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NUR Leadership

LEADERSHIP UNITS

QuestionAnswer
Critical Triad decision making, management, leadership
Decision Making complex cognitive process defined as choosing a particular course of action triggered by a problem
Problem Solving systematic process that focuses on analyzing a difficult situation
Critical Thinking thinking from general to specific, reflect on meaning of state, examine evidence/reasoning, form judgement
Nursing Process assess, plan, implement, evaluate
Decision Grid compare each decision and alternative by same criteria
Payoff Table cost-profit-volume
Decision Tree plot decisions over time to see consequences
Consequences Tables various alternatives create consequences
Logic Models pictures of how programs were supposed to operate
Program Eval and Review Techinique flowchart of which events must take place if fianl event is to occur
Management Process planning, organization, staffing, directing, controlling
Behavioral Theories 1. Authoritarian, Democratic, Laisser-faire
Authoritarian strong control, coercion, commands, downward communication, sole decision making, useful in crisis, autonomy is reduced
Democratic less control, awards to motivate, communication up and down, teamwork, less efficient
Laissez-faire permissive with little or no control, emphasis on group good for brainstorming
Interactional Theories 1. transactional 2. transformational
Transactional set goals, gives directions rewards, focuses on management tasks
Transformational motivate performance beyond expectations thru ability to influence attitudes, comitted, empower others
Formal Structure framework for defining managerial authority, responsiblity and accountablility
Informal Stucture social with blurred or shifting lines of authority and accountability
Chain of Command formal relationships, lines of communication and authority depicted on org chart
Span of Control number of people directly reporting to you
Top Level Manager look at org as whole coordinating internal and external influences, decision with few guidelines orstructres CEO
Middle Level Manager coordinate efforts of lower level managers, day to day ops but also contribute to long-term planning and policies
first level managers units specific workings immediate problems and personal needs -- charge nurse
Formal Structure framework for defining managerial authority, responsiblity and accountablility
Informal Stucture social with blurred or shifting lines of authority and accountability
Chain of Command formal relationships, lines of communication and authority depicted on org chart
Span of Control number of people directly reporting to you
Top Level Manager look at org as whole coordinating internal and external influences, decision with few guidelines orstructres CEO
Middle Level Manager coordinate efforts of lower level managers, day to day ops but also contribute to long-term planning and policies
first level managers units specific workings immediate problems and personal needs -- charge nurse
Centrality location of positon in the middle of org chart
Stakeholders internal and external;entities in orgs environ that play a role in orgs health and performance and also affected by org
Organizational Culture total or orgs values language traditions customs symbols and interactions of each org. org's personality
Shared Governance joint practice committees; board members, drs nurses management --- power and accountablity for decisions
Magnet Status award based on quality of nursing leadership, care org stucture, manage style,etc ... p 283
Authority rigtht to command, function of any mangement position
Types of Power reward, coercive, legitimate, expert refferent, empowerment
Reward Power grant favors or reward for meeting stds
Coercive Power punishment for not meeting stds
Legitimate Power power gained by title or position (authority)
Expert Power gianed thru knowlwdge or experience or expertise
Referent Power power cuz other id with that leader or with what they symbolize ---- role models
Empowerment to enable, develop or allow---employees make the most of creativity, talents input etc...
