478 Final Exam

Define Constructive Discipline

- foster employee growth - supportive and corrective manner - employee should understand that punishment is because of actions and not who they are as a person

When should you complete an incident report? (6)

1. Any time a patient makes a significant complaint. 2. A medication error. 3. Medical device malfunctions. 4. Patient, staff member, or visitor injured. 5. Patient, staff member, or visitor is involved in a situation with the potential for injury. 6. Any other time outlined in your organizations policy on incident reports.

What are the reportable misdemeanors to the AZ State Board of Nursing?

1. Assault 2. Theft 3. Fraud 4. Abuse, neglect, exploitation of a child or vulnerable adult 5. Sexual assault 6. Drug and/or ETOH (includes DUI) 7. Arson (guns) 8. Animal abuse and cruelty

Chemical Impairment in Nursing is resultant from (2)

1. Drug abuse OR 2 Alcohol abuse

ON THE TEST- What are the 4 steps in progressive discipline?

1. Informal reprimand or verbal warning 2. Formal reprimand or written warning 3. Suspension from work w/o pay 4. Termination (last resort)

NLRB 1. Stands for? 2. What does it oversee?

1. National Labor Relations Board 2. Oversees implementation of the National Labor Relations Act

1. What is closed-unit staffing? 2. What is mandatory overtime?

1. Occurs when staff members on a unit make a commitment to cover all absences and needed extra help themselves in return for not being pulled from the unit in times of low census. - fill all needs with own staff 2. Employees are forced to work additional shifts, often under threat of patient abandonment should they refuse to do so.

What are actions for unfreezing in that stage of change?

1. gather data 2. accurately dx the problem 3. decide if change is needed 4. make others aware of the need for change

"ABLE" Tips for dealing with conflict (DO NOT NEED MEMORIZE)

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

What is management by objectives (MBOs)?

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. - method mostly cares about the results achieved, but not the way how employees can fulfill them - you either meet or don't meet the objectives

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

Answer: C

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

Answer: C

How does a manager determine the staffing needs for their unit? (4)

Based on... 1. Patient census 2. How many RNs to patient ratio (patient acuity) 3. Budget 4. Expertise of the unit RNs/PCTs

Define bargaining?

Coming to an agreement

What are the different types of direct (2) and indirect liability (1)?

Direct liability: 1. Individual liability - Negligent supervision 2. Corporate liability Indirect liability: 1. Vicarious liability

What are psychological appraisals?

Evaluations more focused on employees emotional, intellectual, and motivational and other personal characteristics affecting performance - Strengths and weaknesses addressed/how you cooperate with others

In performance appraisals, is actual performance/behavior or intent measured/evaluated?

Measures ACTUAL BEHAVIOR, not intent.

What is the relationship between motivation and behavior?

Motivation: the force within the individual that influences or directs behavior ("the fire from within"). Behavior: the way in which one acts or conducts oneself, especially toward others.

What is a self-appraisal?

Self-Evaluation method in which employees are being asked to submit written summaries of their work-related accomplishments and productivity --Not easy for some employees -- Could probably be viewed negatively rather than positively

What is the purpose of a union?

To collectively bargain wages, hours, and conditions of employment for the selected positions.

ON THE TEST- What are the differences between the first, middle, and top levels of management?

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

What is flex time?

When employees get to select the time schedules that fits their personal needs but able to meet employers responsibilities. - in the past, most flextime's been possible only for RNs in roles that did not require continuous coverage

What is a marginal employee?

employees who meet minimal standards - contribute very little to the unit & organizational efficiency

What are actions for refreezing in that stage of change?

support others so that the change continues

KNOW A LITTLE ABOUT EACH FOR TEST- What are the 7 Motivational Theorists?

#1- MASLOW Hierarchy of Needs (Maslow believed that people are motivated to satisfy certain needs, ranging from basic survival to complex psychological needs and that people seek higher need only when the lower needs have been predominantly met) - Order goes: Physiological/ basic needs--> security/safety--> social/love/belonging-->self-esteem--> self actualization #2- SKINNER People can be conditioned to behave in a certain way based on a consistent reward and punishment - Behavior that is rewarded will be repeated and behavior that is punished or goes unrewarded is extinguished #3- HERZBERG Believed that employees can be motivated by the work itself and that there is an internal or personal need to meet organizational goals #4- VROOM Expectancy theory (model/theory says that a person's expectations about his/her environment or a certain event will influence behavior) - People look at all actions as having a cause and effect - People make conscious decisions in anticipation of reward (expectancy--> effort-->performance-->reward--> valence/combined power) #5- MCCLELLAND People motivated by THREE BASIC NEEDS= achievement, affiliation, and power - Achievement-oriented people actively focus on improving what is; they transform ideas into action - Affiliation-oriented people focus energies on families and friends - Power-oriented people are motivated by the power that can be gained as a result of a specific action #6- GELLERMAN "Stretching" (involves assigning tasks that are more difficult than what the person is used to doing) - This includes personal and professional development in areas of vocational knowledge, skills, and expertise - Giving people responsibility often causes them to rise to the challenge - Ex: Stephanie coming by when passing medications and asks patho for why pt receiving that medication (correlating to their disease process)* #7- MCGREGOR Theory X & Y X= dislike work; require close supervision, need threats to be motivated Y= like and enjoy work, need general supervisor, seek responsibility

What are the 5 core steps in the collect bargaining process?

#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. #2- Discussion Both parties meet to set ground rules for the collective bargaining negotiation process. #3- Proposal Both representatives make opening statements, outlining options and possible solutions to the issue at hand. #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. #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.

ON THE EXAM- What are the 3 Behavioral Strategies for the Change Agent?

#1- Rational-Empirical Change Strategy (Give current research as evidence to support the change) #2- Normative-re-educative change strategy #3- Power-coercive change strategy

What is a performance appraisal?

(aka performance review/ evaluation) A method by which the job performance of an employee is documented and evaluated. - about ascertaining (understanding) the value of a person's work performance by assessing employee strengths and development needs using different measurements and evaluation methods

What are the modern tools of performance appraisals?

