Nursing Management Leadership 463

Five Rights of Delegation

a) Right Task b) Right Circumstance c) Right Person d) Right Direction/Communication e) Right Supervision "Tell me the time that the patient in room 205 voids for the first time after the catheter is removed" The nurse is using the five rights of delegation by providing specific information about the task, expectation, timeframe, and when to report the information back to the nurse.

Competing/Controlling is

assertive and uncooperative - an individual pursues his or her own concerns at the other person's expense. This is a power-oriented mode, in which one uses whatever power seems appropriate to win one's own position - one's ability to argue, one's rank, economic sanctions. Competing might mean "standing up for your rights," defending a position which you believe is correct, or simply trying to win.

Critical pathways are used

by the interdisciplinary team to track a client's progress. The clinical pathway outlines assessments, interventions, treatments, and outcomes for health-related conditions for a specified period of time.

Human capital represents the

capability of the individual.

clinical pathways

case management tools used to communicate the standardized, interdisciplinary plan of care for a particular group of patients; care guidelines and outcomes are specified for each day of the patient's stay they prevent unnecessary expense by implementing evidence based practice and cost effective approaches to patients that have specific and common diagnosis

Servant leadership is a

contemporary leadership model that puts serving others as the first priority.

The nurse should use a ____ as a cost-effective strategy to guide care for clients who have a specific medical diagnosis or are undergoing a specific procedure.

critical pathway

Strengths-based leadership focuses on the

development or empowerment of workers' strengths as opposed to identifying problems, improving underperformance, and addressing weaknesses and obstacles.

Centralized staffing is generally

fairer to all employees because policies tend to be employed more consistently and impartially. In addition, centralized staffing frees the middle-level manager to complete other management functions.

Nursing Process

five-step systematic method for giving patient care; involves assessing, diagnosing, planning, implementing, and evaluating

servant leadership

focuses on providing increased service to others—meeting the goals of both followers and the organization—rather than to oneself. ...is a contemporary leadership model that puts serving others as the first priority (fosters collaboration, teamwork, and collective solutions)

Principal agent theory suggests that

followers may have an informational (expertise or knowledge) advantage over the leader as well as their own preferences, which may deviate from those of the principal. This may lead to a misalignment of goals

Psychologist Bruce Tuckman, building on the work of earlier management theorists, labeled these stages__ __ __ __ in his classic 1965 work

forming, storming, norming, and performing

​The primary goal of nursing informatics is to

improve health care outcomes by allowing nurses and health care providers to access, evaluate, and use best practice guidelines, scientific theories, and research information

Authentic leadership suggests that

in order to lead, leaders must be true to themselves and their values and act accordingly.

The nurse should complete an ____ as part of error reporting and quality improvement

incident report

Compromising is

intermediate in both assertiveness and cooperativeness. The object is to find some expedient, mutually acceptable solution which partially satisfies both parties. It falls on a middle ground between competing an accommodating. Compromising gives up more than competing but less than accommodating. Likewise, it addresses an issue more directly than avoiding, but doesn't explore it in as much depth as collaborating. Compromising might mean splitting the difference, exchanging concessions, or seeking a quick middle-ground position.

conflict resolution strategy: compromising

involves each individual agreeing to give something they value up

conflict resolution strategy: collaboration

involves finding a win-win solution

Decision making

is a complex, cognitive process often defined as choosing a particular course of action

Nurses cannot delegate

nursing process, client education, tasks that require nursing judgment

Centralized staffing, however, does not

provide as much flexibility for the worker, nor can it account as well for a worker's desires or special needs. In addition, managers may be less responsive to personnel budget control if they have limited responsibility in scheduling and staffing matters

Tim Porter-O'Grady

suggest that because the unexpected is becoming the normative, the quantum leader must be able to address the unsettled space between present and future and resolve these conflicts appropriately.

Advantages of decentralized staffing are

that the unit manager understands the needs of the unit and staff intimately, which leads to the increased likelihood that sound staffing decisions will be made. In addition, the staff feels more in control of their work environment because they are able to take personal scheduling requests directly to their immediate supervisor. Decentralized scheduling and staffing also lead to increased autonomy and flexibility, thus decreasing nurse attrition.

