Nursing Management Midterm
Power and management
'Authority' grants power. The ability to create, get, and/or use authority (power) to achieve one's goals. Comes from the ability to influence others or affect others' thinking or behavior. Informal (personal) or Formal (position) We previously discussed that managers are given "authority" with their position. This authority is considered "influence" and can be considered "power." Power and leadership (management) are closely connected and highly intertwined concepts. This is because power is one of the vehicles by which leaders influence followers to take action. To lead and manage, nurses need to acquire, possess, and use power appropriately to achieve outcomes and goals of the unit and organization.
The Silent Generation
- 1925-1945 95% have retired intellectual capital and institutional knowledge strong work values and ethics see themselves as strong contributing members of the workforce likes status quo, authority, hierarchy, and is loyal to employer Methods of communication: -chain of command -letter writing -in person -email -cell phones
The Baby Boomers
-1946-1964 the "Me" generation invented the work-life balance managers running our organizations today career oriented accepts authority, workaholics, struggle with technology loyal to employer Methods of communication: -group problem solving -phone -fax -email -facebook -voicemail -ipods
Gen X'ers
-1961-1981 Next generation of leaders most well educated generation goal oriented adaptive to change good with technology family life is important frequent job changes Methods of communication: -independent, don't like group work -decisions without unnecessary discussion -cell phones -facebook -twitter -texting -hate voicemail and landlines -ipads and iPhones are utilities
components of advanced directives
-living will: legal document stating clients wishes in the event that they become incapacitated or is near end of life -durable power of attorney: legal document that designates a health care proxy to make health care decisions for the patient
functions of nurse managers
1. Planning: -the decisions regarding what needs to be done, how it will be done and who is going to do it 2. Organizing: -Process of coordinating the work to be done -determines the lines of authority, channels of communication, and where decisions are made 3. Directing: -Process of getting the organization's work done -leadership role assumed by a manager that influences and motivates staff to get work done 4. Controlling: -Establishing standards of performance -Measuring performance -Evaluating performance -Providing feedback 5. Staffing: -the acquisition and management of adequate staff an staffing mis
Milennials
1981-2001 focus is on family and children terrorism scheduled and structured lives multiculturalism heroism/ patriotism parental advocacy globalism concerned about workplace safety value independence and achievement goal oriented challenge the status quo want the opportunity to impact optimistic and self confident technology is way of life at ease with cultural diversity Methods of communication: -social media -dislike email -like to text -dont have landlines
ethical decision making model
6-Step Problem Solving Process: 1. Define the problem 2. Develop alternative courses of action 3. Evaluate each alternative course of action 4. Select the best course of action 5. Implement the selected course of action 6. Monitor the results
six sigma
A term derived from statistics meaning six standard deviations from the mean and the limit A production standard with 3.4 defects* in every 1 million units or opportunities (.03%) *defect = anything that could lead to customer dissatisfaction Six Sigma seeks to improve the quality of process outputs by identifying and removing the causes of defects (errors) and minimizing variability Define: goals & current process Measure: key aspects of current process Analyze: data for cause & effect Improve: based on data analysis Control: continuous monitoring
Quality/performance improvement is focused on all of the following except:
A. Fixing latent errors in care delivery systems B. Punishing the healthcare provider at fault C. Collecting and analyzing data D. Reducing the variation in provision of care Answer: B
The hospital began an "aim for zero" catheter acquired urinary tract infections (CAUTI) initiative. Which improvement model is most likely being used?
A. Quality assurance B. Total quality Improvement C. Institute for Healthcare Improvement D. Six Sigma Answer: D
" Each patient will have a written assessment and plan of care documented within eight hours of admission." This is an example of a:
A. Structure standard B. Benchmark C. Quality indicator D. Process standard Answer: D
normal accident theory
Accidents are not only inevitable, but are more likely due to the complexities of human systems.
process of care measures
Acute Myocardial Infarction Heart Failure Pneumonia Surgical (SCIP) Emergency Department Preventive Care Asthma - Children's Hospitals Stroke Blood Clot Prevent/Treat Pregnancy & Delivery
standard
Agreed-upon levels of excellence to meet patient care needs (based on EBP) Types: 1. Structure = the setting for care delivery Organization-centered 2. Process = the manner of care delivery Provider-centered 3. Outcome = the end results of care delivery Patient-centered EBP (standards) + consistency/ reliability (standardization) = success
sources of conflict
Allocation/availability of resources Personality differences Differences in values Internal/external pressures Cultural differences Competition Differences in goals Issues of personal/professional control
Manager definition
An employee who is responsible and accountable for efficiently accomplishing the goals of the organization Directly responsible for maintaining standards of care, managing fiscal resources, and developing staff. effective managers usually posses good leadership skills but they are a formal position of leadership
incident reports
An event that is unexpected, unusual, unintentional, or inconsistent with the desired outcome which affects a patient, employee, volunteer or visitor. Anytime your gut says "something is wrong" or "this should be done differently" (near miss/good catch)
models and methods
An interprofessional approach is used in performance improvement activities to: (1)"Aim for Zero" rates of care-related injury, and (2) create systems/practices that are reliable in providing high quality care.
