Leadership Exam 1
Delegation Process
Assess and plan COOUNICATE DIRECTIONS SUPERVISE EVALUATE
Screening
Conducted by Human Resources to eliminate persons who do not meet the basic requirements of the company.
Stress
Conducted either to see how you handle pressure; or, may be an untrained interviewer on a power trip. o Interviewer stares, lets long silences go by, fires questions, interrupts answers, uses sarcasm, etc.
Telephone
Designed to screen out less qualified applicants. o Initial screening can also be done by faxes and emails.
One-on-One
Most often used. ♣ Informal ♣ Structured ♣ Unstructured ♣ Sequential
Behavioral
Real-life situations o Describe how you would do things under certain circumstances or how you have done things in the past.
Roles and Functions of Change Agents and Followers
Roles may vary due to kind of change ○ Low-complexity (linear) vs. high-complexity (non-linear) ● Ultimate goal is a "unified" win-win change ● Followers must actively participate and stay flexible in thinking and tolerate ambiguity ● Both the change agent and follower must form a relationship of trust ● Must incorporate feedback to the change process - two-way feedback loop
∙ ANA Nursing Scope and Standards of Practice Standard 14
The RN assigns or delegates tasks based on the needs and condition of the patient, potential for harm, stability of the patient's condition, complexity of the task, predictability of the outcome, and abilities of the staff to whom the task is delegated.
Spiral
a moving in and out and up and down style ● The nurse has a rational, independent responsibility for shaping career. (Example: Nurse who returns after raising a family, a second degree nurse) ● Spiraling in and out of the profession
triple aim
coined by IHI. access to care, quality of care, and cost of care
● Civil Rights Acts, 1964
illegal for an employer to refuse to hire, discharge an individual because of race, color, religion, sex, national origin
● Otter-
influencing, people oriented
fidelity
keeping ones promise or commitment
• Transformational Theories
leader attends to the needs and motives of followers so that the interaction raises each to high levels of motivation and morality. Inspires followers through displayed optimism, intellectual stimulation, and encourages follower creativity ➢ Being a transformational leader ➢ Nurse leaders experiment with systems redesign, empower staff, create enthusiasm for practice, and promote scholarship of practice at the patient-side
• RNs cannot delegate to LPN/LVN or AP (assistive personnel)
o steps in the nursing process, o client education, or o tasks that require nursing judgment
Complexity Theory
replaces traditional centralized organizational hierarchy with a decentralized approach where decision making is widely distributed. Take risks, think broadly and from various perspectives, have a vision - a creative tension which inspires others to achieve a desired goal Components: 1. Develop networks • Social networking - use of technology to create relationships with common involvement; enhances communication, problem solving; provides support and resources for effective leading and managing 2. Bottom up encouraged; shared governance 3. Become a leadership "Tag" - philosophical, patient-centered, and values-driven characteristics; "hallmarks of culture" (Ex: Caring, Compassionate, Research driven) 4. Focus on emergence - think "outside the box" and unleashing constructive energy 5. Think systematically - big picture view; balance short and long term objectives; recognize dynamic, complex and interdependent nature of all systems
Civil Rights Acts 1991
sexual harassment in the workplace, prevention and correction
certification
special knowledge beyond basic licensure; an expectation in some settings for career advancement in advanced practice or in specialized area and goes beyond basic preparation
● Golden Retriever
steadiness, outgoing and people oriented, "let's keep things the way they are"
veracity
telling the truth and demands that the truth be told completely
informed consent
the authorization by the patients legal rep to do something to the patient age 18 competency involves the ability to understand consequences of actions or the ability to handle personal affairs patient was not coerced by fraud, duress, or deceit right to refuse nurse serves as witness, nurse has an obligation to inform HCP if patient does not understand procedure and if it hasn't been signed
autonomy
the right to choose what will happen to ones self as well as the accountability for making individual choices informed consent respect for others even if the nurse manager does not agree
Laggards
they have a hard time adopting but then you work with them and they come around to the idea * How to help them accept change: * Tell them the benefits of the change * Monitor outcomes and evaluating- show them the results!! Show them the reason why we are doing this
