Leadership & Management Exam I

Quadrant 3 (Quadrant of Deception) AVOID

-Not important but Urgent

How The Tax Credit Works (Premium Tax Credit)

"The Affordable Care Act provides a new tax credit to help you afford health coverage purchased through the Marketplace. Advance payments of the tax credit can be used right away to lower your monthly premium costs. If you qualify, you may choose how much advance credit payments to apply to your premiums each month, up to a maximum amount. If the amount of advance credit payments you get for the year is less than the tax credit you're due, you'll get the difference as a refundable credit when you file your federal income tax return. If your advance payments for the year are more than the amount of your credit, you must repay the excess advance payments with your tax return. Also called premium tax credit.

Competitive conflict

-Resolve through competition -Emphasis placed on winning -Determine by a set of rules

Leadership: What it Takes to Work with Teams

-Respect -Empowerment -Gracious Communication

Examples of Important but Not Urgent

-preparation -prevention -values clarification -relationship building through re-creating -empowerment

Diagnoses

-primary -secondary -nursing -medical -surgery date

Expected shift outcomes

-priority outcomes for one to two nursing diagnoses -patient learning outcomes

Interdisciplinary collaboration is influenced by

-professional role -structural characteristics -personal characteristics -history of collaboration

Bronstein's Model

-Characteristics of interdisciplinary collaboration -interdependence -newly created professional activities -flexibility -collective ownership of goals -reflection on process

How to create synergy

-Clear purpose -Active listening -Compassion -Telling the truth -Being flexible -Committing to resolution

Prioritization

-Do -Delegate -Delay -Delete (to remove what isn't necessary)

Areas of Real or Perceived Differences

-Goals -Values -Ideas -Culture -Attitudes -Beliefs -Feelings -Resources -Workload -Personalities

Synthesis Project

"The Synthesis Project is an initiative of the Robert Wood Johnson Foundation to produce briefs and reports that synthesize research findings on perennial health policy questions. These products give policy-makers reliable information and new insights to inform complex policy decisions. The project pairs researchers with policy analysts to produce Synthesis reports and briefs. Members of the project's advisory group provide insights and guidance to the project and actively participate in the development and review process for Synthesis products".

Aggressive behavior

-"Win-lose" competition -Scapegoating

Leadership and Management Theory: Quantum

-(based on concepts from Chaos theory) -Maintaining a balance between tension and order prevents an unstable environment and promotes creativity; change is constant and the workplace is fluid -Environment is complex and dynamic and directly impacts organizational productivity; leaders embrace uncertainty -Leaders must work together with subordinates to identify common goals, exploit opportunities, and empower staff to make decisions for organizational productivity to occur -Beneficial during periods of rapid change and needed transition

Management Theories

-*Scientific Management -*Bureaucratic Management -*Human Relations -Contingency (flexible approach - see leadership notes) -Resource Dependence -*Strategic Management -Population Ecology -Institutional -Social Network -Complex Adaptive Systems

Time Efficient Work Environment

--Gather all supplies and equipment needed before starting an activity -Group activities that are in the same location -Use time estimates -Document nursing interventions as soon as possible after an activity is completed -Always strive to end the workday on time

Disproportionate Spending

-10% of population---> 60% of spending -1% of population ----> 20% of spending -Describe the top spending population....

Performing Stage

-Group cohesion, collaboration, and solidarity evident -Group reaches maturity -Team functions as whole to achieve tasks -looking at results, working through difficulties

The Uninsured

-2006: 16 percent of Americans uninsured; "self-pay" -2010: 47 million Americans uninsured (Kelly) -Current trends: 10.4% of the U.S population, or 33 million people, were uninsured in 2014, down from 13.3% in 2013 (The Commonwealth Fund)

Updated Helath Insurance Survey

-2016 Biennial Health Insurance Survey -Percentage of people who shopped for insurance on their own who could not find an affordable plan dropped from 60% in 2010 to 34% in 2016. -Uninsured adults age 19-34 fell from 27 to 15% between 2010 and 2016. Greatest gains in coverage for any age groups. -Among those with health problems, 70% said they had trouble finding an affordable plan in 2010, compared to 42% in 2016.

PEW Health Professions Commission 1998

-21 competencies for 21st century -All healthcare professionals be required to develop interdisciplinary competence

The US spent $3,205.6 Billion on Health Care in 2015. Where did it go?

-32.3% was spent on hospital care -15.7% was spent on physician services -14.8% was spent on other personal health care

Leading Change

-A dynamic process that leads to an alteration in behavior -Leadership style influences the approach to initiating the change process

Generation

-A group that shares birth years, age, location, and significant life events -Approximately 15 to 20 years in length -Has a different value system from the preceding generation and later generations

Prioritizing--Urgent and Important

-A patient's condition becomes life threatening and you have other patients who need your care -How do you handle the situation?

What is leadership?

-A process in which the leader influences or inspires others toward goal achievement -it's a reciprocal relationship

What kills synergy?

-A self-appointed expert -Knows it all and is righteous -Someone who doesn't speak up -Knows a great deal but doesn't share knowledge and information -A loner -Someone who doesn't want to be a team player

Time management

-A set of related common-sense skills that helps you use your time in the most effective and productive way possible -Allows us to achieve more with available time -Involves efficiency in completing tasks as quickly as possible and effectiveness in deciding the most important task to do (prioritizing) and doing it correctly

Team

-A small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they are mutually accountable -The World Heath Organization (WHO) -Two or more people working interdependently toward a common goal

Spiritual Distress

-Acute illness -Chronic illness -Terminal illness -Near-death experience -used to identify an individual has an impaired ability to integrate meaning and purpose in life through the individual's connectedness with self, others, art, music, literature, nature or power greater than themself

Workplace behavior guidelines

-Adapt to your organization's culture -Good communication requires listening and clarifying -Go to the source of the communication -Observe for cultural differences in the workplace -Realize that health care is a 24/7 business; make arrangements early with your manager for time off for religious or cultural holidays

Medicare; Nations 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)

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

Evaluate change

-Analyze each objective -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? -Adjustments are made if needed

Incivility

-Another term used to describe mistreatment or discourtesy to another person -Disruptive behaviors such as eye-rolling, and other nonverbal behaviors and sarcastic comments, intimidation, physical violence

Policy maker options; defined as rationing?Technology Cost Control

-Appropriate application of medical technology to patients likely to receive the highest benefit -Reduce incentives that favor services incorporating new technologies -Increase use of consumer financial incentives and support; provide information on treatment alternatives and quality of different providers of care

June 2015 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.

Retention Tips (styles of learning)

-Ask people how they learn best. -When people ask for the tools to do their work, give them the tools. -Provide the latest technology as monies permit. -Expect, plan for personal and professional development. -Communicate about how well they are doing and where they can improve. -Set goals and help with the plan to achieve them

Steps to Effective Delegation

-Assess the knowledge and skills of the delegatee. -Match tasks to the delegatee's skills. -Communicate clearly: -Task, outcome, time -Listen attentively. -Provide feedback. (ALWAYS provide GOOD feedback)

Improving Communication

-Avoid use of slang terms and regional expressions -Provide coworker with resources that can help reinforce verbal communication -Praise coworker's competency in technical skills -Appreciate knowledge gained working alongside skilled nurse from another culture -Use "I" statements when offering constructive criticism -If cannot achieve effective communication with coworker, request to work with another person

Methods of conflict resolution

-Avoidance -Accommodation -Competition -Compromise -Mediation

Leadership and Management Theory: Relational

-Based on collaboration and teamwork -Focuses on the relationship between leader and followers -Finds a common purpose -Works together cooperatively -Less emphasis on leader traits, the situation, or outcome and more emphasis on the leader's relations with others

Contemporary Approach: Charismatic Theory

-Based on personal beliefs and characteristics -Personal qualities include charm, persuasiveness, personal power, self-confidence, extraordinary ideas, and strong (often unconventional) convictions -Leader's personality/inspirational quality promotes an emotional connection from followers -Use powerful personalities to advance revolutionary goals -Consequence: Leader may be so strong that it takes on an almost supernatural purpose & leader is worshipped

Leadership Theories

-Behavioral Approach -Contingency Approach -Contemporary Approach -Charismatic Theory -Transformational Leadership Theory -Servant Leadership -Knowledge Workers

Qualities of Effective Team Members

-Being proactive and motivated -Taking charge of own life and surrounding circumstances -Taking full responsibility for own actions, decisions, and behavior -Developing personal sense of purpose, mission, and professional goals

Democratic leadership (participative management)

-Believes every group member should have input into problem solving and goal development -participatory, Delegates authority to others; leader makes decision based on input of group members -Uses expert power & close, personal relationships; strong performance of group with leader present or not; positive feelings

Organization socialization

-Beneficial to organization when employees have the following: -High commitment to organization -Little intention to leave -High levels of job satisfaction -Little work-related stress -Begins as part of new hire's orientation

Force Field Analysis - Lewin

-Brainstorm to produce a list of all driving and restraining forces. -Estimate the strength of each force. -Note the most important forces, then research and analyze them. -List and document possible responses or actions that might strengthen each important driving force (need motivation such as law, change, motivation) or weaken each important restraining force (things that hold back change rom being implemented

Payers/Insurance in other developed nations

-Britain; government taxes pay for all -Citizens of France may pay up to 21% of their salary for healthcare insurance -Germany; private insurance, with premiums split employers/ workers -Canada; everyone pays premiums to government (single payer system)

Lippitt's Model of Change

-Built on Lewin's model -Emphasizes the participation of key personnel & change agent in designing and planning change -Emphasizes communication

Benefits of Multigenerational Team

-Can attract/retain talented people of all ages, more inclusive -More flexible -Can gain/maintain greater market share because reflect multigenerational market -Decisions are stronger, more broad-based with multiple perspectives -More innovative and creative -Can meet needs of diverse public and can relate more effectively

Interprofessional Collaboration

-Can be accomplished through referrals to or consultations with other healthcare specialists and through client care conferences involving members of all health care disciplines -The nurse should collaborate with other members of the health care team and serve as a liaison between the client and others and as a resource to others to ensure continuity of care

Benefits of the Interprofessional Approach

-Can improve clinical outcomes -Provide satisfaction in a variety of disease processes, populations, & settings -Reduce length of stay -Increase likelihood of patients receiving care concordant with patient & family values -Enhance patient safety, organizational commitment, & heightened productivity -Improve communication

Informal teams

-Can influence the organization either positively or negatively -Are not directly established or sanctioned by the organization, but often form naturally to fill a personal or social interest or need -Can become very powerful

Qualities of Effective Team Leaders

-Can organize, facilitate, and manage the entire team -Must understand how various learning styles, cultural diversity, and personality differences play into the dynamics of teamwork -Have good communication skills, conflict resolution skills, and leadership skills

Using Knowledge and Emotional Intelligence

-Capacity to recognize your own feelings and those of others, for motivating yourself, and for managing emotions well in yourself and in your relationships. -Complementary to academic intelligence.

