Nursing Leadership & Management: Exam 1, Leadership & Management Exam 1, Ch. 23 Nursing Leadership and Management, Leadership and Management in Nursing, Nursing Leadership & Management Exam 1, Nursing Leadership & Management, Nursing Leadership & Man...

Leadership Styles

*Autocratic*- also called directive leadership or authoritarian leadership, involves the leader assuming complete control over the decisions and activities of the group. *Democratic*- also called participated leadership, is characterized by a sense of equality among the leader and other participants. *Laissez-faire*- also called nondirective leadership, the leader relinquishes power to the group, such that an outsider could not identify the leader in the group. *Transformational*- can create revolutionary change. *Situational*- theory considers the leadership style, the work's group maturity, and the situation at hand to form a comprehensive approach to management style. *Quantum*- leadership that moves beyond the traditional modes previously experienced by all levels of workers; spawned by the impact of the information age on work and the worker.

Conflict Resolution Strategies

*Avoiding-* awareness of the situation but the parties involved decided to ignore or avoid/postpone its resolution. *Collaborating-* win win situation. all parties set aside previously determined goals, determine a common goal, and accept mutual responsibility for achieving this goal. *Competing-* win for one party. win-lose *Compromising-* both parties must be willing to relinquish something of equal size. *Cooperating/Accommodating-* one party makes a conscious decision to let the other group win. but IOU's in the future. *Smoothing-* an effort to complement the other party and focus on agreement rather than disagreement thus reducing the emotion in the conflict.

Types of Power

*Explicit* —power by virtue of position *Implied* —power due to other factors, such as personality

Evolving Models of Nursing Care Delivery

*Functional nursing* Nurses and other staff are assigned to specific tasks for a group of patients. Based on the assembly-line concept found in industry; specializing tasks increases efficiency but results in impersonal *Team nursing* A team made up of a registered nurse and other caregivers provides care to a designated group of patients on a given shift. Modified the depersonalized approach of functional nursing and focused on individual patient care *Total care or Case nursing* A nurse as a caregiver provides total care to a group of patients for a designated shift. A patient-centered model; suffers from a lack of continuity between shifts and is expensive because of highly paid nurses provide all aspects of care. *Primary nursing* A nurse is accountable for planning, evaluating, and directing the care of a patient 24 hours a day throughout the patient's period of care. A model of providing comprehensive, individualized, and consistent care; expensive *Case management* One nurse is responsible for overseeing the quality and financial outcomes of patient care. The nurse works collegially with physicians and other caregivers as well as with payers to manage patients along an agreed-on clinical pathway *Patient-centered or Patient-focused care* Cross-functional teams consisting of groups of professionals and assistive personnel from various departments. These teams work together as a unit-based team to provide care to a given group of patients. Care is designed around the needs of the patients and not the needs of the departments or professionals *Collaborative practice model* Nurses and physicians work together in collaborative practice models

Gosling and Mintzberg (2003) Five Managerial Perspectives

*Reflective mindset*- allows managers to mentally digest experiences and relfect on them in a different way. *Analytical mindset*- encourages introspection so that one can recognize biases and see things in a unique way. *Worldly mindset*- recognizes cultures and contexts or "seeing differently out to reflect differently in" *Collaborative mindset*-involves listening more than talking and allowing people to take initiative and control their own work. *Action mindset*- mobilizes energy to change while being sensitive about the capabilities of the team and the direction that is needed.

Lewin's Theory of Change

*Unfreezing* —the need for change is recognized *Moving* —change is initiated after a careful process of planning *Refreezing* —change becomes operational

qualities of effective management include:

- leadership - professionalism - advanced clinical expertise - human resource management expertise - financial management - coordination of pt care - Involves a combination of leadership, clinical expertise, and business sense

Roles and responsibility of an RN

-Advanced clinical skills in caring for the ACUTE client with complex care needs; OUTCOME UNCERTAIN ** Nurse cannot delegate what you can EAT (Evaluate, Assess, Teach)

Managers

-Are always assigned a position within an organization -Have a legitimate source of power due to the delegated authority that accompanies their position -Are expected to carry out specific functions -Emphasize control, decision making, decision analysis, and results

Knowledge of Process for Planned Change

-Assessing: Force Field Analysis -Planning -Implementing -Evaluating

Roles and responsibility of an AP/UAP

-Basic Hygiene -Grooming -Reports to LPN or RN -Provides assistance with ADLs (Nutrition, elimination, & mobility -Basic skills: taking vital signs, including pulse oximetry & calculating I&O ** Emphasis is on maintaining a safe environment & recognizing situations to report to immediate superior

Top-level Managers

-Board of Directors -Chief Executive officer -Administrators

Planed Change Requires......

-Change Agent -Change Target -Knowledge of process

Transformational Leaders are

-Charismatic -Individually considerate -Intellectually simulating

Democratic Leadership

-Communication flows up and down -Emphasis on "we" not "I" -Input from many

Examples of Restraining Forces

-Conformity -Organizational culture that rewards complacency -Security/threat -To prestige -Economic threat -Fear of failure

Autocratic/Authoritarian Leadership

-Controlling, power-oriented, closed-minded -Communication flows down -May not be loved, but are liked for getting the job done. -Enjoy structure, feel a lot of pressure to succeed.

Disadvantages of the Organization Chart

-Does not show the informal structure of the organization -Does not indicate the degree of authority held by each line position -May show things as they are supposed to be or used to be rather than as they are -Possibility exists of confusing authority with status

Leaders

-Empower others; maximize workforce effectiveness -Needed to implement the planned change that is part of system improvement

Managers

-Guide, direct, and motivate others -Intervene when goals are threatened -Emphasize control

Shared Governance

-Introduced in the 1980s -Nurses at every level play a role in the decisions that affect nursing activity throughout the system -Usually defined by a structure of rules or bylaws -Groups are called "councils"

Qualities of Nurse-Manager a True Blended Role: Manager and Leader

-Knowledgeable and skilled in nursing practices -Competent in all aspects of management -Excellent communicator -Effective team builder -Proactive in preparing for emerging new threats

Advantages of the Organization Chart

-Maps lines of decision-making authority -Helps people understand their assignments and those of their coworkers -Reveals to managers and new personnel how they fit into the organization -Contributes to sound organizational structure -Shows formal lines of communication

Roles and responsibility of an LPN

-Meets health needs of clients -Cares for clients whose condition is considered to be STABLE &/or CHRONIC w/an EXPECTED OUTCOME -Performs REINFORCEMENT teaching -Contributes to care plan -Administers IVPB (premixed & not the 1st dose) -Monitors IV fluids

Bureaucracy as an organizational design

-Must be a clear division of labor -A well-defined hierarchy of authority must exist -There must be impersonal rules -There must be a system for dealing with work situations -There must be a system of rules for covering the rights and duties of each position -Selection for employment must be based on technical competence

Minimizing Conflict

-Mutual trust -Do not use inflammatory language -Create homogenous groups -Reduce status difference (level them, co-leaders) -Reduce communication distortions -Reduce interdependence - Increase resources and rewards -Increase meaningful interaction -Superordinate goals: bring people together to accomplish goal.

Ways Change Happens

-Naturally: accidents, acts of God: when not deliberate -Emulative: through identification with power figures. Lead by example. -Empirical-Rational: When people see changes as beneficial to their personal interest. -Socialization: When one conforms to needs of a social group. -Power-Coercive: Person in power orders change. -Normative-Re-educative: Occurs when values, attitudes, skills and important relationships change. -Forms of mutual goal setting -Technocratic: through data collection and analysis.

