LM Final Exam

What is Capitation?

-A mode of payment in managed care systems based on a fixed dollar amount allocated PER MEMBER/PER MONTH (ex: $150/per adult/month) -Pays a set amount for each enrolled person assigned to them, per period of time, whether or not that person seeks care

cost=

price x utilization

are used to describe future goals or aims of an organization. It is a description in words that conjures up a picture for all group members of what they want to accomplish together.

vision

punitive/exemplary injury

willful, wanton conduct. The defendant acted with conscious disregard for the patients safety

What is primary nursing?

-One RN functions autonomously as the patient's primary provider throughout the hospital stay -RN assumes 24 hour responsibility, associate nurses implement the plan of care in collaboration with the primary nurse when the primary RN is not working on the unit

What is the orientation phase of socializing a new nurse

-Orient to activities specific to position -Provided by HR (payroll, benefits), staff development, and individual unit (specific policies) -Unit specific orientation: specific competencies needed to care for typical patients assigned to the unit, technical skills, documentation, introduced to members of unit and functions and roles of people

Politics and Advocacy

-Patient advocacy a fundamental aspect of nursing -Nurse needs knowledge of system to guide patient -Advocacy can be risky if nurses wishes go against another HC provider or organization -Consumer groups helpful in influencing legislation

adv of primary nursing

-Patients and families are able to develop trusting relationship w/ RN -Clearly defined RN accountability and responsibility as primary provider of care -Decision-making authority = autonomy

Benner proficient?

-Perceives and understand situations as whole parts -More holistic understanding improves decision-making -Learns from experiences what to expect in certain situations & how to modify plans --Pattern recognition

Costs do not fluctuate with volume/census (buildings and equipment depreciation, administrative salaries, mortgage payments)

fixed costs

competing

forced to compete for the goal; produces winner and loser, possible resentment of loser, knows what's at stake -win at all costs -quick decision needed, short time to make decision

actual harm/damages suffered by plaintiff

injury

Reports substandard nursing care to appropriate authorities following the establish chain of command

leadership role

Serves as a role model by providing nursing care that meets or exceeds accepted standards of care

leadership role

Updates knowledge and skills in the field of practice and seeks professional certification to increase expertise in a specific field

leadership role

enacts laws that govern (codes, statues, ordinances) NPA

legislative law

special injury

loss/expenses incurred as result of injury; medical bills, lost wages, cost of future care

Delegates to subordinates wisely, looking at the manager's scope of practice and that of the individuals he or she supervises

management role

Ensures patients have reasonable access to information in the medical record, following established organizational processes

management role

Ensures that organization guidelines regarding scope of practice are consistent with the state Nurse Practice Act

management role

Increases knowledge regarding sources of law and legal doctrines that affect nursing practice

management role

Increases staff awareness of intentional torts and assists them in developing strategies to reduce their liability in these areas

management role

Minimizes the risk of product liability by assuring that all staff are appropriately oriented to the appropriate use of equipment and products Monitors subordinates to ensure they have a valid, current, and appropriate license to practice nursing

management role

Protects all patients' rights to confidentiality under the Health Insurance Portability and Accountability Act

management role

Provides education for staff and patients on issues concerning treatment and end-of-life issues under the Patient Self-Determination Act

management role

Provides educational and training opportunities for staff on legal issues affecting nursing practice

management role

Secures appropriate background checks for new employees to reduce managerial liability

management role

Understands and adheres to institutional policies and procedures

management role

Uses foreseeability of harm in delegation and staffing decisions

management role

failure to do something a reasonable, prudent person, nurse would have done

omission

What are the types of tort law?

strict liability, intentional, negligence, malpractice,

Operating Costs

supplies = the second largest expenditure) Purpose: focuses on the total revenues and expenses of the organization for the year (could include supplies and minor equipment, electricity, repairs, etc.)

What does costs include?

supplies, labor, equipment, utilities

What are the two common mistakes in planning?

underestimating and not allowing adequate time for planning

May be formally stated and explicit, or may be implicit (applied by seeing how they operate) and part of the organizational culture

values

What are the 3 phases on socializing a nurse?

induction, orientation, socialization

What are the standards applicable to all nurses?

All vocational nurses, registered nurses and registered nurses with advanced practice authorization shall: a. Know and conform to the Texas Nursing Practice Act and the board's rules and regulations as well as all federal, state, or local laws, rules or regulations affecting the nurse's current area of nursing practice; b. Implement measures to promote a safe environment for clients and others; c. Know the rationale for and the effects of medications and treatments and shall correctly administer the same; d. Accurately and completely report and document: --the client's status including signs and symptoms; --nursing care rendered; --physician, dentist or podiatrist orders; --administration of medications and treatments; --client response(s); and --contacts with other health care team members concerning significant events regarding client's status; e. Respect the client's right to privacy by protecting confidential information unless required or allowed by law to disclose the information; f. Promote and participate in education and counseling to a client(s) and, where applicable, the family/significant other(s) based on health needs; g. Obtain instruction and supervision as necessary when implementing nursing procedures or practices; h. Make a reasonable effort to obtain orientation/training for competency when encountering new equipment and technology or unfamiliar care situations; I. Notify the appropriate supervisor when leaving a nursing assignment; J. Know, recognize, and maintain professional boundaries of the nurse-client relationship; K. Comply with mandatory reporting requirements of Texas Occupations Code Chapter 301 (Nursing Practice Act), Subchapter I, which include reporting a nurse: --who violates the Nursing Practice Act or a board rule and contributed to the death or serious injury of a patient; --whose conduct causes a person to suspect that the nurse's practice is impaired by chemical dependency or drug or alcohol abuse; --whose actions constitute abuse, exploitation, fraud, or a violation of professional boundaries; or whose actions indicate that the nurse lacks knowledge, skill, judgment, or conscientiousness to such an extent that the nurse's continued practice of nursing could reasonably be expected to pose a risk of harm to a patient or another person, regardless of whether the conduct consists of a single incident or a pattern of behavior. --except for minor incidents (Texas Occupations Code §§301.401(2), 301.419, 22 TAC §217.16), peer review (Texas Occupations Code §§301.403, 303.007, 22 TAC §217.19), or peer assistance if no practice violation (Texas Occupations Code §301.410) as stated in the Nursing Practice Act and Board rules (22 TAC Chapter 217). l. Provide, without discrimination, nursing services regardless of the age, disability, economic status, gender, national origin, race, religion, health problems, or sexual orientation of the client served; m. Institute appropriate nursing interventions that might be required to stabilize a client's condition and/or prevent complications; n. Clarify any order or treatment regimen that the nurse has reason to believe is inaccurate, non-efficacious or contraindicated by consulting with the appropriate licensed practitioner and notifying the ordering practitioner when the nurse makes the decision not to administer the medication or treatment; o. Implement measures to prevent exposure to infectious pathogens and communicable conditions; p. Collaborate with the client, members of the health care team and, when appropriate, the client's significant other(s) in the interest of the client's health care; q. Consult with, utilize, and make referrals to appropriate community agencies and health care resources to provide continuity of care; R. Be responsible for one's own continuing competence in nursing practice and individual professional growth; s. Make assignments to others that take into consideration client safety and that are commensurate with the educational preparation, experience, knowledge, and physical and emotional ability of the person to whom the assignments are made; t. Accept only those nursing assignments that take into consideration client safety and that are commensurate with the nurse's educational preparation, experience, knowledge, and physical and emotional ability; u. Supervise nursing care provided by others for whom the nurse is professionally responsible; and v. Ensure the verification of current Texas licensure or other Compact State licensure privilege and credentials of personnel for whom the nurse is administratively responsible, when acting in the role of nurse administrator.

Activities undertaken by a group of people with a common interest

Collective Action

What are regulatory requirements

JC does not mandate staffing levels but does assess staffing effectiveness

4th Reentry into workforce

Left profession and now re-entering nursing

Who's theory did Lippit extend?

Lewins 3 step change theory

Cost-based reimbursement aka?

Retrospective reimbursement

What is the largest expenditure?

Workforce/personnel

the breach of duty caused the injury

causation

formal expression of the purpose or reason for existence of the organization

mission statement

slander

spoken defamation

What is direct care?

time spent providing hands-on care

libel

written defamation

What is intentional tort?

wrongful act intended to cause harm; voluntary willful acts

Texas Nurse practice act

- it is considered nursing law and applies to all licensed nurses regardless of educational level - This Occupations Code defines nursing practice and gives the BON the authority to make rules which are then implemented and interpreted in the Texas Nurse Practice Act

2nd Momentum

-11-29 years of experience --Graduate BSN 1974. FT, PT Practice til 1995 --"1995...Year 21 found passion as educator" Rice -Experienced clinicians with expert knowledge, skills, abilities, credentials, and education base. -Time of accomplishment, challenges, strong sense of purpose, become a role model. -Finding a voice thru aligning strengths with passion -Most significant challenge: continue career progression rather than stagnation -Life long learner, seize unexpected opportunities -Expert witness, Guatemala, writing LM theory & clinical courses, CNS continued, COL status

3rd Harvest

-30-40 years of experience -Expert clinicians -2021 - CNS CC 1995-2021 = 26 years RIce -Retirement December 2021 Rice after 47 years of practice -Actively strive to "reinvent" to renew value to team -Knowledgeable, savvy, adaptable

What is modular nursing?

