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Leadership > Final Exam > Flashcards

Final Exam Flashcards

1
Q

General tips for cover letter (4)

A
  • no abbreviations
  • mention mission and value of org to show you’ve done your research
  • include date so they review yours prior to others
  • no errors b-c errors indicate you do not pay attention to detail
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2
Q

Purpose of cover letter (2)

A
  • function as first impression alongside resume
  • convey to recruitment and manager that you are different and will be good fit
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3
Q

Cover Letter: Introductory Paragraph (5)

A
  • Do not start with “My name is…”
  • Where you are graduating from
  • When you graduate
  • What are you graduating with
  • Where you are interested in working (Avoid being too specific or too broad)
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4
Q

Cover Letter: Content/Mission Paragraph (4)

A
  • mention strengths and skills
  • Mention past jobs, what you learned, and how the skill set will make you a better nurse
  • Avoid ”I am an excellent nurse” b-c it is pompous and a lie (may give off narcissistic vibes)
  • Be positive and demonstrate self-confidence
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5
Q

Cover letter: Conclusion (2)

A
  • Request an interview with hours you’re available between 8-5 so no evening hours
  • End with written handshake “ I look forward to meeting with you to discuss available positions”
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6
Q

Composition of Resume (6)

A
  • contact info (name, address)
  • professional objective
  • education
  • experience
  • certification (include expiration date)
  • Honors
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7
Q

Resume: Education (5)

A
  • all colleges attended and high school)
  • Expected date of graduation or graduation month and year
  • Degree obtained (or purpose if no degree)
  • City, state (only thing that can be abbreviated is state)
  • GPA (can be included or excluded; not customary to put; usually just last degree)
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8
Q

Resume: Experience (5)

A
  • only work experience (community service in separate section)
  • dates on right margin
  • label in reverse chronological order
  • include organization, job title, city, state
  • main job responsibilities (bulleted and past tense
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9
Q

Resume

What is it?
General tips (4)

A
  • short account of career or professional life that reflects work experience and education

General tips
- accurate and truthful (do not misrepresent your skill set)
- be careful about verbiage (i.e. Nursing assistants do not assess patients; Nursing assistant != certified nursing assistant)
- make sure cover letter and resume info match
- Do not include references (If putting someone as a reference, you must talk to them first and get their permission)

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10
Q

Resume: Objective statement (5)

A
  • one or two sentences long
  • tailored to the job being applied for
  • consider the type of career you are seeking
  • describes attributes that make you the ideal candidate
  • Reminds whoever is reading your resume about what you are looking for
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11
Q

Tips for Background checks (4)

A
  • Can only go back 7 years
  • Multistate check
  • Arrests show up for 7 years
  • Conviction of crime shows indefinitely
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12
Q

Tips for Drug Screens (3)

A
  • Report any prescription drugs to avoid trouble
  • Marijuana detectable for 30 days in urine
  • Cocaine detectable for 3 months in blood
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13
Q

Interview Process

  • Screening (2)
  • Interview (who is it done by?)
  • post interview (4)
  • Job offer (3)
A

Screening
- may be personality test (do in one sitting)
- may include phone interview

Interview (panel, recruiter, department)

Post interview
- thank you note
- background check and drug screen must be done prior to starting
- job testing (physical assessment)
- call after 1-2 weeks if no follow-up from employer (ask if they need anything else from you

Job offer
- be thoughtful and not impulsive about accepting a position
- ensure position aligns w/ your care goals and is a good git
- Company things consider: tenure, education mix of staff, unions, compensation

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14
Q

Types of Interview

  • video conference (3)
  • telephone (3)
A

Video Conference
- Dress appropriately w/ conservative colors
- Have your resume on hand for reference
- Write notes if needed

Telephone
- Typically for screening
- Listen carefully to questions then give thoughtful response
- It is okay to ask for question to be repeated (but not every question

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15
Q

Tips for Answering Interview Questions (5)

A
  • Explain why you chose to apply to that hospital (ex. previous experience as patient)
  • If asked about strengths and weaknesses, be honest (no weaknesses is a red flag)
  • If Tell me about a time is asked, give example
  • If why should I hire you is asked, talk about your strengths
  • If where do you see yourself in 1 year asked, be honest
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16
Q

Do’s of interview (5)