sentinel event
An unexpected occurrence involving death or serious physical injury, or the risk thereof.
critical thinking and decision making
Analyzing the issues Synthesize information Make decisions Critical thinking can be defined as a set of cognitive skills including, "interpretation, analysis, evaluation, inference, explanation, and self-regulation. Critical is characterized by thinking that has a purpose, is systematic, considers alternative viewpoints, occurs within a frame of reference, and is grounded in information. What is being asked? What information is needed? Do I have all information? What conclusions are justified? Are there any other alternatives? Questioning is implicit in the critical thinking process. Critical thinkers need to know the "why" of the thinking, the mode of reasoning, what the source and accuracy of the information is, what the underlying assumptions and concepts are, and what might be the outcome of thinking. Critical thinkers in nursing go beyond the step-by-step processes outlined in the nursing process and its traditional problem solving. A critical thinker challenges and questions the norm and considers in the context of decision making potential unintended consequences. Critical thinkers are creative in their thinking and anticipate the consequences of their thinking. Managers must look at the "BIG Picture" when making decisions. Decision making is the essence of leadership and management and the decisions are visible outcomes of the leadership and management process. Remember this! The manager must make decisions based on critical thinking, knowledge and experience. decision making styles: -decisive: the team uses a min amount of data and generates one option -flexible: the team uses a limited amount of data and generates several options -hierarchical: the team uses a large amount of data and generates one option -integrative: the team uses a large amount of data and generates several options
near miss
Any process variation that did not affect an outcome but for which a recurrence carries a significant chance of a serious adverse outcome.
Leader definition
Anyone who uses interpersonal skills to influence others to accomplish a specific outcome To achieve consensus within a group about its goals, and facilitate accomplishment of goals not always in a management position; may be an informal power of leadership cannot be a leader without followers
principles of ethics
Autonomy-self determination Beneficence- doing good Nonmaleficence- avoid harm Paternalism-assumes right to make decisions Utility-good for may Justice- treating people fairly Veracity-truth telling Fidelity-keeping promises Confidentiality- respecting privileged information
approaches to conflict resolution
Avoiding: -just not dealing with it. What do you think will happen if the manager deals with conflict this way. Staff will not respect the manager and feel that "things" (problems) are not addressed. There will be no progress and the problems will continue to grow. Confronting: -the problem head on is the answer. A solution will develop for the problem and it will stop before it develops into a "monster." Collaborating: - ensues when the parties in the conflict each desire to fully satisfy the concerns of all parties. The intention is to solve the problem by clarifying the differences and look for a resolution. -results in a win-win Compromising: -involves in both parties "giving in" and realizing they need to look at the other's viewpoint. The end result is a blend or hybrid of each persons suggestions or viewpoint. Negotiating: - is talking all aspects of the issue and looking at all suggestions. It also allows for "partial wins" on both sides. Collaborating, negotiating, and compromising are best approaches to solve the issues and conflict.
safety culture team behaviors
Briefs (plan) Huddles (problem-solve) debriefing (reflect and improve)
laws affecting nursing and management
Clinical and/or Nursing Laws: -Child & Elder abuse...report any suspected abuse -Incompetent professional practice -Nurse licensure & discipline Multi-state licensure compact
managerial conflict resolution
Communication that is clear, non threatening, honest, but direct. Acknowledges and deals with the issues Recognizes that all viewpoints are important Establishes trust Conveys empathy Avoids personal attacks Concludes with fair solution
Autocratic Leadership
Concerned with task accomplishment Makes decisions for the group/ alone Exercises power with coercion communication occurs down the chain of command work output is usually high ex. emergencies
Authentic leaders
Connect to pressures of front-line staff Are passionate about creating quality work environment Generate energy to do the impossible
Climate and Culture
Culture is based on: -Values, beliefs, priorities - Type of nursing care delivery Climate is based on: -The "feel" of the work environment -Characteristics of the work environment An appreciation for work culture and the climate are critical for today's nurse leader/manager. Nurse insight into culture enables them to better understand staff behaviors and relationships, norms, change processes, expectations, and communications. The culture of the organization may be the same throughout, but each individual unit/department will have its own climate. Many times it is the leader/manager who influences the culture and climate of the unit/department. Why is this important to discuss? Organizational and unit based culture and climate will have an effect on the quality of patient care and patient outcomes. The leadership/manager will have a great influence on overall climate and culture of the unit and the organization. Each organizational unit has cultural norms and values that blend the social realities and features that shape interaction among staff, patients and families. The manner in which the staff perceives organizational culture, manages boundaries, and translates implied values to the unit level has a direct effect on the production of patient care.