Rejecters
they just say no, they may quit, they may sabotage the change and make it difficult for the others Fear is the biggest problem
• Appropriate authority
what the individual is expected to be able to perform o Designated to RN by law
Family and Medical Leave Act of 1993
written to balance the demands of work with demands of family; allows job security for unpaid leave for men or women worked 12 months and worked atlas 1250 hrs take up to 12 weeks of unpaid leave; give employer 30 days notice
Management:
• Is an engaged process of guiding others through a set of evidence based practices and pre-determined policy/procedures to satisfy pre-established outcomes consistent with an organization's mission and purpose • Differs from leadership - actions required are less ambiguous, outcomes are known, sequence of specific actions are prescribed
Responsibilities of the Organization
• provide resources • documented competencies for all staff • delegation policies
Middle Career
"Momentum" (11 - 29 years) o The stage of providing expert nursing care ♣ Clinician ♣ Teaching as a nurse educator ♣ Management as an administrator ♣ Being visible within the nursing profession
Early Career
"Promise" (first 10 years) o 4 phases: ♣ Recruitment ♣ Selection ♣ Orientation ♣ Socialization
Lewin's Three Stages REFREEZE
(change is integrated and stabilized, "hard-wired") - changes are integrated; maintenance of the change once it has been started; reinforcement of new behavior by leaders; evaluation of degree of implementation and identification of needed alterations. ■ Ensures that the change becomes permanent ■ Resolidify changes. "We like this so let's do it and monitor and advise outcomes"
Resistant acceptance of assignment/delegation by a staff member. What is the issue?
- lacking knowledge, confidence - power struggle - workload - undesirable task - indifference - boredom
Examples of improper delegation that you may observe
- task does not match skill level - delegating nursing process (assessment, evaluation) - delegating expert knowledge, professional judgment - failure to provide clear instructions - failure to monitor, supervise
○ Texas NPA Whistleblower Protections for Nurses
1. Protects the nurse from employer retaliation - If the registered nurse believes in good faith that the actions of a regulated entity (registered nurse, licensed practitioner, health care facility or other licensed provider) could harm or produce risk of harm to a patient or other person, and reports those concerns to the employer or regulatory authorities, the nurse cannot be retaliated against. 2. Provides recourse if retaliation occurs ■ The nurse has the right to file a complaint with the state agency regulating the entity involved in the retaliation. ■ The nurse has the right to file a civil lawsuit for damages if: ● there was a report to the employer and/or state agency of professional regulation. ● the report stated alleged violation of a state or federal law, rule, or regulation. ● nurse gave written notification to employer and reasonable time to correct problem before reporting.
• Style Theories
1950s; focused on what leaders do in relation and contextual terms. Achievement of satisfactory performance measures requires supervisors to pursue effective relationships with subordinates; to understand "style" leaders need to obtain feedback from followers, superiors, peers. Employees centered leaders tend to be the leaders most able to achieve effective work environments and productivity.
• Situational-Contingency Theories
1960's and1970's; leadership effectiveness depends on the relationship among the leader's task at hand, his or her interpersonal skills, and the favorableness of the work situation ➢ Three factors are critical: • The degree of trust and respect between leaders and followers • The task structure denoting the clarity of goals and the complexity of problems faced. • The position power in terms of where the leader was able to reward followers and exert influence. • Consider the challenge of the situation and encourage an adaptive leadership style to complement the issue being faced. Nurses must assess each situation and determine appropriate action based on people involved
• OB Modification
2011; foundation for Organizational Behavior Modification (OB Mod); antecedent analysis of expectations, behavioral analysis, and consequence analysis ➢ Use of positive reinforcement to motivate followers to repeat constructive behaviors. Negative events that de-motivate staff are negatively reinforced and the staff is motivated to avoid certain situations that cause discomfort. Extinction is ignoring of negative behaviors. Punishment is used sparingly
What is a resume?