Middle-level Managers

-Nursing supervisors -Department heads

Leadership (list)

-Often Informal -Encompasses more area -Deals with influence over others behaviors -Require competence in diagnosing, adapting, and communicating. -Have followers by virtue of personal characteristics

Leaders

-Often do not have delegated authority, but obtain their power through other means -Have a wider variety of roles than managers and may have different personal goals -Are frequently not part of the formal organization -Focus on group process, information gathering, feedback, and empowering others

Laissez-faire Leadership

-Passive, ineffective, unproductive -Mature followers can be successful (don't have to tell anyone to do anything d/t their experience and education; leaders can get in the way) -Would work well in CCRU

ex of strength based nursing leadership

-Paying attention to multiple points of view -Searching for common ground -Prioritizing continuous learning in the workplace -Promoting collaborative relationships (Wong)

Areas of Management Function

-Planning: What is to be accomplished. Determining long and short term objectives of the organization and means to achieve these ends. For examples: planning implementation of new supply system. -Organizing: Mobilizing human and material resources in order to achieve objectives. For example: determining how much staff on each shift -Directing: Motivating, leading, instructing personnel to carry out action needed to achieve objectives. For example, instructing staff to take ER admissions immediately. -Controlling: Comparing results with predetermined standards of performance and taking corrective action when indicated. For example: budget, performance appraisals, quality improvement initiatives.

Examples of Driving Forces

-Pressure from manager -Wish to improve self -Wish to conform to group -Desire to improve care -Wish to be seen as cooperative

focus of Greenleaf's Servant Leadership

-Putting others, including employees, customers, and the community as the number one priority -Fostering a service inclination in others that promotes collaboration, teamwork, and collective activism

Transactional

-Rewards based on task completion -Motivate and high satisfaction "do this for me"

Service line organization

-Sometimes called care-centered organizations -Smaller in scale than large bureaucratic systems

Organization Structure Terminology

-Span of Control -Unity of Command -Scalar Chain -Authority -Responsibility -Accountability

First-level Managers

-Team leaders -Charge nurses -Primary care nurses -Case managers

Organizational Culture ad

-The values and behaviors that contribute to the unique social and psychological environment of an organization -A sum total of values, language, past history of "sacred cows," formal and informal communication networks, and the rituals of an organization

Ad hoc design (ST solution)

-Uses a project team or task approach and is usually disbanded after a project is completed -Overcomes the inflexibility of line structure

Strength Based Nursing Leadership

-Works with the whole, while appreciating the interrelationships among its parts -Recognizes the uniqueness of staff, nurse-leaders, and the organization -Creates work environments that promote nurses' health and facilitate their development -Understands the significance of subjective reality and created meaning -Values self-determination -Recognizes that person and environment are integral and that nurses function best in environments where there is a "goodness of fit" that capitalizes on their strengths -Creates environments that promote learning and recognizes the importance of readiness and timing -Invests in collaborative partnerships

four common traits of born leaders are the management of:

-attention -meaning -trust -self

Three competencies of leadership

-diagnose -adapt -communicate

decisional activities of management include

-employee evaluation -resource allocation -hiring/firing employees -planning for the future -job analysis and redesign

interpersonal activities of management include

-networking -conflict negotiation and resolution -employee development -coaching

informational activities of management include

-spokesperson -monitoring -reporting

Conflict Assessment

1) Type of conflict 2) Phase of conflict development 3)Seriousness of disagreement *Note: The assessment is important; the manager doesn't intervene unless the conflict is causing loss of productivity, endangers safety, or causes other major issues, the management must intervene.

Define deontology (formalism):

1)act is good only if it springs from good will 2)does not allow for actions based on concepts

Advantages of face to face and walking reports:

1)allow for questions to be exchanged between RNs 2)two RNs assessing the pt's situation & pt's participation

What is an advanced directive:

1)an end of life decision made by a patient in advance of the actual need 2)"living will"

What is transactional leadership?

1)an exchange between leader and the employee 2)needs of employee are identified & the leader provides rewards exchange for performance 3)takes place in HIERARCHAL ORGANIZATION

What is modular nursing?

1)based on the physical layout of the unit 2)have a group of staff & group of pt 3)pt grouped by floor plan clustering 4)standardized assignment

What are the ways to give report?

1)change of shift- face to face review of pt 2)tape recorded reports- give pertinent info 3)walking reports- walk to pt room to give report

What are the variables in the number of medical errors that occur in hospitals?

1)communication 2)lack of a consistent process of communication of patient condition

What does Medicare part A cover?

1)covers hospital stays or extended stays at a skilled nursing facility 2)max length is 100 days: first 20 days completely covered remaining 80 require a co pay 3)hospice & home health

Part D Medicare Program:

1)effective jan 1, 2006 2)eligible if have medicare a or b 3)can be enrolled in a stand alone prescription drug plan 4)is NOT standardized 5)plans/insurance co decided what is(not) covered 6)for people 65+, some disabled & people with end stage renal disease

What are the disadvantages of case management?

1)fragmented communication 2)needs to be integrated into care delivery model

Define what a competent RN is:

1)has been practicing 2 to 3 years- can prioritize/cope with various contingencies 2)needs help with situations not yet experienced

Define what an advanced RN is:

1)has enough experience to recognize patterns in work nut continues to need help in setting priorities 2)relies on rules/protocols

Define what a proficient RN is:

1)has enough experience to see the big picture 2)decision making is efficient/accurate 3)able to prioritize/plan even more challenging care

Define private agencies:

1)have volunteering governing bodies 2)not governed by US government 3)required to meet state licensing requirements and regulations 4)for profit or not for profit

Define medicare:

1)health insurance program for people aged 65 + 2)those under 65 with certain disabilities 3)any age with end stage renal disease

Part A Medicare Program Criteria:

1)hospital admission must be at least 3 days 2)nursing home admission must be for a condition that was diagnosed in the hospital 3)care in the nursing home must be skilled

What are the 3 I's used to help manage your workplace?

1)identify your priorities 2)Interact differently with others 3)Initiate action

What are the advantages of primary nursing?

1)improved quality of care 2)simplified communication 3)increased RN satisfaction 4)pt feels care is more personalized

What are the disadvantages of primary nursing?

1)increased # of RN 2)pt satisfaction results inconclusive 3)difficult to implement with pt that has multi unit transfers

What are some issues associated with delegation?

1)lack of training on how to delegate 2)poor communication/interpersonal skills 3)lack of resources 4)insecure delegator 5)unwilling delegate 6)lack of trust in others

What are the benefits of the JCO?

1)leads to improved pt care 2)demonstrates organizations commitment to safety 3)offers an educational on site survey experience 4)supports and enhances safety and quality improvement efforts 5)strengthens and supports recruitment 6)helps secure managed care contracts 7)provides a competitive advantage 8)fullfils licensure requirements 9)recognized by insures 10)strengthens community confidence

Define upper level manager:

1)middle manager reports to 2)responsible for establishing organizational goals & strategic plans for entire division

Define what a expert RN is:

1)no longer relies on rules to understand a situation 2)focuses quickly on viable situation 3)able to lead a team efficiently 4)can organize others work/supervise them

What are the levels of compliance?

1)noncompliance 2)partial compliance 3)substantial compliance

What can be delegated?

1)noninvasive/nonsterile treatments - foley care 2)collection/report of data - v/s, weight, BS 3)hygiene care, ambulation 4)socialization activity

What is primary nursing?

1)one to one approach to pt care 2)24hr responsibility for care during hospital stay 3)primary RN works with RN on other shifts to coordinate care 4)decision making at pt bedside 5)care can be delegated to other staff

Part B Medicare Program:

1)optional program that covers services not covered in part a 2)vaccinations, diagnostic testing covered 3)medication administration covered only in MD administers during an office visit 4)covers durable medical equip. (walkers, wheelchairs & prostheses)

What items should be made available when speaking with a MD?

1)patient chart 2)list of current meds, allergies, IV fluids & labs 3)most recent v/s, EKG 4)lab results- provide date/time when completed 5)code status

Part C Medicare Program:

1)patients are able to chose to receive their medicare benefits through private insurance plans 2)known as medicare advantage plan

When communication with patients/staff the RN must remember:

1)patients/families are customers and should be communicated to your honesty & respect 2)need to find a balance between medical jargon & too simple 3)provide angry guests with a place to communicate concerns 4)provide interpreter services 5)learn the cultural issues to be able to recognize communication issues

What are the advantages of case management?

1)provide professional practice model for nurses 2)is cost effective

What can't be delegated?