Influences on Management
Demand to Reduce Errors Cultural & Generational Differences: -Immigrant populations -Aging patients & nurses Change: -Evidence-based practice -Electronic health Records -Robotics & Remote Care
what is this organization?
Demanding technologies Unforeseen periods of high peak demand Internal complexity Intense interaction Exacting tasks done under time pressure Near-perfect avoidance of catastrophic failures over periods of years
Bureaucratic Leadership
Depends on rules & policies Trusts neither followers or self; relates impersonally ex. follows the rules so there is a time and place
types and levels of management
Depends on the size and structure of your organization The larger organizations will have more levels of management The smaller organizations will have less levels of management When an organization structure is made, duties and responsibilities are assigned to the management level. Typically in hospital setting you will have a Chief Nursing Officer, Directors, Managers, Supervisors, Charge Nurses. Each of the positions will hold different authority, responsibilities and duties. In smaller organizations the Director could be the manager, charge nurse and even a staff nurse. We will focus on the manager level overseeing a unit of a hospital for this course. But remember, a Chief Nursing Officer may act as a Director or a Director may act as a manager if needed to make the facility function properly.
national patient safety goals
Designed to spotlight areas of highest priority to patient safety and quality care. Established in 2002. Updated annually by The Joint Commission's Sentinel Event Advisory Group (patient safety experts). Accuracy of Patient Identification: -Use 2 identifiers -Label specimens in the patient's presence -Eliminate transfusion errors related to pt. misidentification Communication Among Caregivers: -Report critical results of tests and diagnostic procedures in a timely manner Safe Use of Medications: -Label all medications in peri-op/procedure areas -Reduce harm for patients on anticoagulant therapy -Maintain & communicate accurate patient medication information (Reconcile Medications) Improve Safety of Alarm Systems: -Make improvements to ensure alarms on medical equipment are heard and responded to on time. Prevent Health Care-Associated Infections: -Follow hand hygiene guidelines: CDC or WHO -Prevent health care-associated infections (MDRO = Multi- Drug Resistant Organisms) -Prevent central line bloodstream infections (CLABSI) -Prevent surgical site infections (SSI) -Prevent indwelling catheter-associated urinary tract infections (CAUTI) Identify Patient Safety Risks: -Conduct a risk assessment for patients likely to try to commit suicide -Address safety needs and appropriate setting for treatment -Upon leaving the hospital, provide suicide prevention information Universal Protocol for preventing wrong site, wrong procedure*: -Conduct a pre-procedure verification process -Mark the procedure site Do a time-out before the procedure (final check) -*Applies to all surgical and invasive procedures
management and emotional intelligence
Emotional intelligence (EI) is the ability to perceive and manage the emotions of self and those around them must be able to do this in order to provide client centered care To discriminate between different emotions and label them appropriately, To use emotional information to guide thinking and behavior. Management of expression of emotion Intersection between thinking and emotion Focus on positive emotions Helps create the culture and climate characteristic of a successful nurse leader -aware of the emotions of team members -understands perspectives of others -encourages constructive criticism and is open to new idea -maintains focus while multitasking -does not judge in emotionally charged situations until facts are gathered
laws affecting nursing management
Employment laws: -Civil Rights Act -Age Discrimination in Employment Act -Americans with Disabilities Act (ADA) -Equal Pay Act -Family Leave Act -Sexual harassment & whistleblower protection -Occupational Safety & Health Act (OSHA) -Health Insurance Portability & Accountability Act (HIPAA)
characteristics of successful leaders
Energy Enthusiasm Commitment/ initiative Ability to inspire others to commit to goals respect positive attitude communication problem solving and critical thinking skills
informal leadership
Exercised by a staff member who does not have specified management role or job description. ex. experienced nurse
sources of power
Expert power - Own knowledge to help others. Considered an "expert" in the field, a mentor and reference for others. Legitimate power- "Owned or inherited" with position. "A right" given with the position. Referent (charismatic) power - Personal traits, admired by others. Identify with the leader. Coercive power - Perceived as fear. A penalty will be imposed if task not completed. Example: loss of promotion Reward power - Offering a reward for completing assigned tasks. Produces positive results. Reward must appeal to the followers. Reward power needs follower to believe leader will reward them. Coercive power needs follower to believe leader will punish them. Legitimate power needs follower to believe leader has right to instruct them. Referent power need follower to believe leader has desirable qualities. Expert power need follower to believe leader is an expert.
