Nursing Management Final Exam

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Sexual harassment

Unwelcome sexual advances, requests for sexual favors and other verbal or physical conducts of a sexual nature when submission to or rejection of this conduct explicitly or implicitly affects an individual's work performance; or creates an intimidating, hostile or offensive work environment

Civil Rights Act of 1964

Updated 1977 Set equal rights employment practice Recognizes sexual harassment as a form of sex discrimination

Why is a disciplinary conference conducted? A.) Explain the termination process B.) Review their job description C.) Clarify reason and expectation for change in behavior

Prospective payment system (PPS)

With DRGs, hospitals join the ___________________, whereby they receive a specified amount for each Medicare patient's admission regardless of the actual cost of care

Rules

_________ or regulations worth having should be enforced All ______, regulations and policies should be regularly reviewed or relevance

Leaders

__________ inspire people to want to do something

14 forces of Magnetism

1. Quality of nursing leadership 2. Organizational structure 3. Management style 4. Personnel policies and programs 5. Professional models of care 6. Quality of care 7. Quality improvement 8. Consultation and resources 9. Autonomy 10. Community and the hospital 11. Nurses as teachers 12. Image of nursing 13. Interdisciplinary relationships 14. Professional development

Patient classification systems (PCS)

A review of literature consistently demonstrates that as RN hours decrease in NCH/PPD, adverse patient outcomes increase This includes: - Increased medication errors - Patient falls - Decreased patient satisfaction with pain management

Evidence based practice

A shared responsibility of the professional nurse, the organization, leader-managers and the education or staff development department

A structured interview format with a team approach has the best reliability: A.) True B.) False

Quality control

A systematic process A collection of quantitative and qualitative data is used as well as a specific and systematic process Standards have to exist to establish control criteria and leaders have to know what those standards are and what's expected of them

Seeking consensus

Always an appropriate goal in resolving conflicts and in negotiation All parties support, or at least do not oppose, an agreement Greatest challenge in consensus building is time

Medicare

Established in 1965 Primary populations are elderly, disabled, and renal dialysis patients. Two parts: A and B - Part A funded by Social Security tax and federal taxes. - Part B subsidized 75% by federal government and 25% by subscribers

Ethics are rules of conduct recognized in respect to a particular culture, group? A.) True B.) False

Staff development activities

Evaluation criteria for ______________________: - Learner's reaction - Behavior change - Organizational impact - Cost effectiveness

Organizational communication

Even more complex than interpersonal or group communication, as there are more communication channels, more individuals to communicate with, more information to transmit, and new technologies, which both complicate and ease care delivery. Thus, ___________________ is a high-level management function; it must be systematic, have continuity, and be appropriately integrated into the organizational structure, encouraging an exchange of views and ideas. Is complex, however, and communication failure often results in a failure to meet organizational goals. In addition, there are confidentiality risks that must be addressed.

Functional method of nursing

Evolved as a result of World War II Uses relatively unskilled workers who have been trained to complete certain tasks Care is assigned by task rather than by patient

Accountable care organizations

Groups of providers and suppliers of service who work together to better coordinate care for Medicare patients (does not include Medicare Advantage) across care settings with the expectation that efficiency as well as quality of care will result in shared savings

Factors affecting healthcare trends

Growing elderly population Healthcare reform Reductions in reimbursements New quality imperatives Shift in focus of care to community settings Technological advancements Shift to customer-focused care

ANA Code of Ethics

Guidelines for ethical nursing practice Nine provisions Used as a standard of practice in a court of law

Decision tree

Map possible outcomes of a series of related choices Guides thinking towards desired outcomes Because decisions are often tied to the outcome of other events, management analysts have developed ___________

Staffing

Matters to nursing—staffing is everything and determines whether you will stay in their workplace or even the profession

Training

May be defined as an organized method of ensuring that people have knowledge and skills for a specific purpose and that they have acquired the necessary knowledge to perform the duties of the job

Scalar principle

Means that there should be a clear definition of authority in the organization and that this authority flows, one link at a time, through the chain of command

Alternative dispute resolutions (ADRs)

Mediation Arbitration Ombudsperson

Chief nursing officers

The CNO must be a participant in the hospital's governing body, as well as the body responsible for strategic planning. The CNO must have at least a master's degree. If the degree is not in nursing, the officer must have either a bachelor's degree or a doctorate in nursing

Leaders

1. Inspire change 2. Requires vision 3. Requires imagination 4. Requires abstract thinking 5. Requires ability to articulate 6. Requires as aptitude to sell 7. Requires understanding of the external environment 8. Requires risk taking 9. Confidence in uncertainty 10. Accountable to the organization

Managers

1. Manages transformation 2. Requires tenacity 3. Requires specifics 4. Requires concrete data 5. Requires ability to interpret 6. Requires an aptitude to teach 7. Understands how works get done within an organization 8. Requires self-discipline 9. Requires blind commitment to completing the task 10. Accountable to the team

Frameworks for Ethical Decision Making

1. Utilitarianism ( Teleological) 2.Duty-based reasoning 3. Rights-based reasoning 4. Intuitionist

Scientific Management

1900 - 1930 Frederick Taylor Time and motion studies, and expertise from experience workers to scientifically design work to promote greatest efficiency of time and energy Scientific personnel system to hire, train, and promote workers based on technical competence and abilities "Fit" in organization; financial incentives Cooperative relationship between managers & workers; Distinct difference in the role of workers and managers

Human relations management

1930 - 1970 Participatory management (Mary Parker Follett) Emphasizes people rather than machines (Elton Mayo) - Produced the "Hawthorne effect"...people respond to the fact of being studied & will increase that behavior that brings attention Theory X and Theory Y (Douglas McGregor) Employee participation (Chris Argyris)

Behavioral theories

1940 - 1980 Authoritarian Democratic Laissez-faire

MORAL Decision making model

1985 M - Massage the dilemma O - Outline options R - Review criteria and resolve A - Affirm position and act L - Look back. Evaluate the decision making

Patient self-determination act (PSDA)

1991 Requires health care organizations that receive federal funding to provide education for staff and patients on issues concerning treatment and end-of-life issues-living wills

HIPAA (Health Insurance Portability and Accountability Act)

1996 Protects the privacy of health information and improves the portability and continuity of health insurance coverage

A Unit manager demonstrated passion for serving the staff rather than being served. Taking time to listen, the UM prefers to be a teacher first before being a leader, which is characteristic of which leadership style? A.) Transformational B.) Transactional C.) Servant D.) Charismatic

A nurse who has recently been promoted to UM, comes across a theory which states that the leadership style is effective depends on the situation. Which of the following styles best fits a situation when the followers are self-directed, experts, and are matured, self-motivated professional individuals who anticipate up and down communication? A.) Democratic B.) Bureaucratic C.) Human Relations D.) Laissez-faire

Ethics

A system of moral conduct and principles that guide a person's actions in regard to right and wrong and in regard to oneself and society at large

Relationship/Information age

Adaptive skills Invitation and interdependence Cooperation Discerning purpose Finding meaning What you know (information) Circular (egalitarian) Metaphor: organic network (connected parts) Leadership: trusteeship

Professional negligence

Also called malpractice Failure of a person to act in a reasonable and prudent manner Five components: 1. Duty to follow the standard of care (follow policy and practices set forward by agency and organizations) 2. Failure to meet standard of care-breach of duty 3. Foreseeability of harm-nurse must know that the possibility of harm exists 4. Direct relationship between breach and injury can be proved 5. Injury-actual harm resulted due to one's actions or failure to act

Thought leadership

Applies to someone recognized among peers for innovative ideas and who demonstrates the confidence to promote these ideas Thought leaders attract followers not by any promise of representation or empowerment, but by their risk-taking Ideas are future-oriented and generally problem-oriented

Deontological

Approach to ethical decision making Duty-focused normative approach centered on rules from which all action is derived

Situational

Approach to ethical decision making No prescribed rules, norms, or majority-focused results that must be followed

Teleological

Approach to ethical decision making Outcome-focused approach that places emphasis on results and protects the interest of the majority

Intentional torts

Assault and battery- threatening or touching without permission False imprisonment-use of physical restraints led to these claims Invasion of privacy Defamation of character

Civil law

Based on a preponderance of the evidence Law which are concerned with private relations between members and usually is non violent in nature and involves property (divorce, most malpractice cases)

Democratic

Behavioral theory Less control maintained Economic and ego awards used to motivate Others directed through suggestions and guidance Communication flows up and down Decision making involves others Emphasis is on "we" Criticism is constructive

Administrative law

Clear and convincing standard Law that governs the activities of agencies of government (LSBN, Equal Opportunity Act violations)

Compassion fatigue

Combination of physical, emotional, and spiritual depletion associated with caring for patients in significant emotional pain and physical distress Overcome by strengthening interpersonal and communication skills Use of self-assessment-gain insight into stressors that contribute to CF Nurses-need help to develop own recovery plans Usually seen-physical, emotional & work related symptoms Symptoms - Work Related => Avoidance/dread of certain patients => Reduced feeling of empathy => Frequent absences => Lack of joyfulness - Physical => Headaches, digestive upset, insomnia, fatigue => Cardiac symptoms: chest pain, palpitations - Emotional => Mood swings => Restlessness => Irritability, anger => Anxiety, depression => Excessive use of nicotine, alcohol, drugs => Poor concentration, focus and judgement => Loss of objectivity

Beneficence

Doing good Implement actions that benefit clients Good requires competence Treating client in holistic manner, including beliefs, feelings, wishes

Nonmaleficence

Duty to do no harm Intentionally or unintentionally Protect those who can't protect themselves

Malpractice

Failed to act in a reasonable and prudent manner-also called professional negligence. Cannot claim ignorance as an excuse-having all the information in a situation may impede one's ability to foresee harm. Did not provide reasonable and prudent care as determined by the testimony of expert nursing witnesses. Reducing Risk: • Practice within the scope of the State's Nurse Practice Act • Practice within your individual competence • Know and follow the policies and procedures • Model standards which follow evidence based practice • Put patient rights and welfare first • Upgrade your skills • Know legal basis of nursing decisions • Seek opportunities for lifelong learning

Good samaritan immunity

Generally, a nurse is not liable for injury that occurs as a result of emergency treatment when care is provided at the scene of the emergency which is not grossly negligent. Revise in LA after hurricane Katrina

Utility

Good of the many outweighs the wants/needs of the individual

Leadership theories

Great Man Theory/Trait Theories Behavioral Theories Situational and Contingency Leadership Theories Interactional Leadership Theories

Leadership theories

Great man theory Trait theory Behavioral theories Situational and contingency theories Interactional theories Transactional leadership theory Transformational leadership theory

Implied consent

In an emergency physician documents when patient is unable to sign

Leadership ethics

In an era of markedly limited physical, human, and fiscal resources, nearly all decision making by nurse leaders involves some ethical component. Important leadership responsibility-in creating an ethical work environment role modeling ethical behavior.

Moral uncertianty

Individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is

Situational-Contingency leadership theory

Leadership theory 1950-1980 Mary Parker Follet: Law of the Situation Fiedler: Contingency approach Blake and Mouton: Managerial Grid Hersey - Blanchard Model Tannebaum and Schmidt Leadership Continuum

Interactional leadership theory

Leadership theory 1970 - Present Based on how leadership behavior is influenced by the relationship between the leader's personality and the specific situation • People are complex & variable • People have different motives for doing things • People's motives change over time - don't stay constant

Standards of care

Minimal level of expertise that may be delivered to a patient Conduct of a reasonably prudent nurse in similar circumstances Regionally based Set by Professional Organizations (i.e. Association of Critical Care Nurses, American Nurses Association, Oncology Nursing Society)

Ordinary negligence

Omission to do something that a reasonable person would do with average judgment, foresight, intelligence and skill

One leadership theory states that "leaders are born and not made," which refers to which of the following theories? A.) Charismatic B.) Situational C.) Trait D.) Great Man

Paternalism

One person can make decisions for another Often seen as undesirable Negative ethical principle if it violates autonomy - Entire decision is taken away Positive principle - Assist in deciding major moves or plans by providing more data...thus help the person fully understand all aspects

Character

One's ___________ is judged not by what is done for those who can assist you in reaching your goals but in what is done for those who have no voice or power

Management Process

Planning -> Organizing -> Staffing -> Directing -> Controlling

Authentic leader

Purpose Values Relationships Self-discipline Heart

Human capital theory

Represents the capability of the individual Retain Motivate Train Hire

Reflective thinking

Requires nurse leaders to be nimble, flexible, and responsive to change Must be able to continually adapt, reflect on progress and setbacks, and adjust their course as needed

Vicarious liability

Respondeat superior-the "master" is responsible for the "servants". Employer responsible for employees except when employee acts erroneously

Moral distress

Result of the individual knowing the right thing to do but organizational constraints make it difficult to take the right course of action

Ethics

Rules of conduct recognized in respect to a particular culture, group. Origin-social system, external Society says right/wrong Ethics tend to be consistent "Ethos" means character Ethics are governed by prof and legal guidelines in time and place

Management theories

Scientific Management Management Functions Human Relations Management

Constitution

Source of the law System of fundamental laws that govern a nation Involvement with Nursing Practice: - Little direct involvement with malpractice

Administrative laws

Source of the law Valid only to the extent that they are within the scope of the authority granted to them by the legislative body

