Leadership Midterm

Baby Boomers

born 1940-1960 came of age during a time of much available education and economic expansion. They work for the challendge of work and career advancement. Characterized as workaholics, strong-willed individuals who are working for material gain, promotions, recognition, job security, and corner offices.

Compromising

conflict mgmt- each side gives up something and gains something. Adv:No one should win or lose, but both should gain someting; good for disagreements between individuals. Dis: <ay cause a return to the conflict if what is given up becomes more important than the original goal.

Negotitating

conflict mgmt- high level discussion that seeks agreement but not necessarily consensus. Adv: Stakes are very high and solution is rather permanent; often involves powerful groups. Dis: Agreements are permanent; even through each side has gains and losses. Lewicki, Hiam, and Olander 1996- state there are 5 approaches to negotitating 1. collaborative (win-win) 2. Competitive (win at all costs) 3. Avoiding (lose-lose) 4. Accomodating (Lose to win) and compromise (split the difference).

Confronting

conflict mgmt- immediate and obvious movement to stop conflict at the very start. Adv: Deos not allow conlict to take root; very powerful. Dis: May leave impression that conflict is not tolerated; may make somehting big out of nothing.

Competing

conflict mgmt- the two or three sides are forced to compete for the goal. Adv: Produces a winner, good when time is short and stakes are high. Dis: Produces a loser; may leave anger and restentment on losing side.

Transformational theory

contemporary approach- Burns 1978, defined a process in which "leaders and followers rasie one another to higher levels of motivation and morality. These leaders motivate others by behaving in accordance with values, and empowering others to contribute.

Charasmatic theory

contemporary approach- These leaders have an inspirational quality that prmotes an emotional connection in followers. House 1971 developed. Display self-confidence and strength in their convictions, and communicate high expectations and confidence in others. These leaders emerge in a crisis, have a communicating vision, and using personal power and unconventional strategies.

Knowledge workers

contemporary approach- these workers bring specialized, expert knowledge to an organization. The knowledge organization will share, provide, and grow the information necessary to work efficiently and effectively. Workers with the expertise and information to act are teh organization's leaders. They do not require a lot of supervision.

Benners- Proficient

deep understanding of situations as a whole rather than seeing things a series of tasks. Has learned from experience and how to modify plans in response to these events. Can recongize when an expected situaitons does not materilize. Quickly sees what is most imporatnt in a situation.

leadership

defined as the process of interaction in which the leader influences others toward goal achievement. A position of authority is not necessary. These are people that do the right thing. Influences others by inspiring, enliving, and engaging others to participate. Have a vision for what the organization can become.

Benners-Advanced

demonstarte marginally acceptable behavior. They may have coped with enough situations or have had them pointed out by a mentor. Require piror experience in acutal situaitons for recognition. Still need help setting priorities.

Culture Shock

develops when the values and beliefs upheld by a person's new culture are radically diffent from the person's native culture. For successful assimilation into a new culture, immigrants may want to learn that culture's improant values and expectations.

Chaos

hypothesizes that chaos acutally has order. Most organizations go through periods of rapid change and innovation and then stabalize before chaos erupts again. Order emerges through fluctations and chaos. Thus, the potential for choas means that the nurses and organization must be able to organize and implement change quickly and forcefuly. There is little time for orderly linear change.

Leadership characteristics

includes intelligence, self-confidence, determination, integrity, and sociability. Visonary, enthusiastic, supportive, knowledgeable, high-standards and expectations, value education and professional development, demonstrate power and status in the organization, and communicate openly. Research findings suggest that nurses that are caring, have respectability, trustworthiness, and flexible were most valued. Leaders that are different from nonleaders in six traits: drive, desire to lead, honesty, integrity, self-confidence, congnitive ability, and knowledge of the business.

Benners-Expert

intuitively knows what is going on. No longer relies on rules or guidelines. Flexible and highly proficient. Can visualize what is possible in the future.

Leaders

is about creating change. Involves establishing a direction, aligning people through empowerment, and motivating and inspiring them toward producing useful change and achieving the vision.

Path-Goal theory

the leadership style is matched to the situational characteristics of the followers, such as the desire for authority, the extent to which teh control of goal achievement is internal or external, and the ability of the follower to be involved. The leadership style is also matched to the situational factors in the enviorment, including the complexity of the task, the power assoicated with the leaders position, and the work group relationship. This theory is based on the expectancy theory, which holds that people are motivated when they believe they are able to carry out the work, they think their contribution will lead to the expected outcome, and they believe that the rewards for their efforts are valued and meaningful.

Team member roles

Self-oriented personal needs of the group and often negtively influence the effectiveness of the group. Aggressor, blocker, recognition seeker, and dominator.

