NURS 455: Exam 1

elastic thinking

"bottom-up" process: non-linear process that can produce creative ideas that would not have arisen in a step-by-step progression of analytical thinking allows decision makers to solve novel problems and overcome neural and psychological barriers that can impede us from looking beyond the existing order

Scientific Management: Frederick Taylor

"father of scientific management" 4 principles: - "rule of thumb": scientifically designing work to promote greatest efficiency of time and energy - scientific personnel system: workers can be hired, trained, and promoted based on their technical competence and abilities - "economic animals": workers are motivated by money so they were reimbursed according to their level of production rather than by hourly wage - functional foreman: role of managers is to plan, prepare and supervise while the role of workers is to work outcomes: - increase productivity and profits: work should be as efficient as possible - lacked humanism and his principles were not in

traditional problem-solving process

(1) ID the problem (2) gather data to analyze (3) explore alternatives (4) evaluate alternatives (5) select appropriate solution (6) implement the solution (7) evaluate weaknesses with process: - amount of time needed for proper implementation - lack of initial objective setting step --> decision-maker may become sidetracked

managerial decision-making model

(1) determine the desired outcome/objectives - identify the decision, who needs to be involved, timeline, goals that should be achieved - determine which criteria should be weighted most heavily in making the decision (2) research/ID options - identify as many alternatives as possible (3) compare & contrast consequences of the options - SWOT (strengths, weaknesses, opportunities, threats) - decision making grids or pay off tables (4) make a decision/chose a solution (5) implement an action plan (6) evaluate

planned change

:deliberate application of knowledge and skills to bring about a change organizational change is constant: leading change is one of the most difficult burdens of a leader's command many change attempts fail because of the approach used to implement the change lacks structure or planning change that results from a well-thought-out and deliberate effort to make something happen: people are working around the rules and figure out other ways to do a task — leader needs to look at that rule they are working around and see how it can be amended

planning hierarchy

plans at the top influence the plans the follow hierarchy broadens at lower levels --> representing an increase in number of planning components Planning components at the top are more general while lower components are more specific Top to bottom: Mission --> philosophy --> goals --> objectives --> policies --> procedures --> rules

Sherwood and Horton-Deutsch: Reflective Thinking and Practice

today's chaotic healthcare environment requires nurse-leaders to be nimble, flexible and responsive to change need for change arises from the awareness that current practices or processes aren't working - results of these practices or processes aren't producing the desired outcomes nurse-leaders must be so agile that they are able to continually adapt, reflect on progress and setbacks, and adjust their course as needed extension of EBP and research: - reflection provides an opportunity to apply theory from all ways of knowing and learning also allows individuals to learn from experience by considering what they know, believe, and value within the content of current situations and then reframe to develop future responses or actions

Management Function: Henri Fayol

identified management functions of planning, organization, command, coordination and control 7 activities of management: planning, organizing, staffing, directing, coordinating, reporting, budgeting

leadership v management: 10 Distinctions

(1) leadership inspires change; management manages transformation (2) leadership requires vision; management requires tenacity (3) leadership requires imagination; management requires specifics (4) leadership requires abstract thinking; management requires concrete data (5) leadership requires ability to articulate; management requires an aptitude to interpret (6) leadership requires an aptitude to sell; management requires an aptitude to teach (7) leadership requires understanding of the external environment; management requires understanding of how work gets done inside the organization (8) leadership requires risk taking; management requires self-discipline (9) leadership requires confidence in the face of uncertainty; management requires blind commitment to completing the task at hand (10) leadership is accountable to the entire organization; management is accountable to the team

Gabriel and Goleman: Emotional Intelligence (EI)

EI: - ability to perceive, understand and control one's own emotions as well as those of others - allows us to understand and label emotions as well as express and regulate them - can be learned but it can also improve with age: we must be willing to change, practice changed behaviors, and receive feedback regarding our progress Gabriel: - being empathetic, being able to look at situations from alternative points of view, being open minded, bouncing back from challenges, and pursing goals despite challenges Goleman: 5 Components - self-awareness: ability to recognize and understand one's moods, emotions, and drives as well as their effects on others - self-regulation: ability to control or redirect disruptive impulses or moods as well as the propensity to suspend judgement - motivation: passion to work for reasons that go beyond money or status; propensity to pursue goals with energy and commitment - empathy: ability to understand and accept the emotional makeup of other people - social skills: proficiency in handling relationships and building networks; ability to find common ground emotional literacy: - being self-aware about one's emotions and recognizing how they influence subsequent action

Great Man Theory/Trait Theories

Great Man Theory: - asserts that some people are born to lead, whereas others are born to be led - great leaders will arise when the situation demands it Trait Theory: - some people have certain characteristics or personality traits that make them better leaders than others - researchers studied the lives of prominent people throughout history: did not look at the effect of followers or the impact of the situation debates about these theories - leadership skills can be developed not just inherited - some people have certain characteristics or personality traits that may make it easier for them to lead

Human Relations Management: Douglas McGregor

Theory X and Theory Y - how managers treat their employees can be directly correlated with employee satisfaction - Theory X managers: believe that their employees are basically lazy, need constant supervision and direction, and are indifferent to organization needs - Theory Y managers: believe that their workers enjoy their work, are self-motivated, and are willing to work hard to meet personal and organization goals

decision making: critical elements - define objectives clearly

decision that is made w/o a clear objective in mind or a decision that is inconsistent with one's philosophy is likely to be a poor-quality decision sometimes the problem has been identified but the wrong objectives are set