Emotional intelligence refers to the

the ability to understand one's own emotions and the emotions of people with whom one interacts on a daily basis ability to use emotions effectively and is considered by many to be critical to leadership and management success.

Scientific Management

the application of scientific principles to increase efficiency in the workplace

Quantum leadership suggests that

the environment and context in which people work is complex and dynamic and that this has a direct impact on organizational productivity.

In diagonal communication,

the manager interacts with personnel and managers of other departments and groups such as physicians, who are not on the same level of the organizational hierarchy. Although these people have no formal authority over the manager, this communication is vital to the organization's functioning. Diagonal communication tends to be less formal than other types of communication.

downward communication,

the manager relays information to subordinates. This is a traditional form of communication in organizations and helps to coordinate activities in various levels of the hierarchy.

Marquis-Huston model for teaching critical thinking

the model comprises four overlapping spheres, each being an essential component for teaching leadership and management.

Middle career stage

11-29 years experienced expert, expert clinicans role model to others

WHO global deficit of ____ health workers currently and is estimated to increase to 16-19 million by 2030

14.5 Million

Situational and Contingency

1950-1980 -depends (no one leadership style is ideal for every situation)

Great Man Theory

a theory of leadership that explained leadership by examining the traits and characteristics of individuals considered to be historically great leaders Leaders are born not made - trait theory (1900-1940

Thought leadership refers

to any situation whereby one individual convinces another to consider a new idea, product, or way of looking at things. Thought leaders attract followers not by any promise of representation or empowerment but by their risk taking and vision in terms of being innovative.

The traditional manager who is concerned with the day-to-day operations, is called a

transactional leader.

The manager who is committed, has a vision, and is able to empower others with this vision is termed a

transformational leader, whereas the traditional manager, concerned with the day-to-day operations, is called a transactional leader.

Full-range leaders evolve and adapt their leadership style based on which leadership styles are needed for a given situation but need

transformational, transactional, and laissez-faire leadership skills to be successful. Full-range leadership theory suggests that context is an important mediator of transformational leadership.

Accommodating is

unassertive and cooperative - the opposite of competing. When accommodating, an individual neglects his or her own concerns to satisfy the concerns of the other person; there is an element of self-sacrifice in this mode. Accommodating might take the form of selfless generosity or charity, obeying another person's order when one would prefer not to, or yielding to another's point of view.

Avoiding is

unassertive and uncooperative - the individual does not immediately pursue his own concerns or those of the other person. He or she does not address the conflict. Avoiding might take the form of diplomatically sidestepping an issue, postponing an issue until a better time, or simply withdrawing from a threatening situation.

Social capital represents

what a group can accomplish together.

Abbreviation CDSS stands for

​Clinical decision support systems use evidence-based practice and clinical guidelines to assist physicians, nurses, and others to make the best practice decisions based on client data.

conflict resolution strategy: smoothing

- 1 party attempts to smooth another party by trying to satisfy the other party - Focus is on what is agreed upon, leaving conflict largely unresolved - Usually lose- lose situation focuses on ares of agreement instead of differences

Nursing Interventions for delegating

--Provide supervision, either directly or indirectly(assigning supervision to another licensed nurse). --Monitor performance.--Intervene if necessary (for unsafe clinical practice). --Provide feedback: Did the delegatee complete the tasks on time? Was the delegatee's performance satisfactory? Did the delegatee document and report unexpected findings? Did the delegatee need help completing the tasks on time? --Evaluate the client and determine the client's outcome status. --Evaluate task performance and identify needs forperformance‑improvement activities and additional resources.

Interactional Leadership Theory (1970-present)

-Transactional leaders focus on tasks and getting the work done -Transformational leaders focus on vision and empowerment (desirable however with transactional qualitites)

Centralized vs. Decentralized

1) Centralization - authority concentrated in upper levels of government: - monopoly over environmental regulation. -Homogeneity of regulation across local governments. -Local governments must implement centralized policies. 2)Decentralization - authority shared with lower levels of government: -Regulations developed and implemented at local levels -More responsive to local levels. -Greater interaction and trust within local communities