(they promote objectivity and reduce bias) 1. Management by objectives 2. Psychological appraisals (discusses strengths, weaknesses, how you communicate, teamwork) 3. 360 degree feedback 4. Human resource method (they look at how much revenue you provide for the hospital based on your worth) - Ex: you are a surgeon, if you don't have enough surgeries--> you are not providing enough money to the hospital, which could lead to being fired.

What is the patient right to die option?

- Applies to patients >18 years old - Capacity to make medical decisions - Terminal disease expected to result in death within 6 months - AZ does not have the Pt Right to Die - 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.

What are some behaviors and actions that may signify chemical impairment in an employee or colleagues?

- being absent from work w/o good explanation - extended 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 w/o explanations

What are strategies to create a motivating climate?

- 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 - + attitude with high energy and enthusiasm - allow employees to be involved in decision making - use incentives - recognize when employees do good work - make satisfying work environment

Factors influencing development of staff using performance appraisal

- offer HR support to supervisors - begin with a strong performance plan (should be objective, not subjective) - link organization's objectives with employee goals - keep a performance goal for each employee - use a uniform evaluation cycle - 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 eval reviews

IMPORTANT TO KNOW- 1. What is the FTE if you work 40 hours/week? 2. What is the FTE if you work 32 hours/week? 3. Why is this important?

1. 1.0; because you divide 40/40 hours= 1.0 2. 0.8; because you divide 32/40 hours 0.8 3. It determines if you get full-time benefits or not (at Banner, 0.8 FTE means you still get the benefits equivalent of a full-time employee)

What are the differences between... 1. Mission statement 2. Philosophy 3. Values 4. Goals and objectives

1. A brief statement ID reason organization exists= the PURPOSE - can become powerful decision making tools when they become a template of purpose for the organization's activities 2. Flows from the purpose or mission statement. - basic foundation that directs all further planning toward that mission 3. Have a tremendous impact on the decisions people make. - examine their value system and recognize the role that it plays in decisions, conflicts, and perceptions - when RN experience lack of harmony between personal and organizational values= may be interpersonal conflict and burnout 4. Goals should be measurable and realistic and should delicate the desired end product

Who can informed consent be given by?

1. A competent adult 2. Legal guardian or individual holding durable power of attorney 3. An emancipated or married minor 4. Mature minor (varies by state) 5. Parent of minor child (under 16 y/o) 6. Court order

IMPORTANT TO KNOW- 1. What are Full-time equivalents? 2. Productive and nonproductive hours?

1. A measure of the work commitment of a full-time employee 2. Productive hours= hours worked and available for patient care - ACTUAL worked time Nonproductive hours= hours for benefits such as vacation, sick time, and education time - time that the organization pays the employee for not working

1. What is vicarious liability? 2. Direct or indirect?

1. A situation where someone is held responsible for the actions or omissions of another person. - A legal doctrine that holds the employer legally responsible for the acts of it's employees - Employer's malpractice insurance coverage will protect the nurse 2. Indirect liability; because the employer is indirectly responsible for the harm

What are the 8 different principles of ethical reasoning? (*On NCLEX)

1. Autonomy= promotes self-determination and freedom of choice. 2. Beneficence= actions are taken in an effort to promote good. 3. Paternalism= limits freedom of choice. Authority will make a decision for another person. 4. Utility= provide the greatest good for the greatest # of people. 5. Justice= treating people fairly. 6. Veracity= tell the truth. 7. Fidelity= keep your promises. 8. Confidentiality= respect the privacy of another and to hold certain info in strict confidence.

What are the 10 steps in the strategic planning process?

1. Clearly defines the purpose of the organization. 2. Establish realistic goals and objectives consistent with the mission of the organization. 3. Identifies the organization's external constituencies and then determine their assessment of the organization's purposes and operations. 4. Clearly communicates the goals and objectives to the organization's constituents. 5. Develops a sense of ownership of the plan. 6. Develops strategies to achieve the goals. 7. Ensures that the most effective use is made of the organization's resources. 8. Provides a base from which progress can be measured. 9. Provide a mechanism for informed change as needed. 10. Build a consensus about where the organization is going.

What are the most common drugs that nurses are abusing or diverting? (4)

1. Demerol (Narcotic to treat moderate to severe pain) 2. Oxycodone (OxyContin is the brand name)* (Narcotic to treat severe pain) 3. Vicodin (Narcotic to treat severe pain) 4. Alcohol

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

1. Duty to use due care (defined by the standard of care) - The care that should be given under the circumstances of what the reasonably prudent RN would have done 2. Breach of duty (failure to meet standard of care) - Not giving the care that should be given under the circumstances 3. Injury (foreseeability of harm) - The RN must have reasonable access to info about whether the possibility of harm exists 4. Causation (breach of duty has to cause injury/ a direct relationship between failure to meet the standard of care and injury can be proved) - Patient is harmed because proper care is not given 5. Foreseeable harm (injury) - Actual harm results to the patient

What are factors influencing nurses joining unions?

1. Elimination of discrimination and favoritism 2. Increase the power of the individual 3. Increase nurses input into organizational decision making 4. Nurses social situation (need to be accepted in the workplace) 5. Employers would be required to accept employee's as equal 6. Nurses believe it will improve patient outcomes and quality of care

Wk 9 Article for "Strengthening frontline nurse investment in organizational goals"- What are the key strategies from the telephone interviews found from organizations reporting strong outcomes in patient safety, clinical quality, and patient experience?