Gino: Thought Leadership and Rebel Leadership

a person who is recognized among her/his peers for innovative ideas and who demonstrates the confidence to promote those ideas - any situation in which one individual convinces another to consider a new idea, product, or way of looking at things - challenge the status quo and attract followers not by any promise of representation or empowerment but by their risk taking and vision (being innovative) - ideas are future oriented and make a significant impact and are generally problem oriented Gino: - argues that companies should encourage employees to pursue core strengths of novelty, curiosity, perspective, diversity, and authenticity because success is often linked to breaking rules and traditions - when people break the rules to explore new ideas and create (+) change --> everyone benefits 8 principles: - seek out the new - encourage constructive dissent - open conversations (don't close them) - reveal yourself and reflect - learn everything (then forget nothing) - find freedom in constraints - lead from the trenches - foster happy accidents (mistakes may unlock a breakthrough)

planning: principles

all plans must flow from other plans. Short-range plans must be congruent with long-range plans. Be sure objectives are clear planning in all areas of the organization must follow the mission, philosophy, and goals of the overall organization planning involves the same process regardless of the period involved don't bypass levels of people - remember, interpersonal relationships are important the length of the plan is determined by what actions are necessary to make the plan successful - keep target dates realistic all plans must include a regular review process (an evaluation step)

decision making tools: decision grid

allows one to visually examine alternatives and compare each against the same criteria - any criterion may be selected, the same criteria are used to analyze each alternative - it is possible to weight some criteria more heavily than others if some are more important (ex. give a numerical value) Like a pros and cons list: having consistent headings and alternatives in order to choose the best decision

SWOT (strengths, weaknesses, opportunities, and threats) analysis

allows strategic planners to identify those issues most likely to impact a particular organization or situation in the future and then develop an appropriate plan for action - internal: strengths and weaknesses - external: opportunities and threats important components: honesty, specificity, simplicity, and self-awareness Step 1: identify desired end state or objective - decision makers must decide if objective can be achieved in view of SWOT

planning: leadership roles

assessment and forecasting vision influence and inspire values clarification active listening and feedback communication encouragement receptive to new ideas role model (model the way)

decision making tools: decision tree

decisions are often tied to outcome of other events can see the variables affecting a decision (ex. cost, revenue from procedures)

barriers to planning

benefits of effective planning: - timely accomplishment of higher quality work - best possible use of capital and human resources important points for managers to remember - organization can be more effective if movement within it is directed at specified goals and objectives: keeps managers focused on the bigger picture and saves them from getting lost in minute details of planning - plans must be flexible and allow for readjustment as unexpected events occur - manager should include all people and units that could be affected by plan: increases commitment to goal achievement; communicate clearly the goals and specific individual responsibilities to all those responsible for carrying out plans so that work is coordinated - plans should be specific, simple and realistic - know when to plan and not to plan - good plans have built-in checkpoints so that there can be a midcourse correction if unexpected events occur: a final evaluation should always occur at the end of a plan

Blanchard: Strategic and Operational Leadership

both are needed for success in an organization strategic leadership: - establishing a clear vision, maintaining a culture that aligns a set of values with that vision, and declaring must-do or strategic imperatives the organization needed to accomplish operational leadership: - the "how" for the organization: policies, procedures, systems, and leader behaviors that cascade from senior management to frontline workers - the real key to operational vitality: if this leadership is done effectively, employee passion and customer devotion will follow the (+) experiences and overall satisfaction people have with the organization

decision making: critical elements - generate numerous alternatives

brainstorming at least 4 alternatives: think of all possible alternatives even those that may seem "off target" will not limit the possibilities to only the appropriate ones but will allow new ideas to surface the greater the number of alternatives that can be generated --> the greater the chance that the final decision will be sound involving others increases the # of alternatives

planning hierarchy: policies - expressed policies

delineated verbally or in writing promote consistency of action (ex. dress code)

Lewin's Change Theory of Unfreezing, Movement and Refreezing: Refreezing

change agent assists in stabilizing system change so that it becomes integrated into the status quo if incomplete, change will be ineffective and pre-change behavior will be resumed does not eliminate possibility of further improvements to change: measuring impact of change should always be a part of the process change agent must: - be supportive and reinforce individual adaptive efforts of those affected by the change - be involved until change is complete (at least 3-6 months)

