Nursing Alterations Test #6

What is mediation?

1. A dynamic, structured, interactive process where a neutral third party assists disputing parties in resolving conflict through the use of specialized communication and negotiation techniques. All participants are encouraged to actively participate in the process. 2. It is a "party-centered" process in that it is focused primarily upon the needs, rights, and interests of the parties. 3. Uses a wide variety of techniques to guide the process in a constructive direction and to help the parties find their optimal solution as well as manages the interaction between parties and facilitates open communication. 4. Is also evaluative in that the it analyzes issues and relevant norms ("reality-testing"), while refraining from providing prescriptive advice to the parties 5. It is a learned skill for which advanced training and/or certification is available.

What is organizational culture?

1. A system of shared assumptions, values, and beliefs, which governs how people behave in organizations. 2. These shared values have a strong influence on the people in the organization and dictate how they dress, act, and perform their jobs.

Magnet™ Recognition

1. Achieving recognition for improving quality care for patients 2. Recognizes health-care organizations that demonstrate excellence in nursing philosophy and practice, adherence to national standards for improving patient care, leadership and sensitivity to cultural and ethnic diversity. 3. Applicants undergo a rigorous evaluation that includes extensive interviews and review of nursing services, clinical outcomes, and patient care. Research shows there are clear benefits to hospitals that have this status and to the communities they serve: a. Facilities consistently outperform other facilities in recruiting and retaining nurses - resulting in increased stability in patient care and positive patient outcomes. b. Because quality nursing is one of the most important factors in enlisting high-caliber physicians and specialists, this status becomes an attractive force that extends to the entire facility. c. These facilities have lower mortality rates and shorter lengths of stay. d. Health-care consumers have more confidence in the overall quality of a hospital if it has achieved the level of nursing standards established by the this program.

Primary Nursing

1. Adaptation of the case method or total patient care developed by Marie Manthey 2. RN functions autonomously 3. Provides coordinated comprehensive continuous care 4. Associate nurses care for the patient based on the primary care nurse's plan for the patient. 5. Primary nurse may or may not due bedside care, uses the team to take care of treatments, etc 6. Tend to be experienced nurses

Organizational conflict

1. Arises when discord exists about policies and procedures, personnel codes of conduct, or accepted norms of behavior and patterns of communication. 2. Some is related to hierarchical structure and role differentiation among employees. 3. A major source stems from strategies that promote more participation and autonomy of direct care nurses.

Right person

1. Assess and verify the competency of the health care team member. a. The task must be within the team member's scope of practice. b. The team member must have the necessary competence/training. 2. Continually review the performance of the team member and determine care competency. 3. Assess team member performance based on standards and, when necessary, take steps to remediate a failure to meet standards.

Role of the Nurse Manager (Case Method)

1. Assess patient needs to determine level of care: a. RN care b. RN-supervised care using LPNs or Unlicensed Assistive Personnel (UAPs) 2. Considers the balance between cost and care required.

Right circumstance

1. Assess the health status and complexity of care required by the client. 2. Match the complexity of care demands to the skill level of the health care team member. 3. Consider the workload of the team member.

Entrenched Workforce: 1946-1965

1. Baby Boomers (born after world war II) 2. Believe in the power of collective action 3. Expect leaders to be professional, supportive with high integrity along with honesty, approachable, competent, knowledgeable.

Role of the Manager (Functional Nursing)

1. Balances quality care with financial implications 2. Each staff member is responsible for specific tasks so the nurse manager must assume the role of achieving patient outcomes. 3. May need to rotate staff assignments so that staff have greater variety in the interventions they provide.

Emerging Workforce: 1965-1995

1. Born after the Baby Boomers 2. Change jobs more frequently 3. Focus on work life balance 4. Seek feedback on their performance 5. Do not have confidence in leaders and institutions

Care Models

1. Case method 2. Functional nursing 3. Team nursing 4. Primary nursing 5. Case management

Role of the Manager (Team Nursing)

1. Charge nurses and team leaders must have management skills to lead the patient care...the nurse manager ensures the competence of these leaders. 2. Nurse manager provides the right staff mix and orientation to this model of nursing 3. Manager may have more than one unit and therefore relies on the skills of charge nurses to help with support on the unit/decision making

Right direction/communication

1. Communicate either in writing or orally: a. Data that need to be collected b. Method and time line for reporting, including when to report concerns/assessment findings c. Specific task(s) to be performed; client-specific instructions d. Expected results, time lines, and expectations for follow-up communication

The Synergy Model

1. Competencies are essential for contemporary nursing practice, but each assumes more or less importance depending on a patient's characteristics. 2. Results when the needs and characteristics of a patient, clinical unit or system are matched with a nurse's competencies. 3. Logically, the more compromised patients are, the more severe or complex are their needs. The dimensions of a nurse's practice are driven by the needs of a patient and family.

