Leadership FINAL

-a few managers at the top of the hierarchy make most of the decisions -decision making is diffused throughout organization; problems are solved by lowest practical managerial level (usually at level they occur) -larger organization benefit more form which

-centralized decision making -decentralized decision making -decentralized

NCH/PPD problem example pg 242 round to what place

(136 hrs / 25 pts) = 5.44 (always record in hundredths place)

Mentoring -formal relationships lasts ______ time with mentor being how much older -difference in this from preceptors

-2 to 5 years, one generation -mentors involve choice where preceptors are usually assigned; preceptor relationship is usually short time while mentor is longer

R or L brain -analytical & methodical -creative & artistic

-L -R

AIDET= pt satisfaction

-acknowledge (saying hello to pt) -introduce (self) -duration (tell about time of care "hr off floor") -explanation (why this is happening) -thank you

-sometimes used temporarily to facilitate project completion within a formal line organization (overcomes the inflexibility of line structure) handles large amount of info & uses a project team approach -what happens after project is complete -disadvantage

-ad hoc design -disbanded (if problem, who could response if dissolved) -decrease strength of chain of command, decrease employee loyalty to parent organization

Nursing Shortage Solutions -look at historical data & looking at whats ahead: -hire more, lots of money goes into this -hire individual and teach other similar areas incase needed to be pulled -staff promise to cover unit as long as not pulled to others -last resort, extra work often due to shortage and threat of pt abandonment should they refuse

-advanced planning -recruitment -cross training -closed unit staffing -mandatory overtime

-formal plan that sets propose income and expenditures (helps maximize- get most out of physical resources one has) -dont change with volume or vary (Ex: mortgage payment is consistent amount) -those that vary with volume (ex: # of employees, cost of supplies may have changed at hospital) -some control over (hourly wages, number of employees highered) -no control over (utlitily bill)

-budget -fixed -variable -controllable -non-controllable

-refers to the location of a position on an organization chart where frequent and various types of communication occur. -who has largest degree of centrality

-centrality -middle manager (get info from up, down, horizontal, diagonal)

institution specific and must be modified to reflect unique staff/pt population in each organization

patient classification system (PCS)

-tendency to search for and favor information that confirms our beliefs while simultaneously ignoring/devaluing info that contradicts our beliefs

Confirmation bias

T or F we are responsible for managing time -when you do a task because you want the individual to stop asking you, to get it off your back

false- managed is how time is used squeaky wheel principle

-where does our first experience with power usually occur -knowing what's happening around you and how it affects your specific institution

family unit political savy

medical ethics beginnings

first, do no harm (primum non nocere)

(McGregor's hot stove rule) Four elements must be present to make discipline as fair and growth-producing as possible

forewarning immediate consequences impartiality consistentcy

motivation-hygiene theory (motivation factors- within work itself/ hygeine- keeps employees from being dissatisfied)

herzberg

4 phases of role transition

honeymoon "everything is wonderful" shock (encountering weaknesses) recovery (balanced view of negatives & positives) resolution

-greatest fact contributing to resistance of change is

lack of trust between employee & organization

where managers overrate employees; want employees to like them; want good camaraderie

leniency error

The employee and supervisor meet and agree on the principal duties and responsibilities of the employee's job. The employee sets short-term goals and target dates in cooperation with the supervisor or manager.

management by objectives

-modification of team and primary nursing; like team nursing but uses smaller teams; pairs professional nurse with ancillary staff to deliver care to groups of patients

modular nursing

-force within the individual that influences/direct behavior motivation means Intrinsic vs extrinsic -job performance or productive -application of rewards/punishments -most powerful source -parents and peers, cultural background

motivation -to move -intrinsic -extrinsic -intrinsic -intrinsic

has the potential for increased professionalism, performance, and professional accountability among practicing staff and is gaining popularity

peer review

-manager actively brings areas of unacceptable behavior or performance to the attention of the employee and works with him or her to establish a plan to correct deficiencies.

performance deficiency coaching

whose beleifs- mixture of democratic & autocratic styles based on nature of situation, ability of group, skills of leader

tannenbaum & Schmidt

Career development (accomplished through 6 areas)

-self and work assessment -job analysis -education -training -job search -work experience

-gave unions many rights in organizing; rapid union growth (protected rights to excerice union, pick bargaining agent) -returned some power to management; results in more equal balance of power between unions/management (excluded employees from nonprofit institutions) -amended wagner act to allow public employees to join union (initial collective bargaining in nursing) -allowed nonprofit organization to join union (everyone could join)

-1935 national labor act/wagner act -1947 taft hartley amendment -1962 kennedy executive order 10988 -1974 amendments to wagner act

-problem with separate form with every classification with job; behavior angrily rating scale -narrative written about employee strengths and weaknesses (focuses usually on positives) -workers make decisions that aren't always best; bring employee in and ask them how they make their decisions because the one made was not the best (time consuming) -an assessment by all individuals within the sphere of influence of the individual being appraise (supervisor and around 4-8 colleagues)

-BARS -essay -critical incident review -360 degree evaluation

McClelland said 3 basic needs that motivate

-achievement -affiliation -power

-systematic and official examination of a record, process, structure, environment, or account to evaluate performance. -performed after the client receives the service -performed while the client is receiving the service -used to identify how future performance will be affected by current actions. -used to determine what results if any occurred as a result of specific nursing interventions for the client. -used to measure the process of care or how the care was carried out -looks at the setting in which care is occurring (ensure safety environment but dont address actual care provided)

-audits -retrospective -concurrent -prospective -outcome -process audit -structure

-organizations can no longer rely on rules, policies, and hierarchies to get work accomplished in inflexible ways (finding underlying order in apparently random data) -can say that small changes in conditions can drastically alter system's long term behavior