Lewin's Change Theory of Unfreezing, Movement and Refreezing: Movement

change agent identifies, plans, and implements appropriate strategies, ensuring that driving forces exceed restraining forces change movement should not be delayed solely because of fear of the unknown or because some ambiguity exists: "we can make this work" confidence to move quickly into implementation behaviors that inspire change: - inspiring others: set aspirational goals, explore alternative avenues to reach objectives, seek other's ideas for best methods to use going forward - noticing problems: see situations where change is needed and to anticipate potential snares in advance - providing clear goal: fixing everyone's sight on same goal - challenging standard approaches: may challenge rules that seem carved in stone - building trust in your judgement: improving your judgment and others' perceptions of it - having courage: willingness to live in discomfort - make change a top priority: daily focus on change effort, track its progress carefully, and encourage others responsibility of change agent: - develop a plan, set goals and objectives, identify areas of support and resistance, include everyone who will be affected by change in its planning, set target dates, develop appropriate strategies, implement the change, be available to support others and offer encouragement through the change, use strategies for overcoming resistance to change, evaluate the change, modify the change (if necessary)

transformational leadership

committed, has a vision, can empower others with this vision identifies common values caretaker inspires others with vision has long-term vision looks at effects empowers others leaders are doing the right thing for the right reason, treat people with compassion, encourage followers to be more creative and innovative, and inspire others with their vision --> leads followers to levels of higher morals must have transactional qualities as well or the leader will fail

long-range or strategic plans

complex organizational plans that involve a long period (3-7 years) may be done once or twice a year in an organization that changes rapidly - on a unit, planning that is >6 months in the future may be considered long-range planning leader-managers who adopt these plans eventually help their organizations become more profitable and have happier employees and shareholders typically examines an organization's purpose, mission, philosophy, and goals in context of its external environment --> this planning can forecast future success by matching and aligning organization's capabilities with its external opportunities - ex. strategic plan to address nursing shortage organizations need to look closely at their competencies and weaknesses, examine their readiness for change, and identify those factors critical to achieving future goals and objectives - gather data r/t financial performance, human resources, strategy, service offerings as well as outcomes and results --> feedback from senior leadership, medical staff, and board so a consensus from stakeholders is obtained regarding organization's strengths and weaknesses --> action plan is created to strengthen organization's infrastructure --> evaluation of how well organization is achieving its goals and objectives

decision making

complex, cognitive process often defined as choosing a particular course of action last step of the problem-solving process: selecting a logical choice from available options triggered by a problem but is often handled in a way that does not focus on eliminating underlying problem if time, energy, or resources are not available to solve the problem - person decided to handle a conflict when it occurred but did not attempt to identify the real problem causing the conflict; ex. a staff nurse is absent a great deal over the last 3 months and the supervisor knows that the nurse will be resigning soon to return to school in another state so she decides to do nothing (save time and energy)

transactional leadership

concerned with the day-to-day operations focuses on management tasks directive and results oriented uses trade-offs to meet goals does not identify shared values examines causes uses contingency reward superior that makes decisions with little or no input (parent-child) 3 methods used: - reward for desired work - correct problems as they arise - deal with problems retrospectively

proactive planning

consider the past, present and future and attempt to plan the future of their organization rather than react to it adaptability is a key requirement d/t the organizational setting changing often occurs in anticipation of changing needs or to promote growth within an organization and is required of all leader-managers so that personal and organizational needs and objectives are met

Luther Gulick: Activities of Management/Management Process - staffing

consists of recruiting, interviewing, hiring, and orienting staff scheduling, staff development, employee socialization, and team building

Burrowes and Needs: Stages of Change Model (SCM)

contemporary adaptation of Lewin's model precontemplation: no current intention to change contemplation: individual considers making a change preparation: intent to make change in near future action: individual modifies his/her behavior maintenance: change is maintained and relapse is avoided

Situational and Contingency Leadership Theories

contingency leadership: - law of the situation: the situation should determine the directives given after allowing everyone to know the problem - no one leadership style is ideal for every situation situational leadership: - as people mature, leadership style becomes more relationship orientated and less task focused - the leadership style that is most appropriate depends on each situation and the followers' maturity - crucial factors of trust and clarity of goals effectiveness based on interpersonal skills, work situation and task

decision making tools: consequence table

demonstrate how various alternatives create different consequences lists the objectives for solving a problem down one side and rates how each alternative would meet desired outcome like a decision grid but with a different twist -- what happens if I use this alternative

decision making tools: payoff tables

cost-profit-volume relationship and are very helpful when some quantitative information is available (ex. item's cost or predicted use) must determine probabilities and use historical data (ex. hospital census) help visualize data

planning

deciding in advance what to do; who is to do it; and how, when, and where it is to be done involves choosing among alternatives proactive and deliberate process that reduces risk and uncertainty encourages unity of goals and continuity of energy expenditure (human, financial) and directs attention to objectives of organization plan is a guide to reach a goal: - must be flexible and allow for readjustment as unexpected events occur critically important to and takes precedence over all other management functions - without adequate planning, the management process fails, and organizational needs and objectives cannot be met - "he who fails to plan, plans to fail"

planning hierarchy: mission - vision statement

describe future goals or aims of an organization an organization will never be greater than the vision that guides it

planning hierarchy: goal

desired result toward which effort is directed - the aim of the philosophy increasing emphasis on including workers in setting organizational goals can change with time and require periodic reevaluation and prioritization should be measurable and ambitious but realistic dangers of goal evaluation as primary means of assessing organizational effectiveness - goals may conflict with each other --> confusion for employees and consumers - publicly stated goals may not truly reflect organizational goals but rather individual or personal goals - goals are global and it is often difficult to determine whether they have been obtained

decision making tools: PERT

determine timing of decisions: flowchart that predicts when events and activities must take place if a final event is to occur critical path: shows something that must occur in the sequence before one may proceed

