Leadership Final

Leaders vs Managers

Leaders lead and influence people No assigned responsibility May have good management skills, but may not always be the case Managers coordinate activities and things Assigned responsibility to accomplish goals of the organization May be a good leader, but may not always be the case

Interactional Leadership Theory

Leaders learn their role from social interaction with co-workers (doesn't matter their ranking in the workplace) Development of trust in the relationship Includes concepts of behavioral theories, which begin to address that leaders are made and not born, since the needed behaviors can be taught and learned Input and contributions from the group are the basis for interaction and trust in the leader Democratic concepts of management are used

Contingency/Motivational Theory of Management

Figure out what best motivates a group of people Offer incentives The manager is able to blend the elements of all the earlier theories and use those elements and concepts to determine what best motivates people to make choices that will lead to the most effective methods to complete the work that needs to be done Employees work in a productive and timely manner to meet the goals of the organization

Impact of staffing patterns on the quality of care

Lower levels of hospital nurse staffing are associated with more adverse outcomes Studies have found a correlation between too few nurses on a unit and higher rates of pneumonia, upper gastrointestinal bleeding, shock/cardiac arrest, urinary tract infections, failure to rescue, lung collapse, falls, pressure ulcers, thrombosis after major surgery, pulmonary compromise after surgery, longer hospital stays, and 30-day mortality rates Clients in hospitals today are more acutely ill than in the past, but skill levels of nursing staff have declined Higher-acuity clients have added responsibilities that increase nurse workload Avoidable adverse outcomes, such as pneumonia, can raise treatment costs by up to $28,000 Hiring more RNs does not decrease hospital profit Higher levels of nurse staffing could have a positive impact on both quality of care and nurse satisfaction How Are Nursing Work Assignments Determined? Model of care delivery Condition/acuity of the clients The architecture of the unit Expertise of the staff Staffing plan (written staffing plan, fixed nurse-patient ratios, public reporting of staffing ratios) Who Had Higher Teamwork Scores? Those who... had less than 6 months of experience work 8 or 10 hour shifts (as opposed to 12 hours or a combination of 8 and 12 hour shifts) are part-time staff (as opposed to full time) work night shift had little or no overtime had a perception of adequate staffing and fewer patients cared for on the previous shift Scheduling Patterns: HOSPITALS ARE OPEN 24 HOURS A DAY, 365 DAYS A YEAR!!! TAKE THAT WALMART! 8 hours 5 days a week 10 hours 4 days a week 12 hours 3 days one week and 12 hours 4 days the next week Weekend alternative (Baylor plan) two 12 hour weekend shifts for 36 hours of pay WHOLE BUNCH OF DAYS ON, THEN A WHOLE BUNCH OF DAYS OFF...and on and on and on... What About the Use of Overtime? Accident rates begin to increase at the ninth hour of work and to double that of the ninth hour after the twelfth hour of work. Job stress from overwork is estimated to be responsible for costs of $150 billion per year in absenteeism, health insurance premiums, diminished productivity, compensation claims, and direct medical costs. A deficit in sleep "the fatigue factor" can result in decreased alertness, problems completing tasks, reduced concentration, irritability, slower response times, altered mood and motivation, reduced morale and initiative, and unsafe action and decision making. www.texasnurses.org In a 2006 study of 2,274 nurses, 25% of these nurses worked 12 or more hours per day and 33% of these nurses worked more than 40 hours a week. In another study done in 2004 43% of registered nurses worked more than 40 hours per week and 9% worked more than 60 hours per week. In 2010, 16 states regulated mandatory nursing overtime.

Transcribing Written Orders

The physician or provider order must clearly indicate what is to be done, when it should be done, how often it should be done, the patient's identifying information, current date, and time, and the physician or provider's signature It is the nurse's responsibility that the order is implemented correctly (as many people may be involved in transcribing orders) If any part of the order is not clear, the physician or health care provider should be contacted for clarification

Clinical Information Systems (CIS)

"a collection of various information technology applications that provides a centralized repository of information related to client care across distributed locations" (Sittig and colleagues, 2002) This repository may include the patient's history of illnesses, and interactions with providers by encoding knowledge capable of helping clinicians make decisions about the client's condition, treatment options, and wellness activities The repository also encodes the status of the decision, actions underway for those decisions, and relevant information that can help in performing those actions The database could also hold other information about the patient including genetic, environmental, and social contexts CIS uses the computer to provide and store information 10 E's in E Health: Efficiency Enhancing quality of care Evidence-based Empowerment Encouragement Education Enabling Extending Ethics Equity Electronic Health Record: Longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting Information could include patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports Automates and streamlines the clinician's workflow Generates a complete record of a patient encounter as well as support evidence-based decision support, quality management, and outcomes reporting What is the difference between EHR and EMR? 8 Functions of EHR: Health information and data Result management Order management Decision support Electronic communication and connectivity Patient support Administrative processes and reporting Reporting and population health Advantages of EHR: Simultaneous, remote access to client from many locations Legibility of record-no handwriting Safer data-backup and disaster recovery system so less prone to data loss Patient data confidentiality-authorized use can be restricted and monitored automatically Flexible data layout-can recall data in any order Integration with other information resources Incorporation of electronic data from other sources (bedside monitors, laboratory analyzers, and imaging devices) Continuous data processing-check and filter for errors, alerts Assisted search Greater range of output modalities-data can be presented to users via computer-generated voice, two-way pagers, email, and hand held devices Tailored paper output-fonts, colors, sizes, and picture images (also saves trees!!!) Always up to date Health Information Technology is the GOAL But the reality is... There is lack of standardization across care areas There is a lack of funding and information technology is costly for hospitals Privacy laws are needed to simplify the task of communicating across facilities, agencies, and local, state, and federal governments There is a lack of a uniform approach to match patients to their record A new law was enacted in 2009 by the American Recovery and Reinvestment Act and the Centers for Medicare and Medicaid Services, that proposed a rule on Medicare and Medicaid payment incentives for "meaningful users". Despite this law the barriers remain. Trends: Using the internet Electronic communication E-mail Texting, Twitter, other social media, video conferencing Data access at the point of care Computers in the nurses' station Mobility in the clinical world "smart carts" Smartphones

Nursing Informatics

"a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge, and wisdom in nursing practice." (ANA, 2001) "facilitates the integration of data, information, and knowledge to support clients, nurses, and other providers in their decision making in all roles and settings." (ANA, 2001) The Informatics Nurse (IN) and Informatics Nurse Specialist (INS): The American Nursing Credentialing Center (ANCC) first certified in 1994 The IN has experience in nursing informatics; the INS has an advanced degree in the specialty Extensive clinical background, and a unique understanding of workflow, the hospital and clinical environment, and specific procedures that are necessary for effective healthcare information infrastructure Focus is to improve client care with health care automation that encourages caregivers and physicians to make more accurate and timely decisions Communicate with technology staff on an intellectual level regarding hardware, software, communications, data representation, and security (EHR) Involved in system implementation, training, testing, presenting, and facilitating knowledge...in other words translates standard information into practical models that all hospital staff can understand in order to improve patient care Some work for health care vendors in both hardware and software areas, engineers/design teams, consulting firms, and government and educational institutions

Roger's Diffusion of Innovation Theory

5-step process of an individual's decision to adopt an innovation Knowledge Persuasion Decision Implementation Confirmation

Shortage of Nurses

Although there have been nursing shortages over the past 50 years, the most recent shortage, which began in 1998, has been the most persistent In 2009 the U.S. Bureau of Labor Statistics reported that the health care sector of the economy is continuing to grow despite significant job losses in nearly all industries and 544,000 jobs have been added since the recession began The U.S. nursing shortage is projected to grow to 260,000 RNs by 2025 making it the largest nursing shortage since the mid-1960s. 55% of nurses surveyed reported their intention to retire between 2011 and 2020 (Aging Nursing Workforce Survey, 2006) 5% of a hospital's budget may go to paying for nursing turnover

How to Evaluate Websites for Medical Information

Authority- who is the author and what is their expertise and qualification? Timeliness and Continuity- when were the materials created or updated? Purpose- who is the targeted audience and what are the goals/aims/objectives? Content: Accuracy and Objectivity- Who is accountable for accuracy, how complete and accurate is the information and is there bias? Structure and Access- Does the site load quickly, do graphics serve a purpose, is there appropriate interactivity, is the site secure?

Budgets

Budget-tool that helps to make allocation decisions and plan for expenditures. Do we have enough budget to hire more nurses on the unit? Revenue-all the money brought into the unit as payment for a good or service. Some areas of a hospital generate a great deal of income for the hospital (radiology and surgery). Expense-all the costs of producing a product. Nursing care is lumped into the room rate on most units. But some areas such as recovery room, intensive care, and labor and delivery have a separate charge for nursing care. MARGIN OR PROFIT= REVENUE - EXPENSES. Whether a hospital is not-for-profit or for-profit, it must make a profit. Types: Capital Budget- The beginning point of a budget cycle where hospital administrators may ask departments or units for a list of items that their area will need to purchase in the coming year. These needs are then summarized and prioritized according to funds available. Operating Budget- Includes a statement of the expected expenses of the unit for a time period, usually one year. The volume of client care is carefully analyzed, as well as data from the past months and year. Activity and acuity of the unit is also considered. Included in this are all of the items needed for care on the unit. Personnel Budget- Is the largest part of nursing unit expenses and includes determining the number of nurses required to care for clients. Hours of care per patient day, number of hours that a nurse employed full time is available to perform all employment activities, and consideration of productive and non-productive time of nursing are part of this.

Case Management

Collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet a person's health needs, while reducing costs Case managers work in all types of health care organizations and settings including acute care, sub-acute care, rehabilitation, psychiatric/substance abuse, a variety of community service agencies, insurance and utilization review companies, and employee health Case managers should be skilled in communication, critical thinking, negotiation, and collaboration. Knowledge of resources and good patient and family relationships are important Clinical pathways (care maps) and disease-management protocols are the tools of case managers Pts that need case management: have complicated health care needs. are receiving care that is expensive, as well as complicated. pose discharge planning problems. are receiving care from multiple providers. are likely to have significant physical and psychosocial problems.