Traditional change theories- Lewin

1951-This model has three simple steps: Unfreezing, moving to a new level, and refreezing. Unfreezing means that the current or old way of doing is thawed. People begin to be aware of the need for doing things differently, that change is needed fora specific reason. This change can be easy for some and difficult for others. In the next step, moving to a new level, change is implemented. In the third step, refreezing occurs. This means that the new way of doing things is incorporated into the routines or habits of the affected people. Move in a linear way. Orderly manner from one step to another. Unfortunately, change is not often this simple and often requires more personal, professional, and organization change.

Traditional change theories- Lippitt

1958- Seven phases of change 1. Diagnoses problem. 2. Assess motivation and capacity for change. 3. Assess change agent's motivation and resources. 4. Select progressive change objective. 5. Choose appropriate role of change agent. 6. Mantain change. 7. Terminate helping relationship.

Fielders contingency theory

1967- devloped the contingency model of leadership effectiveness. Views the pattern of leader behavior as dependent upon the interaction of the personality of the leader and the needs of the situation. The needs needs of the situation is toward teh leader influences leader member relationships, the degree of task structure, and the leader's position of power. Leader member relations are the feelings and attitudes of followers regarding acceptance, trust,and credibility of the leader. Good leader-member relations exist when followers respect, trust, and have confidence in the leader.

Traditional change theories- Havelock

1973 Six-step change model 1. Build relationship 2. Diagnose problem. 3. Acquire resources. 4. Choose solution. 5. Gain acceptance. 6. Stabalize and self-renew. MOST COMMONLY USED FOR EDUCATIONAL AND CULTURAL CHANGE.

Bushy's six behaivoral response to change

1992 1. Innovators- embrace change and enjoy the challenge of change and often lead to change. 2. Early adoptors- open and receptive to change, but not obsessed with it. 3. Early majority- enjoy and prefer the status quo, but do not want to be left behind.They adopt change before the average person. 4. Late majority- often known as the followers. They adopt change after expressing negative feelings and are often skeptics. 5. Laggards- last group to adopt change . They prefer tradition and stability to innovation. They are somewhat suspicius of change. 6. Rejectors- openly oppose and reject change. May be surreptitious or covert in their opposition. They may hinder the change process to the point of sabotage.

Traditional change theories- Rogers

1995- Diffusion of innovations theory. 1. Awareness 2. Interest 3. Evaluation 4. Trial. 5. Adoption.

Feedback

A powerful tool that managers use to assist in motivating behavior. To maximize its benefit nurses need to identify their behavior needs to change. Needs to be frequent, timely, and given at precise time intervals to sustain new behaviors. Must be usable, consistent, correct, and of sufficient diversity. Should not be potrayed as good or bad as nurse know when they have missed the goal.

Politics

A process by which people use a variety of methods to achieve their goals. These methods involve some level of competition, negotation, and collaboration for the power to achieve desired outcomes, as well as to protect and enhance the interests of groups or individuals. Exist bc resources can be limited, and some people control more resources than others. Resources include people, money, facility, technology, rights to properties, services, and technologies.

Problem solving

An active process that starts with a problem and ends with a solution. Nurses address multiple needs and problems daily. Some problems are uncomplicated and require one simple solution. Others may be complex and require more analysis by the nurse.

Management Roles

A taxonomy is a system that groups or classifies principles. Three categories: Information processing roles, interperonal roles, and decision making roles. A role includes behaviors, expectations, and recurrent activiities within a pattern that is part of the organizations structure. Information processing: mointior disseminator, and spokesperson which are used to manage peoples informaiton needs. Interpersonal roles are figurehead, leader, and liason, and used to manage relationships with people. Decision roles are entrepreneur, disturbance handler, allocator of resources, and negotiator.

Group Decision Advantages/ Disadvantages

Advantages: Can generate more ideas thus allowing for more choices and increased chance of higher quality outcomes. When members particpate in process, decision is more likely to be accepted. Groups may be used as medium for communication and dispersed to others. Disadvantages: Time consuming, without effective leadership, groups can waste time and be nonproductive. Group decision making can be costly and lead to conflict, Groups can be dominated by one person or become the battlegroud for power struggle among assertive members.

Conflict

An important part of the change process is the ablility to resolve conflict. Is a disagreement about something of importance to the people involved. Conflict resolution skills are leadership and management tools that all RNs should have. Conflict can be healthy. Conflict allows for creativity, innovations, new ideas, and new ways of doing things. Without some conflict groups can become stagnat and routine. Develop a mentatlity of we have always done it that way. Can be stimulated by scarce resources, invasion of personal space, safety or security issues, cultural differences, scarce nursing resources, increased workload, group competition, and various nursing demands and responsibilites.

Subcultures

Are smaller groups within a culture that may be based upon: Professional and occupations affiliations, Nationality or race, age groups, gender, socioeconomic, political viewpoints, sexual orientation.

Plan for personal power

Assess personal, patients, community, and professional needs. Maintain and develop expertise, network with others, take actions and evaluate outcomes. Volunteer for commitee assignments.

