Leadership Clinical Final Nutt

Stress interventions for nurses

& stressful situations in clinical SELF-CARE, saying NO, taking breaks, pursuing hobbies etc.

strategic planning & strategic planning objectives

(p.167) Clearly define the purpose of the organization, establish realistic goals and objectives, identify external constituencies and their assessment of the organization, clearly communicate the goals to the constituents, develop a sense of ownership of the plan, develop strategies to achieve the goals, ensure effective use of resources, provide a base from which progress can be measured o Strengths - internal attributes helping agency reach goals o Weaknesses - internal attribute challenging agency in reaching goals o Opportunities - external conditions that promote goal achievement O Threats - external conditions challenging goal achievement

LPN/RN/UAP role according to the Nurse Practice Act

***depends on state*** LPN: Roles/skills: chronic cases, routine and stable care, stale clients, routine procedures Education: LPN (licensed) RN: Roles/skills: specialty care, severe cases, sterile procedures, assessment, teaching (initial), evaluation, IV meds; ultimately in charge of assigned patients and their care; total assessments, care planning, totality of the nursing process (cannot delegate APE part of nursing process) Education: ASN; BSN (licensed) UAP: Roles/skills: routine procedures (blood draws, BP, baths, hygiene, feeding, ambulation, V/S), ADLs, tasks for which they are trained and competent on stable pts in uncomplicated circumstances Education: certified (not licensed)

Henri Fayol

**SEE PIC PAGE 44** Planning → Organization → Staffing → Directing → Controlling (Luther Gulick added Reporting and Budgeting) - phases of management process Planning → determining philosophy, goals, objectives, policies, procedures and rules; long/short projections, fiscal course of action, manage planned change Organization → est. structure to carry out plans, patient care delivery, group activities to meet goals, use power/authority correctly Staffing → recruit/interview/hire/orient staff, schedule, development socialization, team building Directing → entail human resource management, motivating, manage staff conflict, delegate, communicate, facilitate Controlling -> performance eval of staff, appraisal, fiscal accountability, quality control, legal/ethical/professional/collegial control

importance of acuity on patient classification system

- Deciding: based on acuity system and not on economics alone, knowledge and skills required for specific population should be true driver in determining patient care delivery model - The number of personnel (determined by acuity of pts) - Up to nurses to continually searching for ways to discover effective and safe staffing

Promotion

- can help move people into different directions Internal employee recruitment - can help to develop employees to fill higher positions as they become vacant; powerful motivation and recognition tool External employee recruitment - organization infused with new ideas, prevents stagnation, however usually more costly than internal Energy of managers!

Laissez-faire

- hands off approach, expect others to control selves Permissive, provides little or no direction Good with highly motivated people, creative thinking Less effective with novice ppl

Grapevine

- heart of informal structure (i.e. private conversations/break room/cars/social media), difficult to control, little accountability

Incentives

- organization needs to know the need of offering valued incentives that help each member perform better (spontaneous praise when deserved instead of r/t routine behavior)

Bureaucratic

- shared decisions, motivates / involves others (democratic) Decision making with others, constructive criticism Good for groups working together Less efficient when making quick decisions

Ad Hoc design

-professionals handle large amounts of info, uses team/task approach, disbanded after project complete

Service line organization

-used in large organizations to address shortcomings, product line organization (focus on group)

Review Learning Exercises & Notes/Discussions from first 3 tests & Post Conference 3/Clinical Final Prep Guidelines for a meeting according to Journal 3 Look at missed test questions Saunders review questions

14.5 p. 328-329, 17.8 p. 410, 17.9 p. 411, 19.9 p. 461, 19.4 p. 450, 20.3 p. 478, 20.9 p. 285, 21.3 p. 498, 21.10 p. 512 Guidelines for meeting according to Journal 3: - purpose, information dissemination, opinion seeking, problem solving - prepared an agenda and any related materials - ID the category of each agenda item; for information, for development, for implementation, for change in the system - Set the size at four-seven - Carefully select the team members (based on skill and expertise) - Distribute agenda well in advance - Start on time - Listen carefully; process the interactions - Control the flow of interactions - Keep the meeting directed toward accomplishing objectives

dosage calculation

6-7 questions

Ms. J. is a 63-year-old woman who is admitted directly to the medical unit after visiting her physician for shortness of breath and increase swelling in her ankles and calves. Her admitting diagnoses is rule out chronic renal failure (CRF). Ms. J. states that her symptoms have become worse over the past two to three months and that she uses the bathroom less often and urinates in smaller amounts. Her past medical history includes hypertension (30 years), coronary artery disease (18 years) and type 2 diabetes (14 years). Admissions Vital Signs: Temp 97.8 F BP 162/96 HR 88 RR 28 Pulse ox 91% on room air. Admission laboratory tests to be collected on the unit include serum electrolytes, renal function tests, complete blood count (CBC), and urinalysis. A 24-hour urine collection for creatinine clearance has also been ordered. 2. You are the team leader supervising an LPN/LVN. Which nursing care action for Ms. J. should you delegate to the LPN/LVN? A. Insert an intermittent catheter to assess for residual urine. B. Plan fluid restriction amounts to be given with meals. C. Check breath sounds for presence of increased crackles. D. Discuss renal replacement therapies with the patient.

A

Ms. J. is a 63-year-old woman who is admitted directly to the medical unit after visiting her physician for shortness of breath and increase swelling in her ankles and calves. Her admitting diagnoses is rule out chronic renal failure (CRF). Ms. J. states that her symptoms have become worse over the past two to three months and that she uses the bathroom less often and urinates in smaller amounts. Her past medical history includes hypertension (30 years), coronary artery disease (18 years) and type 2 diabetes (14 years). Admissions Vital Signs: Temp 97.8 F BP 162/96 HR 88 RR 28 Pulse ox 91% on room air. Admission laboratory tests to be collected on the unit include serum electrolytes, renal function tests, complete blood count (CBC), and urinalysis. A 24-hour urine collection for creatinine clearance has also been ordered. 5. Six months later, Ms. J. is readmitted to the unit. She has just returned from HD. Which nursing care action should you delegate to the nursing assistant? A. Obtain vital signs and post-dialysis weight. B. Assess HD access site for bruit and thrill. C. Check access site dressing for bleeding. D. Instruct patient to request assistance getting out of bed.

A

The following events are occurring at 6:30 p.m. on the surgical unit. As the charge nurse, consider what action is a priority and what actions can be delegated to others if they are available. A family member is at the desk complaining about care and demanding to see the nurse in charge. A physician is waiting in a patient's room for assistance in performing a difficult and complex dressing change. The unit secretary tells you that a patient has called and asked for his pain medication. The admitting department has called and stated that they have a patient ready to send to your unit for admission. You have not had time to take your dinner break, and the hospital cafeteria stops serving dinner in half an hour.