Tool: Ishikawa, Fishbone, Cause and effect Diagram
Factors: Personnel Environment Equipment Policies Time Cause and effect diagram
just culture
Focus on correcting errors/system flaws rather than blame and unjustly terminating the one "who did it" Employees feel safe to speak up to report errors and question practices Employees learn from mistakes and constantly improve (Mistakes = opportunity to improve a system)
IHI critical behaviors
Follow written safety protocols Speak up when you have concerns Communicate clearly Don't let yourself or others get careless Take care of yourself
critical behaviors
Follow written safety protocols Speak up when you have concerns Communicate clearly Don't let yourself or others get careless Take care of yourself
Stages of team formation
Forming: -members of team get to know each other -the team leader defines tasks for the team and offers direction Storming: -conflict arises and team members begin to express polarized views. -the team establishes rules and members begin to take on various roles Norming: -the team establishes rules -members show respect for one another and begin to accomplish some of the tasks performing: -the team focuses on accomplishment of tasks
standards
Found within all professions -Nurse Practice Act -Professional organizations and specialty groups -Federal agency guidelines and regulations -Hospital policy and procedure manuals -Job descriptions May be internally or externally set Jco is a certifying body Different states have different certifying body CDC sets certains protocols
ANA code of ethics
Framework for nurses and managers
professional nursing
Guided by the professional practice of nursing ANA Social Policy Statement (2010): -Competent -Follow standards -Ethical practice -Legal regulation -Personal accountability (own up to mistakes)
emotional leaders
Have emotional intelligence & social competence Maintain a positive environment Emphasize importance of emotions & relationships in success
current reality: pay for performance
Health care system reform requires a higher-quality, higher-productivity system with strong financial incentives for effective, efficient, coordinated care. Organizations must measure and report processes and outcomes to survive and thrive.
characteristics of management
Hold formal position of authority Possess clinical expertise Network with members of a team Coach subordinates Make decisions about organizational functions
discipline in a just culture
How does the manager/leader respond to these three types of behaviors? 1. Human Error - unintentional and unpredictable 2. At-Risk Behavior - tend to drift into unsafe habits (complacency) "short cuts" "work-arounds" 3. Reckless Behavior - conscious Violations of Nurse Practice Act Failure to report an adverse event Criminal behavior False reporting Refusal to use error prevention systems
the choices: personal convictions
How will you work as a member of the team to improve patient safety and quality in your workplace? How will you act in the everyday routine of work (when no one else is watching)? How will you choose to act as a result of the concepts covered today?
high reliability organization theory
Human errors are inevitable, but accidents are preventable when safety is upheld as the key organizational objective.
Crossing the Quality Chasm: A New Health System for the 21st Century (2001)
IOM Report Recommended a redesign of the American health care system. "Aims for Improvement": -Safe -Timely -Effective -Efficient -Equitable -Patient-Centered
choices
Improvement can't happen if problems, mistakes and near misses aren't known. Health care professionals have two jobs: (1) provide care (2) improve care ANA Code of Ethics #6: The nurse participates in...improving healthcare environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.
Trait theory of leadership
Inborn traits of successful leaders
measurement/ indicators
Indicator: "A tool used to measure the performance of structure, process, and outcome. It is measurable, objective, and based on current knowledge." (Sullivan & Decker, 2009, p. 81) A tool used "to make quality visible to stakeholders in health care". (Huber, 2014, p. 323) Nurse-Sensitive Indicator: A valid and reliable measure which reflects the structure, process and outcomes of nursing services. KPI = Key Performance Indicator
To Err is human: Building a safer health system (1999)
Institute of Medicine (IOM) Report Reported a national crisis in patient safety. 98,000 deaths/year attributed to medical error.
human factors engineering
Integration of the abilities and limitations of human beings into the job environment. Working conditions: -Interruptions, noise, light, space, stress Interruptions - Med. Admin. -Scheduling/breaks: overwork and fatigue -Equipment: standardization & lack of compatibility
types of conflict
Intrapersonal - occurs within the person and may involve internal struggle related to contradictory values or wants. Example: A nurse wants to move up the career ladder but is finding that time with her family is or will be subsequently compromised. Interpersonal - occurs between two or more people with differing values, goals, and/or beliefs. Disagreements between co-workers, family members and within a health care team. Example: Two co-workers (nurses) want the same day off. Two Patient Care Technicians are "discussing" their current pain assignments and one has determined that her assignment is unfair. Intergroup - occurs between two or more groups of individuals, departments, or organizations. There can be various causes to a group conflict such as a policy change, determining a new process, creating a plan or distinguishing and delegation of duties. Example: Pharmacy does not agree with the placement of expired medications. Nursing likes the area, as it is easier with their workflow.
behavioral theory of leadership
Leaders made through education, training, and life experience
American organization of nurse executives definition of Leadership/Manager competencies
Leadership/Manager to have competencies including: -communications -relationship management -professionalism -knowledge of healthcare environment -business skills and principles. These will work together
what are legal and ethical concepts?
