NUR425 Exam 1

When did Hurricane Katrina occur?

August 2005

What is authority?

Authority is the right to act Does everyone have some authority? To delegate you must transfer the authority

What is functional nursing?

Functional nursing was developed in an effort to use ancillary personnel more efficiently. Each worker is assigned a set of tasks to accomplish during their shift. For example NAs give all the baths and pass ice water, LPNs do the treatments, and RNs pass medications and assess patients. Functional nursing is economical, uses fewer RNs, and uses unlicensed personnel more effectively. But care is fragmented and the lack of RN interventions may lead to poorer patient outcomes. *certain tasks*

Who was the first African-American registered nurse?

Mary Ezra Mahoney In 1879 Mary Ezra Mahoney became the first African-American women to become a registered nurse in the United States. Because of the successes of this alumna, the New England Hospital for Women and children, loosened policies against admitting African-American nursing candidates. She went on to advocate for the rights of all African-American nurses and co-founded the National Association of Colored Graduate Nurses (NACGN) in 1908.

How do errors impact health care?

Medical errors lead to higher healthcare cost Identify some medical errors 2 million immune acquired infections 100,00 deaths $27.5 billion cost

What is the most expensive healthcare program?

Medicare

What is Karpman triangle?

Nurses can fall into this game easily. For example, you are a public health nurse visiting Jane and her five children. One of the children needs to go to the dentist for extensive dental work. Jane says she can't go because she has no one to care for her children. You get upset and tell her she must go or she is a bad mother (persecutor). Jane cries and gets upset (victim). She says she doesn't have the money to take her other children to a babysitter while she takes one to the dentist. You feel guilty and agree to have your daughter babysit for free (rescuer). Have you ever been caught in a similar trap?

What is charismatic leadership?

Personal qualities Able to persuade others Strong convictions

What is a quality of autocratic leader?

makes all decisions

What are the levels of nursing management?

*I. First Level Manager (first line manager)*: Supervises the work of non-managerial personnel and the day to day activities of work unit (s). The managers are also responsible for: Clinical nursing practice Patient care The use of fiscal and other resources Personnel development Strategic planning Representing staff to upper administration 24 hour responsibility of management of their assigned work areas *II. Middle-Level Management*: Supervises first level managers and are responsible 24/7 for their defined work areas. The managers also act as a liaison between upper management and first level management. This level of management is being eliminated or reduced in many health care organizations due to financial reasons. *III. Upper-Level Management* (executive-level management) The managers are responsible for establishing organizational goals and strategic plans. *IV. Charge Nurse*: This is the level of management students are most familiar with. The charge nurse is responsible to act as a liaison to the nurse manager and staff. The charge nurse is responsible for the shift to shift operation of the nursing unit. The charge nurse is also responsible for many of the following activities depending on his or her job description: Making patient care assignments Facilitating shift to shift change over Promoting quality patient care Solving problems Assisting staff with decision making Communicating with other departments Bed control May also be responsible for replacing staff if call in's occur

What are the different directions of communication?

- Downward: person of authority to a staff person - Upward: staff to management - Lateral: individual of same hierarchical level - Diagonal: different hierarchical levels

What are some examples of conflict management?

1. Competing or forcing: one person wins at the expense of the other In the above situation, I could have said "If I don't get Christmas off, I will call in sick for the whole holiday season or go on prn or quit". I know the manager can't replace me for that time period, so she is likely to give me what I want. 2. Accommodating: one person gives up something to the other. You say "OK, take all the holidays off". 3. Smoothing occurs when one party in the conflict attempts to reduce the level of conflict by complimenting the other person or focusing on their areas of agreement rather then differences. This usually doesn't work. 4. Avoiding: simply avoiding the conflict. This may work if the issue is minor or when the problem will solve itself. Nurses use this strategy too often and the conflict may become even larger than it was originally. 5. Collaborating: the people involved in the conflict work together to solve it. Each person is responsible for reaching a common goal. This strategy is not used when one of the parties has a lot more power than the other. I am not going to collaborate with my boss about my holiday schedule but I could collaborate with you.

What are the steps of delegation?

1. Define the task What do you want to delegate? 2. Choose the right time 3. Choose the right person Fully transfer the authority Check to make sure the task was completed

What are ethical and legal issues?

1. Deontological theories support the idea that acting according to duties and rights is the correct (ethical) way to act. Deontological theories are most closely associated to Immanuel Kant (1724-1804). Kant believed that everyone has an inherent dignity and this alone entitles everyone to respect. Respect is demonstrated by never using people to achieve goals or outcomes. He supported the idea that the morally correct thing to do is always guided by moral duties, rights, and responsibilities. Kant also believed that some actions are intrinsically moral, no matter how negative the consequences might be. The implication being the moral rightness or wrongness of an action can not be judged by its consequences alone. Kant believed that ethical behavior is duty driven and how you achieve an end does matter. EXAMPLE: You are starting an IV and get stuck with a needle that has been exposed to the patient's blood. You ask the patient if he will consent to a blood test for HIV and Hepatitis. The patient says he was tested for HIV at a STD clinic about a year ago and he was negative. He sees no reason to be tested again. Later in the shift, you approach the patient again. You tell him it is his duty to be tested and relieve you of your worry about getting one or both of the diseases. According to Deontological Theory, the patient's right to be or not to be tested is more important than consequences of having the blood test or not. Most of us immediately see a problem with this approach. Is the patient's right to have or not have the test more important than the nurse's right to know? 2. Teleological or the utilitarianism approach to ethics is concerned with the consequences of actions. This categories of theories arose mainly because of the problems inherent in the Deontological Theories. The basis of utilitarianism is: an act is right (ethical) if it helps bring about the best consequences overall. This approach was developed by Jeremy Bentham and John Stuart Mill. They were English philosophers who lived around the same time as Kant. They were opponents of Kant's teaching. Using a utilitarian approach to an ethical problem you would first consider several different actions and what could be accomplished with each (what would be the outcome or goals of each course of action). If one course of action can achieve several goals that is the course of action to take. But often this is not possible and a course of action that is the most likely to achieve the best consequences overall should be chosen.

What are the frameworks/principles for making ethical decisions?

1. Distributive Justice: giving each person what they deserve. All person should share the benefits and burdens of a particular situation. 2. Intuitionist: review each problem on a case-by-case basis. The decision is based on what is right for a particular situation. 3. Autonomy: freedom of choice or accepting responsibility for one's choices. People make choices regarding their behavior and should be responsible for their behavior. These choices determine the decision. 4. Fidelity: keeping promises. Most ethicists believe breaking a promise is wrong regardless of the consequences. 5. Virtue Theory: Doing what a reasonable person would do in a given situation. For instance: If you were a a swimming pool and witnessed a child drowning would you attempt to save the child? Most people would make some effort to save the child from drowning. Justice: What is good for one must be good for all. Veracity: Being truthful.