-A kind of team nursing that divides a geographic space into modules of patients -Each module has an RN assigned as team leader w/a group of LVN's -Each RN assisted by others to deliver patient care -RN functions as coordinator and information processor -Equipment and resources - in close proximity

What is a Stakeholder analysis?

-A stakeholder is any person, group, or organization that has a vested interest in the program or project under review -A systematic consideration of all potential stakeholders and ensure they are incorporated in the planning phase. -When stakeholders are not involved in the project planning, they do not get a sense of ownership

What does Case Management do?

-A strategy to improve patient care and reduce hospital cost through coordination of care -Case manager coordinates care by est. goals from admission through discharge -Targets high risk population or service

What is Reward Power?

-Ability to reward others to influence them to change their behavior -This type of power is NOT suited for long-term change!! -People are unlikely to change their attitudes long term

What is the learning organization theory?

-According to Peter Senge, learning organizations are: "...organizations where people continually expand their capacity to create the results they truly desire... where collective aspiration is set free, and where people are continually learning to see the whole together." -emphasis on interrelationships of all parts of the organization -Respond quickly and improve relationships -organizations respond to changes using learning approach -focus on communication, education, and cooperation among all parts of the organization -concept of continuous learning -mutual goals of organization and individuals leads to: 1. quick response to chaos 2. positive results for organization and individual

What is the socialization of the new nurse?

-Acculturate, role transition into real world of nursing -Gaps in academic and practice expectations can lead to new RN feeling frustrated, overwhelmed, conflicted --Reality shock -Establish times to share openly, clarifying values necessary to acculturate --Blending academic values with actual nursing --Support the new nurses values -Value of transition to practice programs -Listen and carefully observe your professional setting

How to have a fair and accurate assessment?

-Appraiser develops awareness of their biases, prejudices -Seek consultation when unsure -Gather data appropriately -Keep accurate records, anecdotal notes to ensure accuracy and fairness -Collected assessments should contain positive examples of growth, achievement and areas of needed development -Include employee's own appraisal of his work -Be on guard for --Halo effect - only focus on the positive --Horns effect - negative aspects solely influence --Central tendency - rater hesitant to risk true assessment so rates everyone as average --Matthew effect - same appraisal each year ---"the rich get richer, the poor get poorer" -Ask employee how the organization or manager can make work easier/more efficient to achieve better quality, greater volume, and improved outcomes

How are nurses as political activist?

-As largest HC group, nurses can have voice in their work environments for patients as well as themselves -Nurses should define their role as individual nurse, nurse citizen, nurse activist, and nurse politician -Nurses must study issues, garner political support, and become active in professional nursing orgs

What is the 360 degree evaluation?

-Assessment by all individuals within the sphere of influence of the individual being appraised. -A process in which an individual is assessed by a variety of people in order to provide a broader perspective -Nurses asked to evaluate their peers need orientation to the process and to the specific tool being used

What are the standards of practice?

-Basis of quality, competent HC -Protect the public -Criteria for determining if less than adequate care was delivered -Determine what a reasonable, prudent nurse should do -Outlines the duties nurse has to a client -Internal standards set by: role, job description; education, expertise; institutional policy and procedure -External standards set by: state board of nursing, professional org, TJC, Magnet status, federal orgs/guidelines

Benner Novice?

-Beginner, no experience -Taught rules to perform task -Rules: context-free, independent of specific cases and applied universally -Rule-governed behavior limited and inflexible -"Tell me what I need to do and I'll do it"

What is the Chaos Theory?

-Butterfly effect: in the early 1960s, Lorenz realized that small differences in a dynamic system can trigger vast and often unsuspected results -order emerges through fluctuation and chaos -process is cyclical -little tie for orderly, linear change -organization must be able to act with speed, adaptability, and intensity -leaders act quickly and flexible

How do you calculate NHPPD?

-Calculated by dividing total nursing care hours by the total census (# of patients on the unit) -Total nursing care hours/# of patients on the unit = NHPPD -Ex: What is the NHPPD for a medical surgical unit with 20 patients providing 200hrs of care daily? (200 nursing hours/20 patients=10.0 NHPPD)

What is Team nursing?

-Care is provided to a group of patients by a team of personnel -Team leader makes assignments and is responsible for coordination EX: Modular (district) nursing- Communication between team members is important RN team leader must possess good delegation and supervisory skills

What are clinical pathways?

-Care mgmt. tools that outline the expected clinical course & outcomes for a specific patient type -Generally, outline the normal course of patient care -Patient progress is measured against expected outcomes

What is Roger's diffusion of innovation theory?

-Change can be initially rejected and then adopted at a later time -change can be initially adopted then rejected -during implementation, change process takes on own life -careful management and planning essential to change process -innovation better than status quo and compatible with existing values -organized communication channel to transmit innovate idea -time required for spread of ideas -social system can facilitate or impede change -innovation better than status quo and compatible with existing values -organized communication channel to transmit innovative idea -time required for spread of ideas -social system can facilitate or impede change

How do you create an environment of self discipline?

-Clearly written, communicated rules and regulations -atmosphere of mutual trust -judicious use of formal authority -Employee ID with organizational goals and missions

Power and Accountability

-Nurses have a professional obligation NOT to view power as a negative concept -Nurses retain accountability and have this regardless of position -Nurses should avoid power struggles and those who seem to savor power

What do you look at for successful preceptors?

-Clinical experience, enjoy teaching, and committed to the role -Match teaching style to new nurse's learning needs -Give specific directions, learning objectives --Essential to document achievement of the objectives -Demonstrate skills, be detailed with explaining skills, break tasks into components to see proper order, priority of items -Familiar with organization's policies & procedures -Willingly share knowledge, display effective communication -Follow the preceptor schedule

What is personal Power?

-Comes from the characteristics of the individual and comes from offering services that society needs (student example on news) -Is closely linked to how one perceives power, how other perceive you, and the extent to which you can influence others (hopefully for the good) -Realize that people who are perceived as experts in healthcare have significant amounts of authority and influence

What do you do in an Urgent Situation?

-Complete the quick request form -Or, just write the facts describing the situation -Later, complete the comprehensive request form -*You question the medical reasonableness of a physicians with regard to accuracy, safety, and/or effectiveness of an order for a given patient or set of patients

How do you create an injury compensation system that is patient centered and serves the common good?

-Conducting demonstration projects of alternatives to medical liability that promote patient safety and transparency and provide swift compensation for injured patients -Encouraging continued development of mediation and early-offer initiatives -Prohibiting confidential settlements that prevent learning from events -Redesigning the National Practitioner Data Bank -Advocating for court-appointed, independent expert witnesses to mitigate bias in expert witness testimony

disadv of collective bargaining

-Cost money -Potential adversarial relationships -Unpreventable strikes -Not seen as professional by many nurses -Union interfere with the management of organizations

What is the Performance Deficiency Coaching?

-Creates a disciplined work environment -Active employer engagement, requires planning, time intensive commitment -Address unacceptable behavior & performance -Establish a plan -Manager/leader COACHES & helps the employee -Outcome: improved performance for everyone

What is the Unfreezing stage?

-Current process is flawed -Unthaw the current or old way of doing something -Opportunity, need, or problem for which some action is necessary -May occur naturally as a progressive development or as a result from a deliberate activity as a first step in planning change -Disrupts the old status quo -Gather data -Accurately diagnose the problem -Decide if change is needed -Make others aware of need for change

What are characteristics of Shared Governance?

-Demands partnerships, equity, accountability, & ownership. -Empowered nurses -Career ladders -Access to power -Participation in decision-making -Recognition and rewards -Evidence-based practice

Benner: Advanced Beginner

-Demonstrates acceptable performance -Has gained prior experiences in actual situations to meaningful components --Pattern recognition -Principles, based on experiences, being to be formulated to guide actions -Where you are at the end of nursing school

What is Referent Power?

-Derived from how much others respect and/or like an individual, group, or organization -New nurses often start job with a blank state

What is Expert Power?

-Derived from knowledge & skills that nurses possess -Involves knowing more about a subject than others, combined with legitimacy of holding a position --This gives an individual a decided advantage --"Knowledge Empowers You"

What is legitimate Power?