A family member is at the desk complaining about care and demanding to see the nurse in charge. Charge nurse A physician is waiting in a patient's room for assistance in performing a difficult and complex dressing change. RN The unit secretary tells you that a patient has called and asked for his pain medication. LPN or RN assigned to that pt (especially if opioid) The admitting department has called and stated that they have a patient ready to send to your unit for admission. Charge nurse (LPN must say she is not appropriate to receive info and needs to get RN) You have not had time to take your dinner break, and the hospital cafeteria stops serving dinner in half an hour. Secretary to receive meal for you

Basics of budget

A plan (not a rule) with numerical data to predict activities of organization over time Forecast future spending based on previous year's data

Best way to make assignments

Acuity of pts, client's needs, worker's needs, and abilities NCH/PPD Formula: (nursing hours worked in 24 hrs / per patient day/census) EXAMPLE: 11PM- 7AM (4 staff) = 32hrs 7AM- 3PM (7 staff) = 56hrs 3PM- 11PM (8 staff) = 64hrs 136 hours/25 patients = 5.44 NCH/PPD ^ tells how much staff is needed in 24 hr period it's used as a workload measurement tool to help with scheduling

12 hour shift in staffing

Advantages: continuity of care, less nurses taking care of one patient; decrease stress; costly due to overtime pay, increased satisfaction Disadvantages: we get tireddddd, increased judgement errors

8 hour shift in staffing

Advantages: less fatigue and sleep deprivation; safer patient care; cost-effective Disadvantages: requires more nurses, more shift changes

Verbal communication

Assertive - express themselves in direct honest and appropriate ways that do not infringe on another person's rights Aggressive - direct, threatening, condescending, inappropriate and infringes on another person's rights Passive - suffers in silence, although they feel strongly about the issue Passive / Indirect-Aggressive - limited verbal exchange with opposite nonverbal behaviors; underlying tone gives message without being explicitly stated

Communication

Assertive - express themselves in direct honest and appropriate ways that do not infringe on another person's rights Aggressive - direct, threatening, condescending, inappropriate and infringes on another person's rights Passive - suffers in silence, although they feel strongly about the issue Passive / Indirect-Aggressive - limited verbal exchange with opposite nonverbal behaviors; underlying tone gives message without being explicitly stated Technology - handle by giving to younger nurses (millennials)

Strategies to increase clear communication

Assess first Understand the organizational structure Identify stakeholders Seek feedback Clear, simple, precise Multiple methods of communication No TMI that would overwhelm ppl

Which leadership style am I? Janice Brown is in charge of the emergency department, working with a receptionist, an EMT and the ER physician Dr. Black. In the waiting room at 9:00 p.m. is a mother with a young child who is complaining of an earache, a teenager who cut his hand hitting a window, and just arriving is an older gentleman who is in obvious distress. His face is pale and his skin is clammy, but he dismisses his discomfort as indigestion. The EMT begins to take the bleeding teenager back to a treatment room. The mother of the young child protests that she was there first. The receptionist announces that it is time for her supper break and prepares to leave for the cafeteria. Because of her position as leader of the group and because of her greater knowledge of the possible ramifications of each patient's presenting symptoms, Nurse Brown takes charge of the situation. She instructs the EMT to take the older gentleman into the cardiac assessment room and instructs the receptionist to call Dr. Black first and then to call the cardiopulmonary technician and the laboratory technician. She gives the teenager a temporary dressing for his wound and tells him and the other waiting patients that someone will be with them as soon as possible. Then she prepares to start an IV, draw blood samples, and attach ECG leads on the older gentleman. Later, when all patients have been cared for, she thanks the staff members for their prompt response and shares with them the knowledge about some of the early indications of a myocardial infarction.

Authoritarian

Magnet organizations

Autonomous, professional, self-managing, adequate staffing, ANAs Scope and Standards for Nurse Administrators (Ex: St Vincent or Children's)

Clinical issue with consents (have to think about this one)

Autonomy, paternalism, duty, confidentiality, privacy, prevent bias (justice) Emergency situation does not require consent Otherwise must get consent from the patient, immediate family member, or two Dr's You are just the witness that they know RBAs Cannot be under the influence or coerced Every effort must be made to obtain permission from a responsible family member to perform surgery if the client is unable to sign the consent form. Telephone consent must be witnessed by 2 authorized individuals who hear the family member's oral consent. The 2 witnesses then sign the consent with the name of the family member, noting that an oral consent was obtained. Consent is not informed if it is obtained from a client who is confused, unconscious, mentally incompetent, or under sedation. In emergencies, the client may be unable to sign and family members may not be available. In this type of situation, the HCP is legally permitted to perform surgery without consent.

Ms. J. is a 63-year-old woman who is admitted directly to the medical unit after visiting her physician for shortness of breath and increase swelling in her ankles and calves. Her admitting diagnoses is rule out chronic renal failure (CRF). Ms. J. states that her symptoms have become worse over the past two to three months and that she uses the bathroom less often and urinates in smaller amounts. Her past medical history includes hypertension (30 years), coronary artery disease (18 years) and type 2 diabetes (14 years). Admissions Vital Signs: Temp 97.8 F BP 162/96 HR 88 RR 28 Pulse ox 91% on room air. Admission laboratory tests to be collected on the unit include serum electrolytes, renal function tests, complete blood count (CBC), and urinalysis. A 24-hour urine collection for creatinine clearance has also been ordered. 3. As team leader, you observe the nursing assistant (NA) perform all of these actions for Ms. J. For which action must you intervene? A. NA assists Ms. J to replace oxygen nasal cannula. B. NA checks Ms. J's vital signs after the patient drinks fluids. C. NA ambulates with Ms. J. the bathroom and back. D. NA washes Ms. J.'s back, legs, and feet with warm water.

B

Brans 12 habits to master time management

Be authentic Favor trusting relationships Maintain lifestyle of max energy Organize day by biorhythms Set a few priorities and stick to them Turn down things inconsistent with priorities Set aside time for focused effort Always look for ways of doing things better and faster Build solid processes Spot trouble ahead and solve problems Break goals into small units of work and only do one at a time → ON 1st Test! Finish what is important and stop doing what is not worthwhile Complete highest priority task 1st Complete one task before another Reprioritize based on new information received/gathered

Ms. J. is a 63-year-old woman who is admitted directly to the medical unit after visiting her physician for shortness of breath and increase swelling in her ankles and calves. Her admitting diagnoses is rule out chronic renal failure (CRF). Ms. J. states that her symptoms have become worse over the past two to three months and that she uses the bathroom less often and urinates in smaller amounts. Her past medical history includes hypertension (30 years), coronary artery disease (18 years) and type 2 diabetes (14 years). Admissions Vital Signs: Temp 97.8 F BP 162/96 HR 88 RR 28 Pulse ox 91% on room air. Admission laboratory tests to be collected on the unit include serum electrolytes, renal function tests, complete blood count (CBC), and urinalysis. A 24-hour urine collection for creatinine clearance has also been ordered. 1. Which task associated with a 24-hour urine collection, is appropriate to delegate to the nursing assistant? A. Instruct Ms. J. to collect all urine with each voiding. B. Explain the purpose of collecting urine for 24 hours. C. Ensure that the 24-hour urine is kept on ice. D. Review Ms. J's urine for color, odor, and sediment.