1. Established greater line of sight between individuals actions and organizational priorities - recognize the connection between what RN does on a daily basis and their institution's larger priorities 2. Creating culture of shared responsibility - caregivers feel accountable not only to assigned patients but also to all patients and outcomes across the unit or institution as a whole 3. Provide external motivation - structured reward system (Additional Notes= - frontline nurses are foundational to any organizational goal concerning pt care)

ON THE TEST- What are the various organizational structures? (*You will need to be able to ID different types of structures by description)

1. Flat Design versus tall: Flatten chain of command and decentralize organization - Flat occurs when there are few layers in the organization - More authority and decision making occur WHERE the work is carried out - Tall structures have many reporting layers illustrating the change of command - Ex= hospital that had all the RNs reporting to the director of nursing 2. Matrix structures: Designed to focus on BOTH the PRODUCT and FUNCTION - Has the formal vertical and horizontal chain of command - Tasks required to produce a product - Have fewer formal rules and fewer levels of the hierarchy - Can cause slow decision making due to info sharing - Can produce confusion and frustration for workers b/c of dual-authority hierarchical design 3. Service line organization: Similar to matrix design - Used in some large institutions to address the shortcomings that are endemic to traditional large bureaucratic organizations - "Care-centered organizations" - Decide on the processes to be used to achieve the goals determined by the larger organization 4. Line structures: Bureaucratic organizational designs 5. Ad hoc design: Used on a temporary basis to facilitate completion of a project

ON THE EXAM- McGregor's Hot Stove Rule What are the 4 elements that make discipline as fair and growth producing as possible?

1. Forewarning: all employees must be FOREWARNED that if they touch the hot stove ["break a rule"], they will be burned [punished/disciplined]. - they must know the rule beforehand and be aware of the punishment 2. Immediate consequences: if the person touches the stove [breaks a rule], there will be IMMEDIATE CONSEQUENCES (getting burned). - all discipline should be administered immediately after rules are broken 3. Consistency: if the person touches the stove AGAIN, he/she will again be burned. Therefore, there is CONSISTENCY; each time the rule is broken, there are immediate and consistent consequences. 4. Impartiality: if any other person touches the hot stove, he/she also will get burned. - discipline must be IMPARTIAL, and everyone must be treated in the same manner when the rule is broken.

What are challenges related to accurate planning?

1. HC reform (improvement) 2. Rapidly changing technology 3. Increasing government regulation of HC 4. Scientific advances

HC Delivery Model- 1. What is Functional Nursing? 2. Advantages 3. Disadvantages

1. Idea is for RNs to be assigned tasks, not patients. - patient will receive complete care, but from different people - ex: medicine RN administers drugs; discharge nurse focuses on discharges of the day; tx nurse takes care of diagnostics; charge RN works with the provider in ensuring patient is receiving optimum care 2. cost effective - hire more nurse aids and LPNs (less RNs) - one skill set refined - tasks completed quickly 3. fragmented care - too many care aids for one patient - impersonal relationship with patient - limits application of skills received in education and training - less challenging

What are the types of budgeting methods?

1. Incremental 2. Zero based 3. Flexible= budgets flex up and down over the year depending on volume. 4. Performance= emphasizes outcomes and results instead of activities or outputs. The manager would budget as needed to achieve specific outcomes and would evaluate budgetary success accordingly.

What are the two most common budgeting methods?

1. Incremental= simplest method for budgeting. Solved by multiplying current-year expenses by a certain figure (typically inflation rate or consumer price index) and the budget for the next coming year would be projected 2. Zero based= managers must rejustify their program or needs every budgeting cycle This method does not automatically assume that because a program has been funded in the past, it should continue to be funded

What are the 2 types of direct liability?

1. Individual -Negligent supervision: A tort that may apply in various contexts such as supervision of employees, children, or adults. --Implies a lack of supervision 2. Corporate: When hospitals have a duty to maintain safe and adequate facilities and equipment.

10 key "success" characteristics of high-performing clinical microsystems:

1. Leadership 2. Organizational Support 3. Staff Focus 4. Education and Training 5. Interdependence 6. Patient Focus 7. Community and Market Focus 8. Performance Results 9. Process Improvement 10. Information and Information Technology

Majority of disciplinary actions by licensing boards are related to misconduct from chemical impairment. What are the two situations?

1. Misappropriation of drugs for personal use 2. Sale of drugs/drug paraphernalia to support the nurse's addiction

HC Delivery Model- 1. What is Total Patient Care? 2. Advantages 3. Disadvantages

1. Model is patient oriented - oldest model of organizing patient care - nurse is responsible for planning, organizing, and performing all care for the patient - Ex= ICU, PACU 2. high degree of autonomy for RN - lines of responsibility/ accountability are clear - pt receives whole care (not unfragmented) 3. each RN may have a different approach to care - not cost effective - lack of RN availability

What are the 4 types of ethical issues?

1. Moral issues: includes moral uncertainty, moral conflict, moral distress, moral outrage, and ethical dilemmas. 2. Moral uncertainty/moral conflict: individual is unsure which moral principles or values apply. 3. Moral distress: knows the right thing to do but organizational constraints make it difficult to take the right course of action. Ex= Pt wants DNR; MD's want to continue with care 4. Moral outrage: witnesses the immoral act of another, but feels powerless to stop it. Ex= Physician gives inadequate care and has been reported several times and nothing has been done

What are the three major types of budgets?

1. PERSONNEL BUDGET= PEOPLE - largest of budget expenditures is the workforce/personnel - managers need to use historical data about unit census fluctuations in forecasting/predicting short and long-term personnel needs - manager must monitor closely to prevent understaffing or overstaffing (# of nurses you need to run your unit; census and acuity both taken into consideration) 2. OPERATING BUDGET = how the hospital RUNS - reflects expenses that change in response to the volume of service (you need people, supplies, equipment needed for patient care) - Ex= cost of electricity, repairs, maintenance, and supplies for patient care 3. CAPITAL BUDGET= plan for the purchase of buildings or major equipment (includes long lasting for over 5-7 years) - reqs long-term planning - means buy BIG ITEMS and replacing old items as well (Ex: ventilator, MRI, Hoyer lift) *- designation of capital equipment req that the value of the equip EXCEED a certain dollar amnt (dollar amnt will vary from institution to institution, but $1000-$5000 is common

KNOW FOR TEST- What did the 1974 HC Amendments provide? (2)