A detailed and customized document developed to highlight your accomplishments ● Tailored to describe the way in which you can fulfill a role or meet the needs of a specific organization ● The best choice for selling your abilities to a potential employer ● A personal summary of your professional history and qualifications ● It includes information about your career goals, education, work experience, activities, honors, and any special skills you might have. ● One to two pages are acceptable ● Avoid buzzwords, fads, and automated formats for resume building. ● Marketing tips using an Electronic Resume- an important key to getting an interview. ● Use action words. ● Developed, created, and initiated are words that convey a powerful message. ● Should be error-free and grammatically correct ● Presents an accurate and articulate portrayal of your accomplishments ● Font: Avoid fonts smaller than 10 point and larger than 12 point ● Print your resume with a laser or high quality ink-jet printer. ● Print the resume on high-quality paper, preferably 25% Cotton bond/Linen weave with a laser or high quality ink-jet printer (8 1/2" X 11" 20 - 24lb. paper) ● Send the resume as an attachment in Word format
Late Career
"Harvest" (30 years plus) o Nurses maintain productivity. o Nurses prepare for effective retirement.
Trait Theories
1900s to 1950's - "being born with leadership traits" ➢ Leaders have a certain set of physical and emotional traits that are crucial for inspiring others to reach a goal. ➢ Being self-aware of traits to be a leader
NCSBN
NCLEX
Whistleblower Laws
No employer can discharge, threaten or discriminate against an employee because the employee reported a violation of a law, rule, or regulation of state or federal law.
∙ ANA Code of Ethics, 2001, Provision 4
The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum patient care.
paternalism
allows one person to make partial decisions for anther and is most frequently deemed to be a negative or undesirable principle. can be used to assist a person to make decisions when they don't have sufficient data or expertise
Mentor
an experienced person who helps a less experienced person navigate into expertise.
Lewin's Three Stages MOVING
change agent's use of education, motivation and resources; integration of a new way of thinking or doing; incorporating what is new into work and interpersonal areas ■ Execute the intended change ■ May take multiple process changes depending on the amount of change to be made ■ Plan and implement changes
● Equal Employment Opportunity Laws
enacted to prohibit discrimination based on gender, age, race, religion, handicap, pregnancy, national origin; enforced by Equal Employment Opportunity Commission (EEOC) and by state laws
Employment Laws
ensure safety or rights of specific groups of people
Delegation Liability
failure to delegate within acceptable standards Obj. 3 • BON Rule 217.12 (D) defines Unprofessional Conduct to include delegating or assigning nursing functions or a prescribed health function when the delegation or assignment could reasonably be expected to result in unsafe or ineffective client care. • Improper delegation can increase your liability for malpractice, negligence
acts of omission
failure to do something that a reasonable and prudent nurse would do
Advanced Practice Registered Nurse (APRN)
more freedom to practice independently in several states. in tx they have more independence but still have to contract with a physician for oversight
Patient Protection and affordable care act
nurses must lead, manage, and collaboratively follow
• Supervise performance of task
o Monitor performance o Intervene if necessary o Ensure appropriate documentation
• Responsibility
obligation to accomplish work at acceptable level
Malpractice
referred to as professional negligence; failure to act in a reasonable and prudent manner.
o Assignment
refers to work each person is to accomplish in a designated work period - the downward and lateral transfer of both responsibility and accountability of an activity from one individual to another; even though the responsibility and accountability are transferred, the RN is still accountable to correctly assign (experience level, scope of practice, etc.) - therefore the accountability is shared.
• Accountability
responsibility to explain actions, inactions, results, outcomes
• ANA Code of Ethics (2015
serves as a guide for self-regulation within professional practice. inform the public of the minimum standards acceptable for conduct by members of discipline and assist the public understanding a disciplines professional responsibility outline the major ethical considerations a profession provide to its members guidelines for professional practice serve as a guide for the disciplines self regulation
management
the ability to plan, direct, control, and evaluate others in situations where the outcomes are known or prestablished, where one of more ways of performing have been agreed upon based upon evidence where feedback and communication is shared to improve clinical processes and outcomes
● Occupational Safety and Health Administration Act of 1970 (OSHA)
to ensure healthful and safe working conditions in the workplace ○ Isolation procedures, standard precautions (bodily fluids), proper grounding of electrical equip, protective storage of flammable and combustible liquids, gloving of all when handling bodily fluids ○ Guidelines addressing violence in the workplace -- greatest hidden health and safety threat in the workplace today ○ Failed to address safe patient handling at the federal level ■ Texas Safe Patient Handling Law - SB1525 ○ Ergonomics legislation - ensuring healthy and safe working conditions
Delegation
transfers responsibility but not accountability - only elements of the work are delegated (activities, basic skills, ADL's) ● The RN will still be accountable even if the task is delegated to a UAP.