What are some examples of laws that effect nurses?

1. Reporting laws include reporting abuse of children and the elderly. In several states nurses are required to report incompetent practice. Indiana has such a law. You will find it in the ISBN Rules and Regulations 848 IAC 2-3-2 and 848 IAC 2-3=3. 2. Informed consent: Nurses are most often involved in informed consent when they are asked to have patients sign consents. When you are a witness to the patient's (or representative's )signature on a surgery or treatment consent you are attesting to the voluntary signing of the consent. If you have reason to believe that the patient/representative doesn't understand what he/she is consenting to or the patient/representative actually says he/she doesn't understand, you are obligated to contact the physician, specifically the person who is to perform the surgery/test. 3. Privacy and Confidentiality: You should all be well aware of these laws. In most if not all nursing classes a breach of privacy/confidentiality by the students will result in a clinical failure. As an employee you will also be held accountable for following these laws. 4. Age Discrimination Employment Act: the law says employers can't discriminate against people over 40. There are some exceptions.

When was the term RN first introduced?

1903 in NY Rochester City HospitalNurses from this hospital were instrumental in forming the first nursing organization in the Country, The New York State Nurses' Association, home of the American Journal of Nursing (AJN). The title of Registered Nurse (RN) comes from the Nurse Registration Act of 1903.

What is chaos theory?

A cause and effect theory The world is filled with chaos, unpredictability, uncertainty The life of an organization is dependent on the environment Example: An abortion clinic closes because people have protested it's existence; therefore women have stopped coming resulting in a decrease in business.

What is risk management?

A program designed to reduce the organizations risk, lawsuits Must involve everyone in the organization Identifies risk Establishes programs to prevent or reduce risk Educates, Monitors, Evaluates

What is capitation?

A set fee monthly provided to care providers for services to patients

What is reality shock?

A shock reaction that occurs when an individual who has been educated in a nursing education system with one view of nursing encounters a different view of nursing in the practice setting There are four phases to reality shock: Honeymoon phase: Preceptees are happy to be in their clinical rotations and may say "everything is wonderful." Shock phase: Preceptees begin to encounter weaknesses, discrepancies, and inconsistencies in the work environment and their new colleagues. Recovery phase: Preceptees begin to perceive the realities of the professional practice environment with a balanced view of both negative and positive aspects. Resolution phase: Preceptees may adopt less than ideal values or beliefs to resolve the conflicts of values and find ways to "fit in" with their coworkers.

What is strategic planning?

A strategy to project the organizations goals and activities for the future 2-5 years. It is based on the values, mission and philosophy of the organization

What is a vision?

A written statement of the organizations goals What we want to attain: Ball Hospital wants to be the premier hospital in Delaware County

What is shared governance?

Allows decision making at all levels Accountability Based on the philosophy that a group is best determined by it's members Members have control over decisions of practice When would shared governance not work well?

Who founded the American Army Nurse Corps in 1901?

Anna Maxwell

When completing discharge instructions on a male client the nurse should consider? a. Repeating information because males tend to interrupt more b. Use questions rather than direct statements as men prefer this communication technique c. Relate personal experiences when speaking with male clients d. Promote consensus when discussing discharge instructions

Answer: A.

What communication technique should the nurse consider when communicating with an Amish client? a. Direct conversation only to husband b. Speak loudly and directly c. Avoid using scientific or medical jargon d. Avoid conversation altogether and provide simple written instruction

Answer: C.

When making assignments to a team consisting of a registered nurse (RN), one licensed practical nurse (LPN), and two unlicensed assistive personnel (UAP), which is the best client to assign to the LPN? a. A client requiring frequent temperature checks b. A client requiring assistance with ambulation every 4 hours c. A client on a mechanical ventilator requiring frequent assessment and suctioning d. A client with a spinal cord injury requiring urinary catheterization every 6 hours

Answer: D.

What is quantum leadership?

Based on chaos (always changing) Outcome orientated Employees are involved in the decision making Encourages change

What are HeLa cells?

Cancer cells donated from Henrietta Lacks, nicknamed the "immortal cells" 1951

What is case nursing?

Case nursing, one nurse caring for one patient, was popular in the 20's and 30's when many nurses worked in patients' homes. When used in a hospital nurses care for a small group of patients. They may or may not be assigned to the same patients the next day.

What are the four established principles of organizing?

Chain of command: In traditional bureaucratic organizations the chain of command is hierarchical with authority flowing from upper administration down to staff. Communication flows downward from upper administration to staff. There have been many attempts to flatten the chain of command and reduce the number of managers. Unity of command: In the traditional bureaucratic organization employees have only one manager. This is the most common model for nursing organizations. Span of control: One person manages a group of employees who are basically in the same geographic area and have similar functions. This is changing in that managers are now managing groups of employees in different geographic areas and employees that have a variety of functions. Division of labor: Each person has a special function. In today's organizational structures this is changing with cross training of personnel.

What are systems theory?

Closed or open Closed is self contained Open interacts internally and with environment Input: employees, patients, money, equipment come from within the environment Throughput: essentially work is performed to produce a product Output: the product is exported to the environment Now explain this theory within the hospital

What are different examples of communication?

Communication can be:SpokenWritten, memosEmailTelephoneText messageInternetIntranet

What is CONTINUOUS QUALITY IMPROVEMENT(CQI)?

Continuous quality improvement (CQI) A program that improves quality and performance Systematic ways to improve patient care: Evaluation, Action, Excellence 4 members in the process - Resource group: senior management - Coordinator: provides day-day management of the CQI process - Team Member: evaluate and improve the processes - Team Leader: organizes the meetings and guides process, and evaluation

What is servant leadership?

Desire to serve Putting others needs first Need skills: listen, awareness, persuasion, foresight, stewardship, commitment

What is magnet designation?

Developed in 1994 by the American Nurses Credentialing Center (ANCC) A study of hospitals during a nursing shortage revealed some did not lose nurses and in fact they were hiring and the nurses were happy The program now recognizes organizations that demonstrate nursing excellence

What are DRG's?

Diagnosis-Related Groups (DRG's) is a prospective payment system.

What is differentiated practice?

Differentiated practice is a system to define levels of nursing practice according to educational preparation, clinical expertise, and competency. Willingness to assume or not to assume a higher level of responsibility is also considered when determining a nurse's level of practice. There are two basic ways to created levels of practice. One is by using the educational level of the nurse: ADN, BSN, MSN . The second method is by competency or the level of clinical expertise the nurse has achieved. An example of differentiated practice would be different job descriptions for nurses who are graduates of BSN programs and ASN programs. The BSN would be in a supervisory position and the ASN more involved with the technical aspects of care. Of course differentiated practice is not widely accepted. It is especially unacceptable to organizations whose workforce in mostly AD grads.

