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