NURS 412 exam One

Strategies to Improve Problem Solving and Decision Making

- Case Studies - Simulation - Problem-based Learning

Flat Designs

• Remove hierarchical layers by flattening the scalar chain and decentralizing the organization: take away the middle men

First level

Charge nurse Team leader Primary nurse

Flat Designs

Effort to remove hierarchical/bureaucracy layers by flattening the chain of command and decentralizing the organization; take away the middle men

Fatal Flaws of a Leader

● I will do it myself". ● "I'm not doing that, no matter what management says". ● Sitting at the desk while others are "sinking". ● "I do what is required of me". But never goes above and beyond. ● "I don't have time to teach you that, they have a class for that".

Hierarchy (Scalar Chain)

- Used for communication flow - Doesn't tell you authority

The Authority-Power Gap

- You don't trust what they say - Make promises but don't follow through

Total Patient Care

RN is responsible for all aspects of care, the RN works directly with the patient, family, and other health care team members.

Principal Agent Theory

Agent/follower may have a better understanding of how something works Ex: I'm the agent or follower and my manager is the principal, the manager tells me I have to do something a certain way and because I've been there longer than them, I have a better understanding of how something works than my manager, so I'm going to do it my way

Authentic Leadership (aka Congruent Leadership)

Being true to oneself and their values and act accordingly

Clinical Nurse Leader

-master's prepared generalist clinician -oversees care coordination of a distinct group of patients, evaluates outcomes and has the decision- making authority to change

A nurse manager is making a decision based on a problem with a staff member. What would be the optimal end product of the decision?

A chosen course of action

Which of the following will derail a group decision-making process?

A leader who does not establish clear objectives and expectations for the group.

Team Nursing

method of nursing care in which a nurse acts as a leader of a group of people giving care

goal is to get pts in and out as fast as possible and have home health or long term care facility take care of them because it's cheaper

Acute care settings (hospitals)

Principal Agent Theory

Agent/follower may have a better understanding of how something works

Formal Structure

organizational positions and formal power

Leads people to believe that managers are saying they're powerful while staff is being told to follow what management says. Productivity is high because employees are being told what to do by given direction

Authoritarian

Line Structures

Authority and responsibility are clearly defined

Line Structures

Authority and responsibility are clearly defined = efficiency and simplicity of relationships; chain of command; flow of communication

A nurse manager is mentoring a new facilitator. What decision-making models can the manager suggest to the facilitator that will help minimize the impact of an unskilled facilitator? (Select all that apply.)

Consequence table, Payoff table, Decision tree, Decision grid

External Stakeholders

outside organization, invested organization externally

Punishment/Coercive Power

Based on fear of punishment if the manager's expectations aren't met

Authentic Leadership

Being true to oneself and their values and act accordingly

Top Level

Chief nursing officer Chief executive officer Chief financial officer

According to Marquis and Huston (2021), there are other critical elements that nurse managers/leaders use to complete the decision-making process.

Clearly define objectives, gather data carefully, take the necessary time, generate multiple alternative, think logically, choose and act decisively

emphasis on "we" rather than I and you; criticism is constructive

Democratic

Matrix Structure

Focus on both product and function Ex: good pt outcomes are the product, staff education and adequate staffing may be the functions necessary to produce the outcome

Matrix Structure

Focus on both product and function Function- all the tasks required to produce the product, and the product is the end result of the function Ex: good pt outcomes are the product, staff education and adequate staffing may be the functions necessary to produce the outcome

Bridging The Gap

For a successful organization, mutual trust b/w managers and employees

Expert Power

Gained through knowledge, expertise, or experience Ex: a person with vast expertise in music would be powerful only in that area, not another specialization

The Authority-Power Gap

Gap between position of authority and subordinate response

What qualities would a Nurse leader/manager need?

