L&M Exam 1

What is per capita?

$ per person

What is the pareto principle?

-20% of focused efforts results in 80% of outcome results. -Efficient time management requires that a shift be changed from doing unfocused activities that require 80% of time for achieving 20% of desired results, to doing planned & focused activities that use only 20% of time or input to achieve 80% of desired outcomes. -AKA the 20/80 rule. Work smart & not hard! -Ex: Cleaning your room takes 1 hour to do, but if someone said they were coming over, it would only take you 15 mins bc you are not distracted with Netflix, music, etc. So now you have managed your time bc it only took 20% of the time to achieve at least80% of the desired outcome!

What is currently happening with the ACA?

-2019-2020: Elimination of cost-sharing reductions (government payments made to insurance providers in individual markets) drove up silver premiums by an average of 10% ("silver loading") -New rules allow more loosely regulated plans - short-term limited duration (STLD) plans and association health plans (AHPs) - to proliferate on the individual market in competition with ACA-compliant coverage. These more loosely regulated plans will serve as a more affordable option (lower cost coverage) for some people who are not eligible for the ACA's premium tax credits. -Ultimately, we need to know the cost of marketplace health insurance policies has increased since the passing of aca. We are seeing an increase in weird catastrophic policies that cover very little.

What is the U.S disproportionate spending on healthcare?

-50% of our population spends less than 3% of healthcare spending, -5% of our population spends 50% of the healthcare spending -1% of the population is more than 20% of the healthcare spending. -90% of the nation's 3.3 trillion in annual spending are for people with chronic & mental health conditions. -45% of healthcare expenses are concentrated on 5 predominate health problems ranking from heart conditions, musculoskeletal trauma, then pulmonary conditions, endocrine conditions, then nervous systems. -The most expensive healthcare conditions to treat in the U.S is cardiovascular conditions, followed by trauma bc most of the time you end up in the ICU, which is about 6,000 a day.

What is California vs Tx (Tx vs U.S in the lower courts)?

-A lawsuit over the constitutionality of the individual mandate and, with it, the entire ACA. 20 states have joined. -They argue that the penalty-less mandate is no longer enforceable as a tax and thus is no longer valid. -In Dec 2018, a judge with the Northern District of Texas determined that the unconstitutional individual mandate was inseverable from the rest of the ACA and therefore, the entire ACA was unconstitutional. -In June 2021, the Supreme Court determined the mandate might be severable and states did not have standing, did not otherwise rule on constitutionality of the ACA. -This is another court case that tried the mandate being constitutional or unconstitutional, in which it was deemed constitutional, but the mandate was brung down to zero dollars.

What is Medicaid?

-Administered by the state; sets own guidelines -Covers indigent/low income, blind, disabled, disabled children -Funded by state funds and matching federal funds •Services can vary state to state -Covers services provided by hospitals, physicians, laboratories, nursing home, home health, and prenatal care -Medicaid is different bc services & eligibility can vary state by state. The states have a much larger role & it is typically funded by matching state & federal funds.

What are some characteristics of someone with low emotional intelligence?

-Aggressive -Demanding -Egotistical -Bossy -Confrontational -Easily distractable -Selfish -Poor listener -Impulsive -Resistant to change & more!

What are the three basic steps in time management?

-Allow for planning & establish priorities -Complete the highest priority task whenever possible & finish one task before beginning another. Make sure you are able to differentiate between the high priorities & low priorities. -Reprioritize based on the remaining tasks & on new info that may have been received. Important to do this as needed!

What is minimum essential coverage?

-Ambulatory care (outpatient care) -Emergency services -Hospitalization -Maternity & newborn care -Mental health care, including treatment for substance use disorders -Prescription drugs -Rehabilitation services & habilitative services, including devices -Laboratory services -Preventive care & chronic disease management -Pediatric vision & dental care (coverage for adult dental & vision services is not required)

How do nurses make clinical decisions?

-Apply the nursing process -Know your patient. We need to make sure we know how the pt operates, so we can notice subtle changes in the pt. -Use clinical decision-making practices bc accurate clinical decision making keeps you focused on the proper course of action -It's okay to ask for help!

What is King V Burwell Supreme Court Upholds ACA Subsidies?

-Argued that middle and low income adults who purchased health insurance through the federally run Healthcare.gov marketplace were entitled to subsidies based on the language of the law that says tax credits are only to be distributed for marketplaces "established by the state." -Supreme Court ruled (6-3) that Americans are entitled to keep the tax subsidies that help them afford insurance. -Reasoned that Congress meant for those provisions to apply in every State as well.

What are the different types of procrastinators?

-Arousal type: Thrill seeker and does it for the euphoric rush -Avoiders: Avoiding fear of failure or even fear of success, but either way you are probably worried about what others think -Decisional: Can't make a decision. If you do not make a decision, that absolves you from the responsibility of the outcome -Perfectionists

How can nurse prioritize in the order of importance?

-Ask yourself, is it life threatening or potentially life threatening if the task is not done? -Would another pt be endangered if I do this? -Is this task or process essential to pt or staff safety? -Is this task or process essential to the plan of care?

What are some characteristics of someone with high emotional intelligence?

-Assertive -Ambitious -Driving -Strong-valued -Decisive -Warm -Enthusiastic -Sociable -Charming -Persuasive -Patient -Stable -Predictable & more

What are the steps to effective delegation?

-Assess the knowledge and skills of the delegatee -Match tasks to the delegatee's skills -Communicate clearly: -Task, outcome, time (how long they have to complete the task) -Listen attentively (not only to veral, but also non0verbal. -Provide feedback (Let them know to let you know when they are done or if there was any problems encountered. Provide feedback regarding the performance, regardless the outcome.)

How the the expansion of the premium tax credit affect healthcare?

-August 16, 2022- Inflation Reduction Act will boost ACA tax credit -Historically income between 100-400% of the federal poverty level is eligible for tax credit expansion -The Inflation Reduction Act removed the 400% cap, making more Americans eligible for the tax credit -Will ensure tax credit expansion through 2025 -The premium tax was scheduled to end this year where the premium discounts would no longer be available. Just a couple of weeks ago, the inflation reduction act was passed and with this, it stated that they are going to continue the tax credit. Not only will it continue it, but also expand it, bc before you had to make 400% or less of the federal poverty level to be eligible, but now they have taken off the 400% cap. Bc this legislation just passed, we don't know what the new cap is going to be, but there will be one. The legislative act has also extended the deadline of the tax credit to at least 2025, but if someone else takes office, a legislative act could be passed to change this.

What is the democratic approach to leadership?

-Believes every group member should have input into problem solving & goal development. All about "We" -Delegates authority to others. The leader makes the decision based on the input from the group -Uses expert power & close personal relationships. There will be a strong performance of the group with the leader present or not bc it promotes cooperation & coordination. -Uses participatory approach -People feel as if they are being heard with democratic decision.

What is the authoritarian/autocratic approach to leadership?

-Centralized decision making (only one person making decisions) -Leader dominates the group -Leader makes all decisions & uses power & command to control others -Well defined group actions that are predictable -Productivity is high -Good approach to use during crisis in nursing, such as if a pt is crashing -Not recommended for long term or everyday style bc there is not a lot of room for creativity, self autonomy, or motivation! -All about management & their peers knowing who is in charge no matter what.

What is executive (top/upper) nursing management?

-Chief nursing officer (CNO), chief nursing executive (CNE), & director of nursing (DON) -Supervises numerous departments & works closely with the administrative/executive team of the organization. -Involved in establishing organizational goals & strategic planning w key stakeholders, such as how to keep the hospital profitable enough to survive. -Ensures client care is consistent with the objectives, goals, philosophy, & vision of the organization. -They work closely with outside organizations such as Lamar University. -They are in the liaison role & figurehead of the organization. -Typically need a doctorate degree for this. -Unusual to see these people on the unit bc they are putting out fires for the organization as a whole.

What is the underinsured rate in the U.S?

-Compared to 2010, when the ACA became law, fewer people were uninsured but more people were underinsured bc of high out-of-pocket costs & deductibles. -The greatest increase of the underinsured are occurring among those in employer plans. -The underinsured typically only have plans that cover trauma, but still struggle with prescription coverage & doctor visits, etc.

What are the symptoms of poor time management?

-Constant rushing -Caught in crisis mode -Fatigue or listlessness, "overwhelmed" feeling -Constantly missing deadlines -Insufficient time for rest or personal relationships -Sense of being overwhelmed by demands & details -Having to do what you don't want to do, most of the time. It is important to find something you enjoy to find a balance!

What is scientific management?

-Developed by Frederick Taylor & the main goal was to have increased productivity & efficiency to make more money. -It used the scientific method to make maximize productivity -Workers were hired, trained, & promoted based on competency & abilities. -Workers were externally motivated & reimbursed by their level of production. -Managers supervised and workers worked. -People were paid on how much productivity they accomplished, which made them work harder bc they were paid more. -This is the earliest management theory.

What is Fayol's management functions?

-Developed by Henry Fayol who discovered there are five roles of a manager 1. Planning (setting objective, goals, & philosophies, etc) 2. Organizing, such as what kind of policies & procedures need to be developed to meet a goal 3. Staffing, such as recruitment, hiring, team building, interviewing, orienting, etc 4. Directing & leading, such as managing conflict, persuading & motivating people, etc 5. Controlling, such as quality control, physical control, budget, performance standards, ethical issues, etc.

What are some qualities of an integrated leader-manager?

-Effective communicator -Promotes interprofessional collaboration -Credible -Critical thinking -Initiator of action -Risk taker -Persuasive & influences employees -Think long term by looking at the future & how we can b successful -Think bigger picture (organization wide) -Influences others beyond own group (done through communication) -Emphasizes vision, values, & motivation -Politically astute (knowing who your leaders are, goals that are important to the executive management to sell ideas, etc). -Embrace change & renewal

How did the ACA expand public programs?

-Eligibility for Medicaid expanded to 138% Federal Poverty Level (Texas did not expand eligibility) -Initially, more funding by federal dollars, but will phase down after first three years to 90% by 2020 -Maintain income eligibility level for CHIP until 2027 -Extended funding for the Children's Health Insurance Program (CHIP) and continues the authority for the program through 2027. -Historically, anyone that was under 100% of the federal poverty level were eligible for Medicaid. The states had a choice to enroll in the expansion of Medicaid or not.

What is strategic management?

-Emphasizes fit or alignment between the organizations strategy, external environment, & internal structure & capability. -Links quality improvement efforts to core strategies & capabilities of the organization to meet organizational needs. Ex: CHF is the #1 expensive medical condition in the U.S & bc of this, hospitals have created outpatient programs to where if the pt is a known readmission for chf, they are referred to the outpatient clinic where they can be managed & it be much cheaper than the ER. -Planning, assessment, & monitoring of an organization to determine what's the next step to meet their goals. -Things we look at when doing this includes issues that can be detrimental to our organization, things that are in the way of reimbursement, the pandemic, issues in the community that can impact us, etc. Ex: Both St. Mary's & Baptist hospital in Orange were shut down bc they were not profitable for the organization & the daily costs & operations were outweighing the profit we were bringing in. The decision to close the hospitals down was made bc if we didn't, we would be risking losing all the other associated hospitals as well.

What is human relations management (1930's to 1970's)?

-Emphasizes people rather than machines -Participative decision making -Hawthorne experiments: Developed when a group of people decided to change the lightning of the environment, people started to work harder. -Hawthorne effect: When people are being watched, their performance changes. The hawthorne effect prompted the theory that people are people & that they should have a role in decision making.