justice
treating all persons equally and fairly
leadership
use of individual traits and abilities, in relationship with others, and the ability to interpret the environment where a situations emerging and enter the situation in the absence of a scripture defined plan that could have been projected
• Ethical Decision-making Framework
∙ Who should make the choice ∙ Possible options or courses of action ∙ Available options ∙ Consequences ∙ Rules, obligations, and values ∙ Desired goals or outcomes
● RN delegates to UAP
○ authority and responsibility are transferred; accountability is not
Managing Complex Change
● With change there must be several ingredients for success. Without these key ingredients, there will be: ○ Without vision there is confusion ○ Without skills there is anxiety ○ Without incentives there is gradual change ○ Without resources there is frustration ○ Without action/plan there is false starts ○ With everything we have CHANGE! :)
• Two-Factor Theory
➢ Hygiene factors, working conditions, salary, status, and security. Motivate workers by meeting safety and security needs and avoiding job dissatisfaction ➢ Doesn't necessarily create job satisfaction, must be in place for work to be accomplished. If not these factors will only serve to dissatisfy staff ➢ Needs to be there for work to be accomplished.
RESUME
Current contact information o Objective statement o Qualifications (3 - 4 statements) ● Main qualifications you believe that you have and that you must elaborate on ● Ex: teamwork ● Make them truthful, be able to talk about them and have experiences to back them up ● Use assertive speech instead of passive speech ● Ex: Effective communicator instead of "good communicator" o Education (include only college/university degrees earned; include UT Tyler - we assume you will be graduating this semester) Do not include high-school, this is assumed. ● Only include your GPA if requested by a specific agency o Work experience ● most recent work first (reverse chronological); only 3 - 4 bullets per work experience; be brief, concise o Clinical experience ● refer to the example template on Bb o Certifications/Honors ● include dates o Organizations, Memberships, Community Service ● include dates o Special skills ● bilingual, exceptional computer/technology use, etc.
Critical Elements of an Interview
Go prepared with questions. ● Practice answering what you know they will ask. ● Select words carefully when you are emotional about an issue. ● Be mindful of your non-verbal communication. ● Evaluate the messages the interviewer is sending. ● Salary should not be discussed until the end of the interviewing process when the offer of a position has been made. ● Stay calm, be yourself...smile. ● BEHAVIORAL BASED QUESTION! "Tell me more about yourself"
Stage 1 Novice
Has a body of knowledge but little application (experience) to situations o The focus is on completing tasks o "Chases a problem" instead of being ahead of a problem o Do without the understanding of the broader picture or knowing why Ex: A post-op patient who had a cervical laminectomy states that his pills "seem stuck in his throat". The nurse crushes the tablets and does not view this change as a problem.
LVN
Independent practice not permitted; under supervision of RN, APN, PA, MD, DDS, or podiatrist Cares for clients with predictable healthcare needs Performs focused nursing assessments Participates in planning of care Implements teaching plan Assists in evaluating clients' responses and outcomes Utilizes a problem solving approach Assumes accountability and responsibility for care provided Assigns specific tasks and maintains supervision of licensed and unlicensed personnel
• Expectancy Theory
Individuals' perceived needs influence their behavior. Motivated behavior is increased if a person perceives a positive relationship between effort and performance. Motivated behavior is further increased if a positive relationship exists between good performance and outcome or rewards ➢ In this theory, leaders need to provide specific feedback about positive performance
● Lion
Leader, task oriented, directive and outgoing
Professional Letters
Letters to market yourself during your career ● Include your name, address, phone numbers, fax number, e-mail address, and website address, if you have one, as they appear on your resume. ● Should be in a business format ● No longer than one page ● Use quality-bond paper. ● Proof all letters for layout, typographic errors, spelling, and content. ● Each of these letters usually contains three key paragraphs. ● The closing follows the text of the letter. · Followed by your name · Usual spacing between the closing and your name is four lines. o Include your full name with credentials and degrees. o Sign your name as it is typed using black or blue ink.