1)pt assessment 2)planning/evaluation of care 3)development of care 4)pt teaching

What pointers/info may assist the oncoming RN?

1)report vital info (allergies, code status, dx, critical labs) 2)review current status & therapeutics 3)discuss upcoming plans 4)review discharge plan 5)pertinent info to care

What are the 5 rights of delegation? BOX 3-2

1)right task 2)right circumstance 3)right person 4)right direction/communication 5)right supervision

Define ethics:

1)science that deals with the principles of right and wrong and of good and bad 2)governs our relationships with others 3)is based on personal beliefs/values

5 principles of effective communication:

1)sender of communication is responsible for clarity & the receiver has to translate the message 2)use simple, exact language 3)communication encourages feedback 4)sender must have credibility (trustworthy/reliable) 5)use of direct communication channels (less chance of distortion)

S.B.A.R. stand for?

1)situation: id self, unit, pt/room #, state the problem, when it happened, & severity 2)background: admitting dx & date of admission, list of meds, allergies, IV fluids, labs, recent v/s, lab results, code status 3)assessment: most recent assessment 4)recommendation: notify that pt has been admitted, pt needs to be seen now & order change

Define world health organization:

1)specialized agency of the UN that acts as a coordinating authority on international public health 2)est in 1948

Define health:

1)state of complete physical, emotional, mental wellbeing 2)resource of everyday life, not the object of living

Define middle level manager:

1)supervises first level manager within a specified area 2)responsible for people & activity in those areas 3)acts as a liaison between 1st & upper level management

10 rules of email etiquette:

1)use it the way u want everyone to use it 2)take another look before u send an email 3)quote original messages properly in replies 4)avoid sarcasm, irony, & emotional tones 5)clean up emails before forwarding 6)send plain text 7)writing in all caps is shouting 8)ask before you send large attachments 9)use of smiley faces raises an alarm 10)avoid me too messages

Define teleology:

1)values of a situation is determined by its consequences 2)the outcome is what counts not the actions 3)"the end justifies the means"

10 Fatal Leadership Flaws

1. A lack of energy and enthusiasm 2. Acceptance of their own mediocre performance 3. Lack of a clear vision and direction 4. Having poor judgment 5. Not collaborating 6. Not walking the talk 7. Resisting new ideas 8. Not learning from mistakes 9. A lack of interpersonal skills 10. Failing to develop others

1. Quality of nursing leadership 2. Organizational structure 3. Management style 4. Personnel policies and programs 5. Professional models of care 6. Quality of care 7. Quality improvement 8. Consultation and resources 9. Autonomy 10. Community and the hospital 11. Nurses as teachers 12. Image of nursing 13. Interdisciplinary relationships 14. Professional development

14 Forces of Magnetism:

balanced processing, internalized moral perspective, relational transparency, and self-awareness

4 factors that cover the components of authentic leadership

purpose values heart relationships self-discipline

5 distinguishing characteristics of authentic leader:

Change (Powerpoint)

A significant disruption in established patterns of behavior and/ or expectations.

Situational

Adapt different style based on the situation or experience of the subordinate.

ACCORD- Conflict Resolution Process

Agree to collaborate- Agree to work together and resolve. Clarify the needs of both-Both identify perspectives and needs; theirs first; avoid premature problem solving. Confirm understanding - summarize and clarify needs of all Offer options-Involve other party in searching for best possible list of alternatives Reach agreement- Select a few options acceptable to both and mentally/ verbally test each. Determine appropriate next steps- Work out an implementation plan and time frame to revisit. Acknowledge progress.

Transformation Leadership (Book)

An act of encouraging followers to follow the leaders style and change their interest with concern for a broader goal.

Katherine is a young Unit Manager of the Pediatric Ward. Most of her staff nurses are senior to her, very articulate, confident and sometimes aggressive. Katherine feels uncomfortable believing that she is the scapegoat of everything that goes wrong in her department. Which of the following is the best action that she must take? A. Identify the source of the conflict and understand the points of friction B. Disregard what she feels and continue to work independently C. Seek help from the Director of Nursing D. Quit her job and look for another employment.

Answer: A. Identify the source of the conflict and understand the points of friction This involves a problem solving approach, which addresses the root cause of the problem.

She wants to ensure that every task is carried out as planned. Which of the following tasks is NOT included in the controlling process? A. Instructing the members of the standards committee to prepare policies B. Reviewing the existing policies of the hospital C. Evaluating the credentials of all nursing staff D. Checking if activities conform to schedule

Answer: A. Instructing the members of the standards committee to prepare policies Instructing the members involves a directing function.

When she presents the nursing procedures to be followed, she refers to what type of standards? A. Process B. Outcome C. Structure D. Criteria

Answer: A. Process Process standards include care plans, nursing procedure to be done to address the needs of the patients.

He plans for his sampling method. Which sampling method gives equal chance to all units in the population to get picked? A. Random B. Accidental C. Quota D. Judgment

Answer: A. Random Random sampling gives equal chance for all the elements in the population to be picked as part of the sample.

Which criteria refer to the ability of the instrument to detect fine differences among the subjects being studied? A. Sensitivity B. Reliability C. Validity D. Objectivity

Answer: A. Sensitivity Sensitivity is an attribute of the instrument that allow the respondents to distinguish differences of the options where to choose from

Ms. Valencia is responsible to the number of personnel reporting to her. This principle refers to: A. Span of control B. Unity of command C. Carrot and stick principle D. Esprit d' corps

Answer: A. Span of control Span of control refers to the number of workers who report directly to a manager.

She plans of assigning competent people to fill the roles designed in the hierarchy. Which process refers to this? A. Staffing B. Scheduling C. Recruitment D. Induction

Answer: A. Staffing Staffing is a management function involving putting the best people to accomplish tasks and activities to attain the goals of the organization.

Which of the following is evidence that the controlling process is effective? A. The things that were planned are done B. Physicians do not complain. C. Employees are contended D. There is an increase in customer satisfaction rate.

Answer: A. The things that were planned are done Controlling is defined as seeing to it that what is planned is done.

Which of the following terms refer to the degree to which an instrument measures what it is supposed to be measure? A. Validity B. Reliability C. Meaningfulness D. Sensitivity

Answer: A. Validity Validity is ensuring that the instrument contains appropriate questions about the research topic

He plans to use a Likert Scale to determine A. degree of agreement and disagreement B. compliance to expected standards C. level of satisfaction D. degree of acceptance

Answer: A. degree of agreement and disagreement Likert scale is a 5-point summated scale used to determine the degree of agreement or disagreement of the respondents to a statement in a study.

Which of the following articles would Kevin least consider for his review of literature? A. "Story-Telling and Anxiety Reduction Among Pediatric Patients" B. "Turnaround Time in Emergency Rooms" C. "Outcome Standards in Tertiary Health Care Institutions" D. "Environmental Manipulation and Client Outcomes"

Answer: B. "Turnaround Time in Emergency Rooms" The article is for pediatric patients and may not be relevant for adult patients.

Which of the following statements refers to criteria? A. Agreed on level of nursing care B. Characteristics used to measure the level of nursing care C. Step-by-step guidelines D. Statement which guide the group in decision making and problem solving

Answer: B. Characteristics used to measure the level of nursing care Criteria are specific characteristics used to measure the standard of care.

Alexandra is tasked to organize the new wing of the hospital. She was given the authority to do as she deems fit. She is aware that the director of nursing has substantial trust and confidence in her capabilities, communicates through downward and upward channels and usually uses the ideas and opinions of her staff. Which of the following is her style of management? A. Benevolent -authoritative B. Consultative C. Exploitive-authoritative D. Participative

Answer: B. Consultative A consultative manager is almost like a participative manager. The participative manager has complete trust and confidence in the subordinate, always uses the opinions and ideas of subordinates and communicates in all directions.

She tries to design an organizational structure that allows communication to flow in all directions and involve workers in decision making. Which form of organizational structure is this? A. Centralized B. Decentralized C. Matrix D. Informal

Answer: B. Decentralized Decentralized structures allow the staff to make decisions on matters pertaining to their practice and communicate in downward, upward, lateral and diagonal flow.

