EXAM 2 Flashcards
Productive Hours
Hours doing pt care
Nonproductive hours
hours in staff meetings, CEUs, etc
Employee Classifications - Direct care
Time spent providing hands-on care to pts
Employee Classifications - Indirect care
Time spent on activities related to patient care
EX: documentation, interacting with multidisciplinary team members
Nurse Intensity
Measure of amount and complexity of nursing care needed by a patient
- Patient classification system (PCS) is used to determine workload
- patient acuity (workload each pt generates)
Utilization of Classification system data
acuity data used to plan nursing staffing during next 24-hour period
Considerations in developing a Staffing Plan
- Skill mix (ex ratios of RN to LPN to PCTs)
- Staff support (pt transport)
- Historical Information
Average daily census (inpatient unit)
Total numbers of pts at census time, usually midnight, over period of time and dividing by number of days in time period.
Units of Service
Nursing workload dependent on nursing care needs of patients
Nursing hours per pt day (NHPPD) (required nursing hours for 24hr period, hrs of operation)
Considerations for Staffing
- Staff experience
- Patient need
Shift Variations
- Traditional (8s)
- 12-hr shifts
- weekends
Scheduling concerns
Financial implications
Impact on pt care
Models of Care Delivery
- Care delivery models organize work of caring for pts
- choose care delivery model based on needs of pts and availability of competent staff
Delegation
- pg 369
- primarily about entrusting your authority to others
- at its most basic, it is empowering one person to act for another
Accountability
Being responsible and answerable for actions and inactions of self or others in context of delegation S - specific M - measurable A - achievable R - realistic T - time bound
KSBN - 65-1165 - Supervision of delegated nursing procedures
All nursing procedures, including but not limited to administration of medication, delegated by a licensed nurse to a designated unlicensed person shall be SUPERVISED.
KSBN - 65-1136 - IV fluid therapy
“Supervision” means provision of guidance by a qualified nurse for the accomplishment of a nursing task or activity with initial direction of the task or activity and periodic inspection of the actual act of accomplishing the task or activity.
Responsibility
- Involves reliability, dependability, and obligation
- Involves people providing pt care to perform at an acceptable level for which they have been educated
- Nurse transfers responsibility and authority for delegated tasks, but retains ACCOUNTABILITY for delegation process
Authority
Right to delegate duties and give directions to unlicensed assistive personnel places RN in position of authority
Assignment
Distribution of work each staff member is responsible for performing as condition of employment
-within legal scope
Competence
Required to practice safely and ethically in designated role and setting
-Built on knowledge gained in nursing education program, orientation to specific settings, and experiences of implementing nursing
-License = minimal competence
Competence requires application of:
Knowledge, interpersonal decision making, and psychomotor skills
Supervision
Provision of guidance or direction, oversight, evaluation and follow up by licensed nurse for accomplishment of nursing tasks delegated.
Levels of supervision
- Unsupervised
- Initial direction and periodic inspection
- Continuous
Assistive Personnel Scope
bathing, feeding, toileting, ambulating
-Cannot assess or evaluate response to treatment
LPN responsibilities
- Provides care for STABLE patients, with predictable outcomes
- Cannot complete initial patient assessment
Rights of delegation
Right task Right circumstance Right person Right direction/communication Right supervision
Tasks that can NEVER be delegated
- Patient assessment
- Triage
- Nursing diagnosis
- Nursing plans of care
- extensive teaching or counseling
- Telephone advice
- Outcome evaluations
- patient discharges
Successful organization of patient care requires:
- Governance structures
- Patient care delivery process
- Measures of outcome of care delivery
External and Internal
.
Environmental assessment
SWOT analysis
Stakeholder
any person, group or organization that has vested interest in program or project under review
-could be its, nurses, docs, community reps, insurances companies, hospital administrators, or accreditation agencies.
