N478 Final

Resistance to Change: Individuals' resistance typically depends on four things - their ____ to ____ - their _____ of the immediate ____ - the ______ _____ of the _____ - their ____ of what they have to _____ and _____ List and describe the 2 types of resistance

Individuals' resistance typically depends on four things: - Their flexibility to change. - Their evaluation of the immediate situation. - The anticipated consequences of the change. - Their perceptions of what they have to lose and gain. Types of Resistance - active: more vocal and expressive - passive: don't say anything

McGregor's (1967) Hot Stove Rule 4 elements that make _____ fair and ____ _____ as possible: 1. ______ 2. ______ _____ 3. ______ 4. ______

(4 ) elements - make discipline fair & growth producing as possible: 1. Forewarning 2. Immediate consequences 3. Consistency 4. Impartiality

CHIEF GOAL OF ETHICS - determine right from ____ - collect, analyze, and _____ the data - state the ____ - consider the choices of ____ - analyze the _____ and _____ of the situation - make the ____

- Determine right from wrong - Collect, analyze and interpret the data - State the dilemma - Consider the choices of action - Analyze the advantages and disadvantages of the situation - Make the decision

Successful Strategic Planning - start planning at the ____ - keep planning organized, ____, and definite - do not ____ levels of people - have short- and long-range ____ and goals - know when to plan and when ____ to - keep target ____ realistic - gather data appropriately - be sure objectives are ____ - remember, _______ relationships are important

- Start planning at the top - Keep planning organized, clear, and definite - Do not bypass levels of people - Have short- and long-range plans and goals - Know when to plan and when not to - Keep target dates realistic - Gather data appropriately - Be sure objectives are clear - Remember, interpersonal relationships are important

Disciplinary Conference - state the ____ clearly - ask employee why there has been no ____ - explain ____ action - describe the _____ change - get _____ to and _____ of plan

- State the problem clearly - Ask employee why there has been no improvement - Explain disciplinary action - Describe the behavioral change - Get agreement to & acceptance of plan

Fiscal Planning (Budget) ppt

1. Anticipate, recognize, and creatively problem solve budgetary constraints 2. Accurately compute the standard formula for calculating nursing care hours per patient day (NCH/PPD) 3. Demonstrate cost consciousness in identifying personal and organizational needs 4. Define basic fiscal terminology appropriately 5. Differentiate among the three major types of budgets (personnel, operating, and capital) and the two most common budgeting methods (incremental and zero based)

Collective Bargaining Process: List the Five Core Steps in Collective Bargaining

1. Preparation 2. Discussion 3. Proposal 4. Bargaining 5. Final Agreement

What is true about vicarious liability? Select all that apply a) is dependent on the legal relationship between two entities b) most commonly involves a relationship between employer and employee c) is based on the legal principle of respondeat superior d) is a form of direct liability

A, B, C

Nurses seeking expressed consent for a medical procedure must first.......: (Select all that apply) a) verify the patient's identity and watch him/her sign the consent form b) witness the physician provide all necessary information about the procedure to to the patient c) assess the patient's understanding of the information provided as part of the informed consent process d) provide information on the medical procedure to patients based on identified knowledge deficits

A, C

Patient classification systems (pcs): ____ vs _____ - eating - _____ - elimination - _____, specialized beds - general ____ - treatments - _____ - teaching and ____ support

Acuity vs. Workload •Eating •Grooming •Elimination ( Foley, Urinal, Condom cath) •Comfort (q 2 hour turning), Specialized beds •General Health •Treatments •Medications •Teaching and emotional support ( refer: page 444 Table 17.3 in textbook)

What is the oldest model of nursing? A.Modular nursing B.Total patient care C.Primary care D.Case management

B

An Operational budget accounts for: A. Purchase of minor & major equipment B. Construction & renovation C. Income & expenses associated with daily activity within an organization D. Applications for new technology

C

Driving forces _____ a system toward change; restraining forces _____ change

Driving forces advance a system toward change; restraining forces impede change

T or F: A typical young organization is characterized by low energy and resistance to change?

False Rationale: The young organization is characterized by high energy, movement, and virtually constant change and adaptation

Forecasting - is using _____ _____ patterns to assist in _____ _____ - benefit of forecasting: examines present ____ and projected _____ to determine ____ ____

Forecasting is using available historical patterns to assist in planning strategically! Forecasting examines present clues and projected statistics to determine future needs

Integrative Healthcare Systems Humans needed to be ____ to their _____ to ____, which means that: - we have an _____ ______ of our ____ and seek out ____ with certain _____ - the _____ can _____ or ____ ____, which in turn impacts our ____ in multiple ways

Humans needed to be sensitive to their surroundings to survive, which means that •We have an innate awareness of our environment and seek out environments with certain qualities •the *environment can create or reduce stress*, which in turn impacts our bodies in multiple ways

Nurse Staff Ratios for Hospitals (Sample)

Minimum RN to Patient Ratio in California •ICU 1:2 •Med/surg 1:6 •Tele 1:3 •Peds 1:4 •OR room 1:1 Minimum RN to Patient Ratio in Arizona •ICU 1:4 •Med/surg/PCU 1:4 •Tele 1:4 •Peds 1:4 •ED 1:4

Malpractice Awards vs Licensure Action: National Practitioner Data Bank - receives data on _____ payments and _____ _____ actions - 2006-2016: 144,250 reports made for RNs --> 2.6%: _____ --> 82.2%: board _____ actions - data available to employers, insurance ____, Medicaid ____ units, _____ and federal law enforcement

National Practitioner Data Bank •Receives data on malpractice payments and SBON disciplinary actions •2006-2016: 144,250 reports made for RNs --> 2.6% malpractice --> 82.2% board disciplinary actions •Data available to employers, insurance companies, Medicaid fraud units, state and federal law enforcement.

Identify driving and restraining forces of change within an identified problem ex: What are some of the reasons you may or may not return to school down the road Restraining Forces: - ____ energy - limited _____ - _____ _____ - time with ____ already ____ Driving Forces: - _____ for ____ - _____ - _____ self ____ - family is ____

Restraining Forces - Low Energy - Limited Finances - Unreliable Transportation - Time w Family already impacted Driving Forces - Opportunity for advancement - Status - Enhanced Self Esteem - Family is Supportive

Strategic Planning as a Management Process: Strategic planning typically examines an organization's - ____ - ____ - ____ - and _____/_____ in the context of its _____ environment

Strategic planning typically examines an organization's: - purpose - mission - philosophy - and values/goals in the context of its external environment

Staffing: the process of determining and providing the ____ number and mix of _____ personnel to produce a desired level of care to meet the patients' _____

The process of determining and providing the acceptable number and mix of nursing personnel to produce a desired level of care to meet the patients' demands

Organizing a bargaining unit (union) and the nurse manager There are some basic steps involved in winning a union voice on the job. Here's how it happens ... - ____ talk to a few of your ___-_____ who you think may be interested in ____. This ____ group starts to privately discuss _____ issues, what is involved in organizing a ____, and making plans to contact the _____.

There are some basic steps involved in winning a union voice on the job. Here's how it happens ... •Quietly talk to a few of your co-workers who you think may be interested in organizing. This small group starts to privately discuss workplace issues, what is involved in organizing a union, and making plans to contact the union. --> What will the nurse manager be sensing/see? --> What should the nurse manager do?

Differentiate between the Typical Levels of Management; give examples of each

Top-Level Managers - Board of Directors - Chief Executive Officer - Administrators Middle-Level Managers - Nursing supervisors - Department heads First-Level Managers - Team leaders - Charge nurses - Primary care nurses - Case managers

Match the following to their correct type of Care Delivery Model a) Task oriented, evolved in 1950s, uses diversity of skill, education and qualification level of each team member- pairing a novice and skilled RN (not a blind leading another....) b) This model arose during great depression-there was a lack of skilled professionals, shortage of RNs; was more practical to teach a nurse aid one skill set versus inundating with several skill sets c) Common in the OR (i.e. charge nurse, circulator nurse, surgical tech, anesthesia tech) d) Patient care unit is divided into modules or zones with an RN as a team leader e) Nurse is responsible for planning, organizing and performing all care-e.g. ICU,PACU f) Evolved in 1970s to improve autonomy g) Used in hospice, home health, long term care setting. h) This model relies on a team leader with effective communication and leadership skills. i) Adopted in 1980s, no direct care; reserved for inpatients-long term, expensive cases, chronically ill patients, RNs assumes a planning and evaluative role. j) Primary nurse assumes 24 hr responsibility for the patient- for planning care, directing and evaluating . k) The principal idea is for nurses to be assigned tasks, not patients. Patient will receive complete care but from different people l) Coordinates care from a payor or facility perspective. m) Specific Patients are allocated to one nurse n) Modification of team nursing o) May use Clinical Pathways-a predetermined written plan of care for a particular health problem. p) Same team is consistently assigned to the same geographic area e.g. specialty ORs q) This model is patient oriented; oldest model of organizing patient care r) Assumes 24 hr. responsibility for patient/s from admission to discharge s) Associate RNs provide care when primary nurse off duty t) Medicine nurse administers drugs; Discharge nurse focuses on discharges of the day, treatment nurse takes care of the diagnostics, charge nurse works with the provider in ensuring patient is receiving optimum care u) Ancillary Personnel collaborate with the RN in providing care to a patient-used in most inpatient and outpatient area v) Assignments happen based on geographic location

Total Patient Care: e, q •This model is patient oriented; oldest model of organizing patient care •Nurse is responsible for planning, organizing and performing all care-e.g. ICU,PACU Functional Nursing: b, k, t •This model arose during great depression-there was a lack of skilled professionals, shortage of RNs; was more practical to teach a nurse aid one skill set versus inundating with several skill sets. •The principal idea is for nurses to be assigned tasks, not patients. Patient will receive complete care but from different people. •Medicine nurse administers drugs; Discharge nurse focuses on discharges of the day, treatment nurse takes care of the diagnostics, charge nurse works with the provider in ensuring patient is receiving optimum care. Team Nursing: a, c, h, u •Task oriented, evolved in 1950s, uses diversity of skill, education and qualification level of each team member- pairing a novice and skilled RN (not a blind leading another....). •This model relies on a team leader with effective communication and leadership skills. •Ancillary Personnel collaborate with the RN in providing care to a patient-used in most inpatient and outpatient area •Common in the OR (i.e. charge nurse, circulator nurse, surgical tech, anesthesia tech) Modular Nursing: d, n, p, v •Patient care unit is divided into modules or zones with an RN as a team leader. •Modification of team nursing •Same team is consistently assigned to the same geographic area e.g. specialty ORs •Assignments happen based on geographic location Primary Care Nursing: f, g, j, m, r, s •Evolved in 1970s to improve autonomy •Primary nurse assumes 24 hr responsibility for the patient- for planning care, directing and evaluating •Used in hospice, home health, long term care setting. •Specific Patients are allocated to one nurse •Assumes 24 hr. responsibility for patient/s from admission to discharge •Associate RNs provide care when primary nurse off duty Case Management: i, l, o •Adopted in 1980s, no direct care; reserved for inpatients-long term, expensive cases, chronically ill patients, RNs assumes a planning and evaluative role. •Coordinates care from a payor or facility perspective. •May use Clinical Pathways-a predetermined written plan of care for a particular health problem.

Performance Appraisal Tools: Traditional vs Modern Tools a) studies qualities of an employee b) reduce bias c) Older method d) Promote objectivity List the 6 types of Traditional Performance Appraisal Tools List the 4 types of Modern Performance Appraisal Tools

Traditional Tools: A, C - Older method, studies qualities of an employee - tools: ranking, forced distribution, checklist, behaviorally anchored rating scales, narrative essay, critical incident Modern Tools: B, D - Promote objectivity, reduce bias - tools: management by objectives, psychological appraisals, 360-degree feedback, human resource method

T of F: When information and decision making are shared, subordinates feel that they have played a valuable role in the change

True

T or F: Because change disrupts the homeostasis or balance of the group, resistance should always be expected.

True

Define Civility: a behavior that shows ____ toward another ____, makes that person feel ____, and contributes to mutual ____

a behavior that shows respect toward another person, makes that person feel valued, and contributes to mutual respect

Fill in the blanks: A staff nurse failed to take appropriate action on behalf of a patient with c/o SOB & chest pain and who subsequently died of a massive MI. For which type of liability (individual, corporate, negligent supervision) might each be held ? a. The staff nurse: b. The charge nurse: c. The nurse manager: d. The hospital:

a) individual b) negligent supervision only if the charge nurse was made aware of the pt's condition, but failed to act c) negligent supervision if the nurse manager hired the staff nurse but did not wait for the staff nurse's credentials to come through d) corporate

A minor's legal rights to give consent and expect confidentiality is based on which type of law? Select all that apply a) common b) state c) federal d) mature minors doctrine e) supreme court decisions

all of the above

The IHI Triple Aim: list the aims What is the quadruple aim?

•1. Enhancing the Patient Experience •2. Improving Population Health •3. Reducing Costs •4. Improving the work life of clinicians and staff

What is the Quadruple Aim?

•4. Improving the work life of clinicians and staff

Budget Preparation - ____ cycle - _____ year - _____ year

•Yearly cycle •Fiscal year: can start in April, July, October •Calendar year

AACN Standards for Healthy Work Environment 1. skilled _____ 2. _____ _____ 3. effective ____ _____ 4. ______ ______ 5. meaningful _____ 6. ______ ______

1.Skilled Communication 2.True Collaboration 3.Effective Decision Making 4.Appropriate Staffing 5.Meaningful Recognition 6. Authentic Leadership

List the types of direct liability and indirect liability. And describe if there is a breach of duty or not for direct liability and indirect liability

*Direct Liability*: Breach of duty - Individual Liability --> Negligent supervision - Corporate Liability *Indirect Liability*: No breach of duty - Vicarious Liability (employer does not have a breach in their duty, but they are held liable simply because they are the boss)

Kurt Lewin - "if you want to truly understand something, try to ____ it" - is the ____ of ____ ____ Lewin's Thoughts - Change should only be implemented for _____ reason - Change should always be _____ - All change should be ______, and not _____ or _____ - All individuals who may be affected by the change should be _____ in _____ for the change

- "If you want to truly understand something, try to change it." - Kurt Lewin is the Father of Change Theory Lewin's Thoughts - Change should only be implemented for good reason - Change should always be gradual - All change should be planned, and not sporadic or sudden - All individuals who may be affected by the change should be involved in planning for the change

What does SWOT stand for? Match the following to their correct term a) are those internal attributes that challenge an organization in achieving its objectives b) are external conditions that promote achievement of organizational objectives c) are those internal attributes that help an organization to achieve its objectives d) are external conditions that challenge or threaten the achievement of organizational objectives

- *Strengths* are those internal attributes that help an organization to achieve its objectives (C) - *Weaknesses* are those internal attributes that challenge an organization in achieving its objectives (A) - *Opportunities* are external conditions that promote achievement of organizational objectives (B) - *Threats* are external conditions that challenge or threaten the achievement of organizational objectives (D)

Strategic Planning Should Include: - a clear ____ of the organization's _____ - the ____ of the agency's external _____ or _____ - the determination of the agency's ____ and operations - the agency's strategic goals and objectives, typically in a __-__ year plan - the development of strategies to ____ the goals

- A clear statement of the organization's mission. - The identification of the agency's external constituencies or stakeholders - The determination of the agency's purpose & operations. - The agency's strategic goals & objectives, typically in a 3 to 5 year plan. - The development of strategies to achieve the goals.

ETHICAL DECISION MAKING FOR A NURSE LEADER - professional _____ - eliminate ____ and ____ - focuses on _____ decision-making _____ - _____ problem-solving _____

- Professional approach - Eliminate trial and error - Focuses on proven decision-making models - Organizational problem-solving processes

Formal Grievance Process - a grievance occurs when the employee and manager ______ _____/______ differently - the discrepancy can be resolved by a formal means: a ____ procedure - the steps are outlined in ______ policies or _____ contracts - typically entails progressive _______ of _____ up the chain of _____ - difference not settled in the formal grievance process, then it generally proceeds to _____

- A grievance occurs when the employee & manager perceive "fair/just" differently - The discrepancy can be resolved by a formal means: a grievance procedure - The steps are outlined in administrative policies or union contracts - Typically entails progressive lodging of complaints up the chain of command - Difference not settled in formal grievance process, generally proceeds to arbitration

Management Rights Clause - a management rights clause is an _____ between _____ and _____ about how much ____ the employer has in running day-to-day business operations - before a workforce is _____, the company's management has the right to make _____ that affect that ____, subject to state and federal laws - when a workforce is _____, the company still has the ____ to make _____ but management must ____ by the _____ agreed upon - some management rights clauses are more _____ than others Example: "All rights are reserved to ____ except those expressly limited by the _____ ____ contract"

- A management rights clause is an agreement between employers and unions about how much autonomy the employer has in running day-to-day business operations. - Before a workforce is unionized, the company's management has the right to make decisions that affect that workplace, subject to state and federal laws. - When a workforce is unionized, the company still has the right to make decisions but management must abide by the "clause" agreed upon. - Some management rights clauses are more permissive than others. Example: "All rights are reserved to management except those expressly limited by the collective bargaining contract."