Causes of Medical Errors

Communication problems Inadequate information flow Human problems Patient-related issues Organizational transfer of knowledge Staffing patterns/work flow Technical failures Inadequate policies and procedures

How to Evaluate a Website CARS Checklist

Credibility-an authoritative source Accuracy-source that is correct today Reasonableness-fairness, objectivity, moderateness, consistency, and worldview Support-source that provides evidence for claims ...then to the CAFÉ (Challenge the information, Adapt and require more credibility and evidence, File new information rather than immediately believing it, Evaluate and reevaluate)

Nurse as Leader

Customer Service Provider Team Builder Resource Manager Decision Maker Problem Solver Change Agent Caring Environment Creator Other duties as assigned...

Quality

Degree of excellence. A distinguishing attribute.

Allocation Decisions

Government (Medicare decisions to cover some services and not others) Payer (Insurance companies have rules about what will be covered and what will not be covered) Marketplace (Implies that health care is a normal good, similar to a car or piece of clothing, where rules of supply and demand apply) Unpredictability of demand Consumer knowledge Barriers to entry to the market Lack of price competition

Number of Nurses Needed for Pt Care

Hours per Patient Day (HPPD)-Each patient-care unit will have a designed number of hours of care per patient day Full-Time Equivalent (FTE)-The number of hours that a nurse employed full-time is available to perform all the employment activities (calculated to be 52 weeks times 40 hours), which is usually split into productive and nonproductive time Productive Time-Time providing patient care (8 hour day, 7.5 is productive time, .5 is lunch) Nonproductive Time-Time that is not available for direct patient care (vacations, days off, holidays, time at education seminars, breaks, lunch, committee work)

HIPAA and Technology

In 1996 HIPAA was signed into law to ensure that health care organizations collect the right data in a common format so that data could be shared, as well as protect the privacy and security of client data Health care entities must adopt written privacy policies and procedures that define how they intend to abide by the highly complex regulations and protect individually identifiable health information and ensure that all staff members who have access to client information have an understanding of the consequences of noncompliance In 1998, all health care entities that maintain or transmit health information electronically were required to establish and maintain responsible and appropriate safeguards to ensure the integrity and confidentiality of client information The Joint Commission wrote 10 information management (IM) standards in the mid-1990's

Patient Safety

In 2000, the Institute of Medicine (IOM) called for care that was safe, effective, patient-centered, timely, efficient, and equitable In 2004, the Institute for Healthcare Improvement (IHI) launched the 100,000 Lives Campaign which included no needless deaths, no needless pain or suffering, no helplessness in those served or serving, no unwanted waiting, and no waste In 2006, IHI also launched the 5 Million Lives Campaign which included concerns such as hospital acquired infections (MRSA), high-alert medication, surgical complications, pressure ulcers, CHF, and governance structures In 2008, The Joint Commission outlines principles for the hospital of the future to include principles related to the following: 1) support economic viability 2) guide technology adoption 3) guide achievement of patient-centered care 4) guide design of hospitals of the future, and 5) address staffing challenges The Joint Commission 2016 National Patient Safety Goals

Magnet Hospitals

In the early 1980s, hospitals were studied that had successes in attracting and keeping nurses Several hospitals were nominated for their reputations in attracting and retaining nurses There is a relationship between the effects of the hospital care environment and patient mortality and nurse outcomes "Forces of Magnetism" were created Forces of Magnetism: Quality of nursing leadership Organizational structure Management style Personnel policies and programs Professional models of care Quality of care Quality improvement Consultation and resources Autonomy Relationship between the community and the health care organization Nurses as teachers Image of nursing What Encourages Nurses to Stay? Autonomy Variety Supervisory support Workgroup cohesion Procedural justice (rights are applied universally to all employees Collegial nurse/provider relations Opportunity for promotions

Developing your Skills in Nursing Leadership

Increase your own personal competence and knowledge Develop and maintain flexibility Develop self-confidence, decisiveness, and integrity in decision making Walk, talk, and look poised and confident Develop and maintain alliances Develop your own personal physical resources

General Systems Theory

Interdependent parts- elements of the system that interact for processing Input- any outside element or factor that is brought into the system Process- the activity of the system Output- any product that is produced from the processing activity Control- rules or procedures within the system Feedback- reusing output from the system as input back into the system for validation or correction ...serves as the conceptual framework for nursing informatics

Trends Affecting Rising Health Care Costs

Intrinsic Factors: The 2010 Census reported 308.7 million people in the U.S., a 9.7% increase from the 2000 Census For the years 2012 to 2060 growth is predicted to be much slower, but diversity is expected to increase For the years 2012 to 2060, the population of those over age 65 is expected to more than double; the population of the "oldest old" those over age 85, is expected to more than triple Extrinsic Factors: Availability of new medical technology has contributed to the rising costs of health care, but to remain competitive an organization must adopt new technology early Prescription drug spending in 2011 reached 263 billion dollars. This has actually slowed from the average rate of increase of 7.8% a year that happened between 2000 and 2010.

Disease Management: Clinical Pathways

Multidisciplinary plans of "best" clinical practice for groups of patients with a specific medical diagnosis Four essential elements include 1) a timeline outlining when specific care will be given, 2) the categories of care or activities and their interventions, 3) intermediate and long-term outcomes to be achieved, and 4) a variance record that allows caregivers to document when and why the progress of individual patients varies Protocols: System of coordinated health care interventions and communications for persons with conditions in which self-care is important in controlling the disease Patients are often enrolled in preventive and educational programs tailored for their health care needs before they enter into the acute stage of their illness Supports the physician or practitioner-patient relationship and plan of care Emphasizes prevention of exacerbation and complications by using evidence-based practice guidelines and patient empowerment strategies Evaluates clinical, humanistic, and economic outcomes on an ongoing basis, with the goal of improving overall health

Pay for Performance Payment System

New approach to reduce costs and improve quality Physicians, hospitals, medical groups, and other health care providers are rewarded for meeting certain performance measures for quality and efficiencies Disincentives, such as eliminating payments for negative consequences of care, such as medical errors, have also been proposed

Nomenclature, Classification, and Taxonomy

Nomenclature act as descriptors or labels Classifications are group or class entities Taxonomy is the study of the classifications Nomenclatures offer a recognized, systematic classification and consistent method of describing nursing practice If the unique nomenclature of classification systems is used consistently, gathered data elements can be captured, stored, and manipulated accurately in the electronic medical record 12 Classification Systems: North American Nursing Diagnosis Association International (NANDA) Nursing Interventions Classifications System (NIC) Nursing Outcomes Classification System (NOC) Nursing Management Minimum Data Set (NMMDS) Clinical Care Classification (CCC) Omaha System Perioperative Nursing Dataset (PNDS) SNOMED CT Nursing Minimum Data Set (NMDS) International Classification for Nursing (ICNP) ABC codes Logical Observation Identifier Names & Codes (LOINC) The ANA Committee for Nursing Practice Information Infrastructure requires that: classifications or language provide a clinical useful terminology and rationale for development. classifications or language consist of clear and unambiguous terms. the developer provides evidence of reliability, validity, and utility. The classification or language include a unique identifier for each item.

Fiscal Responsibility

Nurses have a FISCAL RESPONSIBILITY to the client and to the employing institution There is a duty/obligation to the client to allocate financial resources of the client to maximize health benefits to the client There is a duty/obligation to the employer to allocate financial resources of the employer to maximize organizational cost-effectiveness Strategies: Provide quality nursing care that prevents complications. Make conscious decisions about the allocation of professional nursing time. Understand Medicare and Medicaid insurance coverage. Engage in evidence-based practice and follow best practice guidelines. Share information with patients and families about the costs of care and alternatives. Assign assistive personnel appropriately to help with care. Work with other members of the health care team to promote fiscal responsibility for clinical practice. Document patient condition accurately. Begin discharge planning on admission. Complete charge slips for patient supplies, if needed. Avoid burnout by taking scheduled breaks, meal times, and vacations. Engage in safe clinical practice that will avoid personal injury.

Economics of Caring

Nurses may hesitate thinking that this concept somehow makes them less caring The value can be that the nurse can bring the values of nursing to the decision-making process for patient care Nurses can be a voice by knowing what the literature says about decreased staffing and overtime in a way that business administration staff often may not know about

Evidence-Based PracticeIs It the Latest and Best?

One strategy to reduce the amount of time required to integrate new health care findings into practice Includes a systematic search for the most relevant evidence to the question, a critical evaluation of the evidence found, your own clinical experience, and patient preferences and values There are 14 evidence-based practice centers for evaluating evidence-based practice research. There is a rating system for evaluating evidence-based practice research (Table 15-1 page 334). There are centers in schools of nursing in the U.S. that serve as resources regarding evidence-based practice (UT San Antonio, Indiana and New Jersey Center/Joanna Briggs Institute, Case Western Reserve School of Nursing, and Arizona State University).

