NURS 412

Reasons Why Nurses Do Not Want to Join Unions

- Belief that unions promote the welfare state - Need to demonstrate individualism and promote social status - Belief that professionals should not unionize - Identification with management's viewpoint - Fear of employer reprisal - Fear of lost income associated with a strike or walkout - the cost of membership dues - they are employed in "right to work" states that grant workers a choice about whether to belong to a union

National Patient Safety Goals

- Identify patients correctly - Improve staff communication - Use medicines safely - Use alarms safely - Prevent infection - Identify patient safety risks - Prevent mistakes in surgery

reasons why nurses join unions

- Increase the power of the individual - Increase input into organizational decision making - Eliminate discrimination and favoritism - Because of social need to be accepted - Because they are required to do so by employer - Because they believe it will improve patient outcomes and quality of care

classic change strategies

- Rational-empirical strategies: using research or EBP to back up the change, proof that change will work - Normative-reeducative strategies: use group norms and peer pressure to socialize and influence people so that change will occur - Power-coercive strategies: when people are forced to make change

ways management can deter nurses to become unionized

- find out what makes the nurses unsatisfied - find out drives and needs behind joining a union and address them - let nurses voice their thoughts - do not show favoritism or discrimination - share ideas with nurses - the more unhappy the nurses are the more likely they are to join a union

overcoming barriers in planning

- follow specific goals so they don't get lost in little details - be flexible - everyone should participate - be simple, realistic, but not too vague - don't overplan or underplan - have checkpoints in middle in case something goes wrong

nursing advocacy in legislation

- managers need to stick up for the nurses - nurses need to stick together - personal letters are more influential than formal letters - when talking to the media, do not use medical jargon, have good facts, be clear and concise, don't ramble, look confident, back away from a fight

select union-organizing strategies

- meetings - leaflet and brochures - pressure on hospital corporation through media and community contacts - political pressure of regional legislators and local lawmakers - corporate campaign strategies - activism of local employees - using lawsuits - bringing pressure from finances - technology

Right to die/ Physician assisted suicide

- must be 18 or older - must have terminal illness - dr needs to tell you you have 6 months or less to live - must verbally request it 2x within 15 days - 1 written request, signed, dated, and witnessed by 2 adults - nobody can request it other than the person dying, so no durable power of attorney, no advanced health care directive, conservator, or any other person - need to sign final adastation 48 hours before the drug is given - pt must be the one physically taking the drug - physicians get to choose if they want to be part of it - drs cannot be held liable for any part of it

career development program

- reduced employee turnover, keeps employees - provides equal employment opportunity - increase opportunities for growth - improves work life - improves competitiveness - avoids outdated practice - helps employees climb the ladder

whistleblowing

- this is the last resort, except when patient lives are at stake - go up the chain of command first - internal is within the organization - external is using the media, newspaper, radio - leaders/managers mus advocate for whistleblowers

incremental budgeting method

-involves multiplying the current yr's budget by a predetermined figure based on cost of living, consumer price index or inflation rate, that # to project for next fiscal yr >advantages = it is very simple and requires little expertise >disadvantage = inefficient and does not encourage prioritization of needs for the future, nor does it facilitate motivation to contain cost.

Lewin's Theory of Change

1). Unfreezing: The need for change is recognized. 2). Moving: Change is initiated, gradual overtime 3). Refreezing: Change becomes stabilized (may take 3-6 months)

steps to establish a union

1. create an internal, volunteer organizing committee, identify targets, recruiting, solicit 2. union informs NLRB about the unionizing, NLRB will hold a hearing and set an election date 3. union writes and organizing drive, union talks to employees and usually employees become uninterested. 4. representation election is held, secret ballot election is held

Patient bill of rights goals

1. make patients feel more confident going into hc system 2. importance of good relationship with pt and hcp 3. want the patient to feel safe

Leapfrog Initiatives

4 EBP standards that will provide the biggest impact to reducing med errors -Computerized physician-provider order entry -Evidence-based hospital referral -ICU physician staffing (dr always on hand in ICU) - national quality forum: someone is always following up with parameters to measure outcomes

Medicaid

A federal and state assistance program that pays for health care services for people who cannot afford them, lower income adults, certain children, pregnant, disabilities

medicare

A federal program of health insurance for persons 65 years of age and older, certain disabilities part A: hospital insurance program part B: outpatient care part C: patient can use managed care plans part D: limited prescription coverage

medication reconciliation

A procedure to maintain an accurate and up-to-date list of medications for all patients between all phases of health care delivery. 1. identify medications the patient is taking 2. identify medication information 3. compare medication the patient brought to the one that id ordered 4. provide patient with written information about medication 5. explain importance to adhering to medication

chaos theory

A theory that emphasizes systems processes that produce change, even sudden, rapid change, no predictable pattern