Total Patient Care Nursing/Case Method Nursing RN assume total care resp to meet all needs of pt
Functional Method Unskilled people trained to do simpl;e tasks and gain proficiencey by repetion ... task complete instead of care .... CNA
Team/Modular Nursing care of group of pts under direction of RN with ancillary caregiver colabaration
Primary Nursing RN assigned total care from admit to discharge --- holistic high quality care -- consistent
Case Management Collaborative assesses, plan, implement, coordinate, moitor and eval options and serviecs to meet health needs thru commun, reslurces --- quality cost effective outcomes
Ethics systematic study of what a person's conduct and acitons should be with regard to self, others and enviroment; justifiaciton of right/good; SYSTEM OR MORAL CONDUCT AND PRINCIPLES THAT GUIDE A PERSON'S ACTIONS TO RIGHT AND WRONG
Moral Uncertainty/Moral Conflict individual unsure which moral principle or value applies and may be uncertain what the moral porble is
Moral Distress know right thing to do but org contrans and makes it difficult to do the right thing
Moral Outrage witness an immoral act of other and can't stop it
Moral/Ethical Dilemma 2 or more clear moral principles apply byut support different courses of action; eg having to choose the lesser of two evils
Teleological/Utilitarianism Decision Making greated good for the greatest number
Deontological Decision Making judges action as right or wrong regardless of cosequences
Deontological - Rights Based individuals basic ingherent rites that should not be interfered with
Deontological - Duty Based duty to do something or to refrain from doing something
Deontological - Intuitionist case by case to determine raltive gails duties rights etc
Autonomy freedom of choice (self-determination)
Beneficience doing good; actions to promote good
Nonmaleficence actions to avoid harm --- can't do good ... do no harm`
Paternalism individual assumes rite to make decisions for another
Utility good of many outweighs wants and needs of individuals
Jusrice treating pople fairly
Veracity truth telling
Fidelity keep promises' bird of word
Confidentiality keep privleged information private
Professional Code of Ethics for Nurses p 78 set of principles to guide to highest sts of ethical practice for RNs
Constituition Highest law of the land - little or nothing to do with RN
Statuetes state or fed laws; affect malpractice laws and nurse practice acts
Administrative Agencies rules established by government agencies eg BON
Court Decisions courts interprett statues and set precients --- most malpractice
Negligence omission to do do something that a reasonable person guided by the considrations that ordinarliy regulate human affairs; reasonable and prudent thing to do; what someone with similar training and experience would do
Malpractice/Professional Negligence 5 conditions - duty for due care, failure to meet std, foreseeable harm, direct relationship from failure to harm, injury
Duty to use Due Care care that should be given under the circumstances
Failure to meet Std of care/breach duty not providing appropriate care
Forseeablity of Harm RN has access to infor about possibility of harm (ignorance is no excuse)
Direct relationship between failure to meet std of care and injury can be proven eg wrong dosage = adverse rxn
Injury actual harm results
Incident Reports Do not mention in chart, condidential can't be subpeopnaed; chart enough info about incident to treat pt
Unintentional Torts negligence
Intentional Torts legal wrongs committed against person or property eg assault, battery , false imprisonment, defamation
Assault conduct that makes a person feel fearful, produces apprehension of harm
Battery interntional and wongful physical contact with a person that entails injury or offensive touching
False Imprisonment unlawful confinement with fixed boundaries by physical, emotional or chemical means
Defamation communicating to 3rd party false info that injures a person's reputaiton, causes economic damage, diminishes esteem, respect, goodwill or confidnce
Informed Consent pt receives full disclusre of all pertinent info regarding surg or procedure;comprehends procedure, risks, outcomes, complications and alternatives, over 16, competent or have parent or guard unless emergent
Meical Records chart of info on treatment
Patient Self Deteremination Act every pt gets end of life educaiton and advance directive info
Good Samaritan Law healthcare workers proteced from potential liablity if they volunteer nursing skills away from work, provided not grossly negligent, limited to emergencies
Health Insurance Protabliity and Accountability Act of 1996 (HIPAA) safeguard rites to pts personal health info, provacy and confidntiality for every pt
Nursing license Supeension or Revocation prof. negligence, no license, felony, ciminal abortion pariticipation, not report substd care, care under influence of drugs/etoh, narcotics w/o order, false call oneself nurse practioner (p113)
Advocacy helping others to grow, self-acutalize; inform of rites and ascertain that they have sufficient info on which to base decision
Areas in Need of Advocacy end of life,technology, insur reimburs, acess healthcare, provder-pt conflict, withold info, insuraace author, med errors, pt info disclose, pt griencance, cultural diveristy, pt dignity, inadequate consent, incompetnet provide, social problems, aging
Proactive Planning considr past, present, future --- plan rather thatn react to future --- forecasting
Strategic Planning fociuses on purpose, mission, phil, and dolas in context of external environment
Vision Statements Futree Goals or Aims of Org
Mission Statement reason for being for Org
Philosophy Statement flows from mission statement --- set of values and beliefs that guide actions of org
Goals desired result to which effort is directed --- aim of phil... measurable , ambitious
Objectives more specific and measurable than goals determine how and when goals are to be accomplished; explicit, measurable, observable, obtainable
Policies statement of expectations that sets boundaries for action taking and decision making
Procedures plans that establish customary or accectable ways to do thing or tasks, delineate steps of required action
Phases of change unfreezing, movement, refreezing
Unfreezing convinces member of group to change or when gulit, anxiety or concern is elicited; people discontent and aware of need to change
Movement ids, plans, implemnts appropriate strategies ensuring that driving forces exceed restraing forces; overcome resistance
Refreeze stabilizing system change so that it becomes the new status quo
Basic Steps to Time Management 1. set time aside to plan/prioritize 2. complete highest priority before moving on to next 3. reprioritize what needs to be accomplished based on new info - update
Managing Time at Work gather all supplies before, group activities, estimate amt of time needed, nursing interventions when complete, end on time, manage timewasters
Cost-containment effective and efficient services while generating revenues for continued productivity; quality care and make money doing it
Responsibility Accounting someone respionsible for orgs expenses, revenues, assets liablities on each unit; make each unit profitable
Fixed Expenses do not vary with volume eg rent
Variable Expenses vary with volume
Controllable Expenses manager can control # of staff per shift
Uncontrollable Expenses number and types of supplies needed by each pt
Personnel Budget staffing mix, largest expense, nursing care hours per patient day = #hrs/census; CNA and RNs count same (does not take into account accutiy etc)
Operating Budget expenses that change in repsonse to volume eg supplies
Capital Budget plan for purchase of fixed assests
Clinical Pathways one method of planning, assessing, implementing and evaluating cost-effectiveness of pt care; std predictions of pts progress for specific diagnosis or procedure
Medicare fed insurance for over 65 or catastrophic or chronic illness at any age
Medicaid financially indigent
Prospective Payment System recv medicare $ in flat fee per diagnosis regardless of condito of pt --> early discharge get them out!