Affordable Care Act

Signed into law in 2010 by Congress and President Obama with the goal to provide health care coverage at an affordable cost for all Americans The timeline for implementing the ACA is from 2010 to 2015. Sets up a new competitive private health insurance marketplace giving millions of Americans and small business owners access to affordable coverage Holds all health plans accountable for providing a standardized, easy-to-read Summary of Benefits and Coverage, which allows consumers to compare health plans Began prohibiting denial of coverage for children with preexisting conditions beginning in 2010 and for adults with preexisting conditions in 2014 Beginning in 2011 began allowing young adults up to age 26 to stay on their parent's insurance policy Provides expanded Medicaid coverage for low-income children and adults Preventive screening and services are covered by insurance without additional cost to consumers

Managed Care

Strategy that has been used to reduce costs Best illustrated by the following formula Value= (Access + Quality)/ Cost So increased value = low cost, increased access, and high quality (Does this sound like your health care system? History: In the early 1900's patients and families paid the hospital or physician directly for medical services In the early 1980's Medicare introduced the prospective payment system where a fixed fee was paid to the hospital or doctor for a specific diagnosis (incentive was to treat a patient so that a shorter length of stay was necessary, reducing the consumption of resources)...thus began the practice of managed care. With capitation, employers pay a set fee each month to an insurance company for each covered employee and dependent and this amount DOES NOT vary based on care given (incentive here is for insurance companies and providers to keep patients healthy, which is less expensive than hospitalization) HMO plans make an annual payment on behalf of the members to a group of providers who deliver all of the health services covered under the plan (incentive here is avoiding hospitalizations reduces costs) PPO plans include members who must use physicians who have agreed to provide services at a lower fee to avoid out-of-pocket expenses (incentive here is to use a doctor in network and avoid out-of-pocket expenses, but can use a doctor out-of-network and pay more) Impact: Initially managed care reduced the costs of health care. However, costs have increased sharply in response to backlash from restrictive managed care policies Since 2002, employer-sponsored health coverage for family premiums have increased by 97%, placing increased burdens on employers and workers There are currently various proposals to reform US healthcare to reduce cost, as well as increase access for the uninsured including investment in information technology, improving quality and efficiency of care delivery, adjusting provider compensation, prevention, increasing consumer involvement in purchasing, and altering the tax benefits for employer-sponsored insurance The ANA (2009) issued a statement on reducing health care costs by focusing on health promotion and disease prevention, cultural competency, health education, chronic disease management, coordination of patient care, and community-based nursing care Obama Affordable Care Act Strategies to Control Cost: Case management Evidence-based practice Appropriate staffing Improving retention of staff Electronic health record use (EHR) Reducing patient-care errors

Ethics

The behavior that surrounds the trust that clients have in individuals who handle confidential information Security policies must be explicit and well defined for privacy and confidentiality Imagine how technology has added a whole new level to this concept???

Peer Mentoring

The mentors (senior nursing students) gain leadership skills and professional role development behaviors by mentoring other nursing students in the nursing program The mentor maintains competency with nursing skills as he/she is continually teaching the skills to mentees in the nursing lab The mentees gain experience in learning nursing skills and may be more comfortable performing these skills in front of a student than a clinical instructor May address decreased clinical site availability

Nursing Care Delivery Models

Total Patient Care/Private Duty: RN provides complete care of a group of clients on a 1:1 basis, providing total client care during the shift Quality of care is usually high Decreases communication time between nurses Reduces the need for supervision Allows one person to perform more than one task simultaneously Some nurses like because they do not have to supervise others, some nurses do not like because they cannot delegate client care activities Client satisfaction is usually high if continuity of care and communication are maintained Functional Nursing: Started with World War II, when nurses took over hospital duties Positions of aides and licensed practical nurses came into being Caused fragmentation and impersonal kind of care Assembly-line approach More errors and omissions occurred with this model Team Nursing: Started in the 1950's to fix the problems of functional nursing models Groups of clients were assigned to a team headed by a team leader, usually an RN, who coordinated care for a designated group of clients Work assignments determined by patient acuity and team ability Success depends on good communication among team members Time is needed for communication and continuity of care Primary Nursing: Started in the 1960's and 1970's A nurse plans and directs the care of a client over a 24-hour period Designed to reduce or eliminate the fragmentation of care between shifts and nurses Relationship-based practice is the new name for primary nursing RN may be called the care coordinator, the responsible nurse, the principle responsible nurse, case manager, or care manager-a relationship develops from admit to discharge Patient-Focused Care: Evolved within the last 15 years Tasks are centralized on the unit under the direction of the RN Staff are cross-trained to perform more than one function Client comes into contact with fewer people RN supervises the delivery of care Tasks that do not require an RN can be delegated to other assistive personnel Telehealth: this is a newer one. The delivery of health-related services and information via telephone communications technologies Could be as simple as two health professionals discussing a patient case over the phone or as complicated as doing robotic surgery between facilities on opposite sides of the globe Care includes both preventive and treatment strategies Allows patients access to experts they might not normally have access to The Institute of Medicine (IOM) (2012) discussed the role of telehealth as a health care delivery method ...In the real world you seldom find purely one form of nursing care delivery model. Good Models Have: An elevated RN role from traditional care delivery to primary care manager A sharpened focus on the client Specialized tools for assessment, teaching, and measurements that allow for smooth transitions from one level of care to another Leveraging of technology to enhance communication, reduce labor-intensive documentation, improve access to information, or reduce wasted time Measurement of a broad range of clinical, quality, financial, and satisfaction indicators to drive redesign and indicate viability and sustainability

Economics

What are the choices about spending? Currently the U.S. is spending 18% of its income on health care. As the payer of Medicare (national health insurance program for those over 65 years and some with disabilities and ESRD under 65 years) and Medicaid (joint federal and state program that pays for medical assistance for certain individuals and families with low income and resources), the federal government is the nation's largest purchaser of health care. What are the choices about services to provide? Treatment for premature infants, cleft palate, hip fracture, and stroke are covered under most plans, radial keratotomy, cosmetic dentistry, and varicose vein treatments are not. What are the choices about methods to produce health care? A woman may choose to have her annual physical examination with a gynecologist, nurse practitioner, or certified nurse midwife. Some procedures that were once routinely done in hospitals can now be done in an outpatient setting. What are the choices about allocation? The World Health Organization (WHO) states in its constitution that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being (2004). How much health care is a right? Who should pay for those who cannot afford health care? Who decides who gets the health care?

Behavioral/Human-Interaction Theory of Management

Workers are humans too People have feelings Gave workers a voice Evolved when it was decided that the humanistic side of management needed to be addressed in order to maintain a stable, satisfied work force Employees may seek assistance outside their place of work such as a labor union

Thinking About Nursing Informatics?

You will be involved in informatics on a daily basis!!! The following skills may be helpful... concepts of information and communication technology using the computer and managing files word processing spreadsheets using databases presentation web browsing and communication skills needed to find, retrieve, analyze, and use information

Avoidance Conflict Management

"The Escapist" Avoidance includes the following: -Withdrawal from the situation -Attempt to remain neutral -Delay in responding to the conflict -Unassertive and uncooperative behavior -In some situations, avoidance is not considered a true form of conflict resolution, because the conflict is not resolved Lose-Lose approach When to Use: Tempers are flaring and anger is present and time is needed for emotions to cool down Short-term strategy, important to get back to the problem after emotions have cooled

Accommodation Conflict Management

"The Peacemaker" Appear to agree, but behavior may say otherwise; often these folks end up feeling resentful and angry. These folks... -suppress and smooth over differences -dread conflict -maintain harmony -neglect own concerns to satisfy concerns of others -put own concerns aside and lets others have their way Giving in results in a lose-win situation When to Use: When the person you are in conflict with has the power to resolve the conflict unilaterally. When conflict would create serious disruption, such as arguing Differences can be suppressed or played down while agreement is emphasized

Competition Conflict Management

"The Player" Focuses on an individual's own perspective Force or the use of power occurs These folks: -focus on tasks and goals, usually well organized -are committed to their own perspective and what they want -expect others to come forward with their viewpoint -fear loss of control when undermined or overtaken -defend their own position -can be aggressive and uncooperative Winner takes all; win-lose situation When to Use: You need a quick and decisive response, may be appropriate for short-term needs You need to deliver an unpopular decision

Collaboration Conflict Management

"The Problem-Solver" Fully cooperative and assertive in nature Involves a high level of concern for the problem, the outcome, and the relationship Deals with confrontation and problem solving The needs, feelings, and desires of both parties is taken into consideration and reexamined while searching for proper ways to agree on goals Objectively evaluates differing views Often leads to creativity and new ideas Slow process Results in a Win/Win situation for both parties Those who are collaborative: Are non-avoiding Identify concerns of both parties and find alternatives Have curiosity about others' underlying motives and needs Are open to exchange insights and work towards creative solutions and new ideas Believe outcomes of the negotiation will be the best solution When to Use: Objective is to learn more about the other party Provide a creative solution to both sets of needs and concerns Both parties are committed to merging both views and interests

Compromise Conflict Management

"The Trader" Focuses on trying to satisfy both parties Seldom confronts conflict Middle of the road position Compromise includes the following principles: -Recognition of the importance of both the resolution of the problem and the relationship between the two people -Compromise is a moderately assertive and cooperative step in the right direction -May be a temporary solution until more options become available Modified Win/lose and Win/lose situation for both sides (a give and take by both parties) When to Use: When you need a temporary solution until more options become available When the relationship is just as important as the resolution

Negative Communication Techniques

Blocking-responding in a noncommittal or general way- "Many people feel that way." False assurances-responding in a placating way or showing a lack of concern or lack of knowledge- "It will be okay, don't worry." Conflicting messages- "Hi, Mr. Smith, I will be your nurse today." (enter patient's room with no smile and looking rushed and busy)

Group Process

Forming- Common bond that brings you together for well-defined reasons Storming- State of pandemonium exists where you begin to play the role you normally portray in the presence of your peers as you discuss fears, fantasies, and hopes for a successful outcome Norming- Development of mutual goals and guidelines Performing- Everyone knows one another, trusts one another, and begins to work with one another Adjourning- (AKA deforming and mourning phase) Completion and disengagement, both from tasks and group members

Listening

Give attention to the sender Provide feedback Face the sender and give eye contact Note body language Finish listening before you speak Hearing is listening enough to know what was said. Understanding is processing the information you heard. Judging is making a decision about what you heard.

