Management: Final exam
Medicare
- "caring for elderly population" - For individuals older than 65 and for certain groups with catastrophic or chronic illness (Elderly, disabled, and renal dialysis patients are most common)
transactional leadership
- "give and take" - leadership based on an exchange process in which followers are rewarded for good performance and punished for poor performance
Continuous Quality Improvement (CQI)
- "keep on keeping on" - Based on the premise that the individual is the focal element on which production and service depend - Focus is on doing the right things, the right way, the first time, and problem-prevention planning, not inspective and reactive problem solving
What guides policies?
- Basic standard of care - Accrediting body's standards (JACHO) - Authoritative standards (ANA, AACN- American Association of critical care-nurses, etc.) - State and Federal guidelines Evidence based practice
what are the characteristics of sherman tanks?
- Bramson (1981) "Sherman Tanks" - Strong need to prove themselves right - Very confident - Devalue those who are not confident; do not value people who are not like them - Often demean others - Very opinionated, very direct, assertive
what are the common outcomes of conflict on a team?
- Disturbing issues brought out into the open may avert more serious conflict. - Group cohesiveness may increase as individuals resolve issues. - New leadership may develop as a consequence of resolution. - Results of conflict can be constructive, as occurs when productive outcomes are achieved, or they can be destructive, leading to poor communication and creating dissatisfaction
how do we deal with snipers?
- Expose them, "smoke them out" - Get group confirmation or denial when criticized - Never let them see the injury - Prepare, prepare, prepare
what are the characteristics of complainers?
- Feel powerless - Need attention but not action - Points out problems from a non-constructive stance
Medicaid
- Financially indigent is primary population - Majority of recipients are women and children - Administered by states under broad federal guidelines - Covers about 17% of US population - Medical and long-term care coverage for people with disabilities and assistance with health and long-term care expenses for low-income seniors - Health coverage for low income; disability, elderly, pregnant women, children, impoverished - Some states cover all adults below a certain threshold; depends on state
industrial age leadership
- Focuses on outcomes - focused mainly on traditional hierarchical management structures, skill acquisition, competition, and control (the same skills traditionally associated with management)
Relationship Age Leadership
- Focuses on people - focuses primarily on the relationship between the leader and his/her followers, on discerning common purpose, working together cooperatively, and seeking information rather than wealth
how do we deal with sherman tanks?
- Keep fear and anger under control - Avoid an outright confrontation - Step aside; do not be run over - Defend yourself w/o fighting - Politely but firmly cut them off - Maintain eye contact - Body position—get them to sit down
how do we deal with complainers?
- Listen to the complaints - Acknowledge their concerns - Paraphrase or restate for clarification - Move into a problem-solving mode
magnet hospitals
- Magnet designation is conferred by the ANCC to health-care organizations that exemplify five model components: transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovation, and improvements; and empirical quality results - Nurse-focused/nurse-driven - Gives nurses opportunity for certifications, conferences, classes, etc.
Leadership Styles: Laissez-faire
- No direction - Hands-off approach - Permissive, little to no control - Motivates by support when requested by the group or individual - Provides little or no direction - Upward and downward communication - Disperses decision making throughout the group - Places emphasis on group - Does not criticize - If group self-motivated and self-directed, can be productive but if not can be frustrating - Appropriate when problems poorly defined, and brainstorming is needed to generate alt solutions
Best responses during a job interview
- Prepare questions (benefits, education, loan forgiveness, etc) - Do NOT ask questions that are answered on the facility website - Do NOT ask about salary avoid answering personal questions, keep a neutral space, and do not volunteer personal details
incident reporting
- Quality improvement - ***DO NOT GO IN THE PATIENT CHARTS*** - location & who was involved: finished report goes to every unit involved
how do we deal with clams?
- Read nonverbal communication - Use open-ended questions - Wait for a response; "clam up" - FSS (Friendly Silent Stare) - Be attentive when they communicate - Avoid polite ending - Use "out of the box" strategies
what are characteristics of clams?
- Refuse to respond when answer or discussion needed - "maddening" behavior
What is the purpose of policies and procedures?
- To facilitate adherence with recognized professional practices. - To promote compliance with regulations, statues, and accreditation requirements (ex: HIPAA, EMTALA, CMS, and join commission) - Reduce practice variation - Standardize practices in a health care system - Resource for staff, particularly new staff - Reduce reliance on memory
what are the characteristics of snipers?
