Final Exam 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

- 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 4

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

Answer 5

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 6

- 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 7

- 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 8

- 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 9

- 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 10

- 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 11

- 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 12

- 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 13

- 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 14

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

Answer 15

- 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 16

- 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 17

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

Answer 18

- 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 19

- 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 20

- 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 21

- 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 22

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 23

- 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 24

- 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 25

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

Answer 26

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

Answer 27

- 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 28

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 29

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 30

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 31

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 32

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 33

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 34

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 35

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 36

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 37

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

Answer 38

- 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 39

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 40

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 41

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 42

- 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 43

- 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 44

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

Answer 45

- 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 46

- 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. Standards 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 47

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

Answer 48

- 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 49

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 50

- 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 51

- 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 52

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

Answer 53

- 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 54

- 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 55

- 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 56

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

Answer 57

- 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 58

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 59

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 60

- 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 61

- 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 62

- 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 63

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

Answer 64

- 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

Answer 65

- nationally standardized publicly reported survey about patient perspectives of hospital stay - measures patient satisfaction - hospital needs 300 surveys a year - 29 items (18 r/t to critical aspects of care)

Answer 66

- randomized - 18 yr. or older at admission (no pediatric) - at least 1 over night stay and admitted as inpatient (med surg or maternal child) - Survey given within 48 hrs to 6 weeks after discharge - NON psychiatric diagnosis - Alive at discharge Exclusions - not discharged home (prisoners, hospice, nursing home) - observation/outpatients or psych - foreign address - no publicity patients (patients who request for their room # to not be shared ex. Famous or IPV cases)

Answer 67

- 25% of value based purchasing (2% penalty if hospital chooses not to report) - Used to get a star rating on Hospital Compare website where you type hospital name and get quality info - LeapFrog scoring, r/t hospital SAFETY (letter grade to analyze hospital efficacy

Answer 68

- Communication with Nurses (Reason for whiteboards in rooms) - Communication with Doctors - Responsiveness of Hospital Staff (Answering call lights) - Communication about Medication (Med ed. at discharge) - Discharge Information - Care Transition - Cleanliness of Hospital Environment - Quietness of Hospital Environment (Stoplights on units) - Overall Rating of Hospital - Recommendation of Hospital

Answer 69

- Produce Comparable objective data across hospitals - Create incentive for hospitals to improve quality of care b-c they are publicly reported, comparisons can be made - Increases public accountability b-c increases transparency

Answer 70

- Promote the use /adoption of EHRS in the U.S via giving incentives to hospital (If hospital chose not to participate, received 1-3% decrease in incentives) - Supports the meaningful use of technology in healthcare Unintended consequences - Security threats r/t malware - Increased burden and complexity of documentation - usability issue - safety concerns

Answer 71

Purpose of both: reduce errors (Prior to bar code scanning, 1 med error per patient per day) Computerized Provider Orders Entry (CPOE) - rule that providers have to put orders in the computer rather than just verbalizing it to you - Goal = physician put in 80% of discharge prescriptions, 60% of med order, 30% of lab orders, and 30% of radiology orders in computers to meet meaningful use standards Bar Code Scanning - Still need to do 5 rights of med administration and look at labels - MUST SCAN MEDS b-c shows up if meds not scanned and can lead to decreased reimbursement

Answer 72

- improve quality, safety, efficiency, and reduce health disparities - engage pt + families in their own health - Improve care coordination - Improve public + population health via looking at trends - Ensure privacy + security protection for personal health record (i.e passwords on computer)

Answer 73

- Defines minimum U.S govt standards for electronic health records - Outlines clinical data that can exchanged b/w providers, insurance, and patient - Provide exchange of healthcare info to improve quality of care

Answer 74

- Process of developing and implementing strategies to minimize risk and mitigate the impact of adverse events on the hospitals Responsibilities - Preventing patient injury in hospital - Minimizing financial loss after a problem (i.e. prevent hospital being sued or reducing amount sued for) - Preserving the organization’s reputation

Answer 75

- Mandatory reporting - Identifying risk + any vulnerabilities r/t patient safety, equipment malfunction via risk assessment and reports - Do claims management (investigation and coordinate legal depositions) - Regulatory compliance (DNV, TJC, CMS) - Investigate errors via Root cause analysis (looks at processes) - Track and trend events or incidents - Responsible to ensure hospitals compliant w/ policy and security - Concerned w/ safety of patient and hospital - Collab w/ state and local officials

Answer 76

- Any abuse or neglect regardless of unit - Nosocomial infections (SSI, CAUTI, CLABSI) - Unexpected occurrences or accidents that lead to death (Any death within 24 hrs of admission) - EMTALA Violations (25-50K fine for violations) - Deaths related to restraints and seclusion - Wrong site surgery (Reason for marking site; time out; checklists) - Retained surgical objects - Infant deaths, births, and reportable fetal deaths - Infants discharge to the wrong person - Patient suicides or attempted suicides - Stage 3 or 4 hospital acquired pressure ulcers - Patient deaths from falls - Sexual assaults of patients - Drug overdoses r/t Opioid crisis - Sentinel events

Answer 77

- prevents patient dumping - Must do medical screening exam in ED before transferring patient or asking about insurance - Must have legitimate reason for transfer; cannot be r/t insurance and cannot be unstable patient including pregnant woman - Hospital have to document every pt that was transferred out of ED, where they were transferred, and need to say WHY VIA EMTALA log

Answer 78

- Needs to be confidential, not discoverable!!! - Should not be mentioned in the pt’s medical records b-c it could then be discovered - Be objective (do not make assumptions) - Do not photocopy or take pictures of the incident report - Never ordered by physician - always assess patient and let HCP know about incident prior to filing report

Answer 79

- Discharge pt from ED and then they commit suicide within 72 hrs - Unintentional death of full-term infant - Discharge of infant to the wrong family - Any event that requires transfer to higher level of care - Abduction of patient - Hemolytic transfusion reaction - Elopement: pt leaves that has been admitted (if results in adverse outcome) ---Different from AMA; Elopement is they go missing and you do not know they are gone - Wrong site surgery - Raped, assaulted, or killed - Fire, flame, smoke in equipment during direct patient care - Maternal deaths unrelated to admission reason

Answer 80

- Patient injury - Unanticipated patient death - Malfunction or failure of equipment - Adverse events related to patient care - Safety issues related to the physical environment

Answer 81

- Process improvement approach where you develop and adhere best practices via repeating key processes the same way every single time Types Clinical protocol (Ex. MRT, stroke team, standing order; blood glucose control; protocol for codes, sepsis protocol (draw lactic acid) - Decision path that has been approved by the physician based on a specific episode - Don’t need to call for permission for these incidences Critical pathways - written plan that describes optimal sequencing of events for common diagnoses - Explains what needs to be done on each DAY to get pt through the SYSTEM over the length of their stay

Answer 82

- patient safety event that reaches a patient and results in death, permanent harm, or severe temporary harm. - Unrelated to patient’s condition - Require additional surgery, or treatment or transfer to higher level of care

Answer 83

Serious and costly preventable complication or error that occurs during an in-patient stay that could be reasonably prevented through adherence to evidence-based guidelines.