HMO health maintenance org corp body funded by insurance premiums
POS Point of service - select provided out of network and pay higer premiums and co-pays
PPO preferred provider org, fee for service basis but incentives when preferred provider used
Career Development intentional careeer planning; strengths weakness goals opportunites and develop activites
Certifications formal recognition for specialized knowledge, skills and experience demonstrated by achievement of stds id'd by specialty to promote optimal health outcomes
Steps in Staffing 3 and types of personnel needed; recruit, interview, select assign; induction& orient; socialize, creative flex schedule based on pt needs
Current Nursing Shortage aging workforce, inadequate educational opportunites for nurses,
Basic Steps to Time Management 1. set time aside to plan/prioritize 2. complete highest priority before moving on to next 3. reprioritize what needs to be accomplished based on new info - update
Managing Time at Work gather all supplies before, group activities, estimate amt of time needed, nursing interventions when complete, end on time, manage timewasters
Cost-containment effective and efficient services while generating revenues for continued productivity; quality care and make money doing it
Responsibility Accounting someone respionsible for orgs expenses, revenues, assets liablities on each unit; make each unit profitable
Fixed Expenses do not vary with volume eg rent
Variable Expenses vary with volume
Controllable Expenses manager can control # of staff per shift
Uncontrollable Expenses number and types of supplies needed by each pt
Personnel Budget staffing mix, largest expense, nursing care hours per patient day = #hrs/census; CNA and RNs count same (does not take into account accutiy etc)
Operating Budget expenses that change in repsonse to volume eg supplies
Capital Budget plan for purchase of fixed assests
Clinical Pathways one method of planning, assessing, implementing and evaluating cost-effectiveness of pt care; std predictions of pts progress for specific diagnosis or procedure
Medicare fed insurance for over 65 or catastrophic or chronic illness at any age
Medicaid financially indigent
Prospective Payment System recv medicare $ in flat fee per diagnosis regardless of condito of pt --> early discharge get them out!
HMO health maintenance org corp body funded by insurance premiums
POS Point of service - select provided out of network and pay higer premiums and co-pays
PPO preferred provider org, fee for service basis but incentives when preferred provider used
Career Development intentional careeer planning; strengths weakness goals opportunites and develop activites
Certifications formal recognition for specialized knowledge, skills and experience demonstrated by achievement of stds id'd by specialty to promote optimal health outcomes
Steps in Staffing 3 and types of personnel needed; recruit, interview, select assign; induction& orient; socialize, creative flex schedule based on pt needs
Current Nursing Shortage aging workforce, inadequate educational opportunites for nurses,Nurse Reinvestment act of 2002
Recruitment acively seeking out or atracting applicatns
Retention org creates work environment that cause people to stay
Overcome Interview limits prepare-know job, team approach, structred interview,scenarios for decision making, multiple interviews, evaluation 4 hire, legal aspects
Selection eduction, credentials; references; preemployment screening, physical exam
Indoctrination planned guided adjustment of employee to org and work --> induction, orientation socialization
Induction activites to educate new employee about org, employ and personnel policies andprocedures
Orinetation activites specific to positon; feel like part of team
Socialization behvaiors that accompany each role learned socially, by instuction, observation and trial and error
Staff Development encourage individual growth and support staff development
Theories of Learning techniques to strutre training to improve competemnce of staff
Adult Learning Theory learner is self-directed, self-motivated, experiences are varied,teachers and students work together to set goals, decisions, activiities, and eval
Social Learning Theory learn most behavior by direct evidence and observation
Readiness to Learn ks
Motivation to Learn kkk
Reinforcement jkjkl
Task Learning kjkjl
Transfer of Learning jklkljl
Span of Memory kjljklj
Chunking klkjljkj
Knowledge of Results kjkjlj
Staff Development Activities establish competence, meet new learning needs, satisfy interests the staff may have in a specific area
Socialization behaviors that accompany each role that are learned socially and by instruction, observation, and trial and error
Role Model somone worth of imitation, experienced, competent
Preceptor experienced nurse who provides knowledge and emotional support, one on one
Mentor interactive relaitonship; assist the protege in attaining expert status and furthering career development
Major contributors to job dissatisfaction inflexible schedule and extended work schedule
