NURS 478 Midterm
What is time management?
Appropriate use of tools, techniques, and principles to control time spent on low-priority needs and to ensure that time is invested in activities leading toward achieving desired, high priority outcomes.
A nurse residency program lasts a duration of...
At least 6 months and obtains ANCC certification (American Nurse Credentialing Center)
KNOW FOR TEST: Contemporary Leadership Theories- Servant Leadership
#1 priority= serving others (employees, customers and the community) - to be a great leader, you must be a servant 1st - leaders consider follower needs 1st, then empower them to achieve organizational goals
What are the 4 overlapping spheres consistent with the Marquis-Huston Critical Thinking Teaching Model?
#1- Didactic theory: - material presented in each chapter - a TEACHING METHOD that follows a consistent scientific approach/education style to engage the student's mind #2- Problem solving: -problem-based learning approach (simulations) - same as nursing process= --ID problem (NDx) --gather data (assessment) --explore alternative solutions (planning) --select appropriate solution (implementation) --evaluate #3- Group process: - large/small groups and classroom discussion (nursing process) #4- Personalized learning: -material must be made REAL for the learner so that the learning is internalized. -accomplished through (writing exercises, personal exploration, values clarification, risk-taking as case studies are examined)
What is a "Code Lavender?"
Intervention to reduce stress and burnout for nurses and physicians. -Serves patient and providers in need of intensive emotional or spiritual support -Team provides Reiki and massage, health snacks and water, and lavender arm bands to remind the individual to relax for the rest of the day
**POSSIBLY ON TEST: What are the three different leadership STYLES?
(*Also look at Leadership Style table!) 1. Authoritarian: Strong control, motivate others by coercion, self directed, communication flows downward, decision making does not involve others, emphasis on difference of status (I and you), criticism is punitive 2. Democratic: Less control, economic and ego awards are used, directed through suggestions and guidance, communication flows up and down, decision making involves others, emphasis is on (we), constructive criticism 3. Laissez-faire: Permissive, little or no control, motivates by support, provides little or no direction, up and downward communication by group, places emphasis on group, does not criticize, disperses decision making throughout group
What are the 3-4 basic steps to ensure time management?
*Assess activities which need to be accomplished. 1. allow time to plan and prioritize 2. complete tasks according to priority (finish one before beginning another) 3. reprioritize according to ongoing evaluation (based on new info received)
What is active listening?
Is not just refraining from talking but actively trying to understand the other person's total message. - Caregivers must listen for both the content and feelings being expressed by the pt.
How to enhance time management in nursing?
- assess info for the day - prioritize key activities - gather supplies and equipment - effective, efficient pt care communication - delegate - set priorities after report - reassess periodically and adjust - collaborating with interdisciplinary team members - ask for help when needed
Link between nursing burnout and pt safety
-Calling out of work= pt safety may be compromised by calling in sick
Interactive leadership theories- Quantum Leadership
-Transformational leadership managers must work together/SHARED DECISION MAKING with their employees to have common goals, exploit opportunities, empower staff to make decisions to promote organizational productivity -Common goals and empowers the staff
1. What is the difference between a law and rule? 2. Which are laws/rules from the options: a) scope of practice b) protect pt safety c) competent practice d) maintain privacy & confidentiality (HIPAA)
1. Law: much heavier consequences associated with breaking them. Rule: less amount of weight than a law. 2. (a) Law (b) Rule (c) Rule (d) Rule; HIPAA violation could lead to termination, but you can possibly still not lose license*
1. SBAR stands for? 2. What is it?
1. Situation: - ID yourself, occupation, where you're calling from - ID pt - Describe reason for phone call or current status of pt Background: - Give pt presenting complaint - Give pt relevant PMHx - Brief summary of background Assessment: - VS and relevant assessment data Recommendation: - Explanation of what you require, how urgent and when action needs to be taken - Suggest/ clarify what action is to be taken 2. A specific format for communication in healthcare
Integrative Nursing Article: 1. Define burnout? 2. What is it characterized by?
1. A term used to describe workers' reaction to chronic stress. 2. Emotional exhaustion, depersonalization, and reduced personal accomplishment.
As an RN, what are the activities which you cannot delegate?