Role of the Direct Care Nurse

1. Complete tasks assigned by the charge nurse 2. May be frustrated with task oriented role 3. This model may work well for disaster situations or extended care type organizations.

Nurse Case Manager (NCM)

1. Coordinates patient care throughout the admission process a. Facilitates access to needed health resources b. Monitors utilization of resources c. Measures outcomes and quality d. Uses Critical Pathways or Care MAPs

Team Nursing Advantages

1. Cost effective 2. Decisions made at the "grass roots" level, often by staff caring for the patient 3. Improved patient satisfaction

What is the role of the Board of Nursing in Wisconsin?

1. Deals with licensures, nursing practice information, and more. 2. Controls disciplinary actions of licensing of nurses

Care MAPs

1. Describes the steps and decision points in the management of a condition. It is based on medical guidelines, recent evidence, and expert consensus. 2. Made up of one or more pages which together show the complete patient journey for a condition.

Associate nurse

1. Education: 2 year Associate's degree 2. a tertiary education nursing degree which typically take 2-3 years to complete. In the United States, this type of degree is usually awarded by community colleges or similar nursing schools. Some four year colleges also offer this degree.

Primary nurse

1. Education: Minimum of Bachelor's degree 2. Role is based upon responsibility, accountability and authority: the responsibility to develop a therapeutic relationship, the accountability to the patient, family and members of the health-care team and the authority to develop and implement an individualized plan of care for the patient.

Advanced practice nurse

1. Education: Should hold a graduate degree and be certified in their specialty. This certification is important because it validates and standardizes their practice competencies. 2. Are licensed registered nurses prepared at the graduate degree level as either a Nurse-Midwife, Nurse Practitioner, Clinical Nurse Specialist, or Nurse Anesthetist. 3. Nurses prepared at the graduate level function in a variety of roles as advanced practice nurses in specialty areas of practice.

Functional Nursing Advantages

1. Efficient 2. Assistive personnel can be trained to perform specific tasks. 3. Cost-effective

Manager Traits

1. Emphasizes organizing, coordinating and controlling resources (space, supplies, people, etc). 2. Attends to short-term objectives/goals. 3. Maximizes results from existing resources. 4. Interprets established policy, procedures and mandates. 5. Moves cautiously, dislikes uncertainty. 6. Enforces policy mandates, contracts, etc (acts as a gatekeeper).

Role of the Leader in Conflict Management

1. Encourages positive work relations 2. Creates a practice environment that offers open communication and collaborative practice. 3. May be seen as conflict coaches.

Eight Characteristics of Effective Leaders

1. Engage in lifelong learning 2. Are service oriented 3. Are concerned with the common good 4. Radiate positive energy 5. Believe in other people 6. Lead balanced lives and see life as an adventure 7. Are synergistic (See things as greater than the sum of the parts) 8. Engage themselves in self renewal

Delegation Decisions

1. Factors a. Patient's condition b. Complexity of the task to be performed c. Predictability of outcomes 2. Complication related to delegatee a. Age b. Gender c. Ethnicity

Functional Nursing Disadvantages

1. Fragmented care; task oriented 2. Patient and family needs may be overlooked. 3. Lapses in communication 4. Quality of care may be compromised; holistic view of patient and family may be lacking. 5. Frustrating to professional nurse

WISCONSIN NURSE PRACTICE ACT

1. General Nursing Procedures: An RN shall utilize the nursing process in the execution of general nursing procedures in the maintenance of health, prevention of illness or care of the ill. The standard is met through performance of each of the following steps of the nursing process: 2. Assessment: the systematic and continual collection and analysis of data about the health status of a patient culminating in the formulation of nursing diagnosis. 3. Planning: Development of a nursing plan of care for a patient, which includes goals and priorities, derived from the nursing diagnosis.