Luther Gulick: Activities of Management/Management Process - planning

determining philosophy, goals, objectives, policies, procedures, and rules carrying out long and short-term projections determining fiscal course of action managing planned change

critical thinking

disciplined thinking that is clear, rational, open-minded and informed by evidence reflecting on the meaning of statements, examining the offered evidence and reasoning, and forming judgements about facts a mental process where the nurse actively and skillfully conceptualizes, applies, analyzes, synthesizes, and evaluates information to reach an answer or a conclusion: manifested when nurses ask why, how, and what to arrive at a correct diagnosis or best prioritization of care involves higher order reasoning and evaluation and has both cognitive and affective components not everyone is successful in problem solving through trial and error: you can systematically go through and come up with best possible solution

decision making: critical elements - take the time necessary

do not go on first impressions or assumptions (take a little more time but taking the few minutes or hours will help you come up with the best solutions) slower and more controlled deliberation is needed when outcomes may have significant consequences although it might take 30 minutes to come to the same conclusion that make have come in 5 minutes, you will have a better idea of the nuances of the situation (ex. variables) and less mistakes will occur

Luther Gulick: Activities of Management/Management Process - organizing

establishing structure to carry out plans determining the most appropriate type of patient delivery grouping activities to meet unit goals working within the structure of the organization and understanding and use power and authority appropriately

planning hierarchy: philosophy

flows from the purpose or mission statement and delineates the set of values and beliefs that guide all actions of the organization

Industrial Age Leadership

focused primarily on traditional hierarchical management structures, skill acquisition, competition, and control primary drivers of economic prosperity: machines and capital (things) management practices: focus was on controlling workers, fitting them into a slot, using reward and punishment for external motivation, people were necessary but replaceable technical skills, command and control, competition, gaining advantage, gathering facts, what you have (wealth), hierarchy (top-down), metaphor for organizations is machines (separate parts), leadership by position

Relationship Age Leadership

focuses primarily on the relationship between the leader and his/her followers, on discerning common purpose, working together cooperatively, and seeking information rather than wealth ex. servant leadership, authentic leadership, reflective thought and practice, human and social capital, and EI leading people who have the power to choose - requiring leaders to embrace the whole person adaptive skills, invitation and interdependence, cooperation, discerning purpose, finding meaning, what you know (information), circular (egalitarian), metaphor for organizations is organic network (connected parts), leadership by trusteeship

Lewin's Change Theory of Driving and Restraining Forces

forces that push the system toward change are driving forces, whereas the forces that pull the system away from change are restraining forces ex of driving forces (facilitators): desire to please one's boss, to eliminate a problem, to get a pay raise, to receive recognition ex of restraining forces (barriers): conformity to norms, unwillingness to take risks, fear of the unknown task for change agent: for change to occur, driving forces must be increased or restraining forces decreased - need to address the restraining forces to see what is causing problems that are preventing the change from happening

management functions in planned change

forecasts unit needs with an understanding of organization's and unit's legal, political, economic, social and legislative climate recognizes need for planned change and identifies options and resources available to implement that change appropriately assesses and responds to driving and restraining forces when planning for change identifies and implements appropriate strategies to minimize or overcome resistance to change seeks subordinates' input in planned change and provides them with adequate information during change process to give them some feeling of control supports and reinforces individual efforts of subordinates during change process identifies and uses appropriate change strategies to modify behavior of subordinates as needed periodically assesses unit/department for signs of organizational aging and plans renewal strategies continues to be actively involved in refreezing process until change becomes part of new status quo

decision making: critical elements - use an evidence-based approach

go to the literature: trial and error is not the best research changes as data comes out evidence-based: approach that has been reviewed by experts in the field using accepted standards of empirical research and that reliable evidence exists that the approach or practice works to achieve the desired outcomes PICO: patient or population, intervention, comparison, and outcome nurses feel they do not have time, access, or expertise needed to search and analyze research literature to answer clinical questions administrative support is needed to access resources, provide support personnel, and sanction the necessary changes (policies, procedures, and practices) for EBP to be part of every nurse's practice

decision making: laisse-faire

group apathy and disinterest can occur: it works if members are highly motivated and self-directed appropriate when problems are poorly defined and brainstorming is needed to generate alternative solutions not making a decision is still a decision characteristics: - takes the hands-off approach - permissive with little or no control - motivates by support when requested by the group or individuals - provides little or no direction - uses upward and downward communication between members of the group - disperses decision making throughout the group - places emphasis on group - does not criticize

planning hierarchy: philosophy - values

have an intrinsic worth for a society or an individual beliefs that guide behavior public discussion of values is often neglected

human and social capital theory

human capital: - employees are viewed as assets or capital that can be developed and nurtured - the collective skills, knowledge, or other intangible assets of individuals can be used to create economic value for the individuals, their employees, or their community - can refer to the group's collective knowledge or experience - ex. formal educational attainment generally increases human capital because the returns are in the form of wage, salary, and other compensation human capital theory: - individuals and/or organizations will invest in education and professional development if they believe that such an investment will have a future payoff - ex. tuition reimbursement --> higher degrees --> more educated staff --> increased quality of care and higher retention rates --> higher productivity and financial return - helping employees thrive in all areas of their lives (not just work) will create more engagement, productivity, and overall happier employees

