leadership quiz 2
manifest or overt conflict
-action is taken (withdraw, compete, debate, seek conflict resolution) -uncomfortable or reluctant to address conflict (fear or retaliation, ridicule, alienating others, feel like they do not have the right to speak up, past negative experiences with conflict situations are present) -past experiences and gender may affect how one might deal with conflict
before negotiating
-be prepared by doing your homework -determine your starting point, trade-offs, your bottom line -look for hidden agendas, both your own and the parties whom you are negotiating
perceived or substantive conflict
-can sometimes be resolved before internalized or felt -can be resolved by acknowledging potential or actual problem exists, open communication, mutual support
After negotiation
-close on a friendly note -restate the compromise -if you win more than anticipated with the negotiation, hide your astonishment -remember the result should be satisfaction by all parties -follow up formal negotiation in writing by sending a latter or memo stating what was agreed
concepts that are critical to negotiate effectively
-come prepared -appropriate negotiation strategies -closure and follow up
ways to resolve a conflict
-compromising -competing -cooperating/ accommodating -smoothing -avoiding -collaborating
latent conflict
-conditions are ripe for conflict (short staffing, rapid change) -no conflict has actually occured yet (sometimes it does not occur at all)
Managers and organization commit to planned change
-creating a logical step-by-step approach in order to accomplish the objectives is vital -requires managers to follow an 8-step process for successful implementations
in quality control, management needs to...
-determine standards that will be used -monitor the quality of the product (in healthcare organizations the product is pt care) -have to assess and promote pt satisfaction
traditionally, women view power as
-dominance vs submission -associated with personal qualities, not accomplishment -dependent on personal or physical attributes, not skills -believe they do not inherently possess power, but must rely on others to acquire it
compromising
-each party gives up something it wants -may result in a lose-lose situation -both parties should be willing to give up something of EQUAL value -becomes a win-win situation when both parties perceive they won more than the other
felt or effective conflict
-emotionalized -felt emotions: hostility, fear, mistrust, anger -perceived conflict and not feel (no emotion attached to conflict, views as a problem to be solved) -feels conflict but unaware of roots
how to bridge the power gap
-establish mutual trust -managers should be careful not to belittle, ignore, or avoid conversations with subordinates who seem disillusioned with their leader
the authority power gap
-gap that exists btwn authority and subordinate -authority has a given right to command orders -orders are not always followed -when workers do not trust their managers bc of situations in the past, the power gap widens because the person in power fails to deliver
three primary categories of conflict
-intergroup -interpersonal -intrapersonal
destructive negotiation tactics
-intimidation or manipulation -people who use these tactic make more competitive approach rather than a collaborating approach -successful managers do not use these tactics, but since others may, you should always be prepared to counter it (ridicule, ambiguous or inappropriate questioning, flattery, helplessness, aggressive takeover)
collaborating
-is the best method to resolve conflict to achieve long-term benefits bc it enhances a person's participation in decision making to accomplish mutual goals -results in a win-win situation -parties set aside their original goals and work together to establish a common goal -lengthy process so may not be the best approach
empowerment occurs when...
-leader communicate their vision -employees are given the opportunity to make the most of their talents -learning, creativity, and exploration are encouraged
how to overcome barriers to empowerment
-leaders should develop strategies at the unit level to empower staff -be a role model -assist staff in building their own personal power base -involve workers in planning/implementing change
during a negotiation, is it important to...
-maintain your composure -show good communication skills: speaking and listening, assertiveness, and flexibility -avoid using destructive negotiation techniques (intimidation/manipulation) but be prepared to counter them if they are used against you
alternative dispute resolution
-mediation -fact finding -formal arbitration -ombudsperson -due process hearings
barriers to empowerment
-not having a commitment -rapid organizational belief about authority and status -a manager's personal feelings regarding empowerment's potential effect on the manager's own power
cooperating/accommodating
-one party sacrifices his/her beliefs and allows the other party to win -the actual problem is not usually solved -the person cooperating/accommodating often expects some type of payback
strategies used during negotiation
-only use factual statements -listen carefully and watch non-verbal communication -keep an open mine -be honest -try to think of where the other party is coming from -never tell the other party what you are willing to negotiate completely -if you are confronted unexpectedly politely say: "I am sorry but I am not prepared to discuss this right now"
seeking consensus
-reaching an agreement (used for decisions that relate to a core problem or need a deep level of group support to implement successfully) -used to resolve conflicts in a group setting -requires leadership and good communication skills -time consuming
conflict aftermath
-repercussions of conflict become apparent -can be positive or negative -positive outcome: those involved believe their position was given a fair hearing -negative outcome: conflict issues may remain or return to cause more conflict -may be more significant than the original conflict if conflict has not been handled constructively
when should you negotiate as a nurse?