-Derived from the position a nurse holds in a group --For example, being a formal manager -Indicates a nurses degree of authority -Legitimate power is a significant part of influence & control -Downsides: ---May not be universally effective ---May not be sufficient as one's only source of power

What do you need to understand about Staffing?

-Determine # & types of personnel needed -Workforce diversity is needed to reflect community composition --Lack of ethnic, gender, and generational diversity in the workforce linked to health disparities in population served -Recruit, interview, select, assign --Behavior interviews are common & essential --Work ethics and behaviors are difficult to change -Socialize employee to organizational values & norms -Creative, flexible scheduling required

What is a breach of duty?

-Deviated from, fell below the standards of care --Omission- nothing was done when something should have been done. Ex: not doing hourly glucose monitoring for pt on insulin IV continuous drip --Commission- something done that should not have been done. Ex: giving Aldactone to pt with K 5.6, giving metoprolol to pt with HR 50

What is a marginal employee

-Disrupts unit functioning d/t quantity or quality of their work -consistently meets minimal standards -usually do not warrant dismissal -little contribution to organizational efficiency -Employee makes tremendous efforts to meet competencies, yet usually meets only minimal standards -Traditional discipline generally is not constructive in modifying their behavior

adv of team nursing

-Each team members is able to participate in decision making and problem solving -RN is able to get work done through other team members

What is the Formal Grievance Process?

-Employee grievance= statement of wrongdoing -This is an opportunity for employee to resolve conflicts with supervisors -Steps are clearly outlined in union contracts or administrative policies -Progressive lodging of complaints up the chain of command -If differences are not settled in this process, dispute proceeds to arbitration (a professional mediator reviews the case, then a decision is made)

Nursing implications for Informed consent?

-Ensure provider gave necessary information (the nurse is Not responsible for explaining the procedure) -Ensure client understood information and is competent to give informed consent -Nurse is a patient advocate -Determine pt's level of understanding -Clarify information by reinforcing the info the provider originally gave -Nurse should not give new info to pt that contradicts physician-patient interaction -Notify provider if client has more questions or doesn't understand the information provider; The provider then gives clarification

What is duty of care?

-Existence of a duty & nature of the duty -What is owed others we are entrusted to care for? Failed to monitor patients response to treatment -How one conducts themselves? Act in patients best interest -Actions ordinary, reasonably prudent nurse would do -Duty is defined by standard of care -NPA 217.11 standards of professional nursing practice

Nurses role in Reporting incidents

-FIRST - Assess for Injuries -Institute immediate care to decrease further injury -Notify provider -Carry out provider orders -Complete incident report -Should be completed by person who identifies the event -Complete as soon as possible (within 24 hrs of event) -Confidential, not shared with client, client not informed of report IR not placed in nor mentioned in client's health care record --However, objective description of event and actions taken Are documented in client record -Forwarded to appropriate authorities -Provides data useful to performance improvement -Report should include --Client's name, hospital number, date/time/location of event --Factual description of event & injuries incurred --Name of witnesses & client comments regarding incident --Corrective action taken & provider notified --Name, dose of medication or equipment involved in event

What are the Key concepts for determining staff needs?

-Full Time Equivalent (FTE): measure of the work commitment of a full time employee A full time employee that works 40 hours a week, 2,080hrs/yr, is referred to as 1.0 FTE FTE hours are a total of all paid time which includes productive and nonproductive

How do you have time management?

-Gather all the supplies and equipment that will be needed before starting an activity -Get organized -Group activities that are in the same location -Use time estimates -document your nursing interventions as soon as possible after an activity is complete -always strive to end the workday on time

What is Constructive (positive) Discipline?

-Helps the employee grow -Carried out in supportive, corrective manner -Employee reassured punishment given due to actions and NOT who they are as a person

disadv of primary nursing

-High cost with higher RN skill mix -The person making assignments needs to be knowledgeable about all the patients and staff to ensure appropriate matching of nurse to patient -Nursing time is often used in functions that could be completed by other staff -Nurse-to-patient ratios must be ___?_____ 24 hour accountability -Communication complicated -Accountability of associate nurse

Change: Assessment

-Identify the problem or the opportunity for change -Collect and analyze data -Data collection and analysis should come from different sources --Structural (physical space or configuration) --Technological (lack of wall outlets, poorly situated computer locations, lack of computers) --People (commitment of staff, levels of education, and interest in the project)

Why do employees join unions?

-Increase their power -In response to mgmt.'s action/inaction -Poor working conditions -Job inequities in wages, promotion, & benefits -Poor quality in immediate supervision -Poor communication between employee & employer -Gain control over their work environment

What is patient Care Redesign?

-Initiative that was developed in the 1990s -Emphasis on redesigning how patient care was delivered -Motivated by needs to reduce costs while maintaining quality HC

What is corporate liability?

-Institute responsible/accountable for maintaining safe quality environment "deep pocket" Hiring the "best" is essential, maintaining staff competencies, maintaining/ensuring patient safety and quality care Agency nurse both nurse manager and corporate responsibilities -Check references -Assign resource nurse -Monitor care provided -Review periodically -Terminate when necessary

What is the moving stage?

-Intervention or change introduced, explained, and implemented -Benefits, disadvantages discussed -New status quo -Try to implement change gradually whenever possible - because change is complex, it requires a good deal of planning & intricate timing -Develop plan, set goals/objectives -Identify support & resistance -Set hard target dates -Develop strategies, implement change -Evaluate change, modify if necessary

How do you promote open communication between patients and practitioners?

-Involving health-care consumers as active members of the health-care team -Encouraging open communication between practitioners and patients when adverse events occur -Pursuing legislation that protects disclosure and apology from being used as evidence giant practitioners in litigation -Encouraging non punitive reporting of errors to third parties that promote information and data analysis as a basis for developing safety improvement -Enacting federal safety legislation that provides legal protection for when information is reported to patient safety organization

Rights of at-will employees:

-Managers have greater latitude in selecting disciplinary measures -Although the state & federal laws provide some protection, at-will employee may be terminated: at any time for any reason except discrimination -They work at the will of the employer -Employees are also free to leave a job any time for any or no reason with no adverse legal consequences.

Benner Expert?

-No longer relies on principles, rules, or guidelines to connect situations & determine actions -More background experiences -Intuitive grasp of clinical situations --Pattern recognition -Performance fluid, flexible & highly proficient

Benner Competent

-Nurse with 2-3 years experience on the job in the same area or similar day-to-say situations -Increase awareness of long-term goals -Gains perspective from planning own actions based on conscious, abstract, and analytical thinking which helps to achieve greater efficient and organization

What are examples of Collective Actions?

-Nurses achieving Magnet status -Pt care being delivered in hospitals 24/day by shifts of nurses.

What are examples causation?

-Nurses actions or lack of actions directly caused the patient harm. Ex: wrong dosage caused patient to have convulsions -My direct action caused injury. Not sufficient that the standard of care was breached but a direct relationship existed between failure to meet the standard of care and patient injury

Consumer-Oriented Vision

-Nurses can be co-creators for consumer-oriented HC -Need to be more educated and articulate about their value to HC -Need to get stakeholders and policy makers involved to promote value of nursing

How do you prepare for an interview?

-Perform self assessment, id your level of knowledge -learn about institution -rehearse typical interview questions, be critiqued -Bring Resume, references, other mission related information in clean folder ---References Available on Request - No ---High quality paper - not necessary ---Cover letter -Wear professional, conservative, comfortable clothing and neatly groomed ---Solid, dark color, conservative suit ---Limited jewelry ---Neat, professional hairstyle -Arrive 10 minutes early ---Do not plan other interviews that day -You will be nervous -They interview you and You interview them. -Address by Mr/Ms. Rice not first name. -Working phase --Highlight personal and professional accomplishments --Respond in calm, problem-solving fashion to questions -Maintain eye contact, listen, notes only if necessary --No gum, playing with hair -Accentuate the positive -Answer questions directly -Ask for more information -Say only positive things about present employer -Appropriate Questions: --What is your contact address? --Attendance is important. Are you able to meet this expectation? --Do you need any special accommodations to perform the job? --Is there anything that would prevent you from performing this work as described? --Can you lift 40 pounds? ---Physical exam performed after you are selected --Do you understand that our philosophy subscribes a Christian philosophy. --Be sure to read Chapter 15, Table 15.1, page 389 -assess your learning style and inform your preceptor

What is a performance appraisal?

