Exam 1 Flashcards

Question

Policy - What is it? - Purpose (3) - Who does it apply to ? Ex. Attendance, consent, patient privacy, handwashing, DNR orders

Answer 1

What is it? - Formal guidelines for a problem Purpose - Guides or directs organizational decision making - Helps coordinate a plan and control performance - increases consistency of action Who does it apply to? - Applies to everyone

Answer 2

What is it - Step by step directions which are written in details for commonly occurring events Who does it apply to? - Taken by specific people to complete objective Components - purpose - who can do it - step by step what to do - List of supplies

Answer 3

Components - health care org = governing board - must have Chief nursing officer per CMS (responsible for patient care AND nurse must report to a nurse regardless of what department they are in) Purpose - determine lines of communications and lines of authority in organizations

Answer 4

- Set standards of operation for healthcare facilities - ensuring compliance w/ federal and state regulations - Approve quality and safety - Investigate and make judgments regarding patient and family complaints - Should be collaborative effort w/ HCO

Answer 5

- granted deeming authority from CMS to accredit orgs - Hospitals must meet conditions of participation from CMS and individual agency's standards

Answer 6

Largest and most influential health insurance program from government Conditions of participation - Quality and safety measures that hospitals must meet to get reimbursement i.e must be CNO in org; HCO must give info on how to contact CMS to patients - Describes Minimum standards of care - Orgs that meet conditions of participation become accredited)

Answer 7

- Technical (clinical expertise and nursing knowledge to produce product) - Human (ability and judgment to work with and lead people) - Conceptual (ability to understand complexity of org you work for and how their area fits into org)

Answer 8

- Influencing and motivating people - Vision development - Communication and collaboration (coordinate patient care; awareness of patient satisfaction) - Building culture of teamwork and morale - Goal attainment (compliance w/ regulations; use EBP and good judgement)

Answer 9

- the act of guiding or influencing people to achieve desired outcomes - occurs any time a person attempts to influence the beliefs, opinions, or behaviors of an individual

Answer 10

- interpersonal process of participation - follower takes guidance and direction from the leader to accomplish group goals. - Followers determine leader’s power (no followers = not a leader)

Answer 11

- Skilled - act synergistically with others (everybody contributes b-c sum of everybody > 1 person) - Speak and act with integrity and principles - Self-directed (do what they are supposed to do w/o you hovering or step in when you're not there) - Add value to work being accomplished - Use critical thinking and problem solving (Question managers and ask for directions if unsure about tasks) - Open and support new ideas

Answer 12

- activities involved in coordinating the resources of people, time, and supplies to achieve a desired outcome or goal - involves decision making and problem-solving - control day-to-day operations toward goal attainment - Plan and organize what needs to be done and who, how, and when it should be done

Answer 13

- Identify and set goals and objectives of what you are going to do (based on mission and customer needs) - Assess environment (financial and manpower resources) - Identify strategies (What is the right thing to do?) - Assign responsibilities (Who is going to do what?) - Establish timeline - Document plan (action steps) Note: process fails if ineffective planning; basis of all management functions

Answer 14

- establish lines of authority and levels of management needed - establish communication method (decision making) - determine policies and procedures needed - Establish roles and responsibilities - Look at necessary resources (staffing qualifications, supplies; policies and procedures)

Answer 15

- Determine # and type of staff needed based on goals and budgets (meet patient needs and be flexible) - determine recruitment and hiring strategy - determine how to orient and provide continuing development to staff - determine how schedules and patient care and other assignments will be made Note: very time consuming

Answer 16

- Communicate expectations - Utilize motivation and influence to coach staff to work effectively and efficiently and make a positive contribution - Determine how delegation and assignments can be used to accomplish work - Directing and supervising personnel and activities - Skills needed: clear communication, behavior modeling, facilitation of feedback

Answer 17

- Establish performance standards - Determine how to measure nursing care outcomes - Compare actual performance to performance standards and benchmarks (benchmark can be changed) - Determine what process can be used to develop an action plan to improve and evaluate performance if performance metrics not met

Answer 18

- Leader's organizational behavior is contingenton the situation or environment - no one leadership style is ideal for every situation - leadership varies by circumstances, maturity of leader, knowledge and skills Requires - Trust b/w leader and follower - task to be accomplished is based on goals and complexities of problems - positional power

Answer 19

- Based on assumption that leaders are born with certain leadership characteristics - leaders are not made and traits are not learned - Problem: people can develop/learn skills and it fails to account for stuff learned

Answer 20

- system is set of interrelated and interdependent parts that together form a whole - If something happens with one part, all parts are affected - Rational approach necessary to achieve common goal * Difficult to implement in hospital if a bunch of silos (isolated individuals or units that feel more important than other parts