A
  • Smile and be pleasant and respectful (no sitting till asked)
  • Review values of organization prior to interview
  • Make eye contact
  • Dress appropriately (suit, dress, slacks; no bulky jewelry or blue jeans or shorts, no perfume or cologne; no open toe shoes)
  • Always have 1-2 questions in your mind b-c no questions shows not interests; can say what you were going to ask if they already answered your questions (residency/orientation programs, response to nurse manager, benefits and pay, unit stability (average nursing tenure, vacancy rate))
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17
Q

Don’ts of Interview (4)

A
  • Do not say negative things about previous managers
  • No mints, gums, food
  • Mute and do not check phone
  • Do not talk too much
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18
Q

Illegal Interview Questions (8)

A
  • Age
  • Race, ethnicity, or color
  • Gender or sex
  • Country of national origin or birthplace
  • Religion
  • Disability
  • Marital or family status or pregnancy
  • Financial/credit status
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19
Q

Post Interview: thank you note

Components (4)
Notes (2)

A

Components
- position you are seeking
- what you found most interesting about interview
- answer any question you were unable to answer
- thank for their time

Notes
- handwritten and mailed 1-2 days after interview
- do even if bad interview

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21
Q

Types of Interview

  • in person (4)
A

In person
- Plan to spend several hours at hospital
- If tour not offered, ask for one to see staff interactions and climate on unit (assignment boards for nurse/CAN ratio, secretary, physician interactions)
- Bring two copies of your resume (1 for you to reference)
- Arrive 10-15 minutes early and account for traffic (on time = late)

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21
Q

Mission Statement

Ex. “In keeping with the three-fold ministry of Christ — Healing, Preaching and Teaching — Baptist Memorial Health Care is committed to providing quality health care.”

A
  • describes purpose of organization and reason it exists
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22
Q

Vision Statement (2)

Ex. “We will be the provider of choice by transforming the delivery of health care through partnering with patients, families, physicians, care providers, employers and payers; and by offering safe, integrated, patient-focused, high quality, innovative and cost-effective care.”

A
  • desired state that organization wants to be in
  • describes future goals or aims of the organization
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23
Q

Core Values (2)

Ex. trust, goals, teamwork, innovation, ethics, responsibility, customers

A
  • beliefs that guide organization’s activities
  • do not change regardless of what is happening to the organization
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24
Q

Philosophy (5)

Ex. “We believe that a strong patient/physician relationship is at the heart of good health care. We also recognize that part of that relationship is making sure that our patients’ needs, and expectations, are always met.”

A
  • explanation of the systems of belief that determine how the mission and vision will be achieved
  • guiding principle of organization’s behavior
  • basis of organizational planning
  • abstract
  • usually starts with “we believe”
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25
Q

Policy
- What is it?
- Purpose (3)
- Who does it apply to ?

Ex. Attendance, consent, patient privacy, handwashing, DNR orders

A

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

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26
Q

Procedure
- What is it?
- Who does it apply to?
- Components (4)

Ex. Foley insertion, codes, wound care, Invasive procedures (IV, PICC)

A

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

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27
Q

Role of Regulatory Agencies (5)

A
  • 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
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28
Q

Non Governmental Regulatory Agencies

How they work? (2)

Ex.
- The Joint Commission
- Det Norske Veritas Healthcare Inc. (DNVHC)
- Healthcare Facilities Accreditation Program (HFAP)
- Center for Improvement in Healthcare Quality (CIHQ)

A
  • granted deeming authority from CMS to accredit orgs
  • Hospitals must meet conditions of participation from CMS and individual agency’s standards
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29
Q

Center of Medicare and Medicaid Services (CMS)

What is it?
What are the conditions of participation? (3)

A

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)

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30
Q

Management Functions: Planning (6)

A
  • 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

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31
Q

Management Functions: Organizing (5)

A
  • 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)
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32
Q

Management Functions: Staffing (4)

A
  • 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

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33
Q

Management Functions: Directing (5)

A
  • 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
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34
Q

Management Functions: Controlling (4)

A
  • 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
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35
Q

Leadership Theories: Contingency/Situational Theory
- What it says? (3)
- What does it require? (3)

Ex. Patient vs CNA complaints are handled differently (patient may need nonconfrontational and polite communication; CNA may require telling to reinforce task)

A
  • 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

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36
Q

Leadership Theories: Trait Theory
- What is it? (2)
- What is the problem?