Learning organization theory

Based on 5 learning disciplines 1. Personal mastery- learning to expand our pesonal capacity to create the results we most desire. 2. Mental models- reflecting on, continually clarifying, and improving internal pictures of the world. 3. Shared vision- building a sense of commitment in a group by developing shared images of the future we seek to create. 4. Team learning- encouraging conversational and collective thinking skills. 5. Systems thinking- a way of thinking about and understanding the forces and interraltionships that shape the behavior of systems. Highlights that change in one area will affect other areas of the system.

Learning Organization Theory

Based on five learning disciplines and demonstrate responsivenes and flexibility. Because organizations are open to systems, they could best respond to unpredictable changes in their enviorment by using a learning approach in their interactions and interdiscplinary workings with one another. Focus on communiation, education, and cooporation among all parts of organization.

Benners- Competent

Been on the job for 2-3 years. Begins to see actions as part of a long-range goal or plans. Has a feeling of mastery and the ability to prioritize and manage the many aspect of clinical nursing.

Laissez-faire leadership

Classified as behavioral- is passive and permissive, and the leader defers decision making. Associated with low productivity and feelings of frustration in the group.

Change promotion

Bennis, Benne, and Chin 1969 identified three strategies to promote change in groups or organizations. Different strategies work in different situations. The power or authority of the change agent has an impact on the strategy selected. The change agent is one who is responsible for implementation of a change project. This person maybe from within or outside an organization. Most change agents use a variety of approaches to promote successful change.

Generation X

Born 1960-1980 latch key kids, as their parents were often away working. They learned to be self relient and independent. Look for carerr security not job security. They are willing to change jobs and have little loyalty to their employers. Not workahoics as they seek balance between work and leisure. They want a technologically current work enviorment, with competent leaderships, and provides a mentor or coach for a boss.

Generation Y

Born after 1980. Echo boomers or Millennials. Primarily the children of baby boomers. Grew up at the end of the Cold War, Internet, and speak-your-mind philosophy. Just beginning to make mark in workforce. Focus on early retirement, Mantra is change, and they expect countless options.

Traditionalists

Born before 1940. Came of age after the Great Depression and were raised to be disciplined and obey their elders. They feel obligated to conform and believe that work is one's duty.

Authocratic leadership

Classified as behavioral- involves centralized decision making, with the leader making decisions and using power to command and control others. This style is used by the leader in sitations in which the task or outcome is simple, when most team members would agree, or when a decision needs to be made promptly. Is associated with high-performing groups, but close supervision is necessary and feelings of hostility were present toward the leader.

Democratic leadership

Classified as behavioral- is participatory, with authority often delegated to others. To be influential, the leader uses expert power and the power base afforded by having close, personal relationships. The leader will ask the opinions of the entire team, but the final decision lies with the leader. There may also be mutual decision making by both team members and the leader, with everyone having an equal vote. This process encorages everyone to fully accept the team's conclusion. This style allows all to have the opportunity to provide input and differing perspectives into the decision. Endanagered positive feelings in their groups, group and performance was strong whether or not the leader was present.

Sources of power

Come from a combination of conscious and unconscious factors that allow an individual to influence others to do as the individual wants. Is described as having a basis in expertise, legitamacy, reference (charisma), reward, and coercin or connection. Effective nurses use these resources of power and combine reference(charasmatic) power and expert power from a legitamate power base. Expert power- devrived from knowledge. Legitamate- from academic degree. Referent-based on trust and respect .

Organization communication

Communication can be the following: From top down: Ceo to directors, From bottom up: CNA to CEO or in network. Networks cary along several diminesions. The most appropriate pattern depends upon the situationin which it is used. Nurse must have networks to fit various communication needs.

Technology and decision making

Computers to offer ways to support evidence based information and needs of nurses. Use of computers with EHRs, lab/x-ray reporting, e-scribing, quality improvement data collection/summary systems. Many HCPs using PDAs for med administration, accessing literature, pathophysiology, nursing care plans, and nursing diagnosis.

Collaborating

Conflict mgmt- both sides work together to develop optimal outcomes. Adv: Best solution for the conflict and encompases all improant goals to each side. Dis: Takes alot of time; requires committment to success.

Avoiding

Conflict mgmt- ignoring the conflict. Adv: Does not make a big deal out of nothing; conflict may be minor in comparison to other priorities allows tempers to cool. Dis: Conflict can become bigger than anticipated; source of conflict might be more important to one person or group than others.

Accomodating

Conflict mgmt- smoothing or cooperative one side gives into the other. Adv: One side is more concerned with an issue than the other side. stakes are not high enough for one side and that side is willing to give in. Dis: One side holds more power and can force the other side to give in; the importance of the stakes are not as apparent to one side as teh other; can lead to parties feeling "used" if they are always pressured to give in.

Decision Making

Considering and selecting interventions from a repertoire of actions that facilitate the achievement of a desired outcome. 5 step process 1. Identify the need for a decision and gather data. 2. Determine the goal or outcome. 3. Identify all alternative actions and the benefitcs and consequences of each. 4. Make the decision and act on it. 5. Evaluate the decision.