Who created the first NP program?

Dr. Loretta Ford and Dr. Henry Silver Together created the first Nurse Practioner (NP) program at the Univerity of Colorado in 1965, which paved the way for the more advanced pratice nurse and additional NP programs.

What are management theories?

Early industrialist Henri Fayol identified the basic functions of management: planning, organizing, directing, and controlling. These four function remain the basic management function even in today's chaotic times. Your book describes these four functions in detail. Please read this information for a better understanding of this theory.

What are managers?

Employed by organization, responsible and accountable for organizational goals

What is Rogers change theory?

Everett Rogers also identified phases of change. His phases are: Invention of the change Communication the change Adoption or rejection of the change There are 5 steps to diffusion: Knowledge, Persuasion, Decision, Implementation and Confirmation. Rogers's believed that for change to be successful it must meet the following criteria: The change must be better than the current system. The change must be compatible with existing values and beliefs. The change must be understandable and relatively simple to implement. It must be trialed (implemented on a small scale i.e. pilot projects) The benefits from the change must be easily identified. Rogers's work also led to the identification of six behavioral patterns seen in the actions of people faced with change. The six patterns are: Innovator: people who like change, want change. They will immediately adopt the change and may even be the creators of the change. Early adopters: open to change, adopt change early in the process Early majority: adopt change before the average person Late majority: hesitant to adopt change, more questioning, more negative Laggards: last to adopt Rejecters: do not adopt the change and may work against it or leave the organization. Rogers believed people could change their minds about accepting or not accepting change. Change is fluid, and it is important to have change agents and people involved in policy making committed and involved in the change process. Roger's and other rational mode change strategies are based on the assumption that people are rational and when presented with information will make rational decisions. We all know this is not necessarily true. No one would smoke if the rational model was always effective. These change strategies do work well when there is a readiness for change.

Who is Lillian Wald?

Founder of public health/community nursing Nurse Lillian Wald taught immigrant women on Manhattan's lower East Side about home nursing and good hygiene in 1890. She founded the Visiting Nurse Service and the Henry Street Settlement House Community Center, offering comprehensive assistance services to people in need. Her nursing staff became the first public health nurses in the United States. A pioneer in public health, Wald was responsible for nurses being placed in American public schools, established the National Organization of Public Health Nursing, the National Woman's trade Union League to advocate for working women and the Children's Bureau to help end child labor.

What are the 6 types of change resisters?

Innovators: love change Early Adopters: receptive to change Early Majority: prefers status quo but eventually accept Late majority: resistive, accept after others Laggards: openly dislike change Rejecters: oppose change, sabotage change and may leave organization People are naturally resistant to change

How have electronic health records impacted health care?

Integrates information from all sources Can be accessed from remote locations Increasing confidentiality Improves efficiency, reduces errors

What is Roger's Diffusion of Innovation?

Knowledge: people are introduced to the change and begin to understand the need or reason Persuasion: change agent tries to present a favorable attitude towards the change Decision: a decision is made to reject or adopt the change Implementation: change is put into place, alterations may occur Confirmation: reinforcement that it was the correct decision

What is Kurt Lewin's change theory?

Kurt Lewin's Theory of Change is frequently cited in the literature. Lewin's theory involves three stages. The first stage is The Unfreezing Stage. The nurse manager/change agent identifies a need for a change. The manager/change agent creates disequilibrium; which causes the staff to be discontent with the status quo. The disequilibrium could be created because the staff believed there was something lacking in the current system or believed they were not using the most recent care delivery system or providing the highest quality of care. Managers can do this by posting articles describing the change the manager wants to make or by discussing the need for change in staff meetings or when talking to staff members individually. The second stage is The Moving Stage. During this stage the manager/change agent plans for and makes the change. One of the most difficult things the manager/change agent must do is to overcome resistance. Forces for change (driving forces) such as personal benefits must out weight the forces against change (restraining forces). The manager may have to work diligently to create an environment where staff feel psychologically safe with the change. This can only be done in an environment where the nurses trust the manager and the administration. The third stage is The Refreezing Stage. The manager continues to provide guidance to the nurses but increasingly becomes less active. Group members take over leader responsibilities. The change is integrated and stabilized as part of the work culture and eventually evaluated for effectiveness and changes made if necessary. Kurt Lewin's change theory is widely used in nursing and involves three stages: the unfreezing stage, moving stage and refreezing stage. Lewin's theory depends on the presence of driving and resistant forces. The driving forces are the change agents who push employees in the direction of change.

What are qualities of successful leaders?

Leaders learn Listen Are disciplined Have quite time Don't wait for other to do for them Manage time Are persistent Focus on the positive Are authentic Desire to excel and share Are themselves!

What is leadership?

Leadership can be defined as influencing others to work together effectively. This definition indicates that leaders do not always have management positions. According to Gardner's (Yoder-Wise, 2003) tasks of leadership include: envisioning goals action affirming values motivating managing achieving workable unity developing trust explaining serving as symbol representing the group renewing

What is Lewin's Theory of Change?

Lewin, 1951 developed a view of the change process There are three (3) components to the theory Unfreezing: diagnosis the problem Moving: Assess the motivation to change, motivate people to agree to the change, identifies, plans and implements the change Refreezing: reinforces the new change, change now becomes the status quo This force field model has a dynamic balance of forces working in opposing directions...there are driving forces...encouraging the change and restraining forces...the barriers to change. Lewins model is a shift in the balance in the direction of change using a thre step process: Unfeezing, moving, refreezing.

What are the types of healthcare provider payers?

Managed care: HMO Provides an agreed upon healthcare and service package Preferred provider organizations PPO Contracts with physicians etc at a discounted rate Point of service POS May use different providers outside of the network but pay higher cost

What is management?

Management is also the process of influencing others to perform effectively, but it is aimed at meeting organizational goals. Management is the process of getting the work done through others. Managers are people appointed to positions of authority. Managers serve in a variety of roles. All managers are charged with several basic responsibilities such as planning, organizing, directing, and controlling. Effective managers may also be leaders.

What is managed care?

Many employers have or are changing to managed care organizations to save on health insurance costs. They usually offer either traditional insurance but with the stipulation that employees will pay a bigger part of the cost BUT if the employee enrolls in in the managed care insurance option, cost will be lower. Employers can chose between several different types of managed care organizations. Most frequently found in this area are HMOs and PPOs Health care providers offer reduced costs if patient-employees use providers who are either part of the HMO network or the PPO network. If you chose a physician, hospital, lab, or radiology service that is not part of your employers managed care organization, you the employee-patient will pay more of the cost. There are some exceptions if the services/specialists are not part of the managed care organization and the patient must go out of the network..