What is the aca prevention & wellness focus for upstream spending?

-Establish National Prevention, Health promotion, & public health council to try to focus on initiatives to improve preventative care & increase access to those in Medicare & Medicaid -Require food venders (including chain restaurants & vending machines) to disclose nutritional content & post calorie counts (Effective May 2018)

What is the inflation reduction act of 2022?

-Expanded tax credit for insurance marketplace -Allows Medicare to negotiate for cheaper prescription drug prices -Caps out of pocket prescription costs for Medicare beneficiaries at 2,000 per year (trying to eliminate the donut hole) -Requires pharmaceutical companies to pay a rebate to Medicare if they raise drug prices faster than inflation increases (to disincentive companies from excessive price increases) -Medicare is trying to decrease that huge amount of money spent on pharmaceuticals from the part D act.

What is the healthcare reform act?

-Extremely complex & the final version is over 2000 pages long. -The provisions began to take effect in 2014, but the act will not be full implemented until the end of 2022. -Attempts to address rising healthcare costs through preventative strategies, increasing access to primary care, targeting fraud, abuse, & waste, & other provisions as well. -There has been a ton of political debate over this. It depends on what primary party is in office & where the pendulum will swing. -There has been a lot of discussion of whether the aca is even constitutional, but it has been deemed constitutional bc it is still in affect.

What is the U.S department of health & human services (DHHS)?

-Federal government's primary department for protecting the public's health and human services -Funds more than 300 programs and multiple agencies -Some of programs administered; Social Security, Medicare, maternal and infant health, Mental health, prevention of child abuse and domestic violence and much more... -Proposed budget for fiscal year 2020 $1,287 billion; represents a 12 percent decrease from the 2019 estimated level -This is the government's main department that controls social security, Medicare, cdc, cms, etc. It is a very expensive program and it is guiding funding for all and more of the government programs listed above. -A large amount of the spending is Medicare, which we expect to increase bc the aging population is going to become eligible for Medicare.

What is the ABCD system for prioritization?

-Use the ABCD system when items cannot be handled right away -A pile: Requires action asap -B pile: Necessary, but can wait -C pile: Can wait until you get to it or until it can be discarded -D pile: Can be immediately discarded or delegated to someone else, such as trash, junk mail, etc.

What is Blake & Mouton's Leadership Grid?

-Focused 100% on the manager & their style of leadership! -Team manage is what the goal of every manager should be, which is high people & high task. -If the manager is burned out & doesn't care about people or tasks, they are an impoverished manager bc their people & task is low. -If the manager is super focused on productivity and not people, they are an authority obedient manager bc they have low people skills with high tasks. -Middle of the road manager is having a little bit of focus on both people & task, meaning they have medium task & people relations. -Team manager is where we want to be, with high task & people!

What are the types of healthcare entities?

-For-profit organizations -Non-profit organizations: Charitable entities are seen a lot at non-profit hospitals, which is when a pt needs help paying medical expenses bc they are uninsured, they will be entered into a charitable program that can help them. -Public government

How to we create a time efficient work environment?

-Gather all supplies needed before starting an activity -Get organized -Group activities together that have to be done in the same location -Use time estimates (estimating how long it will take to complete a task) -Document nursing interventions as soon as possible after they are completed (Best advice is to stay in the pt's room & document) -Always strive to end the work day on time bc incremental overtime can occur. Incremental overtime is when the nurse stays overtime for a few mins each day, which soon adds up to an hour or so & the nurse supervisor or manager may have to step in.

What are the characteristics of leadership?

-Guiding vision, passion, integrity (one of the biggest components of leadership is having a vision or future plan for your unit) -Intelligence, self-confidence, determination, integrity, & sociability. Emotional intelligence is important! -Visionary, enthusiastic, & supportive -Knowledgeable with high standards & expectations -Demonstrate power & status -Visible & responsible while communicating openly -Demonstrate caring, trustworthiness & flexibility -Have drive, desire to lead, honesty, integrity, self-confidence, cognitive ability, & knowledge of the business. -Must have followers -Can also be barriers if there is a policy in place that they refuse to follow, bc others will refuse also. -Need to be a change agent!

What ethnicities have the highest uninsured rates?

-Hispanics & American Indian & Alaskan Natives. -If you live in a state that did not expand Medicaid or Medicare, you will have more people uninsured bc less people are eligible.

What are the 5 types of key resources to accomplish a nurse manager's purpose?

-Human resources, which is any personnel or employees -Financial resources, which deals with tuition reimbursement, grants for the hospital, etc. -Physical resources such as VS machines, stretcher, wheelchairs, etc. -Information resources such as databases, technological information, etc -Intellectual resources, which are very valuable, but not as tangible. For example, secret recipe for a meal or pharmaceutical company having a great drug that nobody else has the formula for.

What are some daily planning actions we can do to utilize time?

-Identify key priorities to be accomplished that day. In order to set priorities for the pt, we need to think about what's the worst thing that can happen to the pt during the shift, then set you goals, priorities, & interventions. -Determine the expected level of achievement for a prioritized task. -Assess the staff assigned to work with you. We must learn to delegate & make sure we give the people we delegate to the expected outcome. -Review the short & long term plans of the unit -Plan ahead for meetings. For meetings, we need to make sure we know who is in charge. For example, if we leave the unit fo a break, we need to ask one of our co-workers to watch our pt & make time to give them a short report over the pt. -Allow time to assess progress of goal attainment. -Take regular breaks -Electronic calendars can be used -Think about whether you are maximizing or satisficing your time.

What are some additional hints when prioritizing care?

-Identify the busiest times on the unit -Do not schedule a dressing change when meds for other pt's are due -Plan on preparing meds at least 30-45 mins before th hour they are due -Do not procrastinate & start early! -Similar teaching for multiple clients can be done in group settings if possible -Use appropriate resources! -Collaborate with members of the healthcare team (Needs to be included in documentation about who was consulted, etc) -Ask seasoned nurses about their time management tips

What is Herzberg's two factor theory?

-If an organization/leader does not provide the hygiene factors such as company policy, quality of supervision, relations with others, etc, people will be dissatisfied & demotivated. -But if we could provide those hygiene factors, people would be satisfied, but not motivated to do more. -However, if we build in the motivational factors such as job interest, personal growth, achievement, etc, it will lead to a positive environment where people are satisfied & motivated.

What is the tipping point for quality?

-If we cut too deeply and are worried about the cost & not quality, our patient's will ultimately suffer, in the long run increasing the cost of care. -We are trying to find cost effective care, where it is not cheap, still effective, but something we can afford to do and stay viable

Why has prescription drug spending increased?

-In the 1990's, there was legalization of advertising drugs on commercials. These commercials only used the brand name of the drug, which is what the people would ask for, bc they did not know the generic would be cheaper. -The U.S is the only country that allows drugs to be advertised on commercials. -Around the late 1990's, chip expanded, which made more children eligible for healthcare & coverage of prescriptions. -When the ACA started to take affect, more people had access to healthcare & started to obtain treatment & get the meds they needed. -The price of Epipens increased tremendously, so so other manufacturers learned how to make a generic of the pen & the prices decreased bc now more than one company was selling it & competition was being started (a way free enterprise can be good for the U.S, even though it increases cost overall). -Around 2014-2015, they came up with a hepatitis C treatment, which there is no cure for. This med cost 75,000 for a 12 week treatment plan. Insurance did not cover this drug bc it was cheaper to allow the p to go into liver failure and get a transplant, than pay for this drug.

What are some factors that affect access to healthcare?

-Income -Type of insurance -Gender -Race or ethnicity -geographic location -system characteristics -Even when overall quality of care does improve, healthcare disparities often still exist across socioeconomic groups, racial & ethnic populations, & geographical areas. -Socioeconomic status is the #1 predictor of your health in this country. Despite all other things, if you are poor, it is the biggest factor of your health.

How can managing your time benefit you as a nurse?

-Increases your success in school, work, &, in life -Managing your time will reduce stress -Managing your time will enhance work-life balance

What are other public programs for healthcare?

-Indian Health Service -TRICARE (enlisted military & dependents) -Veterans Health Administration -Tricare is the insurance company that covers people presently enlisted in the military. -VA is the insurance program for the veterans that are no longer actively enlisted.

What are the highpoints of the affordable care act?

-Individual mandate: Required U.S citizens & legal residents/immigrants to have qualifying health coverage (minimum essential coverage) -Penalties have been phased since 2014 & there are some (but few) exemptions & began increasing in 2017 d/t the cost of living adjustment. -In 2018, those citizens w/o coverage pay a tax penalty of $695 per adult, $347.50 per child under 18, or 2.5% of income, whichever was higher.

What are the type of drugs we spend the most money on?

-Inflammatory conditions, diabetes, oncology, etc. -W/o regulations, the drug companies can charge whatever they want for the medication. W/o the regulations & caps on meds, we have manufacturing companies charging tons of money, which increases cost overall.

What is the difference between intrinsic & extrinsic motivation?

-Intrinsic: Comes from within the person, driving them to be productive. Often influenced by family, friends, cultural values, upbringing, & the people around us. It may just be a sense of achievement or pride. It comes from an internal place of your feelings or whatever is driving you based on your surroundings. -Extrinsic: Comes from outside the individual. Performs behaviors or activity to earn a reward or avoid punishment. Type of motivation that we think of when we think of motivation, such as money, status, fear of getting in trouble, the desire for an award, etc. -As a leader, it is important to provide a climate/setting that stimulates both extrinsic & intrinsic motivation.

What are some personal characteristics of time wasting?

-Is not self aware -Does not understand time planning -Cannot distinguish between what is important & what is not -Underestimates time & effort needed to accomplish a task -Makes too many rules or procedures or approvals. (Can cause barriers for the managers bc all rules can be bent, & there is always a loophole!) -Anxiety about planning robs the energy -Does not look at the standard of work necessary -You need to be aware of what is going on in the environment and how you will manage it

What are organizational factors?

-Job enlargement: Organizational structure that can affect time demands. This is an increase in job tasks & responsibilities. A horizontal increase expansion. Job enlargement have necessitated time management -Flatter organizational structure: Positions combined, with managers having more staff to supervise. With this, there are less levels of hierarchy. -You will see job enlargement a lot with flatter organizational structures.

What are some solutions to procrastination?

-Know yourself -Do the worst task first -Break large tasks down into smaller tasks -Reward yourself for completing smaller tasks -Go public/ask for help -Use post-it notes or other means to keep self on task. -Know that you can't do everything perfectly.

What are ten fatal leadership flaws?

-Lack of energy & enthusiasm -Acceptance of the own mediocre performance -Lack of clear vision & direction -Having poor judgment -Not collaborating -Not walking the talk -Resisting new ideas -Not learning from mistakes -A lack of interpersonal skills -Failing to develop others

What are the differences of a leader & manager?

-Leadership is more about the vision! They maximize the effectiveness of change, create change, take risks empowers others, motivate, inspire & align others, has a vision, & accountable to the organization. Communicating the need for change to promote buy-in is something a leader should do! -Management is more about making sure the day-to-day needs are met! They control the complexity of change, such as how long it will take & what policies are needed. They bring order & consistency, are predictable, plan & organize, deal with the budget & staffing, problem solve, & are accountable to their team. Promoting buy-in is a job for the manager, but they Do Not have to discuss it with the team, even though a good manager would.

How do we control healthcare costs?