C

Ms. J. is a 63-year-old woman who is admitted directly to the medical unit after visiting her physician for shortness of breath and increase swelling in her ankles and calves. Her admitting diagnoses is rule out chronic renal failure (CRF). Ms. J. states that her symptoms have become worse over the past two to three months and that she uses the bathroom less often and urinates in smaller amounts. Her past medical history includes hypertension (30 years), coronary artery disease (18 years) and type 2 diabetes (14 years). Admissions Vital Signs: Temp 97.8 F BP 162/96 HR 88 RR 28 Pulse ox 91% on room air. Admission laboratory tests to be collected on the unit include serum electrolytes, renal function tests, complete blood count (CBC), and urinalysis. A 24-hour urine collection for creatinine clearance has also been ordered. 4. You are supervising a new orienting nurse providing care for Ms. J., who has had surgery to create a left forearm dialysis access. Which of the actions performed by the nurse requires that you intervene? A. The nurse monitors the patient's operative site dressing for evidence of bleeding. B. The nurse obtains blood pressure reading by placing the cuff on the right arm. C. The nurse draws post-operative laboratory studies from temporary dialysis access. D. The nurse administers oxycodone by mouth for moderate post-operative pain.

C

Nurse Manager/Director Role

Carry out daily operations but are still involved in some long-term planning and in establishing unit policies - focus on integrating unit-level day to day needs with organizational needs - combine of long and short range planning - upward and downward communication with great centrality Staffing, fall risk/patient satisfaction, trends, chart audit, supply/staffing budget, keeping track of all of the quality indicators

Centralized/decentralized

Centralized - top-down, managers make decisions (Used in organizations that want more direction, guidance, and coordination; helps minimize role conflict and clarify role expectations) Decentralized - decision making throughout organization, problem solved by lowest level (Large businesses, allow problems to be solved where they began)

Group think

Committees, structure, roles of chairperson and members, how to have the best committee -appropriate number of members (not too large), prepared agendas, clearly outlined tasks, effective leadership. SEE JOURNAL #3 GROUP GUIDELINES Watch out for group think (conformity, lack merit)

6 cultural phenomena considered with culturally diverse staff (David heiserengeiger?)

Communication Space Social organization (who is locus of control in the social group) Timing (past/present/future oriented) Environmental control Biological variations

Communication with caregiving team

Communication process - most critical leadership skills Internal climate Values Feelings Stress Person's nature External climate Weather conditions Temperature Timing Organizational climate Status Power Authority

Common conflict resolution strategies:

Compromise: goal is to find "middle ground". Each party gives up something they want. Competition: low relationship, high issue, goal is "win", one party pursues what it wants at the expense of the other. Cooperation/Accommodation: high relationship, low issue, goal is "yield", one party sacrifices his or her belief Smoothing: one party in the conflict attempts to pacify the other party and focus on agreement as opposed to differences. Avoidance: low relationship, low issue, goal is "delay", parties choose to ignore conflict Collaboration: high relationship, high issue, goal is "win/win", set aside original goals to establish common goals

Ethical issues related to patient rights and invasion of privacy

Confidentiality: Respecting the privacy of both parties and keeping details secret, keep privileged information private with pt, family, and direct care providers *protects self determination* EX. observing client without their consent Deontological: study and nature of duty and obligation o Rights based - ppl have basic rights that shouldn't be ignored o Duty Based - duty to do something or refrain from doing something o Intuitionist - case by case basis to determine relative goals/duties/rights Teleological: study and nature of describing things by their directed purpose o Utilitarian - greatest good for the greatest number of ppl

handling conflicts with a staff member

Conflict: internal and external discord that occurs as a result of differences in ideas, values, or beliefs of two or more people; conflict is natural, neither positive nor negative Created when there is a difference in economic and professional values and when there is competition among professionals Some level of conflict in an organization appears desirable, although the optimum level for a specific person or unit at a given time is difficult to determine Too little conflict → organizational stasis Too much conflict → reduced organizational effectiveness with eventual immobilization of employees

Additional nurse manager conflict resolution strategies

Confrontation - managers can encourage subordinates to handle their own problems by using face-to-face communication Third-party consultation - managers can be used as a third-party to help resolve problems constructively if both parties want to solve the problem.. Behavior change - only for serious cases of dysfunctional conflict, education, training can help develop self-awareness Responsibility charting - when there is an overlap of roles, clear definitions must be provided of each role Structure change - adding or removing personnel from the floor, or changing titles of different peoples roles

Organizational culture/climate

Culture - values/beliefs/social/psychological environment Climate - how individuals perceive organization (may be accurate or inaccurate)

Ms. J. is a 63-year-old woman who is admitted directly to the medical unit after visiting her physician for shortness of breath and increase swelling in her ankles and calves. Her admitting diagnoses is rule out chronic renal failure (CRF). Ms. J. states that her symptoms have become worse over the past two to three months and that she uses the bathroom less often and urinates in smaller amounts. Her past medical history includes hypertension (30 years), coronary artery disease (18 years) and type 2 diabetes (14 years). Admissions Vital Signs: Temp 97.8 F BP 162/96 HR 88 RR 28 Pulse ox 91% on room air. Admission laboratory tests to be collected on the unit include serum electrolytes, renal function tests, complete blood count (CBC), and urinalysis. A 24-hour urine collection for creatinine clearance has also been ordered. 6. Ms. J. is preparing for discharge. You are supervising the student nurse who is teaching the patient about her discharge medications. For which statement by the student nurse will you intervene? A. "Your Renagel prevents your body from absorbing phosphorus." B. "You should take your folic acid after dialysis on dialysis days." ? C. "The docusate is to prevent constipation that may be caused by ferrous sulfate." D. "You must take the Epogen three times weekly by mouth to treat anemia."

D (not by mouth, but should be SQ or IV)

Situations where you assign tasks or care to LPN and UAP & delegating to a float nurse...

Delegate sterile skills (e.g., dressing change) to the RN or LPN. (float nurse must demonstrate competence in that area if they work on that unit!) Where non-skilled care is required, delegate the stable client to the nursing assistant. Assign the most critical client to the RN. Clients who are being discharged should have final assessments done by the RN. The Licensed Practical Nurse (LPN) can monitor clients with IV therapy, insert urinary catheters, feeding tubes, and apply restraints. Assessment, teaching, medication administration, evaluation, unstable patients cannot be delegated to an unlicensed assistive personnel.