Raphael is interested to learn more about transcultural nursing because he is assigned at the family suites where most patients come from different cultures and countries. Which of the following designs is appropriate for this study? A. Grounded theory B. Ethnography C. Case study D. Phenomenology

Answer: B. Ethnography Ethnography is focused on patterns of behavior of selected people within a culture

St. Raphael Medical Center just opened its new Performance Improvement Department. Ms. Valencia is appointed as the Quality Control Officer. She commits herself to her new role and plans her strategies to realize the goals and objectives of the department. Which of the following is a primary task that they should perform to have an effective control system? A. Make an interpretation about strengths and weaknesses B. Identify the values of the department C. Identify structure, process, outcome standards & criteria D. Measure actual performances

Answer: B. Identify the values of the department Identify the values of the department will set the guiding principles within which the department will operate its activities

Which phase of the employment process includes getting on the payroll and completing documentary requirements? A. Orientation B. Induction C. Selection D. Recruitment

Answer: B. Induction This step in the recruitment process gives time for the staff to submit all the documentary requirements for employment.

She notes that there is an increasing unrest of the staff due to fatigue brought about by shortage of staff. Which action is a priority? A. Evaluate the overall result of the unrest B. Initiate a group interaction C. Develop a plan and implement it D. Identify external and internal forces.

Answer: B. Initiate a group interaction Initiate a group interaction will be an opportunity to discuss the problem in the open.

As a young manager, she knows that conflict occurs in any organization. Which of the following statements regarding conflict is NOT true? A. Can be destructive if the level is too high B. Is not beneficial; hence it should be prevented at all times C. May result in poor performance D. May create leaders

Answer: B. Is not beneficial; hence it should be prevented at all times Conflicts are beneficial because it surfaces out issues in the open and can be solved right away. Likewise, members of the team become more conscientious with their work when they are aware that other members of the team are watching them.

The nursing theorist who developed transcultural nursing theory is A. Dorothea Orem B. Madeleine Leininger C. Betty Newman D. Sr. Callista Roy

Answer: B. Madeleine Leininger Madeleine Leininger developed the theory on transcultural theory based on her observations on the behavior of selected people within a culture.

Which pattern of nursing care involves the care given by a group of paraprofessional workers led by a professional nurse who take care of patients with the same disease conditions and are located geographically near each other? A. Case method B. Modular nursing C. Nursing case management D. Team nursing

Answer: B. Modular nursing Modular nursing is a variant of team nursing. The difference lies in the fact that the members in modular nursing are paraprofessional workers.

Aubrey thinks about primary nursing as a system to deliver care. Which of the following activities is NOT done by a primary nurse? A. Collaborates with the physician B. Provides care to a group of patients together with a group of nurses C. Provides care for 5-6 patients during their hospital stay. D. Performs comprehensive initial assessment

Answer: B. Provides care to a group of patients together with a group of nurses This function is done in team nursing where the nurse is a member of a team that provides care for a group of patients.

She checks the documentary requirements for the applicants for staff nurse position. Which one is NOT necessary? A. Certificate of previous employment B. Record of related learning experience (RLE) C. Membership to accredited professional organization D. Professional identification card

Answer: B. Record of related learning experience (RLE) Record of RLE is not required for employment purposes but it is required for the nurse's licensure examination.

He checks if his instruments meet the criteria for evaluation. Which of the following criteria refers to the consistency or the ability to yield the same response upon its repeated administration? A. Validity B. Reliability C. Sensitivity D. Objectivity

Answer: B. Reliability Reliability is repeatability of the instrument; it can elicit the same responses even with varied administration of the instrument

Ms. Valencia develops the standards to be followed. Among the following standards, which is considered as a structure standard? A. The patients verbalized satisfaction of the nursing care received B. Rotation of duty will be done every four weeks for all patient care personnel. C. All patients shall have their weights taken recorded D. Patients shall answer the evaluation form before discharge

Answer: B. Rotation of duty will be done every four weeks for all patient care personnel. Structure standards include management system, facilities, equipment, materials needed to deliver care to patients. Rotation of duty is a management system.

He thinks of an appropriate theoretical framework. Whose theory addresses the four modes of adaptation? A. Martha Rogers B. Sr. Callista Roy C. Florence Nightingale D. Jean Watson

Answer: B. Sr. Callista Roy Sr. Callista Roy developed the Adaptation Model which involves the physiologic mode, self-concept mode, role function mode and dependence mode

Kevin is a member of the Nursing Research Council of the hospital. His first assignment is to determine the level of patient satisfaction on the care they received from the hospital. He plans to include all adult patients admitted from April to May, with average length of stay of 3-4 days, first admission, and with no complications. Which of the following is an extraneous variable of the study? A. Date of admission B. Length of stay C. Age of patients D. Absence of complications

Answer: C. Age of patients An extraneous variable is not the primary concern of the researcher but has an effect on the results of the study. Adult patients may be young, middle or late adult.

Katherine tells one of the staff, "I don't have time to discuss the matter with you now. See me in my office later" when the latter asks if they can talk about an issue. Which of the following conflict resolution strategies did she use? A. Smoothing B. Compromise C. Avoidance D. Restriction

Answer: C. Avoidance This strategy shuns discussing the issue head-on and prefers to postpone it to a later time. In effect the problem remains unsolved and both parties are in a lose-lose situation.

He opts to use a self-report method. Which of the following is NOT TRUE about this method? A. Most direct means of gathering information B. Versatile in terms of content coverage C. Most accurate and valid method of data gathering D. Yields information that would be difficult to gather by another method

Answer: C. Most accurate and valid method of data gathering The most serious disadvantage of this method is accuracy and validity of information gathered

Which of the following statements is NOT true about performance appraisal? A. Informing the staff about the specific impressions of their work help improve their performance. B. A verbal appraisal is an acceptable substitute for a written report C. Patients are the best source of information regarding personnel appraisal. D. The outcome of performance appraisal rests primarily with the staff.

Answer: C. Patients are the best source of information regarding personnel appraisal. The patient can be a source of information about the performance of the staff but it is never the best source. Directly observing the staff is the best source of information for personnel appraisal.

Ms. Valencia prepares the process standards. Which of the following is NOT a process standard? A. Initial assessment shall be done to all patients within twenty four hours upon admission. B. Informed consent shall be secured prior to any invasive procedure C. Patients' reports 95% satisfaction rate prior to discharge from the hospital. D. Patient education about their illness and treatment shall be provided for all patients and their families.

Answer: C. Patients' reports 95% satisfaction rate prior to discharge from the hospital. This refers to an outcome standard, which is a result of the care that is rendered to the patient.

In a horizontal chart, the lowest level worker is located at the A. Left most box B. Middle C. Right most box D. Bottom

Answer: C. Rightmost box The leftmost box is occupied by the highest authority while the lowest level worker occupies the rightmost box.

Which of the following variables will he likely EXCLUDE in his study? A. Competence of nurses B. Caring attitude of nurses C. Salary of nurses D. Responsiveness of staff

Answer: C. Salary of nurses Salary of staff nurses is not an indicator of patient satisfaction, hence need not be included as a variable in the study.

There are times when Katherine evaluates her staff as she makes her daily rounds. Which of the following is NOT a benefit of conducting an informal appraisal? A. The staff member is observed in natural setting. B. Incidental confrontation and collaboration is allowed. C. The evaluation is focused on objective data systematically. D. The evaluation may provide valid information for compilation of a formal report.

Answer: C. The evaluation is focused on objective data systematically. Collecting objective data systematically can not be achieved in an informal appraisal. It is focused on what actually happens in the natural work setting.

She knows that performance appraisal consists of all the following activities EXCEPT: A. Setting specific standards and activities for individual performance. B. Using agency standards as a guide. C. Determine areas of strength and weaknesses D. Focusing activity on the correction of identified behavior.