Ex. knowledge, initiative, tenacity, energy, decision making skills, flexibility, creativity, charisma, emotional intelligence, drive and motivation, confidence, honesty, integrity

A
  • 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
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37
Q

Leadership Theories: Systems Theory

What is it? (3)
When is it difficult to implement?

A
  • 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
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38
Q

Leadership Theories: Chaos Theory (2)

Ex. people responding to a code

A
  • degree of order can be obtained by viewing complicated behaviors and situations as predictable
  • Variation in these situations is normal
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39
Q

Leadership Theories: Complexity Theory (3)

Ex. History of blood pressures says more about patient than one moment in time blood pressure b-c discusses relationships b/w blood pressures

A
  • 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
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40
Q

Transactional Leadership: Leader’s behavior (5)

A
  • 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
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41
Q

Transactional Leadership: Followers (3)

A
  • Fulfills the contract or get punished
  • Does the work and gets paid
  • Errors are corrected in a reactive manner
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42
Q

Transactional Leadership: Organizational Outcomes (4)

A
  • 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)
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43
Q

Transformational Leadership: Leader behavior (5)

A
  • 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
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44
Q

Transformational Leadership: Followers (4)

A
  • 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
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45
Q

Transformational Leadership: Organizational Outcomes (3)

A
  • 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)
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46
Q

Autocratic Leadership

What is the downside?
What is criticism?
When is it effective?

A

Downside: Emphasis on I and not we which can stifle innovation and creativity

Criticism: punitive

Effective: those w/ little formal education or in emergencies

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47
Q

Democratic Leadership

What is it?
Manager Characteristics (2)

A
  • 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)

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48
Q

Laissez Faire Leadership

What is it?
Manager Characteristics (3)

A
  • 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”)

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49
Q

Laissez Faire Leadership

What is the downside?
What is criticism?
When is it effective?

A

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

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50
Q

Democratic Leadership

What is the downside?
What is criticism?
When is it effective?

A

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

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51
Q

Autocratic Leadership

What is it?
Manager Characteristics (3)

A
  • 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

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52
Q

Position Power (Direct)

  • Legitimate
  • Reward
  • Coercive
A

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

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53
Q

Personal Power (Indirect)

  • Referent
  • Expert
  • Information
  • Connection
A

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

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54
Q

Performance Appraisal

What is it?
Timing

A

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

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55
Q

Performance Appraisal: Purposes

  • Administrative (3)
  • Measurement (2)
A

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

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56
Q

Performance Appraisal: Purposes

  • Development (3)
  • Relationship (3)
A

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

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57
Q

Performance appraisal

How to choose a tool? (3)
Who should appraiser be? (3)

A

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

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58
Q

4 Types of Performance Appraisals

What is the type?
What is the problem with the type?
When is the type useful?

A

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

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59
Q

Bias in Performance Appraisals

  • Halo effect
  • Recency
  • Leniency (2)
  • Similar to me
A

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

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60
Q

Bias in Performance Appraisals

  • Contrast
  • Horns effect
  • Central Tendency (2)
A

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

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61
Q

Grounds for immediate Termination (2)

A
  • abuse or mistreatment of patient
  • substance abuse on the job (hospitals can do on the spot drug screen)
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62
Q

Notes on Disciplinary process (3)

A
  • 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
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63
Q

Disciplinary Process
- Verbal Warning (2)
- Written Warning (4)

A

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)

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64
Q

Disciplinary Process
- Suspension (3)
- Termination

A

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

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65
Q

Performance Improvement Plan

Purpose
Components (4)

A

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

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66
Q

Factors that interfere w/ culture of safety (6)

A
  • 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)
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67
Q

Culture of Safety (4)

A
  • 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
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68
Q

Why is safety important? (3)

A
  • key component in accreditation process
  • TJC requires formal safety program
  • allows nurse to coordinate quality care for patients
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69
Q

Key findings from IOM Report: To Err is Human: Building a Safer Health System (5)

A
  • 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)
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70
Q

AHRQ’s 8 Common Root Causes of Medical Errors:

A
  • 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
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71
Q

Goal of IOM Healthcare Quality Initiative (3)

A
  • improve health of population
  • enhance experience + outcome of patients
  • Reduce per capita cost of care
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72
Q

IOM STEEEP Principles

A
  • 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
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73
Q

10 principles of Redesign of Healthcare

A
  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
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74
Q

Components of Healthcare Safety: Patient-Centered Care (4)

A
  • 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
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75
Q

Components of Healthcare Safety (6)

A
  • 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
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76
Q

Just Culture: Human Error

What is it?
Care for it?
Management for it?