Managerial Decision-Making Model

1. Determine the decision and the desired outcome (set objectives) 2. Research and identify options 3. Compare and contrast these options and their consequences 4. Make a decision 5. Implement an action plan 6. Evaluate results

traditional problem solving process

1. Identify the problem 2. Gather data to analyze the causes and consequences of the problem 3. Explore alternative solutions 4. Evaluate the alternatives 5. Select the appropriate solution 6. Implement the solution 7. Evaluate the results

What are the 5 stages of nursing ability

1. Novice nurse 2. Advanced beginner 3. Competent nurse 4. Proficient nurse 5. Expert nurse

Four key measures that are key to retaining nurses

1. Reduce overtime 2. Practice shared governance Programs 3. Implement Data-given staffing 4. Develop quality care

This typically requires that leaders create teams that have a balance of strengths in the following four leadership domains:

1. Strategic Thinking: Effective leaders keep everyone focused on a long-term future. 2. Influence: Effective leaders can sell ideas, develop political support, and get people to rally behind a project or an initiative. 3. Relationship Building: Effective leaders are able to unite a group of disparate individuals into a team that works toward a common goal. 4. Execution: Effective leaders know how to get things done by translating plans into action.

A transition has occurred in the

21st century from industrial age leadership to relationship age leadership.

Standarized Care Plan=

=best practice guidlines

Program Evaluation and Review Technique (PERT)

A method for analyzing the tasks involved in completing a given project, estimating the time needed to complete each task, and identifying the minimum time needed to complete the total project. a project management technique that employs three time estimates for each activity

Electronic Health Record (EHR)

An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization

Authentic Leadership

A style in which the leader is true to himself or herself while leading ...suggests that in order to lead, leaders must be true to themselves and their values and act accordingly

Behavioral Theory

A theory that considers the outward behavior of students to be the main target for change. -•influence (1940-1980) -Authoritarian leader - strong, controlling, communication goes down -Democratic - promotes autonomy and growth, communication goes up and down -Laissez-fair - no control, no direction, group communication

Examples of tasks nurses may delegate to a AP assistive personnel like CNAs

ADLs, bathing, grooming, dressing, toileting, ambulating, feeding (w/o swallowing precautions), positioning, bed making, specimen collection, I&O, vital signs for stable pts

Difference between problem solving and decision making

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.

Managers

Are assigned a position by the organization Have a legitimate source of power due to delegated authority that accompanies their position Have specific duties and responsibilities they are expected to carry out Emphasize control, decision making, decision analysis, and results Manipulate people, the environment, money, time, and other resources to achieve the goals of the organization Have a greater formal responsibility and accountability for rationality and control than leaders Direct willing and unwilling subordinates

Nursing Code of Ethics

Autonomy: Promotes self-determination and freedom of choice Beneficence: Actions are taken in an effort to promote good Nonmaleficence: Actions are taken in an effort to avoid harm Paternalism: One individual assumes the right to make decisions for another Utility: The good of the many outweighs the wants or needs of the individual Justice: Seek fairness; treat "equals" equally and treat "unequals" according to their differences Veracity: Obligation to tell the truth Fidelity: Need to keep promises Confidentiality: Keep privileged information private

clinical judgement

Clinical judgment is the decision made regarding a course of action based on a critical analysis of data when nursing knowledge is applied to a clinical situation. Clinical judgment requires the nurse to use critical thinking skills when: -Analyzing client data and related evidence. -Ascertaining the meaning of the data and evidence. -Determining client outcomes desired and/or achieved as indicated by evidence-based best practices.

Clinical reasoning

Clinical reasoning is the mental process used when analyzing all the elements of a clinical situation and making a decision based on that analysis.

Centralized staffing

Central staffing office float the best for the whole hospital more consistent with policy and cost effective less flexibility for employees

Streamlining workflow- Standarized tools to prevent nursing care errors

Critical pathway- used when they have a common need or medical attention computerized care plan- started when they are admitted

Communication flow for democratic leadership is

Down the chain of command

Communication flow for authoritative leadership is

Down the chair of command

Promise career stage

Earlist (first 10 years of employment) Less experienced overload

Transformational leaders

Empower and inspire followers to achieve a common, long term vision

Transactional Leadership

Focus on immediate problems, maintaining the status quo and using rewards to motivate them

Grrrr

Greeting respectful listening Review recomend or request more information Reward

Clinical reasoning supports the clinical decision making process by:

Guiding the nurse through the process of assessing and compiling data Selecting and discarding various bits of data based on their relevance Making decisions regarding client care based on nursing knowledge

Clinical decision making model

Identify that a client issue or problem exists. Analyze and interpret relevant data. Make inferences based on this interpretation to determine possible causes. List all possible actions that could be taken. Evaluate each action and possible outcome. Select best action. Outcome of the clinical decision making process is the clinical judgment.

