HCA Final Exam
traditional problem solving process
1. Identify the problem 2. Gather data to analyze the causes and consequences of the problem 3. Explore alternative solutions 4. Evaluate the alternatives 5. Select the appropriate solution 6. Implement the solution 7. Evaluate the results biggest fall back is that it is time consuming
advantages of the organization chart
1. Maps lines of decision-making authority 2. Helps people understand their assignments and those of their coworkers 3. Reveals to managers and new personnel how they fit into the organization 4. Contributes to sound organizational structure 5. Shows formal lines of communication
Unit Checklist of Employee Staffing Policies
1. Name of person responsible for staffing 2. Type and length of staffing cycle used 3. Rotation policies 4. Transfer policies 5. When shift begins and ends 6. Day of the week schedules begin 7. Time and location of schedule posting 8. Weekend off policy 9. Tardiness policy 10 Low census procedures 11. Policy for trading days 12. Day-off requests 13.Absenteeism 14. Rotating to other unit 15. Vacation time request 16. Holiday time off requests 17. Resolving conflicts requesting days off, holidays or requested time off 18. Emergency request policies 19. Mandatory overtime
overcoming interview limitations
-Use a team approach. -Develop a structured interview format for each job classification. -Use scenarios to determine decision-making ability. -Conduct multiple interviews. -Provide training in effective interviewing techniques.
destructive discipline
-Use of threats and fear to control behavior. -Employee always alert to impending penalty or termination. -Arbitrarily administered and either unfair in the application of rules or the resulting punishment.
staffing shortages
-nationwide downsizing of hospitals in 1990s -aging of nursing workforce -accelerating demand for professional nurses -inadequate enrollment in nursing programs of study -aging of nursing faculty
types of communication
-passive -aggressive -indirectly aggressive (passive-aggressive) -assertive
overdelegation
-poor management of time -spending too much time trying to get organized -insecurity in the ability to perform a task
limitations to centralized staffing
-provides less flexibility for the worker and may not account for a specific worker's desires or special needs -managers may be less responsive to personnel budget control in scheduling and staffing matters
three reasons for staff development
1. to establish competence 2. to meet new learning needs, fill in gaps 3. to satisfy interest the staff may have in learning in specific areas
four common steps in progressive discipline
1. verbal admonishment 2. written admonishment 3. suspension from work without pay 4. involuntary termination or dismissal
Great Man theory/trait theories
1900-WWII, some people are just born to lead, natural born leaders, rise up when the situation arises
Douglas McGregor's theory
1960, Theory X and Y how the manager views the employee is on some type of spectrum if treat employee appropriately, they will like and enjoy work how manager views and treat worker impacts how organization will function and productivity/motivation, some is manager's assumption and then how the manager treats the employee
shared governance
1980s nurses at every level play a role in the decisions that affect nursing activity throughout the system nurse-managers move out of traditional industrial model roles into collegial models, becoming moderators of the service process usually defined by a structure of rules or bylaws nurses from each unit/department collaborate to look at policies, tx options, stragetgic plans, even bedside nurses are involved in stared governance -nurses play a role in every level -nurse managers move out of authoritative figure into moderater role -empowers employees in decision making system -all magnet hospitals have shared governance in nursing
types of managed care organizations
Health Maintenance Organization (HMO): Point of Service (POS) and Exclusive Provider Organization (EPO) Preferred Provider Organization (PPO)
illegal interview inquiries
Age Marital status Children Race Sexual preference Financial or credit status National origin Religion
right circumstances
Appropriate patient setting, available resources, and other relevant factors considered
where do you see total patient care nursing
CCU, recovery room in PACU, some hospitals and home health agencies
medicare and medicaid managed care
CMS is largest purchaser of managed care in the country MCOs recieve reimbursement for eligible patients based on a formula established by CMS (looks at age, gender, geographic regions, and average cost/patient at a given age). Then the government gives itslef a 5% discount and gives the rest to the MCO
common conflict resolution strategies
Compromising Competing Cooperating/accommodating Smoothing Avoiding Collaborating
advocating for patients as managers
Creating a work environment that recognizes patients' needs and goals as paramount Creating a work culture in which patients are respected, well informed, and empowered Advocating for patients with regard to distribution of resources and the use of technology Taking risks particularly when advocating for a client may be in direct conflict with a provider or institutional goal
Maintenance
Change is maintained and relapse is avoided
case management nursing
Collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual's health needs through communication and available resources to promote quality, cost-effective outcomes It coordinates care through an episode of illness, the focus is on individual clients, not populations of clients. anticipating what patient will need for discharge and follow up, very collaborative and multidisciplinary use critical pathways and multidisciplinary action plans (MAPs)
profession of nursing
Entry into a profession involves a personal and public promise to serve others with the special expertise that a profession can provide and that society legitimately expects it to provide If nursing is to advance as a profession, practitioners and leader-managers must broaden their sociopolitical knowledge base to understand better the bureaucracies in which they live Nurses who participate in professional organizations are integral in determining whether voluntary or legal controls represent what nursing is and should be
functional method of nursing
Evolved as a result of World War II after shortage of nurese Uses relatively unskilled workers who have been trained to complete certain tasks, delegating Care is assigned by task rather than by patient. see it in long-term care facilities, nursing homes, extended care facilities , operating room
T or F managers can directly motivate subordinates
F because motivation comes from within a person, a manager cannot directly motivate subordinates however, the humanistic manager can create an environment that maximizes the development of human potential
learning theories
Knowles: adult learning theory Bandura: social learning theory
Herzeberg's theory
Motivators and Hygiene Factors
precontemplation
No current intention to change
reenty guidelines for the recovering nurse
No psychoactive drug use is tolerated The employee should be assigned to day shift for the first year The employee should be paired with a successfully recovering nurse whenever possible The employee should be willing to consent to random urine screening with toxicology or alcohol screens The employee must give evidence of continuing involvement with support groups such as Alcoholics Anonymous or Narcotics Anonymous. Employees should be encouraged to attend meetings several times each week The employee should be encouraged to participate in a structured aftercare program The employee should be encouraged to seek individual counseling or therapy as needed license is suspended, go through drug rehab program, and they may or maynot be able to come back into employment where those drugs are administered, random drug screenings, documentation of different support groups and counseling
elements of nonverbal communication
Space Environment Appearance Eye contact Posture Facial expression and timing Vocal expression
Stages of Change Model (Burrowes and Needs, 2009)
Stage 1: precontemplation Stage 2: Contemplation Stage 3: Preparation Stage 4: Action Stage 5: Maintenance
SWOT definitions
Strengths Weaknesses Opportunities Threats
Management by Objectives (MBO)
The employee and supervisor meet and agree on the principal duties and responsibilities of the employee's job The employee sets short-term goals and target dates in cooperation with the supervisor or manager Both parties agree on the criteria that will be used for measuring and evaluating the accomplishment of goals It has been proved to increase productivity and commitment in employees The employee and supervisor meet regularly to discuss progress The manager's role is supportive, assisting the employee to reach goals by coaching and counseling During the appraisal process, the manager determines whether the employee has met the goals The entire process focuses on outcomes and results, and not on personal traits SMART goals industrial occupational nursing better way to do things in getting employee feedback problem: requires a lot of coaching, hard in healthcare due to large amounts of staff
McGregor's (Hot Stove Rule)
The following four elements must be present to make discipline as fair and growth-producing as possible: -Forewarning -Immediate consequences -Consistency -Impartiality
Sault Gellerman's theory of motivation
Theory of "Stretching" individuals should be periodically "stretched" to do tasks more difficult than they are used to doing the challenge of stretching is to energize people to enjoy the beauty of pushing themselves beyond what they think they can do. encourages growth can't do it all the time, every day. Alternate heavier and lighter loads
Kurt Lewin's Change theory
Three phases through which change agent must proceed before change occurs: Unfreezing, movement, refreezing -change should be only implemented for good reasons -change should be gradual (too much at one time overwhelms the system and people) -all changes should be planned, not sporadic or sudden -anyone who will be affected by the change should be involved in the planning
clinical practice guidelines
Provide diagnosis-based step-by-step interventions for providers to follow in an effort to promote quality care Also called standardized clinical guidelines Should reflect evidence-based practice (EBP); that is, they should be based on cutting-edge research and best practices ex: post op lap chole
chunking
two pieces of independent information presented and grouping them together into one unit the typical individual has the ability to remember 5-9 chunks of data, although this increases with expertise and experience
formal grievance process
a grievance is essentially a statement of wrongdoing, the steps are outlined in union contracts or administrative policies entails progressive lodging of complaints up the chain of command if differences are not settled in formal grievance process, then dispute generally proceeds to arbitration
managed care
a system that attempts to integrate efficiency of care, access, and cost of care utilization review and capitation
span of memory
ability to retain information that you learn
motivators
achievement, recognition, work, responsibility, advancement, possibility for growth
help seeker
insecure, manipulative, want sympathy
obstacles to learning
institutional barriers time self-confidence situational obstacles family reaction special individual obstacles
clinical reasoning
integrating and applying different types of knowledge to weigh evidence, critically think about arguments, and reflect upon the process used to arrive at diagnosis collaborative and reflective process that involves content-specific knowledge, engagement of the patient and family in understanding the clinical problem, and incorporation of critical contextual factors leads to deliberative decision making and sound clinical judgement
unstructured interviews
inter-rater reliability is low, means you will not have the best candidate forward interview generally doest 80-90@ of the talking
customers
internal (staff and patients) and external (community)
perception of message is altered depending on ___ and __ ___
internal and external climate
intrinsic motivation
internal drive to do or be something, can be and is often impacted by others
leader
inventor or creator r of the planned change
perceived conflict
involves issues and the role
external whistle-blowing
involves reporting outside the organization, such as to the media or an elected official
discipline
involves training or molding the mind or character to bring about desired behaviors, is often considered a form of punishment but is not quite the same thing as punishment ex: for nurses who don't do their restraint logs, make them in charge of the log
personality/behavior changes
irritable, mood swings, more defensive with colleagues (med errors in particular), start social and change to isolated
fiscal planning
not intuitive, a learned skill that improves iwth practice important and often neglected should reflect the philosophy, goals, and objectives of the organization a skill increasingly critical to nursing managers because of increased emphasis on finance and "big business" of health care
termination
last resort when dealing with poor performance, but is necessary for employees who continue to break rules despite repeated warnings it is always difficult for the employee, manager, and unit however the cost in terms of managerial/employee time and unit morale of keeping such an employee is enormous
four criteria for evaluation of staff
learner's reaction behavior change organizational impact cost-effectiveness
Bandura's social learning theory
learning from interactions with others in a social context ex: team work modeling
a burned-out, tired manager will develop a ____ and _____ staff
lethargic and demotivated
decision grids
lets you see all the equipment out there for example, can see alternatives and compare them against each other
Theory Y employees
like and enjoy work, are self-directed, seek responsibility, are imaginative and creative, have underutilized intellectual capacity, need only general supervision, are encouraged to participate in problem solving
blockers
like to express negative points of view, like to resurrect dead issues
playboy
like to horse play
preactive planner
like to utilize technology to accelerate change, future oriented, tend not to value experience as much