How do we control cost?

-Capitation - fixed amount per person over period of time -Prospective Payment -Fixed amount for service is received based on the relative cost of resources they use to treat Medicare patients with in each diagnosis related group (DRG groups) -Medicare Hospital Prospective Payment System -Reduced Services -Public Information and Education -Risk Sharing -Controlling HC costs the new way -Other Ideas??????

Avoid falling into the perfectionism trap

-Catch yourself when you start to do it, realize what you are doing & stop!!! -Have a clear understanding of what it is you are trying to accomplish & have an established completion criteria so you can easily tell when you should be done

Championing Spirituality

-Champion spirituality for all staff -Develop understanding and empathetic approach to nurses' needs for religious holidays and celebrations that have spiritual significance

Importance of the Change Agent

-Change agent is the person who leads and manages the change -Ultimately responsible for the success of the change project -Manage the dynamics of the change process -MUST maintain communication, momentum and enthusiasm while still managing the process

Refreezing Phase

-Change becomes stabilized -make change permanent -establish new way of things -reward desired outcomes

Move/Changing Phase

-Change is planned -Implementation occurs -take action -make changes -involve people

ACA Medicaid

-Changes to brand name drug rebates -Prohibit Medicaid payments for healthcare acquired conditions -Increase Medicaid payments for primary care services

Glen Parker's Characteristics of Effective Teams

-Clear purpose -Shared leadership -Informality -External relations -Participation -Style diversity -Listening -Self-assessment -Civil disagreements -Consensus decisions -Open communication -Clear roles and work assignments

Implement Change

-Clear understanding (and preparation) of the change to take place -What to expect, -The meaning of the change, and -What is required of the client system in adapting to the change. -Pilot study -Iron out problems -Less threatening -"Sell" the rest of the client system on the idea

Approaches to Negotiating

-Collaborating -Win-win -Avoiding -Lose-lose -Competing -Win at all costs -Accommodating -Lose to win -Compromising -Split difference -Confronting -Stops conflict -Negotiating -Seeks agreement

Transformational Leader

-Committed to a vision that inspires others; promote change & autonomy -Long-term vision that reflects mutual values -Empowers & motivates others -Shared governance -Change agent, courageous, believes in people, value driven, ability to deal with complexity, ambiguity and uncertainty -Not defined by a position

12 Cs of Teamwork

-Communication -Cooperation -Cohesiveness -Commitment -Collaboration -Confronts problems directly -Coordination -Conflict management -Consensus -Caring -Consistency -Contribution

Barriers and Challenges to Effective Interprofessional Team Function

-Communication breakdown -Hierarchical structures -Muddied roles of team members -System issues

Spirituality

-Component of healing in nearly every culture -Important assessment during hospitalization -Multifaceted concept -Specific to individual -Nurses can use various resources to provide spiritual support and tools

Interdisciplinary team

-Comprised of necessary disciplines contributing to an individual patient's care -All members work together to come up with alternative solutions and final decisions -Leadership and membership ______ depending on situation

Financing ACA

-Congressional Budget Office estimates additional 32 million covered by 2019 -Estimates cost of coverage to be $938 billion over ten years. -Financed through taxes and fees -Estimates reduced federal deficit by $124 billion over ten years

Management

-Control complexity -Bring order & consistency -Predictable -Planning & organizing -Budget -Staffing -Problem solving

Overcoming barriers to change

-Create a flexible and adaptable environment -Encourage the people involved to plan and set goals for change -Include all involved in the plan for change -Focus on the benefits of the change in relation to improvement of client care -Delineate the drawbacks from failing to make the change in relation to client care -Evaluate the change process on an ongoing basis, and keep everyone informed of progress - Communication is key! -Provide positive feedback to all involved -Commit to the time it takes to change

Leadership

-Create change -Lead change -Empower others -Motivate -Inspire & align others -Vision

Healthcare Insurance Exchanges--Marketplace

-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 Benefit Tiers; Bronze through Platinum -Restricted to citizens and legal immigrants -Qualifications of participating plans -Requirements of the exchanges -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 (or separate premium) -Effective 2014

Premium and Cost-Sharing Subsidies to Individuals

-Creates insurance exchanges to provide premium credits and subsidies to individuals and families with incomes between 133% and 400% of the federal poverty level -The federal poverty level varies by family size. In 2013, it is $11,490 for a single adult and $23,550 for a family of 4.

Current State of ACA

-Currently, the ACA is the law of the land -Great debate -No consensus around any single approach at the moment -Repeal and Replace? -What do you keep? -What do you throw out?

DESC Example

-D- When you scream at me in front of my co-workers about the delay in care, you're making it personal. -E- This reduces my credibility with the patients and undermines my authority with staff. I feel you don't respect me. -S- If you are upset about delays or other patient care issues, pull me aside and I will address your concerns. -C- If your outbursts continue we won't have a working relationship, and patient care will suffer.

DESC

-Describe the specific situation -Express your concerns about the action -Suggest other alternatives -Consequences should be stated

Managerial Responsibility

-Determine which cultural groups are represented on staff -Understand organization's values and goals -Decide what is best for future of organization -Analyze present situations -Plan ways to reach future goals -Evaluate results -Plan informal meetings for nurses to discuss cultural differences -Provide cultural workshops

Concepts and Principles of Culture

-Develops over time -Is responsive to its members and their familial and social environments -Is learned and shared by members -Is essential for survival and acceptance -Changes with difficulty

Cultural Shock

-Develops when values and beliefs upheld by new culture differ radically from person's native culture -For successful assimilation into new culture, newcomers must learn and internalize new culture's important values

Health disparity

-Differences in health risks and health status measures found disproportionately in certain population groups -Affects groups with lower socioeconomic status

Challenges of Team

-Disciplinarity: authorization, vocabulary, problem solving approach -May be lack of interest or motivation, ability, or skill -May take longer to achieve a goal than one individual -Team members may have disagreements on the best course of action -Professional prerogatives

Covert and inappropriate behavior

-Displaced anger -Resignation -Retaliation -Projection -Rationalization -Attention-seeking behaviors

Communication with Others

-Do not take verbal orders from a foreign physician whose language is difficult to understand -Use caution when supervising unlicensed assistive personnel who have difficulty understanding and speaking English

What are some techniques for handling difficult people?

-Don't get run over, step aside -Stand up for yourself -Give them a little time to run down and express what they might be ranting about -If possible, try to get them to sit down -Maintain eye contact -Don't argue with them or try to cut them down -When they finally hear you, be ready to be friendly

Communication Tips for Managers

-Don't manage, mentor -Don't assign, explain -Don't dictate, solicit -Don't ignore, respond -Don't conceal, communicate

Compromise

-Each party gives up something it wants -Compromisers are: -Assertive and cooperative -Work creatively and openly to find the solution that most fully satisfies all important goals and concerns to be achieved

Qualities of an Effective Leader and Manager

-Effective communicator -Promotes interprofessional collaboration -Credible -Critical thinking -Initiator of action -Risk taker -Persuasive and influences employees

Expansion of Public Programs

-Eligibility for Medicaid expanded to 133% FPL (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 2019 -Extended funding for the Children's Health Insurance Program (CHIP) through FY 2015 and continues the authority for the program through 2019.

Strategic Management Theory

-Emphasizes fit or alignment between the organization's strategy, external environment, and internal structure and capability -Links quality improvement efforts to core strategies and capabilities of the organization to meet organizational needs

Shift-Hand Off Report

-Ensures continuity of care among nurses caring for a client -Describes the client's health status and informs the nurse on the next shift about the client's needs and priorities for care -May be written, oral, audiotaped, or provided during walking rounds at the client's bedside (Bedside reporting)

Advantages of Team

-Equalizes power through shared governance -Creates effective inter-professional communication -Optimizes safe patient outcomes -Improves interpersonal relationships and job satisfaction -Promotes free exchange of ideas, team cohesion, trust, and mutual respect -Improves stability in employee satisfaction

ACA Prevention/Wellness

-Establish National Prevention, Health Promotion, and Public Health Council -Modifications to Medicare and Medicaid covered preventative services -Require chain restaurants and vending machine foods to disclose nutritional content

Recommendations for National Academies included

-Establish mandatory system for reporting errors and adverse events -Set reporting standards

Making the most of your time in ALL areas of care delivery

-Estimate how much time each activity will take and plan accordingly... -Does your unit's environment support time management? -Shift Hand-Off Report

Effective nurse possess the following

-Excellent communication skills -Sensitivity toward others' cultural and value differences -Awareness of others' abilities -Genuine interest in team members

Health Care Reform Act

-Extremely complex, final version of bill is over 2000 pages long -The provisions began to take effect in 2014, but the act will not be fully implemented until 2018. -Attempts to address rising healthcare costs through -Preventative strategies -Increasing access to primary care -Targeting fraud, abuse, and waste -Other provisions

Characteristics of the Nonelderly Uninsured (2015)

-Family work status -family income -race

U.S. Department of Health and Human Services (HHS)

-Federal government's primary department for protecting the public's health and human services -Some of programs administered; Social Security, Medicare, maternal and infant health, Mental health, prevention of child abuse and domestic violence and much more... -Budget for fiscal year 2017 $1,145 billion; funds more than 300 programs and multiple agencies

Norming Stage

-Feeling of group cohesion develops -Team members master ability to resolve conflict -Team members learn to respect differences of opinion -Communication of ideas, opinions, and information occurs through effective cooperation -"become we"

Contingency Approach: Different behavior patterns will be effective in different situations

-Fielder's contingency theory -Situational theory of Hersey and Blanchard -Path-goal theory -Idea of substitutes for leadership?????