Health Care Systems ppt

- Address the Triple and "Quadruple Aims" - Describe the scope of service of the current healthcare system in the United States. - Discuss the delivery of health care and possible gaps in the healthcare delivery system. - Identify essential concepts of a dynamic system. - Apply key concepts of systems theory to the current healthcare system

Patient Right to Die - applies to patients > ___ years old - capacity to make ____ decisions - terminal disease expected to result in death within ___ mo - California End of Live Option Act: patient to make two verbal requests in __ days and one written that is ____, dates, and witnessed by 2 ____ - patients can rescind for the request in aid to dying at _____ - Prescription is given to the patient once filled the patient has to fill out the "Final Attestation for an aid in Dying Drug to End my Life in a Humane and Dignified Manner" with in ____ hours before self-administering the medication. The Death certificate "shall not constitute _____" - This is more a _____ law , in Canada at present they have passed this law for the "Patient right to Die", but this needs to be signed by two ______ first.

- Applies to patients >18 years old - Capacity to make medical decisions - Terminal disease expected to result in death within 6 months - California End of Life Option Act- patient to make two verbal requests in 15 days and one written that is signed dated and witnessed by two adults. - Patients can rescind for the request in aid to dying at anytime. - Prescription is given to the patient once filled the patient has to fill out the "Final Attestation for an aid in Dying Drug to End my Life in a Humane and Dignified Manner" with in 48 hours before self-administering the medication. The Death certificate "shall not constitute suicide" - This is more a silent law , in Canada at present they have passed this law for the "Patient right to Die", but this needs to be signed by two Physicians first.

List the Steps in the Change Process

- Assessment - Planning - Implementation - Evaluation the steps in change process are similar to the nursing process

PRINCIPLES OF ETHICAL REASONING Match the following to their correct principle of ethical reasoning a) limits freedom of choice. The Authority to make a decision for another person. b) accepting the responsibility of one's choice. Promotes self-determination and freedom of choice c) treating people fairly -equals to be treated the same and unequal's treated according to their differences. d) need to keep promises and commitments e) actions are taken in an effort to promote good f) respecting privileged information g) the good of many outweighs the needs of the individual h) obligation to tell the truth

- Autonomy (self determination)- accepting the responsibility of one's choice. Promotes self-determination and freedom of choice (B) - Beneficence (doing good)-actions are taken in an effort to promote good (E) - Paternalism-limits freedom of choice. The Authority to make a decision for another person. (A) - Utility-the good of many outweighs the needs of the individual (G) - Justice(treating people fairly) -equals to be treated the same and unequal's treated according to their differences. (manager gives raises in accordance to performance) (C) - Veracity (truth telling)- obligation to tell the truth. (H) - Fidelity(keeping promises)- need to keep promises and commitments. (D) - Confidentiality(respecting privileged information)-the privacy of another and to hold certain information in strict confidence. Keep privileged information private. Only broken confidentiality if it is life threatening situation. (F)

SWOT may be used in aiding an organization in setting their strategic plan-- SWOT Rules - be ____ about the ____ and ____ of your organization - be clear about how the present organization ____ from what might be possible in the ____ - be specific about what you want to _____ - always apply SWOT in relation to your _____ - keep SWOT ____ and ____ - remember that SWOT is ____

- Be realistic about the strengths and weaknesses of your organization - Be clear about how the present organization differs from what might be possible in the future - Be specific about what you want to accomplish - Always apply SWOT in relation to your competitors - Keep SWOT short and simple - Remember that SWOT is subjective

Disciplining the Unionized Employee - due ____ for unionized staff that management must provide union staff with a ____ _____ outlining _____ _____ and the reasons for the _____ - unionized staff must be _____ according to specific, pre-_____ steps and penalties within an established time frame - detailed _____: _____, _____ attempts

- Due process for unionized staff that management must provide union staff with a written statement outlining disciplinary charges and the reasons for the penalty - Unionized staff must be disciplined according to specific, pre-established steps and penalties within an established time frame. - Detailed records --> Misconduct --> Counseling attempts

Fundamentals of Strategic Planning - clearly defines the _____ of the organization - establish ____ goals and objectives - identifies external constituencies and determine their assessment of the organization's _____ - clearly communicates the goals to the ____ - develops a sense of ____ of the plan - develops strategies to ____ the goals - ensures that the most effective use is made of _____ - provides a base from which progress can be _____

- Clearly defines the purpose of the organization - Establish realistic goals and objectives - Identifies external constituencies and determine their assessment of the organization's purposes - Clearly communicates the goals to the constituents - Develops a sense of ownership of the plan - Develops strategies to achieve the goals - Ensures that the most effective use is made of resources - Provides a base from which progress can be measured

Strategies to Create an Environment of Self-Discipline - having clearly ____ and _____ rules and regulations - atmosphere of _____ ____ - non-_____ ______ - ____ use of formal ______ - employee identifies with ______ goals

- Clearly written & communicated rules and regulations - Atmosphere of mutual trust - Non-threatening environment - Judicious use of formal authority - Employee identifies with organizational goals

Bully Nurse Traits - _____ - super ____ - _____ nurse - _____ nurse - _____ nurse - _____ nurse

- Cliques - Super Nurse - Resentful Nurse - Jealous Nurse - Gossip Nurse - Backstabbing Nurse

Informed Consent for Minors is Based On what 5 laws? Match the following to their correct law: a) age of consent (18 in most states) and exceptions b) legal principle which allows minors to make decisions if they can show they are mature enough to make a decision c) Title X of the Public Health Service Act and HIPAA d) unwritten law based on precedent; used when there is no other law e) right to privacy when seeking contraception and abortion

- Common law: unwritten law based on precedent; used when there is no other law (D) - Mature minor doctrines: legal principle which allows minors to make decisions if they can show they are mature enough to make a decision (B) - State law: age of consent (18 in most states) and exceptions (A) - Federal law: Title X of the Public Health Service Act and HIPAA (C) - Supreme Court decisions: right to privacy when seeking contraception and abortion (E)

End of Life Issues: Strategies - communicating and _____ to patients and families - incorporating integrative _____ principles - discussion with physician on patient's _____ - donor ____--- who and when to call - team ____ on EOL - patients care-- ______ care -- who to notify, care of the body, debriefing - ethics team involvement - patient ____-- differentiate between controlling the patient and ____ the patient choices - patient resources: case manager, social ____, financial consultant

- Communicating and Listening to patients and families - Incorporating Integrative Nursing Principles - Discussion with Physician on patients situation - Donor Network- who and when to call - Team meetings on End of Life - Patients care - postmortem care- who to notify, care of the body, debriefing - Ethics team involvement - Patient advocate- differentiate between controlling the patient and assisting the patient choices - Patient Resources: Case Manager, Social Worker, Financial Consultant

Chemically Impaired Employee: Re-entry into Practice Guidelines - consent to ____ urine _____ for _____/_____ screens - assigned to ___ shift for the ____ year back - provided evidence of ongoing ______ with _____ groups (i.e. attending meetings ____) - can't use ________ drugs - should be paired with a successfully _____ RN whenever possible - encouraged to seek individual _____/_____ and a structured aftercare program

- Consent to random urine testing for toxicology/alcohol screens - Assigned to day shift for the first year - Provided evidence of ongoing involvement with support groups - attend meetings weekly - Can't use psychoactive drugs - Should be paired with a successfully recovering RN whenever possible. - Encouraged to seek individual counseling/ therapy and a structured aftercare program

Ethical Dilemma - defined as making a choice between ___ or more equally _____ _____ - the individual who must solve an ethical dilemma is the only person who can ____ if actions taken were _____ with personal _____ - ____-_____ is vital in ethical decision making, as it is in other aspects of ____ - give an example

- Defined as making a choice between two or more equally undesirable alternatives - The individual who must solve an ethical dilemma is the only person who can ascertain if actions taken were congruent with personal values. - Self-awareness is vital in ethical decision making, as it is in other aspects of management. - E.G. You believe that nobody should not be let go (pass on) by using Morphine during signs of death? Could be Religious or your own values/beliefs!

Chemical Impairment in Nursing - ____ or ____ abuse: _____, Oxycodone, ____, Vicodin, alcohol - majority of disciplinary actions by ____ ____ are related to _____ from _____ _____ - _____ of drugs for _____ use - sale of ____/_____ _____ to support the nurse's addiction

- Drug or alcohol abuse: Demerol, Oxycodone, OxyContin, Vicodin, Alcohol - Majority of disciplinary actions by licensing boards are related to misconduct from chemical impairment - Misappropriation of drugs for personal use - Sale of drugs/drug paraphernalia to support the nurse's addiction

Marginal Employee - employees who meet _____ standards - contribute very ____ to the unit and organizational _____ Strategies to deal with marginal employees: - _____ to another unit - offer ____ - offer early _____ - _____

- Employees who meet minimal standards - Contribute very little to the unit & organizational efficiency Strategies to deal with Marginal employees - Transfer to another unit - Offer coaching - Offer early retirement - Dismissal

Ethics - ethics is the ______ study of what a person's ____ and ____ should be with regard to ____, other human beings, and the _____ - justification of what is ____ or _____ - ethics is a _____ of ____ ____ and principles that guide a person's _____ in regard to _____ and _____ - regard to oneself and ____ at large

- Ethics is the systematic study of what a person's conduct and actions should be with regard to self, other human beings, and the environment. - Justification of what is right or wrong. - Ethics is a system of moral conduct and principles that guide a person's actions in regard to right and wrong. - Regard to oneself and society at large

Why Strategic Plans fail - ____ assumptions - not knowing overall ____ - not enough _____ - ____ time or other resources - low ____ levels - ____ strategies not used - inadequate ____ of authority - not recognizing ____ goals and needs - planning too ____ in scope-- not recognizing ____, legal, and ____ requirements

- False assumptions - Not knowing overall goal - Not enough alternatives - Inadequate time or other resources - Low motivation levels - Sound strategies not used - Inadequate delegation of authority - Not recognizing organizational goals and needs - Planning too narrow in scope—not recognizing community, legal, and licensing requirements

List the Types of Organizational Structures - ____ design - ____ design: describe - _____ structures - ____ line ______ - line _____ - ____ ____ design

- Flat design - Tall design: Tall structures have many reporting layers illustrating the change of command - Matrix structures - Service line organization - Line structures - Ad hoc design

Flat Line Organizational Structure - occurs when there are ___ layers in the organization - give an example - hierarchial layers are flattening the ____ chain and _____ the organization - continues to have _____ _____, but because the organizational structure is flattened, more authority and ____ making can occur where the work is being ____ out - despite being very flat, often retain many characteristics of a ______

- Flat occurs when there are few layers in the organization - An example of a Flat organization would be a hospital that had all the nurses reporting to the DON. - In a flat line structure, hierarchical layers are flattening the scalar chain (decision-making hierarchy or pyramid) and decentralizing the organization - Flat line continues to have line authority, but because the organizational structure is flattened, more authority and decision making can occur where the work is being carried out - Despite being very flat, often retain many characteristics of a bureaucracy

Confronting the Chemically Impaired RN/Staff - gather as much _____ as possible - immediate ____ - denial of the impairment or use of ______ mechanisms should be _____; manager should not ____ or _____ employee - manager should outline plan for employee to _____ chemical ______

- Gather as much evidence as possible - Immediate confrontation - Denial of the impairment or use of defense mechanisms should be expected; manager should not nurture or counsel employee - Manager should outline plan for employee to overcome chemical impairment

Challenges Related to Accurate Planning - health-____ ____ - rapidly changing ____ - _____ government regulation of health ____ - _____ advances

- Health-care reform - Rapidly changing technology - Increasing government regulation of health care - Scientific advances

Steps for Leading Change: Identify the responsibilities of a change agent - identify the ____ using ____ field analysis - identify the optimal outcome ____ and the desired outcome ____ - identify ____, _____, resources, and ____ groups - identify and explore potential _____/ and then choose the ____ ____ (_____ Matrix) - _____ the ____ process - _____ the _____ for a given time - evaluate the _____

- Identify the problem (Force Field Analysis) - Identify the optimal outcome solution & the desired outcome objectives - Identify constraints, capabilities, resources, & claimant groups - Identify and explore potential solutions/ and then choose best solution (Decision Matrix) - Plan the implementation process - Implement the solution for a given time - Evaluate the outcome

Strategies to Decrease Resistance to Change: - implement ____ if possible - ____ ____ needs to see it ____ - _____ ____ for ____ reasons

- Implement gradually if possible - Change agent needs to see it through - Implement change for good reasons

Reasons Why Ethics Is Becoming a Greater Force in Management Decision Making - increasing _____, ______ pressures, and ______ among HCPs - national nursing _____ - _____ fiscal _____ - _____ of supplies and _____ - the public's increasing ____ in the health care delivery system, and with different _____

- Increasing technology, regulatory pressures, and competitiveness among health care providers - National nursing shortages - Reduced fiscal resources - Costs of supplies and salaries - The public's increasing distrust in the health care delivery system, and with different institutions

Termination - last ____ - necessary for employees who ____ to break rules despite _____ - difficult for employee, _____, and unit - cost is _____ in terms of: --> managerial/employee ____ --> unit _____

- Last resort - Necessary employees who continue to break rules despite warnings - Difficult for employee, manager & unit - Cost is enormous in terms of --> Managerial/employee time --> Unit morale

TYPES OF ETHICAL ISSUES: match the following to their correct type of ethical issue a) individual is unsure which moral principles or values apply b) ex: Physician gives inadequate care, and has been reported several times, & nothing has been done c) knows the right thing to do but organizational constraints make it difficult to take the right course of action d) witnesses the immoral act of another, but feels powerless to stop it e) ex: pt. wants DNR, doctors want to continue with care

- Moral issues includes moral uncertainty, moral conflict, moral distress, moral outrage and ethical dilemmas - Moral uncertainty/moral conflict: individual is unsure which moral principles or values apply (A) - Moral distress: knows the right thing to do but organizational constraints make it difficult to take the right course of action. (pt. wants DNR, doctors want to continue with care) (C, E) - Moral outrage: witnesses the immoral act of another, but feels powerless to stop it. (Physician gives inadequate care, and has been reported several times, & nothing has been done) (B, D)

Rule Breaking - most common reason for _____ if rule is consistently broken, ask: - ____ rule is it? - do we still ____ the rule? Staff morale is _____ when staff are not disciplined Any undesirable conduct should merit further _____

- Most common reason for discipline If rule is consistently broken, ask: - Whose rule is it? - Do we still need the rule? Staff morale is jeopardized when staff are not disciplined Any undesirable conduct should merit further action

ETHICS COMMITTEES - _____ teams: Chaplin, Doctors, Nurses, Social Worker, Case Manager, and sometimes this includes patients. - _____ Review _____: of your organization will also look at the situation especially if there is a incident (Sentinel event), and determine the process. - using the ethical frameworks do not solve the _____ problem but assist individuals involved in the problem to clarify their values and ____ - There is Legal and Ethical issues, although they are not the same and this can be very difficult for _____ - _____ controls are generally clear and impartial. - _____ controls are unclear and individualized.

- Multidisciplinary teams : Chaplin, Doctors, Nurses, Social Worker, Case Manager, and sometimes this includes patients. - Institutional Review Boards: of your organization will also look at the situation especially if there is a incident (Sentinel event), and determine the process. - Using the ethical frameworks do not solve the ethical problem but assist individuals involved in the problem to clarify their values and beliefs. - There is Legal and Ethical issues, although they are not the same and this can be very difficult for committees. - Legal controls are generally clear and impartial. - Ethical controls are unclear and individualized.

Professional Codes of Ethics - one tool managers use for guidance in ethical problem solving is a ____ ____ of _____ - a code of ethics is a set of _____, established by a _____, to guide the individual ____ - the first code of ethics for nurses was adopted by the ANA in ____ and has been revised ___ times since then - professional codes of ethics do not have the power of ____. They do, however, function as a guide to the _____ standards of ethical practice for nurses The Scope and Standards of Practice of Nursing - Administration Practice --> Published by the ____ --> Specific to the ____-_____ role

- One tool managers can use for guidance in ethical problem solving is a Professional Code of Ethics. - A code of ethics is a set of principles, established by a profession, to guide the individual practitioner. - The first code of ethics for nurses was adopted by the American Nurses Association in 1950 and has been revised five times since then. - Professional codes of ethics do not have the power of law. They do, however, function as a guide to the highest standards of ethical practice for nurses. The Scope and Standards of Practice of Nursing Administration Practice: - Published by the ANA - Specific to the nurse-manager role

The "Essential" Provision: 1974 Health Care Amendments - provided ____ ____ rights to ____ of ___-____ hospitals - hospital services are deemed ____ services and thus nurses as _____ workers and the union MUST provide a ___-day notice of ____ to ____ before being able to _____ (this is unlike other industries which can call a ____ and go ___ the ____ day) - Passage of the ____ Health Care Amendments caused an ____ of RNs ____ in some states in the US

- Provided collective bargaining rights to employees of non-profit hospitals. - Hospital services are deemed "essential" services and thus nurses as "essential" workers and the union *MUST provide a 10-day notice of "intent to strike"* before being able to strike (This is unlike other industries which can call a strike and go out the same day). - Passage of the 1974 Health Care Amendments caused an increase of RNs unionizing in some states in in US.

