management exam 3

are out-of-pocket expenses and includes deductibles, co-pays and co-insurance

Personal payment

this is the largest expense for a nursing unit as paying nurses accounts for roughly 50% of this expense. Consider how a nurse manager might want to 'reduce' this expense?

personnel budget

Is a major element of the forces of Magnetism (Magnet Model

transformational leadership

What is politics in nursing

· the process of influencing the allocation of scare resources · affecting what we do in healthcare through legislative changes · an area where nurses need 'a voice' about their nursing practice · a process where collectively nurses can in influence healthcare

Is a quality improvement initiative using the method of: plan-do study-act

PDSA

What does PDSA stand for

Plan-Do-Study-Act

1. What are three primary factors that are contributing to the high cost of health care?

Ø price of new technology Ø construction of new facilities Ø expansion of health care organization Ø duplication of services Ø high cost of drugs and medical equipment Ø rising salaries for healthcare workers Ø growing population of the elderly requiring increased complexity of health care Ø cost of providing care to the elderly in the nursing home or long-term care settings (this is four times greater the cost than the younger population due to multiple chronic illnesses of the elderly) Ø higher survival rates leading to greater need for more intensive care

Role of managers in quality management

-Are problem-solvers -Take a reactive approach to solving problems -Are negotiators; duller approach -Only set goals out of necessity -Systems, policies, and procedures are the bottom line; staff come second -Management is from a job title and not necessarily behavior; are told what to do

Role of a leader in quality management

-Are risk takers -Take an active approach to goal setting -Create excitement in others -Believe that trust is a major concern -Work for the organization, but never totally belong to it -A job title alone does not make a leader only a person's behavior determines this

a. Shared governance is needed in order to achieve Magnet status (pg. 334) b. Retaining highly qualified nurses c. Maintain a positive working environment

1. Magnet Status - exemplifies excellence in nursing practice

-Identify root cause of problem and confirm this with data; the theory has been tested and confirmed -These causes will form the basis for solutions to the problem

Analyze (opportunities)

Six Sigma Process for Quality Improvement

DMAIC Define Measure Analyze Design Optimize Verify

-The purpose and scope of the project; includes a clear statement of the intended improvement -List what is important to the customer (the patient)

Define

-Develop an appropriate model

Design

This is an example of... Implement a process that all RNs must use the SBAR format for communicating with other shifts and departments

Do

this is implementing the plan for improvement, altering a process to eliminate the problems and improve the quality of the product and/or service and the process by which the work is done

Do

- Implement solutions that address the root cause -These solutions should eliminate or reduce the impact of the identified root cause - Describe how the results will be evaluated

Improve (optimize performance)

1. What is the purpose of the Wisconsin Nurses Association?

It functions at the* state level, purpose and goals are with* promoting the nursing profession

theory focuses on cultural care theory. (will connect this theory again when we discuss quality improvement measures)

Madeleine Leininger

Science of Unitary Human Beings - belief is that the person and the environment are 'one thing' and can't be separated.

Martha Rogers

-Gather information on the current situation -Determine a more focused problem statement

Measure (performance)

- Federal level program - Care for the elderly > 65 years of age - End stage renal disease - ↑ numbers with the 'baby boomer' population that is aging

Medicare

This is an example of.... Hold discussion forums with nursing staff; provide information about data collection regarding errors with miscommunication and patient dissatisfaction. Problem with communication between shifts and departments regarding patient status and procedures; missing key information; recommended SBAR format; training and education implemented for all RNs.

Plan

this refers to all studies, research, planning, data collection with analysis, training and preparation that is required before one changes a system

Plan

a. Goal of improving patient safety b. Understanding Quality Improvement measures and the impact it on nursing practice c. Has 6 core competencies (Table 22.2, p. 512) d. Improving care is based on ' value', not the quantity of services

QSEN - The Quality and Safety Education for Nurses

a. incorporates shared decision making (pgs. 401-402) b. This is not nurses 'performing' management functions c. It involves nurses to make decisions related to their practice

Shared Governance

This is an example of... Survey the RNs to check on the process of giving and receiving information about patients using the SBAR format. What does the data tell you? Are they satisfied? Are there any areas still needing improvement?