The emotionally intelligent leader:

1. Has insight into the emotions of members of the team. 2. Understands the perspective of others. 3. Encourages constructive criticism and is open to new ideas. 4. Is able to maintain focus while multitasking. 5. Manages emotions and channels them in a positive direction, which in turn helps the team accomplish its goals. 6. Is committed to the delivery of high-quality client care. 7. Refrains from judgment in controversial or emotionally charged situations until facts are gathered.

Characteristics of Managers

1. Hold formal position of authority and power 2. Possess clinical expertise 3. Network with members of the team 4. Coach subordinates 5. Make decisions about organization function, including resources, budget, hiring, and firing

Role of the Direct Care Nurse (Case Method)

1. Holistic care to a group of patients for the shift 2. All aspects of the care are completed by the assigned RN 3. Eliminates delegation and supervision

Right task

1. Identify what tasks are appropriate to delegate for each specific client. a. A right task is repetitive, requires little supervision, and is relatively noninvasive for the client. 2. Delegate tasks to appropriate levels of team members (LPN, AP) based on standards of practice, legal and facility guidelines, and available resources.

Democratic

1. Includes the group when decisions are made. 2. Motivates by supporting staff achievements. 3. Communication occurs up and down the chain of command. 4. Work output by staff is usually of good quality - good when cooperation and collaboration are necessary.

Delegation Complications

1. Information Decay: When patient's health status changes rapidly and specific information is no longer relevant to the patients condition 2. Information Salience: When the quality, meaning, and clarity of the information is assessed and must be clearly understood by the delegator and delegatee

Transformational Leadership

1. Inspiring vision that changes the framework of the organization, charismatic. 2. Five key practices in transformational leadership: Challenging the process Inspiring shared vision or move toward shared goal Enabling others to act: Extra effort will have rewards Modeling the way Encouraging the heart: Thank yous for a job well done 3. Creates increased loyalty, commitment, job satisfaction, morale and performance.

Types of Conflict

1. Intrapersonal 2. Interpersonal 3. Organizational

Managed Care

1. Introduced in 1980s 2. Goal: provide services efficiently and at appropriate costs 3. CMS: Never Events

Compromising

1. Involves both assertiveness and cooperation on the part of everyone and requires maturity and confidence. Negotiating is a learned skill that is developed over time, with a give-and-take relationship that results in conflict resolution helping each person meet their most important priorities as much as possible. 2. Appropriate uses: a. When 2 sides are committed strongly to mutually exclusive goals. b. When temporary solutions to complex issues need to be implemented. c. When conflicting goals are semi-important and not worth a major confrontation. d. When time pressures to expedite a solution. e. When collaborating and competing fail.

Quality Indicators

1. Joint Commission a. standards put into place due to EBP, want to improve what standards we have. 2. National Data Base of Nursing Quality Indicators great source for EBP 3. Both standards aimed at improving patient safety

Five Rules of Leaders

1. Maintain balance 2. Generate self motivation 3. Build self confidence 4. Listen to his or her constituents 5. Must have positive attitude

Authoritative

1. Makes decisions for the group. 2. Motivates by coercion. 3. Communication occurs down the chain of command. 4. Work output by staff is usually high - good for crisis situations and bureaucratic settings. 5. Effective for employees with little or no formal education.

Laissez-faire

1. Makes very few decisions, and does little planning. 2. Motivation is largely the responsibility of individual staff members. 3. Communication occurs up and down the chain of command and between group members. 4. Work output is low unless an informal leader evolves from the group. 5. Effective with professional employees

How do managers differ from leaders?

1. May also be a leader but is not required to have leadership skills within the context of moving a group of people toward a vision. 2. Is a designated leadership position. 3. Can be taught and learned using traditional teaching methods. 4. Concerned with doing things correctly in the present. 5. Ensure that operations run smoothly and that well-developed formulas are applied to staffing situations, economic decisions and other daily operations. 6. Not as concerned with developing creative solutions to problems as with using known strategies to address today's issues.