What are contingency theories?

Mary Parker Follet, the author of "The Giving of Orders" (1925), was one of the first to recognize that in each organization there are a number of contingencies that affect each situation. In other words, in each situation there are a number of factors that affect the actions of the leader. For example, if you are the leader-manager of a group of highly skilled and motivated workers, you would act as a facilitator rather than a supervisor. On the other hand, if you had a group of new, unskilled workers you would be more directive and authoritarian. Fiedler's Contingency Theory is a fairly complex theory. But basically Fiedler believed that leadership effectiveness depends on the relationship between the leader and followers, the the task at hand, the leader's interpersonal skills, and the favorableness of the work situation. Hersey, Blanchard, and Johnson's situational leadership theory is an expansion of Fiedler's theory. They included the worker's willingness and readiness to perform specific tasks as another factor that will affect the actions of the leader. They developed four specific leadership styles to be used by the leader depending on the willingness/readiness/ability of the employee See page 48-9 in your text to learn more about these four styles. House's Path-Goal Theory proposed that the leader's roles are to remove obstacles employees encountered when working toward goals, provide coaching, and rewards for goal achievement. The idea behind the theory is that employees "...work for rewards they find attractive and that result from successful performance" (Sullivan & Decker, 2005, p. 51). Vroom-Yetton's Expectancy Theory: The author's identified five leadership styles: (a)telling; (b)selling; (c) joining; (d) consulting; and (d) delegating. Quantum Leadership Theory looks at leadership, employees, and the work environment from an entirely different perspective. It is based on the Chaos Theory which rejects any linear, set method of approaching organizations or employees. Leaders who subscribe to the Chaos Theory do not follow any particular style or method. They advocate creative and flexible processes which can be readily adjusted in times of change. The leader who subscribes to the Quantum Theory challenges followers to welcome and excel in changing environments. They share information with the nurses. No one particular leadership theory is used. Openness and willingness to change are stressed.

What are motivational theories?

McGregor's Theories X and Y are based on the idea that what the manager believes about his/her employees affects employees' motivation and work performance. *For example, if a manager believes employees are lazy and need constant supervision and direction (Theory X) he will treat them as lazy, and will provide constant supervision and direction*. These employees will not be motivated and can be fearful of the manager. *But if on the other hand, the manager believes the employees enjoy their work, and are willing to work hard (Theory Y), the employees will be motivated to go a great job*. Maslow's Hiearchy of Needs Theory is based on the idea that people are motivated by a series of needs. Basic needs, physiological and safety/security, must be met or partially met before the higher needs can be achieved. Managers who want to use this theory would have to consider all levels of need. The text has a detailed description of ways a manager can facilitate meeting these needs. Herzberg's Two Factor Theory (Hygiene and Motivation) is based on the idea that an employee's needs can be divided into two categories, hygiene factors and motivation factors. Hygiene factors meet an employee's need to avoid discomfort and insecurity. Adequate salary and safe working conditions are examples of hygiene factors. If the employees' hygiene needs are met, they are not dissatisfied. Motivation factors are those that meet the employee's need to grow psychologically. If the employees' motivational needs are met they are satisfied. Meetings one type need does not effect the other and managers must try to facilitate the meeting of both. Ouchi's Theory Z focuses on finding better ways to motivate employees. The organization is viewed as a family. The atmosphere is informal and egalitarian. It is a 'we' rather than an 'us versus them' atmosphere. Basic tenets of organizations that use this theory are: a) collective decision making b) the use of quality circles for problem solving c) long term (usually lifetime) employment d) slower promotions e) indirect supervision f) a holistic concern for employees Miller's Behavior Management Theory is similar to Skinner's operant conditioning in that rewards are used to control behavior. Remember B.F. Skinner? He developed operant conditioning by teaching rats to press a bar to receive food. He also use operant conditioning with his infant daughter. While you are in the clinical environment working with a leader-manager try to discern if he/she is using a contingency/situational style of leadership.

What is MINTZBERG'S BEHAVIORAL DESCRIPTIONS AND CONTEMPORARY MODEL OF MANAGERIAL WORK?

Mintzberg recognized that human relations plays a significant role in management. Mintzberg believed that managers behaved in more of a reactive manner rather than a proactive manner. Based on these ideas Mintzberg identified three categories of management roles: interpersonal, informational, and decisional roles. In 1994 Mintzberg published a new model depicting managerial functions. This model depicts three levels of managerial work: informational, people, and action.

What are some obstacles to delegation?

Necessitating: belief that you are the only person who can do the job Fear Lack of confidence Control Criticism

What is negotiation?

Negotiation is a skill that takes time and experience to develop. Most of us think of negotiation in terms of negotiating union contracts. But negotiation is a valuable skill when working with other people in any situation. The first step in negotiation is recognizing the conflict. Negotiation cannot occur unless those involved recognize its existence. It is also very important that those who will be involved in the negotiation want to continue their relationship. Both parties in the negotiation must maintain the option to withdraw from the situation when and if they want. For example, I am having a conflict with my fellow staff nurses. I have a choice to stay in the situation and work the problem out or I can leave. I must also recognize that when I am attempting to negotiate with my fellow employee that I will be expected to actually negotiate a resolution with the other person. Usually negotiators attempt to win as much as possible while losing as little as possible. But it is important that the other party in the negotiation feels satisfied with the outcome of the negotiation. Some negotiations result in a compromise that is unsatisfactory to one party. Negotiation may occur because one or both of the parties involved have an emotional issue that involves the other person. For example one employee feels another employee is rejecting her/his input or suggestions. The employee may have hurt feelings or believe the other employee is depriving him/her of the recognition he/she deserves. Substantive issues also result in negotiation. Substantive issues are not based on feelings but conflicts about roles, salaries, the work itself, and other more tangible or objective issues. Negotiations can be informal or formal. You have probably already engaged in informal negotiation. As the initiator of the negotiation you approach the other person informally and ask for a short meeting to discuss an issue. You might ask the other person to meet you for a coke. You concentrate on reaching a series of agreements that will eventually result in a positive outcome for both of you. Formal negotiation may be more time consuming than informal negotiation and demands a more assertive or possibly aggressive approach. Your text describes a situation in which a person is negotiating for a higher salary. The person ask for the upper limit of what he/she wants. After this opening move the person then can negotiate, making concessions when appropriate, but never losing sight of what they actually want. In the end a equally agreeable compromise should be reached. But not always, in the example given in the book the organization may not be willing to meet the salary demands. The person making the demands must seek employment else where or be willing to except a salary lower than he/she wanted. Resolving conflict takes skill and practice. Since conflict is inevitable you will need to develop a variety of conflict management skills.

How can nurses delegate effectively?