Much in Common

-Flexible schedules -Desire for employment - opportunities to learn and grow on the job -Coaching approach to leadership - bosses that ask rather than tell -Respect - feeling listened to, included and valued

Consideration

-Focus is on employee and emphasize relating and getting along with people via good communication and fostering trust -Focus on well-being of others (e.g. nurse taking the time to talk with coworkers, be empathetic) -relationship oriented

Initiating Structure

-Focus is on work to be done and production -Focus on organization and achievement of goals (e.g. Charge nurse making patient assignments) -includes planning, establishing deadlines, directing others, and how work should be done -work oriented

Conflict Resolution Guidelines

-Focus on the future -Focus on what will work -Speak one at a time -Don't speak for others -Post pone evaluation until after option generated -Don't monopolize discussion time

Hersey and Blanchard's Situational Theory

-Focuses on follower readiness to select leadership style for a situation -addresses follower characteristics in relation to effective leader behavior -they use task behavior and relationship behavior

Transactional Leader

-Focuses on management tasks -Day-to-day operations -Is a caretaker -Uses trade-offs to meet goals -Does not identify shared values -Examines causes -Uses contingency reward

Storming Stage

-Group settles into comfortable team setting -Conflict may arise and must be identified -Natural process -Team members come from many different backgrounds -Real teams emerge when conflicts resolve, trust develops, and interdependence and hard work begin

Characteristics of Leadership

-Guiding vision, passion, integrity (Bennis & Nanus) -Intelligence, self-confidence, DETERMINATION, integrity & sociability (Stodgill) -Visionary, enthusiastic, supportive -Knowledgeable, high standards & expectations -Demonstrate power and status -Visible and responsible, communicate openly -Demonstrate caring, trustworthiness & flexibility -DRIVE, desire to lead, honesty, integrity, self-confidence, cognitive ability, and knowledge of the business

Human Relations

-Hawthorne Experiments -focuses on empowerment of the individual worker as the source of control, motivation, and productivity in meeting the organization's goals -Hawthorne's studies at Western Electric plant in Chicago led to the belief that human relations between workers and managers and among workers are the main determinants of efficient -the Hawthorne effect refers to the phenomena of how being observed or studies results in a change in behavior -emphasizes that participatory decision making increases worker autonomy and provides training to improve work

The Downstream Focus

-Healthcare focus on illness and injury -Fits with Disease Model (Cure) -Less focus on Upstream Care; health promotion and illness prevention -Dollars go downstream -Disproportionate focus on specialists -Fragmentation of health systems -Proliferation of unregulated commercial care

45% of healthcare expenses are concentrated on 5 predominant health problems

-Heart conditions -Musculoskeletal/Trauma -Pulmonary conditions -Endocrine -Nervous System

Tipping Point for Quality

-How do we know if we cut too deeply? -How do we define value in health care as compared to another "good" value? -Currently, shifting from volume to value

Managerial Resources-- Four types of resources to accomplish Nurse Manager's purpose

-Human resources -Financial resources -Physical resources -Information resources

Fluids/tubes/oxygen, laboratory tests and treatments

-IV fluid, rate, site -tube feedings--type of tube, solution, rate and toleration -oxygen rate, route, other tubes (e.g., chest tube, NG tube, Foley, and so on), type of tube and type of drainage -abnormal lab and test values -labs and tests to be done on oncoming shift -treatments done on your shift, including dressing changes (times, wound description) and procedures -identify treatments to be done during next shift

Conflict Management Checklist

-Identify boundaries of the conflict -Understand the factors -Be aware of whether more than one issue is involved -Be open to ideas -Be willing to accept outside help to mediate the conflict

Prioritizing Your Care - Additional HINTS

-Identify the busiest times on the unit -Do not schedule a dressing change when medications need to be given -Plan on preparing meds at least 30-45 minutes before the hour they are due. -Do not procrastinate; start early -Similar teaching for multiple clients; do group teaching if appropriate -Ask seasoned nurses about their time management tips

Quadrant 1 (Quadrant of Necessity) MANAGE

-Important and Urgent

Quadrant 2 (Quadrant of Quality) FOCUS

-Important but Not Urgent

Spiritual Assessment

-Important for nurse to conduct spiritual assessment to determine specific spiritual concerns patient may have -Several spiritual assessment tools available -Carson and Koenig's assessment -Five broad questions nurse can ask -"FAITH" assessment tool -Parsian and Dunning's spirituality questionnaire

Conflict Management Issues

-Important part of nurse manager's job -Consider personal role in conflict -Be realistic about outcome -Decide if/when to intervene -Choose neutral location for serious confrontation -Allow time

Cadillac Tax

-Impose excise tax on insurers of employer-sponsored health plans with higher $ coverage (40% tax). Also known as Cadillac Tax (originally effective 2018, delayed to 2020 by Congress) -1 in 4 employers (26%) offering health benefits could be subject to the Affordable Care Act's tax on high-cost health plans -Applies to employer based plans exceeding $10,200 in premiums per year for individuals and $27,500 for families -It's likely that many employers will revise their plans to avoid the tax, at least initially, through modifications that could include reducing options for employees or shifting costs to workers in the form of higher deductibles and other patient cost sharing

ACA...Tax Changes... Funding

-Impose new annual fees on pharmaceutical manufacturing sector -Impose an annual fee on the health insurance sector Impose excise tax of 2.3% on sale of any taxable medical device -Impose 10% tax on amount paid for indoor tanning

U.S. Spends a lot of dollars on health care

-In 2015, $9,990 per capita -U.S. healthcare spending will reach nearly $5 trillion, or 20% of GDP, by 2021 (CMS)

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 persist across socioeconomic groups, racial and ethnic populations, and geographic areas.

Coverage Gaps Still Exist

-Incomplete healthcare coverage -Affordability of co pays and deductibles -Lack of provider choice -Need for preauthorization -Between employee sponsored programs

Strategies to Eliminate Health Care Disparities

-Increase diversity of nursing staff -Utilize culturally and linguistically based approaches -Improve access and infrastructures at public health and health care systems levels -Examine organization's culture, conditions, and training needs -Breaking down barriers & ensuring access to education -Serving as role models for new nurses

Other Public Programs

-Indian Health Service -TRICARE (enlisted military & dependents) -Veterans Health Administration

Highpoints of Affordable Care Act

-Individual Mandate -Employer Requirements -Expansion of Public Programs

Quadrant 4 (Quadrant of Waste) AVOID

-Not important and Not urgent

Other Driving Forces for Growth in Health Care Spending

-Inflation in the cost of -medical services -products -Aging population -The need for access, quality, safety, and reasonable cost has driven various initiatives to improve healthcare in the past and present

More Research

-Influences on collaboration -Equality of power -Recognition of interdependence (not territory) -Educational system to develop plurality -Organizational supports -Administrative support -Resources; time and work space -Interactional influences on collaboration -Trust in self and others, respect for others -Open and active communication

Other researchers focused efforts on two dimensions of leader behavior:

-Initiating Structure(structure of tasks and work) -Consideration (relating, communicating trust)

Culture

-Integrated patterns of human behavior that include the following: -Thoughts, communication, and actions -Customs, beliefs, and values -Institutions of racial, ethnic, religious, or social groups -Incorporates past and influences future

Types of conflict

-Intrapersonal (within one individual) -Interpersonal (between two or more individuals) -Organizational or Intergroup (between two or more groups) -Interprofessional (with other member of the health care team)

Interprofessional Consultation

-Is a process in which a specialist is sought to identify methods of care or a treatment plan to meet the needs of a client -Is needed when the nurse encounters a problem that cannot be solved using nursing knowledge, skills and available resources -May be made to health care provides as medical specialists, surgeons, wound care specialists, physical therapists, occupational therapists, social workers, clergy, hospice care, home health..... -Rapid response teams within hospitals provide nursing staff with internal consultative services provided by expert clinicians

Procrastination Solutions

-Know thyself -Do 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

Behavioral Approach

-Kurt Lewin, 1930's conveyed 3 leadership styles: -Autocratic leadership -Democratic leadership -Laissez-faire leadership

Guidelines for Meetings

-Leadership -Fundamental skill in effectively working with teams -Leader focuses on the following: -Encouraging and guiding team's sense of self-direction, ownership, and responsibility to accomplish desired goals -Outcome improvement -Set a time frame for the meetings and stick to it -Review the progress -Help group members feel comfortable with one another -Establish ground rules -Get a report from each member -Sustain the flow of the meetings -Manage the discussion -Work to avoid groupthink -Close the meetings by summarizing accomplishments -Identify a time frame for future meetings

Leadership vs. Management

-Leadership influences and inspires actions and goals of others -Position of authority is not a requirement to demonstrate leadership -Not all leaders are managers -Management is a structural process -Goals and tasks are achieved and problems are solved

Traditional Change Theories

-Lewin's force-field model (1951)* -Lippitt's phases of change (1958)* -Havelock's six-step change model (1973) -Rogers' diffusion model (1983)

Disorganization Solutions

-Make a to-do list -Limit list to 6 items -Organize tasks and supplies -Group in logical sequence -Use time tools -Develop a routine

Ways to think of Prioritization

-Maslow's Hierarchy of Needs

Bureaucratic Management Theory

-Max Weber -focuses on hierarchal superior-subordinate communication transmitted from top to bottom via a clear chain of command -uses rational, impersonal management; distributes activities among personnel -uses merit and skill as basis for promotion and/or reward -uses rules and regulations; focuses on exacting work processes and technical competence -limits personal freedom -emphasizes career service, salaried managers

Leadership Difference

-Motto: Do the right thing -Challenge: Change -Focus: Purposes -Time Frame: Future -Methods: Strategy -Questions: Why? -Outcomes: Journeys -Human: Potential

Management Difference

-Motto: Do things right -Challenge: Continuity -Focus: Structures and Procedures -Time Frame: Present -Methods: Schedules -Questions: Who, what, when, where, how? -Outcomes: Destinations -Human: Performance

Interprofessional Team

-Multiple health workers from different professional backgrounds work together with patients, families, caregivers and communities to deliver the highest quality care -Responsibility for decision making and problem solving is shared -Leadership is based on expertise that matches the situation

Managerial Process

-Multiple management functions - described by multiple individuals with various acronyms -How managers spend their time on particular roles or functions varies by the level of their positions in the organizations -First-level -Mid-level -Executive level

National Academies

-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

Performance and Quality Measurement

-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

Conflict

-Natural & inevitable condition -Prerequisite to change -Consequence of real or perceived differences -Dynamic process -Can be positive or negative, healthy or dysfunctional

Accomodate

-Neglect their own needs, goals, or concerns (unassertive) while trying to satisfy those of others -Accommodators obey and serve others and often feel resentment and disappointment because they get nothing in return -Use if the item of conflict is not of high value to the person doing the accommodating

The Collage of Providers and Payers

-Non profit organizations -For profit organizations -Public government

Nurses as Servant Leaders

-Nurses listen and are empathetic -Work to understand/help patients heal physically and mentally -May persuade patients of what is needed to help them heal -Nurses are stewards -Nurses make patients and families aware of services beyond the hospital

Knowledge and Emotional Intelligence

-Nurses use knowledge to... -recognize even subtle changes in patient's conditions -anticipate patient care problems -Intervene appropriately to minimize/avoid complications -Nurse managers use knowledge to... -Have the right type & right number of personnel

Forming Stage

-Occurs when team created -Meet as team for first time -Purpose of team explored -Each member identifies what he or she can contribute -Team goals, expectations, and boundaries defined -Communication

Competition

-One party pursues what it wants at the expense of the others -Use when quick, decisive action is needed -On important issues for which unpopular courses of actions need implementing -On issues vital to company welfare -When protection is needed against people who take advantage of noncompetitive behavior

Recruiting Millenials

-Opportunities to learn new things -Diverse work experiences -Flexible schedule -Emphasis on work itself and less on where and when the work gets done

More Data on Health Spending

-Over the past two years, GDP growth was 4.0% annually while healthcare spending grew 5.5% annually (Businessinsider.com) -Increase due in increased enrollment in private insurance (ACA mandate) and employer-sponsored plans -In comparison: -GDP growth in 2015 was 1.6% -1st quarter 2017 was 1.2%