-salary -vacation time -travel nurse contract -overtime hourly rate -during your shift
SBAR
-situation: introduce yourself and the pt and briefly state the issue that you want to discuss (pt's condition) -background: desrcibe the background or context (pt diagnosis, admission date, medical diagnosis, and tx) -assessment: summarize the pt's condition and state what you think the problem is -recommendation: identify any new tx or changes ordered and provided options or recommendations for further action
benefits of managing conflict
-stable work environment -constructive conflict results in creativity, innovation, and growth for the workplace -decreases workplace bullying/voilence -increases patient safety
avoiding
-the parties are aware of a conflict but choose not to acknowledge it -may be identified when cost of dealing with the conflict exceeds the benefit of solving it -conflict will remain and will often re-emerge at a later time and in even more exaggerated fashion
Lewin's change theory
-unfreezing: convincing others to implement change (educating them on why the change is good) -movement: the change agent identifies, plans, and implements appropriate strategies, exceeding restraining forces -re-freezing: stabilizing the change so that it is integrated into the healthcare system (change agents must be supportive, and ready to adapt)
channels of communication
-upward -downward -horizontal -diagonal -grapevine
smoothing
-used to manage a situation, attempts to pacify the other party or to focus on agreements rather than differences -the emotional aspect is minimized -appropriate for minor disagreements
competing
-used when one party pursues what it wants at the expense of others -only one party typically wins, the competing party seeks to win regardless of the cost to others -appropriate when an individual needs to resist unsafe pt care policies or procedures, unfair treatment, abuse of power, or ethical concerns
8-step approach
1. create a sense of urgency around the need for change (# of infections r/t lack of compliance) 2. form a guiding coalition (infection control, nurse managers, unit charge nurses) 3. create a vision for change (posting signs, frequent reminders) 4. communicate the vision (installing more hand sanitizes, refilling) 5. remove the obstacles 6. create short term wins (pizza party) 7. build on the change (continue effort to reach goal) 8. anchor the changes in the corporate culture (talk about what is being done even with those not directly involved in pt care)
five stages of the conflict process (managers must assess five stages accurately before attempting to intervene)
1. latent conflict 2. perceived or substantive conflict 3. felt or effective conflict 4. manifest or overt conflict 5. conflict aftermath
three different audit types
1. outcome audits 2. process audits 3. structure audits
action plan for increasing professional power in nursing
1. place more nurses in positions that influence public policy 2. increase level of nurses' understanding regarding all healthcare policy efforts 3. build coalitions within and outside nursing 4. promote greater research to strengthen EBP 5. support nursing leaders 6. pay attention to mentoring future nurse-leaders 7. stop nurses from acting like victims
five stages of change
1. pre-contemplation 2. contemplation 3. preparation 4. action 5. maintenance
six driving forces that increase nursing power
1. right timing (entering a time where their energy and expertise are valued more) 2. sizing of the nursing profession 3. nursing referent power (high degree of trust in nurses) 4. increasing knowledge base and education for nurses (EBP is used in care) 5. nursing's unique perspective (science and critical thinking blended together) 6. desire of consumers and providers for change
quality control process
1. the criterion or standard is determined 2. info is collected to determine if the standard has been met 3. educational or corrective actions taken if the criterion has not been met
During a nursing staff meeting, the nurses resolve a problem of delayed documentation by agreeing unanimously that they will make sure all vital signs are reported and charted within 15 minutes following assessment. This is an example of which characteristics of effective communication? Select all that apply a. Group decision making b. Group leadership c. Group power d. Group identity e. Group patterns of interaction f. Group cohesiveness
A, B, C, F
What factors contribute to increase authority-power gap (Select All That Apply)? a) Lack of Trust b) Managers belittling or ignoring subordinates c) Manager communicating unreliable or incorrect information to subordinates d) Managers empowering subordinates
A,B,C
How can nurses empower each other (Select All That Apply) ? a) Sharing Knowledge b) Maintaining Cohesiveness c) Devaluing the Profession d) Supporting Each Other
A,B,D
Which of the following are Conflict Resolution Strategies? Select all that apply. A. Compromising B. Competing C. Arguing D. Smoothing E. Avoiding F. Collaborating
A,B,D,E,F
The planned change theory of Nursing was developed by Kurt Lewin, who is considered the father of social psychology. What are the three major concepts surrounding this theory? (select all that apply) A. Driving Forces B. Charisma C. Equilibrium D. Restraining Forces E. Bureaucratic change Forces
A,C,D
Katherine is a young Unit Manager of the Pediatric Ward. Most of her staff nurses are senior to her, very articulate, confident and sometimes aggressive. Katherine feels uncomfortable believing that she is the scapegoat of everything that goes wrong in the department. Which of the following is the best action that she must take? A. Identify the source of the conflict and understand the points of friction B. Disregard what she feels and continue to work independently C. Seeks help from the Director of Nursing D. Quit her job and look for other employment
A.