-chaos theory (thietart) -butterfly effect

-all planning involves ______ (the more ______ you have, the more sound your decision will be) -planning must follow (what you look at prior to planning)

-choices; alternatives -mission/philosophy of organization

-prohibits discrimination based on factors unrelated to job qualifications/ promotes employment based on ability and merit -plans are aimed at actively seeking to fill job vacancies with groups who are underemployed, such as women, minorities, and the disabled whereas -promote employment of older people based on their ability rather than age -hire and recruit and promote those with dissabilities who are qualified) -mandated that remployemnt after military service must be done

-civil rights act 1964 -affirmative action -age discrimination and employment act 1967 -rehabilitation act 1973 -veterans readjustment assistance act

-all employees required to join union and pay dues -employess not required to join union -formed to implement Wagner Acted 1. determine who should be official bargaining unit when a new unit is formed and 2. who should be in it; unfair labor charges -organization formed by wage earners to maintain or improve their terms and conditions of work by bargaining with employers

-closed chop/union shop -open shop/agency shop -national labor relations board -labor union

-and goal setting in career planning should help employees identify how to exceed minimal levels of competency as well as to identify competencies employees may wish or need to achieve in the future. -granted by professional associations as a formal but voluntary process of demonstrating expertise in a particular area of nursing

-competency assessment -speciality certification

CONTRACT VS COVENANT -between people of equal power (egalitarian) -promise between people not equal in power -which is 24/7 -limited duration (quid pro quo) -relational -pt/client

-contract -covenant -covenant -contract -covenant -contract

types of law -beyond a reasonable doubt; incarceration, probation, & fines -clear & convincing standard; suspension or loss of license -based upon preponderance of evidence; monetary damages -typically includes malpractice; individual uses another monetarily to compensate for perceived loss

-criminal -administrative -civil law -civil case

-_____________ is empowering one person to act for another/ directing the performance of one or more people to accomplish organizational goals -always delegate to the right 3 things: -main reason for improper delegation

-delegation -right time, reason, person -not within ones scope

-desire to train/mold person to bring about desired behavior -undesirable event that follows unacceptable behavior -measures the same thing consistently

-discipline -punishment -reliability

Types of power -gained through knowledge, skills, experience (having knowledge to give out knowledge) -likability, gain from reputation, followers because person is liked (identify with leader or what they symbolize) -gain by position -based on fear/punishment through threats -granting favors with whatever they value -inspiring power -giving out info people need -through maturity/security in own being

-expert -personal/referent -legitimate -coercive -reward -charismatic -informational -self/feminist

-evolved as a result of World War II-uses relatively unskilled workers who have been trained to complete certain tasks -care is assigned how

-functional nursing -by task not by patient

-essentially a statement of wrongdoing -if this cannot be handled informally, what occurs (complaints up chain of command) -if formal grievance doesn't settle it, what occurs

-grievance -formal process -arbitration

-believing one is good at everything if good at one thing -believing one is bad at everything if she cant do one thing -rating everyone average -when evaluating employee, due so based on his/her self -occurs when recent issues are weighed more heavily than past performance.

-halo efect -horns effect -central tendency -contrast error -recency effect

SBAR/ISBAR -are useful for

-handoff reports

-union membership increases when/decreases -high or low demand for nurses correlated with increased union activity

-high employment/prosperity -economic recessions/layoff

Planned, guided adjustment of an employee to the organization and the work environment -education about organization, personnel, policies & procedures; employee handbook -activities more specific for the job hired for; want employee to feel a part of the team -third step

-indoctrination -induction -orientation -socialization

goals of the advocate

-inform -enhance autonomy -respect decisions of others

4 common steps in progressive discipline

-informal reprimand/verbal admonishment -formal reprimand/written admonishment -suspension without pay -termination

-enjoy challenge of change, enthusiastic, love adventure -like status quo -skeptical of innovation, express negative views but will accept when everyone does -openly dont want change; may sabotage it -open to new ideas but not out seeking change -last to adopt change, dedicated to tradiition/stability, suspicious of change

-innovator -early majority -late majority -rejectors -early adopters -laggards

-performance evaluation should be based on -the effective manager and astute leader are aware that ____________ regarding performance is one of the best methods for improving work performance and building a team approach.

-job description -day-to-day feedback

-are regulations dealing with the conditions of the employees' work: including physical conditions, financial aspects, and the amount of hours worked. Minimum wage and maximum hours -men and women performing equal work receive equal compensation. In health care this started out when male 'orderlies' were paid more than female 'aides', performing identical duties. Now in most health care agencies these employees are referred to as nursing assistants and are paid equal wages.

-labor standards -equal pay act of 1963

-move to different floor/ similar role and same institution -going down often to work back up (career plan may warrant this) -takes job that is less stressful and doesn't demand as much energy; usually see at latter part of nurse's career

-lateral transfer -downward transfer -accommodating transfer

-planned, systematic management action that occurs over the duration of an employee's employment. -should occur how often

-long term coaching -annually

-what causes power gap to increase -narrow power gap causes -wide gap causes

-manager loses credibility -dependency -organizational chaos

-these employees disrupt unit functioning because the quantity or quality of their work consistently meets only minimal standards (make tremendous efforts but meet minimal standards at best) -T or F should use constructive criticism

-marginal employees -false (doesnt modify behavior may use performance coaching or transfer)

-who had hierarchy of needs; meet basic ones first then move up pyramid -reward/punishmnet system (reward behavior will be repeated, unrewarded will be extinguished) -believed that employees are motivated by work itself and that theres internal needs meet organizational goal

