Management Exam 1
moving
*lewins change theory* occurs after recruitments of individuals who will take on the responsibility to make the change
interview dont's
-Argue or contradict the interviewer -Chew gum -Wear uncomfortable footwear or have wrinkled clothing
primary nursing disadvantages
-Primary nurse must practice with a high degree of responsibility and autonomy -RN must accept 24-hour responsibility -More RNs needed so is not cost-effective
Primary Nursing Model
-RN as the "primary nurse' assumes 24-hour responsibility for planning, directing and evaluating care -Evolved in the 1970s to improve RN autonomy -Commonly used in hospice, home health and long-term care settings (patients not as critical)
team nursing advantage
-High-quality, comprehensive care with a high proportion of ancillary staff -Team members participate in decision making and contribute their own expertise -decrease costs due to using people within their scope of practice
Prepare yourself for an interview
-Have your schedule ready when you receive a call to schedule -Questions? Have them handy too -Ask for help- get feedback from friends and family re: appearance, dress, responses, and body language -Rehearse possible interview questions ~~~Tell me about a time when... ~~~What are your strengths and weaknesses? ~~~What are your future career plans and goals?
Storming
-Individual differences and beliefs surface Small groups may form within the team -Leader should expect to be challenged by the members and should focus is on the problem and not the members on the team -Behaviors: may have arguing, defensiveness and competition, may question the wisdom of the leader, or may establish unrealistic goals -Feelings: members may feel resistance to new or different approaches or may feel sharp fluctuations in attitude
Phases of the interview (fact finding)
-Interviewer is looking to see if you would be a good "fit" -Be able to speak to the mission and culture -You will be talking a lot here-slow down and take deep breaths
Who initiates change and why? (Lewins change theory)
-Is this management? Is this the patient (consumer)? Is this the nurse? Is this the healthcare provider? -Need to realize that the most common reason for change is that what the 'system' has done in the past is no longer effective or efficient. -Changes will occur when there are new regulations by those agencies who license or accredit the organization (corporate compliance, HIPAA, core measures, quality indicators, etc)
Communicating with supervisor/superior
-Keep them informed about any potential or upcoming issues, what is going on? -If a problem starts to develop, make an appointment and discuss it with them. Come prepared to focus on ways to revolve the problem. -Choose words carefully. Avoid blaming others, exaggerating, and using overly dramatic expressions -Do not talk to your supervisor when you are angry. Be prepared to discuss your frustrations in a respectful and professional manner. -Accept feedback, and learn from it through self-reflection. -Never go above the chain of command. Always communicate with your supervisor first before "going up the chain". -Keep your conversations private and avoid gossiping.
Resume (5. extras - honors, etc.)
-Licensure, Professional Organizations, and Honors & Awards-Optional a. Include Outstanding Student, President's List, Dean's List and other recognition such as holding offices in Nursing Club, volunteer work, knowing sign language, fluency in another language, study abroad in another country, etc
Non-verbal communication
-Make eye contact -Stand/Sit up straight with shoulders back -Use an assertive voice without pauses, which suggests confidence -Watch for distracting behaviors
Norming
-Members are settling in and the work is getting done -Leader should clarify roles and responsibilities again at this stage, keep those on task to create a good outcome -Behaviors: members attempt to achieve harmony, friendliness and team cohesion occurs; members continue to establish and maintain team ground rules -Feelings: members have the ability to express criticism constructively; acceptance of membership in the group and relief
Total Patient Care Model
-Nurse is responsible for planning, organizing & performing all care -Oldest method of organizing patient care -Typically performed by nursing students -Commonly used in ICU/PACU/OB units (high acuity)
Nurse v. patient conflict
-Nurse's goal for care of the patient is different from the goal the patient has for their own care -May be a cultural, ethnic, spiritual, educational, socioeconomic, physical, mental, etc -Could be related to the quality of care, staff inconsistency, family involvement, treatment decision, etc -work with patient to understand goal of family
Where to look for a job?
