Leadership/CPA 3: Ch. 10 & 13

SPHM standards that outline the roles of nurse leaders and mangers as well as staff and encompass the following

- A culture of safety - A formal and sustainable SPHM program throughout the organization - An ergonomic-specific approach - Inclusion of SPHM technology - An effective system of education, training, and maintaining competence - Patient-centered assessments and plans of care adapted to meet individual patient needs - Reasonable accommodations and postinjury return to work for staff members who have been injured - A comprehensive evaluation system to evaluate SPHM program status

Nurse leaders and managers recruiting new nurses

- Based on the complexity of health care and high acuity of patients, some health-care organizations prefer to hire experienced nurses and/or nurses with baccalaureate degrees or advanced education. - Nurse leaders and managers must be committed to recruiting and hiring the brightest and the best. - When hiring new graduates, managers should provide transition to practice (TTP) programs. - Experienced nurses pass on their knowledge - New nurses provide continuing education, up-to-date technology, professional development, and opportunities for advancement

What are the characteristics of an effective coach?

- Be a good listener - Demonstrate professionalism and leadership qualities - Be inspiring and motivating to others - Be able to build confidence and self-esteem, and personal leadership in others - Act as a "sounding board," allowing problems and issues to be aired and redirected - Provide constructive feedback when necessary - Acknowledge work well done - Emphasize achievement, learning and development, and joy in work

What are the steps of the corrective action plan?

- First violation - verbal reprimand is given o Nurse leader meets with the employee o Explores plan for improvement o Verbally discusses agreed-on plan for improvement - Second violation: A written reprimand is given o Meets with employee to discuss violation or deficiency o Establishes an agreed-on plan for improvement o Discusses consequences if violation continues or no improvement is shown o Documents reprimand in writing - Third violation: violation occurs a third time and/or there is no improvement o Consults with human resources o Meets with employee to discuss violation or deficiency o Suspends employee with or without pay o Encourages employee to examine the situation while away from work and determine a plan for improvement o Documents reprimand in writing - Fourth violation: violation continues to occur after multiple reprimands or employee fails to improve performance to the level of standard of performance o Consults with human resources o Meets with employee o Terminates employee o Documents process in writing according to policy and procedure

What are some evidence-based strategies that nurse leaders and managers use to prevent nurse fatigue

- Limiting shifts nurses work to no more than 12 hours in 24 hours and no more than 40 hours per week - Conducting regular audits to ensure that safe schedule policies are followed - Ensuring that nurses are able to take scheduled meal and rest breaks - Establishing policies to allow nurses to take naps during long shifts - Supporting nurses' decisions to decline working extra shifts or overtime without penalizing them

How can nurse managers manage generational differences?

- Nurse leaders and managers must identify strategies to create cohesive partnerships among the different generations to ensure safe and quality nursing care and create a healthy work environment. - Improved health and technological advances are allowing older nurses to work longer, and these expert nurses are needed for their skills and experiences to fill many essential positions. -Third-age nurses (50-70 years old) needed to combat the shortage: Looking to keep working. Not looking to retire - To leverage generational differences, nurse managers and leaders can use the following strategies to make the workplace more generationally comfortable: - Accommodate differences by recognizing strengths of each generation and use those strengths to build a sustainable workforce - Be flexible when giving options in the workplace, and consider alternate scheduling options. Seek input from staff on recruitment, retention, and staffing matters that could decrease turnover and increase job satisfaction o Flexible scheduling needs to applied to all ages schedules - Use sophisticated management style, and modify management approaches to address the differences and similarities of each generation.Keeping staff informed, proving the big picture and using rewards, recognition, and feedback are management strategies that appeal to all generation - Respect competence and initiative, and value the talents and work ethics of each generation, even though they differ. Use the expertise and experience of older and seasoned nurses to help develop policies and procedures and set up programs to assist new nurses. provide younger nurses w/ opportunities to solve problems and contribute to teamwork on their own terms. Nurses of younger generations tend to be collaborators prefer frequent feedback, so provide them with seasoned mentors who will coach them as they launch their nursing career

What are some strategies to prevent workplace violence?

- Report incidence of violence. Establish trust with others on the unit. Get education on workplace violence. Hold yourself accountable for own actions. Take someone in the room with you if patient is violent - Nurse leaders and managers must examine the workplace for the presence of elements of an unhealthy environment - Increasing awareness of workplace violence by providing information at staff meetings can help prevent workplace violence - Nurse leaders and managers should support the development of organizational zero-tolerance workplace violence programs and policies - Nurse leaders and managers must ensure that communication is open, nonbiased, and respectful at all times - Nurses must be able to trust their colleagues and believe that they work within a team

What are the six Essential Standards for Establishing and Sustaining a Healthy Work Environment?