Frederick W. Taylor, Scientific Management

In 1911, this work was published to describe that the application of the scientific method to the management of workers could improve productivity. the "father of scientific management,"

Authentic Leadership

Inspire others to follow them by modeling a strong internal moral code

Work output for Laos'ez-faire leadership is

Is low unless an informal leader evolves from the group

The laissez-faire leader is characterized by the following behaviors:

Is permissive, with little or no control Motivates by support when requested by the group or individuals Provides little or no direction Uses upward and downward communication between members of the group Disperses decision making throughout the group Places emphasis on the group Does not criticize

The democratic leader exhibits the following behaviors:

Less control is maintained. Economic and ego awards are used to motivate. Others are directed through suggestions and guidance. Communication flows up and down. Decision making involves others. Emphasis is on "we" rather than I and you. Criticism is constructive.

Managers vs. Leaders

Managers: make decisions, assign tasks, allocate resources, solve problems Leaders: motivate and inspire, provide vision, collaborate with others

leaders

Often do not have delegated authority but obtain power through other means, such as influence Have a wider variety of roles than managers Focus on group process, information gathering, feedback, and empowering others May or may not be part of the formal hierarchy of the organization Emphasize interpersonal relationships Direct willing followers Have goals that may or may not reflect those of the organization

Career stages

Promise Momentum Harvest

Staffing needs

Staffing mandates impact of nursing staff shortages on staffing fiscal (during our budget section) and ethical Accountability for staffing

The authoritarian leader is characterized by the following behaviors:

Strong control is maintained over the work group. Others are motivated by coercion. Others are directed with commands. Communication flows downward. Decision making does not involve others. Emphasis is on difference in status ("I" and "you"). Criticism is punitive.

The emergency medical treatment and active labor act (EMTALA)

The EMTALA includes guidelines for care within a health care facility for all clients, regardless of financial status.

International Council of nurses position statement

The International Council of Nurses is a federation of more than 130 national nurses associations. It was founded in 1899 and was the first international organization for health care professionals

The four spheres of the Marquis- Huston model

The first is a didactic theory component, such as the material that is presented in each chapter; second, a formalized approach to problem solving and decision making must be used. Third, there must be some use of the group process, which can be accomplished through large and small groups and classroom discussion. Finally, the material must be made real for the learner so that the learning is internalized. This can be accomplished through writing exercises, personal exploration, and values clarification, along with risk taking, as case studies are examined.

Expected stages of conflict occur in what order

The first stage of the conflict process is 1. latent conflict, which involves awareness of potential situations that can create conflict. 2. Stage two is perceived conflict, where those who are affected discuss the situation in an impersonal manner. 3. Stage three is felt conflict, which occurs when those who are affected become personally involved. 4. Stage four is manifest conflict and is signaled by those who are involved taking action. 5. In stage five, or conflict aftermath, those who are involved recognize the positive and negative outcomes of how the situation was managed.

Difference Between Interpersonal and Intrapersonal Conflict.

The key difference between Interpersonal and Intrapersonal conflict is that interpersonal conflict is a disagreement between two people, whereas intrapersonal conflict is a disagreement within an individual

If a patient is experiencing adverse effects after receiving a new medication, what communication tool would you use for management of this complication? 1. critical pathway 2. incident reporting 3. SBAR framework 4. root cause analysis

The nurse should use the SBAR framework to identify the situation, background, assessment, and recommendation for a specific circumstance. The nurse can focus on the client's immediate circumstances to promote clinical decision making.