-Online searches -Applications such as Linked In, Handshake, etc. -Job Fairs/Open Houses -Family/Friends
patient focused care advantages
-Patient comes into contact with fewer workers -Workers are unit based; spend more time in direct-care activities -Team is supervised by a RN -RN is accountable for a wide range of services and functions at a higher level -Is cost-effective
Phase of the interview (closing)
-Potential Tour of unit -Interviewer may offer details about benefits and compensation -Information about the next step in the hiring process -Final Questions and THANK interviewer
Benefits for a job
-Shift, holiday, and weekend differentials -Sign-on bonus? What are the requirements to receive it? (if any) -Holiday, weekend, and night rotations; rotating shifts -Vacation time (how much, accruing? talk about it) -Tuition reimbursement (requirements, amount of $) -Health, dental, and life insurance -Sick or short-term disability (upcoming surgery, maternity leave) -Retirement plans (401K, do they match? vesting?) -Health Savings Accounts (HSA) or Flex-spending Accounts
Resume Basics
-Should be neat and visually appealing -clear, concise snapshot of what you have to offer as it relates to the position -Watch templates and formatting-no all will convert nicely in electronic format -Avoid using "I" or "me" in your resume -Do not exaggerate what you can and cannot do -1 page ONLY -goal is to get an interview
functional nursing model
-Staff members assigned to complete specific tasks for a group of patients (expert at that task) -Evolved during WW II as a result of the nursing shortage -Unskilled workers trained to perform routine, simple tasks -Commonly used in the surgery
Importance of 1st Nursing Job
-Take time to create a career path or plan -Will influence who you are, your career trajectory, and your care -Be informed! -> educate yourself! -Right fit= High fulfillment and satisfaction= Low burnout and dissatisfaction
Research the Employer, How do I know that the organization will be a good fit?
-Talk to PEOPLE! - Colleagues, patients, family, etc -Do your research-Go to their website and take a look at their Mission and Philosophy Statements -what is their culture? their reputation? is staff happy on the unit?
Nurse v. Doctor/provider conflict
-Treatment decisions, communication differences, etc. -how should the patient be treated?
What does shared governance look like?
-Was introduced to improve nurses' work environment, satisfaction, and retention -Provides the structure and context to organize the delivery of care. -May be called "self-governance" or "decentralization of management" or "participative decision-making" -Basically...RNs have an active role in the decision making within the organization -High involvement in councils, committees, and task forces to create positive change
How Do Facilities/Units Decide on the Appropriate Delivery Model (focus on quality care and patient outcomes)
-What care delivery model is the best 'fit' for the patient population served? -How much care do the patients need? How likely is the patient's condition to change?
Interprofessional Practice
-Working across disciplines (Pharmacist, OT, PT, LPN, Dietitian, Provider, Supervisor all involved in patient care decisions) -Cross-functional teams of professionals and UAPs working together is key to patient-focused care while being a patient advocate -This approach functions at a higher level and is cost-effective care -Utilizes clinical pathways -Supervised by an RN -Focus on quality and efficiency - Are there Quality Improvement (QI) processes in place?
Managed Care (HMO)
-an annual payment is made on behalf of the members to a group of providers to deliver all services under the plan PROS: -better on cost savings -lower premiums -low or no deductible CONS: -not flexible (esp when on vacay) -PCP referral needed to see a specialist -must use provider within specified network -limited choice of provider
compromise
MODIFIED WIN-LOSE doesn't have opinions about the situation, takes a 'middle of the road' position and works by giving and taking by all involved in the situation, will seldom confront the conflict that is occurring
Resume (1. demographics)
Name, address, phone number, email address; NO-SSN#, Marital status, or picture
Resume (2. personal objective - optional)
Includes: -The specific position you are applying for -Reflects how you can fit the needs of the organization -Relates to the mission/values of the organization Example template: "[strong descriptor + professional title] seeking a position at [organization] where they can expand [goals for working with organization] and use [relevant experience, hard and/or soft skills] to help patients." Example of entry level objective statement: "Thoughtful and caring registered nurse seeks position working with special needs children at [insert organization]. Utilizing an extensive educational background and internships to best help those who need it most."
avoidance
LOSE-LOSE -withdrawal from the situation, person tries to remain neutral (has no opinions), delays responding to the conflict
accomodation
LOSE-WIN -The individual has the ability to suppress and smooth over any differences of opinions, does not like conflict and will try to maintain harmony without regard for the best results
Performing
-Group members trust each other -Leader allows for flexibility with collaborative decision making -Behaviors: members demonstrate constructive self-change; they will prevent or work through group problems and have a close attachment to the team -Feelings: members show insight and understanding of the team's work and feel satisfied with their progress
Primary nursing advantages
-High-quality, holistic patient care -Establishes rapport with patient -RN feels challenged and rewarded -high responsibility, very skilled, autonomous
Problem solving steps (in order)
1. define the problem 2. gather data 3. analyze the data 4. find/identify possible solutions 5. organize the process 6. implement the solution 7. evaluate the results *THINK ADPIE*
Resume Outline
1. demographics 2. professional objective 3. education 4. professional experience 5. extras (honors, awards, deans list, etc.) 6. references (no longer needed)
When is the decision to hire made?