Study

this is where you monitor the process to determine if the planned improvement has been successfully accomplished; you check with the customers to determine if their needs are better satisfied

Study

Nurse leaders have the obligation to find ways to deliver nursing care services within the allotted payment structure while incorporating cost-cutting strategies to stay within the nursing budget. What measure could the nurse leader implement to reduce cost (expenses) for the nursing unit that would have the greatest impact with cost containment? a. implementing a quality improvement program to improve patient satisfaction by using a 'discharge' survey to gather feedback on cost efficiency from the patient's perspective b. increasing the usage of unlicensed assistive personnel (UAPs) on each shift to perform non-RN tasks that could be delegated to them to 'free up' the RN for more complex tasks c. increasing the nurse to patient ratios on all shifts in an effort to reduce the costs associated with patient care errors d. asking the nursing staff for suggestions on how to reduce supply waste in the department

b.

Nursing licensure is granted from the State Board of Nursing. Considering the legal obligations of the Board, what are the two primary purposes for having regulations for nursing licensure? a. to renew grants for research development and mentoring for depositions when preliminary testimony is needed for a lawsuit b. to protect the public when receiving healthcare services and ensuring enforcement of the Nurse Practice Act c. to initiate disciplinary action for nurses who violate policies and mandating the State's compact licensure agreements d. to support the standards of care and implementing the National Patient Safety Goals

b.

1. Evidence-based practice refers to: a. Incorporating personal experiences into your own standard for nursing b. Consistently following the standards of practice as set by the Joint Commission c. Following the Scope of Nursing Practice as mandated by the Board of Nursing d. Utilizing research findings and outcomes as a basis for nursing practice

d

1. Qualitatively designed research studies are used to: a. synthesize data form a collection of research studies b. manipulate the independent and dependent variables to prove a point c. determine the 'cause and effect' of a problem d. explore phenomena such as 'lived' experience

d

With a concern for economic stability, the nurse manager of the Med-Tele unit along with three of the unit RNs are working on the nursing budget for the next fiscal year. Which task should they accomplish first? a. implement the same budget as last year as the new fiscal year already starts the next month and then re-evaluate the budget as needed within the first 90 days b. develop a 'draft' budget for the nursing staff to review over the next 2 months and then provide them with feedback as to concerns from the supervisor regarding cost efficiency c. evaluate all deficits form the last 3-5 years of budgets before considering what is important to include in the current budget for this year d. plan for the current needs of the nursing unit that includes the average number of patient days with the acuity levels, and most frequently admitted diagnoses before starting on the new budget

d.

This type of nurse manger is 'people oriented' and includes team members in part of the decision making process

democratic

Understanding a 'lived' experience

Phenomenology research

1. What is CMS and how does this impact on your role as a nurse?

-What is it:- Rates hospitals for 'quality' of care based on patient feedback from HCAHPS surveys (patient experience rankings and top performing hospitals) - High scores (rating of 1-5) show better quality of care and is directly tied into reimbursements in the shift we are seeing in the U.S. to value-based payments - Patient can look at these ratings and 'compare' care quality on a public website

Six steps with measuring quality

1. identify needs that are the most important to the consumer of health care services 2. assemble multidisciplinary team to review the identified consumer needs and services 3. collect data to measure the current status of these services 4. establish measurable outcomes and quality indicators 5. select and implement a plan to meet the outcomes 6. collect data to evaluate the implementation of the plan and the achievement of outcomes

WNA 5 core issues

1. workplace rights 2. appropriate staffing 3. workplace health and safety 4. continuing competence 5. patient safety and advocacy

Functions at the federal level - Includes all states in the U.S. except California Works on a variety of issues - Workplace mandatory overtime is a current issue Rights of nurses and patients - Minimum staffing levels for patient safety Recognizes excellence in the profession through Magnet status

ANA

This is an example of... SBAR report is required by all RNs when 'handing off' a patient between shifts or between departments. Is reinforced as part of the Joint Commission National Patient Safety Standards

Act

What is HCAHPS? Why is this important?