1. Provided collective bargaining rights to employees of non-profit hospitals 2. Hospital services= essential services and thus nurses= essential workers and thus... MUST PROVIDE a 10-day notice of "intent to strike" before being able to strike (Passage of these amendments cause an increase in unionization of RNs across the country)*

Performance Appraisal Tools- Traditional tools (main ones/most subjective) 1. Ranking 2. Forced distribution 3. Checklist* 4. Behaviorally anchored rating scales* 5. Narrative essay* 6. Critical Incident

1. Rank an employee from best to worst on a particular trait by comparing the employee with other employees on a particular performance level trait. 2. The employees are being distributed to different categories of the ranks. *3. 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. *4. Scale points are defined by statements of effective and ineffective behaviors. *5. Weaknesses, overall performance, suggestions for improvement etc.. in an essay format-focus is employee behavior. --written by supervisor 6. Supervisor keeps a record of all undesirable examples of employees work related behavior and review it with the employee at the time of appraisal.

What are the 4 types of proactive planning?

1. Reactive: occurs AFTER a problem exists. - b/c there is dissatisfaction with the current situation, planning efforts are directed at returning the organization to the previous comfortable state - probs dealt with separately w/o integration with the whole organization 2. Inactivisim: seeks the status quo - they spend their energy preventing change and maintaining conformity - when changes do occur, they occur slowly and incrementally 3. Preactive: utilizes technology to accelerate change - future oriented 4. Interactive or proactive planning: considers the past, present, and future - attempts to plan the future of an organization rather than react to it

Organization Structure Define- 1. Span of control 2. Stakeholders

1. Refers to the # of people directly reporting to any one manager and determines the # of interactions expected of him or her 2. 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. - people who invest in the business

What are the steps necessary to start a bargaining unit?

1. Start with quietly talking to a few of your co-workers (this small group privately discusses workplace issues) 2. ID leader 3. Info about workplace must be gathered (about structure, employee info, employer info) 4. Adopt an issues program (to communicate issue to other RNs) 5. Sign-up majority on union cards (need at least 30% before going to NLRB)

ON THE EXAM- NEED TO KNOW DIFFERENCE 1. What is a fiscal year? 2. What is a calendar year?

1. Starts on October 1st to September 3rd of the next year/tax year 2. Starts January 1st ending December 31st *(Want to do a yearly cycle maximum)

What are the 6 types of ethical theories?

1. Teleological (Utilitarian) theory: Provide the greatest good for the greatest # of people. 2. Deontological theory: Judges whether the action is right or wrong regardless of the consequences. - Uses duty-based reasoning and rights-based reasoning 3. Duty based reasoning (deontological): A duty to do something or refrain from doing something. 4. Rights-based reasoning (deontological): Individuals have basic inherent rights that should not be interfered with. 5. Ethical relativism: Individuals make decisions based only on what seems right or reasonable according to their value system. 6. Ethical universalism: Ethical principles are universal and constant. - Ethical decision making should not vary as a result of individual circumstances or cultural differences.

1. What is ethics? 2. What is an ethical dilemma?

1. The systematic study of what a person's conduct and actions should be with regard to self, other human beings, and the environment - System of moral conduct and principles that guide a person's actions in regard to right and wrong 2. Making a choice between 2 or more equally undesirable alternatives.

What are the HC delivery models?

1. Total Patient Care 2. Functional Nursing 3. Team Nursing 4. Modular Nursing 5. Primary Care Nursing 6. Differentiated Practice 7. Case Management

ON THE EXAM- What are the 3 stages of Lewin's change theory?

1. Unfreezing (occurs when change agent convinces members of a group to change or when guilt, anxiety, or concern can be elicited) 2. Movement (IDs, plans, and implements appropriate strategies, ensuring that driving forces exceed restraining forces) 3. Refreezing (the change agent assists in stabilizing the system change so that it becomes integrated into the status quo)

HC Delivery Model- 1. What is Team Nursing? 2. Advantages 3. Disadvantages

1. Uses diversity of skill, education, and qualification level of each team member - model relies on a team leader with effective communication and leadership skills - ancillary personnel (supportive staff) collaborate with the RN in providing care to a patient 2. strength of every HC professional utilized - every team member contributes to decision making and comprehensive care - improves level of communication 3. prolonged patient handoff (team handoff vs individual handoff) - incidental OT - delegation and communication skill sets are important while working with ancillary care team - RN still responsible for overall care although she assigns tasks to ancillary team

What components are considered in Patient Classification Systems?

1. Varies per hospital/unit Considers acuity vs. the workload - eating - grooming - elimination - comfort - general health - treatments/ meds - teaching and emotional support

1. What is corporate liability? 2. Direct or indirect liability? 3. What are the duties?

1. When HOSPITALS have a duty. 2. Direct liability 3. Hospitals have a duty to: - 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 its walls - Select and retain competent physicians and staff

General rules about change (4)

1. change should only be implemented for good reason 2. change should always be GRADUAL (b/c people will do a lot better with that) 3. all change should be planned and not sporadic/sudden 4. all individuals who may be affected the change should be involved in planning for the change

HC Delivery Model- 1. What is Case Management? 2. Advantages 3. Disadvantages

1. coordinates care from a facility perspective - may use clinical pathways (a predetermined written plan of care for a particular health problem) 2. there is a time frame within which clinical outcome should be achieved 3. large case load of a RN - more focus on health expenses than the quality of care

What are actions for movement in that stage of change?

