Leadership Final
Upon entering a patient's room, the Emergency Department nurse observes a visitor attempting to choke the patient. The visitor appears agitated and is screaming at the patient. The patient is gasping and looks cyanotic. What should the nurse do first? A) Attempt to remove the visitor from the room. B) Attempt to reason with the visitor and calm him or her down. C) Assess the patient for injuries. D) Call security for help.
D) Call security for help.
In order to maximize authority and accountability for all aspects of the nursing practice in the nurses responsible for the delivery of care, the most effective strategy an organization can take is to: A) Position management and administrative levels to coordinate and facilitate the work of the practicing nurses. B) Define in specific detail the daily activities of frontline nurses. C) Have nurses report directly to physicians. D) Develop multidisciplinary teams of care providers.
A) Position management and administrative levels to coordinate and facilitate the work of the practicing nurses.
what is AHRQ?
Agency for healthcare research and quality; the primary federal agency devoted to improving quality, safety, efficiency and effectiveness of healthcare.
Janice wants to be a change agent. Which action listed below would be the most appropriate for Janice to take? A) Become an early adopter. B) Wait until a more experienced nurse vocalizes support. C) Seek help from her nurse manager. D) Talk to a peer on another unit about the problems with more experienced nurses.
A) Become an early adopter.
Being able to think systematically involves: A) Being able to consider the "Big Picture," beyond the needs of your unit. B) Considering what nursing tasks need to be completed before the next medication pass. C) Focusing on the number of patients each nurse is assigned, unrelated to patient acuity. D) Refusing to come to staff meetings on your day off.
A) Being able to consider the "Big Picture," beyond the needs of your unit
Healthcare organizations that wish to develop a comprehensive workplace violence prevention program should do which of the following? (Select all that apply.) A) Commit to a zero tolerance policy for workplace violence and ensure that managers, supervisors, co-workers, clients, patients, and visitors know about this policy. B) Conduct a worksite analysis of risk for workplace violence of both physical and psychological nature. C) Ignore safety concerns identified through reporting of violent incidents. D) Develop a plan for workplace safety, prevention, and control of violence. E) Collect and analyze data and evaluate the effectiveness of the program. F) Provide training for staff on conflict management and de-escalation techniques. G) Address horizontal violence at all levels of the organization. H) Assign responsibility or accountability for a violence prevention program to individuals or teams with inadequate training and skills in workplace violence. I)Withhold adequate resources for this effort from the team responsible for developing workplace violence prevention in health care.
A) Commit to a zero tolerance policy for workplace violence and ensure that managers, supervisors, co-workers, clients, patients, and visitors know about this policy. B) Conduct a worksite analysis of risk for workplace violence of both physical and psychological nature. D) Develop a plan for workplace safety, prevention, and control of violence. E) Collect and analyze data and evaluate the effectiveness of the program. F) Provide training for staff on conflict management and de-escalation techniques. G) Address horizontal violence at all levels of the organization.
Managers need to address all but which of the following when effectively implementing organizational change that promotes patient safety? A) Learn quickly as you must complete all tasks before the end of the shift. B) Create and sustain trust. C) Actively manage the change process. D) Involve the staff in decision making in the redesign of the workflow.
A) Learn quickly as you must complete all tasks before the end of the shift.
The nurse manager in ICU develops a plan to implement the new sepsis management protocol. The plan includes education, focused sessions to discuss concerns with the staff, and sepsis warning signs in various places on the unit. This is an example of which A) Planned change B) Complexity management C) Unplanned change D) Open systems
A) Planned change
Classic principles characterizing effective change implementation: Clarity
clearly states the purpose of change and the methods that will be used to implement it
preferred provider organization
contracts are developed between hospitals and physicians with discounted rates and props payment
passive delegation
delegation that does not require decision making process. The decisions derive from job descriptions or policies and thus the tasks are not actively delegated they are assume virtue of the policy or job description.
DESC script
describe specific situation or behavior express how the situation makes you feel suggest other alternatives and seek agreement consequences should be stated in terms of impact on established team goals.
Covey's Eight Characteristics of Effective Leaders
engage in lifelong learning, service-oriented, concerned with common good, radiate positive energy, believe in other people, lead balanced lives and see life as an adventure, are synergistic (they see things breather than the sum of the parts) and engage themselves in self-renewal
Primary continuum of healthcare organizations
entry into system, heath maintenance, long-term care, chronic care, treatment of temporary non incapacitating malfunction. (doctors office, school health clinic)
Classic principles characterizing effective change implementation: leadership
equip every leader and every change agent with the skills and abilities needed to mobilize the change.