Match the following to their correct type of planning a) occurs after a problem exists b) utilizes technology to accelerate change; future-oriented c) seeks the status quo d) considers the past, present, and future and attempts to plan the future of an organization rather than react to it

- Reactive planning: occurs after a problem exists (A) - Inactivism: seeks the status quo (C) - Preactive planning: utilizes technology to accelerate change; future-oriented (B) - Interactive or proactive planning: considers the past, present, and future and attempts to plan the future of an organization rather than react to it (D) Proactive planning is key to success.

NURSING BOUNDARIES - respecting patient's ____ - right to self-_____ - _____ tasks appropriately - practicing good _____ - accepting ______ in practice - alleviating _____ - being ____ to patients interests - working within the nurse practice acts and nursing standards of _____ - nurse-to-nurse relationships, nurse-to-physician, nurse-to-patient multidisciplinary ______ - self-____/development boundaries- advancing knowledge/research, competencies, self-respect, and professional _____

- Respecting patients dignity - Right to self-determination - Delegating tasks appropriately - Practicing good judgement - Accepting accountability in practice - Alleviating suffering- this can be a grey area? - Being attentive to patients interests - Working within the nurse practice acts and nursing standards of practice - Nurse-to-Nurse relationships, nurse-to-physician, nurse-to- patient, multidisciplinary collaboration. - Self-Care/development boundaries- advancing knowledge/research, competencies, self-respect and professional growth

Your Role as New Grads-- You'll be expected to: - ____ old _____ - find ____ ways to ____ - improve the ____ process, _____ process - participate in ___ projects - prepare for ______ visits

- Revise old procedures - Find new ways to improve - Improve evaluation process, promotion process - Participate in QI projects - Prepare for accreditation visits

Self-Discipline - rules are ____ - part of the person's ______ - ____ and most ____ form of discipline - possible only if _____ know the rules and accept them as ____

- Rules are internalized - Part of the person's personality - Highest & most effective form of discipline - Possible only if subordinates know the rules and accept them as valid

Types Ethical Theories: Match the following to their correct type of ethical theory a) belief that some things are a person's just due. Rights are different from needs, wants or desires. ( some individuals belief in the truth only) b) judges whether the action is right or wrong regardless of the consequences. Uses duty-based reasoning and rights-based reasoning c) individuals make decisions based only on what seems right or reasonable according to their value system d) the needs and wants of individual are diminished, the greatest good for greatest number of people e) ethical principles are universal and constant, that ethical decision making should not vary as a result of individual circumstances or cultural differences f) ethical framework some decisions must be made because there is a duty to do something or refrain from doing something

- Teleological theory- the needs and wants of individual are diminished, the greatest good for greatest number of people (D) - Deontological theory- judges whether the action is right or wrong regardless of the consequences. Uses duty-based reasoning and rights-based reasoning. (B) - Duty based reasoning- ethical framework some decisions must be made because there is a duty to do something or refrain from doing something (F) - Rights -based reasoning- belief that some things are a person's just due. Rights are different from needs, wants or desires. ( some individuals belief in the truth only) (A) - Ethical relativism- individuals make decisions based only on what seems right or reasonable according to their value system (C) - Ethical universalism- ethical principles are universal and constant, that ethical decision making should not vary as a result of individual circumstances or cultural differences (E)

1974 Health Care Amendments (National Legislation and Nurses being able to Unionize) - the National _____ Relations Act amended to extend _____ and protection to employees of ___-____ hospitals - when the new legislation was considered by the ____ Committee on Labor and ____ Welfare, it was recognized that labor relations in the health care industry required special _____ - the Senate Labor Committee sought to fashion a mechanism which would ensure that the needs of the ____ would be met during _____ arising out of _____ ____ - the new law represented a sound and _____ _____ of these competing interests

- The National Labor Relations Act (NLRA) amended to extend coverage and protection to employees of non-profit hospitals. - When the new legislation was considered by the Senate Committee on Labor and Public Welfare, it was recognized that labor relations in the health care industry required special considerations. - The Senate Labor Committee sought to fashion a mechanism which would ensure that the needs of the patient would be met during contingencies arising out of labor disputes. - The new law represented a sound and equitable reconciliation of these competing interests.

Systematic problem-solving/decision making model - the nursing _____: form of decision-making tool - individuals forget at times to include alternative or to evaluate the results in _____-making - the structured approach to problem solving: data ____, multiple alternatives are analyzed and used to problem ____. Even if it is a poor ____ you can reflect back on what you have done and maybe come up with an _____.

- The Nursing Process- assess, diagnose, plan, implement and evaluation. - This is a form of decision-making tool. - Individuals forget at times to include alternatives or to evaluate the results in decision making. - The structured approach to problem solving is: data gathering, multiple alternatives are analyzed and used to problem solve. Even if it is a poor outcome you can reflect back on what you have done and maybe come up with an alternative .

Ethical decisions - the manager must have knowledge of ethical principles and ______ - organizations must have ethics _____, institutional review ____, and professional code of ____ - clinical nurses must also be aware of the ethical principles, frameworks and different _____ to deal with ethical dilemmas

- The manager must have knowledge of ethical principles and frameworks - Organizations must have ethics committees, institutional review boards, and professional code of ethics - Clinical Nurses must also be aware of the ethical principles, frameworks and different committees to deal with ethical dilemmas

Magnet Status Hospitals - the term Magnet is used to denote organizations who are able to ____ and ____ nurses - Magnet status is not an ____, it is a ____ which recognizes nursing _____ With Magnet Status: - well-qualified nurse executives are in a _____ environment with organizational structures that emphasize open, ______ management - it is an ____, self-managing, self-____ climate that allow nurses to fully practice their clinical ____, has ____ staffing, adequate ____ ratios, and clinical career _____ - this leads to a professional practice ____ in all aspects of nursing care - Magnet status is compliant with standards in the ____ Scope and Standards for Nurse Administrators

- The term Magnet is used to denote organizations who are able to attract and retain nurses. - Magnet status is not an award, it is a credential which recognizes nursing excellence. With Magnet Status: •Well-qualified nurse executives are in a decentralized environment, with organizational structures that emphasize open, participatory management •It is Autonomous, self-managing, self-governing climates that allow nurses to fully practice their clinical expertise, has flexible staffing, adequate staffing ratios, and clinical career opportunities •This leads to a professional practice culture in all aspects of nursing care •Magnet status is Compliant with standards in the ANA's Scope and Standards for Nurse Administrators

Nursing Managers Violating the National Labor Relations Act (NLRA) - threatening employees with loss of ____ or ____ if they ___ or vote for a ____ or engage in protected concerted activity - threatening to close the plant if employees select a _____ to _____ them - questioning employees about their ____ ____ or activites in circumstances that tend to interfere with, restrain, or coerce employees in the exercise of their _____ under the Act - promising ____ to employees to _____ their union support - transferring, laying off, _____, assigning employees more ______ work tasks, or otherwise punishing employees because they: --> engaged in a ____ or protected _____ activity --> filed ____ ____ practice ____ or participated in an _____ conducted by the National Labor Relations Board

- Threatening employees with loss of jobs or benefits if they join or vote for a union or engage in protected concerted activity. - Threatening to close the plant if employees select a union to represent them. - Questioning employees about their union sympathies or activities in circumstances that tend to interfere with, restrain or coerce employees in the exercise of their rights under the Act. - Promising benefits to employees to discourage their union support. - Transferring, laying off, terminating, assigning employees more difficult work tasks, or otherwise punishing employees because they: --> engaged in union or protected concerted activity. --> filed unfair labor practice charges or participated in an investigation conducted by National Labor Relations Board (NLRB).

Labor Union Conduct that Violates the National Labor Relations Act (NLRA) - threats to employees that they will ____ their jobs unless they support the ____ - seeking the _____, discharge, or other punishment of an employee for ____ being a ____ member even if the employee has paid or offered to pay a _____ initiation fee and periodic fees thereafter - refusing to process a _____ because an employee has criticized union ____ or because an employee is not a member of the union in states where union ____ clauses are not permitted - fining employees who have validly ____ from the ____ for engaging in protected concerted ____ following their _____ or for crossing an ____ ____ line - engaging in ____ ____ misconduct, such as _____, assaulting, or barring non-____ from the employer's _____ - _____ over issues unrelated to the _____ terms and conditions or coercively enmeshing _____ into a labor _____

- Threats to employees that they will lose their jobs unless they support the union. - Seeking the suspension, discharge or other punishment of an employee for not being a union member even if the employee has paid or offered to pay a lawful initiation fee and periodic fees thereafter. - Refusing to process a grievance because an employee has criticized union officials or because an employee is not a member of the union in states where union security clauses are not permitted. - Fining employees who have validly resigned from the union for engaging in protected concerted activities following their resignation or for crossing an unlawful picket line. - Engaging in picket line misconduct, such as threatening, assaulting, or barring non-strikers from the employer's premises. - Striking over issues unrelated to employment terms and conditions or coercively enmeshing neutrals into a labor dispute.

Service Line Organizations - used in some _____ institutions to address the ____ that are ____ to traditional _____ _____ organizations - sometimes called ____-_____ organizations - ____ in scale than ____ _____ systems

- Used in some large institutions to address the shortcomings that are endemic to traditional large bureaucratic organizations. - Sometimes called care-centered organizations. - Smaller in scale than large bureaucratic systems

ETHICS IN NURSING - values and ____ of the nursing profession - clinical nurses have different ethical responsibilities than a _____ - management is a discipline and not a _____, but has norms and values of the _____ - organizations also have to follow the norms of e.g. society, JACHO, _____, physicians, etc. - there is a difference between personal, organizational, _____, and _____ responsibilities, great potential for nursing managers to experience _____ conflict about the appropriate course of action

- Values and Norms of the Nursing Profession - Clinical nurses have a different ethical responsibilities than a Manager - Management is a discipline and not a profession, but has norms and values of the organization - Organizations also have to follow the norms of e.g. Society, JACHO, Medicare, Physicians etc. - There is a difference between personal, organizational, subordinate and consumer responsibilities, great potential for nursing managers to experience intrapersonal conflict about the appropriate course of action.

List characteristics of Change Agents - _____ - ____ ____ - ______ - excellent _____ - _____ - _____ - current

- Visionary - Risk taker - Flexible - Excellent communicator - Creative - Sensitive - Current

ETHICAL DILEMMAS: - what is the ethical _____? - ____ will make the decisions in this case? - what ethical ____ is appropriate for this case? - what ethical ____ is appropriate for this case?

- What is the ethical problem? - Who will make the decisions in this case? - What Ethical Framework is appropriate for this case? - What Ethical Principle is appropriate for this case?

Within the local health system, there are a myriad of clinical microsystems such as: - a ____ practice - a ____ dialysis team - an _____ practice - an ___-___ _____ center - a ____ surgery team - a NICU - a home ____ care ____ team - an _____ department, and so on

- a family practice - a renal dialysis team - an orthopedic practice - an in vitro fertilization center, - a cardiac surgery team - a neonatal intensive care unit - a home health care delivery team - an emergency department, and so on.

Most Common Changes in healthcare relate to: - _____ ______ - _____ ______ - _____ ______

- organizational restructuring - quality improvement - employee retention

Planning - really important and ____ all other ____ functions - with effective planning, the manager must identify short and long-term ____ - without adequate planning, the management process fails, and organizational needs and objectives cannot be ____

- really important and precedes all other management functions - With effective planning, the manager must identify short and long-term goals - Without adequate planning, the management process fails, and organizational needs and objectives cannot be met

5 Factors that Influence patient's health outcomes - _____ connection to _____ - ____ patient _____ - enhance ____ ____ - ______ ______ _____ - provide ____ ____

-Increase connection to nature -Offer patient choices -Enhance social support -Reduce environmental stressors -Provide pleasant diversions

Ethics and End of Life Issues ppt

1. Define ethics and ethical dilemmas from a leadership perspective. 2. Compare and contrast utilitarian, duty-based, rights-based, intuitionist frameworks. 3. Use a systematic problem-solving or decision-making model to determine appropriate action for select ethical issues. 4. Define the six different principles of ethical reasoning. 5. Differentiate between legal and ethical obligations in making decisions. 6. Model ethical decision making congruent with the American Nurses Association Code of Ethics and Interpretive Statements and professional standards. 7. Professional Nursing Boundaries and Boundary crossings in nursing. 8. Define End of Life Issues and how to be a Patient Advocate.

When should you complete an incident report: 1. any time a patient makes a ____ ____ 2. medical ____ (including ____ errors) 3. medical device/equipment _____ 4. patient, staff ____, or ____ is ____ or threatened with _____ 5. patient, staff ____, or ____ is ____ or involved in an incident with significant risk of _____ 6. and any incident as defined in your organization's ____ and _____

1. Any time a patient makes a (significant) complaint 2. Medical errors (including medication errors) 3. Medical device/equipment malfunctions 4. Patient, staff member, or visitor is assaulted or threatened with assault 5. Patient, staff member, or visitor is injured or involved in an incident with significant risk of injury 6. And any incident as defined in your organizations policies and procedures

Organizing Patient Care (Nursing Care Delivery Models) ppt

1. Compare/contrast care delivery models and their impact on patient outcomes. 2. Identify advantages and disadvantages for each model. 3. Differentiate between the different nursing care models. 4. How are variances managed? 5. Differentiate between case management in the acute care setting vs. the community setting.

Organizational Structure ppt

1. Describe how the structure of an organization facilitates or impedes communication, flexibility, and job satisfaction. 2. Differentiate various organizational structures. 3. Discuss the advantages and disadvantages of each organizational structure type and which would be best suited to meet organizational objectives. 4. Identify line and staff relationships, span of control, unity of command, on the organizational chart. 5. Differentiate between informal and formal organization structure. 6. Differentiate between first, middle, and top levels of management. 7. Contrast individual authority, responsibility, and accountability in given scenarios. 8. Identify appropriate strategies to create actively a constructive organizational culture. 9. Identify symptoms of poorly designed organizations. 10. Describe characteristics of a magnet hospital.

Creating a Motivating Climate ppt

1. Describe the relationship between motivation and behavior. 2. Differentiate between intrinsic and extrinsic motivation Develop strategies for creating a motivating work environment. 3. Develop increased self-awareness about personal motivation and the need for "self-care" to remain motivated in a leadership or management role. 4. Identify positive reinforcement techniques that may be used by a manager in an organization. 5. Describe the constraints managers face in creating a climate that will motivate employees. 6. Delineate how the work of individual motivation theorists has contributed to the understanding of what motivates individuals inside and outside the work setting.

Staffing Needs and Scheduling Policies ppt

1. Differentiate between centralized and decentralizing staffing, citing the advantages and disadvantages of each. 2. Identify the driving and restraining forces for the implementation of mandatory minimum staffing ratios in acute care hospitals. 3. Identify organizational variables that impact the numbers of staff needed to carry out the goals of the organization. 4. Use standardized patient classification formulas to determine staffing needs based on patient acuity. 5. Calculate nursing care hours per patient day if given total hours of care in a 24 hour period as well as the patient census. 6. Explain the relationship of flex-time and self-scheduling to increased job satisfaction.

Operational & Strategic Planning ppt

1. Discuss the relationship between an organizational mission statement, philosophy, goals, objectives, policies, procedures, and rules of the organization. 2. Differentiate between an organization's mission, vision and philosophy. 3. Define the purpose and describe the steps necessary for successful strategic planning. 4. Identify barriers to planning as well as actions the leader-manager can take to reduce or eliminate these barriers. 5. Recognize the steps necessary in successful strategic planning. 6. Discuss appropriate actions that may be taken when personal values are found to be in conflict with those of an employing organization.

What 5 main elements must be present for a professional to be held liable for malpractice or professional negligence?

1. Duty 2. Breach of duty 3. Injury 4. Causation 5. Foreseeable Harm

Malpractice Insurance: List 5 good reasons why nurses might want to avoid purchasing professional liability (malpractice) insurance: 1. employer's ____ will ____ the nurse 2. many employers ____ _____ it 3. chance of getting ____ is ____ 4. ____ and ____ 5. could ____ you in a ____

1. Employer's coverage will protect the nurse. 2. Many employers advise against it 3. Chance of getting sued minimal 4. Time and money 5. Could keep you in a lawsuit

Which statements are true about incident reports? Select all that apply a) they are part of the patient's legal medical record b) they are considered confidential communications among hospital personnel c) they can be used as evidence in a lawsuit d) they must be reviewed and signed by patient

B, C

Performance Appraisal ppt

1. Identify and use appropriate performance appraisal tools for measuring professional nursing performance. 2. Identify factors that increase the likelihood that a performance appraisal will develop and motivate staff. 3. Provide feedback regarding peer performance in a constructive and assertive manner. 4. Describe coaching techniques that promote employee growth in work performance. 5. Develop an awareness of biases that influence a person's ability to complete a fair and objective performance appraisal. 6. Differentiate between performance appraisal tools such as rating scales, checklists, essays, self-appraisals and management by objectives (MBOs). 7. Identify what conditions should be present before, during, and after the performance appraisal that increase the likelihood of a positive outcome.