Good communicators, organizers, want to work as a team and be team builders/work together, visionary/thinking outside the box, proactive not reactive, innovative be able to work with technology

Legitimate Power/Authority

Has inherent in it the ability to create feelings of obligation or responsibility

Nurse Navigators

Help pts and families navigate the complex health-care system by providing information and support

Management has no control and are permissive; hands-off approach; they don't enforce anything and let staff do what they want; they'll give support and employees are motivated, but they don't give direction

Laissez-faire

Formal Structure

Legitimate power over others

How to Become a Good Problem Solver and Decision Maker

Life Experiences- learned through our lives/or what has happened to us to help guide us in our process of decision making Trial and Error- Life or death situations not going to use a lot of trial and error - Used for little things Ex: wound care, drsg done one certain way and no difference seen in wound, so suggest to MD to try something else to see if it would work better Reasoning Insightfully- collecting data, analyzing, conceptualizing the data to help in decision making - Important info can be given by family of pt - Getting as much data as possible to help make your decision

External Stakeholders

Local businesses Area colleges and universities Insurance companies and HMOs Community leaders Unions Professional organizations

A nurse manager schedules a meeting with the staff to discuss policy changes. What does the manager hope to achieve by having some upper left-brain dominant staff members lend their input?

Logical and rational analysis

Servant Leadership

Number one priority is to serve others

Reward Power

Obtained by the ability to grant favors or reward others with whatever they value

What is the nurse leader/manager role in all of this?

Recruitment, turn over rates (what you can do to keep workers), political aspects (mandatory OT), minimum staffing, governmental input into what can be done at job/institution, high quality practice (care is above and beyond), successful recruitment

Reward Power

Rewarding employee with a gift

What is the first thing you do in managerial positions

Set objective

A staff nurse is having difficulty with problem solving in patient care and the nurse manager is counseling the nurse. What suggestions by the nurse manager may assist the staff nurse in improving problem solving skills? (Select all that apply.)

Slow down thinking, Systematize data collection, Override bias

Emerging New threats

Terrorism, biological warfare, global pandemics

Managers think their employees are all lazy

Theory X

visionary, innovative, think outside box and encourage others to be this way as well; inspirational and employees will be inspired to be the best they can, want others to work at the best they can,

Transformational

Follower's Needs from Leader

Trust Compassion Stability Hope Tea comes sweet and hot

Follower's Needs from Leader

Trust, compassion, stability and hope.

Middle Level

Unit supervisor Department head Director

Ad Hoc Design

Use a project team or task approach and are usually disbanded after a project is completed

Service Line Organization

Used in some large institutions to address the shortcomings that are endemic to traditional large bureaucratic organizations Sometimes called care-centered organizations Smaller in scale than large bureaucratic systems means whose going to look at particular service, not really showing who's in charge/no hierarchy, rather who will take care of a particular issue

Service Line Organization

Used in some large institutions to address the shortcomings that are endemic to traditional large bureaucratic organizations Ex: in organizational design the overall goals would be determined by larger organization, but the service line would decide on the processes to be used to achieve the goals

Modular Nursing

Uses a mini team (2 to 3 members with at least one member being an RN, with members sometimes being called care pairs)

Descriptor of a leader

Visionary, inspired changes, imagination, abstract thinker, ability to articulate, understand the external environment, risk taker, confident, accountability

Manager will have bridged the authority-power gap if followers:

a. Perceive that the manager is doing a good job b. Believe that the organization has their best interests in mind c. Do not feel controlled by authority

Internal Stakeholders

anyone who steps foot into the place at any time

Internal Stakeholders

anyone who steps foot into the place at any time Ex: the nurse, laundry, dietary, nurses aid, physicians, other departments (OT, PT, RT), patients, any visitors that step foot in a hospital

Powerful

are respected and get cooperation from their followers and can get things accomplished

Legal-Rational Authority

based on the belief in legitimacy of the pattern of normative rules and the rights of those elevated to authority under such rules to issue commands Ex: person will say "this is what we want you to do and you're going to do it"

Decentralized Decision Making

collaborative, everyone works together; hard to make decisions in this type

Grapevine

communication network, which is at the heart of informal organization Ex: Conversations in the break room, down halls, during carpool, in between work, social media that allows relationships of informal groups to develop

4 Leadership Domains

executing, influencing, relationship building, strategic thinking

Informal Structure

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

Charismatic Power

is more personal type of power

What are the changes in Healthcare

- People are living longer, so there are more disease processes associated with it - More innovation and technology in workplace

Referent Power - people "brownnose" the leader

- Power gain by being with someone with power

Which of the following competencies are important for the nurse leader to develop?