Authentic leadership

Suggests that in order to lead, leaders must be true to themselves and their values Components - Balanced processing - Internalized moral perspective - Relational transparency - Self-awareness

Moral courage

Tendency to do what is right regardless of other pressures

Emotional intelligence (EI)

The ability to perceive, understand, and control one's own emotions as well as those of others The ability to use emotions effectively and is required by leaders/managers in order to enhance their success Emotional intelligence is critical for building a cooperative and effective team Five Components - Self-awareness - Self-regulation - Motivation - Empathy - Social skills

Legislation

The primary purpose of law and legislation is to protect the patient and the nurse

Resipsa loquitur

The thing speaks for itself-harm is obviously the result of negligence

Stare decisis

To let the decision stand and use precedents

Transactional leadership

Traditional type Focuses on management tasks Committed Uses trade-offs to meet goals Does not identify shared values Examines causes Uses contingency reward

Moral outrage

When an individual witnesses the immoral act of another but feels powerless to stop it Experiences contribute to compassional fatigue

Mediation

Alternative dispute resolution (ADR) Neutral third party Fact-finding

Fatal leadership flaws

1.) A lack of energy and enthusiasm 2.) Acceptance of their own mediocre performance 3.) Lack of a clear vision and direction 4.) Having poor judgement 5.) Not collaborating 6.) Not walking the talk 7.) Resisting new ideas 8.) Not learning from mistakes 9.) A lack of interpersonal skills 10.) Failing to develop others

Termination conference

1.) Clearly state the reasons for dismissal 2.) Explain the employment termination process 3.) Ask for the employee's input 4.) End the meeting on a positive note

Employee indoctrination

1.) Induction 2.) Orientation 3.) Individual orientation to each department

Transferring employees

1.) Lateral Transfer 2.) Downward Transfer 3.) Accommodating Transfer 4.) Inappropriate Transfer

Disciplinary conference

1.) Reason for disciplinary action 2.) Employee's response to disciplinary action 3.) Rationale for disciplinary action 4.) Clarification of expectations for change 5.) Agreement and acceptance of action plan

Common staffing options

10 or 12 hour shifts Premium pay for weekend work Part-time staffing pool for weekend and holiday Cyclical staffing, allow long term knowledge of future work schedules with a master pattern of 8- hour shifts repeating every 4 weeks Job sharing Allowing nurses to exchange hours of work among themselves Flextime Use of supplemental staffing from outside registries and float pools Staff self-scheduling Shift bidding—nurses bid for shifts rather than requiring mandatory overtime

National Labor Act/Wagner Act

1935 Gave unions many rights in organizing Resulted in rapid union growth

Fair Labor Standard Acts

1938 Has been amended many times since 1938 Sets minimum wage and maximum hours that can be worked before overtime is paid

Taft-Hartley Amendment

1947 Returned some power to management Resulted in a more equal balance of power balance of power between unions and managements

Patient bill of rights

1960, 1998 NLN, the American Hospital Association, and many states have passed bills of rights for patients used to guide professional practice. Patient Protection and Affordable Care Act in 2010

Kennedy Executive Order 10988

1962 Amended the 1935 Wagner Act to allow public employees to join unions

Executive Order 11246 and 11375

1965; 1967 Sets affirmative action guidelines

Age discrimination act

1967 1978 Amendment Protects against forced retirement

Rehabilitation act

1973 Prohibits discrimination on the basis of disability

Vietnam veterans act

1973; 1974 Provides reemployment rights

Amendments to Wagner Act

1974 Allowed nonprofit organizations to join unions

National labor relations board ruling

1989 Allowed nurses to form their own separate bargaining units

California Fair Pay Act

2016 Companies in California must justify any pay disparities between men and women doing "substantially similar" work Prior fair pay legislation only required men and women of the same job title to be paid equally Also, legally guaranteed employees the right to ask coworkers about pay without retribution from management

Decision making

A complex, cognitive process often defined as choosing a particular course of action The thought process of selecting a logical choice from the available options - This implies that doubt exists about several courses of action and that a choice is made to eliminate uncertainty

A delegation strategy to employ would be consideration of skill and education level? A.) True B.) False

Service Employees International Union (SEIU)

A large union in the health-care industry, representing more than 1.9 million nurses, LPNs, doctors, lab technicians, nursing home workers, and home care workers. Of this membership, there are 80,000 RNs in 21 states

Bundled payment

A payment structure in which different health-care providers who are treating a patient for the same or related conditions are paid an overall sum for taking care of that condition rather than being paid for each individual treatment, test, or procedure. In doing so, providers are rewarded for coordinating care, preventing complications and errors, and reducing unnecessary or duplicative tests and treatments

Change agent

A person skilled in the theory and implementation of planned change Manager

Learning organization

A place "where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free, and where people are continually learning to see the whole together."

Budget

A plan that uses numerical data to predict the activities of an organization over a period of time

Learning organization

A premise of the __________________ is that learning itself enhances the team

Nursing process

A problem solving and decision making model Can be applied to leadership and managerial situations Multiple places where feedback happens Constant input

Recruitment

A process of activity seeking out and attracting applicants for existing positions An ongoing process May be nurse recruiter—collaborative relationship with individual departments Personnel Department Considerations—Organization's philosophy, benefit programs, salary scale and other factors influencing retention

Utilization review

A process used by insurance companies to assess the need for medical care and to assure that payment will be provided for the care

Capitation

A prospective payment system that pays health plans or providers a fixed amount per enrollee per month to provide a defined set of health services based on enrollee needs

Advocacy for staffing

ANA continues to advocate for safe staffing approaches that: • Provide assurance that RNs are not forced to work without orientation in units in which they are not adequately trained or experienced; • Establish procedures for receiving and investigating complaints; • Allow for civil monetary penalties for known violations; • Include whistleblower protections; and • Require public reporting of staffing information

Safe staffing

ANA supports a legislative model in which nurses are empowered to create staffing plans specific to each unit. This approach aids in establishing staffing levels that are flexible and account for changes including: • Intensity of patient's needs, • The number of admissions, discharges, and transfers during a shift, • Level of experience of nursing staff, • Layout of the unit, • Availability of resources (e.g., ancillary staff, technology). Establishing minimum, upwardly adjustable staffing levels in statute will also help the committee in achieving safe and appropriate staffing plans.

Addressing workplace violence

ANA's Code of Ethics with Interpretive Statements & ANA's Position Statement on Incivility, Bullying, and Workplace Violence Joint Commission's Workplace Violence Prevention Resources for Health Care Health-care organizations uIndividual States mandates OSHA- no current standard. Health-care employer citation

Collective bargaining

Activities occurring between organized labor and management that concern employee relations Negotiation of formal labor agreements and day-to-day interactions between unions and management

LPN/LVN practice act

Administer oral and intravenous medications Chart in the medical record Take the patient's vital signs Change wound dressings Collect specimens such as blood, urine, sputum, etc Insert and care for urinary catheters Care for patients with tracheostomy tube and ventilators Insert and care for patients that need nasogastric tubes Give feedings through a nasogastric or gastrostomy tube Care for ostomies Monitor patients for a change in clinical condition Call the physician if needed Perform CPR in emergencies Are supervised by an RN

Scheduling options

Advantages and Disadvantages of ___________: • Continued debate about 12 hour shifts that result in fatigue with judgement errors and slower reaction times by nurses • Nurses who work longer hours have higher instances of burnout and job dissatisfaction as well as cardiovascular disease, hypertension, diabetes and mood disorders. • Studies show long shifts lead to increased sick time • Nurses continue to report increased satisfaction with 12- hour shifts • Less work days = improved work/life balance and solutions to child care • Some organizations pay overtime for any shift over 8 hours • Less handoffs = better communication and continuity of care • Agency or Travel Nurses—Usually paid 2 to 3 x higher without benefits, but is expensive and could lead to poor continuity of care. Often nurses don't want to ask questions and charting errors are common Per Diem—Nurses have higher pay flexibility and can choose when and where they want to work, but no benefits. Also threat to safety because they're not familiar with P/P • Float pool • Float staff • Self scheduling • Not easy to implement: Manager must have good oversight of these schedules and workability depends on the leadership to make sure there is adequate staffing. • Most schedules are done 4 to 6 weeks in advance with self scheduling • Offers nurses greater control Shift-Bidding—allows nurses control over extra shifts to reduce overtime by allowing nurses to bid on the shift which is usually more than the hourly wage

Functional method of nursing

Advantages and disadvantages of the __________________: - A major advantage of functional nursing is its efficiency; tasks are completed quickly, with little confusion regarding responsibilities. - However, functional nursing may lead to fragmented care and the possibility of overlooking patient priority needs

Organization chart

Advantages of the ______________: - Maps lines of decision-making authority - Helps people understand their assignments and those of their coworkers - Reveals to managers and new personnel how they fit into the organization - Contributes to sound organizational structure - Shows formal lines of communication

Staffing

Affects the cost of care—The costs of mortality, readmission and compromised safety are high so staffing plays a role in reducing the incidence, and cost of each

Staffing

Affects the quality of care—Studies have shown a correlation between optimum levels of staffing and optimum outcomes

Group member roles

Aggressor Blocker Recognition seeker Self - confessor Playboy Dominator Help seeker

Nurse empowerment

All nurses should have a say in patient care and be involved in data collection, a collaborative approach that empowers nurses

Decision grids

Allows one to visually examine the alternatives and compare each against the same criteria. Although any criterion may be selected, the same criteria are used to analyze each alternative. When many alternatives have been generated or a group or committee is collaborating on the decision, these grids are particularly helpful to the process. This tool, for instance, would be useful when changing the method of managing care on a unit or when selecting a candidate to hire from a large interview pool. The unit manager or the committee would evaluate all of the alternatives available using a decision grid. In this manner, every alternative is evaluated using the same criteria. It is possible to weigh some of the criteria more heavily than others if some are more important. To do this, it is usually necessary to assign a number value to each criterion. The result would be a numeric value for each alternative considered

Health insurance marketplaces

Also called exchanges Are online insurance supermalls, created for individuals without access to health insurance through a job or for small businesses who wish to buy affordable and qualified health benefit plans in a competitive insurance marketplace

Total quality management

Also referred to as continuous quality improvement (CQI) Based on the premise that the individual is the focal element on which production and service depend on Focus is on doing the right things, the right way, the first time, and problem-prevention planning, not inspective and reactive problem solving

Arbitration

Alternative dispute resolution (ADR) Formal Binding

Ombudsperson

Alternative dispute resolution (ADR) Investigates grievance Ensues right and process

Line structures

An advantage is because most people are familiar with this structure, there is little stress orienting people to the organization because authority and responsibility are clearly defined; however, a disadvantage is it can restrict upward communication because of the chain of command and make it difficult for workers to adjust to different circumstances. Good leaders encourage upward communication because in this structure, going outside the chain of command is inappropriate

Clinical nurse leader

An experienced nurse possessing a graduate degree who provides clinical leadership in all health-care settings, implements outcomes-based practice and quality improvement strategies, engages in clinical practice, and creates and manages microsystems of care that are responsive to the health-care needs of individuals and families

Preceptor

An experienced nurse who provides knowledge and emotional support, as well as a clarification of role expectations, on a one-to-one basis Effective ______________ role model and adjust teaching to each learner as needed

Mentoring

An in-depth supportive and nurturing relationship between an expert and a novice Formal relationship typically lasts 2 to 5 years, with mentor being one generation older than mentee Many nurses have limited opportunities to have a true mentoring relationship in their lives

Punishment

An undesirable event that follows unacceptable behavior, which may have negative consequences but can be a powerful motivator for change

Team nursing

Ancillary personnel collaborate to provide care to patients under the direction of a professional nurse. Requires extensive team communication and regular team planning conferences Allows members to contribute their own special expertise or skills Disadvantages are associated with improper implementation rather than the philosophy itself

Diagnosis-related groups (DRGs)

Are predetermined payment schedules that reflect historical costs for the treatment of specific patient conditions

As RN hours decrease in NCH/PPD, adverse patient outcomes increase: A.) True B.) False

Adult learning

Assets for ___________________: - High self-motivation - Self-directed - A proven learner - Knowledge experience reservoir - Special individual assets

Managers

Assigned position Delegated authority - legitimate power Specific duties Control Manipulates people, environment, time, resources Greater formal responsibility and accountability Direct willing and unwilling subordinates

Nurse navigator

Assists patients and families to navigate the complex health-care system by providing information and support as they traverse their illness

Decision making

Available options -> Choose logical course of action Consider existing alternatives Choice with maximum benefit Often triggered by problem, but not always! Often thought to be synonymous with management and is one of the criteria on which management expertise is judged. Much of any manager's time is spent critically examining issues, solving problems, and making decisions. The quality of the decisions that leader-managers make is the factor that often weighs most heavily in their success or failure. ______________, then, is both an innermost leadership activity and the core of management.