Contingency Leadership Theory

Go with the flow Leadership should be flexible enough to address varying situations Brings a flexible approach to each situation where leadership is required

Management

Management refers to the activities involved in coordinating people, time, and supplies to achieve desired outcomes and involves problem-solving and decision-making processes. Managers control day to day operations, plan and organize what is to be done, direct who is to do it, and determine how it is to be done. An appointed management position has responsibilities for performance of administrative tasks (staffing, performance reviews, budgets). Management has a formal line of authority and accountability to ensure that the organization's goals and standards are met. Person with the title

Democratic Manager

Manager cares about what team thinks Manager is part of the team Can be good and bad Middle of the continuum People-oriented and emphasizes effective group functioning Manager is perceived as a group member who is the organizer and keeps the group moving in a defined direction Open environment and communication flows both ways Encourages participation in decision making when it is appropriate

Change

A perceived threat to self in how the change will affect the individual personally, what will be its impact on my self-confidence and self-esteem? A fear of the unknown and a lack of understanding regarding the nature of the change Emotionally draining, as there is a limited ability to cope with change A disagreement about the potential benefits of the change

Situational Leadership Theory

Analyzes the needs of the current situation and then selects the most appropriate leadership style to address that particular situation May use different leadership styles with different individuals involved in addressing the same situation Makes assignments to get the goal accomplished based on competencies of each member

Special Influences on Communication

Appearance and behavior Gender differences Generational differences Cultural diversity Interdisciplinary differences Confidentiality and privacy "The Grapevine" Technology

Autocratic Manager

Manager makes all the decisions and doesn't care what others think about it Dictator Useful in code situations Authoritarian approach Determines policy and makes all decisions Ignores subordinates ideas Dictates work with much control Gives little feedback Makes fast decisions Works with employees with little education and training

Workplace Bullying

A systematic health-harming mistreatment of one or more individuals (targets) by one or more perpetrators that can be verbal, behavioral, or sabotage in nature Not as easy to recognize this type of horizontal violence Many of us believe that bullies cannot possibly exist into adulthood For most nurses, the idea that another person would deliberately bully them is difficult to comprehend Some nurses believe it is somehow their fault for being the target "Nurses eat their young" theory Healthcare environments are particularly situated to foster bullies, because they are hierarchical in nature and tend to involve a great deal of change How to Recognize Bullying: Being falsely accused of errors Regularly being stared at or glared at or receiving other intimidating nonverbal behavior "eye rolling" Ideas, thoughts, or exemplary work being discounted Being given the "silent treatment" Dealing with a person who has uncontrollable mood swings Dealing with a person who makes up rules on the fly Experiencing retaliation Experiencing harsh and constant criticism and verbal put-downs Dealing with a person who starts or fails to stop spreading rumors about you Dealing with a person who encourages others to bully you Being signaled out and isolated from others Being given undesirable and un-doable assignments as punishment Experiencing sabotage of your work, plans, and progression Dealing with a Bully: Name it!!! Say "I am being bullied" in other words, validate your experience Seek respite!!! Take time off of work and "bullyproof" yourself and do the following things: check your mental health check your physical health research legal options research the economic impact to your unit start a job search for a new position Expose the bully!!!

Systems Theory of Management

All areas of the workplace have something to contribute System as units Looks at inputs, transformation of the material, outputs, and feedback Consideration is given to the impact of decisions made by one manager on another manager or parts of the system as a whole Departments function interdependently such as in health care

Standards of Quality Health Care Management

American Nurses Association (ANA) Standards of Nursing Care-standards that guide quality in healthcare The Joint Commission (TJC)-accrediting standards for health care organizations The Agency for Healthcare Research and Quality (AHRQ)-established clinical practice treatment guidelines Each individual healthcare facility sets its own standards of practice

TeamSTEPPS

An evidence-based teamwork system put together by the Department of Defense and the Agency for Healthcare Research and Quality Focused on improving communication and teamwork skills in the health care industry to improve patient outcomes 3 Phases of the TeamSTEPPS Delivery System: Assess the need Planning, Training, Implementation Sustainment Goals: Reduce clinical errors Improve patient outcomes Improve process outcomes Improve patient satisfaction Increase staff satisfaction Reduce malpractice claims

Sentinel Event

An unexpected occurrence involving death or loss of limb or function Sound a warning of the need for immediate investigation and response

Communication Styles

Assertive communicators -express their wants, needs, desires, and feelings using objective direct comments, a style of positive declaration and demonstration of confidence, does not violate the rights of others. Also known as direct communication Nonassertive communicators - are timid and reserved in their behaviors, they do what others tell them without questioning and without concern for what is best for them. Aggressive Communicators -express their wants and needs using commanding, dominant, superior, or loaded words and make accusations that blame or put others down, they convey dominance and imply an inclination to start quarrels or fights, violates the rights of others and often leads to conflict. When would I use Assertive Communication? Communicating expectations "I would like to be oriented to orthopedics before I am asked to float there." Saying NO "I cannot work that extra shift, as I have another engagement." Accepting criticism/feedback "I have been falling behind on my care plans. I would like to review some examples of good care plans." Accepting compliments "Thank you. I like hearing I have made a difference to a patient and their family." Giving Criticism "If you are having difficulty carrying out the assignment, I would like you to ask for help." Accepting Positive Feedback "Thank you. I have been working hard at not responding angrily to Mrs. Johnson's demands for care during the shift." Asking for Help "Will you help me get Mrs. Johnson back to bed, thank you." Benefits of Assertive Behavior: Most effective way to let other people know what you feel, what you need, and what you are thinking Helps you feel good about yourself and allows you to treat others with respect Helps you to avoid feeling guilty, angry, resentful, confused, or lonely Greater chance to get your rights acknowledged and your needs met It is the path to a more satisfying life!!!

Coaching

Assisting an individual's growth and development through partnership with a colleague or other individual who is an equal One person focuses on the unique and internal qualities observed within the other person that may not be recognized or appreciated Works to find new ways to solve problems, reach goals, and design plans of action to motivate persons to perform at the "top of their game." The strength of coaching lies in the facilitation and development of personal qualities in another. ...But a good mentor will coach, and a good coach will mentor according to the situation. "Now I am totally confused."

Conflict Management Styles

Avoidance Accommodation Competition Compromise Collaboration Which technique should I use? Deal with issues, not personalities. Take responsibility for yourself and your participation. Communicate openly. Listen actively. Sort out the issues. Identify key themes in the discussion. Weigh the consequences.

Nursing Without Self Care

Cardiovascular problems Migraine headaches Irritable bowel syndrome Muscle and joint disability Anxiety Depression Insomnia Stress Burnout Alcohol and drug abuse Absenteeism WT problems

Burnout

Causes: Staffing shortages Increase in patient acuity Shortened hospital stays Accelerated rate of change in the health care environment Working environments that are not congruent with your own personal philosophy of high-quality, safe nursing care Early Warning Signs: Irritability WT changes Frequent headaches and GI disturbances Chronic fatigue Insomnia Depression Feelings of helplessness Negativity Cynicism Angry outbursts Self-criticism 5 Stages: An initial feeling of enthusiasm for the job Loss of enthusiasm Continuous deterioration Crisis Devastation and the inability to work effectively

Laissez-faire Management

Manager never really participates Works well if the team is highly proficient, but doesn't work at all if team needs a lot of guidance Permissive climate Provides no guidance, direction, or control Unable or unwilling to make decisions-allows staff to make and implement decisions Does not provide feedback Initiates little change Communicates by memos or emails May work well with professional, highly motivated people

Anger

Something we feel A cover up emotion for frustration, disappointment, or powerlessness Seems to begin in situations of threat or anxiety Anger has two faces: Guilt for what we did or did not do Resentment for what someone else did or did not do Recognize it and listen to it!!! Dealing with Anger: STOP and appraise the situation. LOOK at yourself and determine what image of you is about to be or has been breached. CHANGE how you see the situation. GET ACTIVE by trying exercise or anything involving physical activity. REFOCUS ON SOMETHING POSITIVE. PAY ATTENTION TO YOUR BREATHING slow it down and take slow deep breaths.

Sexual Harassment

Conduct, typically experienced as offensive in nature, in which unwanted sexual advances are made in the context of a relationship of unequal power or authority Can include sexually oriented verbal comments, unwanted touching, and requests for sexual favors Quid pro quo harassment refers to sexual advances being made as a condition of employment or promotion "Hostile work environment" refers to an atmosphere in the work (or other) environment that is offensive or uncomfortable by virtue of sexual advances, sexual requests, or sexual innuendoes What can I do? Ask the person to STOP!!! Tell the person in clear terms what makes you uncomfortable about the behavior and that you want it to stop immediately. Put it in writing and give it to the person, keeping a copy for yourself. Tell others about the harassment and how you are dealing with it. Keep a journal of all harassing events and all attempts to stop the harassment. File an informal complaint. File a formal complaint.