The nurse is calling the health care provider about a patient's changing condition. Which of the following would be included in the SBAR communication? A. Situation, background, assessment, and recommendation B. Subjective information, background, assessment, and revisions needed C. Situation, background, all vitals, and review of orders D. Summary, better plan, accurate diagnosis, and rights
A.
What is an advantage for using SBAR during staff communication? A. Improves verbal communication and reduces medical errors B. Provides a complete patient health history C. Focuses on a comprehensive physical examination D. Avoids making recommendations
A.
What is an advantage for using SBAR during staff communication? A. Improves verbal communication and reduces medical errors B. Provides a complete patient health history C. Focuses on a comprehensive physical examination D. Avoids making recommendations
A.
Which of the following is a true statement regarding negotiation in the conflict resolution process? A. Negotiation is similar to the accommodating or "smoothing" form of conflict resolution. B. Negotiation almost always leads to a win-lose situation. C. Nurses rarely use skills of negotiation, unless other forms of conflict resolution are not successful. D. Negotiation involves both parties accommodating differences.
A.
Conflict can have a positive or negative influence on those involved. A. True B. False
A. True
Planned change is (Select one): A. change that occurs during one's life cycle B. change that is intended to influence the status quo C. change that occurs as a reaction to something D. change that occurs because an organization becomes complex
B.
Which of the following describes compromising as a form of conflict management? A. Each side gives up something and no one wins or loses B. Parties work together to develop the best outcomes of the conflict C. One person cooperates and gives in to avoid hard feelings D. An obvious point is made to stop the conflict before it goes any further
B.
Which of the following statements regarding conflict is NOT true? A. Can be destructive if the level is too high B. Is not beneficial; hence it should be prevented at all times C. May results in poor performance D. May create leaders
B.
A nurse manager tells one of the staff. "I don't have time to discuss the matter with you now. See me in my office later" when a nurse asks if they can talk about an issue. Which of the following conflict resolution strategies did she use? A. Smoothing B. Compromise C. Avoidance D. Restriction
C.
A nursing student is nervous and concerned about the work she is about to do at the clinical facility. To allay anxiety and be successful in her provision of care, it is most important for her to: a. Determine the established goals of the institution b. Be sure her verbal and nonverbal communication is congruent c. Engage in self-talk to plan her day and decrease her fear d. Speak with her fellow colleagues about how they feel
C.
In what setting do we first experience power? a) School b) The Workplace c) The Home d) All The Above
C.
Katherine tells one of the staff, "I don't have time to discuss this matter with you right now. See me in my office later." Which of the following conflict resolution strategies did she use? A. Smoothing B. Compromise C. Avoidance D. Restriction
C.
Which of the following is the correct order of the conflict process? A. Perceived or Substantive Conflict, Latent Conflict, Felt or Affective Conflict, Manifest or Overt Conflict, Conflict Aftermath B. Latent Conflict, Perceived or Substantive Conflict, Manifest or Overt Conflict Felt or Affective Conflict, Conflict Aftermath C. Latent Conflict, Perceived or Substantive Conflict, Felt or Affective Conflict, Manifest or Overt Conflict, Conflict Aftermath D. Perceived or Substantive Conflict, Latent Conflict, Manifest or Overt Conflict, Felt or Affective Conflict, Conflict Aftermath
C.
Which type of power do nurses gain as they empower each other? a) Reward Power b) Charismatic Power c) Referent Power d) Legitimate Power
C.
Ms. Caputo is newly-promoted to a patient care manager position. She updates her knowledge on the theories in management and leadership in order to become effective in her new role. She learns that some managers have low concern for services and high concern for staff. Which style of management refers to this? A. Organizational Management B. Impoverished Management C. Country Club Management D. Team Management
C. Country Club Management
In most situations where change is being considered there are restraining forces to change. Which of the following is not an example of this? (Select one) A. misunderstanding of implications of the change B. failure to see the big picture C. fear that something of value will be lost D. agitation related to a new idea
D.