1. develop plan 2. set goals and objectives 3. ID areas of support and resistance 4. include everyone who will be affected by the change in its planning 5. set target dates 6. develop appropriate strategies 7. implement the change 8. be available to support others and offer encouragement 9. use strategies for overcoming resistance to change 10. eval 11. modify change if necessary

Strategies to decrease resistance to change? (4)

1. educate as to why change needs to occur 2. educate before the change/keep updating them ("giving the heads up") 3. give info 4. implement changes GRADUALLY

HC Delivery Model- 1. What is Modular Nursing? 2. Advantages 3. Disadvantages

1. 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 - assignments happen based on geographic location 2. increase patient safety (less falls) - more continuity of care - helps in nurse responsiveness, call bells being answered, pain managed, less noise - less area to travel to get to patient 3. increased cost to stock each pod/ module

HC Delivery Model- 1. What is Primary Care Nursing? 2. Advantages 3. Disadvantages

1. primary nurse assumes 24 hour responsibility for the patient in planning care, directing and evaluating - 24 hr responsibility from admission to discharge - used in hospice, home health, long term care - specific patients are allocated to one RN 2. decentralization of decisions, authority and responsibility - 24 hr accountability - improved continuity and coordination of care - increased RN, patient, and physician satisfaction 3. RN must be able to exercise high degree of autonomy - not cost effective - RN has to accept 24 hr responsibility

What is the process of a disciplinary conference?

1. state the problem clearly 2. ask the employee why there has been no improvement 3. explain the steps to progressive disciplinary action (verbal to written warning, then suspension w/o pay, then last termination) 4. describe the behavioral change 5. get agreement to & acceptance of plan

Resistance with individuals typically depends on what 4 things?

1. their flexibility to change 2. their evaluation of the immediate situation 3. the anticipated consequences of the change 4. their perceptions of what they have to lose and gain from the change (*because change disrupts the homeostasis of the group, therefore resistance should always be expected)

What are things that a nurse manager (employer) canNOT do because it would violate the National Labor Relations Act?

1. threaten employees with loss of job/benefits if they join or vote for a union 2. threaten to close the plant if employees select a union to represent them 3. 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 4. promising benefits to employees to discourage their union support 5. transfer, lay off, terminate, assign harder tasks b/c they engaged in union 6. transfer, lay off, terminate, assign harder tasks b/c they filed unfair labor practice charges

What is the greatest factor contributing to the resistance encountered with change?

A lack of trust between the employee and the manager or the employee and the organization

What is the role of the nurse navigator?

A member of HC team who helps patients navigate the HC system and get timely care. - follow patient from diagnosis on to the treatment (for cancer example)

What is a force field analysis?

A method of gaining a comprehensive overview of the different forces acting on a potential organizational change issue, and for assessing their source and strength.

What is a misdemeanor?

A minor wrongdoing

What is a clinical microsystem?

A small, interdependent group of people who work together regularly to provide care for specific groups of patients. - this smaller group is usually embedded in a larger organization - these groups may comprise discrete units of care, such as a neonatal intensive care unit or a spine center

What are Nursing hours per patient day?

A standard measure that quantifies the nursing time available to each patient by available nursing staff - reflects only PRODUCTIVE nursing time available (*used when you need to calculate the amount of nurses you need on a given day)

Wk 9 Article on Perfomance Appraisals- A) What is PATHS? B) How many employees can work together? C) What are the 4 career tracks that could be selected for professional advancement?

A) Opportunity to be involved in developing policies Professional Advancement Through High performance and Skill - opportunity for all non-management employees (can be PT, OT, RNs) B) 3 employees who are NON-MGMNT C) #1- EBP #2- Practice Improvement #3- Resource Management #4- Staff development and education [Other examples- Ex: research projects, publishing, LEAN projects (data-driven methods to manage projects by focusing on continuously improving the process/ you are doing something in a cost effective way); PDSA (Plan-Do-Study-Act) quality improvement method]

A. What does the Volunteer Protection Act of 1997 imply? B. What kind of law is this?

A. A volunteer of a nonprofit or governmental entity is not liable for harm caused by an act done is the SCOPE OF RESPONSIBILITY on behalf of the organization. - This applies if the volunteer was properly AUTHORIZED and LICENSED, if such authorization is needed. B. Federal law

A. How did labor unions begin in the US? B. How has labor unions impacted the welfare of all people?

A. Began in the US during the industrial revolution time period. - During this time, workers in factories got paid low wages, while factory owners were getting richer/thriving --This led to industrial worker creating unions to fight for better conditions (backbone of the labor movement/ reason we have labor day) B. Established the Fair Labor Standards Act. - In the past, unions demanded shorter work weeks with an 8-hr work day - Fair Labor Standards Act includes: (1) 40hr work week (2) Regulating child labor (3) Set standards for minimum wages and overtime pay

Components of informed consent/ What is...? A. Common law B. Mature minor doctrines C. State law D. Federal law E. Supreme Court decisions

A. Derived from principles/social mores rather than from rules and regulations. - Used when there is no other law B. Legal principal which allows minors to make decisions if they can show that they are mature enough to make a decision. C. Age of consent and exceptions D. Title X of the Public Health Serive Act and HIPAA E. Right to privacy when seeking contraception and abortion

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. Staff RN B. Charge RN C. Nurse manager D. Hospital

A. Individual liability (direct) B. Negligent supervision C. Negligent supervision D. Corporate liability (direct)

A. What is the Good Samaritan Law? B. RNs are covered only if the care that was provided... (3)

A. RNs not required to stop and provide emergency services as a matter of law, but often feel ethically compelled to stop if they believe they can help. - Suggests that HC workers are typically protected from potential liability if they volunteer their nursing skills away from the workplace. B. #1- In good faith #2- For no money or other consideration #3- The person was not grossly negligent (*if these conditions are met there will be no liability for any problems that arise)

A. When is the grievance procedure utilized? B. What is the grievance procedure? C. What is the formal grievance process?

A. When employees and managers perceive "fair" and "just" differently, the discrepancy can usually be resolved by a more formal means such as the grievance procedure. - growth can only occur when employees perceive that feedback and discipline are fair and just. B. Essentially a statement of wrongdoing or a procedure to follow when one believes that a wrong has been committed. - employees can use it any time they believe that they have not been treated fairly by management. C. Occurs when employee and management cannot resolve differences informally (informal ways to resolve conflicts/grievances= communication, negotiation, compromise, collaboration) - steps include the progressive lodging of formal complaints up the chain of command - difference not settled in formal grievance process, generally proceeds to arbitration (both sides agree on the selection of a professional mediator who will review the grievance, complete fact finding, and interview witnesses before coming to a decision) - the steps of the formal grievance process are outlined in administrative policies and union contracts (know that people have the right to grieve/ "stick up for yourself about" things)

ON THE TEST- A. What is "collective bargaining"? B. What are 2 types of bargaining?