Answer 84

- Remain current in skills - Know job description - Be confident w/ the skills you perform - Follow all safety protocols when administering meds - Ensure you follow orders and get clarity if you need it - Be trained on any equipment you use - Document all patient activities and communication - Be familiar w/ policies + procedures of hospital - ALWAYS USE PROPER PT IDENTIFICATION

Answer 85

Basics - privacy rule and confidentiality law for PHI - Gives patient rights to control the release of information What to know - Only professionals that are directly involved in care can look at medical records - Cannot disclose to unauthorized family member - Policies on viewing your own medical records (may not be able to review until finalized) - No part of record can be copied except b/w health care institutions - Communication with patient needs to take place in a private place i.e., patient room; password protection on computer; no social media

Answer 86

- Requires written notification on admission of rights regarding end of life care - all patients must be asked about advance directives and educated about them if does not have it Concerns - If have living will or power of attorney, need to bring with them to hospital. - CPR must be initiated UNLESS there is a written order for DNR even if living will says otherwise

Answer 87

- law/ statute in each state that regulates practice of nursing - Defines scope of practice (Procedures, actions, duties, processes that RN can do) - Delineates categories of nurses and the scope of practice for each: RN, LPN, APRN - sets the educational and examination requirements necessary for licensure - Defines the standard of competent performance - Defines what behaviors represent misconduct or unprofessional behavior for disciplinary action - If state is in compact agreement, they are regulated by the nurse practice act they are working in not the state their license is in

Answer 88

* Practicing without a valid license * Conduct representing boundary issues (Questionable behavior between nurse and patient OR sexual misconduct) * Practicing while impaired with alcohol or drugs * Violating HIPAA/patient confidentiality * Failure to supervise someone that you've delegated to * Inaccurate or false documentation * Failure to use appropriate Nursing judgment * Medicare Fraud (billing Medicare for services not rendered) * Not reporting violations r/t poor nursing conduct by another nurse * Gross negligence or failure to follow standards of practice or care * Non-professional conduct (ex. felony convictions, practicing outside the scope of license or misuse of drugs)

Answer 89

Board of Nursing - the law enforcement (Board of nursing enforces the nursing practice act) - required by Nurse Practice Acts Nursing license - privilege and not a right - Purpose: protect the public and protect title of RN

Answer 90

- Failure to follow standard of care - Failure to use equipment in a responsible manner (must know what you're using) - Failure to communicate (w/ provider or patient) - Failure to document in the medical record - Failure to assess and monitor pt correctly (shift assessments) - Failure to act as a patient advocate

Answer 91

- Failure to use such care as a reasonably prudent and careful person would use under similar circumstances (below standard of care) - Equated with carelessness (deviation from standard of care)

Answer 92

- Improper or unethical conduct or unreasonable lack of skill by a holder of a professional or official position - Type of negligence by someone with a license - Must prove 6 elements: Duty, breach, foreseeability, causation, injuries, damages (note: license does not have to be proved)

Answer 93

Duty Owed the Patient - Must be employed wherever this incident happened - If you accept the assignment, you are accepting duty Breach of the Duty of Care Owed the Patient - if your actions fall below standards of care Foreseeability - Certain events can reasonably be expected to cause specific results Causation - hardest to prove esp. if many comorbidities - Direct relationship between nurse’s failure to meet standard of care and patient’s injury Injury - Must sustain some physical harm - Cannot be psychological harm or transient harm Damages - Financial damages have come from the events that happened

Answer 94

- Assignment, Delegation and Supervision (delegating to incompetent people OR not effectively communicating) - Duty to Orient, Educate and Evaluate staff ( must investigate any allegation made by patient about someone who is incompetent) - Failure to Warn (not warning potential employers or board of nursing about staff misconduct) - Staffing Issues (inadequate staff:patient ratio (need to notify CNO); inadequate training of agency staff; floating RNs w/o training - Protective and Reporting laws (Elder and child abuse; STDs, Other certain infections; Incompetent practitioners)

Answer 95

Title VI (discrimination law) - Law that says it’s illegal to refuse to hire, discharge, or discriminate against someone because of their sex, race, gender, or origin Age Discrimination in Employment Act of 1967 - Prevents discrimination for those > 40 years old - no mandatory retirement Equal Pay Act of 1963 - Illegal to pay lower wages to one gender over another when job requires equal circumstances (skills, effort, exertion, accountability, training, and education) Family and Medical Leave Act - Ability to take 12-week unpaid medical leave if you're sick or need to take care of a family member (includes births) w/o losing job - Applicable for men and women Provides job security if you must take unpaid leave (12 weeks)

Answer 96

- Ensures healthcare workers are working in safe environment Includes * isolation procedures and universal precautions * proper handling and grounding of equipment * violence in workplace * Certain place to store things to keep safe (cannot set O2 tanks on floor)

Answer 97

- Prohibits employers from discriminating against hiring someone who has a disability unless that person is not qualified or otherwise unable to do the job - Disability: physical or mental impairment that limits 1 or more functions of the person; must be record of disability - You don’t HAVE to hire them but you cannot NOT hire them if they are qualified - Employer must make reasonable accommodations for the disability

Answer 98

- Protects HCP from malpractice when giving emergency assistance outside normal job - nurse not required to stop Requirements if you stop - Must meet standard of care - Stay with victim until handed off to another provider (b-c you have established nurse-patient relationship) - Must not provide care with expectations of getting paid for care

Answer 99

Autonomy - addresses personal freedom and right to self determination. “I have the right to make the decisions I want to make” - Leadership perspective: employee has responsibility to meet job expectations or accept the consequences of actions Beneficence - obligation to do GOOD by acting in ways that promote welfare in best interest of others - Leadership perspective: nurse management encourage staff to grow and assume additional responsibility for growth Nonmalefiecence - Do no HARM, act in a way to not harm - Leadership perspective: in performance appraisal giving both positive and negative feedback to not harm employee; just giving bad feedback can be harmful

Answer 100

Ethical dilemma - Decisions must be made on what's right or wrong in a situation where individual must make a choice between equally unfavorable alternatives Moral Courage - Being able to stand up for what is right and acting based on ethical principles regardless of consequences - Protects ethical values such as honesty, integrity, respect, fairness, empathy, compassion Moral Dilemma - Occurs when someone knows the ethically correct action to take, but they feel powerless to act Internal values conflict with what is happening

Answer 101

Veracity - Telling the truth or demanding that the truth be told completely - Leadership perspective: Nurse manager should inform an employee about the challenges + benefits of the position Fidelity - Keeping promises or commitment - Leadership perspective: Honoring commitment to days off Justice - Treating all people equally and fairly - Leadership perspective: nurse manager uses it to decide whose turn it is to float to another unit OR who gets time off

