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UTA NURS 4351 Exam 2

UTA NURS 4351 Leadership Exam 2

Staffing goal provide appropriate mix and number of nursing staff (nursing care hours) to match actual or projected patient care needs (patient care hours) and deliver safe, efficient and effective nursing care
Centralized staffing staffing decisions for all units made by a central office or computer; tends to be fairer, frees manager to complete other functions, and more cost effective
Decentralized staffing staffing done at the unit level; allows staff to take requests directly to own manager, increases risk that employee risk that employee request are treated unequally or inconsistently, and time-consuming for unit manager
Block staffing set skill mix for every shift; doesn’t vary with census or acuity (common in ED and L&D)
BON guidelines r/t Nursing Work Hours nurses work hours should be limited to no more than 12.5 hours/24-hour period, 60 hrs/7-day week, and 3 consecutive days of 12 hour shifts
Patient classification systems (PCS) or acuity systems develop to objectively determine workload requirements and staffing needs; look at “nursing intensity”; data collected midpoint of each shift to project the numbers and mix of nursing staff for the oncoming shift
Critical indicators patient classification systems (PCS) uses broad indicators such as bathing, diet, IV fluids/medications, and positioning to categorize patient care activities
Summative task patient classification systems (PCS) requires the nurse to note the frequency of occurrence of specific activities, treatments, and procedures for each patient
Nursing care hours per patient day formula nursing hours worked in 24 hours/patient census
Average nursing care hours Med/Surg 5-7 hrs; Critical Care 10-24 hrs; Specialty Units 24-48 hrs
Staffing by FTE 36-40hrs/wk (2080 hrs/yr); filled by one person working full time or any combination of personnel to meet full time requirement
Current evidence on staffing adding one FTE RN decreased risk of death by 9-16%; mortality rates were up to 34% lower when greater proportion had BSN; higher nursing workload increases likelihood of failure to rescue; a net reduction in costs with more RNs
Veteran generation those nurses born between 1925 and 1942 (about 9% of employed nurses); having lived through several military conflicts and the Great Depression, they are often risk adverse, respectful of authority, supportive of hierarchy, and disciplined
Silent generation another term for the veteran generation because they tend to support the status quo rather than protest or push for rapid change
Boom generation born 1943-1960; have traditional work values, but tend to be more materialistic and thus are willing to work long hours at their jobs in an effort to get ahead (more apt to be called “workaholics” than any other generation)
Generation Xers born 1961-1981; lack interest in lifetime employment at one place and value greater work hour flexibility and opportunities for time off; they are pragmatic, self-reliant, and amendable to change
Generation Y born 1978-1986; aka “digital natives”, known for their optimism, self-confidence, relationship orientation, volunteer mindedness, and social consciousness
Economy effect on nursing shortages historically, when the economy improves, nursing shortages occur and when the economy declines, nursing vacancy rates decline as well
Recruitment process of actively seeking out or attracting applicants for existing positions
Illegal interview questions inquiries regarding age, marital status, children, race, sexual preference, financial or credit status, national origin, or religion are illegal because they are deemed discriminatory
Indoctrinations planned, guided adjustment of an employee to the organization and the work environment which includes three separate phases: induction, orientation, and socialization
Retention the ability to continue the employment of qualified individuals who might otherwise leave the organization
Current and Projected Vacancies top job growing in US; growth in # of employed nurses from 2.74 million in 2010 to 3.45 million in 2020; need for 495,500 replacements; shortage most intense in the South and the West
Motivation the force within the individual that influences or directs behavior
Intrinsic vs. extrinsic motivation The intrinsic motivation to achieve is directly related to a person’s level of inspiration. Extrinsic motivation is motivation enhanced by the job environment or external rewards.
Maslow’s Hierarchy of Needs motivation theory people are motivated to satisfy certain needs, ranging from basic survival to complex psychological needs, and will seek higher need only when the lower needs have been consistently met
Skinner’s research on operant conditioning and behavior modification demonstrated that people could be conditioned to behave in a certain way based on a consistent reward or punishment system.