Luther Gulick: Activities of Management/Management Process - directing

human resource management responsibilities: motivating, managing conflict, delegating, communicating and facilitating collaboration

planning hierarchy: mission - purpose/mission statement

identify the reason that an organization exists - identifies organization's constituency and addresses its position regarding ethics, principles, and standards of practice typically, no more than 3-4 sentences should clearly drive action to show what makes this organization unique highest priority in planning hierarchy: - influences the development of an organization's philosophy, goals, objectives, policies, procedures, and rules - an organization must truly believe and act on its mission statement; otherwise, the statement has no value

Sostrin and Hoff: Authentic Leadership (Congruent Leadership)

in order to lead, leaders must be true to themselves and their values and act accordingly - integrity: what leaders profess and how they actually act - it is the leader's principles and their conviction to act accordingly that inspire followers Sostrin: - sustaining an enduring alignment between your values and your actions is vital for leadership success - integrity will produce a more consistent, authentic expression of who you are in the moments that matter Hoff: - authenticity breeds trust - integrity and character command the support and fidelity of their followers --> followers are more likely to go the extra mile and stand by their leader regardless of the circumstance - trust takes time to develop takes great courage especially when external forces (peer pressure) encourages the individual to do something he/she feels morally would be inappropriate Not all leaders are always authentic - leaders may be deceitful and trustworthy: not all good leaders are good people

leaders

individuals who take risks, attempt to achieve shared goals, ability to influence people, and inspire others to action only a person's behavior determines if he/she holds a leadership role the one who influences and guides direction, opinion, and course of action leadership requires a constant exchange between leaders and followers both verbally and non-verbally often do not have delegated authority but obtain power through other means (ex. influence) have a wider variety of roles focus on group process, information gathering, feedback, and empowering others may or may not be part of the formal hierarchy of organization emphasize interpersonal relationships direct willing followers: leaders are determined by their followers have goals that may or may not reflect those of the organization characteristics: - often do not have delegated authority but obtain their power through other means such as influence - have a wider variety of roles than managers - may or may not be part of the formal organization - focus on group process, information gathering, feedback, and empowering others - emphasize interpersonal relationships - direct willing followers Have goals that may or may not reflect those of the organization

critical thinking: key components

insight, intuition, empathy, and willingness to take action the more experience you have --> the easier it becomes to think through these situations

forecasting

involves trying to estimate how a condition will be in the future - use available historical patterns to assist in planning as well as present clues and projected statistics to determine future needs takes advantage of input from others, gives sequence in activity, and protects organization against undesirable changes managers who are uninformed about the legal, political, economic and social factors affecting healthcare make planning errors that may have disastrous implications for their professional development and financial viability of organization

decision making: individual variations

it is inevitable that individuality plays a part in decision making factors: - gender - values: no matter how objective the criteria, value judgements will always play a part in a person's decision making, either consciously or subconsciously - life experience: the more mature a person --> the broader the background --> the more alternatives he/she can identify - individual preference: a decision maker may see certain choices as involving greater personal risk than others and therefore may choose the safer alternative - brain hemisphere dominance and thinking styles: new evidence suggests the existence of L v R brain dominance may be oversimplification

planning: management functions

knowledge of legal, political, economic and social factors affecting planning provide opportunities for stakeholder participation coordinates unit level planning develops and articulates a unit philosophy develops and articulates unit level policies and procedures develops and articulates unit goals reviews unit philosophy, goals, policies and procedures and revises as needed actively participates in the organizational strategic planning, defining and operationalizing such strategic plans at the unit level

leaders: 10 leadership flaws

lack of energy and enthusiasm acceptance of their own mediocre performance lack of a clear vision and direction having poor judgment not collaborating not walking the talk resisting new ideas not learning from mistakes lack of interpersonal skills failing to develop others

decision making: critical elements - choose and act decisively

no action is still a decision many individuals delay acting because they do not want to face the consequences of their choices: it may help to know that even though decisions have long-term consequences and far-reaching effects, they are not usually cast in stone

reactive planning

occurs after a problem exists - past-oriented problems are dealt with separately w/o integration with the whole organization usually done in response to a crisis --> can lead to hasty decisions and mistakes

Porter-O'Grady and Malloch: Quantum Leadership

leaders must work together with subordinates to identify common goals, exploit opportunities, and empower staff to make decisions for organizational productivity to occur - helpful in periods of rapid change and needed transition change is constant - the environment and context in which people work is complex and dynamic and that this has a direct impact on organizational productivity Porter-O'Grady and Malloch: - because the unexpected is becoming normative, the quantum leader must be able to address the unsettled space between present and future and resolve these conflicts appropriately - the ability to respond to dynamics of a crisis and change is not only an inherent leadership skill but must now be inculcated within the very fabric of the organization and its operation

decision making: nursing participation - clinical decisions

managing pain, preventing skin breakdown, refusing to carry out MD's orders, advocating for pt to refuse care, teaching patients or families about meds factors r/t greater clinical decision making: - experience level - independence in level of practice - confidence - communication skills - needs of patients