Answer 102

Planned - change that is well-thought out, organized, and deliberate - advance planning w/ goal to improve something Unplanned - change that is unorganized and unanticipated - adaptive response to something - does not include staff input (leader says what to do)

Answer 103

Unfreezing: thawing out of the system via assessing readiness and motivation for change (has disequilibrium and no status quo) Moving: visual change takes places and is implemented Refreezing: change is integrated, stabilized and becomes new status quo

Answer 104

- Gather data - Accurately diagnose what the problem is - Decide if change is really needed - Make employees aware that there needs to be a change - Help employees accept, buy in, and be on board with the change

Answer 105

- Develop strategies and plan for change - Set goals + objectives w/ target date - Identify areas of support + resistance - INCLUDE everyone impacted by the change in process - Implement change - Offer support + encouragement about the change - Evaluate change - Revise plan as necessary

Answer 106

- Inspect and reinforce positive behavior to hardwire change - respond to employee concerns - ensure everyone is doing what they should be

Answer 107

- CURRENT STATE BEFORE the change occurs (present or desired state) Driving forces: positive forces that push change forward or advance system toward change Restraining forces: obstacles that impede change

Answer 108

Unfreezing - Nursing Process: assessing and diagnosis - Problem Solving: Identification of problem, define problem Moving - Nursing Process: planning and implementing - Problem Solving: Problem Analysis, seeking alternate solutions, implementation Refreezing - Nursing Process: Evaluating - Problem Solving: Evaluation

Answer 109

- need good reason for making change (do not change for sake of change) - Always needs to be planned and implemented gradually (Should never be abrupt or unexpected) - All people affected by change should be involved in planning process to help them buy into change via giving them ownership - Varied reactions and Resistance to change are normal - Communication is important (rumors need to be dispelled) - Managers must plan to inspect change to ensure it is sustained - Celebrate small wins

Answer 110

- financial plan that includes estimated expenses + revenues - Designated for period of time (typically 12-month period) - Dynamic process that guides the allocation/distribution of resources and expenditures to ensure business can function daily and achieve goals - Aligns with identified strategic plan, mission, and vision

Answer 111

- Planning - Coordinating & Communicating - Monitoring Progress - Evaluating Performance

Answer 112

Planning (Ex. Plan to give 3% raise so plan for increase in expenses) - Most important function of budgeting process - Determine the goals of organization - Identify resources - makes Budget assumptions (reasonable expectations on revenue (income) and expenses) Coordinating and communicating (Ex. If you are going to open a new service, you will talk about that here) - Bring various people together to discuss resources and involved factors - Discuss allocation and distribution of resources based on strategic plan

Answer 113

Monitoring progress - Compare actual performance against budget - Do variance analysis (deviations from budgeted dollars are examined by comparing actual performance results to expected or budgeted performance) if there is variance Evaluating performance - Determine effectiveness of manager (i.e. managing of overtime, labor, and supplies) - Staff role in preventing variance: ensure you clock in and out on time AND be mindful of supplies taken into patient's room - Staffing office role in preventing unfavorable variance: controlling budgeted staff

Answer 114

The difference between the planned budget and the actual results Favorable: results better than expected = SPENDING LESS (Ex. Less sick patients, understaffing) Unfavorable: results are worse than you thought = SPENDING MORE (Ex. Sicker patients, Overstaffing , staff turnover)

Answer 115

- Vacation/sick days - Patient acuity (favorable if less sick, unfavorable if more sick) - Staff calling in sick (unfavorable labor variance but favorable budget variance because you save money) - Staffing level and overtime - Hours not moved correctly when nurse is floated to a different unit

Answer 116

Productive time (Ex. Secretary (responds to call lights), UAP, RN) - any time directly in patient care. Includes hourly and overtime Non-productive time (Ex. Orientation, education, doing chart audits, vacations, holidays, sick time) - working on/off the unit not in direct patient care

Answer 117

- financial plan for organization that lists the plans, revenues, and expenses in a designated period - looks at day-to-day expenses - Every hospital has operational budget - includes labor and supply expenses

Answer 118

- includes salaries, Overtime, benefits, education, staff development and training - subset of operational budget - LARGEST EXPENSE OF OPERATIONAL BUDGET - Nursing typically makes up 65% of labor budget

Answer 119

- Money allocated for major equipment and construction projects - expenses between >$500-$2000 - item has to have a life expectancy of >1yr - Considered long term investments - Payment for capital expenses spread over couple of years

Answer 120

- Money that flows in and out of organization - Includes billing + collections, cash on hard - Helps CFO know if they are spending budget productively.

Answer 121

Incremental budgeting - Used most often b-c simple - Look at historical data and make adjustments based on growth or declines Zero-based budgeting - Start from scratch (0) every year - Requires justification and detail for every expense (labor intensive) - Hospitals don’t do this type of budgeting

Answer 122

Unit-of-service: basic measure of product or service being produced - Nursing Units: patient days (total # of days patients admitted over time period) - Cath lab: procedures - OR/PT/OT: time (15-minute increments) - Home health: patient visits

Answer 123

- Responsible for unit-level budget (labor and supply) - managing patient flow such as ADT - Eliminate never events (something that happens in HCO that should never happen if best practice is followed) - Reduce 30-day readmission and length of stay - Improve pt satisfaction on the unit - Reduce staff turnover (costs $60,000 to train a new nurse)

Answer 124

- Safety - Patient and Community engagement (HCAHPS) - Efficiency and Cost Reduction (spending per hospital Patient with Medicare Beneficiary) - Clinical Outcomes

Answer 125

- process of identifying + allocating right # of nurses on a unit based on patient needs (acuity) - Daily operational function each shift - No perfect staffing method (JCO/ CMS don’t tell you how to staff, just say you have to provide adequate care) - staffing is complex and challenging and longest management function)

Answer 126

- Reduced medical and medication errors - Reduced potential for errors - Decreased patient complications b-c patient gets more attention, assessed more frequently so complications noticed earlier - Decreased mortality (1.98% decrease) - Improved patient satisfaction b-c nurses checking on them more often and more attentive - Reduced nursing fatigue and burnout - Increased job retention and satisfaction - Decreased lengths of stay b-c you know more about the patient - Reduced readmissions

Answer 127

- Provide right number of nurses - with the right qualifications/skillset - to deliver safe, high-quality, and cost-effective care to a group of patients and their family - evidenced by positive health outcomes

Answer 128

- hours of nursing care provided per patient by various levels of nursing personnel - used to determine forecasted workload with average daily census Problems - financial metric that does not take into account patient acuity

