Leadership Quiz 1
o In delegation, as nurses we
Are personally responsible for prudent action Are expected to delegate within acceptable standards Can be held liable if we fail to delegate and supervise within acceptable standards
We're moving into a healthcare world of portable services and we're working in an environment that is now primarily being driven by research and evidence that will take us into
Genotherapy Biochemotherapy Pharmacotherapy Technotherapy o And all of these are breaking apart our attachment to the "residency of care" (inpatient care) that was once the foundation of nursing practice
• Discuss six important concepts the nurse graduate will "need to know now"
New employees are expected to be competent followers and self-managers (p 5) Develop trust early with your teammates and the clinical manager/director (p 5) Followership employs the same level of knowledge, skills, and abilities as required of leaders and managers, but is the acceptance of leading and managing for the benefit or organizational and team cohesion Organization and organizational functioning clinical care is delivered in these settings and with interdisciplinary teams Make decisions and then take action. Without action, no leadership or management has occurred Social networking creates web of relationships and resources needed for effective leading and managing
• Documentation requirements*:
- Accuracy - Authentication - Thorough, timely
• Technology advantages
- Decrease errors - Increase access to timely assessment data - Automatic updates to pt record - Decreases forgetting to document important information - Greater accuracy and completeness of documentation - Improved discharge planning and teaching - Eliminate redundant charting - Facilitate effective shift reports/hand-offs - Format data to meet government and insurance requirements
Identify key functions of the Charge Nurse (patient care coordinator)
- Ensure appropriate staffing/patient assignments - Ensure quality patient care - Pt flow/bed management - Crisis management - Demonstrate leadership and professionalism
Key nurse manager functions
- Identify and communicate unit goals/objectives - Assess/evaluate care/operations - Promote teamwork and develop staff - Plan for work assignment - Evaluate staff performance - Actively manage "professional self"
Identify The Joint Commission standards for information management
- Improve pt care processes and outcomes - Improve operational processes and outcomes - Organizations must have a plan to ensure privacy, security, confidentiality, and integrity of pt data
Discuss the relationship between The Joint Commission National Patient Safety Goals and the overall quality of care
- Patient safety/safety of care defined as "freedom from accidental injury" o Is a property of system of care o Ensure that well-designed processes of care prevent, recognize, and quickly recover from errors so that pts are not harmed - HCAHPs= national survey about pt satisfaction o Results used to compare hospitals based on 10 important hospital quality topics
3 leadership qualities that will promote safe, effective delegation
1. Clear direction 2. Respect and support 3. Ongoing communication
Using a Delegation Framework, identify two common failures of RN's who delegate care
1. Direction 2. Follow-through
• 6 Rights of Medication Administration (DDDRPT)
1. Drug 2. Dose 3. Documentation 4. Route 5. Patient 6. Time
, identify two key recommendations for safe delegation
1. Properly qualified 2. Properly identified
5 rights of task
1. Right task 2. Right circumstances 3. Right person 4. Right information communicated (right direction and communication) 5. Right supervision (right supervision and evaluation)
• Assignment (2 meanings)
1. Work every individual is responsible to accomplish in a designated work period 2. Transference of both responsibility and accountability among RNS
o What is complexity compression?
It is the phenomenon that nurses experience when they are expected to assume additional, unplanned responsibilities while simultaneously conducting their multiple responsibilities in a condensed time frame
delegation authority is derived from
Nurse Practice Acts, institutional policies, and position descriptions
the 6th characteristic of effective team?
People are free in expressing their feelings as well as their ideas.
• Negative Outcomes of Delegation
Research suggests that negative patient outcomes seem more related to delegation situations in which the nurse is less experienced in practice and the delegatee is less experienced in a specific work setting
The group has taken time to explicitly discuss group process -- how the group will function to achieve its objectives. The group has a clear, explicit, and mutually agreed-upon approach: mechanics, norms, expectations, rules, etc. Frequently, it will stop to examine how well it is doing or what may be interfering with its operation. Whatever the problem may be, it gets open discussion and a solution found.