types of organizational structures
line structures, ad hoc design, matrix structures, service line organization, flat design
line authority
looking at organizational chart and you see the lines on there and you know exactly who your authority is to go to
recency effect
looking at what they did most recently and basing off of that instead of in total recent issues are weighted more heavily why it is important to keep anecdotal notes
criticism of HMO
loss of existing patient/physician relationships, limited choice of physicians (most won't accept this type of insurance), reuces physicians autonomy if insurance won't cover certain things
performance budgeting
lot of government institutions use this you get x amount of money based on outcomes and results see this in regards to insurance payments for quality
self-confessor
love to use the group setting for personal expression about everything in personal life
inter-rater reliability
low in unstructured interviews better if interview is structured and same interview format is used by all interviewers
span of control
number of people directly reporting to any one manager
Newer Health-Care Delivery Models and Nursing Roles
nurse navigators, clinical nurse-leaders, nurses working in settings that embrace patient and family-centered care
primary nursing
nurses assume 24 hour responsibility for the patient, when the nurse is not on duty the associate nurse follows the primary nurses plan of care some concepts of total patient care, brings nurse back to bedside, can succeed with diverse skill mix job satisfaction is high due to challenges, but difficult to implement due to degree of responsibility and autonomy required of the nurse NICUs and some ICUs, hematology/oncology nursing, hospice, home health decentralized decision making, giving nurses more authority
middle-level managers
nursing supervisors, department heads coordinate efforts of lowest level of hierarchy, conduit between lower and higher level managers looking at carrying out day to day operations, fiscal/financial responsibility, long term planning, establish unit policies
resocialization
occurs when individuals are forced to learn new values, skills, attitudes, and social rules as a result of changes n the type of work they do, in the scope of responsibility they hold, or in the work setting itself
role overload
occurs when the demand of the role are excessive
closed-unit staffing
occurs when the staff members on a unit make a commitment to cover all absences and needed extra help themselves in return for not being pulled from the unit in times of low census drawback: when census is high or super busy, central nursing office won't send people to help you, you have to cover it
internal whiste-blowing
occurs within an organization, reporting up the chain of command
incentives
offer them at the level where the employees value them. This requires that the organization and its managers understand employees' collective values and devise a reward system that is consistent with that value system
disadvantage of whistle-blowing
often looked down upon by the public and they are distrusted, even though public wants corruption reported
total patient care (case method) nursing
oldest mode of organizing patient care nurses assume total responsibility for meeting the needs of all assigned patients during their time on duty (patients assigned as cases), pt receives holistic and unfragmented care disadvantage: nurse is inadequately prepared to provide total care
performance deficiency coaching
manager actively brings areas of unacceptable behavior or performance to the attention of the employee and works with him or her to establish a short-term plan to correct deficiencies
decentralized staffing
manager has more control over unit staffing
what is the desired outcome of budgeting
maximal use of resources to meet organization short and long term needs
ad hoc design
may have a project that needs a team, team gets together outside of regular/scheduled meetings to work on an issue, "project team", disband when project is completed
profile of impaired nurse
may vary greatly typically behavior changes are seen in the following three areas: -personality/ behavior changes -job performance changes -time and attendance changes
one man, one boss/ unity of command
means you have one boss, indicating by vertical solid line between positions on organization chart, employees may have one manager they report to and are responsible too difficult in some large health care organizations because health care often needs a multi disciplinary approach
process audit
measures process of care or how the care was carried out, task oriented, focus on actual practice standards and whether or not they have been fulfilled used to measure the process of care or how the care was carried out, and assume that a relationship exists between the process used by the nurse and the quality of care provided ex: anyone who had significant HTN with suspected blunt force abd injury was to go for exploratory lap in less than 30 min
manager
mechanic who implements the planned change
decreased nursing staff results in ...
med errors, falls, nosocomial infections
harmonizer
mediates between the group
bundled payments
medicare and medicaid use these ex: COPD patient wad dx too soon and patient returned within 24 hr so now bundle both adissions into one
accountable care organizations
medicare uses these group of providers and suppliers of service who work together to better coordinate care for Medicare patients goal is to deliver seamless, high-quality care in an environment that is truly patient-centered and where patients and providers are partners in decision making
greatest impact on legislator
meeting with them with a strong, collective, clinical group
best leaders
mix of transaction and transformation leadership
modular nursing
modification of team and primary nursing, use many smaller teams 2-3 members on a team, pairs professional nurses with ancillary staff to deliver care to groups of patients seen frequently in this area doesn't require as much comunication as team nursing, often do assignments based on geographical location of patients
structure audit
monitor the structure or setting in which patient care occurs staffing ratios, staffing mix
education
more formal and broader in scope than training designed to develop individuals in a broader sense, long term investment
objectives
more specific than goals because they identify how and when the goal is to be accomplished, motivate people to a specific end and are explicit, measurable, observable, or retrievable, and attainable
flexible budgeting
mostly manufacturing flex up and down over the year depending on the volume, automatically calculates what expenses should be given based on volume occurring
power-oriented people
motivated by power that can be gained as a result of a specific action, want recognition, to command attention, and to control others
extrinsic motivation
motivation enhanced by the job environment or external rewards
quality improvement models
moved from quality assurance model to quality improvement
resistance
natural and expected response to change individuals resistance typically depends on four things: -their flexibility to change -their evaluation of the immediate situation -the anticipated consequences of the change -their perceptions of what they have to lose and gain
latent conflict
need to be more proactive here, realize existence of issue at hand
peer review
new orientees assessment of work performance carried out by peers
marginal employee
no matter how many opportunities you throw at them they will always just meet bare minumum disrupt unit functioning because the quantity or quality of their work meets only minimal standards, often make tremendous efforts to meet competencies yet usually manage to meet only minimal standards at best traditional discipline is generally not constructive in modifying their behavior dangerous when it comes to quality of care
problem solving
part of decision making; systematic process focusing on analyzing a difficult situation involving higher-order reasoning and evaluation spend more time finding the cause and treating the cause, like with system failures or high incidence of med errors
PPACA's payment reform provisions
patient protection and affordable care act 1. value-based purchasing 2. accountable care organizations (ACOs) 3. bundled payments 4. the medical home 5. the health insurance marketplace
future scheduling
pattern scheduling preference scheduling rules scheduling self-scheduling
CMS: setting standards and measuring quality in health care
pay-for-performance/quality-based pricing: align payment with quality initiatives hospital consumer assessment of healthcare providers and systems (HCAHPS surveys): publicly reported survey of pts perspective of pt care, looking at how many times/how often vs traditionally looking at satisfaction National Committee for Quality Assurance: private non profit, typically voluntary Maryland Hospital Association Quality Indicator Project (QI project): lots of benchmarks from here Multistate Nursing Home case Mix and Quality Demonstration Report Cards: in order to get CMS you have to put out report care as to how quality is
Herzeberg's motivators and hygiene factors
people can be conditioned to behave in a certain way based on specific reward and punishment system, whatever reward system you use as a manager should meet motivation and hygiene needs (ie. clinical ladder) believed that employees can be motivated by the work itself and that there is an internal or personal need to meet organizational goals. Motivators/job satisfiers are present in work itself and give people the desire to work and do that work well. Hygiene factors keep employees from being dissatisfied or demotivated, but do not act as real motivators. Reward systems should meet both motivators and hygiene factors. motivators: job satisfiers, help people like the job hygiene factors: what maintain people to stay there
quality control
performance is measured against predetermined standard action is taken to correct discrepancies between these standards and actual performance specific type of controlling, refers to activiteis that are used to evaluate, monitor, or regulate services rendered to consumers
management controlling functions
periodic evaluation of unit philosophy, mission goals, and objectives, measurement of individual & group performance against pre-established standards, auditing patient goals and outcomes includes some fiscal responsibility associated with it determining mission, goals, and objectives determines what standards will look like and how you measure yourself to get there studies show taht employees who feel they can influence quality of outcomes can have higher levels of satisfaction and motivation
Laissez-faire leader
permissive, little or no control, little or no direction, place emphasis on the group and let them decide, good if group is highly motivated (instead of micro managing
2 things that eat up budgets
personnel and supplies
top two things taking up most of the budget
personnel and supplies
types of budgets
personnel budget, operating budget, capital budget
forming
process of meeting each other, interpersonal relationships form, expectations are define, clear directions are given
cost effectiveness
producing good results for the amount of money spent expensive items can be cost-effective and inexpensive ites ay not must take into account factors such as anticipated length of service, need for such a service, and availability of other alternatives look at how often you will use them, service for the item, if it is a one time use, length of service of item, and other alternatives
quality measurement as an organizational mandate
professional standards review organizations: Joint commission, NPSG, ORYX medicare/medicaid
gatekeeper
promote open communication within the group
advocacy
protecting and defending what one believes in for both self and others involves helping others to grow and self-actualize inform others of their rights and make sure they have enough information to make informed decisions
standardizing nursing languages and measures
provide consistent terminology for nurses to describe and document assessments, interventions, and outcomes
capitation
providers receive a fixed monthly payment regardless of services used by that patient during the month HMOs will use this ex: $1000/month to take care of that patient, however if don't use it all physician pockets taht money that is left over, if use more than needed it comes out of provider pocket limits provider autonomy
5 characteristics of the authentic leader
purpose values heart relationships self-discipline
fifth step of the management process
quality control
procedural
range the environment making sure it is conducive to getting work done, one person can do more than one role
difficulty in long-term care needs and health-care organizations
rapidly changing technology, increasing government involvement in health care, changing population demographics, reduced provider autonomy
trait rating scales
rates an individual against some standard, most common standard can be job description, desired behaviors, personal traits, etc
behaviorally anchored rating scales
rates desired job expectations on a scale of importance to the position see with sales reps/drug reps
checklists
rates the performance against a set list of desirable job behaviors
job dimension scales
rates the performance on job requirements
reactive planners
react after a problem exists, swoop in and save the day, not always beneficial
types of planners
reactive, inactivism, preactive, proactive
other learning concepts
readiness to learn, motivation to learn, reinforcement, task learning, transfer of learning span of memory chunking knowledge of results
chaos theory
really about finding the underlying order in apparently random data order is constantly changing and determining underlying order is challenging changes in outcomes are not proportional to the degree of change in the initial condition: barriers will affect us and what we are able to do difficult to predict the fugure
Matthew effect
receive the same appraisal results year after year, past appraisal prejudices affect the new appraisal
group commentator
records group process and provides feedback to the group
too much conflict
reduced organizational effectiveness with eventual immobilization of employees
moral hazard
refers to the propensity of insured patients to use more medical services than necessary because their insurance covers so much of the cost
primary nursing is also known as...