Decision making tools & technology

Decision making grid may help separete multiple factors that surround a situation or help decide between two choices. The PERT program evaluation and review technique folwchart provides visual picture depicting sequence of events that must take place to complete a project.

Change

Defined as making something different from what it was. The outcome maybe the same, but the actions performed to get to the outcome maybe different. The ability to change and be innovative is useful in both life and in healthcare situations.

Innovation

Defined as the process of creating new services or products. Change and innovation are different. Change is a generic concept that refers to any modification. Innovation is more restricted to new modification in ideas or practices. Innovation has been applied to medication errors in that system errors such as illegible handwriting, unfamiliar mediations, dosage calc errors, drug/food interactions, lack of documemntation of allergies. Innovation includes implementing computerized medications order entry ststem which made medication admistration safer.

Management

Defined as the process of planning, organizing, and staffing, leading, and controlling actions to achieve goals. Planning involves setting goals and identifying way to meet them. Organizing and staffing is the process of ensuring that the necessary humand and physical resources are availble to achieve the planning goals.

Power

Described as the ability to create, get, and use resources to achieve ones goals. Comes from the ability to influence others' thinking or behavior. The desire takes two forms. 1. An orientation toward achieving personal gain and self-glorification. 2. An orientation toward achieving gain for others or the common good.

Language

English is the second most widely spoken language, with mandarin chinese being the most widely spoken. Any individual seeking healthcare services with limited english proficiency has the right to have interpreter available to facilitate communciation. This is guaranteed under the title IV of civil rights act of 1964, to have an interpreter available to facilitate communication within the healthcare system. The use of a family member is discouraged unless the patient expresses consent.

Communicating with supervisors.

Essential in unit care and professional courtesy. If the issue is not an emergency then request an appointment. State the reason clearly and accurately. Provide supporting evidence and state your willingness to coorperate and be a part of the solution.

Respone to change

Factors affecting nursing, staff response to change. Trust, predicitability, and ability to cope with change. Factors affecting ability to change: Flexibility for change; that is, the ability to adapt to change. Evaluation of the immediate situation, that is, if the current situation is unacceptable, then change will be more welcome. Anctipated consequences of change; that is , the impact change will have on one's current job. Individual stake, or what the individual has to win or lose, in the change; that is , the more individuals perceive they have to lose, the more resistance they will offer.

The Conflict Process

Filley 1975- suggested a process for conflict resolution. 1. Antecedent condtions 2. Perceived and/or felt conflict. 3. Manifest behavior. 4. Conflict resolution or suppression 5. resolution aftermath. As the situation develops conflict is felt and triggers a response or manifest behavior. The conflict is either resolved or suppresed, leading to the dev. of new feelings and attitudes and create new conflicts.

Formal and infomal teams

Formal teams or groups may include a temporary ad joc group that meets to accomplish a specific purpose, such as preparding for the joint comission, or comitteee that meets regularly to accomplish organizational objectives. Informal groups are not directly established or sancitoned by the organization but often form naturally by individuals in the organzization to fill a personal or social interest or need.

Stages of Group/Team Process

Forming- group is created and meets for the first time. Storming- Group relaxes and is more comfortable. Conflict may occur which can cause uneeasiness. Norming- occurs after resistance is overcome in the storming phase. A feeling of group cohesion develops. Team members master the ability to resolve conflict with effective collaboration and coorperation. Personal opinons are expressed. Performing-group cohesion, collaboration, and solidarity are evident. Personal optinions are set aside to achieve group goals. The group reaches maturity,the emphasis is on maintaining amd improving interpresonal relationships within the team as each member functions as a whole. Adjourining stage- termination and consolidation occur. Review and evaluations takes place. Feedback is given and each members leaves with a sense of accomplishment.

Generational effect on workplace

Generations hve different goals and needs which affects retirement and advancement. Generations work alongisde each other. Different management style and increaed flexibilty is required.

Generational preceptions

Generations is a group that shares birth years, age, location, and signiificant life events. Generation is approx. 15-20 years in length. Has different value system from preceding generating and later generations.

Team Guidelines

Great teams don't just happen; there is behind the scenes planning, preparation, and forward thinking before anyone works together. A great team accomplishes what it sets out to do , with everyone on the team particpating to achieve the desired outcomes. Effective teamwork is achieved when there is synergy. Synergy is achieved when things work together harmoniously. The team must have a clearly stated purpose, Identify goals and objectives for the teams project, assess team members strengths and weaknesses. Avoidance of group think. Ensure good communication, develop an action plan, assessment and evaluation are continious.

Team member roles

Group maintaince-foster group unity, positive interpersonal relations among members. Encourager, Harmonizer, gatekeeper- keeps communication open and promotes particpation, standard setter, group observer, and follower.

