Management Exam 2
Research and informed consent
-Any additional costs that they might incur because of the research -potential for any forseeable risks -rights to withdraw at will, with no questions asked or additional incentives given -consequences, if any, of withdrawal before the study is completed -a statement that any significant ew findings will be disclosed -the number of proposed subjects for the study - the information must be in a language that is understandable by the subject's legal representative
Describe common characteristics of empowered organizations.
-Process that acknowledges the values and judgment of individuals and trust decisions -Used for professional development Want an organization where you feel valued Shared values, people focus (employees are greatest resource)
Informed consent
-direct care nurses may approach the nurse manager with questions about informed consent; thus the nurse manager becomes a consultant for the direct care nurse -more often the nurse manager is queried about patient's rights in research that are being conducted in the institution -the issue of medical literacy has implications for the provision of valid informed consent by an ever-growing number of patients
whistleblowing
-disclosure of info regarding misconduct within a workplace that is either illegal or endagering the welfare of others -healthcare provider has been terminated because: 1. speaking out against unsafe practices 2. reporting violations of federal laws 3. filling lawsuits against employers - whisteblower laws state that no employer can discharge, threaten, or discriminate against an employee regarding compensation, terms, conditions, location, or privileges or employment because the employee in good faith reported or caused to be reported, verbally, or in writing what the employee had a reasonable cause to believe was a violation of a state or federal law, rule, or regulation -public policy exception
What factors go into staffing pattern and considerations
-patient acuity -staff experience -number of patients -supports available -education and staff meetings -staffing mix -vacancies that are filled or unfilled Balance between staff needs and pt. safety
Pay for Perfomance Reimbursement
-reimbursement based on outcomes and meeting quality indicators not just services rendered- rewards and incentives for meeting quality of care -
Primary nursing care delivery model ppt 12&13 #47
-Total patient care -Key difference there is 24 hr responsibility to patient- when you are off-shift the person caring for patient becomes the associate nurse can't change care plan without sign on from primary nurse -Primary nurse could get called for consultation Increased satisfaction from pt. and nurse Very holistic care Primary Nursing Hybrids -Partnership Model --RN is paired with technical assistant -Patient-Focused Care -Multidisciplinary approach -RN paired with cross-trained technician in respiratory therapy, phlebotomy, and electrocardiographs.
Discuss reporting statutes and doctrines that minimize one's liability in leading and managing in professional nursing
Informed consent Privacy Confidentiality Whistle Blower law
fidelity
keeping one's promises or commitments- Loyalty
confidentiality
right of privacy to the medical record of a patient; also a respect for the privacy of info and the ethical use of info for its original purpose
Analyze the causes of malpractice for nurse managers. 1 select all that apply
-A professional's wrongful conduct in the discharge of professional duties -Failure to meet standards of care for the profession that results in harm to another individual entrusted to the professional's care -nurse manager must know the applicable standards of care and ensure that all employees of the institution meet or exceed them -must be reviewed periodically
Identify causes of expense report variances.
-Difference between projected budget and actual performance for a particular account. --Favorable variance-budgeted amount was greater than actual amount spent. -Nurses working way too hard; can result in more errors and can result in burn out --Negative variance-budgeted amount was less than actual amount spent. negative variances -Higher than expected patient acuity -Use of overtime -Low census- don't have all beds filled -Overstaffing- kept all staff there with not all beds filled- spending more than bringing in -Vacation and benefit time- paying them for nonproductive time they aren't there but also have to pay someone to backfill their spots
captial budget
-Expenses related to purchase of major "capital" items --Equipment over a set (by hospital) amount -Organization sets minimum cost parameters --Anything below the minimum is considered routine operating cost -Cost of the item is depreciated over the life expectancy of that item (must have useful life >1 yr) --Cost is subtracted from revenues --Affects profits of org. need we-ll documented justifications for spending separated from operating budget
operating budget
-Financial plan for day to day activities -Prepared by cost center (each unit is a cost center --Organizational unit for which costs can be identified -Two portions 1. Revenues- income coming in 2. Expenses- anything going out --Personnel --Other Than Personnel Services (OTPS) Nursing salaries largest operating cost
Explain how networking, mentoring, and collegiality contribute to power and influence in nursing.