1. Assessments 2. IV medications 3. Initiating a nursing care plan 4. Blood/chemo products 5. TPN
Marquis-Huston Critical Thinking Teaching Model: 1. What does it assist in achieving? 2. What is the model composed of? 3. What are the overlapping spheres? (4) Describe each.
1. Assists in achieving desired learner outcomes 2. Composed of 4 overlapping spheres, each being an essential component for teaching leadership and management. 3. #1- Didactic theory: - material presented in each chapter - a TEACHING METHOD that follows a consistent scientific approach/education style to engage the student's mind #2- Problem solving: -problem-based learning approach (simulations) #3- Group process: - large/small groups and classroom discussion (nursing process) #4- Personalized learning: -material must be made REAL for the learner so that the learning is internalized. -accomplished through (writing exercises, personal exploration, values clarification, risk-taking as case studies are examined)
Ouch (1981) Theory Z manager:
1. Consensus decision making, to fit employees to there jobs, security and slower promotions 2. Establishment of strong bonds of responsibility between authority and employees. 3. This was a Japanese-style management to corporate America (if you were responsible for it, you will do a good job)
What are the 6 decision making tools?
1. Decision grids 2. Payoff tables 3. Decision trees 4. Consequence tables 5. Logic models 6. Program eval and review techniques
What are the elements of the Decision-Making Process? (7)
1. Define objectives clearly - determine goals/objectives when probs complex - even when decisions must be made quickly, there is time to pause and reflect on the PURPOSE of the decision 2. Gather data carefully - process and obtain accurate info - "confirmation bias" = our tendency to search for and favor info that confirms our beliefs 3. Take the necessary time 4. EBP approach - use multiple sources of evidence/ established sources - keep alongside evidence - implement and eval nationally sanctioned clinical practice guidelines 5. Generate many alternatives - definition of decision-making implies at least 2 choices in every decision 6. Think logically - draw inferences/conclusions from info 7. Choose and act decisively - in final analysis, one must act - many imdivid's delay b/c don't want to face consequences of choice (ex: manager grants all employee's requests for days off= they would have to accept consequences of dealing w/ short staffing
KNOW THESE TERMS: Decision Making in Organizations- 1. Organization Power 2. Rational and Administrative Decision Making (2 types)
1. Effect of Organizational Power: - powerful ppl in organizations are likely to have decisions made (by themselves or their subordinates) that are congruent with their own prefs and values - could include the Mission & values the organization determines or personal values that can be incorporated - balance between personal values and the organization is key. 2. Rational and Administrative Decision Making: - Simon delineated two types of management decision makers= economic man and administrative man. --Economic man= these managers gather as much info as possible and generate many alternatives; Simon believed that the econ model of man was unrealistic description of organizational decision making b/c time constraints/complexity of info for brain to store and retain amnt of info/ assimilating large amounts of info --Administrative man= never has complete knowledge (like the economic man) and generates fewer alternatives; most management decisions are made using this model of decision making*; these managers want decisions to be "good enough" so that they "work" but are less concerned that the alternative selected is the optimal choice.
Integrative Nursing Article/Nurse Practice Act lecture (Wk 1): What is the "triple aim" that the US is doing?
1. Effort focused on improving the patient experience (quality and satisfaction) 2. Improving the health of populations 3. Reducing the cost of care (Quadruple aim--> also #4: improve the work life of health care clinicians and staff)
What are the 6 integrative nursing principles?
1. Human beings are whole systems inseparable from their environments. 2. Human beings have the innate capacity for health and wellbeing. 3. Nature has healing and restorative properties that contribute to health and wellbeing. 4. Integrative nursing is person-centered and relationship-based. 5. Integrative nursing practice is informed by evidence using a full range of therapeutic modalities, from least invasive to more. 6. Integrative nursing focuses on the health and wellbeing of CAREGIVERS as well as those they serve.
What are factors that lead to Burnout?