relationship based nursing
summative task PCS
requires the nurse to note the frequency of occurrence of specific activities, treatments, and procedures for each patient
negotiation
resembles compromise emphasis is on accommodating differences between the parties each party must consider trade-offs and the bototm line to negotiate successfully psychological and verbal try to come to common sollution to each other
storming
resistance to group influence is evident, feel comfortable enough with each other to disagree
___ is the key to adequate long term staffing
retention
hygiene factors
salary, supervision, job security, positive working conditions, personal life, interpersonal relationships and peers, company policy, status
common sources of conflict
scarce resources, restructuring (new leadership), poorly defined role expectations
self-scheduling
scheduling needs are defined, and then staff on a rotating first-come, first-served basis sign up for available shifts, used with overtime often
trade-offs
secondary gains, often future-oriented, that may be realized as a result of conflict
shared vision
sharing common vision that puts your goals/vision aside to help with common need
Six-Sigma Approach
sigma is a statistical measurement that reflects how well a product or process is performing, organizations should aim for less errors by carefully applying this approach to every aspect of QI higher sigma values=better performance started in moterolla in 1980s historically, the health care industry has been comfortable striving for three sigma processes in terms of health-care quality, instead of six reduce waste and look at working smarter, reduce over time, how are you charting
Bandura
social learning theory
reasons for change
solve a problem, make work procedures more efficient, reduce any unnecessary workload
collaborating
strive for this one, parties set aside their own original goals and work together for best outcomes, win/win situations, not always possible
proactive planning
strive for this, consider the past, present, and future to try to plan for something and not just react to it
types of quality audits
structure, process, outcoome
manifest conflict
action is taken
purpose/mission statement
a brief statement identifying the reason an organization exists identifies the organizations constituency and addresses its position regarding ethics, principles, and standards of practice identfies what is unique about the organization
Knowles
adult learning theory
roles of group members
aggressor, blocker, recognition seeker, self-confessor, playboy, dominator, help seeker, special interest pleader
Total Quality Management (TQM)
aka continuous quality improvement (CQI), developed by Dr. W. Edward Deming based on the premise that the individual is the focal element on which production and service depend. Focus on doing the right things, the right way, the first time problem-prevention planning, proactive always room for improvement, quality can always be better empowering employees by providing positive feedback and reinforcing attitudes that support quality productivity entrusts employees to be knowledgable, accountable, and responsible while providing them the education and knowledge at all levels Quality is more important than profit. If quality is good, profit will come
heart
authentic leaders care for themselves and the people they lead, and their compassion is genuine
values
authentic leaders link between purpose and passion by having congruence in beliefs and actions
self-discipline
authentic leaders practice self-discipline by incorporating balance into their personal and professional lies
purpose
authentic leaders understand their own purposes and passions as a result of ongoing self-reflection and self-awareness
relationships
authentic leaders value building relationships and establishing connections with others, not to receive rewards but rather to strengthen the human connection
line structures
authority and responsibility are clearly defined
theory X employees
avoid work if possible, dislike work, have little ambition, must be directed, avoid responsibility, need threats to be motivated, need close supervision, are motivated by rewards and punishment
avoiding
aware of conflict but choose not to acknowledge it or attempt to resolve it, when you don't address the conflict a toxic work environment is created
rules scheduling
based on an organization's scheduling policies, because it does not take pattern or preference into account it is rarely used alone
classic change strategies
behavioral strategies to prompt change in others rational-empirical strategies normative-reeducative strategies power-coercive strategies
intergroup
between 2 or more groups
interpersonal
between two or more people with different values beliefs or goals
arbitration
binding conflict resolution process, facts are heard and final decision made by this person, sometimes can go to court where due process happens
top-level managres
board of directors, chief executive officer, administrators duty: look at organization as a whole and look at coordinating internal and external influences, what is their strategic plan, what can they do to capitalize on more revenue, what is your community wants from your hospital
authentic leadership
suggest that in order to lead, leaders must be true to themselves and their values and act accordingly four factors that cover the components: balanced processing, internalized moral perspective, relational transparency, and self-awareness
Olson and Eoyang
suggest that the self-organizing nature of human interactions in a complex organization leads to surprising effects
principal agent theory
suggests that not all followers (agents) are inherently motivated to act in the best interest of the leader or employer (principal) followers may have an informational (expertise or knowledge) advantage over the leader as well as their own preferences, which may deviate from the principal's preferences principals must identify and provide agents with appropriate incentives to act in the organization's best interest
complex adaptive systems change theory
suggests that relationship between elements and agents within any system is nonlinear and that these elements are the key players in changing settings or outcomes change disrupts homeostasis and balance: resistance will occur
orienter
summarize decisions
operating budget
supplies, utilities, resources (like linen)
what can managers do for whistle-blowers
support them, it takes a lot of courage to come forward
Key characteristics of Senge's Model of LO's
systems thinking personal mastery team learning mental models shared vision
time and attendance changes
take super long lunch hours, excessive use of sick leave, use all PTO quickly, issue with tardiness, frequently disappear from unit without explanation
quality assurance models
target currently existing quality, what you are currently doing, stops when the problem is fixed seek to ensure that quality currently exists
Quality improvement models
target ongoing and continually improving quality, never stops, always monitoring for opportunities for improvement, more proactive from an automobile industry (Toyota)
orientation
teaches activities that are more specific to the position classes for that area like ACLS, EKG, PALS
opinion seeker
clarify and reflect values of each other
right direction/communication
clear, concise description of the task, including its objective, limits, and expectations
special interest pleader
cloaks his or her own biases in the stereotypes of social causes, such as the laborer, the housewife, the homeless, or the small businessman
team learning
collaboration on getting goals done
philosophy of learning organizations
collective learning goes beyond the boundaries of individual learning and releases gains for both the individual and the organization the learning organization promotes a shared vision and collective learning in order to create positive and needed organizational change
full-range leadership
combo of transformational, transaction, and Laissez-faire
Toyota Production System (TPS)
customer-focused quality improvement model built on the complete elimination of waste and focused on the pursuit of the most efficient production method possible adopting this requires a substantial commitment of leadership time and resources attempt to directly solve problems at time they occur at level they occur managment decisions based on long-term philosophy even at expense of short-term financial goals
internal climate
deals with perceptions things you value, feelings, temperament, stress levels
____ scheduling and staffing lead to increased autonomy and flexibility but ____staffing is fairer to all employees because policies tend to be employed more consistently and impartially
decentralized, centralized
planning
deciding in advance what to do, who is to do it, how it is to be done, and when it is to be done proactive, deliberate process required of all managers a guide for action in reaching a goal and requires flexibility and energy requires management skills such as data gathering, forecasting, and transforming ideas into action short term and long term planning requires: energy, ideas, thought processing, ad hocs
scalar chain
decision making hierarchy you have to follow
decentralized decision making
decision making is diffused throughout the organization, and problems are solved by the lowest practical managerial level. Usually, this means that problems can be solved at the level at which they occur
criteria to meet when handling understaffing issues
decisions made must meet state and federal labor laws and organizational policies staff must not be demoralized or excessively fatigued by frequent or extended OT requests long-term as well as short-term solutions must be sought patient care must no be jeopardized
rules
describe situations allowing only one choice of action or acceptable chocies of action fairly inflexible, the less the better
goals
desired result toward which effort is directed, it is the aim of the philosophy, should delineate the desired end product
outcome audit
determine what results, if any, followed from specific nursing interventions for patients help demonstrate quality of care provided morbidity and mortality rates: find another community with similar core morbidities and will look at them and compare
situation and contingency leadership
developed in 1950s, change your style based on the situation
interactional leadership
developed in 70s, leadership behavior is determined by their personality and the specific situation going on
job performance changes
difficulty meeting deadlines with charting, sloppy charting, high number of assigned patients complaining pain meds are ineffective, everyone complains they are sleeping on the job in empty rooms or bathrooms
aggressive communication
direct, threatening, condescending, win at all costs attitude
authoritarian leader
directed/commanded with coercion, "do it now or else"
fourth phase of management process
directing/coordinating/activating
aggressor
disapprove of everything, offer no solutions, just like to disagree
when receiving inappropriate assignmetn
discuss with charge nurse and negotiate a new assignment, follow chain of command
mental models
diverse thinking and assumptions are challenged
when should performance appraisals be discussed
during unit orientation
responsibility accounting
each of an organization's revenues, expenses, assets, and liabilities is someone's responsibility the person with the most direct control or influence on any of these financial elements should be held accountable for them, usually the leader-manager the unit manager also can best monitor and evaluate all aspects of a unit's budget control