A
  • Product of current system design or flaw

Care: console and teach vs punish person

Managed through choices, processes, procedures, training, design, environment

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77
Q

What is a Just Culture? (3)

A
  • 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
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78
Q

Pros of Just Culture (4)

A
  • 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)
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79
Q

Just Culture: At-risk behavior

What is it?
Care for it?
Management for it? (3)

A
  • 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

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80
Q

Just Culture: Reckless Behavior

What is it?
Care for it?
Management for it? (2)

A
  • Conscious disregard of substantial and unjustifiable risk i.e. person completely ignoring the safety steps

Care: punish

Managed through remedial and punitive action

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81
Q

What are Standards of Quality? (3)

Ex. Sponges accounted for in surgery; want 100% accounted for

A
  • 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)
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82
Q

Model of Quality: PDSA (4)

A

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.

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83
Q

Components of Standards of Quality (3)

A

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)

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84
Q

Process Improvement Tools

  • Flow chart
  • Pareto chart
  • Fishbone chart
A
  • 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)
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85
Q

Process Improvement Tools: Root Cause Analysis

Purpose
Steps (5)

A
  • 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

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86
Q

Roles in Quality improvement: Executive Team (6)

A
  • 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
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87
Q

Roles in Quality improvement: Nurse Manager (3)

A
  • responsible for quality and safety over unit/department
  • Meet regularly w/ employees to communicate and monitor progress
  • document performance and share across department
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88
Q

Roles in Quality improvement: Staff (5)

A
  • 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
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89
Q

Hospital Consumer Assessment of Healthcare Providers + Systems: HCAHPS

Basics (4)

A
  • 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)
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90
Q

HCAHPS

  • Eligibility Criteria (6)
  • Exclusions (4)
A
  • 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)

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91
Q

HCAHPS: Uses (3)

A
  • 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
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92
Q

HCAHPS: Domains (10)

A
  • 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
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93
Q

HCAHPS: 3 goals

A
  • 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
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94
Q

Health Information for Economic + Clinical Health Act (HITECH)

Purpose (2)
Unintended consequences (4)

A
  • 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

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95
Q

Meaningful Use: Examples

Purpose of both

CPOE (2)
Bar Code Scanning (2)

A

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

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96
Q

Meaningful Use: Priorities (5)

A
  • 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)
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97
Q

Meaningful use: Basics (3)

A
  • 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
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98
Q

Risk management

What is it?
Responsibilities (3)

A
  • 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

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99
Q

Risk Manager: Role (9)

A
  • 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
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100
Q

Mandatory Event Reporting (15)

A
  • 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
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101
Q

Healthcare law: EMTALA (Emergency Medical Treatment and Labor Act)

Basics (4)

A
  • 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
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102
Q

Unusual Occurrence Report/Incident Report:

Tips (6)

A
  • 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
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103
Q

Sentinel Event: Types (11)

A
  • 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
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104
Q

Unusual Occurrence Report/Incident Report:

When to file? (5)

A
  • Patient injury
  • Unanticipated patient death
  • Malfunction or failure of equipment
  • Adverse events related to patient care
  • Safety issues related to the physical environment
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105
Q

Standardization

Definition

Types
- Clinical protocol - 2
- Critical/Clinical Pathway - 2

A
  • 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

106
Q

Sentinel Event: Basics (3)

A
  • 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
107
Q

Never Event: definition

Ex. Stage 3 or 4 pressure ulcer, DVT, fall, HAI, air embolism, blood incompatibility, poor glycemic control

A

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.