Care Delivery Models

1. Methods used to care for patients 2. Nursing care is considered a cost or expense a. The goal is to provide high quality care but efficiently 3. No single model is ideal

Collaborating

1. Most time consuming but most creative stance. 2. Is both assertive and cooperative because people work creatively and openly to find a solution that most fully satisfies all important concerns and goals to be achieved. Involves analyzing situations and defining the conflict at a higher level where shared goals are identified and commitment to working together is generated. 3. Appropriate uses: a. When seeking creative, integrative solutions both sides can agree to. b. When learning and growing through cooperative problem solving. c. When identifying & merging diff viewpoints. d. When being honest about and working through difficult emotional issues.

Delegation

1. Multifaceted decision making process 2. The assignment of any responsibility or authority to another person (normally from a manager to a subordinate) to carry out specific activities. It is one of the core concepts of management leadership. 3. The person who delegated the work remains accountable for the outcome of the delegated work. 4. "act of transferring to a competent individual the authority to perform a selected nursing task in a selected situation" (NCBSN, 2006)

Core measures

1. National standards of care and treatment processes for common conditions. These processes are proven to reduce complications and lead to better patient outcomes. 2. Compliance shows how often a hospital provides each recommended treatment for certain medical conditions. 3. Things they want to see for big diseases (CHF, pneumonia, et)

Team Nursing Disadvantages

1. Need a skilled, knowledgeable team leader 2. Need adequate staff with the right skill mix 3. Potential for fragmentation of care 4. Few work settings implement team nursing as originally designed.

Team Nursing

1. Nurse shortage continued after WWII 2. Modified functional nursing model 3. Devised to improve patient satisfaction 4. Staff mix is RNs, LPNs, UAPs 5. Team leader has an assigned group of patients to coordinate care for a. LPNs and UAPs are assigned to these patients as well b. Duties are assigned by scope of practice - Assessments cannot be delegated - LPNs can do data collection c. Several teams per unit

Case Method (Total Patient Care)

1. One nurse assigned to a patient to provide all (total) care 2. Works well in critical care or hospice settings 3. One nurse is responsible for implementing care plans and communication with HC providers. 4. Allows the nurse to spend more time with the patient and notice changes in condition quickly. 5. This model of care is expensive in larger units because more patients means more nurses needed. a. Usually 1-2 patients per nurse b. With 20 patients on a unit = more nurses

What do you think makes a healthy work environment?

1. One that is safe, empowering, and satisfying. 2. Parallel to the World Health Organization definition of health, it is not merely the absence of real and perceived threats to health, but a place of "physical, mental, and social well-being," supporting optimal health and safety.

Clinical Nurse Leader (CNL)

1. Oversees lateral integration of care for a distinct group of patients 2. May actively provide direct care for complex patients 3. Leadership in the care of the sick in and across all environments. 4. Provision of EBP 5. Clinical decision making 6. Design and implementation of care plans 7. Client and community advocacy 8. Education and information management 9. Delegation and oversight of care delivery.

Supervision

1. Oversight of a delegated nursing task (NCSBN, 2006) 2. General and specific

Critical pathways

1. Patient-focused documents that describe the clinical standards, necessary interventions and expected outcomes for the patient throughout the treatment process or hospital stay. 2. Are considered useful if the intervention: a. is a structured multidisciplinary plan of care b. is used to translate guidelines or evidence into a specific situation c. includes steps in a course of treatment or care in a plan, protocol, algorithm, etc. d. includes time frames or criteria-based progression e. aims to standardize care for a specific clinical problem in a specific population.

Accommodating

1. People neglect their own needs, goals, and concerns while trying to satisfy those of others. This approach has an element of being self-sacrificing and simply obeying orders or serving other people. 2. Appropriate uses: a. When other people's ideas or solutions appear to be better or when you made a mistake. b. When the issue is far more important to the other person than it is to you. c. When you build up some important credits for later issues. d. Preserving relationships, avoid defensiveness. e. Letting others learn from their mistakes.

Competing

1. People pursue their own needs and goals at the expense of others. Sometimes use whatever power, creativeness or strategies that are available to win. 2. Appropriate uses: a. When quick, decisive action is needed. b. When important, unpopular action needs to be taken or when trade-offs may result in continued conflict. c. When an individual or group is right about issues that are vital to group welfare.