A. negotiation of wages and other conditions of employment by an organized body of employees. NOT AN INDIVIDUAL NEGOTIATION, IT IS WITH A SMALL TO LARGE GROUP OF PEOPLE INVOLVED* - specifically an industrial relations mechanism or tool and is an aspect of negotiation applicable to the employment relationship - 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 - results in a collective bargaining agreement B. 1. Conjunctive/ Distributive Bargaining: most common type - one side wins and the other loses/ "I WIN YOU LOSE" - Ex: wages and benefits (union interested in increasing wages and management wants more work for as little pay as possible) 2. Cooperative/ Integration Bargaining (interest-based bargaining): similar to problem solving sessions in which both sides try to reach a mutually beneficial alternative - Ex: win-win/ Nursing Labor Management Partnership

What are the advantages and disadvantages of bureaucracy?

Advantages: - 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: - 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

What is self-scheduling?

Allows nurses on a unit to work together to construct their own schedules rather than have schedules created by management - although self-scheduling offers nurses greater control over their work environment, it is not easy to implement

What is the Management Rights Clause?

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 that affect the workplace, but those decisions must not violate the collective bargaining agreement

QIP- A patient at the VA Telemetry unit is currently taking multiple medications to manage his CHF. At 1400, the nurse prepares to give the patient pain medication. The nurse uses the workstation on wheels (WOW) to pull the patient's medication. Due to the WOW opening all the patient's' medication boxes, the nurse pulls pain medication from a different patient's medication box. The pain medication has the same name but different dose. The nurse scans the medication and upon seeing the medication name on the WOW screen overrides the alert of the wrong dose. The nurse administers the patient the medication and upon administering, realizes she gave the right medication but the wrong dose. Due to using a WOW medication dispensary, the nurse committed a medication error. What is the best way to prevent this error? A. Use an automated medication dispenser instead of a WOW B. Don't give the patient all their medications until later C. Keep the medications in the WOW D. Keep all of your patients' medications together in your pocket

Answer: A

QIP- You're a new nurse leader on the SDU at the VA. Your unit manager comes to you and talks about getting training to improve leadership skills among the nursing staff. The nurse manager wants to educate the staff on recent research supporting the change. What is the change agent strategy the unit manager is using when trying to implement this successful change? A. Rational-empirical B. Normative re-educative C. Power-coercive D. All of the above

Answer: A

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

Answer: 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

Answer: A By giving them the explanation and understanding the evidence good to launch change.

QIP Scholarly Test Question Example- You are a nurse manager on a progressive care unit and decide to implement a program to decrease stress among your staff. What element of a microsystem does this nurse's action represent? A. Leadership B. Process Improvement C. Education & Training D. Interdependence of Health Care Team

Answer: A (leadership; the nurse manager is taking initiative to improve well being of staff)

Informed vs. Expressed Consent (Select all that apply) Nurses seeking expressed consent for a medical procedure must: 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 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

Answer: A and C

Informed Consent (Select all that apply) A minor's legal rights to give consent and expect confidentiality is based on: A. Common law B. State law C. Federal law D. Mature minor doctrines E. Supreme court decisions

Answer: A, B, C, D, and E (All of the above)

Professional Licensure (Select all that apply) Applicants and licensees must report which of the following to the AZSBON within 10 working days? 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

Answer: A, B, C, and D (All of the above)

According to AZ law, which of the following misdemeanors affecting public safety must be reported to AZSBON? (Select all that apply) A. Domestic violence B. Credit card or insurance fraud C. A speeding ticket D. A DUI E. Barking dog F. Trespassing G. Buying known stolen property H. Emotional abuse of elderly faculty I. Burning your APA book J. Assaulting a co-worker while on duty (is a felony)

Answer: A, B, D, F, G, and J

ON THE TEST/ PRACTICE QUESTION- The term "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

Answer: A, B, and C

QIP- Based on the systematic review, Nurse Patient ratios as a Patient Safety Strategy, what adverse consequences are prevented from having an improved nurse to patient ratio? (select all that apply) A. Respiratory failure B. DM C. Hospital acquired pneumonia D. Unplanned self-extubation

Answer: A, C, and D

QIP- Which of the following does a good education and training system implement. Select all that apply: A. Holds the microsystem responsible for ongoing education and training programs B. Education programs are approached as needs based C. Responsible for training of students in academic clinical microsystems D. Education and Training aligns with the roles of employers

Answer: A, C, and D

QIP- How does the integrative nursing principle: "Integrative nursing focuses on the health and well-being of caregivers as well as those they serve" relate to the microsystem model of organizational support? A. Utilizing the environment B. Support from management C. Utilizing nature and its properties D. Using evidence based practice

Answer: B

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

Answer: B

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

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

Incident reports: (Select all that apply) A. Are part of the patient's legal medical record B. Are considered confidential communications among hospital personnel C. Can be used as evidence in a lawsuit D. Must be reviewed and signed by patient

Answer: B and C Not A b/c patients medical record should just have medical stuff in it not legal stuff like incident reports.

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.

Answer: C

QIP- To implement a new electronic communication tool on the unit, the nurse manager holds a 2-hour education session about using the device and creates a pocket-sized handout with instructions on the device to give all staff members. What element of the microsystem model is addressed by this nurse manager's actions? A. Interdependence of care team B. Patient focus C. Education and training D. Culture

Answer: C

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

Answer: D

QIP- After taking a Cerner super user course to become more efficient on charting, a nurse decides to spend an extra 15 minutes during the shift getting to know the family of her patients in order to better meet their needs and special requests. Which section of the microsystem assessment does this nurse's act fall under? A. Interdependence of care team B. Culture C. Leadership D. Patient focus

Answer: D

QIP- Empowering other staff members, promoting long-term changes based on out of date ideas, goals, and practices, and having empathy for others are all defining characteristics of which type of leadership? A. Transactional B. Authoritarian C. Democratic D. Transformational E. Laissez-faire

Answer: 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

Answer: 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.