Answer: D. Focusing activity on the correction of identified behavior. Performance appraisal deal with both positive and negative performance; is not meant to be a fault-finding activity

The following are basic steps in the controlling process of the department. Which of the following is NOT included? A. Measure actual performance B. Set nursing standards and criteria C. Compare results of performance to standards and objectives D. Identify possible courses of action

Answer: D. Identify possible courses of action This is a step in a quality control process and not a basic step in the control process.

Kathleen knows that one of her staff is experiencing burnout. Which of the following is the best thing for her to do? A. Advise her staff to go on vacation. B. Ignore her observations; it will be resolved even without intervention C. Remind her to show loyalty to the institution. D. Let the staff ventilate her feelings and ask how she can be of help.

Answer: D. Let the staff ventilate her feelings and ask how she can be of help. Reaching out and helping the staff is the most effective strategy in dealing with burn out. Knowing that someone is ready to help makes the staff feel important; hence her self-worth is enhanced.

She decides to have a decentralized staffing system. Which of the following is an advantage of this system of staffing? A. greater control of activities B. Conserves time C. Compatible with computerization D. Promotes better interpersonal relationship

Answer: D. Promotes better interpersonal relationship Decentralized structures allow the staff to solve decisions by themselves, involve them in decision making; hence they are always given opportunities to interact with one another.

She conducts a 6-month performance review session with a staff member. Which of the following actions is appropriate? A. She asks another nurse to attest the session as a witness. B. She informs the staff that she may ask another nurse to read the appraisal before the session is over. C. She tells the staff that the session is manager-centered. D. The session is private between the two members.

Answer: D. The session is private between the two members. The session is private between the manager and the staff and remains to be so when the two parties do not divulge the information to others.

She decides to illustrate the organizational structure. Which of the following elements is NOT included? A. Level of authority B. Lines of communication C. Span of control D. Unity of direction

Answer: D. Unity of direction Unity of direction is a management principle, not an element of an organizational structure.

Leadership Styles (ATI)

Authoritative, Democratic, Laissez-faire

The right to make one's own decisions is called?

Autonomy

The obligation to do good for others is called?

Beneficence

Anger (personal emotions process through change)

Blames others; may demonstrate envy, rage, resentment.

Leadership Qualities

Charismatic Dynamic Enthusiastic Poised Confident Self-directed Flexible Knowledgeable Politically aware

Leadership Roles

Coach Counselor Teacher Forecaster Visionary Influencer Creative problem solver Change agent Diplomat Role model

Situational

Combination style. -Longer-range thinker -Look outward toward the larger organization -Influence others beyond their workgroup -Vision, values and motivation are emphasized -Politically astute -Think in terms of change and renewal

Leadership Skills

Communication Problem solving Management Self-evaluation

The obligation to observe the privacy of another and maintain strict confidence

Confidentiality

Staffing

Consists of recruiting, interviewing, hiring, and orienting staff. Scheduling, staff development, employee socialization, and team building are also often included as staffing functions

Good Managers

Coordinate resources Optimize resource use Meet organizational goals and objectives Follow rules Plan, organize, control, and direct Use reward and punishment effectively to achieve organizational goals

Denial (personal emotions process through change)

Denies changes will occur, may experience negative changes in health.

Matrix Organizations

Designed to focus on both the product and the function

Chaos (personal emotions process through change)

Diffused energy, feelings of powerfulness, insecurity, disorientation.

planning

Encompasses determining philosophy, goals, objectives, policies, procedures, and rules; carrying out long- and short-range projections; determining a fiscal course of action; and managing planned change

Good Leaders

Envision the future Communicate their visions Motivate followers Lead the way Influence others to accomplish goals Inspire confidence Take risks Empower followers Master change

Steps for Using Time Effectively

Establish goals and priorities for each day. Evaluate goals in terms of your ability to meet needs of patients. Establish a time line. Evaluate your success or failure in managing time. Use these results to direct your next day's priorities and time line.

Overcoming Resistance to Change

Explain proposed change to all affected. List the advantages of the change. Relate the change to the person's existing beliefs and values. Provide opportunities for open communication and feedback. Indicate how change will be evaluated. Introduce change gradually. Provide incentives for commitment to change.

Re-emergence (personal emotions process through change)

Feelings of empowerment as new project are initiated.

The obligation to be faithful to an agreement and responsibilities, to keep promises

Fidelity

-hierarchical layers -bureaucracy

Flat Organizational Designs: -Remove _________ by flattening the scalar chain and decentralizing the organization -Continue to have line authority, but because the organizational structure is flattened, more authority and decision making can occur where the work is being carried out -Despite being very flat, often retain many characteristics of a ________.

future-oriented problem-oriented

Ideas put forth by thought leaders are ___________ and generally ____________

Achieving Self-Knowledge

Identify your strengths. Evaluate how you accomplish work. Clarify your values. Determine where you belong and what you can contribute. Assume responsibility for relationships.

managers top of the hierarchy

In organizations with centralized decision making, a few _______ at the ________ make most of the decisions .

Organization

Includes establishing the structure to carry out plans, determining the most appropriate type of patient care delivery, and grouping activities to meet unit goals. Other functions involve working within the structure of the organization and understanding and using power and authority appropriately

Controlling

Includes performance appraisals, fiscal accountability, quality control, legal and ethical control, and professional and collegial control

Factors Prompting Change in Healthcare Industry

Increased number of chronically ill and older people Increased role of government and industry in healthcare Rising cost of healthcare Changing patterns of healthcare delivery

Nursing Care That Should Never Be Delegated Except to an RN

Initial and ongoing nursing assessment of patient Determination of nursing diagnosis, plan, progress, and evaluation of care delivered to patient Supervision and education of nursing personnel; patient teaching requiring assessment of the patient's educational needs Any other nursing intervention requiring professional nursing knowledge, judgment, or skill

Characteristics of Leaders ( ATI)

Initiative Inspiration Energy Positive Attitude Communication skills Respect Problem-solving and critical-thinking skills

Transformational

Inspirational, motivational, loyal, democratic, promote autonomy and shared responsibility Focus on vision and empowerment Takes time to complete tasks "nurses have been over managed and under led"

The obligation to be fair to all people (when allocating limited resources)

Justice

1. Modeling the way 2. Inspiring a shared vision 3. Challenging the process 4. Enabling others to act 5. Encouraging the heart

Kouzes and Posner's 5 Practices for exemplary leadership:

____ leadership, also known as permissive and nondirective, means "let someone do" and includes very little planning/decision making. This fails to encourage others to plan/make decision making.

Laissez-faire

-Strength based leadership -servant leadership -emotional intelligence and authentic leadership -quantum and thought leadership

Leader-Manager's Repertoire for the Twenty-First Century:

ANCC 4 yrs

Magnet Hospital: ____ Accredidation for __ years.

-decentralized organizational open, participatory

Magnet Hospitals: -Well qualified nurse executives in a ______ environment, with ______ structures that emphasize ____, ______ management -Autonomous, self-managing, self-governing climates that allow nurses to fully practice their clinical expertise, flexible staffing, adequate staffing ratios, and clinical career opportunities -Professional practice culture

-formal vertical and horizontal chain of command -hierarchy -Slow decision making -confusions and frustration dual-authority

Matrix Organization: -Have a _________&_________ chain of command. -Have fewer formal rules and fewer levels of the ________. -Can cause _____________ due to information sharing. -Can produce__________ & _________ for workers because of ________ hierarchical design

Developing Leadership Responsibilities

Mentorship Preceptorship Nursing organizations Continuing education

-Line structures -Ad hoc design -service line organization

Name types of organizational structures:

The obligation not to harm others (Hippocrates states, "First, do no harm.")

Nonmaleficence

Shared Governance

Nurse-managers move out of traditional industrial model roles into collegial models, becoming moderators of the service process

-Staffing -Focus on finances -HCAHPS surveys -Manager to staff communication -Technology integration and safe use -Conflict Management: interpersonal or intragroup

Nursing Management Challenges:

External Change/ External Forces (Powerpoint)

Originate outside the person or organization. Examples: Costs, Demands for quality, New laws or requirements for care providers.