Invoking Safe Harbor
May accept assignment o May refuse assignment ● Unprofessional or criminal conduct ● Beyond scope of practice ● Requires collaboration o Invoking Safe Harbor should be last step after all negotiations have failed o Process of peer review (BON not involved) o Provides protection from employer retaliation and potential action against your nursing license for nurses who have been asked to engage in conduct, which the nurse, in good faith, believes, would violate the nurse's duty to a patient. ● Does not provide protection from civil/criminal liability o Invoke before accepting assignment o Must be in writing
● Beaver
Orderly, list maker's, task oriented
RN
Permitted to engage in independent practice within scope of licensure Cares for all clients through interpretation of health data in collaboration with the health team Performs comprehensive nursing assessments Formulates nursing care plan based on Nursing Diagnoses Develops and implements teaching plan Evaluates clients' responses and outcomes Utilizes a critical thinking approach to decision making Assumes accountability and responsibility for care provided Makes assignments to licensed staff (LVNs, RNs) and delegates to unlicensed staff in compliance with current BON rules
Stage 3 Competent
Reached by nurse who has been in similar job for 2-3 years o Sees actions in terms of long-range goals for the patient o Has increased efficiency and organization o Analyzes situations, can determine what is important o Nurse devises new rules and reasoning procedures for a plan while applying learned rules for action on the basis of the relevant facts of that situation. Ex: The neonatal nurse explains to a mother the feeding progression that her infant will most likely follow in the coming weeks
Stage 4 Proficient
Reached by nurse who has been in similar job for 3-5 years o Perceives situations in terms of overall picture (situational judgment); sees the "whole" person; holistic decision making o Accurate perception of the problem o Performance is guided by maxims (rules, guidelines, principles or instructions) derived from nuances observed o Able to see the big picture (past, present, future.) Ex: A nurse states, "With this complex leg fracture injury, I would be looking for compartment syndrome as a possible complication."
Change Agent Strategies
Strategies to facilitate both linear and nonlinear change processes ● Communication and education through learning ○ Leadership rounding ○ Active empathetic listening 1. Clarity 2. Engagement 3. Resources 4. Alignment 5. Leadership 6. Communication 7. Tracking
Group/Panel
You may meet with more than one person at a time. o May be talking to staff nurses, and managers together
Entrepreneurial and Transient
a style fostering creative solutions to traditional problems "Creative Bent" ● The nurse that desires to create new services; meets own priorities. (Example: Nurses in private practice; temporary assignments) ● Move around the globe, (travel nursing), creating their own business
Steady state
a traditional career style "Positional Plateau" ● The nurse remains at a positional plateau and becomes increasingly competent. (Example: staff nurse) or Bedside nurse for 25 years on the same unit
Linear
a traditional career style "Vertical Movement" ● The nurse moves up the hierarchy of the organization and becomes more diversified. (Example: staff nurse → Nursing service administrator) ● Upward progressive motion
Leadership
ability to elicit a vision from people and to inspire and empower those people to do what it takes to bring the vision to reality
respect for others
acknowledges the right of individuals to make decisions and to live by the decisions
acts of commission
acting in a way that causes injury to the patient
beneficence
actions one takes should promote good; basic obligation to assist others
● Health Care and Education Reconciliation Act (2010
amended Patient Protection & Affordable Care Act to clarify budget resolutions
Preceptor
an experienced clinician who assists in developing the bedside nurse with day to day operations of patient care
Ethics
are internal to an individual • The ultimate good of an individual; rather than society as a whole
● Negligence
conduct lacking in care; carelessness; deviation from care (typically from non-professionals)
Delegation Process Assess the delagatee
delegatee must be qualified to perform the task; i.e. has the ability (knowledge and skills) and authority Ask these questions before delegating a task: • Have you been trained to do this task? • Have you ever performed this task with a patient? • Can you do this task without supervision? • Do you feel competent to do it correctly? • Have you ever had any problems doing this task? ∙ Is the delegatee willing to accept the task, accept the responsibility. If resistant, why? • Lack of knowledge • Lack of confidence • Bored • Unpleasant task • Power struggle • Work overload • Inadequate incentives
followership
each member contributes optimally, but acquiesces to a peer who is leading or managing in a setting where the team has gathered to ensure the best clinical decision making and actions are taken to achieve clinical or organizational outcomes
● Genetic Information Nondiscrimination Act of 2008
first federal law offering protection from genetic discrimination by health insurers and employers
Nurse Practice acts
for nurses most important piece of legislation for nursing because it affects all facets of nursing practice; define the scope of acceptable practice the act is the law within the state or US territory and state BON cannot grant exceptions, waive the act's provisions, or expand practice outside the acts specific provisions define 3 categories of nursing LVN, RN, APN set educational and examination requirements provide for licensing for individauls who have met requirements, and define the function of each category ● Who can change the NPA? Legislators
Delegation
getting work done (tasks) through others; achieving performance of care outcomes for which you are accountable and responsible by sharing activities with other individuals who have the authority to accomplish work.