Team member Roles

Group task- help a group develop and accomplish its goals. Initator-contributor- proposes goals, suggest ways of approaching tasks, and recommends procedures for approaching a problem or task. Information seeker- asks for info, viewpoints, and suggestions about the problem or task. Information giver- offers info, viewpoints, and suggestions about the problem or task. Coordinator- clarfies and synthesizes various ideas in an effort to tie together the work of the members. Orientor- Summarizes, points to departures from goals, and rasies questions about discussion direction. Energizer Stimulatres the group to higher leves and better quality of work.

Nominal group technique

Group technique- meaning nonverbal. There is no discussion; group members write out their ideas or responses to the identified issue or question posed by the group leader. Then presentation of the ideas to the group members, along with the advantages and disadvantages of each. These ideas are presented on a flip board or chart. The third phase offers an opportunity for discussion to clarify and evaluate the ideas. The fourth phase is private voting on the ideas. The idea with the highest number of votes is the solution implemented.

ANA roles

Has a dual role of being a professional organization and a collective bargaining agent which causes controversy. The ANA initatates policies regarding healthcare reform, publishes position statements, and develops and implements initatives.

Strategies to facilitate conflict management

Have open, honest, clear communication. Courtesy and active listenting are encouraged. The setting shuld be private, relaxed, and comfortable. Avoid external interruptions from phones, pagers, overhead speakers, and personnel should be avoided or kept to a minimum. Neurtral territory, establish ground rules, complicance is needed from both sides on outcome. Conflict mgmt is an improatnt part of the change and innovation process. Change and innovation can often threaten individuals and groups. It is improatant to keep in mind that some conflicts resolve themselves so the change agent should not be too quick to jump ito interention mode.

HIPPA

Health insurance portability and accountablity act of 1996. Developed to protect individuals private health information, which an organiztion is holding or transmitting. HHS has issued regulations known as the privacy rule that protects all individually indentifable health information held or transmitted by a covererd entity or its business associate, in any form or media, whether electronic paper, or oral. It applies to healthcare plans, healthcare clearing houses, and HCPs that transmit health information. The law introduced standards for protecting the privacy of individuals identifable health informaiton. 18 identifiers.

The management process

Henri Fayol described the functions of planning, organizing, coordinating, and controlling. Gulick and Urwick 1937- defined the management process according to seven principles: Planning, Organizing, staffing, directing, coordinating, reporting, and budgeting.

Situational theory

Hersey & Blanchard- addresses follower readiness as a factor in determining leadership style and considers task behavior and relationship behavior. High task behavior and low relationship behavior is called telling leadership style. Telling leaders defline the roles and tasks and supervise them closely. Communication is mostly one way as the decsions are made by the leader then announced. A high task, high relationship style is is called a selling leadership style. Seeling leaders define roles and tasks but seeks ideas from their followers. Communication is more two-way. A low task and high relationship style is partcipating leadership style. Day to day decisions are and task allocation are passed to followers. A low task and low relationship style is delegating. Leaders are still involved in decisions and problem-solving but control is with the follower. The follower decides when and how the leader with be involved. An additional aspect- the idea that the leader not only changes leadership style according to followers' needs, but also develops followers over time to increase their level of maturity.

Response to change

Lewin 1951- identified forces that were supportive of, as well as barriers to change. He called these driving and restraining forces. If the restraining forces outweigh the driving forces, then the change must be abandoned b/c it cannot succeed. Driving and restraining forces include: political issues- power groups in factor or agains the proposed change(state/fed regulators), technology issues-updating equipment, cost and structural issues-remodeling, and people issues-education, training, and project interest, fear of job loss.

JC national safety goals and technology

Improve accuracy of pt IDs, effictiveness of communication, safety of medication use, eliminate wrong site, patient, and procedure errors. Improve the effictiveness of clinical alarms, reduce infections, reduce falls, reduce flu and pnx in older adults, reduce surgical fires, encourage active involvement of patiens and families in patients own care, prevent pressure ulcers. Provide a complete list of meds to the patient on discharge, offer flu shot to all staff, identify safety risks, improve recognition in pts condition, identify pts at risk for suicide.

Health care Dispartiy

In poor areas, the marginalization or seperation of some cultural groups away from the mainstream. Marginalized groups often suffer from higer rates of morbidity, mortality, and the burden of disease. Maybe due to lack of healthcare acess, inadequate financial resources, immidgrant resident status, lack of knowledge on how to seek help. The concern for quality care must focus not only on ethnic minorities and populations that have a diffent hertiage than euro-americans, but also on the needs to other marginalized populations. ex: gays/lesbians, older adults, immigrants, etc.

Electronic communication

Increased communication by computers and other modes. Can speed communication process. Nurses must use appropriate mode of communication when relaying important clinical data. The telephone should be used if the data being sharted is potentially life threatening. During emails Do not use CAPS, be brief, use clear subject lines, cool off before responding, forward only with permission, forward jokes selectively if ever, and use good judgement as email maynot be private.