Planned Changed ppt

1. Identify driving and restraining forces of change within an identified problem 2. State the purpose for using a force field analysis and decision matrix in the change process 3. Recognize resistance to change and identify possible sources of resistance 4. Assess driving and restraining forces for change in given situations 5. Identify the responsibilities of a change agent 6. Develop strategies for unfreezing, movement, and refreezing a specific planned change 7. Apply rational-empirical, normative-re-educative, and power-coercive strategies for affecting change 8. Identify and implement strategies to manage resistance to change.

Challenging Employees: Rule Breakers, Marginal Employees, and the Chemically Impaired Nurse ppt

1. Identify the "hot stove" rules described by McGregor to make discipline as fair and growth producing as possible. 2. Describe the usual steps in progressive discipline. 3. Differentiate between constructive and destructive discipline. 4. Identify factors that must be present to foster a climate of self-discipline in employees. 5. Compare and contrast how the disciplinary process may vary between unionized and nonunionized organizations. 6. Analyze situations in which discipline is required and identify appropriate strategies for an organization. 7. Determine appropriate levels of discipline for rule breaking in specific situations. 8. Identify behaviors and actions that may signify chemical impairment in an employee or colleagues.

Collective Bargaining ppt

1. Identify what "collective bargaining" is and the collective bargaining process. 2. Identify factors that influence whether nurses join unions. 3. Identify major legislation that has impacted the ability of nurses to unionize. 4. Identify the steps necessary to start a union. 5. Discuss the important concepts of "management rights" and "union recognition". 6. Describe the potential conflicts inherent in having a professional organization that also serves as a collective bargaining agent. 7. Reflect on whether going on strike can be viewed as an ethically appropriate action for professional nurse.

4 Steps in Progressive Discipline 1. _____ _____ or _____ warning 2. _____ _____ or _____ warning 3. _____ from _____ without ____ 4. _______

1. Informal reprimand or verbal warning 2. Formal reprimand or written warning 3. Suspension from work without pay 4. Termination

Malpractice Insurance: List 5 good reasons why nurses should carry professional liability (malpractice) insurance: 1. nurses should have their own ____ _____ 2. ____ _____ 3. _____ outside of _____ 4. _____ 5. employer may not ____ the _____

1. Nurses should have their own legal rep 2. SBON (State Board of Nursing) complaints 3. Practice outside of employment 4. Cost 5. Employer may not cover the damages

Match the following to their correct step in the Collective Bargaining Process a) Both parties meet to set ground rules for the collective bargaining negotiation process. b) Once an agreement is made between the parties, it must be put in writing, signed by the parties, and put into effect. c) Both representatives make opening statements, outlining options and possible solutions to the issue at hand. d) Choosing a negotiation team and representatives of both the union and employer. Both parties should be skilled in negotiation and labor laws, and both examine available information to determine whether they have a strong standing for negotiation. e) Following proposals, the parties discuss potential compromises, bargaining to create an agreement that is acceptable to both parties. This becomes a "draft" agreement, which is not legally binding, but a stepping stone to coming to a final collective bargaining agreement.

1. Preparation - Choosing a negotiation team and representatives of both the union and employer. Both parties should be skilled in negotiation and labor laws, and both examine available information to determine whether they have a strong standing for negotiation. (D) 2. Discussion - Both parties meet to set ground rules for the collective bargaining negotiation process. (A) 3. Proposal - Both representatives make opening statements, outlining options and possible solutions to the issue at hand. (C) 4. Bargaining - Following proposals, the parties discuss potential compromises, bargaining to create an agreement that is acceptable to both parties. This becomes a "draft" agreement, which is not legally binding, but a stepping stone to coming to a final collective bargaining agreement. (E) 5. Final Agreement - Once an agreement is made between the parties, it must be put in writing, signed by the parties, and put into effect. (B)

What kind of care uses relatively unskilled workers who have been trained to complete certain tasks? A.Modular nursing B.Case management nursing C.Functional nursing D.Team nursing

C

Magnet Status 14 Forces 1. Quality of nursing _____ 2. _____ structure 3. Management ____ 4. ______ policies and programs 5. Professional _____ of care 6. Quality of _____ 7. Quality ______ 8. _____ and resources 9. _____ 10. Community and the _____ 11. Nurses as ____ 12. _____ of nursing 13. Interdisciplinary _____ 14. Professional ______

1. Quality of nursing leadership 2. Organizational structure 3. Management style 4. Personnel policies and programs 5. Professional models of care 6. Quality of care 7. Quality improvement 8. Consultation and resources 9. Autonomy 10. Community and the hospital 11. Nurses as teachers 12. Image of nursing 13. Interdisciplinary relationships 14. Professional development

Legal Issues in Nursing ppt

1. Select appropriate legal nursing actions in sensitive clinical situations. 2. Differentiate among the various types of both direct and indirect liability in health care. 3. Explain the impact of state legislation on health care delivery and management. 4. Discuss how a nurse's personal legal issues can impact professional licensure. 5. Identify the leadership roles and management functions which promote safe and legal nursing practice.

Lewin's Change Theory: List the steps in Lewin's Change Theory. Match the following to their correct phase a) the change agent identifies, plans, and implements appropriate strategies, ensuring that driving forces exceed restraining forces b) the change agent assists in stabilizing the system change so that it becomes integrated into the status quo c) This is where people begin to get used to the idea that things will be different. d) This is the part of the change process where you have to communicate why this change is necessary. Make sure that everyone who will be affected by the change knows this. And, make sure that you deal with people's doubts and concerns. e) This is when the change is set in place, and becomes part of your organization's culture f) Keep communicating how the change will benefit the people involved, so that they continue to support it. g) In this stage, make sure people have the training and support they need to stay on the right track. h) regularly check that the change has happened and that people are using the new processes that you've implemented. i) the change agent convinces members of the group to change or guilt, anxiety, or concern are elicited j) It's also important that you celebrate everyone's hard work in making the change a success. This helps people find closure, and it helps them believe that future changes will also be successful. k) And remember this stage doesn't happen overnight, so, give people plenty of time to adjust to it.

1. Unfreezing: d, i - the change agent convinces members of the group to change or guilt, anxiety, or concern are elicited - This is the part of the change process where you have to communicate why this change is necessary. Make sure that everyone who will be affected by the change knows this. And, make sure that you deal with people's doubts and concerns. 2. Movement of Change: a, c, f, k - the change agent identifies, plans, and implements appropriate strategies, ensuring that driving forces exceed restraining forces - This is where people begin to get used to the idea that things will be different. - Keep communicating how the change will benefit the people involved, so that they continue to support it. - And remember that the Change stage doesn't happen overnight, so, give people plenty of time to adjust to it. 3. Refreezing: b, e, g, h, j - the change agent assists in stabilizing the system change so that it becomes integrated into the status quo - This is when the change is set in place, and becomes part of your organization's culture. - In this last stage, make sure people have the training and support they need to stay on the right track. - And, regularly check that the change has happened and that people are using the new processes that you've implemented. - It's also important that you celebrate everyone's hard work in making the change a success. This helps people find closure, and it helps them believe that future changes will also be successful.

In Summary-for the final

1. Select appropriate legal nursing actions in sensitive clinical situations. •What is the nurse's role in informed and expressed consent? •What federal and state laws impact consent and confidentiality for minors? •What are the key considerations in completing an incident report? •When should nurses use their chain of command? 2. Differentiate among the various types of direct and indirect liability in health care. •What are the 5 elements of professional negligence or malpractice? •What are the differences among the 3 types of direct liability discussed in class (Negligent supervision, professional negligence and corporate liability)? •What is indirect or vicarious liability and how is it different from corporate liability? 3. Explain the impact of state legislation on health care delivery and management. •Explain how Arizona's Medical Marijuana Act might impact nursing practice and leadership. •How does the law protect nurses who volunteer? •What groups are protected against discrimination in the workplace? 4. Discuss professional licensure protection strategies. •What are pros and cons of nurses carrying their own malpractice insurance? •List which personal criminal charges and convictions must be reported to the SBON. •How does the AZ NPA address mandatory reporting? 5. Identify the leadership roles and management functions which promote safe and legal nursing practice. •Describe the nursing management strategies which are particularly critical in maintaining a safe and legal practice. •What is employment discrimination ?

American Nurses Association Code of Ethics

1. The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. 2. The nurse's primary commitment is to the patient, whether an individual, family, group or community. 3. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient. 4. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum patient care. 5. The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, & to continue personal and professional growth. 6. The nurse participates in establishing, maintaining, and improving health-care environments and conditions of employment conducive to the provision of quality health care & consistent with the values of the profession through individual & collective action. 7. The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge, development. 8. The nurse collaborates with other health professionals & the public in promoting community, national, and international efforts to meet health needs. 9. The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.

Rules for Leading Change Are each of the following statements True of False: 1. Squelch all dissent immediately -eliminate anyone who opposes the change. 2. Keep the pace of change high at all times. 3. Make sure everyone understands what changes will be made and why 4. Keep everyone informed as the change progresses. 5. Don't allow any modifications once the change process is under way. 6. Demonstrate clearly why the change is a beneficial one. 7. The work environment is not changing. Change is the work environment!

1. false 2. false 3. true 4. true 5. false 6. true 7. true

According to McNally (1980) 4 characteristics determine a true value: 1. must be truly chosen among ____ only after due _____ 2. must be prized and _____ 3. is consciously and consistently _____ (part of a pattern) 4. _____ affirmed and enacted

1.Must be truly chosen among alternatives only after due reflection 2.Must be prized and cherished 3.Is consciously and consistently repeated (part of a pattern) 4.Positively affirmed and enacted

Revenue is mostly generated through: A.Billable patient services B. Donations to service organizations C. Use of generic drugs/products etc. D. Messenger and escort services

A

A nurse-manager is attempting to restructure the unit to prevent understaffing of the nurses. The nurses agree this is a needed change. What type of change strategy would be most effective? A.Rational-empirical strategies B.Normative-re-educative strategies C.Power-coercive strategies D.None of the above

A Rationale: When using rational-empirical strategies, the change agent assumes that resistance to change comes from a lack of knowledge and that humans are rational beings who will change when given factual information documenting the need for change. This type of strategy is used when there is little anticipated resistance to the change or when the change is perceived as reasonable

TAKE ACTION! Remind yourself to be ABLE What does ABLE stand for: - A: ____ now to address _____ and cynicism - B: _____ your belief in all team members and show they are _____ and important - L: ____ through _____. Show staff that you use the same behaviors you expect from them through all interactions - E: _____ excellence and _____ your employees to achieve the goals they set

A = *act* now to address conflict, cynicism, don't wait B = *bolster* your belief in all team members and show they are appreciated and important L= *lead* through example. Show staff that you use the same behaviors you expect from them through all interactions E= *expect excellence and empower* your employees to achieve the goals they set

Right to Work Law - A Right to Work law guarantees that no ____ can be ______, as a condition of _____, to ____ or not to ____, nor to pay ____ to a ____ _____ - Section 14(b) of the ____-Hartley Act affirms the right of states to enact Right to Work laws - Arizona has been a ____-to-____ State since it's statehood

A Right to Work law guarantees that no person can be compelled, as a condition of employment, to join or not to join, nor to pay dues to a labor union. Section 14(b) of the Taft-Hartley Act affirms the right of states to enact Right to Work laws. State of Arizona has been a Right-to-Work State since statehood, February 14, 1912.

Force Field Analysis: a technique for determining which forces ____ a proposed _____ and which forces ____ it Describe how to use a force field analysis, in the example of returning back to school The force field analysis is much like a ___-___ list but with weighted ____

A technique for determining which forces drive a proposed change and which forces restrain it. List out the restraining forces for returning to school and give them a number that is negative...using a negative 10 as biggest restraining force for not returning to school Do the same for the Driving forces but give them a positive #, using positive 10 as biggest reason for returning to school Add up the numbers from both sides If + values = worthy of going forth If - values = rethink effort This is much like a pro-con list but with weighted numbers

Arizona State Board of Nursing Chemically Addicted Nurses Diversion Option "ATD" - what does ATD stand for? - self- ____ - _____ renewal/_____ - employer _____ - _____ agencies/other regulatory or community referral - purpose: provide for the public's ____ and ____ through early ____, treatment, and monitoring of chemically _____ nurses

ATD: Alternative to Discipline - Self - referral (the employee refers themself) - Licensure Renewal/Application - Employer Referral - Legal Agencies/other Regulatory or Community Referral - Purpose: Provide for the public's safety & welfare through early detection, treatment, & monitoring of chemically dependent nurses

Laws impacting Nurses and Health Care AZ State Law - Arizona ____ ____ Act 2010 - ____ Testing of ____ Act - ___ and ___ Act Federal Law - 1970 ____ ____ Act - 1988 Drug-___ Workplace Act - 1989 Drug-____ Schools and Community's Act - 2018 Farm Bill ____ production, sale, ___ and use of Hemp/____ Policy - ____

AZ State law •Arizona Medical Marijuana Act 2010 (ARS 36-2811) •Drug Testing of Employees Act (2011) •Smart and Safe Act (on the 2020 ballot) Federal law •1970 Controlled Substances Act •1988 Drug-Free Workplace Act •1989 Drug-Free Schools and Community's Act •2018 Farm Bill legalizing production, sale, possession and use of Hemp/CBD Policy •AZBON

Steps Necessary to Start a Bargaining Unit ____ an issues ____ - usually issues have already been identified by the _____, but work needs to be done on best ways to _____ to ____ ____-_____ ____ on union _____ - need at least ___% before going to the NLRB but unions will usually not go to election until they have ___-___% of appropriate ____ ____ signage cards ____ the ____ - must have __% + ___ to win - must be an appropriate _____ unit _____ a _____ - if takes longer than ___ year, then ____ in void - employers employ _____ tactics Make it your ____!

Adopt an issues program •Usually issues have already been identified by the nurses, but work needs to be done on best ways to communicate to nurses Sign-up majority on union cards •Need at least 30% before going to the NLRB (National Labor Relations Board) but unions will usually not go to election until they have 60 - 70% of members of appropriate bargaining unit signing cards Win the union election •Must have 50% + 1 to win •Must be an appropriate bargaining unit Negotiate a contract •If takes longer than 1 year, then election in void •Employers employ delay tactics Make it your union! What is the role of the nurse manager at this point?

Functional Nursing Care Pros and Cons Advantages - cost ____: hire more nurse ____ and ____, less ____ - one ___ set is _____ - tasks are completed _____ Disadvantages - ____ care; too many care ___ for one ____ - _______ relationship with the patient; RN-patient relationship does not ____ - limits the growth of ___ because it limits the application of ____ - because functional nursing is repetitive, it is less _____

Advantages - Cost effective, hire more nurse aids and LPNs, less RNs - one skill set is refined - Tasks are completed quickly Disadvantages •Fragmented care; too many care aids for one patient - Impersonal relationship with the patient; RN-patient relationship does not flourish - limits the growth of RNs because it limits the application of skills she received education and training; less challenging

Bureaucracy as an Organizational Design Advantages of bureaucracy: - clear ____ of ____ - authority and _____ clearly _____ - clear rules and ____ - task specialization and ____ of labor - _____ of relationships - technical ____ - promotion based on ____ Disadvantages of bureaucracy - predisposed to _____ leadership style - use of ____ and ____ - _____ for the advancement of an individual interest - aloofness secondary to _____ - faceless ____ making - ____ management - lack of _____ - lack of _____ - establishment of organizational _____

Advantages of bureaucracy: - Clear lines of authority - Authority and responsibility clearly defined - Clear rules and regulations - Task specialization and division of labor - Impersonality of relationships - Technical efficiency - Promotion based on competence. Disadvantages of bureaucracy - Predisposed to authoritarian leadership style - Use of rewards and punishment - Competition for the advancement of an individual interest - Aloofness secondary to specialization - Faceless decision making - Impersonal management - Lack of flexibility - Lack of accountability - Establishment of organizational barriers

Modular Care Nursing- Pros and Cons Advantages - increase in patient ____ - more ____ of care - addresses all components of HCAHPS score-- nurse ____, call bell ____, pain managed, less _____, increased patient ____ - less ____ to travel Disadvantages - increased ____ to ____ each pod/module - long ____ not perfect to be a module

Advantages: - Increase in patient safety (less falls?) - More continuity of care - Addresses all component of HCAHPS score-- Nurse responsiveness, call bell answered, pain managed, less noise. Increased patient satisfaction - Less area to travel Disadvantages: - Increased cost to stock each pod/module - Long hallways not perfect to be a module

Team Nursing: Pros and Cons Advantages - strength of every HCP is _____ - every team member contributes to ____ ____ and comprehensive care - improves level of _____ - increases job ____ and staff ____ Disadvantages - ____ patient handoff - incidental _____ - if daily team assignments vary (different pt every day, _____ suffers)

Advantages: - Strength of every health care professional is utilized. - Every team member contributes to decision making and comprehensive care. - Improves level of communication - Increases job satisfaction and staff morale. Disadvantages: •Prolonged patient handoff (team hand off vs individual), incidental overtime. - Delegation and communication skill sets are important while working with ancillary care team. The nurse is still responsible for overall care although she assigns tasks to ancillary team. •If daily team assignments vary (different patient every day, continuity suffers.