Follower Traits

1. Perceives the needs of both the leader and other staff. 2. Demonstrates cooperative and collaborative behaviors. 3. Exerts the power to communicate through various channels. 4. Remains fully accountable for actions while relinquishing some autonomy and conceding certain authority to the leader. 5. Exhibits willingness to both lead and follow peers, as the situation warrants, allowing for competency-based leadership. 6. Assumes responsibility to understand what risks are acceptable for the organization and what risks are unacceptable.

Functional Nursing

1. Popular during WWII when there was a shortage of nurses 2. Each member of the nursing staff performs specific tasks for a large group of patients. 3. Each staff member gets proficient in their task 4. A charge nurse coordinates the care for the patients and might be the only nurse who knows all the needs of a given patient. 5. Financial benefit is that a large number of patients can be cared for by using a fixed number of nurses and larger number of UAPs.

Budgets

1. Preparing a detailed budget a. office supplies, supplies for nursing, staff 2. Responsible for Full Time Equivalents (FTEs) 3. Responsible for over all budget 4. Staff self scheduling

Case Management

1. Provides care in outpatient settings 2. When effective, it is a proactive coordination of care from the point of admission with identified time goals for care outcomes. 3. Includes case selection, multidisciplinary assessment, collective planning, coordination of events, negotiation, evaluation and documentation of outcomes. 4. Employed in acute care settings, rehabilitation facilities, subacute care facilities, community-based programs, home care, and insurance companies.

Nurse Navigator

1. Provides specific services designed to improve care 2. Removes barriers to care 3. Works as a mediator, makes sure patients get to the place they need to go for a particular service. 4. Coordinates patient care

Responsibility

1. Reliability, dependability, and obligation to accomplish work. 2. Always responsible for any task you delegate

Nurse Manager Role

1. Research 2. Organizational Culture 3. Mentoring 4. Day to Day Management Challenges 5. Workplace Violence 6. Managing work complexity and stress 7. Managing Resources

Delegation and Authority

1. Resides within the Nurse Practice Act of each state 2. Examines the value of UNP in patient care delivery 3. Declares the importance of delegation decisions is safety and welfare of the public

The Role of the Manager (Primary Nursing)

1. Responsible for leadership, guiding practice, budgets, and quality. 2. Functions as a role model, coach and consultant.

Transforming Care at the Bedside

1. Robert Wood Johnson mastermind 2. Those working at the bedside drive the care of the unit, not the directors or people indirectly involved with patient care. 3. Was designed to develop new interventions to improve the hospital work environment, with the goal of improving the quality of care provided by nurses at the bedside.

Professionalism

1. Set the example 2. Nursing's Social Policy Statement a. Provides ideals for all nurses: autonomy, self-regulation, and accountability

Delegation Review

1. State exactly what is being delegated and the expected outcome. 2. Convey the authority to perform what is expected. 3. Identify priorities. 4. Acknowledge monitoring activities that may be performed. 5. Specify any performance limitations. 6. Specify deadlines, including the exact times if appropriate. 7. Specify report time frames and data expected. 8. Specify deviations, including when immediate action must be taken. 9. Identify appropriate resources, including individual consultants. 10. Emphasize what may not be delegated and ask delegatee to provide examples.

Transactional Leadership

1. Superior makes decisions without input from subordinates. 2. Formal authority and power of organizational position used to reward and punish. 3. Quid pro quo used to get work done. 4. Work is supervised and completed according to the rules and deadlines are met. 5. Limited job satisfaction with low to stable levels of commitment. 6. Followers fulfill the contract or get punished

The Five Rights of Delegation

1. Task Appropriate and legal 2. Circumstance Appropriate environment/resources/ equipment 3. Person Willing and able with expertise 4. Direction/Communication Clear/concise instructions 5. Supervision Monitor and evaluate patient

Emotional Intelligence

1. The ability of an individual to perceive and manage the emotions of self and others. 2. The nurse must be able to perceive and understand his own emotions and the emotions of the client and family in order to provide client-centered care. 3. Is also an important characteristic of the successful nurse leader. 4. Developed through understanding the concept and applying it to practice in everyday situations.

What is management?