Nurses can learn to delegate effectively.Nurses can delegate only those things which they are responsible for. One model for delegation follows: The first step is to identify the tasks that can be delegated. Second, the nurse must identify the skill or educational level needed to accomplish the task correctly. Next, the nurse must identify which person is most capable of completing the task. The nurse delegates the responsibility to complete the task after the delegatee is given clear instructions about the task including the time frame in which the task is to be completed. The nurse needs to monitor how the task is being done. After the task has been completed the nurse evaluates the delegatee's performance and provides feedback. Finally the delegatee should be rewarded in an appropriate manner. This could simply be a 'thanks, you did a great job'. The Five Rights of Delegation Right task Right person Right direction/communication Right supervision or feedback Right circumstances The Five Right of Delegation were published by the ANA in 1997 Review the text to find a decision making tree for delegation, and you will find a discussion of the delegation process. Delegation by the registered nurse to unlicensed assistive personnel may be a source litigation. It is most important for you to remember while working with UAPs that you are responsible and accountable for the patient outcomes. You must assess the patient, plan for care, and evaluate outcomes. Tasks you delegate to UAPs must not require nursing judgment. Refusing Delegated Assignments What do you do when your subordinates refuse to perform delegated tasks? Most nurses gripe, but don't confront the subordinates. They do the tasks themselves and feel used and angry. There are many reasons why subordinates don't do assigned tasks. If you are a new nurse, subordinates may not do their assignments completely just to see how far they can push you. If this is the case, you must be assertive or you will be considered a push-over. Some times subordinates don't complete their delegated tasks because they are just too busy, overloaded. In this situation the delegating nurse is guilty of not assessing the situation correctly. Sometimes, employees just don't think they are qualified to do the task. This is commonly seen with new employees or with new procedures.

What is delegation?

Nurses must learn to delegate effectively. If you try to do everything yourself you will eventually fail in today's fast paced health care environment. When you delegate you are getting work done though others. Routine tasks are commonly delegated to others on the health care team by the manager (head nurse, team leader, or other persons working in a management type position). The keys to successful delegation are to delegate the right task or responsibility to the right person at the right time for the right reason and to follow up appropriately. An example of inappropriate delegation would to be delegate the making of all the beds on the unit to a registered nurse. This is called under-delegating. Delegating responsibilities only the manager is accountable for to a staff RN would be over- delegating. Another example of over-delegating would be, to ask a staff RN to prepare the personnel budget for the next fiscal year, complete patient-nurse assignments and take a patient assignment.

What are nurses reluctant to delegate?

Nurses, managers and staff nurses, are reluctant to delegate. I think staff nurses have a problem delegating to unlicensed personnel (and sometimes to LPNs) because they were taught to take total care of the patient. Some RNs believe only RNs can care for patients effectively. Other workers should only be assigned limited tasks such as bed making and passing ice water. In this type of situation who is sitting and who is working? Who is overworked and who is under worked? Many times managers don't delegate because they want to do it themselves. Managers may not trust their employees to get the job done or they don't want to make the employees mad. But when managers don't delegate employees suffer because things just don't get done in a timely manner. Evaluations aren't completed on time, requests for educational programs are ignored, and employees are limited in what they can do.

What is organizational climate?

Organizational climate is like a personality. It is the subjective perceptions employees have about the organization. For example an employee may view the organization as relaxed and informal while an employee of another organization views their organization as hostile and untrusting. Managers have a great deal of influence on how employees view the organization. For example, a manager who maintains high standards and employee support will create a climate of achievement and pride. Other ways to create positive organizational climates include: a) actively investing in the development of the staff, b) being sensitive and responsive to staff complaints and concerns, c) recognizing and rewarding nurses for their contributions, and d) providing employees and patients with attractive, comfortable surroundings.

What is organizational culture?

Organizational culture is a very interesting topic. Can you identify any ways of behaving that are part of the organizational culture where you work or have clinical experiences? For example if some one is ill is there a consensus or belief that one of the staff should cover for the ill person? What is the relationship between the shifts? Is there a lot of anger or do they value working together? Some times it is difficult for the new employee to identify the cultural values and ways of doing things. There are no guidebooks available that tell the new person about the culture mores. They have to learn though watching and listening. Changing an organizational culture is very difficult. If the culture is 'sick' then it may be impossible for current managers to change the culture because they are part of it. Change comes from the top down. Often this will take new management and a large time commitment. The culture is the norms and traditions of the organization At St. Vincent a prayer is said several times throughout the day Nurses where a specific color of scrub Performance evaluations are based on the core values

What is patient focused care?

Patient focused care is a delivery system that attempts to locate services/supplies as close to the patient as possible. Examples include having satellite pharmacies, x-ray rooms, and diet kitchens located on nursing units. Patients would be able to chose the foods they want from a much larger menu i.e. it's meatloaf and ham on the menu but you order cheeseburgers and fries. Nursing care is usually provided by two workers, a care pair. One is usually a registered nurse. The other may be a UAP who is cross trained to provide respiratory treatments and physical therapy. Or maybe the second person is a radiation technologist who has been cross trained to work on the nursing unit. Patients know who their care givers are and staff are are usually happier. Two potential problems with patient focused care are: cost and the blurring of responsibility in the care pair. Care partners must be vigilant to maintain their responsibilities in accordance with their licensure.

What is Contigency theory?

Performance is enhanced by matching the organization's structure to the environment What is the environment? The people, objects, ideas outside that have an influence on the organization This would be our patients, vendors, physicians, insurance companies, competition Economic and social factors, technology and people have an impact on the organization Example: A rural clinic will be structured differently than a big city hospital

What is primary nursing?

Primary nursing is an attempt to improve patient care by putting the registered nurse at the bedside. The registered nurse who is designated as the primary nurse for a group of patients is responsible for planning care from admission to discharge. The primary nurse is responsible for patient care while on duty and is assisted by associate nurses on days/shifts off. A focus of primary nursing is increased autonomy for professional nurse care givers and holistic patient care. But a major problem with primary care is how it is implemented. Often professional nurses are not willing to take on the high degree of responsibility and accountability associated with primary care. Other problems are the lack of professional nurses, the lack of education about primary care, and possibly increasing costs with having an all professional staff. (Some research findings show that primary care is more effective than traditional models in keeping costs down.)

What is the process of EBP?

Process: Identify issue Find evidence Evaluate evidence Apply evidence Evaluate outcome

What is QI?

Quality improvement (QI)This is an old program and is viewed by nursesThere is a peer on a QI team who uses a specific audit tool to find mistakes made by staffThe report is given to the manager

What is quality management?

Quality management is a program to prevent problems Total quality management is a program where everyone in the organization must contribute Benchmarking is a strategy used by organizations to compare performance outcomes

What is redesign, restructuring, and downsizing?