108
Q

How to avoid risk management issues (9)

A
  • 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
109
Q

Health Insurance Portability and Accountability Act (HIPAA)

Basics (2)
What to know (5)

A

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

110
Q

Healthcare law: Patient Self-determination Act

Basics (2)
Concerns (2)

A
  • 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

111
Q

Differences between the following:

Nurse Practice Act (7)

A
  • 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 requirementsnecessary 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
112
Q

Nurse Practice Act: Behaviors that represent misconduct (11)

A
  • 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)
113
Q

Differences between the following:

Board of Nursing (2)
Nursing License (2)

A

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

114
Q

Negligence: Most common charges that become Malpractice (6)

A
  • 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
115
Q

Negligence: Definition (2)

A
  • 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)
116
Q

Malpractice: Basics (3)

A
  • 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)
117
Q

Elements of Malpractice

  • Duty Owed the Patient - 2
  • Breach of the Duty of Care Owed the Patient- 1
  • Foreseeability - 1
  • Causation - 2
  • Injury - 2
  • Damages - 1
A

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

118
Q

Malpractices: Causes for Nurse Managers (5)

A
  • 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)
119
Q

Healthcare Laws

Title VI - 1
Age Discrimination in Employment act - 2
Equal Pay Act of 1963 - 1
Family and Medical Leave Act - 2

A

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)

120
Q

Healthcare Law: Occupational Safety and Health Act (OSHA)

What is it?
Includes (4)

A
  • 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)

121
Q

Healthcare Law: American with Disabilities Act (4)

A
  • 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
122
Q

Healthcare Law: Good Samaritan Law

Basics (2)
Requirements if you stop (3)

A
  • 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

123
Q

Ethical Principles: Definition and Leadership Perspective

Autonomy
Beneficence
Nonmaleficence

A

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

124
Q

Differentiate the following:

Ethical Dilemmas - 1
Moral Courage - 2
Moral Dilemma - 1

A

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

125
Q

Ethical Principles: Definition and Leadership Perspective

Veracity
Fidelity
Justice

A

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

126
Q

Types of Change

Planned (2)
Unplanned (3)

A

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)

127
Q

Lewin’s Change Theory: Three stages

A

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

128
Q

Lewin’s Change Theory: Unfreezing Stage

Manager’s role (5)

A
  • 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
129
Q

Lewin’s Change Theory: Moving Stage

Manager’s role (8)

A
  • 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
130
Q

Lewin’s Change Theory: Refreezing Stage

Manager’s role (3)

A
  • Inspect and reinforce positive behavior to hardwire change
  • respond to employee concerns
  • ensure everyone is doing what they should be
131
Q

Force Field Analysis

  • What is it?
  • Driving Forces
    (Ex. scheduling, informal leaders that encourage everyone to do walking rounds)
  • Restraining Forces
    (Ex: employees that don’t want to participate and protest changes; employee fear)
A
  • 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

132
Q

How do Lewin’s Theory of Change match up with nursing process and problem solving?

A

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

133
Q

Lewin’s rules for Implementing Change (7)

A
  • 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
134
Q

Budget: Basics (4)

A
  • 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
135
Q

Budgeting Process: 4 steps

A
  • Planning
  • Coordinating & Communicating
  • Monitoring Progress
  • Evaluating Performance
136
Q

Budgeting Process:

  • Planning (4)
  • Coordinating and Communicating (2)
A

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

137
Q

Budgeting Process:

  • Monitoring Progress (2)
  • Evaluating Performance (3)
A

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

138
Q

Variance

What is it?
Favorable vs unfavorable

A

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)

139
Q

Factors that cause Variance (5)

A
  • 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
140
Q

Differentiate the Following:

Productive time
Nonproductive time

A

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

141
Q

Budgets: Operational Budget (4)

A
  • 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
142
Q

Budgets: Labor Budget (4)

A
  • 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
143
Q

Budget: Capital Budget (5)

A
  • 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
144
Q

Budget: Cash budget (3)

A
  • Money that flows in and out of organization
  • Includes billing + collections, cash on hard
  • Helps CFO know if they are spending budget productively.
145
Q

Budgeting Methods

Incremental (2)
Zero-based budgeting (3)

A

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

146
Q

Unit of Service

What is it?
What are the unit of services for:
- Nursing Units
- Cath lab
- OR/PT/OT
- Home health

A

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
147
Q

Budgeting: Nurse Manager’s Role (6)

A
  • 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)
148
Q

Healthcare Reimbursement/Financing: Value Based Purchasing

4 domains (each 25% of score)

A
  • Safety
  • Patient and Community engagement (HCAHPS)
  • Efficiency and Cost Reduction (spending per hospital Patient with Medicare Beneficiary)
  • Clinical Outcomes
149
Q

Staffing

Basics (4)

A
  • 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)
150
Q

Staffing: Outcomes of Adequate Staffing (9)

A
  • 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
151
Q

Goal of Staffing (4)

A
  • 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
152
Q

HPPD: Hours per patient day

What is it?
What is the problem?