compromising
each party gives up something of equal value
personal mastery
each team member has a commitment to improve his/her ability, be better
external climate
easier to assess than someone's feelings, weather, temperature, timing, authority, organizational climate
transfer of learning
educating others
management by objectives
employee and management agree upon goals of performance to be reached lots of manufacturing, SMART goals
mandatory overtime
employees are forced to work additional shifts, often under threat of patient abandonment it is neither efficient nor effective in the long term, has even more devastating short-term impact in terms of staff perceptions of a lack of control and its subsequent impact on mood, motivation, and productivity
portfolios
employees submit written summaries of their work related accomplishments professional development, recognitions, continuing education, things they've done or how thye grow
systems thinking
encourage staff to see themselves as connected to what the organization looks like, can have impact beyond individual sense, part of community
group building and maintenance roles
encourager, harmonizer, compromiser, gatekeeper and expediter, standard setter, group observer and commentator, follower develop in norming
steps of the quality control process
establish criteria/standard gather information/data to determine if standard is met: how will you collect the data, collect info and analyze it, make judgement call education/corrective action if don't meet the standard then reevaluate
staff development
evaluation for quality control and fiscal accountability in regards to development managers and education department staff have a shared responsibility for the education and training of staff cost effective way to help increase productivity through training and education opportunities
Vroom's theory
expectancy model, 1964 a person's expectations about his/her environment or a certain event will influence behavior employees will make conscious decision in anticipation for a reward but if not rewarded, are less likely to perform the behavior in the future seen often in grade school
Threats
external conditions that challenge or threaten the achievement of organizational objectives
opportunities
external conditions that promote achievement of organizational objectives
abandonment
failure to accept assignment wtihout following proper channels
power-coercive strategies
feature the application of power by legitimate authority, economic sanctions, or political clout of the change agent change or there will be a sanction against you government uses this with other countries, in hospital get discipllinary action
centralized decision making
few managers at the top of the hierarchy make most of the decisions
phases of mentoring
finding and connecting learning and listening changing and shifting mentoring others
fact finding
finding if that was truly their bottom and discovering agendas
fiscal accountability
fiscal accountability to the organization for staffing is not incompatible with ethical accountability to patients and staff it should be possible to stay within a staffing budget and meet the needs of patients and staff
incremental budgeting
flat percentage increase method (trying to predict what an inflated cost will be ) ex: like 5000 plus 5% on top of that for inflation no motivation to increase cost, know you will get extra, not used often in health care
float pools
float staff must be able to perform the core competencies of the unit they are floating to meet their legal and moral obligations as caregivers
philosphy
flows from the purpose or mission statement and delineates the set of values and beliefs that guide all actions of the organization
affiliation-oriented people
focus energy on family; overt productivity is less because they view their contribution to society different from those achievement-focused people EX: nurses, mothers, women
matrix structures
focus on both product and function, formal vertical and horizontal chain of command, fewer formal rules and fewer levels of hierarchy, can cause slow decision making to occur due to decreased amount of information sharing can produce confusion and frustration for workers because of horizontal and vertical chains of command
achievement-oriented people
focus on improving what is; transform ideas into action, judiciously and wisely, taking risks when necessary
first-level managers
team leaders, charge nurses, primary care nurses, case managers concerned iwth specific units workflow, deal with specific problems, deal with daily unit operational needs
traditional patient care delivery methods
total patient care functional nursing team and modular nursing primary nursing case management
two types of quality improvement models
total quality management (TQM) Toyota Production System (TPS)
two important parts of staff development
training and education
flat designs
try to remove hierarchy layers by flattening chain of command and do this decentralized takes a lot of bureaucracy out but hard to do with large organizations
stages of group communication
forming, storming, norming, performing
assertive communication
gets confused with aggressive but it isn't (esp with women), allows people to express themselves in a direct and honest way, quick and to the point, not threatening or condescending, just clear to your point and your feelings, express yourself openly and honestly, this doesn't infringe on others (biggest difference in aggressive and assertive)
delegation
getting work done through others directing the performance of one or more people to accomplish giving someone else the authority to complete a task or action on your behalf transfer or hand-off to a competent individual, the authority to perform a task/activity in a specific setting/situation YOU ARE STILL RESPONSIBLE FOR MAKING SURE THE TASK GETS DONE
elaborator technician
give ex of how things can work
logic models
higher level management, starting to develop programs, picturing how the program to look, how are you gonna get it there
financial
how does it help
organizational climate
how employees perceive an organization may be accurate or inaccurate and people in the same organization may have different perceptions about the same organization
personnel budget
how much do you have and how many people do you need/have
work redesign/changing delivery methods
how will social interactions change degree of autonomy what abilities and skills will it requires employee evaluation, how will thye get feedback on their performance communication patterns: how wil these change
budgeting methods
incremental budgeting, zero-based budgeting, flexible budgeting, performance budgeting
using a balances scorecard
indication of where we are at -develop metrics (how you will measure your performance) -collect data -analyze that data from four perspectives: financial, customers, business processes, learning and growth
passive-aggressive communication
indirectly aggressive send aggressive messages presented in a passive way (ie. Bless your heart), limits verbal exchange backstabbing, manipulation, this damages relationships, AVOID IT
passive communication
individuals who suffer in silence even though they may feel strongly about an issue, want to avoid conflict, bottle up their feelings
Quality Gap
when you look at difference between top-level institutions and how they perform (mayo clinic, John Hopkins, Cleveland Clinic) and the national average
staff authority
who is the staff responsible to and what are they responsible for
competing
win/lose, one party pursues what it wants regardless of cost to someone else
intrapersonal
within the person, internal struggle, conflicted based on an order received and know it isn't right
workplace advocacy
work environment is safe and conducive to growth workplace violence nurses are concerned with reporting due to fear of retaliation
performing
work starts getting done
bullying
workplace sabotage, overworking someone with unfair or unsafe assignments, threats to professional status, isolation (withhold information you should know), destabilization (not giving credit where it is due)
democratic leader
"we" instead of "I", decisions involve others on your team, good when you have cooperating parties, not good if you don't
Contemplation
Individual considers making a change
Action
Individual modifies his or her behavior
channels of communication
*Upward*: From subordinate to superior *Downward*: From superior to subordinate *Horizontal*: From peer to peer *Diagonal*: Between individuals at differing hierarchy levels and job classifications (charge nurse communicating with radiology supervisor, communication with physicians) *Grapevine*: Informal, haphazard, and random, usually involving small groups, senders have little accountability for message and message can get distorted
strategies for successful planning
- Start planning at the top - Keep planning organized, clear, and definite - Do not bypass levels of people - Have short- and long-range plans and goals - Know when to plan and when not to - Keep target dates realistic - Gather data appropriately - Be sure objectives are clear - Remember, interpersonal relationships are important
resistance to delegation
- common response by subordinates to delegation - one of most common causes: failure of the delegator to see the subordinate's perspective - may occur when tasks are over-delegated in terms of frequency or micro-managed
common staffing and scheduling options in health care organizations
-10-12 hr shifts -premium pay for weekend work -part time staffing pool for weekend shifts and holidays -cyclical staffing, which allows long-term knowledge of future work schedules because a set staffing pattern is repeated every few weeks -job sharing -allowing nurses to exchange hours of work among themselves -flextime -use of supplemental staffing from outside registries and float pools -staff self-scheduling -shift bidding, which allows nurses to bid for shifts rather than requiring mandatory overtime
steps for using strategic planning
-Clearly define the purpose of the organization -Establish realistic goals and objectives -Identify external constituencies and determine their assessment of the organization's purposes -Clearly communicate the goals to the constituents -Develop a sense of ownership of the plan -Develop strategies to achieve the goals -Ensure that the most effective use is made of resources -Provide a base from which progress can be measured
leaders
-Empower others; maximize workforce effectiveness -Needed to implement the planned change that is part of system improvement -art of getting work done through others willingly -leaders are in the front, moving forward, taking risks, and challenging the status quo -a job title alone does not make a person a leader, only a person's behavior determines if he or she occupies a leadership position don't have formal organization role on organization chart, empower others, make things effective on the floor, getting work done through others willingly, wider variety of roles than managers and may hav different personal goals focus on group process, information gathering, feedback, and empowering others
common areas requiring nurse-patient advocacy
-End-of-life decisions -aging populations -Technological advances -Health-care reimbursement -Access to health care -Provider-patient conflicts -Withholding of information -Insurance authorization -Medical errors -Patient information disclosure -Patient grievance and appeals process -Culture and ethnic diversity and sensitivity -Respect for patient dignity -Inadequate consents; complex social problems -Incompetent health-care providers
Why do plans fail?