- Weapons: innuendos, digs, non-playful teasing - Hidden attack rather than frontal - Mean to make you look ridiculous - "PASSIVE-AGGRESSIVE"
list an example of an Sentinel Event
- falls - baby being taken - etc.
Six Sigma
- is a method of improvement that strives to decrease variation and defects - quality improvement and INCREASING PROFIT*
What is important about informed consent?
- must have informed consent before procedures - IF you are BUSY (say hanging blood...), THEN get another nurse to obtain consent. - WE DO NOT DO ANYTHING WITHOUT OBTAINING CONSENT FIRST!
leadership style: autocratic
- strong control is maintained by coercion - others motivated by coercion - others directed with commands - communication flows downward - decision making doesn't involve others - emphasis on difference in status (I & you) - criticism is punitive (punishment) - well defined group actions that are predictable, reducing frustration and giving sense of security - productivity high, creativity, self-motivation and autonomy reduced - found in large bureaucracies such as armed forces
what are quality improvement methods (QI)?
- total quality management (TQM) (*same as CQI) - toyota production system (TPS): consumer focused quality improvement
what are the barriers to quality improvement (QI)?
1. Cost- quality costs only focus on the cost to the organization*** 2. Tradition- change is hard but necessary 3. Organizational Values- fire prevention vs. firefighting
According to Quality and Safety Education for Nurses (QSEN), which phrase defines patient-centered care? A. Understanding that the client is the source of control when providing care B. Functioning effectively within nursing and interprofessional teams to deliver quality care C. Using data to evaluate outcomes of care processes and designing methods to improve health care D. Minimizing the risk for harm to clients and health care workers through improved professional performance
A
After a nurse leader teaches organizational behavior modification (OB Mod) theory of leadership to a group of new nurses, which statement made by a new nurse indicates effective learning? A. "I should use punishment sparingly." B. "I should motivate staff by providing the hierarchy of human needs." C. 'I should use motivator factors liberally to inspire work performance." D. "I should assess each situation and determine action based on the pessle involved."
A
After the nurse manager teaches the principles of quality management and improvement, which participant's statement indicates ineffective learning? A. Managers define the quality." B. Decisions should be based on data." C. Quality improvement focuses on outcomes." D. Managers and workers must be committed to quality improvement."
A
The nursing manager issued orders to take the utmost care of a client with myocardial infarction and expects the staff to obey and follow the rules immediately. Which type of decision-making is the manager using? A. Autocratic B. Optimizing C. Laissez-faire D. Bureaucratic
A
Which type of quality improvement would the nurse manager utilize when gathering data from different care providers and comparing methods to plan a counseling center for clients in the outpatient department? A. Benchmarking B. Risk management C. Quality management D. Performance improvement
A
Which type of relationship between the nurse delegator and delegate causes the nurse delegator to use the leadership behavior of "telling?" A. Limited B. Established C. New or developing D. Developing or ongoing
A
The nurse manager shares experiences faced during the journey to leadership with other staff members. Which statement made by the nurse manager appropriately describes barriers faced during the leadership journey? Select all that apply. One, some, or all responses may be correct. A. "Leadership requires a time commitment." B. "The title doesn't guarantee good leadership." C. "Leadership requires a mentor who offers advice and criticism." D. "The concept of leadership involves sharing rewards with the other team members. E. "Leadership mandates leaders take responsibility for an activity with a low-outcome achievement."
A, b
Which statement correctly indicates a similarity between evidence-based practice and quality improvement? Select all that apply. One, some, or all responses may be correct. A. Nurses conduct the activities in both. B. Funding resources are internal in both. C. The effects of the practice are measured in both. D. Expert opinions are the data resources in both. E. Institutional Review Board approval is needed for both.