- Skilled communication: Nurses must be as proficient in communication skills as they are in clinical skills - True collaboration: Nurses must be relentless in pursuing and fostering true collaboration - Effective decision making: Nurses must be valued and committed partners in making policy, directing and evaluating clinical care, and leading organizational operations - Appropriate staffing: Staffing must ensure that effective match between patient needs and nurse competencies - Meaningful recognition: Nurses must be recognized and must recognize others for the value each brings to the work of the organization - Authentic leadership: Nurse leaders must fully embrace the imperative of a healthy work environment, authentically live it, and engage others in its achievement

What are some contributing risk factors for workplace violence?

- Systemic factors include increased productivity demands, cost containment, and stress from fear of litigation - Nurses are expected to take the violence. Has always happened, expected to let it go - Inadequate information between organization leadership and staff and a lack of staff involvement in decisions can also contribute to workplace violence - Nurses have been expected to cope with violence and accept abuse as part of the job - Risk factors involve age, gender, nursing experience, and present or previous history of involvement in an abusive relationship - Younger or less experienced nurses are more likely to be victims of workplace violence

What are the consequence of underreporting of workspace violence?

- The ANA contends that those who witness workplace violence and do not acknowledge it, choose to ignore it, or fail to report it are actually perpetuating it - Nurses who are victims of workplace violence can experience physical and psychological problems as a result - Some physical effects include frequent headaches, gastrointestinal upset, weight loss or gain, sleep disturbances, hypertension, and decreased energy - The psychological effects may include stress, anxiety, nervousness, depression, frustration, mistrust, loss of self-esteem, burnout, emotional exhaustion, and fear

What interview questions are allowed to be asked?

-Are you old enough to do this type of work? -If hired, can you supply transcripts of you college education? -What are you long-term career goals? -Are you able to do the duties listed in the job description without accommodations? -What professional associations are you a member of? -Are you available to travel on short notice? -If you are hired, are you able to provide documentation to prove you are eligible to work in the U.S? -Have you ever been convicted of a crime? -In what branch of the military did you serve?

According to the ANA what does an un-healthy work environment include?

-Bullying -Workplace violence -Nursing fatigue

Competent Nurses characteristics and actions

-Can differentiate important tasks from less important aspects of care -Their time as a new graduate is recent enough that they can approach the preceptorship with empathy. A less than ideal preceptor is an expert and proficient nurse bc nurses at this stage make rapid decisions based on previous experiences, have difficulty putting what they know into works for the new nurse to understand, and may have less patience fr the ongoing feedback the new nurse graduate requires

What are the Key elements to sustaining a quality nursing workforce?

-Create a vision for a healthy work environment and model it. - Establish a collaborative practice culture built on mutual trust and respect. - Promote workplace autonomy - Respect nurses rights and responsibilities. - Foster skilled communication to protect and advance collaboration. - Establish a culture of accountability. - Encourage shared decision making at all levels. - Recognize nurses for their meaningful contributions to the unit and organization - Match nurses competencies to patients needs - Advocate for patients and nurses - Promote a workforce that habitually pursues excellence - Promote accountability for nursing practice

Novice and advanced beginners characteristics and actions

-Dont have experiences to base decisions on. -Patient care is slow and methodical. -Focused on being safe and efficient. Needs regular verbal and written feedback to build confidence and self-esteem. -Best paired with a nurse at the competent stage that has about 3 years of experience

Examples of Incivility

-Gossiping -Spreading rumors about others -Refusing to assist a coworker

What interview questions should you avoid asking?

-How old are you?-When did you graduate college? (violates the Age Discrimination in Employment ACT -When do you plan on retiring? Do you have a disability? Have you ever filed a workers compensation claim? Do you have a preexisting medical condition? (violates American with Disabilities ACT) -Do you go to church? What outside activities do you participate in?- (Violates Title VII of the Civil Rights Act) -Are you married? Do you have children? When do you plan to start a family? (violates the Act of 1964; Pregnancy Discrimination Act) -Are you a U.S. citizen? What was your maiden name? (violates Tittle VII of the Civil Rights Act; Immigration Reform and Control Act) -Have you ever been arrested? -If you have been in the military, where you honorably discharged?