-False assumptions -Not knowing overall goal -Not enough alternatives -Inadequate time or other resources -Low motivation levels -Sound strategies not used -Inadequate delegation of authority -Not recognizing organizational goals and needs -Planning too narrow in scope—not recognizing community, legal, and licensing requirements, lose flexibility -Lack of subordinate input
factors affecting recruitment
-Financial resources. -Adequate nursing pool. -Competitive salaries. -The organization's reputation. -The location's desirability. -The status of the national and local economy.
motivational theories
-Maslow: hierarchy of needs -Skinner: operant conditioning/behavior modification -Herzberg: motivator/hygiene theory -Vroom: expectancy model -McClelland: basic needs -Gellerman: stretching -McGregor: Theory X and Y
confronting the chemically impaired employee
-Gather as much evidence as possible of employee's impairment. -Immediate confrontation is necessary if manager suspects employee may be impaired and thus poses a risk to clients. -Denial of the impairment or use of defense mechanisms should be expected from the employee. -the manager should outline the plan for the employee to overcome chemical impairement -The manager should not try to nurture or assume the role of counselor to the employee. Others are more qualified to assume this role. -The manager must be very careful not to assume the role of counselor or treatment provider for the impaired nurse. Others who have greater expertise and objectivity should assume this role. DO NOT APPROACH THE PERSON, GO TO SUPERVISOR, caught in medication audits, will be reported to state boards
evolution of leadership theories
-Great Man theory/trait theories -Behavioral theories (authoritarian, democratic, Laissez-faire) -situational and contingency leadership theories -interactional leadership theorieies -transactional and transformational leadership -full-range leadership theories
Strategies to create a motivating climate
-Have clear expectations for workers. -Be fair and consistent with employees. -Encourage teamwork. -Know the uniqueness of each employee. -Stretch employees intermittently. -Reward desired behavior. -Allow employees as much control as possible. be careful that rewards don't become a source of competition, it will demotivate employees
constructive discipline
-Helps the employee to grow -Is carried out in a supportive, corrective manner -Employee is reassured that punishment is given because of actions and not because of who he or she is as a person. -Primary focus is to assist employees to be self-directed in meeting organizational goals.
reminders with delegation
-In assigning tasks to NAP, the RN must be aware of the job description, knowledge base, and demonstrated skills of each person -The UAP has no license to lose for "exceeding scope of practice" and nationally established standards to state what the limits should be for UAP in terms of scope of practice do not exist -It is the RN who bears the legal responsibility for allowing UAP to perform tasks that should be accomplished only by a licensed health-care professional
interviewing as a selection tool
-Is the most common method for employee selection used by managers. -Is also the most time-consuming and thus one of the most costly selection tools. -Generally requires an interviewer to use judgments, biases, and values to make decisions based on a short interaction with an applicant in an unnatural situation. Thus, reliability and validity are always suspect. DO IT BY INTERVIEW PANELS AND MORE THAN TWO PEOPLE, HAVE DIVERSITY ON INTERVIEW PANELS, because of biases and judgements the reliability and validity are always suspect
strategies for promoting EBP
-Make research findings accessible through libraries and computer resources -develop and refine research-based policies and procedures -build consensus from the interdisciplinary team through development of protocols, decisions trees, standards of care, institutional clinical practice guidelines, etc -provide organization support, such as time to do research and educational assistance to teach staff to interpret research statistics and use findings -encourage cooperation among professionals -when possible, hire nurse researchers or consultants to assist staff
strategies for successful delegation
-Plan ahead, -Match the task to the education and skill level of the person, -Select capable people, -Communicate goals clearly, -Empower the delegate, -Set deadlines and monitor progress, -Monitor the role and provide guidance, -Evaluate performance, -Reward accomplishment -identify necessary skill and education levels to complete the delegated task -clearly delineate your desired outcomes -truse person you are delegating too -monitor and provide feedback
factors affecting staffing needs
-Source of nursing pools -Number of students enrolled in local nursing schools -Usual length of employment of newly hired staff -Peak staff resignation periods -Times when patient census is highest -Patient care delivery system in place -Knowledge level of needed staff -Budget constraints
late stage chemical dependency
-Tolerance is developed to the chemical and the individual needs the chemical in greater amounts and more often to achieve the same effect. -The individual characteristically exhibits high defensiveness. -Employee must continually use substance even though he/she generally no longer gains pleasure from it.
implications of Knowles' work for trainers and educators
-a climate of openness and respect will assist in the identification of what the adult learner wants and needs to learn -adults enjoy taking part in and planning their learning experiences -adults should be involved in the evaluation of their progress -experiential techniques work best with adults -mistakes are opportunitites for adult learning -if the value of the adult's experience is rejected, the adult will feel rejected -adults' readiness to learn is greatest when they recognize that there is a need to know (such as in response to a problem) -adults need the opportunity to apply what they have learned very quickly after the learning -assessment of need is imperative in adult learning
preceptors
-active and purposeful relationship -an experienced nurse who provides emotional support -strong clinical skill role model -close supervision -nonjudgemental
monitoring delegated tasks
-ask individual if they are capable of completing the task -observe for completion of task
selecting optimum mode of organizing patient care
-based on patient acuity not just economics -knowledge and skill required for particular activities with specific population should always be the true driver in determining appropriate care delivery models -not every nurse desires a challenging job with the autonomy of personal decision making
strategies for becoming an effective coach
-be specific, not general in describing behavior that needs improvement -be descriptive, not evaluative when describing what was wrong with the performance -be certain that the feedback is not self-serving but meets the needs of the employee -direct the feedback toward behavior that can be changed -use sensitivity in timing the feedback and make sure employee understand feedback look at it as behavior, don't make it a personal attack
Strategies to prevent medication errors
-better reporting of the errors that occur -"just culture" David Marx -Leapfrog initiatives -reform of the medical liability system -Other point of care strategies: bar coding, smart IV pumps, medication reconciliation
overcoming appraisal interview difficulties after interview
-both manager and employee must sign appraisal form -end on a pleasant note, if possible -document goals -document any long term coaching needs and the follow-up to occur signature means you have seen a copy and it has been discussed not that you agree with it -can write on there what you don't agree with have employee give back some goals
Maslow's hierarchy of needs ranking
-bottom: physiological/basic needs -security/safety -social/love -esteem -top: self-actualization
limitations to decentralized staffing
-can result in more special pleading and arbitrary treatment of employees -may not be cost-effective for organization since staffing -more time consuming for the unit manager
Lewin's rules for implementing change
-change should be only implemented for good reasons -change should be gradual (too much at one time overwhelms the system and people) -all changes should be planned, not sporadic or sudden -anyone who will be affected by the change should be involved in the planning
organizational conflicts
-communication problems, -organizational structure -individual behavior -unclear expectations -stafing or operational changes
good managers
-coordinate resources -optimize resource use -meet organizational goals and objectives -follow rules -plan, organize, control, and direct -use reward and punishment effectively to achieve organizational goals
decision-making tools
-decision grids -payoff tables -decision trees -consequence tables -logic models -program evaluation and review technique
demand factors leading to potential nursing shortage
-demand for RN is expected to continue or accelerate -RN occupation will grow due to shortage of RNs -technological advances in patient care and preventative health care -magnet status
strategies to ensure performance appraisal accuracy
-develop self-awareness regarding own biases and prejudices -use appropriate consultation -gather data adequately over time -keep accurate anecdotal records for the length of the appraisal period -collect positive data and identify areas where improvement is needed -include employee's own appraisal of his or her performance -guard against the halo effect, horns effect, central tendency trap, and Matthew effect
characteristics of effective health care delivery systems
-elements of the various designs present in the system in use in any organization -does it facilitate meeting the goals of the organization -is it cost-effective -will it satisfy the patient even better than before -does it provide role satisfaction to nurses -allow implementation of the nursing process - provide for adequate amount of communication among HCP
reasons for staffing shortages
-nationwide downsizing of hospitals in 1990s -aging of nursing workforce -accelerating demand for professional nurses -inadequate enrollment in nursing programs of study -aging of nursing faculty
overcoming appraisal interview difficulties before interview
-employee has copy of appraisal form -select an appropriate time -give 2-3 days notice -be prepared mentally for the conference yourself -make sure there is no interruptions -select a seating arrangement that reflect collegiality rather than power
good leaders
-envision the future -communicate their visions -motivate followers -lead the way -influence others to accomplish goals -inspire confidence -take risks -empower followers -master change
role models
-examples are experienced, competent employees -the relationship is passive or nonexistent - you see behavior in someone you want to emulate -a person can have many -there is a cumulative effect
underdelegating
-fear that delegation may be interpreted as a lack of ability to do the job completely or correctly -a desire to complete the whole job himself or herself -fear that subordinates will resent delegated work -lack of experience in the job or with delegation, or the need to control or be perfect -enjoyment of the work -novice managers may find it difficult to assume the nurse manager role and delegate
transactional leader
-focuses on management tasks -is a caretaker -users trade-offs to meet goals -does not identify shared values -examines causes -uses contingency reward ACTION focuses on actions and tasks needed to be done
strength-based leadership
-focuses on the development or empowerment of worker's strengths activities include: -paying attention to multiple points of view -searching for common ground -prioritizing continuous learning in the workplace -promoting collaborative relationships
overcoming appraisal interview difficulties during interview
-great employee warmly -ask employee on their progress -avoid surprises -listen carefully to what the employee has to say -focus on performance and not on personal characteristics -avoid vague questions -be straightforward, don't cloud the message
factors affecting health care trends
-growing elderly population -health-care reform -reductions in reimbursements -new quality imperatives ("report cards", quality, data has to be public) -shift in focus of care to community settings -technological advances -shift to customer-focused care
managers
-guide, direct, and motivate others -intervene when goals are threatened -emphasize control have a formal position, have a legitimate source of power, can discipline and hire, have to carry out specific functions and responsibilities, have to manipulate the people and environment to achieve the organization goals emphasize control, decision making, decision analysis, and results
barriers to identifying long-term needs in planning
-health-care reform -rapidly changing technology -increasing government regulation of health care -scientific advances
1998 patient bill of rights
-help the patient feel comfortable in whatever syste they are in -provides strong patient provider relationships -patient have a role in staying healthy themselves
transformational leader
-identifies common values -is committed -inspires others with vision -has long-term vision -looks at effects -empowers others inspire others to envision the future vision and empowerment by inspiring others
supply factors leading to potential nursing shortage
-increases in nursing school enrollment has not kept pace with loss of nurse retirement -inadequate resources for nursing education including clinical site, classroom space, nursing faculty and clinical preceptors -faculty shortages
group roles
-initiator, -information seeker, -information giver, -opinion seeker, -elaborator, -coordinator, -orienter, -evaluator, -energizer, -procedural technician, -recorder
characteristics of a critical thinker
-insight -intuition -empathy -willingness to take action -flexible -observant -out of box thinker
qualities of a nurse-manager
-knowledgeable and skilled in nursing practices -competent in all aspects of management -excellent communicator -effective team builder -proactive in preparing for emerging new threats not reactive but proactive
conflict process
-latent conflict -perceived conflict -felt conflict -manifest conflict (overt conflict) -conflict aftermath
strengths to decentralized staffing
-manager has greater control over staffing -staff are able to take requests directly to their manager -provides greater autonomy and flexibility for individual staff member
manager role in controlling subordinates
-must be able to distinguish between employees who need progressive discipline and those who are chemically impaired, psychologically impaired, or marginal employees so that the employee can be managed in the most appropriate manner -not disciplining an employee who should be disciplines jeopardizes an organization's morale
strengths to centralized staffing
-provides organization wide view of staffing needs, which encourages optimal utilization of staffing resources -staffing policies tend to be employed more consistently and impartially -more cost-effective than decentralized staffing -frees the middle-level manager to complete other management functions
core concepts of patient and family centered care
-pt care organized around the needs of the patients -pt and family perspectives sough and honored -HCP communicate openly and honestly with pt and family, empower them -pt, families, HCP collborate regarding facility design and implementation of care -voice of pt and family are represented at both organizational and policy level -family is who the pt says they are
servant leadership
-putting others including employees, customers, and the community as the number one priority fostering a service inclination in others that promotes collaboration, teamwork, and collective activism putting others first, always think before you react
actions to take when under attack by an aggressive person
-reflect -repeat the assertive message -point out the implicit assumption -restate the message by using assertive language -question
factors influencing the future of health care
-robotic technology (less invasive and faster healing times) -biomechatronics (simulations, used in nursing school and new grad orientations) -biometrics and smart cards (grading) -point-of-care testing: CCU and ER, OR, get things instantly right there with the pt, glucometer checks for example -telehealth and the internet -growing elderly population -nursing shortages in acute care hospitals
common themes among emerging care delivery models
-role of nurses from caregivers to care integrators -team approach to interdisciplinary care -bridging the continuum of care outside the primary care facility -defining the home as a setting of care -targeting high users of health care, esp older adults -sharpening focus on the patient, an active engagement of the patient and her/his family in care planning and delivery, greater responsiveness to the patient's wants and needs -more family centered care intiatives -leveraging technology -improving satisfaction, quality, and cost
successful decision makers
-self-aware -courageous -sensitive -energetic -creative
five components of emotional intelligence
-self-awareness: recognize your own mood and the effect your mood has on others -self-regulation: you have the ability to control any disruptive impulse or mood -motivation: you have strong internal and external motivation, passion that goes beyond money or status -empathy: have an understanding of others, can put yourself in their shoes and see things from their perspective, your perspective is more open -social skills: you have the ability to find common ground with others
factors influencing effective performance appraisal
-should be based on a standard -appraisal tool must adequately and accurately assess job performance -employee should have input into the development of the standard -employee must know the standard in advance -employee must know the sources of data gathered for the appraisal -appraiser should be someone who the employee trusts and respects -employee should know in advance what happens if the expected performance standards are not met
organizational staffing policies should address..