Assuming the right to make decisions for another

Paternalism

Considerations When Delegating Nursing Care

Patient's condition Complexity of the activity Potential for harm Degree of problem solving and innovation necessary Level of interaction required with the patient Capabilities of the UAP Availability of professional staff to accomplish workload

Change Agent (Powerpoint)

Person responsible for leading change effort. Example: Nurse Manager.

Leader (Book)

Person who demonstrates and excursuses influence and power over others.

Role of Nurse Manager

Planning Organizing Directing Controlling

anticipated, planned for and embraced

Quantum Leadership: Change is a constant to be ______ _______ _______ as necessary

complex and dynamic

Quantum Leadership: Suggests that the environment and context in which people work is ______ & ________ and that this has a direct impact on organizational productivity

The Five Rights of Delegation

Right task Right circumstances Right person Right direction/communication Right supervision

Henri Fayol

Roles of Manager 1925...from this the management process arose.

Openness (personal emotions process through change)

Some renewal of energy and willingness to take on new roles or assignments as result of change.

internal and external

Stakeholders may be both _____ & _______

greater community of stakeholders

Stakeholders: every organization should be viewed as being part of a _________ of _______

Quantum Leadership

States that leaders must work together with subordinates to identify common goals, exploit opportunities, and empower staff to make decisions for organizational productivity to occur

worker's strengths

Strength based nursing leadership focuses on the development or empowerment of ____ _____.

authentic leadership

Suggests that in order to lead, leaders must be true to themselves and their values and act accordingly

Frederick Taylor

The father of "scientific management" during Industrial Revolution 1900-1930....(time and motion studies, paid piece work, efficiency...think automobile factory line....doing same job over and over!

ANA Principles for Delegating Care

The nursing profession determines the scope of nursing practice The nursing profession defines and supervises UAPs involved in providing direct nursing care The RN is responsible and accountable for nursing practice The RN supervises any assistant providing direct patient care The purpose of UAP is to work in supportive role to the RN

organizational culture

The perception may be accurate or inaccurate, and people in the same organization may have different perceptions about the same organization

Manager (Book)

The person with accountability for a group of people.

Stakeholders

Those entities in an organization's environment that play a role in the organization's health and performance, or that are affected by the organization

risk-taking and vision in terms of being innovative

Thought leaders attract followers not by any promise of representation or empowerment, but by their ___________.

Reasons for Resistance to Change

Threat to self Lack of understanding Limited tolerance for change Disagreements about the benefits of change Fear of increased responsibility

What is the nurse's role with regards to informed consent?

To witness the client signature Provide clarification to info already given by the provider (do not give new info) Advocate for the client by protecting the client's rights

Planning organization command coordination control

Traditional view "Roles of a Manager":

Bargaining (personal emotions process through change)

Tries to eliminate change "If only talk"

Directing

Usually entails human resource management responsibilities, such as motivating, managing conflict, delegating, communicating, and facilitating collaboration

The obligation to tell the truth

Veracity

Considerations for Planned Change

What is amenable to change? How does the group function as a unit? Is the group ready for change and at what rate? Are the changes major or minor?

-UMMS, other local hospitals and employers -Other colleges and universities that transfer students to us. -Local businesses, apt owners, etc.

Who are the stake holders of UMSON?

Laissez-faire

Will work with very mature work group, motivated; "directionless".

6.9%

___% of hospitals are accredited as Magnet Hospitals.

Define leadership:

ability to influence people to work toward the meeting of stated goals

Define JCO:

accreditation organization that strives to continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations

Define management:

act of planning, organizing, staffing, directing, and controlling to achieve organizational goals

Define supervision:

active process of directing guiding & influencing the outcome of an individuals performance

Define centers for disease control and prevention:

agency charged with the promotion of health and quality of life by preventing and controlling disease, injury, and disability

Define health care system:

all the structures and organizations and serves designed to deliver professional health and wellness services to consumers

thought leadership

applies to a person who is recognized among peers for innovative ideas and who demonstrates the confidence to promote these ideas

Define accountability:

assumption of responsibility for actions, decisions & policies within the scope of practice

heart

authentic leaders care for themselves and the people they lead, and their compassion is genuine

values

authentic leaders link between purpose and passion by having congruence in beliefs and actions

self-discipline

authentic leaders practice self-discipline by incorporating balance into their personal and professional lives

purpose

authentic leaders understand their own purposes and passions as a result of ongoing self-reflection and self-awareness

relationships

authentic leaders value building relationships and establishing connections with others, not to receive rewards but rather to strengthen the human connection

_____ leadership, also known as directive, controlling, and authoritarian, gives orders and makes decisions for the group. It may squelch creativity and may decrease team member motivation.

autocratic

What are the 4C's of communication?

be clear, concise, correct, and complete

Define morality:

behavior in accordance with custom or tradition and usually reflects personal or religious beliefs

What does Part D medicare not cover?

benzodiazepines, cough suppressants, barbiturates

Disadvantages of face to face and walking reports:

can be costly to the hospital if they are not completed in a timely manner

_____ leadership comes from servant leadership and emotional intelligence.

caring

Emotional Intelligence

characterized by social skills, interpersonal competence, physiological maturity, and emotional awareness that help harmonize to increase their value in the workplace.

Define SBAR:

communication mechanism useful for framing any conversation, especially those requiring a rapid response from a clinician

Leader personality

confidence, courage, ethical, able to prioritize

Define utilitarianism:

decision based on what will provide the greatest good for the greatest # of people

Decentralized decision making

decision making is diffused throughout the organization, and problems are solved by the lowest practical managerial level. Usually, this means that problems can be solved at the level at which they occur

Define assignment:

delegation of work to a selected group of caregivers--retaining accountability for the outcome

______ leadership, also known as participative, shares leadership. Plans and decisions are made with the team. Is more flexible and increases motivation and creativity

democratic

Define accreditation:

determination by an accrediting body that an eligible health care organization complies with applicable standards of the joint commission

Management of pain & JCO:

document assessment of pain, document assessment of pain relief, use of therapeutics to manage pain, assessment of therapeutics

Define beneficence:

duty to do good to others--maintain a balance between benefits & harm

Define fidelity:

duty to keep ones word

1. self awareness 2. self-regulation 3. motivation 4. empathy 5. social skills

emotional intelligence in critical for building a cooperative and effective team: 1. 2. 3. 4. 5.

inspiring a shared vision

entails visioning that inspires followers to want to participate in goal attainment

Define bioethics:

ethics specific to health care

Tim Porter-O'Grady

father of Quantum leadership

Define national instate for occupational safety and health (NIOSH):

federal agency responsible for conducting research and making recommendations for the prevention of work related injury and illness --part of the cdc

Define centers for medicare and medicaid services (CMS)

federal agency that administers medicare, medicaid, state children's health insurance program and other health related programs

______ involves actively determining the group's direction, invest time and energy in the group, think critically, and advocate for new ideas.

followership

Define state departments of health and human services:

foster accessible and high quality health and senior services to help all people to achieve optimal health, dignity and independence

enabling others to act

fostering collaboration, trust, and the sharing of power

Define health maintenance organization:

geographically organized system that provides an agree on package of health maintenance and treatment services

Define IRB:

group that has been formally designated to approve, monitor, & review biomedical and behavioral research involving humans with the alleged aim to protect the rights/wellfare

Informal Organizational Structure

has its own leaders and communication channel (grapevine)

organizational climate

how employees perceive an organization

Scalar Chain

how many steps for communication from bottom to top

____ management believes work is something to be avoided and people want to do as little work as possible. It uses control, supervision, and punishment

human relations-based management theory X

____ management emphasizes guidance rather than control, development rather than close supervision, and reward rather than punishment.

human relations-based management theory Y

Define direct patient care activities:

hygiene care, feeding patient, taking v/s, BS, EKG, ambulation

challenging the process

identifying opportunities and taking action

qualities of a leader

integrity courage positive attitude initiative energy optimism perseverance generosity balance ability to handle stress self-awareness

