Nursing Management Final Exam
Sexual harassment
Unwelcome sexual advances, requests for sexual favors and other verbal or physical conducts of a sexual nature when submission to or rejection of this conduct explicitly or implicitly affects an individual's work performance; or creates an intimidating, hostile or offensive work environment
Civil Rights Act of 1964
Updated 1977 Set equal rights employment practice Recognizes sexual harassment as a form of sex discrimination
C
Why is a disciplinary conference conducted? A.) Explain the termination process B.) Review their job description C.) Clarify reason and expectation for change in behavior
Prospective payment system (PPS)
With DRGs, hospitals join the ___________________, whereby they receive a specified amount for each Medicare patient's admission regardless of the actual cost of care
Rules
_________ or regulations worth having should be enforced All ______, regulations and policies should be regularly reviewed or relevance
Leaders
__________ inspire people to want to do something
14 forces of Magnetism
1. Quality of nursing leadership 2. Organizational structure 3. Management style 4. Personnel policies and programs 5. Professional models of care 6. Quality of care 7. Quality improvement 8. Consultation and resources 9. Autonomy 10. Community and the hospital 11. Nurses as teachers 12. Image of nursing 13. Interdisciplinary relationships 14. Professional development
Patient classification systems (PCS)
A review of literature consistently demonstrates that as RN hours decrease in NCH/PPD, adverse patient outcomes increase This includes: - Increased medication errors - Patient falls - Decreased patient satisfaction with pain management
Evidence based practice
A shared responsibility of the professional nurse, the organization, leader-managers and the education or staff development department
A
A structured interview format with a team approach has the best reliability: A.) True B.) False
Quality control
A systematic process A collection of quantitative and qualitative data is used as well as a specific and systematic process Standards have to exist to establish control criteria and leaders have to know what those standards are and what's expected of them
Seeking consensus
Always an appropriate goal in resolving conflicts and in negotiation All parties support, or at least do not oppose, an agreement Greatest challenge in consensus building is time
Medicare
Established in 1965 Primary populations are elderly, disabled, and renal dialysis patients. Two parts: A and B - Part A funded by Social Security tax and federal taxes. - Part B subsidized 75% by federal government and 25% by subscribers
A
Ethics are rules of conduct recognized in respect to a particular culture, group? A.) True B.) False
Staff development activities
Evaluation criteria for ______________________: - Learner's reaction - Behavior change - Organizational impact - Cost effectiveness
Organizational communication
Even more complex than interpersonal or group communication, as there are more communication channels, more individuals to communicate with, more information to transmit, and new technologies, which both complicate and ease care delivery. Thus, ___________________ is a high-level management function; it must be systematic, have continuity, and be appropriately integrated into the organizational structure, encouraging an exchange of views and ideas. Is complex, however, and communication failure often results in a failure to meet organizational goals. In addition, there are confidentiality risks that must be addressed.
Functional method of nursing
Evolved as a result of World War II Uses relatively unskilled workers who have been trained to complete certain tasks Care is assigned by task rather than by patient
Accountable care organizations
Groups of providers and suppliers of service who work together to better coordinate care for Medicare patients (does not include Medicare Advantage) across care settings with the expectation that efficiency as well as quality of care will result in shared savings
Factors affecting healthcare trends
Growing elderly population Healthcare reform Reductions in reimbursements New quality imperatives Shift in focus of care to community settings Technological advancements Shift to customer-focused care
ANA Code of Ethics
Guidelines for ethical nursing practice Nine provisions Used as a standard of practice in a court of law
Decision tree
Map possible outcomes of a series of related choices Guides thinking towards desired outcomes Because decisions are often tied to the outcome of other events, management analysts have developed ___________
Staffing
Matters to nursing—staffing is everything and determines whether you will stay in their workplace or even the profession
Training
May be defined as an organized method of ensuring that people have knowledge and skills for a specific purpose and that they have acquired the necessary knowledge to perform the duties of the job
Scalar principle
Means that there should be a clear definition of authority in the organization and that this authority flows, one link at a time, through the chain of command
Alternative dispute resolutions (ADRs)
Mediation Arbitration Ombudsperson
Chief nursing officers
The CNO must be a participant in the hospital's governing body, as well as the body responsible for strategic planning. The CNO must have at least a master's degree. If the degree is not in nursing, the officer must have either a bachelor's degree or a doctorate in nursing
Leaders
1. Inspire change 2. Requires vision 3. Requires imagination 4. Requires abstract thinking 5. Requires ability to articulate 6. Requires as aptitude to sell 7. Requires understanding of the external environment 8. Requires risk taking 9. Confidence in uncertainty 10. Accountable to the organization
Managers
1. Manages transformation 2. Requires tenacity 3. Requires specifics 4. Requires concrete data 5. Requires ability to interpret 6. Requires an aptitude to teach 7. Understands how works get done within an organization 8. Requires self-discipline 9. Requires blind commitment to completing the task 10. Accountable to the team
Frameworks for Ethical Decision Making
1. Utilitarianism ( Teleological) 2.Duty-based reasoning 3. Rights-based reasoning 4. Intuitionist
Scientific Management
1900 - 1930 Frederick Taylor Time and motion studies, and expertise from experience workers to scientifically design work to promote greatest efficiency of time and energy Scientific personnel system to hire, train, and promote workers based on technical competence and abilities "Fit" in organization; financial incentives Cooperative relationship between managers & workers; Distinct difference in the role of workers and managers
Human relations management
1930 - 1970 Participatory management (Mary Parker Follett) Emphasizes people rather than machines (Elton Mayo) - Produced the "Hawthorne effect"...people respond to the fact of being studied & will increase that behavior that brings attention Theory X and Theory Y (Douglas McGregor) Employee participation (Chris Argyris)
Behavioral theories
1940 - 1980 Authoritarian Democratic Laissez-faire
MORAL Decision making model
1985 M - Massage the dilemma O - Outline options R - Review criteria and resolve A - Affirm position and act L - Look back. Evaluate the decision making
Patient self-determination act (PSDA)
1991 Requires health care organizations that receive federal funding to provide education for staff and patients on issues concerning treatment and end-of-life issues-living wills
HIPAA (Health Insurance Portability and Accountability Act)
1996 Protects the privacy of health information and improves the portability and continuity of health insurance coverage
C
A Unit manager demonstrated passion for serving the staff rather than being served. Taking time to listen, the UM prefers to be a teacher first before being a leader, which is characteristic of which leadership style? A.) Transformational B.) Transactional C.) Servant D.) Charismatic
D
A nurse who has recently been promoted to UM, comes across a theory which states that the leadership style is effective depends on the situation. Which of the following styles best fits a situation when the followers are self-directed, experts, and are matured, self-motivated professional individuals who anticipate up and down communication? A.) Democratic B.) Bureaucratic C.) Human Relations D.) Laissez-faire
Ethics
A system of moral conduct and principles that guide a person's actions in regard to right and wrong and in regard to oneself and society at large
Relationship/Information age
Adaptive skills Invitation and interdependence Cooperation Discerning purpose Finding meaning What you know (information) Circular (egalitarian) Metaphor: organic network (connected parts) Leadership: trusteeship
Professional negligence
Also called malpractice Failure of a person to act in a reasonable and prudent manner Five components: 1. Duty to follow the standard of care (follow policy and practices set forward by agency and organizations) 2. Failure to meet standard of care-breach of duty 3. Foreseeability of harm-nurse must know that the possibility of harm exists 4. Direct relationship between breach and injury can be proved 5. Injury-actual harm resulted due to one's actions or failure to act
Thought leadership
Applies to someone recognized among peers for innovative ideas and who demonstrates the confidence to promote these ideas Thought leaders attract followers not by any promise of representation or empowerment, but by their risk-taking Ideas are future-oriented and generally problem-oriented
Deontological
Approach to ethical decision making Duty-focused normative approach centered on rules from which all action is derived
Situational
Approach to ethical decision making No prescribed rules, norms, or majority-focused results that must be followed
Teleological
Approach to ethical decision making Outcome-focused approach that places emphasis on results and protects the interest of the majority
Intentional torts
Assault and battery- threatening or touching without permission False imprisonment-use of physical restraints led to these claims Invasion of privacy Defamation of character
Civil law
Based on a preponderance of the evidence Law which are concerned with private relations between members and usually is non violent in nature and involves property (divorce, most malpractice cases)
Democratic
Behavioral theory Less control maintained Economic and ego awards used to motivate Others directed through suggestions and guidance Communication flows up and down Decision making involves others Emphasis is on "we" Criticism is constructive
Administrative law
Clear and convincing standard Law that governs the activities of agencies of government (LSBN, Equal Opportunity Act violations)
Compassion fatigue
Combination of physical, emotional, and spiritual depletion associated with caring for patients in significant emotional pain and physical distress Overcome by strengthening interpersonal and communication skills Use of self-assessment-gain insight into stressors that contribute to CF Nurses-need help to develop own recovery plans Usually seen-physical, emotional & work related symptoms Symptoms - Work Related => Avoidance/dread of certain patients => Reduced feeling of empathy => Frequent absences => Lack of joyfulness - Physical => Headaches, digestive upset, insomnia, fatigue => Cardiac symptoms: chest pain, palpitations - Emotional => Mood swings => Restlessness => Irritability, anger => Anxiety, depression => Excessive use of nicotine, alcohol, drugs => Poor concentration, focus and judgement => Loss of objectivity
Beneficence
Doing good Implement actions that benefit clients Good requires competence Treating client in holistic manner, including beliefs, feelings, wishes
Nonmaleficence
Duty to do no harm Intentionally or unintentionally Protect those who can't protect themselves
Malpractice
Failed to act in a reasonable and prudent manner-also called professional negligence. Cannot claim ignorance as an excuse-having all the information in a situation may impede one's ability to foresee harm. Did not provide reasonable and prudent care as determined by the testimony of expert nursing witnesses. Reducing Risk: • Practice within the scope of the State's Nurse Practice Act • Practice within your individual competence • Know and follow the policies and procedures • Model standards which follow evidence based practice • Put patient rights and welfare first • Upgrade your skills • Know legal basis of nursing decisions • Seek opportunities for lifelong learning
Good samaritan immunity
Generally, a nurse is not liable for injury that occurs as a result of emergency treatment when care is provided at the scene of the emergency which is not grossly negligent. Revise in LA after hurricane Katrina
Utility
Good of the many outweighs the wants/needs of the individual
Leadership theories
Great Man Theory/Trait Theories Behavioral Theories Situational and Contingency Leadership Theories Interactional Leadership Theories
Leadership theories
Great man theory Trait theory Behavioral theories Situational and contingency theories Interactional theories Transactional leadership theory Transformational leadership theory
Implied consent
In an emergency physician documents when patient is unable to sign
Leadership ethics
In an era of markedly limited physical, human, and fiscal resources, nearly all decision making by nurse leaders involves some ethical component. Important leadership responsibility-in creating an ethical work environment role modeling ethical behavior.