A, b
According to theories of transformational leadership, which characteristic would the nurse leader possess? Select all that apply. One, some, or all responses may be correct. A. Empowering staff B. Creating enthusiasm for practice C. Promoting scholarship of practice at the client side D. Providing specific feedback about positive performance E. Using positive reinforcement to motivate followers to repeat constructive behaviors
A, b, c
The nurse is caring for an obese client with diabetes mellitus. Which nursing action satisfies the Quality and Safety Education for Nurses (QSEN) competency called teamwork and collaboration? Select all that apply. One, some, or all responses may be correct. A. Engaging the physical therapist in managing the client's condition B. Explaining the client's medication routine to the next shift nurse C. Consulting with the dietician to help manage the client's condition D. Consulting old records of similar client cases before preparing a care plan E. Documenting in the electronic health record after administering every medication
A, b, c
To decrease hospital readmissions for heart failure clients, which action would the nurse manager employ during implementation and evaluation of a quality improvement project? Select all that apply. One, some, or all responses may be correct. A. Meeting regularly with staff throughout project implementation B. Using readmission data for heart failure clients to evaluate project effectiveness C. Collaborating with staff to address continuing high readmission rates post-project implementation D. Ensuring that staff are provided time to participate in development and implementation of the new project E. Coaching staff on effective implementation of the transition of care for heart failure clients being discharged
A, b, c, d, e
Which power strategy would nurse leaders use? Select all that apply. One, some, or all responses may be correct. A. Accept responsibility for one's mistakes. B. Give credit to others where credit is due. C. Learn to be uncomfortable with conflict and ambiguity. D. Use business cards when introducing yourself to new contacts. E. Develop the ability to let constructive criticism roll off your back.
A, b, d
Which strategies will promote safety and quality of client care on the unit? Select all that apply. One, some, or all responses may be correct. A. Communicate with clarity and precision when designing multidisciplinary plans of care. B. Create a safety huddle so all health care professionals are aware of the clinical objectives. C. Emphasize electronic communication is quick and most effective means of sharing information in all situations. disciplines. D. Conduct communication simulations to increase knowledge about expertise of other health care E. Explain effective communication will take more time and effort compared with ineffective communication.
A, b, d
Which quality would the nurse need to possess to successfully fulfill the role of leader for a nursing unit? Select all that apply. One, some, or all responses may be correct. A. Having adaptability to hospital rules B. Encouraging the newly appointed nurses C. Penalizing the nurses for poor performance D. Doubting the health care staff performances E. Being aware about the events of the organization F. Collaborating with the staff for decision-making
A, b, e, f
Which action by the nurse manager best accords with the transformational style of leadership? Select all that apply. One, some, or all responses may be correct. A. Providing intellectual stimulation B. Intervening only when problems exist C. Performing experiments with system redesign D. Using motivation to inspire work performance E. Monitoring performance and taking corrective action
A, c, d
Which point would the nurse consider while preparing strategies to improve the quality of health care provided by the nursing team in the hospital? Select all that apply. One, some, or all responses may be correct. A. Determine the root causes of the adverse events. B. Focus chiefly on the process of the care delivery system. C. Ensure that all adverse events are well documented. D. Be prepared to deal with events that may cause harm to a client. E. Use failure mode effective analysis to assess the root cause of a sentinel event.
A, c, d
Which statement supports the premise, "In today's workplace, female-male collaboration should provide efficacious models for the future"? Select al that apply. One, some, or all responses may be correct. Select all that apply A. Men and women must learn to work together. B. Male managers make decisions on limited data. C. Women are better at deciphering what needs to be done. D. Male managers have a more participative management style. E. Women and men bring separate perspectives to resolving problems.
A, e
A client says, "None of the medications will work on me because I am away from my holy land. Which course of action would the nurse take to comply with teamwork and collaboration competency according to the Quality and Safety Education for Nurses (QSEN)? A. Provide care to the client with respect to diversity, values, and beliefs. B. Approach the agency chaplain to discuss the spiritual needs of the client. C. Conduct thorough research on the effect of emotional distress on the client's health. D. Use the flow chart data to provide the best care and monitor the outcome of care processes.
B
A registered nurse notices that the insertion site of a client receiving intravenous medication is swollen. The nurse takes appropriate measures to treat the area and takes a photo of the insertion site and saves it in the client's electronic health record. Which Quality and Safety Education for Nurses (QSEN) competency is the nurse following? A. Safety B. Informatics C. Patient-centered care D. Teamwork and collaboration
B
How often should a health care facility that is loint Commission accredited plan to test the emergency preparedness plan? A. Annually B. Twice a year C. Every 2 years D. Every 3 months
B
The registered nurse (RN) finds that the delegatee is scheduled to work for half a day in the health care unit. Which leadership style is most appropriate in this situation? A. Selling B. Telling C. Delegating D. Participating
B
The unlicensed assistive personnel (UP) is delegated a task that can be completed in 2 hours. The UAP has limited knowledge and willingness regarding the specific task. Which leadership style would be implemented by the delegator in this situation? A. Selling B. Telling C. Monitoring D. Participating
B
When the nurse leader teaches about the quality assurance (QA) process, which statement made by a participant indicates ineffective learning? A. The goal is to improve quality." B. The major task is staff development." C. The focus is on discovery and correction of errors." D. The outcomes are set by the QA team with input from staff.