-sick leave -vacations -holidays -call-offs for low census -on-call pay -tardiness and absenteeism
LPN delegation tasks
-some meds (not IV pushes) -monitoring client findings -reinforcement of client teaching from a standard care plan -trach care -suctioning -checking NG tube patentcy -administration of enteral feedings -insertion of urinary catheter cannot: assess, teach, evaluate clients or care for unstable clients
factors affecting staffing needs
-source of nursing pools -number of students enrolled in local nursing schools -usual length of employment of newly hired staff -peak staff resignation periods -times when patient census is highest -patient care delivery system in place -knowledge level of needed staff -budget constraints
pitfalls in performance appraisal
-subjectivity as a factor -tendency to be lenient -inadequate record keeping -"recency effect"
self-discipline
-the process by which rules are internalized and become part of the person's personality -highest and most effective form of discipline -self-discipline is possible only if subordinates know the rules and accept them as valid internal motivation for that person
two aspects carrying most weight when recommending for or against hiring
-the requirements of the job: qualified versus overqualified -personal bias: examine any negative feelings occurring in the interview for personal bias
types of performance appraisal tools
-trait rating scales -job dimension scales -behaviorally anchored rating scales -checklists -essays -self-appraisals -management by objecties -peer review -porfolios
scheduling alternatives
-travel nurses -agency nurses -flextime -self-scheduling -float pools
reliability and validity issues of the selection process
-validity increases with a team approach -negative information tends to be weighed more heavily than positive information -the same standards should be used for all applicants -selection should be based on established criteria, not value judgments -personal bias should be minimized, because negative feelings likely have no relation to the criteria necessary for success in the position -personal bias should be minimized, because negative feelings likely have no relation to the criteria necessary for success in the position -major defect of hiring interview is subjectivity, a skill that must be developed
promotion: elements to prevent negative outcomes
-whether recruitment will be internal or external -what the promotion and selection criteria is -pool of candidates that exists -handling rejected candidates -how employee releases are to be handled do not urge people to apply notify those you don't choose first
improper delegatin
-wrong time, to the wrong person, or for the wrong reason -beyond the capability of the person, or something the manager should do -decision making without providing adequate information
The planning hierarchy
1) Mission 2) Philosophy 3) Goals: desired result toward which your efforts are directed 4) Objectives: measurable and time specific 5) Policies: plans reduced into statements 6) Procedures: step by step process 7) Rules: acceptable choices of action, least amount you can b/c there has to be consequence if rules are broken
steps in the budget process
1. Assess what needs to be covered in the budget 2. Diagnosis of the goals for the budget 3. plan for the budget cycle 4. implementation or ongoing management and analysis of the budget 5. evaluate and periodic review of the budget for the fiscal year
managerial decision making model
1. Determine the decision and the desired outcome (set objectives) 2. Research and identify options 3. Compare and contrast these options and their consequences 4. Make a decision 5. Implement an action plan 6. Evaluate results set objective right in the beginning, more common to see
nursing values central to advocacy
1. Each individual has a right to autonomy in deciding what course of action is most appropriate to meet his or her health-care goals 2. Each individual has a right to hold personal values and to use those values in making health-care decisions 3. All individuals should have access to the information they need to make informed decisions and choices 4. The nurse must act on behalf of patients who are unable to advocate for themselves 5. Empowerment of patients and subordinates to make decisions and take action on their own is the essence of advocacy
factors affecting recruitment
1. Financial resources 2. Adequate nursing pool 3. Competitive salaries 4. Organization's reputation 5. Location's desirability 6. Status of national and local economy
disease management programs
1. Provide a comprehensive, integrated approach to the care and reimbursement of common, high-cost, chronic illnesses 2. Focus on prevention as well as early disease detection and intervention to avoid costly acute episodes 3. target population groups not individuals 4. multidisciplinary health-care 5. use standardized clinical guidellines 6. use integrated data management systems to track patient progress across care settings and allow continuous and ongoing treatment 7. frequently employ professional nurses in the role of case manager or program coordinator work with patients to maintain healthy lifestyles and decrease readmittance, reduce costs in the long run by early detection and prevention goal: address such illnesses or conditions with maximum efficiency across treatment settings regardless of typical reimbursement patterns population-based health care
tips for interacting with the media
1. Respect and meet the reporter's deadlines 2. Assume, until proven otherwise, that the reporter will be fair and accurate in his/her reporting 3. Have key facts and figures ready for the interview 4. Limit your key points to two or three and frame them as bullet points 5. Avoid technical or academic jargon 6. Speak confidently but do not be afraid to say when you do not have the expertise to answer a question or when a question is better directed to someone else 7. Avoid being pulled into inflammatory arguments or blame setting and repeat key points if you are pulled off into tangents 8. Provide the reporter with contact information for follow-up and needed clarifications
5 rights of delegation
1. Right task 2. Right circumstance 3. Right person 4. Right direction/communication 5. Right supervision/evaluation
termination conference
1. State the facts of the case and the reason for termination. 2. Explain the termination process. 3. Ask for the employee's input and respond calmly and openly. 4. End the meeting on a positive note, if possible. never make this personal, stay calm (highly charged environment), want HR representative there with you
the disciplinary conference
1. State the problem clearly 2. Ask the employee why there has been no improvement 3. Explain the disciplinary action to be taken 4. Describe the expected behavioral change 5. Get agreement to and acceptance of the plan (signature means they agree to the plan)
Hallmarks of Effective Quality Control Programs
1. Support from top-level administration -willing to put resources into fixing things 2. Commitment by the organization in terms of fiscal and human resources 3. Quality goals reflect search for excellence rather than minimums 4. Process is ongoing (continuous)
strategic planning as a management process should include:
1. a clear statement of the organization's mission 2. The identification of the agency's external constituencies or stakeholders and the determination of their assessment of the agency's purpose and operations 3. The delineation of the agency's strategic goals and objectives, typically in a 3-5 year plan 4. The development of strategies to achieve the goals
how to calculate a staffing pattern
1. determine staffing pattern: 8 hr/ 12 hr shifts, fixed, variable, block, flextime 2. determine nursing care hours per patient day NCHPPD 3. determine the FTE needed
disadvantages of the organization chart
1.Does not show the informal structure of the organization 2.Does not indicate the degree of authority held by each line position 3.May show things as they are supposed to be or used to be rather than as they are 4.Possibility exists of confusing authority with status
questions asked when changing the patient care delivery mode
1.How will the reorganization alter autonomy and individual and group decision making? 2.How will social interactions and interpersonal relationships change? 3.Will employees view their unit of work differently? 4.Will the change require a wider or more restricted range of skills and abilities on the part of the caregiver? 5.Will the redesign change how employees receive feedback on their performance, either for self-evaluation or by others? 6.Will communication patterns change?
limitations of the interview process
1.Subjectivity can never be totally eliminated 2.High interview assessments do not necessarily correlate with high-level performance on the job 3.Mixed reliability and validity negative info about applicant is weighted more heavily than positive info, the earlier in the interview, the greater the negative effect most decisions about the applicant are made in the first 30-60 seconds, physical appearance plays a big role artifical environment: hard to relax and be natural interviewer may have poor communication skills interviewers frequently ask questions that demonstrate a self-fulfilling prophecy regarding their first impression of the applicant
David McClelland's theory
Basic Needs Theory 1971 people are motivated by three basic needs: -achievement (transfer learning into action, take risks) -affiliation (how they view their contribution, like they belong) -power (what is gained as a result) if you satisfy those three needs, employees will be motivated often seen in manufacturing
"Just Culture"
David Marx, if make a mistake, have to feel comfortable enough reporting mistake without having disciplinary actions taken against them if worry about mistakes leading to punish them, will lead to hiding things and dishonesty realizes that people are humans and make mistakes, reporting mistakes can lead to more education and corrective actions
advantage of functional nursing
Efficiency; tasks are completed quickly, with little confusion regarding responsibilities
reflective practice or clinical coaching
In reflective practice or clinical coaching, the *manager or mentor meets with an employee regularly to discuss aspects of his or her work* Both individuals determine the agenda jointly, with the *goal of an environment of learning that can span the personal and professional aspects* of the employee's experience day to day feedback regarding performance is one of best methods to improve work performance and build a team approach preceptors, orientation
categories of conflict
Intrapersonal. Interpersonal. Intergroup.