Moral uncertianty
Individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is
Situational-Contingency leadership theory
Leadership theory 1950-1980 Mary Parker Follet: Law of the Situation Fiedler: Contingency approach Blake and Mouton: Managerial Grid Hersey - Blanchard Model Tannebaum and Schmidt Leadership Continuum
Interactional leadership theory
Leadership theory 1970 - Present Based on how leadership behavior is influenced by the relationship between the leader's personality and the specific situation • People are complex & variable • People have different motives for doing things • People's motives change over time - don't stay constant
Standards of care
Minimal level of expertise that may be delivered to a patient Conduct of a reasonably prudent nurse in similar circumstances Regionally based Set by Professional Organizations (i.e. Association of Critical Care Nurses, American Nurses Association, Oncology Nursing Society)
Ordinary negligence
Omission to do something that a reasonable person would do with average judgment, foresight, intelligence and skill
D
One leadership theory states that "leaders are born and not made," which refers to which of the following theories? A.) Charismatic B.) Situational C.) Trait D.) Great Man
Paternalism
One person can make decisions for another Often seen as undesirable Negative ethical principle if it violates autonomy - Entire decision is taken away Positive principle - Assist in deciding major moves or plans by providing more data...thus help the person fully understand all aspects
Character
One's ___________ is judged not by what is done for those who can assist you in reaching your goals but in what is done for those who have no voice or power
Management Process
Planning -> Organizing -> Staffing -> Directing -> Controlling
Authentic leader
Purpose Values Relationships Self-discipline Heart
Human capital theory
Represents the capability of the individual Retain Motivate Train Hire
Reflective thinking
Requires nurse leaders to be nimble, flexible, and responsive to change Must be able to continually adapt, reflect on progress and setbacks, and adjust their course as needed
Vicarious liability
Respondeat superior-the "master" is responsible for the "servants". Employer responsible for employees except when employee acts erroneously
Moral distress
Result of the individual knowing the right thing to do but organizational constraints make it difficult to take the right course of action
Ethics
Rules of conduct recognized in respect to a particular culture, group. Origin-social system, external Society says right/wrong Ethics tend to be consistent "Ethos" means character Ethics are governed by prof and legal guidelines in time and place
Management theories
Scientific Management Management Functions Human Relations Management
Constitution
Source of the law System of fundamental laws that govern a nation Involvement with Nursing Practice: - Little direct involvement with malpractice
Administrative laws
Source of the law Valid only to the extent that they are within the scope of the authority granted to them by the legislative body
Authentic leadership
Suggests that in order to lead, leaders must be true to themselves and their values Components - Balanced processing - Internalized moral perspective - Relational transparency - Self-awareness
Moral courage
Tendency to do what is right regardless of other pressures
Emotional intelligence (EI)
The ability to perceive, understand, and control one's own emotions as well as those of others The ability to use emotions effectively and is required by leaders/managers in order to enhance their success Emotional intelligence is critical for building a cooperative and effective team Five Components - Self-awareness - Self-regulation - Motivation - Empathy - Social skills
Legislation
The primary purpose of law and legislation is to protect the patient and the nurse
Resipsa loquitur
The thing speaks for itself-harm is obviously the result of negligence
Stare decisis
To let the decision stand and use precedents
Transactional leadership
Traditional type Focuses on management tasks Committed Uses trade-offs to meet goals Does not identify shared values Examines causes Uses contingency reward
Moral outrage
When an individual witnesses the immoral act of another but feels powerless to stop it Experiences contribute to compassional fatigue
Mediation
Alternative dispute resolution (ADR) Neutral third party Fact-finding
Fatal leadership flaws
1.) A lack of energy and enthusiasm 2.) Acceptance of their own mediocre performance 3.) Lack of a clear vision and direction 4.) Having poor judgement 5.) Not collaborating 6.) Not walking the talk 7.) Resisting new ideas 8.) Not learning from mistakes 9.) A lack of interpersonal skills 10.) Failing to develop others
Termination conference
1.) Clearly state the reasons for dismissal 2.) Explain the employment termination process 3.) Ask for the employee's input 4.) End the meeting on a positive note
Employee indoctrination
1.) Induction 2.) Orientation 3.) Individual orientation to each department
Transferring employees
1.) Lateral Transfer 2.) Downward Transfer 3.) Accommodating Transfer 4.) Inappropriate Transfer
Disciplinary conference
1.) Reason for disciplinary action 2.) Employee's response to disciplinary action 3.) Rationale for disciplinary action 4.) Clarification of expectations for change 5.) Agreement and acceptance of action plan
Common staffing options
10 or 12 hour shifts Premium pay for weekend work Part-time staffing pool for weekend and holiday Cyclical staffing, allow long term knowledge of future work schedules with a master pattern of 8- hour shifts repeating every 4 weeks Job sharing Allowing nurses to exchange hours of work among themselves Flextime Use of supplemental staffing from outside registries and float pools Staff self-scheduling Shift bidding—nurses bid for shifts rather than requiring mandatory overtime
National Labor Act/Wagner Act
1935 Gave unions many rights in organizing Resulted in rapid union growth
Fair Labor Standard Acts
1938 Has been amended many times since 1938 Sets minimum wage and maximum hours that can be worked before overtime is paid
Taft-Hartley Amendment
1947 Returned some power to management Resulted in a more equal balance of power balance of power between unions and managements
Patient bill of rights
1960, 1998 NLN, the American Hospital Association, and many states have passed bills of rights for patients used to guide professional practice. Patient Protection and Affordable Care Act in 2010
Kennedy Executive Order 10988
1962 Amended the 1935 Wagner Act to allow public employees to join unions
Executive Order 11246 and 11375
1965; 1967 Sets affirmative action guidelines
Age discrimination act
1967 1978 Amendment Protects against forced retirement
Rehabilitation act
1973 Prohibits discrimination on the basis of disability
Vietnam veterans act
1973; 1974 Provides reemployment rights
Amendments to Wagner Act
1974 Allowed nonprofit organizations to join unions
National labor relations board ruling
1989 Allowed nurses to form their own separate bargaining units
California Fair Pay Act
2016 Companies in California must justify any pay disparities between men and women doing "substantially similar" work Prior fair pay legislation only required men and women of the same job title to be paid equally Also, legally guaranteed employees the right to ask coworkers about pay without retribution from management
Decision making
A complex, cognitive process often defined as choosing a particular course of action The thought process of selecting a logical choice from the available options - This implies that doubt exists about several courses of action and that a choice is made to eliminate uncertainty
A
A delegation strategy to employ would be consideration of skill and education level? A.) True B.) False
Service Employees International Union (SEIU)
A large union in the health-care industry, representing more than 1.9 million nurses, LPNs, doctors, lab technicians, nursing home workers, and home care workers. Of this membership, there are 80,000 RNs in 21 states
Bundled payment
A payment structure in which different health-care providers who are treating a patient for the same or related conditions are paid an overall sum for taking care of that condition rather than being paid for each individual treatment, test, or procedure. In doing so, providers are rewarded for coordinating care, preventing complications and errors, and reducing unnecessary or duplicative tests and treatments
Change agent
A person skilled in the theory and implementation of planned change Manager
Learning organization
A place "where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free, and where people are continually learning to see the whole together."
Budget
A plan that uses numerical data to predict the activities of an organization over a period of time
Learning organization
A premise of the __________________ is that learning itself enhances the team
Nursing process
A problem solving and decision making model Can be applied to leadership and managerial situations Multiple places where feedback happens Constant input
Recruitment
A process of activity seeking out and attracting applicants for existing positions An ongoing process May be nurse recruiter—collaborative relationship with individual departments Personnel Department Considerations—Organization's philosophy, benefit programs, salary scale and other factors influencing retention
Utilization review
A process used by insurance companies to assess the need for medical care and to assure that payment will be provided for the care
Capitation
A prospective payment system that pays health plans or providers a fixed amount per enrollee per month to provide a defined set of health services based on enrollee needs
Advocacy for staffing
ANA continues to advocate for safe staffing approaches that: • Provide assurance that RNs are not forced to work without orientation in units in which they are not adequately trained or experienced; • Establish procedures for receiving and investigating complaints; • Allow for civil monetary penalties for known violations; • Include whistleblower protections; and • Require public reporting of staffing information
Safe staffing
ANA supports a legislative model in which nurses are empowered to create staffing plans specific to each unit. This approach aids in establishing staffing levels that are flexible and account for changes including: • Intensity of patient's needs, • The number of admissions, discharges, and transfers during a shift, • Level of experience of nursing staff, • Layout of the unit, • Availability of resources (e.g., ancillary staff, technology). Establishing minimum, upwardly adjustable staffing levels in statute will also help the committee in achieving safe and appropriate staffing plans.
Addressing workplace violence
ANA's Code of Ethics with Interpretive Statements & ANA's Position Statement on Incivility, Bullying, and Workplace Violence Joint Commission's Workplace Violence Prevention Resources for Health Care Health-care organizations uIndividual States mandates OSHA- no current standard. Health-care employer citation
Collective bargaining
Activities occurring between organized labor and management that concern employee relations Negotiation of formal labor agreements and day-to-day interactions between unions and management
LPN/LVN practice act
Administer oral and intravenous medications Chart in the medical record Take the patient's vital signs Change wound dressings Collect specimens such as blood, urine, sputum, etc Insert and care for urinary catheters Care for patients with tracheostomy tube and ventilators Insert and care for patients that need nasogastric tubes Give feedings through a nasogastric or gastrostomy tube Care for ostomies Monitor patients for a change in clinical condition Call the physician if needed Perform CPR in emergencies Are supervised by an RN
Scheduling options
Advantages and Disadvantages of ___________: • Continued debate about 12 hour shifts that result in fatigue with judgement errors and slower reaction times by nurses • Nurses who work longer hours have higher instances of burnout and job dissatisfaction as well as cardiovascular disease, hypertension, diabetes and mood disorders. • Studies show long shifts lead to increased sick time • Nurses continue to report increased satisfaction with 12- hour shifts • Less work days = improved work/life balance and solutions to child care • Some organizations pay overtime for any shift over 8 hours • Less handoffs = better communication and continuity of care • Agency or Travel Nurses—Usually paid 2 to 3 x higher without benefits, but is expensive and could lead to poor continuity of care. Often nurses don't want to ask questions and charting errors are common Per Diem—Nurses have higher pay flexibility and can choose when and where they want to work, but no benefits. Also threat to safety because they're not familiar with P/P • Float pool • Float staff • Self scheduling • Not easy to implement: Manager must have good oversight of these schedules and workability depends on the leadership to make sure there is adequate staffing. • Most schedules are done 4 to 6 weeks in advance with self scheduling • Offers nurses greater control Shift-Bidding—allows nurses control over extra shifts to reduce overtime by allowing nurses to bid on the shift which is usually more than the hourly wage
Functional method of nursing
Advantages and disadvantages of the __________________: - A major advantage of functional nursing is its efficiency; tasks are completed quickly, with little confusion regarding responsibilities. - However, functional nursing may lead to fragmented care and the possibility of overlooking patient priority needs
Organization chart
Advantages of the ______________: - Maps lines of decision-making authority - Helps people understand their assignments and those of their coworkers - Reveals to managers and new personnel how they fit into the organization - Contributes to sound organizational structure - Shows formal lines of communication
Staffing
Affects the cost of care—The costs of mortality, readmission and compromised safety are high so staffing plays a role in reducing the incidence, and cost of each
Staffing
Affects the quality of care—Studies have shown a correlation between optimum levels of staffing and optimum outcomes
Group member roles
Aggressor Blocker Recognition seeker Self - confessor Playboy Dominator Help seeker
Nurse empowerment
All nurses should have a say in patient care and be involved in data collection, a collaborative approach that empowers nurses
Decision grids
Allows one to visually examine the alternatives and compare each against the same criteria. Although any criterion may be selected, the same criteria are used to analyze each alternative. When many alternatives have been generated or a group or committee is collaborating on the decision, these grids are particularly helpful to the process. This tool, for instance, would be useful when changing the method of managing care on a unit or when selecting a candidate to hire from a large interview pool. The unit manager or the committee would evaluate all of the alternatives available using a decision grid. In this manner, every alternative is evaluated using the same criteria. It is possible to weigh some of the criteria more heavily than others if some are more important. To do this, it is usually necessary to assign a number value to each criterion. The result would be a numeric value for each alternative considered
Health insurance marketplaces
Also called exchanges Are online insurance supermalls, created for individuals without access to health insurance through a job or for small businesses who wish to buy affordable and qualified health benefit plans in a competitive insurance marketplace
Total quality management
Also referred to as continuous quality improvement (CQI) Based on the premise that the individual is the focal element on which production and service depend on Focus is on doing the right things, the right way, the first time, and problem-prevention planning, not inspective and reactive problem solving
Arbitration
Alternative dispute resolution (ADR) Formal Binding
Ombudsperson
Alternative dispute resolution (ADR) Investigates grievance Ensues right and process
Line structures
An advantage is because most people are familiar with this structure, there is little stress orienting people to the organization because authority and responsibility are clearly defined; however, a disadvantage is it can restrict upward communication because of the chain of command and make it difficult for workers to adjust to different circumstances. Good leaders encourage upward communication because in this structure, going outside the chain of command is inappropriate
Clinical nurse leader
An experienced nurse possessing a graduate degree who provides clinical leadership in all health-care settings, implements outcomes-based practice and quality improvement strategies, engages in clinical practice, and creates and manages microsystems of care that are responsive to the health-care needs of individuals and families
Preceptor
An experienced nurse who provides knowledge and emotional support, as well as a clarification of role expectations, on a one-to-one basis Effective ______________ role model and adjust teaching to each learner as needed
Mentoring
An in-depth supportive and nurturing relationship between an expert and a novice Formal relationship typically lasts 2 to 5 years, with mentor being one generation older than mentee Many nurses have limited opportunities to have a true mentoring relationship in their lives
Punishment
An undesirable event that follows unacceptable behavior, which may have negative consequences but can be a powerful motivator for change
Team nursing
Ancillary personnel collaborate to provide care to patients under the direction of a professional nurse. Requires extensive team communication and regular team planning conferences Allows members to contribute their own special expertise or skills Disadvantages are associated with improper implementation rather than the philosophy itself
Diagnosis-related groups (DRGs)
Are predetermined payment schedules that reflect historical costs for the treatment of specific patient conditions
A
As RN hours decrease in NCH/PPD, adverse patient outcomes increase: A.) True B.) False
Adult learning
Assets for ___________________: - High self-motivation - Self-directed - A proven learner - Knowledge experience reservoir - Special individual assets
Managers
Assigned position Delegated authority - legitimate power Specific duties Control Manipulates people, environment, time, resources Greater formal responsibility and accountability Direct willing and unwilling subordinates
Nurse navigator
Assists patients and families to navigate the complex health-care system by providing information and support as they traverse their illness
Decision making
Available options -> Choose logical course of action Consider existing alternatives Choice with maximum benefit Often triggered by problem, but not always! Often thought to be synonymous with management and is one of the criteria on which management expertise is judged. Much of any manager's time is spent critically examining issues, solving problems, and making decisions. The quality of the decisions that leader-managers make is the factor that often weighs most heavily in their success or failure. ______________, then, is both an innermost leadership activity and the core of management.