Which of the following is a correct definition of change? (Select one): A. Process leading to alteration in behavior B. Process of alterations in the structure of society C. Process of teaching health promotion D. All of the above
D.
How do women traditionally view power? a) Dominance vs. submission b) Associated with personal qualities, not accomplishment c) Dependent on personal or physical attributes, not skills d) Believe they do not inherently possesses power but must rely on others to acquire it. e) All the above
E.
identified three phases through which the change agent must proceed before a planned change becomes part of the system: unfreezing, movement, refreezing
Kurt Lewin in the mid-20th century
Nurse leader should understand the criteria or standards that are needed to establish quality control process. True or False
True
Leapfrog Group
a growing conglomeration of non-healthcare Fortune 500 company leaders who are committed to modernizing the current healthcare system. They have identified 4 evidence-base standards to help prevent or reduce medical errors including computerized physician-provider order entry, evidence based hospital referrals, ICU, barcoding to help reduce point-of-care medication errors
planned change
a well-thought-out and deliberate effort to make something new happen -deliberate application of knowledge and skills by a leader to bring about change
During a nursing staff meeting, the nurses resolve a problem of delayed documentation by agreeing unanimously that they will make sure all vital signs are reported and charted within 15 minutes following assessment. This is an example of which characteristics of effective communication? Select all that apply a. Group decision making b. Group leadership c. Group power d. Group identity e. Group patterns of interaction f. Group cohesiveness
a,b,c,f
The nurse is calling the health care provider about a patient's changing condition. Which of the following would be included in the SBAR communication? a. Situation, background, assessment, and recommendation B. Subjective information, background, assessment, and revisions needed C. Situation, background, all vitals, and review of orders D. Summary, better plan, accurate diagnosis, and rights
a.
The six aims for improving quality health care as directed by the Institute of Medicine include safe, effective, patient-centered, timely, efficient, and ______ a. Equitable b. Alternative c. Naturalistic d. Holistic
a.
There are hallmarks that are associated with effective quality control programs. Select those hallmarks from the following list: a. Administration support, organizational support, process is ongoing b. Organizational support, community support, fiscal support c. Fiscal support, administrative support, annual process d. Annual process, community support, organizational support
a.
stages of change: refreezing
after the change had been implemented, supporting others so that the change continues
passive-aggressive communication
aggressive communication that is presented in a passive way. normally involves limited verbal exchange. over time this type of communication damages relationships and respect.
in the early 20th century, conflict was originally viewed as..
an indication of poor organizational management
referent power
association with others or what leader symbolizes
diagonal communication
between individuals at differing hierarchy levels and job classifications (this is when everyone on the healthcare team is communicating with one another for continuous patient care)
A nurse is delegating to the LPN to help grab her supplies for a sterile dressing change. What type of communication is this? a. Horizontal b. Upward c. Downward d. Diagonal
c.
A nursing student is nervous and concerned about the work she is about to do at the clinical facility. To allay anxiety and be successful in her provision of care, it is most important for her to: a. Determine the established goals of the institution b. Be sure her verbal and nonverbal communication is congruent c. Engage in self-talk to plan her day and decrease her fear d. Speak with her fellow colleagues about how they feel
c.
maintenance
change is maintained and relapse is avoided
communication must be...
clear, simple, precise
one of the most critical leadership skills
communication
assertive communication
communication that is direct, honest, and appropriate... that does not infringe on another person's rights
opposite of competing
cooperating/accomodating
optimal goal in conflict situations
creating a win-win for everyone involved in the conflict (although not always possible)
barriers to communication
culture, gender, power, status
Nurse leaders need to understand that in order to be effective, the quality control process must be________. a. Cyclical b. Formative c. Reflective d. Ongoing
d.