Herzberg’s Motivator/Hygiene Theory Motivator factors are present in the work itself and gives employees the desire to work and to do that work well; Hygiene (Maintenance) factors prevent employee dissatisfaction, but do not act as real motivators
Herzberg’s Motivator Factors achievement, recognition, responsibility, advancement, work itself, potential for growth and professional development
Herzberg’s Hygiene Factors salary, supervision, interpersonal relations/peers, job security, positive working conditions, personal life, company policies, status
Vroom’s expectancy model looks at motivation in terms of the person’s valence, or preferences based on social values; a person’s expectations about his or her environment or a certain event will influence behavior
McClelland Basic Needs Theory people are motivated by 3 types of needs: achievement, focus on improving ‘what is’; Power, gained by specific action (generally in men); Affiliation, focus energies on people (generally in women)
Gellerman’s Theory of Stretching individuals should be periodically “stretched” or challenged with tasks more difficult than they usually do. Most managers “over-manage” and make jobs too narrow.
McGregor’s Theory X and Y importance of manager’s assumptions about workers on the intrinsic motivation of the workers
Mayo and the Hawthorne Studies people responded to the fact they were being studies which suggested that the “human element” matters
Motivating climate clear expectations, fair and consistent, encourage teamwork, know the uniqueness of each employee and their expectations, stretch employees intermittently, reward desired behavior, allow employees as much control as possible
Financial planning activities designed to allocate resources and plan for the efficient operation of an organization
Budget a financial plan that includes estimated expenses as well as income for a period of time
Cost containment vs. cost-effective cost containment is effective and efficient delivery of services while generating needed revenues for continued organizational productivity; whereas, Cost-effective is producing good results for the amount of money spent (product is worth the price)
Fixed vs. Variable expenses fixed do not vary with volume (e.g., taxes, leases, contracts, salaries); whereas, variable vary with volume (e.g., staffing numbers, payrolls, supplies)
Responsibility accounting an essential feature of fiscal planning; each of an organizations, revenues, expenses, assets, and liabilities is someone’s responsibility
Forcasting making an educated budget estimate by using historical data
Controllable vs. Noncontrollable expenses controllable can be controlled or varied by the manager (e.g., staffing mix/shift); whereas, noncontrollable cannot (e.g., equipment depreciation, supplies)
Budget process steps Assess what needs to be covered; diagnose the goals or what is to be accomplished; plan based on fiscal year; implement plan with careful monitoring and analysis; and evaluate periodically and modify when indicated
Types of budgets personnel, operating, and capital
Personnel budget largest budget expenditure because healthcare is labor intensive; salaries, benefits, shift differentials, overtime, on-call hours, premium pay, merit raises, cost of living adjustments
Largest of the budget expenditures personnel budget because health care is labor intensive
Operating budget reflects expenses that change in response to the volume of service (e.g., electricity repairs and maintenance, and supplies)
Second most significant component in the hospital budget (next to personnel costs) supplies
Just-in-time ordering a process whereby inventory is delivered to the organization by suppliers only when it is needed and immediately before it is to be used
Capital budget plan for the purchase of buildings or major equipment (equipment that has a long life, is not used in daily operations, and is more expensive than operating supplies
Incremental budgeting simplest method for budgeting; budget for coming year may be projected by multiplying current-year expenses by a certain figure, usually the inflation rate or consumer price index
Zero-based budgeting must rejustify their program or needs every budgeting cycle using a decision package to set funding priorities
Flexible budgets budgets that flex up and down over the course of the year dependant on volume
Performance budgeting emphasizes outcomes and results instead of activities or outputs
Balance sheet portrays the financial “health” of the organization
Balance sheet major components assets (what organization owns), liabilities (what organization owes), fund balance/owner equity (what organization is worth; assets – liabilities)
Variance difference between the projected amount for an item on the budget and the actual cost
Favorable vs. unfavorable variance favorable are more earnings than expected or fewer costs; whereas, unfavorable are fewer earnings than expected or higher costs
Volume variances due to increases or decreases in patient volume
Efficiency variances difference between budgeted an actual nursing care hours provided
Critical pathways a strategy for assessing, implementing, and evaluating the cost-effectiveness of patient care; predetermined courses of progress that patients should make after admission for a specific diagnosis or after a specific surgery