What are some strategies to retain nurses?

-Inadequate staffing leads to nurse dissatisfaction, burnout and turnover, all of which jeopardizes the quality of patient care. -Nurses feel safe from physiological and psychological harm and can find meaning and joy in their work -Nurse leaders and managers are responsible for creating the cultural norms and environment that result in workforce safety, meaning, and joy - Should say "yes" every day to the following questions: * Am I treated with dignity and respect by everyone? * Do I have what I need so I can make a contribution that gives meaning to my life? * Am I recognized and thanked for what I do - unhealthy work environment if lacking - Meaningful recognition is important in retaining experienced nurses.

New nurse graduate characteristics and actions

-Most new graduate nurses exhibit characteristics of the novice and advanced beginner stage, and new nurse graduates demonstrate marginally acceptable performance -New nurse graduates use context-free rules to guide their actions or many begin to formulate some guideline for their actions -they have not developed enough insight to discern which tasks are relevant in real-world situations

What model did the National Council of State Boards of Nursing (NCSBN) create to assist new nurses in the transition?

-NCSBN: determined that the inability of new nurse graduates to transition into clinical practice has and will continue to have great consequences for the nursing profession and patient outcomes. - Created a TTP model to assist new nurses in the transition: o Structured TTP programs that are at least 6 months long and include core competencies, clinical reasoning, regular feedback on progress, self-reflection, and specialty knowledge in an area of practice improve that quality and safety practice of new graduate nurses, increase job satisfaction, decrease work stress, and decrease turnover

According to The Institute of Medicin (IOM) prolonged work hours results in what?

-Negative worker performance -Slow reaction times -Lapses of attention to detail -Errors of omission -Compromised problem solving

Orientation phase

-Nurse leaders adn managers must be dedicated to providing a proper orientation for new staff to enhance retention -When setting up orientation for new nurses as well as seasoned nurses, the nurse leader and manager must consider the characteristics of the new staff members and successful preceptor assignments -Nurse leaders and managers must consider the characteristics of the new staff members and select an appropriate preceptor (novice-to-expert model: assist with making successful preceptor assignments) -Appropriate preceptor is critical to successful on-boarding of new nurses

What are the types of violence?

-Nurse-to-nurse violence -Third-party violence -Nurse-to-pt violence -Patient-to-nurse violence -Organizational violence -External Violence -Sexual Harassment -Mass Trauma or Natural Disasters

What is the next step for nurse leaders and managers after a quality applicant is identified?

-Once a quality applicant is identified, the nurse leader and manager should prepare for interview by making notes of key questions to ask during the interview. - Some organizations may use a team approach to interviews in which applications are also interviewed by a panel of nurses and other staff members. - Adequate time for interview and questions without interruption -*A position description reflects current practice standards and provides clear, written expectations about the roles and responsibilities of the position.* - During the interview, the nurse leader and manager must avoid asking questions that are considered inappropriate (age, marital status, medical information)

Nurse-to-Nurse violence

-Physical or nonphysical violence between or among nurses who have a workplace relationship, has many other names, such as lateral violence, horizontal violence, and vertical violence

Musculoskeletal disorders (MSDs) in nurses

-Registered nurses risk musculoskeletal disorders on a daily basis through activities such as standing for extended periods of time and moving equipment -Most common task that ca lead to MSDs include lifting, transferring, ad repositioning patients -There is not such thing as safe lifting, when nurses use their bodies as lifting mechanisms -Nurses cite specifically the lack of a "no-lift" policy, the lack of adequate lifting equipment, and inadequate space on pt care units as major barriers to the development safe pt handling measures. Lack of equipment, decreased staffing levels, and the architecture of the environment are the three main modifiable attributes to improving the environment of care and increasing the safety of pt handling and mobility

According to the ANA what does a healthy work environment include?

-Safe patient handling and moblility -Healthy working hours

According to the National Institute for Occupational Safety and Health (NIOSH) what are the classifications for workplace violence?