Kouzes and Posner: transformational leadership - 5 Practices of Exemplary Leadership

modeling the way: - value clarification and self-awareness so that behavior is congruent with values - titles are granted but behaviors earn respect inspiring a shared vision: - visioning that inspires follower to want to participate in goal attainment - desire to make something happen - cannot be commanded challenging the process: - identifies opportunities and taking action - pioneers and early adopter - involves risk enabling others to act: - fosters collaboration, trust, and the sharing of power encouraging the heart: - recognizes, appreciates, and celebrates followers and the achievement of shared goals - genuine acts of caring - encourages others to not give up

planning hierarchy: objective

motivate people to a specific end and are explicit, measurable, observable or retrievable, and obtainable more specific and measurable than goals because they identify how and when the goal is to be accomplished - specific time frame, be stated in behavioral terms, be objectively evaluated, and identify positive outcomes rather than negative ones the more specific objectives for a goal can be --> the easier for all involved in goal attainment to understand and carry out specific role behaviors process objectives: - written in terms of the method to be used - ex. 100% of staff nurses will orient new patients to call-light system, within 30 minutes of their admission, by first demonstrating its appropriate use and then asking the patient to repeat said demonstration result-focused objectives: - specific the desired outcome - ex. 95% of postoperative patients will perceive a decrease in their pain levels following the administration of parenteral pain medication process: - assess unit's constraints and assets and determine available resources --> identify how goals might best be translated into objectives and implemented (important to be receptive to new and varied ideas) --> use well-developed interpersonal skills to involve and inspire subordinates in goal setting --> clearly writing identified goals and objectives, communicating changes to subordinates, and periodically evaluating and revising goals and objectives as needed

planning hierarchy: policies - implied policies

neither written nor expressed verbally and have usually been developed over time and follow a precedent ex. employees should be encouraged and supported in their activity in community, regional, and national healthcare organizations

Lewin's Change Theory of Unfreezing, Movement and Refreezing: Unfreezing

occurs when change agent convinces members of group to change or when guilt, anxiety, or concern can be elicited --> people become discontent and aware of need to change to make change effort successful, leader must clear away competing priorities and shine a spotlight on need for a change to happen successful leaders often bring up issues others avoid: leaders should encourage transformational conservations instead of avoiding the real issue or problem responsibilities of change agent: - gather data, accurately diagnose the problem, decide if change is needed, make others aware of the need for change (raise group's discontent level)

decision making: critical elements - gather data carefully

one must learn how to process and obtain accurate information avoid confirmation bias: our tendency to search for and favor information that confirms our beliefs while simultaneously ignoring or devaluing information that contradicts our beliefs; people negate new information if it does not validate their perceptions or ideas human values influence our perceptions: problem solvers must be vigilant that their own preferences and those of others are not mistaken for facts; facts can be misleading if taken out of context (texts and emails)

problem solving

part of decision making and is a systematic process that focuses on analyzing a difficult situation attempts to identify the root problem in situations: focuses on the underlying causes to solve the problem

Luther Gulick: Activities of Management/Management Process - controlling

performance appraisals, fiscal accountability, quality control, legal and ethical control, and professional and collegial control

change agent

person skilled in the theory and implementation of planned change (ex. manager) deal appropriately with conflicted human emotions and to connect and balance all aspects of organization that will be affected by that change: thorough and accurate assessment of the extent of and interest in change, the nature and depth of motivation, and the environment in which the change will occur many good ideas fail because of poor timing or lack of power on the part of the change agent: - ex. an outsider as the change agent: organizations and individuals may feel they have inadequate knowledge or expertise about the current status or they do not trust the outsider's motives; an outsider tends to be more objective in his/her assessment - ex. if an organization just underwent a lot of changes, then any other change should wait until group resistance decreases (change fatigue) change should be implemented for good reasons: must remember that people need a balance between stability and change in the workplace; change should be gradual qualities: visionary, risk taker, flexible, excellent communicator, creative, sensitive, current (know what is going on presently) have a good relationship with all the stakeholders so you can learn what they are concerned about and how to best support them during the change process: all individuals who may be affected by the change should be involved in planning for the change - subordinates should feel that they have played a valuable role in the change

planning hierarchy: philosophy - individual philosophies and values

personal beliefs and values are shaped by that person's experiences value indicator: if value does not meet criteria of true value periodic clarification is necessary to see how values may have changed: - includes examining values, assigning priorities to those values, and determining how they influence behavior so that one's lifestyle is consistent with prioritized values - change may be a result of life experiences or newly acquired knowledge - becoming more worldly increases our awareness of alternatives from which we select out values sometimes individual values conflict with those of the organization: - the organization's philosophy determines its priorities in goal selection and distribution of resources - when a nurse experiences cognitive dissonance between personal and organizational values, the result may be intrapersonal conflict and burnout - managers should encourage all potential employees to read and think about the organization's mission statement or philosophy before accepting the job - also ask current employees in various positions about how the organization's philosophy is implemented and community members about the institution's reputation for care - managers who take a position with the idea that they can change the organization's philosophy to more closely agree with their own philosophy are likely to be disappointed

planning hierarchy: policies

plans reduced to statements or instructions that direct organizations in their decision making derived from organization's philosophy, goals, and objectives explain how goals will be met and guide general course and scope of organizational activities direct individual behavior toward organization's mission and define broad limits and desired outcomes of commonly recurring situations while leaving some discretion and initiative to those who must carry out that policy unit managers must determine how policies will be implement on their units - should use input from subordinates in forming, implementing, and review policy --> their feedback is crucial for successful implementation should be evidence based policy's perceived value often depends on how it is communicated