Which of the following is considered nursing leadership roles in regards to quality control? a. Selects and uses quality control tools b. Establishes measurable patient outcomes c. Uses findings to determine educational staff needs d. Embraces, supports, and champions the quality improvement process
d.
outcome audits
determine what results (if any), followed from specific nursing interventions for patients. these audits assume that the outcome accurately demonstrates the quality of care that was provided.
stages of change: movement
developing a plan, setting goals and objectives, identifying areas of support and resistance, including everyone who will be affected by the change in its planning, setting target dates, developing appropriate strategies, implementing the change, being available to support others and offer encouragement through the change, using strategies for overcoming resistance to change, evaluating the change and modifying it if necessary
aggressive communication
direct, threatening, and condescending. infringes on another person's rights, or personal space
A nurse is delegating to the LPN to help grab her supplies for a sterile dressing change. What type of communication is this? Horizontal Upward Downward Diagonal
downward
negotiation
each party gives up something, and the emphasis is on accommodating differences between the parties (similar to collaboration)
charismatic power
employs the use of charm to engage an audience and gather a following
horizontal communication
from peer to peer (form nurse to nurse)
upward communication
from subordinate the superior (UAP letting the nurse know something is wrong with their patient)
downward communication
from superior to subordinate (nurse delegating to the UAP)
expert power
gained through knowledge, expertise, and experience
stages of change: unfreezing
gathering data, accurately diagnosing the problem, deciding if change is needed, and making other aware of the need for change
SBAR
gives a structured, orderly approach in providing accurate, relevant information in emergent patient situations as well as routine handoffs
contemplation
individual considers making change
action
individual modifies his or her behavior
grapevine communication
informal, haphazard, and random, usually involving small groups (this is usually when errors occurs bc the message is not value or seen as important)
conflict
internal or external discord that results from differences in ideas, values, or feelings btwn two or more people
power is neither good nor evil...
it is what purpose it is used for that matters
__________ is key in helping inspire subordinates to establish and achieve high standards of care
leadership
standards in quality control must be developed first and foremost
measuring performance is impossible if standards are not clearly established
adverse events that could be prevented given the current state of medical knowledge
medical errors
the most common type of medical error and are a significant cause of preventable adverse effects
medication errors
structure audits
monitor the structure or setting in which pt care occurs (such as the finances, nursing service structure, medical records, and environmental structure)
sentinel event
nation's most comprehensive databases of serious adverse event by healthcare professionals and their underlying causes such as death, permanent harm, and suicide
pre-contemplation
no current intention to chnage
quality improvement
on-going process to continuously improve the quality of patient care and patient outcomes
the healthcare culture needs to switch from a culture of blame to..
one in which errors are identified and responded to in a timely manner
legitimate power
power obtained by title or official position
the communication process
sender --> message --> receiver
conflict is viewed as...
something that should not be avoided or encouraged, but rather managed -the leader must create a work environment that can turn conflict into a source of growth, productivity, and innovation
when negotiating a salary, should you start high or low?
start high
if either party become angry during the negotiation, it is important to...
take a break
coalition
the "team" that is going to oversee the implementations and overall change
reward power
the ability to grant favors or reward with whatever they value
power
the capacity to act or the strength and potency to accomplish something
corporate culture
the facility or organization
our first experience with power usually occurs in..
the family unit...power may be feared, worshiped, mistrusted, a positive or negative familial power experience may greatly affect a person's ability to deal with power system during adulthood, and having power gives one the potential to change the attitudes and behaviors of individual people and groups
in the mid 20th century..
the importance of worker satisfaction and feedback was recognized and conflict was viewed as producing growth
National Database of Nursing Quality Indicators
the largest provider of unit-level performance data to hospitals (ANA, 2014), allowing them to develop more effective, finely targeted improvements and also helping them to understand the relationship between the nursing-sensitive quality indicators, staffing data, and RN survey data
informational power
the need for information, have information that others need to accomplish their goal
what does quality control provide managers with?
the opportunity to evaluate organizational performance from a systematic, scientific, and objective viewpoint.
coercive power
the opposite of reward power, based on fear of punishment if expectations are not met
authority
the right to command
preparation
there is intent to make change in the near future
when a party loses in a competition...
they usually feel angry, frustrated, and wanting to get even
the empowerment of staff is a hallmark of ________ leadership
transformational
process audits
used to measure the process of care or how the care was carried out and assume that a relationship exists btwn the process used by the nurse and the quality of care provided.
Patient Safety and Quality Improvement Act
was signed into law in 2005, protects medical error information voluntarily submitted to private organizations (patient safety organizations) from being used in legal discovery and generally requires that the information is treated as confidential.
passive communication
when a person suffers in silence, even if they feel strongly of an issue. these people avoid conflict, and bottle up feelings that may lead to an eventual explosion
when can conflict occur in the communication process?
when the receiver does not fully understand the message the sender is presenting
three different ways the message can be sent in the communication process
written, nonverbal, verbal
what is the one main thing you should keep in mind when communicating?
your audience