Which leadership style am I? John Smith is working with a newly graduated nurse, an experienced LPN, and a nursing assistant. Together they have the responsibility for medical patients in one wing of Hastings Hospital. Nurse Smith has confidence in his subordinates because he has worked with them for some time. He knows that they make keen observations and often bring him important information about their patients. He also knows that they function within their assigned roles and are careful not to exceed their authority. As they report for duty, Nurse Smith and his subordinates receive the report on their group of patients. Following the report, they meet to formulate a plan to deliver care. Nurse Smith requests their input, particularly on patients they might have cared for previously. LPN Jones indicates that one patient has to be watched particularly closely because of a tendency to climb over the bed rails. Nursing Assistant White suggests that another patient might be a particularly interesting assignment for the new graduate nurse, because the patient has a condition that is rarely seen at this hospital. The four coworkers design a plan for jointly caring for the assigned patients, with the team manager, Nurse Smith, providing information, encouragement, and direction as it is needed.

Democratic

Criteria for delegation to UAPs (general guidelines from North Carolina 2013); assigning tasks which are appropriate

Determine first what tasks can be given Tasks that frequently occur in daily care of group of clients Tasks performed according to standardized steps Tasks with little modification from pt to pt Tasks may be performed with predictable outcome Tasks do not inherently involve ongoing assessment, interpretation, or decision-making Tasks do not endanger the health or well-being of patients Tasks are allowed by agency

Identify Driving Forces and Restraining Forces (Change theory case study) Staffing on a nursing unit at Community Hospital needed to be changed from total patient care (in which an RN performs all nursing duties and tasks for a group of patients) to partners in practice (in which one RN and one nursing assistant care for a group of patients). This change was necessitated by the shortage of RNs in the area. RN positions could not be filled, and the unit was working with short staffing, overtime, and missed days off. By using an approach developed around the empirical-rational strategy, the manager educated the staff on the desirability of the change and how it would affect working conditions for the nurse. There would be the immediate alleviation of some things contributing to poor work satisfaction. With fewer RNs needed for each day, the current staff could fill the staffing needs. In addition, there might be increased efficiency, more time for the nurse to spend on professional patient activities such as teaching, and more staff at an equal or lower cost. The nurse's beliefs or feelings about the abilities of the nursing assistant or supervising others were not discussed. The RNs on the unit were very upset when presented with the completed plan and a date for implementation. They insisted that nursing assistants could never provide the quality of care expected on their unit. They vowed that they would quit before they would compromise their principles about nursing care.

Driving forces (promote change): shortage of RNs, improved work satisfaction, increased efficiency, a lot of open positions, morale is low and unsatisfied with work Restraining forces (impede change): RNs upset and perspective of nsg assistants not supportive, threaten to quit, equal or lower cost (less pay) *SATA on the test*

Intuition

Each case weighed on a case-by-case basis to determine relative goals, duties, and rights (deontological)

Goal and objectives of staffing

Fair and uniform staffing Scheduling policies must be written and communicated to all staff Need policies that address: sick leave, vacations, holidays, call-offs for low census, on-call pay, tardiness and absenteeism

Job satisfaction is influenced by

Focuses on outcomes that lead to higher motivation and job satisfaction, and those outcomes that can prevent dissatisfaction- motivators job satisfier present in work itself and give desire to do work well- hygiene: keep employees from being dissatisfied but not true motivators- must include the employee and give reward system (Hertzberg) employee's level of satisfaction in his or her company and the extent to which that loyalty - or lack thereof - is communicated to external customers- how happy or content employees are

Why leaders are born (what is the bases for some leaders are born to lead)

Great man theory: born to lead - most traditional thought process/bases behind leadership - Bases for some leaders are born to lead: impact of great men, or heroes; highly influential and unique individuals who, due to their natural attributes, such as superior intellect, heroic courage, or divine inspiration, have a decisive historical effect.

Utilitarianism

Greatest good for the greatest number of people (teleological)

servant leadership

Greenleaf's servant leadership focuses on putting others as the number one priority. Promotes collaboration, teamwork, and collective activism. · Characteristics of a servant leader: listens, keeps an open mind, deals with ambiguity and complex issues, being honest, making clear goals, is a servant/helper/teacher, thinks before acts, chooses words carefully, uses foresight and intuition, sees the big picture

Staffing by acuity

Groups patients according to specific characteristics (these are unique to each organization) Differing hours of nursing care assigned to each level of pt classification (ex: UAMS has "progressive" patients which almost always require hourly interventions). Critical indicators: bathing, diet, IV, meds, and positioning to classify Summative task: nurse must note the freq of occurence of activities, treatments, and procedures Used in medicare reimbursement Cancel agency PRN first (aka travel nurses), overtime, then cancel in house staff

How to improve effectiveness of change

INVOLVE others, focus on changing the behavior of ONE person, not a group, use a support network, it is easier to have technology changes instead of changing behaviors or "norms", trust is the biggest factor to resistance, change should be viewed as a challenge, not a threat (all from end of chap 8).

Categories of conflict

Intrapersonal - within self (internal conflict with self) Interpersonal - person to person (RN to RN) Intergroup - group to group (btw departments)

Intrinsic and extrinsic strategies to motivate

Intrinsic motivation - internal drive to do or be something Extrinsic motivation - motivation enhanced by environment or external rewards Strategies to Motivate Clear expectations for workers Fairness / consistency Encourage teamwork Know uniqueness of each employee, strengths and weaknesses Stretch employees periodically Reward desired / extraordinary "above and beyond" behavior Allow as much control as possible

Which leadership style am I? Nancy Stevens is one of four registered nurses who provide care to established patients on an inpatient psychiatric unit. The supervising nurse, recognizing the competence and accountability of the four RNs, allows them individually to structure and deliver care for the patients for whom they are responsible, as long as they adhere to general schedules for meals, group meetings, and medication administration. Each nurse develops a plan of care in conjunction with the individual patient and shares the patient's progress with other members of the staff at regularly scheduled case conference meetings at which the psychiatrist, the social services worker, and other professionals also present information.

Laissez-faire

Conflict process:

Latent - no conflict has actually occurred, can be prevented or reduced Perceived - sometimes conflict can be resolved before it's felt. Can be solved by open communication by pointing out a potential or actual problem exists Felt / Affective - when conflict is emotionalized.. Manifest - aka overt conflict, action is taken here. Action may be to withdraw, compete, debate or seek conflict resolution Aftermath - always exists, whether positive or negative. Depends on how conflict is managed.