within the first 60 seconds -first 5 minutes are critical, be prepared
Three types of conflict within nursing
1. intrapersonal - within the individual 2. interpersonal - between 2 or more people 3. intergroup - between two or more groups of people or organizations
An RN is employed at a memory-care facility where staff provide care for 40 residents elderly residents. Bedside cares are performed by CNAs within the unit; however, the RN is responsible for 24-hours a day. What nursing delivery model does this nurse practice within? A. Team Nursing b. Total Patient Care Nusing C.Primary Nursing D. Functional Nursing
C In this model, Nurses assume 24-hour responsibility for planning, directing, and evaluating care for the patients. Locations were these models are often seen: Hospice, Home Health, and Long-Term Care
Resume (3. education)
Chronological order with most recent, list month and year of graduation and what degree you received (GPA of > 3.5) [FYI- Your degree at CVTC is- Associate of Applied Science- Nursing]
Healthcare Challenges
Cost of healthcare- Reimbursement ratios/factors Evidence-based nursing practice- always changing and making improvements towards "best practice" & decreased costs Shortage of healthcare professionals-Baby boomers, nurse burnout nationally Patient safety Nurse Staffing - is it adequate? Political-Healthcare changes depending on who is leading the state and country & cost **2018 GDP 18% on healthcare ($3.7T)
The position that you are seeking should be noted in the 2nd paragraph of your cover letter. True False
False The position, as well as the job # and where you found out about the position, should be in the 1st paragraph of your cover letter-Not the 2nd
collaboration
Focus on problem-solving, decision making, and improving outcomes
Resume (6. references)
No longer need to include "References available upon request", but make sure you have them available a. 3 professional references with names, phone numbers, and email addresses b. Ask references PRIOR to submitting
Post-Interview Process Reflection
Remember, interviewing is an art, the more you do it the better it will get-so take some time to reflect. Consider the following questions: -Jot down any notes that you have about how the interview went, esp if multiple interviews scheduled in one day -What were your strengths and weaknesses? -Any surprises? -How do you feel like you handled the situation and questions asked? -How can you improve for next time? *Common courtesy to send out thank you notes to those who interviewed you
commitment
Share a common goal to improve patient care
Conflicts of the role of the RN (personal competency gaps)
The nurse's skill level interferes with their own expectations of standards of practice for themselves
A great way to get information about a employer is through family & friends who are currently employed at the facility you are looking at. (T/F)
True! Good to get their input on how they like the job
Lewins Change Theory (work in teams to create change)
Unfreezing - consider all the factors that may cause resistance to change Moving - occurs after recruitment of individuals who will take on the responsibility to make the change Refreezing - occurs when the plan is in place and all others know what is happening and what to expect with the change
Competition
WIN-LOSE -based on power, aggressiveness and being uncooperative -however, can be appropriate in certain situations with a short-term need
collaboration resolution
WIN-WIN Individual is assertive and cooperative, can objectively evaluate different viewpoints, this is the 'problem solver' which can often lead to new ideas with creativity and an open mind
Shared Governance
is a nursing practice model designed to integrate core values and beliefs that professional practice embraces, as a means of achieving quality care
intergroup conflict
is conflict between two or more groups of people or organizations [example: there might be a conflict regarding role differentiation or conflict regarding advances in technology at the agency or conflict regarding research versus expansion of access to care]
Communication
resolves conflict, work as a team, be open to different opinions
conflict resolution
to create an environment where conflicts are dealt with in a cooperative and constructive manner rather than competitive and destructive manner
How Do Facilities/Units Decide on the Appropriate Delivery Model (patient to RN ratios)
-Are staffing levels appropriate for the acuity levels of the patient? -Is there an acuity classification system? -How the organization 'manage' short staffing for a shift? -What is the ratio of RNs to UAPs on a shift?
clinical pathways
*controlling costs* -are multidisciplinary plans of "best" practice for patients with a specific medical diagnosis -Also known as: Care maps or disease management protocols -Specifies desired outcomes and interventions from many areas including: Lab work, Imaging, etc. -Dictates the type and amount of care given to help control cost -Uses patient outcomes to drive decisions (driven by EBP) *everyone treated equally/fairly
Total patient care disadvantages
-Each RN may have a different approach to care -Not cost effective -Lack of RN availability, dependent on this
Patient focused care model
-Cross-functional teams of professionals and assistive personnel work together as a unit-based team -Recent development as one of the nursing care delivery models -More patient-oriented than department-oriented -Models vary considerably among facilities
Cover Letter Layout (1 page only)
1st Paragraph -position seeking, include job or reference # -where you found out about the job (family, friend, etc) 2nd Paragraph -states why the employer would want to select you (summary of resume) -support data from the resume 3rd Paragraph *how can the employer contact you (email, phone) -give thanks -when do you plan to follow up with the employer
Which of the following is NOT considered appropriate attire for an interview? A. Business suit or jacket b. Jeans and tennis shoes c. Clothes free of wrinkles d. Minimal or no perfume
B That is not professional dress
Which of the following is NOT a great way to start describing your responsibilities at a previous employer? a. Designed a scheduling system... b. Collaborated with distributors... c. I took care of residents who... d. Delegated tasks that...