Answer 129

process of determining the set number and type of staff for a future time period (4 weeks) by assigning individual personnel to work specific hours, days and shifts in a specific unit for a designated time period Types - centralized - decentralized - self-scheduling (nurse creates schedule based on certain requirements) - fixed/cyclic scheduling (set hrs and days worked each week)- not common in nursing

Answer 130

Patient acuity - severity of illness or complexity of care needs - higher acuity = more assistance - Forecasted workload (HPPD and ADC) do not account for acuity Patient intensity - amount of care required by patient

Answer 131

- Age of patient (older = higher acuity) - Functional ability - Communication skills (If they do not speak English, acuity will increase b-c need translator) - severity and urgency of the condition - Procedures scheduled - Complexity of care needs of patient. (Ex: extensive ulcers will require extensive wound care) - Geography of the environment (ex: better for nursing station to be in the middle for access) - Availability of technology - Experience of staff providing care

Answer 132

Budget based on HPPD - Most predictable model of nurse staffing - financial metric used by hospitals Nurse-patient ratio - Pure method - Not cost effective b-c one patient over budget = need a whole nurse for that one person - Not used by hospitals Patient acuity - Most likely need people on call - Must be calculated everyday - ambiguous so not used

Answer 133

Basics: how well workforce uses available staff; you want correct # of staff to take care of patients so productivity = 100% ( > 100% = understaffed; <100% = overstaffed) Factors - Variance (do variance analysis) - Overtime - agency nurses - nurses in nonproductive time (training, orientation,education)

Answer 134

- Projected unit workload and units of service for next year (is anything on unit going to change)---Ex: if you have a new cardiac surgeon and now the unit will have more cardiac pts, predict a change - Historical staffing requirements - Effectiveness of current staffing plan (may need a change) - Trends of acuity on the unit - Anticipation of skill mix. ex: using LPN, UAP - Experience + education of staff (new physicians; educational hours) - New technology (new programs or service needs) - Patient outcomes (ex. if you have a lot of bad pt outcomes w/ current staffing, there may need to be a change) - Productivity index

Answer 135

- Must have competencies to work in the unit you are supposed to be working in - Must have knowledge and skills for the unit - Are they experienced? (novice to expert) ---Never schedule all new nurses to work at once

Answer 136

- Financial (salaries are the largest expense for any HCO) - Productivity (Has DIRECT impact on bottom line/budget) - Licensing + Accreditation ( does not mandate any type of staffing, but they observe unit’s atmosphere to see if nurses are freaking out or calm and collected; interview patients, and check licenses) - Customer Satisfaction (ex. HCAHPS publicly reported)---NEVER okay for nurse to discuss short staffing with a patient b-c jeopardizes pt’s trust; Critical to be competitive in the market

Answer 137

Decentralized: Nurse manager responsible and accountable for schedule on individual unit including covering scheduled + unscheduled absences Pros - Staff can request time off directly to manager - Staff has more flexibility and autonomy b-c can change shifts w/ coworkers Cons - May lead to manager giving certain people special treatment (unfairness) - May not be as cost effective because there is not a single person seeing all the units of the hospital

Answer 138

Centralized: When staffing decisions are made by staffing office rather than the manager Pros - wide view of whole organization rather than just one unit - encourages optimal utilization of staffing resources - Easier to consistently implement staff policy (float pool, agency, Per diem (1 day) nurses are pulled in and often paid more b-c must be flexible and work wherever they’re sent) - More cost effective than decentralized staffing - Frees up manager to have more time to do other management functions since not dealing with staffing all day Cons - Office doesn’t always know the particulars regarding patient acuity on individual units - manager not in tune w/ productivity on unit b-c not worried about staffing

Answer 139

Acuity - Take into consideration the complexity of care and the resources needed for the patient - skip rooms - Ideal way to do it (but not always possible if no tool to rate acuity) Block - Easiest way to make assignments - Rooms are dives up amongst number of nurses - You take patients in a row

Answer 140

- Method used to provide care to the patient ( # and types of caregivers matched to patient needs) Describes - how healthcare workers will perform tasks - Who is responsible for doing what - who has authority to make decisions

Answer 141

- Oldest model of organizing patient care - Nurses are doing everything: planning, organizing, performing all care including hygiene, med, treatment, education --“ I am doing everything as the RN” Used in ICU Pros: - Care is not fragmented - Nurses have a high degree of autonomy - Lines of responsibility and accountability are clear b-c RN reports to charge nurse and that is it Cons: - May not be enough nurses available for this model - Costly because RNs are doing things UAP can do for cheaper (B-c no nursing assistances)

Answer 142

- Staff assigned to complete certain tasks for a group of patients rather than care for specific patients - Very task oriented (tasks determined by scope of practice) - Charge nurse = coordinates assignments and has to be knowledge about everyone’s skill set Pros - tasks completed quickly and efficiently - Little confusion about who's responsible for what because assignments are clear - Do not need as many nurses to supervise

Answer 143

- RN functions as team leader and each team given group of patients to care for Requirements of team leader - coordinates care for group of patients - responsible for knowing condition and needs of all pts on her team - Requires cooperation within team w/ delegation and supervision - Requires clear communication and leadership skills (Be careful who you pick as a team lead)

Answer 144

- You have a patient and you provide total care for it 24h/day - Associate nurse fills in for primary and follows primary nurse plan of care when primary nurse is not on shift Requirements - needs to be able to communicate effectively because she delegates + manages care 24 hr. a day - Must coordinate care even when not on shift (is called) - Must have high degree of clinical judgment, decision making - Works better with 5 8h shifts rather than 3 12h shifts Used in home health or hospice

Answer 145

Cons - fragmented care - huge potential to overlook priority needs of its since everyone is task oriented - Very confusing model to patient b-c patient does not really know who their nurse is - Care is not individualized or personalized so patient can perceive this module as lack of customer service - caregivers can become frustrated b-c repetitive work all day

Answer 146

Pro - provide high quality, safe, effective care - Each team member can bring their own expertise and decision making Cons - Expensive - Continuity of care can be lost b-c assignments can change every day

Answer 147

- lack of trust in nursing assistant (NEED MUTUAL TRUST!) - Not enough time to delegate b-c too long to explain - Lack of experience in job (role of RN) - Failure to anticipate need for help prior to becoming overwhelmed - Delegator takes responsibility back prior to task completed - Desire to be in complete control (people may do things different from you but outcome still met; Frightening to give responsibility of a task to a team member

Answer 148

Reasons for over delegating - Insecurity (insecure in your own abilities so hand it off to someone else so you don’t have to figure it out) - Depend on same UAP to do things that they shouldn’t do b-c you are comfortable w/ them -> Can become a punishment - Give too much authority/responsibility to some people (Ex: delegating stuff to the secretary when you shouldn’t) Reasons for Improper delegating: - Not following 5 rights of delegation - Delegate to someone something beyond their capabilities - Delegating without proper instruction - Delegating for the wrong reason

