NURS 412 exam One
Strategies to Improve Problem Solving and Decision Making
- Case Studies - Simulation - Problem-based Learning
Flat Designs
• Remove hierarchical layers by flattening the scalar chain and decentralizing the organization: take away the middle men
First level
Charge nurse Team leader Primary nurse
Flat Designs
Effort to remove hierarchical/bureaucracy layers by flattening the chain of command and decentralizing the organization; take away the middle men
Fatal Flaws of a Leader
● I will do it myself". ● "I'm not doing that, no matter what management says". ● Sitting at the desk while others are "sinking". ● "I do what is required of me". But never goes above and beyond. ● "I don't have time to teach you that, they have a class for that".
Hierarchy (Scalar Chain)
- Used for communication flow - Doesn't tell you authority
The Authority-Power Gap
- You don't trust what they say - Make promises but don't follow through
Total Patient Care
RN is responsible for all aspects of care, the RN works directly with the patient, family, and other health care team members.
Principal Agent Theory
Agent/follower may have a better understanding of how something works Ex: I'm the agent or follower and my manager is the principal, the manager tells me I have to do something a certain way and because I've been there longer than them, I have a better understanding of how something works than my manager, so I'm going to do it my way
Authentic Leadership (aka Congruent Leadership)
Being true to oneself and their values and act accordingly
Clinical Nurse Leader
-master's prepared generalist clinician -oversees care coordination of a distinct group of patients, evaluates outcomes and has the decision- making authority to change
A nurse manager is making a decision based on a problem with a staff member. What would be the optimal end product of the decision?
A chosen course of action
Which of the following will derail a group decision-making process?
A leader who does not establish clear objectives and expectations for the group.
Team Nursing
method of nursing care in which a nurse acts as a leader of a group of people giving care
goal is to get pts in and out as fast as possible and have home health or long term care facility take care of them because it's cheaper
Acute care settings (hospitals)
Principal Agent Theory
Agent/follower may have a better understanding of how something works
Formal Structure
organizational positions and formal power
Leads people to believe that managers are saying they're powerful while staff is being told to follow what management says. Productivity is high because employees are being told what to do by given direction
Authoritarian
Line Structures
Authority and responsibility are clearly defined
Line Structures
Authority and responsibility are clearly defined = efficiency and simplicity of relationships; chain of command; flow of communication
A nurse manager is mentoring a new facilitator. What decision-making models can the manager suggest to the facilitator that will help minimize the impact of an unskilled facilitator? (Select all that apply.)
Consequence table, Payoff table, Decision tree, Decision grid
External Stakeholders
outside organization, invested organization externally
Punishment/Coercive Power
Based on fear of punishment if the manager's expectations aren't met
Authentic Leadership
Being true to oneself and their values and act accordingly
Top Level
Chief nursing officer Chief executive officer Chief financial officer
According to Marquis and Huston (2021), there are other critical elements that nurse managers/leaders use to complete the decision-making process.
Clearly define objectives, gather data carefully, take the necessary time, generate multiple alternative, think logically, choose and act decisively
emphasis on "we" rather than I and you; criticism is constructive
Democratic
Matrix Structure
Focus on both product and function Ex: good pt outcomes are the product, staff education and adequate staffing may be the functions necessary to produce the outcome
Matrix Structure
Focus on both product and function Function- all the tasks required to produce the product, and the product is the end result of the function Ex: good pt outcomes are the product, staff education and adequate staffing may be the functions necessary to produce the outcome
Bridging The Gap
For a successful organization, mutual trust b/w managers and employees
Expert Power
Gained through knowledge, expertise, or experience Ex: a person with vast expertise in music would be powerful only in that area, not another specialization
The Authority-Power Gap
Gap between position of authority and subordinate response
What qualities would a Nurse leader/manager need?