Behaviors of effective managers includes

interpersonal activities decisional activities informational activities

What is a concise communication

is one in which the right amount of communication has been given

Define medicaid:

joint federal and state assistance program design to pay for medical long term care assistance for individuals and families with low income and limited resources

____ is the ability to influence the behavior of others.

leadership

Define what a novice RN is:

limited experience with tasks and needs rules to guide actions

Define managed care:

linkage between the financing and delivery of services in such a way as to permit payers to exercise control over the delivery of services

Define preferred provider organization (ppo)

managed care company that contracts with HCP and payers to provide HC to a defined population for predetermined fees

_____ is getting work done through others and doing what is needed to assist employees to work well.

management

Define first level manager:

manager responsible for supervising non managerial personnel & day to day activities of specific work units

_____ is the process of consciously working with your manager to obtain the best results for everyone involved

managing up

Define continuum of care:

matching an individuals ongoing needs with the appropriate level & type of medical, psychological,health or social services care

____ leadership involves deciding how one ought to remain honest, fair, and socially responsible under any circumstances.

moral

Define unlicensed assistive personnel:

not licensed by the state & are trained to assist RNs by performing pt care tasks

Define veracity:

obligation to tell the truth

Authority

official power to act and direct the work of others

Define not for profit organizations:

organizations with financial structures that project financial goals with particular tax and legislative protection

Define for profit organizations:

organizations with stated financial structures that include profit goals and tax liabilities

Define american osteopathic association (AOA)

osteopathic accreditation program that ensures osteopathic students receive their training with the provision of high quality patient care

Religious views

p106

The JCO standards that address performance are:

patients rights, patient treatment, and infection control

span of control

people for whome you are authorized to control "direct reports"

Define nonmaleficence:

principle of doing no harm

Define justice:

principle of fairness

Define communication:

process by which information is shared between and among individuals

Define change of shift report:

process by which patient information is shared by nurses who have taken care of the patient for the previous shift and are reporting to the incoming caregivers

Define computerized physician order entry:

process by which the clinician orders are entered through electronic information systems

Autocratic/Authoritarian

productivity high, low level of satisfaction

formal Organizational Structure

provides a framework for defining managerial authority, responsibility, and accountability

Define autonomy:

provides for the privilege of self determination in deciding what happens to one's body in health care

encouraging the heart

recognize, appreciate, and celebrate followers and the achievement of shared goals

Define health care network:

refers to interconnected units that are owned by the institution or have cooperative agreements with other institutions to provide a full spectrum of wellness and illness services

Responsibility

related to job assignment and must be accompanied by enough authority to accomplish the assigned task

modeling the way

requires value clarification and self-awareness so that behavior is congruent with values

The international council of nurses code of ethics: (p103)

respect for human rights, including the right to life, to dignity and to be treated with respect

caring leaders characteristics

respects others listens to others maintains awareness emphasize develop their capacities are competent

Define respect for others:

right of people to make their own decisions

Define indirect patient care activities:

routine activities of the patient unit that deal with the day to day function of the unit -- restock supplies

_____ management is efficiency focused and emphasizes tasks aspects. Increasing productivity is the goal. Workflow and time to complete tasks is measured and evaluated.

scientific

Authority

scope

____ leadership applies more to people in supervising or administrative positions than people in staff positions. Believes "employee first" not :"manager first"

servant

Define veterans health administration:

serve the needs of america's veterans by providing primary care, specialized care and related medical/social support services

behaviors of a leader include

setting priorities thinking critically solving problems respecting people communicating skillfully communicating a vision for the future developing oneself and others

_____ leadership recognizes complexity of work situations and encourages the leader to consider many factors when deciding what action to take. Adaptability is key.

situational

Democratic

slower decision making-speed, interactive- more brain storming time. Better, more variety of ideas but takes longer.

Line authority

solid, vertical line of authority

To set realistic goals be S.M.A.R.T.

specific, measurable, attainable, relevant, time bound

HCAHPS

standardized survey instrument and data collection methodology that has been in use since 2006 to measure patients' perspectives of hospital care.

The most effective leader balances ______. It is common for one to be overemphasized which leaves the other unrecognized.

tasks and relationship

emotional intelligence

the ability to use emotions effectively and is required by leaders/managers in order to enhance their success

Formal Organizational Structure

the emphasis is on organizational positions and formal power

Informal Organizational Structure

the focus is on the employees, their relationships, and the informal power that is inherent within those relationships

Accountability

the moral responsibility that accompanies a position

What is the foundation for managed care organizations?

the primary care provider--serves as the gate keeper to coordinate/manage the pt's use of resources, referrals

What does a flat organizational structure signify?

the removal of hierarchy layers, demonstrating that the authority for action occurs at the point of service

Disadvantages of taped reports:

there is little opportunity for questioning and sharing the information

Define compliance:

to act in accordance with stated requirements/standards

Define delegation:

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

____ leadership focuses on meaning, inspiration, and vision. The goals of the leader and staff become "fused"

transformational

Line structures

typical bureaucratic model

Define OSHA:

us department of labor agency that ensures the safety and health of america's workers by setting and enforcing standards

Define US department of health and human services:

us government principle agency for protecting the health of all americans and providing essential human services

Conflict Resolution Win-Win; Win-Lose; Lose-Lose

-Avoidance/Withdrawing (Lose-Lose): Withdrawing from situation; appropriate at times. -Compromise/ Negotiating (Lose-Lose): Minimum losses and gains; appropriate at times. -Competition/ Forcing (Win-Lose): Rarely appropriate -Accommodation/Smoothing (Win-Lose): Surrendering; appropriate at times. -Collaboration/ Problem Solving (Win-Win): Work toward common goals and consensus. Time consuming and requires that everyone is willing to come to the table.

Potential Undesirable Effect of Conflict

-Contention(heated disagreement) spreads to peripheral issues -Disputants pull others into conflict -Unresolved conflict causes alienation, violence -Disputants scapegoat a peripheral group member -Start choosing sides -If not resolved they will recur

Situational-Contingency Theories

-Contingency Theory - Vroom and Yetton's -Path-Goal Theory

Conflict Resolution via Collaboration

-Deal with issues not personalities -Take responsibility for self and own participation -Listen actively (clarify, paraphrases) -Sort out issues -Identify key themes -Weigh consequences

Causes of Conflict in Nursing

-Differing values, interests, goals, needs, or approaches. -Can be interpersonal, interpersonal, intergroup, latent or overt; vertical or horizontal. -Role conflict: often when two or more people have the same or related responsibilities with ambiguous boundaries. -Rivalry: two people wanting the same thing. -Communication conflict: Failing to communicate with another. -Goal conflict: when achievement is thwarted and one person puts their interest over another. -Personality conflict: Cynicism, short fuses, arrogance. -Ethical or values of conflict: Often is over goal versus process.

Transformational Leadership

-Emphasis on goals and growth of both leader and follower; de-emphasizes differences in roles. -Leader motivates others through vision, shared values, and empowerment. -Have better performance ratings and make a better contribution to the organization -Not a solution, at times is inappropriate

Management (list)

-Formal -Narrow concept -Deals with organizational goals -Requires technical, human, and conceptual skills -Authority by virtue of position -Getting work done through others

Possible Positive Outcomes of Conflict

-Issues are brought into the open where they can be resolved and avert a more serious issue. -Group cohesion may increase as individuals work together to resolve conflict. -New leadership may emerge. -Results can be constructive and impetus for change. -Can result in individual growth and development. -Increase communication and improve understanding of how the facility functions. -Can increase motivation

Conflict Phases

-Latent Antecedent conditions are present and predict conflict -Perceived: Cognitive awareness of stress. -Manifest: Overt behavior resulting from antecedent, perceived/felt conflict -Constructive or destructive

Great Man Theory

-Leaders are born not made -Emphasized that a person is either born with or without the necessary traits of a leader. -Leader is charismatic -Commanding personality, charm, courage, intelligence, persuasiveness, aggressiveness.

Power

-Legitimate: from formal position in the organization. -Referent: People will follow those they admire/like. -Reward: raises, good assignments, recognition. -Coercive: threats of punishments -Expert: specialized knowledge and skills -Informational: when other want/need your information -Connection: who do you work with, who you know -Motivational: ability to inspire and work toward a goal.