Avoidance

-Parties are aware of conflict but choose not to acknowledge or attempt to resolve -Unassertive and uncooperative -Indicated when: -Issues are trivial -Costs of dealing with conflict exceeds the benefits of solving it -When problem should be solved by people other than you

Healthcare financing reform

-Patient Protection and Affordable Care Act -Estimated that 45 million Americans are uninsured or underinsured. Lack of healthcare is a major factor = lack of access... -Everyone agrees reform is NECESSARY...we can't agree how... -After hundreds of deliberations that were often contentious, and after more than a year of debate, Congress passed the Patient Protection and Affordable Care Act (PL111-148), which was signed into law March 23, 2010. -The Health Care Reform Act is an extremely complex piece of legislation and the final version of the bill exceeded 2000 pages. There are many health-related provisions of the law. -A few of the provisions of the Health Care Reform Act were implemented in 2010, but most do not take effect until 2014, and it will not be fully implemented until 2018. Further, the Act remains very controversial, and legislative and legal challenges are anticipated

PPACA and HCERA

-Patient Protection and Affordable Care Act, 2010 -Health Care and Education Reconciliation Act, 2010

Anatomy of a Winning Team

-Patient welfare and safety depend on health care professionals collaborating together -Effective teamwork achieved through synergy -In health care, synergy means needs and characteristics of patient, clinical unit, or system matched with nurse's competencies

Common Characteristics of Win-Lose and Lose-Lose

-Person centered -Direct energies toward victory & defeat -See issue from own viewpoint -Emphasize outcomes -Personalize conflicts -Short-run goal

Barriers to Spiritual Care

-Personal beliefs of the nurse -Nurse may be uncomfortable and embarrassed by their own spirituality -Does not believe spirituality is a nursing responsibility -Lack of knowledge regarding the specific beliefs of the patient's religion Insufficient nursing time or privacy

Functions of Management

-Planning -Determining objectives and identifying methods that lead to the achievement of objectives -Organizing -Using resources (human, material, financial) to achieve predetermined outcomes -Directing -Guiding and motivating others to meet expected outcomes -Controlling -Using performance standards as criteria for measuring success and taking corrective action

Conductive Environment for Teamwork

-Political environment -Too few or too many team members can impact progress of team -Requires ongoing time and effort

Flatter organizational structure

-Positions combined, with managers having more staff to supervise -often seen in Magnet hospitals (shared governance)

Organizational Research on Teams

-Positively associated with performance outcome and effectiveness -Autonomy -Supervisor setting high standards -Group cohesiveness -Psychological characteristics of successful team members -Disciplinary competence -Broad interest -Sense of achievement -Tolerance for unknown -Understanding of other disciplines way of thinking

Spiritual Nursing Interventions

-Prayer -Presence -Scripture reading -Meditation -Validation of client's thoughts -Music -Pastoral care -Active Listening -Peaceful environment -Trusting relationship

Variables of Substitutes for Leadership

-Presence of structured tasks -Presence of satisfaction in the workplace -Presence of a cohesive group (formal organization, rigid - adheres to rules) -Experience can serve as a substitute for direction and supervision of a leader

Chaos Theory

-Prevalent in healthcare organizations -Organizations must be able to organize and implement change quickly and forcefully -Little time for orderly linear change -Example: electronical documentation (cost benefit analysis)

Making Assignments: What to Consider

-Priority of patient needs -geography of nursing unit -complexity of patient needs -other responsibilities of staff -need for continuity of care -agency organizational system -state laws, e.g. state nurse practice act -need for fair work distribution among staff -need for lunch/break times -need for isolation -need to protect staff and patients from injury -needs of other units in hospital, number of staff -skill, education, and competency of staff (e.g., RN, LVN, UAP) -hospital policy and procedure -patient care standards -environmental concerns -accreditation regulations -desired patient outcomes

Resistance to Change

-Resistance to change occurs when an individual rejects proposed new ideas without critically thinking about the proposal -Change requires energy -The change process does not guarantee positive outcomes

Healthcare Insurance

-Private Insurance employer based -Premiums increased 114% between 1999-2007; Wage earnings increased 27% same period -Premiums increased 31% between 2006-2011 -Premiums increased 20% between 2011-2016 -Other factors to consider -Preexisting conditions- addressed by Affordable Care Act -Denied claims -Preauthorization -Provider contracts with employers -Copays -Deductibles

Cost shifting: a thing of the past?

-Private insurance companies were paying for the cost of providing care to their enrollees and Medicare patients. -Only after a few years after implementation of the PPS by Medicare, private healthcare plans followed the government's lead. Managed care groups negotiated with providers to render care for a specified amount of reimbursement based on community ratings modified by group-specific demographics. Prospective reimbursement created incentives to control costs but also to led to instances of undertreatment and underuse of the system

4 types of reimbursement

-Private insurers -Public government-funded payers -Charitable entities -Direct payment by patients

Confrontation

-Problem -oriented -Conflict is brought out into the open -Attempts to resolve are done through knowledge and reason -Goal: achieve win-win solutions -Use facts! -Outcome should be explicit - no question as to what is expected -Most effective in private ASAP after incident occurs -If emotions are running high - may be best to wait

Unfreezing phase

-Problem is identified -Facts and supporting evidence of need for change are gathered -examine status quo -increase driving forces for change -decrease resisting forces against

Changes to Private Insurance

-Process for reviewing increases in premiums & justification -Dependent coverage for children up to 26 -Prohibits lifetime limits on $ value of coverage and from rescinding coverage -Limit deductibles -Limit waiting period for coverage -Requires chain restaurants and foods sold from vending machines to disclose nutritional content of each item

Cultural Competence

-Process of acquiring specific knowledge, skills, & attitudes to ensure delivery of culturally congruent care -Complex integration of knowledge, attitudes, and skills that enhances cross-cultural communication and appropriate, effective interactions

Subcultures may be based on the following

-Professional and occupational affiliations -Nationality or race -Age groups -Gender -Socioeconomic factors -Political viewpoints -Sexual orientation

Multidisciplinary team

-Professionals from a variety of disciplines -Members contribute information from their own area of expertise within the roles of their specific discipline -One person makes the final treatment decision -Leadership and membership are fixed

Basic Rules of Mediation

-Protect self respect -Deal with issues -Encourage solution rather than put blame -Allow discussion -Maintain equity in presentation -Encourage expression -Listen actively -Identify key themes and restate -Encourage feedback -Help develop alternative solutions -Follow-up on progress -Give positive feedback

Benefits of Conflict

-Provide heightened sensitivity -Increase creativity -Recognize legitimate differences -Serve as a powerful motivator to improve effectiveness -Produce leaders -Test power base

Barriers to cultural competence

-Provider barriers -Systems barriers -Nurses -Health and health care disparities -Provider variables -Patient variables

Conflict Process Model

-Provides format for examining conflict behavior in relation to job -Helps explain why conflict occurs -Helps minimize or resolve conflict with least amount of negative outcomes -Filley's conflict process model/framework

Safety

-Psychological safety created by mutual respect and trust among team members -Fosters productive discussion -Lets people believe that if mistakes made, other members will not penalize or think less of them -Leader behavior has powerful influence on level of psychological safety in teams

Common Areas of Conflict

-Quality of care—how does hospital meet their special needs? -Treatment decisions—physician may order treatments with which family does not agree -Family involvement—family's real need to feel significant -Staff inconsistency—make sure that each shift is consistent in enforcing hospital policies, and that they notify other shifts of any attempts at manipulation by family members or patients -Power plays and competition between groups -Scarce resources -Cultural differences -Invasion of personal space

Signs of Spiritual Distress

-Questioning the meaning of life -Loss of purpose -Being afraid to fall asleep at night -Anger at God/higher power -Feelings of being abandoned by God/higher power -Questioning their own belief system -"What good are they?" -Feeling a sense of emptiness/direction -Loss of hope Impaired ability to cope -Questioning the meaning of suffering -Is this punishment? -Pain and other physical symptoms can be expressions of spiritual distress

Teamwork on a Patient Care Unit

-RN has a large role -effective nurses possess many different characteristics

How the Cadillac Tax Works

-Rather than simply repealing the old tax structure, the Obamacare solution is an additional tax, a penalty imposed on "Cadillac" or very high cost health plans. It calls for a 40% excise tax on employer-sponsored plans spending more than $10,200 per employee (or $27,500 per family). This number includes employer and employee-paid premiums and employer contributions to Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs). There will purportedly be some adjustment for areas where healthcare is more expensive and for employees in high-risk jobs, but the regulations have not yet been promulgated. -The purpose of the Cadillac tax is threefold: to address cost of the ESI, to help finance the Affordable Care Act (ACA), and to reduce employer incentive to overspend on health plans and employee incentive to overuse services encouraged by these high-cost plans.

Stabilize Change

-Reinforcement -Two-way communication -Follow-up

Bullying

-Repeated, heath-harming mistreatment of one or more persons by one or more perpetrators -Abusive conduct that is threatening, humiliating or intimidating in nature -Also known as horizontal bullying -Can pose a danger to patient

ACA Medicare

-Restructure payments to Medicare Advantage Programs -Establish Independent Payment Advisory Board; submit proposals to reduce Medicare spending -Reduce payments to hospitals for excess readmissions -Reduce Medicare payments for hospital-acquired conditions by 1%

Five Rights of Delegation

-Right Task -Right Circumstance -Right Person -Right Direction -Right Supervision

Plan the Change

-Select people to carry out the change plan -Design a method to evaluate the outcome -Anticipate resistance to the change -Develop strategies to manage resistance -Design a plan to stabilize the change

Premium Subsidies to Employers

-Small business (less than 25 employees with average wages less than 50,000) receive tax credits -Tax years 2014 and beyond= up to 50% tax credits (if purchased through State Exchange) -Full credit for 10 or fewer employees

SMART acronym for Planned Changed

-Specific -Measureable -Attainable -Realistic -Time

Nursing Cultural Variations

-Staff nurses from different cultures have different perceptions of staff responsibilities -Collectivism -Individualism -Cultural differences affect assignments, teamwork, and harmony

Working with staff from different cultures

-Staff responsibilities to each other -The role of the nurse (not the HC practitioner) in patient care -Locus of control -Time orientation -Educational differences -Language differences

Do you know what your own beliefs are?

-Start your day with a few moments of silence or prayer. -Work purposefully with your clients. -Touch your clients, show genuine concern. -Ask your client if there is any spiritual needs being unmet. -Keep your prayers realistic, don't instill false hope. -Acknowledge the spirit in everyone. -Everyone needs to feel cared for and loved

Status differences

-Status -Measure of worth conferred on individual by group -Differences motivate people, offer means of identification, and provide force for stability -Have profound effect on function of team -Have significant impact on patient outcomes -Communication patterns derived from status differences partly responsible for medical errors -Trust-sensitive environments must be created -Members can disagree with leader without repercussions

Recruiting Gen Xers

-Talk about creative environment -Offer diverse work experiences -Emphasize future plans & how they can contribute to them -Flexible schedule

Recruiting Veterans

-Talk about history & future -Tell them how they can help others -Flexible schedule

Price Drivers in the U.S.