Conflict resolution strategies

Avoiding Compromising Competing Cooperating/Accommodating Smoothing Collaborating

Managed care

Based on the concept of capitation, whereby providers prospectively receive a fixed monthly payment, regardless of what services are used by that patient during the month. This encourages providers to treat less because their potential profits decline as treatment increases

Plan

Because a _______ is a guide to reach a goal, it must be flexible and allow for readjustment as unexpected events occur

Reinforcement

Because a learner's first attempts are often unsuccessful, good preceptors are essential to reinforce desired behavior. Once the behavior or skill is learned, it needs continual reinforcement until it becomes internalized

Role models

Behavior you want to emulate May be passive or nonexistent relationship A person can have many role models There is a cumulative effect

Laissez-faire

Behavioral theory Permissive,; little or no control Motivates by support when requested by the group or individuals Provides little or no direction Uses upward and downward communication Disperses decision making throughout the group Places emphasis on group Does not criticize

Authoritarian

Behavioral theory Strong control over employees Motivation by coercion Directing with commands Communication flows downward Employees not involved in decision making Emphasis is on difference in status ("I" and "you") Criticism is punitive

Reasons nurses do not join unions

Belief that unions promote a welfare state Need to demonstrate individualism and promote social status Belief that professionals should not unionize Identification with management's viewpoint Fear of employer reprisal Fear of lost income associated with a strike or walkout

Unity of command

Best described as one person/one boss in which employees have one manager to whom they report and to whom they are responsible Indicated by the vertical solid line between positions on the organizational chart

Criminal law

Beyond a reasonable doubt Laws which relate to crime. These laws regulate social conduct and cover threatening, harmful or otherwise endangering to property, health, safety and moral welfare of people (murder, assault)

Top level managers

Board of directors Chief executive officer Chief nursing officer Administrators Scope of Responsibility - Look at the organization as a whole including external influences Primary planning focus - Strategic planning Communication flow - Mostly top down but received subordinate feedback both directly and through middle level managers

Nursing licensure

Boundaries for practice are defined in the Nurse Practice Act of each state. Nursing licensure is a privilege and not a right. First mandatory Nurse Practice Act passed in New York in 1938; nursing has been legislated, directed, and controlled to some extent.

Authority power gap

Bridging the ___________________: - Overt displays of authority should be used as a last resort. - The leader should make a genuine effort to know and care about each subordinate as a unique individual. - The manager needs to provide enough information about organizational and unit goals to subordinates so that they understand how their efforts and those of their manager are contributing to goal attainment - Empowerment of staff is a hallmark of transformational leadership

Managed care

Broadly defined as a system that attempts to integrate efficiency of care, access and cost of care

Flexible budgeting

Budgeting method Are budgets that flex up and down over the year depending on volume

Performance budgeting

Budgeting method Emphasizes outcomes and results instead of activities or outputs

Zero based budgeting

Budgeting method In comparison, managers who use _____________ must rejustify their program or needs every budgeting cycle

Incremental budgeting

Budgeting method ____________ or the flat-percentage increase method is the simplest method for budgeting

Personal power base

Building a _____________________: - Maintain personal energy. - Present a powerful picture to others. - Pay the entry fee. - Determine the powerful in the organization. - Learn the language and symbols of the organization. - Learn how to use the organization's priorities. - Increase professional skills and knowledge. - Maintain a broad vision. - Be flexible. - Develop visibility and voice in the organization. - Learn to toot your own horn. - Maintain a sense of humor. - Empower others

Workplace violence

Bullying / horizontal bullying Incivility Mobbing Zero tolerance Typology - Nurse-to-nurse - Patient-to-nurse - Organization-to-nurse - External perpetrators - Third-party - Impact-of-mass trauma/natural disasters - Nurse-to-patient - Personal violence Consequences - Medical => Increased health c/o => Emotional/psychological consequences - Decrease in Pt care/pt safety => Less-patient centered care => Difficulty in maintaining ethical boundaries

Staffing

Can blow a budget—Nursing accounts for most of an acute facility's total payroll

Staffing

Can make---or break—the relationship between finance and nursing. Although we've come far, acuity remains subjective

Case management nursing focuses on the individual and coordinates care through an episode of illness: A.) True B.) False

Managing care with case management

Case managers often manage care using critical pathways and multidisciplinary action plans (MAPs) to plan patient care. The care MAP is a combination of a critical pathway and a nursing care plan, which indicates times when nursing interventions should occur. All health-care providers follow the care MAP to facilitate expected outcomes. If a patient deviates from the normal plan, a variance is indicated Some feel that the role of case manager should be reserved for the advance practice nurse or RN with advanced training

Centralized staffing characteristics are: A.) May not be cost effective B.) Staffing policies are consistent and less impartial C.) Staff have less flexibility

Power coercive

Change strategy Authoritative Laws Accept or leave

Rational emperical

Change strategy Lack of knowledge Humans are rational

Normative reeducative

Change strategy Peer pressure Humans are social creatures

Leadership

Characteristics Associated with Successful ________________: - Intelligence - Knowledge - Judgement - Decisiveness - Oral fluency - Emotional intelligence - Independence - Personable - Skilled communicator - Adaptability - Creativity - Cooperativeness - Alertness - Self-confidence - Personal integrity - Emotional balance and control - Risk taking - Critical thinking - Ability - Able to enlist cooperation - Interpersonal skills - Tact - Diplomacy - Prestige - Social participation - Charisma - Collaborative priority setting

Effective healthcare delivery systems

Characteristics of _________________________: - Facilitate meeting the goals of the organization - Cost-effective - Satisfy the patient - Provide role satisfaction to nurses - Allow implementation of the nursing process - Provide for adequate communication among health-care providers

Critical thinker

Characteristics of a ______________: - Analytical - Communicative - Intuitive - Persistent - Insightful - Open to new ideas - Creative - Adaptive - Collaborative

Characteristics of a clinical nurse leader are: A.) Create and coordinate plans of care for patients B.) Assists patients and families through their course of illness C.) Management of high cost high resource diseases

Clinical reasoning uses both knowledge and experience to make decisions at the point of care: A.) True B.) False

Art of negotiation

Collaboration Emphasis is on accommodating differences between the parties. Consider trade-offs and the bottom line Look for & Acknowledge hidden agendas uIs both psychological & verbal

Case management nursing

Collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual's health needs through communication and available resources to promote quality, cost-effective outcomes Coordinates care through an episode of illness The focus is on individual clients, not populations of clients

Transformational leadership

Committed, has a vision, and can empower others with this vision Identifies common values Is a caretaker Inspires others with vision Has long-term vision Looks at effects Empowers others

Leadership

Common ___________ Roles: - Decision maker - Communicator - Evaluator - Facilitator - Risk-taker - Mentor - Energizer - Priority setter - Coach - Counselor - Teacher - Critical thinker - Buffer - Advocate - Visionary - Director - Forecaster - Influencer - Creative problem-solver - Change agent - Role model - Diplomat - Innovator - Encourager

Grievance

Essentially a statement of wrongdoing or procedure to follow when one believes that a wrong has been committed

Nurse patient advocacy

Common areas of __________________: • End of life decisions • Use of technology • Use of resources • Access to health care • Conflicts between patient and provider(s) • Withholding information or lying to patients • Privacy and confidentiality • Respect for patient dignity • Inadequate consents • Incompetent health care providers • Complex social problems-care of the elderly, abused, disadvantaged

Disease management programs

Common features of ___________________: - Provide a comprehensive, integrated approach to the care and reimbursement of common, high-cost, chronic illnesses. - Focus on prevention as well as early disease detection and intervention to avoid costly acute episodes but provide comprehensive care and reimbursement - Target population groups (population based) rather than individuals. - Employ a multidisciplinary health-care team, including specialists. - Use standardized clinical guidelines—clinical pathways reflecting best practice to guide providers - Use integrated data management systems to track patient progress across care settings and allow continuous and ongoing improvement of treatment algorithms. - Frequently employ professional nurses in the role of case manager or program coordinator

Leapfrog group initiatives

Computerized physician-provider order entry Evidence-based hospital referral ICU physician staffing The use of Leapfrog safe practices scores

Compromising

Conflict resolution strategy Could result in lose-lose

Avoiding

Conflict resolution strategy Not acknowledged

Smoothing

Conflict resolution strategy Pacify

Cooperating/Accommodating

Conflict resolution strategy Sacrifice-win; Expect future payback

Competing

Conflict resolution strategy Win-lose

Collaborating

Conflict resolution strategy Win-win Emotional maturity

Restraining forces

Conformity, non-risk taker, fear of unknown

Chemically impaired employee

Confronting the _________________: - Gather as much evidence as possible of employee's impairment - Immediate confrontation is necessary if manager suspects employee may be impaired - Denial of the impairment or use of defense mechanisms should be expected - The manager should not try to nurture or assume the role of counselor to the employee

Human values

Confusing preferences for facts Tremendously influence our perceptions Therefore, as problem solvers gather information

Communication

Constant to ensure basic, safe care

Sources of the law

Constitution Statues Administrative agencies Court decisions

Types of discipline

Constructive Destructive Self-discipline

Payoff tables

Cost-Profit-Volume relationship Historical data -> Determines probabilities The decision aids known as payoff tables have a cost-profit-volume relationship and are very helpful when some quantitative information is available, such as an item's cost or predicted use To use ______________, one must determine probabilities and use historical data, such as a hospital census and a report on the number of operating procedures performed. To illustrate, a _____________ might be appropriately used in determining how many participants it would take to make an in-service program break even in terms of costs. If the instructor for the class costs $500, the in-service director would need to charge each of the 20 participants $25 for the class, but for 40 participants, the class would cost only $12.50 each. The in-service director would use attendance data from past classes and the number of nurses potentially available to attend to determine probable class size and thus how much to charge for the class. _________________ do not guarantee that a correct decision will be made, but they assist in visualizing data

Leadership advocacy

Create a work environment that recognizes patients' needs and goals as paramount. Creating a work culture in which patients are respected, well informed, and empowered. Patient advocacy includes distribution of resources and the use of technology. Patient advocacy includes risk taking, particularly when advocating for a client may be in direct conflict with a provider or institutional goal. Perform subordinate advocacy to assist subordinates resolve ethical problems and live with the solutions at the unit level.

Benchmarking

Critical event analysis and root cause analysis help to identify not only what and how an event happened but also why it happened, with the end goal being to ensure that a preventable negative outcome does not recur

Planning

Critically important to and precedes all other management functions Without adequate ____________, the management process fails and organizational needs and objectives cannot be met

Managed care

Criticisms of ____________: - Loss of existing physician-patient relationships - Limited choice of physicians for consumers - Less continuity of care - Reduced physician autonomy - Longer wait times for care - Consumer confusion about the many rules to be followed

Decentralized staffing strengths include: A.) More flexibility to staff B.) More cost effective C.) Less work for the middle manager

Planning

Deciding in advance what to do, who is to do it, how it is to be done and when it has to be done A proactive, deliberate process requires of all managers

Decision-making tools

Decision grids Payoff tables Decision trees Consequence tables

Decentralized decision making

Decision making is diffused throughout the organization and problems are solved at the lowest practical managerial level

Centralized decision making

Decisions are made by a few managers at the top of the hierarchy

Medicaid

Established in 1965 Primary population is the financially indigent. The majority of Medicaid recipients are women and children. Administered by the states under broad federal guidelines Covers about 17% of the US population How does cost sharing (deductibles, copayments, and coinsurance) impact moral hazard?

Minimum staffing criteria

Decisions made must meet state and federal labor laws and organizational policies. Staff must not be demoralized or excessively fatigued by frequent or extended overtime requests. Patient care must not be jeopardized, but improved California is the only state in the U.S. that has enacted legislation requiring mandatory staffing ratios in hospitals and long-term care facilities. The answer as to whether mandated ratios have improved care or created new cost burdens for California is still unclear

Managerial decision-making model

Define what decision needs to be made/Set objective -> Identify/research options -> Compare/contract options -> Rank options and make decision -> Implement plan -> Evaluate results To address the weaknesses of the traditional problem solving process, many contemporary models for management decision making have added an objective-setting step These models are known as _________________ or rational decision-making models

Multicultural work team

Delegating to a _________________: - There are six cultural phenomena that must be considered when working with staff from a culturally diverse background: 1. Communication 2. Space 3. Social organization 4. Time 5. Environmental control 6. Biological variations

Underdelegating

Delegation error False assumptions Lack of trust

Overdelegating

Delegation error Poor time management Disorganized Insecure

Improper delegating

Delegation error Wrong time, person and reason Task beyond the capabilities Inadequte information

Plan ahead

Delegation strategy Avoid becoming overwhelmed Assess the situation

Reward

Delegation strategy Give recognition

Empower the right personnel

Delegation strategy ID best staff Innovative and willing Delegate the authority and responsibility

Evaluate

Delegation strategy Positive and negative

Role model

Delegation strategy Provide guidance

Skill and education level

Delegation strategy RN Practice Act Scope of Practice

Deadlines

Delegation strategy Set and monitor timelines

Common goals

Delegation strategy What, purpose and goal of the task

Consequence tables

Demonstrate how various alternatives create different consequences Lists the objectives for solving a problem down one side of a table and rates how each alternative would meet the desired objective

Matrix organizations

Designed to focus on both the product and the function Have a formal vertical and horizontal chain of command Have fewer formal rules and fewer levels of the hierarchy Can cause slow decision making due to information sharing Can produce confusion and frustration for workers because of dual-authority hierarchical design

Driving forces

Desire to please, recognition, pay raise, eliminate problem

Supervision

Directing, guiding

Organization Chart

Disadvantages of the _________________: - Does not show the informal structure of the organization - Does not indicate the degree of authority held by each line position - May show things as they are supposed to be or used to be rather than as they are - Possibility exists of confusing authority with status

Disease management programs target population groups rather than individuals? A.) True B.) False

Manager role

Distinguish between employees who need progressive discipline and those who are chemically impaired, psychologically impaired, or marginal employees so that the employee can be managed in the most appropriate manner

State board of nursing treatment programs

Diversion Programs Intervention or Peer Assistance Programs Voluntary, confidential program Goal - Protect the public by early identification and to provide intervention and treatment programs for nurses Nurses who refuse participation in programs are subject to disciplinary review by the State Board of Nursing

During an interview, it is okay to ask if the applicant has children? A.) True B.) False

Personal mastery

Each member of the staff has a commitment to improve his or her personal abilities. This personal and professional learning is then integrated into the team and organization

Responsibility accounting

Each of an organization's revenues, expenses, assets, and liabilities is someone's responsibility. As a corollary, the person with the most direct control or influence on any of these financial elements should be held accountable for them, usually the leader-manager

Emerging care delivery models

Elevating the role of nurses and transitioning from caregivers to "care integrators" Taking a team approach to interdisciplinary care Bridging the continuum of care outside of the primary care facility Defining the home as a setting of care

Employees have a right to participate in union organizing under the NLRA, and managers can't interfere with this right? A.) True B.) False

Organizing a union

Employees have a right to participate in union organizing under the NLRA, and managers must not interfere with this right. Once management is faced with dealing with a bargaining agent, it has a choice of either accepting or opposing the union

Float pool

Employees who are cross-trained on multiple units so they can work when there is higher census or other staffing issues. Some staff uncomfortable with floating because they're not adequately oriented

Maintenance roles

Encourager Harmonizer Compromiser Gatekeeper Standard setter Group commentator Follower

Negotiation closure

End on a friendly note. Restate the final decision. Hide astonishment at your success. Make the other party feel that he or she also won. Follow up with a memo.