Primary Care Nursing- Pros and Cons Advantages - _____ of decisions, ____, and responsibility - ___-hr ____ - improved ____ and coordination of ____ - increased ____, patient, and physician _____ Disadvantages - RN must be able to exercise high ____ of _____ - not ____ effective - RN has to accept 24-hour ____

Advantages: •Decentralization of decisions, authority and responsibility •24-hr accountability •Improved continuity and coordination of care •Increased nurse, patient and physician satisfaction. Disadvantages: •RN must be able to exercise high degree of autonomy •Not cost effective •RN has to accept 24hour responsibility

Total Patient Care-Pros and Cons Advantages - high degree of _____ - lines of responsibility and ____ are clear - patient receives ____ care-- _____ Disadvantages - each RN may have a different ____ to care - not ____ effective - lack of ___ availability

Advantages: •High degree of autonomy •Lines of responsibility and accountability are clear. •Patient receives whole care- unfragmented. Disadvantages: •Each RN may have a different approach to care •Not cost effective •Lack of RN availability

Presenting to a small group of vocal employees a new system to be implemented is an example of which type of strategy? A.Rational B.Normative C.Power

B Rationale: uses the group

Advocating against implementing a new hospital computer system is an example of which type of planning? A. Reactivist B. Inactivist C. Preactivist D. Proactivist

B. Inactivist Rationale: Inactivists would rather maintain the status quo than take a risk with a new way of doing things

Patient classification systems measure nursing workload needed by the patient. The higher the patient's acuity, the more care that is required by the pt. Which of the following statement is a weakness of classifications systems? A. Pt. Classification data are useful in predicting the required staffing for the next shift & for justifying nursing hours provided. B. Pt. Classification data can be utilized by the nurse making assignments to determine what level of care a patient requires. C. Classification systems typically focus on nursing tasks rather than a holistic view of a patient's needs. D. Aggregate pt classification data are useful in costing out nursing services and for developing the nursing budget.

C

Patient classification systems: describe the 4 categories

Categories 1 - 4 •Category 1: Feed self •Category 2: Needs some help in preparing food tray •Category 3: Cannot feed self but is able to chew and swallow •Category 4: Cannot feed self and may have difficulty following

List the Two Types of Bargaining Match the following to their correct type of bargaining a) The most common type of bargaining and involved a zero-sum negotiations b) wages and benefits - union interested in increasing wages and management wants more work for as little pay as possible c) Similar to problem solving sessions in which both sides try to reach a mutually beneficial alternative, i.e. win-win. d) One side wins and the other loses. e) Both parties share information about interests and concerns. f) Both parties try to maximize their gains g) Ex: Nursing Labor Management Partnership (NLMP)

Conjunctive/Distributive Bargaining: A, B, D, F •The most common type of bargaining and involved a zero-sum negotiations. One side wins and the other loses. Both parties try to maximize their gains •Example: wages and benefits - union interested in increasing wages and management wants more work for as little pay as possible Cooperative/Integration Bargaining (Interest-based bargaining): C, E, G •Similar to problem solving sessions in which both sides try to reach a mutually beneficial alternative, i.e. win-win. Both parties share information about interests and concerns. •Ex: Nursing Labor Management Partnership (NLMP)

Constructive Discipline vs Destructive Discipline Constructive - fosters ____ growth - ______ and ______ manner - employee should understand that _____ is because of ____ and not who they are as a ____ - primary focus: self ______ in meeting _____ goals Destructive - includes the use of ____ and _____ to control ______

Constructive Discipline - Foster employee growth - Supportive & corrective manner - Employee should understand that punishment is because of actions & not who they are as a person - Primary focus: Self directed in meeting organizational goals Destructive Discipline - Includes the use of threats & fears to control behavior

MORAL DECISION-MAKING MODEL Crisham (1985) developed decision-making model incorporating the nursing ____ and principles of _____ ethics Moral: - massage the dilemma: collect data about the ethical _____ and who should be involved in the _____-_____ process - outline _____: identify _____, and analyze the causes and _____ of each - review criteria and _____: weigh the _____ against the values of those involved - affirm ____ and act: develop the ______ strategy - look ____: evaluate the ____-_____

Crisham (1985) developed decision -making model incorporating the nursing process and principles of biomedical ethics. MORAL: - Massage the dilemma- collect data about the ethical problem & who should be involved in the decision-making process. - Outline options- Identify alternatives, and analyze the causes and consequences of each. - Review Criteria & resolve- Weigh the options against the values of those involved. - Affirm position & act- Develop the implementation strategy - Look back- Evaluate the decision making

Cost centers are best described by: A. Developing historical and demographic data B. Tracking expense line items C. Plan for strategic growth D. Tracking financial data within a department or unit

D

Productivity can be measured by: A. Number of beds in hospital B. Reimbursement rates for services rendered C. Past Performance and history regarding revenue D. Volume of services delivered

D

The purpose of monitoring a budget is to: A. Keep expenses above budget B. Maintain revenue above the previous year's budget C. Ensure revenue is generated monthly D. Generate revenue and control expenses within a projected framework

D

To determine the number of FTE's required for a renal transplant unit, you must review all but which of the following? A. Benefited time such as vacation and sick time. B. Educational time for staff, including orientation of new staff. C. Indirect patient care staff that support the operations of the direct care staff 24 hours a day. D. Coverage for other depts. that do not staff to cover their own benefited time off

D

Differentiate between centralized and decentralized staffing, citing the advantages and disadvantages of each Match the following strengths and limitations to their correct type of staffing: a) can result in more special pleading and arbitrary treatment of employees b) staff are able to take requests directly to their manager c) provides organization-wide view of staffing needs, which encourages optimal utilization of staffing resources d) more time consuming for the unit manager e) staffing policies tend to be employed more consistently and impartially f) manager retains greater control over unit staffing g) more cost-effective h) may not be cost-effective for organization since staffing needs are not viewed holistically i) frees the middle-level manager to complete other management functions j) provides greater autonomy and flexibility for individual staff member k) provides less flexibility for the worker and may not account for a specific worker's desires or special needs l) managers may be less responsive to personnel budget control in scheduling and staffing matters

Decentralized Staffing: a, b, d, f, h, j - Strengths --> manager retains greater control over unit staffing --> staff are able to take requests directly to their manager --> provides greater autonomy and flexibility for individual staff member - Limitations --> can result in more special pleading and arbitrary treatment of employees --> may not be cost-effective for organization since staffing needs are not viewed holistically --> more time consuming for the unit manager Centralized Staffing: c, e, g, i, k, l - Strengths --> provides organization-wide view of staffing needs, which encourages optimal utilization of staffing resources --> staffing policies tend to be employed more consistently and impartially --> more cost-effective than decentralized staffing --> frees the middle-level manager to complete other management functions - Limitations --> provides less flexibility for the worker and may not account for a specific worker's desires or special needs --> managers may be less responsive to personnel budget control in scheduling and staffing matters

Match the following characteristics to their correct term a) Training /Molding the mind or character to bring about desired behaviors b) Undesirable event that follows unacceptable behavior c) Constructive - assists employees growth

Discipline: a, c - Constructive - assists employees growth - Training /Molding the mind or character to bring about desired behaviors Punishment: b - Undesirable event that follows unacceptable behavior

Discrimination in the workplace: Hiring, firing , demoting, promoting, training, wages, benefits and disciplining an employee based on any of the following categories - ____ - race, ____, or national ____ - ____ (and status) - _____ - sex: sexual ____, gender ____, gender ____ - ____ status - _____ - accents - pregnancy and ____ - _____ information - _____ blowers or people who have filed a discrimination _____ - _____ association - people _____ by a union or who wish to form, ____, or support a ____ - ____ service (past, present, or future obligations)

Discrimination in the workplace: Hiring, firing , demoting, promoting, training, wages, benefits and disciplining an employee based on any of the following categories •Age (40+) •Race, ethnicity or national origin •Citizenship (and status) •Disability •Sex •Sexual orientation •Gender identity •Gender expression •Marital status •Religion •Accents •Pregnancy and children •Genetic information •Whistle blowers or people who have filed a discrimination complaint •Political association •People represented by a union or who wish to form, join, or support a union •Military service (past, present or future obligations)

Which is an example of why plans might fail? A.Not enough alternatives B.Low motivation levels C.False assumptions D.Lack of sound strategies E.All of the above

E. All of the above

Factors influencing nurses joining unions and nurse manager influence - elimination of _____ and ____: who gets better ___ choices? - ____ the power of the individual: who gets their ___ heard? - ____ nurses' input into ____ ____ making: what ideas are brought forward for ____? - nurses ____ situation-- need to be accepted: ___ or supported? - employers would be required to accept employee's as _____: married v ____? - nurses believe it will improve ____ ____ and quality of ____: poor ___ v. acceptable and agreed upon staffing

Elimination of discrimination and favoritism ØWho gets better shift choices? Increase the power of the individual ØWho gets their voice heard? Increase nurses' input into organizational decision making ØWhat ideas are brought forward for consideration? Nurses social situation - need to be accepted ØIsolated or supported? Employers would be required to accept employee's as equal ØMarried v. single? (i.e. married couples get the same holiday off; instead everyone is treated equally) Nurses believe it will improve patient outcomes & quality of care ØPoor staffing v. acceptable and agreed upon staffing

List the Three Types of Employees Match the following to their correct type of employee a) Checked out b) Drive innovation and move organization forward c) Acting out their unhappiness d) Passion e) Connection to their company f) Time not energy into work

Engaged: b, d, e •Passion •Drive innovation and move organization forward •Connection to their company Not-engaged: a, f •Checked out •Time not energy into work Actively disengaged: c •Acting out their unhappiness

What's the difference between a formal structure vs an informal one-- Match to correct structure a) unplanned and covert, with informal authority and lines of communication b) exist in every group, even when they are never formally acknowledged. Nearly ALL settings have an "informal leader and structure" c) provides a framework for defining managerial authority, responsibility, and accountability d) roles and functions are defined and systematically arranged, different people have differing roles, and rank and hierarchy are evident

Formal Structure: c, d - A formal structure provides a framework for defining managerial authority, responsibility, and accountability. - roles and functions are defined and systematically arranged, different people have differing roles, and rank and hierarchy are evident. Informal Structure: a, b - An informal structure is unplanned and covert, with informal authority and lines of communication. - People need to be aware that informal authority and lines of communication exist in every group, even when they are never formally acknowledged. Nearly ALL settings have an "informal leader and structure"

Microsystem characteristic: Leadership - IOM study findings and discussion with its lead investigator reveals leadership is threaded through many of the eight ____ and was strongly present - health system redesign can succeed only with ___ who take ____ to ____ - small ____ units to optimize performance to meet/exceed patient needs and ____

IOM study findings and discussion with its lead investigator reveals leadership threaded through many of the other eight dimensions and was strongly present •Health system redesign can succeed only with leaders who take action to transform •small clinical units to optimize performance to Meet/exceed patient needs and expectations

Microsystem characteristic: Leadership Tips If you are a leader, and you want to improve your microsystem, you need to _____. ____ _____ - create a clear _____ sense of organizational ____ and structure to promote, _____, and reward ____ performance in _____, ____ across microsystems, and _____ in all parts of the enterprise to achieve the mission - recognize the ways in which the ____ encourages ____ performance and ways ____ may need to be enriched _____ _____ - EXCEPTION: provide _____ support services only in areas that _____ cannot manage ____ and more ____ - an overarching suggestion for senior leaders is to recognize power of using microsystem-based approaches for strategic _____, operating ____, and change, and ______

If you are a leader, and you want to improve your microsystem, you need to communicate. *Communicate mission* - Create a clear compelling sense of organizational purpose and structure to promote, recognize, and reward high performance in microsystems, linkages across microsystems, and innovation in all parts of the enterprise to achieve the mission. - Recognize the ways in which the culture encourages high performance and ways culture may need to be enriched. *Decentralize accountability* - EXCEPTION: provide "centralized" support services only in areas that microsystems cannot manage better and more efficiently - An overarching suggestion for senior leaders is to recognize power of using microsystem-based approaches for strategic thinking, operating excellence, and change and innovation

Informed vs. Expressed Consent - what's the difference between informed and expressed consent? - it is within the scope of practice of the RN to obtain informed consent for treatments and procedures that the ___ will perform - expressed consent: is is within the scope of practice of the ___ to witness ____ on documentation indicating understanding of ____ consent provided by other ____ such as PAs, NPs, and MDs - it is NOT within the scope of practice of the RN to obtain _____ consent for ____ treatment plans

Informed consent: ensuring the patient *understands* the procedure Expressed consent: the patient *signing* the consent form •It is within the scope of practice of the ...RN to obtain informed consent for treatments and procedures that the *RN will perform* • expressed consent: It is within the scope of practice of a RN ... to witness signatures on documentation indicating understanding of informed consent provided by other practitioners, such as physician assistant, nurse practitioner, and physician (expressed consent). •It is NOT within the scope of practice of the RN to obtain informed consent for medical treatment plans.

Leadership & Building an Organizing Committee _____ are identified and an _____ committee representing all major ____ and all shifts and reflecting the ____, ethnic, and gender diversity in the ______ is established Information about the _____ must be gathered including: - ____ _____: departments, work ___, jobs, shifts - _____ _____: name, _____, phone, shift, job ____, department for each worker (employee list) - _____ _____: other locations, parent _____, products, customers, union _____

Leaders are identified and an organizing committee representing all major departments and all shifts and reflecting the racial, ethnic and gender diversity in the workforce is established. Information about the workplace must be gathered including: •workplace structure: departments, work areas, jobs, shifts •employee information: name, address, phone, shift, job title, and department for each worker (employee list) •employer information: other locations, parent company, product(s), customers, union history

The Planning Hierarchy Mission (top of pyramid) ↓ ______ ↓ Goals ↓ ______ ↓ Policies ↓ ______ ↓ Rules (bottom of pyramid)

Mission (top of pyramid) ↓ Philosophy ↓ Goals ↓ Objectives ↓ Policies ↓ Procedures ↓ Rules (bottom of pyramid)

Match the following to their correct term a) identifies what is unique about the organization b) the basic foundation that directs all further planning toward that mission c) has the capacity to drive action over time; can become powerful decision making tools when they become a template of purpose for the organization's activities d) Sometimes health care policy makers tend to focus on technology, cost analysis and cost effectiveness e) are the ends toward which the organization is working f) a brief statement (no more than 3 or 4 sentences) identifying the reason the organization exists g) flows from the purpose or mission statement and delineates the set of values and beliefs that guide all actions of the organization h) should be measurable and realistic and should delineate the desired end product

Mission Statement: A, C, F - A mission statement is a brief statement (no more than 3 or 4 sentences) identifying the reason the organization exists. - A well written statement identifies what is unique about the organization. - The statement should also have the capacity to drive action over time...In other words, mission statements can become powerful decision making tools when they become a template of purpose for the organization's activities. Philosophy: B, G - the philosophy flows from the purpose or mission statement and delineates the set of values and beliefs that guide all actions of the organization. - It is the basic foundation that directs all further planning toward that mission. - Statements of philosophy can usually be found in policy manuals...The organizational philosophy provides the basis for nursing philosophy at the unit level and for nursing services as a whole Values: D - Sometimes health care policy makers tend to focus on technology, cost analysis and cost effectiveness. - However values have tremendous impact on the decisions people make. - People should carefully examine their value system and recognize the role that it plays in decisions, conflicts, and perceptions Goals and Objectives: E, H - Goals and objectives are the ends toward which the organization is working. - All philosophies must be translated into specific goals and objectives if they are to result in action. Therefore the goals and objectives "operationalize" the philosophy. There is increasing evidence concerning the value of including admin and all workers in setting organizational goals. Goals should be measurable and realistic and should delineate the desired end product.

Staff Nursing Policies Need policies that address: 1. ____ leave 2. ____ 3. _____ 4. call-____ for ___ census 5. on-___ pay 6. _____ and _____ Be aware of violations - do not violate ____ laws, union ____, state and national laws

Need policies that address: 1.Sick leave 2.Vacations 3.Holidays 4.Call-offs for low census 5.On-call pay 6.Tardiness and absenteeism Be aware of Violations - Do not violate: Labor laws, Union contracts, State & National laws

Examples of Non-nursing Tasks vs. Professional Nursing Activities Match to either non-nursing or professional nursing tasks a) Transport pts b) Interpreting V/S c) Assessing/monitoring physical conditions d) Taking V/S e) Preparing meals f) Getting supplies & equipment g) IV drugs, therapy h) Planning for discharge

Non-nursing Tasks: a, d, e, f •Taking V/S •Transport pts. •Preparing meals •Getting supplies & equipment Professional Nursing Activities: b, c, g, h •Interpreting V/S •Assessing/monitoring physical conditions •IV drugs, therapy •Planning for discharge

How does the organizational culture differ from the organizational climate-- match to correct term a) is the soul and personality of the institution; It is the basis of the corporate values and mileu b) Their perception may be accurate or inaccurate, and people in the same organization may have different perceptions about the same organization c) this is how individuals perceive the organization d) one can't see or touch this, as this is essentially invisible, but very real none- the less

Organizational Climate: b, c - this is how individuals *perceive* the organization - Their perception may be accurate or inaccurate, and people in the same organization may have different perceptions about the same organization Organizational Culture: a, d - one can't see or touch this, as this is essentially invisible, but very real none- the less - Culture is the soul and personality of the institution. It is the basis of the corporate values and mileu

Organizational Structure - refers to the way in which a group/organization is ____, its lines of _____, and its means for channeling ____ and making _____ - indicates _____, power, _____, span of ____, expected communication ____ for decisions - shows how work gets ____--- the processes for _____

Organizational structure refers to the way in which a group/ organization is formed, its lines of communication, and its means for channeling authority and making decisions What does the structure indicate? - Authority, power, hierarchy, span of control, expected communication lines for decisions... - Shows how work gets done - the processes for communicating

What's the difference between Centralized vs. Decentralized Decision Making-- match to correct term a) decision making is diffused throughout the organization, and problems are solved by the lowest practical managerial level b) a few managers at the top of the hierarchy make most of the decisions c) problems can be solved at the level at which they occur

Organizations with Centralized Decision Making (B) - a few managers at the top of the hierarchy make most of the decisions. Organizations with Decentralized Decision Making (A, C) - decision making is diffused throughout the organization, and problems are solved by the lowest practical managerial level. - Usually, this means that problems can be solved at the level at which they occur.