-Technology is key driver of healthcare spending (Synthesis Project, RWJ, 2008) -Aging Population and rising rates of chronic disease -Health status important; *obesity -Cultural biases that influence care utilization -Administrative burden on providers, payers, and patients -Health care legal and regulatory environment (including malpractice, fraud, and abuse laws) -Fee-for-service (retrospective payment system) -Higher prices for drugs (70% higher) -Provider consolidation -Fragmentation in care delivery -Rising hospital and medical services costs

Adjourning Stage

-Termination and consolidation -Closure process begins when team has achieved goals and assigned tasks -Team reviews activities and evaluates progress -Leader summarizes team's accomplishments and role played by each member -Each team member must leave with sense of accomplishment -retooling phase -interpersonal

Employer Requirements

-The ACA does not require businesses to provide health benefits to their workers, but larger employers face penalties if they don't make affordable coverage available. -All businesses with >50 full-time equivalent employees provide health insurance for their full-time employees or pay a fee -Enforcement of those penalties will begin in 2015/2016. This simple flowchart illustrates how those employer responsibilities work (Kaiser Family Foundation, 2013)

Population diversity

-The United States is becoming more diverse. -Health disparities among ethnic and racial minorities continue to increase. -Racial and ethnic minorities often experience poor access to care

Current Status of Medicaid Expansion Decisions

-The federal government will finance the full cost of the Medicaid expansion for the first three years (2014-2016); after that, the federal government's share of costs will phase down, reaching 90% in 2020. Nationally, 17 million currently uninsured nonelderly adults may meet the income and citizenship criteria to be eligible for Medicaid under the expansion.3 The number of eligible individuals varies by state, reflecting the income and age distribution in the state as well as the scope of insurance coverage prior to the ACA. -However, with many states opting not to implement the Medicaid expansion, millions of adults will remain outside the reach of the ACA and continue to have limited, if any, option for health coverage: most do not have access to employer-based coverage through a job, few can afford coverage on their own, and most are currently ineligible for public coverage in their state. While a small share may be eligible to purchase subsidized coverage through the new Health Insurance Marketplaces, most have incomes below the poverty level and thus will be ineligible for these premium tax credits. It is unlikely that people who fall into the coverage gap will be able to afford Marketplace coverage: The national average premium for a 40-year-old individual purchasing coverage through the Marketplace is $270 per month for a silver plan and $224 per month for a bronze plan,7 which equates to about half of income for those at the lower income range of people in the gap and about a quarter of income for those at the higher income range of people in the gap. Further, people in the coverage gap are ineligible for cost-sharing subsidies for Marketplace plans and may face additional out-of-pocket costs up to $6,350 a year if they were to purchase Marketplace coverage. Given the limited budgets of people in the coverage gap, these costs are likely prohibitively expensive.

Perfectionism

-The practice of continuing to work on a project or task well past the point where the extra effort is adding meaningful value -Steals your time and energy working on things that do not give you a good return on your investments -Avoid falling into the perfectionism trap

Emotional intelligence

-a component of leadership and refers to the capacity for recognizing your own feelings and those of others, for motivating yourself, and for managing emotions well in yourself and in your relationships -it describes abilities distinct from, but complementary to, academic intelligence

Gross Domestic Product (GDP)

-The sum of the outputs of every class of enterprise (expressed in trillions). -One of the primary indicators used to gauge the health of a country's economy. -It represents the total dollar value of all goods and services produced over a specific time period - you can think of it as the size of the economy.

Current Trends in Reimbursement

-There is a shift from volume to value (paying for performance) -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 -Helps avoid unnecessary duplication of services -Creates accountability for quality, appropriateness of service, efficiency, and increased consumer satisfaction

Medicare and Medicaid

-Title XVIII established Medicare -Title XIX established Medicaid -Both Titles Legislated in 1965 -As part of ACA; Texas did NOT expand Medicaid eligibility

Prioritizing--Urgent but Not Important

-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 -How do you handle the situation? -write a paper, documentation from chart -pictures (and whatever you are using to measure ulcer)

Delegation

-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

Behaviors of an Effective Leader and Manager

-Treats employees as unique individuals -Inspires and stimulates critical thinking -Assists with adapting to change -Is visible and flexible -Offers guidance, assistance, and feedback -Communicate vision, establishes trust, empowers others -Motivates employees to achieve goals

A Few Value Metrics

-U.S. Infant Mortality Rate 5.82 per 1000 live births (2.7 in top 3 of 19 countries). Dropped 15% from 2005 to 2014. -Preventive care in U.S.; adults 49% -Socioeconomic disparities in insurance, regular care, deaths for certain illness -Racial disparities for Hispanics and African Americans -Same day appointments in the U.S. - 30%; Same day appointments in Canada - 23%

When is the DESC used?

-Ultimately, consensus shall be reached. -Whenever you have a personal conflict with another health team member that threatens your ability to perform your job well

How should nurses prioritize their time?

-Understand the BigUnderstand the Big Picture Decide on Optimal Desired Outcomes Do First Things First Is the conditioning life-threatening or potentially life-threatening? (____ priority) Is this an activity essential to safety? (____priority) Is this an activity that includes comfort, healing and teaching? (___priority) Picture -Decide on Optimal Desired Outcomes -Do First Things First -Is the conditioning 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 and teaching? (3RD priority)

Developing Spiritual Leadership

-Use compassion, caring, and nurturing to create an environment that reflects the values and beliefs of the leaders, patients, and staff -Spiritual leaders develop trust and connect with their staff on both a personal and a professional level

Dimensions of organizational culture

-Values -Language -Traditions -Customs -Sacred cows -Relative diversity -Resource allocation and reward -Degree of change -Strength of culture

Generations in the Workplace

-Veteran and Silent -Born between 1922 and 1945 -Baby Boomers -Born between 1946 and 1964 -Generation X -Born between 1965 and 1979 -Generation Y or Millenials -Born between 1980 and 2000 -Generation Z? -Baby boomers and Generation Y get along well

How do you handle change?

-Victim -Bring crises -Undermine morale -Decrease productivity -Create conflict -Manager -Improvement -Raise morale -Increase productivity -Meet patient and employee needs effectively -Object is to gain control of the forces of change in your organization, work environment and life.

Barbara Spradley's Planned Change Model

-Views an organization as an open system that is influenced by external and internal forces. -Change is governed by principles of interdependence of systems, homeostasis, opposing forces, and resistance. -8-step Planned Change Model allows systematic and innovative planning to direct change creatively.

Servant Leadership...What it's NOT

-Weak form of leadership -Requires us to be "doormats" -Submissive, passive leadership style -Soft and "foo-foo" -Irrelevant in business (7-eleven, Chick-fil-a)

Motivation

-Whatever influences peoples' choices and creates direction, intensity, and persistence in behavior -Process that occurs internally to influence and direct behavior in order to satisfy needs

Workplace Violence

-When bullying, incivility, and mobbing occur in the workplace -Can also include physical violence as well as various antisocial behaviors and incidents that lead a person to believe that he or she has harmed by the experience

Areas of Conflict

-Work hours -Work ethics -Organizational hierarchy -Technology issues -Dealing with change -Beliefs about other generations' lack of respect

The Future of Teams: Virtual Teams

-Work interdependently with shared purpose across space, time and organization boundaries using technology to communicate and collaborate -Allow organization to combine the best expertise -Can be formed and can meet online

Prioritizing--Important but Not Urgent

-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 -How do you handle the situation?

Signs that Conflict Resolution is Needed

-You feel very uncomfortable in a situation -Members of your team are having trouble working together -Team members stop talking with each other -Team members begin "losing their cool" attacking each other verbally

Selling (coaching) leadership style

-direct and support -for people who have: some competence, some commitment

activity log

-a time management tool that can assist the nurse in determining how time is used. -it should be used for several days -behavior should not be modified while keeping the log -the nurse should record every activity, from the beginning of the shift until the end, as well as periodically note feelings while doing the activities -review of this log will illuminate time use as well as time wasted -analysis of the log will allow the separation of essential professional activities from activities that can be performed by someone else

Motivational factors

-achievement -career advancement -personal growth -job interest -recognition -responsibility

Contingency Approach

-acknowledges that other factors in the environment influence outcomes as much as leadership style that leader effectiveness is contingent upon or depends upon something other than the leaders behavior

Second Priority: Activities Essential to Safety

-activities that are essential to safety are very important and include those responsibilities that ensure the availability of life-saving monitoring, medications, and equipment, and that protect patients from infections and falls. They include asking for assistance or providing assistance during two-people transfers, or turning and movement of heavy patients -they also include monitoring the patient for the prevention of adverse nurse-sensitive outcomes

Potential Problems with Conflict

-aggressive behavior -covert and inappropriate behavior -competition -competitive conflict -disruptive conflict

ABC method

-airway -breathing -circulation

Respiratory Patients Potential Threats

-airway compromise -choking -asthma -chest trauma

Motivation theories

-are helpful to explain why people act the way they do and how nurse managers can relate to individuals as human beings and workers -includes: -Maslow's Hierarchy of Needs -Two-Factor Theory -Theory X & Theory Y -Theory Z -Vroom's Expectancy Theory

Contingency Approach: Substitutes for Leadership

-are variables that may influence followers to the same extent as the leader's behavior -some of these variables include follower characteristics

Timing the Actions

-assigning a completion of time for the intervention makes it more likely for the intervention to be completed during the shift -this makes the outcome more likely to be accomplished

Care support

-availability of family or friends to assist in ADL/IADL (activities of daily living/instrumental activities of daily living)

Transformational Leadership Theory

-based on the idea of empowering others to engage in pursuing a collective purpose by working together to achieve a vision of a preferred future -can influence both the leader and the follower to a higher level of conduct and achievement the that transforms them both -at the organizational level is about innovation and change -has been the basis for nursing administration curriculum

Understand the Big Picture

-before priorities are set, the big picture must be examined -nurses should know what is expected of their coworkers, what is happening on the other shifts, and what is happening beyond the unit -if nurses know what is expected of their coworkers, they can offer assistance during coworkers' busy times and in turn receive assistance during their own bust times -when nurses take the big picture into consideration, they are less likely to be frustrated when asked to assist others on their unit or on other units in the hospital -they can also build into their time management plan the possibility of giving and receiving assistance

Cardiovascular Patients Potential Threats

-cardiac arrest -shock -hemorrhage

$150-250 Billion spent on what medical condition? What is the next medical condition spent?

-circulatory system (hypertension, heart attack, etc.) -musculoskeletal system (arthritis, back pain, etc.)