Staffing needs

Factors affecting _________________: • Education and knowledge level of current and needed staff • Peak resignation periods • Times of high patient census • How long new hires usually stay employed • Third party insurer reimbursement levels • Budget constraints • Patient care delivery system • Number of students enrolled in local nursing schools • Source of nursing pools • Historically, when the economy improves, nursing shortages occur. When the economy declines, nursing vacancy rate declines => Supply ==> Increases in enrollment will not be adequate to replace retiring nurses ==> Inadequate resources to provide nursing education including faculty, sites and preceptors ==> AACN (2019) reported 75,029 qualified applicants turned away from baccalaureate and graduate nurse programs => Demand ==> Aging population and extended longevity ==> Demand for care is escalating • Leaders should proactivity recruit and hire staff with age, gender, cultural, ethnic, and language diversity to better mirror the increasing diversity of the communities they serve • Brings new perspectives to thinking and problem solving

Factors affecting staffing needs are: A.) Peak resignation times B.) Budgets C.) Patient delivery system D.) All of the above

Future of health care

Factors influencing the ____________________: - Robotic technology - Biomechatronics - Biometrics and smart cards - Point of care testing - Telehealth and the internet - Growing elderly population - Nursing shortages in acute care hospitals - Managers who are uninformed about the legal, political, economic, and social factors affecting health care make planning errors that may have disastrous implications for their professional development and the financial viability of the organization

Resistance to delegation

Failure to see perspectives Lack of self-confidence Resistance to authority Over-delegated tasks

Fidelity

Faithful to agreements and promises Nurses have responsibilities to clients, employers, government, society Crucial in concept of accountability Foundation of trust

Confirmation bias

Favor information that confirms what one already believes

Queen bee syndrome

Female dominated professions often exemplify the ________________ The queen bee is a woman who struggled to become successful, but once successful, she refuses to help other women be successful

Assets

Financial resources that a health-care organization receives, such as accounts receivable

Chaos theory

Finding underlying order Future difficult to predict Tiny change = dramatic affects - AKA the butterfly effect Outcomes not proportional to change

Strength based leadership

Focuses on the development or empowerment of workers' strength Embodies an orientation towards strength and developing collective efficacy Four leadership domains: - Strategic thinking - Influence - Relationship building - Execution

Organization

Follows planning as the second phase of the management process This is where relationships are defined, procedures are outlined and tasks are assigned

Management functions

Forecast unit needs Recognize need for planned change Periodically assess for signs of organizational aging Actively involved in refreezing process until the change becomes part of the new status quo

Group communication stages

Forming Storming Norming Performing

Progressive discipline

Four common steps in _______________: 1.) Verbal admonishment 2.) Written admonishment 3.) Suspension from work without pay 4.) Dismissal All but the most serious infractions should be removed from the employee's record at conclusion of a predesignated period

Strategic planning

Generally, complex organizational plans that involve a long period (usually 3 to 7 years) are referred to as long-range or strategic plans. Typically examines an organization's purpose, mission, philosophy, and goals in the context of its external environment Unlike the 20-year strategic plans of the 1960s and 1970s, most long-term planners today find it difficult to look even 5 years in the future

Collective learning

Goes beyond the boundaries of individual learning and releases gains for both the individual and the organization

Storming

Group communication stage Challenging each other

Forming

Group communication stage Meeting each other

Performing

Group communication stage Working as one

Norming

Group communication stage Working with each other

Dominator

Group member role Attempts to control and manipulate the group

Aggressor

Group member role Expresses disapproval of others' values or feelings through jokes, verbal attacks or envy

Blocker

Group member role Persists in expressing negative points of view and resurrects dead issues

Playboy

Group member role Remains uninvolved and demonstrates cynicism, nonchalance or horseplay

Help seeker

Group member role Uses expressions of personal insecurity, confusion or self-deprecation to manipulate sympathy from members

Self-confessor

Group member role Uses the group setting as a forum for personal expression

Recognition seeker

Group member role Works to focus positive attention on him/herself

Staffing by acuity

Grouping of patients according to specific characteristics Hours of nursing care assigned for each patient classification Unique to a specific institution Ongoing review critical

Accountable care organizations

Groups of providers and suppliers of service who work together to better coordinate care for Medicare patients (does not include Medicare Advantage) across care settings

Budgeting methods

Incremental budgeting Zero-based budgeting Flexible budgeting Performance budgeting

Equal employment opportunities

Have fostered many profound changes in the American workplace. Women, minorities, and individuals with handicaps have had some success in gaining jobs previously denied to them; however, only modest gains in achieving ethnic diversity have occurred in nursing State and federal employment legislation often overlap; as a general rule, the employer must abide by the stricter of the two regulations Although some legislation makes the job of managing people more difficult for managers, it has resulted in increased job fairness and opportunities for women, minorities, older adults, and individuals with disabilities

Personnel workforce budget

Health care is labor-intensive. The personnel budget accounts for the majority of most health-care organization's expenses Next to personnel costs, supplies are the second most significant component in the hospital budget

Helpful negotiation strategies involve: A.) Aggressiveness B.) Ambiguous questioning C.) Factual statements

Advocacy

Helping others to grow and self-actualize Nurses advocate for themselves, patients, subordinates and the profession. The foundation and essence of nursing, and nurses have a responsibility to promote human advocacy. Goals of the advocate: • To inform • To enhance autonomy • To respect others' decisions

Baseline data

Historical information on dollars spent, acuity level, patient census, resources needed, hours of care, and so forth. This information is used as basis on which future needs can be projected

How can a nurse leader promote evidence based practice? A.) Build census from interdisciplinary teams B.) Make research and data accessible C.) Hire a nurse researcher D.) All of the above

Organizational climate

How employees perceive an organization The perception may be accurate or inaccurate, and people in the same organization may have different perceptions about the same organization

Process audits

How nursing care is provided and assumes a connection between the process and the quality of care. Critical pathways and Standardized clinical guidelines are examples of efforts to standardize the process of care

Objective

How the goal will specifically be achieved - Includes time frame and is measurable

How would you define "Norming" as a group communication strategy? A.) Meeting each other B.) Challenging each other C.) Working as one D.) Working with each another

Problem solving process

Identify problem -> Gather/analyze data -> Explore alternatives -> Evaluate alternatives -> Select appropriate solution -> Implement solution -> Evaluate results

Identify the concept of Moral Distress: A.) Witness the immoral act of another but feels powerless to stop it B.) Combination of physical, emotional and spiritual depletion C.) Knowing the right thing to do but there is organizational constraints

Identify the symptoms of Compassion Fatigue? A.) Poor concentration, focus and judgement B.) Cardiac symptoms: chest pain, palpitations C.) Irritability, anger D.) All of the above

Motivation to learn

If learners are informed in advance about the benefits of learning specific content and adopting new behaviors, they are more likely to attend the training sessions and learn. Telling employees why and how specific educational or training programs will benefit them personally (to gain buy in) is a vital management function in staff development

Disease management protocols

Illnesses often managed with ________________________: - Cancer - Acute otitis media - Diabetes - Hyperlipidemia - Asthma - Hypertension - COPD - Hormone replacement therapy - AIDS - Stroke

Chemical impairment

Impairment resulting from drug or alcohol addiction

Implementing change

Implemented for good reason Gradual Planned vs. sporadic Inclusive

Trainers and educators

Implications of Knowles's Work for _______________________: - A climate of openness and respect will assist in the identification of what the adult learner wants and needs to learn - Adults enjoy taking part in and planning their learning experiences - Adults should be involved in the evaluation of their progress - Experiential techniques work best with adults - Mistakes are opportunities for adult learning - If the value of the adult's experience is rejected, the adult will feel rejected - Adults' readiness to learn is greatest when they recognize that there is a need to know (such as in response to a problem) - Adults need the opportunity to apply what they have learned very quickly after the learning - Assessment of need is imperative in adult learning

Communication and team building

Important skill for clinicians and teams Encourage trust and cooperation Feelings toward team members can affect the teams ability to accomplish tasks. It is the reasonability of the leader - manager to use communication in such a way that builds the team

Confidentiality

In the ANA Nurses Code of Ethics In ANA Standards of Practice 1996 Health Insurance Portability & Accountability Act (HIPAA) Nurses safeguard the trust of clients by keeping their medical records private. Records used on a "need to know" only basis

Frequent legal claims against nurses

Inadequate charting Inadequate communication with physician or supervisors about changes in patient conditions. Leaving potentially harmful items within patient reach. Unattended patient falls. Inaccurate counting of operative instruments and sponges. Misidentifying patients for medications, surgeries, tests

External climate

Includes external factors: - Weather - Temperature - Timing - Status - Power - Authority - Organizational climate

Internal climate

Includes internal factors: - Values - Feelings - Temperament - Stress

Reasons nurses join unions

Increase the power of the individual Increase input into organizational decision making Eliminate discrimination and favoritism Because of social need to be accepted Because they are required to do so by employer Because they believe it will improve patient outcomes and quality of care

Conflict categories

Intrapersonal conflict Interpersonal conflict Intergroup conflict

Suggested interview format

Introduce yourself and greet the applicant Make a brief statement about the organization and clarify the position in which the person is applying Discuss the information on the application and seek clarification as needed Discuss applicant qualifications and proceed with a structured interview format If applicant is qualified, discuss the position further Explain hiring procedures Terminate the interview

Intuitive decision making does not involve experience or pattern recognition: A.) True B.) False

External whistleblowing

Involves reporting outside the organization, such as to the media or an elected offician

Discipline

Involves training or molding the mind or character to bring about desired behaviors

Forecasting

Involves trying to estimate how a condition will be in the future. Forecasting takes advantage of input from others, gives sequence in activity, and protects an organization against undesirable changes

Is "Just following physician's orders" a defense for malpractice? A.) True B.) False

Joint Comission

Is the major accrediting body for healthcare organizations and programs in the United States. It also administers the ORYX initiative and collects data on core measures to better standardize data collection across acute care hospitals

Organizational culture

Is the total of an organization's beliefs, history, taboos, formal and informal relationships, and communication patterns. Much of an organization's culture is not available to staff in a retrievable source and must be related by others

Team learning

It is through the collaboration of team members that LOs achieve their goals. Values, such as trust and openness, commitment to one another's learning, and acknowledgment that mistakes are part of the learning process, are important characteristics of an LO

Model of learning organizations

Key characteristics of Senge's _______________________: - Systems thinking - Personal mastery - Team learning - Mental models - Shared vision

Stages of conflict process

Latent conflict - (1st: Antecedent) Perceived conflict - (2nd: Intellectualized) Felt conflict - (3rd: Emotionalized) Manifest conflict - (4th: Action) Conflict aftermath - (5th: Positive/negative

Participatory management

Lays the foundation for shared governance, they are not the same Implies that others are allowed to participate in decision making over which someone has control Thus, the act of "allowing" participation identifies for the participant the real and final authority

Decentralized staffing

Lead to increased autonomy and flexibility but centralized staffing is fairer to all employee because policies tend to be employed more consistently and impartially

Social learning theory

Learning from interactions with others in a social context Also an important part of LOs because it suggests we learn from our interactions with others in a social context. (This is a part of the teamwork and mental model development in LOs.) Albert Bandura, a social psychologist, is often credited with developing social learning theory in the 1970s. Bandura (1977) believed that direct reinforcement could not account for all types of learning and that, instead, most people learn their behavior by direct experience and observation, known as observational learning or modeling

Socialization

Learning the behaviors that accompany each role by instruction, observation, and trial and error Involves a sharing of the values and attitudes of the organization Creates a fit between new staff members and the unit by introducing them to the norms of the group The first ________________ to the nursing role occurs during nursing school and continues after graduation