The group is self conscious about its own operations: characteristic of effective teams
RN does NOT abandon pt or _________for pt care. RN must complete critical analysis, using nursing process, to determine if actions taken in a situation were appropriate, and if not, what occurred and why.
accountability
must be able to explain actions and results. determines if the actions were appropriate and provides a detailed explanation of what occurred
accountability
o Marginally acceptable performance o Enough real life situations to identify recurring, meaningful situational components Can build on experience o Principles to guide actions begin to be formed. Principles are based on experience o Time: practice in similar/same clinical area 1-2 yrs (new grad @ first job)
advanced beginner
Discuss the role informatics (information technology/systems) can play in healthcare quality and efficiency
advancing patient safety to improve OR obstruct work performance, communication, documentation organized, legible and alerts can signal critical findings and remind the nurse of key interventions
• Work to be accomplished in a designated period (example: care assignment from charge nurse, transfer of care from one RN to another) • Assignment may be patient care, learning activities, leadership activities (QI, standards, scheduling, etc.)
assignment or work
ability to perform duties in a specific role
authority
: equipment for dx, physiologic monitoring, testing, or administering therapies to pts; technology supplements but does NOT replace skilled observation, assessment, and evaluation of the pt
biomedical diagnositics
extension of wireless technology that enables hands-free communication among mobile hospital workers; speech recognition; TELEHEALTH (provide healthcare to pts at a distance and transmits information to provide care, enable distance learning - virtual classrooms)
communication technology
o See both immediate needs and how the plan will move the pt toward long-term goals o Engage in considerable conscious, abstract, analytic thought around patient problem helps achieve efficiency/organization o Feeling of mastery, manages contingencies, may lack speed and flexibility o Not yet enough experience to always see overall picture or identify which aspects are more important o Time: practice in similar/same clinical area 2-3 yrs
competent
The criticism has a constructive flavor -- oriented toward removing an obstacle that faces the group.
criticism is frequent, frank and relatively comfortable: characteristic of effective team
The transfer of responsibility for the performance of a task from one individual to another while retaining accountability for the outcome
delegation
an art and skill of professional nursing; complex decision-making strategy implemented to improve the work-related performance of the staff employed in health care organizations; learning how to distribute work appropriately; used appropriately can lead to improved pt outcomes; most effective professional management strategy to improve safety and quality of pt care.
delegation
• Work to be accomplished in a designated period (RN delegates care to LPN or UNP; responsibility for the care is transferred, but accountability is retained by the RN)
delegation of work
o New graduate residency o New employee orientation (standardized at organizational level) o Unit orientation (individualized)
developement and retention
acceptance of work occurs passively or actively; 2 people in mutual work situation where one has accountability and the other has authority to perform specific tasks; critical component is authority and the delegated task must comply with the law, state nurse practice act, and/or educational preparation/certification of the individual
direction
meeting or exceeding the expectations of other group members. Each individual is respectful of the mechanics of the group: arriving on time, coming to meetings prepared, completing agreed upon tasks on time, etc. When action is taken, clear assignments are made (who-what-when) and willingly accepted and completed by each group member.
each individual carries his or her own weight: characteristic of effective team
o No longer relies entirely on analytic principle to connect understanding and appropriate action o Intuitive grasp of each situation and zeros in on important aspects of the problem Don't waste time/resources on alternative diagnoses/solutions o Operates from deep understanding of total situation o No longer consciously focused on rules and performance is fluid and highly proficient o Uses highly skilled analytic tools in novel situations & when pt outcomes are not achieved
expert
Evaluate key factors associated with the high cost of healthcare in the U.S
fee for service system unneeded treatment 16.2% of the GDP on healthcare large disparities price of goods/services increased cost of healthcare insurance
lack of clear/concise directions; failure to report results and findings; RNs knowledge of delegatee's qualifications and experience is crucial for safe and successful delegation
follow through
excite, eager, high expectations, anxiety about performance. Lots of questions. Develop structure, roles, establish rules
forming
Team norms are used for?