Fee-for-service vs. prospective payment system in fee-for-service reimbursement was based on costs incurred and profits with no ceiling placed on total amount; whereas, prospective payments systems reimburse a specified amount for each admission, regardless of cost of care
Effect of prospective payment system length of stay for most hospital admissions has decreased greatly
Medicare vs. Medicaid Medicare is a federally sponsored health insurance for the elderly and certain groups with catastrophic or chronic illness; whereas, Medicaid is a federal-state cooperative health insurance plan created primarily for the financially indigent
Balanced Budget Act contains numerous cost-containment measures, including reductions in provider payments for traditional fee-for-service Medicare program participants
Managed care a system that attempts to integrate efficiency of care, access, and cost of care; use primary care providers as gatekeepers, focus on prevention, decreased emphasis on inpatient hospital care, use of clinical practice guidelines, and selective contracting
Selective contracting providers agree to lower reimbursement levels in exchange for patient population contracts
Utilization review process used by insurance companies to assess the need for medical care and to assure that payment will be provided for the care; includes precertification/preauthorization for elective treatments, concurrent review, and retrospective review (emergency)
Most common type of managed care organization HMO
Moral hazard the propensity of insured patients to use more medical services than necessary because their insurance covers so much of the cost
Nursing care delivery system method used to provide care to patients and clients; provides structure for nurses to deliver nursing care to a specified group of patients
Total patient care method of delivering care the oldest mode of organizing patient care; nurses assume total responsibility during their time on duty for meeting all the needs of assigned patients (e.g., 1:1 assignments, private duty, or student nurse assignment)
Total patient care method of delivering care pros relationship established with patient, continuity of care, holistic and unfragmented care
Total patient care method of delivering care cons requires highly skilled nurses which cost more, safety may be compromised d/t inexperience or inadequate preparation, differences among practitioners may cause different approaches and confusion
Functional method of delivering nursing care evolved as a result of the nursing shortage caused by WWII and the rapid construction of hospitals as a result of the Hill Burton Act; personnel are assigned to complete certain tasks (e.g. a med nurse, treatment nurse, and UAP for vitals)
Functional method of delivering nursing care pros efficiency (tasks completed quickly with little confusion regarding responsibilities) and competency
Functional method of delivering nursing care cons fragmented care, overlooks priority needs, patient & nurse dissatisfaction, lack of identified accountability, cost draining- need for multiple coordinators
Team nursing method of delivering nursing care ancillary personnel collaborate in providing care to a group of patients under the direction of a professional nurse (team leader)
Team nursing method of delivering nursing care cons shift responsibility, change of team leader causes fragmented care, requires team “spirit” to succeed
Team nursing method of delivering nursing care pros capabilities are maximized creating job satisfaction, leadership skills development, continuity of care, patient satisfaction, team spirit
Modular nursing method of delivering nursing care uses a mini-team (2-3 members with at least one being an RN) approach with members sometimes being called care pairs; units are typically divided into modules or districts and assignments are based on geographical location
Model RN line uses direct care RNs and patient care technicians working together as a synchronized primary pair to provide care
Primary nursing method of delivering nursing care RN primary nurse assumes 24-hour responsibility for planning the care of one or more patients from the start of treatment to discharge; during hours normally works, provides direct total care
Primary nursing method of delivering nursing care cons unavailable consistent staff, intimidating to less skilled staff/new graduates, time investment, variable cost effectiveness
Primary nursing method of delivering nursing care pros increased satisfactions (pts & RNs), maximized autonomy & responsibility, continuity of care, positive communication
Case management goal achieve a desired patient outcome within a specified period of time; focus on decreasing hospital readmissions, LOS, and resources while adhering to therapeutic regime, increasing functional status and patient satisfaction
Differentiated nursing practice an attempt to separate nursing practice roles based on education or experience or some combination of both
Education model of differentiated nursing practice differentiates roles based on the educational preparation of the nurse and includes 3 basic components: provision of care, communication, and management
Competency model of differentiated nursing practice role differentiation based on individual nurse skill level, expertise, experience, etc.