Laissez-faire

a policy or attitude of letting things take their own course, without interfering.

decentralized

Unit manager is responsible increasing and decreasing staff based on census and acuity greater autonomy and flexibility may result in special treatment of employees

Communication flow for Laissez-faire leadership is

Up and down the chain of command

Work output for democratic leadership is

Usually good quality but hen cooperation are necessary

Work output for authoritative leadership is

Usually high : good for crisis situations and bureaucratic situations

Five stages of nursing ability

Were identified by Patricia bender (1984) and are based on level of competence. Level of competence= length of time in practice and exposure to clinical situations. When nurses move to a new clinical setting that requires acquisition of new skills and knowledge, their level of competence will return to a lower stage

The Myers-Briggs Type Indicator (MBTI) is an

an assessment that is believed to measure psychological preferences in how people perceive the world and make decisions. According to the Myers-Briggs test, there are 16 different types of personalities an introspective self-report questionnaire with the purpose of indicating differing psychological preferences in how people perceive the world around them and make decisions.

The most informal communication network is often called the

grapevine. Grapevine communication flows quickly and haphazardly among people at all hierarchical levels and usually involves three or four people at a time

Collaborating

is both assertive and cooperative - the opposite of avoiding. Collaborating involves an attempt to work with the other person to find some solution which fully satisfies the concerns of both persons. It means digging into an issue to identify the underlying concerns of the two individuals and to find an alternative which meets both sets of concerns. Collaborating between two persons might take the form of exploring a disagreement to learn from each other's insights, concluding to resolve some condition which would otherwise have them competing for resources, or confronting and trying to find a creative solution to an interpersonal problem.

Problem solving

is part of decision making and is a systematic process that focuses on analyzing a difficult situation. Problem solving always includes a decision-making step.

Harvest stage of career

last stage -30 to 40 years having prime experiences legacy clincians

authoritarian leader

leader who takes charge, makes all the decisions, and dictates strategies and work tasks

Interactional leadership theory focuses more on

leadership as a process of influencing others within an organizational culture and the interactive relationship of the leader and follower.

Transformational Leadership

leadership that generates awareness and acceptance of a group's purpose and mission and gets employees to see beyond their own needs and self-interests for the good of the group -Focus on vision and empowerment

Transactional Leadership

leadership that motivates subordinates by rewarding them for high performance and reprimanding them for low performance -Focus on tasks and getting the work done

In centralized staffing, the manager's role is

limited to making minor adjustments and providing input. For example, the manager would communicate special staffing needs and assist with obtaining staff coverage for illness and sudden changes in patient census. Therefore, the manager in centralized staffing continues to have ultimate responsibility for seeing that adequate personnel are available to meet the needs of the organization.

In horizontal communication,

managers interact with others on the same hierarchical level as themselves who are managing different segments of the organization. The need for horizontal communication increases as departmental interdependence increases.

Examples of tasks nurses may delegate to a LPN (licensed practical nurse) like LVNs

monitor findings (as input to the RN's ongoing assessment), reinforce pt teaching from a standard care plan, perform tracheostomy care, suctioning, check NG tube patency, admin enteral feedings, insert urinary catheter, administer medications (except IVs meds)

Important to Harvest stage

preventing the perception if the obsolete being savy and adaptable elevating their mastery professional statesperson establishing a legacy

Leadership task: advocacy

promoting and protecting safety for staff and clients by providing information that allows staff to act autonomously ex. having an in service class on incidence that have occurred on the floor

a nurse should recognize that to be a meaniful user of electronic health record, they should do

respond appropiately to all clinical decesion- making support systems Clinical decision-making support systems use automated guidelines and alerts to help nurses prevent errors and assist with improved decision-making.

decentralized staffing, the unit manager is often

responsible for covering all scheduled staff absences, reducing staff during periods of decreased patient census or acuity, adding staff during periods of high patient census or acuity, preparing monthly unit schedules, and preparing holiday and vacation schedules. Nursing management is highly decentralized in most hospitals, with considerable variation found in staffing among patient care units.

The nurse should use ____ during the quality control process to determine why a standard is not being met.

root cause analysis

democratic

ruled by the people. In a democracy, citizens elect representatives to make and carry out laws.

Important to the middle stage

sense of purpose life long learning career progression and not stagnation

Jim Collins - From Good to Great

•Studied 1,435 companies •Developed the 5 Levels of Leadership -Highly capable individual -Contributing team member -Competent Manager -Effective Leader -Great Leader •humility and will