Classic principles characterizing effective change implementation: alignment
evaluate all the subsystems that impact and are impacted by the change, then make sure they support the change endeavor.
what is a critical pathway?
it is a component of a car MAP that is specific to diagnosis-related group reimbursement. The purpose is to ensure patients that are discharged before insurance reimbursement is eliminated. ( how long will they stay at the hospital and how many days will the insurance cover) *cannot replace professional clinical judegment
Classic principles characterizing effective change implementation: communication
keep a two-way information path that clarifies issues, answered questions and remains responsive to challenges in accomplishing the change.
Classic principles characterizing effective change implementation: tracking
monitor and measure to be sure that the goals that leach to change are being accomplished
what are the other names of the critical pathway?
multidisciplinary care pw, integrated care pw, critical path, or collaborative care pw
Patient variables affecting staffing decisions
number of patients, range of conditions, observations and interventions required, patients' satisfaction, stage of illness, family situation and needs, treatment required.
non-profit organization
organization that has funds redirected to maintenance and growth rather than as dividends to stockholders.
active delegation
proactively making a decision about tasks and people to accomplish effective work. (RN assesses the situation, determines what is appropriate for patient care, directs a UNP to perform certain tasks and holds the individual accountable)
Diffusion of innovation theory
process by which ideas spread through a culture; does not necessarily follow a linear path-- external factors may sometimes contribute to the adoption of innovation. (occurs in stages of knowledge, persuasion, decision, implementation and confirmation) *Kat Picked Deer In Charades
public institution
providing health services under the support and direction of the local, state or federal government.
Ethnocentrism
refers to the belief that one's own ways are the best, most superior or preferred waist act, believe or behave.
Complexity theory
requires readers to expand and respond to engaging dynamic change and focus on relationships rather than on prescribing and approaching changes as a lock-step, pre-prescribed method. (leaders try less to control the future and spend more time influencing, innovating and responding to the many factors that influence health)
Community services
services, including public health departments are focused not he treatment of the community rather than the individual.
Feedback
should be timely, respectful, specific, directed, considerate
SBAR
situation, background, assessment, recommendation
STEP
status of patient, team members, environment, progress toward goal
Transactional leadership style
the act of using rewards and punishment as part of daily overusing of employees in seeking to get the group to accomplish a task. traditional "boss" image and the superior makes all the decisions.
Cultural sensitivity
the affective behaviors in individuals-- the capacity to feel, convey, or react to ideas, habits, customs or traditions unique to a group of people. (not what the police do)
Social capital
the networks of relationships among people who live and work in a particular society, enabling that society to function effectively (trusting people basically)
Five rights of delegation
the right task, circumstances, person, director/ communication, supervision
organizational theory
the systematic analysis of how organizations and their component parts act and interact. (based on the systematic investigation of the effectiveness of specific organization designs in achieving their purpose)
Which of the generations is challenged by sharing leadership with other generations? A) Baby Boomers B) Generation Y C) Generation X D) Generation Z
A) Baby Boomers
Secondary continuum of health care organizations
Prevention of disease complications (hone health, ambulatory care centers, nurse centers)
Classic principles characterizing effective change implementation: Resources
Provide the resources that are essential for making the change happen.
Check-Back
Sender initiates message, receiver accepts message and gives feedback, sender double checks (example: "give 25 mg Benadryl IV push" "25 mg Benadryl IV")
CUS
"I am concerned, I am uncomfortable, this is a safety issue"
Laissez-faire skills
"delegate leadership" is a type of leadership style in which leaders are hands-off and allow group members to make the decisions. (lowest productivity)
actively listening
"tell me more about that" "listen with the intent to understand, rather than to respond"
Negotiation
(or bargaining) is a critically important skill for organization and political power. It is the process of making trade-offs (negotiating with a supervisor for a more desirable work schedule)
During bedside rounds, a surgeon turns to you and says, "The poor nursing care has caused this wound to become infected. Can't nurses at this hospital do anything right?" The best response is: A) "The nursing care on this unit has received awards and certainly is not the problem." B) "Let's first decide what to do for Mrs. Johnson and then step into the hall and talk further about your concerns." C) "It is inappropriate to talk to me that way. I will report this to my supervisor." D) "Would you like to change the antibiotic Mrs. Johnson is receiving?"
B) "Let's first decide what to do for Mrs. Johnson and then step into the hall and talk further about your concerns."