Benchmarks are part of quality improvement that are used to identify best performance* of the nurses' care based on the standards for patient care

a. uses a 'system' mode with a focus on prevention or prevention measures as a response to stress. Utilizes primary prevention (to prevent an illness such as with adequate sleep, exercise, diet, etc.). Then utilizes secondary prevention to intervene when an illness occurs

Betty Neuman

-Evaluate the solutions and the plan -Maintain the improvements by standardizing the process; outline steps for ongoing improvement -Document the results, what was learned, recommendations for future

Control (verify performance)

use DRG's in hospital settings or PPS in nursing home settings. The federal government may stop these payments if certain citations are severe enough or if the institution loses its accreditation as these are required to receive this type of health care reimbursement.

Federal government plans

o Is the Hospital Consumer Assessment of Health Plans Survey] o Is a patient survey that uses the data collected to 'compare' hospitals as to quality Areas focus on communication, responsiveness, pain management, discharge information, cleanliness of the hospital environment and quietness of the environment.

HCAHPS

theory focuses on 'caring'

Jean Watson

-is looking at quality care and how an organization 'measures up' to the standards. • Commitment from leadership • Quality defined; needs and expectations of the consumer • All employees involved; is a work process versus individual process • Quality by design (prevention) • National Patient Safety Goals - Look at improving, reducing risk, prevention - Based on evidence-based guidelines - *targets problematic areas for safety with recommendations to prevent errors • Scientific problem-solving process

Joint Commission

What is the 'key' for making a change in nursing practice

Must be supported* by evidence-based practice using research studies to validate what we do, how we do it and why we do things in nursing

is a plan that allows consumers to choose their own physician or health care provider that is not a member, but then will reduce the reimbursement that is paid to the consumer for services used

POS - Point of Service

are an organization of providers that contracts on a "fee-for-service" basis with payer groups to provide comprehensive health services to consumers covered by the plan and agrees to discount fees in exchange for increased patient load

PPO - Preferred Provider Organization

What is the PDSA method for

Quality improvement

Adaptation model. The person is 'seen' as a 'bio psychosocial' being who is seeking equilibrium with 4 adaptation modes. This focuses on how the person is coping and adapting to stress/events that is making the person ill or having an impact of why the person is not adapting positively

Sister Calista Roy

1. were initially designed to be partial reimbursement for care so that health care was paid at least somewhat; thereby decreasing the burden of payment for those who were low income or had no income. However, it has now become an insurance plan for these folks in Wisconsin (Badger Care). There are some physicians, clinics and/or dentists who won't accept or limit the acceptance of these patients for care.

State administered plans

1. Government regulation has much influence over healthcare and 'dictates' how we practice as nurses. If you observed a situation that was considered unethical, illegal or unsafe nursing practice (i.e. reusing syringes more than once on different patients or dumping of hazardous waste products), what law would protect you for reporting this situation? a. Wisconsin Act 176 b. The Wisconsin Nurses Association (WNA) or the Minnesota Nurses Association (MNA) c. The State Nurse Practice Act d. The National Labor Relations Board e. The American Nurses Association (ANA)

a.

1. What is the most sophisticated method of acquiring evidence-based knowledge in healthcare and the nursing profession a. disciplined research studies with evidence-based conclusions b. trial and error with a focus on the quality of patient care c. logical reasoning with support of professional intuition d. professional nursing experience with a traditional approach

a.

A RN in Wisconsin is moving to another state in three months to begin a new job and is questioning if their current license is valid or if a new license is needed. What agreement recognizes a nursing license among participating states so that only one license is needed to practice nursing as a RN. a. The National Compact Licensure Agreement b. The RN Renewal Licensing Agreement Board c. The State Nursing Association d. The State Nurse Practice RN Agreement clause

a.

A newly hired registered nurse on a busy Neuro-Trauma unit has just completed their 3-month orientation session. To help with increasing their comfort level and professional well-being, this RN is being 'paired' with an experienced RN to advise, guide, help promote success for them, act as a role model and takes a long-term interest in their career. What role has this experienced RN assumed? a.mentor b.facilitation coach c.novice coach supporter d.preceptor

a.