Improving Your Leadership Style

-Most important: improve your interpersonal and communication skills. -Get a mentor: usually someone who is on your level but with more experience, tenure, or one step higher in the organization. -Keep an open mind, be flexible -Continue to learn and grow -Believe in yourself -Treat others with respect and consideration

Conflict

-Recognized as the existence of real or perceived differences within an individual or between two or more individuals , or groups, is a clash between hostile or opposing parties. -To fight, battle, contend, to be antagonistic, incompatible, or contradictory or in opposition, clash, to battle. -The process itself is neutral.

Force Field Analysis (Lewin)

-Restraining Forces are those aspects of the organization that keep change from happening. (Holding back) -Driving forces are those that move the target toward change. (Moving forward) -Status Quo is maintained when driving forces equal restraining forces. -Organizational culture can be either restraining or driving force.

Components of Emotional Intelligence

-Self-awareness of own emotions and effect on others. -Managing emotions, self regulation. -Motivating self and others -Being empathetic -Social or people skills.

Variables important to choice of strategy

-Time pressure: is an important variable-if there were never any time pressures, collaboration might always be the best approach to use. -Issue importance: the extent to which important priorities, principles or values are involved in the conflict. -Relationship importance- how important it is that you maintain a close, mutually supportive relationship with the other party. -Relative Power: how much power you have compared to how much power other party has.

What are the 5 basic practices in transformational leadership?

1)challenging the process, questioning the ways that things have always been done, and creatively thinking in new ways of doing things 2)motivating & inspiring shared vision or bringing everyone together 3)empowering others to act 4)modeling change 5)praising the employee for the work done

What is transformational leadership?

1)consultative & collaborative 2)contains 5 basic practices 3)shared governance

What are the disadvantages of functional nursing?

1)decreased pt/RN satisfaction 2)fragmented communication/accountability 3)unit coordination = charge responsibility

What are the advantages of functional nursing?

1)large # of tasks completed in a shift 2)efficient financially 3)staff trained to master one task (i.e iv therapy)

What are the disadvantages of total patient care?

1)may not be cost effective 2)RNs dislike doing "CNA" tasks

What are the disadvantages of team nursing?

1)need increase time to communicate 2)more staff = more expenses 3)increased time needed to supervise, coordinate, delegate

What are the three levels of management?

1)nurse manager-higer/fire, complaints, watch 1 unit 2)director-looks over multi units 3)chief nurse officer-advocate for others,establish RN goals, set up budgeting

What is total patient care?

1)oldest model of providing care 2)1 RN assumes accountability for the complete care of the group ("primary nursing") 3)care responsibility doesn't extend past shift 3)seen in private duty nursing/ICUs

What are the characteristics of management?

1)produces a degree of predictability/order 2)produce short term results, administers

What are the characteristics of leadership?

1)produces change, often to a dramatic degree 2)potential to produce extreme useful change 3)has long range perspective, innovator

What are the advantages of total patient care?

1)quality of care 2)continuity of care for a given shift 3)high pt satisfaction 4)decrease hand off time 5)reduces need for supervision 6)allow 1 person to do more than 1 task

Employees of functional structures:

1)report to manager or VP 2)professional expertise

What are the advantages of team nursing?

1)supervision of new RN 2)increase quality of care 3)1 person coordinates care

What are matrix structures?

1)they combine both function and service line in an integrated service structure 2)need collaboration between both

What is functional nursing?

1)work is allocated according to specific tasks/tech skills 2)Charge id task/work assigned 3)efficient during RN shortage

Transactional or Exchange Theory

Clarifies goals, provides needed resources, regulates efforts; rewards those who achieve.

Transformation Leaders (ATI)

Empower followers to assume responsibility for a communal vision, and personal development is a secondary outcome.

Equilibrium (personal emotions process through change)

Feelings of peace, blanche, harmony.

Transactional Leaders (ATI)

Focus on immediate problems, maintaining the status quo and using rewards to motivate followers.

Lewin's Change Theory Stages

Implementation -Unfreezing: Weakening the bounds that support present system; either strengthening the driving forces or weakening the restraining forces. Can be something as simple as creating dissatisfaction, such as a union does. This is easier when there already is turmoil. -Movement: When the change takes place. Evaluation -Re-freezing: Making change permanent fixture; can be hastened by support and rewards.

Democratic (ATI)

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

Change agents (Book)

Individuals with formal or informal legitimate power whose purpose is to initiate, champion, and direct or guide change.

Emotional Intelligence (Powerpoint)

Is the ability to understand how emotions function in self and others and to use them effectively.

Change is.....

It's constant and inevitable. It can be planned or unplanned. How it's managed will be the key in determining success.

Resignation (personal emotions process through change)

Lack of enthusiasm as change is accepted passively."You give in"

Path-Goal Theory (House & Mitchell)

Leader role is to remove obstacles to goal achievement and to reward for completed tasks.

Trait Theory

Leaders have a certain set of physical and emotional characteristics that are crucial for inspiring others toward a common goal.

Contingency Theory

Leadership will be effective or ineffective dependent on: -Leader-Member relations -Task structure is ability to define task and measure progress toward it (or number of correction solutions) -Position power to use rewards and punishments

Authoritative (ATI)

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

Laissez-faire (ATI)

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

Depression (personal emotions process through change)

No energy left, nothing seems to work, sorrow, self pity, feelings of emptiness.

Internal Change/ Internal Forces (Powerpoint)

Occurs from within the individual or individual organization. Examples: New ideas about health care delivery, Expansion, New ways of delivering supplies.

Performance Appraisal

Primary function is to communicate how employee is doing with goal of maintaining or improving performance. Should be based on standard, be objective, applied employee's work and is trained in the use of the tool and components should be known in advanced by employee. Should be done regularly but often are not because both the employee and manager get stresses by appraisal. In nursing we use nursing standards in addition to the job description for performance appraisal.

Empowerment

Process in which a person who has power shares it others; provides more satisfaction.

Expectancy Theory (Vroom)

Proposes that a persons behavior occurs because of expectations as to the outcomes of that behavior.

Leadership

Refers to the ability to guide, motivate, and inspire (Not a formal position).

Management

Refers to the pursuit of specific goals through planning, organizing, directing, and controlling. Is a formalized position, such as a nurse manager. The manager has the authority/power to direct others and accountability/responsibility for meeting goals because of the position. *Not all managers are leaders.

Transactional Leadership (Book)

The act of using rewards and punishments as a part of the daily oversight of employees in seeking to get the group to accomplish a task.

Change Target (Powerpoint)

Who/what is to be changed: Think of this as who has the power to make decisions related to whatever it is your trying to change, or whose attitude do you need to change?

Readiness (personal emotions process through change)

Willingly expends energy to explore new events reunification of emotions and cognition.

What is team nursing?

a delivery approach that uses a group of staff members led by a RN--supports group work & productivity

What are the fundamental elements of any patient care delivery system?

clinical decision making, work allocation, communication, management, coordination, accountability

What are the benefits of product line structure?

coordination of al services within the speciality & a similarity of focus

What factors are used to deciding on the type of organizational model?

financial, staffing, capabilities, patient population, organizational mission, philosophy

What are product line structures?

functions necessary to produce a specific service--under the control of single manager

What traits do leaders need?

future oriented, visionary, focus on purposes, empower others to set/achieve organized goals

What are the key steps in decision making?

id the problem, evaluate the potential solutions to problem, seek alternative solutions, select the best solution for everyone

What is hierarchal organization?

is one where decision making occurs at the top of the structure and is communicated to the employees

Define total patient care:

model of care in which RN assumes full accountability for care of a group of patients

Define case management:

model of care in which RN integrates delivery of clinical services in combination with financial services

Define team nursing:

model of care in which a group of staff members led by a nurse provides care

Define functional nursing:

model of care in which nursing work is allocated according to specific tasks/skills

Define primary nursing:

model of care in which one RN assumes accountability for care delivered by another personnel in 24hr period