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487- Leadership/Mngmnt > Exam 3 (comp) > Flashcards

Exam 3 (comp) Flashcards

1
Q

delivery systems- 4 elements

A

clinical dm
work allocation
comm
management

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2
Q

del. systems- clinical dm

A

is there shared gov?
prof. practice exist?- Yes if there is control abt decisions

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3
Q

del. systms- work allocation

A

based on acuity lvl
what floor pt goes to
and indivi. nurse assignments

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4
Q

del systems- management

A

monitoring and eval, quality control

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5
Q

del systems- comm

A

chain of command

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6
Q

factors when choosing care del. system

A

skill/expertise of staff (scope of practice)
availability of RNs
economic resources
acuity of pts
complexity of tasks

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7
Q

case method

A

funnel (charge- nursing staff- pts)

total pt care
began when rich ppl had private nurses

one nurse assumes TOTAL responsibility for <3 ppl
ex. home health, iCU, community

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8
Q

case method- advantages v disadvantages

A

advantages-
unfragmented, inc pt satisfaction (client focused)
nurses have inc autonomy

disadv-
COSTLY
dec efficiency (takes inc coord)
poor pt care if wrkld high
learning curve for inexperienced RNs

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9
Q

functional nursing

A

‘divide and conquer’- scientific mngmnt (charge, RN, LPN, CNA- unit of pts)

task oriented- “care through others”

emphasis on efficiency
unskilled wrks become proficient w/ repitition

nurse is not responsible for total care

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10
Q

functional nursing- advantages v disadv

A

advantages-
efficient/effective (most wrk in least amnt time)
train wrks (less cost, less RNs)

disadvantages-
fragmented care
diff. to assess pt progress
dec accountability and responsibility
dec job satisfaction

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11
Q

team nursing

A

waterfall (charge, team leader, nursing staff, pt)
(similar to functional)

goal- dec fragmentation of care
provide pt centered care
democratic leadership works best
teams NO more than 5 members

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12
Q

team nursing- leader role

A

assign each member a pt or specific respons.

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13
Q

team nursing- adva and disadv

A

advantages-
inc pt satifs.
dm at lwr levels
*each member participates in dm process
INC COMMUNICATION

disadvantages-
inc time
poor leadership/implementation

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14
Q

primary nursing

A

desire for INC AUTONOMY= decentralization

1st formal professional model (can only access pt through nurse)

primary nurse for 24hr TOTAL pt care from admin to dc
(prefer BSN)

delegates to others when not working

*not used in acute care

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15
Q

primary nursing- advantages and disadv

A

advantages-
inc RN autonomy
continuity of care
psychosoci needs met
inc trust/communication

disadvantages
costly (all RNs)
burnout (total accountability)
trouble if RN shortage

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16
Q

client-focused care

A

Unit-based
organize care around pt needs

RN, LPNS, CNA, unit clerks and unit manager

pts dispersed in hospital based on care requirements v same dx
supplies brought to the pt

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17
Q

client focused care- principles

A

based on principles of primary nursing and case mngmnt
staff must be cross trained

caregivers @ bedside reduced but responsiblities are INC

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18
Q

client-focused care- advant and disadva

A

advantages-
inc pt satisf
service/waiting times dec
cost effective

disadv-
fewer # RNs
inc responsiblity for caregivers
role confusion

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19
Q

differentiated nursing practice

A

maximized nursing resources

3 components
education
experience
competence

2 models

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20
Q

differentiated nursing practice education model

A

role differentiation based on education
ADN- direct pt care
BSN- admin to dc, coord care and client ed
MSN- case mngmnt, collab w/ disciplines

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21
Q

differentiated nursing practice competency model

A

based on ANA standards and
Brenner’s 5 lvls of practice

*lvls do not transfer btw floors

novice- no experience
advanced beginner- some exper, performs effectively
proficient- perfor guided by standards
expert- intuitive understanding

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22
Q

differentiated nursing practice- adv v disadv

A

advantages-
dec cost, inc efficiency
best use of resources

disadv-
nurse is a nurse mentality
inc use of UAP

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23
Q

case management- 2 core components

A

coord of care
management of risk

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24
Q

case mngmnt- goal

A

assessing, planning, facilitation and advocacy
goal- promote quality, cost-effective outcomes

interdisc, involves the pt, uses critical pathways

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25
Q

case management- 4 principles

A

coord and integration of a continiuum of holistic care
promotion/preservation of health thru periods of transition and risk
conservation and allocation of scare resources
provision of FU care that tracks service long term (reduce fragm care)