Legal -Following the law Ethical -Following what should be done
What are legal and ethical concepts?
Legal: -following the law Ethical: -following what should be done
What do managers do?
Managers can wear many hats!! Coach, mentor, leader, confidant, counselor, friend, Financial planner, strategic planner, team leader, committee member and conflict resolver are a few of the many roles The responsibilities are sometimes vast and each day the responsibilities change. remember they change daily, sometimes hourly!
challenges of management
Managers must balance interests of Administrators & staff members in new health care systems ADMINISTRATORS: Focus on cost & efficiency in order for the organization to compete & survive EMPLOYEES: Want to be supported in their work with adequate staffing, supplies, equipment, & time.
role of leaders and managers in conflict resolution
Model conflict resolution behaviors. Lessen perceptual differences of parties. Assist parties to identify resolution techniques. Create environment conducive to conflict resolution. If cannot be resolved, minimize or lessen perceptions of conflicting parties.
nursing comparison data
National Database of Nursing Quality Indicators (NDNQI): Nurse-sensitive indicators Comparison data (unit specific) Benchmarks
professional negligence
Negligence -is the omission to do something reasonable -not doing something reasonable in general Malpractice -failure of a person with professional training to act in a reasonable manner -not doing something reasonable based on training Liability -the person being responsible can protect yourself from being sued by joining the ANA and specialty organization always document when you notify the charge nurse and doctor good samaritan laws protect nurses who provide emergency assistance outside of the employment location nurses who practice according to institutional policy are legally protected if that standard of care still results in an injury standards of care guide, define, and direct the level of care that should be given by practicing nurses and are used in malpractice lawsuits to see if that level was maintained should never practice outside of your scope of practice and you can use formal chain of command to verbalize concerns
nurse's role
Nurses are Leaders in Quality and Safety Initiatives: -Nurses are able to recognize, interrupt, evaluate and correct healthcare errors more than any other health professional. (Rothschild et al., 2006) Empowerment = "CEO of shift" Engagement = 200% Accountability Nursing practice is ideally suited to coordinate care in complex clinical systems to create safety, quality, and value.
standards of practice for nursing administrators
Nursing administration RN engaged in leadership or oversight of services or staff. Defines the scope and various levels of practice for nursing administration. Outlines qualifications for these roles across all settings. Provides standards of care and professional performance for this specialty. developed by the state board of nursing, facility policies, protocols
professional negligence malpractice
Omission Reasonable and prudent Plaintiff must prove: -Deviation from standard -Breach of duty -Foreseeability of harm -Failure to meet the standard must have the potential to cause injury -Actual harm must occur Texas has tort reform: legislation which limits the amount of money a person can sue for can avoid being liable for negligence by: -following standards of care -giving competent care -communicating with other health team members -developing a caring rapport with clients -documentation of assessments, interventions, and evaluations
team building and inter professional groups
One of the functions of a manager is team building. Team building can occur with staff, interprofessional teams and groups. A significant percentage of work completed in the workplace today is done through collective efforts, either in work groups, committees, or teams. Teamwork has become imperative for leaders/managers today because the level of knowledge required to meet the demands of both patients, families, and systems of care requires collective pooling of thinking styles, diversity of professional backgrounds, and collaboration of many individuals utilizing all talents. Why are teams or groups formed? To solve a problem, an issue or to create something. The leader/manager must be able to determine their role and responsibility within the team or group. They may lead the team or just be asked to collaborate and be a part of the team. To create and work with successful teams nurses must learn essential skills. Essential skills for teamwork: -Collaboration -Mutual respect -Conflict negotiation skills -Professional presence -Good communication skills -Leadership -Assertiveness
PDCA/ PDSA improvement model
PLAN DO CHECK ACT Find an opportunity Organize a team Clarify the current process Understand variation Select an improvement act-> plan->Do-> check/study
common ethical issues for managers
Patient Care Issues: -End of Life Care -Right to Refuse Care -Futile Treatment -Informed Consent -Confidentiality -Allocation of Resources Other Professionals: -Disclosure of Medical Errors -Physician Behavior -Performance Evaluation
Patient experience measures
Patient Satisfaction Surveys: -Press Ganey -HCAHPS: Health Consumers Assessment of Hospital Providers and Systems Best Practice Examples: -Rounding -Peer to peer accountability (200%) "Are you P.A.C.E.ing yourself?" = Patients are the center of everything Link: ED Wait Times
National quality measures: what is a core measure?