When the leader observes the employee has a significant increase in errors and may have some emotional problems, the most appropriate response is: A) Schedule a series of meetings with the employee to support and assist the employee in addressing the problem. B) Ask the employee some questions ending with a suggestion that Employee Assistance might be an option. C) Put the employee on the first steps of disciplinary action.
B) Ask the employee some questions ending with a suggestion that Employee Assistance might be an option.
Which of the following statements is true regarding complexity theory? A) Complexity theory is used to predict the health and illness trajectory of critically ill patients. B) Nurses can understand the dynamic nature of health care processes using complexity theory. C) The need for additional staff can be justified based on complexity theory. D) Complexity theory is used to explain the relationships among leading, managing, and following.
B) Nurses can understand the dynamic nature of health care processes using complexity theory.
Which of the following best demonstrates the concept of followership? A) Completing the tasks associated with your patient assignment without deviation with the intent of receiving praise from your manager B) Preparing for a committee meeting by reviewing the agenda and supplemental materials, so that you can be an active participant in the meeting C)Assessing a clinical situation and following a set of guidelines in order to delegate tasks to unlicensed personnel D) Administering medications to patients in conjunction with other nursing actions in order to make effective use of your time
B) Preparing for a committee meeting by reviewing the agenda and supplemental materials, so that you can be an active participant in the meeting
When caring for a patient who had a hip replacement that morning, a nurse is providing what level of care? A) Primary B) Secondary C) Tertiary D) Essential
B) Secondary
Janice is a new graduate nurse working in the intensive care unit of a large medical center. Janice completed her nurse residency and began working full-time on the unit about 6 weeks ago. Janice is the only new graduate nurse on a unit where her colleagues range from 29 to 48 years old. Janice is a member of the American Association of Critical-Care Nurses and is aware that the protocol for sepsis management in patients recently changed. Janice wants the ICU to adopt these best practices but doesn't know how to go about implementing the change. Which of the following is the best approach Janice could take? (Select all that apply.) A) Adopt the practices herself and become a role model. B) Talk with the nurse manager about the recent protocol change. C) Post an article reviewing the new sepsis management protocol on the bulletin board in the staff lounge. D) Ask other nurses on the unit why they are still using old standards of practice.
B) Talk with the nurse manager about the recent protocol change. C) Post an article reviewing the new sepsis management protocol on the bulletin board in the staff lounge.
Which objective best reflects the SMART objectives? A) To obtain the Beacon Award B) To successfully work as a team and gather all evidence to obtain the Beacon Award by December 2015 C) To conduct a gap analysis for the Beacon Award D) To think about applying for the Beacon Award
B) To successfully work as a team and gather all evidence to obtain the Beacon Award by December 2015 SMART: specific measurable agreed on realistic time bound
Nurses were long viewed by physicians, legislators, the media, and others as powerless because nurses: A) declined to participate in political activities in the earliest years of the profession in the United States. B) as women were subject to control by medicine and other groups because women had limited legal rights in late 19th-century America. C) and nursing leaders in the mid-20th century did not wish to be viewed by those outside of nursing as pushy or demanding. D) were subject to nursing practice acts that limited their ability to take political action.
B) as women were subject to control by medicine and other groups because women had limited legal rights in late 19th-century America.
tertiary continuum of health care organizations
Rehabilitation, long-term care (home health care, long-term care facilities, rehab centers, skilled nursing facilities, assisted living)
Leadership Team STEPPS
Brief, huddle, debrief
To maximize the coordination of care, provide seamless transitions, and improve quality of care, organizations are increasingly turning to which organizational structure? A) Academic medical centers B) Public health institutions C) Accountable care organizations D) Proprietary, investor-owned organizations
C) Accountable care organizations- accountable care organizations are designed to coordinate care, provide chronic disease management and improve overall quality of care
A newly hired nurse has observed bullying behaviors on her new unit that include gossip, demeaning, criticizing, and intimidation. She also feels other nurses are avoiding her or giving her the silent treatment. The unit manger does little to address these behaviors. The consequences of this toxic culture include all of the following EXCEPT: A) Loss of productivity and potential for high staff turnover B) Potential for patient safety errors that may increase the cost of care C) An increase in teamwork and communication D) Increase in anxiety, low self-esteem, and sleep disorders among the staff
C) An increase in teamwork and communication
How can a leader deal fairly with employees who fail to meet established standards of care? A) First, determine if the employee issue is a will or skill issue. B) Conduct a chart review that reflects the care issue. C) Ask questions of the employee that can reflect the employee's knowledge base.
C) Ask questions of the employee that can reflect the employee's knowledge base.