-maslow -skinner -herzberg

-neutral party doesn't take sides but find solution to conflict -ask questions to find issue at hand, listens to both parties, meets with parties privately to identify solutions both parties want -often in unions, third party comes in and hears facts & makes decisions -help individuals know their rights

-mediation -fact finding -arbitration -ombudspersons

-can handle one task at a time (organized desk) -can handle 1 or more tasks at same time (changes plans, lends things out frequently, emphasizes people more than tasks)

-monochronic -polychronic

-when an individual questions why morality in practice is even necessary -when an individual is unsure which moral principles apply and may be uncertain what moral problem is -when individual knows right thing to do but organizational constraints make it difficult to take right course of action -individual witnesses the immoral act of another but feels powerless to stop it

-moral indifference -moral conflict -moral distress -moral outrage

-combination of critical pathway and a nursing care plan that indicates when nursing interventions should occur -commonly used in which kind of nursing to facilitate expected outcomes/document variances

-multidisciplinary action plans -case management nursing

person should be able to identify how organization is implanting philosophy by

-observing nurse -reviewing budgetary priorities -talking to pt

-requires employer's to have place of employment free from recognized hazards that may cause physical harm

-occupational safety and health act (OSHA)

-a periodic formal evaluation of how well personnel have performed their duties during a specific times period. -falls under what function

-performance appraisal -controlling

—well-thought out and deliberate effort to make something happen -when change happens accidentally -one skilled in the theory and implementation of planned change "visionary"

-planned change -change by drift -change agent

-the roots of union activity occur where -who has little do to with negotiating labor contract; however greatly involved in daily implementation of contract -greatest impact on quality of relationship between labor & management

-poor relationships between employees/ leaders -first and middle level managers -middle level manager

as originally designed, it requires an all-RN nursing staff/ RN primary nurse assumes 24-hour responsibility for planning the care of one or more patients from the start of treatment to discharge -collaborative process that assesses, plans, facilitates and advocates for options and services to meet an individual's health needs through communication and available resources to promote quality, cost-effective outcomes (coordinates care throughout episode of illness)

-primary care nursing "relationship based nursing" case management nursing

Job stages in nursing -usually first 10 year, reality shock, taking school culture to work field, often good director/mentor guides -(last 30-40yrs) very experienced, leaving legacy -(year 11-29) very experienced, knowledge, compensable in skills, role models for new grads

-promise -harvest -momentum

-I give you something and you give me something in return; sign contract to do work and then no more responsibility -if terms are not met, can go to court -the word patient means -don't think more highly of yourself than you ought

-quid pro quo -legally binded -sufferer -self effacement

Change Agent Strategies -power is from knowledge: human follow own interest and will follow if self gain and see reason for change -about skill & interpersonal relationships; driven by high standards "group norms and peer pressure to influence people" -driven by authority/control over the person

-rational empirical -normative-reeducative -power-coercive

-one that reacts after problem exists -disadvantage -tell you they like status quo and spend energy preventing change; change is slow in nature -future oriented, use technology, dont value experience as much and lookout for future, dont dwell on past -consider the past, present, and future and attempt to plan the future of organization rather than react to it

-reactivists -make poor decisions because making in haste/reacting to situation -inactivists -preactive planner -proactive planning

-least flexible type of planning so there should be as few as possible

-rules (keep few as possible in organization)

3 good reasons for change

-solve problems -make work more efficient -reduce unnecessary workload

5 components necessary for professional negligence to occur

-standard of care is in place -failure to meet care -foreseeability of harm exists -provable correlation between care and harm -actual pt injury

-the legal principle of determining points in litigation according to precedent "let the decision stand" -a wrongful act or an infringement of a right -a doctrine that partly is responsible for (employer reliable for employees) "the master is responsible for the acts of his servants" -the principle that the occurrence of an accident implies negligence "the thing speak for itself" -is the area of law in which manufacturers, distributors, suppliers, retailers, and others who make products available to the public are held responsible for the injuries those products cause -where someone is held responsible for the actions or omissions of another person

-stare decisis -tort -respondeat superior -res ipsa loquitur -product liability -vicarious liability

-who is ineligible to belong to union -outsider comes into organize union -perception on the part of union member that management has failed in some way to meet terms of labor agreement

-supervisors "any nurse who directs less skilled employees as part of her duties" -salting -grievance

-ancillary personnel collaborate to provide care to a group of patients under the direction of a professional nurse; requires planning conferences and extensive communication -this is good for which leadership

-team nursing -democratic

-do now category usually reflects the operation of -when a new situation occurs that is more important than current situation -who deals with more interruptions

-the day to day unit -positive interruption -lower level manager

3 steps to time management

-time allowed for planning/priorities -completing highest priority task before beginning another -reprioritize based on new information

-should bear the cost of management development classes and create an organizational structure that allows managers to apply their new knowledge.

-top level management

-oldest mode of organizing patient care-nurse assumes total responsibility for meeting the needs of all assigned patients during his or her time on duty -where would this work well

-total pt care or case method nursing -ICU/hospice

3 phases of planned change -problem seen, problem identified (guilt, anxiety, concern elicited) -staff experience change, benefits, disadvantage, done slowly as possible -I can go out on unit and see nurses doing better; work is incorporated

-unfreezing -movement -refreezing

-provide greater good for greatest number of people -individuals have basic inherent rights that should not be interfered with -duty to do something -each case weighed on case by case basis to determine goals/duties

-utilitarian -right based -duty based -intuitionist

-the beliefs that guide behavior -when a nurse experience cognitive dissonance between personal and organization values, result may be