Why is scheduling so difficult in nursing?
It does not fit traditional business cycle There is an erratic and unpredictable health-care demand High-level expertise is required 24/7 Stress of job requires balanced work-recreation schedule Staffing mix varies with acuity
organizational communication strategies
Leader-managers assess organizational communication Leader-managers understand the organization's structure and recognize who is affected by decisions Communication is not a one-way channel; communication must be clear, simple, precise Senders should seek feedback whether communication is received Multiple communication methods should be used Unnecessary information should not be disclosed recognize who is affected by decisions
examples of nursing languages and measures
NANDA NIC NOC NMDS
nursing care hours/per patient day (calculating nursing care hours)
NCH/PPD = nursing hours worked in 24 hours / patient census
determining FTE
NCHPPDx14 (2weeks)x (avg census) __________________ hr worked in 2 weeks
subordinate advocacy
Nurse administrators should advocate for other health-care providers (including subordinates) as well as patients, especially when this is related to health and safety Workplace advocacy occurs when the manager works to see that the work environment is both safe and conducive to professional and personal growth for subordinates biggest thing is staffing levels so quality does not change
right task
One that is delegable for a specific patient
Knowles' adult learning theory
Pedagogy vs androgogy you have to be internally motivated and self directed to learn Pedagogy: child learning, learner is dependent androgogy: adult learning, internal motivation
right person
Right person is delegating the right task to the right person to be performed on the right person
building a new culture
Success in building a new culture often requires new leadership and/or outside analysis
purposes of the selection interview
The interviewer seeks to *obtain enough information to determine the applicant's suitability* for the available position The applicant seeks to obtain adequate information to make an intelligent decision about accepting the job, should it be offered The interviewer seeks to conduct the interview in such a manner that, regardless of the interview's result, the applicant will continue to have respect for and good will toward the organization
Benchmarking
The process of measuring products, practices, or services against best-performing organizations helps determine how and why their organization differs from exemplars, then use the exemplars as role moels for standard development and performance improvement
common delegation errors
Underdelegating Overdelegating Improper delegating
successful decision maker
Understands: -Gender (frontal lobe larger in females, men use gray matter more and women use white matter meaning they can multi-task quicker -Personal individual values -Life experience -Preferences -Willingness to take risks -Brain hemisphere dominance -Predominant thinking style
writing a letter to a legislator
Write a personal letter. Be formal, but polite. The letter should be one page Address the legislator by title Establish your credibility early in the letter as both a constituent and as a health-care expert Refer to a specific bill by number State your position on the issue. Offer your assistance as a resource person for additional information Sign the letter, including your name and contact information. Be persistent and write repeatedly to legislators who are undecided on an issue
service line organization
a lot of hospitals are using this, overall goal is determined by larger organization but service line decides on the process to be used to help achieve the goals ex: middle level admin handles all of critical care and their sub categories
essays
a narrative appraisal of job performance academic centers
budget
a plan that uses numerical data to predict the activities of an organization over a period of time includes estimated expenses, income for a period of time provides a mechanism for planning and control, as well as for promoting each unit's needs and contributions
utilization review
a process used by insurance companies to assess the need for medical care and to assure that payment will be provided for the care allows case manager to get approval for payment for care
self-appraisals
an appraisal of performance by the employee tend to be more critical of self
employee engagement
an employee's emotional commitment to the organization and its goals don't work for a paycheck or promotion but on behalf of the organization's goals
mentoring
an in-depth supportive and nurturing relationship between an expert and a novice formal relationship typically lasts 2-5 years with mentor being one generation older than mentee many nurses do not have the opportunity to have a true mentoring relationship in their lives invest time, knowledge, and experience in someone open door for the next generation without shutting it closed
training
an organized method of ensuring that people have knowledge and skills for a specific purpose and that they have acquired the necessary knowledge to perform the duties of the job specific purpose like new medication pump, immediate use
punishment
an undesirable event that follows unacceptable behavior, which may have negative consequences but can be a powerful motivator for change
team nursing
ancillary personnel collaborates in providing care to a group of patients under the direction of a professional nurse requires extensive team communication and planning conferences allows members to contribute special expertise or skills democracy in team nursing, give autonomy to contribute expertise no more than 5 people on the team' med surg floors
positive feedback
annual performance review can be a change for positive feedback and praise from supervisor, esp if employee receives infrequent praise on a day-to-day basis indirectness and ambiguity are more likely to inhibit communication than enhance it, and the employee is left unsure about the significance of the message
performance management
appraisals are eliminated as the manager places his or her efforts into ongoing coaching, mutual goal setting, and the leadership training of subordinates generally linked to the organization's business calendar seldom used changes as you are coaching the person used in smaller sectors with less employees than MBO
horns effect
appraiser allows some negative aspects of the employee's performance to influence the assessment to such an extent that other levels of job performance are not accurately recorded
halo effect
appraiser lets one or two positive aspects of the assessment or behavior of the employee unduly influence all other aspects of the employee's performance
right supervision
appropriate monitoring, evaluation, intervention, as needed, and feedback
standard setter
are we meeting standards
smoothing
attempt to reduce the emotional component of conflict
The attitude and energy level of managers directly affects the ___ and ___ of their employees
attitude and productivity
workplace violence
bullying, incivility, mobbing results in decrease in quality of care
health insurance marketplace
buy affordable health care plans on a market exchange (small business owners for example to provide for employees) creates competition amongst providers
two budget cycels
calendar year from January to December Fiscal year (July 1st to June 30th)
advocacy values
caring, autonomy, respect, and empowerment
planned change
change that results from a well-being thought-out and deliberate effort to make something
business process
change the way you run things and how learning and growth from it
decision trees
compares between the two items and you are looking at the consequences of them
decision making
complex, cognitive process of choosing a particular course of action; the thought process of selecting a logical choice form available options
felt conflict
conflict is being emotionalized, can have hostility, fear, anger, and mistrust
analysis
critical event analysis and root cause analysis help identify not only what and how an even happened but also why it happend end goal is to ensure that a preventable negative outcome does not recur
patient classification systems
critical indicator PCS sumataive task PCS the use of a PCS is a condition for participation in Medicare and is required by the Joint Commission for certification
incidence of chemical impairment in nursing
greater in healthcare than that of general public majority of disciplinary actions by licensing boards are related to misconduct resulting from chemical impairment, including the misappropriation of drugs for personal use and the sale of drugs and drug paraphernalia to support the nurse's addiction often detected in medication audits number one reason nurses lose licenses is divergence of drugs
due process hearings
grievances are brought to court in front of impartial judge
norming
group begins to establish rules and design of work begins to happen
Leapfrog Group
group of non healthcare fortune 500 companies that looked at healthcare and recommended the following changes: -computerized physcian-provider order entry -evidence-based hospital referral: to get pt to the provider who can treat them the best -ICU physician staffing 24/7 -the use of leapfron safe practices scores
indoctrination
guided adjustment of the employee to the organization and work environment
seeking employee diveristy
having staff that is diverse in terms of gender, culture, age, ethnicity, and language is helpful in meetig the needs of an increasingly diverse population brings new perspectives to thinking and problem solving recruit a staff that is both sensitive and responsive to diversity of community and represents it
how nurses can act as advocates
helping others make informed decisions acting as intermediaries in the environment directly intervening on behalf of others advocating for social justice
Maslow's thoery
hierarchy of needs suggested that people are motivated to satisfy certain needs, ranging from basic survival to complex psychological needs, and that people seek a higher need only when the lower needs have been predominantly met
intra-rater reliability
high reliability and validity
assets for learning
high self-motivations self-directed a proven learner knowledge experience reservoir special individual assets
UAP delegated tasks
hygiene, feeding/nutrition, output/elimination, ambulation/activity, positioning, bed making, specimen collection, totaling input or output, vitals on stable clients nothing of independent thinking that requires nursing skills nothing in the nursing process cannot do assessments, teaching, evaluation, admin meds, or care for unstable clients (like they can't do their vitals)
specifics of case management tasks
identify the most cost effective providers, treatments, and care settings possible helps patients access community resources, helps patients learn about their medication regiment and treatment plan, and ensures that they have recommended tests and procedures look at loss/profit margins
rules
if a rule or regulation is worth having, it should be enforced if allowed unpunished, groups have to adjust and replicate the low-level performance of the rule breaker as few as possible should exist should be regularly reviewed for modification or deletion deal with extraneous circumstances on case by case basis
problem with Vroom's expectancy model
if you don't give reward when expected, it will likely decrease motivation if not rewarded, are less likely to perform behavior in the future
incivility
impacts turn over, impacts how quickly nurses leave unit which impacts quality of care
clinical nurse-leaders
implement things based on evidenced based outcomes, engage in clinical practice, collaborate with interdisciplinary teams, not utilized often in hospitals, VA will, new terminology is nurse educator collaborate with teas, research shows (nurse educator)
participatory management
implies that others are allowed to participate in decision making over which someone has control the act of allowing participation identifies for the participant the real and final authority
disadvantage to team nursing
improper implementation due to poor communication, people get confused about their role and there can be blurred lines about responsibiliut
disadvantage of primary nursing
improper implementation: an inadequately prepared or incompetent primary nurse may be incapable of coordinating a multidisciplinary team or identifying complex patient needs and condition changes nurse may be uncomfortable in this role or initially lack the experience and skills necessary for the role difficult to recruit and retain enough RNs for this role
medical home
improve access to care designed around patient needs and aims to improve access to care and increased communication between providers and patients
motivational tools
incentives and recognition
induction
includes all activities that educate the new employee about the organization and employment and personnel policies and procedures hospital orientation, same for everyone regardless of position
360 degree evaluation
includes an assessment by all individuals within the sphere of influence of the individual being appraised
follower
just accepts and listens and goes with the flow
inactivism/inactivists
keep with the status quo as the stable environment, maintain conformity, they spend a great deal of energy preventing change and maintaining conformity