1. Low pay, long hours, too much paperwork/technology 2. Client losses, lack of appreciation and understanding, lack of support, unresponsive to client needs, powerlessness, discrimination, 3. Inadequate advancement
ON TEST/ NEED TO KNOW DIFFERENCES BETWEEN THESE TWO: What are the consequences of not abiding by the Nurse Practice Act? (2 types)
1. NON-DISCIPLINARY ACTION: letter of concern --low risk --harm to the public 2. DISCIPINARY CONSEQUENCES: a) Decree of censure= --Public reprimand (scolding) violation of Nurse Practice Act --Does not impose any continued risk on the pt/public --This disciplinary action is a public reprimand by the Board of Nursing for a violation of the Nurse Practice Act. It is in the form of a written document and does not impose any conditions on the practical or professional license. b) Probation= -All licensed nurses (LPN or RN) on probation have work conditions and may have other mandated requirements. -EMPLOYERS must be presented with a complete copy of the licensee's Probated Order, including findings of fact, conclusions of law, and terms of the order. -Can still work, but harder to find job - USUALLY ASSOCIATED WITH NURSES WITH SUBSTANCE ABUSE c) Civil Penalty= -A monetary penalty of up to $1000 for each violation of the Nurse Practice Act. d) Revocation: - license privilege is revoked for a period of 5 years. A nurse whose license has been revoked in the State of Arizona may make application to the Board for reinstatement after a period of five (5) years. - TAKING AWAY LICENSE
Differences between problem solving, decision making, and critical thinking?
1. Problem solving: part of decision making and is a systematic process that focuses on analyzing a difficult situation. 2. Decision making: a complex, cognitive process often defined as choosing a particular course of action. - Last step of problem solving, but decision can be made without solving problem 3. Critical thinking: sometimes referred to reflective thinking, is r/t eval and has a broader scope than decision making and problem solving. - components of critical thinking are insight, intuition, empathy, and willingness to take action
KNOW FOR TEST: Contemporary Leadership Theories
1. Situational and Contingency Leadership Theories (1950 - 1980) 2. Interactional Leadership Theories (1970 - Present) 3. Transactional Leadership (1970) 4. Transformational (participative) Leadership (mid 1970's) 5. Full-Range Leadership Model/Theory (late 20th century) 6. Leadership Competencies
ON TEST: What are examples of stress in nursing?
1. Stress= lack of exp as new grad 2. Interactions with MD's 3. Organization skills 4. New situations /procedures 5. Managing large # of pt 6. Inadeq orientation to pts 7. Goal to be best 8. Lack of support other RN's
McGregor's Theories (1960's)- 1. Theory X 2. Theory Y
1. Theory X managers believe that their employees are basically lazy, need constant supervision and direction, and are indifferent to organizational needs. - work is something to be avoided - ppl want to do as little work as possible -use control-supervision (punishment) - suggests that w/o active intervention by management, workers would be passive and nonproductive in their role in the organization. 2. Theory Y managers believe that their workers enjoy their work, are self-motivated, and are willing to work hard to meet personal and organizational goals - the work itself can be motivating - ppl really want to do their job well - use guidance-development = reward - assumes that the desire to work is just as natural as the desire to play or rest, that external control and threat or punishment are not required to achieve organizational objectives -SUPPORTS DEMOCRATIC LEADERSHIP
**Theoretical Approaches to Problem Solving and Decision Making (Process and Models)
1. Traditional Problem-Solving Process: #1- ID prob (NDx) #2- gather data to analyze causes and consequences of the prob (assessment) #3- explore alternative solutions #4-evaluate alternatives #5-select appropriate solution (decision-making occurs) #6- implement solution #7- evaluate (Weaknesses= NO OBJECTIVE-SETTING STEP like managerial decision-making model; amnt of time needed for proper implementation= reduces effectiveness when time constraints are a consideration) 2. Managerial Decision-Making Models: #1- Determine desired outcome (set objectives= OBJECTIVE SETTING STEP THAT ISN'T IN TRADITIONAL) #2-research options #3- compare/contrast options and there consequences #4- make a decision #5- implement an action plan #6- evaluate results (absenteeism in employees) 3. Nursing Process: Assessment, Dx, Plan, Implementation, Evaluation 4. Integrated Ethical Problem-Solving Model (FOR AN ETHICAL PROBLEM--OB): #1- State the problem #2- collect additional info and analyze prob #3- develop alternatives #4- select best alternative and justify decision #5- implement #6- evaluate 5. Intuitive Decision-Making Models: first gut reactions should be integrated into decision
Factors affecting recruitment of nurses
1. competitive salaries 2. reputation 3. location of organization 4. national and local economy status
What are the 6 roles and functions of the nurse manager?
