NUR 4320: Exam #1 [Ch. 1, 2, 3, 12 & delegation]

nurse leaders

-Guide and motivate nurses -Design, develop, implement, and sustain the organizational environment -Act as a stabilizing influence among constant change

Management Overview

-Managers manage people and organizations Definition of Management -Process of coordination and integration of resources Nurse managers balance two competing needs: the needs of the staff related to growth, efficiency, motivation, morale, and accomplishment with the outcome of staff satisfaction and the needs of the employer for productivity, quality, and cost effectiveness with the outcome of productivity.

Professional Practice Environment

Continuous learning Professional nursing development Shared perception of learning to enhance practice, quality, and outcomes When knowledge is freely shared it is contagious Unit journal clubs, unit presentations by staff, poster displays of success, EBP teams

Parallel Form

Coordinating across functional departments Mechanism: teams, specialists, task forces, liaison roles, standing committees Benefits: fosters collaboration and cross-fertilization of knowledge across divisions, consistency in clinical and management practices (rapid response teams)

Change Management

Executives do not direct change; they initiate and influence the direction. Recipients of change translate and edit plans for change. The main method used by recipients to interpret change is informal communication. Senior management must monitor and engage the "informal" channels. Attention must be given to open discussions and storytelling in communication about change. Recipients of change will mediate outcomes; managers need to engage in activity with them. Using change ambassadors to help the engagement may be helpful (especially in large organizations). Senior managers need to "live the changes" they want to adopt.

Healthy Work Environments

Back injury Needlesticks Chemical exposure

Root cause analysis

Beliefs about errors and their cause (RCA)

Key Theories of Organizations as Social Systems

Bureaucratic Classic management Human relations school Open systems theory

Institute of Medicine

Institute of Medicine's To Err Is Human: Building a Safer Health System (2000) 98,000 persons die annually in hospitals due to errors

leadership skills: diagnosing

understand the situation

effective leadership

-Adapt in a complex and chaotic environment -Possess strong self-awareness -Have a preferred leadership style -Use personal style for goal attainment

Leadership and Management Implications

-Affect how nurses feel about their work -Are important to nurses because of the size of the profession -Are needed to guide and motivate nurses -Are needed to inspire nurses

management

-Coordination and integration of resources -Planning, organizing, coordinating, directing to accomplish organization's goals focused on task accomplishment

steps of management process: controlling

-Establishing benchmarks or standards -Comparing actual performance against them -Taking corrective action, if required the management function of monitoring and adjusting the plan, processes, and resources to effectively and efficiently achieve goals.

steps of management process: planning

-Identify the mission -Conduct an environmental scan -Analyze the situation -Establish goals -Identify strategies to reach goals -Set objectives to achieve goals -Assign responsibilities and time lines -Write a planning document -Celebrate success and completion

followership

-Leaders need Followers -A process whereby an individual or individuals accept the influence of others to accomplish a common goal

Situational Leadership Theories

-Leadership in groups is never a static circumstance -Groups move back and forth through stages -Leadership styles are fluid based on group needs

Practices of Exemplary Leadership (Kouzes and Posner)

-Model the way-set example -Inspire a shared vision-share the dream -Challenge the process-go beyond the stauts quo -Enable others to act-strengthen the team -Encourage the heart-celebrate accomplishments, recognize individuals

leadership

-Process of influencing people to accomplish goals -Motivating people -Key concepts of leadership: influence, vision, communication, group process, motivation focused on human relationship aspects

Change Theories/Models Used in Nursing

1. Lewin's planned change theory (1947, 1951) 2. Kotter's model of change (1996)

Magnet Recognition Program

American Nurses Credentialing Center (ANCC) is the founder of the Magnet Recognition Program Magnet-designated hospitals are recognized for excellent patient care, supportive nursing practice environments, and the ability to attract and retain nurses.

Major Areas of Change Influencing Health Care Today

1.Population as customer 2.Wellness care and prevention 3.Cost management 4.Interdependence among professionals 5.Client as consumer of cost and quality 6.Continuity of information

The following is true regarding informal power:

A. Informal power comes from relationships and alliances with people in the organization. B. Informal power is derived from work that is relevant to pressing organizational issues and that provides opportunities to perform extraordinary and highly visible activities. C. Executive leaders do not have informal power. D. Informal power is a type of empowerment. A: Informal power comes from relationships and alliances with people in the organization.

All of the following influence the shape of the organization except:

A.Formal reporting relationship B.Span of control of managers C.Informal and formal power structures D.Number of management layers C: informal and formal power structures

Empowerment and shared decision making are practices found in:

A.Small organizations. B.Learning organizations. C.Innovative organizations. D.Stagnant organizations. B: learning organizations

Evidence shows that planned change is best carried out with the input of:

A.Top leaders and managers only. B.Those affected by the change. C.Outside consultants. D.Anyone interested. B: Those affected by the change.