Philosophy
Statement of beliefs based on core values
Values
-Stated in mission statement
Mission statement
Formal statement of purpose or reason for organizations existence
Three elements of a mission statement
- No longer than a couple sentences
- States organizations PURPOSE using ACTION words
- Simple and from the heart
Four elements of a Vision Statement
- Written down
- Present tense as though it were already accomplished
- Covers variety of activities
Balances needs of providers pts and environment
Goal
Specific aim or target that unit wishes to attain with in time span of ONE year
Objective
Measurable step taken to reach goal
Shared Governance
Organizational framework grounded in philosophy of decentralized leadership that fosters atonomous decision making and professional nursing practice
-Implies allocation of control, power or authority among mutually vested parties
Five main arenas of Shared governance model
- Clinical practice
- Quality
- Education
- Research
- Management of resources
Responsibility of Clinical practice council
Establishes nursing practice standards for workgroup
Responsibility of Quality council
Makes recommendations about hiring, promoting, and credentialing nursing staff
-Oversees unit’s quality management initiatives
Responsibility of Nursing Education council
Assesses learning needs of unit staff, develops and implements programs to meet needs
Responsibility of Research council
Advances research utilization with intent of incorporating EBP findings into clinical practice
Responsibility of Management council
Ensures upholding of standards of nursing practice and governance agreed upon by unit staff and adequate resources to deliver patient care
Responsibility of Coordinating council
Facilitates and integrates activities of other councils, usually composed of first-line pt care manager and chairpersons of other councils
- facilitates annual review of unit mission and vision
- develops annual operational plan
Benner’s Novice to Expert - Five levels
- Novice nurses
- Advanced beginner
- Competent
- Proficient
- Expert
Novice
Task-oriented and focused on rules
Advanced beginner
Demonstrate marginally acceptable independent performance
Competent
Have developed ability to see own actions as pare of long-range goals for patients
Proficient
Can perceive whole situation
Expert
Intuitively knows what is going on with patients
Situational Leadership
There is no one best leadership style
-effective leadership lies in matching leadership style to individual’s or group’s level of task-relevant readiness
Accountability-based care delivery
Focuses on roles, their relationship to work to be done, and outcomes they are intended to achieve
Accountability
Is about OUTCOMES rather than processes
Is individually defined
Inherent in roles, but delegated
Foundation for evaluation
Time management
Set of related commonsense skills that help people use time in the most effective and productive way possible
Pareto Principle (time management concept)
Time management requires shift from wasting time on process of being busy to organizing time to achieve desired outcomes
80/20 rule
Time analysis
Consider what tasks can be delegated to personnel who receive less compensation than nurses
Prioritizing use of time
- Life threatening or potentially life-threatening conditions
- Activities essential to safety
- Activities essential to plan of care
Internal climate
How you perceive yourself
External climate
How others perceive you
Levels of communication
Public
Intrapersonal
Interpersonal
Group communication - Forming
interpersonal relationships, expectations, directions
Group communication - Storming
comfortable enough to disagree; can lead to increased trust, positive competition, effective barganing
Group communication - Norming
establishes rules and define the work; doesn’t come if can’t agree
Group communication - Performing
the work gets done
Barriers to communication
-Use of language
-Anger
DEFENSIVENESS
-false reassurance
-Stereotyping
-interrupting
-being inattentive
-being stressed
-unclear expectations
-giving incongruent responses
-illiteracy
Workplace communication
Nurses’ diverse roles and relationships require different communication patterns with supervisors, co-workers, practitioners, etc
Workplace communication- GRRRR
Greeting Respectful listening Review Recommend or request more info Reward
Communication skills
.
Assertiveness
A ways of communicating that allows people to express themselves in direct, honest and appropriate ways that do not infringe on another person’s rights
Passive communication
a person suffers in silence although they may feel strongly
Aggressive communication
express themselves in a direct and hostile manner that infringes on others’ rights- demonstrating self-excellence
Passive-aggressive communication
An aggressive message presented in a passive way
Strategic planning
sum total or outcome of processes by which organization engages in environmental analysis, goal formulation and strategy development for purpose of organizational development
Steps in Strategic planning
-Environmental assessment
Situational assessment, external assessment, internal assessment
-SWOT analysis
-Community and stakeholder assessment
SWOT analysis
Strengths
Weakness
Opportunities
Threats
Organizational climate
How employees perceive the organization
Cultural traits
- Adaptability
- Involvement
- Consistency
- Mission
Division of labor
way labor force is divided or organized has impact on how mission is accomplished
Factors that influence organizational structure
-Experiencing severe problems
-Technology
-Diversity
-Size of organization
-Other reasons to rethink structure
ie EXTERNAL REVIEW PROBLEMS
Lewin’s Force-Field Model (Change theory)
- Unfreeze
- Move to a new level
- Refreeze
Lippitt’s Phases of Change (Change theory)
- Dx problem
- Assess motivation and capacity for change
- Assess change agents motivation and resources
- Select progressive change objective
- Choose role of change agent
- Maintain change
- Terminate helping relationship
Havelock’s Six step change model
- Build relationship
- Dx problem
- Acquire resources
- Choose solution
- Gain acceptance
- Stabilize and renew
Roger’s Diffusion of Innovations theory
Five steps: Awareness Interest Evaluation Trial Adoption
Stages of Change model (SCM)
5 steps: Precontemplation Contemplation preparation action maintenance
Steps in the change process
A- assessment P-planning I-implementation E-evaluation Stabilization Adjourning
Stabilization of change
Change is no longer pilot or experimental
-should occur as soon as change process complete
Adjourning
Final stage of change process
Termination and consolidation occur
Natural and expected response to change
Resistance
Factors that affect staff responses to change:
Trust
Predictability
Ability to cope with change
Leadership & Management roles in conflict management
S- share the facts T- tell your story A- ask for opinions T- talk tentatively, value for person E- encourage testing