Performance based/accountability measures mandated by CMS & The Joint Commission (TJC) Measures are based on evidence-based practice (best practices) Data is available to the public
Laissez- Faire Leadership
Permissive, abstains from leading few decisions and little planning motivation is the responsibility of staff members communication up and down chain of command and between staff members low work output unless an informal leader evolves from the group effective with professional employees "free-for-all" ex. everyone running in circles
legal issues associated with management and leadership
Personal Personnel Financial Political Regulatory
5 functions of a manager
Planning: -Decisions on what needs to be done, how it will be done, and who is going to do it. Examples: planning a new addition service line for the unit, addition of new equipment for the unit Organizing: -Structure of the organization determines lines of authority, channels of communication, and where decisions are made. Examples: creating a process and following through on implementation, organizing staff to complete a task Directing: -Influences and motivates staff to perform assigned roles and responsibilities. Following up with staff for verification and accountability. Examples: looking a the needs within the unit for capital purchases, delegating duties to a supervisor, creating a team to complete a new educational task Staffing: -Creating a staffing plan for unit which will provide safe, effective, high quality care. Examples: working on a staffing plan for the unit, acquisition of staff, onboarding, orientation of staff, education of new staff Controlling: -Evaluation of staff performances and evaluation of unit goals to ensure identified outcomes are being met. Examples: conflict resolution, evaluation of a product, evaluation of meeting goals and measurement of outcomes of the unit Evaluation of staff performances and evaluation of unit goals to ensure identified outcomes are being met. Examples: conflict resolution, evaluation of a product, evaluation of meeting goals and measurement of outcomes of the unit
malpractice in nursing management
Potential Risks: -Staffing -Delegation & supervision -Evaluation -Failure to warn
power, conflict and emotional intelligence
Power is given when someone assumes authority. Conflict is inevitable and how you deal with it affects outcomes. Emotional Intelligence is a learned skill essential for management/leadership.
professional misconduct
Practice incompetently or negligently Are sexually or physically abusive Practice under the influence of, or are dependent on, alcohol or other drugs Charge patients or insurance companies for work not done Fail to follow required infection-control procedures Refuse to return records or provides copies of records upon request Disclose confidential information without permission Practice without a license, or beyond the scope of the profession Permit an unlicensed person to do work requiring a license Advertise in a false or misleading fashion You can claim that you don't feel safe practicing in a certain department Can work on pain meds if you have a prescription and it doesn't impair you
formal leadership
Practiced by a nurse with legitimate authority that is described in a job description ex. CNO, supervisor
Health Professions Education: A Bridge to Quality (2003)
Prepare clinicians to: -Provide patient-centered care -Work in interdisciplinary teams -Employ evidence-based practice -Apply quality improvement -Utilize informatics -Focus on patient safety
Democratic Leadership
Primary concern with human relations & teamwork Fosters communication & collaboration includes the group when decisions are made motivates by supporting staff achievements communication both up and down chain of command work output is usually of good quality when cooperation and collaboration are necessary ex. unit project
5 whys tool
Probably the most simple and effective tool Example/Problem: You are on your way home from work and your car stops in the middle of the road. Why did your car stop? —Because it ran out of gas. Why did it run out of gas? —Because I didn't buy any gas on my way to work. Why didn't you buy any gas this morning? —Because I didn't have any money. Why didn't you have any money? —Because I lost it all last night in a poker game. Why did you lose your money in last night's poker game? —Because I'm not very good at "bluffing" when I don't have a good hand
All Nurses are Managers
Responsible for directing the work of professionals & nonprofessionals to achieve desired outcomes of: -Patient care -Unit & Organizational Goals Can use leadership skills to be effective & successful Influenced by external & internal forces to the organization
Tool: root cause analysis
Retrospective process Examination of an adverse event (or near miss) to determine its causes and the necessary action(s) to prevent a recurrence Team approach
risk management
Risk Manager = Patient Safety Officer Everyone's responsibility: -Reporting - Incident Reports -Managing complaints (service recovery)
role of organizational leaders
Shape the culture, and set priorities to drive behavior change and provide resources for improvement. Create a culture of safety with well-orchestrated communication and teamwork in a non-punitive environment. Build accountability through measurement, feedback, and coaching.