-Performance Appraisal How well employee carries out duties of their assigned jobs -Review work performance with employee, informed of their job performance -State expectations of organization -Not personal --Actual performance evaluated -Objective, systematic, formalized manner -Could generate salary adjustment, promotions, transfers, disciplinary actions, termination -Provide in a positive atmosphere -Should motivate employee and promote growth

What are the strategies the nurse manager should use to modify behavior issues?

-Performance Deficiency Coaching -Disciplinary Conference -The Termination Conference -Formal grievance Process -Transferring Employees

Change: Implementation

-Plan goes live -Provide information -Competency-based education -The benefits stated as positive outcomes actually begin to materialize

Evaluation for SP

-Planning goals and objectives -Prioritize according to strategic importance, resources required, and time and effort involved Set timeline -Develop a marketing plan -Communicate the plan, the goals, and objectives -Design, implement, train, and evaluate the new program -Assures that all stakeholders have the needed information

disadv of func nursing

-Potential communication issues; this model of care requires significant planning and communication -Patient may feel that care is disjointed and uncoordinated -Overlooks priority patient needs which are not acted upon -Frequent uncoordinated interruptions -No evaluation of response to care -Staff and patient dissatisfaction

What should the NM consider when staff scheduling?

-Primary Considerations: --Patient acuity --Volume of patients --Needs and experience of staff --Organizational philosophy and policies -Staffing plan development -Historical information --What has worked in the past? --Were the staff able to provide the care needed? --How many and what kind of patients? --How was the staff utilized? -Benchmarking -Regulatory Requirements -Skill mix

What is included in informed consent regarding receiving full information/disclosure/comprehension

-Procedure to be performed & Name of person performing it -Risks involved - possible complications, side effects -Expected or desired outcomes, benefits. -Options -Alternative therapies (including no therapy at all) -Patient can withdraw consent

Power and accountability are inherent in the nurses role?

-Professional accountability is given by the TBON -We have a direct responsibility for decisions made and actions carried out

What are some causes of malpractice for Nurse Managers?

-Professional negligence -Practicing medicine or nursing without a license -Obtaining a nursing license by fraud or allowing others to use your license -Felony conviction for any offense substantially related to the function or duties of an RN -Participating professionally in criminal abortions -Failing to follow accepted standards of care -Not reporting substandard medical or nursing care -Providing patient care while under the influence of drugs or alcohol -Giving narcotic drugs without an order -Falsely holding oneself out to the public or any health-care practitioner as a 'nurse practitioner' -Failing to use equipment safely and responsibly ***The manager is responsible for monitoring that all licensed subordinates have valid, appropriate, and current license to practice***

What is the goal of performance Appraisal?

-Provide an opportunity to document specific criteria for salary increase, promotions, or disciplinary action. -Provide ongoing communication, setting achievable goals with clear expectations, and having a plan of action for the next period. -Identify strengths and develop potential -Aid in setting goals

What is the nursing role in Advance Directive?

-Provide written info regarding AD -Document client's AD status -Ensure AD is current and reflect client's current decision -Recognize client's choice takes priority -Inform health care team of client's AD

What is transferring employees when related to behavior?

-Reassigned to another job -Could be a lateral transfer- Moved to another unit that has a similar scope of responsibilities -Could be a downward transfer- Position below previous level -May be done if: RN is stressed, has role overload RN requests it Is in later stages of career

What are positive sanctions?

-Reference group sets behavioral norms, applies sanctions to ensure the new members adopt the group norms before being accepted -Listen, observe new professional setting -Powerful socialization tool

NM role in primary nursing

-Relinquish role as delegator and decision maker -Function as a role model and coach -Manage the budget

How should the manager identify strategies to modify problem behavior?

-Review personnel file -Investigate the situation -Were the rules clear? -Did the employee know they were breaking the rules? -Has this negative action occurred before with the employees or others? -Consult with supervisor, HR prior to meeting -Carefully document behavior and attempts to counsel employee -anecdotal notes are essential

Rights of individuals in collective bargaining contracts:

-Rights for the workers to join a union -Right to bargain collectively to improve wages and working conditions. -Texas is a right-to-work state. This means that under the Texas Labor code, a person cannot be denied employment because of membership or non-membership in a labor union or other labor organizations ---Texas law protects employees from threats, force, intimidation, or coercion for choosing to either participate or not participate in a union.

What are administrative law proceedings?

-Rules and regulations adopted by federal or state agencies to implement statutory (legislative) law adopted by US. Congress or state legislature -Federal examples: ---Civil rights act of 1964 (federal) ---No discrimination in the workplace -HIPAA ---Protect medical information- destroy patient information before leaving the hospital -OSHA ---Est. safe workplace- storage of hazardous substances, protect employees from infection and workplace violence, immunization, "sharps" container, PPE -Social security, ---Medicare -State examples: board of nursing enforces NPA

What is Self-discipline

-Rules are internalized and become part of the person's personality -Possible if subordinate knows the rules and subordinate accepts the rules as valid

disadv of team nursing

-Shared responsibility and accountability can cause confusion and a lack of accountability -Patients often receive fragmented, depersonalized care -The team leader may not have the leadership skills required to effectively direct the team and create a "team spirit" -Communication is complex

What does the review for EBP need for strategic planning?

-Should be completed prior to strategic planning or beginning any new project or program -Allows project team to identify similar programs, their structures and organization, potential problems and pitfalls, and successes -Ongoing process -Identify best practices or evidence-based innovations that have been adopted with success by other organizations -Nurses planning to develop a new program need to carefully examine the existing evidence and practices prior to beginning the planning

Observed Behaviors with employee substance abuse?

-Smell of alcohol -Frequent use of mouthwash -Impaired coordination, sleepy, shaky, slurred speech -Mood swings, memory loss -Neglect personal appearance -Excessive use of sick leave, tardy, absent after weekend off, holiday, or payday -Leave unit for short periods of time, leave shift early -Forget to have another nurse witness controlled substance waste -Patients report poor pain management -Document pain meds to patient not receiving the med -Prefer night shift since less supervision -Prefer units where controlled substances are more frequently given

adv of Collective Bargaining?

-Some equalization of power between administration and staff -Professionalism can be promoted -Nurses gain control of practice -Viable grievance procedures -Improved staffing and equitable workload -Reduction in unfair quality of services while maintaining job security

What are motivational deficiences?

-Some may lack the the motivation to overcome the education and personal challenges inherent when learning a new role -Very tiring physically, emotionally, and intellectually to learn. This needs to be explained to your family so they will understand your new demands

What are the RF for a chemically impaired employee?

-Staff Shortages -Increased patient acuity/staffing ratios -Shift rotation -Demanding administrations/providers -Long hours -Incivility -"Invulnerable" caregiver mentality, self diagnosis, self medicate -Ease of access -Fatigue, stress (COVID)

What is the termination conference?

-State facts of case & reason for termination -Explain the process of termination -Ask for the employee's input; respond openly & calmly -End the meeting on a positive note, if possible -This is a LAST RESORT when dealing with poor performance & is a difficult action for everyone

How do you pursue patient safety initiatives that prevent medical injury?

-Strengthening oversight and accountability mechanisms to better ensure the competencies of physicians and nurses -Encouraging appropriate adherence to clinical guidelines to improve quality and reduce liability risk -Supporting team development through team training -Continuing to leverage patient safety initiatives through regulatory and oversight bodies -Building an evidence-based information and technology system that impacts patient safety and pursue proposals to offset implementation costs -Promote the create of cultures of patient safety in health-care organizations -Establishing a federal leadership locus for advocacy of patient safety and health-care quality -Pursuing "pay-for-performance" strategies that provide incentives to improve patient safety and health-care quality

How do you evaluate Staffing Effectiveness?

-Studies have found consistent significant findings between nurse staffing and patient outcomes -NM's should assess staffs perception of staffing adequacy -Staff should be empowered to communicate both in written and verbal form regarding staffing concerns

What is the Refreezing stage?

-Sustain new approach, stabilize change -New way incorporated/integrated into routine/habits -Acceptance occurs when staff integrate change into work process -Reinforce behavior essential -Some say change needs 3-6mos before part of the system - positive feedback, encourage, constructive criticism

What are the right to work laws in Texas?

-Texas is a right-to-work state. This means that under the Texas Labor Code, a person cannot be denied employment because of membership or non-membership in a labor union or other labor organization. https://www.oag.state.tx.us/agency/righttowork.shtml Texas laws protect employees from threats, force, intimidation, or coercion for choosing to either participate or not participate in a union. -The choice of whether to join a labor union is yours; you may not be required to join or pay dues to a union as a condition of employment, nor may you be denied employment because you have joined a union.

A strategic plan is:

-The sum total or outcome of the processes by which an organization engages in environmental analysis, goal formulation, strategy development with the purpose of organizational growth and renewal -Provides unified vision and goals for the organization -Helps ensure that the needed resources are available to carry out initiatives

What is the Disciplinary Conference?