Conflict resolution strategies
Avoiding Compromising Competing Cooperating/Accommodating Smoothing Collaborating
Managed care
Based on the concept of capitation, whereby providers prospectively receive a fixed monthly payment, regardless of what services are used by that patient during the month. This encourages providers to treat less because their potential profits decline as treatment increases
Plan
Because a _______ is a guide to reach a goal, it must be flexible and allow for readjustment as unexpected events occur
Reinforcement
Because a learner's first attempts are often unsuccessful, good preceptors are essential to reinforce desired behavior. Once the behavior or skill is learned, it needs continual reinforcement until it becomes internalized
Role models
Behavior you want to emulate May be passive or nonexistent relationship A person can have many role models There is a cumulative effect
Laissez-faire
Behavioral theory Permissive,; little or no control Motivates by support when requested by the group or individuals Provides little or no direction Uses upward and downward communication Disperses decision making throughout the group Places emphasis on group Does not criticize
Authoritarian
Behavioral theory Strong control over employees Motivation by coercion Directing with commands Communication flows downward Employees not involved in decision making Emphasis is on difference in status ("I" and "you") Criticism is punitive
Reasons nurses do not join unions
Belief that unions promote a 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
Unity of command
Best described as one person/one boss in which employees have one manager to whom they report and to whom they are responsible Indicated by the vertical solid line between positions on the organizational chart
Criminal law
Beyond a reasonable doubt Laws which relate to crime. These laws regulate social conduct and cover threatening, harmful or otherwise endangering to property, health, safety and moral welfare of people (murder, assault)
Top level managers
Board of directors Chief executive officer Chief nursing officer Administrators Scope of Responsibility - Look at the organization as a whole including external influences Primary planning focus - Strategic planning Communication flow - Mostly top down but received subordinate feedback both directly and through middle level managers
Nursing licensure
Boundaries for practice are defined in the Nurse Practice Act of each state. Nursing licensure is a privilege and not a right. First mandatory Nurse Practice Act passed in New York in 1938; nursing has been legislated, directed, and controlled to some extent.
Authority power gap
Bridging the ___________________: - Overt displays of authority should be used as a last resort. - The leader should make a genuine effort to know and care about each subordinate as a unique individual. - The manager needs to provide enough information about organizational and unit goals to subordinates so that they understand how their efforts and those of their manager are contributing to goal attainment - Empowerment of staff is a hallmark of transformational leadership
Managed care
Broadly defined as a system that attempts to integrate efficiency of care, access and cost of care
Flexible budgeting
Budgeting method Are budgets that flex up and down over the year depending on volume
Performance budgeting
Budgeting method Emphasizes outcomes and results instead of activities or outputs
Zero based budgeting
Budgeting method In comparison, managers who use _____________ must rejustify their program or needs every budgeting cycle
Incremental budgeting
Budgeting method ____________ or the flat-percentage increase method is the simplest method for budgeting
Personal power base
Building a _____________________: - Maintain personal energy. - Present a powerful picture to others. - Pay the entry fee. - Determine the powerful in the organization. - Learn the language and symbols of the organization. - Learn how to use the organization's priorities. - Increase professional skills and knowledge. - Maintain a broad vision. - Be flexible. - Develop visibility and voice in the organization. - Learn to toot your own horn. - Maintain a sense of humor. - Empower others
Workplace violence
Bullying / horizontal bullying Incivility Mobbing Zero tolerance Typology - Nurse-to-nurse - Patient-to-nurse - Organization-to-nurse - External perpetrators - Third-party - Impact-of-mass trauma/natural disasters - Nurse-to-patient - Personal violence Consequences - Medical => Increased health c/o => Emotional/psychological consequences - Decrease in Pt care/pt safety => Less-patient centered care => Difficulty in maintaining ethical boundaries
Staffing
Can blow a budget—Nursing accounts for most of an acute facility's total payroll
Staffing
Can make---or break—the relationship between finance and nursing. Although we've come far, acuity remains subjective
A
Case management nursing focuses on the individual and coordinates care through an episode of illness: A.) True B.) False
Managing care with case management
Case managers often manage care using critical pathways and multidisciplinary action plans (MAPs) to plan patient care. The care MAP is a combination of a critical pathway and a nursing care plan, which indicates times when nursing interventions should occur. All health-care providers follow the care MAP to facilitate expected outcomes. If a patient deviates from the normal plan, a variance is indicated Some feel that the role of case manager should be reserved for the advance practice nurse or RN with advanced training
B
Centralized staffing characteristics are: A.) May not be cost effective B.) Staffing policies are consistent and less impartial C.) Staff have less flexibility
Power coercive
Change strategy Authoritative Laws Accept or leave
Rational emperical
Change strategy Lack of knowledge Humans are rational
Normative reeducative
Change strategy Peer pressure Humans are social creatures
Leadership
Characteristics Associated with Successful ________________: - Intelligence - Knowledge - Judgement - Decisiveness - Oral fluency - Emotional intelligence - Independence - Personable - Skilled communicator - Adaptability - Creativity - Cooperativeness - Alertness - Self-confidence - Personal integrity - Emotional balance and control - Risk taking - Critical thinking - Ability - Able to enlist cooperation - Interpersonal skills - Tact - Diplomacy - Prestige - Social participation - Charisma - Collaborative priority setting
Effective healthcare delivery systems
Characteristics of _________________________: - Facilitate meeting the goals of the organization - Cost-effective - Satisfy the patient - Provide role satisfaction to nurses - Allow implementation of the nursing process - Provide for adequate communication among health-care providers
Critical thinker
Characteristics of a ______________: - Analytical - Communicative - Intuitive - Persistent - Insightful - Open to new ideas - Creative - Adaptive - Collaborative
A
Characteristics of a clinical nurse leader are: A.) Create and coordinate plans of care for patients B.) Assists patients and families through their course of illness C.) Management of high cost high resource diseases
A
Clinical reasoning uses both knowledge and experience to make decisions at the point of care: A.) True B.) False
Art of negotiation
Collaboration Emphasis is on accommodating differences between the parties. Consider trade-offs and the bottom line Look for & Acknowledge hidden agendas uIs both psychological & verbal
Case management nursing
Collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual's health needs through communication and available resources to promote quality, cost-effective outcomes Coordinates care through an episode of illness The focus is on individual clients, not populations of clients
Transformational leadership
Committed, has a vision, and can empower others with this vision Identifies common values Is a caretaker Inspires others with vision Has long-term vision Looks at effects Empowers others
Leadership
Common ___________ Roles: - Decision maker - Communicator - Evaluator - Facilitator - Risk-taker - Mentor - Energizer - Priority setter - Coach - Counselor - Teacher - Critical thinker - Buffer - Advocate - Visionary - Director - Forecaster - Influencer - Creative problem-solver - Change agent - Role model - Diplomat - Innovator - Encourager
Grievance
Essentially a statement of wrongdoing or procedure to follow when one believes that a wrong has been committed
Nurse patient advocacy
Common areas of __________________: • End of life decisions • Use of technology • Use of resources • Access to health care • Conflicts between patient and provider(s) • Withholding information or lying to patients • Privacy and confidentiality • Respect for patient dignity • Inadequate consents • Incompetent health care providers • Complex social problems-care of the elderly, abused, disadvantaged
Disease management programs
Common features of ___________________: - Provide a comprehensive, integrated approach to the care and reimbursement of common, high-cost, chronic illnesses. - Focus on prevention as well as early disease detection and intervention to avoid costly acute episodes but provide comprehensive care and reimbursement - Target population groups (population based) rather than individuals. - Employ a multidisciplinary health-care team, including specialists. - Use standardized clinical guidelines—clinical pathways reflecting best practice to guide providers - Use integrated data management systems to track patient progress across care settings and allow continuous and ongoing improvement of treatment algorithms. - Frequently employ professional nurses in the role of case manager or program coordinator
Leapfrog group initiatives
Computerized physician-provider order entry Evidence-based hospital referral ICU physician staffing The use of Leapfrog safe practices scores
Compromising
Conflict resolution strategy Could result in lose-lose
Avoiding
Conflict resolution strategy Not acknowledged
Smoothing
Conflict resolution strategy Pacify
Cooperating/Accommodating
Conflict resolution strategy Sacrifice-win; Expect future payback
Competing
Conflict resolution strategy Win-lose
Collaborating
Conflict resolution strategy Win-win Emotional maturity
Restraining forces
Conformity, non-risk taker, fear of unknown
Chemically impaired employee
Confronting the _________________: - Gather as much evidence as possible of employee's impairment - Immediate confrontation is necessary if manager suspects employee may be impaired - Denial of the impairment or use of defense mechanisms should be expected - The manager should not try to nurture or assume the role of counselor to the employee
Human values
Confusing preferences for facts Tremendously influence our perceptions Therefore, as problem solvers gather information
Communication
Constant to ensure basic, safe care
Sources of the law
Constitution Statues Administrative agencies Court decisions
Types of discipline
Constructive Destructive Self-discipline
Payoff tables
Cost-Profit-Volume relationship Historical data -> Determines probabilities The decision aids known as payoff tables have a cost-profit-volume relationship and are very helpful when some quantitative information is available, such as an item's cost or predicted use To use ______________, one must determine probabilities and use historical data, such as a hospital census and a report on the number of operating procedures performed. To illustrate, a _____________ might be appropriately used in determining how many participants it would take to make an in-service program break even in terms of costs. If the instructor for the class costs $500, the in-service director would need to charge each of the 20 participants $25 for the class, but for 40 participants, the class would cost only $12.50 each. The in-service director would use attendance data from past classes and the number of nurses potentially available to attend to determine probable class size and thus how much to charge for the class. _________________ do not guarantee that a correct decision will be made, but they assist in visualizing data
Leadership advocacy
Create a work environment that recognizes patients' needs and goals as paramount. Creating a work culture in which patients are respected, well informed, and empowered. Patient advocacy includes distribution of resources and the use of technology. Patient advocacy includes risk taking, particularly when advocating for a client may be in direct conflict with a provider or institutional goal. Perform subordinate advocacy to assist subordinates resolve ethical problems and live with the solutions at the unit level.
Benchmarking
Critical event analysis and root cause analysis help to identify not only what and how an event happened but also why it happened, with the end goal being to ensure that a preventable negative outcome does not recur
Planning
Critically important to and precedes all other management functions Without adequate ____________, the management process fails and organizational needs and objectives cannot be met
Managed care
Criticisms of ____________: - Loss of existing physician-patient relationships - Limited choice of physicians for consumers - Less continuity of care - Reduced physician autonomy - Longer wait times for care - Consumer confusion about the many rules to be followed
A
Decentralized staffing strengths include: A.) More flexibility to staff B.) More cost effective C.) Less work for the middle manager
Planning
Deciding in advance what to do, who is to do it, how it is to be done and when it has to be done A proactive, deliberate process requires of all managers
Decision-making tools
Decision grids Payoff tables Decision trees Consequence tables
Decentralized decision making
Decision making is diffused throughout the organization and problems are solved at the lowest practical managerial level
Centralized decision making
Decisions are made by a few managers at the top of the hierarchy
Medicaid
Established in 1965 Primary population is the financially indigent. The majority of Medicaid recipients are women and children. Administered by the states under broad federal guidelines Covers about 17% of the US population How does cost sharing (deductibles, copayments, and coinsurance) impact moral hazard?
Minimum staffing criteria
Decisions made must meet state and federal labor laws and organizational policies. Staff must not be demoralized or excessively fatigued by frequent or extended overtime requests. Patient care must not be jeopardized, but improved California is the only state in the U.S. that has enacted legislation requiring mandatory staffing ratios in hospitals and long-term care facilities. The answer as to whether mandated ratios have improved care or created new cost burdens for California is still unclear
Managerial decision-making model
Define what decision needs to be made/Set objective -> Identify/research options -> Compare/contract options -> Rank options and make decision -> Implement plan -> Evaluate results To address the weaknesses of the traditional problem solving process, many contemporary models for management decision making have added an objective-setting step These models are known as _________________ or rational decision-making models
Multicultural work team
Delegating to a _________________: - There are six cultural phenomena that must be considered when working with staff from a culturally diverse background: 1. Communication 2. Space 3. Social organization 4. Time 5. Environmental control 6. Biological variations
Underdelegating
Delegation error False assumptions Lack of trust
Overdelegating
Delegation error Poor time management Disorganized Insecure
Improper delegating
Delegation error Wrong time, person and reason Task beyond the capabilities Inadequte information
Plan ahead
Delegation strategy Avoid becoming overwhelmed Assess the situation
Reward
Delegation strategy Give recognition
Empower the right personnel
Delegation strategy ID best staff Innovative and willing Delegate the authority and responsibility
Evaluate
Delegation strategy Positive and negative
Role model
Delegation strategy Provide guidance
Skill and education level
Delegation strategy RN Practice Act Scope of Practice
Deadlines
Delegation strategy Set and monitor timelines
Common goals
Delegation strategy What, purpose and goal of the task
Consequence tables
Demonstrate how various alternatives create different consequences Lists the objectives for solving a problem down one side of a table and rates how each alternative would meet the desired objective
Matrix organizations
Designed to focus on both the product and the function Have a formal vertical and horizontal chain of command Have fewer formal rules and fewer levels of the hierarchy Can cause slow decision making due to information sharing Can produce confusion and frustration for workers because of dual-authority hierarchical design
Driving forces
Desire to please, recognition, pay raise, eliminate problem
Supervision
Directing, guiding
Organization Chart
Disadvantages of the _________________: - Does not show the informal structure of the organization - Does not indicate the degree of authority held by each line position - May show things as they are supposed to be or used to be rather than as they are - Possibility exists of confusing authority with status
A
Disease management programs target population groups rather than individuals? A.) True B.) False
Manager role
Distinguish between employees who need progressive discipline and those who are chemically impaired, psychologically impaired, or marginal employees so that the employee can be managed in the most appropriate manner
State board of nursing treatment programs
Diversion Programs Intervention or Peer Assistance Programs Voluntary, confidential program Goal - Protect the public by early identification and to provide intervention and treatment programs for nurses Nurses who refuse participation in programs are subject to disciplinary review by the State Board of Nursing
B
During an interview, it is okay to ask if the applicant has children? A.) True B.) False
Personal mastery
Each member of the staff has a commitment to improve his or her personal abilities. This personal and professional learning is then integrated into the team and organization
Responsibility accounting
Each of an organization's revenues, expenses, assets, and liabilities is someone's responsibility. As a corollary, the person with the most direct control or influence on any of these financial elements should be held accountable for them, usually the leader-manager
Emerging care delivery models
Elevating the role of nurses and transitioning from caregivers to "care integrators" Taking a team approach to interdisciplinary care Bridging the continuum of care outside of the primary care facility Defining the home as a setting of care
A
Employees have a right to participate in union organizing under the NLRA, and managers can't interfere with this right? A.) True B.) False
Organizing a union
Employees have a right to participate in union organizing under the NLRA, and managers must not interfere with this right. Once management is faced with dealing with a bargaining agent, it has a choice of either accepting or opposing the union
Float pool
Employees who are cross-trained on multiple units so they can work when there is higher census or other staffing issues. Some staff uncomfortable with floating because they're not adequately oriented
Maintenance roles
Encourager Harmonizer Compromiser Gatekeeper Standard setter Group commentator Follower
Negotiation closure
End on a friendly note. Restate the final decision. Hide astonishment at your success. Make the other party feel that he or she also won. Follow up with a memo.