contemporary theories of leadership
Situational Leadership: -Managers adapt their leadership style based on the situation & the follower Transactional leadership: -Leaders are successful to extent that they understand & meet needs of followers & use incentives to enhance loyalty & performance -focus on immediate problems, status quo maintenance, and using rewards to motivate followers Transformational Leadership: -Foster follower's inborn desire to pursue higher values; generate commitment to vision of organization rather than themselves Servant Leadership: -Leadership originates from desire to serve & that in course of serving one is called to lead; other's needs take priority. These believe that leaders can develop the necessary skills
sources of law
Stare decicis: -let the decision stand - uses precendents as a guide for decision making Res judicator: -thing or matter settled by judgment -limits appeals Remember that all laws are fluid and subject to change Constitutional law: -highest law, supreme court, federal court system - ex. Freedom of speech, right to bear arms Statuary Law: -written law, generally at the state level, voted on and written -ex. Speed limits, no J walking Administrative law: -procedures created by administrations - ex. Nursing license (governed by the board of nursing and law passed by the state government) -board of nursing has the power to adopt rules and regulations that further regulate nursing practice Common law: -body of law that applies to federal and state agencies; usually to protect public safety; not written - based upon court decisions, criminal acts, civil acts -ex. Ownership of property -ex. Common law marriage (represent living and life together for a certain number of years)
value based purchasing
Strategy developed by CMS Emphasis on paying for value (not volume) Total Performance Score (TPS) = 1. FY 2014 Scoring -Clinical Process of Care (Core Measures)45% -Patient Experience of Care (HCAHPS) 30% -Outcome Mortality 25% 2. FY 2015 Scoring -Clinical Process of Care (Core Measures) 20% -Patient Experience of Care (HCAHPS) 30% -Outcome (Mortality, Patient Safety, CLABSI) 30% -Efficiency 20%
legal liability and tort
Tort: personal liability -form of civil law (protects individual rights of people -unintentional tort (negligence, malpractice) -quasi-intentional tort (breach of confidentiality, defamation of character) -intentional tort (assault, battery, false imprisonment) Personal Liability- you made the mistake -nurse who falsifies a record to cover up a mistake may be found guilty of breaking criminal law Vicariously Liability- organization is responsible for the action of the employee Nurses can be sued....fastest growing lawsuits out there..cannot get money from doctors if they are only there 10% of the time -med errors blame nurses bc we give them Nurse Managers can be vicariously liable - ex. Staffing unit with all GNs Health Care Facilities: -sued for not always educating on new protocols - education for new equipment, IV pumps, catheters, etc.
scope of practice
Types and Expertise in Practice: -Basic: BSN Preferred -Advance: MSN, DNS, PhD Depends on: -Education & Experience -Role -Population Roles: -RN Educator -RN Administrator -RN Researcher
outcome measures
Unplanned Readmissions & Death (within 30 days) -Acute MI -Heart Failure -Pneumonia Surgical Complications Healthcare Associated Infections: CLABSI, CAUTI, SSI
Strategic management
What if the manager just did not plan? What if they manager just let things "happen"? What would the results be? - The work would not get completed effectively or efficiently. Patient outcomes and organizational goals would not be met. Strategic planning is a "blueprint" for operating a business, establishing a competitive position, ensuring customer service and satisfaction, and reaching strategic objectives and goals. Strategic management is defined as the management of an organization based on its vision, mission and values. These are the organization's framework which describes what the organization views as its business and future direction. Managers spend a large part of their time planning the future of their units. They must think about the needs of their unit and it grows and changes as it follows the organization's goals, mission, vision and values. Units change day by day and the strategic plan must reflect these changes.
high reliability
What is it? -Consistency over time with the same quality result -Technical skills + non-technical skills + designed processes in a culture of safety Why is it hard to achieve? -Health care providers trained to be competent, vigilant individuals and not trained as a team. -Health care environments lack a culture of safety -Health care organizations can have poor process design
patient safety
What is it? -Freedom from unintended harm Why is it hard to achieve? -Unsafe acts -System complexity What type of unsafe act is this? -Human error -At risk (violation) -Negligence (reckless) What is your action as a manager? 1. A nurse documented the same shift assessment done by a previous nurse when she didn't have time to assess her patient. 2. A nurse incorrectly set the flow rate on a patient's IV infusion pump. 3. A nurse didn't verify an insulin dose with another RN.