Good communicators, organizers, want to work as a team and be team builders/work together, visionary/thinking outside the box, proactive not reactive, innovative be able to work with technology
Legitimate Power/Authority
Has inherent in it the ability to create feelings of obligation or responsibility
Nurse Navigators
Help pts and families navigate the complex health-care system by providing information and support
Management has no control and are permissive; hands-off approach; they don't enforce anything and let staff do what they want; they'll give support and employees are motivated, but they don't give direction
Laissez-faire
Formal Structure
Legitimate power over others
How to Become a Good Problem Solver and Decision Maker
Life Experiences- learned through our lives/or what has happened to us to help guide us in our process of decision making Trial and Error- Life or death situations not going to use a lot of trial and error - Used for little things Ex: wound care, drsg done one certain way and no difference seen in wound, so suggest to MD to try something else to see if it would work better Reasoning Insightfully- collecting data, analyzing, conceptualizing the data to help in decision making - Important info can be given by family of pt - Getting as much data as possible to help make your decision
External Stakeholders
Local businesses Area colleges and universities Insurance companies and HMOs Community leaders Unions Professional organizations
A nurse manager schedules a meeting with the staff to discuss policy changes. What does the manager hope to achieve by having some upper left-brain dominant staff members lend their input?
Logical and rational analysis
Servant Leadership
Number one priority is to serve others
Reward Power
Obtained by the ability to grant favors or reward others with whatever they value
What is the nurse leader/manager role in all of this?
Recruitment, turn over rates (what you can do to keep workers), political aspects (mandatory OT), minimum staffing, governmental input into what can be done at job/institution, high quality practice (care is above and beyond), successful recruitment
Reward Power
Rewarding employee with a gift
What is the first thing you do in managerial positions
Set objective
A staff nurse is having difficulty with problem solving in patient care and the nurse manager is counseling the nurse. What suggestions by the nurse manager may assist the staff nurse in improving problem solving skills? (Select all that apply.)
Slow down thinking, Systematize data collection, Override bias
Emerging New threats
Terrorism, biological warfare, global pandemics
Managers think their employees are all lazy
Theory X
visionary, innovative, think outside box and encourage others to be this way as well; inspirational and employees will be inspired to be the best they can, want others to work at the best they can,
Transformational
Follower's Needs from Leader
Trust Compassion Stability Hope Tea comes sweet and hot
Follower's Needs from Leader
Trust, compassion, stability and hope.
Middle Level
Unit supervisor Department head Director
Ad Hoc Design
Use a project team or task approach and are usually disbanded after a project is completed
Service Line Organization
Used in some large institutions to address the shortcomings that are endemic to traditional large bureaucratic organizations Sometimes called care-centered organizations Smaller in scale than large bureaucratic systems means whose going to look at particular service, not really showing who's in charge/no hierarchy, rather who will take care of a particular issue
Service Line Organization
Used in some large institutions to address the shortcomings that are endemic to traditional large bureaucratic organizations Ex: in organizational design the overall goals would be determined by larger organization, but the service line would decide on the processes to be used to achieve the goals
Modular Nursing
Uses a mini team (2 to 3 members with at least one member being an RN, with members sometimes being called care pairs)
Descriptor of a leader
Visionary, inspired changes, imagination, abstract thinker, ability to articulate, understand the external environment, risk taker, confident, accountability
Manager will have bridged the authority-power gap if followers:
a. Perceive that the manager is doing a good job b. Believe that the organization has their best interests in mind c. Do not feel controlled by authority
Internal Stakeholders
anyone who steps foot into the place at any time
Internal Stakeholders
anyone who steps foot into the place at any time Ex: the nurse, laundry, dietary, nurses aid, physicians, other departments (OT, PT, RT), patients, any visitors that step foot in a hospital
Powerful
are respected and get cooperation from their followers and can get things accomplished
Legal-Rational Authority
based on the belief in legitimacy of the pattern of normative rules and the rights of those elevated to authority under such rules to issue commands Ex: person will say "this is what we want you to do and you're going to do it"
Decentralized Decision Making
collaborative, everyone works together; hard to make decisions in this type
Grapevine
communication network, which is at the heart of informal organization Ex: Conversations in the break room, down halls, during carpool, in between work, social media that allows relationships of informal groups to develop
4 Leadership Domains
executing, influencing, relationship building, strategic thinking
Informal Structure
focus on employees, their relationships, informal power that is inherent within those relationships
Charismatic Power
is more personal type of power
What are the changes in Healthcare
- People are living longer, so there are more disease processes associated with it - More innovation and technology in workplace
Referent Power - people "brownnose" the leader
- Power gain by being with someone with power
Which of the following competencies are important for the nurse leader to develop?