guide team member behavior assess how members are interacting enable team members to call each other out on any behavior that is dysfunctional or that is negatively impacting the success of the team
2014 patient safety goals
identify patients correctly improve staff communication use meds safely use alarms safely prevent infection indentify patient safety risks prevent mistakes in surgery
science that combines a domain science, computer science, information science, and cognitive science - combines nursing knowledge and skills with computer expertise; improve decision-making - Important for new grads due to federal push to adopt electronic health records - Focuses on care of pts rather than on specific discipline; requires interdisciplinary collaboration
informatics
occurs when pt health status changes rapidly and specific info loses its value or becomes irrelevant to the pt's condition (ex: rapid change in VS that when reported is decayed or incomplete → poor clinical judgements and adverse effects on pt care
information decay
assesses quality, meaning, and clarity of information; consider that culture, edu, and experience shape meaning of information...salience of info that is shared must be clearly understood
information salience
: recording, processing, and using data and information to deliver and document pt care
information technology
expert systems to help clinicians make decisions about pt care
knowledge technology
is the ability of an individual to influence the behavior of others
leadership
• is about coping with change • The business world has become competitive and volatile with faster technologic change and more intense competition • Survival requires change that is responsive to the needs of all stakeholders • INFLUENCE OTHERS • An activity
leadership
ability to transfer selected nursing activities in a given situation to a competent individual; RN retains accountability for ensuring that the task is completed by the right person and that person is supervised appropriately (supervision = provision of guidance and oversight of delegated nursing tasks)
legal authority
generic function that includes focusing on completing the work that must get done; must self-manage and manage others
management
is getting work done through others
management
• is about coping with complexity • Large, complex organizations can become chaotic in ways that threaten their very existence • Good _____brings order, consistency to key dimensions like quality, profitability • Position/authority
management
o ULTIMATE GOAL OF DELEGATION:
maximizing pt care outcomes
set of standards defined by Medicare and Medicaid HER Incentive Programs that governs the use of EHRs and allows eligible providers and hospitals to earn incentive payments by meeting specific criteria - GOAL: promote implementation and effective use of EHRs to improve healthcare in the US - Benefits: complete and accurate info, better access to info, patient empowerment
meaningful use
However, those who disagree with the general agreement of the group do not keep their opposition private and let an apparent consensus mask their disagreement. The group does not accept a simple majority as a proper basis for action.
most decisions are made at a point where there is a general agreement: characteristic of effective team
comfortable, incr. acceptance, true team, resolve problems, frequent communication, shift energy to reaching team goals, incr. productivity, evaluate process and production
norming
o No experience o Use rules to help themselves perform o Rules are context-free and applied universally o Rule-governed behavior is extremely limited, inflexible o "just tell me what to do and I'll do it" o Time: none to graduation (NURSING STUDENT)
novice
• Challenge of Delegation
o Complex, convoluted, work-enhancing strategy o Used properly, it can enhance the effect the RN has on patient care o Used improperly, it can increase anxiety and put patient safety and the RN's license at risk o When performed skillfully, delegation is one of the most effective professional management strategies an RN can use o The American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN) created a joint statement on delegation to guide nurses in this practice (Joint Statement, 2009)
• A 2nd Chapter focuses on the patient medical record and includes:
o Components of a complete medical record o Documentation requirements* o Standards for auditing and retaining records
• Delegatee Factors to Consider
o Education, training, and experience o Knowledge and skill to perform the task o Level of critical thinking required to perform the task o Ability to communicate with others about the task o Demonstrated competence o The delegatee's culture o Agency policies and procedures o Legislation (state nurse practice acts)
• Emerging Realities
o Hospitals are slowly but inexorably being nudged out of the center of the future of healthcare delivery o Healthcare delivery must become fluid, efficient, fast and effective in a highly mobile context (hospital leadership will be dismantling much of the infrastructure they spent their careers building) o Nursing activity is moving toward information-based technologies that inform, empower & actualize the consumer o Health service organizations are moving away from medical diagnostic categories of health service to more population-based models of service—change is rampant o Healthcare outcomes are becoming more transparent—publicly reported data, outcomes-based reimbursement o We must anticipate needed change to keep up with the needs of the marketplace o Nurses must now "mature" their practices into true professional roles