-Type 1: The perpetrator has criminal intent and no legitimate relationship with the organization or its employees -Type 2: The perpetrator is the customer or client, patient, family member, or visitor and has a relationship with the organization and becomes violent while receiving services. this type of workplace violence is very common in health care -Type 3: The perpetrator is another coworker or commits worker-on-worker violence. This type of workplace violence includes incivility and bullying and is very common in health care -Type 4: The perpetrator has relationship with a worker but no relationship with the organization. This type of workplace violence involves personal relationships (an employee is followed to work by his or her spouse with the intent to threaten or harm the employee

Examples of bullying

-Undermining -Degrading others -Hostile remarks -Verbal attacks -Threats -Taunts -Intimidation -Withholding of support

Nurse leaders and managers using corrective action

-With regard to middle and low performers, nurse eladers adn managers must address deficiencies and substandard performance immediately to avoid escalating of the behavior -When establishing a corrective action plan, the nurse leader and manager must first determine the reason for the substandard performance: is it the result of a lack of knowledge, sill, or experience, or did the employee violate policy or procedure? -A corrective action is a progressive process used to improve poor performance, it is used to figure out what went wrong and how we can improve it

Workplace Violence

-Workplace violence: create a culture of fear, diminish staff morale, impact patient safety and job satisfaction, and drain joy and meaning from work - Bullying: repeated, unwanted actions intended to humiliate, offend, and cause distress in recipients - Incivility: disrespect, rudeness, and general disdain for others - Disruptive behavior: non-verbal behavior (eye rolling) on one end of the spectrum and physical violence and tragedy on the other

What are the steps to follow when conducting an effective performance appraisal?

1) Prepare for the performance appraisal by keeping employee files updated w/ appropriate data and anecdotal notes that reflect performance observed through out the review period. 2) Plan for performance appraisal to be conducted in a formal but replaced atmosphere. Schedule the performance appraisal at a time that is convenient for the employee, and ensure thee will be no interruptions 3) Conduct the performance in such a manner as to encourage productive exchange of ideas and joint problem solving 4) Review the employees achievements and ask whether he or she has achieved goals set during the previous performance appraisal 5) Provide the employee feedback on his or her achievements 6) If the performance appraisal process calls for ratings or scoring, seek input from the employee and strive for agreement 7) Discuss plans for improvement, and assist the employee in identifying areas to work on and developing a realistic plan, but avoid actually developing the plan for the employee 8) Address the employee career plans, and offer realistic feedback regarding opportunities for advancement 9) Assist the employee in developing new goals and objectives for the upcoming year by using the SMART (specific, measurable, appropriate, realistic, timed) techinique 10) Ask the employee for feedback including how you can support he employee 11) Provide an opportunity for the employee to add written comments on the performance appraisal

360-degree feedback

A form of peer review that is a type of constructive feedback in which nurses receive feedback from everyone around them- supervisors, peers, physicians, other health-care professionals, and even patients and their families. This is usually annonymous -Goal is to provide specific opportunities for the employee to use in his or her development plan.

Performance appraisal:

A formal evaluation of the work performance of an employee that is conducted by the nurse leader and manager. An effective performance appraisal can foster staff growth and development and promote retention. -Evaluated according to the position description and established standards of practice. The nurses performance is weighed against the position description. -Appraisal should be written and signed by the nurse leader and manager and the employee

Workplace Safety

A workplace free from risk of both physical and psychological harm.

Lateral Violence

AKA horizontal violence, consists of bullying or incivility between two or more nurses at the same level -Ex: Susan, a RN, is at the end of her shift ad is told that Barb will be her relief. Susan says to several other nurses, I hate to give report to Barb. She asks so many annoying questions. When barb arrives for report, Susan rudely says, "Dont ask m any questions. Im tired and want to go home!" The nurses who overhear all giggle.

Peer Review

Another element for performance appraisal, in which nurses from common practice areas assess, monitor, and make judgments about the quality of nursing care provided by a nurse peer. It fosters accountability and supports self-regulation.

Vertical Violence

Consists of bullying or incivility between a nurse subordinate and someone at a higher level (manager or charge nurse) -Ex: in a staff meeting, the nurse leader and manager is explaining to everyone about an upcoming change related to documentation. Several staff nurses ask about who made the decision to make the change. The nurse leader and manager rolls her eyes, sighs loudly, and says, "It was my decision, and I do not appreciate you questioning me!"

Sexual Harassment

Inappropriate friendly behavior, sexually based comments, vulgar, sexual language or inappropriate jokes or stories; unwelcome advances or requests for sexual favors; unwanted physical contact of a sexual nature; and sexual innuendo -Occurs between nurses, between nurses and their supervisors, and between nurses and pts or family members

Deconstructive Feedback

Includes threats and fear to control employee behavior, by criticizing the employee and making him or her feel humiliated (Are you stupid? You should never walk out of the pts room with gloves on!)