Staffing needs
Factors affecting _________________: • Education and knowledge level of current and needed staff • Peak resignation periods • Times of high patient census • How long new hires usually stay employed • Third party insurer reimbursement levels • Budget constraints • Patient care delivery system • Number of students enrolled in local nursing schools • Source of nursing pools • Historically, when the economy improves, nursing shortages occur. When the economy declines, nursing vacancy rate declines => Supply ==> Increases in enrollment will not be adequate to replace retiring nurses ==> Inadequate resources to provide nursing education including faculty, sites and preceptors ==> AACN (2019) reported 75,029 qualified applicants turned away from baccalaureate and graduate nurse programs => Demand ==> Aging population and extended longevity ==> Demand for care is escalating • Leaders should proactivity recruit and hire staff with age, gender, cultural, ethnic, and language diversity to better mirror the increasing diversity of the communities they serve • Brings new perspectives to thinking and problem solving
D
Factors affecting staffing needs are: A.) Peak resignation times B.) Budgets C.) Patient delivery system D.) All of the above
Future of health care
Factors influencing the ____________________: - Robotic technology - Biomechatronics - Biometrics and smart cards - Point of care testing - Telehealth and the internet - Growing elderly population - Nursing shortages in acute care hospitals - Managers who are uninformed about the legal, political, economic, and social factors affecting health care make planning errors that may have disastrous implications for their professional development and the financial viability of the organization
Resistance to delegation
Failure to see perspectives Lack of self-confidence Resistance to authority Over-delegated tasks
Fidelity
Faithful to agreements and promises Nurses have responsibilities to clients, employers, government, society Crucial in concept of accountability Foundation of trust
Confirmation bias
Favor information that confirms what one already believes
Queen bee syndrome
Female dominated professions often exemplify the ________________ The queen bee is a woman who struggled to become successful, but once successful, she refuses to help other women be successful
Assets
Financial resources that a health-care organization receives, such as accounts receivable
Chaos theory
Finding underlying order Future difficult to predict Tiny change = dramatic affects - AKA the butterfly effect Outcomes not proportional to change
Strength based leadership
Focuses on the development or empowerment of workers' strength Embodies an orientation towards strength and developing collective efficacy Four leadership domains: - Strategic thinking - Influence - Relationship building - Execution
Organization
Follows planning as the second phase of the management process This is where relationships are defined, procedures are outlined and tasks are assigned
Management functions
Forecast unit needs Recognize need for planned change Periodically assess for signs of organizational aging Actively involved in refreezing process until the change becomes part of the new status quo
Group communication stages
Forming Storming Norming Performing
Progressive discipline
Four common steps in _______________: 1.) Verbal admonishment 2.) Written admonishment 3.) Suspension from work without pay 4.) Dismissal All but the most serious infractions should be removed from the employee's record at conclusion of a predesignated period
Strategic planning
Generally, complex organizational plans that involve a long period (usually 3 to 7 years) are referred to as long-range or strategic plans. Typically examines an organization's purpose, mission, philosophy, and goals in the context of its external environment Unlike the 20-year strategic plans of the 1960s and 1970s, most long-term planners today find it difficult to look even 5 years in the future
Collective learning
Goes beyond the boundaries of individual learning and releases gains for both the individual and the organization
Storming
Group communication stage Challenging each other
Forming
Group communication stage Meeting each other
Performing
Group communication stage Working as one
Norming
Group communication stage Working with each other
Dominator
Group member role Attempts to control and manipulate the group
Aggressor
Group member role Expresses disapproval of others' values or feelings through jokes, verbal attacks or envy
Blocker
Group member role Persists in expressing negative points of view and resurrects dead issues
Playboy
Group member role Remains uninvolved and demonstrates cynicism, nonchalance or horseplay
Help seeker
Group member role Uses expressions of personal insecurity, confusion or self-deprecation to manipulate sympathy from members
Self-confessor
Group member role Uses the group setting as a forum for personal expression
Recognition seeker
Group member role Works to focus positive attention on him/herself
Staffing by acuity
Grouping of patients according to specific characteristics Hours of nursing care assigned for each patient classification Unique to a specific institution Ongoing review critical
Accountable care organizations
Groups of providers and suppliers of service who work together to better coordinate care for Medicare patients (does not include Medicare Advantage) across care settings
Budgeting methods
Incremental budgeting Zero-based budgeting Flexible budgeting Performance budgeting
Equal employment opportunities
Have fostered many profound changes in the American workplace. Women, minorities, and individuals with handicaps have had some success in gaining jobs previously denied to them; however, only modest gains in achieving ethnic diversity have occurred in nursing State and federal employment legislation often overlap; as a general rule, the employer must abide by the stricter of the two regulations Although some legislation makes the job of managing people more difficult for managers, it has resulted in increased job fairness and opportunities for women, minorities, older adults, and individuals with disabilities
Personnel workforce budget
Health care is labor-intensive. The personnel budget accounts for the majority of most health-care organization's expenses Next to personnel costs, supplies are the second most significant component in the hospital budget
C
Helpful negotiation strategies involve: A.) Aggressiveness B.) Ambiguous questioning C.) Factual statements
Advocacy
Helping others to grow and self-actualize Nurses advocate for themselves, patients, subordinates and the profession. The foundation and essence of nursing, and nurses have a responsibility to promote human advocacy. Goals of the advocate: • To inform • To enhance autonomy • To respect others' decisions
Baseline data
Historical information on dollars spent, acuity level, patient census, resources needed, hours of care, and so forth. This information is used as basis on which future needs can be projected
D
How can a nurse leader promote evidence based practice? A.) Build census from interdisciplinary teams B.) Make research and data accessible C.) Hire a nurse researcher D.) All of the above
Organizational climate
How employees perceive an organization The perception may be accurate or inaccurate, and people in the same organization may have different perceptions about the same organization
Process audits
How nursing care is provided and assumes a connection between the process and the quality of care. Critical pathways and Standardized clinical guidelines are examples of efforts to standardize the process of care
Objective
How the goal will specifically be achieved - Includes time frame and is measurable
D
How would you define "Norming" as a group communication strategy? A.) Meeting each other B.) Challenging each other C.) Working as one D.) Working with each another
Problem solving process
Identify problem -> Gather/analyze data -> Explore alternatives -> Evaluate alternatives -> Select appropriate solution -> Implement solution -> Evaluate results
C
Identify the concept of Moral Distress: A.) Witness the immoral act of another but feels powerless to stop it B.) Combination of physical, emotional and spiritual depletion C.) Knowing the right thing to do but there is organizational constraints
D
Identify the symptoms of Compassion Fatigue? A.) Poor concentration, focus and judgement B.) Cardiac symptoms: chest pain, palpitations C.) Irritability, anger D.) All of the above
Motivation to learn
If learners are informed in advance about the benefits of learning specific content and adopting new behaviors, they are more likely to attend the training sessions and learn. Telling employees why and how specific educational or training programs will benefit them personally (to gain buy in) is a vital management function in staff development
Disease management protocols
Illnesses often managed with ________________________: - Cancer - Acute otitis media - Diabetes - Hyperlipidemia - Asthma - Hypertension - COPD - Hormone replacement therapy - AIDS - Stroke
Chemical impairment
Impairment resulting from drug or alcohol addiction
Implementing change
Implemented for good reason Gradual Planned vs. sporadic Inclusive
Trainers and educators
Implications of Knowles's Work for _______________________: - A climate of openness and respect will assist in the identification of what the adult learner wants and needs to learn - Adults enjoy taking part in and planning their learning experiences - Adults should be involved in the evaluation of their progress - Experiential techniques work best with adults - Mistakes are opportunities for adult learning - If the value of the adult's experience is rejected, the adult will feel rejected - Adults' readiness to learn is greatest when they recognize that there is a need to know (such as in response to a problem) - Adults need the opportunity to apply what they have learned very quickly after the learning - Assessment of need is imperative in adult learning
Communication and team building
Important skill for clinicians and teams Encourage trust and cooperation Feelings toward team members can affect the teams ability to accomplish tasks. It is the reasonability of the leader - manager to use communication in such a way that builds the team
Confidentiality
In the ANA Nurses Code of Ethics In ANA Standards of Practice 1996 Health Insurance Portability & Accountability Act (HIPAA) Nurses safeguard the trust of clients by keeping their medical records private. Records used on a "need to know" only basis
Frequent legal claims against nurses
Inadequate charting Inadequate communication with physician or supervisors about changes in patient conditions. Leaving potentially harmful items within patient reach. Unattended patient falls. Inaccurate counting of operative instruments and sponges. Misidentifying patients for medications, surgeries, tests
External climate
Includes external factors: - Weather - Temperature - Timing - Status - Power - Authority - Organizational climate
Internal climate
Includes internal factors: - Values - Feelings - Temperament - Stress
Reasons 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
Conflict categories
Intrapersonal conflict Interpersonal conflict Intergroup conflict
Suggested interview format
Introduce yourself and greet the applicant Make a brief statement about the organization and clarify the position in which the person is applying Discuss the information on the application and seek clarification as needed Discuss applicant qualifications and proceed with a structured interview format If applicant is qualified, discuss the position further Explain hiring procedures Terminate the interview
B
Intuitive decision making does not involve experience or pattern recognition: A.) True B.) False
External whistleblowing
Involves reporting outside the organization, such as to the media or an elected offician
Discipline
Involves training or molding the mind or character to bring about desired behaviors
Forecasting
Involves trying to estimate how a condition will be in the future. Forecasting takes advantage of input from others, gives sequence in activity, and protects an organization against undesirable changes
B
Is "Just following physician's orders" a defense for malpractice? A.) True B.) False
Joint Comission
Is the major accrediting body for healthcare organizations and programs in the United States. It also administers the ORYX initiative and collects data on core measures to better standardize data collection across acute care hospitals
Organizational culture
Is the total of an organization's beliefs, history, taboos, formal and informal relationships, and communication patterns. Much of an organization's culture is not available to staff in a retrievable source and must be related by others
Team learning
It is through the collaboration of team members that LOs achieve their goals. Values, such as trust and openness, commitment to one another's learning, and acknowledgment that mistakes are part of the learning process, are important characteristics of an LO
Model of learning organizations
Key characteristics of Senge's _______________________: - Systems thinking - Personal mastery - Team learning - Mental models - Shared vision
Stages of conflict process
Latent conflict - (1st: Antecedent) Perceived conflict - (2nd: Intellectualized) Felt conflict - (3rd: Emotionalized) Manifest conflict - (4th: Action) Conflict aftermath - (5th: Positive/negative
Participatory management
Lays the foundation for shared governance, they are not the same Implies that others are allowed to participate in decision making over which someone has control Thus, the act of "allowing" participation identifies for the participant the real and final authority
Decentralized staffing
Lead to increased autonomy and flexibility but centralized staffing is fairer to all employee because policies tend to be employed more consistently and impartially
Social learning theory
Learning from interactions with others in a social context Also an important part of LOs because it suggests we learn from our interactions with others in a social context. (This is a part of the teamwork and mental model development in LOs.) Albert Bandura, a social psychologist, is often credited with developing social learning theory in the 1970s. Bandura (1977) believed that direct reinforcement could not account for all types of learning and that, instead, most people learn their behavior by direct experience and observation, known as observational learning or modeling
Socialization
Learning the behaviors that accompany each role by instruction, observation, and trial and error Involves a sharing of the values and attitudes of the organization Creates a fit between new staff members and the unit by introducing them to the norms of the group The first ________________ to the nursing role occurs during nursing school and continues after graduation
Nurse practice act
Legal instrument that defines what the functions of nursing shall be and sets standards for licensure. Grants a nurse the authority to carry out those functions. Each state Nurse Practice Act differs-all must be consistent with provisions or statutes established at the federal level. National Council of State Boards of Nursing is a resource Protects the public
Level 5 leadership
Level 1 - Highly capable individual Level 2 - Contributing team member Level 3 - Competent manager Level 4 - Effective leader Level 5 - Greater leader
A
Lewin's unfreezing stage determines the need for change: A.) True B.) False
Organizational structures
Line structures Ad hoc design Matrix structures Service line organization Flat designs
GRRRR
Listening tool Greeting Respectful listening Review Recommend or request more information Reward
Ethical dilemma
Making a choice between two or more equally undesirable alternatives. Individual who must solve an ethical dilemma is the only person who can ascertain if actions taken were congruent with personal values. Self-awareness is vital in ethical decision making, as it is in other aspects of management. Characteristics: - The problem cannot be solved using only empirical data - The problem is so perplexing that it is difficult to decide what facts and data are needed to be used in making the decision - The results of the problem - far-reaching effects
Management functions
Management Organizations - Henri Fayol - 1925 - Planning - Organization - Command - Coordination - Control Activities of Management - Luther Gulick - 1937 - Planning - Organizing - Staffing - Directing - Coordinating - Reporting - Budgeting
Performance deficiency coaching
Manager actively brings areas of unacceptable behavior or performance to the attention of the employee Works with employee to establish a plan to correct deficiencies
Workplace advocacy
Manager ensures safety in work environment Environment conducive to professional and personal growth for subordinates. Advocate for whistle-blowers, who speak out about organizational practices they believe may be harmful or inappropriate
Collective bargaining
Managers must be able to see _________________ and employment legislation from four perspectives: 1. The organization 2. The worker 3. General historical/societal 4. Personal
A
Medicare Part ___: - Financed primarily through employee payroll deductions and employer contributions - Covers inpatient hospital care, limited skill nursing facility care, home health, and hospice care, although beneficiaries pay a deductible for each inpatient benefit period as well as coinsurance for hospital and skilled nursing facility stays
B