-values -intrapersonal conflict/burnout

-the dream of the institution (future goals/aims) -this flows from mission -the ends toward which organization is working "operationalize the philosophy" -defined as result toward which effort is directed; aim of philosophy; measurable (what do we want to achieve) -motivate people to specify end and are explicit, measurable, observable, obtainable (how do we get there) -plans reduced to statements or instruction that direct organization decision making -plans that establish customary/acceptable ways of accomplishing task and delineate a sequin of steps of required action (step by step of what to do) -plans that define specific action or nonaction (should be enforced)

-vision statement -philosophy -goals/objectives -goal -objective -policies -procedures -rules

-peoples' expectations about their environment or event will influence their behavior (all actions have a cause and effect relationship) people make decisions in anticipation of reward -"stretching employees" giving them more difficult tasks than they are used to doing to empower them (push beyond what one thinks they can do)

-vroom expectancy model -gellerman

Group Building roles 1-accepts and praises all contributions & viewpoints 2-mediates and resolves conflict 3-yields his/her position in conflict situation 4-promotes open communication and facilitates participation 5-express or evaluates standards to evaluate group process 6-records group process and provides feedback 7-accepts groups ideas and listings to discussion

1-Encourager 2-Harmonizer 3-Compromiser 4-Gatekeeeper 5-standard setter 6-Group commentator 7-Follower

Administrative vs economic man 1-make rational decision 2-only carries out decisions that are satisfying 3-generate many alternatives and complete knowledge of problem 4-unrealistic description of decision making b/c brains cannot retain that much info 5-decisions are "good enough" so they work 6-never has complete knowledge & generates fewer alternatives 7-best choice is often too costly of time/resources so another less costly/workable solution is found 8-decision maximize utility

1-economic 2-administrative 3-administrative 4-administrative 5-administrative 6-economic 7-administrative 8-economic

4 steps to termination conference

1. state facts for reason of termination 2. explain termination process 3. ask for employee input and respond calmly 4. end meeting on positive note

5 steps of disciplinary conference

1. state problem clealry 2. ask employee why theres been no improvement 3. explain disciplinary action 4. describe expected behavior changes 5. get agreement and acceptance of plan

Many Nurses Lack a ________ and Instead View Nursing as a Job (this viewpoint limits opportunities for professional advancement and personal growth since what cannot be imagined rarely becomes a reality)

Career Focus

SWOT analysis

Strength weakness opportunity threat Harmful: weakness/threat Helpful: strength/oppertunity internal: strength & weakness external: opportunity & threat

nurses at all levels of the organizational hierarchy are responsible not just for preventing nursing care problems but also for continuous improvement of all aspects of nursing care

TQM: total quality management

to be successful, management development must be planned and supported by top level management; this is called

succession planning

-the moral responsibility that accompanies a position -is related to job assignment and must be accompanied by enough authority to accomplish the assigned task -the official power to act and direct the work of others.

accountability responsibility authority

Involves helping others to identify professional goals and career options and then designing a career plan to achieve those goals In short-term career coaching, the manager regularly asks employees questions or challenges them to refocus

career coaching refocus perspective or improve performance

Negotiation of formal labor agreements and day-to-day interactions between unions and management

collective bargaining

-standards are set/ performance is measured/ action is taken (which phase of management) -tool for identifying desired standards of organizational performance/ measuring products, practices, and services against "best performing organizations -predetermined level of excellence that serves as a guide for practice

controlling benchmarking standard

-reviewing an existing process that provides a product or service/ determining where there's wasted time or effort/ developing an improved, streamlined way to achieve the same results more efficiently -refers to an attempt to separate nursing practice roles based on education or experience or some combination of both

cycle time reduction differentiated nursing practice

first step in staffing process

determine type/number of personnel needed

-which phase of the management process is effected with collective bargain, unionization, employment laws

directing

-comprehensive, integrated approach to the care and reimbursement of high-cost, chronic illnesses/ Goal is to address the illness or condition with maximum efficiency regardless of treatment setting(s) or typical reimbursement patterns

disease management

-advance a system toward change (facilitators) -impede change/pull away from (barriers)

driving forces restraining forces

-hallmark of transformational leadership (to develop, enable, allow) -to keep power one must know when to share info, how much to share, who to share with, what not to share

empowerment benign neglect

-the authority & ability to get things accomplished (influence behavior) -the right to command -given to you based on your title/position -defined as the art of using power effectively

power authority legitimate authority politics

Probably the most critical skill in good time management.

priority setting

-process of actively seeking out and attracting applicants for existing positions -the most common method for employee selection used by managers -validity increases with

recruitment interviewing team approach

the manager or mentor meets with an employee regularly to discuss aspects of his or her work. Both individuals determine the agenda jointly, with the goal of an environment of learning that can span the personal and professional aspects of the employee's experience.

reflective practice or clinical coaching

The process by which rules are internalized and become part of the person's personality-highest and most effective form of discipline

self discipline

-a minimal level of expertise that may be delivered to a patient; the conduct of a reasonably prudent nurse in similar circumstances -the failure of a person with professional training to act in a reasonable and prudent manner—also called professional negligence.

standard of care malpractice

-the manager helps subordinates resolve ethical problems and live with the solutions at the unit level -the manager works to ensure that the work environment is both safe and conducive to professional and personal growth for subordinates. -Upper level managers must also be willing to advocate for _________, who speak out about organizational practices they believe may be harmful or inappropriate.

subordinate advocacy workplace advocacy whistle blowers

requires health care organizations that receive federal funding to provide education for staff and patients on issues concerning treatment and end-of-life issues -generally, a nurse is not liable for injury that occurs as a result of emergency treatment, provided that: care is provided at the scene of the emergency & care is not grossly negligent

the patient self determination act good samaritan immunity

suggests that individuals often rise "to the level of their incompetence."