planning hierarchy: rules

plans that define specific action and non-action describe situations that allow only one choice of action fairly inflexible so the fewer rules the better

planning hierarchy: procedures

plans to establish customary or acceptable ways of accomplishing a specific task and delineate a sequence of steps of required action save staff time, facilitate delegation, reduce cost, increase productivity, and provide a means of control identify the process or steps needed to implement a policy and are generally found in manuals at unit level in organizations

decision making: nursing participation - administrative

presenting in-services, serving on a committee, planning for unit budget, conducting a study, choosing new equipment, determining method of delivery, determining QA indicators or monitors nurses may prefer to be involved in supervisory roles (budgeting and staffing), equipment, delivery of care the staff have valuable insight but we don't involve them because we think we don't have time but if you ask them you will make the unit more efficient, effective and a good place to work

planning hierarchy: philosophy - organizational philosophy

provides basis for developing nursing philosophies at unit level and for nursing service as a whole

planning hierarchy: philosophy - true value

require a person to take action 4 characteristics: - it must be freely chosen from among alternatives only after due reflection - it must be prized and cherished - it is consciously and consistently repeated (part of a pattern) - it is positively affirmed and enacted

decision making tools: logic models

schematics or pictures of how programs are intended to operate - includes resources, processes, desired outcomes and depicts exactly what the relationships are between the 3

decision making: democratic/participative

seek input from their followers and include them in decision making whenever possible - leader values their ideas and experience appropriate for groups who work together for extended periods, promotes autonomy and growth in individual workers effective when cooperation and coordination between groups are necessary less efficient quantitatively characteristics: - less control is maintained - economic and ego awards we used to motivate - others are directed through suggestions and guidance - communication flows up and down - decision making involves others - emphasis is on "we" rather than I and you - criticism is constructive

inactivism planning

seek the status quo and spend their energy preventing change and maintaining conformity when changes do occur --> they occur slowly and incrementally big problem in nursing: some nurses do not want to change

Greenleaf: servant leadership

servant leaders: - put serving others (employees, customers, community) FIRST - foster a service inclination in others that promotes collaboration, teamwork, and collective activism - must still create and communicate their vision, direction, and goals - values are the pillars for the entire structure: honesty, truth, compassion, and acceptance - ability to listen on a deep level and to truly understand - ability to keep an open mind and hear w/o judgement - ability to deal with ambiguity, paradoxes, and complex issues - belief that honestly sharing critical challenges with all parties and asking for their input is more important than personally providing solutions - being clear on goals and good at pointing the direction toward goal achievement w/o giving orders - ability to be a servant, helper and teacher first and then a leader - always thinking before reacting - choosing words carefully to not damage those being led - ability to use foresight and intuition - seeing things whole and sensing relationships and connections followers must be clear about what the leader is trying to accomplish as well as their values and goals

planning hierarchy: philosophy - nursing service philosophy

should address fundamental beliefs about nursing and nursing care; quality, quantity, and scope of nursing services; and how nursing specifically will meet organizational goals draws on concepts of holistic care, education and research

planning hierarchy: philosophy - unit philosophy

specifies how nursing care provided on unit will correspond with nursing service and organizational goals unit-level managers are active in determining, implementing, and evaluating this - incorporate knowledge of unit's internal and external environments and an understanding of unit's role in meeting organizational goals - should not only reflect current practice but also incorporate a view of the future a working philosophy is evident in a department's decisions, in its priorities, and in its accomplishments

strategic planning: management process

steps: - clearly define purpose of organization - establish realistic goals and objectives consistent with mission of organization - identify organization's external stakeholders and then determine their assessment of organization's purposes and operations - clearly communicate goals and objectives to organization's constituents - develop sense of ownership of plan - develop strategies to achieve goals - ensure most effective use is made of organization's resources - provide base from which progress can be measured - provide a mechanism for informed change as needed - build a consensus about where the organization is going who should be involved: - all departments and levels of hierarchy to promote increased effectiveness of nursing staff, better communication between all levels of personnel, a cooperative spirit relative to solving problems, and a pervasive feeling that the departments are unified, goal directed, and doing their part to help organization accomplish its mission

Rath and Conchie: Strength-Based Leadership and Positive Psychology Movement

strength-based leadership: the development or empowerment of strengths as opposed to weaknesses or areas of needed growth positive organizational scholarship: focuses on successful performance that exceeds the norm and embodies an orientation towards strengths and developing collective efficacy effective leaders are always investing in strengths but that they consciously and consistently work to use their KEY strengths to their advantage rather than putting significant effort into being better rounded effective leaders surround themselves with the right people (people who have different strengths than they do) to maximize their team 4 leadership domains: - strategic thinking: keep everyone focused on a long-term future - influence: sell ideas, develop political support, and get people to rally behind a project or initiative - relationship building: able to unite a group of disparate individuals into a team that works toward a common goal - execution: how to get things done by translating plans into action effective leaders understand follower's needs - trust: nothing happens w/o it - compassion: want to know that their leaders care about them - stability: want leaders who they can depend on - hope: want to feel positive about their future prospects

factors influencing planning in healthcare

technology, cost management, aging population, electronic access, alternative medicine, and healthcare team