A
  • 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

153
Q

Scheduling

Definition
Types (4)

A

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

154
Q

Define the following:

Patient Acuity (3)
Nursing intensity

A

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

155
Q

Factors that affect patient acuity (9)

A
  • 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
156
Q

Models of Nurse Staffing

  • Budget based on HPPD (2)
  • Nurse-patient ratio (3)
  • Patient acuity (3)
A

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

157
Q

Productivity Index

Basics
Factors (4)

A

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)

158
Q

Factors Impacting Staffing Requirements

  • Nursing Leadership Considerations (9)
A
  • 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
159
Q

Factors Impacting Staffing Requirements

  • Staff Preparation (3)
A
  • 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
160
Q

Factors Impacting Staffing Requirements

  • Organizational Needs (4)
A
  • 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
161
Q

Scheduling: Decentralized

Basics
Pros (2)
Cons (2)

A

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

162
Q

Scheduling: Centralized

Basics
Pros (5)
Cons (2)

A

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

163
Q

Patient Assignments

  • Acuity (3)
  • Block (3)
A

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

164
Q

Nursing Care Delivery Models

What is it?
What does it describe? (3)

A
  • 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

165
Q

Total Patient Care

What is it? (2)
Where is it used?
Pros (3)
Cons (2)

A
  • 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)

166
Q

Functional Nursing

What is it? (3)
Pros (3)

A
  • 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

167
Q

Team Nursing

What is it?
Requirements of team leader (4)

A
  • 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)

168
Q

Primary Nursing

What is it? (2)
Requirement of Primary Nurse (4)
Where is it used?

A
  • 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

169
Q

Functional Nursing

Cons (5)

A

Cons
- fragmented care
- huge potential to overlook priority needs of itssince 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

170
Q

Team Nursing

Pros (2)
Cons (2)

A

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

171
Q

Delegation Errors

  • Reasons for Under Delegating (6)
A
  • 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
172
Q

Delegation Errors

  • Reasons for Over delegating (3)
  • Reasons for Improper Delegation (4)
A

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

173
Q

Communication Styles

  • Assertive (5)
A

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

174
Q

Communication Styles

  • Aggressive (4)
A

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

175
Q

Communication Styles

  • Passive (4)
A

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

176
Q

Communication Styles

  • Passive Aggressive (4)
A

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)

177
Q

Characteristics of Team

  • Functional (7)
A
  • 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
178
Q

Characteristics of Team

  • Dysfunctional (5)
A
  • 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
179
Q

Delegation

Definition

A

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

180
Q

Safe delegation practices

Know (5)

A

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)

181
Q

Define:

  • Accountability (2)
  • Responsibility
  • Supervision
  • Assignment (2)
A

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

182
Q

Delegation: Delegator’s Accountability (7)

A
  • 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
183
Q

Delegation: Delegatee’s Accountability (6)

A
  • 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
184
Q

Delegation: Organization’s Responsibilities (4)

A
  • 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
185
Q

Things to never delegate (3)

A
  • Nursing Process (assessment, diagnosis, planning, and evaluation) –Implementation depends on the task to be delegated
  • Patient education
  • tasks that requires clinical judgement
186
Q

Five Rights of Delegation (5)

A
  • Right Task
  • Right Circumstance
  • Right Person
  • Right Direction/Communication
  • Right Supervision and Evaluation
187
Q

Delegation: Right Task (5)

A

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
188
Q

Delegation: Right circumstance (4)

A
  • 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
189
Q

Delegation: Right Person (2)

A
  • Appropriate knowledge and skill to perform the task
  • Within their job description, policies and procedures, nurse practice act
190
Q

Delegation: Right Direction/communication (4)