Answer 149

Assertive (best + healthiest) - Actively listen, reflective feedback + respect - works with another person to find an acceptable solution to problems w/o compromising anybody’s needs - Requires self-confidence, self-awareness and ability to set limits - Honest, transparent, and direct while respecting and valuing them - Does not violate the rights of others

Answer 150

Aggressive (assertive on steroids) - makes decisions for themselves and other with the outcome of always coming out as the winner - Wants their needs exclusively met via using guilt, hurt, anger and manipulation to get what they want (controlling and feel superior) - Escalates conflict rather than resolves it - Leaves people hurt, defensive, resentful, and humiliated

Answer 151

Passive - Use indirect communication to allow everyone to make the decisions for them to avoid confrontation or difficult situations at all costs - Manipulate people to achieve their goal but avoid the confrontation - Self-denying and inhibiting - Dishonest because do not state their true feelings

Answer 152

Passive Aggressive - Avoids confrontation but manipulate others to achieve their goal - Appear honest but go through backdoor - Win by making other people look bad i.e. gossip, pout, play victim - Giving conflicting messages (Saying one thing but may have aggressive tone or body language; May sound passive but their body language is different)

Answer 153

- Open and honest communication - Constructive feedback among team w/o backlash) - Create mutually agreeable resolution and resolve together - Assist each other - Maintain confidentiality within team (“ What happens in team, stays in team) - trustworthy and keep commitments - Loyal to team members

Answer 154

- Absence of trust b/w team members - Fear of conflict - Lack of commitment - Avoidance of accountability ( ” I don’t like these people and I don’t want to be accountable for their choices” - Inattention to results

Answer 155

transfer of responsibility for the performance of a task from one individual to another while retaining the accountability for the outcome

Answer 156

Know - Know nurse practice act (SUPERSEDES any hospital policy) - Know policies and procedures of hospital you are working in - Know the patient (assess and assess patient stability) – do not delegate if change in condition possible after task - Know the staff member (skills, knowledge, competencies, in their job description, past experiences) - Know the task yourself (NEVER DELEGATE IF YOU DO NOT KNOW THE TASK)

Answer 157

Accountability - answerable to yourself or others for your own choices, decisions or actions. - Measured based on standard of care Responsibility - doing something that you are suppose to do or obligated to do Supervision - provision of guidance, monitoring, oversight of a delegated task Assignment - distribution of work among staff members - Delegation is things outside the CNA’s normal job description or assignment

Answer 158

- their own acts (Not responsible for delegatee’s mistakes unless due to not following rights of delegation) - act of delegation and supervision - assessment of situation and patient - follow-up/evaluation - intervention - Corrective action if needed - Communicating appropriate info to the person on what they need to do and what to report back to you

Answer 159

- their own acts - If activity within their job description, skill set, and competency, must accept delegation - accomplishing the task - asking for assistance or training if needed - clarification of questions - Communicate back to delegator

Answer 160

- Understand processes used during delegation - Evaluate and determine what nursing responsibilities can be delegated by RN - Write policies and procedures r/t delegation - Promote positive work environment

Answer 161

- Nursing Process (assessment, diagnosis, planning, and evaluation) --Implementation depends on the task to be delegated - Patient education - tasks that requires clinical judgement

Answer 162

- Right Task - Right Circumstance - Right Person - Right Direction/Communication - Right Supervision and Evaluation

Answer 163

Conforms w/ - organizational guidelines - Policies and procedures - Staff job description - What staff it can be delegated to (any or particular staff?) - Nurse practice act rule on delegation

Answer 164

- clinical condition of patient needs to be STABLE - delegated task does not require nursing JUDGEMENT - Within their job description, policies and procedures - Appropriate resources available

Answer 165

- Appropriate knowledge and skill to perform the task - Within their job description, policies and procedures, nurse practice act

Answer 166

- Clear directions - Expected outcome - When, how, what they need to report back to you - Allow for questions/feedback/clarity

Answer 167

- RN ALWAYS RESPONSIBLE FOR SUPERVISION either directly or indirectly (Provision of guidance, oversight, and follow-up of the accomplished nurse ) - Create environment of trust and cooperation - RN need to have competency in task being delegated - Give feedback (positive and negative) - Evaluate patient’s condition + response to delegated task - Intervene and report unsafe or poor performance

Answer 168

- Non-invasive and non-sterile treatments - Vital signs - Intake and output - Mobility (Positioning, turning, Ambulation) - Transportation of non critical pt within facility - ADLs (unless unstable or complex i.e., new stroke pt)

Answer 169

- Administer P.O. medication - With IV certification course (Administer floor stock IV solutions and start IVs) -- no IV Push/central line - Chart observations in medical record after RN does initial patient assessment - Complete the history on admission assessment (RN must do physical assessment) - Reinforce teaching initiated by RN - Feeding through NGT - Execute plan of care developed by the RN - Colostomy care - Non-complex wound care

Answer 170

Unsupervised - Only if you delegate to an RN b-c same skills and credentials so you don’t need to supervise them Initial direction then Periodic inspection - RN supervises UAP or LPN Continuous supervision - continual support and assistance - Ex: when you delegate a task to someone for the first time and don’t know how they will do so you go and watch them

Answer 171

- Tasks can be delegated, nursing practice CANNOT be delegated. - Explain tasks, expected outcomes, and f/u to prevent errors or patient harm - Expect responsible actions from Delegatee (Trust the person and Do not intervene in the task unless assistance requested, needed, or you observe unsafe practices) - Delegatee cannot delegate the task to someone else - Be supportive, positive, and available when delegating (Positivity gives them a sense of accomplishment) - If there are performance issues, need to let manager know!! b-c do not want them to be trends

Answer 172

- process of assigning meaning to needs, feelings, and perceptions and then interpret what is brought into your awareness Notes - Basic principle in managing and coordinating care - Professional communication sets tone for unit (upset charge nurse = upset everyone else) - Lack of communication = significant barrier in errors of healthcare - Nonverbal speaks louder than your verbal behavior because they SEE you before they HEAR you

Answer 173

Interpretation - receiver’s beliefs about the message - You can say one thing, but the way that the message is interpreted could be different Filtration - all information received is filtered by receiver i.e., colander - Be mindful to not filter out too much because you may filter out something that is important when listening - Be aware of filtration b-c it is essential that person you’re talking to understands the message that you’re sending Feedback - The RESPONSE and reaction FROM RECEIVER - influenced by receiver's interpretation and filtration - Feedback loop starts cycle over

Answer 174

Develop Trust - Essential for all good relationships (pt needs to trust their nurse; needed for all relationships) - Enhanced by responsiveness openness, honesty, integrity, and dependability - To foster, Change communication style based on who you are communicating with to improve clarity (at their literacy level); protect confidentiality, be available Use “I” messages (Ex. “I feel like I did not get a good report” instead of “YOU didn't give a good report”) - Always begin with “I” messages to not sound accusatory and make the receiver feel defensive - Provides opportunity to address the real issue Establish Eye Contact - Shows respect and you care and value the conversation - Make person feel you are giving undivided attention - If no eye contact, can be perceived as shy, insecure, preoccupied, unprepared or dishonest (Be aware of cultural differences)

Answer 175

Keep Promises - Follow through or you will lose trust. - Just explain if you can’t keep a promise - Be careful with what you say (Important for elderly pts b-c some patients watch the clock) Express Empathy - Ability to put yourself in another person’s situation to better understand the person and to share the emotions and feelings the person is having - It is NOT feeling sorry for someone Use open communication - Open-ended questions allow for elaboration - Allows for an answer rather than yes / no or one word answers Ex: Are you distracted vs. you seem distracted where are you at right now?