confidentiality
clients have right to privacy and confidentiality HIPPA: -allows clients to obtain a copy of their medical record and request to amend erroneous or incomplete information -providers must provide written information about how medical information is used and how it is shared with other entities -privacy and confidentiality caution to nurses with social media and information security
advanced directives
communicate a clients wishes regarding end of life care should the client be unable to do so patient self determination act requires all clients admitted to a health care facility be asked if they have an advance directive DNR/AND must be obtained by the provider and placed in the medical record
IHI improvement model
forming a team setting aims: : time specific, population specific, measurable establishing measures selecting changes testing changes in the real work setting implementing changes spreading changes
quality improvement process
identification of standards and outcome indicators based on evidence standard developed by facility committee standard made available to staff by ways of policies and procedures quality issues are identified by staff, management, or risk management dept interprofessional team is developed to review the issue the current state of structure and process related to the issue is analyzed data collected methods are determined (quantitative methods such as audits- structure/process/outcomes and retrospective/concurrent/prospective) data is collected, analyzed, and compared with benchmark if the benchmark is not met, possible influences are determined. a root cause analysis may be done to critically assess all factors that influence the issue potential solutions or correction actions are analyzed and one is selected for implementation educational or corrective action is implemented the issue is reevaluated at a reestablished time to determine the efficacy of the solution or corrective action
types of disruptive behavior
incivility: -action that is rude, intimidating, and insulting Lateral Violence: -occurs between workers who are at the same level within the organization bullying behavior: -persistent and relentless and is aimed at an individual who has limited ability to defend themselves -perpetrator is at a higher level than the victim cyberbullying: -disruptive behavior using the internet or other electronic means
informed consent
legal process by which a client has given written permission for a procedure or treatment to be performed consent is considered to be informed when the client has been provided with and understands: -reason for tx/procedure -the benefits -the risks -other options -the risk involved with no tx nurses role is to witness the signature on the informed consent form implied consent: when the pt complies with the instructions provided by the nurse written consent for invasive procedure or surgery individuals authorized to grant consent for another: -parent of a minor -legal guardian -court specified representative -spouse or closest individual who has durable power of attorney for health care
Reasons swiss cheese model
notes all of the missed safety checks that lead to a mishap occurring...each layer of cheese provides opportunity for defense or another step of failure
quality improvement
process used to identify and resolve performance deficiencies includes measuring performance against a set of predetermined standards focuses on assessment of outcomes and determines ways to improve the delivery of quality care joint commission standards require institutions to show evidence of quality improvement in order to attain accreditation status
quality/ performance improvement methods
quality assurance decreased variation=increased reliability
behavioral change strategies
rational- empirical: -the manager provides factual information to support the change; used when resistance to change is minimal normative-reeducative: -the manager focuses on interpersonal relationships to promote change power-coercive: -the manager uses rewards to promote change. used when individuals are highly resistant to change
advocacy
refers to the nurses role in supporting clients by ensuring that they are properly informed, that their rights are respected, and that they are receiving the proper level of care ensures pt has all information necessary to make decisions about health care be careful to assist clients and not direct or control their decisions nurses are accountable for their actions even if they are carrying out a providers prescription
ethical decision making
resources: -ethics committee -professional organizations an ethical dilemma is a problem for which there is more than one choice that can be made and the choice is influenced by the values and beliefs of the decision makers
client rights
right to be informed about all aspects of care and take an active role in the decision making process accept, refuse, or request modification to the plan of care receive care that is delivered by competent individuals who treat the client with respect refuse treatment: -patient self determination act requires workers to inform patients of their right to refuse or accept care -if they leave without discharge or refuse procedure, they are asked to sign a document understanding risk and choice; "against medical advice form" -nurse must notify doctor and explain risks to patient
Quality and Safety Education for Nurses (QSEN) competencies
safety: -the minimization of risk factors that could cause injury or harm while promoting quality care and maintaining a secure environment for clients, self, and others Patient centered care: -the provision of caring and compassionate, culturally sensitive care that addresses clients physiological, sociological, spiritual, and cultural needs, preferences, and values Evidence Based practice: -the use of current knowledge from research and other credible sources on which base clinical judgement and client care Informatics: -the use of information technology as a communication and information gathering tool that supports clinical decision making and scientifically based nursing practice Quality Improvement: -care-related and organizational processes that involve the development and implementation of a plan to improve health care services and better meet clients needs Teamwork and Collaboration: - the delivery of client care in partnership with multidisciplinary members of the health care team to achieve continuity of care and positive client outcomes
Generations
there are 4 generations in the workplace can vary with communication styles and leaderships preferences generation gap can make it hard to get things done or make people feel as though their work is viewed negatively by those of other generations want to: -avoid stereotyping -value each generations contributions -encourage mutual respect -leverage difference to enhance teamwork -recognize differences in communication -maintain peaceful coexistance
Conflict management
what is conflict? -Conflict is the result of opposing thoughts, ideas, feelings, perceptions, behaviors, values, opinions, or actions between individuals. Conflict is an inevitable part of professional, social, and personal life and can have constructive or destructive results. Conflict can be internal or external to an individual or groups Nurses must understand conflict and how to manage it.
3 outcomes of conflict
win- win win-lose lose-lose