A registered nurse, who has been in practice for one year, is now due for an annual performance appraisal (job evaluation). In preparing for this evaluation as part of the self-assessment, the nurse should look to which document as an effort to evaluate own performance as a RN when it comes to tasks, responsibilities and expectations? a. The employee's written job description for expectations as a registered nurse b. the State Nurse Practice Act identifying legal responsibilities for a nurse c. the American Nurses Association (ANA) Standards for Patient Care d. the employer's guidelines for clinical care for inpatient nursing care

a.

1. What are the benefits of the American Nurses Association? (ANA)

a. The benefits of this organization are for nurses, it functions at the *federal level, the focus is on *workplace issues for nurses, is good for networking with other nurses in the country

this is where adjustments are made that are necessary to successfully implement the improvement and then make the improvement a part of the routine system or process

act

This type of management style works well in a crisis situation such as during a Code Blue

authoritarian or autocratic

is when the leader is focused, maintains strong control, make decisions and addresses all of the problems. Will dominate the group and makes commands rather than seeking suggestions or input from the staff to address a problem on the unit.

autocratic

1. The staff on a GI unit is leading a task force to develop quality indicators for improving patient care with an effort to reduce blood transfusion reactions. Which of these indicators would best indicates a measurement for improving quality? a. all patients will be screened for blood antibodies as part of the admission protocol b. all blood must be auto-transfused within 6 hours from when it is 'released' from the lab c. all patient receiving blood transfusions will have a chemistry panel drawn daily until discharge d. all units of blood prior to administration must be electronically scanned and verified by 2 RNs for correct blood type and donor type prior to administration

b

1. With a concern for economic stability, the nurse manager and a group of RNs are working on the nursing budget for the next fiscal year. Which task should this work group do first: a. develop a draft budget for peer review by the nurses b. plan for the current needs of the nursing unit before starting the budget c. implement the current budget on time (start of the fiscal year) d. evaluate deficits from the previous year's budget before starting the process

b

1. Clinical pathways are implemented on the behavioral health unit to facilitate decision making for nursing care of patients who are admitted with Tricyclic overdoses. The nurse manager is using clinical pathways as a measure of which quality care measure? a. Best performance indicators b. benchmarking tools c. standards of nursing care d. clinical rapid cycling change

b.

1. Nursing fatigue and the increased risk for errors has been a topic of discussion among healthcare leaders and others in the healthcare field. The American Nurses Association (ANA) works on a variety of issues that RNs encounter in their nursing practice. The ANA works: a. very closely with all 50 states as it is part of the Nurse Practice Act that is governed at the state level by the Assembly and Congress b. At the federal level to promote health through political action by lobbying for the rights of nurses c. To protects nurses who reported in 'good faith' a violation of nursing practice to their State Board of Nursing where they are practicing nursing d. To stimulate the economy through the management of government sponsored healthcare programs for the poor and disadvantages segments of the population

b.

Budgets are needed to control costs and to efficiently run a department as organizations today must run on a 'business model' in order to be successful with maintaining 'the bottom line' with covering overall expenses. What type of budget is used to predict expenses on the unit while considering patient volume (patient hospital days)? a.nursing budget b. operating budget c. personnel budget d. capital budget

b.

Interviews are granted by an employer after first 'screening' applicants through their resumes. Questions are asked regarding a person's background, education, professional attributes, 'soft' skills' and a few personal questions. Which of the following questions would be considered appropriate and legal by the employer to ask a potential employee? a. Do you have a dependable form of transportation to get to work on time? b. Describe how you would handle a conflict with another nurse? c. What arrangements have you made for childcare? d. Is your significant other supportive of you working rotating shifts including the night shift?

b.

What is an example of a cost containment measure that could be implemented in a hospital setting? a. using only pre-packaged supply kits, even if only a few items are needed, as it is far more cost-efficient to waste a few items in the kit and use what is needed b. keeping frequently used supplies, needed by the nurse, near the bedside to minimize the time that is spent finding and retrieving those supplies c. that the hospital provide an admission supply kit for each patient free of charge (as this is bundled into the total nursing charges for a hospital stay) d. launching a patient care survey at the time of discharge to ask about the 'efficiency' of the RN with using supplies to provide care during their hospital stay

b.