Communication Process

Interactive processs that occurs when a person (the sender) sends a verbal or nonverbal message to another person (the receiver) and receives feedback. Is influenced by emotions, needs, perceptions, valvues, educations, culture, goals, literacy, cognitive ability, the communication mode and the noise. Health care communication coordinates patients care and safety which is a major goal. Note that communication is affected by following the rules of civility, as in do not demean others, show consideration, keep your voice low in public places, give praise, and admit you are wrong, and smile.

American Nurses Assoc.

Is a professional organization representing the nations entire RN population. Their mission is to work for the improvement of health standards and availability of healthcare services for all people, foster high standards for nursing, stimulate and promote the professional development of nurses, and advance their economic and general welfare.

Management

Is about controlling complexity in an effort to bring order and consistentency. Is defined as planning, budgeting, organizing, staffing, problem solving, and controlling complexity to produce predictability and order. These are the people that do things right. They ensure that things run smoothly.

Intuitive thinking

Is described as an innate feeling that nurses develop that helps them to act in certain situations. A gut feeling that something is wrong. Results from uncounscious assessment and analysis of data based on an individual's past experience. Older novice nurses those with more social support, and those with more hospitalizations use intiution more often in decision making.

Cultural competence

Is imporatnt as you need to know what is important to your patient as far as health care. You need knowledge of their skills to enchance communication. Their care plan should be designed for them and their culture. The goal is to provide care that is consistent with teh patients cultural needs. This requirement is manadatory for NLN accreditation.

Motivation

Is whatever influences our choices and creates direction, intensity, and persistence in our behavior. Is a process that occurs internally to influence and direct our behavior in order to satisfy needs. The theories are useful b/c they help explain why people act the way they do and have a manager can relate to individuals as people and workers.

18 HIPPA identifiers

Names, geographic subdivisions smaller than a state ex: address, all elements of dates, including all ages over 89, telephone numbers, fax numbers, email addresses, ss numbers, MR numbers, health plan beneficiary numbers, account numbers, cert/lic numbers, vehicle ids and serial numbers, device ids and serial numbers, IP addresses, URLS,Biometrics IDS including fingerprints and voice prints, full face photos and any comparable images, any other unique ID number, characteristic, or code unless otherwise permitted.

Benners-Novice

No experience with situations. See nursing as a series of tasks with specific rules. Rules are followed ridgidly to complete tasks rather than use rules with discretion. Can handle only pieces of the situiaton instead of the whole situation.

Political goals for nurses

Nurse individual- Highlights important role of nurse to prevent adverse patient outcomes. Highlights the dimensions of nursing, and particpates in ANA, etc. Nurse Citizen-Votes on an writes congress regarding issues of interest. Educates pts on how to evaluate web site sources of healthcare info. Nurse acitvist-lobbies and influences state and federal legislation as active member in prof. org. Notifies hospital board of trustees of any quality issues. Nurse politician-runs for political office and serves society as a whole. Collaborates with other HCPs to improve care at the local, state, and national level.

Nurses as polticial activist

Nurses are the largest healthcare group, and nurses who are politically active have a definitvive voice in their work enviorments for patient welfare as well as for themselves. Nurses should define role as individual nurse, nurse citizen, nurse activist, and nurse politican. Nurses must study the issues, garner political support, and become active in professional nursing organizations.

Use of power

Nurses use power to improve position of patients and nurses. Nurses can use their power in the legal system, professional nursing associations, and the media to improve care. Nurses strengthen their power by taking ownership of their problems in serving patients.

Barriers to decision making

Past expeirences, values, personal biases, and preconceived ideas affect the way people view problems and situations. Criteria that may negatively affect the decision making or problem solving processes: Jumping to conclusions w/out examining the situation throughly. Failing to obtain all of the necessary information. Choosing decisions that are too broad, too complicated, or lack definition. Failing to choose and communicate a rational solution. Failing to intervene and evaluate the decision or solution appropriately.

Types of change

Personal- a change made in one's life, often for self-improvement. Professional- A change in one's career, such as obtaining additional academic credentials or being promoted to a new work position. Organizational-a change in an organization to achieve organizational goals.

Change promotion

Planned to change in work enviorment similar to planned change on personal level. Basic reasons to introduce change: Solve problem, improve efficency, and reduce unnecessary workload for some group. To plan change, one must know what has to be changed.

Team work on the pt care unit

RNs have a large role that incorporates entire spectrum of care provided to family by wide variety of people. Effective nurse possesses: excellent communication skills, sensitivity toward others' cultural and value differences, awareness of others abilities, and genuine interest in team members.

Race and Ethnic considerations

Race descibes a geographical or global human population distinguiashed by genetic traits and physical characteristics sich as skin color or facial features. Cultural ethnicity identifies a person or group based on raical, tribal, linguistic, religious, national, or cultural group. EX: Jewish, Irish, or Native american tribes. Acculturation: Is the adaption to condiitons, language, and customs to the larger culture.

Group Decision making

Realize that it may be necessary in certain situations. Involve people that are most affected in the decision. The effectiveness of the group depends greatly on the group's members. The size of the group and the personalities of group members are important considerations when choosing particpants. More ideas can be generated with groups, thus allowing for more communication and more choices.