the peter principle

-being self aware of when you are most productive -T or F medicine has always been consumer drive

time inventory false- used to be paternalism "dr always right"

T or F Every individual you hire for a leadership role should have the capability to grow into your role -should be viewed as a lifelong process involving both the individual and the environment in which he or she lives.

true career development

-anything that occurs to alter the client's progress through the normal critical path. -documenting when and why a patient's care varies from the clinical pathway.

variance variance tracking

Difficult personality types -explode abruptly, intimidating, domineering, erosional attacks, aggressive, temper tantrum, make a scene -passively aggressive, work to sabotage others -whiney, finds faults in all situations, blames others, self righteous, don't want to bring solutions to table -shuts down, unresponsive, avoids answering direct questions, doesn't participate as team member

volcano sniper chronic complainer clam

3 things unions bargain for

wages -hours -working conditions

the innermost leadership activity and core of management `

decision making

3 primary requisites for successful management & leadership:

decision making problem solving critical thinking

-represents a particular case type for which medicare provides a flat dollar amount of reimbursement -are predetermined courses of progress that patients should be making after admission for a specific diagnosis or a specific surgery

diagnosis related group critical pathways

T or F information and communication are the same, they are interdependent

false-there different

Stages of group process -beginning to know each other, expectations defined, directions given -competitive nature comes out; identify identified, effective bargaining -rules/regulations made -getting work done -closure, everything summarized/closed

forming -storming -norming -perfomring -termination

-occurs when there is too much conformity to group norms, often resulting in opinions and ideas that may lack merit/ fail to take adequate risks by disagreeing, being challenge, or assessing discussion carefully

group think

-formula for successful leadership (if lose one quality, lose trust of employees and then authority/power)

honesty + confidence + inspiration + vision (CHIV) = credibility

-theory that suggests the individuals and/or organizations will invest in education & professional development if they believe that such investment will have future pay off (ex: hospitals provide tuition reimbursement for nurses to gain higher degree so that there may be increase quality of care & higher retention rates)

human capital theory

Nurses at every level play a role in the decisions that affect nursing activity throughout the system/ Nurse-managers move out of traditional industrial model roles into collegial models, becoming moderators of the service process -similar to shared governance, but thus allowed to participate in decisions in which someone has control

shared governance participatory management

People learn as a result of the direct experience of the effects of their actions/ Knowledge is sometimes vicarious in nature (someone else's actions) / People learn by judgment voiced by others/ people evaluate new information both deductively and inductively (by observing and imitating others)

social learning theory

dotted lines indicate -solid lines indicate -T or F staff positions have inherent legitimacy authority -the number of people that report to one manager (nurse manager has 43 staff member; her _____ is:)

staff/advisory -formal relationship, line of communication, authority (denote chain of command-vertical) -false (only line positions) -span of control is 43

-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. (ex: pt, pt family, universities, community, investors)

stakeholders

theorist-nurses should have skill in both leadership roles and management functions; the two must be integrated for greatest potential (think longer term, look outward toward larger organization)

-integrated leader manager (Gardner)

-difference between budget and actual results -compare actual results with the budget, followed by an investigation to determine why the variance occurred

-variance -variance analysis

-if too many people reporting to single manger -if too few

-delays decision making -inefficient top heavy orgnaiziation

-staffing decisions for all units are made by a central office/computer -why is this way often fairer to employees -disadvantage -unit manager responsible for covering all scheduled staff absences, reducing staff during low census, adding staff during high census, and preparing unit schedules -advantage -disadvantage

-centralized staffing -no impartialness, more cost effective -managers may be less responsive to personnel budget control if they have limited responsibility in scheduling -decentralized staffing -manger knows the needs of the unit and staff intimately, staff feels more in control of work environment & more flexibility -risk of being treated unequally/inconsistent

Effective methods -both parties set apart goals and come up with new goals; focus on solving problem not defeating opponent -discussion aimed at reaching an agreement (involves winning and losing for both parties) -win=win situation each party must give up something -a hostile or argumentative meeting or situation between opposing parties (face to face, most effective) Less effective techniques of conflict management -decrease emotional components of conflict (often for minor problems) -putting what you want ahead of others "win regardless of cost of others" -power drives, might makes right -wants other to like & accept them so quick to give what they want; doesn't want to hurt others

-collaboration -negotiation -compromising -confrontation -smoothing -forcing -competing -accomodating

-is what occurs when real or perceived differences exist in goals, ideas, attitudes, beliefs, feelings, or actions between two or more parties -occurs with oneself -occurs with 2 or more people within a group -occurs between 2 or more groups

-conflict -intrapersonal -intragroup -intergroup

PCS -uses broad indicators (bathing, diet, IV fluids, meds, positioning) to categorize pt care activities -requires nurse to note the frequency of occurrence of specific activities, treatments, and procedures (teaching, elimination, hygiene)

-critical indicator -summative task

-mental process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, & evaluating info to reach an answer, broader but more complex scope than decisions making/problem solving -apply different types of knowledge for evidence, critically think, reflect on process (knowledge & experience to make decisions in care)

-critical or reflective thinking -clinical reasoning

Decision Making Tools -allows one to visually examine alternatives and compare each against the same criteria (good when looking to select a candidate to hire from large interview pool) -cost profit (Cost vs benefit) relationship and are helpful when quantitative information is available, item's cost or predicted use (determine participants it would take to have inservice program break) -demonstrates how various alternatives are visible and make best decision -useful in deterring timing of decision for final event to occur; keeps everyone up to date (look at chart in break room and see where target is for end of week)

-decision grid -payoff tables -decision tree -PERT chart (program evaluation & review technique)

-complex cognitive process, choosing a particular course of action/ "the thought process of selecting a logical choice from available options" -systematic process of analyzing a difficult situation/ has a decision making step -what makes the two terms different