1. is accountable for excellence in clinical practice of nursing and delivery of patient care on a selected unit/area within the healthcare institution 2. is accountable for managing human, fiscal, and other resources needed to manage clinical nursing practice and patient care 3. is accountable for facilitating development of licensed and unlicensed nursing and health care personnel 4. is accountable for ensuring institutional compliance with professional, regulatory, and government standards of care 5. is accountable for strategic planning as it relates to the units(s) or area(s), department, and organization as a whole 6. is accountable for facilitating cooperative and collaborative relationships among disciplines/departments to ensure effective quality patient care delivery
Interactive leadership theories- What is an emotional intelligence leader? (5 components)
1. self-aware 2. self-regulate (control impulses) 3. motivation (passion to work beyond the paycheck) 4. empathy 5. social skills
Sheppard Article and Nursing Burnout ppt: What happens to nurses who don't deal with stress/ compassion fatigue sx?
1st= work performance changes (they may be at risk for med errors) -W/o realizing why, they may start to call in sick more frequently -May be short-tempered, sarcastic, or rude to colleagues and even to pt/families -They may appear tired and may become more easily startled
What is the purpose of the AZ Nurse Practice Act?
Regulates our scope of practice by providing rules and regulations all to ensure patient safety as the ultimate goal.
Sheppard Article (wk 2): Define Compassion Fatigue
A loss of satisfaction that comes from doing one's job well, or job-related distress that outweighs job satisfaction. -Sometimes, merely being exposed to another's traumatic experience leaves us feeling emotionally distraught= called secondary traumatic stress (a part of compassion fatigue) -Deep awareness of another's suffering and the desire to alleviate it
ON TEST- Disciplinary Consequences: What is a civil penalty?
A monetary penalty of up to $1000 for each violation of the Nurse Practice Act.
ON TEST- Disciplinary Consequences: What is a decree of censure?
A public reprimand by the Board of Nursing for a violation of the Nurse Practice Act. It is in the form of a written document and does not impose any conditions on the practical or professional license.
What is a transformational leader?
A theory of leadership where a leader works with teams to identify needed change, creating a vision to guide the change through inspiration, and executing the change with committed members of a group.
Define Integrative Nursing
A way of BEING-KNOWING-DOING that advances the health and wellbeing of persons, families, and communities through caring/healing relationships.
What are the interactive leadership theories?
A) Level 5 Leadership 1. Highly Capable, 2. Contributing Team Member, 3. Competent manager, 4. Effective Leader, 5. Great Leader B) Servant Leadership Listen, keep open mind, no judgment, serving others, always thinking before reacting. (Huston, C. & Marquis, B., pg. 52, display 3.1) C) Principal Agent Theory -Not all employees (followers) are motivated to act in the best interest of the leader (manager) -The employees might have expertise over there leader D) Human and Social Capital Theory: Individuals/organizations will invest in education, and professional development, that will have future payoff. i.e. tuition reimbursement (MS, CRNA, etc.) E) Emotional Intelligence: Perceive, control and evaluate ones emotions. -Understanding and knowing how people work. Understanding YOUR emotions at the beginning F) Authentic Leadership G) Thought Leadership: Where one person convinces another to consider new ideas, product or a way of looking at things. Problem orientated. E.g. Blue Cross developed private health insurance in late 1920's H) Reflective Thinking and Practice: The goal is to become so agile that one is able to continually adapt, reflect on progress and setbacks and adjust the course as needed. I) Quantum Leadership
Heal Environments include
Research reveals that specific design changes environments can reduce our stress and alleviate the consequences of that stress. -Sacred space (scenic murals, warm, music, lights dimmed) -Healing gardens
You are caring for a caseload of four intermediate care pts: A) 55 y/o s/p MI with severe CHF B) 60 y/o admitted with DKA on an insulin drip with every 2hr blood glucose C) 65 y/o s/p colectomy for colon cancer D) 70 y/o admitted for severe SOB d/t end-stage COPD Question: The 70 y/o has sudden severe SOB with severe chest pain, all pts are on the call light. How do you handle your assignment? Option 1: Go to the pt Option 2: Call the charge nurse
Answer: Option 1 GO TO THE PT -You would go to the bedside b/c your pt is SOB to perform: --physical assessment --take VS --nebulizer PRN/ call RT for nebulizer --call MD if further intervention needed
True or False- Arizona's Nurse Practice Act specifies that I must know the competencies and abilities of the person to whom I delegate.
