Leadership Flashcards
Healthcare delivery system
Goals; Cost-effective, high-quality care
-Decreased costs, improved outcomes for groups of clients
Healthcare providers, agencies collaborate
Managed Care
Coordinate, facilitate, follow clients use of health, social services over time
Insurance-based
Identify specific cases that most benefit
Professionals include nurse, social workers
-sometimes referred to as discharge planners
Case Management
Total Care
- One nurse assigned to comprehensive care of clients during an 8 to 12 hr shift.
- Client has consistent contact of one nurse during shift but different nurses on other shifts
- Precursor of primary nursing
- Continues to be used in intensive care nursing
Case method
Focuses on jobs to be completed
-bed making
-temperature measurement
Based on production and efficiency model giving authority, responsibility to person assigning the work
Disadvantages:
-Fragmentation of care
-Emotional needs of client may be overlooked
Functional Method
Consists of:
RN’s
LPN’s
-provide direct client care under direction of RN, physician, other licensed practitioner
UAP’s
-assume delegation aspects of basic client care
Team Nursing
One nurse responsible for overseeing total care of a number of clients 24/7
-Even if nurse does not deliver all care personally.
Uses technical knowledge, management skills
Primary Nursing
Two or more people working toward a common goal by combining skills, knowledge, and resources
- avoiding duplication of effort
- Goal: improve client outcomes
Collaboration
Between nurses, between healthcare providers and clients, between healthcare providers from different professional backgrounds
- ANA standards of professional Nursing Practice
- includes identifying and acknowledging expertise of those inside and outside nursing profession
- includes referring client to others in order to meet client’s needs
The Nurse as Collaborator
Objectives-high quality client care and client satisfaction
Care becomes client-centered and client-directed.
Healthcare providers from variety of disciplines work in tandem with clients and communities.
Greater autonomy for both nurses, clients
Collaborative Practice
Can only be effective if each team member commits to understanding each member’s specific role, appreciates member as individual
Communication skills
When two or more individuals show, feel honor or esteem toward one another
Mutual respect
Individual confident in actions of another individual
Trust
- Expressed verbally, nonverbally
- Magnet hospitals foster respect among professionals
Mutual Respect and Trust
Shared responsibility for outcome
Facilitated by mutual respect; timely, effective feedback
Requires full consideration of, respect for diverse viewpoints
Identify, give priority to discipline best able to address client’s needs
Decision Making
- Conflict inevitable in workplace
- Although viewed as negative, conflict can be impetus for better communication, stronger team relationships, healthy changes
Conflict Management
Healthy People Initiatives:
- Focus of health care changing: clients demand comprehensive, compassionate, affordable care
- Clients have greater knowledge, expect to be involved in decisions
- Clients assuming more responsibility for their health, view healthcare professionals as resource
Collaboration and the Healthcare Consumer
Examine the nurses (and the student nurse) responsibility related to Chain of Command
Leadership Exemplar
-Chain of Command
Provides structure for reporting and helps employees manage supervisory relationships
- Authority and Responsibility
- Line Authority
- Staff Authority
Chain of Command
Power to command
Authority
being accountable
Responsibility
Directs activities of subordinates
Line Authority
Provides advice and support
Staff Authority
Describe the need for responsibility, accountability, and authority when delegating.
Distinguish how effective delegation benefits the delegator, the delegate, and the organization.