Ability to diagnose a situation, adapt, and communicate
intuitive, and holistic are characteristics of
right-brain-dominant people
External Stakeholders
outside organization, invested organization externally Ex: Local businesses Area colleges and universities Insurance companies and HMOs Community leaders Unions Professional organizations
Decision Making
picking something from available choices
Legitimate Power/Authority
power gained by title or official position w/in organization
Problem Solving
systematic process, analyzing data in a challenging situation to come up with info to do the problem solving/make a decision; id root problem, analyzing data
Ad Hoc Design
temporary basis to facilitate completion of a project
The manager of several related departments brings the team together to inform them that they will all be cross training to other units for the purpose of increasing productivity. What form of leadership does this manager demonstrate?
transactional
Full Range Leadership includes what?
transactional, transformational, and Laissez-faire
A nurse in a leadership role is committed to a vision for retention in the medical-surgical unit and is able to empower others with this vision. What form of leadership is this nurse demonstrating?
transformational
Powerless leader-managers
withhold info from others that makes it difficult to work with
Punishment/Coercive Power
■ Opposite of reward power - Based on fear of punishment if the manager's expectations aren't met
Internal Stakeholders
Hospital employees Physicians Patients Patients' families Union shop stewards Board of directors
Human and Social Capital Theory
Invest self into something if it's worth it and helps them in their future/pay off in the future Ex: health-care organization that provides tuition reimbursement for nurses to go back to school to earn higher degrees is likely doing so in anticipation that a more highly educated nursing staff will result in increased quality of care and higher retention rates which would translate into higher productivity and financial return
Legal-Rational Authority
Issue commands Ex; person will say "this is what we want you to do and you're going to do it"
A nursing instructor is discussing ways to improve critical thinking during a clinical rotation with a student. The student asks the nurse what critical thinking is. What is the best response by the nursing instructor?
It requires reasoning and creative analysis.
Informational Power
Obtained when people have information that others must have to accomplish their goals
Management process
POSDCORB
if DM is found but pt was admitted for HF, care for DM may not be covered by insurance
Paid for performance
Functional Method
Personnel were assigned to complete certain tasks rather than care for specific pts; relatively unskilled workers were able to gain proficiency by task repetition; RNs became managers of care rather than direct care providers; "care through others"
Patient and Family Centered Care
Planning, Delivering and Evaluating Healthcare while including patients and families in all processes.
Primary Nursing
Primary nurse assumes 24 h responsibility for planning care of one or more pts
Which of the following are behaviors associated with effective leaders?
Priority setting, critical thinking, skillful communication
4 leadership domains
Strategic Thinking- effective leader who has staff thinking about future; set long-term goals; analytical, have input, intellectual, futuristic Influence- staff wants to follow; give support to staff; good communication, maximizer, make significant decisions, self assured in what they do, develop political support, sell ideas Relationship Building- tendency to collaborate with others well and work together/unite a group into a team towards a common goal; empathy, work in harmony with others, positivity Execution- know how to get things done by translating plans into action; come up with idea, work it out, and execute idea; responsible, focused, achievers Rise and Shine to help remember
Managers think all their employees are great
Theory Y
Centralized Decision Making
Top person communicates everything to the lower levels; top to bottom approach
Centralized Decision Making
Top person makes the decision Top person communicates everything to the lower levels; top to bottom approach; better approach than decentralization The vision or thinking of one or a few individuals in the organization guides the organization's goals and how those goals are accomplished
manager only focuses on day to day leadership; not looking down the road a week or month; "traditional manager"
Transactional
Descriptor of a management
Transformation, tenacity, specific, data, interpretation, understand of inside the organization, self discipline, commitment, accountability
Strengths-Based Leadership
focuses on the development or empowerment of workers' strengths as opposed to identifying problems, improving underperformance, and addressing weaknesses and obstacles
Human and Social Capital Theory
invest self into something if it's worth it and helps them in their future/pay off in the future
Referent Power - people "brownnose" the leader
is gained only through association with powerful others
Reflective Thinking and Practice
manager looks at how she/he is doing things and if it is the correct way; look at EBP and change ways if there are better ways