RN considerations in delegating to UAPs:

Liability for negligence (RN is responsible for decision to delegate care) RN must assess pt prior to delegation and must be nearby for assistance at all times UAP cannot supervise another UAP or re-delegate the task to another UAP

Chief Nursing Officer (CNO) Role or Vice President for Patient Care Services Role

Look at the organization as a whole, coordinating internal and external influences, and generally making decisions with few guidelines or structures. Determining the organizational philosophy, setting policy, and creating goals and priorities for resource allocation. Greater need for leadership skills→ less skill for daily operation - look at organization as a whole as well as external influences - strategic planning - more often top-down but receives subordinate feedback both directly and via middle-level managers

Ethical issues (recognize examples)

Moral indifference - when someone Q's why morality in practice is necessary Moral uncertainty - when someone is not sure what the moral problem is or which moral principles or values apply Moral distress - when someone knows the right thing to do but organizational constraints make it hard to do what is right Ns sees another ns not wash hands and reports it to charge ns, who is friends with the ns, and charge ns does not take action regarding this issue Moral outrage - when someone witnesses someone else's immoral act but feels powerless to stop it Ethical dilemmas - being forced to choose bw two or more undesirable alternatives Steps to solving ethical dilemma: - gather all info relevant to the case - examine and determine one's own values on the issue - verbalize problem - consider possible courses of action - negotiate the outcomes - evaluate the action

Hertzberg

Motivators: achievement, recognition, work, responsibility, possibility for growth Hygiene factors: salary, job security, positive work conditions, interprof. Relationships He believed employees can be motivated by the work itself and that there is an internal need to meet organizational goals

Unit Educator Role

Nurse educators serve an important function within the hospital system. They promote professional role development and growth along the continuum from nursing novice to expert. The rapid pace of change in the healthcare sector creates knowledge gaps for all professionals. Nurse educators assist nursing staff in developing and maintaining their competencies, advancing their professional nursing practice and facilitating their achievement of academic and career goals. These professionals understand the challenges faced by nurses and how to convey critical and lifesaving knowledge to them. This is essential to a hospital's success. A nurse educator can help mitigate errors, streamline processes, shorten new hire ramp time (the time between when an employee is hired and when he/she starts to become productive at their new job), and identify opportunities to improve processes and mitigate risks to the patient, nurse, and hospital. Within the hospital setting, nurse educators serve as partners for practice transitions, learning facilitators, change agents, mentors, leaders, champions of scientific inquiry, and advocates for the specialty. Clinical nurse educators use multiple modalities to educate staff, such as simulations, online education, and traditional face-to-face education.

Strategies of successful delegation:

Plan ahead, ID necessary skill and education needed Select capable personnel Communicate goals clearly Empower Set deadlines & monitor progress Model/role model & provide guidance Evaluate performance Reward accomplishment

P&P

Policies are plans reduced to statements (ie. they are guidelines directing decision making) These are evidence based · Procedures are step by step processes (ie. skills) Evidence based · Rules are plans that specifically define acceptable choices of action (ie. no gray area)

pros & cons of traditional problem solving method and nursing process

Pros cons o Traditional decision making/problem solving o Identify the problem o Gather data to analyze the causes and consequences of the problem o Explore alternative solutions o Evaluate the alternatives o Select the appropriate solution o Implement the solution o Evaluate the results § PROS systematic, step by step § CONS no objective setting step, no set time

How to handle aggressive communication

Reflect and re-phrase the speaker's message, repeat the assertive message focusing on its objective and content; point out the implicit assumption by listening closely and letting the aggressor know you have heard them; put non-verbal cues into question "I noticed that ... when you ... I feel ... I want ... (define the outcome)"

Delegation to transcultural work team

Remember that dialect, volume, touch, and eye contact may be interpreted differently

LPN

Roles/skills: chronic cases, routine and stable care, stale clients, routine procedures Education: LPN how to determine if LPN or UAP competent: Watch them, have them validate skills to you

Charge nurse

Roles/skills: ensure nurses and staff members have completed jobs; patient care is completed Education: Bachelors or higher

Nurse manager

Roles/skills: ensure that all staff are present and patients are appropriately cared for Education: masters or higher

UAP ("nurse aides/assistants/techs")

Roles/skills: routine procedures (blood draws, BP, baths), ADLs Education: certified (not licensed) - no license to lose for "exceeding scope of practice" and nationally est. standards to state what the limits should be for UAP in terms of scope of practice do not exist (based on state board of nursing) - RN is liable for negligence, issues for task description (job description, knowledge base, demonstrated skills), responsible for pt outcomes

RN

Roles/skills: specialty care, severe cases, sterile procedures, assessment, teaching (initial), evaluation, IV meds; ultimately in charge of assigned patients and their care Education: ASN; BSN

Making Assignments: You are the charge nurse for an Oncology unit. Your current census is 10 patients with expected 3 admissions for inpatient chemotherapy. The current patients are listed below with an acuity system of 1-3. Make assignments based on information given to you by faculty (LPN or RN?).

Room 1 Breast cancer post-op day 1 mastectomy probable discharge with JP drain RN Room 2 Ovarian cancer older female with abdominal pain on IV narcotics Depends...RN Room 3 Colon cancer with brain mets confused and getting oob LPN or RN is better Room 4 Prostate cancer with urinary retention and bloody urine going for tests LPN Room 5 Colon cancer with inpatient chemotherapy continuous infusion RN Room 6 Breast cancer recurrence starting new investigational chemotherapy RN Room 7 Liver metastasis with N&V, NPO liver scan ordered LPN Room 8 Colon resection post-op day 2 still has NG tube to LIS, colostomy pouch RN Room 9 Cancer of larynx going to surgery for laryngectomy RN Room 10 Colon cancer post-op day 5, going home to start chemo in 6 weeks LPN but needs RN for teaching

SBAR communication/GRRR communication

SBAR: situation, background, assessment (state pt problem), recommendation GRRRR: greeting, respectful listening, review, recommend/request more info, reward

prioritizing and determining which patients to see first (you tube/cure)

See case study example from test 3 & example from study guide ABCs (someone just returning from surgery has all 3 problems), Change in LOC, Pain > 5/10, Safety, Sepsis (fever/elevated WBCs), ABGs, Lab values/heart/lung, diagnosis (acute before chronic)

Elements of nonverbal communication

Space (in personal territory) Environment (where communication takes place) Appearance, eye contact (emotional connection), posture, gestures, facial expressions Timing, vocal expressions (tone, volume, inflection)

SWOT

Strengths, weaknesses, opportunities, threats o Strengths - internal attributes helping agency reach goals o Weaknesses - internal attribute challenging agency in reaching goals o Opportunities - external conditions that promote goal achievement O Threats - external conditions challenging goal achievement

Review structures of organizations

Structure - Line Structure-- bureaucratic/staff organization, authority and responsibility clearly defined leading to efficiency and simple relationships; can lead to monotony, decr. upward communication, dotted line = staff position, solid line = line position · Ad Hoc design --professionals handle large amounts of info, uses team/task approach, disbanded after project complete · Matrix Structure -- product and function. Vertical and horizontal lines, fewer rules and fewer hierarchy, slow decisions · Service Line Organization --used in large organizations to address shortcomings, product line organization (focus groups) - Flat line organization-- remove hierarchal layers by flattening the chain of command and decentralizing the organization, more authority and decision making occur where it is being carried out · Centralized/Decentralized p 304 o Centralized - top-down, managers make decisions o Decentralized - decision making throughout organization, problem solved by lowest level (Large businesses allow problems to be solved where they began, the large the organization the greater the need to decentralize) · Grapevine - heart of informal structure (i.e. private conversations/break room/cars/social media), difficult to control, little accountability