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26
Q

case management- target pop

A

pts and families at great risk for neg outcomes
high cost
high risk
high recidivism (returning)

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27
Q

critical pathways

A

standards of care or clinical practice guidelines

map time and activity sequence

based on DRG classification

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28
Q

critical path- components

A

assessments
consults
test
treatments
meds
activities
nutrition
dc planning

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29
Q

critical path- varients

A

anything that alters system, pt or provider
positive (achieved b4 expected)
or
negative

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30
Q

centralized staffing- gen, pros and cons

A

decisions made by person in staffing center

pros-
fairer, cost effective, frees up manager

cons-
dec flexibility
don’t know employee needs

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31
Q

decentralized staffing- gen, pros and cons

A

unit manager schedules
*can be delegated to clinical coord or charge nurse

pros-
staff has inc autonomy
more flexibility

cons-
unfair rewards
time away frm manager

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32
Q

staffing alternatives

A

self-scheduling
float pools
per diem
agent/travel
flextime

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33
Q

intergroup/organization- conflict

A

btw 2+ grps of ppl, departments or organizations

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34
Q

intra- personal conflict

A

internal struggle

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35
Q

inter- personal conflict

A

btw ppl w differing values/wants/beliefs

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36
Q

sources of organizational conflict

A

pwr divisions
communication misunderstandings
personal goals diff than organizations
resource allocation
poorly define role expectations
varying background/beliefs btw members

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37
Q

conflict resolution- top lvl

A

= strengthened relationship
results in mutual benefits

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38
Q

conflict resolution- middle lvl

A

temporary agreement
little enhancement to the realtionship

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39
Q

conflict resolution- lower lvl

A

= mutual damage
one person submits to demands of the other

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40
Q

conflict process- 5 stages

A

latent conflict-
(no present conflict but conditions are conducive)

perceived conflict
(ppl recog logically before internalizing)

felt conflict

manifest conflict
action taken (debate or withdraw)

conflict aftermath
either + or -

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41
Q

positive effects of conflict

A

prov. intellectual stim and creativity
facilitates change
improves dm
improves grp performance

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42
Q

negative effects of conflict

A

dec comm
dec performance
dec cohesiveness
inc absenteeism and turnover

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43
Q

conflict resolution strategies- 5

A

compromising
competing
cooperating/accomodating
avoiding
collaborating

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44
Q

selection of conflict resolution

A

depends on nurse managers values regarding work production and human relationships

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45
Q

avoiding- balance

A

low results
low ppl

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46
Q

avoiding

A

use when ppl need to cool down
if more info needs to be gathered
cost of dealing w/ conflict exceeds benefit
one party is more powerful than the other
DO NOT use if you made a mistake

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47
Q

accommodating/cooperating- balance

A

HIGH ppl
low results

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48
Q

accommodating/cooperating

A

when you made a mistake
issue is more important to one party than the other
more concerned about preserving harmony

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49
Q

competing- balance

A

High results
low ppl

50
Q

competing

A

quick, decisive action is needed (emergency situation or need to discipline )
if an unpop. action is needed
focused on pt safety and care

can be authoritarian

51
Q

compromising- balance

A

medium results
medium ppl

52
Q

compromising

A

if collab and competing fail

status quo
balance pwr and priorities

*b/ parties lose

53
Q

collaborating- balance

A

HIGH results
HIGH ppl

54
Q

collaborating

A

*optimal approach
satisfys all members

need to merge vastly diff viewpoints
discuss issues interfering w/ morale and productivity
if seeking creative and integrative solutions

55
Q

dudley weeks- conflict partnership process

A

WE v “you and I”

deal w/ conflict in context of OVERALL relationships
resol should improve relationships
should result in mutual benefits

relationship building and conflict resol are CONNECTED

56
Q

dudley weeks- 8 steps

A
  1. create effective atmosphere (non-threat. environ)
  2. clarify perceptions (what is the conflict abt, what have you done to add to it?)
  3. focus on indiv and shared needs (personal needs v grp needs)
  4. build shared positive pwr (power WITH, have clear self image)
  5. look at future, learn from past
  6. generate options (be prepared for hidden agendas)
  7. develop “do-ables” (neutral, obtainable, measurable steps)
  8. make mutual benefit agreement
57
Q

mediate wrkplace conflict

A

responsibility of charge nurse- facil. resolution

address on own, then meet w/ antagonists together
determine own responsibility (is it unit problem)
have particip discuss and commit to a resolution