Answer 176

Clarifying Information - Asking for feedback to ensure receiver understands message being said Being Aware of Body Language - Positioning and body movement show a strong message - Closed body language makes a patient believe that you are closed/uninterested (e.g., crossed arms) - Leaning forward can demonstrate interest in the receiver and conversation (Be careful b-c being too close can cause harm) Using Touch - Can portray genuine interest and concern - Be sensitive to people’s body space and personal and culture preferences - Read situation prior to using touch

Answer 177

Closed communication styles - Require single word answer or yes/no questions which limit response Blocking - Occur when the response is generalized, cutting off a person’s feelings - Can be perceived as minimizing concerns - Happens when you are uncomfortable with a topic Ex. Cutting the conversation off “Well everyone feels like that” False assurances - Placate or show lack of concern or knowledge about situation - Dismissing patients concerns “You will be okay, you’re going to live” Conflicting messages - Nonverbal not matching w/ verbal (What you say does not match how you act; nonverbal speaks louder) Ex. Rolling your eyes OR tell pt call you if they need anything but you don’t answer when you answer

Answer 178

- Faulty logic and reasoning that is barrier to communication - Related to individual’s culture, gender, background, or personal experiences - Occurs at significant times of stress in a person’s life

Answer 179

Ad hominem abusive: - An argument that attacks person over the issue - Goal = discredit a person by bringing up unrelated fact. Ex. “That doctor is too young to be practicing medicine” after not doing something right for a patient Appeal to Emotion - Attempt to manipulate other people’s emotions to avoid the real issue Ex. “You are always late”-> “I have three kids, they have a lot going on, and I could not get here on time” Red Herring - Introduction of a completely irrelevant topic to divert attention from the real issue Ex. “You are mad about my documentation because I am going back to NP school” Ex. “It is not my work that you’re really made about, it is that I am a guy and you do not like male nurses”

Answer 180

- Paraphrasing content of the message (clarifying meaning and interpretations; “What I hear you saying is”) - Reflecting on message (respond to emotions; “You are angry, what happened?”) - Open questions (Obtain more information to avoid assumptions “What happened when you talked to them?”) - Acknowledging (Conveys appreciation of other person’s perspective i.e. “This seems to be very frustrating to you”) - Summarizing (Pull important information together i.e. “So what is bothering you is ___”) - Directing a conversation: Communicate your message in a way people will be open to hearing it - Framing (Transferring issue to another person “I think it will be better to speak with nurse manager about these issues since she is more directly involved ”) - Reframing (Helps person see their concerns in a new light; Broadening the information and Diffuses negative feeling ‘It sounds like you need more information”)

Answer 181

- a clash or struggle that occurs within oneself or with others when a real or perceived threat or a difference exists between desires/wants, thoughts, attitudes, and feelings. - catalyst for change (beneficial or detrimental) - No conflict = no change/stagnate

Answer 182

- Improves the quality of decisions - Stimulates creativity - Encourages interest - Provides medium for problem awareness and tension relief - Promotes open and honest discussion - Fosters environment of change - Improves group performance

Answer 183

- Constricts and blocks communication (disruptive) - Decreased team building/ cohesiveness of group - Hinders performance of the group and work environment - most NEGATIVE PARTS OF CONFLICT IS ITS IMPACT ON PATIENT OUTCOMES - can explode into fighting

Answer 184

- Ineffective communication and inactive listening - Interdependence (i.e. b/w co-workers): conflict in communication between people who are dependent on each other and perceive their interests as incompatible, different, or there is tension - Differences in Goals (do not see eye to eye; Agree to disagree) - Differences in Perceptions

Answer 185

Relationship conflict: interpersonal differences in ideas i.e. annoyance, frustration, or irritation Impairs team performance Task conflict: disagreement on how to complete tasks Process conflict: incompatibility or viewpoint on how work can be accomplish

Answer 186

Intrapersonal = Within (Internal conflict) - Discord, tension or stress inside of someone - Due to unmet needs, expectations, or goals Ex. My 3-year-old child is sick, but I must work or they will be short Interpersonal - Between two or more people - Clash in values, style, perspectives, beliefs Intragroup = Conflict within members of the group Intergroup - Conflict BETWEEN two or more groups - Related to authority, territory or resource issues Ex: between physician and nursing between whose responsibility it is Organizational - struggle for scarce resources within an organization - r/t goals, roles, policy and procedures, behaviors, personal conduct

Answer 187

- Personality differences - Value differences - Ineffective communication - Diversity r/t age, gender, race, or ethnicity (Older vs younger nurses)

Answer 188

- Blurred job boundaries (Ex: Issues with LPNs on what they can and cannot do) - Battle for limited resources - Unmet expectations - Lack of clear jurisdiction (who does this person report to)

Answer 189

Stage 1: Latent Conflict - Actual Conflict has not developed but factors are present that have high likelihood of causing conflict Ex: walking rounds are going to be implemented Stage 2: Perceived Conflict - Person perceives a problem as a conflict when it might not exist Ex: rumor that goes around about time off or changing, and nurse thinks it will impact vacation request Stage 3: Felt Conflict - Begins when people involved start to feel an emotional response related to conflict Stage 4: Manifest Conflict - Parties involved aware of conflict and Conflict is being resolved positively or negatively Stage 5: Conflict Aftermath - completion of conflict but can be Positive (satisfied w/ plan developed) or Negative (cannot come to joint resolution)

Answer 190

Negotiation - Two people do it together - Separate own feelings about situation so there can be negotiation with goal of resolving conflict Mediation - When things can’t be resolved, there must be a neutral mediator to listen to both sides of party and facts - Listen to evidence and assist in making decision Arbitration - If the conflict is so complex, there is a 3rd party involved to make the final decision. - Cannot bring in attorney - binding or non-binding - last step and no turning back

Answer 191

Avoidance/Withdrawing (Turtle)- Low assertiveness - Aware of conflict but actively avoids - Conflict is never resolved and neither party has their goals met - Lose-lose because they are not dealing with the conflict and it can later resurface - May be appropriate if one person has more power in the situation or problem is time-limited Smoothing - When someone tries to pacify the other party - Focus on what they agree on rather than disagreement/conflict - Used to preserve a peaceful working environment - Lose-lose because you don’t deal w/ conflict