standards for information management: goals of information mgmt. are to:
o Improve pt. care processes and outcomes o Improve operational processes and outcomes o Organizations must have a plan for continuity of care should IT systems fail or be disrupted (backup plan) o Organizations must have a plan to ensure privacy, security, confidentiality and integrity of patient data and information
consistent elements of delegation
o Involves at least 2 people o Work is at issue o There is a transfer of authority o There remains a responsibility to perform the work
Discuss what "the evidence" tells us about the kind of organizational structure that is needed to create change
o Leaders are known for actions NOT titles o Top-down NOT sustainable for change creation, must be complemented with change led from the bottom up o Change can originate at any point and is effective when supported by webs of interested and committed individuals o Every voice counts o Power equally distributed among all of the stakeholders
- Technology disadvantages
o Must be mindful of risks and preventable adverse events that implementation can create o Can have negative impact on pt safety if improperly used or implemented, failure to "fit" organization needs o Relying too heavily on health info tech can reduce teamwork and communication...STILL NEED PERSONAL COMMUNICATION
• Task Factors to Consider Before Delegating
o Predictability of outcome o Potential for harm o Complexity of care o Need for problem solving and innovation o Level of intervention with the patient
• Ethical Considerations When Delegating and Assessing
o Recognize limitations and use available information and resources to make best possible delegation decisions. o Responsibility that patients receive safe , effective nursing care remains with the RN o Nurses must follow ANA code of standards in delegating and assigning tasks
• Specific Supervision After Delegation
o Task completed on schedule o Task performed at a satisfactory level o Additional or unexpected findings recorded and reported o Assistance needed to complete task in timely manner o Assignment re-evaluated for needed change
team norm essentials
o Team members as coworkers o Team member communication o Team member interaction in meetings o Team organization and function o Team communication with other employees including managers o Team problem solving, conflict resolution, and decision making:
- Impact of clinical information systems
o access to pt info o clinical decision support that can reduce errors and inefficiencies o organized, legible info (especially meds!) o complete allergy info o alerts to critical information and test results o nursing reminders (often linked to "best practices) o improved communication across clinicians, safer hand-offs o documentation efficiency and decrease in redundant documentation o decreased med errors o bar code technology (helps with 6 rights of med administration)
goals of joint commision
obtain, manage, and use info to improve pt care processes and pt outcomes, as well as to improve other organizational processes; improve continuity of care; ensure privacy, security, confidentiality, and integrity of data and info
o Empowerment, autonomy, and accountability are closely linked o Managers must encourage staff to employ the freedom of making decisions while retaining accountability for the consequences of those decisions o Shared governance= dynamic staff-leader partnership that promotes collaboration, shared decision making and accountability for improving quality of care, safety, and enhancing work life
ongoing staff development and empowerment
satisfaction, share insight, confident in team's abilities, can prevent/solve problems, roles may be more fluid, significant progress towards goals, measure & celebrate team progress
performing
cannot be delegated."
pervasive functions of assessment, planning, evaluation, and nursing judgement
Leading contributors to cost:
price inflation administrative insufficiency increased utilization inappropriate or ineffective medical procedures cultural attitudes changing in population demographics
o Perceives situations as whole rather than in terms of parts or aspects (see long-term) o Performance guided by maxims (standards/evidence) Modify care based on nuances o Knows what to expect in given situations and how plans need to be modified in response o Recognize when expected normal picture does NOT happen, improving decision making
proficient
o Decision to delegate is based on several factors
pt condition, task complexity, predictable outcomes
reliability, dependability & obligation to accomplish work at an acceptable level and to inform RN of any limitations
responsibility
• Delegator discusses with delegatee the tasks to be completed and transfers
responsibility and authority
Employee life cycle
select, develop, and retain nursing staff
o HR prescreens all applicants for qualifications and "fit" o Interview best applicants
select: employee life cycle
frustration, anger, concerns about meeting goals, anxiety about differences and conflicts, disagreements, frustrations about slow progress, arguments and criticism, refocus on goals, develop task-mgmt skills
storming
are a set of rules or guidelines that a team establishes to shape the interaction of team members with each other and with employees who are external to the team. Can be developed during an early team meeting. More norms can be added as the team sees the need for additional guidelines
team norms
what strategy does the delegator use to interact with a delegatee?