C Remember, always start your descriptors with an ACTION WORD! What did you DO?
interpersonal conflict
is conflict between two or more individuals with different values, goals or beliefs
Nurse v. nurse conflict
**nurses have differing values towards their philosophy of nursing that interfere with teamwork Examples: -Absenteeism or frequent tardiness- having to 'cover' for another person who is always late Uncooperative or unproductive nurse- doing only the minimum expectations -Immature nurse -Clinically incompetent nurse- safety is an issue at times -Emotional problems- need to frequently discuss personal issues that interfere with the work productivity of others of the team -Chemical dependency- quality of care and safety issues for other workers and the patients on the unit -Resistance to change
Managed Care
*controlling costs* -a system of healthcare in which patients agree to visit only certain doctors and hospitals, and in which the cost of treatment is monitored by a managing company -Started after WWII, as insurance became an insurance benefit following the war -3rd party payers (ie. insurance companies) agree to pay a provider an agreed-upon fee for services -Encourages healthcare organizations to treat the patient in a way that requires a shorter length of stay than necessary in order to decrease cost and resource consumption
Case Management
*controlling costs* (work with insurance co and help decrease cost by getting the lowest level of care needed) -typically an RN role that advocates and helps navigate patients through the health care system ~coordination of care ~communication ~collaboration ~transition between levels of nursing care (ex. Being cared for at home to hospital stay to assisted-living facility)
Job Reflection
*important to reflect on the job itself* -How do benefits compare? Do they meet your needs? (insurances) -What were your impressions of the organization and unit? -Do the hours fit into your life? -Will "on-call" hours and floating be something that you will have to do? (common) -What level of orientation will you receive? (adequate onboarding, avg cost to onboard a nurse is $50k) -are people happy/welcoming, do they seem to like their job?
Unfreezing
*lewins change theory* consider all the factors that may cause resistance to change
refreezing
*lewins change theory* occurs when the plan is in place and all others know what is happening and what to expect with the change
team nursing model
*modified model of functional nursing* -RN as team leader coordinates care for a group of patients, small team works together to provide care -Evolved in the 1950s to improve patient satisfaction -Goal was to reduce fragmented care -Commonly used in most inpatient and outpatient nursing care areas
Resume (4. work experience)
*should be easy to read, chronological order with newest first* a. List employer, position held, dates of employment, and brief description of responsibilities b. Through past 7 years-All experiences are valuable c. Start each description with an ACTION word- what did you do at that job and how can it relate to your new RN role?
Forming
*team development* -Initial formation of the team -Members often do not fully trust each other LOW Productivity -Behaviors: members attempt to define the task, they attempt to determine acceptable behaviors and may offer complaints about the organization and barriers to the task -Feelings: are those of excitement, pride, tentative attachment and perhaps suspicion
Listening
*the most powerful communication tool we have. Oftentimes, we are thinking about our response even before the other person is done speaking* -Make sure you can hear what is being said -Focus your attention on what is being said -Make the decision to listen and accept the other person's needs and feelings -Pay attention to non-verbal communication -Fight off distractions -Respond positively to the feelings being communicated
Interview Do's
-Arrive early -If you are unable to make the interview or will be late, call HR ASAP -Show enthusiasm in your voice and body language-eye contact, avoiding distracting mannerisms, smiles, and handshakes -Wait to ask about salary and benefits to the end -Bring your list of questions (favorite part about working there, how can the specific organization help me succeed as an RN, improvement) -Dress conservatively and professionally! -Women-Suits or business-dress; Men-Suits or jacket and dress shirt -Minimal jewelry & perfume
What is a cover letter?