Answer: 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

Answer: D; The ratio of output to inputs used in a production process. Helps businesses to be more profitable.

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

Answer: E

Calculation of Nursing Hours Per Patient Day (NHPPD) There are 28 patients on a Step-Down Unit. 7 RN's times 2 shifts= 14 RNs total All RNs working 12 hour shifts Calculate the NHPPD

Answer= 6 NHPPD 14 RNs working 12 hour shifts= 168 hours available 168 hours/28 patients= 6 NHPPD

KNOW FOR TEST- Change Agent Behavioral Strategy: Power-coercive change strategies are?

Application of power by LEGITIMATE authority, economic sanctions, or political clout of the change agent. - Ex: using authority inherent in an individual position to effect change - the individual must accept it OR LEAVE -"Top down method" - saying "this is changing on (date) and this is how its going to be" - Ex: the change agent might refuse to ride in the smoker's car if the person smokes while driving

According to the AZ Nurse Practice Act, who is responsible for reporting criminal charges and convictions against a licensed RN?

BEST is the applicant or licensed offender through self-reporting Also, licensees, certificate holders, and HC institutions who have any info that a licensee, was or may be a threat to public health or safety

What is the difference between a Category 1, 2, 3, and Category 4 patient?

Category 1 patient= self-care (needs minimal assistance with care) - feeds self Category 2= needs some help (minimal care) - needs some help in preparing food tray Category 3= intermediate/modified intensive care - cannot feed self, but is able to chew and swallow Category 4= full and total assistance needed (intensive care patient) - cannot feed self and may have difficulty swallowing

What is the difference between centralized and decentralized decision making?

Centralized decision making: A few managers at the top of the hierarchy make MOST of the decisions. Decentralized decision making: Decision making is diffused throughout the organization and problems are solved by the LOWEST PRACTICAL MANAGERIAL LEVEL. - This means that probs can be solved at the level at which they occur.

What is the difference between centralized and decentralized staffing?

Centralized staffing: organization where staffing decisions are made by personnel in a central office or staffing center. - such centers may or may not be staffed by RNs, although someone in authority would be a nurse even when a staffing clerk carries out the day-to-day activity Decentralized staffing: the unit manager is often responsible for covering all scheduled staff absences, reducing staff during periods of decreased patient census/acuity, adding staff during periods of high patient census or acuity, preparing monthly unit schedules, and preparing holiday and vacation schedules

What is the difference between constructive and destructive discipline?

Constructive Discipline: - Foster employee growth - Supportive and 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 and fears to control

Difference between direct and indirect care

Direct care: time spent providing hands-on care to patients Indirect care: time spent on activities that are patient-related, but are not done directly to the patient (ex= rounding, charge RN role--nonproductive indirect care)

What is the difference between discipline and punishment?

Discipline: - constructive (assists employees growth) - training/molding the mind or character to bring about desired behaviors Punishment: - undesirable event that follows unacceptable behavior

Planned change- What are examples of driving and restraining forces?

Driving forces= opportunity for advancement, social gratification, enhanced self-esteem, family support, desire to get a pay raise Restraining forces= low energy level limited $ resources, unreliable transportation, unwillingness to take risks, conformity to norms *one of the tasks required of a change agent includes increasing driving forces or decreasing restraining forces

What is a budget?

Financial plan showing income and expenses

Fixed vs Variable Budget

Fixed= mortgage; know that it is not going to change (controllable factor) Variable= ER bill; didn't plan to get sick (non controllable factor)

What is the difference between formal and informal organization structure?

Formal Structure: Provides a framework for defining managerial authority, responsibility, and accountability. - roles and functions defined and systematically arranged - different ppl have differing roles Informal Structure: Unplanned and covert, with informal authority and lines of communication. - exists in every group, even when they are never formally acknowledged

KNOW FOR TEST- Change Agent Behavioral Strategy: Rational-empirical change strategies are?

Give current research as evidence to support the change The change agent using this set of strategies assumes the resistance to change comes from a lack of KNOWLEDGE and that humans are rational beings who will change when factual information documenting the need for change. *Give them the rationale and empirical logic about WHY you are making the change (*people respond best to this strategy) - used when there is little anticipated resistance to the change or when the change is perceived as reasonable - Ex: change agent might present the person with the latest research on cancer and smoking

What is the difference between informed, implied, and expressed consent?

Informed consent: Pt has received complete explanation of the surgery and indicates that he/she understands risks/benefits related to it. Implied consent: Physician states in progress notes in an emergency that the pt is unable to sign but tx is immediately needed and is in the pt's best interest. Expressed consent: Frequently seemed by RNs by witnessing pts sign a standard consent form. - In express consent, the role of the RN is to be sure that the pt received informed consent and the seek remedy if he/she has not.

What is the difference between intrinsic and extrinsic motivation?

Intrinsic: Comes from within the individual (Internal drive to do or be something/ ASPIRATION from within!) - often influenced by family unit and cultural values Extrinsic: Comes from outside the individual (Motivation enhanced by the job environment or external REWARDS) - rewards and reinforcements are given to encourage certain behaviors and/or levels of achievement

What does it mean to extend liability?

It is the concept of going liability, in which the RN, physician, and employing organization are all held liable.

What does "MORAL" stand for in the MORAL Decision Making Model?

M= Massage the dilemma [ASSESSMENT] Collect data about the ethical prob and who should be involved in the decision-making process. O= Outline options [DX] ID alternatives and analyze causes and consequences of each. R= Review criteria and resolve [PLAN] Weigh the options against the values of those involved in the decision. A= Affirm position and act [IMPLEMENT] Develop the implementation strategy. L= Look back [EVAL] Eval the decision making. (*Similar to the nursing process)

What is the order of the Planning Hierarchy?