-This conference is used if coaching (Performance Deficiency) is unsuccessful, and a more aggressive step is needed -This conference must always be 'scheduled', never impromptu, and always in a private setting (never at the nurses station/during patient care) 1st step: Discuss reason for the disciplinary action; never apologize or be hesitant 2nd step: Listen to what the employee has to say/their response 3rd step: Explain the disciplinary action 4th step: Present a performance improvement plan (PIP) This is a behavioral change, remediation, and consequences that are clearly stated 5th step: Agree and accept the action plan The employee must be supported to promote growth 6th step: Give a written copy of the plan Place it in their personal file Inform agency performance improvement file. Inform agency P&P for how long forms will remain in file

Credibility and politics

-To have credibility, nurses must demonstrate professional competence and degree of professional accountability that exceeds consumer expectations -Nurses professional credibility demonstrated by being life-long

What are examples of performance appraisal tools?

-Trait rating scales -Rating a person against a standard (job description, desired behaviors, personal traits, job knowledge) --Subject to halo, horns effect and central tendency -job dimension scales --ratings based on job description. administers medications using barcodes. 5,4,3,2,1 -management by objectives --objective stated, result (attend 12 head nurse meetings, attended 10 of 121 head nurse meetings) -self appraisal (reflective) --peer review --360 degree evaluation

Discuss the board of nursing investigatory and disciplinary process

-Typically, suspension and revocation proceedings are administrative -Following a complaint the BON completes an investigation - most reveal no grounds for discipline -If the need for discipline is found nurses are notified of charges -Nurses then prepare a defense -There is a hearing (similar to a trial), where the nurse can present evidence -Actions a nurse should take when being investigated by the BON --Do not ignore the Board's notification. It won't go away. --Do not unnecessarily share news of the complaint with friends and colleagues as it may undermine your credibility. --Read employee handbooks/contracts/policy and procedures to determine if you must report the investigation to your employer. --Consider contacting an attorney If a lawyer is needed, hire an experienced one --Carefully consider anything you put in writing --Contact your malpractice insurance provider --If the investigation involves a patient, do not violate HIPAA by copying the patient's medical record --Do not alter the patient's medical record --Be prepared for a lengthy process of investigation -Based on the evidence presented the administrative law judge makes a recommendation to the State Board of Nursing -The BON makes the final decision -Process can take up to 2 years or longer

What are the 3 processes to Lewins force field model? and what do you need to identify?

-Unfreezing, Moving, Refreezing -Barriers (things that hinder change/restraining forces) and Facilitators/driving forces (support change)

What is destructive discipline?

-Use of threats and fear to control behavior -Employee always alert to impeneding penalty or termination -arbitrarily administered -Unfair in the application of rules or resulting punishment

What is Havelock's 6 step change model?

-Uses six stages of planned innovation for change 1. building a relationship 2. dx problem 3. acquire relevant resources 4. choosing the solution 5. gaining acceptance (including communication) 6. Stabilizing the innovation and generalizing self-renewal -emphasizes planning stage -Resistance to change can be overcome with careful planning and staff inclusion -Change agent encourages participation

What is information power?

-Very important for functioning healthcare teams and organizations --This is because accurate & timely information sharing is required --For example, our class president, Peter! -Information sharing can improve: --Patient care --Increase collegiality --Enhance organizational effectiveness --Strengthen one's profession

Organizational Power comes from?

-Your position in the organization's hierarchy -Your understanding of how the organization is structured and functions -Actually being authorized to function as a powerful member within the organization's culture E.g., Eileen Breslin (Dean

What is an environmental assessment?

-a situational assessment requiring a broad view of the organizations' current environment -external assessment: Is broadly based and attempts to view trends and future issues and needs that could impact the organization -Internal assessment: seeks inventory the organizations assets and liabilities -SWOT analysis

what is foreseeability?

-certain levels reasonably cause specific results -Certain events may be reasonably expected to cause certain results ---Insulin drip- what electrolytes must I watch? K+ ---Diarrhea- what acid-base imbalance should I expect to develop? -Ignorance not justified excuse -Nurse had knowledge or availability of information -Remember importance of being persistent when notifying provider

accommodating

-cooperate: one side gives in, loose to win, low stakes, need to move forward

Three categories of priority settings

-don't do -do later -do now (Daily staffing needs, dealing with equipment shortages, meeting schedules, conducting hiring interviews, and giving performance appraisals. o Includes items that also may have been put off earlier)

Factors the influence organizational structures:

-environmental changes (new programs, services, or product lines. Change in leadership, political climate, pandemic) -technology -Socio-cultural environment -Size -Repetitiveness of Tasks (greater differentiation equals more level or management) -Trends in Organizations (need for leadership to promote sound ethical and quality care)

Organizations are structure to:

-facilitate the execution of mission, philosophy, values -strategic plans -reporting lines -communication within the organization

Daily planning actions that may help the unit manager identify and utilize time as a resource most efficiently might include the following?

-identify key priorities at the start of each day with specific actions that need to be taken to accomplish. Also ID actions that need to be taken to meet ongoing, long term goals -determine the level of achievement that you expect for each prioritized task -assess the staff assigned to work with you and delegate by capability and willing to accomplish the priority task that you identified. Express clearly expectations and explain when the delegated task needs to be complete. -review the short and long term plans of the unit regularly. Include colleagues and subordinates in id the unit problems or concerns that can be fully invovled for planning need for change -plan ahead for meetings and prepare agendas -allow for several points throughout the day to assess progress of meeting daily goals or unexpected occurrences -take scheduled breaks -use electronic calendar to organize

What is the Flat Model?

-no middle managers -works best for Projects that are completely uncoupled from all other projects -works well if you can control it, but when you become bigger and more complex, effectiveness declines

What is the Change Process?

-planned change in the work environment is similar planned changed on a personal level -basic reasons to introduce change: solve a problem, improve efficiency, reduce the unneccessary workload for some group -to plan, one has to know what needs to be changed

What is Lippit's theory?

7 step process: Information is continuously exchange through the process 1. dx of the problem 2. assess motivation/capacity for change 3. assess the change agent's motivation and resources 4. the selection of progressive change objectives 5. choose appropriate role for the change agent 6. maintenance of the change once started 7. termination of the helping relationship -Key personnel and change agent participate designing/planning change -Communication is key

What are the three basic steps to time management?

1. Allow time for planning and establish priorities 2. Complete the highest priority task whenever possible and finish one task before beginning another 3. Reprioritize based on the remaining tasks and on new information that may have been received

What proof of liability or fault is required for proving malpractice?

1. Duty of care was owed to the injured party 2. breach of duty 3. foreseeability 4. causation 5. injury 6. damages

What are the manager's role in assisting the impaired employee?

1. Gather evidence (collect objective data before confrontation, written records, interview others to validate observations, analyze narcotic/attendance records, appearance at work -Immediate confrontation (remove from pt care-safety) -Schedule a formal meeting within 24hrs 2. Formal meeting, focus on their performance 3. Outline plan-expectations, disciplinary plan, timelines

What are the progressive discipline steps?

1. Informal reprimand/verbal admonishment with an informal meeting, discussion of performance deficiency, not following rules and suggestions for improvement. 2. Formal reprimand, written admonishment, no improvements since verbal meeting. Specific ID of violation (date, time P&P violated), potential consequences if not altered to meet organizations expectations, plan of action is established. This is signed by employee and employer-acknowledges discussion, employee signature does not imply agreement with all allegations, employee allowed to respond in writing, employee receives copy and copy maintained in employee personal file 3. Suspension from work, with or without pay, opportunity for employee to reflect on behavior 4. Involuntary termination/dismissal, repeated warnings not address by employee, last option. "In progressive discipline, the slate should be wiped clean at the predesignated period"

What are the Steps in Strategic Planning Process?

1. Perform environmental assessment 2. Conduct stakeholder analysis 3. Review Literature 4. Determine congruence with organizational mission 5. identifying planning goals and obj 6. Estimate resources required for the plan 7. prioritize according to available resources 8. ID timelines and responsibilities 9. Develop marketing plan 10. Write and communicate business plan/strategic plan 11. Evaluation

What is DRG?