-Limits reimbursement: Government usually paves the way for trends, such as reimbursement, payment, etc. -Increasing access to healthcare, specifically in preventable ways, bc if we can get more people to access their pcp & focus more on upstream expenditures, we will eventually decrease healthcare costs. -Health promotion & preventative activities -Public info & education -Technological & pharmaceutical advancement -Risk sharing: When the company tries to estimate who they think will be high or low spenders & then average out the quotes of the insurance. Everyone will pay the same premium, but some people may not use it as much, which is why it is controversial. -Utilization of costs: Insurance companies saying you must have our permission to see a specialists (depending on the type of insurance you have) -Rationing: When we have limited resources, so we must decide how to use the resources -Cost shifting: Also a controversial idea. This is when the hospitals charge private insurance more money for the same service than they would the government funded programs bc private will pay more.

Why is delegating to others important?

-Many studies have demonstrated that approximately 50% of nursing time is spent on non-nursing activities like cleaning, running errands, clerical duties and stocking supplies. -Delegation of non nursing tasks can provide the nurse with additional time to dedicate to client care -No one is an island -You can accomplish a lot more with help -This is important bc it allows us to care for pt's when we delegate particular activities to other personnel, specifically uap. -Remember, you cannot provide safe pt centered care to your pt without the help of others.

How did the ACA affect Medicare & Medicaid?

-Medicare: Restructured payments to Medicare Advantage Programs, establish Independent Payment Advisory Board; submit proposals to reduce Medicare spending, reduce payments to hospitals for excess readmissions, & reduced Medicare payments for hospital-acquired conditions by 1% -Medicaid: Changes to brand name drug rebates, prohibited Medicaid payments for healthcare acquired conditions, increased Medicaid payments for primary care services. -The main change to Medicare & Medicaid is that the government was not paying for readmissions within 30 days & hospital acquired conditions. -The aca is trying to increase accessibility to preventable care & services with Medicare & Medicaid.

What is the national academy of medicine?

-National Academy of Medicine is part of the National Academies of Sciences~ formerly known as Institute of medicine (IOM), name was changed effective July 2015. -"Advisors to the nation" -Shocked the nation in To Err is Human (1999) -Brought safety to the forefront Recommendations included: Establish mandatory system for reporting errors and adverse events & set reporting standards -Formerly know as the iom (institute of medicine) -We need to do a better job of reporting errors and adverse events & have reporting standards in place. There are 8 places of reform that they say healthcare organizations & nurses need to work on.

How are we evaluated for performance & quality measurements?

-National Health Care Quality Report -Health Assessment Tools -National Academy of Medicine Health Care Reports -Other National Public Quality Reports -Accreditation and Patient Safety -Health Professions Education -Quality and Safety Education for Nurses -There are many different quality initiatives that we are held accountable & evaluated on. -There are all different people such as government programs, regulatory bodies, etc, looking to see how our quality is bc we must balance the cost with the quality of care we are giving.

What are some healthcare spending projections?

-National health spending growth is expected to be driven primarily by long-observed demographic & economic factors fundamental to the health sector. -Spending growth projections are largely fueled by changes in economic growth & population aging, & not as much by changes in insurance coverage. The largest effects from the ACA increased enrollment in private insurance (ACA mandate) & employer sponsored plans). With ACA, people who didn't have insurance through private employers now has an option to purchase it, if they can afford it. The more people insured, the more likely they are to have access to healthcare. -We are going to see a large aging population that will need healthcare, which is going to increase spending in the future. -The outlook for national health spending & enrollment over the next decade is expected to be primarily driven by key economic factors such as growth income & employment (economic growth is increasing, but so is the cost of living & everything else, leading to great deal of spending still), demographic factors such as the baby boomer generation continuing to age from private insurance into Medicare, & increases in prices for medical goods & services. -Among the major payers, average annual spending growth in Medicare is expected to exceed that in Medicaid & private health insurance as a result of enrollment growth in Medicaid from the aging population. -By 2027, federal, state, & local governments are expected to finance 47% of national health spending.

What should the charge nurse consider when pt assignments?

-Need to know as much information as possible about unit, nurses and patients -Patient Demographics (gender, age, cultural bg, language, etc) -Acuity -Workload -Safety measures -Psychosocial support -Nurses Demographics -Preference -Competence -Hospital policy and procedure -Patient care standards -Environmental concerns -Accreditation regulations -Desired patient outcomes -Breaks -Not only do we need to know info about the patient and the nurse, but also the unit. -It is important to look at the language of the pt so we can determine if we need an interpreter or not. -We need to look at the acuity to assess how sick they are. Ask about the chief complaint, admitting diagnosis, code status, cognitive status, co-morbidity, lab work, procedures, surgery needed (if any), vital signs, & their weight. -When looking at workload, we need to assess for nursing interventions that may need to be completed, such as admission, discharge, transfer, blood products that need to be given, chemotherapy, end of life care, dressing changes, iv therapy, etc. -Some safety measures include are they able to swallow, is their airway clear, any contact or transmission precautions, etc. -Psychosocial support need to be considered, such as what the pt may need, their family, intellectual needs, etc. -With care coordination, you need to see if any consults, diagnostics tests, orders that may be received, healthcare provider visits, etc. -Nurses demographics need to be looked at as well, such as what their ethnic bg is, their culture, generational differences (big thing), genders, personality type, etc. -The preference of the nurse should also be looked at, such as if they want to continue to care for the same pt on the next shift, etc. You want to look at the nurse's competence, such as their certifications, education, etc. You will want to look at the skill needs of each type of nurse, such as if you have LVN's, RN, BSN, etc. Important to know if you have a secretary for that unit also. The charge nurse needs to know the knowledge of your nurses, such as if there are knowledge deficits where a more seasoned nurse needs to be paired with a new nurse. -Look at the orientation status of the nurses on your unit, meaning how long have they been off orientation, or if they are even off orientation. The charge nurse needs to assess the nurses speed & status, such as if they are a floating nurse or travel nurse.

What is reflective thinking & practice?

-Nurse leaders must continually adapt, reflect on progress & setbacks, & adjust their course as needed -Individuals learn from experience by considering what they know, believe, & value within the content of current situations & then reframe to develop future responses of actions. -No leader is going to fall into one single category. They may have principles that they are pulling from other theories. -One of the greatest characteristic of a leader is self-reflecting bc this can allow you to grow as a person & professional. You can think about what went well, what didn't, & what you could do better for next time. If we do not do this, you may not grow any wisdom & learn from situations to move forward.

What are some external time-wasters?

-Open door policy -Interruptions -Socializing -Meetings -Lack of info -Poor communication -Lack of feedback -Lack of adequately described policies & procedures -Incompetent co-workers -Poor filing system -Paperwork and reading

What are the interactional leadership theories?

-Open systems theory is is when someone believes everything is impacted by its environment. We have inputs from the environment and as a result, our outputs are impacted. It is a continuous feedback system -Schien's assumptions states that people motives change depending on the situation. We can come to the assumption that we can't always choose one leadership we can't always choose one leadership style or approach bc people are everchanging & evolving. -Hollanders theory is the belief that the interaction between leaders & followers can change drastically depending on the situation. Essentially, they are both going to get something out of the situation & it is reciprocal. For example, professors enjoy teaching & hope that the info serves the student well in the future, & the students are learning & growing, meaning they are both benefitting from the situation. Things will always change depending on the situation you are in.

How is ACA financed?

-Original estimates cost of coverage to be $938 billion over ten years. -Financed through cuts in government spending, taxes, fees & penalties, such as, imposing new annual fees on pharmaceutical manufacturing sector, imposing an annual fee on the health insurance sector, impose excise tax on sale of any taxable medical device (not all consumer goods), & impose 10% tax on amount paid for indoor training. -We are still trying tom find ways to finance it, but these are some of the main things we are doing.

How does the U.S compare to other countries?

-Our 30 day mortality for heart attacks & ischemic strokes are lower than other countries bc we have more protocols & core measures in place. -Our post-op sepsis is less prevalent in the U.S -General practitioner, specialists, & nurses in the U.S earn significantly more income -Mortality rates for breast, colorectal, & cervical cancers are lower in the U.S. -Use of ER in place of regular doctor visits are more common in the U.S (people should be educated on how expensive it is for this so they can get a regular pcp) -U.S utilizes a higher number of diagnostic tests than other countries bc of the fear that providers may be sued if something goes wrong when the pt is discharged. -Hospital admissions for preventable diseases are more common in the U.S -Hospital admission rates in the U.S are higher than in comparable countries for chf, asthma, & complications d/t diabetes. However, the U.S has lower rates of hospitalization for HTN than comparable wealthy countries do on average. -51% of adults who made a same-day or next-day appointment when needing care is less in the U.S -U.S has less physicians than other countries bc reimbursement is going down & the doctors are ending up with lots of debt from many years in school. -Pregnancy related death rates is higher than comparable countries. -The U.S ranks last among comparable countries in amendable (preventable) mortality. We have more people die from preventable deaths than any other country. -Premature death is declining, but art a slower rate than other countries. -U.S has a higher rate of medical, medication, & lab errors (one could argue it's bc we do so many of them) -U.S continues to have a higher disease burden (overall unhealthy people) than those of comparable countries. -There are more people in the U.S with comorbidities & advanced diseases that will ultimately decrease their life expectancy than other countries. -U.S healthcare system is improving across each of these dimensions, though it continues to lag behind comparably wealthy & sizeable countries in many aspects. -Although the U.S spends more on healthcare than any other developed country, its health outcomes (infant mortality, life expectancy, & quality of care) are generally no better

What is the laissez-faire approach to leadership?

-Passive, non-directive, & inactive bc the leader relinquishes part or all of the responsibility to group members. -Defers decision making to group members, provides little guidance, support, or feedback. -Can cause low productivity & feelings of frustration & disinterest among group members bc the leader is too laidback & people don't know what to do at all. -Good style to adopt when you want to promote creativity, such as in the tech industry.

What is the change process?

-Plan the change by selecting people to carry out the change, designing methods to evaluate the outcome, anticipate resistance to the change, develop strategies to manage resistance, & design a plan to stabilize the change, & develop a timeline on how long the change will take. -Implement the change by making sure there is a clear understanding of the change to take place such as what to expect, the meaning of the change, what's required of the employees, etc. Utilize pilot studies to iron out problems, less threatening, & sell the rest of the client system on the idea. -Evaluate the change by analyzing each objective and asking was it met, what evidence shows that it was met, was the best means used to accomplish it, or would another method have worked better, etc. Adjustments are made if needed during this phase. -Stabilize the change by having reinforcement, two-way communication, & follow ups.

What are health insurance exchnages?

-Platforms or portals for comparing & purchasing coverage -All U.S citizens & legally present residents who are not imprisoned are eligible to use the exchange -States have the option of creating their own exchanges or relying on the federal government to create an exchange for them (or a hybrid of both) -States are not required by law to create a market place or exchange. If they don't have one, residents must purchase from the federal marketplace or exchange. -Permit states option to create a Basic Health Plan for uninsured with incomes 133-200% FPL -Permit states to prohibit plans in Exchange from providing coverage for Abortions -Create state-based American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges -Small businesses (up to 100 employees) and individuals can buy insurance -Four "Metal" Benefit Tiers; Bronze through Platinum. Bronze insurance plans are going to be the lowest, which only pays for about 60% coverage & is the cheapest option. The best plan is the platinum, which is very expensive monthly, but pays for about 90% coverage. -Restricted to citizens and legal immigrants

How can disasters impact healthcare?