Hygiene maintenance factors include

-company policies -quality of supervision -relations with others -personal life -rate of pay -job security -safe and tolerable working conditions -adequate salary status

Herzberg's Two-Factor Theory

-consist of hygiene-maintenance factors and motivational factors -when these factors are absent, they can be sources of job dissatisfaction -when they are present, job dissatisfaction can be avoided. However, these factors alone will not lead to job satisfaction

Lewin's Force-Field Model of Change

-consist of three steps: Unfreezing phase, moving/changing phase, refreezing phase

Examples of Important and Urgent

-crises -pressing problems -deadline driven projects, meetings, preparations

Cultural Competence contains five interlocking components

-cultural awareness -knowledge -skill -encounters -desire

Three Major ways to Create Personal Time

-delefate work to others or hire someone else to do work -eliminate chores or tasks that add no value -get up earlier in the day

Tool for End-of-Shift Hand-Off Report

-demographics -diagnoses -patient status -fluids/tubes/oxygen, laboratory tests and treatments -expected shift outcomes -plans for discharge -care support -priority interventions

Race

-describes a geographical or global human population distinguished by genetic traits and physical characteristics such as skin color or facial features -Classification of people according to shared biologic characteristics, genetic markers, or features

TeamSTEPPS

-designed to assist healthcare professional with safety concerns -Developed by the Department of Defense (DoD) and the Agency for Healthcare Research & Quality (AHRQ) -An evidence-based teamwork system to improve communication and teamwork skills among health care professionals related to patient safety -Includes four skills: leadership, situation monitoring, mutual support and communication

Handling Conflict Situations

-determine the person or group with whom there is conflict -analyze the causes of the conflict -consider alternative strategies -choose strategy(ies) that will produce best results -implement the decision -evaluate the decision

Patient status

-do not resuscitate (DNR) status -current vital signs -problem with ABCs, level of consciousness, or safety -oxygen saturation -pain score -skin condition -ambulation -fall risk -suicide risk -presence/absence of signs and symptoms of potential complications -new orders/changes in treatment plan

Disruptive conflict

-does not emphasize winning -does not follow any rules -designs to reduce defeat and eliminate the opponent -takes place in an environment charred wither, anger and distress -can result in irrational, upsetting, or violent behavior

Identifying Problems with Time Management and Prioritizing (Priority Traps)

-doing whatever hits first -trying to do too much (taking the path of least resistance) -responding to the squeaky wheel -completing tasks by default -relying on misguided inspiration -inability to say no -complaining -interruptions by others -personal disorganization -clutter -perfectionism

Using Downtime

-during any dar, there is time available that is seldom used

Complex Adaptive Systems

-emphasizes that an organization is a system of interrelated, unpredictable elements, and if a manager adjusts one part of a system, then other parts will be affected automatically; emphasizes that the organization is an open system that constantly interacts with its environment -encourages staffs to look at their activities on one unit as part of a larger picture that may affect other units -emphasizes importance of innovation and rapid information sharing to improve performance

Plans for discharge

-expected date of discharge -referrals needed -progress toward self care and readiness for home

What are some various ways to conduct an end of shift hand-off report?

-face-to-face meeting -walking rounds (bedside reporting)

Scientific Management Theory

-focuses on goals and productivity; organization is a machine to be run efficiently to increase production -selects the right person to do job; provides the proper tools, training, and equipment to work efficiently -uses time and motion studies to make the work efficient

Organization behavior styles

-greetings -titles -time -body language -dress

Perfectionists

-hate criticism -are devastated by failure -get depressed and give up -reach for impossible goals -value themselves for what they do -have to win to maintain high self esteem -can only live with being number one -remember mistakes and dwell on them

What are the costs of procrastination?

-health (weakened immune system, hypertension, anxiety, GI problems) -destroys team work and relationships with others -monetary costs -low self esteem

Time Spent Hunting and Gathering

-hunting and gathering is about 25% of a nurse's day

Executive (upper/top) Nursing Management

-includes Chief Nursing Officer (CNO), Chief Nursing Executive (CNE), Director of Nursing (DON) -Supervises numerous departments and works closely with the administrative/executive team of the organization -Involved in establishing organizational goals and strategic planning with key stakeholders -Ensures client care is consistent with the objectives, goals, and vision or the organization

First-Level Nursing Management

-includes Frontline manager or first level (charge nurse, team leader, and client care coordinator) -Supervises those involved with the delivery of client care; day to day activities -Coordinate activity of all staff who provide client care and supervise team members during the manager's period of accountability (assigned shift) -spend the majority of time directly managing patient care and supervising others as they deliver care -the next highest percentage of their time is spent in planning

Middle Management

-includes Unit manager/director, nursing supervisor, service line director -Responsibilities include supervising staff, preparing budgets, preparing work schedules, writing and implementing policies that guide client care and unit operations, and maintaining quality of client services -Integrates day to day operations with organizational goals and strategic planning -Analyzes, appraises and interprets performance (hires, fires and evaluates) -Accountable for quality patient care -Usually requires a graduate degree -In larger institutions- can be responsible for multiple nurse managers/units with 24-hour responsibility

Examples of Not important but Urgent

-interruptions, some phone calls -some mail, some reports -some meetings 0many proximate, pressing matters -many popular activities

Priority interventions

-interventions that must be done this shift

Servant Leadership

-introduced by 1970's, Robert Greenleaf -Wanting to put needs of others above all else as #1 priority -Can you be a servant and a leader?

Autocratic Leadership

-involves centralized decision making; leader dominates the group -Leader makes all decisions and uses power and command to control others

Laissez-faire leadership

-is Passive and permissive, nondirective, and inactive approach -Leader relinquishes part or all of the responsibility to group members -the leader Defers decision making to group members; provides little guidance, support, or feedback -Can cause low productivity & feelings of frustration among group members

First priority: Life-threatening or Potentially life-threatening conditions

-patients at risk to themselves or others and patients whose vital signs and level of consciousness indicate potential for respiratory or circulatory collapse -a patient whose condition is life threatening is the HIGHEST PRIORITY and requires monitoring until transfer or stabilization

Maslow's Hierarchy of Needs

-physiological needs -safety needs -love and belonging needs -self esteem needs -self actualization needs

Types of Change

-planned changed -unplanned change

Two other individuals, Gulick and Urwick, in some part as a result of their esteemed status as informal advisers to President FDR, served to define the management process according to seven principles. These seven principles include: POSDCORB

-planning -organizing -staffing -directing -coordinating -reporting -budgeting

What is a premium tax credit?

-is an advanceable, refundable tax credit designed to help eligible individuals and families with low or moderate income afford health insurance purchased through the Health Insurance Marketplace, also known as the Exchange, beginning in 2014. You can choose to have the credit paid in advance to your insurance company to lower what you pay for your monthly premiums, or you can claim all of the credit when you file your tax return for the year. If you choose to have the credit paid in advance, you will reconcile the amount paid in advance with the actual credit you compute when you file your tax return. -When you apply for coverage in the Marketplace, it will estimate the amount of the premium tax credit that you may be able to claim for the tax year, using information you provide about your family composition and projected household income. Based upon that estimate, you can decide if you want to have all, some, or none of your estimated credit paid in advance directly to your insurance company to be applied to your monthly premiums. If you choose to have all or some of your credit paid in advance, you will be required to reconcile on your income tax return the amount of advance payments that the government sent on your behalf with the premium tax credit that you may claim based on your actual household income and family size. -If you do not opt for advance credit payments, you may claim the credit when you file your tax return for the year, which will either lower the amount of taxes owed on that return or increase your refund.

Planned change Model

-is purposeful and intentional. There are specific reasons or goals prompting change. -To solve a problem -To improve efficiency -To reduce unnecessary workload for some group -The change is by design, not by default.

Healthcare Transparency

-is truth in reporting -Pros: -Discover information about healthcare costs -Medical errors -Practice preferences -Preferably before receiving services -Cons -Fear of litigation or reprisal against healthcare provider -Transparency encourages healthcare providers to recognize and respond to underlying hazards as well as risks to patient safety in a timely manner and implement evidence-based improvement initiatives

Management

-it is a Process of coordinating actions and allocating resources to achieve organizational goals -it is a process of Planning, organizing & staffing, leading and controlling actions to achieve goals -Daily activities of managers are diverse, fast-paced, and full of interruptions -Ability to set priorities, make decisions and interact with others is KEY

Disadvantages of Face-to-Face report

-it is time consuming -it is easy to get sidetracked and gossip or discuss non-patient related business -both consuming and departing nurses are in report -patients are not included in planning

Disadvantages of Walking Rounds (Bedside report)

-it is time consuming -there is a lack of privacy in discussing patient information

Organizational factors

-job enlargement -flatter organizational structure

Patient Centered Care

-landmark reports -Crossing the Quality Chasm (IOM, 2001) -Unequal Treatment (Smedley et al., 2003) -cultural competence vs. patient-centered care -Each emphasizes different aspects of quality -Patient-centeredness provides individualized care and restores an emphasis on personal relationships -Cultural competence aims to increase health equity and reduce disparities by concentrating on people of color and other disadvantaged populations

Causes of Procrastination

-laziness -fear of failure -perfectionism

Leadership can occur between:

-leader and individual -leader and a group -leader and an organization, community or society

McGregor's Theory X

-leader must direct and control because motivation results from reward and punishment. Employees prefer security, direction, and minimal responsibility, and they need coercion and threats to get the job done -authoritarian, repressive style. Tight control, no development. Produces depressed culture. -externally motivated

McGregor's Theory Y

-leaders must remove work obstacles because, under the right work conditions, workers have self control and self discipline. The workers' rewards are their involvement in work and in the opportunities to be creative -liberating and developmental. Control, achievement and continuous improvement achieved by enabling, empowering and giving responsibility. -internally motivated

Characteristics of a Servant Leader

-listening, empathy, healing, awareness, persuasion, foresight, stewardship, growth, and building community -Fosters a service inclination in others that promotes collaboration, teamwork, and collective activism

The leader behaviors of initiating structure and consideration define leadership style. The styles are as follows:

-low initiating structure, low consideration -high initiating structure, low consideration -high initiating structure, high consideration -low initiating structure, high consideration

Neurological Patients Potential Threats

-major head injury -unconscious -unresponsive -seizures

Other Patients Potential Threats

-major trauma -traumatic amputation -major burn, especially if airway involvement -abdominal trauma -vaginal bleeding -anaphylaxis -diabetic with altered consciousness -septic shock -child or elder abuse

Making Assignments

-nurses cannot accomplish patient objectives by themselves, they must delegate and make assignments to other team members -assignments should be part of the planning process and should include delegation of nursing and non-nursing tasks to others, with specific reporting guidelines and deadlines for accomplishment of the tasks

Servant leader

-nurses care for the whole of the patient and their significant others, including their physical, mental, spiritual, and psychosocial being -nurses are both servants and leaders

Advantages of Face-to-Face report

-nurses get clarification and can ask questions -nurse giving report has actual audience and tends to be less mechanical -nurses are more likely to give pertinent information than they would to a tape recorder

Participating (supporting) leadership style

-praise, listen, and facilitate -for people who have: high competence, variable commitment

Advantages of Walking Rounds (Bedside report)

-provides the prior shift and incoming shift staff the opportunity to observe the patient while receiving report. Staff can address any assessment or treatment questions -information is accurate and timely -patient is included in the planning and evaluation of care -accountability of outgoing care provider is promoted -patient views the continuity of care -incoming shift makes initial nursing rounds -departing nurse can show assessment and treatment data directly to oncoming nurse

Planned change

-purposeful and intentional; a deliberate effort to improve a situation -To solve a problem -To improve efficiency -To reduce unnecessary workload for some group

DeBono's Six Thinking Hats

-red (intuition, gut feeling, try to think how others will react) -white (data) -blue ( look at process) -yellow (think positively, sunshine) -green (creative) -black (negativity)

Task structure

-refers to the degree to which work is defined with specific procedures, explicit directions, and goals -How specific is the work to be done defined (e.g. directions, goals)

Individual Mandate

-requires U.S. citizens and legal residents/immigrants to have qualifying health coverage (minimum essential coverage) -Those without coverage pay a tax penalty of $695 per adult, $347.50 per child under 18, or 2.5% of income- whichever is higher -Penalties have been phased in since 2014 and their are some (but few) exemptions. -Beginning in 2017, the penalties will be increased by the cost-of-living adjustment.