Mission--> Philosophy--> Goals--> Objectives--> Policies--> Procedures--> Rules

Define Termination

Necessary for employees who continue to break rules despite warning - last resort - always have to have HR involved

When an chemically impaired employee denies the impairment or uses defense mechanisms, should the manager counsel the employee?

No; the manage should not nurture or counsel the employee.

Maslow's Hierarchy of Needs Theory- What is self-actualization?

Occurs when an individual maximizes their full potential; doing the best that he or she is capable of doing.

What is the Clinical Ladder in Nursing?

Only for RN's There are 4 levels in the ladder (I, II, III, IV) 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. Nurse 1= new grad Nurse 2= experienced nurse + more money Nurse 3= still bedside nurse + EBP project Nurse 4= MSN + present at conferences

What is the difference between organizational culture and climate?

Organizational Culture: a system of symbols and interactions and may include a sum total of values, lang, past history, formal and informal communication networks, and the rituals of an organization - the soul and personality of the institution Organizational Climate: how individuals perceive the organization

KNOW FOR TEST- Change Agent Behavioral Strategy: Normative-re-educative change strategies are?

Peer pressure often used to effect change Use group norms and PEER PRESSURE to socialize and influence people so that change will occur. - Idea that people are more influenced by others than by facts. - Strategy does not require the change agent to have legitimate power base. - Using people within your team to serve as change agents - Ex: the change agent might have friends and family encourage the person socially

What is the purpose of the strategic planning process?

Planning is a proactive and deliberate process that reduces risk and uncertainty. - encourages unity of goals and continuity of energy expenditure - directs attention to the objectives of the organization

What is Forecasting?

Predicting or estimating a future event or trend. - Uses available historical patterns to assist in planning strategically - Examines present clues and projected stats to determine future needs

What does "right to work" states mean?

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. - In a section of the Taft-Hartley Act this affirms the right of states to enact Right to Work laws - If you resign from union membership, you are still fully covered by the collective bargaining agreement (ex: wages, seniority, vacations, etc.) and the union remains obligated to represent you - AZ is a Right-to-Work State - There are 25 Right To Work States

ON THE EXAM- What are the 5 step stages of change model?

Stage 1: Precontemplation (no current intention to change his/her behavior in the foreseeable future) Stage 2: Contemplation (individual considers making a change, but has not yet made a commitment to take action) --*according to Lewin, this would be the phase in which unfreezing would occur Stage 3: Preparation (there is intent to make a change in the near future) Stage 4: Action (individual modifies his/her behavior) --*stage would be synonymous with movement Stage 5: Maintenance (change is maintained and relapse is avoided) --*stage would be synonymous with refreezing

Accurately compute the standard formula for calculating nursing care hours per patient day (NCH/PPD) What are the steps to solving?

Step 1= 1. Multiply total # of staff on duty each shift by hours each worked one their shift 2. Each shift total added together to get total # of nursing hours worked on all 3 shifts (or 24 hours) Step 2= Divide nursing hours worked in 24 hours by patient census

What is the "SWOT" tool that is used to assist organizations in setting their strategic plan? (what does it stand for too*)

Strengths: Those INTERNAL attributes that help an organization to achieve its objectives. Weaknesses: Those INTERNAL attributes that challenge an organization in achieving its objectives. Opportunities: EXTERNAL conditions that promote achievement of organizational objectives. Threats: EXTERNAL conditions that challenge or threaten the achievement of organizational objectives.

Subjective or Objective eval- You come with a plan to decrease CAUTIs so the supervisor may disregard that you have been calling in sick

Subjective evaluation (because no SCALE; a scale is in an objective eval)

What is the difference between a subjective and objective evaluation?

Subjective: evaluation depends on a learned and experienced human being who can detect TALENTS and aptitudes usually missed by a scale Objective: evaluation involves a scale and minimizes dependence on human beings

What are 14 characteristics of a magnet hospital?

Term used to denote organizations who are able to attract and retain RNs. - It is not an award, it is a credential which recognizes nursing excellence 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

What is one tool managers can use for guidance in ethical problem solving?

The Professional Code of Ethics (The Scope and Standards of Practice of Nursing) - A code of ethics is a set of principles established by a profession to guide the individual practitioner. - Adopted/published by the American Nurses Association (ANA Standards)

What is the difference between disciplining unionized and non unionized employees?

The present of a union generally entails more procedural, legalistic safeguards for administering discipline and a well-defined grievance process for employees who believe that they have been disciplined unfairly. - Due to the 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.

What is the difference between traditional and modern tools for performance appraisals?

Traditional (main) Tools: Older method, studies qualities of an employee (most subjective) Modern Tools: Promote objectivity/reduce bias

Define grievance

a real or imagined wrong or other cause for compliant or protest, esp unfair tx

Planned change- What is the chaos theory?

deals with complex systems whose behavior is highly sensitive to slight changes in conditions, so that small changes in conditions can drastically alter a system's long-term behavior

What is a patient classification system?

measurement tool to determine nursing workload for specific patient or group of patients, over specified time period (*pt acuity= the measure of nursing workload that is generated for each pt)

Planned change- What is the Complex Adaptive Systems (CAS) Change theory?

suggests that the relationship between elements and agents within any system is nonlinear and that these elements are constantly in play to change the environment or outcome Ex: although an individual may have behaved one way in the past, CAS theory suggests that future behavior may not always be the same/ predictable

Traditional tools for performance appraisals are really based on...?

the QUALITIES of an employee (very subjective)

Identify factors that must be present to foster a climate of self-discipline in employees.

the ability to control one's feelings and overcome one's weaknesses - rules are internalized (part of the person's personality) - highest and most effective form of discipline - possible only if subordinates know the rules and accept them as valid

What is a union?

the action or act of joining or being joined, especially in a political context.

What does Per Diem staff mean?

work on an as-needed basis, often less than full-time employees, with a flexible schedule, and they do not receive benefits. (PRN workers)