5 "rights" of delegation ("The Computer Plays CDs")

Task Circumstance Person Communication/Direction Supervision

Never delegate the following (TEAACUP):

Teaching Evaluation Assessment Advanced Interventions Collaboration with HC team Unstable patient Planning care

House Supervisor Role

The house supervisor assumes leadership in the absence of the chief nursing officer. The role is one of authority and responsibility and entails arranging staffing schedules, directing patient care and making administrative decisions. As an RN house supervisor, your primary responsibilities are to handle patient care, lead nurses and other staff, complete clerical work, and make administrative decisions. Other duties include allocating patients and staff throughout the health care facility, maintaining the organization's mission and values, and assisting during emergencies. As the administrative resource for the nursing team, you may also provide clinical support to the nursing team as needed. There after hours from ns manager, staffing for whole hospital, day shift and night shift, get there before 5 pm when most other managers leave, go to all codes, think about who needs to transfer to ICU (bed consultant), call if you cannot get in touch with doctor to call the Chief Medical Officer

Change agent

The nurse acts as a change agent when assisting others to make modifications in their own behavior. Nurses also often functions to make changes in a system such as clinical care, if it is not helping a client return to health. A person skilled in the theory and implementation of planned change

Nursing process

Theoretical system for solving problems and making decisions. The greatest strength of the nursing process may be its multiple venues for feedback. When the decision point has been identified, initial decision making occurs and continues throughout the process via a feedback mechanism. Can be adapted as a model for solving leadership and management problems.

Roles

Travel What it is: nurse hired for 3-6 month window When to use: when scheduling relief is needed Agency What it is: agency nurse is someone who comes in and helps with PRN / as needed basis When to use: this is good to fill staffing shortages for the long term or during times of high census; not good for continuity of care and is expensive Float pool What it is: a higher rate of paid nurse but without benefits When to use: employee shortage Charge nurse Roles/skills: ensure nurses and staff members have completed jobs; patient care is completed Education: Bachelors or higher Nurse manager Roles/skills: ensure that all staff are present and patients are appropriately cared for Education: masters or higher

**Channels of communication:

Upward: from subordinate to superior Downward: from superior to subordinate (primarily directive) Horizontal: peer to peer Diagonal: between individuals of differing hierarchy levels/jobs/departments Grapevine: informal, small groups #haphazard

Communication modes

Verbal - telephone, face-to-face Non-verbal Written - email and memo

Nurse as pt advocate with abuse

We are mandated reporters and must report ASAP if suspected abuse Professional negligence or malpractice occurs if not advocating and reporting as required.

Clinical Issues for Nurses It's your turn to float to your sister unit. You have two diabetic patients and you give report to the PCT that you need BG before breakfast and lunch. The PCT informs you that the night shift tech did them the shift before and gives you the results. On your unit, the BG are done by the day shift PCT after 7am. What is the evidence for best practice related to BG, insulin and meals? How would you handle this situation immediately? What discussions should occur at the unit council level? What discussions should occur within the department and possibly across all nursing departments?

What is the evidence for best practice related to BG, insulin and meals? BG checks within 30 min of meals (1 hour max), Insulin given 15-30 minutes before the meal *include citation* (American Diabetes Association, 2018) How would you handle this situation immediately? Tell the UAP to get a new blood glucose or do it yourself and provide teaching on the reason why What discussions should occur at the unit council level? Hospital policy, education What discussions should occur within the department and possibly across all nursing departments? Make sure the policy is consistent across the organization, uniformity can help, overall aim to accomplish after identifying this issue is consistency across all departments, change and education, quality improvement measure: BG checks closer to meal time

Case managment: individual

What it is / setting: Collaborative process (promotes use of all personnel) that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual's health needs; use communication and resources to promote quality/cost-effective care, coordinated through the entire episode of illness; focuses on individual clients, not populations of clients; managers often manage care using critical pathways and multidisciplinary action plans (MAPS) to plan patient care; care MAP is a combination of a critical pathway and nursing care plan (indicates times when nursing interventions should occur); all healthcare providers follow care MAP to facilitate expected outcomes; if patients deviate from normal plan, a variance is indicate (utilization review) Advantages: nurses address each patient individually and work to identify the most cost-effective providers, treatments, and care settings possible; help access community resources, learn about medications, treatments, and tests (overall helps provide more holistic and effective healthcare for patient), episodic acute care or unit based/primary nursing and case manager is more of an overseer Disadvantages: some feel that the role of case manager should be reserved for the advanced practice nurse or RN with advanced training Case management represents an interdisciplinary health care delivery system that promotes appropriate use of hospital personnel and material resources to maximize hospital revenues while providing for optimal outcomes of client care.

Team

What it is / setting: ancillary personnel collaborates in providing care to a group of patients under the direction of a professional nurse; (functional nursing evolved into Team nursing); requires extensive team communication and regular team planning conferences Advantages: allows members to contribute their own special expertise or skills Disadvantages: requires extensive team communication and regular team planning conferences; improper implementation rather than the philosophy itself; not enough time to communicate or plan care can cause it to fail, poor line of responsibility and fragmented care, democratic leadership style Ex. An RN leads 2 licensed practical nurses (LPNs) and 3 UAPs in providing care to a group of 12 clients.

Functional

What it is / setting: evolved as a result of WWII; uses relatively unskilled workers who have been trained to complete certain tasks, care is task oriented; care is assigned by task rather than patient (i.e. giving techs vital signs to perform on patients; LPN give certain meds; RN doing assessments as manager of care); used in hospitals and nursing homes Advantages: tasks are completed quickly, with little confusion regarding responsibilities Disadvantages: priority problem left behind, fragmented care and possibility of overlooking patient priority needs, decreased job satisfaction because not challenged, cost effective/economically efficient

Modular

What it is / setting: modifications of team and primary nursing; similar to team nursing but uses a smaller team (care pair: ns and tech together = primary mode of delivery in med-surg! charge ns may take pts & validate LPN; Ex. Unity); pairs professional nurse with ancillary staff to deliver care to groups of patients; still used frequently for patients (ex: RN assigned room 10-15, Tech assigned room 5-15), based on units assigned by geographic location, same team members together Advantages: allows members to contribute their own special expertise or skills; more time for pt care, smaller team makes communication easier and helps with continuity of care, assign rooms based on geographic location Disadvantages: requires extensive team communication and regular team planning conferences; improper implementation rather than the philosophy itself