Medicare Part ____: - Financed largely from federal general funds - Is a supplementary medical insurance, which covers primary care provider services, outpatient diagnostics tests, certain medical supplies and equipment, and (since 1998) home health care (previously Part A) - Is optional for beneficiaries, although most elderly pay the premiums
A
Medication is a type of dispute resolution that uses a neutral 3rd party for fact finding: A.) True B.) False
Culturally diverse staff
Meeting the educational needs of a ____________________: - Respect cultural diversity - recognize its desirability - Recognize different perceptions of classroom and instruction learning
Before the negotiation
Mental preparation Know the other party's incentives Start high & know bottom line, & trade-offs Look for hidden agendas
Planning hierarchy
Mission Philosophy Goals Objectives Policies Procedures Rules A person should be able to identify exactly how the organization is implementing its philosophy by observing members of the nursing staff, reviewing the budgetary priorities, and talking to patients
Modular nursing
Modification of team and primary nursing Similar to team nursing, but uses a smaller team Pairs professional nurses with ancillary staff to deliver care to groups of patients Used frequently during the 1980s and 1990s
Ad hoc design
Modification of the bureaucratic structure Sometimes used temporarily to facilitate project completion within a formal line organization Overcomes the inflexibility of line structure Serves as a way for professionals to handle increasingly large amounts of information Uses a project team or task approach and is usually disbanded after a project is completed May result in decreased employee loyalty to the parent organization
A
Moral hazard refers to the propensity of insured patients to use more medical services than necessary: A.) True B.) False
Organizational communication
More channels More individuals More information Impact of technology The nurse-leader communicates with clients, colleagues, bosses and subordinates In addition, because nursing practice tends to be group oriented, interpersonal communication among team members is necessary for continuity and productivity One must have excellent interpersonal communication skills, then, to be an effective leader-manager. In fact, communication is perhaps the most critical leadership skill
Communication modes
More direct→ more clear Written Communication Face-to-Face Communication Telephone Communication Nonverbal Communication
Education
More formal and broader in scope than training. Whereas training has an immediate use, education is designed to develop individuals in a broader sense
Problem solving
Moving from undesirable to desirable state Analyze difficult situation Systematic process -> Root problem - Decision making as last step Always includes a decision-making step. - Many educators use the terms problem solving and decision making synonymously, but there is a small, yet important, difference between the two. Although decision making is the last step in the problem-solving process, it is possible for decision making to occur without the full analysis required in problem solving. Because problem solving attempts to identify the root problem in situations, much time and energy are spent on identifying the real problem
Accountability
Must be able to explain actions and results
Float staff
Must be able to perform the core competences of the unit they are floating to meet legal and moral obligations
Magnet hospitals
Must demonstrate the following: - A higher percentage of satisfied registered nurses - Lower RN turnover and vacancies - Greater nurse autonomy - Improved patient satisfaction Well-qualified nurse executives in a decentralized environment, with organizational structures that emphasize open, participatory management Autonomous, self-managing, self-governing climates that allow nurses to fully practice their clinical expertise, flexible staffing, adequate staffing ratios, and clinical career opportunities A professional practice culture in all aspects of nursing care Compliance with standards in the ANA's Scope and Standards for Nurse Administrators
Organizational staffing policies
Need policies that address: - Sick leave - Vacations - Holidays - Call offs for low census - On-call pay - Tardiness and absenteeism - Shift work The nurse manager should be involved in policies that are written to allow flexibility for the staff
Organizational politics
Negating the effects of _______________________: - Become an expert handler of information and communication. - Be a proactive decision maker. - Expand personal resources. - Develop political alliances and coalitions - Be sensitive to timing - Promote subordinate identification - View personal and unit goals in terms of the organization - Leave your ego home in a jar
Reentry guidelines
No psychoactive drug use will be tolerated Assigned day shift for first year Paired with a successfully recovering nurse, when possible Willing to consent to random urine screening with toxicology or alcohol screens Give evidence of continuing involvement with support groups such as AA and NA Encouraged to participate in a structured aftercare program Encouraged to seek individual counseling or therapy, as needed
Leaders
Non-delegated authority Varied role Informal organizational association Focus on group process Direct willing followers Overarching goals
UAP appropriate tasks
Noninvasive and nonsterile treatments Collecting, reporting and documenting data - Vitals, CBGs, I/Os Ambulation, positioning Transport within the facility Personal hygiene, elimination Feeding Socialization activities ADLs
Complex adaptive systems
Nonlinear relationships Unpredictable future behavior Situational differences Snowball or dominoes effect
Principal agent theory
Not all followers (agents) are inherently motivated to act in the best interest of the leader or employer (principal) Followers may have an informational (expertise or knowledge) advantage over the leader as well as their own preferences, which may deviate from the principal's (employer's) preferences Principals must identify and provide agents (followers) with appropriate incentives to act in the organization's best interest
Ethical decision-making
Not based on personal values Reason to clarify and explore your values Employ reflective thinking Know your individual and professional code of ethics Learn and hear and respect another's viewpoint - Whether you agree or not Three approaches - Deontological - Teleological - Situational
Fiscal planning
Not intuitive; a learned skill that improves with practice An important but often neglected dimension of planning Should reflect the philosophy, goals, and objectives of the organization A skill increasingly critical to nursing managers because of increased emphasis on finance and "big business" of health care
Management
Nurse Managers must be registered nurses. They have around-the-clock accountability for the RNs at the hospital, handle performance reviews, recruiting, and other managerial duties related to the nursing department
Express consent
Nurse witnesses patient signature after reasonable assurance that the patient understands procedure, risks and alternatives
Conflict response
Nurse-managers can no longer afford to respond to conflict traditionally (i.e., to avoid or suppress conflict), because this is nonproductive
Shared governance
Nurses at every level play a role in the decisions that affect nursing activity throughout the system. Nurse-managers move out of traditional industrial model roles into collegial models, becoming moderators of the service process. Usually defined by a structure of rules or bylaws
Self scheduling
Nurses construct their own schedule instead of the manager
Principles for social networking
Nurses must not transmit or place online individually identifiable patient information. Nurses must observe ethically prescribed professional patient — nurse boundaries. Nurses should understand that patients, colleagues, institutions, and employers may view postings. Nurses should take advantage of privacy settings and seek to separate personal and professional information online. Nurses should bring content that could harm a patient's privacy, rights, or welfare to the attention of appropriate authorities. Nurses should participate in developing institutional policies governing online conduct.
Nursing care hours
Nursing hours worked in 24 hours / Patient census
Nursing care hours per day
Nursing hours worked in 24 hours / Patient census
Middle level managers
Nursing supervisors Nursing directors Department heads Scope of responsibility - Integrating unit level day to day needs with organizational needs Primary planning focus - Combination of long and short range planning Communication flow - Upward and downward with great centrality
Responsibility
Obligation to accomplish work
Justice
Obligation to be fair to all people - Individuals have the right to be treated equally regardless of race, sex, marital status, medical diagnosis, economic level, social standing, religious beliefs or sexual orientation - Fair allocation of scarce resources
Adult learning
Obstacles to ___________________: - Institutional barriers - Time - Self-confidence - Situational obstacles - Family reaction - Special individual obstacles
Informed consent
Obtained only after the patient receives full disclosure of all pertinent information regarding the surgery or procedure and only if the patient understands the potential benefits and risks associated with doing so. Only obtained by MD
Resocialization
Occurs when individuals are forced to learn new values, skills, attitudes, and social rules as a result of changes in the type of work they do, in the scope of responsibility they hold, or in the work setting itself
Role overload
Occurs when the demands of the role are excessive
Closed unit staffing
Occurs when the staff members on a unit make a commitment to cover all absences and needed extra help themselves in return for not being pulled from the unit in times of low census
Groupthink
Occurs when there is too much conformity to group norms, often resulting in opinions and ideas that may lack merit
Internal whistleblowing
Occurs within an organization, reporting up the chain of command May involve use of compliance hot line
Affordable care act
Officially known as the Patient Protection and Affordable Care Act, this act passed in March 2010 to provide more Americans access to affordable health insurance
Coaching
One person helping another to achieve an optimal level of performance Tool for empowering subordinates, changing behavior, and developing a cohesive team Emphasis on assisting the employee to recognize greater options, to clarify statements, and to grow
A
Organizational Culture is a sum total of values, languages, traditions, formal and informal communication: A.) True B.) False
Proactive planning
Organizations and planners tent to use one of the four planning modes: - Reactive - Inactivism - Preactivism - Proactive A ___________________ style is always the goal
Role change
Organizations often fail to address socialization problems that occur in job, position, or status changes
Clinical judgement
Outcome/result/conclusion Decision regarding action Client needs
Powerlessness
Power is likely to bring more power in an ascending cycle, whereas ___________________ will only generate more ____________________
Quality assurance and quality improvement
Over the past three decades, the American health-care system has moved from a quality assurance (QA) model to one focused on quality improvement (QI). The difference between the two concepts is that QA models target currently existing quality; QI models target ongoing and continually improving quality Two models that emphasize the ongoing nature of QI include total quality management (TQM) and the Toyota Production System (TPS)
Threats
Part of SWOT External conditions that challenge or threaten the achievement of organizational objectives
Opportunities
Part of SWOT External conditions that promote achievement of organizational objectives
Weaknesses
Part of SWOT Those internal attributes that challenge an organization in achieving its objectives
Strengths
Part of SWOT Those internal attributes that help an organization to achieve its objectives
Problem solving
Part of decision making and is a systematic process that focuses on analyzing a difficult situation. Always includes a decision-making step. Many educators use the terms problem solving and decision making synonymously, but there is a small, yet important, difference between the two
Types of communication
Passive Aggressive Passive-Aggressive Assertive
Adult learning theory
Pedagogy vs. Andragogy Many managers attempt to teach adults with pedagogical learning strategies. This type of teaching is usually ineffective for mature learners because adults have special needs. Knowles (1970) developed the concept of andragogy, or adult learning, to separate adult learner strategies from pedagogy, or child learning. Knowles suggested that the point at which an individual achieves a self-concept of essential self-direction is the point at which he or she psychologically becomes an adult. Table 16.1 shows how pedagogical and andragogical learning environments typically differ. Adult learners then are mature, self-directed people who have learned a great deal from life experiences and are focused toward solving problems that exist in their immediate environments. This is because adult learners need to know why they need to learn something before they are willing to learn it. Adult learning theory has strongly influenced how adults are currently taught in staff development programs. Based on the individual's needs, a combination of approaches may be required. Display 16.3 identifies the implications of Knowles's work for trainers and educators
Human error
People gathering information are not infallible
Autonomy
People have a right: - To determine their own actions based on their values and beliefs - To self-determination, independence and freedom Involves HCP's willingness to respect the patient's right to make decisions about and for themselves even if HCP does not agree with those decisions Limitations: - If individuals ________ interferes with others' rights, health and wellbeing - HCP required to report child/elder abuse and neglect - Informed consent is related to _______ - _________ underlies 1st statement in ANA Code of Ethics for nursing
A
Performance budgeting methods utilize the following in budgeting: A.) Emphasize the outcomes and results B.) Incremental or flat percentage increments C.) Flex up and down depending on volume
Powerlessness
Perhaps it is ________________ that corrupts instead of power
Induction
Phase 1 of Employee Indoctrination All activities that educate the new employee about the organization and employment and personnel policies and procedures
Orientation
Phase 2 of Employee Indoctrination Activities specific to the position
Individual orientation to each department
Phase 3 of Employee Indoctrination Specific departments are responsible for developing their own orientation program
Mentoring process
Phases of the ____________________: 1.) Exploring whether to begin a mentoring relationship 2.) Negotiating a mentoring agreement, with a goal(s) and deadline(s) 3.) Implementing the agreement and periodically reviewing progress made 4.) Summarizing and formally concluding the mentoring relationship
Joint collaboration
Pioneer - Pioneer creative nurse staffing approaches Assess - Assess new technology Work - Work towards joint accountability to embrace best practices Agree on - Agree on shared principles => Safe nurse staffing leads to better patient satisfaction and outcomes => Interprofessional collaboration
Capital budgets
Plan for the purchase of buildings or major equipment. This includes equipment that has a long life (usually greater than 5 years), is not used daily, and is more expensive than operating supplies
Types of Change
Planned change Unplanned change
Proactive planning
Planning has a specific purpose and is one approach to developing strategy. In addition, planning represents specific activities that help achieve objectives; therefore, planning should be purposeful and proactive. Although there is always some crossover between types of planning within organizations, there is generally an orientation toward one of four planning modes: reactive planning, inactivism, preactivism, or proactive planning
A
Planning precedes all other management functions? A.) True B.) False
Policies
Plans reduced to statements
Rules
Plans that specifically define acceptable choices of action
CMS (Centers for Medicare and Medicaid Services)
Plays an active role in setting standards for and measuring quality in health care including pay for performance
Breakeven point
Point at which revenue covers costs. Most health-care facilities have high fixed costs. Because per-unit fixed costs in a noncapitated model decrease with volume, health-care facilities under this model need to maintain a high volume to decrease unit costs
Managing
Policies and procedures Counting value Power and control Have subordinates Managing people and work processes Work focused Authoritarian style Risk averse and stability Reactive Plans detail Maintain status quo Give directions
Critical pathways
Predetermined courses of progress that patients should make after admission for a specific diagnosis or after a specific surgery Strategy for assessing, implementing, and evaluating the cost-effectiveness of patient care Utilization review Provision of service no longer guarantees reimbursement. Clear and comprehensive documentation of the need for services and actual services provided is needed for reimbursement
