has to accomplish work - the individual obligation to perform competently at the level the person has been educated - accept responsibility when he or she agrees to perform a task delegated to them

underdelegation

occurs when there is failure to transfer authority for a task or to provide clear direction to the delegate because the RN fears losing control or authority, feels insecure, believes he or she can accomplish the task quicker, or is inexperienced

RNs can delegate to

other RN, LPN, LVN and UAP

break-even point

point—point at which revenue covers costs. Most health-care facilities have high fixed costs. Because per-unit fixed costs in a noncapitated model decrease with volume, health-care facilities under this model need to maintain a high volume to decrease unit costs.

Health Insurance Portability and Accountability Act (HIPAA)

privacy rule security rule breach notification rule

Surveillance step of delegation

process of observing and staying attuned to the patients status and staff performance and following up on any problems

bundled payments

provider agree to expect a discounted payment that represents a coordinated price to cover their illness

communication step of delegation

provision of clear directions to the delegate, including unique patient information and expectations regarding what to do, what to report, when to ask for assistance

Diagnosis-related groups (DRGs)

rate-setting PPS used by Medicare to determine payment rates for an inpatient hospital stay based on admission diagnosis. Each DRG represents a particular case type for which Medicare provides a flat dollar amount of reimbursement. This set rate may, in actuality, be higher or lower than the cost of treating the patient in a particular hospital.

cost containment

refers to effective and efficient delivery of services while generating needed revenues for continued organizational productivity. Cost containment is the responsibility of every health-care provider, and the viability of most health-care organizations today depends on their ability to use their fiscal resources wisely.

delegation

require problem-solving, critical thinking skills, and clinical judgement - based on patient needs and complexity

feedback step of delegation

review of whether the task was performed correctly whether the desired outcome was achieved and any areas of improvement

5 rights of delegation

right task right circumstance right person right direction/communication right supervision/evaluation

What are LPN/LVN scope of practice

scope of practice dictated by state practice acts - can perform all task UAP are qualified for plus others - duties include health status, updating initial assessments, reinforcing teaching, enteral feedings

nurses leaders and managers are accountable for

setting expectations for appropriate delegation ensuring that RN, lVN and UAP are aware of individual roles providing safe environment that supports the delegation process

zero budgeting style

starts from zero each year - with goals to have zero left at the end of the fiscal year - must rejustify their program or needs every budgeting cycle. This method does not automatically assume that because a program has been funded in the past, it should continue to be funded. - set funding priorities is a key feature of zero-based budgeting.

fixed budget

style of budgeting that is based on a fixed, annual level of volume, such as number of patient-days or tests performed, to arrive at an annual budget total. These totals are then divided by 12 to arrive at the monthly average. The fixed budget does not make provisions for monthly or seasonal variations.

right supervision/evaluation

the delegating nurse must: -provide supervision (direct or indirect) -provide clear instructions and understandable expectations of the task(s) to be performed -monitor performance -provide feedback -intervene if necessary (unsafe clinical practice) -evaluate the client and determine if client outcomes were met -evaluate client care tasks and identify needs for performance improvement activities and/or additional resources

who decides what can be delegated

the nurse practice act

ANA def of delegation

the transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome

medicare b

through government

capitation

under DRG- pays provider a fixed amount per enrollee per month to cover their needs

productivity

using little amount of time to get the outcome you need done doesn't look at quality just looks at what got done focused on labor and time= how much labor able to put out in a certain amount of time

Diagnosis step of budget

would be the goal or what needs to be accomplished, which is to create a cost-effective budget that maximizes the use of available resources. revise and develop new goals based on previous years and upcoming years needs

C - critical needs

• Chest pain • Respiratory distress • Sudden change in mental status

nurses cannot delegate

•Certain aspects of the nursing process to LPNs, LVNs, and UAPs •A task that is not in the scope of practice of the delegate