-Networking supports the empowerment of participants through interaction and refinement of their interpersonal skills -active participation in nursing organizations is most effective at est a professional network outside one's place of employment -membership in civic organizations, educational operations also provide networking opportunities -mentoring provides expanded access to information, power, and career opportunities -the process of seeking out mentors is an exercise in growth for proteges and learn new skills from mentors and gain self-confidence and mentors gain satisfaction by experiencing the evolution of those nurses into experienced nurses -collegiality demands that nurses value the accomplishments of nursing colleagues and express a sincere interest in their efforts -turning to one's colleagues for advice and support empowers them and expands one own power base at the same time -collegiality demands mutual respect no friendship
cash budget
-Operating plan for monthly cash receipts and disbursements. -Organizational survival depends on paying bills on time. Liquid assessments What you have freeflowing cash after paying bills Usually set by chief financial officer
Explain the role of the nurse leader in managing costs and preparing budgets. 1 select all that apply
-Preparing unit budget --Requires collecting data: trends in acuity, patient pop., etc. --Done annually -Calculating workload -Developing unit operation objectives -Justifying capital equipment requests
Distinguish key strategies in the interviewing of potential employees.
-Prescreen applicant. -Prepare for interview.- want to know what your staff wants -Control the environment. -Clarify roles.- go over job descriptions, org. structure -Use listening skills.- really listening can help u determine if this is a good fit, and be able to ask questions -Ask behavioral questions- bigger insight into a person -Want to know an actual situation "tell me about a time..." -Be honest. -Provide closure.- who will be contacting them and time frame- always end on a positive note thanking for your time
Nurse Practice Act
-Single most important legislation for nursing --Affects all facets of nursing practice --Is THE law within the state -Describes scope of practice -Duties allowable by the profession -Described by each state
Prospective Payment Reimbursement
-Third party payer decides in advance what will be paid for a service or episode of care -if costs of care are greater than the payment the provider absorbs the loss, if costs are less that the payment the provider makes a profit -Flat-rate reimbursement (prospective)- paying a flat rate ahead of time PPS prospective payment system for hospital care that uses the DRGs as the basis for payment DRG- groups patients into categories based on the average number of days of hospitalization for specific medical diagnoses --payment includes expected costs for diagnostic tests, various therapies, surgery, and LOS --does not reflect the variability of patient or acuity within the DRG not good for nurses as the amount of supplies and resources needed to care for patients are directly r/t acuity --Organization needs to know what flat rates are --Get to keep more money if they do better than expected, patient goes home early --Low quality of care fall, get a deficit, and actually end up paying more for care
minors and informed consent
-competency involves the abilit to understand the consequences of actions or the ability to handle social affairs -the following types of minors may be able to give valid informed consent: emancipated minors, minors seeking treatment for substance abuse or communicable disease, and pregnant minors
Examine nurse practice acts, including legal differences between registered nurses and practical nurses.