Critical Communication Times

Critical Patient Tests: Very vulnerable time for errors to occur Warrants expeditious communication to the responsible licensed caregiver without delay Includes not only laboratory panic values, but also other diagnostic test results Get information to the person who can fix the problem in the quickest way Thorough documentation about how this was accomplished is essential Critical Hand-Off: I Identification- Identify yourself and your patient (use 2 identifiers) S Situation-What is happening at the present time? B Background-What are the circumstances leading up to this situation? A Assessment-What do you think the problem is? R Response or Request-What should we do to correct the problem? R Readback or Response-Receiver acknowledges information given. What is the response? Communication: Standardize critical content Hardwiring within your system Allowing opportunities for questions Reinforcing quality and measurement Educating and coaching Shift Change: Patient identifiers Diagnoses Physicians/Other providers on the case Pertinent medical/social history Current physical condition (Review of systems) Resuscitation status (DNR, Full resuscitation) Nutritional status (nutritional intake, NPO, supplements) Pending or critical issues and tests Quick introduction of both off-going and on-coming caregivers with the client Interruptions: Recognize when you are interrupting yourself Recognize that some interruptions are part of your job responsibilities Recognize that everyone needs time without interruptions Telephone Time: Say who you are right away. Do not apologize for phoning. State your business briefly, but completely. Ask for specific orders when appropriate. If you want the provider to assess the client, say so. If the provider is coming, ask when to expect him or her. If you get cut off, call back. Document attempts to reach a provider. If a provider is rude or abusive, tell him or her so. If you cannot reach a provider or get what you need, notify your chain of command. Watch for non-verbals Don't let things get lost in translation

DMAIC

DEFINE- Define the issue, possible causes, and goals (select team, write charter, identify problems and prioritize, make a timeline) MEASURE- Measure the existing system with metrics (define key performance indicators, measure baseline, develop work plan, document data) ANALYZE- Analyze the gap between the existing system and goal (identify where problems are and why, prioritize where to improve) IMPROVE- Improve the system with creative strategies (brainstorm ideas for change, plan and do rapid cycle changes for 3 to 7 days, analyze and tweak, keep what works, document results, identify lessons learned) CONTROL- Control and sustain the improvement (standardize what works, flow new process, write steps, guidelines, and protocols, make it easy to do the right thing, avoid reverting to old ways)

Problem Solving Strategiesfor Management

Data Gathering Definition of the problem Identification of alternate solutions Implementation of the plan Evaluation of the solution Assessment Analysis/nursing diagnosis Development of a plan Implementation of a plan Evaluation/ Assessment Figure out what the problem is before you gather data

Core Measures

Developed by The Joint Commission and defined by the Centers for Medicare and Medicaid Goal is to improve the quality of health care by implementing a national standardized performance measurement system A way for hospitals to improve care by focusing on the results of that care 4 categories to include the following: Acute Myocardial Infarction Heart failure Pneumonia Surgical Care Improvement Process Mandated by TJC Based on problem areas that tend to reoccur Advance directives, autopsy rates, leaving AMA and elopement rates, blood-product use, blood transfusion reaction rates, code blue rates, conscious sedation complication rates, fall rates, medication error rates, mortality rates, pain management effectiveness, restraint use, perinatal care, rates of deep vein thrombosis, and surgical infection rates May reveal the need for more extensive data collection or remedial action to resolve an identified problem Must be continually tracked in order to monitor quality care

Positive Communication Techniques

Develops trust Uses "I" messages Establishes eye contact Speaks honestly Expresses empathy Uses open communication Clarifies information Indicates awareness of body language Listens intensively Uses touch if and when appropriate Lets people know they are appreciated Be aware of culturally appropriate communication techniques

Emotional Intelligence

Do I know my emotions? Am I feeling fearful, angry, sad, ashamed, happy, guilty, or lonely? Can I distinguish between these feelings? Can I manage my emotions? Have I found appropriate ways to express or deal with my feelings? Do I let my feelings build? Do I stuff my feelings away? Can I motivate myself? Can I recognize emotions in others? Can I handle relationships? Remember, feelings or emotions are neither good nor bad, they are indications of our self-truths, our desires, and our needs.

History and Evolution of Quality in Health Care

Edward Deming is the father of quality improvement and his teachings embraced the philosophy that quality is everyone's responsibility within an organization Joseph M. Juran emphasized the Pareto principle which stated that 80% of the problems are caused by 20% of sources, people, or things Phillip Crosby is the father of "zero defects", as he often proposed simplifying things so everyone could understand them

Holistic Self Assessment Tool

Emotional Potential Social Potential Physical Potential Spiritual Potential Mental Potential Choice Potential (options for how you want your life to go)

Nurse as Follower

Enthusiastic, intelligent, and self-reliant participation without star-billing in the pursuit of an organizational goal Investment of self Clear identification of your responsibilities Clear identification of the expectations of your leader Supportive behavior for your leader and group Provision of stimulation for your leader and group Following channels of communication and responsibilities

Transactional Leadership Theory

Focuses on a vision and describes that vision to others Think Hitler (but it isn't always bad like that) Leader has a greater focus on vision, defined as the ability to envision some future state and describe it to others so they can begin to share that vision Leader holds power and control over followers by providing incentives when the followers respond in a positive way to the leader's vision and the actions needed to reach that vision Based on the concept that punishment and reward motivates people Leader intervenes when it appears goals will not be obtained This type of leadership still exists in most organizations today

Nurse Residency Program

Formalized orientation that varies in length (anywhere between 5 and 16 months, but usually about 1 year), where a new graduate nurse works full-time on the unit where he/she will be working following completion of the residency program. Assists the new graduate nurse with the transition into the new role by providing orientation to the unit to which the new graduate nurse is hired, and working with a dedicated and experienced nurse throughout the residency who serves as both a mentor and a coach In addition, provide additional specialty training, certification, and courses that may be unit specific for the newly hired graduate nurse Includes a focus on curriculum and specific clinical experiences grounded in evidence-based practice Allows for professional growth and socialization as a member of the health care team

Needlesticks and Sharps

Health care workers suffer between 600,000 and 1,000,000 injuries from conventional needles and sharps annually. At least 1,000 health care workers are estimated to contract serious infections annually from needlestick and sharps injuries. Exposures from needlestick injury can lead to hepatitis B, hepatitis C, HIV, tuberculosis, syphilis, malaria, herpes, and many other infections. RNs working at the bedside sustain an overwhelming majority of these exposures. Over 80% of needlestick injuries could be prevented with the use of safer needle devices. Less than 15% of U.S. hospitals use safer needle devices. In 1992, the FDA issued an alert, not a mandate, to all health care facilities to utilize needleless systems when possible...therefore health care facilities are under no legal obligation to comply. OSHA has established guidelines that organizations must follow to protect workers The Needlestick Safety and Prevention Act became law on November 6, 2000 and provides important protection for health care workers regarding needlestick injuries The Blood-Borne Pathogen Standard was amended to require safer devices to protect from sharps injuries and keeping a log to document, at a minimum, the type and brand of device involved in each incident, the department or work area in which the exposure occurred, and an explanation of how the incident happened, all while maintaining employee confidentiality State health departments also have guidelines Report and document all needlestick and sharps injuries immediately!!!

Dealing with Short Staffing

How many clients do you have and what is going on with each of them? What nursing tasks do you have to accomplish and what are your priorities? What are your resources? Do you have someone you can delegate tasks to? What families are present to help with patients? Are you aware of a nurse colleague who might be able to help you? Is there any other way to deliver care? What are the hospital's policies for high census or high client load? Greater workload = greater risk of harm to clients

Improve Verbal and Written Communication for Client Safety

Practice the "read back" method Recognize there are "human factors" that influence communication (nonverbal behavior, distraction, sleepiness, worry, forgetfulness, etc...) Write it down!!! Write legibly- There is no other way!!! Watch trailing 0's (5.0mg may be mistaken for 50mg and what a difference that could make!) Do not use abbreviations for dosage frequency (QD may be mistaken for QID or QOD) Get proper translation for prescription orders written in other languages (Take once daily for 5 days in Spanish means take 11 times daily for 5 days-YIKES!) Notify the provider, ask for a clarifying order, and document the clarification See Table 11-1 page 241 for The Joint Commission Official "Do Not Use" List of Abbreviations

Mentoring

Is a fundamental form of development where one person invests time, energy, and personal know-how in assisting the growth and ability of another person. Most importantly, mentoring is the act of passing one's knowledge to the next generation and grooming this generation for the responsibilities that will be assumed over a lifetime. Mentoring has become synonymous with trusted advisor, friend, teacher, guide, and wise person It requires a primary focus on the needs of the mentee and an effort to fulfill the most critical of these needs It requires going the extra mile for someone else The rewards of mentoring are enormous: a sense of personal achievement, mentee appreciation, and a sense of building a better organization It is a partnership created between two people; the mentor possesses the educational degree to which the mentee aspires (Shea, 1999) Mentors lead another's growth and development, professionally and personally. They act as role models for the behaviors they are teaching. The focus is on wisdom and judgment. The mentor teaches, coaches, and explains, while supporting and shaping critical thinking skills, providing advice, and introducing the mentee to the world of nursing. Mentors and mentees walk the path together, and then mentors assume a more passive role. It is now up to the mentee to "get his/her feet wet" and actively seek advice of the mentor, as the mentor begins to follow the direction of the mentee. Mentors know when it is time to let go and get out of the way and let the new graduate nurse soar on their own. This does not mean the relationship has to end, as now there are shared common values and beliefs in lifelong learning. How to Find a Mentor: Keep an open mind, be flexible, and remain optimistic As you finish nursing school, write down the goals you feel a mentor could help you achieve Get a feel for the different personality types you will see as a nurse Look for a common background in either education or area of expertise/practice or interest Tell the person about yourself Start with an open-ended introduction such as "I would really enjoy spending some time learning about pediatric nursing with you." Characteristics of a Successful Mentor: Communicates high expectations to the mentee Demonstrates an atmosphere of mutual respect Has good listening skills by providing a nonjudgmental, listening ear Has empathy as he/she remembers what it was like to be "the new kid on the block" Offers encouragement and nurturing by providing subtle guidance and reassurance Is trustworthy and sincere Is experienced and knowledgeable in his/her area of nursing Is generous with his/her time and knowledge Has values and goals compatible with those of the mentee Displays a good sense of humor and enjoys nursing Characteristics of a Successful Mentee: Communicates clearly Welcomes mentor input Accepts constructive feedback Practices openness and sincerity Takes initiative to maintain the relationship Explores options actively with the mentor Shares results with the mentor Listens for the whole message, including the mentor's feelings Is alert to the mentor's nonverbal communication Types of Mentoring Relationships: Formal mentoring- Traditional, structured, driven by organizational needs and results are measured by the organization frequently Informal mentoring- Voluntary, very flexible, there is a mutual acceptance of roles and periodic check-ups are done by supervisors Situational mentoring- Brief contact, often casual, usually a one-time event, with results that are assessed later on Mentoring thru Reality Shock: Honeymoon phase- Mentor is supportive by listening and understanding when the mentee shares the excitement of starting a new position, mentor acts as an intermediary with other staff members and as a role model Shock or rejection phase- Mentor encourages mentee to discuss their feelings of disillusionment and frustration, as well as share their own personal transition process through this phase ..."I remember when I was a brand new nurse." Recovery phase- Mentor maintains an open channel of communication as the mentee begins to accept the reality of the situation and puts issues into perspective, mentor also encourages mentee to "step outside their comfort zone" and try new things Resolution phase- Mentor reinforces positive qualities that the mentee possesses and encourages the mentee in problem-solving any issues, relating to the desire to either change nursing positions or to stay put