B
Which action would the nurse consider an example of quality improvement by a team of nurses? A. Designs a strategy for improving the technique of administering injections B. Identifies the possible reasons for the delays of client admission into special units C. Implements a new system for following aseptic techniques during wound debridement D. Nurses evaluate the effectiveness of initiating weekly professional training programs
B
Which information is appropriate to include in education about sentinel events? A. Causes moderate harm to the client B. Undesirable and largely avoidable C. Effect is mitigated by interventions D. Very common in hospital settings
B
Which statement made by the nurse is true regarding Hersey's Situational Leadership Model? A. The situational leadership model cannot be applied to real work-related situations. B. The situational leadership model provides a solid foundation for delegation decisions. C. The situational leadership model does not relate to the behavior of the delegate during delegation. D. The situational leadership model contends that managers should not behave differently on different occasions.
B
When the nurse manager monitors employees' performance and takes punitive action when necessary, which outcome would the organization expect with this type of leadership? Select all that apply. One, some, or all responses may be correct. A. Increased loyalty B. Adherence to deadlines C. Increased performance D. Limited job satisfaction E. Low-to-stable levels of commitment
B, D, E
To implement strategies for improving the quality of an organization, the nurse leader would use which tactic? Select all that apply. One, some, or all responses may be correct. A. Participate actively in quality improvement activities B. Set priorities for staff effectiveness and client health outcomes C. Provide support systems for staff who have been involved in a sentinel event D. Build infrastructure, providing resources, and removing barriers for improvement E. Meet regularly with staff to monitor their progress and help them improve their work
B, c, d
The nurse recognizes that which advisory bodies aim to improve the quality, safety, efficiency, and effectiveness of health care? Select all that apply. One, some, or all responses may be correct. A. The Joint Commission (TJC) B. Institute of Medicine (10M) C. National Quality Forum (NQF) D. National Center for Nursing Quality (NCNQ) E. Centers for Medicare&Medicaid Services (CMS) F. Association for Healthcare Research and Quality (AHRQ)
B, c, d, f
In reviewing Hersey's situational leadership model, which factors explain ability and willingness? Select all that apply. One, some, or all answers may be correct. A. Willingness relates to knowledge and skills in a specific situation. B. An individual's ability does not change from one moment to the next. C. An individual's willingness can fluctuate from one moment to another. D. Ability relates to the individual's attitude and commitment toward a specific situation. E. Ability and willingness need to be assessed to determine the level of the filower's readiness.
B, c, e
According to Kouzes and Posner, in which key practice of transformational leadership would the nurse engage with the staff? Select all that apply. One, some, or all responses may be correct. A. Engaging in self-renewal B. Taking an active role in the work of change C. Seeing things as greater than the sum of the parts D. Bringing everyone together to move toward a goal E. Encouraging people by giving attention to personal things that are important
B, d, e
An organization was suffering financial losses from poor work flow when leadership publicly reognized a team member's creative solutions. Which leadership theory is at work in this scenario? A. Trait theory B. Style theory C. Transformational theory D. Situational-contingency theory
C
The nurse is working in a hospital that receives most of its payment from Medicare and Medicaid services. In the annual assessment of The Joint Commission, the hospital had not met all the standards set forth in the Centers of Medicare and Medicaid Services. Which action would the nurse expect to be taken? A. The Centers of Medicare and Medicaid Services will stop paying the hospital. B. The hospital will lose its accreditation given by The joint Commission. C. The Joint Commission would conduct an unannounced follow-up survey in the hospital. D. The Centers of Medicare and Medicaid Services will conduct a follow-up survey in the hospital.
C
The statement "Effective leadership depends on the executive nurse's interpersonal skills" is an emphisis for which theoretical approach? A. Hierarchy of needs B. Transformational theories C. Situational-contingency theories D. Organizational behavior modification (OB Mod) theory
C
When the registered nurse (RN) motivates a new nurse to use the complexity principle known as leadership "tag," to which explanation would the RN refer? A. Value human resources with a rich perspective B. Shape policy and practices that affect client care C. Be philosophic, client-centered, and values driven D. Unleash constructive energy rather than constraining energy
C
Which course of action would the nurse take to adhere to the Quality and Safety Education for Nurses (QSEN) competency called evidence-based practice when caring for a client who lost both feet in an accident? A. Check whether the client prefers artificial limbs or crutches. B. Work with the physical therapist to enhance the client's remaining limb function. C. Refer to medical textbooks to understand the psychological effects of loss of limbs. D. Use data gathered from previous cases to determine the best approach for delivering care.