A DRG is a patient classification system that standardizes prospective payment to hospitals and encourages cost containment initiatives. In general, DRG payment covers all charges associated with an inpatient stay from the time of admission à discharge -CHF

Rule 217.12

1. Unsafe Practice--actions or conduct including, but not limited to: a. Carelessly failing, repeatedly failing, or exhibiting an inability to perform vocational, registered, or advanced practice nursing in conformity with the standards of minimum acceptable level of nursing practice set out in §217.11 of this chapter; b. Failing to conform to generally accepted nursing standards in applicable practice settings; c. Improper management of client records; d. Delegating or assigning nursing functions or a prescribed health function when the delegation or assignment could reasonably be expected to result in unsafe or ineffective client care; e. Accepting the assignment of nursing functions or a prescribed health function when the acceptance of the assignment could be reasonably expected to result in unsafe or ineffective client care; f. Failing to supervise the performance of tasks by any individual working pursuant to the nurse's delegation or assignment; or g. Failure of a clinical nursing instructor to adequately supervise or to assure adequate supervision of student experiences. 2. Failure of a chief administrative nurse to follow standards and guidelines required by federal or state law or regulation or by facility policy in providing oversight of the nursing organization and nursing services for which the nurse is administratively responsible. 3. Failure to practice within a modified scope of practice or with the required accommodations, as specified by the Board in granting an encumbered license or any stipulated agreement with the Board. 4. Conduct that may endanger a client's life, health, or safety. 5. Inability to Practice Safely--demonstration of actual or potential inability to practice nursing with reasonable skill and safety to clients by reason of illness, use of alcohol, drugs, chemicals, or any other mood-altering substances, or as a result of any mental or physical condition. 6. Misconduct--actions or conduct that include, but are not limited to: a. Falsifying reports, client documentation, agency records or other documents; b. Failing to cooperate with a lawful investigation conducted by the Board; c. Causing or permitting physical, emotional or verbal abuse or injury or neglect to the client or the public, or failing to report same to the employer, appropriate legal authority and/or licensing board; d. Violating professional boundaries of the nurse/client relationship including but not limited to physical, sexual, emotional or financial exploitation of the client or the client's significant other(s); e. Engaging in sexual conduct with a client, touching a client in a sexual manner, requesting or offering sexual favors, or language or behavior suggestive of the same; f. Threatening or violent behavior in the workplace; g. Misappropriating, in connection with the practice of nursing, anything of value or benefit, including but not limited to, any property, real or personal of the client, employer, or any other person or entity, or failing to take precautions to prevent such misappropriation; h. Providing information which was false, deceptive, or misleading in connection with the practice of nursing; i. Failing to answer specific questions or providing false or misleading answers in a licensure or employment matter that could reasonably affect the decision to license, employ, certify or otherwise utilize a nurse; or j. Offering, giving, soliciting, or receiving or agreeing to receive, directly or indirectly, any fee or other consideration to or from a third party for the referral of a client in connection with the performance of professional services. 7. Failure to pay child support payments as required by the Texas Family Code §232.001, et seq. 8. Drug Diversion--diversion or attempts to divert drugs or controlled substances. 9. Dismissal from a board-approved peer assistance program for noncompliance and referral by that program to the Board. 10. Other Drug Related--actions or conduct that include, but are not limited to: a.Use of any controlled substance or any drug, prescribed or unprescribed, or device or alcoholic beverages while on duty or on call and to the extent that such use may impair the nurse's ability to safely conduct to the public the practice authorized by the nurse's license; b. Falsification of or making incorrect, inconsistent, or unintelligible entries in any agency, client, or other record pertaining to drugs or controlled substances; c. Failing to follow the policy and procedure in place for the wastage of medications at the facility where the nurse was employed or working at the time of the incident(s); d. A positive drug screen for which there is no lawful prescription; or e. Obtaining or attempting to obtain or deliver medication(s) through means of misrepresentation, fraud, forgery, deception and/or subterfuge. 11. Unlawful Practice--actions or conduct that include, but are not limited to: a.Knowingly aiding, assisting, advising, or allowing an unlicensed person to engage in the unlawful practice of vocational, registered or advanced practice nursing; b. Violating an order of the Board, or carelessly or repetitively violating a state or federal law relating to the practice of vocational, registered or advanced practice nursing, or violating a state or federal narcotics or controlled substance law; c.Aiding, assisting, advising, or allowing a nurse under Board Order to violate the conditions set forth in the Order; or d. Failing to report violations of the Nursing Practice Act and/or the Board's rules and regulations. 12. Leaving a nursing assignment, including a supervisory assignment, without notifying the appropriate personnel.

What are the conflict resolution process?

1. antecedent conditions (latent): specific preexisting conditions 2. Perceived and or felt conflict: cognition 3. Manifest behavior: visible evidence of conflict 4. Conflict resolution or suppression: leads to developing new attitudes/feelings 5. Resolution aftermath

What are the Shirley and Benner career stages?

1. promise 2. momentum 3. harvest

When was the age discrimination in employment act established?

1967

When was the occupational safety and health act

1970

When was the Family and medical leave act?

1993

What are patient Classification Systems?

A measurement tool used to determine the nursing workload for a specific patient or group of patients over a specific period of time. The measure of nursing workload generated for each patient is called patient acuity

What is the Safe Harbor Act?

A process that protects a nurse from employer retaliation and licensure sanction when a nurse makes a good faith request for peer review of an assignment or conduct the nurse requested to perform and that the nurse believes could result in violation of the NPA or Board of rules Safe harbor must be invoked prior to engaging in the conduct or assignment for which peer review is requested and may be invoked at anytime during the work period when the initial assignment changes Designed to help the nurse protect patients and maintain professional status Invoke safe harbor in good faith meaning that the RN believes that the requested conduct violates his/her duty to a patient and that belief is one a reasonable RN could hold Notify the supervisor making the assignment that he/she is invoking safe harbor

What is the induction phase

After being hired, before performing job Provide general info Employee handbook

What is the commonality of all the theories?

All the theories relate to the process of "unfreezing, moving, freezing." Many of the theories describe linear processes that move in a step-by-step manner

Decentralized Organizational Model

Allows for faster adaptation of policy because satellite facilities have more autonomy

Staff Nurse role in func Nursing

Become skilled at assigned tasks Follow clearly defined policies and procedures

What phase is the promise phase equivalent to?

Benners Novice to expert

What is the benner novice to expert?

Blends education and experience

is a written, detailed financial plan for carrying out the activities for a certain period. It is stated in terms of ($) and includes proposed income and expenses Generally developed for a 12-month period or yearly cycle that can be based on a fiscal year. Ex: October 1, 2016 to September 30th, 2016 or January 1 to December 31st. It is stated in terms of dollars and included proposed income and expenses

Budget

What are the possible LM responses to a marginal employee?

Coaching (suggest early retirement, resignation), ignore issue is a poor choice

Conflict vs Bullying

Conflict: Disagreement or argument in which both sides express their views Equal power between those involved Generally stop and change behavior when they realize it is hurting someone Bullying: Goal is to hurt, harm or humiliate Person bullying has more power "Power" can mean the person bullying is older, bigger, stronger, or more popular Continue behavior when they realize it is hurting someone Bullying is toxic - can destroy the entire facility

What are the 3 criteria for Informed consent?

Consent given to Person with Legal capacity, voluntary action, receives sufficient information/full disclosure and fully comprehends it

NM role in Functional Nursing

Consider: budget constraints, quality patient care, patient outcomes

Adv of TPC?

Consistency of one person providing patient care for an entire shift Trusting relationship Clear cut lines of responsibility and accountability

are the expenses associated with the delivery of healthcare services

Cost

What are examples of prospective reimbursements?

DRG and Capitation, government reimbursement, private insurance, individual private pay

manager role in Team nursing

Determines team leaders, effective skill mix Development of the team leaders (mentoring) Overall supervision of teams

What is care delivery mgmt. tolls?

Diagnostic related groups est by the federal gov in 1983 as payment systems for hospitals

What is functional nursing?

Divides the nursing work into functional roles that are assigned to one of the team members

Centralized organizational model

Each satellite facility reports back to the mothership, regulated very tightly but his makes it slower to respond

What is the promise phase?

Earliest phase •First 10 years of nursing employment •Less experienced yet critical to make wise choices during this phase •Reality overload occurs due to less experience Milestones to achieve: •Socialization to nursing, becoming an insider •Building knowledge, skills, abilities, credentials, educational base •Exposure to variety of experiences •Identify strengths, build confidence, position yourself for the future

adv for func nursing

Efficient- care can be delivered to a large # of patients Uses other types of HC personnel to perform tasks not required by an RN

What does the progressive discipline process allows?

Employees to correct unidentified issues, the process must be written and well communicated

What is the NM role in TPC?

Evaluate cost of personnel Determine level of care needed Know experience and skill of staff

-Charting an assessment was done but it was not done -Charting an action was done when it wasn't -NOT DOCUMENTING CARE -Crushing medications that can not be crushed -Giving IVP, IVPB medications too rapidly -Not setting alarm limits appropriately

Examples of violations of standards of care

What are some examples of inappropriate questions?