Which of the following statements regarding organizational culture is true?

A: Staff are unaffected by organizational climate. B: Staff retention, workplace safety, and patient outcomes are directly affected by the organizational climate. C: Organizational leadership does not affect organizational culture. D: Working in an organizational culture that values continuous learning has been found to decrease nurses' job satisfaction. B: Staff retention, workplace safety, and patient outcomes are directly affected by the organizational climate.

two roles of a nurse

Care provider -Direct care provider Coordinator/integrator -Day-to-day coordination of service delivery -Information flow regarding care and service delivery

Changes in Health Care

Challenges faced by healthcare organizations Economic Social Financial Now forced to compete based on ability to be lean, efficient and maintain quality outcomes PAY FOR PERFORMANCE & OUTCOMES

change

Change is inevitable in health care. The pace of change is accelerating. Change is complex. Nurses are always adapting to change.

Suggestions for Nurse Leaders

Communicate, communicate, communicate Listen, listen, listen

Organizational Change

Conscious change leadership

nurse management

Coordination and integration of nursing resources by applying processes to accomplish nursing care and organizational goals

innovation

Definition of innovation Organized abandonment Purpose and role of innovation in organizations

Magnetä Hospitals

Designation of excellence Gold standard Culture that supports nurse autonomy, effective communication, and adequate resources Environment in which practice excellence is the norm

Scientific Management School

Determines the single best way to structure an organization Improve labor relations and the low industrial standards Goal: Enhance organizational performance in a spirit of improved cooperation between management and labor Bottom-up approach to organizational design

Functional Form

Dividing the work by occupation (RN, Pharm, Custodian) Organizations capitalize on the expertise, experience, efficiency, and professional standards of each discipline Benefits include cost reduction, improved performance, and higher quality Disadvantages include professional silos, minimal informal relationships across disciplines, and fragmented care delivery

Key Organizational Design Concepts

Division and coordination of labor Division of work by occupation or function is a form of specialization Advantages of specialization—improved work performance and a critical mass of experts Organizations may differentiate work by function to serve distinct client populations Subdividing work creates breaks in work flow

Change Practices of Learning Organizations

Empowerment Shared decision making Self-direction Shared governance

Kotter's Model of Change

Establish a sense of urgency. Create a guiding coalition. Develop a vision and strategy. Communicate the change vision. Empower employees for broad-based action. Generate short-term wins. Consolidate gains and produce more change. Anchor new approaches in the culture.

Patient Safety Culture and Climate

Factors that influence a nurse's ability to watch over patients to avoid errors include: ØManagerial leadership ØCommunication style ØStaffing levels ØExcess fatigue ØEducation and experience Commitment to safety Beliefs about errors and their cause Learn from our mistakes Safe culture for nurses and patients

Emotional Responses to Change

Fear Sadness Outrage Stress Disorientation Eroded loyalty Lack of commitment Low risk taking

Rogers' Innovation Theory

Five stages of innovation-decision process: ØKnowledge of innovation's existence/functions ØPersuasion to form an attitude toward the innovation ØDecision to adopt or reject ØImplementation of the new idea ØConfirmation to reinforce/reverse the innovation decision

leadership theories: trait theories

Focuses on identifying characteristics of leaders

leadership theories: situational theories

Focuses on observed behaviors of leaders and how styles can be matched to situations

Five Basic Organizational Forms

Functional Program Parallel Modified program Matrix

Transactional leader

Functions in a caretaker role and is focused on day-to-day operations.

Categories of Adopter Frequency

Innovators Early adopters Early majority Late majority Laggards

Program Form

Integration of work by consumer, service, or geography Emphasis on outputs Each program operates semiautonomously with its own management team Benefits: capitalizes on experts, multidisciplinary approach Disadvantages: difficulty coordinating services among programs, duplication of resources

Three Contemporary Trends: Achieving a Culture of Quality

Magnet Recognition Program Professional practice environment Patient safety culture and climate

steps of management process: directing/leading

Managing Motivating Directing -the managerial function of establishing direction and then influencing people to follow that direction.

leadership theories: additudinal theories

Measures attitudes toward leader behavior

models of change

Planned change theories/models Emergent models

4 steps of management process

Planning Organizing Directing Controlling

Power and Politics

Power issues and politics are central in considering change. Hierarchical managerial practices and top-down control often make change difficult to implement. Long-term consequences of change must be assessed prior to implementation.