-Business formatted letter that is typically required for professional positions -Explains why are you writing (need to include the position) -Explains why you the best 'fit' for the job (in other words, why should they hire you - how you the best 'match' for their mission, philosophy and organizational culture) -Summarizes your strengths -Explains how you will follow up with the organization-is optimistic and shows that you anticipate a call
functional nursing advantages
-Care is provided economically and efficiently -Minimum number of RNs required -Tasks are completed quickly and efficiently
functional nursing disadvantages
-Care may be fragmented, nobody sees the full picture -Patient may be confused with many care providers -Caregivers feel unchallenged
team nursing disadvantage
-Continuity suffers if daily team assignments vary -Team leader must have good leadership skills -Insufficient time for planning and communication
conflicts of the role of the RN (competing role conflicts)
-conflict occurs when the nurse's time, energy and attention is 'pulled' in different directions because of various roles that the nurse is required to fulfill at one time (the nurse also plays the role of teacher, counselor, advocate, pharmacist, physical therapist, dietitian, discharge planner, social worker, etc). -As nurses are expected to take on more roles with providing holistic care, it has become very overwhelming without the needed support services -This also impacts on consistency or rather inconsistency of staff (is every nurse following the same policies, procedures, values, etc)
total patient care advantages
-high degree of autonomy -lines of responsibility and accountability are clear -patient receives holistic and seamless care
Managed Care (PPO - preferred provider organization)
-members must use physicians who have agreed to provide service at a lower price to the insurer Pros: -no need to have PCP -no referral needed -some out-of network coverage (extra cost) CONS: -higher premiums -usually have a deductible
Types of Role Conflicts
-patient v. nurse-goal differences -nurse v. nurse -doctor/provider v. nurse
case management reserved for...
-patients who have complicated healthcare needs -patients who receive care that is expensive -patients who may have discharge planning concerns -patients who are being seen by multiple providers -patients who have physical or psychosocial problem
expert power
-power based on specialized knowledge, skills ex: IV team nurses, speciality nurses
coercive power
-power by fear of consequences ex: parents - give consequences for bad behavior charge nurse - may give unfavorable assignment
referent power
-power due to desired/admired personal characteristics, may not be good -cultivate trust/admiration in a group
legitimate power
-power linked to the position -CEO, DON, charge nurse
reward power
-power to give rewards ex: supervisor may give raises (eval based on $ received)
leadership power
-power to influence others to make change -create order from conflicts, chaos and contraindication -good mentor to have
How does Magnet Status work?
-shared governance model is required -established by the American Nurses Credentialing Center (ACNN) -identifies 14 "forces of magnetism" that exemplify nursing excellence -may be a marketing tool for the organization to recruit nurses -good for employers, really value input of nursing in the hospital
patient focused care disadvantages
-sounds good in theory, but hard to make happen -Major change in organizational structure is required -Departments other than nursing must be willing to accept nursing leadership -Nurse manager supervises many different types of workers, many different professionals
Steps to Problem Solving
1. Define the problem, issue or situation - know the facts and scope of the problem 2. Gather data - must be accurate, relevant, valid and timely. How much time will it take? 3. Analyze the data - need to differentiate the problem from the 'symptoms' of the problem 4. Generate potential solutions/options - be open minded and flexible. How will we proceed? 5. Organize the process - Select a solution that will have a desirable outcome - 'weigh' the options 6. Implement the solution - be prepared with a contingency plan to deal with negative consequences. Without a 'set' plan, it won't be successful - we need set of directions. How will we implement the plan? 7. Evaluate the result - this step requires considerable time and energy, be prepared to make mistakes (learn from them) and use a systematic approach to work through the issues while minimizing potential barriers. Did we meet the goal? Whether we did or not, we still need to seek feedback from staff who were involved in the process. Any new ideas?Were there any barriers?
4 stages of Team Development
1. Forming (first step) 2. Storming (think conflict and push back) 3. Norming (think "norm" established here) 4. Performing (think high performance)
Types of Power
1. Legitimate 2. Reward 3. Coercive 4. Expert 5. Referent 6. leadership
Phases of the interview
1. break the ice (light chit-chat, IMPORTANT) 2. fact finding 3. closing
Interprofessional Practice {Instituteof Medicine 3 C's}
1. communication: resolves conflict, work as a team, be open to different opinions 2. Collaboration: Focus on problem-solving, decision making, and improving outcomes 3. commitment: Share a common goal to improve patient care
Intrapersonal conflict
is conflict within the individual; an internal struggle that involves risks to solve
Self-Assessment for Nursing Job
What are my clinical interests? What are my Likes and Dislikes? -High patient interaction or technical routine? -High autonomy or close direction and supervision? -Physical energy requirements -Shift times and how they work best for you and your family (are you willing to move?) -8 hr vs. 12 hr shifts -What do you need to be happy? (will this be a passion? Is it a good fit?) What are my personal Needs and Interests? What are my career goals?
Magnent Status
a status or recognition given to hospitals that meet criteria that measure the strength and quality of their nursing