Answer 21

- degree of order can be obtained by viewing complicated behaviors and situations as predictable - Variation in these situations is normal

Answer 22

- world is full of patterns that interact and adapt through relationships - Studies interrelationships on unit and across other units to explain behavior of organizations - Look at behavior and relationships over time rather than 1 isolated incident

Answer 23

- Comfortable with the status quo (no reaction until a problem; reactionary) - Reward staff for the desired work - Monitor work performance and correct as needed - Concerned with day-to-day operations - Relies on their authority and formal position to reward or punish

Answer 24

- Fulfills the contract or get punished - Does the work and gets paid - Errors are corrected in a reactive manner

Answer 25

- Work is supervised and completed according to the rules - Deadlines are met - Limited job satisfaction - Low to stable levels of commitment (do not go above and beyond to get job done)

Answer 26

- Identify and clearly communicates vision and direction - Empowers the workgroup to accomplish goals and achieve the vision -> followers and leader exceed expectancy and rise above on needs - Imparts meaning and challenge to work (mentor) - Anticipates and tries to alleviate problems - Traits: admired, emulated, inspiring, charismatic

Answer 27

- Motivated to reach fullest potential (followers change over time) via mentoring and coaching - A shared vision - Increased self-worth (A sense of being valued b-c helping leader reach goals) - engage in Challenging and meaningful work

Answer 28

- Increased loyalty and commitment - Increased morale and job satisfaction b-c feel what you are doing is important - Increased performance (usually but can have trouble w/ day to day b-c so visionary)

Answer 29

- unilateral downward flow of info Manager characteristics - makes all decisions (no staff input or collaboration; directs) - provides little feedback or recognition for work done - uses position authority to make decisions and accomplish goals

Answer 30

Downside: Emphasis on I and not we which can stifle innovation and creativity Criticism: punitive Effective: those w/ little formal education or in emergencies

Answer 31

- bilateral flow of information - emphasis on we vs I (what's your opinion) Manager Characteristics - provides direction via suggestions and guidance - provides rewards as ego (good job) or economic (bonuses)

Answer 32

Downside: takes a lot of time so not useful in emergencies Criticism: constructive Effective: when collaboration and cooperation are necessary

Answer 33

- Permissive and promotes complete freedom for the group or individual to make decisions Manager characteristics - unwilling or unable to make decisions - Communicates by emails or memos b-c do not want to deal with face-to-face - No interference or guidance ("you're on your own")

Answer 34

Downside: employees become apathetic and disinterested Criticism: not present Effective: self-efficient employees who do not need a lot of guidance

Answer 35

Formal Leadership: Someone appointed to a position and given authority to lead (ex. Manager, charge nurse, CNO) Informal Leadership: No official authority or position to act but persuades and influences people

Answer 36

Impact - positive or negative influence - affect efficiency of workplace - affect success of initiatives Managing informal leaders - seek informal leaders out to get their support b-c they can make or break what you are trying to do - address their behavior if negative influence on others OR if undermining what is done on the unit

Answer 37

- Ability to motivate people to get things done w/ or w/o legitimate right of organization - you need power to lead and get support

Answer 38

- Legitimate and formal right to direct others Flow: involuntary and unidirectional submission required due to authority Source: given by organization through authorized position

Answer 39

- informal, dynamic, ambiguous strategy to get people to support your goal Flow: multidirectional flow (no involuntary submission) Source: personal characteristics, expertise, opportunity (anyone can influence)

Answer 40

Assertiveness: express opinion and take charge w/o violating the rights of others (aggression is violating rights) Ingratiation: trying to make someone feel important by giving praise or offering sympathy with the goal of advancing yourself Rationality: presenting logical arguments, providing pertinent information, presenting reasons, and laying things out in a structural manner Sanctions: threats

Answer 41

Exchange: you do something for me and I’ll do something for you Upward appeal: goes to higher authority to arbitrate (going to mom) Blocking: deliberately keep others from getting their way (ex. Ignoring, not being friendly) Coalitions: group of people get together to speak or negotiate in one voice

Answer 42

Legitimate: based on official organizational power; person’s role in organization Reward: ability to grant favors or reward others for complying with your wishes. Ex. Money, praise, recognition Coercive: opposite of reward power; based on fear of punishment for noncompliance or fear of consequences

Answer 43

Referent: respect or admire person which gives them power Expert: based on knowledge, skills or expertise (ex. Good at starting IVs) Information: possess information that is valuable to others Connection: r/t who you know that others see as powerful

Answer 44

formal appraisal or evaluation of how well employee performs based on job duties or description (employees should get ongoing feedback throughout year; should not be a complete surprise) Timing: usually one after 90-day probational periods and then one annually