-define 3 categories 1. licensed practical or vocational nurses LPNs & LVNs 2. licensed registered nurses RNs 3. advanced practical nurses -nurse practice act sets educational and exam requirements provide for licensing by individuals -define functions of each category of nurse both in general and in more specific terms must be read to ascertain what actions are allowable for the 3 categories of nurses -some states there are separate acts for RNs and LPNs/LVNs exist they must be reviewed at the same time to ensure there is no overlap between the acts -nurse managers should understand that individual state nurse practice acts are not consistent in defining or delineating nurse practice, esp for advanced nursing roles
Privacy and confidentiality
-nurse manager is cautioned to ensure that staff members both understand and abide by rules regarding patient privacy and confidentiality -all nurses may need to review the current means of giving reports to oncoming shifts and policies about telephone info -patient's have rights to access their health info -prudent nurse managers complete and have staff members complete incident reports as though they will be open records, omitting any language of liability ex. "The patient would not have fallen if Jane Jones RN, had ensured the side rails were up in their locked position" -nurse managers have the responsibility to ensure that those they supervise uphold patient rights as dictated by HIPAA and to take corrective actions should these rights not b upheld
consent and health literacy
-the degree to which individuals have the capacity to obtain, process, and understand basic health info, including services needed to make appropriate health decisions -nurses play a role in addressing this problem -first issue to address is awareness of the problems as many patients hide the fact that they do not understand -second ensuring that the info and words nurses use to communicate with patients are at a level that the person can comprehend -teachback is a good way to make sure they understand
6 elements required for malpractice select all that apply?
1. A duty or obligation created by law, contract, or standard practice that is owed to the complainant by the professional -duty owed to the patient 2. A breech of this duty, either by omission or commission -breach of the duty of care owed the patient 3. Foreseeability: certain events may reasonable be expected to cause specific results 4. Causation -the nurses' actions or lack of actions directly caused harm (must directly cause) 5. Injury, which can be physical, emotional, or financial, to the complainant (patient) -must be physical not merely psychological or transient, some physical harm must be incurred before malpractice will be found 6. Damages -must be able be able to prove damages -vital because because malpractice is nonintentional -pt. must show financial harm before the courts will allow a finding liability against nurse or hospital
Describe cost considerations for nurses working in managed care environments.
1. Prepare Staffing Plan # RNs, LPNS/LVNs, Aids, Clerks per shift -Based on Average Acuity per shift 2. Determine Labor Costs -Include Straight time hours -Overtime -Differential -Premium pay- preceptors -Benefits (social security, retirement, healthcare) 3. Shift Differentials -10% evenings -15% nights -20% weekends and holidays 4. Overtime -Project for next year -Historic # hours/year -Hourly rate x 1.50 (includes differential) Projected overtime costs = # Hours/year X (Hrly rate X 1.5)
Demonstrate how to calculate full-time equivalents and hours paid. 2 questions look on B
1. Productive hrs per FTE = Total paid hours - non-productive hours 2. Total # FTEs required = Total patient care hours ÷ Number of productive hrs 1 FTE = 2, 080 hrs Workload/ 1 FTE ***no one works 7 days a week Most people do not work every assigned shift without taking time off- think about nonproductive time 3 12 hour shifts- 36 hrs per week x 52 weeks a year = 1872 1872/ 2080 = 0.9 Considered full time really close to one FTE Every other week is x 26 2 12 every week 3 8 every other week 24 x 52 = 1248 24 x 26 = 624 1872/2080 = 0.9
Retrospective Reimbursement
Cost based system consists of the cost of providing a service plus a mark up for profit -Charges: The cost of providing a service plus a mark up for profit (retrospective determined after services are delivered- provided services and billed later) -Cost-based reimbursement (retrospective determined after services are delivered) --all allowable costs are calculated and used as the basis for payment --each payer (government or insurance) determines what are the allowable costs are for each procedure, visit, or service --Helps allow for org. not to charge an astronomical amount --Survey payers and determine what payers will normally cover --when reimbursed costs are less than the full charge for the service a contractual allowance (discount from full charges)
Defending malpractice
Defendant must prove: -Duty owed was fulfilled -A breach of duty did not cause harm -Policies and procedures were followed -State Nurse Practice Act was followed -Care was provided accordingly to standards of care -Care was provided in a reasonable manner, as other nurses would do in a like situation
Relate floating and the use of supplemental agency staff to nurse satisfaction and patient safety.