How old are you? Are you married? What does your husband/wife do? How many and how old are your children? Who takes care of the children? Do you live nearby? Do you have any physical disabilities? All questions on race, religion are prohibited Can not ask sex on application

Change: Planning

Identify the who, how, and when of change Identify the target date Goals and outcomes clearly determined and stated in measurable terms

Types of Conflict?

Intrapersonal, interpersonal, organiztional/Intergroup

What are the Traditional Change Theories?

Lewin's force-field model, Lippit's Phase of Change, Havelock's 6 step change model, Rogers's diffusion of innovations theory, Emerging theories of Change, Learning organization Theory,

Legal document that expresses client's wishes regarding medical treatment if client is unable to express desires/facing end of life issues Legal in all states, laws vary by state 2 witnesses required though some states accept notarized document

Living Will

Organization Types?

Matrix, Flat vs Tall, Decentralized vs Centralized

-Legal document designating health care proxy -Proxy makes health care decisions for client who is unable to make decisions themselves -Proxy knows client and their wishes

Medical Power of Attorney aka durable power of attorney

Roles of leaders and managers in conflict resolution

Model conflict resolution behaviors Lessen perceptual differences in parties Assist parties to identify resolution techniques Create environment conducive to conflict resolution If conflict cannot be resolved, minimize/lessen perceptions of conflicting parties

Role of the Manager and staff nurse for staffing?

Monitor the effectiveness of the staffing plan which identifies how many and what kind of staff are needed by shift and daily to staff a unit or department

What is Coercive Power?

My way or the highway -Derived from people who have the ability to administer punishment or take disciplinary action against another person -THIS IS THE LEAST DESIRABLE TACTIC -People don't want to be coerced! --Often perceive punishment as humiliating

Can incident reports be supoenaed by client or used as evidence in lawsuits if the document is not placed in the EMR or IR ?

NO

What are: Medication errors Procedure/treatment errors Equipment related injuries Needle stick injuries Client falls/injuries Threat made to client or staff Loss of property

Necessary to include incident report

price=

Set rate for service

Who is responsible for staff scheduling?

Nurse Manager

Newer delivery systems of Primary nursing

Nurse navigators: navigate system, specific clinic setting (ie: MD Anderson Cancer Center) Clinical nurse leader: clinical leadership at the point-of-care Patient- and Family-Centered Care

When the Nurse is a leader and an activist?

Nurses must be able to clearly articulate dimensions of nursing to any audience or stakeholder

A standard measure that quantifies the nursing time available to each patient by available nursing staff *reflects only productive nursing time

Nursing hours per patient per day (NHPPD)

What is Total Patient Care?

Oldest method of providing care One nurse provides TOTAL CARE for one patient during entire shift Works well in certain areas (ie; specialized units, intensive one-on-one nursing care)

Strategies to manage conflict resolution

Open, honest communication Willing to tell the truth Willing to discuss inappropriate actions Private, relaxed, comfortable setting for discussion Expectation of compliance to results by both sides

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

Patient Classification System

A value statement of the principles and beliefs that direct the organizations behavior How they go about doing what they do

Philosophy

team leader role

Plan, delegate, and supervise patient care Follow up w/ members to evaluate the care Updates care plans Exhibits strong communication skills

Personnel

Purpose: focus on patient acuity so that the most economical level of nursing care that will meet patient needs can be provided In addition to staffing numbers, manager must be aware of staffing mix (# RNs vs # LVNs vs # CNAs) Must be assessed using NCH/PPD formula (Nursing Care Hours Per Patient Day) Budget includes productive time and non-productive time (which is what the organization pays someone when they're not working, such as when they are getting oriented to the unit or on their lunch break)

Variance may be due to what?

Price: price of supplies will fluctuate Volume: unexpected increase or decrease Acuity: unexpected increase or decrease in the intensity of the patient's needs for care Wages: wage may be adjusted for factors including inflation and promotion

_____ is perhaps the most critical skill in good time management because all actions we take have some type of relative importance

Priority setting

What is the Equal Employment Opportunity?

Prohibit employment discrimination- gender, age, race, religion, handicap, pregnancy, national orgin

capital

Purpose: plan for the purchase of big items (buildings, expensive equipment to be used longer than 5-7 years). It includes items that are not used in daily operations and that are more expensive than operating supplies. Items to be purchased within the capital budget must often exceed a certain dollar amount (such as $5,000)

Payer decides in advance amount to be paid (regardless of actual cost)

Prospective reimbursement

What are negative sanctions?

Provide cues that enable people to evaluate their performance consciously and to modify behavior when needed Not bullying Telling new employees when their behavior is not an acceptable part of their role Given constructive manner

What is the Staff Nurse Role in TPC?

Provide holistic care to a group of patients Provide physical, emotional and technical aspects of care Assessments, coordination of care-be aware of the total care plan, and patient/family teaching

DNR is written and record in patient record by who?

Provider

What is central tendency?

Rater hesitant to risk true assessment so rates everyone as average

why are profit margins in healthcare very thin?

Reimbursement is low and slow Costs are escalating 29 million uninsured Americans (decrease from previous 50 million)

what are the types of revenue?

Reimbursement: Government, Private Insurance, Individual Private Pay Investment income Grants Gifts

IOMs 6 quality aim for improvement

Safe Timely Effective Efficient Equitable Patient Centered

Discuss the leadership and management roles in staff development?

Selection: A good fit for our organization? Verify education, work history Reference checks Possible physical exam Placement: -"huge" decision that affects the potential employee and team "fits in well with group" -Qualities needed for position --Great communication skills --Flexible --Supportive --Positive attitude --Energetic --Team player

What is the most effective form of discipline?

Self discipline

What was the civil rights act of 1991?

Sexual harassment

What are the differences of all of the theories?

Some theories do not work well in complex or nonlinear situations Some theories work better for one type of change than another

Describe 3 cost effective resource allocations nursing practices

Supplies Quality care (reduce length of stay, prevent complications) Time utilization (avoid overtime, id and report duplication in effort (double charting), all personnel to fullest, delegate effectively)

What are other methods of assessments with conducting stakeholder analysis?

Surveys/questionnaires (Used when large numbers of stakeholders and general idea of the options are available) Focus group/interviews: Focus groups: small groups of individuals with a common characteristic who meet in a group and respond to questions about a topic Time-consuming and expensive to conduct Work best when the topic is broad and the options are not as clear Advisory Board: Benefits large projects Board members come from various constituencies affected by project Has no formal authority, but reviews plan and makes recommendations

Change: Evaluation

The effectiveness of the change is evaluated according to the outcomes identified during the planning and implementation steps The most overlooked step Time intervals for evaluation should be identified and allowed to elapse before modifications and declarations of failure are asserted

What is power?

The ability to create, get, and use resources to achieve one's goals

Describe the assessment of budget planning

The first step is to assess what needs to be covered in the budget. Generally, this determination should reflect input from all levels of the organizational hierarchy because budgeting is most effective when all personnel using the resources are involved in the process

describe the implementation of budget planning

The fourth step is implementation. In this step, ongoing monitoring and analysis occur to avoid inadequate or excess funds at the end of the fiscal year. In most health-care institutions, monthly statements outline each departments projected budget and deviations from that budget

describe the evaluation of budget planning

The last step is evaluation. The budget must be reviewed periodically and modified as needed throughout the fiscal year. Each unit manager is accountable for budget deviations in his or her unit. Most units can expect some change from anticipated budget, but large variance must be examined for possible causes and remedial action taken if necessary

describe the dx of budget planning

The second step is diagnosis. In the case of budget planning, the diagnosis 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. Unfortunately, some managers artificially inflate their department budgets as a cushion against budget cuts. If several departments partake in this unsound practice, the entire institutional budget may be ineffective. If a major change in the budget is indicated, the entire budgeting process must be repeated. Top-level managers must watch for and correct unrealistic budget projections before they are implemented.

What is self-scheduling?

a process in which unit staff take leadership in developing and implementing the work schedule within clearly established guidelines/expectations Requires greater work accountability Nurse manager retains an important role in self-scheduling

describe the plan of budget planning

Third step is to develop a plan. Can be developed in many ways. A budgeting cycle that is set for 12 months is called a fiscal-year budget. This fiscal year, which may or may not coincide with the calendar year, is then usually broken down into quarters or subdivided into monthly or semiannual periods. Most budgets are developed for a 1-year period, but a perpetual budget may be done on a continual basis each month so that 12 months of future budget data are always available. Selecting the optimal time frame for budgeting is also important. Errors are more likely if the budget is projected too far in advance. If the budget is shortsighted, compensating for unexpected major expenses or purchasing capital equipment may be difficult.

What is the patient-self determination act?

federal legislation that requires all clients admitted to a health care facility to be asked if they have advance directives

What is a visual chart to plan day with?