Delegation
Primarily about entrusting your authority to others ANA: Assignment of activities and task performance R/T pt care to UAPs: Maintain - Transfer responsibility - Maintain accountability Empowering one person to act for another. (Susanne A. Quallich) Critical to managerial productivity and efficiency. NCSBN: Transfer authority to a competent individual Assignment vs Delegation
Relationship based nursing
Primary nurse assumes 24-hour responsibility for planning patient care from admission or start of treatment to discharge or treatment's end. During work hours, the primary nurse provides total direct care for that patient. When the primary nurse is off duty, associate nurses follow the care plan established by the primary nurse and provide care Brings nurse back to the bedside to provide clinical care Can succeed with a diverse skill mix or an all-RN staff Job satisfaction is high; however, this method is difficult to implement because of the degree of responsibility and autonomy required of the nurse Disadvantages lie primarily in improper implementation
Organizational planning
Principles of ____________________: - All plans must flow from other plans. Short-range plans must be congruent with long-range plans. - Planning in all areas of the organization must follow the mission, philosophy, and goals of the overall organization. - Planning involves the same process regardless of the period involved - The length of the plan is determined by what actions are necessary to make the plan successful. - All planning must include an evaluation step and requires periodic reevaluation and prioritization. - All people and organizational units affected by a plan should be included in the planning
Morals
Principles, habits with respect to right or wrong conduct, personal compass Origin individual-internal We believe right/wrong Usually consistent but can change individual's beliefs "Mos" means custom Morality transcends cultural norms
Critical thinking
Process "Reflective thinking" Purposeful, informed, outcomes focused thinking More complex/broader than decision making Related to evaluation and has a broader scope than decision making and problem solving. Dictionary.com (2018) defines critical thinking as "disciplined thinking that is clear, rational, open-minded, and informed by evidence". Also involves reflecting on the meaning of statements, examining the offered evidence and reasoning, and forming judgments about facts. Insight, intuition, empathy, and the willingness to take action are components of critical thinking. Whatever definition of _______________ is used, most agree that it is more complex than problem solving or decision making, involves higher order reasoning and evaluation, and has both cognitive and affective components. The authors believe that insight, intuition, empathy, and the willingness to take action are additional components of critical thinking. These same skills are necessary to some degree in decision making and problem solving.
Critical thinking
Process Broad inside and outside of clinical setting Sometimes referred to as reflective thinking, is related to evaluation and has a broader scope than decision making and problem solving
Clinical reasoning
Process Specific patient care issues When nurses integrate and apply different types of knowledge to weigh evidence, critically think about arguments, and reflect on the process used to arrive at a diagnosis Uses both knowledge and experience to make decisions at the point of care
Clinical reasoning
Process of evaluating evidence, generating and appraising alternatives in order to choose the best action Assessment/Interpretation of Patient Information Clinical experience Evidence-based nursing Critical evaluation of arguments for nursing actions Collaboration with patient/family Clinical knowledge
Moral disengagement
Process that involves justifying one's unethical actions by altering one's moral perception of those actions, defense mechanism and displacement of responsibility, a form of moral distress. Occurs in the health care industry poses serious threats to patient safety, the culture of the institution, and even the mental health of care providers.
Learning organization
Promotes a shared vision and collective learning in order to create positive and needed organizational change
Clinical practice guidelines
Provide diagnosis-based step-by-step interventions for providers to follow in an effort to promote quality care Also called standardized clinical guidelines Should reflect evidence-based practice (EBP); that is, they should be based on cutting-edge research and best practices
Bundled payments
Providers agree to accept a discounted payment either retrospectively or prospectively, which represents a coordinated plan of care for patients over the course of a single episode of an illness
Value based purchasing
Providers are held accountable for the quality and cost of the health-care services they provide by a system of rewards and consequences, conditional upon achieving prespecified performance measures
Interviewing
Purpose of the Interview • Interviewer obtains enough information to determine suitability • Applicants obtain information to make a decision about the job Requires to interviewer to use judgments, biases, and values to make decisions based on a short interaction with an applicant. Reliability and validity are always suspect.
Patient Protection and Affordable Care Act (PPACA)
Put in place comprehensive insurance reforms that were to be phased in over a 4-year period: o New Patient's Bill of Rights o Bundled payments o Accountable care organizations o Hospital value-based purchasing o The medical home o Health insurance marketplaces Value based purchasing
Educational Program
Sequence for developing an _____________________: 1.) Identify the desired knowledge or skills that the staff should have. 2.) Identify the present level of knowledge or skill. 3.) Determine the deficit of desired knowledge and skills. 4.) Identify the resources available to meet needs. 5.) Make maximum use of available resources. 6.) Evaluate and test outcomes after use of resources.
Servant leadership
Putting others as the number one priority Fostering a service inclination in others that promotes collaboration, teamwork, and collective activism Defining qualities: - The ability to listen on a deep level and to truly understand - The ability to keep an open mind and hear without judgment - The ability to deal with ambiguity, paradoxes, and complex issues - The belief that honestly sharing critical challenges with all parties and asking for their input is more important than personally providing solutions - Being clear on goals and good at pointing the direction toward goal achievement without giving orders - The ability to be a servant, helper, and teacher first and then a leader - Always thinking before reacting - Choosing words carefully so as not to damage those being led - The ability to use foresight and intuition - Seeing things whole and sensing relationships and connections
Delegating
Questions to ask when ______________: TASK: - Is the task appropriate - Legal CIRCUMSTANCE - Appropriate situation - Environment conducive - Available equipment & resources - Staffing rations PERSON - Delegatee willing and able - Delegatee has knowledge and experience - Delegatee has expertise to complete the task safely and efficiently DIRECTION/COMMUNICATION - Both use a common work related language - Delegator provide clear and concise directions for the task - Delegatee understand the assignment, directions, limitations and expected results - Both maintain open communication lines - Delegatee know how, what, & when SUPERVISION - Delegatee have appropriate supervision - Will Delegator provide feedback related to the task - Delegator able to monitor and evaluate the pt appropriately
NCSBN guidelines
RNs must provide clear communications to APs: - Expected timelines - Guidelines for consulting with RN - Guidelines for reporting back completion of delegated activities APs should be instructed to: - Repeat the directions - Confirm the understanding - Be encouraged to ask questions - Be encouraged to feel part of the healthcare team
Change strategies
Rational-emperical Normative-reeducative Power-coercive
Sources of power
Referent Legitimate Coercive Reward Expert Charismatic Informational
Chunking
Refers to presenting two independent items of information and grouping them together into one unit Although the mind can remember only a limited number of chunks of data, experienced nurses can include more data in those chunks than can novice nurses
Span of control
Refers to the number of people directly reporting to any one manager and determines the number of interactions expected of him or her Too many people reporting to a single manager delays decision making, whereas too few results in an inefficient, top-heavy organization Can be determined by the organizational chart
Moral hazard
Refers to the propensity of insured patients to use more medical services than necessary because their out of pocket cost is so small (insurance covers most of the cost)
Operating budget
Reflects expenses that flex up or down in a predetermined manner to reflect variation in volume of service provided
Responsibility
Related to job assignment and must be accompanied by enough authority to accomplish the assigned task
Recruitment; Retention
Relationship between ___________ and ____________: • Expensive to replace RNs—Typically replacement closer to $64,000 per RN; some as high as replacement cost in the 80 thousand range • Although some turnover is normal; excessive turnover results in increased costs for temporary replacements, traveling nurses and overtime • Experience takes years of development: loss of experienced nurses could lead to errors by more novice nurses • Leader -Manager recognizes the link and has the greatest impact in promoting a positive social climate and environment for retention • High levels of employee engagement and satisfaction benefit recruitment and retention
Medical home
Relies on a team of providers to integrate all aspects of health care through well-developed health information technology, including electronic health records
Flat organizational designs
Remove hierarchical layers by flattening the scalar chain and decentralizing the organization Continue to have line authority, but because the organizational structure is flattened, more authority and decision making can occur where the work is being carried out Despite being very flat, often retain many characteristics of a bureaucracy
Equal Pay Act of 1963
Requires that men and women performing equal work receive equal compensation Four equal pay tests exist—equal skill, equal effort, equal responsibility, and similar working conditions
Knowledge of results
Research has demonstrated that people learn faster when they are informed of their progress. The knowledge of results must be automatic, immediate, and meaningful to the task at hand. People need to experience a feeling of progress, and they need to know how they are doing when measured against expected outcomes
A
Resistance is an expected response to change: A.) True B.) False
After the negotiation
Restate agreements • Verbal • Written Recognize all parties involved in the negotiation
Clinical judgement
Result; The final decision Conclusion, decisions based on The process by which the nurse decides on data to be collected about a client, makes an interpretation of the data, arrives at a nursing diagnosis, and identifies appropriate nursing actions; this involves problem solving, decision making, and critical thinking
Destructive negotiation tactics
Ridicule Ambiguous or Inappropriate questioning Flattery Sadness Helplessness Aggressive take over/controlling
Five rights of delegation
Risk task Right circumstances Right person Right direction/Communication Right level of supervision
Planning hierarchy
Rules as a part of the _________________________: - Because rules are the least flexible type of planning, there should be as few rules as possible in the organization. - Existing rules, however, should be enforced to keep morale from breaking down and to promote organizational structure
International nurses
Unique socialization needs of ____________________: - Often experience cultural, professional and psychological dissonance - Communication problems - Anxiety, homesickness and isolation
Staffing
Sequential steps in __________: 1.) Determine the number and types of personnel needed => Fulfill the philosophy of organization => Meet fiscal responsibilities => Carry out the patient care delivery system 2.) Recruit, interview, select and assign personnel => Based on established job description performance standards 3.) Use organization resources for orientation and induction 4.) Assure adequate socialization or organizations values and unit norms 5.) Use create and flexible scheduling based on patient care needs - Increases productivity and retention
Six sigma approach
Sigma is a statistical measurement that reflects how well a product or process is performing. Higher sigma values indicate better performance. Historically, the health-care industry has been comfortable striving for three sigma processes in terms of health-care quality, instead of six
Non-verbal communication
Silence Space Environment Appearance Eye contact Posture Gestures Facial expression Timing Vocal expression
SWOT
Simple rules for _________ analysis: - Be realistic about the strengths and weaknesses of your organization. - Be clear about how the present organization differs from what might be possible in the future. - Be specific about what you want to accomplish - Always apply ______ in relation to your competitors - Keep ______ short and simple - Remember that _______ is subjective
SBAR
Situation Background Assessment Recommendation
Nursing's power base
Six driving forces to increase _____________________: 1.) The timing is right 2.) The size of the nursing profession 3.) Nursing's referent power 4.) Increasing knowledge base and education for nurses 5.) Nursing's unique perspective 6.) Desire of customers and providers for change
Delegation strategies
Skill and education level Plan ahead Empower the right personnel Common goals Deadlines Role model Evaluate Reward
Reward
Source of power Ability to grant favors
Referent
Source of power Association with others
Coercive
Source of power Fear
Expert
Source of power Knowledge and skill
Charismatic
Source of power Personal
Legitimate
Source of power Position
Informational
Source of power The need for information
Administrative agencies
Source of the law Given authority to act by the legislative bodies Create rules and regulations that enforce statutory laws State Boards of Nursing • Implement and enforce the State Nurse Practice Act • By writing Rules and Regulations • By conducting investigations and hearings to ensure the law's enforcement. Involvement with Nursing Practice: => Agencies which enforce the statues - LSBN
Court decisions
Source of the law Interpret legal issues that are in dispute Involvement with Nursing Practice: - Judicial or decisional law impact nursing => Includes malpractice cases
Statues
Source of the law Laws that govern _________ are official enacted and passed Example: Nurse Practice Acts Involvement with Nursing Practice: -Effect malpractice; Nurse practice act
A
Span of Control refers to the number of people directly reporting to one manager: A.) True B.) False
Stages of change model
Stage 1 - Pre-contemplation Stage 2 - Contemplation Stage 3 - Preparation Stage 4 - Action Stage 5 - Maintenance
Three phases of planned change
Stage 1 - Unfreezing Stage 2 - Movement Stage 3 - Refreezing
Pre contemplation
Stage 1 of Change Model No intention of changing Unaware of behavior or need for change, not planning to make a change
Unfreezing
Stage 1 of Planned Change Gather data Accurately diagnose the problem Determine need for change Makes others aware of need Examine status quo Increase driving forces for change Decrease resisting forces against
Contemplation
Stage 2 of Change Model Unfreezing Considers change but not committed Thinking about change Seeking out support and information
Movement
Stage 2 of Planned Change Develop plan Set goals & objectives ID support/resistance Include all who are affected Set target dates Develop appropriate strategies Implement the change Be available for support Strategize to overcome resistance Evaluate the change Modify if necessary Take action Make changes Involve people
Preparation
Stage 3 of Change Model Intends to change in near future Transition from unfreezing to movement begins Planning to make change Gathering confidence and resources
Refreezing
Stage 3 of Planned Change Support others so that change continues Make change permanent Establish new way of things Reward desired outcomes
Action
Stage 4 of Change Model Movement Actively modifies behavior Taking positive steps to make change and putting plans into practice
Maintenance
Stage 5 of Change Model Refreezing Works to maintain changes to prevent relapse Achieving results and behavior becomes part of daily life
Procedures
Step by step process
Strategic planning
Steps in ________________________: 1.) Clearly define the purpose of the organization 2.) Establish realistic goals and objectives 3.) Identify external constituencies and determine their assessment of the organization's purposes 4.) Clearly communicate the goals of the constituents 5.) Develop a sense of ownership of the plan 6.) Develop strategies to achieve the goals 7.) Ensure that the most effective use is made of resources 8.) Provide a base from which progress can be measured There is increasing recognition of the importance of subordinate input from all levels of the organization to give strategic plans meaning and to increase the likelihood of their successful implementation