Locus of Control

Refers to the degree of control that individuals feel that they have over events. People who feel in control of their enviorment have an internal locus of control. People who believe in luck, fate, or chance control their lives have an external locus of control. US trained HCP feel they have an Internal Locus of control. People who believe in luck, fate, or chance lives have external locus of control. They believe that they cannot control matters of life and death.

Culture

Refers to the integrated patterns of human behavior that include the language, thoughts, communication, actions, customs, beliefs, values, and instituitions of racial, ethnic, religious, or social groups. Culture incorporates the experience of the past an influences of the present. Culture influences what we eat, language we speak, our values, and the actions we take. Children learn about culture when growing up. When people emigrate from their native cultures into a new culture, they often experience shock.

Leadership and managemnt role

Should model coflict resolution behaviors to staff. Lessent perpectual diffence of partiies, assist parties to identify resolution techniques, create enviorment conducive to conflict resolution, if conflict cannot be resolved, minimize or lessen perceptions of onflicting parities. If both parties are unable to agree then minimize the conflict and agree on valididity of the disagreement.

SBAR

Situation: Identify date and time of call, nurses name and unit, identify pt name, room number, diagnosis, and date of admission, state the problem. Background: Review pertinent the history related to the situation. Assessment: tell them your assessment of the patient. Recomendation: What is needed from the practitioner? Response: Document the response of the practitioner.

Teams and communication

Team is a small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for what they hold themselves mutually accountable. They exist for specific purposed and may be informal or formal.

Whistle blowing

The act in which an individual discloses information regarding a violation of a law, rule, or regulation, or a substantial and specific danger to public health or safety. The person filing the suit will not be divulged if the goverment does not consider the matter to involve health care fraud, therefore protecting the person from any retribution from employer.

Striking

The decision to strike is made only if the majority of union members decise to do so. Most nursing collective bargaining agents insert in the contract a no strike clause, stating that striking is not an option for its members. The union members decide on the no strike clause. The Taft-Hartley Act (1974)guarantees continuation of patient care and requires unions to provide contract expiration notice, advance strike notice, making mediation mandatory, and giving the hospital the option of establishing a board of inquiry prior to work stoppage. Nurses in Minnestota 2002, had a strike for better working conditions. As a result, they gained the ability to refuse new patients to a unit and close the unit until staffing situations were addressed. The CA nurses assoc. seperated from the ANA in 1995, and created their own collective bargaining agent known as the AARN.

Collective barganing

The group bargains with management for what the group desires. If the group cannot achieve its desires through informal collective bargaining with management, the group may decide to use a collective bargaining agent to form a union. In general, nurses who are content in their workplace do not unionize. It is when nurses feel powerless or need a collective voice that they initate attempts to unionize. Issues that are commonly the subjective of collective bargaining are poor wages, unsafe staffing, health care safety issues, mandatory overtime, poor quality of care, job security, and restructuring issues such as cross-training nurses for area of speciality other than those in which they were hired to practice.

Path-Goal theory

The leader works to motivate followers and influence goal accomplishment. Robert House (1971) By using the appropriate style of leadership for the situation, the leader makes the path toward the goal easier for the follower. The directive style style provides structure through direction and authority, wit hteh leader focusing on the task and getting the job done. The supportive style-is relationship oriented, with the leader providing encouargement, interest, and attention. Particpative-means that the leader focuses on involing followers in the decsion making process. Achievement-oriented- style provides high structure and direction, as well as high support through consideration behavior.

Power and the media

The publics perception can be created or changed through advertising and marketing, damage control, timely press releases and well orchestrated media events. The way the media present nursing to the public will empower or disempower nursing. Nurses must work to consistently use the media as effectively as other, more powerful, occupational groups. To date, the media has familed to recongnize nursing as one of the largest most trusted groups in health care. The media can be used to show nurses as decsion makers, coordinators of care, and pirmary health providers.

Wheatley New Science of leadership

There is a simplier way to lead organiztions. One that requires less effort and produces less stress than the current practices. The leaders function is to guide an organization using vision, to make choices based on mutual values, and to engate in teh culture to provide meaningand coherence.

Critical thinking

Thinking about your thinking while you're thinking in order to make your thinking better. Essential when making decisions and solving problems. Nurses decision-making role expanded due to rapid changes in health care enviorment. Ex: Stringent budgets, more complex patients care, and earlier discharge of patients. You need to examine decsions from all sides and take into account varying points of view. Generate new ideas and alternatives when making decisions. Ask why questions about situations in order to arrive at best decision. Skills include reading, listening, writing, and speaking then asking yourself whether the ideas are clear, precise, specific, and accurate.

The change agent

This person leads the change process, manages change process and group dynamics, understands the groups feelings, maintains momentum and enthusiam, mantains vision of change, communicates change, profress, and feelings, knowledgeable about organization, trustworthy, respectful, and intuitive.