Balanced scoreboard approach

A top-down management system that organizations can use to clarify their vision and strategy and transform them into action - financial - customers - internal business process - learning and growth

procedures

An established or official way of doing something step by step on how to do something

competency assessment

Analysis of the sets of skills and knowledge needed for decision-oriented and knowledge-intensive jobs

Benchmarking

Comparing an organization's practices, processes, and products against the world's best.

controllable expenses

Costs that can be influenced by the decisions of a manager.

fixed expenses

Costs that do not change from month to month ex: mortgage

3 steps of career coaching

Gathering data - spend time with employee, experience, performance, education, credentials Ask what is possible - future changes, openings, transfers, challenges, opportunities, look into the future Conduct a coaching session - helping employee increase their effectiveness

NANDA

North American Nursing Diagnosis Association, purpose is to define, refine, and promote a taxonomy of nursing diagnostic terminology of general use to professional nurses.

long term career coaching

Planned, systematic management action that occurs over the duration of an employee's employment "do later"

value clarification

Process of becoming conscious of and identifying ones values, what you prioritize the most

3 career stages

Promise: first 10 years, start to gain knowledge and skills momentum: 10-20 years, start valuing where the experience has brought you, professional, starting to realize how great you are harvest: 30-40 years, considered having prime experience, wanting to share your experience/knowledge, want to pass on skills 40+ = legacy clinician reentry: due to crisis situations and nursing shortages, retired nurses come back

Veterans Readjustment Assistance Act

Provides employment rights and privileges for veterans with regard to positions that they held before they entered the armed forces.

Equal Pay Act of 1963

Requires that men and women be paid the same amount for doing the same job

clincial practice guidelines

Specific procedures or protocols for medical professionals to follow for patients with a particular diagnosis or medical condition based on research.

Complex adaptive systems change theory

Suggests that the relationship between elements and agents within any system is nonlinear and that these elements are the key players in changing settings or outcomes manager must look at and understand all relationships between all elements and how it affects the organization

HCAHPS

Survey: Hospital Consumer Assessment of Healthcare Providers and Systems Measures: - Environment cleanliness* - Environment quietness* - Nurse communication - Physician communication - Communication about pain* - Communication about medications - Responsiveness of hospital staff* - Discharge information* - Transition of care - Overall hospital rating - Likely to recommend

butterfly effect

The idea that a small effect or thing can have a large impact if it happens to tip the balance, causing other changes that create a major event.

Quality Assurance

The ongoing process of making sure that a software product is developed to the highest standards possible subject to the ever-present constraints of time and money.

capital budget

a budget for spending on major investments $1000-5000 on equipment for it to be capital

strategic planning

a good leader needs to proactively plan 4 models

Prospective Payment System

a health insurance system that pays the health care provider a fixed amount based on the medical diagnosis or specific procedure, rather than on the actual cost of hospitalization or care; if the actual cost for care is greater than the fixed amount, the provider must absorb the additional expense

Total Quality Management (TQM)

a management philosophy that focuses on satisfying customers through empowering employees to be an active part of continuous quality improvement

Mission Statement

a statement of the organization's purpose, why the organization exists

Rehabilitation Act of 1973

added people with disabilities to the list of Americans protected from discrimination

retrospective audit

after patient receives service

sentinel event reporting

an unexpected occurrence involving death, or serious or psychological injury or the risk thereof

steps in budgetary process

assess: determine what needs to be included in the budget (employee costs, phone lines, equipment, supplies) diagnose: determine what must be accomplished in departments using the most cost effective approach (looking at older computers and see what ones need to be replaced) plan: develop a budget (fiscal: 12 month, monthly, perpetual: keeping track where they are every month to see if they are meeting budget) implement: continue to monitor budget, see if they are on track, see if readjustments need to be made evaluation: evaluate end and make adjustments for next year

Continuous Quality Improvement (CQI)

assumes that production and service focus on the individual and that quality can always be better, always room for improvement, never ending

planned change

change activities that are intentional and goal oriented

variable expenses

costs that do change

cost containment

delivering care in an effective and efficient way ex: staffing another nurse because they will save money and the quality of care goes up over time, better than overtime

vision statement

describes future goals or aims of an organization

the occupational safety and health act

ensures safe and healthy working conditions for working men and women by setting and enforcing standards, providing training, outreach education, and assistance

forecasting

estimate and guess how things may plan out in the future

cost effective

everyone's responsibility to make sure they are not wasting supplied and not buying cheap products just to save money

operating budget

expenses linked to volume of service (electric, gas, repair services, phone)

flexible budget method

fluctuates based on how many admission the hospital hasna dn how many staff members are needed ex: patients go up = staff goes up = budget goes up