List the 4 P's of Microsystems. Need to know examples of each!

Patient Centered Services 4P's: *1. Know your patients.* •Who are we caring for? •Are there subpopulations we could plan services for differently? •What are the common patient diagnoses and conditions? •What other microsystems support what we do to meet patients' needs? •How satisfied are patients with our microsystem? *2. Know your people.* •Who provides patient care, and who are the people supporting the caregivers? •What skills and talents do the members need to provide the right service and care at the right time? •What is the morale of our team? •What is the role of information technology as a "team member"? *3. Know your processes.* •How do we deliver care and services to meet our patients' needs? •Who does what in our microsystem? •Do our hours of operation match the needs of our patients? *4. Know your patterns.* •What are the health outcomes of our patients? •What are the costs of care? •How do we interact within our microsystem? •What does it feel like to work here? •What are the costs of our microsystem?

Team Nursing Delivery Care Model: RN Team Leader Role - managing the ____ - team ____ - _____ of care - patient ____ - _____ team member Functions - develops/evaluates ____ - assures ____ outcomes - resolves _____ encountered by team - conducts ____ and ____, huddles

ROLE •Managing the care •Team supervisor •Coordinator of care •Patient Advocate •Interprofessional team member- ST,RN,Surgeon, Patient Advocate FUNCTIONS •Develops / Evaluates POC (plan of care) •Assures quality outcomes •Resolves problems encountered by team •Conducts briefings and debriefs, huddles

Change Agent Strategies (Bennis et al, 1969) Match the following to their correct Change Agent Strategy a) change agent has good understanding of roles and relationships b) uses the group process, assumes humans are social, more easily influenced by others rather than facts c) change agent knows that people have a lack of knowledge and once given that knowledge they will change when given the facts d) uses power by legitimate source, economic sanction or political clout ie new law enactment e) used when there is little anticipated resistance to the change or when the change is perceived as reasonable f) use group norms and peer pressure to socialize and influence people so that change will occur g) feature the application of power by legitimate authority, economic sanctions, or political clout of the change agent

Rational-empirical: C, E - change agent knows that people have a lack of knowledge and once given that knowledge they will change when given the facts - used when there is little anticipated resistance to the change or when the change is perceived as reasonable Normative-re-educative: A, B, F - uses the group process, assumes humans are social, more easily influenced by others rather than facts, - change agent has good understanding of roles and relationships - use group norms and peer pressure to socialize and influence people so that change will occur Power-coercive: D, G - uses power by legitimate source, economic sanction or political clout ie new law enactment - feature the application of power by legitimate authority, economic sanctions, or political clout of the change agent

Match the following definitions to their correct term a) Too many people reporting to a single manager delays decision making, whereas too few results in an inefficient, top-heavy organization b) top-level managers, middle-level managers, first-level managers c) Those entities in an organization's environment that play a role in the organization's health and performance, or that are affected by the organization d) Every organization should be viewed as being part of a greater community of stakeholders e) Refers to the number of people directly reporting to any one manager and determines the number of interactions expected of him or her f) is related to job assignment and must be accompanied by enough authority to accomplish the assigned task g) May be both internal and external h) is the moral responsibility that accompanies a position i) the official power to act and direct the work of others

Span of Control: a, e - Refers to the number of people directly reporting to any one manager and determines the number of interactions expected of him or her - Too many people reporting to a single manager delays decision making, whereas too few results in an inefficient, top-heavy organization Levels of Management: b - top-level managers, middle-level managers, first-level managers Stakeholders: c, g, d - Those entities in an organization's environment that play a role in the organization's health and performance, or that are affected by the organization - May be both internal and external - Every organization should be viewed as being part of a greater community of stakeholders Authority: i - the official power to act and direct the work of others Responsibility: f - is related to job assignment and must be accompanied by enough authority to accomplish the assigned task Accountability: h - is the moral responsibility that accompanies a position

Organizational Chart The Advantages of an organizational chart: 1. maps ____ of ____-_____ authority 2. helps people understand their ____ and those of their ____ 3. reveals to ____ and new personnel how they fit into the _____ 4. contributes to _____ organizational structure 5. shows formal lines of _____ The Disadvantages of an organizational chart: 1. does not show the _____ structure of the organization 2. does not indicate the degree of ____ held by each line _____ 3. may show things as they are supposed to be or used to be rather than as ____ _____ 4. possibility exists of confusing _____ with _____

The Advantages of an organizational chart: 1.Maps lines of decision-making authority 2.Helps people understand their assignments and those of their coworkers 3.Reveals to managers and new personnel how they fit into the organization 4.Contributes to sound organizational structure 5.Shows formal lines of communication The Disadvantages of an organizational chart: 1.Does not show the informal structure of the organization 2.Does not indicate the degree of authority held by each line position 3.May show things as they are supposed to be or used to be rather than as they are 4.Possibility exists of confusing authority with status

Arizona Registered Nurses Ratify First-ever RN Union - the ____-year contract runs through May 31, 2023. - Nurses say that in addition to being proud to vote "yes" on the first-ever RN _____ in the state, they feel good about negotiating the important safe patient care protections during ____-19 Contract features include: - a voice for nurses on ____, optimal patient ___, lift _____, and communicable disease issues, helping them advocate for their patients - a ____ _____ Committee made up of bedside nurses from units throughout the hospital who meet _____ to discuss optimal patient care and nursing practice. - Rest between shifts of at least ____ hours to ensure nurses are able to give high quality care. - Ensures nurses only work in units of their clinical _____ - Establishes a fair and transparent wage ______ and wage scales for new hires to ensure recruitment and retention of experienced nurses. Nurses will receive increases of _____ percent a year for the next two years on top of any increases already received earlier this year. - Staffing protections to ensure the hospital is in compliance with its staffing ______

The three-year contract runs through May 31, 2023. Nurses say that in addition to being proud to vote yes on the first-ever RN contract in the state, they feel good about negotiating the important safe patient care protections during COVID-19. Contract features include: - A voice for nurses on personal protective equipment (PPE), optimal patient handling, lift equipment, and communicable disease issues, helping them advocate for their patients. - A Professional Practice Committee (PPC) made up of bedside nurses from units throughout the hospital who meet monthly to discuss optimal patient care and nursing practice. - Rest between shifts of at least eight hours to ensure nurses are able to give high quality care. - Ensures nurses only work in units of their clinical competence. - Establishes a fair and transparent wage increase and wage scales for new hires to ensure recruitment and retention of experienced nurses. Nurses will receive increases of two percent a year for the next two years on top of any increases already received earlier this year. - Staffing protections to ensure the hospital is in compliance with its staffing matrix.

Union Recognition - the union recognition clause is as important to the ____ as the management rights clause is to _____. each wants the _____ terms possible. to arrive at an ____ there is usually a _____ in these two areas example of a union recognition clause: "the employer _____ the ____ as the sole and exclusive _____ agent, for the purpose of establishing ____, hours, and conditions of employment"

The union recognition clause is as important to the union as the management rights clause is to employers. Each wants the strongest terms as possible. To arrive at an agreement there is usually compromise in these two areas (and many others of course) Example of a union recognition clause: "The employer recognizes the Union as the sole and exclusive bargaining agent, for the purpose of establishing wages, hours and conditions of employment."

What are the 2 sides in a malpractice case?

There are 2 sides in a malpractice case: the plaintiffs (making the complaint) and the defense

Conflict: A professional organization and a collective bargaining agent (union) There are conflicts within professional nursing organizations - A good example is what happened to the American ____ Association and the State ____ Associations - most SNAs, that provide ____ _____ services, have ____ comprised mostly of staff ___ covered by ____ _____ agreements - few managerial nurses are members of an SNA that engages in _____ _____ - about 20 years ago, ANA ended the organization's _____ _____ status, this led to ______ on the ANA-SNA network and SNA's with _____ ____ found "homes" with other _____ _____

There are conflicts within professional nursing organizations. •A good example is what happened to the American Nurses Association (ANA) and the State Nurses' Associations (SNAs) •Most SNAs, that provide collective bargaining services, have memberships comprised mostly of staff nurses covered by collective bargaining agreements •Few managerial nurses are members of an SNA that engages in collective bargaining •About 20 years ago ANA ended the organization's "collective bargaining" status this led to fragmentation on the ANA-SNA network and SNAs with collective bargaining found "homes" with other labor unions.

Corporate Liability - this occurs when an ____ is _____ based on its policies, _____, and ______ - the corporation is the institution itself, not the hospital's _____ - although it might be a managers action or inaction that makes the institution liable, people are not _____ ____. the _____ is corporately _____

This occurs when an institution is negligent based on its policies, practices and oversight. The corporation is the institution itself, not the hospital's managers. Although it might be a managers action or inaction that makes the institution liable, people are not corporately liable. The institution is corporately liable.

Chemically Impaired Employee: Time/Attendance Issues - being ____ from work without good _____ - ____ lunch hour - excessive ____ leave or request for days ____ - staying ____ for no apparent reason - consistent ____/being _____ - disappearing _____ from the unit without _____

Time/Attendance Issues - Being absent from work without good explanation - Extend lunch hour - Excessive sick leave or request for days off - Staying late for no apparent reason - Consistent tardiness/being late - Disappearing frequently from the unit without explanations

T or F: Whenever possible, all those who may be affected by a change should be involved in planning for that change

True

Arizona Medical Marijuana Act 2010 (ARS 36-2811) - unless a failure to do so would cause an employer to lose a monetary or ____ related benefit under federal law or regulations, an employer may not ____ against a person in hiring, ____, or imposing any term or condition of employment or otherwise penalize a person based upon either: --> 1. the person's status as a ____ --> 2. a registered qualifying employee's ____ drug test for marijuana components or ____ unless the employee used, possessed or was impaired by marijuana on the premises of the place of employment or during the ____ of employment - the AMMA prohibits professional regulatory boards from _____ individuals simply for having a medical ____ card, using ____, or being a designated ____ as permitted by law

Unless a failure to do so would cause an employer to lose a monetary or licensing related benefit under federal law or regulations, *an employer may not discriminate against a person in hiring, termination or imposing any term or condition of employment* or otherwise penalize a person based upon either: •1. The person's status as a cardholder. •2. A registered qualifying employee's positive drug test for marijuana components or metabolites, *unless the employee used, possessed or was impaired by marijuana on the premises of the place of employment or during the hours of employment.* 36-2811: A *registered qualifying patient* or registered designated caregiver *is not subject* to arrest, prosecution or penalty in any manner, or denial of any right or privilege, including any civil penalty or *disciplinary action by a court or occupational or professional licensing board or bureau.* •*Prohibits professional regulatory boards from disciplining individuals simply for having a medical marijuana card, using marijuana, or being a designated caregiver as permitted by law*(AZSBON, n.d.) - *AMMA prevents discrimination of a qualified employee for a positive drug test for marijuana components or metabolites unless the employee used, possessed or was impaired by marijuana on the premises of the place of employment or during the hours of employment* •AZ APN cannot certify their patients for Medical Marijuana (only MDs, DOs, ND/NMDs in Arizona) •2011 Amended law giving employers added protection (HB 2541) --> Some believe it is unconstitutional •2019 New Medical Marijuana Law (SB1494): --> Added quality and cost controls •2020 Smart and Safe Act (Prop 207 on 11/3 ballot)

What is Collective Bargaining - it is a _____ - collective bargaining is specifically an _____ _____ mechanism or tool and is an aspect of _____ applicable to the employment relationship - in collective bargaining, the ____ always has a ____ ____ since the negotiations are for the _____ of several _____ - collective bargaining refers to the ____ process between an ____ and a ____ comprised of ____ to create an ____ that will govern the terms and ____ of the workers' employment - collective bargaining results in a _____ _____ ____ (CBA), a ____ ____ agreement that lays out policies agreed to by _____ and _____

What is Collective Bargaining? It is a Process Department of Labor - Definition - Collective bargaining is specifically an industrial relations mechanism or tool and is an aspect of negotiation applicable to the employment relationship. - In collective bargaining, the union always has a collective interest since the negotiations are for the benefit of several employees. Cornell Law School - Definition - Collective bargaining refers to the negotiation process between an employer and a union comprised of workers to create an agreement that will govern the terms and conditions of the workers' employment. Jobs with Justice - Definition - Collective bargaining is the formal process of negotiation between an employer and a group of employees—often with their union representative—that sets the terms and conditions of work. - Collective bargaining results in a collective bargaining agreement (CBA), a legally binding agreement that lays out policies agreed to by management and labor.

According to the Arizona Nurse Practice Act, which misdemeanors must be reported to AZSBON? (Select all that apply) a) domestic violence b) credit card or insurance fraud c) speeding ticket d) DUI e) barking dog f) buying known stolen property g) harassing 65+ faculty h) assaulting a co-worker

a, b, d, f, h

Which must be reported to the AZSBON within 10 working days? (select all that apply) a) felony charges b) felony convictions c) misdemeanor criminal charges involving conduct that may affect patient/public safety d) misdemeanor criminal convictions involving conduct that may affect patient/public safety

all of the above

List the 9 characteristics of successful microsystems - _____ - _____ - ____-_____ support - ____ focus - ____ focus - _____ of care ____ - ____ and _____ _____ - _____ improvement - _____ pattern These nine success characteristics are _____ and very _____ An improvement in one area may affect other _____

• *Leadership* of microsystem • *Culture* of microsystem • *Macro-organizational support* of microsystem • *Patient focus* • *Staff focus* • *Interdependence of care team* • *Information and information technology* • *Process improvement* • *Performance pattern* The nine success characteristics are interdependent and very dynamic. An improvement in one area may affect other characteristics.

Baldrige Criteria: Areas that the Malcolm Baldrige National Quality Award Assesses: - _____ _____ - ____-focused ____ - ____ and personal ____ - valuing staff and ____ - _____ - focus on the ____ - managing for ____ - _____ by fact - _____ responsibility and _____ health - focus on ____ and creating ____ - _____ perspective

• Visionary leadership • Patient-focused excellence • Organizational and personal learning • Valuing staff and partners • Agility • Focus on the future • Managing for innovation • Management by fact • Social responsibility and community health • Focus on results and creating value • Systems perspective have to perform strongly in 7 of the criteria in ordered to be considered for this award

Other Legal Responsibilities of the Nurse Manager - ____ and ____ - ____ of _____ - monitoring patient ____ - ____ medical records - ____ education - ____ practice standards; _____ research - communication --> healthy work ____ --> creating safe ____ for reporting ____/____ care

•*Policy and procedures* •*Chain of command* •Monitoring patient care •Auditing medical records •Staff education •Best practice standards; disseminating research •Communication --> Healthy work environments --> Creating safe environment for reporting poor/unsafe care

Health Care Systems: The Parts 1. _____ systems (______) are made of _____ ____ 2. these ____ systems (______) produce _____, _____, and _____ outcomes at the ____ ____ of care 3. Ultimately, the _____ of the _____ can be ___ better than the _____ of which it is composed

•1. Bigger systems (macrosystems) are made of smaller systems; •2. These smaller systems (microsystems) *produce quality, safety, and cost outcomes at the front line of care; and* •3. Ultimately the *outcomes of the macrosystems can be no better than the microsystems of which it is composed.*

Options in Nursing - ___- or 12-hour shifts - premium _____ for weekend work - part-time staffing ____ for weekend shifts and ____ - job sharing- two or more _____ - flextime: employees to select the time schedules that fits their _____ needs but able to meet employers _____ - use of supplemental staffing from outside _____ and float pools - staff self-scheduling - on-____ - shift ____, which allows nurses to bid for shifts rather than requiring mandatory ____

•10- or 12-hour shifts •Premium pay for weekend work •Part-time staffing pool for weekend shifts and holidays •Job sharing- two or more people •Flextime: employees to select the time schedules that fits their personal needs but able to meet employers responsibilities. •Use of supplemental staffing from outside registries(traveler/agency) and float pools •Staff self-scheduling •On Call •Shift bidding, which allows nurses to bid for shifts rather than requiring mandatory overtime

Calculation of Nursing Hours per Patient Day (NHPPD) Ex: there are 28 patients on a Step-Down Unit, with 7 RN's working day shift, and 7 RNs working night shift. What is the calculated NHPPD?