Agile Leadership

the ability (and agility) to think in many ways so that they can be flexible, adaptable, and fast in their decision making - inclusive, democratic leaders who exhibit a greater openness to ideas and innovations - passion for learning, focus on developing people and strong ability to define and communicate a desired vision --> are able to inspire others and become an agent for change within an organization - listen deeply and ask powerful questions to gain insights and make the right decision for the organization to move forward through problems rejects the "one-size-fits-all" model: - people like to be communicated with and recognized differently - when agile leaders show how much they value their team's contribution by understanding and being what they need --> increase in productivity and engagement

Human Relations Management: Mary Parker Follett

the human element: emphasized people rather than machines participative decision making or participative management: - managers should have authority with, rather than over, employees - solutions could be found that satisfied both sides w/o having one side dominate the other

managers

the process of leading and directing all or part of an organization through the deployment and manipulation of resources the one who brings things about: who accomplishes, has the responsibility, and conducts assign to position by organization: job title makes you a manager have legitimate source of power d/t delegated authority that accompanies their position have specific duties and responsibilities they are expected to carry out emphasize control, decision making, decision analysis, and results manipulate people, the environment, money, time, and other resources to achieve goals of organization greater formal responsibility and accountability for rationality and control direct willing and unwilling subordinates

Collins: Level 5 Leadership

truly great organizations have leaders who possess qualities found in all 5 levels - have the knowledge to do the job, have the team building skills, can help groups achieve shared goals, demonstrate humility and seek success for the team - know when to ask for help, accept responsibility for the errors they or their team make, are incredibly disciplined in their work level 1: highly capable individual - high-quality contributes to work, possesses useful levels of knowledge, has talent and skills to do a good job level 2: contributing team member - uses knowledge and skills to help team succeed and work effectively, productively, and successfully with other people in the group level 3: competent manager - able to organize group effectively to achieve specific goals and objectives level 4: effective leader - able to galvanize a department or organization to meet performance objectives and achieve a vision level 5: great leader - all the abilities needed for the other levels + unique blend of humility and will that is required for true greatness

preactivism planning

utilize technology to accelerate change and are future oriented - attempt to predict the future and react to that prediction do not value experience and believe that the future is always preferable to the present

leadership roles in planned change

visionary in identifying areas of needed change in organization and healthcare system demonstrates risk taking in assuming role of change agent demonstrates flexibility in goal setting in rapidly changing healthcare system anticipates, recognizes, and creatively problem solves resistance to change serves as a role model to followers during planned change by viewing change as a challenge and opportunity for growth role model for high-level interpersonal communication skills in providing support for followers undergoing rapid or difficult change demonstrates creativity in identifying alternatives to problems demonstrates sensitivity to timing in proposing planned change takes steps to prevent aging in organization and to keep current with new realities of nursing practice supports and reinforces individual adaptive efforts of those affected by change

decision making: critical elements - think logically

weigh the factors inferences: part of deductive reasoning in which people must carefully think through information and the alternatives to avoid faulty logic and poor-quality decisions AVOID the following: - overgeneralizing: when one believes that because A has a particular characteristic that every other A also has the same characteristic (ex. stereotyping) - affirming the consequences: one decides that if B is good and he/she is doing A, then A must not be good (ex. if a new method is labeled as the best way to perform a nursing procedure and the nurses on your unit are not using it, it is illogical to assume that the technique currently used on your unit is wrong or bad) - arguing from analogy: applies a component that is present in 2 separate concepts and then states that because A is present in B, then A and B are alike in all respects (ex. if intuition plays a part in clinical and managerial nursing, then any characteristic present in good clinical nurse also should be present in a good nurse manager --> however, a skilled nurse manager does not necessarily possess all the same skills as a skilled clinical nurse)

decision making: autocratic

well-defined group actions that are usually predictable, reducing frustration and give members a sense of security high productivity decreased creativity, self-motivation, and autonomy found in large bureaucracies (ex. armed forces) and effective in emergency situations characteristics: - strong control is maintained over a work group - others are motivated by coercion - others are directed with commands - communication flows downward - decision making does not involve others - emphasis is on difference in status ("I" and "you") - criticism is punitive

clincial reasoning

when nurses integrate and apply different types of knowledge to weigh evidence, critically think about arguments, and reflect on the process used to arrive at a diagnosis uses both knowledge and experience to make decisions at the point of care weight all the information --> look at literature --> look at arguments --> come up with best plan of care

principal agent theory

when one person (the agent) can make decisions on behalf of another person (the principal) occurs because not all followers (agents) are inherently motivated to act in the best interest of the leader/employer (principal) - followers have informational (expertise or knowledge) advantage over leader as well as their own preferences, which may deviate from principal's preferences --> risk agent's pursuing their own objectives instead of the principal's principals must identify and provide agents with appropriate incentives to act in the organization's best interest - must either create incentives that reward employees who are able to complete their work in the allotted shift time or create disincentives for those who don't - ex. working overtime: encouraging staff to do it by offering financial rewards

planning hierarchy: policies - policy and procedure committees

when policies and procedures are developed w/o the input from all levels of the organization usually created by top-level management