-decision making -problem solving -decision making can occur without the full analysis required with problem solving

the management process (5)*** by Fayol/Gulick -motivating, managing conflict, delegating, communication, facilitating collaboration -understanding & using power & authority appropriately, establishing structure -performance appraisals, quality, legal/ethical, professional -encompasses determining philosophy/objectives/policies/rules, determine course of action -recruiting, interviewing, hiring, orienting, scheduling, team building

-directing -organizing -controlling -planning -staffing

formal structure organization should provide 3 things

-effective work system -good lines of communication -job satisfaction

-knowing what sets one off and being able to control actions/yourself as well as those of others (these are essential "soft skills" for the workplace today) -5 componentes of EI -goal fo EI

-emotional intelligence -self awareness, self regulation, motivation, empathy, social skills -emotional literacy (recognizing one's emotions and how they influence subsequent actions)

which stage of conflict process -aka as affective conflict -should have open communication and mutual support than can be resolved by pointing out potential/actual problem -short staffing or rapid change -aka as overt conflict

-felt (3) -perceived (2) -latent (1) -mainfest (4)

-nurses hired centrally and sent to unit based on need -nurses hired on daily basis, not guaranteed assignment and usually come from outside -system that allows employees to select time schedules that best meet their personal needs while still meeting work responsibilities -these nurses are usually directly employed by an external nursing broker and work for premium pay (often 2-3 times that of a regularly employed staff nurse), without benefits -open position in hospital, nurses bid to work and nurse with lowest bid takes the shift

-float pool -per diem -flex time -agency & travel nurses -shift bidding

-what should be used to help focus reader on task/topic -nonverbal communication commonly known as

-headings -body language

-bullying between coworkers -mistreatment or discourtesy of another person (ex: eye rolling, nonverbal behaviors, sarcastic comments) -when employees gang up on an individual -bullying, incivility, and mobbing occur known as

-horizontal bullying -incivility -mobbing -workplace violence

-refers to the attributes of a person which are productive in some economic context although it is normally measured/conceived of as a private return to the individual as well as a social return (ex: examining formal education attainment- with education gain wage, salary, or other compensation) (or organizational- refer to collective group knowledge/experience)

-human capital (represents capability of individual) -social capital (group can accomplish together)

The traditional problem solving process & Harrison's managerial problem solving model: -what makes them different -which has a goal to achieve desired learner outcomes -weakness of traditional

-the Harrison model sets objectives which allow one to work towards goal -Harrison model -time constraint causes less effectivity

Primary Types of Budgeting -spend everything in budget so dont lose it for the next year (disadvantage- discourage cost efficiency) -manager must go back to none; rejustify their needs each budgeting cycle, cognitive of priorities for next year "decision packet" -budgets that go up and down over the year depending on volume -emphasizes outcomes and results instead of activities/outputs; achieving specific outcomes and evaluating budgetary success accordingly

-incremental budgeting (flat percentage increase method) -zero based budgeting -flexible budgeting -performance budgeting

-what is major reason for job dissatisfaction in nursing -who usually has the function of making scheduling

-inflexibility -first & middle level managers

-humans are complex beings whose working environment is an open system to which they respond; success depends on leader assessing the situation/determining best strategy (the situation we are in determines the style we handle it by) -leadership is a dynamic 2 way process (3 elements: leader, followers, situation) -theory Z: support democratic style, looking to see which job is most suitable for person, holistic approach, job security, guarantee lifetime employment

-interactional theory (schein) -hollander's theory -ouchi

-values, feelings, temperament, stress level of the sender to receiver -weather condition, temperature, timing, organization, status, power, authority

-internal climate -external climate

-one consciously incorporates recall or cumulative knowledge that come from education and experience in planning the decision -first impulse; blends with intuition, naturalistic decision making

-intuitive decision making model -recognition primed decision

leaders vs managers -do not have delegated authority; obtain power by other means -wider variety of roles -not part of formal organization -always assigned a position in organization -legitimate source of power by delegated authority -focus on group process, info gathering, feedback -expected to carry out specific functions -emphasize control, decision making

-leaders -leaders -leaders -managers -managers -leaders -managers -managers

-designed to focus on both product & function (formal vertical & horizontal chain of command) (ex: good pt outcomes due to staff education)

-matrix organization

-federally assisted and state administers to pay for meal services of low income individuals -nationwide insurance provides benefits to people 65+

-medicaid -medicare

-refers to the propensity of insured patients to use more medical services than necessary because their insurance covers so much of the cost. -pt has option at time of service to select a provider outside network but pays a higher premium and copayment -must seek care from designated HMO prover or pay all out of pocket cost

-moral hazard -POS: point of service -EPO: exclusive provider organization

-what is the staffing ratio -what is staffing mix -4 reasons staffing mix was changed

-nurse/pt ratio -RNs, LPNs, PCTS (who makes up mix) 1. hiring RNs is more expensive 2. increase efficiency 3. decrease waste 4. reshape pt care delivery

-day to day activity within department and involves all managers; expenses change in response to volume of service (repairs/management, supplies, electricity) -next to personnel costs, what are the second most significant component in hospital budget

-operating budget -supplies

-a sum total of values, language, past history of "sacred cows," formal and informal communication networks, and the rituals of an organization that are not open for change (Ex: logo for hospital designed my original board) -what makes this different from organization climate -success in building a new culture often require

-organization culture -this is how individuals perceive organization -new leadership and/or outside analysis

-too little conflict results in -too much results in

-organization stasis -reduces organization's effectiveness/immobilizes employees

-the largest budget is which and why -actual worked time/salary expense -benefit time, new employee orientation, employee turnover, sick and holiday time, education