Care MAP a combination of a critical path and a nursing care plan, except that it shws times when nursing interventions should occur as well as variances
Clinical nurse leader (CNL) advanced generalist with a MSN that is expected to provide clinical leadership at the point of care, implement outcomes-based practice and quality improvement strategies, engage in clinical practice, and create and manage Microsystems of care
Time management making optimal use of available time
Monochronic time management style orderly, sequential, linear, logical, begins and ends projects on time, highly structured, prefer isolated uninterrupted work place, clean and organized desk
Polychronic style flexible, multiple tasks simultaneously, spontaneous, adaptable; tends to change plans, prefers working in teams, and often works in cluttered environment which if not skillfully managed can deteriorate into chaos
3 basic steps to time management allow time for planning and establish priorities; complete highest-priority task whenever possible and finish one task before beginning another; reprioritize remaining tasks keeping in mind new information received
First and most important step in time management allow time for planning and establish priorities
Common mistakes of new managers/new nurses in time management underestimating the importance of a daily plan and not allowing adequate time (15-20 min) for planning
Number one time waster technology-email/social networking
Most critical skill in good time management priority setting
Vacarro’s five priority setting traps 1. Whatever hits first; 2. The path of least resistance; 3. The squeaky wheel; 4. Default (doing first what is always done first); 5. Inspiration (doing whatever you’re inspired to do)
Limiting socializing do not make yourself overly accessible (e.g., sit with back to others, close door); interrupt (e.g., excuse me, what exactly are you saying); avoid promoting socialization (e.g., no candy or comfortable chairs); be brief; schedule long-winded pests
Time inventory compares what you planned to do, as outlined by your appointments and “to do” entries, with what you actually did
Planning deciding in advance what to do; who is to do it; and how, when, and where it is to be done
4 Planning Modes Reactive, Inactive, Pre-active, Interactive
Reactive planning occurs after a problem exists
Inactive planning seeks status quo and spends energy preventing change and maintaining conformity
Preactive planning utilizes technology to accelerate change and is future oriented; future is always preferable to the present
Interactive (or proactive) planning considers the past, present, and future and attempts to plan the future of their organizations rather than react to it
Key requirement in proactive planning adaptation since the environment changes so frequently
Forecasting trying to estimate how a condition will be in the future; takes advantage of input from others, gives sequence in activity, and protects against undesirable changes
Strategic Plan forecasts the future success of an organization by matching and aligning an organizations capabilities with its external opportunities
Elements of a Strategic Plan Executive summary, background, mission/vision, goals/strategies, and appendixes
Strategic plan focus purpose, mission, philosophy, and goals related to the external organizational environment (e.g. dealing with nursing shortage, succession planning, redesigning workload, developing partnerships)
SWOT Analysis identification of strengths, weaknesses, opportunities, and threats
Balanced scorecard developed by Robert Kaplan and David Norton in the early 1990s; strategic planners develop metrics, collect data, and analyze that data from four organizational perspectives: financial, customers, internal business processes, and learning and growth
Planning hierarchy Mission > Philosophy > Goals > Objectives > Policies > Procedures > Rules
Vision statement vs. Mission statement Vision statements are used to describe future goals or aims; whereas, mission statements are a brief statement indentifying the reason that an organization exists
Philosophy flows from the purpose or mission statement and delineates the set of values and beliefs that guide all actions of the organization
Organizational philosophy provides the basis for developing nursing philosophies at the unit level and for nursing service as a whole
Nursing service philosophy addresses fundamental beliefs about nursing and nursing care; the quality, quantity, and scope of nursing services; and how nursing specifically will meet organizational goals
Unit philosophy adapted from the nursing service philosophy; specifies how nursing care provided on the unit will correspond with nursing service and organizational goals
Goals desired end result toward which effort is directed
Objective more specific and measurable than goals because they identify how and when a goal is to be accomplished
Policies plans reduced to statements or instructions that direct the organizations in decision making
Implied policies neither written nor expressed verbally, but have developed over time and follow a precedent
Expressed policies delineated verbally or in writing
Procedures plans that establish customary or acceptable ways of accomplishing a specific task and delineate a sequence of steps of required action
Rules situations that allow only one choice of action