Role of manager cover all staff absences, reduce staff during low census, add for ^acuity/census, prepare unit schedules and holidays and vacations
Mandatory Staffing Requirements regulates nurse to pt ratio -- requirements for min staffing ratios
Cycclical staffing same rotation very month
job sharing allow RNs to switch hours with others
flextime pick up hrs of choice
supplemental staffing agency, travel and float pools
staff self scheduling staff makes own schedule manager tweaks it
shift bids bid work schedule instead of work mandatory overtime (set max nd RNs bid against max)
Workload Measurement Tools nursing care hrs per pat day; patient classification system - measure acuity to measure staff and mix needs
RN hrs in NCH/PPD decreases cause adverse pt outcomes, ^ med errors, ^ pt falls, decreases satisfaction with pain management
Goal of management stay within staffing budget and meet needs of pts and staff
Role of Manager - Directing (activating, coordinating) doing; create motivating climate, org. communication, manage conflict, enhance collaboration, negotiate, understand impact of collective bargaining and employment laws
Motivation force in individual that influences and directs behavior, willingness to put effort into achieving goal/reward to decrease tension in need --> intrinsic and extrinsic
Intrinsic Motivation within person - drive to be productive
Extrinsic Motivation comes from environment or external rewards -- positive reinforcement and feedback
Joy positive mood directly linked to enhanced creativity, greater helping behavior, integrative thinking, inductive reasoning, more efficient to decision making greater cooperation more success in negotiating
Pathways to Joy connections, love of work, achievement - job well done, recognition
Strategies to Create a mOtivating Climate Chart 18.5 p 432
Communication crosses all phases of management, --- effective communication requires the sender to validate what the listener sees and hears
Effects on Communication verbal; nonverbal; Internal Climate - values, feelings temperament stress, external climate- status, power and s*authority can be barriers - also weather, timing, temp organizational climate
Organizational Communication Strategies assess org comm; recognize structure and who will be affected by comm,not one way, clear simple precise(SBAR Q), senders seek feedback whether comm acurately recvd, mulitlple ways, not overwhlem with unecc. info
SBAR Q S=situation B=background A=assessment R= recommendations Q=questions
Levels of Communication up, down, horizontal, diagonal (other depart and levels), grapevine
Types of Communications written, face to face, nonverbal, telephone
Nonverbal Communication mistaken if not clarified, most reliable -- consider space, environment, appearance, eye contact, posture, gestures, facial expression, timing and vocal cues
Managerial Traits RE; Communication Assertive comm, listen skills, group commm, group building and maintance Roles
Groop Dynamics Forming, Storming, Norming, Performing (p 456) Performing (p456)
Roles for teambuilding encourager, harmonizer, compromiser, gatekeeper, std setter, commentator, follower
Group Tasks initiator, inform seeeker, inform giver, opinion seek, elaborator coordinator, orienter, evaluator, engergizer, prodeural tech and recorder intiator, information seeker, information giver, opinion seeker, elaborator, coord
Delegation getting work done thru others or directing performance o one or more people to accomplish organizational goals
Common errors in Delegation underdelegation - fear; overdelegating, improper delegaton - not qualified, wrong person or time or wrong reason
Effective delegating plan ahead, id skilss(nurse practice), comm goal,empower, deadlines & progress, model role amd respurse and provide guidance, eval, reward
Assigning tasks to UAP job description, knowledge base and demonstrated skills
Subordinate resisitance rt overwhelmed, lack of confidence, inherent resistance to authority, overdelegated
MConflict internal or external discord rt diff in ideas values or feelings btwn 2 or more,; not good or bad; can produce growth or organization
Intergroup conflict btwn 2 or more groupd of people,depart, orgs
Intrapersonal within same person
Interpersonal btwn 2 or more people with diff values, goals, beliefs
Conflict Resolution problem solving; goal is win-win for everyone involved
Compromising each party gives up something it wants; give up equal or lose-lose
Competing one party pursues what it wants at expense of other; win-lose
Cooperating/Accomodating one party sacrifices for other to win --- IOUs
Smoothing focus on agreements rather than disagreements to smoother over
Avoiding choosing not to aknowledge or fix problem
Cllaborating assertive and cooperative approach; win-win; all set aside original goal use shared decision making pwoers
Common Causes of Conflict poor comm, illdefined org, individ behave, unclear expectations, conflit of interest, ops or staff chnage,diveristy in gende,culture, age
Negotiation each party gives up something and emphasis is on accomodating differrence btwn parties