-Population? Displacement, overcrowding of shelters, lack of resources, loss of jobs/insurance -City services? Water, sanitation, hygiene, infrastructure -Community health? Access to care, availability of healthcare services, access to medication, communicable disease, mental health -Healthcare worker? Personal loss, availability to work, mental health -Recovery? -Some things that may happen when disaster occurs that we need to consider is displacement of staff, patients, providers, lack of resources needed, & sometimes companies may close so people no longer have access to insurance & income. -The most treated disease during disasters is cellulitis bc of the unclean water!

What is Burrowes & needs 5 step stages of change model?

-Precontemplation: Enjoying life and don't see an issue -Contemplation: Issue identified and you see a need to make a change -Preparation: Developing the plan -Action: Implementing the change -Maintenance: Maintaining the change -If you can't maintain the change, you may go into a relapse.

What are the 4 different types of reimbursement?

-Private insurers -Charitable entities -Public government funded -Direct payment by patients (Out of pocket): Not seen as often, but a lot of companies & hospitals offer discounts or payment plans if they see you are uninsured and willing to pay out of pocket.

What are the characteristics of U.S healthcare?

-Privately governed (no central governing agency such as the NHS. -Many different payment, insurance, & delivery systems exist such as Medicare (federally funded), Medicare (federally & state funded), & BCBS (private insurance), out-of-pocket, etc. -Government subsidizes private sectors to run healthcare systems, increasing regulatory control -Technology focused. We have high investments in research & innovation r/t healthcare. -Limited access to healthcare for some. This is based on insurance coverage, socioeconomic forces, geographical location such as rural areas, etc. -Legal risks influence practice bc we have a fear of malpractice. We live in a litigious society where you are more likely to get sued as a provider, which impacts the decisions organizations & providers make. -Shrinking reimbursement & rising costs: Insurance companies are wanting to pay less money, but costs are rising at the same time. -Fusion of market & social justice: Asking how do er keep a competitive healthcare system that allows for profit & innovation, but also makes it more affordable & increase access to others.

How did the aca change private insurance?

-Process for reviewing increases in premiums & justification. They are trying to take initiatives to prevent the increases in the insurance premiums from getting more expensive. -Dependent coverage for children up to 26 -Prohibits lifetime limits on $ value of coverage & from rescinding coverage. Insurance companies used to say that people will only spend a certain amount of money on this policy & if something crazy happens to where you needed to spend more, they would cut you off. With the aca, they can't do that anymore. -Limit deductibles. The aca is trying to put caps on deductibles -Limit waiting period for coverage. The employees used to have to wait longer periods for insurance to kick in, but the aca has changed that. -Impact of aca repeal.

What are some internal time-wasters?

-Procrastination -Poor planning -Failure to establish goals & objectives -Inability to delegate -Inability to say no -Management by crisis -Haste -Indecisiveness

What is a patient assignment?

-Refers to the manner in which the total work of the nursing unit is divided up among personnel -According to the board of nursing it is designated responsibility for the provision or supervision of nursing care for a defined period of time in a defined work setting -Includes but is not limited to the specified functions, duties, practitioner orders, supervisory directives, and amount of work designated as the individual nurse's responsibility -Changes in the nurse's assignment may occur at any time during the work period -The charge nurse typically makes the pt assignments. They assign each nurse a certain number of pt's.

Why is making lists important to prioritize your time?

-Remember that lists are planning tools, so they must be flexible! -Reexamine items that remain on the list day after day, sometimes hour by hour. May need to be done or broken down into smaller tasks -Only put as many items on the daily list as can reasonably be accomplished in a day -Being punctual implies that you value other people's time and creates an imperative for them to value your time as well. -Allow adequate time for each task to be completed. We need to make sure we reprioritize as needed. Do not confuse importance with urgency!! We need to block time for unexpected events!

What is the future of healthcare reform?

-Repeal only, Repeal and Replace, vs. Revise. Some people hate the aca & want it to go, so they want it to be repealed. -Unable to come to a congressional agreement on repeal and replace -Medicare for All Act -Protecting Preexisting Conditions and Making Health Care More Affordable Care Act of 2019 (did not get this act passed) -We just need to know that there is a lot of discussion about the aca & healthcare reform

What is the timeline of the individual mandate being appealed?

-Republicans in the house passed the American Health Care Act in 2017, but the legislation failed in the Senate, despite repeated attempts to pass it. -Ultimately, lawmakers passed the Tax Cut and Jobs Act & president Trump signed it into law in December 2017. Although the tax bill leaves the rest of the ACA intact, it repealed the individual mandate penalty, as of 2019. -Reduced penalty mandate for individuals not carrying health insurance to $0, essentially eliminating it in 2019. -7 states still have their own mandates.

What are the 5 rights of delegation?

-Right task: task is delegated for a specific pt & the task is repetitive, requires little supervision, & relatively non-invasive. The results are predictable with minimal risk. -Right circumstance: The appropriate pt setting, available resources, & other relevant factors are also considered -Right person: right task to the right person to be performed on the right pt. -Right direction & communication: clear & concise description of the task, including objectives, limitations, & expectations is given. -Right supervision/evaluation: appropriate monitoring & evaluation, intervention as needed, & feedback is provided to the person completing the task and the person delegating the task.

What are current proposed legislative strategies?

-Scale back Medicaid, work requirements, block grants -Passed increased funding to treat opioid addiction- (PASSED) -Expand ability to use tax-deferred Health Savings Accounts (there are a lot of stipulations on these types of accounts what can be spent on, etc.) -Charge people with pre-existing health conditions higher premiums (people who use healthcare a lot should have to pay higher premiums than those that don't use it a lot)

What are the 5 basic emotional & social competencies?

-Self awareness: Knowing what you are feeling in the moment, having a realistic assessment of your own abilities & a well grounded sense of confidence. It is being able to reflect & ask yourself why are you acting this way -Self regulation: Handling your emotions so they DO NOT facilitate & interfere with the task at hand. This is being able to maintain your composure, so your emotions and feelings aren't dictating a situation & negatively impacting those around you. -Motivation: Using your deepest preferences to move & guide you towards your goals. This is using those beliefs & feelings to guide you towards your goals. -Empathy: Sensing what people are feeling & being able to take their perspective. This is essentially putting yourself in other people's shoes & asking yourself why they are feeling what they are feeling. Can also help establish rapport. -Social skills: Reading social situations accurately & interacting smoothly with others. -We need to think about this when we self reflect bc it can increase our emotional intelligence, which is important as a nurse so we can know how our pt and their families are feeling.

What are the different types of rationing?

-Self rationing: When someone has a limited amount of funds & decides to pay something else such as the light bill than for their medications -Health insurer rationing is when the provider decides if a pt really needs a procedure or could they go without to save resources. -Government healthcare rationing is when we decide who to give Medicaid to, etc bc we can't give it to everybody. -Rationing can result in practice changes & new policy formation in hospitals.

Who are the handoff players?

-Sender -Receiver -It is important that the sender makes sure they are delivering the appropriate message & the receiver is gathering the correct info.

What are some projected drug expenditures?

-Spending for prescription drugs is expected to increase due to efforts to encourage better medication adherence among those with chronic conditions, changing pharmacotherapy guidelines, faster private health insurance spending in response to higher income growth, & an expected influx of new & expensive innovative drugs into the market. -There is a pipeline of new drugs bc the prescription companies are not heavy regulated. As a result, the current law states that if you create a drug, for about 12 years, you have exclusivity or monopoly over the drug to where you don't have to give other manufacturers your formula. Once they hit the 12 year mark & it becomes public knowledge, they will try to produce another new drug that they can keep for themselves for the next 12 years. There will always be new innovative drugs coming to the market, so unless regulatory measures change, prescription spending will continue to be high.

What is Bran's habits to master personal time management?

-Strive to be authentic! -Favor trusting relationships (working in teams & trusting your team members) -Maintain a lifestyle that gives you maximum energy (what are some things you do to rejuvenate yourself) -Organize your day by your biorhythms (if you work better at day or night, etc) -Set very few priorities & stick to them -Turn down things inconsistent with your priorities -Set aside time for focused efforts (responding to emails, returning phone calls, etc) -Always look for ways of doing things better, faster, & more efficiently -Build solid processes -Spot trouble ahead & solve problems immediately -Break goals into small units of work & think only about one unit at a time. -Finish what is important & stop doing what is no longer worthwhile. -According to Bran, one should set up processes that last & run w/o their undivided attention.

What are some price drivers in the U.S?

-Technology is the key driver of healthcare spending, making it more expensive. -Aging population & rising rates of chronic disease w co-morbidities -Health status being important, such as obesity -Cultural biases that influence care utilization. Can be biases coming from the pt or the physician. For example, some cultures don't believe in Western medicine, which is why their disease is so advanced when they come to the hospital. Another example is from the physician's biases, such as certain cultures being more likely to receive less thorough care, resulting in repeat visits & worse results. -Administrative burden on providers, payers, & patients bc we have more steps & processes in everything we do, such as having to go through insurance companies, etc, & all of these people are paid to do their job, which requires more money. -Healthcare, legal, & regulatory environment (including malpractice, fraud, & abuse laws) -Fee for service (retrospective payment system) -Higher prices for drugs -Provider consolidation & increased market power (when providers join practice together, which leads to more money bc they are sharing expenses.) -Fragmentation in care delivery -Rising hospital & medical services costs & ;ack of transparency in cost & quality information (When pt's have no idea about how much something will cost or even if it costs at all. They are blindsided when it comes to cost of healthcare)

How did the aca affect employers?

-The aca did not require businesses to provide health benefits to their workers, but larger employers face penalties of they do not make affordable coverage available. -All businesses with > 50 full time equivalent employees required to offer health insurance (must meet minimum value & affordability requirements) to their full time employees (& dependents) or pay a fee. -Employees who work 30 or more hours per week are considered full time. -The penalty is 2,500 per full time employee, excluding the first 30 employees (they would be paying the penalty for 20 people & not thirty if they only had 50 employees. No matter how many employees you have, the first 30 does not count). -Enforcement of those penalties began in 2015/2016. -The penalty has now increased to 3,860 per employee since it took affect a few years back.

What is theory X & Y?

-Theory X is bad & says that a leader believes people are not motivated, their lazy, avoid work, & they must punish or threaten them in order for the employees to do work. It is associated with authoritarian leadership style with a lot of micromanaging & tight control. Can be depressing bc no matter what you do, the boss thinks you are lazy & need to be threatened to do your job. -Theory Y is the exact opposite. The leader believes the employees are self motivated & that they have the the drive to get things done w/o the leader telling them to do so. They enjoy their work duties and are motivate on their own w/o the leader forcing them to be so.

What are some current trends in reimbursement?

-There is a shift from volume to value (paying for performance) (p. 238-239) -Reimbursement based on quality of care rendered and outcome focused -Fewer inpatient days, more outpatient healthcare -Telemedicine -Accountable Care Organizations (ACO) and bundled payment arrangement, which is a group of providers that come together to provide coordinated care (p. 260). Helps avoid unnecessary duplication of services & creates accountability for quality, appropriateness of service, efficiency, and increased consumer satisfaction. -We are shifting from volume to value in order to try to find a balance. -We are trying to figure out how we can keep health care companies profitable enough to stay viable and get what they need to stay in business, but also to provide care without excessive and absorbent costs. -We are looking at quality also, such as is it a hospital acquired condition, or a 30 day readmission bc the insurance will not pay for it. We are taking quality into consideration when deciding how much to reimburse. -Fewer inpatient dates bc it cost more to be admitted and stay overnight. The longer people stay, the less money we are getting for that stay. -With accountable care organizations, they are trying to reduce fragmentation of care.