•28 patients on a Step-Down Unit •7 RN's x 2 shifts = 14 RN's •14 RN's working 12 hour shifts =168 hours available •168 hours/28 patients = *6 HPPD*

Vicarious Liability - a ____ _____ that holds the _____ legally _____ for the acts of its _____ - not _____ on _____ negligence - employers: the ____, school _____, non-_____, health _____, etc. - it is not the ____ or ______ - it is called ____ liability because the ____ is _____ responsible for the _____

•A legal doctrine that holds the employer legally responsible for the acts of its employees. •Not dependent on employer negligence. •Employers: the hospital, school districts, non-profits, health departments etc. •It is not the supervisor or manager •It is called "indirect liability" because the employer is indirectly responsible for the harm.

Nurse Navigator: a member of the healthcare team who helps patients _____ the healthcare ____ and get ____ care

•A member of healthcare team who helps patients navigate the healthcare system and get timely care.

Volunteer Protection Act 1997 (Federal law) - A volunteer of a ___-____ organization or governmental ____ is not ____ for harm caused by an act or omission done in the scope of _____ on behalf of the organization. This applies if the volunteer was properly ____ and ____, if such ____ is needed State Laws ____ - in AZ, a volunteer is ____ from ___ ___ in any action based on an act or omission resulting in damages if volunteer acted in ____ faith and within scope of ____ functions and duties for a ___-____ corporation or non-____ ____, hospital or governmental _____ --> exception: ___, wanton, or grossly ____ misconduct

•A volunteer of a nonprofit organization or governmental entity is not liable for harm caused by an act or omission done in the *scope of responsibility* on behalf of the organization. This applies if the volunteer was properly *authorized and licensed*, if such authorization is needed. •State laws vary •In Arizona "A volunteer is immune from civil liability in any action based on an act or omission resulting in damages if volunteer acted in good faith and within *scope of official functions and duties* for a non-profit corporation or non profit organization, hospital or governmental entity" --> Exception: willful, wanton, or grossly negligent misconduct.

Match the following definitions to their correct term a) Determines what you do b) Determines how well you do it c) What you're capable of doing

•Ability: What you're capable of doing (C) •Motivation: Determines what you do (A) •Attitude: Determines how well you do it (B)

Case Management Delivery Care Model Advantages - there is a time ___ within which clinical outcome should be ____ --> _____ cost! Disadvantages - ____ case load for a nurse - more focus on health ____ than the quality of _____

•Advantages-There is a time frame within which clinical outcome should be achieved. Streamlines cost! e.g. 4 days stay after C-section; 3 days for detox •Disadvantages-Large case load for a nurse - More focus on health expenses than the quality of care.

Reportable Misdemeanors - ____ and related offenses - ____ and related offenses - _____, deceit, and related offenses - _____, neglect, _____ of a child or vulnerable adult and related offenses - ____ ____ and related offenses - drug and/or ____ and related offenses (including ___) - ____ and related offenses - ____ abuse, ____, and related offenses Per AZ's Nurse Practice Act, RNs must report these charges if they know or suspect that another nurse has not ___-____ Encourage ____-_____

•Assault and related offenses •Theft and related offenses •Fraud, deceit and related offices •Abuse, neglect, exploitation of a child or vulnerable adult and related offenses •Sexual assault and related offenses •Drug and/or alcohol and related offenses (including a DUI) •Arson and related offenses •Animal abuse, cruelty and related offenses Per AZ NPA- RNs must report these charges if they know or suspect that another nurse has not self reported *Encourage self reporting*

Staffing Plan Considerations - _____ - ratios - patient _____ - HPPD - _____ requirements - skill ____ - staff _____ - _____ considerations

•Benchmarking - i.e. NDNQI •Ratios •Patient Classification •HPPD (hours per patient per day) •Regulatory Requirements •Skill Mix •Staff Support •Historical Considerations

Match the following definitions to their correct type of Performance Appraisal Bias a) rater has own standards b) perceived negative quality-overall low c) does the boss like/dislike you? d) most recent behavior influences performance e) perceived positive quality-overall high f) primacy effect g) follow the middle path "average" h) Current performance ~ past performance; the rater carries past performance into a current Appraisal.

•First Impression (primacy effect) (F) •Halo Effect- perceived positive quality-overall high (E) •Horn Effect- perceived negative quality-overall low. (B) •Excessive Stiffness or Lenience- rater has own standards. (A) •Central Tendency- follow the middle path "average". (G) •Personal Biases- does the boss like/dislike you? (C) •Spillover Effect- Current performance ~ past performance; the rater carries past performance into a current Appraisal. (H) •Recency Effect-most recent behavior influences performance (D)

Strategies to Create a Motivating Climate - clear _____ for workers - be ____ and _____ with employees - encourage _____ - know the _____ of each employee - _____ the employees intermittently - reward _____ behavior - positive _____ with ____ energy and enthusiasm - allow employees to be involved in _____ _____ - allow as much _____ as possible - use _____ - recognize _____ for good work - make the work and environment: _____, _____, personally _____ - make jobs _____: all nurse managers can enhance the work of their staff by providing them with ______ to experience challenges that make their jobs _____

•Clear expectations for workers •Be fair and consistent with employees •Encourage teamwork •Know the uniqueness of each employee •Stretch the employees intermittently •Reward desired behavior •Positive attitude with high energy and enthusiasm •Allow employees to be involved in decision making •Allow as much control as possible •Use incentives •Recognize employees/ Good work •Make the work and environment: Enjoyable, Meaningful, Personally satisfying •Making Jobs Exciting: All nurse managers can enhance the work of their staff by providing them with opportunities to experience challenges that make their jobs exciting.

Clinical Ladder in Nursing - the clinical ladder program has existed since ____ - there are ___ levels of the ladder, list them - these levels are based on _____ growth based on: --> ______ --> ______ --> _____ _____ --> professional _____ - points are earned for each ____ and ______ are provided to the ______ - disadvantage: not _____ driven, _____, for ____ only

•Clinical ladder program has existed since 1970. •There are four levels of ladder: I, II, III,IV. •These levels are based on upward growth based on education, experience, continuing education, and professional development. •Points are earned for each area and bonus provided to the applicant. •Disadvantage-not outcome driven, costly, for RNs only.

Microsystems - clinical microsystems are ____, _____, ____-line units that provide most ____ ____ to most ____ - microsystems are essential building ____ of larger organizations and of the health ____ - ____ and value of care produced by a ____ health system can be ___ ____ than services generated by the ____ systems of which it is _____

•Clinical microsystems are small, functional, front-line units that provide most health care to most people. •Essential building blocks of larger organizations and of the health system. •Quality and value of care produced by a large health system can be *no better than Services generated by the small systems of which it is composed*.

Reality of True Health Care Structure-- When we have very high functioning microsystems *or* low functioning microsystems; patients in need of care may find: - clinical _____ working ____ (or ____ one another) - _____-running ____-line health care units (or units in ____) - _____ readily ____, _____ easily, and in a _____ fashion (or not) - health care units that are seamlessly linked _____ (or totally _____) - ____-quality, ______, efficient care (or care that is ____ or even lethal, wasteful, and _____)

•Clinical staff working together (or against one another); •Smooth-running front-line health care units (or units in tangles); •Information readily available, flowing easily, and in a timely fashion (or not); • Health care units that are seamlessly linked together (or totally disjointed); and • High-quality, sensitive, efficient care (or care that is harmful or even lethal, wasteful, and expensive).

Efforts to Measure Nursing Costs - consequently, nursing cost is _____ associated with budgeted and actual nursing care hours per _____ day, a measure of ____ rather than a measure of type or level of care - what does NHPPD stand for?

•Consequently, nursing cost is narrowly associated with budgeted and actual nursing care hours per patient day, a measure of time rather than a measure of type or level of care. •Nursing Hours Per Patient Day- NHPPD

Evaluation of Nursing Delivery Models - cost-_____ outcomes ____? - patient _____ - _____ satisfaction - RNs utilized _____?

•Cost-effective outcomes achieved? •Patient satisfaction •Staff satisfaction •RNs utilized appropriately?

1970 Controlled Substances Act - ____ the possession, ____, distribution, and ____ of schedule __ drugs - Federal law which made ___ a schedule __ drug --> Schedule __ drugs: drugs with no currently accepted ____ use and a high potential for ____ (ex: ____, LSD, ____, Peyote) --> Schedule __ drugs: ____, morphine, ____, ____, opium - has made research ____, limiting evidence to guide _____ - prevents providers from _____ (or advising ____) - complicated access for ____ patients - DEA has ____ multiple petitions to move ____ to another schedule

•Criminalized the possession, manufacture, distribution and sale of schedule 1 drugs •Federal law which made marijuana is a Schedule 1 drug --> Schedule 1 drugs: drugs with no currently accepted medical use and a high potential for abuse. --> With Heroin, LSD, Ecstasy, Peyote --> Schedule 2 drugs: Oxycontin, morphine, Dilaudid, methadone, opium •Had made research difficult, limiting evidence to guide practice •Prevents providers from prescribing (or advising doses) •Complicated access for hospitalized patients DEA has denied multiple petitions to move marijuana to another schedule

Matrix Organizations - designed to focus on both the ____ and the _____ - have a _____ vertical and _____ chain of ____ - have ____ ____ rules and ____ levels of the hierarchy - can cause _____ decision making due to information _____ - can produce ____ and ____ for workers because of ____-_____ hierarchical design

•Designed to focus on both the product and the function •Have a formal vertical and horizontal chain of command •Have fewer formal rules and fewer levels of the hierarchy •Can cause slow decision making due to information sharing •Can produce confusion and frustration for workers because of dual-authority hierarchical design

What Roles do Leaders play related to organizing patient care - evaluates care ____ model periodically - if considering a change, reviews existences of ____ and support - considers the ____ and support during the change - inspires and ensures models promote professional ____ practice

•Evaluates care delivery model periodically •If considering a change, reviews existence of resources and support •Considers the staff and support during the change •Inspires and ensures models promote professional nursing practice

Nursing Cost - Fiscally, nursing is viewed as a _____ center that does not independently _____ revenue. - Ongoing efforts to measure and establish the cost of the various components of nursing care are challenging and not well defined.

•Fiscally, nursing is viewed as a cost center that does not independently generate revenue (MDs/NPs independently generate revenue) •Ongoing efforts to measure and establish the cost of the various components of nursing care are challenging and not well defined.

Workload measurement tool - formula in use where are all nursing and ancillary staff are treated equally for determining hours of _____ care - no differentiation is made for differing ____ levels of patients - formula= ____/_____

•Formula in use where all nursing and ancillary staff are treated equally for determining hours of nursing care •No differentiation is made for differing acuity levels of patients •NCH/PPD = Nursing Care Hours worked in 24 Hours / Per Patient Day (Census) •Patient Classification Systems - per hospital/unit

Determination of Staffing Needs: Match the following definitions to their correct terms a) Hours for benefits such as vacation, sick time, and education time are considered b) Hours worked and available for patient care are designated c) a measure of the work commitment of a full-time employee d) is time spent on activities that are patient-related but are not done directly to the patient e) is time spent providing hands-on care to patients

•Full-time equivalents (FTEs): are a measure of the work commitment of a full-time employee. (C) •Productive hours: Hours worked and available for patient care are designated (B) • Nonproductive hours: Hours for benefits such as vacation, sick time, and education time are considered (A) •Direct care: is time spent providing hands-on care to patients (E) •Indirect care: is time spent on activities that are patient-related but are not done directly to the patient. (D)

Microsystem History - idea for the microsystem in health care stems from work of James Brian ____ that was summarized is his 1992 book, Intelligent _____ - his book is based on _____ research that he conducted on the world's best-of-best _____ organizations, such as: _____, FedEx, ____ ____ Cosmetics, _____, and _____

•Idea for the microsystem in health care stems from work of James Brian Quinn that was summarized in his 1992 book, Intelligent Enterprise. •Quinn's book is based on primary research that he conducted on the world's best-of-best service organizations, Such as Amazon, FedEx, Mary Kay Cosmetics, McDonald's, and Nordstrom.

Budgeting Methods: Match the following to their correct budgeting method a) preparing the budget from the scratch with a zero base b) adjusts/flexes with change in activity/volume c) only incremental amounts are added to arrive at the new budgeted numbers

•Incremental Budgeting - only incremental amounts are added to arrive at the new budgeted numbers (C) •Zero based budgeting - preparing the budget from the scratch with a zero base (A) •Flexible Budgeting - adjusts/flexes with change in activity/volume (B)

Inpatient Unit The number of FTEs needed to meet the staffing plan are calculated for: - direct _____ needs: by ___ and 24-hours - _____ time: calculate amount of additional staff needed to provide for ___ off and ____ time

•Inpatient Unit: Designated location in which staff is able to provide care to patients 24 hours a day, 7 days a week. The number of FTEs needed to meet the staffing plan are calculated for: •Direct Care Needs - by shift and 24-hours •Nonproductive Time - Calculate amount of additional staff needed to provide for days off and benefit time

Intrinsic vs. Extrinsic Motivation - intrinsic: _____ _____ to do or be _____; ______ - extrinsic: motivation enhanced by the _____ ____ or ____ ____

•Intrinsic: Internal drive to do or be something. Aspiration •Extrinsic: Motivation enhanced by the job environment or external rewards.

Why Is Scheduling So Difficult in Nursing? - it does not fit _____ business cycle - there is an erratic and _____ health-care _____ - high-level of ____ is required 24/7 - _____ of job requires balanced work-recreation schedule - staffing ____ varies with acuity

•It does not fit traditional business cycle •There is an erratic and unpredictable health-care demand •High-level expertise is required 24/7 •Stress of job requires balanced work-recreation schedule •Staffing mix varies with acuity

Match the following definitions to their correct Motivational Theorists a) assumptions about workers on the intrinsic motivation b) hierarchy of needs c) Basic needs: Achievement, Affiliation, & Power d) "stretching" going beyond the norm to achieve goals e) Theory Y - like and enjoy work, need general supervision, seek responsibility f) people can be conditioned by reward and punishment g) Theory X - dislike work, require close supervision, need threats to be motivated h) expectancy theory

•Maslow - hierarchy of needs (B) •Skinner - people can be conditioned by reward and punishment (F) •Herzberg - assumptions about workers on the intrinsic motivation (A) •Vroom - expectancy theory (H) •McClelland - Basic needs: Achievement, Affiliation, & Power (C) •Gellerman - "stretching" going beyond the norm to achieve goals (D) •McGregor - Theory X & Theory Y (E, G) --> X - dislike work, require close supervision, need threats to be motivated --> Y - like and enjoy work, need general supervision, seek responsibility

Microsystem Composition - microsystem includes: ____, _____, processes, and _____ patterns-- _____ patterns, _____ flow patterns, and results patterns - a clinical microsystem is a ___ group of people who work ____ on a ____ basis to provide ____ to _____ _____ of patients Microsystems: - has ____ and ____ aims - ____ _____ - a shared _____ ____ - produces ____ ____ Microsystems evolve over ____ and are often embedded in ____ organizations. They are complex ____ systems.

•Microsystems includes *patients, clinicians, processes, and recurring patterns—cultural patterns, information flow patterns, and results patterns.* •A clinical microsystem is a *small group* of people who work together on a regular basis to provide care to discrete *subpopulations of patients.* •Microsystems: - has clinical and business aims - linked processes - a shared information environment - produces performance outcomes. •Microsystems evolve over time and are often embedded in larger organizations. They are complex adaptive systems.

State Minors' Consent Law - most states: covers minors that are __-__ yrs for most health care - exceptions vary by state: ____ health services, _____, _____, _____ abuse, homeless teens, _____ teens, legally ____ - laws not always ____ - usually tied to ____/_____ - follow your organization's ____ and _____ - best practice: include ____ and ____ in medical consent and decisions whenever possible

•Most states: 16-18 for most health care •Exceptions vary by state: mental health services, contraception, pregnancy, substance abuse, homeless teens, emancipated teens, legally married •Laws not always intuitive •Usually tied to privacy/confidentiality •Follow your organization's policy and procedures •Best practice: include minors and parents in medical consent and decisions whenever possible.

Negligent supervision (individual & direct liability) - negligent _____ - failing to act upon ____ - ____ ____ care - failing to ensure that _____ staff know and follow _____ and procedures - unbalanced or inadequate _____ - failure to use ____ of _____

•Negligent delegation •Failing to act upon reports •Unreported unsafe care •Failing to ensure that supervised staff know and follow policies and procedures •Unbalanced or inadequate staffing* •Failure to use chain of command

Nursing Hours per Patient Day - is a standard measure that ____ the nursing ____ available to each _____ by ____ nursing staff - reflects only _____ nursing time ____

•Nursing hours per patient day (NHPPD) is a standard measure that quantifies the nursing time available to each patient by available nursing staff. •NHPPD reflects only productive nursing time available.