Types of Interviews
Unstructured Semistructured Structured
Averting the union
Strategies for _______________: - Knowledge and care of employees - Personnel policies are fair and well communicated. - Well-trained managers - Procedures for handling employee grievances - Competitive wages/benefits - Job security is equal to job performance - The states with the most union organizing for all industries, including health care, are Hawaii, New York, California, Pennsylvania, Michigan, and Illinois - Under current legislation, nurses with less than 10% to 15% (equal to about one shift per pay period) of their time as charge nurse are considered staff nurses, whereas nurses working more than 15% of their professional time as charge nurses are considered supervisors and, therefore, ineligible for protection under the National Labor Relations Act (NLRA) - The issues around who can belong to a union, what the definition of "supervisor" is in nursing, and whether strikes and walkouts are ethically justified for nursing professionals add to the complexity of discussion about whether collective bargaining should be a part of professional nursing
Successful planning
Strategies for __________________: - Start planning at the top - Keep planning organized, clear and definite - Do not bypass levels of people - Have short- and long-range plans and goals - Know when to plan and when not to - Keep target dates realistic - Gather data appropriately - Be sure objectives are clear - Remember, interpersonal relationships are important
Evidence based practice
Strategies for promoting _______________________: - Develop and refine research-based policies and procedures. - Build consensus from the interdisciplinary team through development of protocols, decision trees, standards of care, institutional clinical practice guidelines, etc. - Make research findings accessible through libraries and computer resources. - Provide organization support, such as time to do research and educational assistance to teach staff to interpret research statistics and use findings. - Encourage cooperation among professionals. - When possible, hire nurse researchers or consultants to assist staff.
Self-discipline
Strategies to create an environment of _______________: - Clearly written and communicated rules and regulations - Atmosphere of mutual trust - Judicious use of formal authority - Employee identifies with organizational goals
SWOT
Strengths Weaknesses Opportunities Threats
Decentralized staffing
Strengths: - Manager retains greater control over unit staffing - Staff can take requests directly to their manager - Provides greater autonomy and flexibility for the individual staff member Limitations: - Can result in more special pleading and arbitrary treatment of employees - May not be cost-effective for organization because staffing needs are not viewed holistically - More time-consuming for the unit manager to oversee if sufficient coverage
Centralized staffing
Strengths: - Provides organization-wide view of staffing needs, which encourages optimal utilization of staffing resources - Staffing policies tend to be employed more consistently and impartially. - More cost-effective than decentralized staffing - Frees the middle-level manager to complete other management functions Limitations: - Provides less flexibility for the worker and may not account for a specific worker's desires or special needs - Managers may be less responsive to personnel budget control in scheduling and staffing matters
Limitations of the interview process
Subjectivity can never be totally eliminated High interview assessments do not necessarily correlate with high performance on the job Mixed reliability and validity - Interrater reliability low in unstructured interviews - Interrater reliability is better if the interview is structured and the same interview format is used by all interviewers Decisions are formed in the first few minutes of the interview
HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems)
Survey is the first national, standardized, publicly reported survey of patients' perspectives of hospital care. It measures recently discharged patients' perceptions of their hospital experience
Intuitive decision-making model
Takes intuition into account - Empirical evidence/evidence-based practice - Quick decisions Intuition involves - Pattern recognition - Experience There are theorists who suggest that intuition should always be used as an adjunct to empirical or rational decision-making models. Experienced (expert) nurses often report that gut-level feelings (intuition) encourage them to take appropriate strategic action that impacts patient outcomes, although intuition generally serves as an adjunct to decision making founded on a nurse's scientific knowledge base. Intuition then can and should be used in conjunction with evidence-based practice.
Five rights of delegation
Task that is delegable for a specific patient Appropriate pt setting and available resources Right delegator delegating right task to right delegate on right pt Clear concise task description Appropriate monitoring, evaluation, intervention as needed and feedback
Cannot
Tasks that ___________ be delegated: • Any task that would involve nursing judgment or sophisticated application of the nursing process (Assessment, Plan, Evaluation) • To LPNs: Initial Assessment of New Patients • LSBN: Chemotx, IV push, Blood transfusion • Evaluation success of a treatment • Writing Care Plans/ Establishing plans of care • To UAPs: Interpreting test results • To UAPs: Identifying client needs • Triage • Counseling and Teaching
D
Tasks that can be delegated are: A.) Ambulation and positioning B.) Collecting and documenting vital signs C.) Sterile dressing changes D.) A and B
D
Tasks that cannot be delegated are: A.) Nursing judgement of sophisticated application of the nursing process B.) Triage C.) IV push D.) All of the above
First level managers
Team leaders Charge nurses Primary care nurses Case managers Scope of responsibility - Focuses primarily on day to day needs at the unit level Primary planning focus - Short range, operational planning Communication flow - Most often upward; relies on middle level managers to transmit communication to top level managers
Scientific/Industrial age
Technical skills Command and control Competition Gaining advantage Gathering facts What you have (wealth) Hierarchy (top-down) Metaphor for organizations: machine (separate parts) Leadership: position
Plans
Why do _________ fail? - Sound strategies not used - Inadequate delegation of authority - Not recognizing organizational goals and needs - Planning too narrow in scope—not recognizing community, legal, and licensing requirements
Medicare and medicaid managed care
The Centers for Medicare & Medicaid Services is now the largest purchaser of managed care in the country. MCOs receive reimbursement for Medicare-eligible patients based on a formula established by the CMS, which looks at age, gender, geographic region, and the average cost per patient at a given age. Then, the government gives itself a 5% discount and gives the rest to the MCO
Labor and management
The Relationship between _____________________: - The roots of union activity lie in poor relationships between employees and management. - The middle manager has the greatest impact on the quality of the relationship that develops between labor and management - Union membership and activity increase during high employment and prosperity and decrease sharply during economic recessions and layoffs. - High demand for nurses correlates with increased union activity - Employees' perceptions of the quality of their supervision affects their unionization rates - Although unions historically focused heavily on wage negotiations, current issues that nurses deem just as or more important are nonmonetary, such as guidelines for staffing, float provisions, shared decision making, and scheduling
Power
The authority and ability to get things accomplished The capacity or potential to get others to do something one wants them to do that they would not ordinarily do otherwise
D
The best strategy for resolving conflict is: A.) Smoothing B.) Competing C.) Compromising D.) Collaborating
Behavioral sanctions
The bestowing of rewards and punishments Used to show employees what behavior is rewarded or eschewed in an organization Rarely carried out on a systematic and planned basis
Quality control process
The criterion or standard is determined Information is collected to determine whether the standard has been met Educational or corrective action is taken if the criterion has been met
Patient classification systems (PCS)
The critical indicator PCS uses broad indicators such as bathing, diet, intravenous fluids, medications, and positioning to categorize patient care activities. The summative task PCS requires the nurse to note the frequency of occurrence of specific activities, treatments, and procedures for each patient. At the national level, the use of a PCS is a condition for participation in Medicare and is required by The Joint Commission for certification. Not uncommon to have adequate staffing one day and inadequate the next day with the same number of patients/staff
Scalar chain
The decision-making hierarchy, or pyramid, is often referred to as a scalar chair It's the normal line of authority which moves from highest to lowest in a straight line This chain specifies the route through which the information is to be communicated to the desired location/person
C
The decision-making hierarchy, or pyramid, is often referred to as a: A.) Unity of command B.) Centrality C.) Scalar chain
Goal
The desired result toward which effort is directed
Quality gap
The difference in performance between top-performing health-care organizations and the national average is called the _________________ Although the ________________ is typically small in industries such as manufacturing, aviation, and banking, variation is more common in health care
A
The difference in performance between top-performing organizations and the national average is called the quality gap. A.) True B.) False
Span of memory
The effectiveness of staff development activities depends to some extent on the ability of the participants to retain information. Effective strategies include the chance for repeated rehearsal, grouping items to be learned (three or four items for oral presentations and four to six visually), having the material presented in a well-organized manner, and chunking
Formal organizational structure
The emphasis is on organizational positions and formal power Provides a framework for defining managerial authority, responsibility and accountability
Centrality
The extent to which an employee is integrated into the network of interpersonal relationships within the work system The middle manager often has centrality because he or she has a broader view of the organization and communicates in many directions
Informal organizational structure
The focus is on the employees, their relationships and the informal power that is inherent within those relationships Has its own leaders and communication channels (grapevine)
McGregor's hot stove rule
The following four elements must be present to make discipline as fair and growth-producing as possible: 1) Forewarning 2) Immediate consequences 3) Consistency 4) Impartiality
Nurse manager
The goal of the _____________ is to ensure there is adequate staff to meet the needs of each client
Transfer of learning
The goal of training is to transfer new learning to the work setting. For this to occur, there should first be as much similarity between the training context and the job as possible. Second, adequate practice is mandatory, and overlearning (learning repeated to the degree that it is difficult to forget) is recommended. Third, the training should include a variety of different situations so that the knowledge is generalized. Fourth, whenever possible, important features or steps in a process should be identified. Finally, the learner must understand the basic principles underlying the tasks and how a variety of situations will modify how the task is accomplished. Learning in the classroom will not be transferred without adequate practice in a simulated or real situation and without an adequate understanding of underlying principles
Data collection
The hospital must collect relevant data related to nursing, which must then be compared with that of other hospitals for benchmarking purposes This data must also be used to identify problems and the means for improvement
Span of control
The ideal _______________ in an organization is determined by factors such as the nature of the job, the manager's abilities, task complexity and the level it happens in the organization
Feedback process
The institution must develop a way for nurses to confidentially express concerns about the hospital's practices in a way that encourages them to do so
Conflict
The internal or external discord that occurs as a result of differences in ideas, values or beliefs of two or more people Is natural, neither positive nor negative - It can produce growth or destruction, depending on how it is manager Some level of ___________ in an organization appears desirable, although the optimum level for a specific person or unit at a given time is difficult to know
D
The leadership role in change involves: A.) Being visionary B.) Being a risk taker C.) Being an inventor D.) All of the above
Task learning
The learning of complex tasks is facilitated when tasks are broken into parts, beginning with the simplest and continuing to the most difficult. It is necessary, however, to combine part learning with whole learning. When learning motor skills, spaced practice is more effective than massed practice
Group norms
The manager should know what the _________________ are and should be observant of the sanctions used by the group to make newcomers conform. The manager should take appropriate intervention if group norms are not part of the organizational culture
Accountability
The moral responsibility that accompanies a position
Resistance
The natural and expected response to change Instability Mandated vs. Proactive Type - Technology vs. Social Obvious need Individual personality Mistrust
Span of control
The number of people directly reporting to that member represents the manager's _______________
Authority
The official power to act and direct the work of others
Case method nursing
The oldest mode of organizing patient care Nurses assume total responsibility for meeting the needs of all assigned patients during their time on duty. It is sometimes referred to as the case method of assignment because patients may be assigned as cases. It is still widely used in hospitals and home health agencies
Systems thinking
The organization encourages staff to see themselves as connected to the whole organization, and work activities are seen as having an impact beyond the individual. This creates a sense of community and builds a commitment on the part of individual workers not only to the organization but also to each other. Consequently, one of the main goals of the learning organization (LO) is to construct an organizational culture of learning
Collective bargaining
The process in which working people, through their unions, negotiate contracts with their employers to determine their terms of employment, including pay, benefits, hours, leave, job health and safety policies, ways to balance work and family, and more Preparation objectives choosing negotiation team anticipation of union demands => Timelines for negotiations set ground rules => Each party presents proposals => Proposals presented, discussed, new meetings take place Details settled, contract written and voted on by union membership
Outcome audits
The result of the care provided Determine what results, if any, occurred as a result of specific nursing interventions for patients Assumes the outcome accurately demonstrates the quality of care that was provided
Authority power gap
The right to command does not ensure that employees will follow orders. An ___________________ exists when someone in author issues orders and they are not followed. The negative effect of a wide ____________________ is that organizational chaos may develop
Authority power gap
The size of the ___________________ between a manager and an employee: - Widens as the manager expresses a personal interest in his or her employees - Can be decreased by the visible exercise of authority in decision making - Increases when the manager loses credibility with employees - Is influenced by how much status the manager has
Organizational culture
The values and behaviors that contribute to the unique social and psychological environment of an organization A sum total of values, language, traditions, formal and informal communication networks, and the rituals of an organization
Communication
The way a message is perceived can be influenced by the Internal and External Climate
Nurses unions
There is no single labor union that represents nurses across the nation. Unions such as Service Employees International Union represent nurses as well as many employee groups such as janitors and airport workers. Unions such as National Nurses United and state organizations like the California Nurses Association encourage nurses to join as they claim to be nurse-focused. Most of these unions are neither organized nor led by nurses. Nurses in a collective bargaining unit pay as much as $90 per month for union representation.