What is sbar & isbar communication tools?

-These are primarily used when giving report to physicians. -Before giving SBAR, we need to think about contingency planning & what some of the worst anticipated problems that could occur in the pt, results, procedures & what to do about them. Be specific -At the end of the hand-off, it is important to read it back to the person you are giving it to, so that you can ensure everyone is on the same page, which is called the shared mental model.

What is the difference between Medicare & Medicaid?

-Title XVIII established Medicare -Title XIX established Medicaid -Both Titles Legislated in 1965 -As part of ACA; Texas did NOT expand Medicaid eligibility -Older adults/elderly (65 & older) & people with certain disabilities can qualify for Medicare. (We care for the elderly) -Medicaid (aid the people who need it). Under the ACA, the government said we are going to increase Medicaid funding, but it is up to the state if they want it.

What is delgation?

-Transfers responsibility while remaining accountable for outcomes -Requires knowing which skills are transferable -Results in improved quality, safe patient care, improved efficiency, increased productivity, an empowered staff, and skill development of others -The nurse must know what skills can be delegated to who and when. -The npa of your state along with the principles of authority, accountability, & responsibility is the basis for effective delegation. -Delegation is an essential part of management, but never delegate something just bc you dislike doing it or you wouldn't do yourself bc it can create negative feelings & poor working relationships. As a nurse you are responsible and accountable for providing care to patients & delegating activities to uap, however you do not delegate steps of the nursing process. Those steps require nursing judgement, & pt teaching is also the responsibility of the RN & should not be delegated. We are responsible for the assessment of the pt's ongoing status, but we can delegate vs monitoring to a uap if the pt is stable. Appropriate delegation begins with knowing what skills we can delegate & knowing the npa of your state. -We must also look at the implications when we are delegating these tasks. We need to assess the pt & determine a plan of care before identifying which task can be delegated to someone else and safely be performed. Efficient delegation requires constant communication.

What is the difference between a transformational & transactional leader?

-Transformational is committed to a vision that inspires others and promotes change & autonomy. They have long term visions that reflects their mutual values. They empower & motivate others. They share governance. They are change agents, courageous, believes in people, value driven, have the ability to deal with complexity, ambiguity, & uncertainty. They are not defined by a position or a formal role. We should all aspire to be a transformational leader! They see a vision, articulate it, & have people want to meet us there & buy in bc we make those around us better when we make ourselves better! Ex: Will get a new charge nurse some training before putting them out by themselves. -Transactional leader: Focuses on management tasks, daily operations, committed, uses trade-offs to meet goals, does not identify shared values, examines causes, & uses contingency rewards. Ex: Wants a staff nurse to start charging but doesn't get them trained or anything, but tells them they will get Christmas off if they do this. Sometimes, this type of leader is needed, such as if we are super busy in the ER, which causes for more nurses to come in, so you say you will give the person who comes in a bonus.

What are behaviors of an integrated leader-manager?

-Treats employees as unique individuals -Inspires & stimulates critical thinking -Assists with adapting to change -Visible & flexible -Offers guidance, assistance, & feedback -Communicates their vision, establishes trust, & empowers others. -Motivates employees to achieve goals.

How does the U.S compare to other countries internationally?

-UK has government sponsored universal healthcare system (NHS), which is 4,5 % of the average citizens income -France has universal health coverage. May pay up to 21% of their salary for healthcare insurance. -Germany has private insurance with premiums split between employers & workers -Canada has it to where everyone must pay a premium to government (single payer system). The payment is based on family type & income. -Healthcare reform & big changes to the U.S system is needed but not easy bc of how large our population is compared to other countries. -There are all different types of systems that work for other places, but just bc everyone has access to healthcare doesn't mean it is great. For example, the NHS pt's usually have to wait up to 6 months to be seen by a practitioner.

What are two mistakes commonly made planning?

-Underestimating the importance of a daily plan for time management -Not allowing adequate time for planning

How should nurse prioritize their time?

-Understand the "big picture" (Why is my pt here and what is the worst thing that could happen to them?) -Decide on optimal desired outcomes (What is the best scenario that you would like for the pt?). You need to decide what you can do for the pt during the shift & what are some things you must do for the pt to keep them alive -Do first things first: Is the condition life threatening or potentially life-threatening? (1st priority). Is this an activity essential to safety? (2nd priority). Is this an activity that includes comfort, healing, & teaching (3rd priority) -Maslow's hierarchy of needs can be used to prioritize for pt's also.

Who are the middle management for nursing?

-Unit manager, nurse (house) supervisor, & coordinators. -Responsibilities include supervising staff, preparing budgets, works schedules (making sure holidays are covered), writing & implementing policies that guide client care & unit operations, maintaining quality of client services, & conducting staff meetings). -Integrate daily operations with organizational goals, strategic planning, & policy making. They analyze, appraise, & interprets performance (hires, fires, & evaluates issues with staffing). They are accountable for quality pt care. -Can be responsible for multiple units & is a 24 hour responsibility bc they deal with call outs, shortages on each shift, etc, even though you may never see them during night shift. -Typically requires a graduate degree. -This is a tough level to be bc they are between the first level managers & the top level managers, who don't always agree, so they are bridging the gap. -Coordinators are someone who has a global role in the organization, such as the staffing coordinator, but not just for nurses.

What are some examples of things that are urgent & important

-Urgent & Important is the quadrant of necessity & should be done first. These are things such as crisis, project meetings, last minute demands, deadline driven projects, etc. -Not urgent, but important is the quadrant of quality and it should be done 2nd. These are things such as strategic planning, working towards goals, personal care, relationship building, etc. Ex: You are the clinical preceptor for a nurse student who needs to debrief about how he communicated with the case manager about a patient's discharge plans -Urgent but not important is the quadrant of deception and could be done third or delegated to someone else. These are things such as interruptions, phone calls, emails, some meetings, other people's minor demands, etc. Ex: Today is the deadline to submit a quality assurance report about decubitus ulcers; the study results demonstrate that staff practice is consistent with standards and the decubitus ulcer rate is decreasing (Charge nurse perspective) -Not urgent & not important is the quadrant of waste & should be done last or eliminated altogether. These are things such as web-browsing, social media, binge watching netflix, analysis paralysis, etc. -Analysis paralysis is when someone is afraid to make a decision.

What are the methods of handoff report?

-Verbally -Handwritten notes -Bedside -Telephone -Audiotape -Nonverbally using electronic reports, computer printouts, & memory -The best one that is currently used rn is bedside reporting, in that this would happen inside the pt's room. It would involve the pt's oncoming nurse and the nurse who took care of them during the shift, the pt, & maybe a family member. It is very important to ask the pt if it is acceptable for the family member to be present while bedside report is being given. This type of report can help the pt be the focus of care & help us provide pt centered care. Some people believe that confidential information could be divulged while providing hand-off report. The blended approach could be that some pertinent personal info regarding the pt be provided outside of the pt room & then the remainder of the hand-off report given at the bedside with the pt. You can also assess safety & the environment while getting the beside report from the ongoing nurse.

How do some people handle change?

-Victim: Bring crisis, undermines morale, decrease productivity, & creates conflict. The nurse manager can be a victim to change from higher up. -Leader Manager: Improvement, raise morale, increase productivity, meet patient & employee needs effectively. -Object is to gain control of the forces of change in your organization, work environment, & life.

What are some driving forces for the U.S healthcare system?

-We are a free enterprise, meaning we allow the healthcare system to earn a profit. -Money is a driving factor -Bc we allow profit, we are the most innovative health care system in the world. The big companies want money, so they have a motivator to come out with the next big thing. -It is a constant balancing act where we want to be able to make a profit so that we can have the innovation, but we also want everyone to have access to healthcare. -Competition drives the profit down bc now other people knows how to make the same thing you do, so they can sell it also for cheaper prices than you do & make more from it.

How are nurses servant leaders?

-We listen & are empathetic -Work to understand/help patients heal physically & mentally -May persuade patients of what is needed to help them heal -Nurses are stewards -Nurses make patients & families aware of services beyond the hospital. -We listen to what people say so we can make a realistic plan of care for them. It is not a complete passive leadership style, but also letting people have a say so in their care, which is how we are servant leaders.

How do we create a motivating climate?

-Worker engagement -Worker empowerment -Use of positive reinforcement -Incentives & rewards -Supervisor-employee relationship -Appropriate use of recognition & praise -Hiring top performers (Can be a team motivator), A demotivator can be if you are the only hard working staff nurse on your unit & everyone else is lazy. -IKEA effect: If you give someone ownership and allow them to feel as if they created part of the work environment, they are willing to be more motivated & happier.

What are the costs of procrastinations?

-Your health (weakened immune system, ulcers, GI problems, etc) -Destroys teamwork & relationship with others -Monetary costs -Low self esteem

What are the three categories of prioritization?

1. Don't do: "outdated". Will take care of itself or better if accomplished by someone else. The deadline has past (there is no need to do it) 2. Do later: Large projects broken down into smaller projects. Some are trivial problems that do not have immediate deadlines (book synopsis) 3. Do now: Unit's day to day operational needs (pt that needs insulin for breakfast, etc).

What are the national academy of medicine eight principles that nurses & healthcare workers need to work on?

1.Accountability 2.Efficiency 3.Objectivity 4.Scientific rigor 5.Consistency 6.Feasibility 7.Responsiveness 8.Transparency These principles are consistent with the professional nursing agenda -With increasing accountability & efficiency, we need to make sure we are using EBP. -We need to be consistent with our practice, such as doing the same type of procedures and services for our pt's & not changing them around & doing them different ways for different people. -We need to make sure we are transparent with our care also. -All of these things are important to improve quality of care when caring for patients. -It is a balancing act from a leadership standpoint to be able to understand reimbursement & profitability while also looking at quality.

What are some other key features legislations not related to ACA?

3 key pieces of federal legislation that establish national standards that individual states use to regulate health insurance -Employee Retirement Income Security Act (ERISA): Establishes minimum standard for pension plans & regulates rules regarding employee benefits r/t their pension. -Consolidated Omnibus Budget Reconciliation Act (Cobra): Makes it where an employee must provide temporary access to healthcare insurance when you leave your employment. When you quit your job with full benefits, they are required to offer you a cobra plan that is close to the equivalent of your previous health insurance. It is only temporary, until you find another employer, but it is super expensive (about 700 dollars a month) and rarely used for this reason. -HIPAA

What is the full range leadership model?

A leader applies the principles of transformational, transactional, & laissez faire, -Leaders adapt their style based on what is needed for a given situation. -A leader can choose to adapt other styles of leading, depending on the situation.

Who is a large percent of people that fall into the coverage gap?

A lot of veterans & single parents fall into the coverage gap. -People that fall into this gap describes their health as excellent or very good, bc if they had a bunch of co-morbidities or big concerns about their health, they may have to sacrifice other things such as the cell phone bill, etc to make a premium more affordable. -A large portion of these people are from the South & Tx leads the way bc we decided not to expand Medicaid!

What is thought & rebel leadership?