• Hierarchy of Needs
motivated by hierarchy of human needs: physiologica need > safety, social, esteem, and self-actualization. Lower level needs drive before higher level needs will be addressed. ➢ When this theory is applied, leaders must be aware that the need for safety and security will override the opportunity to be creative and inventive.
Types of Liability •Corporate
newer trend in law whereby the institution is held responsible/accountable to ensure quality/safe healthcare delivery for consumers o Corporate failures: ● Lack of competent staff ● Failure to supervise and monitor ● Outdated policies and procedures ● Failure to maintain safety ● Negligent hiring and firing ● Negligent credentialing ● Ineffective quality/risk management processes
NAP
nursing assistive personnel (unlicensed personnel) who are trained to function in an assistive role to the licensed RN in providing patient care activities as delegated by the RN (ANA, 2005); NCLEX uses term AP (assistive personnel); or UAP (unlicensed assistive personnel)
Types of Liability •Personal
o Defines each person's responsibility and accountability for individual actions or omissions. o You are accountable for your actions!
Types of Liability Vicarious
o Makes employers accountable for the negligence of their employees. o Indemnification - countersuing the nurse for damages paid to an injured patient o Agency and manager accountability
• Evaluate
o Obtain feedback o Provide specific, honest, constructive feedback o Empower staff
Stage 5 Expert
o Reached by nurse who has been in similar job for many years with enormous background of experience o Highly proficient and competent o Has intuitive grasp of the whole situation o Analytic problem solving when unsure o "Thinks in the future" Ex: A psychiatric nurse clinician with 15 years' experience states, "When I say to a doctor, the patient is psychotic, I don't always know how to legitimize that statement. But I am never wrong. Because I know psychosis from inside out. And I trust it."
• Five Rights of Delegation
o Right task o Right circumstances o Right person o Right communication o Right supervision/evaluation
Stage 2 Advanced Beginner
o Still difficult to sort out what is most important (salient); needs support in setting priorities o Perceives recurrent meaningful patterns, operates on general guidelines o Demonstrates a "stimulus-response mode" Ex: During the assessment of a postpartum mother, the nurse notes the fundus is deviated from midline and assists the mother to the bathroom to void.
• Communicate directions
o Strategies (Table 26-2, p. 495) ∙ "Tell and sell" strategy - explain what to do and how to do it ∙ "Participate" strategy - assess if guidance is needed ∙ "Delegate" strategy - minimal direction needed o Follow through with agency protocols, policy, procedure, established standards of practice o Provide clear, concise, correct, and complete instructions, directions, expectations, time line for completing task o Set reporting parameters - what to report, when, how often o Establish routines
nonmaleficence
one should do no harm
For an interview
prefer Everyday Business attire/dress and accessories DO NOT wear jeans, wild prints, or overdressed evening wear
● Lewin's Three Stages ○ Unfreezing
problem identification; assessment of the motivation and capacity for change ■ Ensures that employees are ready for change ■ Talk about pros and cons ■ Brainstorm (list ideas)(pattern?) ■ Look at current situation and see IF change needs to be made. Is it only one time? Is it a trend?