Ability to diagnose a situation, adapt, and communicate

intuitive, and holistic are characteristics of

right-brain-dominant people

External Stakeholders

outside organization, invested organization externally Ex: Local businesses Area colleges and universities Insurance companies and HMOs Community leaders Unions Professional organizations

Decision Making

picking something from available choices

Legitimate Power/Authority

power gained by title or official position w/in organization

Problem Solving

systematic process, analyzing data in a challenging situation to come up with info to do the problem solving/make a decision; id root problem, analyzing data

Ad Hoc Design

temporary basis to facilitate completion of a project

The manager of several related departments brings the team together to inform them that they will all be cross training to other units for the purpose of increasing productivity. What form of leadership does this manager demonstrate?

transactional

Full Range Leadership includes what?

transactional, transformational, and Laissez-faire

A nurse in a leadership role is committed to a vision for retention in the medical-surgical unit and is able to empower others with this vision. What form of leadership is this nurse demonstrating?

transformational

Powerless leader-managers

withhold info from others that makes it difficult to work with

Punishment/Coercive Power

■ Opposite of reward power - Based on fear of punishment if the manager's expectations aren't met

Internal Stakeholders

Hospital employees Physicians Patients Patients' families Union shop stewards Board of directors

Human and Social Capital Theory

Invest self into something if it's worth it and helps them in their future/pay off in the future Ex: health-care organization that provides tuition reimbursement for nurses to go back to school to earn higher degrees is likely doing so in anticipation that a more highly educated nursing staff will result in increased quality of care and higher retention rates which would translate into higher productivity and financial return

Legal-Rational Authority

Issue commands Ex; person will say "this is what we want you to do and you're going to do it"

A nursing instructor is discussing ways to improve critical thinking during a clinical rotation with a student. The student asks the nurse what critical thinking is. What is the best response by the nursing instructor?

It requires reasoning and creative analysis.

Informational Power

Obtained when people have information that others must have to accomplish their goals

Management process

POSDCORB

if DM is found but pt was admitted for HF, care for DM may not be covered by insurance

Paid for performance

Functional Method

Personnel were assigned to complete certain tasks rather than care for specific pts; relatively unskilled workers were able to gain proficiency by task repetition; RNs became managers of care rather than direct care providers; "care through others"

Patient and Family Centered Care

Planning, Delivering and Evaluating Healthcare while including patients and families in all processes.

Primary Nursing

Primary nurse assumes 24 h responsibility for planning care of one or more pts

Which of the following are behaviors associated with effective leaders?

Priority setting, critical thinking, skillful communication

4 leadership domains

Strategic Thinking- effective leader who has staff thinking about future; set long-term goals; analytical, have input, intellectual, futuristic Influence- staff wants to follow; give support to staff; good communication, maximizer, make significant decisions, self assured in what they do, develop political support, sell ideas Relationship Building- tendency to collaborate with others well and work together/unite a group into a team towards a common goal; empathy, work in harmony with others, positivity Execution- know how to get things done by translating plans into action; come up with idea, work it out, and execute idea; responsible, focused, achievers Rise and Shine to help remember

Managers think all their employees are great

Theory Y

Centralized Decision Making

Top person communicates everything to the lower levels; top to bottom approach

Centralized Decision Making

Top person makes the decision Top person communicates everything to the lower levels; top to bottom approach; better approach than decentralization The vision or thinking of one or a few individuals in the organization guides the organization's goals and how those goals are accomplished

manager only focuses on day to day leadership; not looking down the road a week or month; "traditional manager"

Transactional

Descriptor of a management

Transformation, tenacity, specific, data, interpretation, understand of inside the organization, self discipline, commitment, accountability

Strengths-Based Leadership

focuses on the development or empowerment of workers' strengths as opposed to identifying problems, improving underperformance, and addressing weaknesses and obstacles

Human and Social Capital Theory

invest self into something if it's worth it and helps them in their future/pay off in the future

Referent Power - people "brownnose" the leader

is gained only through association with powerful others

Reflective Thinking and Practice

manager looks at how she/he is doing things and if it is the correct way; look at EBP and change ways if there are better ways