1. The administration of an organization, whether it be a business, a not-for-profit organization, or government body. 2. Includes the activities of setting the strategy of an organization and coordinating the efforts of its employees or volunteers to accomplish its objectives through the application of available resources, such as financial, natural, technological, and human resources.

Right supervision/evaluation

1. The delegating nurse must: a. Provide supervision, either directly or indirectly (assigning supervision to another licensed nurse). b. Provide clear directions and understandable expectations of the task(s) to be performed (time frames, what to report). c. Monitor performance. d. Provide feedback. e. Intervene if necessary (unsafe clinical practice). f. Evaluate the client and determine if client outcomes were met. g. Evaluate client care tasks and identify needs for quality improvement activities and/or additional resources.

Clinical reasoning

1. The mental process used when analyzing the elements of a clinical situation and using analysis to make a decision. 2. Supports the clinical decision making process by: a. Guiding the nurse through the process of assessing and compiling data. b. Selecting and discarding data based on relevance. c. Using nursing knowledge to make decisions about client care. Problem solving is a part of decision making

Nursing Case Management

1. The process of coordinating health care through planning, facilitating, and evaluation of interventions to achieve measurable cost and quality outcomes. 2. Might also be called utilization management. 3. The process of providing comprehensive care for those with complex healthcare problems a. Improved patient outcomes b. Decreased length of stay c. Interfaces with multiple disciplines d. Care provided across the continuum of illness, often in different institutions

Accountability

1. To be answerable to oneself and others for one's own actions. 2. If actions were appropriate, includes a detailed explanation (ANA, 2012)

Leadership and Workplace Satisfaction

1. Turnover is costly to an organization. Nurse satisfaction is important to an organization to prevent turnover. 2. Strong leadership sets the tone for the group. 3. Follower Expectations of Leaders Respect Future focused direction Control of decisions that affect them Rewards and recognition Balance of life and work Professional development guidance. 4. Direction, trust and hope - 3 things followers need

Role of the Direct Care Nurse (Team Nursing)

1. Under the guidance of a strong team leader the collective team becomes greater than the functions of individuals. 2. Team nursing uses the strength of each staff member 3. It is the team leads role to assign staff members based on their skill set.

Effective Delegation Skills

1. Understand the nurse practice acts of their states 2. Understand the delegation standard related to individual job descriptions 3. Understand the policies of the healthcare facility 4. Function within their state's regulatory guidelines 5. Policies should never contradict, should parallel NPA of the state

Critical thinking

1. Used when analyzing client issues and problems. Thinking skills include a. interpretation b. analysis c. evaluation d. inference e. explanation. 2. Reflects upon the meaning of statements, examines available data, and uses reason to make informed decisions. 3. Necessary to reflect and evaluate from a broader scope of view.

Leader Traits

1. Values commitments, relationships with others and esprit de corps in the organization. 2. Provides a vision that can be communicated and has a long-term effect on the organization that moves it in new directions. 3. Communicates the rationale for changing paths; charts new paths that lead to progress. 4. Endorses and thrives on taking risks that bring about change. 5. Demonstrates a positive feeling in the workplace and relates the importance of workers.

Avoiding

1. Withdrawn, very unassertive and uncooperative because these people neither pursue their own needs, goals or concerns immediately nor assist others to pursue theirs. 2. Appropriate uses: a. When facing trivial or temporary issues. b. When there is a no-win situation or when others can resolve the conflict more effectively. c. When negative results outweigh benefits. d. When people need to "cool down", distance themselves or gather more information.

Outcomes

1. can be good for one, bad for the other or good for both 2. intangible or tangible, consequence for action taken (resolve, stagnation, no action)

Authority

Ability to perform duties in a specific role

Managers

Address issues through organizing, staffing, controlling, and solving problems while leaders build teamwork, set direction, develop and communicate the direction to staff

Organizational Accountability

Adequate resources and appropriate nurse/UNP ratios

What is a leader?

An individual who works with others to develop a clear vision of the preferred future and to make that vision happen. 1. Individual that inspires others to bring a vision to reality. 2. Leadership is based on performance not formal position 3. Leadership is expected of all nurses 4. Leaders have followers, leaders inspire followers to follow.