Preparation for a Negotiation before- homework, strt pt tradeoffs bottom line, hidden agendas; during- composure, good comm skills, assert, flex, avoid destructive techniques After- restae agree, verbal written, thankyou
Mediation neutral third party with no vested interest in the outcome fact finds and hlps to find resolution
Arbitration facts are heard by third party who makes final binding decision
Consensus negotiating parties reach an agreement that all parties can support
Collective Bargaining activites occurring between organzed labor and management that ocncern employee relations ANA
Unionization Driving Force feeling of powerlessness or perception that admin does not canre about employees
Labor Standards regs dealing with the conditions of employees work, include physical conditions, fifnacial aspects and amt of hrs worked
Hours Worked law that must be paid overtime for any hrs over the set amt per week, 1.5 time std pay
Equal Employment Opportunity Laws aimed at eliminating discrimination against potential employees based on age, disability, equal pay, national origin, race religion, reataliation, sex sexual harassment
Civil Rights Act 1964 promotes employment bases on ability and merit; not race, religion, color, sex and national origin
Affirmative Action actively seeking to fill job vacancies with members from groups who are underrepresented
Quality Control performance measured against predetermined std and action is taken to correct discrepancies between these std adn actual performance
Characteristics to Have a Good QC Program top level support, commitment in $ and people; excellence, continuous improvement
Quality Control Steps criterion or std determined, benchmark; information is collected to determine if std has been met- compare with evidence based practice; educational or corrective action is taken if stds not met
Standards predetermined level of excellence that is guide for pracitce; objective, measurable achievable, developed ANA Scop of practice - p. 544
Audit systematic and official examination of record, process structure, environment or account to eval performance; retrospectively, consurrently or prospecitvely
Outcomes end result of care; determine how nursing interventions changed health status of pts eg - falls, infections, pressure sores, physical restraints, pt satisfaction
Joint commission (JCAHO) independent, not for profit acrediting org, mandate all hospitals have QA programs in plae, implemented core measure to std evidnce based practice in areas of MI, Heart Failure, Pneumonia and preg
Report Cards compare the performance of competing health plans in their area based on information given
Medical Errors try to improve by reporting, leapfrog initiatives, reform of medical liablity system and bar coding, smart IV pumps and medicaiton reconciliiation
Leapfrog Initiiatives non-helath care fortune 500 leaders comitted to modernizing current health care sys - computerized physician-provider order entry, evidence based practice referral, ICU dr staffing, Leapfrog safe practice scores
Evidence -Based Hospital Referes pt with high risk condition treated at hospitals with better outcomes for those conditions
Leapfrog Safe Proctices Scores initiative of 30 safe practices which if utilized would reduce risk of harm in certain processes, systems or environments of care
Performance Appraisal work performance is reviewed and lets empowered employees know of expectaitons; generate adjust for salry info, promotions, transfers, disciplinary actions and terminations
Accuracy and Fairness in Performance Appraisals know biases;consultation frequently, data generated appropriately, record keeping, collective assessments +/-, employees appraisal, beware halo,horn, cntral tendency and matthew effect
Halo Effect everything good
Horns Effect everything Bad
Central Tendeny everyone about the same
Matthew Effect once good always good or once bad always bad
Competence Assessment evaluatew whether and individual has knowledge, education, skills or experience to perform task
Performance Evaluation how well they complete the task
Discipline training or molding of the mind or character to bring about desire behaviors not punishment not always negative --- eg emotional or ducational component
Punishment undesirable event following unacceptable behavior
Constructive Criticism uses discipline as a means of helping the employee grow and not be punished
Self-Discipline highest level and most effective; possible if subordinates know the rules and accept them, mutual trust btwn managers and subordinates
Progressive Discipline Rules made, Punishment known and consistent; verbal warning, formal/written reprimand; suspension, termination/dismissal
Disciplinary Conference reason for acttin, employees response to action, rational for action, clarification of expectations, agree and acceptance of aciton plan
Marginal Employee not warrant dismissal, contribute little to organization
Chemicalyl Impaired Employee maladaptive patterns of substance abuse, must be removed from the work setting immediatedly, se change in personality/behavior, job performance and attendance and use of time
Created by: smpiguana