A
  • Clear directions
  • Expected outcome
  • When, how, what they need to report back to you
  • Allow for questions/feedback/clarity
191
Q

Delegation: Right Supervision and Evaluation (6)

A
  • RN ALWAYS RESPONSIBLE FOR SUPERVISION either directly or indirectly (Provision of guidance, oversight, and follow-up of the accomplished nurse )
  • Create environment of trustand 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
192
Q

Common UAP tasks (6)

A
  • 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)
193
Q

Common LPN tasks (9)

A
  • 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
194
Q

Levels of Supervision (3)

A

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

195
Q

Safe delegation Practices

Tips (6)

A
  • 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
196
Q

Communication:

Definition

Notes (4)

A
  • 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

197
Q

Elements that influence Communication (Feedback loop)

  • interpretation (2)
  • filtration (3)
  • feedback (3)
A

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

198
Q

Positive Communication Techniques

  • Develop Trust (3)
  • Use “I” messages (2)
  • Establish Eye Contact (3)
A

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)

199
Q

Positive Communication Techniques

  • Keep Promises (3)
  • Express Empathy (2)
  • Use open communication (2)
A

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?

200
Q

Positive Communication Techniques

  • Clarifying Information (1)
  • Being Aware of Body Language (3)
  • Using Touch (3)
A

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

201
Q

Negative Communication techniques

  • closed communication styles (1)
  • blocking (3)
  • false reassurances (2)
  • conflicting messages (1)
A

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

202
Q

Logical Fallacies

Basics (3)

A
  • 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
203
Q

Logical Fallacies: Types

  • Ad hominem abusive (2)
  • Appeal to Emotion (1)
  • Red Herring (1)
A

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”

204
Q

Active Listening Techniques (8)

A
  • 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”)
205
Q

Conflict

Basics (3)

A
  • 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
206
Q

Conflict: Constructive effects (7)

A
  • 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
207
Q

Conflict: Destructive effects (5)

A
  • 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
208
Q

Factor underlying conflict (4)

A
  • 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
209
Q

Types of conflict

  • Relationship
  • Task
  • Process
A

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

210
Q

Types of conflict

  • intrapersonal (2)
  • interpersonal (2)
  • intragroup (1)
  • intergroup (2)
  • organizational (2)
A

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

211
Q

Causes of conflict: individual (4)

A
  • Personality differences
  • Value differences
  • Ineffective communication
  • Diversity r/t age, gender, race, or ethnicity (Older vs younger nurses)
212
Q

Causes of conflict: organizational (4)

A
  • 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)
213
Q

5 Stages of Conflict

A

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)

214
Q

Conflict resolution
- negotiation (2)
- mediation (2)
- arbitration (4)

A

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

215
Q

Conflict Management Styles

  • Avoidance/Withdrawing (4)
  • Smoothing (4)
A

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

216
Q

Conflict Management Styles

  • Competing/Coercing (4)
  • Cooperating/Accommodating (4)
A

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

217
Q

Conflict Management Styles

  • Compromising/Negotiating (2)
  • Collaborating (3)
A

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

218
Q

Disruptive Roles in Teams (definition and how to deal with the role)

  • compulsive talkers (2)
  • nontalkers (2)
  • Distracted or unreliable members (2)
A

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

219
Q

Disruptive Roles in Teams (definition and how to deal with the role)

  • Interrupters (3)
  • Squashers (4)
A

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

220
Q

DECIDE Model (6)

A
  • 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)

221
Q

Principles of Prioritization (8)

A
  • 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
222
Q

Prioritizing Traps to Avoid (4)

A
  • 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
223
Q

TIme Management Distractors (and how to manage them)

  • Complaining (1)
  • Perfectionism (3)
  • Interruptions (2)
  • Disorganization (3)
A

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

224
Q

Questions to ask yourself when prioritizing: (5)

A
  • 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?
225
Q

TIme Management Distractors (how to manage them)

  • Doing too much (3)
  • Inability to say “no or not now” (2)
  • Procrastination (2)
A

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

226
Q

Horizontal Violence

Definition (2)

A
  • conflictual behaviors among individuals who consider themselves peers with equal power
  • an act of aggression toward another colleague
227
Q

Horizontal violence

Impact (8)