Answer: True
True or False- Arizona's Nurse Practice Act states that I may be in violation of the standards of conduct if I delegate tasks to those I have reason to know lack the ability to perform the function or responsibility.
Answer: True
True or False- If I fail to supervise those to whom nursing tasks have been delegated, I may be disciplined by the state board.
Answer: True
ON TEST- Disciplinary Consequences: What is probation of a licensure?
All licensed nurses (LPN or RN) on probation have work conditions and may have other mandated requirements. EMPLOYERS must be presented with a complete copy of the licensee's Probated Order, including findings of fact, conclusions of law, and terms of the order. - Can still practice, but it would be harder to find a job!
What is discussed in "Chapter 19: Manager-Employee Interaction in Ambulance Services" article? (Wk 2- Communication)
All the paramedics said that they wished to be more involved in decision processes (also that station managers should provide better explanations of info "from above." -Manager interpersonal relations and support with employees (expressing emotional support= "showing concern") -Insufficient dialogue with managers of stations where they worked - Displaying + attitudes
Which of the following leaders would be considered a transformational leader? A) The Advanced Practice Nurse who encourages a staff RN to advance her career by increasing her education B) A unit manager who reminds a CNA to work on time management skills C) The unit secretary who encourages staff to use the proper forms D) The supervisor of a unit who requests staff to work overtime
Answer: A
What STYLE of Leadership is this: An EMS crew that consists of 2 staff, are working on an unconscious elderly patient. The newly certified paramedic is struggling with an intubation. His partner, the field trainer, mutters an expletive, tells the new paramedic to "get your act together", and takes the airway equipment away from the new paramedic. The field training paramedic intubates the patient and tells the new paramedic "we'll talk about this later!"
Answer: Authoritarian
For which reason would a nurses' license be revoked or the nurse be put on probation? A. The nurse lost a malpractice suit. B. The nurse was found guilty of practicing while under the influence of drugs or alcohol? C. The nurse was accused of negligence? D. The nurse gave a wrong medication?
Answer: B
Unprofessional Practice Witnessed: Susan RN noticed that Karen RN was intoxicated while giving care. However, Susan didn't report it to the supervisor. That same day, Karen made a medication error and a patient was injured. Who may be held responsible? A. Karen RN B. Susan RN, Karen RN, and the hospital C. Susan RN D. Karen RN, and the hospital
Answer: B
The unit manager of a 32-bed medical-surgical unit allows the staff nurses to do self-governance for scheduling, client care assignments, and committee work. The manager would be considered which type of leader? A) Democratic B) Laissez-faire C) Autocratic D) Bureaucratic
Answer: B; Laissez-faire
A problem has been identified with scheduling patient care among the disciplines providing care for the patients on their units. Nurses find themselves waiting to administer medications to accommodate radiology tests, physical therapy visits, and pulmonary care treatments. The problem is addressed by: A) Reporting the problem to upper management so they can fix it B) Working with the other disciplines to make small changes to improve the situation C) Forming a committee to prepare a proposal to administration to resolve this issue D) Recognizing that this problem is an age-old issue that will never be resolved
Answer: B; the organization is using kaizen in at least a small way
A multiple-car accident has occurred with multiple trauma clients being sent to an Emergency Department. The unit manager is preparing the staff for the arrival of the trauma victims. Which type of leadership would be most effective in this situation? A) Laissez-faire B) Bureaucratic C) Autocratic D) Democratic
Answer: C; Autocratic
What STYLE of Leadership is this: An operations manager has been asked to upgrade the cardiac monitors in 25 ambulances. In an effort to promote teamwork and buy-in, the manager forms a project team and assigns certain tasks to staff members. After evaluating 3 different monitors and surveying the staff, the team recommends that the department purchase model "C". The manager endorses the recommendation and the staff feels that they have been included in the process.
Answer: Democratic/ participative
True or False- Once I delegate a task to an unlicensed health care worker, I am no longer accountable for what happens?
Answer: False
True or False- Employer policies or directives can relieve me of my responsibility for making judgments about the delegation of nursing activities.