C
Which decision-making style did the nurse leader, as a manager, use when making a decision about the method of documentation because of the benefits for the nursing team? A. Autocratic B. Informative C. Paternalistic D. Shared decision-making
C
Which effect on followers often results from a nurse leader using a transactional leadership style? A. The followers will have increased self-worth. B. The followers will develop a sense of being valued. C. The followers will correct errors in a reactive manner. D. The followers will perform challenging and meaningful work
C
Which leadership theory behavior did the leader demonstrate when providing specific feedback regarding positive performance to subordinates? A. Trait theory B. Two-factor theory C. Expectancy theory D. Situational-contingency theory
C
Which nursing behavior is essential when working with leadership personnel during the activation of the emergency preparedness plan? A. Triage B. Assessment C. Collaboration D. Resource management
C
Which objective is the most important prerequisite for measuring health care quality delivered in the hospital? A. To implement the root cause analysis tool B. To review all the incident reports documented C. To collect all the medical records of the hospital D. To prepare nurse performance evaluation forms
C
Which response would the administrator of a community hospital consider implementing to help improve outcomes for emergency department visits caused by adverse weather events ? A. Interprofessional team B. Monthly data collection processes C. Permanent quality improvement (Ql) team D. Evidence-based practice research guidelines
C
Which situation describes a possible consequence of negligence by the health care facility for failing to follow regulations set by The Joint. Commission (TJC)? A. Pay a large-dollar-amount to T]C B. Cannot provide treatment to psychiatric clients C. Receive a condition-level deficiency certificate D. No funding from Medicaid and Medicare
C
Which statement would the nurse leader associate with the satisficing decision model? A. The satisficing decision model involves shared decision-making. B. A decision is made by analyzing pros and cons associated with each option. C. The model allows for a quick decision, which is important when lack of time is an issue. D. Satisficing is more appropriate when conflict is likely to occur or when the problem is unstructured.
C
Which theory holds that leaders act as change catalysts and innovators? A. Role theory B. Trait theory C. Quantum theory D. McGregor's Theory X
C
According to Kouzes and Posner, which key practice involves a leader taking an active role in the work of change and creative thinking about new solutions? Select all that apply. One, some, or all responses may be correct. A. Inspiring B. Enabling C. Modeling D. Challenging E. Encouraging
C, d
The nurse caring for a client postsurgery takes necessary steps to achieve quality client care. Which nursing action satisfies the Quality and Safety Education for Nurses (QSEN) competency called informatics? Select all that apply. One, some, or all responses may be correct. A. Washing the hands before handling the client's incision site B. Implementing a new method of monitoring the client's incision site for infection C. Documenting in the electronic health record (EHR) after performing wound debridement D. Locking the electronic health record (HR) after every entrance of necessary information E. Using a computer-assisted instruction (CAI) program to provide better quality of care to the client
C, d, e
Describe CUSS communication
C: concerned U: uncomfortable S: safety issues
Satisficing
Choosing an option that is acceptable, although not necessarily the best or perfect (often used on a time crunch)
In which way are the quality improvement (Ql) processes important for the nurse leader to execute with a team? A. Ql processes involve chart audits. B. The processes inspect nursing activities. C. Ql helps discover and correct errors. D. The processes review the nursing activities.