Self Care Strategies

Spend time with friends and family. Have some friends outside of nursing Have a hobby or participate in a recreational activity outside of nursing. Eat a balanced diet, butbe sure to treat yourself from time to time. Be sure to get plenty of sleep Avoid or quit smoking and limit your alcohol intake. Remember to exercise and maintain a healthy weight Seek 20 minutes of laughter every day. Take time to relax. Do a mental exercise like listen to music, take a walk in the park, or both. Motivate Yourself!!! Maintain a spiritual self...whatever that means for you. Allow yourself to daydream If you are blue, or just don't feel right, talk to someone and get help immediately. Don't take yourself too seriously. Take time to be silly. Find Your Rainbow

Verbal or Phone Order Safety Steps

Step 1 Order is communicated verbally Step 2 Order is written down verbatim Step 3 Written order is read directly back to the person who gave it for confirmation that it is accurate

Med Errors

Know your hospital's policy for reporting the event. Report the event by the appropriate means. Notify the charge nurse, supervisor (or manager), and the physician. Meet with the appropriate staff to discuss the event. Take care of yourself (counseling, etc.). Remember that even cautious nurses make medication errors.

Transformational Leadership Theory

Leader really listens to the people they're leading First developed in the 1970's, but still in its infancy by use in health care Ability to envision some future state and describe it and inspire others so they can begin to share that vision...can put a vision into words for others to understand Leader has a strong, clear vision that has developed through listening, observing, analyzing, and finally by truly buying into the vision to dramatically change the way in which things are currently being done What most of us refer to when we talk about great leaders in our lives and in society

Born Leader/Trait Theory of Leadership

Leaders are born with certain leadership characteristics such as intelligence, alertness, dependability, energy, drive, enthusiasm, ambition, decisiveness, self-confidence, cooperativeness, and technical mastery. Also called the "Great Man" theory

Leadership

Leadership occurs any time a person attempts to influence the beliefs, opinions, or behaviors of a person or group (Hersey and Blanchard, 1988). Leadership is a combination of intrinsic personality traits, learned leadership skills, and characteristics of the situation. A leader guides people and groups to accomplish common goals. A person's behavior determines if he or she occupies a leadership position (Marquis and Huston, 2006). Leaders may not have formal authority or a title granted by the organization, but are still able to influence others.

Traditional/ Scientific Theory of Management

Manage in a way to optimize production Close following of the rules, get the job done Members of the work team don't get to have an opinion Developed during the industrial revolution, a time when there was a need to have the highest productivity level possible from each worker Dominated management thinking for almost two centuries Follows rules closely and understands the concept of the division of labor and chain-of-command structure Though has been the traditional management theory in nursing, does not always work well in health care and structure has changed to styles with more employee involvement

Precepting/ Preceptorship

Means "tutoring" and generally refers to a more formal arrangement-a clinical teaching model in which a student or new RN is assigned one-to-one with a competent, experienced RN, usually during the student's last semester of nursing school or during orientation to the job for a set period of time, with a focus on policies, procedures, and skill development. Preceptors serve as role models and precept during their regularly scheduled work hours, which is part of their work assignment. This partnership eases the student's transition from nursing school into the real-world setting and connects what the students have learned in the classroom to practice What happens when your preceptor does not share the same excitement and interest in participating in the preceptorship? What happens if your personalities don't blend? Identify and write down your issues. Share your concerns with your supervisor before talking with your preceptor. Never approach your preceptor when your emotions are running high. Arrange a time to meet with your preceptor and communicate in a professional manner. Come to the meeting with ideas for possible solutions Allow time for your preceptor to give you constructive feedback. If you are not able to work out a solution, then return to your supervisor for support and guidance.

Mentor vs Preceptor

Mentor: Occurs over time No termination date Sought out by mentee Teaches networking Shares personal experiences Experiences are personal Never really ends Preceptor: Has set time limit Termination date Assigned Occurs during orientation Assists in fine tuning skills Offers suggestions Work-related focus

E- Mentoring

Mentoring that occurs through a blended learning environment consisting of both an online component and onsite at the institution

Multicratic Management

Mix of democratic, laissez-faire and autocratic

Repetitive Motion Disorders

Task, posture, and work activities all interact Workstation ergonomics includes placement and functionality of the chairs(padded, adjustable, and good lumbar support), desks(wide and deep enough to work), and computers, keyboards, and monitors (ideally adjustable to all employees, screens 18-22 inches above the desk surface, and mouse pad placement) Poor workplace design is often a major source of repetitive motion disorders Prevention includes information and training, frequent switching between standing and sitting, and routine stretching of shoulders, neck, arms, hands, and fingers

Back Injury

More than 50% of nurses complain of chronic back pain. Many nurses transfer to a different unit or leave nursing altogether due to back injury. 4 out of every 10 nurses will have a back injury severe enough that they will have to take a leave of absence from work. Why are back injuries so common? Patient-handling tasks are repetitive and are usually done manually with very little mechanical support Lifting, transferring, repositioning, and reaching are the actions that are associated with injuries Often the patient care environment and how it is set up places the nurse at risk for injury Teaching nurses to use proper body mechanics to lift and turn patients does not result in fewer injuries (ANA, 2008) Nurses' backs age as they age, so over time the risk for debilitating injuries increases ...Put more simply risk of back injury is the nature of nursing work (constant, repetitive movements, bigger patients, poor posture) Prevention: Be aware of potential back injury risk by assessing each patient's dependency needs and abilities when deciding what assistive devices to use Never try to move, lift, or turn a dependent patient without the appropriate assistive device Know what assistive devices are available to you and learn how to properly use them Take care of your back even when young and flexible, as this may prevent a career-ending injury later in life Report any injuries immediately and follow the advice of your health care provider so that your body can properly heal Get involved on your unit and become an advocate for a safe patient-handling program The ANA "Handle With Care Campaign" raises awareness, promotes the use of ergonomic equipment and assistive devices, and encourages health care organizations to invest in a safe-patient handling program, and introduced legislation in 2008 seeking health care worker programs restricting or eliminating manual lifting of patients

Patient Safety Agencies

National Patient Safety Foundation (NPSF)- nonprofit agency that promotes safety by providing resources for both health care providers and consumers Institute for Healthcare Improvement (IHI)- nonprofit organization works to advance quality improvements and conducts seminars and conferences on safety topics Quality and Safety Education for Nurses (QSEN)- organization that has developed specific competencies to help prepare future nurses who will be needed in health care environments to improve patient safety Institute of Medicine (IOM)- nonprofit organization whose goal is to supply unbiased health information so health care providers can make informed health decisions by providing reliable research evidence To Err is Human: Building a Safer Health Care System (SEE THIS ARTICLE!!!!)

Hospital Consumer Assessment of Health Plans Survey

National program for collecting and providing health care information from a consumer perspective Patient survey developed for public reporting as a way to compare hospitals across the continuum of patient care Contains ratings of communication, responsiveness, pain management, discharge information, cleanliness and quietness of the hospital environment

Six Sigma

Newest wave of CQI strategy No more than 3.4 defects per million opportunities or 99.99966% accuracy or .00034% error Coined by Motorola Uses statistics to improve the efficiency of business processes Goal is to increase profits and reduce problems by improving standard operating procedures, reducing errors, and decreasing misuse of the system Uses DMAIC to reduce variation in practice

Skills for Nursing Leadership

Technical-clinical expertise and nursing knowledge Human-the ability and judgment to work with people in an effective leadership role Conceptual-the ability to understand the complexities of the overall organization and to recognize how and where one's own area of management fits into the overall organization (looking at the whole picture)

Performance Improvement

Synonymous with quality improvement (QI) New term now called Improvement Science Plan and documentation method that demonstrates what the standard procedures will be for nurses and others within the hospital Includes changes that have been implemented based on previous data collection Similar to the nursing process (assess, diagnose, plan, implement, and evaluate) In your time as a nursing student, what kinds of problems have you noticed on the units that might need the process of performance improvement? Nurse's Role in Improvement Science: Provide quality care that is cost-effective and meets the needs of your clients. Recognize and accept change. Use evidence-based practice to guide your current practice. Always be mindful of the current National Patient Safety Goals. Be accountable and responsible for quality care. Remember... "Quality care is everyone's responsibility."

When Nursing Team Goes Wrong

Nursing staff are unprepared or lack the intrapersonal skills needed to work with other staff members in a unified team setting. Nurses are unwilling to move in and out of leadership roles to ensure the unity of the team and best possible outcomes. Management is being pressured by upper management for faster adaptation to cost-cutting policies, which usually causes communication between management and nursing to be strained affecting the morale of the team. Nursing supervisors and administrative staff appear to support shared governance, but are unwilling to relinquish actual control of the nursing staff.