Demographics

-room number -patient name -sex -age -practitioner

What are some upstream opportunities?

-screenings, vaccines, education -focused on prevention whereas downstream is focused on curing and treating

Emotional Intelligence includes these 5 basic emotional and social competencies

-self awareness -self regulation -motivation -empathy -social skills

The Top 5 Most Expensive Conditions Treated in U.S. Hospitals?

-septicemia -osteoarthritis -implant or graft -liveborn (newborn) -myocardial infarction

Elimination of disparities

-significant national priority -multifaceted challenge that includes intervention aimed at access to care, prejudice and bias

Social Network

-states that all behavior is social in nature, and that successful organizations will develop and use social networks to their advantage

Population Ecology Theory

-states that external environment pressures are primary determinant of success; there is little managers and staff can do if action is not tolerable to the external environment -highlights powerful role played by the external environment; quality improvement efforts alone may not be sufficient if the organization is not well positioned for success in the environment

Institutional Theory

-states that external norms, rules, and requirements cause organizations to conform in order to receive legitimacy; organizations in a similar institutional environment come to resemble each other -emphasizes that quality improvement efforts must take into account regulatory and accreditation pressures from local, state, and federal agencies and accrediting agencies, such as the Joint Commission as well as taking into account public expectations

Telling (directing) leadership style

-structure, control and supervise -for people who have: low competence, high commitment

How does the U.S. compare to others?

-the U.S. ranked last with respect to healthy lives, access, patient safety, efficiency, and equity. -Health outcomes such as -Infant mortality -Immunization rates -Life expectancy are poorer in the U.S. despite high spending in healthcare

Contingency Approach: Path-Goal Theory

-the leader works to motivate followers and influence goal accomplishment -Selects leadership style for the situation, but makes the path toward the goal easy for the follower -Alignment of leadership style with needs of the followers is motivating and believed to enhance performance and satisfaction

Make Patient Care Rounds

-the oncoming nurse needs to first make initial rounds on the patients at risk for life threatening conditions or complications -perform rapid assessments

Three valuable time management concepts

-the relative effectiveness of effort (the Pareto Principle) -the importance of outcome versus process orientation -the value of analyzing how time is currently being used

Third Priority: Comfort, Healing, and Teaching

-these essential activities include those that relieve symptoms--pain, nausea, and so on---and those that promote healing such as nutrition, ambulation, positioning, medication administration, and teaching

Do first things first

-to decide what is reasonable to accomplish, a nurse has to come to terms with the resources that are available and the outcomes that must be achieved -there would be no question that interventions that prevent life-threatening emergencies or save a life when a life-threatening event occurs are priorities -they must be done no matter how short the staffing -it is imperative that nurses protect their patients and maintain both patient and staff safety as well as perform the activities essential to the nursing and medical care plans

Examples of Not important and Not Urgent

-trivia, busy work -junk mail -some phone calls -time wasters -escape activities

Delegating (empowering) leadership style

-turn over responsibility for day to day decision making -for people who have: high competence, high commitment

Controlling interruptions

-urgent or positive interruptions -job waster -phone calls -email -social media -texting -drop-in visitors/coworkers -paperwork

Ouch's Theory Z

-uses collective decision making, long term employment, mentoring, holistic concern, and use of quality circles to manage service and quality. This is a humanistic style of motivation based on the study of Japanese organizations. -Organizations invest in their employees and address BOTH home and work issues creating a path for career development -Mixed results from studies on Theory Z's effectiveness on company's performance -Embraced by Fortune 500 Companies -Participative management

Contingency Approach: Fielder's Contingency Theory (1967)

-views the pattern of leader behavior as dependent upon the interaction of the personality of the leader and the needs of the situation -the needs of the situation or how favorable the situation is toward the leader involves leader-member relationships, the degree of task structure, and the leader's position of power

Control Unwanted Distractions

-visitors -unplanned phone calls -low priority tasks -requests for assistance

Pursuers of Excellence

-welcome criticism -learn from failure -experience disappointment but keep going -enjoy meeting high standards within reach -value themselves for who they are -do not have to win to maintain high self esteem -are pleased with knowing they did their best -correct mistakes and then learn from them

National Academy of Medicine (NAMs) 8 principles to Healthcare Reform

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

Rank order of other wealthy nations as compared to U.S. from lower % of GDP to higher % of GDP (The World Bank, 2013)

1) Canada (lower % of GDP) 2) Netherlands 3) Germany 4) France 5) United States (higher % of GDP)

Seven Phases of Lippitt's Change Model

1) Diagnose problem 2) Assess motivation and capacity for change 3) Assess change agent's motivation and resources 4) Select progressive change objectives 5) Choose appropriate role of change agent 6) Maintain change 7) Terminate helping relationship

Managerial Roles

1) information processing roles 2) interpersonal roles 3) decision making roles

8 Step Planned Change Model

1) recognize symptoms 2) diagnose need 3) analyze alternative solutions 4) select change 5) plan change 6) implement change 7) evaluate change 8) stabilize change

Pareto Principle

states that 20% of focused effort results in 80% of outcome results or conversely, that 80% of unfocused effort results in 20% of outcome results

Use of Nursing Time

25% documentation (charting and reporting) 14% care coordination 14% patient care activities 5% assessment and vital signs 12% medication administration 13% unit related activities: non-nursing 11% non-clinical activities 6% waste: non-productive personal time

DESC Script - A Conflict Resolution Model

A structured, assertive, communication approach for managing and resolving conflict.

Assessing life-threatening emergencies

ABC method

What system is used for prioritization?

ABCD system

Cost containment through access limitation

Access is controlled through designation of covered services. Some services may only be accessed upon approval or referral.

Acculturation

Adaptation to conditions, languages, and customs of a new culture

Intersectionality

Belonging simultaneously to multiple social groups

Leadership and Management Theory: Shared

Based on the belief that several individuals share the responsibility for achieving the health care agency's goals

Strategy for Perfectionism

Become a pursuer of excellence, not a perfectionist, as you pursue your goals.

Strategy for Procrastination

Break a task down into manageable segments, and return to it again and again until it is complete.

Strategy for Social Media

Check social media no more often than once a day. It is a way of communicating but should not take over your life.

Strategy for Clutter

Clear your work area of clutter, and keep it clean. Organize your work area, and take a few minutes at the end of your shit to prepare your area for the next shift.

Conflict Happens

Conflict is... -a normal part of life -a periodic occurrence in any relationship -an opportunity to understand opposing preferences and values -ENERGY

NLNAC 2004

Core competency for nursing education: Interdisciplinary team functioning

Controlling Cost

Costs have to be controlled to meet the public's demand for unlimited health care. Numerous attempts to control costs have been made over the years, but none have been more than marginally successful.

Health care disparities

Differences in quality of health care individual receives not justified by underlying health condition, access to care, or treatment preferences

3 key pieces of federal legislation that establish national standards that individual states use to regulate health insurance

ERISA - Employee Retirement Income Security Act COBRA - Consolidated Omnibus Budget Reconciliation Act HIPAA - Health Insurance Portability & Accountability Act

Current Trends in Cost Containment

Economic or cost containment incentives can be divided into the following broad categories: capitated reimbursement, access limitation, and rationing

Strategy for Emails

Emails should be checked at scheduled intervals and responded to appropriately.

Recruiting Baby boomers

Emphasize company's values, people-focus, communicate how they can contribute to service, status (corner office, parking space), flexible schedule

Collectivism

Emphasizes the importance of group decisions and places the rights of the group as a whole above the rights of any individual in the group

Individualism

Emphasizes the importance of individual rights and rewards

Mobbing

Employees "gang up" on an individual

Strategy for Requests for assistance

Encourage others to be more independent. Give them encouragement, but send them back to complete the job. Decisions to help should be conscious decisions, not drop-in distractions.

Decisional role

Entrepreneur, disturbance handler, allocator of resources, and negotiator roles that managers use to take action with regards to decision-making

FICA Assessment tool

Faith, Belief, Meaning Importance and Influence Community Address

Interpersonal role

Figurehead, leaders and liaison and each of these used to manage relationships with people

Part C of Medicare

Gap coverage

HOPE Assessment

H--sources of hope, strength, comfort, meaning, peace, love and connection O--the role of organized religion for the patient P--personal spirituality and practices E--effects on medical care and end of life decisions

Parts A of Medicare

Hospital Insurance; hospitals, hospice, home health, SNCF (funded through Social Security Taxes)

Cultural ethnicity

Identifies person or group based on racial, tribal, linguistic, religious, national, or cultural group

Registered nurse (RN) has a large role

Incorporates entire spectrum of care provided to family by wide variety of people

Examples of a Servant Leader

Jesus, Florence Nightingale, MLK

Conflict with Clinicians using LEEN Model

L- Can you help me understand how you see the situation, how you are weighing the risks and benefits. E- I can see how you see it that way. E- Let me explain how I see things. N- Let's put the patient first and agree on a plan.

Conflict with Patients/Families LEEN Example

L- Can you help me understand why you are upset. E- That is understandable, I can see why you are upset. E- The reason we wanted to do this was because— N- Let's agree on a path forward.

LEEN--A Model for Conflict Resolution

L- Listen E- Empathize E- Explain N- Negotiate

LETGO Assessment

Listening to the patient's story Encouraging the search for meaning Telling of your concern and acknowledging the pain of loss Generating hope whenever possible Owning your limitations

A transformation leader is seen in what type of organization?

Magnet organizations

Delegating to Others

Many studies have demonstrated that approximately 50% of nursing time is spent on nonnursing activities like cleaning, running errands, clerical duties and stocking supplies. Delegation of nonnursing tasks can provide the nurse with additional time to dedicate to clients care.

What are the driving forces of state of health care?

Market competition can lower prices, improve productivity, and encourage innovation.