the RN gauges needed guidance and support based upon knowledge/abilities and willingness of the individual
There are no obvious tensions, a working atmosphere in which people are involved and interested.
the atmosphere tends to be informal, comfortable, relaxed: characteristic of effective team
for itself and has translated these performance goals into well-defined concrete milestones against which it measures itself. The group defines and achieves a continuous series of "small wins" along the way to larger goals.
the group has set clear and demanding performance goals: characteristic of effective teams
The issue is not who controls, but how to get the job done.
the leadership of the group shifts from time to time: characteristic of effective team
There was free discussion of the objectives until members could commit themselves to them; the objectives are meaningful to each group member.
there is a clear unity of purpose: characteristic of effective team
Disagreements are not suppressed or overridden by premature group action. The reasons are carefully examined, and the group seeks to resolve them rather than dominate the dissenter. Dissenters are not trying to dominate the group; they have a genuine difference of opinion. If there are basic disagreements that cannot be resolved, the group figures out a way to live with them without letting them block its efforts.
there is a disagreement and this is viewed as good. characteristic of effective teams
but it remains pertinent to the purpose of the group. If discussion gets off track, someone will bring it back in short order. The members listen to each other. Every idea is given a hearing. People are not afraid of being foolish by putting forth a creative thought even if it seems extreme.
there is a lot of discussion in which virtually everyone participates: characteristic of effective team
Communication must be
timely, meaningful, understood, and effective; considering context and cultural competencies
Identify characteristics of high performing teams
• Hold shared mental models • Have clear roles and responsibilities • Have clear, valued, and shared vision • Optimize resources • Have strong team leadership • Engage in a regular discipline of feedback • Develop a strong sense of collective trust and confidence • Create mechanisms to cooperate and coordinate • Manage and optimize performance outcomes
said that a river without banks is a pond. Likewise, a team without relationship norms leaves itself open to potential interpersonal problems.
• Ken Blanchard, of One Minute Manager
Identify the personal attributes needed to lead, manage and
• Motivating self (focusing on goals, delaying gratification) • Being empathetic (valuing differences, showing sensitivity) • Managing self (recognition of context and owning feelings) • Handling relationships (social appropriateness, using social skills to help others manage emotions)
Discuss the importance of team members having "a shared mental model" in successful completion of the N460 QI Project
• The perception of, understanding of, or knowledge about a situation or process that is shared among team members through communication. • "Teams that perform well hold shared mental models
Identify strategies used in the healthcare marketplace to manage the decline in third party reimbursement (how do clinics, hospitals and physicians make up for decreases in reimbursement?)
• maximizing scheduling and the method of caring for pts (functional/task, case etc) and streamlining pt care through critical pathways • cost-conscious nursing practice - knowing how to schedule, code, pre-authorize, capture max. reimbursement, informing pts of costs, be efficient w/ time • decr. readmission rate • decr. hospital acquired infections • Less expensive care options (functional nursing, team nursing, case management using clinical pathways, utilization reviews) o Think: UNP and LPN are cheaper than all RNs (case method=$$$$$$) • Well-coordinated collaboration across professions has the potential to allow comprehensive, population-based, cost-effective patient care and a new emphasis on health promotion and disease prevention, which will be essential in meeting contemporary health care challenges (Baldwin, 1994; Grant et al., 1995; Tresolini et al., 1995). INTERPRFESSIONAL! • TCAB: patient-centered care, collaboration, reduce waste/inefficiencies decreased cost