D
Upon receiving a complaint from a client about a staff member being rude when providing care, the nurse manager, rather than punishing the staff member, listens to the nurse's side of the story and then talks to the client to clarify the misunderstanding. Which leadership theory did the nurse manager utilize in this scenario? A. Trait theory B. Two-factor theory C. Expectancy theory D. Situational-contingency theory
D
When examining a health care organization under the rubric of The Magnet Recognition Program's® 14 forces of magnetism, the nurse would review the structural empowerment of the organization for which force of magnetism? A. Quality of care B. Quality improvement C. Interdisciplinary relationships D. Personnel policies and programs
D
Which action by the nurse leader is an example of transactional leadership? A. Accounting for the needs and abilities of individual employees B. Encouraging the novel and innovative thinking of employees C. Motivating employees by articulation of an inspirational vision D. Inspiring the self-interest of employees by offering external rewards
D
Which action, if taken by a nurse manager, would indicate that the manager is also functioning as a nurse leader? A. Implementing best management skills when hiring employees B. Having financial accountability associated with the organization C. Screening effectively to select the right employees for the organization D. Helping employees reach the highest level of their potential excellence
D
Which behavior demonstrated by the nurse leader exhibits charismatic leadership qualities? A. Using a shared vision as a core of leadership B. Encouraging innovation and creativity in solving a problem C. Approaching a situation with the transactional leadership style D. Possessing an inspirational quality that attracts team members
D
Which statement characterizes the use of a "satisficing" decision-making model by the nurse leader? A. Analytic tools are used to make the decision. B. The decision is made using agency policies and procedures. C. Expert opinion and stakeholder views are used to inform the decision. D. An acceptable solution that minimally meets the decision objective is identified.
D
Who founded quality improvement (QI)?
Edward Deming
living will
a written statement detailing a person's desires regarding their medical treatment in circumstances in which they are no longer able to express informed consent. (advanced directive)
smoothing
an individual attempts to reduce the emotional component of the conflict - rarely results in resolution of actual conflict
assault
conduct that makes a person feel fearful and produces apprehension of harm
ethical/values conflict
different types of nurses have different value systems
outcomes of conflict: compromising
each party gives up something it wants - often a lose-lose situation unless each party willing to give up something of equal value; in order to be win-win both parties must feel like they have won more than the other
communication conflict
failing to discuss differences with one another can lead to problems with communication
what are symptoms/signs of reality shock?
feeling unprepared, agitation, restlessness, wishing to start over, unable to see themself as nurse, wishing they were different, thinking about dropping out
what was Edward Deming's focus?
focused on individual and that quality can always be improved
Root Cause Analysis (RCA)
help to identify not only what and how an event happened but also why it happened, with the end goal being to ensure that a preventable negative outcome does not recur
What are the phases of reality shock?
honeymoon, shock and rejection, recovery
Describe aggressive communication
individuals express their feelings and opinions and advocate for their needs in a way that violates the rights of others ex: "this is all your fault", "Do what I say", "You never do anything right"
transformational leadership
leadership that generates awareness and acceptance of a group's purpose and mission and gets employees to see beyond their own needs and self-interests for the good of the group
outcomes of conflict: competing
one party peruses what it wants, regardless of the cost to others - used when one party has more knowledge about topic than other
outcomes of conflict: cooperating/accommodating
one party sacrifices his or her benefits and want to allow the other party to win - **opposite of competing - Loser wants accommodation of the winning party in the future, may cause resentment in future
avoiding
parties are aware of a conflict but choose to not acknowledge it or attempt to resolve it - used when cost of dealing w conflict exceeds the benefit of solving it
moral hazard
people over utilizing medical care bc they have insurance that will cover a specific cost
personality conflict
personalities clash
goal conflict
placing personal achievement and advancement above everyone else's can create conflict
change strategies: rational-empirical
provide evidence or factual information as evidence of the need for change - Used when there is little anticipates resistance or when the change is perceived as reasonable
Quality and Safety for Nurses (QSEN)
provides quality and safety education for nurses
what does the joint commision (TJC) mandate?
quality outcome measures
How do you avoid burnout?
self care activities and holistic self assessment tool
Describe assertive communication
standing up for your own rights and rights of others ex: "I" statements
What type of interview is the best predictor of job performance?
structured- type of interview that relies on a set of standardized and premeditated questions in order to gather information
what are Sentinel Events?
unplanned or unexpected occurrences whether that is death or harm
change strategies: Normative-Reeducative
use group norms and peer pressure to socialize and influence people so that change will occur - Does not require change agent to have a legitimate power base; he/she gains power by skill in interpersonal relationships
How does one recover from reality shock?
use mentors, physical activity, hobbies, and support networks
role conflict
when 2 people have same or related responsibilities with ambiguous boundaries
what is the role of the joint commission (TJC)?
- Accreditation is required to receive government funding (CMS) - Requires error reduction and design of safe patient care processes (QI) - Ensures patient safety
**what are the joint commision (TJC) core measures?
- Acute MI - PNA (community acquired) - HF (CHF) - surgical care improvement
manager
- Always assigned position within an organization - Legitimate source of power d/t the delegated authority that accompanies their position - Expected to carry out specific functions - Emphasize control, decision making, decision analysis, and results - Manipulate people, the environment, money, time, and other resources to achieve organizational goals - Have greater formal responsibility and accountability for rationality and control their leaders - Direct willing and unwilling subordinates
list some common causes of conflict?