Answer 192

Competing/Coercing (Shark) - uses power and creativeness to win at all costs (often defensive and aggressive) - used when a quick or unpopular decision needs to be made ASAP - Win-lose situation - Losing party may get frustrated and try to get even Cooperating/Accommodating (Teddy bear) – low assertiveness - One person puts aside own goals to satisfy other’s desires i.e. “Whatever you want is okay with me” - Lose-win situation - Typically, original conflict will not be resolved and solution may result in more conflict if accommodator expects something in return - Appropriate if unimportant to you

Answer 193

Compromising/Negotiating (Fox) – medium assertiveness - always good - Win-win – both parties give up something to get partial goal attainment i.e. “Let’s make a deal” Collaborating (Owl) – high assertiveness - Win-win-win - both parties try to actively find a new solution that will satisfy both - MOST TIME INTENSIVE APPROACH (Takes longest because both people have to agree and develop new goals) - Both parties set aside their original goals, so there can be some type of mutual agreement and resolution

Answer 194

Compulsive Talkers - Can’t stop talking - Leader’s role: When they pause, thank the person for their input and ask for someone else’s opinion OR If it gets really bad, Manager might have to talk to them in private Non-talkers - Does not say anything and do not contribute due to discomfort w/ group talking - Leader’s role: Ask this person what their opinion is on the topic, Create a safe environment for people to share their ideas! OR meet w/ them in private, show them the agenda, and say you value their opinion and want them to speak up Distracted or Unreliable Members - Not prepared or committed to the team i.e. plays w/ phone, shuffles papers - Leaders role: In private, ask them if they want to work with the team OR Give them a specific assignment with due dates

Answer 195

Interrupters - Demonstrates lack of self-awareness and self-control - Stifles the conversation because other people cannot get their thoughts out - Leader’s role: Ask person to let other person finish their thought then they can talk AND set ground rules so everyone knows what rules are Squashers - Finds something wrong with every idea - Generally, doesn’t like change or putting effort into change - Does not want to take personal risks - Leader’s role: set expectations/ground rules prior to discussion

Answer 196

* used in high stress environments to prevent thinking and cognitive errors* D = Define the problem - Determine what caused the problem and that something needs to be done E = Establish the criteria - decide what you want to accomplish; What needs to stay the same; What you can do to prevent future occurrence C = Consider all the alternatives - determine choices and desirable outcome I = Identify the best alternative D = Develop and implement a plan of action E = Evaluate and monitor the solution (give feedback and troubleshoot)

Answer 197

- systemic before local (life before limb; whole body > local reaction) - acute before chronic - actual problems before potential problems (i.e. listen to patient and do not make assumptions) - trends vs. transient findings (multiple high BPs > 1 high BPs) - medical emergencies and complications vs. expected findings (apply clinical knowledge and procedural standards to prioritize) - ABC (airway, breathing, circulation) - Urgent > non urgent - Unstable findings > stable findings

Answer 198

- Avoid "do whatever hits first" - Avoid taking the path of least resistance (do it yourself vs ask someone else) - Avoid responding to "squeaky wheels”- whoever or whatever is the loudest vs most pressing needs (need to determine if loudest is just loud or actual urgent issue) - Avoid relying on misguided inspiration i.e. putting charting over checking on unstable issue

Answer 199

Complaining (express dissatisfaction and annoyance) - Talk to manager r/t problem solving if continuous problem Perfectionism - May leave things unfinished b-c can not make it perfect - Accept everything will not be perfect - Accept people may do things differently from you Interruptions (Part of everyday life) - Prioritize work - Set limits on time esp. w/ med administration to prevent med errors Disorganization - understand Organization is a PROCESS not product - Anticipate patient needs - Eliminate clutter

Answer 200

- Will the patient be jeopardized if the task is not done? - Is the task a priority because of a deadline? - Do safety concerns make this task a priority? - Will there be serious consequences if the task is postponed? - What are the legal issues related to the priority of this task?

Answer 201

Doing too much - Take a moment to prioritize care - Finish one task before starting a new one - Decide what needs to be done and what is nice to do Inability to say “no or not now” - Decide what you have time to do - Okay to say no (Do not accept tasks you cannot complete) Procrastination - Identify reason for procrastination - Do least desirable task first

Answer 202

- conflictual behaviors among individuals who consider themselves peers with equal power - an act of aggression toward another colleague

Answer 203

- Low morale in staff - Stress - Sleep disturbances - Health complaints - Increased absenteeism - work-related suicide - Turnover - Higher cost

Answer 204

- Repeated, unwanted harmful actions that occur with greater intensity and frequency - carried out in an effort to offend, distress, and humiliate an intended recipient. - Abusive power that makes receiver feel threatened, disgraced, and vulnerable (Ex. Taunting a person, verbal intimidation, undermining, threats) - perceived OR real power difference (receiver has inability or limited ability to defend themselves)

Answer 205

Cyberbullying: Disruptive behavior or slander using electronic devices Verbal Bullying: Talking , Slandering , Ridiculing, Persistent name calling, Offensive remarks, receiver = butt of the joke; abusive or derogatory remarks Physical Bullying: Pushing, Shoving, Kicking, Punching, Damaging working environment, assault, or threats

Answer 206

Incivility - rude, inconsiderate or disrespectful behavior that can be intimidating and insulting (i.e as gossiping, spreading rumors, dirty looks, & refusing to help) - If not addressed, it becomes bullying Exclusion: socially or physically isolating someone

Answer 207

- Psychological and physical stress - Professional disengagement - Underperformance - Increase job turnover - DECREASE in quality of patient care

Answer 208

- Person causing violence has no relation to hospital - Customer or patient of org - Current or former employer - Caused by spouse or partner of employee

Answer 209

- underreported b-c people do not report if not personally done to them - Patient violence is one of most frequent causes of staff injury esp. ED and behavioral health staff - Verbal abuse is the most common violence carried out by patients - assess patient risk for self-violence - Body language is the most significant cue to impending violence

Answer 210

- Expectations not being met - Perceived loss of independence or control - Upsetting diagnosis, prognosis or disposition - History of abuse that causes an event or interaction to retraumatize patient - Long wait time (>1 hour in the ED) - inadequate security personnel - Time of day: 3-11pm = high risk time for violence - Men are more likely to commit physical abuse

Answer 211

- Alcohol and substance withdrawal (alcohol decreases tolerance for frustration and incites violence) - Psychiatric diagnosis: Schizophrenia, Bipolar, MDD (2-3x more likely to demonstrate violent behavior) - Trauma - Stressors: Financial, Relationship, Situational problems. - Hx of violence in the domestic setting - Environmental risks: objects that could be used as weapon (chairs, IV poles)-- remove items that can be used for violence