Components of effective planning flexible; includes all units and people affected by plan; simple, specific, and realistic; and has evaluation checkpoints
Anecdotal notes documents employee behaviors that are out of the ordinary (positive or negative)
Appraisal Errors recency effect; halo effect; horns effect; central tendency
Recency effect common appraisal error; recent issues are weighed more heavily than past performance; often occurs when ongoing anecdotal notes are not maintained throughout the evaluation period
Halo effect common appraisal error; the appraiser lets on or two positive aspects of the assessment or behavior of the employee unduly influence all other aspects of the employee’s performance
Horns effect common appraisal error; the appraiser allows some negative aspects of the employee’s performance to influence the assessment to such an extent that other levels of job performance are not accurately recorded
Central tendency common appraisal error; hesitancy to risk true assessment and therefore rates all employees as average
Matthew effect occurs when employees receive the same appraisal results, year after year
Competence assessment vs. performance evaluation a competence assessment evaluates whether an individual has the knowledge, education, skills, or experience to perform the task, whereas a performance evaluation examines how well that individual actually completes that task
Trait rating scale most widely used appraisal method; a method of rating a person against a set standard, which may be the job description, desired behaviors, or personal traits
Job dimension scales a rating scale is constructed for each job classification; focus on job requirements rather than on ambiguous terms such as “quantity of work”
Weighted scale most frequently used checklist appraisal tool; composed of many behavioral statements that represent desirable job behaviors which have a weighted score attached to them
Essay appraisal method (free-form review) appraiser describes in narrative form an employee’s strengths and areas where improvement or growth is needed
Management by objectives tool for determining an individual employee’s progress because it incorporates both the employee’s assessments as well as the organization
360-degree evaluation includes an assessment by all individuals within the sprere of influence of the individual being appraised, including physicians, patients, the employee’s coworkers, whoever they report to, and employees from other departments with whom they work
Performance management appraisals are eliminated, and the manager places his or her efforts into ongoing coaching, mutual goal-setting, and the leadership training of subordinates
One of the best methods for improving work performance and building a team approach day-to-day feedback regarding performance
Marginal Employees those who disrupt unit functioning because the quantity or quality of their work consistently meets only minimal standards at best
Impaired Employees those who are unable to accomplish their work at the expected level as a result of chemical or psychological disease
Discipline vs. Punishment discipline involves training or molding the mind or character to bring about desired behaviors vs. punishment is an undesirable event that follows unacceptable behavior
Dealing with Marginal Employees coaching for performance improvement; accept performance; if small organization, may need to transfer or terminate employee; or if large organization, passive managerial coping
Drugs most commonly abused by nurses alcohol (#1), demerol, oxycodone, OxyContin, Vicodin, benzodiazepines
Steps in Progressive Discipline informal reprimand or verbal admonishment; formal reprimand or written admonishment; suspension from work without pay; termination
Grievous Offenses Behaviors or actions so grievous or dangerous to patient/staff safety that immediate termination is necessary (e.g., patient abuse, stealing property)
Constructive vs. Destructive discipline constructive uses discipline as a means of helping the employee grow, not as a punitive measure
Highest level and most effective form of discipline self-discipline
Performance deficiency coaching includes ongoing or problem-centered coaching; the manager actively brings areas of unacceptable behavior or performance to the attention of the employee and works with him or her to establish a plan to correct deficiencies
McGregor’s Hot Stove Rules four elements must be present to make discipline as fair and growth-producing as possible: forewarning, immediate consequences, consistency, and impartiality
Disciplinary conference after thoroughly investigating an employee’s offenses, managers confront the employee with their findings
Disciplinary conference steps state problem clearly, ask why no improvement, explain disciplinary action to be taken, describe expected behavioral change and time frame, get agreement and acceptance of the plan
Termination conference contents state facts and reason, explain process, ask for input, remain calm, end meeting on a positive note if possible
Grievance procedure a statement of wrongdoing or a procedure to follow when one believes that a wrong has been committed
Most important outcome of a grievance legitimate opportunity that it provides for employees to resolve conflicts with their superiors
Created by: camellia