- Poor communication - Inadequately defined organizational structure - Individual behavior (incompatibilities or - disagreements based on differences of - temperament or attitudes) - Unclear expectations - Individual or group conflicts of interest - Operational or staffing changes - Diversity in gender, culture, or age
leadership style: democratic
- a little direction, but mostly hands-off - less control maintains - economic and ego awards used to motivate - others are directed through suggestions and guidance - communication flows up and down - decision making involves others - emphasis on "we" - criticism is constructive - appropriate for groups who work together for extended periods, promotes autonomy and growth in individual workers - effective when cooperation and coordination between groups necessary - less efficient quantitatively than authoritative (take more time bc more people have to be consulted)
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
- compares quality of care in healthcare organizations - survey is the first national, standardized, publicly reported survey of patients' perspectives of hospital care. It measures recently discharged patients' perceptions of their hospital experience. 1. helps the consumer choose facilities they wanna go to 2. forces facilities to improve their standards 3. baseline measure from facility to facility
Leader
- empower others; maximize workforce effectiveness - Needed to implement the planned change that is part of system improvement - Art of getting things done through others willingly - In the front, moving forward, taking risks, challenging the status quo - not a job title, person's behavior determines if he/she is a leader, not a job title - Often do not have delegated authority, obtain power through other means - Wider variety of roles than manager and may have diff personal goals - Frequently not part of the formal organization - Focus on group process, information gathering, feedback, and empowering others - People follow leaders by choice, not bc they have to
malpractice
- unintentional tort (NO INTENT BUT DO HAVE HARM) Elements involved: - You must have a duty... In other words, there must be a professional nurse-patient relationship - You must have breached that duty... In other words, you must have fallen below the standard of care for a nurse - Your breach of duty must have been a foreseeable cause of the pt's injury - Damages or injury must have occurred
Which action of the nurse relates to the Quality and Safety Education for Nurses (QSEN) competency of quality improvement? A. The nurse uses data to monitor the outcomes of care. B. The nurse provides compassionate and coordinated care. C. The nurse works to minimize the risk of harm to the client. D. The nurse combines clinical expertise with client preferences.
A
Which leadership theory focuses on the role of leaders in relational and contextual terms? A. Style theory B. Two-factor theory C. Expectancy theory D. Transformational theory
A
Which leadership theory is the nurse leader putting into practice when obtaining feedback from superiors, followers, and peers? A. Style theories B. Trait theories C. Two-factor theory D. Situational-contingency theories
A
Which responsibility of the nurse manager differs from the responsibilities of the nurse leader? A. Planning the budget B. Motivating the team C. Resolving conflicts D. Penalizing for poor performance
A
Which transactional leadership behavior by the registered nurse (RN) results in a low-to-stable level of commitment? A. Punitive B. Charismatic C. Inspirational D. Intellectual stimulation
A
Which type of performance appraisal method does the nurse manager use when keeping a written record of positive and negative performances about employees in a designated time period? A. Critical incident method B. Graphic rating scale form C. Management by objectives D. Behaviorally anchored rating scale (BARS)
A
Which task would the nurse leader perform to increase productivity? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected A. Provide coaching and mentoring for the staff. B. Ask the staff to achieve higher standards in less time. C. Evaluate the unit's productivity performance every 6 months. D. Provide information and direction related to meeting unit productivity goals. E. Prepare a staffing plan that balances the organizational directives with unit needs.
A, d, e
For a client admitted to the hospital secondary to an accident, which decision-making approach by the nurse leader indicates the "satisficing" approach? A. Informing the client's family members B. Providing preliminary care for the client C. Waiting for the primary health care provider to initiate treatment D. Thinking of pros and cons and then performing the action
B
Which characteristic is typical of an adverse hospital event? Select all that apply. One, some, or all responses may be correct. A. May result in death at times B. The client usually experiences minimal harm C. Human error or hospital system error is usually the cause D. Caused by severe variation in the standard of care E. A root cause analysis tool can be used to analyze the cause
B, c
Which statement indicates effective learning regarding quality improvement processes to improve client outcomes and efficiency of health systems? Select all that apply. One, some, or all responses may be correct. A. "Quality improvement processes receive funding from external sources such as grants." B. "Quality improvement processes sometimes require Institutional Review Board (IRB) approval." C. 'Quality improvement processes measure the effects of practice on a specific client population." D. "Quality improvement processes store data from client records or clients who are in. a specific area." E. "Quality improvement processes focus on the implementation of already known evidence into practice."