complexity science
promotes the idea that the world is full of patterns that interact and adapt through relationships adaptive change rather than forced
Americans with Disabilities Act of 1990 (ADA)
protects disabled persons regarding application, hiring, compensation, advancement and other matters; does not mandate that disabled person be hired before fully qualified non-disabled person ○ Responsibility of employer ■ Make reasonable accommodations to employ persons with a disability ■ Many lawsuits since its enactment excludes, homo, sexual behavioral disorder, gambling addiction, kleptomania, pyromania, use of illegal drugs
BON
protects the patient/ public all who present themselves as nurses must be licensed to practice w/in the state
Patient Protection & Accountability Act (2010)
provides for the phased introduction of a comprehensive system of mandated health insurance forms
career
refer to progression of skills, consistency, knowledge, and/or status
o Qualifications for delegator and delegatee
∙ Appropriate education, skills, experience ∙ Documented/demonstrated evidence of current competency
Delegation Process Assess the task
∙ Assessment, evaluation, expert knowledge and professional judgment should NEVER be delegated. ∙ Elements of care may be delegated but not the nursing process itself. ∙ Generally, appropriate activities for consideration in delegation decision-making to unlicensed personnel include those: • which frequently reoccur in the daily care of a client or group of clients • which do not require the AP to exercise nursing judgment • which do not require complex and/or multi-dimensional application of the nursing process • for which the results are predictable and the potential risk is minimal • which utilize a standard and unchanging procedure
● RN assigns to LVN
○ authority, accountability and responsibility are transferred
● RN assigns to another RN
○ authority, accountability and responsibility are transferred
Nonlinear (complex) Change, Unplanned: Second - Order Change
● Complexity & Chaos theory: rapid changing environment due to internal and external changes; ongoing process through which organizations adjust and realign - evolving ○ Helpful approach to understanding dynamic, open system health care organizations. ● Adaptation - "spurts" of change rather than a continuously steady, incremental change. ● Need to be flexible and see various alternative ● Avoid setting rigid inflexible rules ● Learning Organization Theory - emphasis on flexibility and responsiveness
Kotter's Eight-step Model (for leaders to help foster change)
● Create Urgency ● Form a powerful coalition ● Create a vision for change ● Communicate the change vision ● Remove obstacles/barriers (restraining forces) ● Create short-term wins ● Build on the change ● Anchor (hard-wire) the changes in the culture
Linear (planned) change: First - Order Change
● Occurs in a sequential and directional fashion ● Happens over a long period of time and has steps to the process ● Lewin (1947); Lippitt, Watson, and Westley (1958); and Havelock (1973); Rogers (2003) used similar systematic approaches to change. ● Planned change is useful for low-level change in stable environments. ● Involves review of Force-field analysis
Major Change Management Functions
● Planning (includes assessment)- looking ahead to determine how to reach a desired goal or outcome; must look at how the change will affect everyone; need participation; planning should occur before the change is implemented ● Organizing- making decisions about reaching outcomes; must consider: time, personnel, materials, communication, and other activities and resources ● Implementing- consider how to put the plan into action; may have to restructure the plan a few times before it is set; adjust the plan as needed to accomplish the desired outcome ● Evaluating- continually judging how the change process is progressing; monitoring progress; data collection; correct problems early on ● Seeking Feedback- seek input from the group; gather accurate, comprehensive, timely information about the progress of the change process ○ Negative feedback- when a problem exists
Wrongful Discharge
● Procedure for termination not followed ● Malicious or unfair terminations
Responses to Change
● Self-assessment; Table 17-1 pg. 313 ● Human side: (innovators, early adopters, early majority, late majority, laggards, and rejectors); behavioral responses to change 1. Laggards- they have a hard time adopting but then you work with them and they come around to the idea * How to help them accept change: * Tell them the benefits of the change * Monitor outcomes and evaluating- show them the results!! Show them the reason why we are doing this 2. Rejecters- they just say no, they may quit, they may sabotage the change and make it difficult for the others Fear is the biggest problem with laggards and rejecters ● Systems and technologic side - refers to responses that influence the efficiency and effectiveness of work processes and outcomes.
Questioning Medical Reasonableness of a Physician's Order
● Separate form ● Does not involve peer review ● May carry out order or refuse order
Learning Organization Disciplines - Senge's
● Systems thinking — world view a set of multiple visible and invisible parts constantly interacting ● Personal mastery — values and facilitates development of deeper aspirations of its members as well as personal proficiency ● Mental models — set of assumptions, beliefs, and mental pictures about the way the world should work ● Shared vision — all members are involved in moving personal visions of the future into a consolidated yet ongoing vision common to members and leaders ● Team learning — need for cohesive groups to learn together to benefit from the abilities of each person; enhancing team efforts and outcomes. ● COMMUNICATE, SHARE INFORMATION, EDUCATION