Total patient care

What it is / setting: oldest mode of organizing patient care (home health/hospice/critical care); nurses assume total responsibility for meeting the needs of all assigned patients during their time on duty; aka case method of assignment (patients are assigned as cases: Ex. simulation with team/modular behind it, tech in ICU setting); widely used in hospitals and home health agencies Advantages: High autonomy of nursing, increased responsibility for clear lines of delineation, simple and direct care, unfragmented holistic care; Not in my notes, but I would imagine more continuity of care and the nurses are able to see patients and whatever is going on with them because they aren't delegating so many things (can better assess and prioritize patient's priority needs) Disadvantages: delivery occurs when nurse is inadequately prepared or too inexperienced to provide total care for the patient (ns needs experience, not for new grads, this would be nurses who are not used to giving patients baths or are used to having techs help them with vital signs, new grads, COST MORE)

Primary nursing/relationship-based nursing

What it is/setting: uses some of the concepts of total patient care and brings the nurse back to the bedside to provide clinical care; can succeed with a diverse skill mix just as a team nursing or any other model can succeed with an all-RN staff; primarily designed to be used in hospitals but effective in home health, hospice, and other health-care delivery settings (nurses work M-F in 8 hour shifts) Advantages: continuity, acute/home/hospice, higher job satisfaction (once the nurse develops the skill in primary care nursing they feel challenged and rewarded by their work), ns stay with same pt (pieces of primary built into modulation) Disadvantages: difficult to implement because of the degree of responsibility and autonomy require of the nurse; when it is not properly implemented it is usually not effective (we don't have further examples based on her slides), 24 hour care and responsibility to communicate with Dr and associate takes when off shift

Disease management: population

What it is: Aka population-based healthcare and continuous healthcare improvement; Goal is to address such illnesses or conditions with maximum efficiency across treatment settings regardless of typical reimbursement pattern (the APN career was created for this but it has not really been implemented in this way). Advantage: Comprehensive, integrated approach to the care and reimbursement of high cost, chronic illnesses; increased focus on prevention; early detection, target population, multidisciplinary team, data & case management, decrease acute care admissions Disadvantage: I can't think of any except that initially it seems like it would be expensive

Float pool

What it is: a higher rate of paid nurse but without benefits When to use: employee shortage - must be able to perform the core competencies of the unit they are floating to meet their legal and moral obligations as caregivers - internal float pool, external float pool Ex. floating to ICU as a med-surg nurse Floating is an acceptable practice used by hospitals to solve understaffing problems. Legally, the nurse cannot refuse to float unless a union contract guarantees that nurses can work only in a specified area or the nurse can prove the lack of knowledge for the performance of assigned tasks. When encountering this situation, the nurse should set priorities and identify potential areas of harm to the client. That is why clarifying the client assignment with the team leader to ensure that it is a safe one is the best option

Agency

What it is: agency nurse is someone who comes in and helps with PRN / as needed basis When to use: this is good to fill staffing shortages for the long term or during times of high census; not good for continuity of care and is expensive to organization

Per diem

What it is: employed by the hospital, they have the flexibility to choose if and when they want to work; receive higher rate of pay for this flexibility When to use: employee shortage; but the more it is used tends to increase risk to patients due to lack of orientation to hospital or unit (with policies and procedures)

Travel

What it is: nurse hired for 3-6 month window When to use: when scheduling relief is needed; expensive to organization

Patient-Family-Centered Care

What it means: incorporating and basing all aspects of patient care on patient and family desires to better care for them (BEDSIDE REPORT, family can call rapid response, open door policy) Core concepts: Centering and organizing patient care around the needs of the patient Seeking out and honoring patient and family's choices Health-care providers communicate openly and honestly with patients and families → empower the patient and family Patients, families, and HCPs collaborate regarding facility design and the implementation care Voice of the patient and family are represented at both the organizational and policy levels as well as in the health system's strategic planning

Rights based reasoning

a natural rights ethical theory that places the primary emphasis on a person's individual rights that should not be ignored- individuals have basic inherent rights that should not be interfered with (deontological)

Nonmaleficence

active effort to avoid harm / injury to others

Beneficence

active effort to do good / promote well-being of others

leadership styles

autocratic, bureaucratic, laissez-faire

Organizational structure: Formal (positions and power) vs. Informal (relationships)

channels of communication on chart - Line -- communication between people with similar responsibility and power but different functions (solid line) Staff -- Advisory, no legitimate authority i.e. clinical specialist (dotted line)

Decision making

complex cognitive process of choosing a particular course of action; the thought process of selecting a logical choice from the available options.

Autocratic

controlling (authoritarian) · Strong control maintained, communication flows down · Good for productivity and critical, quick decisions · Autonomy reduced

Incremental/flat percentage

director multiplies current year expenditures by a certain number to determine budget for the next year (inefficient, no motivation to contain cost, no need to prioritize services) (ex. Harding's "Pre-bills" ((these are usually inaccurate)))

Fixed expenses vs. Variable expenses

do not vary with volume (manager salary or building's mortgage payment) cost of supplies d/t change in pt census, payroll of employees

Performance

emphasizes outcomes and end-results instead of activities or output (infection rates, patient satisfaction) (ex. High school budgeting for sports over arts)

Negotiation Closure and Follow-Up

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

Justice

fairness / equality

Flexible

fluctuates up and down over the year depending on volume (works well when major changes in census occur) (ex. On a poor college students income for prn work)

Duty based reasoning

focuses on performing one's duty to various people and institutions and whether to refrain from doing something- duty to do something or to refrain from doing something (deontological)

Negotiation

frequently resembles compromise when used as a conflict negotiation strategy; emphasis is on accommodating differences between the parties; each party must consider trade-offs and the bottom line to negotiate successfully; psychological and verbal; proper negotiator always looks calm and self-assured

Utility

good of many outweighs wants/needs of the individual

Maslow

hierarchy of needs (people are motivated to satisfy certain needs and only seek higher needs when lower needs have been mostly met)

job satisfaction is influenced by

intrinsic motivation: internal drive to do or be something extrinsic motivation: motivation enhanced by environment or external rewards Positive reinforcement is the most powerful motivator Related to the degree of control subordinates perceive they have over their work life

Fidelity

keeping promises / being faithful

Charge Nurse Role

liaison between staff nurses, other supervisors, and hospital administration. Same care responsibilities of their nurses they are leading. Responsible for staff & patient problem solving - focus primarily on day to day needs at unit level - short range operational planning - more often upward communication, relies on middle-level managers to transmit communication to top-level managers Creates assignments, admissions/discharge, double check assessment on LPN patients, report on all patients, in charge of huddle meeting (report on all pts, mandatory mtgs, P&P changes, track of admit/discharge, high risk fall pts, high risk pts to watch out for, certain tasks like cardiac drips)

Critical thinking

mental process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and evaluating information to reach an answer or conclusion.