Nurse practice act

Legal instrument that defines what the functions of nursing shall be and sets standards for licensure. Grants a nurse the authority to carry out those functions. Each state Nurse Practice Act differs-all must be consistent with provisions or statutes established at the federal level. National Council of State Boards of Nursing is a resource Protects the public

Level 5 leadership

Level 1 - Highly capable individual Level 2 - Contributing team member Level 3 - Competent manager Level 4 - Effective leader Level 5 - Greater leader

Lewin's unfreezing stage determines the need for change: A.) True B.) False

Organizational structures

Line structures Ad hoc design Matrix structures Service line organization Flat designs

GRRRR

Listening tool Greeting Respectful listening Review Recommend or request more information Reward

Ethical dilemma

Making a choice between two or more equally undesirable alternatives. Individual who must solve an ethical dilemma is the only person who can ascertain if actions taken were congruent with personal values. Self-awareness is vital in ethical decision making, as it is in other aspects of management. Characteristics: - The problem cannot be solved using only empirical data - The problem is so perplexing that it is difficult to decide what facts and data are needed to be used in making the decision - The results of the problem - far-reaching effects

Management functions

Management Organizations - Henri Fayol - 1925 - Planning - Organization - Command - Coordination - Control Activities of Management - Luther Gulick - 1937 - Planning - Organizing - Staffing - Directing - Coordinating - Reporting - Budgeting

Performance deficiency coaching

Manager actively brings areas of unacceptable behavior or performance to the attention of the employee Works with employee to establish a plan to correct deficiencies

Workplace advocacy

Manager ensures safety in work environment Environment conducive to professional and personal growth for subordinates. Advocate for whistle-blowers, who speak out about organizational practices they believe may be harmful or inappropriate

Collective bargaining

Managers must be able to see _________________ and employment legislation from four perspectives: 1. The organization 2. The worker 3. General historical/societal 4. Personal

Medicare Part ___: - Financed primarily through employee payroll deductions and employer contributions - Covers inpatient hospital care, limited skill nursing facility care, home health, and hospice care, although beneficiaries pay a deductible for each inpatient benefit period as well as coinsurance for hospital and skilled nursing facility stays

Medicare Part ____: - Financed largely from federal general funds - Is a supplementary medical insurance, which covers primary care provider services, outpatient diagnostics tests, certain medical supplies and equipment, and (since 1998) home health care (previously Part A) - Is optional for beneficiaries, although most elderly pay the premiums

Medication is a type of dispute resolution that uses a neutral 3rd party for fact finding: A.) True B.) False

Culturally diverse staff

Meeting the educational needs of a ____________________: - Respect cultural diversity - recognize its desirability - Recognize different perceptions of classroom and instruction learning

Before the negotiation

Mental preparation Know the other party's incentives Start high & know bottom line, & trade-offs Look for hidden agendas

Planning hierarchy

Mission Philosophy Goals Objectives Policies Procedures Rules A person should be able to identify exactly how the organization is implementing its philosophy by observing members of the nursing staff, reviewing the budgetary priorities, and talking to patients

Modular nursing

Modification of team and primary nursing Similar to team nursing, but uses a smaller team Pairs professional nurses with ancillary staff to deliver care to groups of patients Used frequently during the 1980s and 1990s

Ad hoc design

Modification of the bureaucratic structure Sometimes used temporarily to facilitate project completion within a formal line organization Overcomes the inflexibility of line structure Serves as a way for professionals to handle increasingly large amounts of information Uses a project team or task approach and is usually disbanded after a project is completed May result in decreased employee loyalty to the parent organization

Moral hazard refers to the propensity of insured patients to use more medical services than necessary: A.) True B.) False

Organizational communication

More channels More individuals More information Impact of technology The nurse-leader communicates with clients, colleagues, bosses and subordinates In addition, because nursing practice tends to be group oriented, interpersonal communication among team members is necessary for continuity and productivity One must have excellent interpersonal communication skills, then, to be an effective leader-manager. In fact, communication is perhaps the most critical leadership skill

Communication modes

More direct→ more clear Written Communication Face-to-Face Communication Telephone Communication Nonverbal Communication

Education

More formal and broader in scope than training. Whereas training has an immediate use, education is designed to develop individuals in a broader sense

Problem solving

Moving from undesirable to desirable state Analyze difficult situation Systematic process -> Root problem - Decision making as last step Always includes a decision-making step. - Many educators use the terms problem solving and decision making synonymously, but there is a small, yet important, difference between the two. Although decision making is the last step in the problem-solving process, it is possible for decision making to occur without the full analysis required in problem solving. Because problem solving attempts to identify the root problem in situations, much time and energy are spent on identifying the real problem

Accountability

Must be able to explain actions and results

Float staff

Must be able to perform the core competences of the unit they are floating to meet legal and moral obligations

Magnet hospitals

Must demonstrate the following: - A higher percentage of satisfied registered nurses - Lower RN turnover and vacancies - Greater nurse autonomy - Improved patient satisfaction Well-qualified nurse executives in a decentralized environment, with organizational structures that emphasize open, participatory management Autonomous, self-managing, self-governing climates that allow nurses to fully practice their clinical expertise, flexible staffing, adequate staffing ratios, and clinical career opportunities A professional practice culture in all aspects of nursing care Compliance with standards in the ANA's Scope and Standards for Nurse Administrators

Organizational staffing policies

Need policies that address: - Sick leave - Vacations - Holidays - Call offs for low census - On-call pay - Tardiness and absenteeism - Shift work The nurse manager should be involved in policies that are written to allow flexibility for the staff

Organizational politics

Negating the effects of _______________________: - Become an expert handler of information and communication. - Be a proactive decision maker. - Expand personal resources. - Develop political alliances and coalitions - Be sensitive to timing - Promote subordinate identification - View personal and unit goals in terms of the organization - Leave your ego home in a jar

Reentry guidelines

No psychoactive drug use will be tolerated Assigned day shift for first year Paired with a successfully recovering nurse, when possible Willing to consent to random urine screening with toxicology or alcohol screens Give evidence of continuing involvement with support groups such as AA and NA Encouraged to participate in a structured aftercare program Encouraged to seek individual counseling or therapy, as needed

Leaders

Non-delegated authority Varied role Informal organizational association Focus on group process Direct willing followers Overarching goals

UAP appropriate tasks

Noninvasive and nonsterile treatments Collecting, reporting and documenting data - Vitals, CBGs, I/Os Ambulation, positioning Transport within the facility Personal hygiene, elimination Feeding Socialization activities ADLs

Complex adaptive systems

Nonlinear relationships Unpredictable future behavior Situational differences Snowball or dominoes effect

Principal agent theory

Not all followers (agents) are inherently motivated to act in the best interest of the leader or employer (principal) Followers may have an informational (expertise or knowledge) advantage over the leader as well as their own preferences, which may deviate from the principal's (employer's) preferences Principals must identify and provide agents (followers) with appropriate incentives to act in the organization's best interest

Ethical decision-making

Not based on personal values Reason to clarify and explore your values Employ reflective thinking Know your individual and professional code of ethics Learn and hear and respect another's viewpoint - Whether you agree or not Three approaches - Deontological - Teleological - Situational

Fiscal planning

Not intuitive; a learned skill that improves with practice An important but often neglected dimension of planning Should reflect the philosophy, goals, and objectives of the organization A skill increasingly critical to nursing managers because of increased emphasis on finance and "big business" of health care

Management

Nurse Managers must be registered nurses. They have around-the-clock accountability for the RNs at the hospital, handle performance reviews, recruiting, and other managerial duties related to the nursing department

Express consent

Nurse witnesses patient signature after reasonable assurance that the patient understands procedure, risks and alternatives

Conflict response

Nurse-managers can no longer afford to respond to conflict traditionally (i.e., to avoid or suppress conflict), because this is nonproductive

Shared governance

Nurses at every level play a role in the decisions that affect nursing activity throughout the system. Nurse-managers move out of traditional industrial model roles into collegial models, becoming moderators of the service process. Usually defined by a structure of rules or bylaws

Self scheduling

Nurses construct their own schedule instead of the manager

Principles for social networking

Nurses must not transmit or place online individually identifiable patient information. Nurses must observe ethically prescribed professional patient — nurse boundaries. Nurses should understand that patients, colleagues, institutions, and employers may view postings. Nurses should take advantage of privacy settings and seek to separate personal and professional information online. Nurses should bring content that could harm a patient's privacy, rights, or welfare to the attention of appropriate authorities. Nurses should participate in developing institutional policies governing online conduct.

Nursing care hours

Nursing hours worked in 24 hours / Patient census

Nursing care hours per day

Nursing hours worked in 24 hours / Patient census

Middle level managers

Nursing supervisors Nursing directors Department heads Scope of responsibility - Integrating unit level day to day needs with organizational needs Primary planning focus - Combination of long and short range planning Communication flow - Upward and downward with great centrality

Responsibility

Obligation to accomplish work

Justice

Obligation to be fair to all people - Individuals have the right to be treated equally regardless of race, sex, marital status, medical diagnosis, economic level, social standing, religious beliefs or sexual orientation - Fair allocation of scarce resources

Adult learning

Obstacles to ___________________: - Institutional barriers - Time - Self-confidence - Situational obstacles - Family reaction - Special individual obstacles

Informed consent

Obtained only after the patient receives full disclosure of all pertinent information regarding the surgery or procedure and only if the patient understands the potential benefits and risks associated with doing so. Only obtained by MD

Resocialization

Occurs when individuals are forced to learn new values, skills, attitudes, and social rules as a result of changes in the type of work they do, in the scope of responsibility they hold, or in the work setting itself

Role overload

Occurs when the demands of the role are excessive

Closed unit staffing

Occurs when the staff members on a unit make a commitment to cover all absences and needed extra help themselves in return for not being pulled from the unit in times of low census

Groupthink

Occurs when there is too much conformity to group norms, often resulting in opinions and ideas that may lack merit

Internal whistleblowing

Occurs within an organization, reporting up the chain of command May involve use of compliance hot line

Affordable care act

Officially known as the Patient Protection and Affordable Care Act, this act passed in March 2010 to provide more Americans access to affordable health insurance

Coaching

One person helping another to achieve an optimal level of performance Tool for empowering subordinates, changing behavior, and developing a cohesive team Emphasis on assisting the employee to recognize greater options, to clarify statements, and to grow

Organizational Culture is a sum total of values, languages, traditions, formal and informal communication: A.) True B.) False

Proactive planning

Organizations and planners tent to use one of the four planning modes: - Reactive - Inactivism - Preactivism - Proactive A ___________________ style is always the goal

Role change

Organizations often fail to address socialization problems that occur in job, position, or status changes

Clinical judgement

Outcome/result/conclusion Decision regarding action Client needs

Powerlessness

Power is likely to bring more power in an ascending cycle, whereas ___________________ will only generate more ____________________

Quality assurance and quality improvement

Over the past three decades, the American health-care system has moved from a quality assurance (QA) model to one focused on quality improvement (QI). The difference between the two concepts is that QA models target currently existing quality; QI models target ongoing and continually improving quality Two models that emphasize the ongoing nature of QI include total quality management (TQM) and the Toyota Production System (TPS)

Threats

Part of SWOT External conditions that challenge or threaten the achievement of organizational objectives

Opportunities

Part of SWOT External conditions that promote achievement of organizational objectives

Weaknesses

Part of SWOT Those internal attributes that challenge an organization in achieving its objectives

Strengths

Part of SWOT Those internal attributes that help an organization to achieve its objectives

Problem solving

Part of decision making and is a systematic process that focuses on analyzing a difficult situation. Always includes a decision-making step. Many educators use the terms problem solving and decision making synonymously, but there is a small, yet important, difference between the two

Types of communication

Passive Aggressive Passive-Aggressive Assertive

Adult learning theory

Pedagogy vs. Andragogy Many managers attempt to teach adults with pedagogical learning strategies. This type of teaching is usually ineffective for mature learners because adults have special needs. Knowles (1970) developed the concept of andragogy, or adult learning, to separate adult learner strategies from pedagogy, or child learning. Knowles suggested that the point at which an individual achieves a self-concept of essential self-direction is the point at which he or she psychologically becomes an adult. Table 16.1 shows how pedagogical and andragogical learning environments typically differ. Adult learners then are mature, self-directed people who have learned a great deal from life experiences and are focused toward solving problems that exist in their immediate environments. This is because adult learners need to know why they need to learn something before they are willing to learn it. Adult learning theory has strongly influenced how adults are currently taught in staff development programs. Based on the individual's needs, a combination of approaches may be required. Display 16.3 identifies the implications of Knowles's work for trainers and educators

Human error

People gathering information are not infallible

Autonomy

People have a right: - To determine their own actions based on their values and beliefs - To self-determination, independence and freedom Involves HCP's willingness to respect the patient's right to make decisions about and for themselves even if HCP does not agree with those decisions Limitations: - If individuals ________ interferes with others' rights, health and wellbeing - HCP required to report child/elder abuse and neglect - Informed consent is related to _______ - _________ underlies 1st statement in ANA Code of Ethics for nursing

Performance budgeting methods utilize the following in budgeting: A.) Emphasize the outcomes and results B.) Incremental or flat percentage increments C.) Flex up and down depending on volume

Powerlessness

Perhaps it is ________________ that corrupts instead of power

Induction

Phase 1 of Employee Indoctrination All activities that educate the new employee about the organization and employment and personnel policies and procedures