Time Inventory: Having this visual reference allows you to compare what you had planned for the day versus what you accomplished by the end of the day, as well as highlight periods of great productivity and decreased productivity. Greatest benefit of time inventories is to establish behavior patterns, so it may be necessary to keep them for a period of time for analysis. Can also be helpful to perform new time inventory annually to see if habits are long-lasting, or if new behaviors have been incorporated

What is the SWOT analysis?

Tool for conducting environmental assessments Identifies both strengths and weaknesses in the internal environment and opportunities and threats in the external environment Stands for S -Strengths W -Weaknesses O - Opportunities T - Threats

Disadv TPC?

Uses a high level of expenses to provide care

Costs that do fluctuate in direct proportion to changes in volume/census (Medical/surgical supplies, laundry, food)

Variable Costs

Change in expected revenue or change in expected expenses

Variance

What are the two forms of collective action?

Workplace advocacy: -Activities within the practice setting. -Shared Governance - Shared decision making & accountability -Address the challenges faced by nurses in the practice setting -Career development, employment opportunities, employment rights & protection, occupational health & safety, and employee assistance -Framework of mutuality, facilitation, protection, and coordination -Active participation by all stakeholders to attain a "healthy workplace" Collective Bargaining Process which organized employees participate w/their employers in decisions about their pay, hours of work, & other terms & conditions of employment

What is a tort?

a wrongful act committed against another person, organization, or their property, that causes harm by invading a legally protected right for which the court will provide remedy in the form of an action for damages -Denial of persons legal right -Failure to comply with a public duty -Failure to perform private duty that results in harm to another -Personal, direct liability -Vicarious, substituted, joint liability --Respondent superior: let the master answer --Employer accountable for the negligence of their employees --Hiring the "best" is essential, maintaining staff competencies

negotiating

a. High level discussion with permanent solution b. Some wins, some losses c. Requires highly developed skills and careful communication i. Have to make the party feel satisfied with outcome d. Can not return to conflict i. Union contract, change policy

Confronting

a. immediate and obvious move to stop conflict b. Powerful c. Conflict does not take root/issues clarified d. Leaves impression conflict not tolerated e. Can make something big out of nothing

Smoothing

a. used to manage a conflict situation b. Is more of a placating strategy c. Rarely reaches a reasonable outcome of the actual conflict

Avoiding/ignoring

a.Could be conscious or unconscious b. Most useful when a cool down period is needed regarding the issue c. However, If issue ultimately not addressed: decreases effectiveness of group problem solving and issue becomes "bigger" than anticipated d. Issues may be more important to person/group than to others

Protects citizens rights at federal and state Authority to act by the legislative laws Board of nursing Creates rules and regulations to enforce legislative laws

administrative law

What is the Tall model?

appears and is used most bureaucratic systems -Board of directors at the top, then general director, then committees, then deputies, secretary/auditory/superintendent/admin/head of technical service, deputy medical superintend/senior nursing officer/head of schools, then head of departments

threat to touch another in offensive manner without the person's permission Threat to give treatment against patients will

assault

What are the steps in budget planning?

assess dx plan implementation evaluation

What is the first priority when a nurse is involved in an incidence?

assess for injuries

What are the steps in the Change Process?

assessment, ,planning, implementation, evaluation, stabilization of change

What is the primary purspose of constructive criticism?

assisting employees/employers working together to meet organizational goals

What are the conflict resolution techniques?

avoiding/ignoring, accomodating, competing, compromising, collaborating, smoothing, negotiating, confronting

touching another person w/o their consent Force a treatment against patients will

battery

What are nonproductive hours?

benefit time such as vacation, sick time and education time

governs how individuals relate to each other in everyday matters

civil law

acting in a way that causes injury to the patient

commission

Examples of people with legal capacity

competent adult, legal guardian or person with durable power of attorney, emancipated or married minor, parent/state/legal guardian of a child less than 16/18 years old, court ordered

freedom of religion, right to die, right to abortion

constitutional law

What is under civil law?

contract and tort

actions done that can intentionally harm others Offensive and harmful to society as a whole

criminal law

general injury

damages are inherent to the injury

false communication or publication harming ones reputation by libel or slander Libel (L=letter, written word), slader (S=speech)

defamation

What is Rule 217.12?

defines the following unprofessional conduct rules which are intended to protect clients and the public from incompetent, unethical, or illegal conduct of licensees. The purpose of these rules is to identify behaviors in the practice of nursing that are likely to deceive, defraud, or injure clients or the public.

What is the Rule 217.11?

describes the minimum acceptable level of nursing practice in any setting for each level of nursing licensure or advanced practice authorization. Failure to meet these standards may result in action against the nurse's license even if no actual patient injury resulted.

Sources of conflict

differences in goals (most common), values (second most common), allocation/availiability of resources, personality differences, internal/external pressures, cultural differences, competition, issues of personal/professional control, miscommunication

person incorrectly led to believe they cant leave a place -Restrain a patient who is of sound mind and not in danger of hurting self or others -Do not let patient leave hospital AMA

false imprisionment

compromising

each side gives up soemthing and gains something, splits the difference, both parties win/lose

What is affirmative action?

enhances employment opportunities of protected groups (Ex:veteran) Necessary for leader/manager to understand

What are productive hours?

hours worked available for patient care

What is strict liability?

imposed when the defendant acted neither negligently nor with the intent to cause harm -Use of defective medical devices -Prescribed dangerous combo of drugs

are records of unexpected, unusual incidents affecting client, employee, volunteer, or visitor

incident reports

What do incident reports include?

incident reports, variance reports, adverse event forms

HIPPA Mandatory reporting- patient abuse, specific infectious disease, blood alcohol level

invasion of right of privacy

Cost-based reimbursement

is the "fee for service," No ceiling on amount charged. All costs reimbursed No long used since the Balanced Budget Act of 1997

Creates a work environment where each person understands he or she has some liability for his or her own conduct

leadership role

Creates an environment that encourages and supports diversity and sensitivity

leadership role

Demonstrates vision, risk taking, and energy in applying appropriate legal boundaries for nursing practice

leadership role

Ensures that patients receive informed consent for treatment

leadership role

Fosters nurse-patient relationships that are respectful, caring, and honest, thus reducing the possibility of future lawsuits

leadership role

Practices within the scope of the Nurse Practice Act

leadership role

Prioritizes patient rights and patient welfare in decision making

leadership role

What is the Emerging Theories of Change and which are they?

more complex, respond to more complex situations than some traditional theories Chaos Theory and Learning Organization Theory

what is the horns effect

negative aspects solely on influence

-Failure to provide the care a reasonable person would ordinarily provide in a similar situation -Failure to exercise the proper degree of care required by the circumstances -Omitting to do something a reasonable person would -Doing something a reasonable person wouldn't do -General term for carelessness -Anyone can be liable for negligence -Unintentional

negligence

-Wrongful conduct in discharge of professional duties -Failure to act as other reasonable, prudent professionals with the same knowledge and education would act under similar circumstances -Employs a higher standard of care than ordinary negligence -Results in harm to another individual entrusted to professionals care

negligence

Do you nurture an impaired employee? do you actively participate in their recover?

no, it leads to enabling no, expert objective intervention is necessary (do not diagnose cause of addiction), Patient safety is always first priority

What does it mean for voluntary action for informed consent?

not coerced by fraud, duress, or deciet

What is the Halo effect

only focus on positive

The measure of nursing workload generated for each patient is called the

patient acuity

What are the behavioral changes to the impaired employee?

personality/behavior changes, job performance changes/declines, time/attendence changes

What is individual private pay?

pt pays out of their own resources -risks -benefits

defines citizens relationship with the government

public law

utilization=

quantity of services provided

emotional injury

rare, limited cases exist

amount receive before expenses are deducted

revenue

What is the matthew effect?

same appraisal each year "the rich get richer, the poor get poorer"

What is Variance Analysis?

the identification of patient or family needs that are not anticipated and the actions related to these needs in a system of managed care Healthcare organizations use variance analysis to explain variation between planned and actual costs or charges

What is skill mix?

the percentage of RN staff compared to other direct care staff (LVN's)

What if a patient refuses care?

they must understand the consequences of refusal

What is indirect care?

time spent on activities that are patient related but are not done directly to the patients

What is benchmarking?

tool used to compare productivity across facilities to establish performance goals

Profit=

total revenue-total costs

what is a contract?

transactions between individuals and/or legal entities Employed nurse -Adheres to p&p employing entity -Fulfill employer duties -Respect rights and responsibilities of other HC providers -Receive pay for services -Adequate assistance in providing care -Necessary supplies, equipment and adequate equipment training -Safe environment -Reasonable treatment from other providers