o Is a quantitative or qualitative point of reference to judge/measure quality or value o Used to 'adopt' best practice methods o Helps to identify gaps o Helps to identify plans for process improvement

benchmarking

1. An example of cost containment measures would be: a. The hospital provides admission supply kits for each patient free of charge b. Equipment is left in the patient's room for easy access in case it is needed again c. The nurse keeps frequently used items near the bedside to minimize the time spent on looking and gathering additional supplies d. The nurse uses only 'pre-packaged' supply kits even if only a few items are needed as it decreases time looking for supplies and the nurse can utilize this time for other tasks

c

Workplace advocacy models have a high level of influence in nursing practice. QSEN is one of those models with six competencies with the goal of improving patient safety. What is this improvement of care based upon? a. morals b. shared governance c. value d. networking

c.

this refers to equipment usually > $5000 such as beds, computers, etc

capital budget

where the cost of care is 'written off' as charity

charitable care

Implementation of national standardized quality performance measures for specific diagnoses such as heart failure or pneumonia

core measures

are centered on problem areas that are likely to reoccur)

core measures

have a focus on preventive care, can be found liable for denying care in certain situations, have the philosophy that health maintenance and promotion will save money; control costs and limit unnecessary medical services

health maintenance organizations

these methods have the ability to 'limit' health care choices, have the 'power' to make decisions about what you 'can and can't do', are involved in establishing health care standards, negotiating changes and stress the importance of documentation to be reimbursed for services rendered

healthcare insurance plans

1. What is cultural competence and how does this fit in with quality care?

i. Cultural competence is a sign of excellence (pgs. 485-487) ii. Is supported by Madeleine Leininger's nursing theory* that focuses on cultural care (pg. 181) (review study guide #1) iii. The American Nurses Association (ANA) affirms in the Nurses' Code of Ethics that is a necessity to be sensitive to the needs of others (pg. 193)

is passive and non-directive, brings up a problem, but no solutions, and lets the staff 'run' the department or take care of problem. Is a laid back approach and going with the 'flow' of things. This can cause conflict among the team as a few of them may be making the decisions vs. the leader/manager.

laissez faire

- State level program - For the disabled, indigent - Access to care for the poor - Major problem is cost shifting (individuals with health insurance pay 'more' to pay for those who can't)

medicaid

This research is done when a researcher uses multiple studies on the same topic and then analyzes the results of all the studies

meta analysis research

not direct care (includes vacations, days off, holidays, time at educational in-services, time for committee work or councils, etc

non productive time

1. What is benchmarking and how is it used in healthcare?

o Is a quantitative or qualitative point of reference to judge/measure quality or value o Used to 'adopt' best practice methods o Helps to identify gaps o Helps to identify plans for process improvement

this is projecting for expected expenses on the unit such as trends, patient volume, and acuity of patients. In other words, what are the 'items' necessary for care of patients on the unit?

operating budget

actual time nurses spend on patient care

productive time

Is a quality of care issue that is viewed as a risk management problem because of a nursing practice problem that is reoccurring

quality indicators

This type of study looks at the cause and effect of a research based on quantified data with numerical values (the N#)

quantitive research

1. What is P-I-C-O-T as it pertains to research?

v P - What is the population of interest? (pediatric patients with RSV, etc) v I - What would be the proposed intervention? (what would be changed) v C -Comparison of the interest (example: group A vs. group B) v O - Outcome as to how will the change be measured? (example: length of hospital stays, # of updrafts, oxygen saturation percentages, etc) v T - Element may or may not apply (how long will the study be conducted before it is 'measured')

1. What are two benefits of networking with colleagues?

· Building relationships with colleagues · Common interest in the nursing profession · Good for references and recommendations in nursing with career advancement

How is quality measured

· QI departments · Prioritizing and looking at 'high risk' items, trending data and patterns · Looking at prevention is a key element* o One example: National Patient Safety Goals Root cause analysis*(looking for a 'cause' to prevent it from reoccurring

quality indicators that measure quality

· core measures (Zerwekh & Garneau (2018), pg. 504) · restraint use, nursing and medical protocols · avoiding use of medical abbreviations (including illegible hand writing) · safety such as: latex free products and preventing needle sticks · preventing adverse outcomes · Standards that guide Quality