Redesign: distribution of work, roles, waste, specialization and role-overlap are examined to combine task to improve efficiency Restructuring: examination to improve productivity Downsizing: eliminating positions

What is a charge nurse?

Responsible to the nurse manager, coordination of shift to shift work and care

What are the five rights of delegation?

Right task Right person Right direction/communication Right supervision or feedback Right circumstances

What is SBAR?

S= Situation/Current B=Background/History A=Assessment/ What do you think is the problem?R=Recommendation/ What do we need to do? The SBAR communication should be used for all communication between individuals. It offers complete information and reduces errorsMany times you have less than 10 seconds: If the phone is dead in 10 seconds what information does the person really need?

What are interactional theories?

Schein's Complex Man and Organizations Theory is based on the idea that people are complex beings who worked in an open system. He proposed that people respond to a wide variety of factors that have complex inter-relationships. He also proposed the idea that a person' s ability, experience, and motivation, as well as the task itself, affect the person's performance. Like situational theorists, Schein believed that managers need to select leadership strategies that are appropriate to the situation. A more recent leadership model by Brandt proposed the idea that leadership involves a responsibility toward the individual worker. The leader-manager is responsible for creating an empowering environment. The leader-manager is concerned for the individual worker's quality of life as well as for the quality of work produced by the individual. Do you believe that the leader-managers you observe are responsible for the individual nurse's quality of life in the workplace? Is this possible? Is empowering the nurse and thus facilitating autonomous practice improving the quality of life for nurse?

What is organizational structure?

Service-line or product line All functions are grouped together to produce a service Benefits include adaptation to quick change Each division is specialized Client satisfaction is usually high Weakness: duplication of service or resource, areas compete, expensive

What is six sigma?

Six sigma is a quantitative program New to nursing Quantitative measure of goals and a system of management to ensure progress

What is TQM?

TOTAL QUALITY MANAGEMENT (TQM) is a result of the work and teachings of W. Edwards Deming. Deming and his associated lectured throughout Japan after WWII. Their focus was to teach Japanese manufacturers how to reverse the world's perceptions about Japanese products. These products were seen as shoddy and cheap. Deming told the Japanese people in 1950 that if they adopted quality management, they could change their reputation and capture world markets. And they did. Total Quality Management (TQM) is a philosophy that places emphasis on a commitment to excellent from all employees Characteristics are: - Customer focus - Total organizational support - Tools for measurement - Identification of key processes for change

What are scientific management theories?

Taylor was primarily concerned with increasing production at the steel plants where he was employed. He proposed the idea that work efficiency could be achieved by using the scientific principles he developed. Taylor believed in the use of time and motion studies to promote worker efficiency, matching workers to their jobs, and paying workers for the amount they produced. The organization was viewed as a machine. He also put forth the idea that management and labor have different roles but should cooperate with each other. This theory is also known as the Traditional Organizational Theory or the classical theory of management.

What are values?

The beliefs or attitudes about people, ideas, objects projecting into behavior Identify some of your values

What is nonmaleficence and beneficence?

The concepts of nonmaleficence and beneficence, doing no harm and contributing to the welfare of others, are core values for ethical decision making. The concept of nonmaleficence probably comes from the Hippocratic Oath i.e. first do no harm. Beneficence and nonmaleficence are usually treated separately with nonmaleficence being the most compelling moral principle when making decisions, however you cannot do beneficence without nonmaleficence.

How are assignments made?

The faculty of this course do not believe delegation and assignment making are the same. We believe assignment making or work allocation is formal, day to day, shift to shift process of allocating work duties/tasks to staff members. Some authors believe assignments are given to non-licensed and/or non-RN staff only and RN staff are delegated responsibilities and the accountability for the work related responsibilities.We do not subscribe to this notion as we believe assignments are part of the overall job description. Assignment making is a major responsibility for professional nurses. Before a nurse makes assignments, he/she must know the staff member's job description and ability. Nurses must make assignments that correspond with both the nurse practice act (for licensed individuals) and the job description. Sometimes the person's abilities do not fit the tasks even though the job description includes the tasks. You often encounter this with new employees or employees new to their positions. Other factors that play an important part in assignment making include setting priorities, continuity, and the perceptions of fairness. None of us wants to be assigned unfairly. The course faculty believe this assignment reflects the assignment making process. How do nurses address assigning work to a float nurse who is unfamiliar with the nursing unit. We believe float nurse should not be assigned the most difficult or time consuming patients on the unit. Don't dump on nurses/assistants floating to your unit. When you do this your unit will gets a reputation and float staff may ask not to be assigned to your unit. We believe float nurses should be able to care for patients that have unusual or time-consuming problems as well as more 'routine' patients.In most instances float nurses are assigned to specific categories of units/patients such as med-surg, mother/baby/L-D, and critical care. Occasionally nurses are floated out of their areas expertise. If this happens the charge nurse should certainly meet with the float nurse, assess her abilities, answer questions, and provide an orientation (this should be done with every new to your unit float nurse). But we also believe the float nurse should be assigned to regular staff nurse as some one the float nurse can go to with questions in addition to the charge nurse.Examples of mew float nurse assignments:the float nurse should be able to care for a patient with a pain control problem, but not the patient who is to have extensive teaching about a treatment, or procedure in which your staff is skilled. I am sure you see the reasoning behind this: since you are not dumping on the float nurse he/she should have time to care for the pain control patient but since the float nurse has never been to your unit and is not familiar with the teaching plan for your patients, it would be far more cost and time effective to assign the patient needing specialized teaching to a regular staff member. Assignments should be made both in writing and verbally. All employees should clearly understand what they are to do, when, how, and what to report to the nurse. Specific directions should be given when the employee is inexperienced in the job. The charge nurse must follow-up on all assignments to make sure they have been done and done correctly. You will be doing this when you make patient rounds. You need to ask the patient if they got their bath, medication, treatment, and teaching.Ask questions like have you seen your doctor today, and have you gotten up in the chair or walked in the hall way.

What are formal and informal organizations?

The formal level of operation is the official way for conducting business. This official way is diagrammed in the organizational chart. This formal level of operation includes the organization's mission, philosophy, and policy statements. The informal level of operation is the way things are really done. It includes a series of relationships not found on the organizational chart. Some might call it an 'old boys' network. A nurse nurse knows the lab manager and together they get things changed the way they want. Many formal aspects of the organization are 'shadowed' in the informal level of operation.

What is the great man theory?

The idea behind this theory is that certain leaders, like Napoleon Bonaparte and Genghis Khan, influence events rather than events influencing the leader. What do you think? Are people in the right place at the right time to become great leaders i.e. events make the leader? Or do you believe great leaders determine the events?

How does human relations impact management?