-personnel because healthcare is labor intensive -productive time -nonproductive time

Task Interdependency -units are independent but draw resources from organization -output of one unit is input of another unit (one task done before another can be) (admission/discharge) functional nursing -output from EACH unit becomes input of the other unit and vice versa (nurse-physician relationship) (radiology-medical surgical units) (team nursing)

-pooled -sequential -reciprocal

-promised rewards -threats/punishment

-postive sanction negative sanction

-measures of inputs to outputs/ refers to resources used to produce product and quantity & quality of service -raw materials, personnel, supplies & equipment & money used in production of product -includes product of health care (pt days, case mix) -ways to measure nursing productivity

-productivity -inputs -outputs -nursing hrs per pt day, salary cost per pt day, standardize pt days

when under attack by aggressive person, assertive person should:

-reflect (reflect message back on speaker) -repeat assertive message -point out the implicit assumptions -restate message using assertive language -question

Generational Diversity -not risk takers or push for change but respectful to authority/like structure and work hard to achieve company goal -smallest workforces, like flex time & 12 hr shifts, stay in one place for long periods, want decisions made without discussion, balance fun & work -high strong work ethic, close to retirement "workaholics" caring for family members on both sides -millennial, global citizens of tomorrow, like to be pushed to limits, self confident, volunteer minded, social conscious, tech savvy, expect immediate feedback, contact by text/email

-silent generation (1925-1942) -generation X (1960s-1980s) -baby boomers (1943-1960s) -genration Y (1980-present)

-Follet- leadership style should vary according to situation or employees involved -everyone involved knew what was going on then directions were given -no leadership style is ideal for every situation

-situational leadership theory -law of the situation -contingency approach

-both leaders and followers have ability to raise each other to higher levels of motivation/morality Transformational vs transactional 1-concerned with day to day operations 2-committed, has a vision, empower others with vision 3-uses trade offs to meet goals 4-does not identify shared values 5-looks at effects 6-uses contingency reward 7-committed 8-caretaker

-transformational and transactional leadership (burns) 1-transactional 2-transformational 3-transactional 4-transactional 5-transformational 6-transactional 7-transactional 8-transformational

Individual roles of group members 1-expresses disapproval of others values 2-persists in expressing negative point of view 3-works to focus positive attention on oneself 4-uses group setting as forum for person expression 5-remains uninvolved and demonstrates cynicism, horseplay 6-attempts to control and manipulate group 7-uses expressions of personal insecurity, confusion to manipulate sympathy 8-cloaks personal prejudices/biases by speaking for others

1-Aggressor 2-Blocker 3-Recognition seeker 4-Self-confessor 5-Playboy 6-Dominator 7-Help seeker 8-Special interest pleader

Group Dynamic Task roles 1- contributor who proposes or suggests group goals or redefines problem 2-searches for factual basis for group's work 3-offers an opinion of what group's view of pertinent values should be 4-seeks clarity or relit the value of others suggestions 5-gives examples or extends meaning and how they could work 6-clarifies ideas, suggestion, and activities of group 7- summarizes decisions and actions; identifies and questions from goals 8-questions group accomplishments and compares with the standard 9- stimulates group to act and raise level of its actions 10-facilitates group actions by arranging the environment 11-records group activities

1-Initiator 2-Information seeker 3-Information giver 4-Opinion seeker 5-Elaborator 6-Coordinator 7-Orienter 8-Evaluator 9-Energizer 10-Procedural technician 11-Recorder

Passive, Assertive, Aggressive, Passive Aggressive 1-a way of communicating that allows people to express themselves in direct, honest, and appropriate ways that do not infringe on another person's rights 2-limited verbal exchange with incongruent nonverbal behavior 3-intrudes in personal space, winning at all cost, def excellence 4-occurs when person suffers in silence 5-uses I statements 6-verbal & nonverbal communication are congruent 7-direct, threatening, condescending 8-may bottle up feelings leading to eventual explosion, avoid conflict 9-withdrawal in an effort to manipulate the situation 10-damages relationships & undercuts mutual respect 11-not rude or insensitive, informed voice that insists on being heard

1-assertive 2-passsive aggressive 3-aggressive 4-passive 5-assertive 6-assertive 7-aggressive 8-passive 9-passive aggressive 10-passive aggressive 11-assertive

-3 types of leadership styles : authoritarian, democratic laissez-faire Autocratic/Democratic/Laissez faire 1-participative 2-permissive, free reign 3-strong control over group 4-others motivated by coercion, directed with commands 5-communication flows downward and decision making doesnt involve others 6-emphasis on group 7-communication flows up & down 8-emphasis on we 9-criticism is punitive 10-economic and ego awards used 11-works well in crisis situation, large bureaucracies, armed forces 12-criticism withheld 13-result: action is predictable, sense of security, high productivity; bad- no autonomy -constructive criticism 14-result: autonomy & growth, works well in group interaction; bad- time consuming 15-motivation by support when asked 16-results: frustration, apathy, disinterest, disorganization/chaos

1-democratic 2-laissez faire 3-authoritarian 4-authoritarian 5-authoritarian 6-laissez faire 7-democratic, laissez faire 8-democratic 9-authoritarian 10-democratic 11-authoritarian 12-laissez faire 13-authoritarian 14-democratic 15-laissez faire 16-laissez faire

Pedagogy vs androgogy (adult learners) 1-Learner is dependent 2-learner is self directed and internally motivated 3-Learner needs external rewards and punishment 4-Learner's experiences are unimportant or limited 5-learners experiences are valued/varied 6-Interaction is subject centered 7-task is problem centered 8-climate is relaxed and informal 9-interaction is teacher directed 10-collaboration encouraged 11-Climate is authoritative 12-Competition is encouraged 13-teacher and students set goals and make decision, teacher/self/peers evaluate 14-teacher sets goals & makes decisions, teacher evaluates.