Marginal employees
These employees disrupt unit functioning because the quantity or quality of their work consistently meets only minimal standards These employees meet only minimal standards despite tremendous efforts to meet competencies
Team building
These roles help to clarify role expectations through the use of social interaction and educational processes. Each role has a different focus and uses different mechanisms
Staffing
Third phase of the Management Process Requires crucial management skills to predict staffing needs to avoid a staffing crisis The leader manager recruits or participates in recruiting, selecting, placing and indoctrinating personnel to accomplish the goals of the organization
C
This audit in Quality determines what results, if any, followed from specific nursing interventions for patients: A.) Structure B.) Process C.) Outcomes
Chunking
This occurs when two independent items of information are presented and then grouped together into one unit. Although the mind can remember only a limited number of chunks of data, experienced nurses can include more data in those chunks than can novice nurses. For example, experienced nurses are typically better able to recognize subtle changes in a patient's condition based on the assessments they have made or changes in lab values, whereas the novice nurse may take a bit longer to connect these pieces of information
Plans fail
Why do _______________?: - False assumptions - Not knowing overall goals - Not enough alternatives - Inadequate time or other resources - Low motivation levels
Readiness to learn
This refers to the maturational and experiential factors in the learner's background that influence learning and is not the same as motivation to learn. Maturation means that the learner has received the prerequisites for the next stage of learning. The prerequisites could be behaviors or prior learning. Experiential factors are skills previously acquired that are necessary for the next stage of learning
D
This theory supported the idea of hiring the ideal worker that would be the best fit with clear task division? A.) Great man theory B.) Situational and contingency theory C.) Management function theory D.) Scientific management theory
Stakeholders
Those entities in an organization's environment that play a role in the organization's health and performance or that are affected by the organization May be both internal and external Every organization should be viewed as being part of a greater community of ______________
Staff development
Three reasons for _______________: 1.) To establish competence 2.) To meet new learning needs 3.) To satisfy interests to staff may have in learning in specific areas
Empowerment
To enable, develop or allow Occurs when: - Leaders communicate their vision - Employees are given the opportunity to make the most of their talents - Learning, creativity and exploration are encouraged
Power
To increase the __________ of the Nursing Profession: 1.) Place more nurses in positions that influence public policy. 2.) Stop nurses from acting like victims. 3.) Increase the level of nurses' understanding regarding all health-care policy efforts. 4.) Build coalitions within and outside of nursing. 5.) Promote greater research to strengthen evidence-based practice. 6.) Support nursing leaders. 7.) Pay attention to mentoring future nurse-leaders and leadership succession
Power
To keep _____________: 1.) Maintain a small authority-power gap 2.) Empower subordinates whenever possible 3.) Use authority in such a manner that subordinates view what happens in the organization as necessary 4.) Use political strategies to maintain power and authority when necessary 5.) Although _______ is a universally available resource, it does not have a finite quality and can be lost as well as gained
Ethical decisions
To make appropriate _________________: - The manager must: => Use a professional approach => Eliminate trial and error - Focus on: => Decision making models or problem solving processes
Late stage chemical dependency
Tolerance is developed to the chemical and the individual needs the chemical in greater amounts and more often to achieve the same effect The individual characteristically exhibits high defensiveness Individual must continually use substance even though he/she generally no longer gains pleasure or gratification
Committees
Too many ___________ in an organization is a sign of a poorly designed organizational structure. To be productive _____________ should have: o An appropriate number of members o Prepared agendas o Clearly outlined tasks o Effective leadership
True
True or False? One way nurses can act as advocates is by directly intervening on behalf of others?
Veracity
Truth Not intentionally deceiving or misleading clients Feeling uncomfortable is not a good reason to avoid telling patients the truth Untruthfulness undermines trust
Outcome
Type of audit Determine what results, if any, followed from specific nursing interventions for patients
Process
Type of audit Measure the process of care or hot the care was carried out
Structure
Type of audit Monitor the structure or setting in which patient care occurs
Unplanned change
Type of change Change by drift Accidental change
Planned change
Type of change Well thought out
Assertive
Type of communication Reduces stress, improves productivity and contributed to a healthy workforce A way of communicating that allows people to express themselves in a direct, honest and appropriate way that doesn't infringe on another person's rights "I" vs. "You" statements No personal attacks Focus on issue Eye contact Establish trust Convey empathy
Constructive discipline
Type of discipline Carried out in a supportive, corrective manner Punishment is given because of an employee's actions and not because of who he or she is as a person
Self-discipline
Type of discipline The process by which rules are internalized and become part of the person's personality _____________ is possible only if employees know the rules and accept them as valid
Destructive discipline
Type of discipline Use of threats and fear to control behavior Arbitrarily administered and either unfair in the application of rules or in the resulting punishment
Structured interview
Type of interview Greater planning time because questions are developed in advance about the specific job requirements and the skills and qualifications. Information about the applicant's experience, willingness and motivation obtained. Format same with all applicants
Unstructured interview
Type of interview Little planning because the goals for hiring may be unclear. The interviewer does more talking than the applicant. This type continues to be the most common selection tool
Semistructured interview
Type of interview Some planning because the flow is focused and directed at major topic areas, but does allow some flexibility in approach
Managed care organizations
Types of ______________: Health maintenance organization (HMO) o Point of service (POS) o Exclusive provider organization (EPO) Preferred provider organization (PPO)
Profile of impaired nurse
Typically behavior changes are seen in the following three areas: • Personality/behavior changes • Job performance changes • Time and attendance changes
Delegation errors
Underdelegating Overdelegating Improper delegating
Overcoming interview limitations
Use a team approach Develop a structured interview format for each job classification - As a predictor of job performance and overall effectiveness, the structured interview is more reliable than the unstructured interview Use scenarios to determine decision making ability Conduct multiple interviews Provide training in effective interviewing techniques Plan, conduction and control the interview
During the negotiation
Use factual statements Discuss issues and not personalities. Be honest, assertive, pleasant Role model good communication use the 70/30 Rule Be patient - take a break Don't concede too early
Service line organizations
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
Balanced scorecard
Using a ______________________: - Analyzes data from four organizational perspectives: => Financial => Customers => Business processes => Learning and growth
Forecasting
Using available historical patterns to assist in planning Examining present clues and projected statistics to determine future needs
Interprofessional teams
Variety of decision-making styles/approaches ◦ Decisive ◦ Flexible ◦ Hierarchical Style/approach influenced by based on ◦ Amount of data - ◦ Type of data ◦ Decision to be made ◦ Number of options generated ◦ Group leader
Leading
Vision and strategy Creating value Influence and inspiration Have followers Leading people People focused Charismatic style Risk and change seekers - Go against the grain Proactive Sets direction Raising expectations Ask questions
Leadership roles
Visionary Risk taker Flexibility Inventor/Creator
Acuity index
Weighted statistical measurement that refers to severity of illness of patients for a given time. Patients are classified according to acuity of illness, usually in one of four categories. The acuity index is determined by taking a total of acuities and then dividing by the number of patients
Formal grievance
What a grievance could proceed to if differences cannot be resolved informally Progressive lodging of a formal complaint up the chain of command Proceeds to formal hearing if resolution is not reached Panel is selected to hear the grievance If not resolved, proceeds to arbitration
D
What are some critical thinking skills? A.) Reflective thinking B.) Forming judgements about the facts C.) Examining evidence D.) All of the above
A
What are some examples of Decision Making Tools? A.) Payoff tables B.) Decision trees C.) Google D.) Consequence tables
D
What are some frequent Legal Claims against Nurses? A.) Unattended patient falls B.) Misidentify patients for medications, surgeries, tests C.) Inadequate charting D.) All of the above
D
What are some of the reasons join a union? A.) Because the believe it will improve patient outcomes and quality of care B.) Increase input into organizational decision making C.) Elimination discrimination and favoritism D.) All of the above
A
What are some reasons do not join unions? A.) Fear of lost income associated with a strike or walkout B.) Because of social need to be accepted C.) Because they are required to do so by employer
B
What best defines fee for service? A.) An intermediary or third party pays the bill B.) Health care providers reimbursed after the services are delivered C.) A health care organization manages the care and pays
C
What best describes an authority power gap? A.) The authority and ability to get things done B.) A conditioned response to authority C.) Issuing orders that are not followed
D
What changes are seen in the impaired nurse? A.) Job performance B.) Behavior change C.) Time and attendance D.) All of the above
A, B, C
What components should the Emotional Intelligent leader display? (Select all that apply): A.) Self awareness B.) Motivation C.) Empathy D.) Self regard
B
What describes the total patient care or case method of nursing? A.) Care is assigned by task rather than by patient B.) Patients may be assigned as cases C.) Nurse provides total direct care for that patient
B
What is "Informed Consent"? A.) Nurse witnesses patient signature after reasonable assurance patient understands B.) Patient receives full disclosure of all pertinent information regarding treatment C.) In an emergency physician documents when patient is unable to sign
B
What is a matrix organizational structure? A.) A design used temporarily to facilitate project completion B.) An organizational design that is focused on product and function C.) A design sometimes called care-centered organizations D.) Removes hierarchical layers by flattening the scalar chain
B
What statement best describes constructive criticism? A.) Threats used to correct behavior B.) Corrective and supportive measures used to correct behavior
Delegation
What you need to know about _____________: - WHY to do it - WHEN to do it - WHO to delegate to - HOW to do it - WHAT to consider in delegation
Shared vision
When all the employees of the LO share a common vision, they are more willing to put their personal goals and needs aside and instead focus on teamwork and collaboration
Moral conflict
When the duties and obligations of healthcare providers or guiding ethical principles are unclear
A, C, D
Which distinguishing characteristics are associated with the Authentic Leader? (Select all that apply): A.) Value B.) Ability to be nice C.) Relationship D.) Self discipline
A
Which function of the Management Process consist of carrying out long and short range projections? A.) Planning B.) Directing C.) Organizing D.) Controlling
Reliability; Validity
___________ and ___________ issues of the Selection Process: - Validity increases with a team approach - Negative information tends to be weighed more heavily than positive information - The same standards should be used for all applicants - Selection should be based on established criteria, not value judgements - Personal bias should be minimized because negative feelings likely have no relation to the criteria necessary for success in the position
Managers
___________ hold people accountable for doing something
Substance misuse
______________ involves maladaptive patterns of psychoactive substance abuse, with the substance user continuing use in face of recurrent occupational, social, psychological or physical problems, and/or dangerous situations
Cost effectiveness
_______________ means producing good results for the amount of money spent. Expensive items can be cost-effective and inexpensive items may not. _____________________ then must take into account factors such as anticipated length of service, need for such a service, and availability of other alternatives
Strategic planning
___________________ as a Management Process includes: - The delineation of the agency's strategic goals and objectives, typically in a 3- to 5-year plan - The development of strategies to achieve the goals
Fiscal accountability
___________________ to the organization for staffing is not incompatible with ethical accountability to patients and staff. It should be possible to stay within a staffing budget and meet the needs of patients and staff. The most fiscally responsible method for determining staffing needs is an agreed upon staffing formula based on client acuity
Mental models
the set of assumptions and generalizations (or even pictures or images) that influence how we understand the world and how we take actions. The goal in the LO is to foster organizational development through diverse thinking. Assumptions held by individuals then are challenged because this releases individuals from traditional thinking and promotes the full potential of individuals to learn