Mandatory Overtime

One way that hospitals deal with short staffing 67% of nurses have reported working some sort of mandatory or unplanned overtime per month Creates a loss of control for the nurse over the ability to schedule non-work activities Puts clients at risk due to nurse fatigue and subsequent loss of the ability to concentrate and make good decisions Once we have accepted a nursing position, we have made a commitment to the institution to provide nursing care at specified intervals and once we accept responsibility for a client assignment, we have that responsibility until either our services are no longer needed or we transfer that responsibility to someone else Does this mean we need to work beyond our capacity? Alternatives to this: Develop an on-call system that provides one or two extra nurses per shift Develop policies that limit mandatory overtime and ensure rotation among all staff Provide incentives to encourage part-time nursing staff to pick up extra time Develop creative shifts for high-activity, high-volume times (special 11am to 2pm shift for admissions and transfers) Develop processes to identify shortages with enough time to arrange coverage Reward nurses who do put forth extra effort for the organization (100$ for every 100 hours of on-call time)

Today's Work FOrce

Silent or Veteran Generation- Born between 1925 and 1942, 10% of the workforce, place a high value on loyalty, discipline, teamwork, and respect for authority, have always worked with older management and leadership styles that involved hierarchy and autocratic styles Baby Boomers- Born between 1943 and 1960, account for 45% of the workforce, "sandwich generation" caught between caring for their children and their aging parents, still products of old hierarchal management, but starting to embrace more humanistic approaches Generation X- Born between 1961 and 1977, account for 30% of the workforce, this generation saw downsizing in the 1990's when organizational loyalty did not protect workers from loss of jobs or retirement, these folks are hard workers and value portability of their career and tend to stay in a job as long as it is good for them, this group wants to work under the motivational leadership of a democratic manager, if they do not find this they tend to move on Generation Y (Generation Net, Nexters, or Millennium Generation)- Born between 1978 and 1995, makes up the largest group and accounts for 10% of the workforce, most educated group just beginning to enter the workforce, children of the baby boomers, optimistic and interactive, technology for them is as transparent as air, value individuality and uniqueness, not team players, see themselves in the driver's seat as they know work is there for them if they want it, they are not seeking the hierarchy of leadership and management as part of their employment and a new skill set will be needed to manage this group Generation Now (IGeneration)- Born between 1995 and now, have never lived without the internet and other forms of rapid communication, have never known a world without immediacy, newest group to the workforce, they want to know who, what, and why a policy was decided and they want input into the process, the way they think, act, find information, negotiate, and make decisions may make our present leadership and management approaches obsolete

Strategies for Communicating with Technology

Smart phones, I-phones, Droids OH MY!!! Do not misuse or overuse fax machines. When leaving a voice mail speak slowly and distinctly. Repeat the phone number. Do not leave callers on hold if you are using call waiting. When you call people ask if they have time to talk. If not, offer to call back at a later time. If using speaker phones, be sure to introduce all who are involved in the conversation. Include your email and fax number on your business cards. Do not send an emotional outburst in an email. Learn to use basic computer software. When you need to send a personal message, reminder, or thank you note, the most powerful way is to send a handwritten note.

When Nurses Work as a Team

Positive psychological and emotional bonds exist between the individuals of the team There are positive self-images of the group members Open and honest communication happens There are learning situations which are fun and enjoyable A mix of complementary skills and experience give strength to the overall team Supportive leadership is present Leadership responsibilities are rotated when possible

Empowerment and Self Care

Power means "to be able" Empower means to "enable" self and others to reach their greatest potential for health and well-being With empowerment comes a feeling of well-being and effectiveness Empowerment in all spheres of life including emotional, physical, mental, social, spiritual, and choice is very important

Hospital Compare

Provided through the efforts of Medicare and the Hospital Quality Alliance Consumers can compare how well selected hospitals serve to provide the care recommended to their patients, so they can make an informed decision about their health care

The Change Truck

REACT- Move out of the way. Let the truck or change pass you by. However, opportunities may be missed. DO NOT ACT- Just stand there and let the truck run you over. It will leave you behind and, more likely, in worse shape than when you started. ACT- Start running when you see it coming. Pace with it until you can decide when to jump on and steer it in the right direction you want to move. Emotional Phases of Change: Equilibrium Denial Anger Bargaining Chaos Depression Resignation Openness Readiness Reemergence

Joint Commission

The Joint Commission (TJC) is the major accrediting body for health care institutions that are Medicare- and Medicaid-funded They set the standards for safe practice and evaluate compliance Having The Joint Commission accreditation symbolizes the organization's commitment to quality Hospitals must develop a systematic approach to error reduction and to design patient care processes with safety in mind (flow, Pareto, run and line, and control charts, and histograms to display data)

Reactive vs Proactive Language

Reactive: There's nothing I can do. That's just the way I am. He makes me so mad. They won't allow that. I have to do that. I can't. I must. If only... Proactive: Let's look at our alternatives. I can choose a different approach. I control my own feelings. I can create an effective presentation. I will choose an appropriate response. I choose. I prefer. I will.

Written Order Safety Steps

Read all of the order(s). Determine whether all request forms (laboratory, medication, diagnostic test) and/or phone calls have been initiated. Review Kardex/MAR/EMR for order entries. Follow institutional policy for rechecking orders and signing off. One-time-only order- An order for a medication or procedure to be carried out only one time. PRN order- An order to be carried out when the client needs it, not on a scheduled basis. An example would be a PRN pain medication. Standing order- A physician's routine set of orders for a specific procedure or condition. For example, a surgeon may have standing orders for an abdominal surgery client. STAT order- An order that is to be implemented immediately. Usually it is a one-time order. Comes from statim which is Latin for "immediately".

Quality Improvement

Refers to the process or activities that are used to measure, monitor, evaluate, and control services, so that we can provide some measure of confidence to health care consumers Includes reports to track progress Quality circles- function along service lines, collaborating to improve care for a group of clients (Examples include surgical units and medical units where teams review specific problems each month to determine if quality care is being delivered) Quality indicator- item of concern that has come about because of a nursing practice problem (Ex. It was noticed on a unit that several urinary catheters were inadvertently pulled out-on investigation and data collection it was found out that the catheters were not being secured properly)...so the indicator is the problem Metric- the measurement of the problem using descriptors, so in the last example with urethral catheters, it would be the rate of urinary catheters not secured in place according to policy...so the metric is the measurement of the problem(Table 22-1 p. 512) Barriers: Costs (health care costs, costs of doing business, liability costs) Nurses' loyalty to old practices Unaware or unwilling to change

Five Steps to Conquering Change

Resistance "I can chart better on paper than I can on the computer." Uncertainty "Well, maybe the computer might be a little faster." Assimilation "I am starting to use the computer, but I still rely on my written notes." Transference "I wonder if I could do my care plans on the computer too?" Integration "I can't imagine how we ever charted without the computer."

Power in Management

Reward -comes from the ability to reward others for complying (money, desirable assignments) Coercive -based on fear of punishment for failure to comply (undesirable assignments, withheld pay increase) Legitimate-based on an official position in the organization (I.e. CEO of hospital) Referent-comes from the followers' identification with the leader, they are liked and admired by others (people look up to them) Expert-based on knowledge, skills, and information Information-based on a person's possession of information that is needed by others (knowing something others don't) Connection-based on a person's relationship or affiliation with other people who are perceived as being powerful (don't burn a bridge. It's who you know)

Floating

Some journal articles tell nurses to agree to float and always take an assignment Other journal articles advise nurses to go, but to only do basic nursing care and not to take an assignment Studies have not demonstrated that the risk of a less skilled nurse on a unit has contributed to client harm So which does more harm- accepting the assignment or refusing the assignment? Don't panic. Remember, you are going to help out another unit that does not have enough staff to care for their clients. Consider the unit and the type of clients on that unit. When you arrive ask for any "overflow" clients that may have needs similar to clients on your normal unit. Ask for a quick tour of the unit and the unit standards of care. Ask to be assigned to clients who are less complex, since you will be learning as you go along. Ask for help as you need it and ask whether a nursing assistant can be assigned with you. Try to enjoy your clients and appreciate the learning that is going on. Use resources to research unfamiliar client care issues. If things do not go well, report the experience to your next chain of command.

Dysfunctional Group Personalities

Self-servers- feel that rules do not apply to them; show up late; come in and out of group appearing to look preoccupied; when they do participate, their contributions are insignificant Critical conservatives- First response is usually "No, it won't work."; give lots of criticism for suggestions other than their own; it is their way or the highway; obsessively negative and fearful of changes Motor Mouths- talk just to hear themselves talk; interrupt frequently and give verbose responses; talk over others to be the center of attention Mouse- Silent observer, often fearful of making an opinion; sits quietly at meetings, nodding head at appropriate times and answering questions in one or two words; may be the best observers and listeners

Difficult People

Sherman Tanks -These are the attackers. They come out charging and are often abusive, abrupt, and intimidating. They tend to be overwhelming. Dealing with the Sherman Tanks: Do not allow yourself to be run over; step aside. Stand up for yourself. Defend yourself, but without fighting. Seek support when warranted. Give them a little time to run down and express what they may be ranting about. Sometimes you may have to be rude; get your word in any way you can. If possible, try to get them to sit down and maintain eye contact with them while stating your opinions and perceptions very forcefully. Do not argue with them or try to cut them down. When they finally hear you, be ready to be friendly. The Snipers -These are the pot-shot artists. They are not openly aggressive like the Tanks. Their weapons are their innuendoes, their digs, and their non-playful teasing all aimed to hurt you. Dealing with the Snipers: Get group confirmation or denial "Is anyone else seeing this?" Set up regular problem-solving meetings with that person. "That sounded like a put-down. Did you really mean it that way?" Constant complainers -These folks feel like they are powerless, and get attention, but seldom action, on their problem. A complainer points out problems from a very nonconstructive stance. Dealing with Constant Complainers: Listen to the complaints and acknowledge them. Paraphrase what you think the person said. Do not necessarily agree with them. Move them into a problem-solving mode. "Did I understand you to say you are having difficulty with your patient assignment?" or "Would it be helpful if I went to the pharmacy for you, so that you could complete your charting?" The Clams - They refuse to respond when you need an answer or want to have a discussion. Dealing with the Clams: Read the nonverbal behavior. Try to get them to open up by using open-ended questions and waiting very quietly for a response. Sometimes "clamming" on your part here can be helpful. Have an inquisitive, expectant expression on your face with raised eyebrows and wait for your response. ("friendly silent stare" or FSS) "This issue was very important to me. I am not going to let this issue drop. I will come back tomorrow at 2pm and talk to you." No "Thanks for coming in. Have a nice weekend. I'll see you tomorrow." kind of stuff here.