Float or staffing pools -Centralized, pool of nurses that are trained to work anywhere in the org. requires more orientation time and more expensive than regular staffing but not as expensive as agency -Very effective, and safe for filling vacancies Floating staff between units -Cross-train, safer, filling vacancies -Not a perfect solution Agency -Travel nurses- good for short term --Might not be as safe, not as vested in org. don't know policies
Functional nursing care delivery model ppt 12&13 #41
For a large group of patients Task based- key word Each care-giver has a piece or task of care Very fragmented Not good for patient satisfaction Advantages -Efficient -Assistive personnel can be trained to perform specific tasks. -Cost-effective- don't have to have as many licensed nurses Disadvantages -Fragmented care; task-oriented -Patient and family needs may be overlooked. -Lapses in communication -Quality of care may be compromised; holistic view of patient and family may be lacking. -Frustrating to professional nurse Nurse manager responsible for patient outcomes
Evaluate the impact of patient and hospital factors, nurse characteristics, and nurse staffing that influence nurse and patient outcomes.
Have to balance safe care with staff satisfaction Want it to be fair and balanced Ability to deliver safe and effective care while maintaining employee satisfaction. Understanding impact of nurse sensitive indicators on patient outcomes. Increased number of RN positions helps with safer care Communication with on call providers can affect patient mortality
Team nursing care delivery model ppt. 12&13 #44
Hybrid of functional nursing Advantages -Cost-effective -Decisions made at the "grass roots" level, often by staff caring for the patient -Improved patient satisfaction Know who their nurses are; not as task oriented Disadvantages -Need a skilled, knowledgeable team leader -Need adequate staff with the right skill mix -Potential for fragmentation of care -Few work settings implement team nursing as originally designed. Not as effective with unstable patients
Case method Care delivery model ppt 12&13 #39
Total patient care 1 patient or small group Beneficial for complex care e.g. ICU, hospice Nurse is providing total patient care for patient No delegating Costly - licensed nurse providing total patient care Can't use if reduced staffing
Appraise the types of behaviors that contribute to a powerful image in nurses.
a sense of self-confidence is a strong foundation in developing one power image and is essential for successful political political efforts in the workplace, within the profession, and within the public policy arena -Self image: thinking of oneself as powerful and effective -Grooming and dress: ensuring that clothing, hair, and general appearance are neat, clean, and appropriate to the situation -Good manners: treating people with courtesy and respect -Body language: maintaining good posture, using gestures that avoid too much drama, maintaining good eye contact, and being confident in movement -Speech: using a firm, confident voice; good grammar and diction; an appropriate vocab; and strong communication skills
Total FTE Calculation
example FTE = Workload ÷ 2080 = 41.625 FTEs (42 FTEs) workload = 86,580 FTEs required = 42 Non productive time: Vacation - 14 days Average sick time - 5 days Holidays - 3 days Personal days - 2 days TOTAL - 24 days 24 days x 12 hr = 288 hrs non productive time 2080 - 288 = 1792 productive hours/FTE Required Patient Care Hours ÷ Productive Hours/FTE = Total FTEs needed 86,580/1792 = 48.3 total FTE
negligence
failure to exercise the degree of care that a person of ordinary prudence, based on the reasonable person standard, would exercise under the same or similary circumstances; also known as ordinary negligence
Explain the primary challenge in recruitment of new staff.
making sure that the individual is a good fit
Calculate occupancy and paid nonproductive time. 3 ques
nonproductive time add up vacation, sick time, holidays, personal days, education days etc. x 12 hr any time not spent in direct patient care Occupancy=daily patient census (rounded) divided by the number of beds in the unit example 40 bed unit Pt. consensus is 36 What is the occupancy 36/40= 0.9 Occupancy is 90%
autonomy
personal freedom and the right to choose what will happen to one's own person
veracity
principle that compels the truth be told completely
beneficence
principle that state's the actions one takes should promote good
nonmaleficence
principle that states that one should do no harm
privacy
the right to protection against unreasonable and unwarranted interference with one's solitude; the right of an individual to be left alone
Underlying principle of good staffing is that
those we serve come first