1-pedagogy 2-androgogy 3-pedagogy 4-pedagogy 5-androgogy 6-pedagogy 7-androgogy 8-androgogy 9-pedagogy 10-androgogy 11-pedagogy 12-pedagogy 13-androgogy 14-pedagogy

1-father of scientific management 2-theory x and theory Y 3-employees participate and flexibility in organization, keep their self esteem and independence or may leave organization 4-participative management or participative decision making 5-hawthorne effect 6-bureaucratic functions 7-teach employee one best way to do something, productivity will increase 8-if workers are praised by management, productivity will go up 9-management functions 10-lots of rules & regulations are involved to increase productivity 11-managers have authority WITH employees not OVER them 12-activities of management (7 activities) 13-one group workers are lazy and need constant supervision/ other group works like job, self motivated, see organizational goals 14-employee participation

1-taylor 2-mcgregor 3-argyris 4-follett 5-mayo 6-weber 7-taylor 8-mayo 9-fayol 10-weber 11-follett 12-gulick 13-mcgregor (x then y) 14- argyris

5 stages of conflict

1st- latent conflict: antecedent conditions; may not be cause of conflict but associated with increased rates of conflict (often is incompatible goals) 2nd- perceived conflict: refers to each party's perception of the other's position (often involves issues & roles) sometimes can be solved here before internalized 3rd-felt conflict; conflict is emotionalized (mistrust, fear, anger) 4th-manifest conflict (action is taken) (male- competitive, dominance, aggression) (female- avoid/pacify conflict) confrontation/debate 5th-conflict aftermath (can be positive or negative; new feelings/ attitudes arise between parties

Lewin, White, Lippit came up with what behavior theories

3 leadership styles: authoritarian, democratic, laissez faire

Hurst's 4 phases of mentoring relationship

initiation: connecting, trust/openness cultivation: learning and listening, mutual respect separation: change and growth; move towards independence redefinition: separate independent relationship

IDEALS model

I. Identify problem D. Define context E. Enumerate choices; come up with options A. Analyze options L. list reasons why each option is appropriate S. self correct; is it feasible? or do I need to make corrections?

-theory that suggests that in order to lead, leaders must be true to themselves and their values & act accordingly (leader's conviction that inspire followers) -theory that applies to a person who is recognized among peers for innovative ideas & demonstrates confidence to promote these idea (refers to any situation in which 1 individual convinces another to consider a new idea, product, way of looking)

authentic leader (congruent leadership) thought leadership

Budget--$34,560. Actual--$36,958. what is your variance? what percent are you over?

Variance--($2,398) %--(6.9)% $2,398/$34,560= 0.069 0.069 X 100= 6.9% over budget

weekender plan (two 12hr shifts)

baylor plan

-plan for building purchase, major equipment, major acquisitions, long term planning (like $1000-5000) (time >5-7 years)

capital budget

when institution gets certain amount of money per employee per month

capitation

-refers to presenting two independent items of information and grouping them together into one unit. (typical person can remember 5-9 but increases with expertise) -Involves one person helping another to achieve an optimum level of performance (emphasis is to grow) -The person who is unwilling to teach others and does not want others to succeed/ keeps others from power

chunking coaching queen bee syndrome

-producing good result from the amount of money spent -making educated budget by using historical data

cost effective forecasting

4 qualities of successful decision maker

courage sensitivity energy creativity

Level 5 leadership

level 1: highly capable individual level 2: contributing team member level 3: competent manager level 4: effective leader level 5: great leader

-if chart has dotted lines coming out it indicates -decision making hierarchy is a pyramid -can cause slow decision making due to information sharing & can produce confusion and frustration for workers because of dual-authority hierarchical design

line and staff scalar chain matrix organization

-the organization & coordination of the activities of a business in order to achieve defined objectives/ manipulation of people, environment, money, time & the resources for organization goals

management

Turnover formula there are 10 faculty members and 2 turnovers in 2012, what is the turnover percentage

number of terminations per year / number of employees for unit x 100 -2/10 x100= 20% (always percentage and rounded to tenths)

-theory that suggests not all followers are inherently motivated to act in the best interest of the leaders/employers -why may this occur -what must a leader do in response to this (ex: nurses do not often want to work overtime shifts but manager usually offers reward financially)

principal agent theory (followers are the agents & principal is the leader) -followers may have informational (expertise/knowledge advantage) over leader which is their own preference -provide appropriate incentives and productivity will go up

-active process that starts with problem and ends with solution -purposeful, outcome-directed thinking that is based on a body of knowledge derived from research and other sources of evidence

problem solving critical thinking

-experienced individuals are forced to learn new values, skill, and social results as result fo changes in the work they do, scope of responsibility, or work setting itself

resocialization

-unclear role expectations

role ambiguity

-used in some large institutions to address the shortcomings that are endemic to traditional large bureaucratic organizations. (smaller insole than large bureaucratic systems) -more authority and decision making can occur where the work is being carried out.

service line organization/care centered organization flat organizational design

this leadership challenges the status quo & attracts followers not by any promise or presentation/empowerment but by their risk taking & vision of being innovative -theory that builds on transformational leadership and suggest leaders must work together with subordinate to identify common goals, exploit opportunities, and empower staff to make decisions for organizational productivity to occur

thought leadership quantum leadership

-an institutional method for applying general rules to specific cases, thereby making the actions of management fair and predictable. -what is flattening the organization

weber: virtue of bureaucracy -increase span of control and reduce number of administrative levels