A
  • Low morale in staff
  • Stress
  • Sleep disturbances
  • Health complaints
  • Increased absenteeism
  • work-related suicide
  • Turnover
  • Higher cost
228
Q

Types of disruptive behavior: Bullying

  • Definition (4)
A
  • 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)
229
Q

Types of disruptive behavior

Cyberbullying
Verbal Bullying
Physical Bullying

A

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

230
Q

Types of disruptive behavior

  • Incivility (2)
  • Exclusion
A

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

231
Q

Types of disruptive behavior: Bullying

Impact (5)

A
  • Psychological and physical stress
  • Professional disengagement
  • Underperformance
  • Increase job turnover
  • DECREASE in quality of patient care
232
Q

Workplace violence: TJC Categories (4)

A
  • Person causing violence has no relation to hospital
  • Customer or patient of org
  • Current or former employer
  • Caused by spouse or partner of employee
233
Q

Patient Violence

General notes (5)

A
  • 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
234
Q

Patient Violence

  • Common Triggers (8)
A
  • 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
235
Q

Patient Violence

  • Predisposing Factors (6)
A
  • 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
236
Q

Warning Signs of Violence: STAMP

A

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

237
Q

Patient Violence

  • Behavioral Cues to observe (8)
A
  • 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
238
Q

Strategies to Keep Yourself Safe Against Patient violence

Things to assess (5)

A
  • 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
239
Q

Strategies to Keep Yourself Safe Against Patient violence

How to respond (6)

A
  • 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
240
Q

Strategies to Keep Yourself Safe Against Patient violence

Communication Strategies (9)

A
  • 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
241
Q

Emergency Preparedness Plan

TJC Requirements of all facilities (5)

A
  • 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
242
Q

Phases of Disaster: Preparedness (3)

A
  • 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
243
Q

Phases of Disaster: Relief Response (6)

A
  • 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
244
Q

Phases of Disaster: Recovery (3)

A
  • Starts within 72 hours AFTER disaster
  • Continues for to 2-3 years
  • Building and rehabilitation
245
Q

Emergency Designations (3)

A
  • Level 1 Emergency: localized incident (Memphis)
  • Level 2 Emergency: regional incident (Shelby county or west Tennessee)
  • Level 3 Emergency: national incident (United States)
246
Q

Emergency Operating Plan: Key Components (9)

A
  • 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
247
Q

Emergency Operating Plan: Necessary Roles (8)

A
  • Incident commander
  • Public information officer (talks to press)
  • Safety officer
  • Liaison officer: communicates w/ other hospitals
  • Operations: oversee hospital operations
  • Planning
  • Logistics
  • Finance/administration
248
Q

Emergency Operating Plan: Key Components

  • Triage (2)
  • Surge Capacity (1)
  • Continuity of Services (2)
A

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

249
Q

Emergency Operating Plan: Key Components

  • Human Resources (2)
  • Post-disaster Recovery (2)
A

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.

250
Q

Emergency Operating Plan: Key Components

  • Command and Control (3)
  • Communication (4)
A

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

251
Q

Transition into Practice

  • Normal feelings when go from SN to RN (6)
A
  • 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
252
Q

Reality Shock

  • Basics (2)
  • Phases (4)
A

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

253
Q

Reality Shock: Honeymoon phase (3)

A
  • 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
254
Q

Reality Shock: Rejection/Shock Phase

  • What happens? (4)
  • Questions to ask self (2)
A
  • 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?

255
Q

Reality Shock: Reactions to Rejection/Shock Phase

  • “Go Native” (3)
  • “Runaway” (1)
  • “Rutters” (1)
A

“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)

256
Q

Reality Shock: Recovery Phase (3)

A
  • 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
257
Q

Reality Shock: Resolution Phase (3)

A
  • grow as person and a professional
  • work expectations are more easily met
  • successful transition to being confident and competent practitioner
258
Q

Reality Shock: Reactions to Rejection/Shock Phase

  • “Burned Out” (3)
  • “Compassion Fatigue” (3)
A

“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

259
Q

Reality Shock: Reactions to Rejection/Shock Phase

  • “Loners” (2)
  • “New Nurse on the Block” (2)
  • “Change Agents” (3)
A

“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

260
Q

Role of a mentor (5)

A
  • 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

Leadership (4 decks)

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