Answer 45

Administrative - Required to prove hospital meets standards of compliance and organizational goals (safe and quality care) - Assists in determining hiring, scheduling, and termination decisions - Affects culture of organizational (gives opportunity to identify problems and grievances) Measurement - Measure employee’s performance against the standard - Allows manager to examine if each employee is meeting the standard or needs improvement

Answer 46

Development - Used to identify if employee or org has learning need - Gives the manager a chance to help employee meet developmental needs i.e. further education, training, certification to promote from within (not meant to be punitive) - First step to ensure legal compliance w/ standard Relationship - Develop one on one trusting relationship - Manager is positive and open while giving feedback - involves be mutual goal setting

Answer 47

Choosing a tool - must be dependent on a standard (job description) - More effective if employee has input in development of evaluation method - Must adequately and efficiently assess the job that you do Appraiser - somebody that employee trusts and respects - someone who has seen employee do work - someone who who makes employees feel supported and have expectations clarified

Answer 48

Self-assessment - employee rates themselves - Problem: difficult for manager to counter this type of assessment if people are too hard or soft on themselves - Useful with experienced staff Peer-reviewed - feedback obtained from people you work with - Problem: can cause hard feelings if peers have negative feelings about you - Useful to give well-rounded view of person 360-degree feedback - assessment based on tool evaluated by peers, other departments, subordinates and all the results compiled via comparison and contrast and given to the person - Problem: Bias if fear of getting the person upset or upset at the perso - Useful to give validation and recognition and encourage continuous improvement; makes person feel more accountable since multiple people evaluating them Written by manager: - Standardized vs individualized - Useful because based on observations, skills, and pre-set standards i.e. job description

Answer 49

Halo effect: positive or negative rating based on one skill or incident Recency: Positive or negative based on recent events vs entire evaluation period Leniency - Everyone on the unit gets the same ratings regardless of how they actually do - Not holding anyone accountable Similar-to-me: Higher rating for those with similar characteristics to appraiser

Answer 50

Contrast: Employee rated against peers rather than job description Horns effect: Focusing on negative experiences Central tendency - Rater does not want to give too high of a score or too low of a score - Everyone is average

Answer 51

- abuse or mistreatment of patient - substance abuse on the job (hospitals can do on the spot drug screen)

Answer 52

- If unionized hospital, contract will state this process must be followed prior to termination of person (know the steps) - If nonunionized hospital, you may not have to follow this process i.e can skip verbal warning - Not meant to punish; meant to correct performance problems to improve employee’s success

Answer 53

Verbal warning - informal reprimand or admonishment where manager discusses the issue and suggest ways to improve - may or may not be signed Written Warning - written document that specifically addresses the behaviors, rules, or policies that were violated. - Indicates specific consequences if behavior is not altered - includes specific plan of action to improve behavior - Signature doesn’t not mean you agree with it, just means you are aware that it will be in the file (if you choose not to sign, two managers will sign it)

Answer 54

Suspension - remove the person from work environment for a few days (Typically 1-3 days; longer if pending investigation) - If during investigation and there was nothing found that they did wrong, they will get paid for the suspension. - If you are found guilty or if it is a regular suspension w/o investigation, you do not get paid for those days Termination - permanently released from employment - last resort because want employee to be better

Answer 55

Purpose: corrects performance issues and helps person be successful prior to termination Components - time frame to correct behavior - identify resources needed i.e. training - details and examples of behavior - SMART goals developed by person and manager

Answer 56

- Flawed systems, processes are flawed. (ex. ED surges; ICU overflow) - Clinician doesn’t want to get blamed - Focus is on rules/policy and procedures not on the knowledge - Assumptions on educational background - focus is on punishing individual rather than improving system. - Assumption that if the pt is not injured, no action is necessary (near misses also need to be reported)

Answer 57

- attitudes, beliefs, perceptions and values that employees share in relation to safety in the workplace - Safety is important in every aspect of the care - All staff see safety as a priority in the work environment - Reporting errors is ENCOURAGED and Rewarded

Answer 58

- key component in accreditation process - TJC requires formal safety program - allows nurse to coordinate quality care for patients

Answer 59

- healthcare and technology are becoming more complex and advanced - more complex healthcare = more errors - overuse of expensive equipment and underuse of inexpensive equipment - healthcare system is wasting money and disorganized - death from preventable medical errors is the 3rd leading cause of death (heart disease and cancer are first two)

Answer 60

- Communication Problems (majority of errors) - Inadequate Information Flow r/t info not following pt when they are discharged or move to another facility - Human Problems (ex. Pstandards of care not being followed by staff) - Pt Related Issues (ex. inappropriate pt identification, education) - Organizational Transfer of Knowledge (ex. training + education of the staff) - Staffing Patterns and Workflow (ex. Putting healthcare workers in situations where they are more than likely to make a mistake i.e. INADEQUATE STAFFING) - Technical Issues - Inadequate Policies