A person who is recognized among peers for innovative ideas & who demonstrates the confidence to promote ideas -Challenges the status quo & is a risk taker -Core strengths include novelty, curiosity, perspective, diversity & authenticity. -They are willing to ask why we do certain things. -Can be very innovative also. -They are not opposed to change

What is the most expensive way to receive care?

Acute care settings such as the ER and he ICU. -Acute care hospitals will be more expensive than any other healthcare service you consume. -As a nurse, if I want to help improve the healthcare system, good education is important to do for your patient. -We should think upstream so we don't have to pay for advanced diseases with critically ill patients.

What is I pass the baton?

Another communication tool used primarily between nurses is the I pass the baton. We will use this tool when preparing for handoff report. -I: introduce yourself -P: patient (name, identifiers, age, sex, & location) -A: Assessment (the problem), procedures, etc so far in the process -S: Situation, current status, circumstances, uncertainty, recent changes, family members that need to be contacted -S: Safety concerns such as critical labs values/reports; Threats, pitfalls & alerts, code status, etc. -B: Background, co-morbidities, previous episodes, current meds, family -A: actions, what are the actions to be taken & brief rational & how quickly it needs to be completed -T: Timing, level of urgency, explicit timing, prioritization of actions -O: Ownership, such as who is responsible (person/team) including pt/family, RT, physician, interdisciplinary team members, etc -N: Next, what happens next? Anticipated changes? Contingencies, such as if the happens, the pt can do this, etc.

What is the decisional managerial role?

Anytime the manager is having to make a decision about allocation of resources, a new policy, how we want to do things, etc. -Ex: Researching new equipment bc ours is outdated, etc. -Can also be the disturbance handler, which is the decision to hire or fire someone.

How much time do documentation take of a nurse's time?

Approximately 25% of the nurse's time each day. 35% for Medsurg nurses. -Hunting & gathering for supplies also takes about 25% of the nurse's time.

What are the benefits for the states to expand Medicaid?

Better outcomes for their patient's states bc there is a decrease in cost, less comorbidities, & improved health of their population.

What is first level nursing management?

Can consist of the charge nurse, team leader, case manager, client care coordinator, or primary care nurse -Supervises those involved with the delivery of client care & day to day activities. Highly focused on the daily needs being met, such as making sure there are enough nurses for the nurse-patient ratio that day, the unit is safe, addressing complaints from pt's that may lead to unsafe situations, pt's all having food trays, etc. -Coordinates activities of all staff who provide client care & supervise their team members during the manager's period of accountability (assigned shift). -The clinical coordinator is someone who has a formal role on the unit, but serves as a charge nurse. They are essentially the charge nurse everyday, but they have additional responsibilities such as developing the schedule. The clinical coordinator is unit specific.

How does Maslow's hierarchy of needs r/t motivation?

Can guide motivation -If you want your nurses to focus on safety, productivity, do their job right, & really be motivated to help patients & do good for the organization, you need to make sure they have breaks to eat, etc, It goes the same for our patients, such as if they are homeless, their focus is on getting a meal & having somewhere to stay & not starting new meds.

What is emotional intelligence (EQ)?

Capacity to recognize & understand your own feelings & those of others around you, for motivating yourself, & for managing emotions as well in yourself & in your relationships. -This is not a fixed thing & everyday, we can increase this. -There is a lot of research that shows your EI may be more indicative of your future success than your IQ. You must be able to have emotional intelligence to be successful. -Has three mental processes: 1. Appraising & expressing emotions in yourself and others by understanding the emotions around us & what we are expressing. 2. We need to be able to regulate the emotions we are putting out from ourselves and into others. 3. We need to be able to use the emotions in adaptive ways by understanding how people are feeling around us, so we can adapt how we are speaking or what er are doing to make a situation better.

What is accidental change/change by drift?

Change that is unpredictable but it beneficial & may go unnoticed. -For example, if a nurse starts showing up late,& her peers get frustrated and start showing up late also.

Who was one of the biggest groups hat the ACA impacted?

College students! -Before this act, if you turned 18 & were still on your parent's insurance, they dropped you. With this act, they extended that age to 26, with the hope that by then, more people would be able to afford health insurance on their own.

Why is communication during transitions in health care?

Communication during transitions of care is under the big umbrella of pt safety & making sure we are accurate & structured so that we can provide safe & effective care to all patients. -This will in turn improve continuity of care & quality of pt outcomes.

What is the Tannenbaum and schmidt continuum?

Demonstrates the level of freedom a leader gives their subordinates dependent upon their level of experience -As the team freedom increases, the manager authority should decrease, which allows both the manager & subordinate to grow. Ex: When Dr Adams first started, Mrs Hsrding guided her through things & now Dr Adams has a lot of freedom to do things by herself. -As a leader & follower relationship progresses as they work, they will continue on the spectrum if they are doing it right. -Important to know that if you are always the authoritarian manager, no one is growing bc you are always doing everything & not learning to give freedom, & your followers are not learning to take initiative.

What is bureaucratic management (1920's)?

Developed by Max weber & it is all about rules, regulations, policies, & procedures. -Hierarchical superior-subordinate communication transmitted from top to bottom via clear chain of command. -Leadership clearly has qualities & procedures in place where everyone knows their roles & follows what is set out for them to do. -Relies on organizational policies & procedures for decision making. -Believes that individuals are motivated by external sources -Merit/skills as basis for promotion & reward -Uses rules & regulations -Focuses on technical competence & hierarchy with talk-down designs. -The government is an example & so is the DMV bc they must operate the same so there is no variations bc it is a national organization that needs to stay the same for everyone.

How is the rise of premiums & deductibles affecting the U.S healthcare system?

Even if you are getting a high rate of pay, but have a benefits package that costs a ton of money, it is not realistic bc you are not getting enough money from your checks. It may be better to work at another place that has cheaper insurance coverage and less hourly wage bc you will end up bringing home more bc less money is taken out of your checks for the benefits. The blue bar is overall inflation, so we do see an increase in this overtime, but it is only about 20%. What's scary is our insurance premiums are much higher than inflation. The black bar is our income & the cost of living is becoming higher while our income is being adjusted very slowly, but it doesn't do anything to help with the premiums bc they are increasing at double the rate. It is becoming increasingly less affordable to get private insurance, even through employers sometimes.

What is upstream thinking focused on?

Health promotion & illness prevention -Preventative treatment includes screening, vaccines, good education about dieting & exercising, etc. -When we don't utilize this, we are letting chronic disease develop such as cardiovascular conditions, diabetes, etc, & it is much more expensive if we don't utilize this.

What is the downstream focus?

Healthcare focuses on illness & injury. -Less focus on upstream care such as health promotion and illness prevention. -Dollars go downstream bc there is disproportionate focus on specialists, fragmentation of health systems, & proliferation of unregulated commercial care (there are new healthcare systems emerging that are typically unregulated, meaning they can charge whatever they want). -Costs increase when dollars go downstream. It is important to know that specialists are more expensive compared to pcp. -Hospice was an unregulated commercial care when it first came out.

What is the premium tax credit?

Help individuals afford healthcare coverage through the Marketplace -Individuals can determine how much of the credit to apply towards monthly payments each month (up to a maximum amount) -If at the end of the year you've taken more premium tax credit in advance than you're due based on your final income, you'll have to pay back the excess when you file your federal tax return. -If you've taken less than you qualify for, you'll get the difference back. -This is saying based on your income, we will give you a certain discount off your monthly premium. This can be redeemed in 1 to 2 ways. You can either say apply it to my monthly premium cost, where each month you pay your premium, the discount will be applied. Or, they will give you the credit in advance & when you go to file taxes it can get tricky bc your income and family size may have changed. If you are eligible for a certain amount at the start of the year, it may be different at the end of the year, so they can ask you to pay back some of the advance they gave, or they might give you more of a rebate, depending on the income and family size, & how they have changed.

What is the main thing we want to get out the affordable care act?

How to decrease cost, increase efficiency, & how to improve access to preventative services & upstream spending.

What are the four steps when talking to a physician?

Identify who you need to talk to, wait for the call back, be confident, & remember they are just people. -When talking to the physician, we need to identify who we need to speak to bc we will probably be calling an operator and telling them who you need to speak with, be prepared for a call back, have the chart readily available so you can give a brief description of the pt (remember the physician has multiple patients at multiple facilities, so they need to be reminded about which pt you are speaking of), be confident about what you are telling them, and then remember they are just people.

What is the planned change & change theory?

In today's health care organizations, continual change occurs with organizational restructuring, quality improvement, & employee retention. -Change is constant & necessary, but it should never be done just because. There should always be a reason. -The most important component to change is communication. No change will ever be effective w/o communication. -A change agent is someone in a formal role & will manage the complexities & effectiveness of the change.

What are managerial roles?

Include but are not limited to -Information processing role -Interpersonal roles -Decisional roles

What is the great man/trait theory?

It is the belief that some people have inborn characteristics that make them great from birth. For example, they are born heroes. -They have inborn characteristics that are not all inclusive & make them better leaders. They just have the "it factor". -Some identified traits include intelligence, integrity, self-confidence, personable, & charisma.

What is personal organization?

Knowing & understanding how & why you use time or set priorities the way you do. -How do you waste time -What type of work do you avoid -What is the best time of the day for you to work -How long can you work before becoming non-productive

What is the motivational theory?

Motivation is a force within us that influences & directs our behaviors, actions, etc, -Employee engagement is how committed the employees are to the organization -Employee satisfaction is how happy/content the employees are at the job. -Employee satisfaction & engagement are are two different things, so don't get them confused! -Motivational theories are helpful to explain why people act the way they do & how nurse managers can relate to individuals as human beings & workers.

What is the Hersey & Blanchard situational theory?

Leaders must take in consideration their followers, who they are working with, & where the followers are at with their tasks readiness & willingness. You can't treat everyone the same, so you must have different approaches to them. The leaders must modify their approach to different people based on their willingness & ability to do something. -The four different type of approaches is telling, selling, participating, & delegating. -Telling is for someone who is unwilling, unable, & not competent. Ex: There is a code and you tell someone to start compressions & they don't think they can, so you start telling them step-by-step what to do. -Selling approach needs to be used when someone is unable, but willing& competent. Ex: New grad & student nurses. Experienced nurses guiding new nurses to do something wile still giving them instructions. -Participating needs to be used when the person is able, but unwilling & not competent. For example, an ER nurse asked to triage for the first time. The leader must encourage the follower & help facilitate their success -Delegating can be used for someone who is experienced & doesn't need supervision. For example, telling a nurse to do triage & not having to oversee them & letting them do their own thing bc you trust that they know what they are doing.

What is the interpersonal managerial role?

Liaison & marketing role. -Ex: If someone finds out you are the manager for a unit, they start to associate you with the unit or affiliation. You start to serve as the figurehead for the unit/organization.

How has the life expectancy in the U.S changed with covid?

Life expectancy for all countries decreased, but this should increase as we covid begins to stabilize, but so many people died that we see this rapid drop in life expectancy. -The point to this is that the life expectancy is lower in the U.S than any other country.

What is the fielder contingency model?

Looks at a grid to make a decision about whether task or relations leadership style is more appropriate for the leader to take on. -First thing to look at is you leader member relations, which are feelings & attitudes of the followers regarding acceptance, trust, & credibility of the leader. This will either be low or high. -The next thing to determine is the task structure, which is how clearly the work to be done by others is defined (directions, goals, etc). This will either be high or low. If roles are clearly defined, the task structure is high, but if not, the ts is low. -Last is the position power, which is the degree of formal authority & influence associated with the leader, such as the ability to fire or hire someone or reward them. For example, if you are a charge nurse, you cannot fire someone so your pp is low, but a manager can fire someone, so there pp is high. -The leader needs to be focused on whichever one is low between the options of task structure or relations. You will either be focused highly on task or relations.