Answer: False; because those policies only expand what the nursing board has said.
What STYLE of leadership is this: It is time for the training department to conduct their quarterly training sessions. The training manager asks two senior staff if they would be interested in developing the training program. The staff accept the offer and start building the program. Once the program is developed, the program is shared with the manager. The manager suggests a few edits, but otherwise approves the program.
Answer: Laissez-Faire/ Delegation
True or False- If a Unlicensed Assistive Personnel (UAP) makes a mistake during a task I have delegated, it would mean I could lose my license.
Answer: True; you are responsible for what you have delegated.
What are the different variations in decision making?
B/c decision-making involves perceiving and eval, and ppl perceive by sensation and intuition and eval their perception by thinking and feeling, it is inevitable that INDIVIDUALITY plays a part in decision making. A) Gender (research suggests that it may play a role in how individs make decisions) -More white matter in women's brains, allowing brain to work faster than a man's B) Values (your own personal values) C) Life experience (edu and decision-making experience) D) Individual preference (some individs make take safer alternatives rather than risk takers) E) Brain hemisphere (frontal lobe- decision making and problem solving) F) Overcoming the variations
KNOW FOR TEST: Contemporary Leadership Theories- Full-Range Leadership Model/Theory (late 20th century):
Context is important mediator of transformational leadership that led to full range leadership model. Apply principles of specifc leadership styles at any given time
The difference between critical thinking and clinical reasoning:
Critical thinking: the mental process of actively and skillfully conceptualizing, applying analyzing, synthesizing, and evaluating info to reach an answer or conclusion Clinical Reasoning: integrating and applying different types of knowledge to weigh evidence, critically think about arguments, and reflect upon the process used to arrive at dx
Decision Making Tool: Program Evaluation and Review Techniques
Determines TIMING of decisions -develop a critical path and # of weeks to complete the task (ex: recruiting staff)
Compare the economic man with the administrative man
Economic man: - makes decisions in a very rational manner - has complete knowledge of the problem or decision situation - has a complete list of possible alternatives - has a rational system of ordering preference of alternatives - selects the decision that will maximize utility Administrative man: - makes decisions that are good enough - b/c complete knowledge is not possible, knowledge is always fragmented - b/c consequences of alternatives occur in the future, they are impossible to predict accurately - usually chooses from among a few alternatives, not all possible ones - the final choice is satisfying rather than maximizing
How often do you need to renew RN license?
Every 4 years
Decision Making Tool: Decision Trees
Ex: hiring regular staff vs cost of temporary staff (travelers)
Sheppard Article (wk 2): What does compassion fatigue feel like?
First sx emotional (nurses talk about feeling bored with their work/feeling detached and distant from pt and colleagues) -May realize they're irritable and short-tempered -Sleepless nights -May be forgetful at work, in school, or at home As compassion fatigue progresses= physical sx arise. -HA or backaches -Nausea driving into work
What are the 3 levels of management?
First-level: -Responsible for supervising non-managerial personnel and day to day activities of specific work units 2. Middle level: -Supervises first-level managers -Liaison between first level and upper level 3. Upper-Level: -To whom middle management reports -Responsible for establishing organizational goals and strategic plans for the entire division of nursing
Interactive leadership theories- What is an authentic leader?
Have a genuine passion to help others through their service and dedication. -Are perceived as sincere individuals who gain respect through their credibility and trustworthiness
What is the difference between the traditional and managerial models?