Nursing Philosophy

focuses nursing care, quality, quantity, and scope of nursing services and how nursing specifically will meet organizational goals

performance budgeting method

focuses on end result of activities themselves, evaluate success of budget based on whatever program they started and see if it meets goal

ANA Standards of Nursing Practice

foundation for all RNs, what they can and can't do

pre activism

future oriented using technology, looking into future to see what issues could arise, speed things up with technology

policies

guidelines used in making decisions regarding specific, recurring situations - implied: not written or verbally said, everyone just kind of goes with it (limit personal leave to 3 months and can return to their jobs with no change of status) expressed: verbally or written (dress code, sick leave, vacation time, getting promoted)

prospective audits

how future client care will be affected

personal budget

largest budget include actual worked time, time of unproductive or benefit time, includes PTO

Genetic Information Nondiscrimination Act

law that protects people from being discriminated against because of information derived from genetic tests makes it illegal for HIP to require genetic information for a persons eligibility illegal for employers to use genetic information when making a decision about hiring, promoting, etc

HMO

limits coverage of care from doctors that work for that contract

transition to practice

little to no training (6-8 weeks), orientation within institutions, doesn't really tell you how to critically think

interactive or proactive

look at how organization handled a situation in the past, how they currently handle situations, and how they should handle them in the future, very flexible, not trying to hurry things up, considers past, present, future

structure audit

looking at quality of care and how it is delivered ex: staffing ratios, staffing mix, emergency department wait times, availability of fire extinguishers in patient care areas

intrapersonal struggle

making a decision for the patient that goes against your value system

workplace advocacy

manager makes sure the work environment is safe, favorable for staff, professional growth is happening, learning opportunities for staff

fiscal planning

managers looking at planning for the year budgeting

zero based budget method

managers need to rejustify program every budgeting cycle, explain why ___ program is important and why they need to keep it

advocating for staff

managers role to make sure staff is involved in decision making process, listen to staff needs, give staff support, understanding whats going on with staff, promote shared governance, promoting autonomy

process audit

measures how nursing care is provided; task-oriented and focus on whether standards are being fulfilled ex: not documenting

outcome audit

measuring the end result of something, reflect the result of care or how the patient's health status changes as a result of an intervention

minimum wage and maximum wage hours

minimum wage: 7.25 any time over 40 hours a week is overtime

reflective practice

nurses complete self assessment to identify areas where they may need to do continued educations

reactive

occurs after a problem exists quick fixes no planning involved does not actually fix the problem

uncontrollable expenses

out of your hands ex: overtime response to emergency event, equipment breaks

Civil Rights Act of 1964

outlawed discrimination based on race, color, religion, sex, or national origin

Age Discrimination in Employment Act

outlaws discrimination against people older than 70 years

change agent

person from inside or outside of an organization to help it transform, like a cheerleader, gets everyone on board, usually manager

rules

plan that define specific action or nonaction, keep things in check, inflexible, shows what will happen if you break the rules

lewin's theory of planned change

precontemplation: individual has no intentions of changing contemplation: beings to think about change preparation: intend to take action in the future (unfreezing) action: change behavior to accept change maintenance: makes the change and keeps it (refreezing)

Americans with Disabilities Act

prohibits discrimination against the disabled

organizational philosophy

provides the basis for developing nursing philosophies at the unit level and for nursing service as a whole

labor relations laws

regulations that describe how unions can form and how companies must respond to them

patient bill of rights

right to informed consent, right to information, right to chose HCP and facility they go to, right to self determination, right to religious beliefs, right to look at own medical record

value indicator

something you say you believe in but do not do ex: telling people to vote but not voting yourself

unit philosophy

specifies how nursing care provided on the unit will correspond with nursing service and organizational goals.

short term career coaching

spontaneous part of management, ask questions to develop and motivate employees, spur of moment

SWOT analysis

strengths (interal), weaknesses (internal), opportunities (external), threats (external)

patient protection and affordable care act

supposed to make healthcare more affordable 1. make sure hc coverage was more available, more affordable, more acceptable 2. prevented hc from going up

Equal Employment Opportunity

the condition in which all individuals have an equal chance for employment, regardless of their race, color, religion, sex, age, disability, or national origin

Interactivism

things are kept in the current state, nothing is activated, nothing is changing, no efforts are being made maintaining conformity

personal values

things we value, shaped by experience, cannot impose beliefs in patient care

change by drift

unplanned or accidental change, but eventually they have the desired outcome, change overtime, slow

career coaching

ways for organization to help employees through mentoring

professional speciality certification

ways to show advanced achievement organizations support this, increases your worth

value conflict

when your values don't match the organizations ex: abortion but you don't believe in it

concurrent audits

while the client is receiving care