Conflict

The dissension that occurs when two or more individuals with different values, interests, goals, or needs view things from different perspectives.....there is a disagreement in points of view. Role conflict Communication conflict Goal conflict Personality conflict Ethical or Values conflict Types: Intrapersonal-Conflict that occurs when an individual in a situation must choose between two alternatives (Example: Should I complete my homework assignment or should I watch Grey's Anatomy?) Interpersonal-Conflict between two or more individuals because of differing values, goals, actions, or perceptions (Example: I am going to the movies with my friend. I want to see a horror flick and she wants to see a comedy.) Organizational Conflict- Conflict that occurs within an organization because of differing perceptions or goals (Example: Administration wants to cut costs. Staffing was cut and a new staffing schedule was devised. Staff nurses are upset with administration as they had no input in this choice.) Conflict as an RN: Quality of care Treatment decisions Family involvement Quality of parental care Staff inconsistency Positives of Conflict: Disturbing issues are brought out into the open, which may avert a more serious conflict Group cohesiveness may increase as individuals resolve issues New leadership may develop as a consequence of resolution Productive outcomes are achieved Outcomes: Win-Lose-one person obtains his or her desired result while the other person fails to obtain what is desired Lose-Lose-there are no winners, resolution is unsatisfactory to both parties Win-Win-both parties walk away from the conflict having achieved all or most of their goals or desires (obviously the most desirable)

What are National Patient Safety Goals?/NPSGs

The primary driving force for continuous quality improvement activities Set forth by The Joint Commission (TJC) in 2002 Used to address specific areas of concern regarding client safety These goals are evidence-based and are re-evaluated each year New NPSGs are announced in July and become effective Jan 1st of the following year NPSGs for various areas of health care such as ambulatory health care, behavioral health care, hospital, home care, lab services, long-term care, and office-based surgery 2017 Themes: Identify patients correctly Improve staff communication Use medicines safely Use alarms safely Prevent infection Identify patient safety risks Prevent mistakes in surgery

Time Management

Time Assessment Exercise: Make a Time Assessment Chart Isn't this a waste of time? How do you use your time? When are you most productive? What are your time savers? What are your time wasters? Be specific-record everything you do! Analyze your log You might reveal something about yourself you never knew!!!!! Will help you both as a student and as a nurse!!!! Top 10 Time wasters: 1. Management by crisis (putting out fires) 2. Inadequate planning 3. Attempting too much 4. Ineffective delegation 5. Personal disorganization 6 Inability to say no 7. Paperwork Paperwork Paperwork!!!!!!!! 8. Leaving tasks unfinished 9. Confused responsibility or authority 10. Poor communication Getting organized before the shift report: It is called lots of things... (Brain sheet, To-Do List, Worksheet) Useful tool to help you remember diagnoses, assessment data, tasks, meds, tests, orders, notes to self etc, etc, etc... (Let's face it most of us think we have a good memory until we hit the floor running!) Get the information you need to plan the care of your patients More time saving and efficient overall Prioritizing your care: Balance between patient needs, needs of the organization, and the accountability of the nurse There is a dichotomy between expected outcomes of efficiency and effectiveness and the perceived limitations of resources, including time "Who is my highest priority patient?" and plan your day around that patient Remain flexible as prioritization may change after initial assessments Patients with problems or potential problems related to the airway Patients with breathing difficulty Patients with circulation problems Patients with all other disabilities Meet physiological needs first Resolve any difficulty with oxygenation first Proceed up the triangle as you go Reprioritize as emergencies occur Allow time for planning ans establishing priorities-> complete highest priority task when possible and finish one task before staring another-> re-prioritize based upon the remaining tasks and upon new info that may have been received Organize your work by patient: THINK AHEAD "What supplies do I need to do this dressing change?" GROUP TASKS TOGETHER "Is there anything I can take to the patient's room while I do a dressing change?" MULTI-TASKING "Can I teach the dressing change while I am demonstrating it with the patient?" "Can I administer some medications?" "Can I complete an assessment?" Pain-Is your patient in pain? Position-Does your patient need assistance in changing positioning? Potty-Does the patient need assistance in toileting needs? Managing Others: Communicating and getting along with others is always a challenging task Most people are easygoing, straightforward, and supportive and add to your energy and ability to function effectively, contributing to your goal attainment Some individuals drain energy from others and from organizational accomplishments through their whining, criticizing, negative thinking, chronic lateness, poor crisis management, dependency, aggression, and similar unproductive behavior...for some it their everyday method of operating Avoidance is one strategy, learning to say "no" and assertive communication can help as well Delegating effectively: Overcome the myth of perfection Delegate stable patients and hang on to unstable, unpredictable patients Appropriate delegation of non-nursing tasks can provide the RN with additional time to dedicate to patient care which includes but is not limited to the following: Assessment, care-planning, initiation of interventions, interdisciplinary collaboration, patient and family teaching, therapeutic communication, counseling, discharge planning, and outcome evaluations. Only delegate away stable patients LPN's and CNA's can reinforce teaching Provide directions with clear expectations of how the tasks on the unit are to be performed Ensure that tasks are being performed according to standards of practice Monitor tasks being performed on the unit and intervene if necessary Evaluate the status of the patients on the unit Evaluate the performance of tasks on the unit Provide constructive feedback as necessary Reassess the plan of care for clients and modify as needed Evaluate delegation with kindness as much as possible

What to Do When Things Arent Going Your Way

Understand the chain of command at your organization. Remain calm and use your great assessment skills to determine the exact nature of your situation. Gather your facts and present your concerns to the next person in authority (charge nurse or a supervisor) in a nonthreatening manner. Ask for whatever assistance is available. If the support you receive is not appropriate, then you need to calmly tell your charge nurse or supervisor that you are going to report your concerns to the next person in charge. Document your concerns. If documentation demonstrates a continuous problem, determine the reason (staff not adequate to meet patient needs, vacancies, sick calls, assignments made incorrectly, nurses doing non-nursing tasks).

Lewin's Change Theory

Unfreezing Phase All the factors that may cause resistance to change are considered, others are sought out to determine whether they recognize a change is needed and to determine their interest in participating Moving Phase Group of individuals has been recruited to take on the responsibilities for implementing the change, sort out what must be done, who will do it, and strategies for dealing with resistance to change Refreezing Phase Plan is put into place and everyone involved knows what is happening and what to expect, the pros and cons of the new plan are recognized, and making the plan stick is the goal, in other words the change is no longer new and becomes a part of everyday life

Evidence Based Management

Using evidence-based practice for management ensures that a manager is not just managing based on conventional wisdom, but on demonstrated outcomes. If a manager is guided by the best logic and evidence and if they relentlessly seek new knowledge and insight, from both inside and outside their organizations, to keep updating their assumptions, knowledge and skills, they can be more effective (Pfeffer and Sutton, 2006) An example from the Harvard Business Review relates to the use of the stand-up meeting versus the traditional sit-down meeting and found that 34% less time was needed to make decisions

Root Cause Analysis

When errors occur, the primary cause needs to be determined so that a solution can be found Process designed for use in investigating and categorizing the root cause of events that occur Rather than placing the blame on one person, it identifies all factors leading up to the error See flow diagram on p. 505 (Nurse administers wrong dose of Versed) Med Errors: Wrong-dose errors Lack of drug knowledge Rule violations Slips and memory lapses Inadequate monitoring Misuse of infusion pumps Faulty-dose checking Failure to identify the correct drug Medication stocking problems Wrong technique System Failures: Lack of easy access to drug information Look-alike packaging Sound-alike drug names Transcription errors Lack of patient information Poor communication Distractions Interruptions Excess workloads Environmental issues Technology

Communication in the Workplace

With My Supervisor? Upward communication takes on a formal nature; keep supervisors informed, make appointments to talk over things, avoid blaming others, do not talk to your supervisor when angry, put it in writing first if it's a new idea, accept feedback, and never go above or around your supervisor With Other Nursing Personnel? Horizontal or lateral flow of information, based on a concept of equality; best done in a climate of trust and respect; nurses must see themselves as competent and worthy of being an equal; gaining self-confidence helps in this communication With Client Care Assistants? Do not give directions in the form of authoritative commands, unless there is some kind of emergency; these folks have needs for satisfaction and self-esteem too; think through what you want done step by step, give full attention to the person, give clear, simple instructions using a supportive tone of voice, ask for feedback to verify directions, and then follow-up

Workplace Violence

Workplace violence is a growing risk and the second leading cause of occupational death in the United States (Henry, 2002). Workplace violence is defined as violent acts, including physical assaults and threats of assault, directed at individuals at work or on duty. Violence is the intentional use of physical force that has a high likelihood or results in injury or death. This can include verbal abuse, threats, unwanted sexual advances, physical assault, and murder (Henry, 2002). 80% or more of nurses have experienced some sort of violence in their career. Crisis intervention programs have been created and nurses are being encouraged to participate. Nurses are being taught how to recognize signs of escalating anger and strategies to de-escalate the situation. Nurses are also being taught how to protect themselves from violence. Hospitals are instituting "code white" programs that alert a potentially violent situation.

Power vs Authority

to have power means having the ability to effect change and influence others to meet identified goals vs. ...to have authority relates to being in a position with the responsibility to act in situations for which one is held responsible within the institutional hierarchy

Those with Healthy Self Esteem

project a face, manner, and way of talking and moving that project the pleasure one takes in being alive. display an ease in talking of accomplishments or shortcomings with directness and honesty. demonstrate an attitude of openness to and curiosity about new ideas, new experiences, and new possibilities of life. are open to criticism and comfortable about acknowledging mistakes because one's self-esteem is not tied to an image of perfection. have an ability to enjoy the humorous aspects of life in one's self and others.