Modes of Conflict Resolution

Avoiding Accommodating Competing Compromising Collaborating

The Role of the Direct Care Nurse (Primary Nursing)

Caregiver Advocate Decision maker Teacher Collaborator Care coordinator manager

Healthy Work Environments

Collaboration Communication Decision making Staffing Recognition Leadership Accountability Self Actualization

Model Selection

Considerations to be addressed when selecting a model: 1. Organizational mission and purpose- goals 2. Unit objectives 3. Patient population 4. Staff availability 5. Economic feasibility

Conflict

Defined as a disagreement in values or beliefs within oneself or between people that causes harm or has the potential to cause harm.

Delegation: 21st Century Goals

Delegate and supervise safe patient care. Evaluate the effectiveness of delegated tasks. Maintain accountability for safe, competent, and effective patient care. Acclimate to new advances in health care. Be an effective delegation decision maker.

Lateral Violence

Destructive behaviors or harassment of nurses against each other. (Peers with equal power)

Barriers to Leadership

False assumptions Time Constraints

Stages of Conflict

Frustration Conceptualization Action Outcomes

Informatics

Health Information Technology for Economic and Clinical Health (HITECH) Act 1. Federal government committed resources to encourage spread of electronic health records Electronic Health Records (EHRs) are expected to: 1. Increase participation in care by patients 2. Increase patient convenience and quality 3. Enhance quality of care 4. Improve health outcomes and accuracy of diagnoses 5. Improve cost savings and practice productivity Allows managers to better measure the acuity of nursing areas, as well as assist in budget planning and in matching patient needs with the right resources.

Improper Delegation

Improper follow through: 1. Delegator a. Failure to provide clear and concise directions related to the assigned task/activity 2. Delegatee a. Failure to report results/findings related to assigned tasks

Horizontal Violence

Involves conflictual behaviors among individuals who consider themselves peers with equal power but with little power in the system.

The Role of the Manager

Many roles in managing a unit. 7 foundational concepts of management today: 1. Management of personnel (salaries, evals) 2. Decentralization 3. Productivity 4. Manager development to ensure professional growth 5. Marketing of services 6. Long range planning for future needs

Leadership development

Mastering the art of persuasion and communication 1. Select a mentor 2. Lead by example 3. Accept responsibility 4. Share the rewards 5. Have a clear vision 6. Be willing to grow

Leadership Styles

Most can be categorized as authoritative, democratic, or laissez-faire. 1. Authoritative 2. Democratic 3. Laissez-faire

Integrating Elements

Need to have all of these to make effective delegative decisions: 1. Safety 2. Critical Thinking 3. Stability 4. Time

Five stages of nursing ability

Novice nurse Advanced beginner Competent nurse Proficient nurse Expert nurse

Nurse as a Leader

Nurse Executive Nurse Manager Direct Care Nurse Leadership in professional organizations Leadership in the community Leadership in elected offices

Intrapersonal conflict

Occurs within a person with the need to think or act in a way that seems at odds with one's sense of self.

The five major management functions are:

Planning Organizing Staffing Directing Controlling

Legal Authority

RNs ability to transfer selected nursing tasks/activities to a competent individual

Five rights of delegation

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

Bullying

Similar to lateral violence but there is a real or perceived power between the instigator and the recipient.

Staffing

The acquisition and management of adequate staff and staffing mix.

Clinical judgment

The decision made regarding a course of action based on a critical analysis of data when using knowledge is applied to a clinical situation. ■ This is used to: a. Analyze data and related evidence. b. Ascertain the meaning of the data and evidence. c. Determine client outcomes desired and/or achieved as indicated by evidence-based practices.

Planning

The decisions regarding what needs to be done, how it will be done, and who is going to do it.

Controlling

The evaluation of staff performance and evaluation of unit goals to ensure identified outcomes are being met.

Directing

The leadership role assumed by a manager that influences and motivates staff to perform assigned roles.

Interpersonal conflict

The most common type of conflict and transpires between and among patients, family members, nurses, physicians and members of other departments.

Organizing

The organizational structure that determines the lines of authority, channels of communication, and where decisions are made.

Action

behavior or response to conflict, seeking some resolution to conflict

American Organization of Nurse Executives (AONE)

developed a framework for nurse manager learning

Conceptualization

emphasis on what is important to each person

Frustration

not being heard, ideas being blocked, goals blocked leading to anger