Orientation

Phase 2 of Employee Indoctrination Activities specific to the position

Individual orientation to each department

Phase 3 of Employee Indoctrination Specific departments are responsible for developing their own orientation program

Mentoring process

Phases of the ____________________: 1.) Exploring whether to begin a mentoring relationship 2.) Negotiating a mentoring agreement, with a goal(s) and deadline(s) 3.) Implementing the agreement and periodically reviewing progress made 4.) Summarizing and formally concluding the mentoring relationship

Joint collaboration

Pioneer - Pioneer creative nurse staffing approaches Assess - Assess new technology Work - Work towards joint accountability to embrace best practices Agree on - Agree on shared principles => Safe nurse staffing leads to better patient satisfaction and outcomes => Interprofessional collaboration

Capital budgets

Plan for the purchase of buildings or major equipment. This includes equipment that has a long life (usually greater than 5 years), is not used daily, and is more expensive than operating supplies

Types of Change

Planned change Unplanned change

Proactive planning

Planning has a specific purpose and is one approach to developing strategy. In addition, planning represents specific activities that help achieve objectives; therefore, planning should be purposeful and proactive. Although there is always some crossover between types of planning within organizations, there is generally an orientation toward one of four planning modes: reactive planning, inactivism, preactivism, or proactive planning

Planning precedes all other management functions? A.) True B.) False

Policies

Plans reduced to statements

Rules

Plans that specifically define acceptable choices of action

CMS (Centers for Medicare and Medicaid Services)

Plays an active role in setting standards for and measuring quality in health care including pay for performance

Breakeven point

Point at which revenue covers costs. Most health-care facilities have high fixed costs. Because per-unit fixed costs in a noncapitated model decrease with volume, health-care facilities under this model need to maintain a high volume to decrease unit costs

Managing

Policies and procedures Counting value Power and control Have subordinates Managing people and work processes Work focused Authoritarian style Risk averse and stability Reactive Plans detail Maintain status quo Give directions

Critical pathways

Predetermined courses of progress that patients should make after admission for a specific diagnosis or after a specific surgery Strategy for assessing, implementing, and evaluating the cost-effectiveness of patient care Utilization review Provision of service no longer guarantees reimbursement. Clear and comprehensive documentation of the need for services and actual services provided is needed for reimbursement

Delegation

Primarily about entrusting your authority to others ANA: Assignment of activities and task performance R/T pt care to UAPs: Maintain - Transfer responsibility - Maintain accountability Empowering one person to act for another. (Susanne A. Quallich) Critical to managerial productivity and efficiency. NCSBN: Transfer authority to a competent individual Assignment vs Delegation

Relationship based nursing

Primary nurse assumes 24-hour responsibility for planning patient care from admission or start of treatment to discharge or treatment's end. During work hours, the primary nurse provides total direct care for that patient. When the primary nurse is off duty, associate nurses follow the care plan established by the primary nurse and provide care Brings nurse back to the bedside to provide clinical care Can succeed with a diverse skill mix or an all-RN staff Job satisfaction is high; however, this method is difficult to implement because of the degree of responsibility and autonomy required of the nurse Disadvantages lie primarily in improper implementation

Organizational planning

Principles of ____________________: - All plans must flow from other plans. Short-range plans must be congruent with long-range plans. - Planning in all areas of the organization must follow the mission, philosophy, and goals of the overall organization. - Planning involves the same process regardless of the period involved - The length of the plan is determined by what actions are necessary to make the plan successful. - All planning must include an evaluation step and requires periodic reevaluation and prioritization. - All people and organizational units affected by a plan should be included in the planning

Morals

Principles, habits with respect to right or wrong conduct, personal compass Origin individual-internal We believe right/wrong Usually consistent but can change individual's beliefs "Mos" means custom Morality transcends cultural norms

Critical thinking

Process "Reflective thinking" Purposeful, informed, outcomes focused thinking More complex/broader than decision making Related to evaluation and has a broader scope than decision making and problem solving. Dictionary.com (2018) defines critical thinking as "disciplined thinking that is clear, rational, open-minded, and informed by evidence". Also involves reflecting on the meaning of statements, examining the offered evidence and reasoning, and forming judgments about facts. Insight, intuition, empathy, and the willingness to take action are components of critical thinking. Whatever definition of _______________ is used, most agree that it is more complex than problem solving or decision making, involves higher order reasoning and evaluation, and has both cognitive and affective components. The authors believe that insight, intuition, empathy, and the willingness to take action are additional components of critical thinking. These same skills are necessary to some degree in decision making and problem solving.

Critical thinking

Process Broad inside and outside of clinical setting Sometimes referred to as reflective thinking, is related to evaluation and has a broader scope than decision making and problem solving

Clinical reasoning

Process Specific patient care issues When nurses integrate and apply different types of knowledge to weigh evidence, critically think about arguments, and reflect on the process used to arrive at a diagnosis Uses both knowledge and experience to make decisions at the point of care

Clinical reasoning

Process of evaluating evidence, generating and appraising alternatives in order to choose the best action Assessment/Interpretation of Patient Information Clinical experience Evidence-based nursing Critical evaluation of arguments for nursing actions Collaboration with patient/family Clinical knowledge

Moral disengagement

Process that involves justifying one's unethical actions by altering one's moral perception of those actions, defense mechanism and displacement of responsibility, a form of moral distress. Occurs in the health care industry poses serious threats to patient safety, the culture of the institution, and even the mental health of care providers.

Learning organization

Promotes a shared vision and collective learning in order to create positive and needed organizational change

Clinical practice guidelines

Provide diagnosis-based step-by-step interventions for providers to follow in an effort to promote quality care Also called standardized clinical guidelines Should reflect evidence-based practice (EBP); that is, they should be based on cutting-edge research and best practices

Bundled payments

Providers agree to accept a discounted payment either retrospectively or prospectively, which represents a coordinated plan of care for patients over the course of a single episode of an illness

Value based purchasing

Providers are held accountable for the quality and cost of the health-care services they provide by a system of rewards and consequences, conditional upon achieving prespecified performance measures

Interviewing

Purpose of the Interview • Interviewer obtains enough information to determine suitability • Applicants obtain information to make a decision about the job Requires to interviewer to use judgments, biases, and values to make decisions based on a short interaction with an applicant. Reliability and validity are always suspect.

Patient Protection and Affordable Care Act (PPACA)

Put in place comprehensive insurance reforms that were to be phased in over a 4-year period: o New Patient's Bill of Rights o Bundled payments o Accountable care organizations o Hospital value-based purchasing o The medical home o Health insurance marketplaces Value based purchasing

Educational Program

Sequence for developing an _____________________: 1.) Identify the desired knowledge or skills that the staff should have. 2.) Identify the present level of knowledge or skill. 3.) Determine the deficit of desired knowledge and skills. 4.) Identify the resources available to meet needs. 5.) Make maximum use of available resources. 6.) Evaluate and test outcomes after use of resources.

Servant leadership

Putting others as the number one priority Fostering a service inclination in others that promotes collaboration, teamwork, and collective activism Defining qualities: - The ability to listen on a deep level and to truly understand - The ability to keep an open mind and hear without judgment - The ability to deal with ambiguity, paradoxes, and complex issues - The belief that honestly sharing critical challenges with all parties and asking for their input is more important than personally providing solutions - Being clear on goals and good at pointing the direction toward goal achievement without giving orders - The ability to be a servant, helper, and teacher first and then a leader - Always thinking before reacting - Choosing words carefully so as not to damage those being led - The ability to use foresight and intuition - Seeing things whole and sensing relationships and connections

Delegating

Questions to ask when ______________: TASK: - Is the task appropriate - Legal CIRCUMSTANCE - Appropriate situation - Environment conducive - Available equipment & resources - Staffing rations PERSON - Delegatee willing and able - Delegatee has knowledge and experience - Delegatee has expertise to complete the task safely and efficiently DIRECTION/COMMUNICATION - Both use a common work related language - Delegator provide clear and concise directions for the task - Delegatee understand the assignment, directions, limitations and expected results - Both maintain open communication lines - Delegatee know how, what, & when SUPERVISION - Delegatee have appropriate supervision - Will Delegator provide feedback related to the task - Delegator able to monitor and evaluate the pt appropriately

NCSBN guidelines

RNs must provide clear communications to APs: - Expected timelines - Guidelines for consulting with RN - Guidelines for reporting back completion of delegated activities APs should be instructed to: - Repeat the directions - Confirm the understanding - Be encouraged to ask questions - Be encouraged to feel part of the healthcare team

Change strategies

Rational-emperical Normative-reeducative Power-coercive

Sources of power

Referent Legitimate Coercive Reward Expert Charismatic Informational

Chunking

Refers to presenting two independent items of information and grouping them together into one unit Although the mind can remember only a limited number of chunks of data, experienced nurses can include more data in those chunks than can novice nurses

Span of control

Refers to the number of people directly reporting to any one manager and determines the number of interactions expected of him or her Too many people reporting to a single manager delays decision making, whereas too few results in an inefficient, top-heavy organization Can be determined by the organizational chart

Moral hazard

Refers to the propensity of insured patients to use more medical services than necessary because their out of pocket cost is so small (insurance covers most of the cost)

Operating budget

Reflects expenses that flex up or down in a predetermined manner to reflect variation in volume of service provided

Responsibility

Related to job assignment and must be accompanied by enough authority to accomplish the assigned task

Recruitment; Retention

Relationship between ___________ and ____________: • Expensive to replace RNs—Typically replacement closer to $64,000 per RN; some as high as replacement cost in the 80 thousand range • Although some turnover is normal; excessive turnover results in increased costs for temporary replacements, traveling nurses and overtime • Experience takes years of development: loss of experienced nurses could lead to errors by more novice nurses • Leader -Manager recognizes the link and has the greatest impact in promoting a positive social climate and environment for retention • High levels of employee engagement and satisfaction benefit recruitment and retention

Medical home

Relies on a team of providers to integrate all aspects of health care through well-developed health information technology, including electronic health records

Flat organizational designs

Remove hierarchical layers by flattening the scalar chain and decentralizing the organization Continue to have line authority, but because the organizational structure is flattened, more authority and decision making can occur where the work is being carried out Despite being very flat, often retain many characteristics of a bureaucracy

Equal Pay Act of 1963

Requires that men and women performing equal work receive equal compensation Four equal pay tests exist—equal skill, equal effort, equal responsibility, and similar working conditions

Knowledge of results

Research has demonstrated that people learn faster when they are informed of their progress. The knowledge of results must be automatic, immediate, and meaningful to the task at hand. People need to experience a feeling of progress, and they need to know how they are doing when measured against expected outcomes

Resistance is an expected response to change: A.) True B.) False

After the negotiation

Restate agreements • Verbal • Written Recognize all parties involved in the negotiation

Clinical judgement

Result; The final decision Conclusion, decisions based on The process by which the nurse decides on data to be collected about a client, makes an interpretation of the data, arrives at a nursing diagnosis, and identifies appropriate nursing actions; this involves problem solving, decision making, and critical thinking

Destructive negotiation tactics

Ridicule Ambiguous or Inappropriate questioning Flattery Sadness Helplessness Aggressive take over/controlling

Five rights of delegation

Risk task Right circumstances Right person Right direction/Communication Right level of supervision

Planning hierarchy

Rules as a part of the _________________________: - Because rules are the least flexible type of planning, there should be as few rules as possible in the organization. - Existing rules, however, should be enforced to keep morale from breaking down and to promote organizational structure

International nurses

Unique socialization needs of ____________________: - Often experience cultural, professional and psychological dissonance - Communication problems - Anxiety, homesickness and isolation

Staffing

Sequential steps in __________: 1.) Determine the number and types of personnel needed => Fulfill the philosophy of organization => Meet fiscal responsibilities => Carry out the patient care delivery system 2.) Recruit, interview, select and assign personnel => Based on established job description performance standards 3.) Use organization resources for orientation and induction 4.) Assure adequate socialization or organizations values and unit norms 5.) Use create and flexible scheduling based on patient care needs - Increases productivity and retention

Six sigma approach

Sigma is a statistical measurement that reflects how well a product or process is performing. Higher sigma values indicate better performance. Historically, the health-care industry has been comfortable striving for three sigma processes in terms of health-care quality, instead of six

Non-verbal communication

Silence Space Environment Appearance Eye contact Posture Gestures Facial expression Timing Vocal expression

SWOT

Simple rules for _________ analysis: - Be realistic about the strengths and weaknesses of your organization. - Be clear about how the present organization differs from what might be possible in the future. - Be specific about what you want to accomplish - Always apply ______ in relation to your competitors - Keep ______ short and simple - Remember that _______ is subjective

SBAR

Situation Background Assessment Recommendation

Nursing's power base

Six driving forces to increase _____________________: 1.) The timing is right 2.) The size of the nursing profession 3.) Nursing's referent power 4.) Increasing knowledge base and education for nurses 5.) Nursing's unique perspective 6.) Desire of customers and providers for change

Delegation strategies

Skill and education level Plan ahead Empower the right personnel Common goals Deadlines Role model Evaluate Reward