The idea that human relations was an important aspect of management was brought to public attention after the studies of Elton Mayo and colleagues were published. While attempting to discover the effect of lighting on production, Mayo and his colleagues found that productivity increased when attention was paid to workers. Mayo's research supported the idea that employee-management relations were influenced by a variety of factors such as differences in employment status, beliefs about fair or unfair treatment, and the influence of informal employee groups. Proponents of human relations theory of management believed that managers needed a different set of skills than used by those who support scientific management. These skills included effective communication, motivating employees to participate in decision making, and gaining the cooperation of employees to achieve organizational goals.

What is philosophy?

The mission, values, goals of the organization written

What are examples of other change strategies?

The normative-re-educative strategy depends on group norms and values to create change. The change agent uses interpersonal skills to persuade people to change. The empirical-re-educative strategy relies on the idea that people are rational and presenting them with a rational change that will benefit them they will chose to change. The question is, are people rational? Rogers' theory discussed above is a rational-re-educative theory and is well developed, identifying the fact that not all people accept change. The power-coercive strategies are used to force people to change. A frequent strategy is to pass a law, for example the seat belt law. Your parents may have often used this strategy. The re-framing mode for change can be confusing. The creators of this approach believed that typical attempts to create change didn't work and frequently made the situation worse. Sometimes a person attempts to change a situation, but makes it worse. The creators of the reframing mode believed that if you rethink a problem from a new perspective you would be able to identify effective solutions.

What is a mission?

The purpose of the organization

What is shared governance?

The shared governance movement started as an attempt to empower nurses and to change the bureaucratic system used in most health care organizations. The focus was to create an environment in which the professional nurse has ownership of his/her practice. Nurses were to become part of the decision making process. Shared governance may create an environment in which nurses strive to be the best they can be but and it is a big but, the biggest enemy of shared governance is the middle level manager. The middle level manager has to give up many of his/her traditional roles such as being the sole problem solver and decision maker for the unit. Managers in a shared governance organization take the role of a facilitator rather than a supervisor or a boss.

What is team/modular nursing?

The team/modular nursing delivery system was developed to reduce the fragmentation of care caused by functional nursing. An RN acts as a team leader. The team consists of RN(s), LPN(s), and unlicensed assistive personnel. In modular nursing, the team is smaller than in regular team nursing. A smaller team facilitates communication between members. The team leader must have an effective system of communication with team members for team nursing to be successful. Specific duties of the team leader depend on patient needs and the number and classification of other team members. Team nursing, as it was originally designed, has never really been implemented. But the basic idea was sound. Organizations adopted some of the basic concepts when implementing their particular form team nursing. Modular nursing was implemented to facilitate the use of the team concept though smaller work groups. Modular nursing can also be defined as a group or team of personnel who are assigned to a group of rooms. For example, Modular Group A always cares for patients in rooms 1 thru 10.

What is case management?

The term case management is defined in different ways. When I first read about case management it was not considered a nursing care delivery system but a method to streamline and facilitate health care delivery. The case manager's responsibilities included finding ways to improve patient outcomes. For example, the case manager reviews patient records and discovers patient teaching is not being done on a regular basis and patients/families don't know how to provide the appropriate care after discharge. The case manager intervenes to correct the situation. Another of the case manager's responsibilities is to reduce patient days (reduce the number of days patients are hospitalized). Again when reviewing patient records the case manager identifies things that are prolonging patients' hospitalizations unnecessarily. For example, the case manager identifies that a doctor is ordering tests that are delaying patient discharge i.e. a 24 hour urine that could be done at home. And thirdly, the case manager is responsible for lowering costs in general. This can be done by the creation of care maps or other plans of care. Case management has been interpreted differently by different organizations. The nurse caring for a client may be considered the case manager in some organizations. The nurse in collaboration with other health care workers, follows a critical path or care map when providing care. The focus of care management is organizing the care around the patient, not around the organizational structure.

What is critical thinking?

There are a variety of definitions for critical thinking such as: a)the rational examination of ideas, assumptions, beliefs, and actions, and b) relective reasoned thinking which is focused on making a decision regarding what to believe and/or do. Some authors use the term critically reflective thinking. Critically reflective thinking focuses on the importance of recognizing and evaluating assumptions during the critical thinking process.. Thinking critically is not easy. It takes a lot of time and practice. Barriers to critical thinking include: having a mindset (a habitual way of thinking) about the way things are. For example, when I was in my basic training and for a few years after I graduated, every patient who had a urinary catheter had catheter irrigations twice a day. No one I knew questions this practice. It was actually a standing order in the hospital. We did it automatically without questioning the potential for injury to the patient or the usefulness of the procedure. Other barriers to thinking in a critical manner include the misuse of statistics and stereotyping.

What are trait theories?

These theories are based upon the idea that leaders possess specific characteristics that enable them to be a leader. People who do not have these characteristics cannot be leaders. These characteristics (traits) include: a) striking physical appearance and personality b) ability to speak persuasively c) intelligence d) self confidence e) self-discipline Recent research has found that certain characteristics are commonly identified in leaders. The most frequently cited characteristics are intelligence and initiative.

What are behavioral and style theories?

These theories focus on what the leader does. The most commonly cited theory is one by Lewin, Lippit, and White. They identified what are now considered the three classic leadership styles while studying groups of teen-age boys who were exposed to two or three different leadership styles. They found that the leader's behavior could influence the behavior of the group. The three leadership styles are: a) Authoritarian (autocratic): The leader exerts strong control over the group. The leader may be either dictatorial or benevolent. But when he gives orders, he expects them to be obeyed. Rules are numerous and creativity is firmly discouraged. This leadership style can create stress for employees. b) Democratic: The leader encourages and supports group involvement in decision making. Creativity is encouraged. The leader guides and facilitates the work, but does dominate the workers. c) Laissez-faire: The leader is passive and non-directive. Most control and decision making are left to the group. This style works if the group members are self-directed and motivated but does not work well if the members are not able to work without some guidance and direction, such as new graduates. In the early 1980's a fourth style was added: bureaucratic. The bureaucratic leader relies on organizational rules and policies to control workers. The leader does not trust employees and believes they are motivated by external forces such as their salary.

What are practice partnerships?

This is a relative new method of delivering patient care. Ideally an experienced(senior nurse) is paired with a junior partner who may be an LPN, UAP, or less experienced RN. The two work the same hours/days and care for the same group of patients. The senior partner plans patient care activities and directs the work of his/her partner. The two work together to meet and exceed patient expectations and needs. Practice partnerships places an experienced RN with a novice RN They work the same shifts and days They share the workload

What are some examples of leading and managing?

Trait theory Behavioral theory Transactional Transformational Theory X and Y Contingency theory Situational theory

What are transformational theories?