Accountability

moral responsibility that accompanies position

Shared governance

nurses at every level play a role in decisions that affect nursing through the system. Rules or bylaws (Ex. Dress code) - increase nursing authority and control over their own nursing practice - accountability based governance system - empowerment of staff nurses is the goal

Veracity

obligation to tell truth

Victor Vroom

one's expectations / preferences about the environment or event influence behavior; if expectation of reward and it does not occur, less likely to repeat the behavior again

Skinner

operant conditioning / behavior modifications (rewarded behaviors repeated and disciplined or unrewarded behaviors will be extinguished)

Flattened organizational structure

p 298, increased spans of control, fewer administrative levels (saves money by utilizing electronic communication)

Problem solving

part of the decision making; systematic process focusing on analyzing a difficult situation.

Three types of budgets

personnel, operating, capital

Capital budget

plan for the purchase of buildings or major equipment, which includes equipment that has a long life (usually greater than 5-7 years), is not not used in daily operations, and is more expensive than operating supplies Composed of long-term planning or a major acquisitions component (Ex: future replacement and organizational expansion that will exceed 1 year - renovation of a major wing in the hospital) Short-term budgeting component (Ex. call-light systems, hospital beds, and medication carts)

Recognition

positive reinforcement

McClelland

ppl motivated by the following 3 basic needs: (3 L's = 3 basic needs) Achievement - transform ideas into action Affiliation - focus energies related to family and friends / social standing Power - gained as result of a specific action

Gellerman

ppl s/b periodically stretched to do more difficult tasks (seeing potential in ppl and encouraging them to stretch out to that)

Confidentiality

private information stays private

Matrix structure

product and function. Vertical and horizontal lines, fewer rules and fewer hierarchy, slow decisions

Responsibility

r/t job assignment must be accompanied by enough authority to accomplish task

Zero-based

rejustify / re-evaluate program's budget needs every cycle (just bc something was in budget before does not mean it is kept, need to balance back to zero)

Autonomy

self-determination freedom of choice for self

How to handle inappropriate technology use?

talk to the nursing supervisor To understand the limits of appropriate use of social media, it is important to have an understanding of confidentiality and privacy in the health care context. Confidentiality and privacy are related, but distinct concepts: Any patient information learned by the nurse during the course of treatment must be safeguarded by that nurse. Such information may only be disclosed to other members of the health care team for the purpose of providing care for the patient. Confidential information should be shared only with the patient's informed consent, when legally required or where failure to disclose the information could result in significant harm. Beyond these very limited exceptions, a nurse is obligated to safeguard confidential information. Nurses must promptly report any identified breach of confidentiality or privacy. Nurses must be aware of and comply with employer policies regarding use of employer-owned computers, cameras and other electronic devices, and use of personal devices in the workplace

Operating budget

the 2nd largest portion of the budget. It reflects expenses that change in response to the volume of service, such as the cost of electricity, repairs, and maintenance & supplies

Personnel budget

the largest of the budget expenditures, man-power cost (HC labor-intensive) based on patient census, to help calculate daily staffing need / cost

Authority

the official power to act and direct the work of others

McGregor

theory X and theory Y (how manager tx workers affects workplace productivity) X - avoid work if possible, need direction, have little ambition Y - like and enjoy work, self-motivated, do not wait for direction

Negotiation strategies

use factual statements; listen and keep an open mind; discuss issues and not personalities; be honest; start tough; delay when confronted with something totally unexpected; never tell the other party you are willing to negotiate totally; know the bottom line but try to use it; take breaks if either party becomes angry or tired

Handling issues in a strategic planning meeting

what is it, how to, purpose, mission, philosophy, goals, and characteristics (p.167) These are long term plans; they forecast the future success of an organization by matching its capabilities with its external opportunities These are often made by the top-level managers and board of directors, with input from all organizational levels Strategic planners analyze four perspectives: financial, customer, business processes, and learning and growth. Clearly define the purpose/mission of the organization, establish realistic goals and objectives, identify external constituencies and their assessment of the organization, clearly communicate the goals to the constituents, develop a sense of ownership of the plan, develop strategies to achieve the goals, ensure effective use of resources, provide a base from which progress can be measured, provide mechanism for informed change, build a consensus about where the organization is going Management: goals in 3-5 year plan, strategies to achieve these goals, request that committee members return to discussing items on the agenda

Paternalism

when someone assumes the right to make decisions for others

clarifying orders in clinical

write down what is said and then repeat back AFTER you write it down Telephone prescriptions involve an HCP stating a prescribed therapy over the telephone to the nurse. The nurse must clarify the prescription by repeating it clearly and precisely to the HCP. The nurse then writes the prescription on the HCP's prescription sheet.

Nurses as change agents; how to respond to change

§ The nurse acts as a change agent when assisting others to make modifications in their own behavior. Nurses also often functions to make changes in a system such as clinical care, if it is not helping a client return to health. § depends on two things: whether the change is mandated and if the change is proactive. Proactive change is less emotional than mandated. Resistance is expected and is part of change. Can disrupt homeostasis. Lewin's Change Theory: (1) Unfreezing: the change agent convinces members of the group to change or guilt, anxiety, or concern are elicited (2) Movement: the change agent identifies, plans, and implements appropriate strategies, ensuring that driving forces exceed restraining forces (3) Refreezing: the change agent assists in stabilizing the system change so that it becomes integrated into the status quo Change should only be implemented for good reason, Change should always be gradual, All change should be planned and not sporadic or sudden, All individuals who may be affected by the change should be involved in planning for the change Resistance depends on: Their flexibility to change, Their evaluation of the immediate situation, The anticipated consequences of the change, Their perceptions of what they have to lose and gain Improve effectiveness of change: INVOLVE others, focus on changing the behavior of ONE person, not a group, use a support network, it is easier to have technology changes instead of changing behaviors or "norms", trust is the biggest factor to resistance, change should be viewed as a challenge, not a threat (all from end of chap 8) whenever possible, all those who may be affected by a change should be involved in planning for that change when info and decision making are shared, subordinates feel that they have played a valuable role in the change Manager: mechanic who implements the planned change Leader: inventor or creator of the planned change

Budgeting

· Personnel: the largest of the budget expenditures, man-power cost (HC labor-intensive) based on patient census, to help calculate daily staffing need / cost · Operating: the 2nd largest portion of the budget. It reflects expenses that change in response to the volume of service, such as the cost of electricity, repairs, and maintenance & supplies · Capital: plan for the purchase of buildings or major equipment, which includes equipment that has a long life (usually greater than 5-7 years), is not used in daily operations, and is more expensive than operating supplies · Composed of long-term planning or a major acquisitions component (Ex: future replacement and organizational expansion that will exceed 1 year - renovation of a major wing in the hospital) Short-term budgeting component (Ex. call-light systems, hospital beds, and medication carts) o Fixed expenses - do not vary with volume (manager salary or building's mortgage payment) o Variable expenses - cost of supplies d/t change in pt census, payroll of employees