Reward

Source of power Ability to grant favors

Referent

Source of power Association with others

Coercive

Source of power Fear

Expert

Source of power Knowledge and skill

Charismatic

Source of power Personal

Legitimate

Source of power Position

Informational

Source of power The need for information

Administrative agencies

Source of the law Given authority to act by the legislative bodies Create rules and regulations that enforce statutory laws State Boards of Nursing • Implement and enforce the State Nurse Practice Act • By writing Rules and Regulations • By conducting investigations and hearings to ensure the law's enforcement. Involvement with Nursing Practice: => Agencies which enforce the statues - LSBN

Court decisions

Source of the law Interpret legal issues that are in dispute Involvement with Nursing Practice: - Judicial or decisional law impact nursing => Includes malpractice cases

Statues

Source of the law Laws that govern _________ are official enacted and passed Example: Nurse Practice Acts Involvement with Nursing Practice: -Effect malpractice; Nurse practice act

Span of Control refers to the number of people directly reporting to one manager: A.) True B.) False

Stages of change model

Stage 1 - Pre-contemplation Stage 2 - Contemplation Stage 3 - Preparation Stage 4 - Action Stage 5 - Maintenance

Three phases of planned change

Stage 1 - Unfreezing Stage 2 - Movement Stage 3 - Refreezing

Pre contemplation

Stage 1 of Change Model No intention of changing Unaware of behavior or need for change, not planning to make a change

Unfreezing

Stage 1 of Planned Change Gather data Accurately diagnose the problem Determine need for change Makes others aware of need Examine status quo Increase driving forces for change Decrease resisting forces against

Contemplation

Stage 2 of Change Model Unfreezing Considers change but not committed Thinking about change Seeking out support and information

Movement

Stage 2 of Planned Change Develop plan Set goals & objectives ID support/resistance Include all who are affected Set target dates Develop appropriate strategies Implement the change Be available for support Strategize to overcome resistance Evaluate the change Modify if necessary Take action Make changes Involve people

Preparation

Stage 3 of Change Model Intends to change in near future Transition from unfreezing to movement begins Planning to make change Gathering confidence and resources

Refreezing

Stage 3 of Planned Change Support others so that change continues Make change permanent Establish new way of things Reward desired outcomes

Action

Stage 4 of Change Model Movement Actively modifies behavior Taking positive steps to make change and putting plans into practice

Maintenance

Stage 5 of Change Model Refreezing Works to maintain changes to prevent relapse Achieving results and behavior becomes part of daily life

Procedures

Step by step process

Strategic planning

Steps in ________________________: 1.) Clearly define the purpose of the organization 2.) Establish realistic goals and objectives 3.) Identify external constituencies and determine their assessment of the organization's purposes 4.) Clearly communicate the goals of the constituents 5.) Develop a sense of ownership of the plan 6.) Develop strategies to achieve the goals 7.) Ensure that the most effective use is made of resources 8.) Provide a base from which progress can be measured There is increasing recognition of the importance of subordinate input from all levels of the organization to give strategic plans meaning and to increase the likelihood of their successful implementation

Types of Interviews

Unstructured Semistructured Structured

Averting the union

Strategies for _______________: - Knowledge and care of employees - Personnel policies are fair and well communicated. - Well-trained managers - Procedures for handling employee grievances - Competitive wages/benefits - Job security is equal to job performance - The states with the most union organizing for all industries, including health care, are Hawaii, New York, California, Pennsylvania, Michigan, and Illinois - Under current legislation, nurses with less than 10% to 15% (equal to about one shift per pay period) of their time as charge nurse are considered staff nurses, whereas nurses working more than 15% of their professional time as charge nurses are considered supervisors and, therefore, ineligible for protection under the National Labor Relations Act (NLRA) - The issues around who can belong to a union, what the definition of "supervisor" is in nursing, and whether strikes and walkouts are ethically justified for nursing professionals add to the complexity of discussion about whether collective bargaining should be a part of professional nursing

Successful planning

Strategies for __________________: - Start planning at the top - Keep planning organized, clear and definite - Do not bypass levels of people - Have short- and long-range plans and goals - Know when to plan and when not to - Keep target dates realistic - Gather data appropriately - Be sure objectives are clear - Remember, interpersonal relationships are important

Evidence based practice

Strategies for promoting _______________________: - Develop and refine research-based policies and procedures. - Build consensus from the interdisciplinary team through development of protocols, decision trees, standards of care, institutional clinical practice guidelines, etc. - Make research findings accessible through libraries and computer resources. - Provide organization support, such as time to do research and educational assistance to teach staff to interpret research statistics and use findings. - Encourage cooperation among professionals. - When possible, hire nurse researchers or consultants to assist staff.

Self-discipline

Strategies to create an environment of _______________: - Clearly written and communicated rules and regulations - Atmosphere of mutual trust - Judicious use of formal authority - Employee identifies with organizational goals

SWOT

Strengths Weaknesses Opportunities Threats

Decentralized staffing

Strengths: - Manager retains greater control over unit staffing - Staff can take requests directly to their manager - Provides greater autonomy and flexibility for the individual staff member Limitations: - Can result in more special pleading and arbitrary treatment of employees - May not be cost-effective for organization because staffing needs are not viewed holistically - More time-consuming for the unit manager to oversee if sufficient coverage

Centralized staffing

Strengths: - Provides organization-wide view of staffing needs, which encourages optimal utilization of staffing resources - Staffing policies tend to be employed more consistently and impartially. - More cost-effective than decentralized staffing - Frees the middle-level manager to complete other management functions Limitations: - Provides less flexibility for the worker and may not account for a specific worker's desires or special needs - Managers may be less responsive to personnel budget control in scheduling and staffing matters

Limitations of the interview process

Subjectivity can never be totally eliminated High interview assessments do not necessarily correlate with high performance on the job Mixed reliability and validity - Interrater reliability low in unstructured interviews - Interrater reliability is better if the interview is structured and the same interview format is used by all interviewers Decisions are formed in the first few minutes of the interview

HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems)

Survey is the first national, standardized, publicly reported survey of patients' perspectives of hospital care. It measures recently discharged patients' perceptions of their hospital experience

Intuitive decision-making model

Takes intuition into account - Empirical evidence/evidence-based practice - Quick decisions Intuition involves - Pattern recognition - Experience There are theorists who suggest that intuition should always be used as an adjunct to empirical or rational decision-making models. Experienced (expert) nurses often report that gut-level feelings (intuition) encourage them to take appropriate strategic action that impacts patient outcomes, although intuition generally serves as an adjunct to decision making founded on a nurse's scientific knowledge base. Intuition then can and should be used in conjunction with evidence-based practice.

Five rights of delegation

Task that is delegable for a specific patient Appropriate pt setting and available resources Right delegator delegating right task to right delegate on right pt Clear concise task description Appropriate monitoring, evaluation, intervention as needed and feedback

Cannot

Tasks that ___________ be delegated: • Any task that would involve nursing judgment or sophisticated application of the nursing process (Assessment, Plan, Evaluation) • To LPNs: Initial Assessment of New Patients • LSBN: Chemotx, IV push, Blood transfusion • Evaluation success of a treatment • Writing Care Plans/ Establishing plans of care • To UAPs: Interpreting test results • To UAPs: Identifying client needs • Triage • Counseling and Teaching

Tasks that can be delegated are: A.) Ambulation and positioning B.) Collecting and documenting vital signs C.) Sterile dressing changes D.) A and B

Tasks that cannot be delegated are: A.) Nursing judgement of sophisticated application of the nursing process B.) Triage C.) IV push D.) All of the above

First level managers

Team leaders Charge nurses Primary care nurses Case managers Scope of responsibility - Focuses primarily on day to day needs at the unit level Primary planning focus - Short range, operational planning Communication flow - Most often upward; relies on middle level managers to transmit communication to top level managers

Scientific/Industrial age

Technical skills Command and control Competition Gaining advantage Gathering facts What you have (wealth) Hierarchy (top-down) Metaphor for organizations: machine (separate parts) Leadership: position

Plans

Why do _________ fail? - Sound strategies not used - Inadequate delegation of authority - Not recognizing organizational goals and needs - Planning too narrow in scope—not recognizing community, legal, and licensing requirements

Medicare and medicaid managed care

The Centers for Medicare & Medicaid Services is now the largest purchaser of managed care in the country. MCOs receive reimbursement for Medicare-eligible patients based on a formula established by the CMS, which looks at age, gender, geographic region, and the average cost per patient at a given age. Then, the government gives itself a 5% discount and gives the rest to the MCO

Labor and management

The Relationship between _____________________: - The roots of union activity lie in poor relationships between employees and management. - The middle manager has the greatest impact on the quality of the relationship that develops between labor and management - Union membership and activity increase during high employment and prosperity and decrease sharply during economic recessions and layoffs. - High demand for nurses correlates with increased union activity - Employees' perceptions of the quality of their supervision affects their unionization rates - Although unions historically focused heavily on wage negotiations, current issues that nurses deem just as or more important are nonmonetary, such as guidelines for staffing, float provisions, shared decision making, and scheduling

Power

The authority and ability to get things accomplished The capacity or potential to get others to do something one wants them to do that they would not ordinarily do otherwise

The best strategy for resolving conflict is: A.) Smoothing B.) Competing C.) Compromising D.) Collaborating

Behavioral sanctions

The bestowing of rewards and punishments Used to show employees what behavior is rewarded or eschewed in an organization Rarely carried out on a systematic and planned basis

Quality control process

The criterion or standard is determined Information is collected to determine whether the standard has been met Educational or corrective action is taken if the criterion has been met

Patient classification systems (PCS)

The critical indicator PCS uses broad indicators such as bathing, diet, intravenous fluids, medications, and positioning to categorize patient care activities. The summative task PCS requires the nurse to note the frequency of occurrence of specific activities, treatments, and procedures for each patient. At the national level, the use of a PCS is a condition for participation in Medicare and is required by The Joint Commission for certification. Not uncommon to have adequate staffing one day and inadequate the next day with the same number of patients/staff

Scalar chain

The decision-making hierarchy, or pyramid, is often referred to as a scalar chair It's the normal line of authority which moves from highest to lowest in a straight line This chain specifies the route through which the information is to be communicated to the desired location/person

The decision-making hierarchy, or pyramid, is often referred to as a: A.) Unity of command B.) Centrality C.) Scalar chain

Goal

The desired result toward which effort is directed

Quality gap

The difference in performance between top-performing health-care organizations and the national average is called the _________________ Although the ________________ is typically small in industries such as manufacturing, aviation, and banking, variation is more common in health care

The difference in performance between top-performing organizations and the national average is called the quality gap. A.) True B.) False

Span of memory

The effectiveness of staff development activities depends to some extent on the ability of the participants to retain information. Effective strategies include the chance for repeated rehearsal, grouping items to be learned (three or four items for oral presentations and four to six visually), having the material presented in a well-organized manner, and chunking

Formal organizational structure

The emphasis is on organizational positions and formal power Provides a framework for defining managerial authority, responsibility and accountability

Centrality

The extent to which an employee is integrated into the network of interpersonal relationships within the work system The middle manager often has centrality because he or she has a broader view of the organization and communicates in many directions

Informal organizational structure

The focus is on the employees, their relationships and the informal power that is inherent within those relationships Has its own leaders and communication channels (grapevine)

McGregor's hot stove rule

The following four elements must be present to make discipline as fair and growth-producing as possible: 1) Forewarning 2) Immediate consequences 3) Consistency 4) Impartiality

Nurse manager

The goal of the _____________ is to ensure there is adequate staff to meet the needs of each client

Transfer of learning

The goal of training is to transfer new learning to the work setting. For this to occur, there should first be as much similarity between the training context and the job as possible. Second, adequate practice is mandatory, and overlearning (learning repeated to the degree that it is difficult to forget) is recommended. Third, the training should include a variety of different situations so that the knowledge is generalized. Fourth, whenever possible, important features or steps in a process should be identified. Finally, the learner must understand the basic principles underlying the tasks and how a variety of situations will modify how the task is accomplished. Learning in the classroom will not be transferred without adequate practice in a simulated or real situation and without an adequate understanding of underlying principles

Data collection

The hospital must collect relevant data related to nursing, which must then be compared with that of other hospitals for benchmarking purposes This data must also be used to identify problems and the means for improvement

Span of control

The ideal _______________ in an organization is determined by factors such as the nature of the job, the manager's abilities, task complexity and the level it happens in the organization

Feedback process

The institution must develop a way for nurses to confidentially express concerns about the hospital's practices in a way that encourages them to do so

Conflict

The internal or external discord that occurs as a result of differences in ideas, values or beliefs of two or more people Is natural, neither positive nor negative - It can produce growth or destruction, depending on how it is manager Some level of ___________ in an organization appears desirable, although the optimum level for a specific person or unit at a given time is difficult to know

The leadership role in change involves: A.) Being visionary B.) Being a risk taker C.) Being an inventor D.) All of the above

Task learning

The learning of complex tasks is facilitated when tasks are broken into parts, beginning with the simplest and continuing to the most difficult. It is necessary, however, to combine part learning with whole learning. When learning motor skills, spaced practice is more effective than massed practice

Group norms

The manager should know what the _________________ are and should be observant of the sanctions used by the group to make newcomers conform. The manager should take appropriate intervention if group norms are not part of the organizational culture

Accountability

The moral responsibility that accompanies a position

Resistance

The natural and expected response to change Instability Mandated vs. Proactive Type - Technology vs. Social Obvious need Individual personality Mistrust

Span of control

The number of people directly reporting to that member represents the manager's _______________