58
Q

what to avoid in conflict resolution

A

believing that only ppl affected are the ones involved
do not meet sides separately

59
Q

healthy response to conflict

A

recog/respond to things that matter to the o/ person
clam, nondefensive
readiness to forgive
ability to compromise

60
Q

unhealthy response to conflict

A

explosive, angry, hurtful beh
inabil to compromise
fear and avoidance of conflict

61
Q

budget

A

financial plan
aim at controlling allocation of resources

62
Q

direct costs

A

attrib to specific source
ex. nursing time
cost of resources

63
Q

indirect costs

A

overhead
what organization is spending money on no matter what

*cannot be directly attribut to one specific unit or pt

64
Q

personnel budget

A

salaries
nurse managers do this

65
Q

operating budget

A

expenses that change in response to vol. of service
daily operating costs

66
Q

capital budget

A

expenses r/t capital assets or long term investments

67
Q

traditional budget method

A

based on budget from previous yr + 3%

68
Q

zero-based budget

A

justify all expenses for each yr
should have 0 at the end of e/ yr
takes lots of time and resources

69
Q

performance budgeting

A

emphasize outcomes and results instead of activities

70
Q

budgeting- unit managers responsibility

A

meeting fiscal goals of company
advocate for high quality and approp staffing
comm, unit needs
comm. budget to staff
bargain for scare resources

*CANNOT DELEGATE BUDGET NEGOTIATING

71
Q

budget process

A

assess
dx
plan
implement
eval

72
Q

budget variances

A

diff btw amnt that was budgeted and actual revenue cost

73
Q

favorable variance

A

more revenue than expected
inc pt census
inc pt stay
inc pt acuity

74
Q

unfavorable variance

A

more sick days
inc travel RNs

75
Q

budget- promotion of cost control

A

time is money (dc pts faster)
efficiency/ standardization
motiv clients to recover
using supplies sparingly

76
Q

nursing personnel budget

A

90%
most expensive item

77
Q

how to calc cost of nursing

A

pt census
diag related grps
acuity/complexity of care
full time equivalent (FTE)

78
Q

how to determine overall staffing plan

A

FTE

79
Q

DRGs

A

dx related groups
reimbursement for care days
DO NOT account for acuity lvls and pt needs

80
Q

census

A

avg dailiy census based on historical data
regulated by JCAHO

1 pt day= 1 pt/day

81
Q

hours per pt day

A

HPPD
hrs of care per pt
per day

no diff is made based on acuity lvl of pt

HPPD= nursing hrs (24)/ pt census

82
Q

productivity

A

ratio output to inputs

83
Q

productivity outputs

A

nursing care, hrs of care, # home visits

84
Q

productivity inputs

A

resources used to provide services, personal hrs, supplies

85
Q

how to inc productivity

A

dec input and inc output

dec productivity= inc input and dec output

86
Q

patient classification system

A

objective method to classify pts by determining amount and complexity of care needed

fed and state mandate use of PCS to determine staffing levels

category I - IV
I- 2hrs
iII- 6hrs
III- 7 hrs
IV- 9 hrs

87
Q

how to calc nursing personnel budget- unit of service

A

unit of service (vol of work needed)/ pt days (avg daily census)

ex. 26 total pts
161 total/24hrs

161 (hr)/ 26 (#)= 6.19= 6.2 standard unit for budget

88
Q

how to calc # of staff members needed (FTE)

A

HPPD (constant) x avg daily census x 365/ 2080 (1FTE) = # FTEs

ex. HPPD= 6.2
avg daily= 26

(6.2 x 26x 365)/ 2080 =
28.3 FTEs for year/unit

89
Q

how to calc FTE for 1 staff member

A

hrs worked per wk/40

ex. 1 RN 3p-3a monday and wed
12 hrs- 2d/wk= 24

24/40= 0.6 FTE

90
Q

calc NCD/PPD

A

number nursing hrs/ pt census

91
Q

differentiated nursing practice

A

based on indivi, not # of staff

92
Q

how to determine if calc budget is productive

A

ex. standard of care= 6.2 HPPD
161 hrs of care per 24hrs
26 pts
when 150 hrs are provided