What is time management?

Making the optimal use of available time -Bc time is a finite & valuable resource, learning to use it wisely requires both leadership skills & management functions -There is a close relationship between time management & stress. -Good time management skills allow an individual to spend time on things that matter. -No one manages time, but we can determine how we use time! -You do not manage time, you manage yourself, others, & work! -Main purpose of time management is to achieve personal & professional goals!

What is personal time management?

Managing time is difficult if a person is unsure of their priorities for time management, including personal short term, intermediate, & long term goals.

What is the donut hole for Medicare?

Medicare will only cover a little bit of prescription costs until you reach a certain amount, which then they will start covering more of the cost of your prescriptions.

What is the information processing managerial role?

Monitor, disseminator, & spokesperson of information. -Ex of disseminator includes if we find out that the tbon is implementing a new law for nurses, so the disseminator must attend a meeting with the executive leadership & describe the new law and how to implement it on the unit.

How did chip affect the uninsured rate of children?

More children were eligible for insurance coverage & if you are low income, you should still be able to get health insurance for children. -Some people do not realize this bc there have been legislative changes within the past 5 to 7 years & with this, they have cut a lot of jobs regarding case management & healthcare accessibility, which means the parents of the children are getting less education about health insurance when in the hospital. -As a result of parents not knowing this, there are a lot of children who go uninsured. -Uninsured rate has decreased since the chip expansion.

What is self-care?

One of the most important strategies to mitigate stress! -Needed to effectively care for patients & families -Ex: Taking personal time each day, getting adequate sleep and nutrition intake, regular exercise, strategies to decrease stress at work, etc. -We should take personal time each day.

What are bundled payments?

One of the newer models that they are trying to implement bc they think it will be a good balance between utilization of services, profitability, & increase in communication among the healthcare team, ultimately decreasing fragmentation. The insurance company gives the hospital a single payment after looking at the overall picture of the pt & tells them that they must distribute it amongst the providers & hospital. Now, everyone wants to talk to each other to make sure they aren't duplicating services & doing other things bc the money is coming out of their pocket.

What is theory Z?

Organizations invest in their employees & address both home and work issues creating a path for career development. It is all about a holistic approach to employees. -Workers are trained as generalists rather than specialists, meaning their employees know how to do more than one job. This is good bc if one job goes away, the employee can stay on bc they know how to do multiple things. -Guarantee of lifetime employment. -Holistic concern for workers -Embraced way of some fortune 500 companies, such as Toyota. -Invests in employees in their professional and personal lives, such as some programs may have daycare, gym, etc. -These companies realize that people are people & support them with their work-life balance. With this type of support, the employees show loyalty to the company.

What does the Mcclelland theory state?

People typically fall into one of three categories. Some people may have a little of motivation for each though. -Achievement oriented: All about accomplishing their goals (whatever that may be to them) -Affiliated oriented: They want to fit in & feel as if they belong -Power oriented: They want to be the boss & have status

What does the gellerman theory state?

People will never learn & grow if they are not stretched. This may be putting pressure on someone to do something that they don't think they can do. For example, if we don't think we can take 3 patients, but our instructor encourages us to do so, & we do good. -Not recommended for everyday use, but occasionally to get someone to the next level. -Corresponds with the selling principle! -Want them to rise to the challenge, stretch them, spurs imagination, ingenuity, & creativity.

What is agile leadership?

Possess ability & agility to be flexible, adaptable, & fast in their decision making. -They are open to change & growth -Typically inclusive democratic leaders who exhibit great openness to ideas & innovations -Open to new ideas & flexible to change -Adaptable -Wouldn't be uncommon if an employee came to this type of new leader with a new idea from research & the leader was excited to hear about their idea

What is planned change?

Purposeful & intentional -Deliberate effort to improve a situation. -Done to solve a problem, improve efficiency, or to reduce unnecessary workload for some groups.

What is procrastination?

Putting off something until a future time, postponing, or delaying needlessly -Not a character flaw, but a set of behaviors that develop over a period of time & that can be changed -The dread of doing a task uses more time & energy than doing the task itself.

Some people that are insured still have trouble getting prescriptions filled, recommended test, & follow ups that are needed bc insurance don't want to cover it. They are having trouble getting things such as preventative care, screenings, etc.

True Also, if you have an insurance plan, it doesn't mean you can still afford something bc insurance chooses how much they will cover, so it can still be unaffordable with an insurance plan.

What is Lewin's force field analysis?

Something looked at during the second stage of his change theory. -Brainstorm to produce a list of all driving and restraining forces. -Estimate the strength of each force -Note the most important forces, then research & analyze them. -List and document possible responses or actions that might strengthen each important driving force or weaken each important restraining force. -As a good leader, we should anticipate problems before they happen. We are looking at some things that will probably hinder our change effectiveness, complaints we may get, things to help make this change, & pushback to anticipate

What is Burwell v. Hobby Lobby?

Stated that businesses with religious objections cannot be forced to pay for insurance that covers contraception for female workers bc doing so is a violation of religious freedom restoration act of 1993. -Make sure we know that it is not illegal for a company to say they don't cover expenses for abortions, etc.

What is Bennis, benne, & chinn?

Stated that if you want sell a change or get buy-in from others, there are 3 different approaches that people will fall in -Rational empirical: People believe info & change need to be disseminated through a rational empirical approach, such as numbers, proof, evidence, & statistics -Normative reeducation: For people who want to fit in & follow cultural norms. You tell them this is the way its being done now & all the good facilities are doing it this way. -Power coercive: Tells people if they don't follow the policies, they will get fired. Or saying this is how it's going to be, no if, ands, or buts about it.

What is vroom's expectancy model?

States that a person expectations about their environment or certain event will influence their behaviors. -It is a feedback loop that continuously makes you want to perform better. -Ex: IF there is a bonus for everyone washing their hands, everyone on the unit will start to wash their hands.

Creating smart goals is important for time management

True!

What is authentic (congruent) leadership?

States that in order to lead, leaders must be true to themselves & their values & act accordingly. -The leaders principles & convictions inspire others -5 characteristics include the purpose (leader understands their own purpose, passion, & values), values( They link their purpose & values by having congruence in their beliefs & actions. They make sure not to tell employers or followers anything they wouldn't be able to do or feel comfortable doing), heart (being genuinely compassionate to yourself & those around you), relationships (establishing connections, rapport, & relationships around you), & self-discipline (practicing self-discipline everyday in your professional & personal lives) -This is a good leadership trait bc in order for a leader to be successful, they must be true to themselves & their values!

What is level 5 leadership by Jim collins?

States that there are 5 different levels of leadership & it is rare to reach level 5. -Level 1 is a highly capable individual & has the talent & skills to get the job. -Level 2 is a contributing team member & has the knowledge & skills to not only do the job, but can also build others up around them -Level 3 is a competent manager. They can start organizing a group effectively to achieve goals & outcomes. Ex: The charge nurse bc they are able to organize the group to meet the daily operations. -Level 4 is an effective leader, who leads an organization, apartment, or meet performance objectives & the goals/visions. Ex: Manager -Level 5 is a great leader, which is when a leader can show humility & stay humble.

What is the Lewin's change theory?

States there are 3 processes to change 1. Unfreezing phase: We become aware of a need for change 2. Moving/changing phase: All about planning & implementing 3. Refreezing: last & hardest phase. It is when the changes are kept & the person is routinely doing it. -This is hard for an organization bc people like to go back to what they are comfortable with doing.

Who is the state with the most uninsured people?

Texas! -The highest rate of uninsured people are way down in the south tip of Tx. -Bc of this, nurses practicing in Tx need to keep in mind that the education & teaching should be dependent on their healthcare accessibility.

What laws & legislative actions affected people without insurance?

The ACA opened the exchanges & marketplaces that allows you to purchase health insurances. -They also allowed states to do Medicaid expansion. -As these laws went into affect, we saw the number of uninsured drop bc people had more access. -We also had the drop of the individual mandate to zero dollars if you did not have insurance, which caused some people to stop paying for insurance bc they weren't being fined anymore.

What is quantum leadership?

The environment is complex & dynamic & directly impacts organizational productivity, leaders embrace uncertainty, & the unexpected becomes the norm. -Maintaining a balance between tension & order prevents an unstable environment & promotes creativity, change is constant, & the workplace is fluid. -Leaders must work together with no subordinates to identify common goals exploit opportunities, & empower staff to make decisions for organizational productivity to occur. -This is a newer leadership style & it just states that the environment is complex & dynamic, & everyday is new to the point where the leader should expect the unexpected. The leader should recognize there will be a lot of unexpected events & try to maintain the balance & reduce tension so it doesn't become chaotic.

Family coverage for a premium is more expensive than single person coverage

True

Health insurance pays for about 75% of healthcare. The 75% is broken down into private health insurance, Medicare, Medicaid, chip, VA, & other small governmental insurance

True

Healthcare insurance is increasing bc we have more access from the ACA

True

What is Medicare?

The nation's largest health insurance plan. -Administered by the Centers for Medicare and Medicaid Services (CMS) -Covers those 65 and older; certain disabilities; and individuals with ESRD (>40 million enrolled) -Part of Medicare -Part A Hospital Insurance; hospitals, hospice, home health, SNCF (funded through Social Security Taxes) -Part B Medical Insurance; covers physician services, outpatient care, medical equipment, and diagnostic tests (funded through federal taxes and monthly premiums paid by recipients) optional -Part C (Medicare Advantage) Gap coverage; managed care plans -Part D optional coverage for outpatient prescriptions -ESRD if they need dialysis can qualify for Medicare. It is a very expensive disease & it is better for the health care system overall to have a payer for this bc no one can afford to pay out-out-pocket, so nobody gets paid at all. -Certain disabilities include severe intellectual disabilities that require them to live in a group home, not having the independence for a good quality of life, etc. -Medicare is federally funded, meaning the federal government pays for Medicare and it doesn't mater what states want or doesn't want it!

How was health care services expenditures during covid?

The personal consumption of healthcare decreased substantially bc the people who did not have covid did not want to go to the doctor & risk it, so they decided to socially distance & wait. -From a strategic standpoint, a lot of hospitals stopped other procedures when they were overloaded with covid pt's bc they needed the units to be turned into covid units.

What are employer based private insurances?

The premiums for private insurance has increased drastically, even though inflation occurred, cost of living is higher, & income is higher, it does not compare to the increases we are seeing w healthcare premiums. All private insurance companies make you pay co-pays, deductibles, & if you have an employer provided plan, they have contracts in place w your employer, & most of them require preauthorization. Preauthorization is similar to utilization review, but not as limiting, where if something is elective, they want the health care provider to notify the insurance and & tell the insurance they are okay with it happening. The insurance can still reject it & deny the claim, but the main difference between the two is that with utilization review, every single thing you do requires a review, whereas with preauthorization, it's mainly for procedures, surgery, and those type of things. One of the biggest changes that came out of the ACA was coverage for pre-existing conditions. Before this, if insurance thought you had a lot of comorbidities or pre-existing conditions, they wouldn't insure you.

What is leadership?

The process in which the leader influences or inspires others toward goal achievement.

What is management?