Nurse Fatigue

Is the impaired function resulting form physical labor or mental exertion. There are 3 types: physiological, or reduced physical capacity; objective, or reduced productivity; and subjective, a weary or unmotivated feeling. -Characteristics: tired, no compassion, capacity is reduced emotionally/physically, weary -Nurses who work more than 12.5 hours in 24 hrs are 3x more likely to make errors than are nurses who work less than 12.5 hours -Nurse fatigue due to lack of rest breaks during working hours can jeopardize pt safety -Fatigue can result in irritability, reduce motivation, inability to stay focused, diminished reaction time, increased risk for errors, decreased memory, increased risk-taking behavior, impaired mood, and ineffective communication skills

Mass Trauma or Natural Disasters

Mass trauma, such as biochemical attacks or terrorist attacks, and natural disasters. -Nurses working during mass trauma or natural disasters can be extremely stressful and has the potential to cause serious health and mental health issues

How can nurse leaders and managers maintain a higher percentage of experienced nurses at the bedside?

Nurse leaders and managers must identify methods to increase nurse satisfaction and explore creative strategies to accommodate older nurses.

Nurse-to-Patient Violence

Occurs when nurses are violent toward those in their professional care, with a resulting violation of the nurses code of ethics -Nurse hitting a pt -Using restraints without an order -Refusing to administer pain medication in a timely matter -Asking a pt on a date

Describe what is a Healthy Work Environment

One that is safe, empowering, and satisfying not merely the absence of real and perceived physical or emotional threats to health but a place of physical, mental, and social well- being, supporting optimal health and safety. -It supports excellent nursing care, creates a culture of physiological and psychological safety, and gives nurses the satisfaction of knowing that they are valued and their work is meaningful.

Patient-to-Nurse Violence

Patient or family member being violent toward a nurse and falls under the NIOSH type 2 category -A pt hitting or biting a nurse, a family member yelling at a nurse -Factors such as acute disease states, alcohol or drug intoxication, self-harming behavior, or a present exacerbation or a psychiatric disease are major contributors to this type of workplace violence -Nervousness, distress, despair, sorrow, irritation, or loss of control also considered contributing factors -Male pts or family members are more likely to execute both physical violence and verbal violence toward nurses who are women

External Violence

Perpetrated by outside persons entering the workplace or when nurses are going to or form the workplace. Type 1 according to NIOSH -usually random, and the perpetrators typically have criminal intent, such as rape, assault, armed robbery for drugs, or gang reprisals in emergency deparments

Constructive Feedback

Supportive, motivates the employee to succeed and grow, and involves showing respect an praising the employee for a job well done (I really appreciate how you handle that difficult patient yesterday)

Coaching

The art of guiding another individual toward fulfilling his or her future; to assist a person in achieving his or her goals, a coach helps him or her develop and prioritize viable-solutions and then act on them. it is a strategy for nurse leaders and managers to motivate and assist their staff member to improve their work performance -Coaching includes observing employee performance, providing ongoing feedback, and constant encouragement -An effective coach assists nurses in recognizing opportunities for learning and development -use coaching when team building, in managing change, for professionalization, and in career planning -Coaching relationship is built on respect and trust -To be effective coaches nurse leaders and managers must become self-aware -This is beneficial to sustaining to workforce bc it increase productivity, pt safety, quality of nursing care, and nurses confidence and professionalism

Self-appraisal

The process of the employee reflecting on his or her own personal actions and professional performance related to sense of self, values, beliefs, decisions, actions,and outcomes

Organizational Violence

This affects the entire health-care organization and occurs as a result of changing work enviroment -Ex: excessive workloads and unsafe working conditions can be considered forms of workplace violence

Safe Patient Handling and Mobility (SPHM) program

To effect change and to ensure safer pt handling and mobility, nurse leaders and managers must implement SPHM programs and establish policies to prevent nurses and pt injuries across care continuum. -Involves the use of pt handling equipment and devices, education, ergonomic assessment protocols, no-lift policies, and pt lift teams has facilitated the reduction in incidences of workplace injuries.

Third-Party Violence

Violence that is witnessed directly or indirectly by others. The person who observes the violence, the third party, can experience the same harm as the victim of the violence.

What reasons do nurse leaders and managers use performance appraisal?

o To assess a new employee at the conclusion of probationary status to determine whether the minimum level of performance for a position has been met o To provide recognition for accomplishments or constructive feedback when improvement in performance is needed o For an annual performance review of the employee's past goals, including performance related to the position description, and to plan for professional development over the next year