biggest factor for resistance
lack of trust between employee and manager or employee and the organization
cooperating/accommodating
one party pursues what it wants regardless of cost to sone part sacrifices beliefs and wants in order for the other party to win
coaching
one person helping another to achieve an optimal level of performance tool for empowering subordinates, changing behavior, and developing a cohesive team emphasis on assisting the employee to recognize greater options, to clarify statements, and to grow
top managers
organization philosophy and determining needs to change it
too little conflict
organizational stasis
role change
organizations often fail to address socialization problems taht occur in job, position, or status changes
structured interviews
panel interviews interview with the same interviewers with all applicants, have better inter-rater reliability interviewer does 50-60% of the talking
types of change
planned change or accidental change (change by drift)
management functions
planning: determining the goals, policies, determining course of action that occurs organizing: establishing the structure in which you will carry out the plan/actions staffing: recruiting, interviewing, hiring, orienting, and team building directing: delegation, communicating, facilitating, HR roles, discipline, firing controlling: quality control and fiscal accountability
policies
plans reduced to statements or instructions that direct organization sin their desired decision making guide organizatioinal activities
procedures
plans that establish customary or acceptable ways of accomplishing a specific task and delineate a sequence of steps of required action
Centers for Medicare and Medicaid Services (CMS)
plays an active role in setting standards for and measuring quality in health care, government based insurance and goverment money, Medicare Quality Initiative/Hospital Quality Initiative (HQI) stopped paying for preventable complications due to a problem with quality of care pay for performance, perform well get higher amounts of reimbursements
sentinel events are the result of ____
poor communication
conflict aftermath
positive or negative outcome based on actions taken in manifest conflict
recognition
positive reinforcement must be specific or relevant to a particular performance positive reinforcement must occur as close to the event as possible reinforcement of new behaviors should be continuous
standard
predetermined baseline condition or level of excellence that constitutes a model to be followed and practiced guide individual practitioners in performing safe and effective care measurable, realistic, attainable, predetermined, established by authority, communicated, accepted by people who will be affected by them
Diagnosis-related groups (DRGs)
predetermined payment schedules that reflect historical costs for the treatment of specific patient conditions hospitals join the prospective payment system (PPS) whereby they receive a specified amount for each Medicare patient's admission, regardless of actual cost of care
forecasting
predict current staffing based on forecasting and historical patters problem with this: novice manager doesn't have enough experience to sue this appropriately, typically underestimate this
turnover
some is normal and desirable infuses the organization with fresh ideas and reduces the probability of groupthink excessive or unnecessary turnover reduces the ability of the organization to produce its end-product and is expensive
staffing turnover
some turnover is normal and good: it infuses the organization with fresh ideas and reduces the probability of groupthink excessive or unnecessary amounts reduce the ability of the organization to produce its end-product and is expensive
factors affecting communication
space, gender (women are more relationship oriented and more collaborative, men tend to do well with precision but more competitive with communication), power and status (workers need to feel they are of value and there is open communication)
individual orientation to each department
specific departments are responsible for developing their own orientation program paired with preceptor and learning unit rules and organizations and policies
pattern scheduling
staff commit to work a set number of shift types in a given time frame at the end of the time period, the pattern repeats can include permanent shifts, block shifts, and rotating shifts
preference scheduling
staff define their preference for shift type, days of the week, and unit defined rules can override preferences
relationship bw staffing and quality of care
staffing mix, staffing ratios, numbers of staff
centralized staffing
staffing schedules are made by personnel in central office like staffing clerks, managers don't do the schedules
zero-based budgeting
start with $0 and with each line item you have to justify why you need it benefit: contain cost disadvantage: lot of work most healthcare institutions use this
components of directing/coordinating/activating
the "doing" phase of management -creating a motivating climate -establishing organizational communication -managing conflict -facilitating collaboration -negotiating, working with unions -complying with employment laws -managing and setting plans into action
emotional intelligence
the ability to use emotions effectively and is required by leaders/managers in order to enhance their success critical for building a cooperative and effective team
sanctions
the bestowing of rewards and punishments rarely carried out on a systematic and planned basis used to show employees what behavior is rewarded or eschewed in an organization BRAVO and daisy awards
refreezing
the change agent assists in stabilizing the system change so that it becomes integrated into the status quo
unfreezing
the change agent convinces members of the group to change or guilt, anxiety, or concern are elicited individual becomes aware that a change needs to be made
movement
the change agent identifies, plans, and implements appropriate strategies, ensuring that driving forces (facilitators) exceed restraining forces
hidden agendas
the covert intention of the negotiation
formal organizational structure
the emphasis is on organizational positions and formal power provides a framework for defining managerial authority, responsibility, and accountability organizational charts, know who reports to who, framework for defining managerial authority, responsibility, and accountability
informal organizational structure
the focus in on the employees, their relationships, and the informal power that is inherent within those relationships has its own leaders and communication channel (grapevine) focus on employees and their relationships amongst the unity and informal power in those relationships
motivation
the force within the individual that influences or directs behavior
conflict
the internal and external discord that occurs as a result of differences in ideas, values, or beliefs of two or more people is natural and neither positive or negative created when there are differences in economic and professional values and when there is competition among professionals some level is desirable because that is how to produce change
group norms
the manager should know what they are and be observant of the sanctions used by the group to make newcomers conform the manager should take appropriate intervention if group norms are not art of the organizational culture
critical thinking
the mental process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and evaluating information to reach an answer or conclusion self reflection and higher level personal thinking
employee empowerment
the process of allowing employees to have input and control over their work and the ability to openly share suggestions and ideas about their work and the organization as a whole
organizational culture
the values and behaviors that contribute to the unique social and psychological environment of an organization a sum total of values, language, past history of "sacred cows", formal and informal communication networks, and the rituals of an organization may include unwritten rules
nurses must advocate for ___, ___, ___, and ____
themselves, clients, subordinates, and their profession
preparation
there is intent to make a change in the near future
capital budget
things that go to hospital committees for approval, ie expensive equipment
mediation
third party, not legally binding, taking the personaal aspect out since they don't take sides
staffing
third phase of the management process leader-manager recruits, selects, orients, and promotes personnel develoment to accomplish the goals of an organization important because organizations are labor intensive
disadvantage of functional nursing
this results in fragmentation of care and lack of accountability by the team member, possibility of overlooking patient priority needs
stakeholders
those entities in an organization's environment that play a role in the organization's health and performance, or that are affected by the organization internal: relationships with each other (lab, nurse/physician), people who work there, external: community, patients, those who reach out for your services, education outreach every organization should be viewed as being part of a greater community of stakeholders
weaknesses
those internal attributes that challenge an organization in achieving its objectives
strengths
those internal attributes that help an organization to achieve its objectives
strategic planning
typically examines an organization's purpose, mission, philosophy, and goals in the context of its external environment complex plan are long-range or strategic plans planning has many dimensions, including time span and complexity of comprehensiveness
nurse managers
unit philosophy, determining mission, goals, and objectives
role of team leader in team nursing
updating nursing care plans, resolve issues team members bring up, conducting nursing care conferences
payoff tables
use cost and profit, looking at volume relationships ie. getting something disposable vs non disposable
normative-reeducative strategies
use group norms and peer pressure to socialize and influence people so that change will occur
PERT
used by the navy, predicts when events and activities must take place in order for a final result to occur, see in manufacturing a lot
vision statements
used to describe future goals or aims of an organization, description in words that conjures a picture of what they want to accomplish together organization will never be greater than the vision that guides it
performance appraisals
used to determine how well employees are performing their job measures actual behavior and not intent can be positive when accurate and appropriate appraisal assessments are performed highly charged and emotional for employees basically giving them feedback
rational-empirical strategies
used when there is little anticipated resistance to the change or whe when given informationn the change is perceived as reasonable give current research as evidence to support the change, resistance is assumed to come from lack of knowledge and that resistance will go away
critical indicator PCS
uses broad indicators such as bathing, diet, intravenous fluids and medications, and positioning to categorize patient care activities.
staffing by acuity
using a patient classification system -groupings of patients according to specific characteristics -hours of nursing care assigned for each patient classification -unique to a specific institution -ongoing review critical -internal or external forces affecting unit influence classification system
ombudsperson
usually hold official title in an organization investigate grievances filed ensure the individuals understand their rights within the process
qualities of change agents
visionary, risk taker, flexible, excellent communicator, creative, sensitive, current
nurse navigators
walk people through what will happen over the course of their stay/ treatment, help them navigate it from diagnosis to end of treatment giving information and support
recognition seekers
want attention on themselves
compromiser
yields their position
accountability
you are morally responsible for the consequences of your actions moral responsibility that accompanies a position
responsibility
you are taking on that duty or action related to job assignment and must be accompanied by enough authority to accomplish the assigned task
knowledge of results
you will learn faster when you are aware of the results of your learning
authority
your official power official power to act and direct the work of others
Phases of Employee Indoctrination
• Induction • Orientation • Individual orientation to each department
magnet hospitals
•Well-qualified nurse executives in a decentralized environment, with organizational structures that emphasize open, participatory management •Autonomous, self-managing, self-governing climates that allow nurses to fully practice their clinical expertise, flexible staffing, adequate staffing ratios, and clinical career opportunities •A professional practice culture in all aspects of nursing care •Compliance with standards in the ANA's Scope and Standards for Nurse Administrators patient ratios or evidenced based, clinical ladder to grow and develop and get education and participate in research, successfully recruit and retain nurses