Managers may or may not be leaders; however, managers do all of the following EXCEPT: A) Build a culture of teamwork. B) Collaborate and translate direction into action, warning the team of potential barriers to the vision. C) Avoid addressing complexity so that the staff does not worry and change may occur anyway. D) Organize, plan, control, and solve problems.
C) Avoid addressing complexity so that the staff does not worry and change may occur anyway.
When entering the postoperative care unit, the nurse manager notices that the temporary agency nurse has incorrectly entered the rate of infusion for the patient's vasopressor medication and that the arterial line is indicating a blood pressure of 76/40. Discontinuing the intravenous infusion, the nurse manager's next most appropriate action is to determine which of the following? A) The nurse in charge of the unit B) If there is an assigned resource nurse to serve as mentor for the temporary nurse C) If there are standing orders for interventions for hypotension D) If the temporary nurse has had an orientation to the unit
C) If there are standing orders for interventions for hypotension
Which of the following represents outcomes of transformational leadership? A) Deadlines are met. B) Work is completed according to the rules. C) Increased job satisfaction D) Pay tends to be higher.
C) Increased job satisfaction
You are the nurse manager for a busy intensive care unit (ICU). Two patients are awaiting admission to the ICU; one is a 42-year-old bank president admitted through the emergency center with a diagnosis of an acute myocardial infarction, and the other is an elderly woman who experienced a cardiac arrest on the general medical unit. After reviewing the charts of all the patients already in the ICU, you contact the physician about a patient who can safely be discharged to a general medical unit so that two beds will be available for the two people awaiting admission. The ethical principle that you have most closely applied is that of: A) Respect for others B) Beneficence C) Justice D) Fidelity
C) Justice
By creating a powerful image: A) a nurse indicates that direct patient care is demeaning to one's level of nursing knowledge. B) others view a nurse as demanding and aloof. C) a nurse communicates self-confidence, competence, and a positive attitude toward nursing. D) others, including patients, may be intimidated.
C) a nurse communicates self-confidence, competence, and a positive attitude toward nursing.
Classic principles characterizing effective change implementation
Clarity, engagement, resources, alignment, leadership, communication, tracking
CPOE
Computerized Provider Order Entry; system that uses computers for creating orders for care to be made electronically and to coordinate with other elements of an individual's care and record so that one entry performs multiple functions.
Transformative leadership style
Creates a much more relaxed environment where followers are encouraged and inspired to take control of their role and expand their capabilities. (employees offering suggestions, working as a team)
What is the benefit of strategic planning for a healthcare organization? (Select all that apply.) A) It allows an organization to set its vision and goals. B) It allows an organization to assess its strengths, weaknesses, opportunities, and threats. C) It defines the driving forces in the environment. D) All of the above
D) All of the above
Managers can effectively reduce workplace stress, improve job satisfaction, and promote a positive work environment by doing all of the following EXCEPT: A) Encouraging autonomy in the workplace. B) Bringing in food for all shifts and encouraging social support among the team. C) Building strong relationships within the leadership team as well as other peers. D) Eliciting support, communicating to the team that deadlines are quickly approaching and that the department is performing poorly.
D) Eliciting support, communicating to the team that deadlines are quickly approaching and that the department is performing poorly.
The ICU soon implements the new evidence-based nursing practice for early identification and management of sepsis. Janice is concerned that the nurses with more experience will not want to adopt a new protocol or change practice patterns. This is an example of which of the following? A) External barrier B) Internal facilitator C) Change strategy D) Internal barrier
D) Internal barrier
Which of the following is not a rule of leadership? A) Maintain a positive attitude. B) Listen to people. C) Maintain balance. D) Maintain likeability.
D) Maintain likeability
Two employees disagree about who should work Christmas Day. The bottom line is that one employee will have to work and the schedule must be posted tomorrow. As the nurse manager, how can you best help them resolve the conflict? A) Use your position of power to resolve the conflict. You decide who will work Christmas Day. B) Rely on centralized staffing to resolve the C) Try to arrange a compromise. Have one employee work the first half of the shift and have the other work the second half. D) Meet with both employees at the same time. Engage them in the problem-solving process.
D) Meet with both employees at the same time. Engage them in the problem-solving process.
An incident report of the incident described in Question 1 needs to be completed. The most appropriate wording to be included in the incident report is: A) Patient was noted to have a low arterial blood pressure (76/40) and the vasopressor medication was discontinued. B) Patient's vasopressor medication was infusing at a higher rate than ordered and the medication was discontinued when the patient's blood pressure dropped to 76/40. C) Nurse MJ started the vasopressor medication; the patient subsequently was noted to have a blood pressure reading of 76/40, the medication was discontinued, and the physician notified. D) Patient receiving vasopressor medication intravenously; blood pressure fell to 76/40 and intravenous infusion discontinued; physician notified and the patient given 500 mL of IV fluid over 15 minutes.