Authority

The official power to act and direct the work of others

Case method nursing

The oldest mode of organizing patient care Nurses assume total responsibility for meeting the needs of all assigned patients during their time on duty. It is sometimes referred to as the case method of assignment because patients may be assigned as cases. It is still widely used in hospitals and home health agencies

Systems thinking

The organization encourages staff to see themselves as connected to the whole organization, and work activities are seen as having an impact beyond the individual. This creates a sense of community and builds a commitment on the part of individual workers not only to the organization but also to each other. Consequently, one of the main goals of the learning organization (LO) is to construct an organizational culture of learning

Collective bargaining

The process in which working people, through their unions, negotiate contracts with their employers to determine their terms of employment, including pay, benefits, hours, leave, job health and safety policies, ways to balance work and family, and more Preparation objectives choosing negotiation team anticipation of union demands => Timelines for negotiations set ground rules => Each party presents proposals => Proposals presented, discussed, new meetings take place Details settled, contract written and voted on by union membership

Outcome audits

The result of the care provided Determine what results, if any, occurred as a result of specific nursing interventions for patients Assumes the outcome accurately demonstrates the quality of care that was provided

Authority power gap

The right to command does not ensure that employees will follow orders. An ___________________ exists when someone in author issues orders and they are not followed. The negative effect of a wide ____________________ is that organizational chaos may develop

Authority power gap

The size of the ___________________ between a manager and an employee: - Widens as the manager expresses a personal interest in his or her employees - Can be decreased by the visible exercise of authority in decision making - Increases when the manager loses credibility with employees - Is influenced by how much status the manager has

Organizational culture

The values and behaviors that contribute to the unique social and psychological environment of an organization A sum total of values, language, traditions, formal and informal communication networks, and the rituals of an organization

Communication

The way a message is perceived can be influenced by the Internal and External Climate

Nurses unions

There is no single labor union that represents nurses across the nation. Unions such as Service Employees International Union represent nurses as well as many employee groups such as janitors and airport workers. Unions such as National Nurses United and state organizations like the California Nurses Association encourage nurses to join as they claim to be nurse-focused. Most of these unions are neither organized nor led by nurses. Nurses in a collective bargaining unit pay as much as $90 per month for union representation.

Marginal employees

These employees disrupt unit functioning because the quantity or quality of their work consistently meets only minimal standards These employees meet only minimal standards despite tremendous efforts to meet competencies

Team building

These roles help to clarify role expectations through the use of social interaction and educational processes. Each role has a different focus and uses different mechanisms

Staffing

Third phase of the Management Process Requires crucial management skills to predict staffing needs to avoid a staffing crisis The leader manager recruits or participates in recruiting, selecting, placing and indoctrinating personnel to accomplish the goals of the organization

This audit in Quality determines what results, if any, followed from specific nursing interventions for patients: A.) Structure B.) Process C.) Outcomes

Chunking

This occurs when two independent items of information are presented and then grouped together into one unit. Although the mind can remember only a limited number of chunks of data, experienced nurses can include more data in those chunks than can novice nurses. For example, experienced nurses are typically better able to recognize subtle changes in a patient's condition based on the assessments they have made or changes in lab values, whereas the novice nurse may take a bit longer to connect these pieces of information

Plans fail

Why do _______________?: - False assumptions - Not knowing overall goals - Not enough alternatives - Inadequate time or other resources - Low motivation levels

Readiness to learn

This refers to the maturational and experiential factors in the learner's background that influence learning and is not the same as motivation to learn. Maturation means that the learner has received the prerequisites for the next stage of learning. The prerequisites could be behaviors or prior learning. Experiential factors are skills previously acquired that are necessary for the next stage of learning

This theory supported the idea of hiring the ideal worker that would be the best fit with clear task division? A.) Great man theory B.) Situational and contingency theory C.) Management function theory D.) Scientific management theory

Stakeholders

Those entities in an organization's environment that play a role in the organization's health and performance or that are affected by the organization May be both internal and external Every organization should be viewed as being part of a greater community of ______________

Staff development

Three reasons for _______________: 1.) To establish competence 2.) To meet new learning needs 3.) To satisfy interests to staff may have in learning in specific areas

Empowerment

To enable, develop or allow Occurs when: - Leaders communicate their vision - Employees are given the opportunity to make the most of their talents - Learning, creativity and exploration are encouraged

Power

To increase the __________ of the Nursing Profession: 1.) Place more nurses in positions that influence public policy. 2.) Stop nurses from acting like victims. 3.) Increase the level of nurses' understanding regarding all health-care policy efforts. 4.) Build coalitions within and outside of nursing. 5.) Promote greater research to strengthen evidence-based practice. 6.) Support nursing leaders. 7.) Pay attention to mentoring future nurse-leaders and leadership succession

Power

To keep _____________: 1.) Maintain a small authority-power gap 2.) Empower subordinates whenever possible 3.) Use authority in such a manner that subordinates view what happens in the organization as necessary 4.) Use political strategies to maintain power and authority when necessary 5.) Although _______ is a universally available resource, it does not have a finite quality and can be lost as well as gained

Ethical decisions

To make appropriate _________________: - The manager must: => Use a professional approach => Eliminate trial and error - Focus on: => Decision making models or problem solving processes

Late stage chemical dependency

Tolerance is developed to the chemical and the individual needs the chemical in greater amounts and more often to achieve the same effect The individual characteristically exhibits high defensiveness Individual must continually use substance even though he/she generally no longer gains pleasure or gratification

Committees

Too many ___________ in an organization is a sign of a poorly designed organizational structure. To be productive _____________ should have: o An appropriate number of members o Prepared agendas o Clearly outlined tasks o Effective leadership

True

True or False? One way nurses can act as advocates is by directly intervening on behalf of others?

Veracity

Truth Not intentionally deceiving or misleading clients Feeling uncomfortable is not a good reason to avoid telling patients the truth Untruthfulness undermines trust

Outcome

Type of audit Determine what results, if any, followed from specific nursing interventions for patients

Process

Type of audit Measure the process of care or hot the care was carried out

Structure

Type of audit Monitor the structure or setting in which patient care occurs

Unplanned change

Type of change Change by drift Accidental change

Planned change

Type of change Well thought out

Assertive

Type of communication Reduces stress, improves productivity and contributed to a healthy workforce A way of communicating that allows people to express themselves in a direct, honest and appropriate way that doesn't infringe on another person's rights "I" vs. "You" statements No personal attacks Focus on issue Eye contact Establish trust Convey empathy

Constructive discipline

Type of discipline Carried out in a supportive, corrective manner Punishment is given because of an employee's actions and not because of who he or she is as a person

Self-discipline

Type of discipline The process by which rules are internalized and become part of the person's personality _____________ is possible only if employees know the rules and accept them as valid

Destructive discipline

Type of discipline Use of threats and fear to control behavior Arbitrarily administered and either unfair in the application of rules or in the resulting punishment

Structured interview

Type of interview Greater planning time because questions are developed in advance about the specific job requirements and the skills and qualifications. Information about the applicant's experience, willingness and motivation obtained. Format same with all applicants

Unstructured interview

Type of interview Little planning because the goals for hiring may be unclear. The interviewer does more talking than the applicant. This type continues to be the most common selection tool

Semistructured interview

Type of interview Some planning because the flow is focused and directed at major topic areas, but does allow some flexibility in approach

Managed care organizations

Types of ______________: Health maintenance organization (HMO) o Point of service (POS) o Exclusive provider organization (EPO) Preferred provider organization (PPO)

Profile of impaired nurse

Typically behavior changes are seen in the following three areas: • Personality/behavior changes • Job performance changes • Time and attendance changes

Delegation errors

Underdelegating Overdelegating Improper delegating

Overcoming interview limitations

Use a team approach Develop a structured interview format for each job classification - As a predictor of job performance and overall effectiveness, the structured interview is more reliable than the unstructured interview Use scenarios to determine decision making ability Conduct multiple interviews Provide training in effective interviewing techniques Plan, conduction and control the interview

During the negotiation

Use factual statements Discuss issues and not personalities. Be honest, assertive, pleasant Role model good communication use the 70/30 Rule Be patient - take a break Don't concede too early

Service line organizations

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

Balanced scorecard

Using a ______________________: - Analyzes data from four organizational perspectives: => Financial => Customers => Business processes => Learning and growth

Forecasting

Using available historical patterns to assist in planning Examining present clues and projected statistics to determine future needs

Interprofessional teams

Variety of decision-making styles/approaches ◦ Decisive ◦ Flexible ◦ Hierarchical Style/approach influenced by based on ◦ Amount of data - ◦ Type of data ◦ Decision to be made ◦ Number of options generated ◦ Group leader

Leading

Vision and strategy Creating value Influence and inspiration Have followers Leading people People focused Charismatic style Risk and change seekers - Go against the grain Proactive Sets direction Raising expectations Ask questions

Leadership roles

Visionary Risk taker Flexibility Inventor/Creator

Acuity index

Weighted statistical measurement that refers to severity of illness of patients for a given time. Patients are classified according to acuity of illness, usually in one of four categories. The acuity index is determined by taking a total of acuities and then dividing by the number of patients

Formal grievance

What a grievance could proceed to if differences cannot be resolved informally Progressive lodging of a formal complaint up the chain of command Proceeds to formal hearing if resolution is not reached Panel is selected to hear the grievance If not resolved, proceeds to arbitration

What are some critical thinking skills? A.) Reflective thinking B.) Forming judgements about the facts C.) Examining evidence D.) All of the above

What are some examples of Decision Making Tools? A.) Payoff tables B.) Decision trees C.) Google D.) Consequence tables

What are some frequent Legal Claims against Nurses? A.) Unattended patient falls B.) Misidentify patients for medications, surgeries, tests C.) Inadequate charting D.) All of the above

What are some of the reasons join a union? A.) Because the believe it will improve patient outcomes and quality of care B.) Increase input into organizational decision making C.) Elimination discrimination and favoritism D.) All of the above

What are some reasons do not join unions? A.) Fear of lost income associated with a strike or walkout B.) Because of social need to be accepted C.) Because they are required to do so by employer

What best defines fee for service? A.) An intermediary or third party pays the bill B.) Health care providers reimbursed after the services are delivered C.) A health care organization manages the care and pays

What best describes an authority power gap? A.) The authority and ability to get things done B.) A conditioned response to authority C.) Issuing orders that are not followed

What changes are seen in the impaired nurse? A.) Job performance B.) Behavior change C.) Time and attendance D.) All of the above

A, B, C

What components should the Emotional Intelligent leader display? (Select all that apply): A.) Self awareness B.) Motivation C.) Empathy D.) Self regard

What describes the total patient care or case method of nursing? A.) Care is assigned by task rather than by patient B.) Patients may be assigned as cases C.) Nurse provides total direct care for that patient

What is "Informed Consent"? A.) Nurse witnesses patient signature after reasonable assurance patient understands B.) Patient receives full disclosure of all pertinent information regarding treatment C.) In an emergency physician documents when patient is unable to sign

What is a matrix organizational structure? A.) A design used temporarily to facilitate project completion B.) An organizational design that is focused on product and function C.) A design sometimes called care-centered organizations D.) Removes hierarchical layers by flattening the scalar chain

What statement best describes constructive criticism? A.) Threats used to correct behavior B.) Corrective and supportive measures used to correct behavior

Delegation

What you need to know about _____________: - WHY to do it - WHEN to do it - WHO to delegate to - HOW to do it - WHAT to consider in delegation

Shared vision

When all the employees of the LO share a common vision, they are more willing to put their personal goals and needs aside and instead focus on teamwork and collaboration

Moral conflict

When the duties and obligations of healthcare providers or guiding ethical principles are unclear

A, C, D

Which distinguishing characteristics are associated with the Authentic Leader? (Select all that apply): A.) Value B.) Ability to be nice C.) Relationship D.) Self discipline

Which function of the Management Process consist of carrying out long and short range projections? A.) Planning B.) Directing C.) Organizing D.) Controlling

Reliability; Validity

___________ and ___________ issues of the Selection Process: - Validity increases with a team approach - Negative information tends to be weighed more heavily than positive information - The same standards should be used for all applicants - Selection should be based on established criteria, not value judgements - Personal bias should be minimized because negative feelings likely have no relation to the criteria necessary for success in the position

Managers

___________ hold people accountable for doing something

Substance misuse

______________ involves maladaptive patterns of psychoactive substance abuse, with the substance user continuing use in face of recurrent occupational, social, psychological or physical problems, and/or dangerous situations

Cost effectiveness

_______________ means producing good results for the amount of money spent. Expensive items can be cost-effective and inexpensive items may not. _____________________ then must take into account factors such as anticipated length of service, need for such a service, and availability of other alternatives

Strategic planning

___________________ as a Management Process includes: - The delineation of the agency's strategic goals and objectives, typically in a 3- to 5-year plan - The development of strategies to achieve the goals

Fiscal accountability

___________________ to the organization for staffing is not incompatible with ethical accountability to patients and staff. It should be possible to stay within a staffing budget and meet the needs of patients and staff. The most fiscally responsible method for determining staffing needs is an agreed upon staffing formula based on client acuity

Mental models

the set of assumptions and generalizations (or even pictures or images) that influence how we understand the world and how we take actions. The goal in the LO is to foster organizational development through diverse thinking. Assumptions held by individuals then are challenged because this releases individuals from traditional thinking and promotes the full potential of individuals to learn

Nursing Management Final Exam

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