ID the prob and thinking about the outcome that you want (think about the desired outcome is in the managerial decision-making model as part of the FIRST step)
Highlights of wk 3- Chapter 13 article "Nurse Leadership"
Intended for experienced acute and critical care nurses. -Quantum leaders leading in new age of todays dynamic/ complex HC system= SHARED DECISION MAKNG WITH the team members - personal leadership goals set and time spent on self-reflection
Compare and contrast internal and external time wasters (wk 2 time mgmnt)
Internal Time Wasters: - trying to do too much in one day - inability to say "no" to taking on tasks - procrastination - complaining - perfectionism - interruptions - lack of organization - INFORMATION OVERLOAD (having way too much to do)* External Time Wasters (from the outside world affecting YOU): - telephone interruptions - SOCIALIZING - meetings - lack of information to complete a task - poor communication - lack of feedback after a task for improvement - incompetent/ inexperienced co-workers - poor organizational systems -poor systems resources
What is discussed in "Tips to Reduce Dangerous Interruptions by HC Staff" article? (Wk 2)
Interruptions= increased risk for medication errors Strategies to decrease interruptions suggested: - "No Interruption Zone" = nurse wore bright yellow vest/shash - "Protected hour" Interruptions had shown to impair a clinician's ability to stay focused on an activity/procedure
Differences between leaders and managers
Leaders: look forward and managing the possibilities that the future may bring in order to set direction. -concerned with moving toward realization of that vision (long range visionary perspective) - Historical leader: Hitler, Florence Nightingale -Current leader: Obama Managers: monitor and adjust today's work, regularly looking BACKWARD to ensure that current goals and objectives were being met. -more concerned with maintaining the status quo and taking few risks (short range perspective and are concerned about the bottom line) -Historical manager: Henri Fayol (first ID the management functions)
KNOW FOR TEST: Contemporary Leadership Theories- What is the Interactional Leadership Theories (1970 - Present):
Leadership behavior is determined by the RELATIONSHIP between the leaders personality and the specific situation. A system was a set of objects, with relationship between the objects and between the attributes. Theory Z
What are the 10 important distinctions between leaders and managers?
Leadership: 1. inspires change 2. requires vision 3. requires imagination 4. requires abstract thinking 5. requires ability to articulate 6. requires aptitude (natural ability) to sell 7. requires understanding of the external environment 8. requires risk-taking 9. requires confidence 10. accountable to the ENTIRE ORGANIZATION Management: 1. manages transformation 2. requires tenacity (determination) 3. requires specifics 4. requires concrete data 5. requires ability to interpret 6. requires aptitude (natural ability) to teach 7. requires understanding of how work gets done inside the organization 8. requires self-discipline 9. requires blind commitment to completing the task at hand 10. accountable to the TEAM
ON TEST- Disciplinary Consequences: What is a revocation of licensure?
Licensee's privilege to practice either as a practical (LPN) or professional (RN) is revoked for a period of five years. A nurse whose license has been revoked in the State of Arizona may make application to the Board for reinstatement after a period of five (5) years. The applicant must demonstrate that the reason for the revocation has been remediated to reduce the potential of harm and unsafe practice.
Define Leadership
Move people in the same direction, towards the same destination, not because they are being forced to, but because they want to. - the ability to influence other people - must remind people of that is important because people can really forget what they are there for
KNOW FOR TEST: Contemporary Leadership Theories- Leadership competencies
Must have certain leadership competencies such as skills, knowledge, and abilites.
What is confirmation bias?
Our tendency to search for and favor info that confirms our beliefs. Making a decision on a first impression *Pitfalls of using tools (to avoid pitfalls you should include others in your decision making process)
Define Mindfulness
Paying attention, on purpose, to the present moment
What are s/s of burnout/ What are the 3 Phases?
Phase #1- Insomnia, forgetful, difficulty concentrating, overwhelmed (if these sx are unrecognized, then phase 2 occurs) Phase #2- Energy conservation (ex: call in, late, fatigue) Phase #3- Chronic, isolation, exhaustion
Suspension of license means
Prevents the licensee from working as a practical (LPN) or professional (RN) nurse for definite or indefinite period of time. -Never can be a nurse again!
What is the MAIN difference between a Problem-Solving and Decision-Making Process/Models?
Problem-solving= you are developing and exploring ALTERNATIVES Decision-making= research options?
Identify benefits and restraints for specialty certification in professional nursing
Professional specialty certification= one way an employee can demonstrate advanced achievement of competencies. Benefits: Rapid promotions, advancement opps, certified nurses paid more than non-certified nurses, certification also leads to improved pt outcomes. Restraints: Must meet eligibility criteria that may include years and types of work experience, as well as minimum educational levels, active nursing licenses, and successful completion of a nationally administered exam. Certifications normally last 5 years.
What was the case with Alex Wubbles Arrest?