Employment (workplace) Harassment - ____ conduct based on ____, color, ____, sex, ____, national ____, ___, disability, and genetic ____ Illegal (and a type of _____) when: - enduring the behavior becomes condition of ____ ____ - is severe or ____ - creates a ____ work environment - does not need to be the ____

•Offensive conduct based on race, color, religion, sex (including pregnancy), national origin, age (40+), disability and genetic information Illegal (and a type of discrimination) when: •Enduring the behavior becomes condition of continued employment •Is severe or pervasive •Creates a hostile work environment •*Does not need to be the supervisor*

Factors influencing development of staff using performance appraisal - offer ____ support to ____ - begin with a ____ _____ plan - link ______ _______ with employee _____ - keep a ______ goal for each _____ - use a ____ ____ cycle - make employee _____ fair and _____ - be aware of _____ _____ - avoid performance ______ - create the right ______ on ______ day - build a _____ that values _____ - monitor and evaluate ______

•Offer HR support to Supervisors •Begin with a strong performance plan •Link organization's objectives with employee goals •Keep a performance goal for each employee •Use a uniform evaluation Cycle (i.e. having a performance appraisal every December) •Make employee reviews fair and objective •Be aware of employees' concerns •Avoid Performance surprises •Create the right atmosphere on review day •Build a culture that values feedback •Monitor and evaluate reviews

Patient Classification Systems - is the tool most broadly used to identify ____ _____ - measurement tool to determine nursing ____ for specific patient or group of patients, over specified time period - patient acuity: is the measure of nursing _____ that is generated for each ____

•PCS is the tool most broadly used to identify nursing cost. •PCS = measurement tool to determine nursing workload for specific patient or group of patients, over specified time period •Patient Acuity: is the measure of nursing workload that is generated for each patient.

Using Classification System Data •Patient classification data - valuable source of information for all organization levels. •Staff and managers - use data day-to-day to plan staffing for the next ___ hours. •Central staffing office - monitors census and acuity on all units and deploys nursing resources to the areas in most ____.

•Patient classification data - valuable source of information for all organization levels. •Staff and managers - use data day-to-day to plan staffing for the next 24 hours. •Central staffing office - monitors census and acuity on all units and deploys nursing resources to the areas in most need.

Scheduling Considerations - Patient ____ --> measured by PCS --> changes in _____ - ____ - _____ and capability of _____

•Patient needs -Measured by PCS -Changes in needs •Volume •Experience & capability of staff

Evaluation of Staffing/Scheduling Effectiveness - patient ____ - nurse staffing and nurse ____ - attain ____ _____ hours

•Patient outcomes •Nurse staffing & nurse outcomes •Attain target productive hours

What is a Performance Appraisal: - a performance appraisal is about _____ the ____ of a person's _____ _____ by assessing employee _____ and development _____ using different ______ and evaluation methods - helps with the _____, promotion, _____ planning, ______ checklist, ______ and development requirements

•Performance appraisal is about ascertaining the value of a person's work performance by assessing employee strengths and development needs using different measurements and evaluation methods. •Helps with the Recruitment, Promotion, Succession Planning, Competency checklist, Training and development requirements.

Integrative Nursing Belief - _____-centered and ____-based - nurses are often described as the "___" that holds the healthcare team together - relationships are with ___, the team, and ____ - ____ and ____ relationships create the context and create the centerpiece of our optimal healing ____

•Person Centered and Relationship based •Nurses are often described as the "glue" that holds the healthcare team together (Oermann and Heinrich, 2003) •Relationships are w patients, the team, students •Caring and Healing Relationships create the context and create the centerpiece of our optimal healing environment (Quinn, 2015)

list the 3 of Types of Budgets and differentiate between them

•Personnel: pay for staff (salaries, hourly), annual leave benefits, health insurance benefits, sick leave, holidays •Operational: day-to-day operations to run a hospital, medical supplies, supplies for patient care, medications, etc. •Capital: expenses that are large (i.e. at banner, an expense over $5,000 is considered capital budget)

Recognition: A Powerful Motivation Tool - positive _____ muse be specific or ____ to a particular ____ - positive ____ must occur as ____ to the event as possible - reinforcement of new behaviors should be _____

•Positive reinforcement must be specific or relevant to a particular performance •Positive reinforcement must occur as close to the event as possible •Reinforcement of new behaviors should be continuous

Health Care System Transformation - to bring about fundamental change in the health system, there needs to be a _____ _____ at all _____ of the _____ - the powerful new idea here is that the ______ concept offers an opportunity to _____ health care at the ____ ____ of service delivery

•To bring about fundamental change in the health system, there needs to be systematic transformation at all levels of the system. •the powerful new idea here is that the microsystem concept offers an opportunity to transform health care at the front line of service delivery

PATHS - what does PATHS stand for: Professional _____ Through ____ ______ and Skill - this is an opportunity for all ___-______ employees - _____ _____ Examples of PATHS - _____ project, _____ - _____ improvement, _____ development, clinical ______ improvement - resource ______, improving unit _____, supply _____ management project - staff _____ and education for unit, patients, mentor/_____ development

•Professional Advancement Through High Performance and Skill •Opportunity for all non management employees •Outcome driven Examples: •Research project, publication •Practice Improvement-PDSA (plan, do, study, act), policy development, Clinical Documentation Improvement. •Resource Management-LEAN projects-yellow belt, improving unit efficiency, supply chain management project. •Staff development and education for unit, patients, mentor/preceptor development.

How Managers determine Staffing Needs - patient ____ - how many ___ to patient ____ - _____ - _____ of the unit RNs/PCTs

•Pt. census •How many RN's to patient ratio •Budget •Expertise of the unit RN's/pcts

Match the following definitions to their correct Performance Appraisal Tools a) scale points are defined by statements of effective and ineffective behaviors. b) The employees are being distributed to different categories. c) It is more focused on employees emotional, intellectual, and motivational and other personal characteristics affecting his performance. d) valuable asset for every organization. tries to find the relative worth of this asset in term of money-example doctors-revenue generation. e) Rank an employee from best to worst on a particular trait by comparing the employee with other employees on a particular performance level trait. f) As the name implies, this method uses multiple appraiser, including supervisor, subordinates and peer of the targeted persons. Information is collected & feedback is provided in full circular fashion top to bottom & back to top. g) is a method of performance appraisal in which managers or employers set a list of objectives and make assessments on their performance on a regular basis, and finally make rewards based on the results achieved. This method mostly cares about the results achieved (goals) but not to the way how employees can fulfill them. It means management by objectives and the performance is rated against the achievement of objectives stated by the management. h) A checklist of statements of traits of employee in the form of Yes or No based questions is prepared. Here the rater only does the reporting or checking and HR department does the actual evaluation. i) weaknesses, overall performance, suggestions for improvement etc.. in an essay format-focus is employee behavior. j) Supervisor keeps a record of all undesirable examples of employees work related behavior and review it with the employee at the time of appraisal.

•Ranking: Rank an employee from best to worst on a particular trait by comparing the employee with other employees on a particular performance level trait. (E) •Forced Distribution- The employees are being distributed to different categories. (B) •Checklist- A checklist of statements of traits of employee in the form of Yes or No based questions is prepared. Here the rater only does the reporting or checking and HR department does the actual evaluation. (H) •Behaviorally Anchored Rating Scales- scale points are defined by statements of effective and ineffective behaviors. (A) •Narrative Essay- weaknesses, overall performance, suggestions for improvement etc.. in an essay format-focus is employee behavior. (I) •Critical Incident- Supervisor keeps a record of all undesirable examples of employees work related behavior and review it with the employee at the time of appraisal. (J) •Management by Objectives- is a method of performance appraisal in which managers or employers set a list of objectives and make assessments on their performance on a regular basis, and finally make rewards based on the results achieved. This method mostly cares about the results achieved (goals) but not to the way how employees can fulfill them. It means management by objectives and the performance is rated against the achievement of objectives stated by the management. (G) •Psychological Appraisals: It is more focused on employees emotional, intellectual, and motivational and other personal characteristics affecting his performance. (C) •360-Degree Feedback: As the name implies, this method uses multiple appraiser, including supervisor, subordinates and peer of the targeted persons. The appraisal is 360 degree in that information is collected & feedback is provided in full circular fashion top to bottom & back to top. (F) •Human Resource method: Human resource is valuable asset for every organization. Human resource accounting method tries to find the relative worth of this asset in term of money-example doctors-revenue generation. (D)

Integrative Healthcare Systems Evidence - According to Ulrich and Zimming, authors of The Role of the Physical Environment in the 21st Century Hospital, research links the ____ _____ of hospitals to _____ ____ - more than 600 credible studies show how aspects of _____ design can influence medical _____

•Research links the *physical environment* of hospitals to *health outcomes*. According to Ulrich and Zimming, authors of The Role of the Physical Environment in the 21st Century Hospital •More than 600 credible studies showing how aspects of healthcare design can influence medical outcomes

Factors to consider with Staffing Needs - self ____/_____ - shift options that are ____ - appropriate ____ to patient ratio - staffing labor ____ of state or national/laws/unions - patient ____/acuity-based staffing tools - plans in place for nurses that ____-in or acuity _____ on unit - resources with in the facility for _____ - admissions/_____/discharges - professional nurse ____ level and _____

•Self scheduling/overtime •Shift options that are feasible •Appropriate staff to patient ratio •Staffing labor laws of state or national laws/unions •Patient needs/Acuity-based staffing tools •Plans in place for nurses that call in or acuity increases on unit •Resources with in the facility for nurses •Admissions/Transfers/Discharges •Professional Nurse skill level & expertise

Corporate Liability: Examples of breaches of a health care facility's corporate duty - slippery _____ - inadequate _____ - ____ patient care _____ - out of date or missing patient ____ _____ - _____ nursing units - _____ hiring (_____ licenses) - failing to fire _____ staff

•Slippery floor; inadequate lighting •Broken patient care equipment •Out of date or missing patient safety policies •Understaffed nursing units •Negligent hiring (verifying licenses) •Failing to fire incompetent staff

Arizona's Good Samaritan Law A.R.S 32-1471 In Arizona, the law provides that any person who renders aid at the *scene of an _____* is not liable for any damages as a result of an act or omission so long as the care was provided: 1. in good ____ 2. for no ____ or other consideration 3. the person was not _____ _____

•State laws vary •In Arizona, the law provides that any person who renders aid at the *scene of an emergency* is not liable for any damages as a result of an act or omission so long as the care was provided: 1) in good faith; 2) for no money or other consideration; and 3) the person was not grossly negligent. If these conditions are met there will be no liability for any problems that arise.

Professional Licensure: According to the AZ Nurse Practice Act, who must report a criminal charge or conviction against a licensed nurse? - the ___ or ____ ____ (self-_____) - licensees, _____ holders, and health care _____ who have any ____ that a ____ was or may be a ____ to public health or _____ - failure to report could be ____ ____ by AZSBON for _____ conduct

•The applicant or licensed offender (self-reporting) BEST •Licensees, certificate holders, and health care institutions (36-401) who have any information that a licensee was or may be a threat to public health or safety --> Failure to report could be disciplinary action by AZSBON for unprofessional conduct

Motivation Definition - the ____ within the ____ that ____ or directs _____

•The force within the individual that influences or directs behavior •Comes from within the individual! •Employees as individuals matter!

Malcolm Baldrige National Quality Award - the purpose of this award is to ____ quality and ____ in the USA by establishing guidelines and ____ to evaluate their own _____ ____ efforts - the Baldrige Criteria addresses key areas of running a _____ health care organization - This award is like ____ status but at a ____ level - this award is given by who? - can be awarded to ____, ____, health ____, and _____ organizations that apply and are judged to be ____ in ____ areas of performance excellence

•The purpose is to improve quality and productivity in the USA by establishing guidelines and criteria to evaluate their own quality improvement efforts •The Baldrige Criteria address key areas of running a successful health care organization •like Magnet status but at a higher level •The Baldrige Award is given by the President of the United States •Can be awarded to businesses and to education, health care, and nonprofit organizations that apply and are judged to be outstanding in seven areas of performance excellence. (have to perform strongly in 7 of the criteria in ordered to be considered for this award)

Key identifiers of each model/ List the types of care delivery models - ____ patient _____ - _____ nursing - _____ nursing - _____ nursing - ____ ____ nursing - ______ practice - _____ _____

•Total Patient Care •Functional Nursing •Team Nursing •Modular nursing •Primary Care Nursing •Differentiated Practice •Case Management

Staff Scheduling--- Considerations: Policies - type and ____ of staffing cycle used (4 weeks, usually once a ___ schedules) - time and ____ of schedule posting (usually 2 weeks prior to next ____) - when shift begins and ____; day of week schedule begins - weekend ___ policy; tardiness ____ - low ____ procedures - mandatory ____ - policy for trading days ___; days ___ request procedures - _____ policies - policy regarding rotation to other ____ (floating) - procedures for ____ time and holiday time requests - _____ request policies - transfer ____ policies

•Type and length of staffing cycle used ( 4 weeks, usually once a month schedules) •Time and location of schedule posting ( usually 2 weeks prior to next schedule) •When shift begins and ends; day of week schedule begins •Weekend off policy; tardiness policy •Low census procedures •Mandatory OT •Policy for trading days off; days off request procedures •Absenteeism policies •Policy regarding rotating to other units (floating) •Procedures for vacation time and holiday time requests •Emergency request policies •Transfer request policies

Variances and Using Classification System Data-- Match the following definitions to their correct terms a) acuity data is essential in preparing month-end justification for variances in staffing numbers b) Acuity data is also used in preparing nursing staffing budgets for the upcoming fiscal year c) acuity data can be used to cost nursing services for a specific pt population & global pt types

•Unit level: acuity data is essential in preparing month-end justification for variances in staffing numbers (A) •Organizational level: acuity data can be used to cost nursing services for a specific pt population & global pt types (C) •Forecasting: Acuity data is also used in preparing nursing staffing budgets for the upcoming fiscal year (B)

Management perspective requires a focus on: - unit _____ conducive to change - uses an ____ approach - match of model to patient ____ needs - maximizes ____ for optimal outcomes - considers _____ goals and cost ______

•Unit philosophy conducive to change •Uses an EBP approach •Match of model to pt. care needs •Maximizes resources for optimal outcomes •Considers organizational goals / cost effectiveness

Corporate liability (direct liability) principles, Hospitals have a duty to: - use _____ care in maintaining ____ and adequate _____ and _____ - formulate adequate _____ to ensure quality of ____ for patients - oversee all persons who _____ within it's walls (organizational _____) - select and _____ competent _____ and _____

•Use reasonable care in maintaining safe and adequate facilities and equipment •Formulate adequate policies to ensure quality of care for patients •Oversee all persons who practice within it's walls (organizational structure) •Select and retain competent physicians and staff

End of Life Issues

•What is End of Life mean to you? •Is there a Living Will, DNR status with your patient? •How will we handle our patient, and family when the patient is at the end of life? •What are the words we will use to comfort the patient and family? • Patient at the end of life is given morphine frequently, is this ethical? •Where do we stand as Nurse's to be ethically justified when caring for a End of Life Patient? •Patient Self-Determination Act- Written information regarding state laws, right to make healthcare decisions, refuse or withdraw treatments, and written Directives. •Financial Situations- Retirement/Obligations •Health Insurance Concerns

Choosing a Nursing Delivery Models - what staff ____ is required? - who makes staff ____ - are assignments patient ___ or task ____ - who will make decisions? An ___? - who will be ____ and accountable? - does it fit with the unit/____/organization? - what type of health care ____? - what are the patient's ___? long-term, ___, chronic?

•What staff mix is required? •Who makes staff assignments •Are assignments patient oriented or task oriented •Who will make decisions? An RN? •Who will be responsible and accountable? •Does it fit with unit/facility/organization? •What type of health care setting? •What are patient's needs? Longterm, acute and chronic?

Peer Feedback - ____ and agile team - a ____ and professional feedback. Measure actual ____ not _____. - supervisors needs to know the ____, the bad, the really ugly

•Who is a peer? A coworker (licensed), superior, doctor, CNA? (for peer review, the peer has to be in a superior position, i.e. nurse manager) •Dynamic and Agile Team •A constructive and professional feedback. Measure "actual behavior" not intent. What can employees improve on? •Supervisor needs to know "The Good, The bad, The Really Ugly" •Should peer feedback be anonymous? Is there a potential for damage to morale? Can employee take it personally? •How often to conduct peer review?-Annually? Quarterly?

CLOSED UNITS - staff members on a unit make a ____ to cover ___ ____ - fill all needs with ____ ____ - in return for not being pulled from the ____ in times of ____ ____

•staff members on a unit make a commitment to cover all absences •Fill all needs with own staff •in return for not being pulled from the unit in times of low census

Integrative Healthcare Systems Research - tens of thousands of Americans die each year from errors in their care, and hundreds of thousands suffer or barely escape from nonfatal injuries that a truly ____ ____ care system would largely _____ - the current system cannot do the ____. trying harder will not ____. _____ systems of ____ will.

■ "Tens of thousands of Americans die each year from errors in their care, and hundreds of thousands suffer or barely escape from nonfatal injuries that a truly high quality care system would largely prevent."(Nelson, p 2) ■ "The current system cannot do the job. Trying harder will not work. Changing systems of care will."(Nelson, p 4)