Transformational theorists propose the idea that the leader is able to visualize a dream and share this dream with others. This shared vision is a vision of the future. The transformational leader is someone who is committed to a long-term plan (vision) and leads others in the quest to realize this vision. The leader does this through empowering employees and creating an atmosphere of trust and creativity. Transformational leaders are generally very likable, push employees to excel, have goals and like change.

What is TCAB?

Transforming Care At The Bedside TCAB evolved in 2003 from a joint venture between The Robert Wood Johnson Foundation and The Institute for Healthcare Improvement 35-40% of unexpected deaths occur at the bedside This initiative was a framework for change on medical surgical units in hospitals There are four main points to the initiative 1. Safe and Reliable Care 2. Vitality and Teamwork 3. Patient Centered Care 4. Value Added Care Process As a result of this initiative: Use of Rapid Response Teams Specific Communication Models Professional Support Programs-Preceptorships and Educational Opportunities Liberalized Diet Plans and Meal Schedules for Patients Redesigned Workspace that Enhances Efficiency and Reduces Waste

What are the different types of delegation?

Under delegation: full authority is not given Over-delegation: too much Ineffective delegation; steps not followed Reverse delegation: someone lower delegating to higher authority

What are leaders?

Uses interpersonal skills to influence others for goal accomplishment

Who is Jane Delano?

With the threat of World War 1 she first established the Red Cross Nursing Service. While she was serving as superintendent of the Army Nursing Services from 1909-1912 she was Chairman of the National Committee on Red Cross Nursing Services, created a plan for the first Volunteer Nursing Unit of the American Red Cross and the enduing legacy of Red Cross nurses, the national symbol of care during crises. Today more than 20,000 nurse volunteers respond to disasters, educate the public through health and safety programs.

What is liability?

You are accountable and responsible for your actions or lack of action (omission). This is called personal liability. Your employer may also be liable for your actions or lack of action. This is called vicarious liability. Corporate liability means the institution is held responsible and accountable for specific actions such as maintaining a safe environment, appropirate staffing, and hiring and firing issues. EXAMPLES OF ACTIONS THE NURSE MANAGER CAN TAKE TO PREVENT LIABILITY 1. Delegate appropriately 2. Ensure staff members are competent 3. Evaluate staff performance on a continuous basis 4. Investigate real or potential problems 5. Follow-up on any corrective action or recommendation 6. Provide adequate and thorough orientation for new/transferred employees 7. Provide timely and adequate education for all employees 8. Provide adequate staffing 9. Alert hospital administrators and upper nursing management of understaffing

What are the benefits of delegation?

You cannot do everything your self You empower others when you delegate You help others grow professionally You build self-esteem You enhance job satisfaction You improve morale You build a sense of belonging

What is total patient care?

You have been using a form of total patient care in your previous nursing classes. You have been responsible for meeting all the needs of your assigned patients. You are only responsible for your patients while you are in clinical. Nurses on other shifts are responsible for the patients after you leave.

What is a living will?

a form indicating a person's desires if they cannot make them known in life saving incidents

What is a change agent?

a person working to bring about change

What is the Tuskegee study?

a study of the natural progression of untreated syphilis in rural African American men who thought they were receiving free health care from the U.S. government.

What are the three types of decisions made in health care organizations?

a) strategic: decisions that are made by top executives and deal with long term goals b) administrative: decisions made by middle management, usually to resolve unusual problems c) operational: decisions that are routine, the day to day decisions

What are some examples of legal issues and liabilities in nursing?

a. Personal liability: the individual nurse is responsible and accountable for his/her own actions or lack of action b. Vicarious liability: the assumption of negligence based on association with a negligent person. For example, you could be found vicariously liable due to your association with a negligent nurse. The organization can also be held liability for the negligent practice of an employee. c. Corporate liability: the organization can be held liable for its own conduct. Areas of high potential liability are: maintaining a safe environment, appropriate staffing, and hiring and termination issues. Managers can be held personally liable for their own acts of delegation and supervision but can't be held liable for the acts of others. To reduce a manager's risk of liability the following suggestions should be followed: 1. Delegate appropriately 2. Ensure all staff members are competent. 3. Evaluate staff member performance on a continuous basis 4. Investigate real or potential problems 5. Follow-up on any corrective action or recommendation 6. Provide adequate and thorough orientation for new/transferred employees 7. Provide timely and adequate education for all employees 8. Provide adequate staffing 9. Alert hospital administrators and upper nursing management of under staffing or any other potential liability issues. In today's health care environment the manager is faced with a variety of legal/ethical issues such as staffing, job redesign, substandard practice, HIPPA laws, and sexual harassment. Organizations are encountering more liability related law suits. Indiana law include abuse reporting laws; they include reporting abuse of children and the elderly. Indiana law (ISBN Rules and Regulations 848 JAC 2-3-3 and 848 IAC 23 +3) requires nurses to report incompetent practice. Several other states have adopted similar laws. Age Discrimination Employment Act: the law states employers can't discriminate against people over 40. There may be some exceptions to this law. It is very possible that employers are allowed to discrimination against specific people under 40. An example of this would be not allowing women of child bearing age to work in battery making facilities where they are expose to high levels of lead which is toxic to fetuses. You will find further discussion of legal issues and specific laws in your text.

What is an authoritarian leader?

concerned about task makes decisions without input from others, uses power

What is functional structure?

employees are grouped in departments by their specialty

What are examples of upper-level management?

executive chief nurse executive

What is the goal of disciplining?

is to change behavior Steps to discipline:Facts, Wait to calm down, Don't change rules, Private, Be clear, Both sides of story, Not personal, Stand your ground, Inform Human resources

What is a clinical nurse leader?

new role (AACN) Responsible for a specific smaller group responding to changes and complexity, MS level, designs, implements, coordinates, delegates and supervises care

What is a durable power of attorney?

permits a competent adult to make decisions for another person

What is a Laissez-faire?

provides little direction works well with very experienced staff

What is distributive justice?

providing what is deserved to a person, fair, equal to all regardless of race, sexual orientation gender, religion or social status

What is the first-level of management?

responsible for day to day operations (head nurse, managers) 24 hour accountability and responsibility

What is the bear trap game?

t goes like this: You are interviewing for a nurse manager position. The person interviewing you promises that you will receive six weeks of vacation per year, a raise at six months, and a large travel budget. After taking the position, you discover the travel budget is $300 and the six weeks of vacation will not be valid until you have been in the position for five years.

What are qualities of democratic leaders?

teamwork, communication important, good with staff

What is coaching?

the day to day process of helping employees improve performance, reach goals and develop professionally - It is an on-going face to face collaborative process - Short-term coaching: is spontaneous, brief and open - Long-term coaching: used to correct performance, planned and behavior specific

What is negligence?

the unintentional failure to perform or not to perform an act

What is the state board of nursing's main purpose?

to protect the public