Answer 61

- improve health of population - enhance experience + outcome of patients - Reduce per capita cost of care

Answer 62

- Provide safe care and prevent injuries to patients - Provide timely care reducing waits and harmful delays - Provide effective care based on scientific knowledge (EBP) - Provide efficient care reducing waste of time or energy - Provide equitable care that does not vary in quality due to gender, ethnicity, socioeconomic status. - Provide patient centered care based on preferences, needs and values

Answer 63

1. Care is based on continuous healing relationships w/ providers 2. Care is customized according to patient needs and values i.e Individualized rather than standardized 3. The patient is the source of control - Ask patient for their daily goal and put it on the whiteboard 4. Knowledge is shared and information flows freely b-c you want patient to be informed 5. Decision making is evidenced based and not based on opinion 6. Safety is a system property (not only a nursing priority; everyone helps) 7. Transparency is necessary and important 8. Needs are anticipated to prevent unnecessary calls 9. Waste is continuously decreased 10. Cooperation among clinicians is a priority

Answer 64

- Care that is respectful of and responsible to individual patients - Partnership between nurses, physicians and patients - Takes into consideration patient values - Providing education and support to help pt make informed decisions

Answer 65

- Leadership commitment (Safety important from governing board to bottom level) - Interdisciplinary participation (Everyone is involved; not only important to nursing staff) - Evidenced Based (EBP = more effective) - Education (All staff understands the goals) - Just Culture - Patient Centered Care

Answer 66

- Product of current system design or flaw Care: console and teach vs punish person Managed through choices, processes, procedures, training, design, environment

Answer 67

- Taking risk but believe insignificant or justified; taking shortcuts and not doing it the way it needs to be done Care: correcting misperceptions and coach Managed through removing incentives for at-risk behaviors, giving incentives for good behavior, increased situational awareness

Answer 68

- Conscious disregard of substantial and unjustifiable risk i.e. person completely ignoring the safety steps Care: punish Managed through remedial and punitive action

Answer 69

- Foundational steps of culture of safety - medical event reporting which emphasizes learning + accountability over placing blame on the incident. - Environment is not punitive but respectful and open to speaking up and learning from mistakes b-c people are going to make mistakes

Answer 70

- Increased incident reporting, b-c reporting is rewarded - Increased reporting of risk issues prior to events happening (near misses) - Fair and consistent application of justice - Reduced fear of punishment (avoids unnecessary punishment)

Answer 71

- Identify patients correctly (ex. Two patient identifiers (DOB, Name, MRN); Give correct blood to correct person (reason for 2 RNs to check)) - Improve staff communication (ex. Policy on notifying HCP about stat labs) - Use medicines safely (ex. Labelled w/ name of drug and dose; Med reconciliation; Anticoagulant home management) - Use alarms safely (ex. Never turn alarms completely off (telemetry)) - Prevent infection (ex. Hand hygiene) - Identify patient safety risks: fall, suicide risks - Prevent mistakes in surgery (ex. Time out; Correct surgery on correct patient on correct site; Surgeon marks surgical site prior to anesthesia)

Answer 72

- Predetermined standards of excellence that act as a guide for practice - Rules that apply to key processes - measured via benchmarks (ex. 0% for Falls; 100% for sponges accounted for in surgery)

Answer 73

Plan = what you want to do, how will you do it, where do you want to go (action plan) Do = carry it out. Test of change. Study the results, what happened. (Did it work? What is the compliance? i.e are people doing it) Act: adopt the change at larger scope or modify change based on the results.

Answer 74

Structure (ex. humans, resources) - internal characteristics of organization Process (ex. workflow, sequence of events, behaviors, nursing process) - whether activities in organizations are being conducted appropriately, EBP, and implemented efficiently Outcomes - did the care provided make a difference - done as unit of measurement (numbers)

Answer 75

- Flow chart: tool that tells you what actually occurs - Pareto chart: bar graph which shows frequency in which events occur - Fishbone chart: tells you cause + effect (important to look at environment, processes, people)

Answer 76

- quality and risk tool after adverse patient event to determine process and systems issues rather than place blame Steps - identify and define problem - understand problem - identify root cause - provide corrective action - monitor system

Answer 77

- leads cultural transformation - sets the priorities on what to decrease (i.e. falls) - provides resources needed to do the work incl. education - assess where organization is currently b-c can not change past - Assess what is staff + management’s knowledge level about quality. - implement and monitor plans

Answer 78

- responsible for quality and safety over unit/department - Meet regularly w/ employees to communicate and monitor progress - document performance and share across department

Answer 79

- follow policies, procedures, and protocols to ensure you are providing safe care - provide evidence based care (not unit-based) - report quality and safety issues to manager - Actively participate in quality activities - Stay up to date on quality and improvement policies and procedures