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NUR Leadership
LEADERSHIP UNITS
| Question | Answer |
|---|---|
| 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 |
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