D) Patient receiving vasopressor medication intravenously; blood pressure fell to 76/40 and intravenous infusion discontinued; physician notified and the patient given 500 mL of IV fluid over 15 minutes.
A new graduate nurse is considering employment opportunities. He wants to make sure he works for an organization that has similar beliefs as he does about nursing. Which of these documents would NOT provide him information to help him make his decision? A) Organizational mission B) Nursing philosophy C) Organizational chart D) Product line
D) Product line
The nurse has received her assignment for the day and notices that her peer has a much lighter assignment in both number and acuity of patients. This is not the first time the nurse has noticed this inequity in assignments. She also has seen her peer and the charge nurse go to lunch together and knows that they spend time outside of work socializing. The nurse feels that this constant inequity in assignment is not fair. What is the best course of action for the nurse to address this problem? A) Avoid the issue and say nothing but remain angry about the situation. B) Confront the charge nurse about the inequity in the assignment. C) Approach the peer and ask to switch assignments. D) Share concerns with the charge nurse and find a mutually acceptable compromise for the situation.
D) Share concerns with the charge nurse and find a mutually acceptable compromise for the situation.
"Power in nursing" refers to the nurse's ability to: A) protest unfair working conditions through walkouts and strikes. B) demonstrate knowledge about organizational behavior. C) act on issues that influence nursing licensure but not patient care. D) use one's influence to create change in pursuit of goals.
D) use one's influence to create change in pursuit of goals.
SOLER
S: sit facing the patient O: observe an open posture L: lean toward the patient E: establish and maintain intermittent eye contact R: relax
Forces influencing patient safety
Institute of medicine reports, AHRQ, NQF, Joint Commission, Det Norske Veritas/National Integrated Accreditation for healthcare organizations, magnet recognition program, institute for healthcare improvement quality and safety education for nurses.
Cross-Monitoring
Monitoring actions of other team members, ensuring that mistakes or over signs are caught quickly and easily
What are the three organizations that are driving the current emphasis on quality in healthcare?
NFQ, AHRQ, IOM
Role ambiguity
a condition in which individuals do not have a clear understanding about performance and evaluation (this could lead to errors in the workplace)
role strain
a subjective feeling of discomfort experience as result of role stress; may manifest through increased frustration, heightened emotional awareness or emotional fragility to situations (linked to absenteeism- absence from work is a way of withdrawing from an undesirable situation short of actually leaving)
Institutional providers
acute care hospitals, long term facilities, rehab are classified as institutional providers
Advocacy and assertion
advocate for patient and assert a corrective action in a firm and respectful manner
Lateral violence
aggressive and destructive behavior or psychological harassment of nurses against each other *bullying
democratic
also called "participative leadership" it is a type of leadership style in which members of the group take a move participative role in the decision-making process. (everyone can participate, ideas are exchanged freely and discussion is encouraged)
Autocratic leadership style (authoritarian)
an authoritarian style that places control within one person's position (more appropriate in crisis situation)
Institute of medicine
an organization that works outside of the federal government to provide independent, scientific advice.
For-profit organization
an organization, such as a hospital that is operated to create excess income (profit) for the benefit of owners or stockholders.
two- challenge rule
assertively voice concerns two times to ensure it has been heard
Name several ethical concepts
autonomy(personal freedom), beneficence(one should only promote good), nonmaleficence (do no harm), veracity (truth be told completely), justice(people treated equally), paternalism(making decisions for another), fidelity(keeping a promise) and respect for others.
Task Assistance
fostering an environment where assistance is actively sought and offered
accountable care organizations
groups of providers and healthcare organizations that agree to work together to provide coordinated high quality care to patients who receive medicare
IM SAFE
illness, medication, stress, alcohol and drugs, fatigue, eating and elimination (if you're going to call into work)
Call-Out
informs all team members simultaneously during emergent situations (example: "airway status?" "airway clear." )
Handoff: I PASS the BATON
introduction, patient, assessment, situation, safety concerns, background, actions, timing, ownership, next.
Classic principles characterizing effective change implementation: Engagement
involve and include the people affected by the change and build a sense of commitment around initiative
Horizontal violence
involves conflictual behaviors among individuals who consider themselves peers with equal power but with little power within the system (coworkers against each other)