Dimensions of nursing

To build power, nurses must be able to clearly articulate at least four dimensions of nursing to any audience or stakeholder. 1. What nursing is 2. What distinctive services nursing provide to consumers (broad spectum care). 3. How nursing benefits consumers. 4. What nursing services cost in relation to other health care services. This is an effort to make the public aware.

Overcome barriers to communication

Understand the reciever, communicate assertively, use two way communication, unite with a common vocab, Elicit verbal and nonverbal feedback. Enhance listening skills, be sensitive to cultural and gender differences, and engage in metacommunication.

Stakeholders and Healthcare

Vested interest groups who control healthcare resources. They exert political pressure on health policy makers- local, state, and federal legistlative bodies in an effort to make the healthcare system work to the economic advantage of the stakeholder. Nurses can garner consumer support for professional nursing positions to help patients and profession of nursing by tapping into strong consumer support. Groups include: Insurance co, consumer groups (AARP), Professional org (ANA, AANP), healthcare groups, and educational groups.

Reflective thinking

Watching or observing ourselves as we perform as task or make a decision about a particular situation. We have two selves: the active self and the reflective self. The reflective self watches the active self as it engages in activities, acts as an observer and offers suggestions about the activities. To be a good critical thinker you must practice reflective thinking. The active self participates actively in the decsiion. Reflection upon a situation or problem after a decision is make allows the individual to evaluate the decisions.

informal leader

an individual who demonstrates leadership outside the scope of a formal leadership role, such as a member of a group rather than the head or leader of the group. ex: nurses with a lot of experience.

Contingency theory

another approach to leadership. Acknowledges that other factor in the enviorment influence outocomes as much as leadership style and that leader effectiveness is contingent upon something other than the leaders behavior.

Leaders and followers

are both necessary roles. Leaders need followers to lead and followers need leaders to follow. They have a reciprocal relationship. The most valuable followers are skilled, self-directed employees who particpate in setting the groups direction and invest time and energy in the work of the group, thinking critically, and advocating for new ideas. Good followers communicate and work well with others, being supportive, yet thoughtful in their approach to new ideas.

Substitues for leadership

are variables that may influence followers to the same extent as the leaders behavior. These variables serve as neutralizers that nullify the effects of the leader's behavior. Some of these variables include follower charactersictics, such as the presence of structured routine tasks, the amount of feedback provided by the task, and the presence of intrinsic satisfaction, and the presence of a group, formal organization, adherence to rules and low position power. Nurses with a lot of experencie do not need a lot of supervision to perform their work. Their knowledge serves as a leadership subsititute. Another substitute is intrinsic satisfaction that emerges from doing the work. Instrinsic satisfaction subsitutes for the support and encouragement of relationship-oriented leader behavior.

Comunication with others

golden rule- do unto other as you have them do unto you. A valuable perspective is that all members of the team are imporatant to sucessfully realize quality patient care. Its imporatant to establish rapport, be assertive, be honest and upfront if something is new, show respect and consideration, honor privacy, offer positive feedback and teach by example. If you dont know something ask questions, seek clarifiction if necesary.

Delphi group technique

group technique- group members do not meet face-to-face. Questionnaires are distributed to group members for their opinions, and the respnses are then summarized and disseminated to the group members. This process continues for as many times as necessary for the group members to reach consenses. An advantage is that it can involve a large number of participants and thus a greater number of ideas.

Consensus Building group techniques

group technique-a general agreement; the judgement arrived at by most of those concerned; a groups solidarity in sentiment and belief. Consensus means that all group members can live with and fully support hte decsiion regardless if they totally agree. Is useful with groups b/c all can participate and can realize the contribution each member makes to the decsiion. A disadvantage is it requires more time. Should be reserved for important decisions that need strong support.

Group think

occurs when maintaing the pleasant atmostphere of the team becomes more important to members than reach a good decision. There is a reduced willingness to disagree and challenge others views . The group may have the illusion of invulnerability-team members may reassure themselves about obvious dangers and becomes overly optimistic and willing to take extraordinary risks. Collective rastionaliztion-overlooking blind spots in their plans. Belief in the inherent morality of the team-belief they are insentitive to the consequences of the decisions. Sterotype others, have pressures to conform, use mindguards (withhold info), self-censorship remain silent about misgivings, and illusion of unaimity- signify agreement. Consequences: limit the group prematurely to one possible solution and fail to conduct a comprehensive analysis of a problem.

Benners model of novice to expert

provdes a framework that can facilitate professional development of nursing leadership and management by building on the skill sets and experience of each practionier. 10 year role states that it takes a decade of heavy labor to maser any field.

Workplace advocacy

refers to the activities nurses undertake to improve work enivorments and address problems in their everyday workplace settings. The ANA partners with organizational leaders is a leader in promoting improved work enviorments, values nurses as professionals, essential provders, and decision makers in all practice settings. The ANA protects, defends,, and educates nurses about their rights as employees under the law, and addresses occupational hazards.