B, c, d
Which points about the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) are correct? Select all that apply. One, some, or all responses may be correct. A. Scores are not affected by nursing environments. B. This is a standardized survey developed to measure client perceptions of their hospital experience. C. The survey is administered to a randomly selected sample of adults who were discharged from a hospital between 48 hours and 6 weeks ago. D. The survey was developed by the National Committee for Quality Assurance (NCQA) as a way for hospitals to collect and report data publicly for comparison purposes E. Surveys have questions that ask clients to rate their communication with nurses and physicians, discuss other details about treatment, and share their willingness to recommend the hospital
B, c, e
Which scenarios are examples of the Quality and Safety Education for Nurses (QSEN) competency called quality improvement? Select all that apply. One, some, or all responses may be correct. A. The nurse studies old medical cases about clients with Alzheimer disease before formulating the care plan for a client. B. The nurse prepares a graph to compare the effectiveness of regular nursing practice with traditional health care practices. C. The nurse demonstrates the method of using electronic health records to assure a client about confidentiality of the records. D. The nurse designs a new method for ensuring surgical asepsis on the basis of information obtained from facility administrators. E. The nurse prepares a flow chart to show the decline in client injuries after implementing a weekly client education program on the use of nurse call lights.
B, d, e
The nurse leader provides feedback to a newly recruited nurse after checking the nurse's progress report. Which action by the nurse leader is most closely aligned with the application of two-factor theory during the feedback session? A. Creating enthusiasm for practice B. Ignoring negative behaviors of the student nurse C. Promoting job enrichment by creating job satisfaction D. Providing specific feedback about positive performance
C
When planning to develop leadership skills of direct-care nurses, in which activity would the nurse manager encourage the direct-care nurses to participate in order to develop these skills? Select all that apply. One, some, or all responses may be correct. A. Participate in public forums B. Participate in civic gatherings C. Serve on practice councils D. Join local professional associations E. Participate in American Heart Association activities
C, d, e
A registered nurse is explaining the Quality and Safety Education for Nurses (QSEN) competencies to a nursing student. Which information would the nurse provide about the competency teamwork and collaboration? A. "Use information and technology to communicate, manage knowledge, mitigate errors, and support decision-making." B. "Understand that the client is the source of control and full partner when providing compassionate and coordinated care.' C. "Implement improvement methods to design and test changes to improve the quality and safety of the health care system." D. "Work effectively within nursing and interprofessional teams by promoting open communication and shared decision-making to provide client care."
D
Which statement made by the nurse indicates a need for further teaching when educating staff about integrating The Joint Commission's National Patient Safety Goals (NPSG) into the behavioral health unit? A. "We should screen all clients for the risk of suicidal ideations." B. "It is important to perform hand hygiene for at least 15 seconds." C. "It is required to obtain a current medication list upon admission." D. "We should use one client identifier before giving medications."
D
While providing feedback, which theory of leadership does the registered nurse apply when using the extinction approach to handle negative behaviors among nurse practitioners? A. Hierarchy of needs B. Transactional theories C. Transformational theories D. Organizational behavior modification (OB Mod) theory
D
The nurse working at a Magnet®-designated organization would expect which Magnet®-specific benefit? A. Salaries that are planned according to education level B. Physicians that provide input for annual performance appraisals C. Assignments that are made according to years of experience D. Opportunities to attend clinical care conferences to discuss client care needs
D.
outcomes of conflict: collaborating
an assertive and cooperative means of conflict resolution whereby all parties set aside their original goals and work together to establish a superordinate or common priority goal - cannot happen if both parties do not set aside their original goals - In collaboration, problem solving is a joint effort with no superior-subordinate, order-giving-order-taking relationships. - True collaboration requires mutual respect, open and honest communication, and equitable, shared decision-making powers.
change strategies: Power-Coercive
feature the application of power by legitimate authority, economic sanctions, or political clout of the change agent - People will change when rewarded or when forced by some power-coercive method (accept or leave)
battery
intentional and wrongful physical contact of a person that entails an injury or offensive touching