She was unrightfully arrested for doing her job following the hospitals policies (she would not draw blood for the detective, because no consent from the pt/other circumstances were not given). - $500,000 she won from law suits
ON TEST: Definition of Stress versus Burnout (S/S OF EACH)*
Stress: Involves too many pressures on you physically/psychologically -Stressed ppl can hope, imagine that if they can control it, things will improve. S/S Stress- -over engaged -emotions overactive -produces urgency -STILL HAS HOPE Burnout: state of emotional, mental, physical exhaustion caused by excessive and prolonged stress. -Burnout is syndrome of depersonalization, emotional exhaustion, low personal accomplishment that leads to decreased effectiveness at work -Extreme exhaustion to want to get out of bed, go to work, too tired, call in sick a lot at work, emotions blunted, and no "light at the end of the tunnel" S/S Burnout- -tired, anxious, sick, disengaged -emotions blunted -dread going to work -produces helplessness/ hopelessness
What is the differences between an RN and LPN scope of practice?
The RN shall: 1. Perform only nursing activities for which the RN has been prepared through basic registered nursing education & additional skills obtained within scope of practice of RN Practice within legal boundaries (ADPIE: Assessment, Diagnosis, Plan, Implement, Evaluate). 2. Utilize the nursing process 3. Provide nursing care within the RN scope of practice 4. Evaluate the impact of nursing care 5. Provide comprehensive nursing and healthcare education 6. Assign and delegate nursing activities The LPN shall: 1. Assign nursing care within the LPN scope of practice to other LPNs 2. Delegate nursing tasks to unlicensed assistive personnel (UAPs). 3. Tasks delegated are consistent with the UAP's job description and can be safely performed according to clear, exact, and unchanging directions 4. Results of the task are reasonably predictable 5. Task does not require assessment, interpretation, or independent decision making during its performance or at completion
KNOW FOR TEST: Contemporary Leadership Theories- What is the Situational and Contingency Leadership Theories (1950 - 1980):
The SITUATION should determine the directives given after allowing everyone to know the problem, contingency (incident) - no one leadership is ideal for every situation
What does "Standards related to scope of practice" mean?
The expected actions of any nurse who holds the identified level of licensure.
KNOW FOR TEST: Contemporary Leadership Theories- What is Transactional Leadership (1970):
The traditional manager that is CONCERNED WITH THE DAY TO DAY OPERATIONS. Emphasizes the process in setting goals and giving directions and SEEKS TO CONTROL both situation and followers
KNOW FOR TEST: Contemporary Leadership Theories- Transformational (participative) Leadership (mid 1970's):
They share information, discuss values, and collaborate on decisions. The SELF ESTEEM OF TEAM MEMBERS correlates with involvement with decision making. Decision about a certain product in a few days without the majority of staff - only a few
ON TEST: What are the Unprofessional conduct? (more in syllabus p.34-35)
Unprofessional Conduct: 1. Pattern of failure to maintain minimum standard of acceptable and prevailing nursing practice 2. Intentionally causing physical/emotional injury 3. Fail to maintain prof boundaries 4. Sexual conduct with pt 5. Abandoning pt who needs immediate nursing care 6. Removing pt off life support w/o authorization 7. Inappropriately viewing a pt record
KNOW FOR TEST: Contemporary Leadership Theories- Quantum or Chaos
any self organizing, self-governing, complex organization which BLENDS chaos and order
Highlights of wk 3- Chapter 3 article "Investation"
existing leaders who sense potential in another individual will invest TIME, KNOWLEDGE and RESOURCES to develop the members leadership skills (these are the 3 tiers) - fxn of leader to produce results and motivate followers to achieve said results -prob with current leadership theories= do not take into consideration the process of finding leadership abilities in other ppl (aka investation)
Decision Making Tool: Payoff Tables
cost-profit-volume relationship (quantitative information). Probabilities and use of historical data (hospital census - Isolation patients)
Decision Making Tool: Consequence Tables
demonstrates how various alternatives create DIFFERENT CONSEQUENCES --lists objectives for solving a problem down one side of the table and rates how each alternative would meet the desired objective
Decision Making Tool: Decision Grids
one tool to visually examine the alternatives and compare each against the SAME CRITERIA (ex: comparing each alternative with its financial effect, political effect, and departmental effect)
Decision Making Tool: Logic Models
schematics (diagram) or pictures are intended to operate (resources, process, outcomes and relationships between the components) --pics telling you how the organization "runs"
Define power
the ability to influence other in an effort to achieve a goal