Answer 212

S= Staring and eye contact (intense or prolonged glaring) T= Tone and volume of voice (increased volume, yelling A= Anxiety (irritability) M= Mumbling P= Pacing or walking back and forth

Answer 213

- STAMP - Aggressive statements: Sharp or casuistic remark; name calling or swearing - Resisting healthcare or failing to cooperate - Becoming quarrelsome or argumentative - Body language: Fist clenching, Teeth gritting - Rude and intimidating - Demanding attention - Asking repeated or rhetorical questions

Answer 214

- Patient and your body language - Hx of drug or alcohol abuse - Hx of mental illness (decrease agitation if their illness is not controlled or if deviation from normal routine) - S/s of aggression (name calling, threat, tense posture, rapid movement, increased voice volume) - Own stressors and how to manage them

Answer 215

- Listen to gut feelings - Keep safe distance - Do not react emotionally but be rational (two emotional people != helpful) - Use buddy system if uncomfortable or afraid to go in patient room - Always be aware of surroundings and know how to call for help - All threats need to be investigated i.e., actual or perceived; spoken or unspoken, specific or vague, veiled

Answer 216

- Build trust and establish rapport (keep promises) - Listen to patient and validate feelings and concerns - Address concerns in a timely manner - Be respectful + professional - Introduce self and formally address patient - Always explain what you are doing before you do it - Ask patient if they have any questions - Offer positive choices prior to less desirable ones - Ensure words and body language (tone, facial expressions, posture, eye contact) match and are calm

Answer 217

- need to be prepared w/ all hazards approach to disaster planning i.e plan, review, analyze, and address all credible hazards and serious threats to community - Need to be able to communicate and coordinate with each other - Need to respond on a local level before utilizing state/federal resources - Need to transport and coordinate supplies and patients during a disaster - Each hospital needs to have credentialing in place for providers to work in different hospitals in emergencies

Answer 218

- Activities are focused on planning, preparing, preventing, and warning - Must have emergency operations plan in place which says how they will respond to disasters - hospitals need to have 2 disaster drills a year

Answer 219

- Activities focused on responding to the disaster - Emergency management system activated - Provide emergency response to victims - Stabilize and minimize factors / effects - Interactions with ALL the responders (EMS, police, fire, hospitals, hazard response team, health department) - Manager on unit must evaluate resources on unit to bring list of # of vacant beds, # of patients that can be safely discharged, Evaluation of supplies on unit

Answer 220

- Starts within 72 hours AFTER disaster - Continues for to 2-3 years - Building and rehabilitation

Answer 221

- Level 1 Emergency: localized incident (Memphis) - Level 2 Emergency: regional incident (Shelby county or west Tennessee) - Level 3 Emergency: national incident (United States)

Answer 222

- Command and Control - Communication - Safety and Security (ensure hospital functions and responds to safety threats) - Triage - Surge Capacity - Continuity of Services - Human Resources - Logistics and Supply Management (ensure linen and food) - Post-disaster Recovery

Answer 223

- Incident commander - Public information officer (talks to press) - Safety officer - Liaison officer: communicates w/ other hospitals - Operations: oversee hospital operations - Planning - Logistics - Finance/administration

Answer 224

Triage - Assigning the degree of urgency to each patient to determine order of treatment - Typically done outside the ED if many victims Surge Capacity - The health care services or hospitals must be able to take care of more patients/expand via expanding patient rooms or putting patients in nontraditional areas Continuity of Services - essential and need to continue to function normally during the disaster (Do you normal job unless told otherwise) - Normal hospital operations need to run PARALLEL to the disaster

Answer 225

Human Resources - Needs to ensure adequate staffing to take care of pts - Implement a call tree (order people are called in when shortage Post-disaster Recovery - Starts at BEGINNING of response activity - has to do w/ recovery efforts to stop or limit long term effects of disaster.

Answer 226

Command and Control Center - HICS (Hospital incident command system) activated by disaster - Each person has a designated role and knows where to report in emergency (be familiar w/ your hospital policy) - Incident commander designates roles of people Communication - Clear, accurate, effective, timely b-c everyone wants to know what is going on - Effective collaboration and cooperation - Designate an informational spokesman who is responsible for communicating everything - Requires public awareness and trust

Answer 227

- Uncertainty - Vulnerability - Isolation b-c Transition from student w/ instructor overview to practicing alone - Excitement - like a failure b-c spend more time on tasks - Stress (Higher degree of stress is normal in first 3-6 months due to concerns about risk for patient injury and errors) Ex. 50% of novice nurses fail to recognize a life-threatening complication AND 40% of novice nurses will make a medication error

Answer 228

Basics - everyone spends a different amount of time in each phase - culture shock b-c real world different than nurse (school = Patient-centered care; work = task oriented) Phases - Honeymoon - shock/rejection phase - recovery phase - resolution phase

Answer 229

- everything is just as the new graduate imagined - excitement about starting a new job and getting paid (no more free work) - Everything is great; the new nurse is optimistic

Answer 230

- Orientation is over; the new nurse is taking their own assignment - faces conflicting viewpoints and different ways of doing skills (question if other nurses care about patient) - Feels like it is “sink or swim” alone - May Withdraw, isolate, lack of confidence Care - What kind of nurse do I want to be? - What do I need to do to ensure my work as a nurse contributes to society?

Answer 231

“Go Native” - Adopt ways of least resistance - be like experienced nurses - takes shortcuts (wing it) “Runaway” - New world is too difficult and leave nursing find new career or return to school “Rutters” - Adopt attitude you will do what you must do to get by i.e. nursing = just a job (working to buy stuff)

Answer 232

- Return of a sense of humor (1st sign) - less tension and anxiety as the new nurse begins to understand the culture they are working in - Increased coping ability

Answer 233

- grow as person and a professional - work expectations are more easily met - successful transition to being confident and competent practitioner

Answer 234

“Burned Out” - bottle up conflict until they are burned out - Have fatigue, sleep disturbances, difficulty with relationships, increased anxiety, illness, and potential for alcohol + drug abuse - Patient may feel they have to “nurse the nurse” “Compassion Fatigue” Aka – negative cost of caring - Emotional and physical exhaustion - Diminished ability to have compassion for others - feels detached, Irritable, angry, difficulty coping

Answer 235

“Loners” - Adopt attitude it is just a job and be quiet - Typically, a night shift nurse “New Nurse on the Block” - Job hopping - Always new on the job and in orientation “Change Agents” - New nurse cares enough to work within system to elicit changes (innovative) - Presents new ideas to nurse manager to improve environment - Incorporates values of organization while remaining true to selves and their beliefs

Answer 236

- Person you select and develop relationship (not same as preceptor) - Discuss issues and concerns with them (Safe person) - Helps you recognize your strengths and weaknesses - Provide you emotional support and guidance - Help you set goals and determine appropriate course of action