161/150= 1.07

> 1 = productivity inc
<1= productivity dec

93
Q

HR def

A

motivation of employees to perform productively

goal- organizational cul makes wrk interesting and leads to satisfied wrkers and clients

form of management controlling

94
Q

perform appraisal def

A

systematic
standardized eval of quality of work
work contribution
potential for advancement
“D”

95
Q

perform appraisal- measures what and should result in

A

nursing performance (based on standards)
should result in inc retention, productivity and pt care

96
Q

components of competence

A

cognitive-
critical thinking, dm, problem solving

affective
interpersonal skills, comm.

psychomotor
physical tasks

97
Q

performance appraisal strategies

A

trait scales
peer review
self eval
management by objectives

98
Q

performance appraisal strategies- trait scales

A

absolute- eval performance against internal standards (ex. 1-5 rating)

BARS- form of absolute- description of what quantitative # means
ex. 1 novice, 5 excellent

behav. anchored rating scales- form for each job classification

comparative- compares employees to one another
personalized to grp- ranking depends on avg competence of class
not commonly used in HC

99
Q

performance appraisal strategies- management by objectives

A

goals written in form of objectives
for given time period
mutually set w/ employee and manager

100
Q

evaluator rating errors- halo effect v horn

A

1-2 positive aspects influence all other performance
generalized overall high rating

vice versa
overall poor rating

101
Q

evaluator rating errors- sunflower effect

A

everyone high rates bc they belong to a “great team”

102
Q

evaluator rating errors- central tendency effect

A

everyone average
does not know much about the person

103
Q

evaluator rating errors- temperament effect

A

performance varies depending on rater
some ppl are more strict

104
Q

evaluator rating errors- matthew effect

A

same appraisal results yr after yr
if you perform well you get good marks
if you struggle, you continue to struggle

105
Q

absence freq

A

total # of distinct absence periods, regardless of duration

ex. 9 days in a row
= 9 total days absent, 1 freq period
ex. 9 mondays
= 9 total days absent, 9 freq periods

106
Q

absenteeism types- vol v invol

A

vol- under employees control
invol- outside employees control

107
Q

effects of absenteeism

A

inc cost
dec morale of peers (inc workload, dec productivity)
dec quality of care
inc stress/conflict
inc absenteeism
“D”

108
Q

turnover- disadvantages

A

inc cost
dec morale
impaired team functioning (conflict, staffing issues)
loss of management potential

109
Q

turnover- personal causes

A

relocation
family considerations
transportation
school

110
Q

turnover- strategies to improve

A

clinical ladder programs
magnet designation
mentoring/coaching
residency programs

111
Q

discipline

A

molding mind/character to bring out desired beh

(disiplina) latin= teaching, learning, growth

112
Q

punishment- scientific management theory

A

old

used discipline to control beh
works for short term but is demoting and dec productivity

113
Q

punishment- constructive discipline

A

new

helps employee grow
demonstrate the actual v expected performance
puts burden on employee to change
requires mutual trust

114
Q

punishment- highest lvl

A

self discipline

115
Q

effects of incivility

A

“disruptive beh”

low morale, high turnover, poor pt care
usually rude and can incl non-verbal beh

116
Q

marginal employee

A

disrupts unit functioning
works to meet MINIMUM standards
“D”

117
Q

strategies to address marginal employee

A

id who they are
dev explicit action plan
performance deficiency coaching
fire to transfer to diff unit if needed

118
Q

strategies to deal w/ impaired employee

A

gather data, beh, work perform, attendance etc
confront
develop plan, goals (can refer to trtmnt)

have to be ubered home from work.
meeting w/in 24 hrs to discuss return

“D”

119
Q

mcgregors hot stove- 4 componets

A

forewarning
know they will be discip if they break rule

immed conseq

consistency
everytime break rule

impartiality

120
Q

progressive discipline def

A

eval performance
provide feedback
steps for sanctions start least severe to most

121
Q

progressive discipline steps

A

verbal (remind of policies- counsel/coach)

written (employee must agree that beh needs to change)

suspension from work (day off w/ no pay- need to return to work w/ written decision)

termination
can apply directly after incident or if employee fails to comply in the future

122
Q

discipline v punishment

A

discipline- training/molding to get desired beh

punishment- undesirable event s/t unacceptable beh

487- Leadership/Mngmnt (3 decks)

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