Small-Scale Change Management

Rapid Cycle Change Transforming Care at the Bedside (TCAB)

organizational charts

Reflect the formal structure of the organization A visual display of the organization's positions and the intentional relationships among them Line positions = solid lines = flow of authority Staff positions or advisory bodies = dotted lines to show consultative relationships Informal structures do not appear on an organizational chart

Determinants of Successful Planned Change

Relative advantage Compatibility Complexity Trialability Observability

Resistance to Change

Resistance to change should be expected as integral to the whole change process. Resistance may be rooted in anxiety or fear. Not all resistance is bad; it may be a warning that something needs readjusting or clarity. Viewing the nurse or resister as the solution rather than the problem helps reframe the issue.

Leadership and Management Implications

Restructuring Reengineering Transparent and participative approach Transformational leaders Interdisciplinary work Organizational assessment

Hierarchy

Structure of authority in an organization Hierarchical centralization varies according to decision type Hierarchy creates formal lines of communication Hierarchy delineates roles and responsibilities -Nursing, respiratory therapy, dietary, housekeeping

Skill Sets Needed by Good Leaders: self-management

Take corrective action and not transfer negative aspects to staff

Leadership: Five Interwoven Aspects

The leader The follower The situation The communication process The goals

bureaucratic theory

Theorist Max Weber (1864-1920) View of bureaucracy as a social leveling mechanism founded on impartial and merit-based selection Warned of potential dehumanizing effects of bureaucracies that emphasize purely economic results at the expense of important social values

Classic Management Theory

Top-down approach Key concepts: differentiation, coordination, scalar principle, centralization, formalization, specialization, and span of control

Current Issues and Trends

Twenty-first century ushered in significant concerns related to the global community and public safety Boundaryless organizations Nursing shortage Medical errors/preventable adverse events-increased disclosure

Modified Program Form

Used to offset the fragmentation and isolation of functions in pure program structures Organizations maintain the program structure and develop integrative mechanisms to unify functions and occupations across programs Nurse manager does not directly control operations, finances, or personnel issues

Characteristics of Nurse Innovators

Willing to take risks Frequently question common beliefs and practices Comfortable with uncertainty Knowledgeable experts Comfortable with occasional failures Able to apply innovation Professional networkers

transformation

a complete change in the appearance or character of something or someone, especially so that thing or person is improved

innovation

a new method, idea, or product

change agent

a person who encourages people to change their behavior or opinions and who may function as a change facilitator

which statement about members of the nursing team and delegation is correct?

a. UAP can delegate to other UAP b. LPN/VNs can delegate to RNs and UAP c. RNs can delegate to APRNs, LPN/VNs, and UAP d. APRNs can delegate to RNs, LPN/VNs, and UAP d. APRNs can delegate to RNs, LPN/VNs, and UAP

which statement about regulation and scope of practice is correct?

a. any licensed nurse can delegate and supervise unlicensed assistive personnel (UAP) b. only registered nurses can delegate and supervise UAP c. all states prohibit licensed practical/vocational nurses (LPN/VNs) from delegating and supervising d. some states prohibit LPN/VNs from delegating and supervising UAP a. any licensed nurse can delegate and supervise unlicensed assistive personnel (UAP)

the nurse evaluates a patient's condition and determines that it is inappropriate to delegate a nursing activity to the UAP. what should the nurse do next?

a. ask the UAP to observe and learn how to perform the skill b. perform the activity himself or herself c. contact the nursing supervisor d. consult another nurse b. perform the activity himself or herself

how does the nurse supervise a delegated activity?

a. by observing the delgatee perform the activity b. by encouraging autonomy, creativity, and self-discipline c. by providing support, guidance and instructions d. by assessing the staff member's knowledge, skills, and abilities a. by observing the delgatee perform the activity

what two factors help ensure optimal outcomes in delegation?

a. communication and collaboration b. license and experience c. training and authorization d. certification and endorsement a. communication and collaboration

the nurse asks the UAP to measure blood pressure, temperature, pulse, and respirations. this is an example of:

a. delegation b. supervision c. assignment d. authorization c. assignment

which of the following is NOT a responsibility of the employer and/or nurse leader involving delegation?

a. ensuring appropriate policies, and procedures regarding delegation are in place b. ensuring adequate staffing c. establishing scope of practice guidelines for UAP d. promoting and maintaining a positive culture b. ensuring adequate staffing

which statement about delegation is correct?

a. nurses are accountable for predicting adverse outcomes b. unlicensed assistive personnel (UAP) must accept any delegated nursing activity c. UAP work under the license of the delegating nurse d. nurses cannot delegate any element of the nursing process d. nurses cannot delegate any element of the nursing process

which of the following is NOT one of the five rights of delegation

a. right reason b. right person c. right task d. right communication a. right reason

which factor can have a negative impact on delegation?