Qualities of a Team Good Player

Maxwell (2002) identified 17 characteristics that make a good team player: adaptable, collaborative, committed, communicative, competent, dependable, disciplined, enlarging, enthusiastic, intentional, mission conscious, prepared, relational, self-improving, selfless, solution-oriented, tenacious.

Part B of Medicare

Medical Insurance; covers physician services, outpatient care, medical equipment, and diagnostic tests (funded through federal taxes and monthly premiums paid by recipients) optional

Public government-funded healthcare programs

Medicare & Medicaid, State Children's Health Insurance Program (SCHIP), Department of VA, healthcare programs for military, American Indians, and federal programs - represent about 47% of all US Health Care costs

Strategy for Interruptions

Open your mail over the garbage can. Response, delegate, or throw it out. Organize your papers. Keep your notebooks, calendar, and phone lists in one three-ring binder so that you have your essentials together.

Part D of Medicare

Optional coverage for outpatient prescriptions and must enroll in approved prescription drug plan Covers costs of some prescription drugs Prescriber pays monthly premiums, yearly deductibles, co-payments, and some out of pocket costs Enrollee responsible for 100% costs between $2830 - $4550 (coverage gap) Once out of pocket costs = $4550; Medicare will pay 95% of costs for prescription drugs for covered individuals

Job enlargement

Organizational structure that can affect time demands

Cost Shifting

Practice of raising prices for the privately insured to offset the lower health care payment from both Medicare and Medicaid as well as the often nonpayment of health care premiums from the uninsured. Cost shifting increases the cost of all health care.

Cost containment through capitated reimbursement

Providers are paid a capitated or maximum payment for services. Providers receive a monetary reward if costs are delivered below the limit set by the third-party payer.

What system is used when reporting to a physician?

SBAR (situation, background, assessment, recommendation)

Strategy for Unwanted/low-priority jobs

Say no to jobs that have little value or in which you have little interest. Leave low-priority tasks undone. If an unwanted job must be done, pay or ask for assistance.

National Academy of Medicine formerly Institute of Medicine 2001

Six recommended aims to reduce redundancy and suboptimization: develop effective teams in healthcare

Subcultures

Smaller groups within a culture

Low importance/High urgency

answering the ringing phone

Perfectionists

a person who refuses to accept any standard short of perfection

Organizational Culture

System of shared values and beliefs that actively influences behavior of organizational members

Synergy

Team members work together to produce extraordinary results that could not have been achieved by one individual

2012 - National Federation of Independent Business v. Sebelius

The Supreme Court found that the so-called "individual mandate," the portion of the Affordable Care Act that required Americans to buy health insurance or pay a penalty, was constitutional.

Strategy for Texting

Turn your phone off and check at scheduled intervals; let your friends and family know this.

One Overarching Principle; makes U.S. health care system different

U.S. allows health care system to earn a profit...

Strategy for Unplanned phone calls

Use an answering machine or voice mail. Consider a humorous message. Set a time to return calls. Don't call when driving.

taxonomy

a system that orders principles into a grouping or classification

High task behavior and low relationship behavior is

a telling (directing) leadership style

What do patient's with life-threatening conditions usually have?

an IV access line and receive continuous monitoring of their cardiac rhythm, blood pressure, pulse, respiration, and oxygen saturation level. Their temperature and urinary output and their potential for other life threatening conditions is monitored closely as well

informal leader

an individual who demonstrates leadership outside the scope of a formal leadership role or as a member of a group. This leader is considered to have emerged as a leader when she is accepted by others and is perceived to have influence

Influence

an instrumental part of leadership and means that leaders affect others, often by inspiring, enlivening, and engaging others to participate.

formal leadership

as when a person is in a position of authority or in a sanctioned, assigned role within an organization that connotes influence, such as clinical nurse specialist

dress

ask what traditional dress is used in your department

Competition

between two or more groups

Physiological needs

breathing, food, water, sex, sleep, homeostasis, excretion

Unplanned change

change that is unpredictable, but is beneficial and may go unnoticed

Good followers

communicate and work well with others, being supportive, yet thoughtful, in their approach to new ideas

GDP calculation

consumption + government spending + investment + net exports (export-import)

Committees

created for specific goals or tasks

Low task behavior and low relationship style is

delegating (empowering) leadership style

greetings

determined by casual or business acquaintance

Health disparities include

differences in occurrence of illness, disease, and data among minorities and other vulnerable populations

Per capita

dollars per person

Examples of Workplace Violence

engaging in favoritism, being verbally abusive, sending abusive correspondence, bulling, pranks, setting up workers up for failure, economic aggression such as denying workers promotional opportunities

Good leader-member relations

exist when followers respect, trust, and have confidence in the leader

Copayment

fixed healthcare fee paid at the time of service

Love and belonging needs

friendship, family, sexual intimacy

Social skills

handling emotions relationships well and accurately reading social situations and networks; interacting smoothly; using these skills to persuade and lead and negotiate and settle disputes; for cooperation and teamwork

Self regulation

handling your emotions so they facilitate and do NOT interfere with the task at hand; being conscientious and delaying gratification to pursue goals; and recovering well from emotional distress

Use of these four leadership styles for Situational Theory

helps a nurse manager assign work to others

What behavioral leadership style is best suited for organizations?

high initiating structure, high consideration, but is not necessary for all organizations

What is a coverage gap?

incomes above Medicaid eligibility limits but below the lower limit for Marketplace premium tax credits

Inn a functioning market,

individuals or entities evaluate competing suppliers and make informed choices about where to spend their money.

Open system

influenced by external and internal factors

titles

introduce yourself by your first and last name

High task structure

involves routine, predictable, clearly defined work tasks

Low task structure

involves work that is not routine, predictable, or clearly defined, such as creative, artistic, or qualitative research activities.

Strategy for Casual visitors

make your environment less inviting. Remain standing. Remove your visitor chair. Keep a pen in your hand.

Teamwork

is defined by the Quality and Safety Education for Nurses (QSEN) initiative as "functioning effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care"

Rationing

is determining the most appropriate use of health care or directing the health care where it can do the most good.

High position power

is favorable for the leader

The supportive style of leadership

is relationship oriented, with the leader providing encouragement, interest, and attention

Position power

is the degree of formal authority and influence associated with the leader

Low position power

is unfavorable

ABCD system

is used when items cannot be handled right away -A pile—requires action AS SOON AS possible -B pile—necessary, BUT can wait for now -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

What does time management allow?

it allows the novice nurse to prioritize care, decide on outmodes, and perform the most important interventions first.

Why is time management important?

it is important to analyze and manage time to achieve key outcomes effectively and efficiently

Self awareness

knowing what you are feeling in the moment; having a realistic assessment of your own abilities and well grounded sense of self-confidence

What is the strongest indicator of a favorable environment?

leader-member relations

When being a leader, what is necessary?

leaders need followers in order to lead and followers need leaders to follow

Change agent

leads and manages change

Psychological needs consist of

love and belonging needs (intimate relationships, friends) and esteem needs (prestige and feeling of accomplishment)

Follower readiness is called?

maturity which is assessed in order to select one of the four leadership styles for a situation

Participative leadership

means that the leader focuses on involving followers in the decision making process

virtuality

means working through virtual means using digital networks, where the worker may be far from the patient but present in a digital reality

Self actualization needs

morality, creativity, spontaneity, problem solving, lac of prejudice, acceptance of facts

Maslow's Hierarchy of Needs

motivation occurs when needs are not met. Certain needs have to be satisfied first, beginning with physiological needs, then safety and security needs, then social needs, followed by self-esteem needs, and then self actualization needs. Needs at one level must be satisfied before one is motivated by needs at the next higher level of needs.

Examples of Cultural Shock

new jobs, new facilities, new places, marriage, new roles

Closed system

no influence from outside

Low task behavior and high relationship style is

participating (supporting) leadership style

Basic needs consist of

physiological needs (food, water, warmth, rest) and safety needs (security, safety) -

Deductible

predetermined amount of $ that is out-of-pocket before health care reimbursement begins

How does U.S. free enterprise system impact health care?

profit, supply and demand, competition

The achievement oriented style

provides high structure and direction as well as high support through consideration behavior

The directive style of leadership

provides structure through direction and authority, with the leader focusing on the task and getting the job done

High importance/High urgency

providing emergency care and safety

time

punctuality is important

mobility

refers to the ability to change skill sets as well as having the work dispersed among a variety of work locations, rather than work occurring at fixed sites

Poor leader-member relations

reflect distrust, a lack of confidence and respect, and dissatisfaction with the leader by the followers

Effective 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 and focused activities that use only 20% of time or input to achieve 80% of desired

High importance/Low urgency

routine wound care

Safety needs

security of body, of employment, of resources, of morality, of the family, of health, of property

Self fulfillment needs consist of

self actualization needs (achieving one's full potential, including creative activities)

Self esteem needs

self esteem, confidence, achievement, respect of others, respect by others

High task behavior and high relationship behavior is

selling (coaching) leadership style

Empathy

sensing what people are feeling, being able to take their perspective; and cultivating rapport and being in tune with a broad diversity of people

The most valuable followers are?

skilled, self-directed employees who participate actively in setting the group's direction and who invest time and energy in the work of the group, thinking critically and advocating for new ideas

Espoused beliefs

stated, often written goals; philosophy

Low importance/Low urgency

taking vital signs every 2 hours on a patient whose vital signs have been normal for 48 hours

The process of leadership involves?

the leader and the follower in interaction

What are nurse-sensitive outcomes?

those outcomes that improve if there is a greater quantity or quality of nursing care--e.g., pressure ulcers, falls, and intravenous infiltrations

desired optimal outcomes

the best possible objectives to be achieved given the resources at hand

Leader-member relations

the feelings and attitudes of followers regarding acceptance, trust, and credibility of the leader

The Common Wealth Fund

they support research and innovation

Arousal type procrastinator

thrill-seeker, who waits until the last minute for that euphoric rush

Information processing role

to Monitor, disseminator and spokesperson, each of which is used to manage the information needs that people have

Primary Reason for Being Uninsured Among Uninsured Nonelderly Adults

tried to get coverage but too expensive (46%)

Underlying assumptions

unconscious but powerful beliefs and feelings

body language

use of direct eye contact is expected in all work situations

Motivation

using your deepest preferences to move and guide you toward your goals, to help you take initiative and strive to improve, and to persevere in the face of setbacks and frustrations

Bad economy

usually means lower profits for companies, which in turn means lower stock prices. Investors really worry about negative GDP growth, which is one of the factors economists use to determine whether an economy is in a recession.

Artifact level

visible characteristics

Avoider procrastinators

who are avoiding fear of failure or even fear of success... either way, you are probably worried about what others think

Decisional procrastinators

who can't make a decision. If you do not make a decision, that absolves you from the responsibility of the outcome, right?

What can we do to lower these numbers?

with health promotion and prevention

>50% of people who are uninsured come from what type of family?

working families , minority, who earn less than $48,000

When the economy is healthy,

you will typically see low unemployment and wage increases as businesses demand labor to meet the growing economy