The process of leading & directing all or part of an organization through the deployment & manipulation of resources. -Organization & coordination of the activities of a business in order to achieve defined objectives. -Planning, organizing, staffing, leading, & controlling actions to achieve goals. -Dealing w resources is a big part of the job. -Daily activities are diverse, fast-paced, & full of interruptions. -Must have the ability to set priorities, make decisions, & interact with other is KEY. -All about how we can meet the unit or organization goals. -Use the 70/30 rule when 70% of your day is spent putting out fires, while the other 30% is planned. -Important to have both leadership & management skills to besuccessful.

What is gross domestic product?

The sum of the outputs of every class of enterprise. One of the primary indicators used to gauge the health of a country's economy. -The total $ value of all goods & services produced over a specified period of time. -It is everything spent or consumed in the country for one year. -Takes into consideration everything, such as what are the people investing, spending, buying, exporting, etc. Each year they release these numbers of how much is spent on what.

What was the national federation of independent business vs Sebelius?

The supreme court found that the individual mandate of the aca that required Americans to buy health insurance or pay a penalty, was constitutional.

Who are the people that fit into the coverage gap?

Their income is above Medicaid eligibility limits but below the lower limits for marketplace premium tax credits -Incomplete healthcare coverage -Affordability of co pays & deductibles -Lack of provider choice -Need for preauthorization -Between employee sponsored programs -This is all the people who do not qualify for Medicaid bc they make too much money, but they do not make enough to afford an insurance premium. -With some of the cheap plans, many of them have hoops to jump through such as not having as many providers to choose from, preauthorization for anything you must do, expensive deductibles & co-pays, etc.

What are premium & cost-sharing subsidies to individuals?

There are two types of subsidies available to marketplace enrollees -Premium Tax Credit-reduces enrollees monthly payments for insurance coverage -Cost Sharing Subsidy minimizes enrollees' out-of-pocket costs when they go to the doctor or have a hospital stay -In order to receive either type of financial assistance, qualifying individuals and families must enroll in a plan offered through a health insurance Marketplace. Only people who purchase insurance plans through the market place are eligible for these subsidies. For example, if I get my insurance through lamar, I am not eligible for these types of subsidies. -Available for individuals and families with incomes between 100% (133% in some states) and 400% of the federal poverty level -The federal poverty level (=100%) varies by family size. These subsidies are typically available dependent upon your income and family size. For example, if I make 1,000,000 dollars a year, I am not eligible for subsidies.

What is the charismatic style of leadership?

These people can be passionate about their ideas & usually have very powerful personalities. -Based on personal beliefs & characteristics -Personal qualities include charm, persuasiveness, personal power, self-confidence, extraordinary ideas, & strong (often unconventional) convictions. -Personality/inspirational quality promotes an emotional connection from their followers -Use powerful personalities to advance revolutionary goals -Consequence is the leader may be so strong that it takes on an almost supernatural purpose and the leader is worshipped to the ends of the earth, no matter what they do. They are influential to the point that people will blindly follow them. -The most important thing to ask yourself when dealing with a charismatic leader is "what is their agenda?"

What are common about the 21st century leadership & management theories?

They are more participatory, transdisciplinary, & collaborative bc those characteristics are becoming more important to meet today's challenging needs of healthcare.

Why is the change agent so important?

They will lead & manage the change. -Must maintain communication, momentum, & enthusiasm while managing the process. -Must know the change process, the people they are working with, the organization, have good self & situational awareness, & to know what is really going on so the change could be effective.

Integration of leadership & management is critical to long-term viability of today's healthcare organizations

True

Medicare has increased the amount of prescription drug spending exponentially in the past couple of years bc part D provides prescription drug coverage

True

Where is the U.S in the healthcare system/performance rating?

This is a report card that looks at care processes, who has access to care, administrative efficiency (what is all involved in processing healthcare), equity, & healthcare outcomes. -The U.S ranked last in everything except care processes bc we have protocols and core measures in place that are useful when caring for common diseases such as MI.

What is Nelson & Burns High performance programming model?

This is all about an organization's perspective & where they are at. -Focuses on the behaviors and characteristics of the organization. -There is reactive, responsive, proactive, & high performing. -Reactive is negative bc it focuses on the past & puts blame. -Responsive is focused on the present & what they can do to make it better today. They are focused on output and doing what they need to do for today. They are not looking into the future. For example, if there is a fall, they will go around the unit & make sure all bed alarms are on, instead of looking at what actually caused the problem. -Proactive is about the future, but maybe not focused on the latest & being innovative & excellent. ex: We realized there was a pt fall & we say this is a problem, so lets do some education & implement interventions so that more people don't fall. -High performing is the best bc its all about excellence & empowerment. For example, we realize we need future plans to prevent falls, but we go look at the literature & find innovative interventions to prevent situations such as falls from occurring. We create policies based on the research we did & implement them. -You can also fall into one of these categories as a nurse.

The U.S has lots of spending with low performance.

True

The cheaper the insurance premium is, the higher the co-pay & deductible will be

True

Brand name drugs have steadily increased while generic has decreased b we now have commercials that only advertise brand names & manufacturers are constantly creating the latest & greatest thing that people think will fix them & doesn't have a generic yet.

True

Depending on the current inflation levels & the economy, the poverty levels in the U.S increases each year

True

The U.S spends a large amount of their gdp on healthcare

True! -The amount rises each year! -On average, other countries spend about 5,000 per capita each year on health care, while the U.S spends 12,00 per capita each year. -The pandemic increased healthcare spending overall, meaning everything got expensive. Even though the pandemic increased the cost of things, we were still exceeding other countries & spending too much on health care & we continue to exceed our gdp growth!

One thing to note about the U.S healthcare system is we are not consuming more healthcare, but our healthcare is just becoming more expensive, which is why we continuously increase healthcare spending every year.

True. -For example, there may be just as many unhealthy people in other countries, but there healthcare is less expensive! -Everything is more expensive bc we don't regulate/cap spending on healthcare.

What is healthcare transparency?

Truth in reporting -Pros: Discover info about healthcare costs, medical errors, & practice preferences. -Cons: Fear of litigation or reprisal against healthcare provider. -Encourages healthcare providers to recognize & respond to underlying hazards as well as risks to patient safety in a timely manner & implement evidence based improvement initiatives. -Allows pt's to see reviews before receiving services -We have done a bad job at making data available for the public. There are now government funded websites that tell you info about healthcare costs, quality, mortality rates, post-op infections, & more. -There is an increased risk of lawsuit bc you can see the trends in care & know that the bad care wasn't just to you. -It can hold healthcare providers accountable bc they will focus more on evidence based practice & make sure they are doing things correctly so they have reduced risk for litigation.

What are HMO's aka managed care

Type of healthcare insurance plan that has become more common over the past few years as a way to reduce cost. This type of policy focuses on the primary care provider as a gatekeeper, meaning they must approve everything, such as going to a specialist, getting tests, etc. It is all focused on prevention & upstream spending. A lot of them do selective contracting, where they won't let you go to Quest, lab corp, etc to have your choice whenever you need x-rays, labs, etc. They will tell you that you can only go to a particular company bc they have worked out a low cost contract with them. If you go to something outside that your insurance does not allow, you will typically have to pay out of pocket bc your insurance will not cover it. They also use utilization review for everything, which is when they determine is it really medically necessary for everything you want done. An example of capitation is when insurance says they will give you a set amount of money (such as 50,000) no matter how many patients you see, you must make sure to balance the money with all the patients. Moral hazard risk is used bc insurance believe utilization review is very important bc if you don't have a gatekeeper or someone micromanaging how you will consume healthcare, that you are just going to go crazy with it. It is the belief that the more freedom we give them and the less stipulations we have, the more they are going to spend on healthcare. Just bc you have this insurance plan, it does not mean they will reimburse you, bc you must only go to providers & companies that the insurance wants & they must approve everything. As a nurse, everything must be clearly documented to determine if the service is actually needed.

What is the prospective payment system?

Utilizes diagnosis related groups based on ICD codes to specify reimbursement amount, regardless of the actual cost of care. -With this, the physicians started to underutilize and not give the pt the care that was really needed bc they could make more of a profit.

What are handoffs?

Verbal exchange of information during transitions in care across the continuum -Occurs between two or more health-care providers -Include an opportunity to ask questions, clarify and confirm -Variety of handoffs such as shift-to-shift, nursing unit to nursing unit, nursing unit to diagnostic area, special settings such as the Or or the ER, discharge & interfacility transfer, handoffs & meds (If they are receiving a new medication during the next shift, there needs to be some type of handoff), physician to physician, nursing to physician

What is the servant leadership created by Robert Greenleaf?

Wanting to put needs of others above all else as #1 priority. -Characteristics include listening, empathy, healing, awareness, persuasion, foresight, stewardship, growth, & building community. -Fosters a service inclination in others that promotes collaboration, teamwork, & collective activism. -This is a challenging leadership style bc you must put people before you! -Takes a lot of empathy, awareness, & emotional intelligence to fill this role. -All about teamwork and collaboration! -Not a weak form of leadership & it is more challenging than the authoritarian style!! -Does not require leaders to be doormats! -It is Not a submissive or passive leadership style! -Not soft & foo-foo! -Not irrelevant to business! Ex of businesses that have this leadership style: Chick-fil-A & 7 eleven

How does healthcare impact immigrants?

We have a large amount of people immigrating to Tx & a lot of these people may be eligible for certain things, but they want to stay off the radar, so they won't go to seek healthcare. -They don't want anyone to know who they are & where they are from, which is a big driver in the uninsured rate.

What is strength based leadership?

When a leader recognizes & uses someone's strengths for building a team. -Leaders utilize their key strengths to build teams and lead others. -Surround themselves with the right people (who have different strengths than they do) to maximize their team. -Understands their followers needs, maximizes their followers strength, & empowers others. -Creates teams that balance strategic thinking, influence, relationship building, & execution. -Followers commonly describe the leader as trustful, compassionate, stable, & hopeful. -Ex: If I were to start a nursing school study program, I am not going to hire just patho teachers, but also med-surg, cc, L&M, etc bc those are all different strengths. By doing this, I am getting the most out of the team & being most productive. -Develop a team where you can utilize everyone' key strengths, including your own.

What is the principle age theory?

When the followers/agents & the leaders interest/intentions do not match. -Not all followers are inherently motivated to act in the best interest of the leader or employer. -Followers can & do mislead leaders, both intentionally & unintentionally. Ex: A nurse cn be falling behind w time management & the leader not realize they are taking a smoke break every hour, which means the leader is now misled and may think the time management problem is bc of something else. -Employers or leaders use rewards or disincentives for the follower to act in the organization's best interest.

Can free enterprise be a good thing for the U.S?

Yes!

Does the majority of the uninsured work?

Yes! -A majority of them have jobs, but still can't afford insurance. -The jobs are low income & the employees doesn't qualify for Medicaid & can't afford private insurance. -With Medicaid, it is hard to find a pcp that accepts it, so we shouldn't get mad or frustrated when these people come into the ER. We need to look at other factors & try to get them the resources they need such as case management, etc. -People who are uninsured typically forego & delay treatment bc of the cost

What was Halbig vs Burwell?

•A three-judge panel in Washington, DC, ruled 2-1 that the federal subsidies are illegal because they were not explicitly mentioned in the law. Thirty-four states have not created their own exchanges, forcing residents to enroll through federal exchanges. -This just stated that it is not required by law for a state to have their own marketplace or exchange for people to purchase health insurance on. If the states don't have it, the residents must buy from the federal marketplace.