a. shortage of training programs for UAP b. variation in roles and responsibilities of UAP c. inconsistent use of a decision tree for delegation d. lack of standardized patient handoffs b. variation in roles and responsibilities of UAP

allowing persons to perform a specific nursing activity, skill, or procedure that is outside the traditional role and basic responsibilities of the delegatee's current job is the definition for which of the following terms?

a. supervision b. delegation c. responsibility d. accountability b. delegation

who is ultimately accountable for the outcome of the delegation?

a. the health care provider b. the health care employer c. the nurse leader d. the nurse who delegates the activity d. the nurse who delegates the activity

Skill Sets Needed by Good Leaders: self-awareness

able to read one's own emotional state and how it impacts others

leadership skills: adapting

adapt behaviors to match situation

change

an alteration to make something become different. -a complex process that occurs over time and is influenced by any number of unpredictable variables

planned change

any kind of alteration or modification which is done in advance and differently for the improvement of present position into brighter one

structure

arrangement of parts within a larger whole

emergent change

assumes that change is continuous, open-ended, and unpredictable process of aligning and realigning an organization to its changing environment

leadership skills: communicating

communicate in a way that people can understand the situation and accept

Skill Sets Needed by Good Leaders: social awareness

empathy and sensitive to emotions of others

organizational social structure

how work is divided and coordinated among members and the resulting relationship, roles, and work groups

Organizational climate

individual perception of working environment

Culture-climate link

interaction of shared values, beliefs, and behaviors

organizations

large entities that group together smaller units

senior management team

medical & surgical services emergency outpatient clinics nursing, pharmacy, dietary, social services, environmental services

Nurse practice environment

norms, values, and ways of working together on a nsg. unit within a larger organization.

Organizational culture

set of values, beliefs and assumptions shared by members of organization

resistance

to refuse to accept or be changed by something, a force that acts to stop the progress of something or make it slower

Skill Sets Needed by Good Leaders: relationship management

use effective communication to disarm conflict

core leadership components

ØIt is a process ØInvolves influence ØOccurs in groups ØInvolves common goals *important for nurses because they need to possess knowledge and skills in the art and science of solving problems in work groups, systems of care, and the environment of care delivery*

characteristics of the leadership role

ØMotivated by challenge ØCommitment ØAutonomy

Work Empowerment Structures

Opportunity: growth, mobility, job enrichment Power ØFormal ØInformal Proportion: social composition of the workforce

Changes in Nursing

Organizational structures Nursing labor force Reimbursement Information systems

steps of management process: organizing

Organize the work Organize the people Organize the environment -a management function related to allocating and configuring resources to accomplish preferred goals and objectives.

Current Issues and Trends

Patient-centered care Patient-centered medical home (primary care) Generational diversity number of nurses <30, >60 are now equal These age groups value different things, work differently, need different Nursing shortage QSEN Quality and Safety Education for Nurses: ØThe purpose of QSEN is to address the skills and attitudes necessary to continuously improve the quality and safety of health care systems

matrix form

People and work are organized along both functional and program dimensions Flexibility to change, deliver efficient services, draw on varied talent pool Costly because specialists may need to be hired

Transtheoretical Stages of Change Model

People move through stages when modifying behavior Time spent at each stage is variable The five stages are: ØPrecontemplation ØContemplation ØPreparation ØAction ØMaintenance

Background of Change

Top-down change Emergent view of change

Lewin's Force Field Analysis

A successful change involves three elements: ØUnfreezing ØMoving ØRefreezing

Providing Support to Staff in Periods of Stress and Change

Active listening Promoting action steps and solutions Keeping staff informed of decisions Soliciting input and encouraging participation Reframing difficult messages

Leaders as Change Agents

Articulate a clear need for change. Get group participation by leaving the details to the people who must implement the change. Get reliable information to the implementers. Motivate through rewards and benefits. Do not promise things that cannot be delivered.

Leadership Styles Theories

Autocratic Bureaucratic Charismatic Democratic Laissez-faire Servant Situational Transactional Transformational

Transformational leader

Motivates followers to perform to their full potential over time by influencing a change in perceptions and by providing a sense of direction.

Just Culture

Movement from punitive/reactive culture to fair/just culture Middle ground between patient safety and culture of error reduction Speak up!

Leadership and Management Implications

Nurse leader creates convincing vision that inspires entire team Caring values are reflective in how an organization treats its staff Challenges of nursing leadership belongs to every nurse, not just managers/administrators

Three Broad Perspectives of Organizations

Objective Subjective: focus on informal aspects of organizations and on the freedom of individual to make choices and influence organizational life Postmodern

Organizational Shapes

Often described as tall or flat Definitions: span of control, scalar principle