Delegation
- transference of responsibility, authority to competent individual
- assumes responsibility, assigns task, retains accountability
- Delegator can devote time to other tasks
- Increase skills, abilities of delegate
- Difficult leadership skill; confusion over who is allowed to do which tasks
- Critical skills for nurses; accomplish more by using others’ help
Overview of Delegation
RN’s increasingly delegate components
- To other RN’s, LPN’s
- To “nurse extenders”; unlicensed assistive personnel (UAP)
- Certified nursing aide or assistant (CNA)
- Home health aide (HHA)
- Client care technician
- Orderly
- Surgical technician
Principles of Delegation
- Taking vital signs
- Measuring I & O
- Client transfers
- Ambulation
- Postmortem care
- Bathing
- Feeding; gastrostomy feedings in established systems
Tasks that may be delegated to UAP
Attending to safety Weighing Performing simple dressing changes Suctioning of chronic tracheostomies Performing basic life support (ie. CPR)
Tasks that may be delegated to UAP’s
Assessment Interpreting data Making a nursing diagnosis Creating a nursing care plan Evaluating care effectiveness
Care that may Not be delegated to a UAP
Care of invasive lines Administering parenteral medications Inserting NG tubes Client education Performing triage Giving telephone advice
Tasks that May Not be delegated to a UAP
Delegating to Unlicensed Assistive Personnel -Nurse must assess first -Client medically stable, or chronic -Task must: Be considered routine for this client Not require substantial scientific knowledge, technical skill Be considered safe for this client Have predictable outcome
Principles of Delegation
Nurse must:
- Learn agency policies
- know scope of practice
- Be aware of variation in ability
- Observe if unsure of abilities
- Clarify reporting expectations
- Create positive atmosphere
Delegating to Unlicensed Assistive Personnel
-Must understand for ea. client: Task to be done When task is to be done Expected outcome for ea. task -Who is available as a resource -When and in what format report expected -Specific tasks
Delegating to Unlicensed Assistive Personnel
-Benefits to the nurse
More time for complex client care
-Benefits to the delegate
Allows delegates to gain new skills, abilities
Bring trust and support
-Benefits to the manager
More time for tasks that cannot be delegated
-Benefits to the organization
Overtime, absences decrease; productivity increases
Benefits of Delegation
Nurses delegate work for which they have responsibility
- Routine tasks
- Tasks for which nurse does not have time
- Lower priority tasks
Defining the task
-Some tasks should not be delegated.
Deciding on the delegate
-Lowest person in hierarchy who has requisite capabilities, allowed legally
The Delegation Process
Describing the task
-Allow enough time to describe task, expectations
Reaching agreement
-Be sure delegate agrees to responsibility, authority for the task
Monitoring performance and providing feedback
- Monitoring too closely conveys distrust
- Remain accessible
- If problems, quietly investigate, explain concerns to delegate
The Delegation Process
Assignment patterns
-Unit-based, pairing, partnering
Accepting delegation
-Delegate responsible for making sure he/she understands task
~Inform delegator is skills lacking
~Accept delegation; accept full responsibility
~Clarify time frame
~Keep delegator informed
~Complete as agreed
Factors Affecting Delegation
Obstacles to delegation
- Nonsupportive environment
- Delegator insecurity
- Fear of competition, criticism
- Fear of liability
- Fear of loss of control
- Fear of overburdening others
- Fear of decreased personal job satisfaction
An unwilling delegate
Factors Affecting Delegation
Ineffective delegation
- Unnecessary duplication
- Under delegation
- Reverse delegation
- Overdelegation
Factors Affecting Delegation
Fear often keeps nurses from delegating
-State nurse practice acts
Guidelines
- Right task
- Right circumstances
- Right person
- Right direction and communication
- Right supervision
Liability and Delegation
-Group
Under direction of a leader
Individual accountability
-Team
Specialized type of group
Work in tandem to accomplish common goals
More flexible hierachy; combining interdisciplinary expertise through teamwork
-Interprofessional teams
-Multidisciplinary team approach
Groups and Teams in Healthcare
Changes that have led to emphasis on collaboration
-several states no longer mandate physician supervision of nurse practitioners, certified registered nurse anesthetists
Process of Interdisciplinary Collaboration
Common purpose, goals identified at outset
Clinical competence of ea. provider
Interpersonal competence
Humor
Trust
Valuing and respecting diverse, complementary knowledge
Characteristics of effective collaboration
- Affordable Care Act, “Obamacare”
- Increased focus on interdisciplinary collaboration
- Incentives for integration of healthcare delivery
- Community-based teams
The Future of Interdisciplinary Teams
Team Strategies and Tools to Enhance Performance and Patient Safety is an evidence-based framework to optimize team performance across the healthcare delivery system.
Team STEPPS
Agency for healthcare research and quality
purpose is to optimize patient outcomes by improving communication and teamwork skills among healthcare professionals
Dept of Health and Human Services
Concerned
Uncomfortable
Safe
CUS words
Leadership, Situation Monitoring, Mutual Support, and Communication.
The core of the TeamsSTEPPS framework is comprised of four skills…
These skills must interplay with the Team Competency Outcomes
Knowledge, Attitudes, and Performance.
Two types of Leaders
Designated and Situational
organizes the team; articulates clear goals; makes decisions through collective input of members; empowers members to speak up and challenge, when appropriate; actively promotes and facilitates good teamwork; and skillfully resolves conflicts.
An effective team leader
This is a short session for planning prior to start to discuss team formation; assign essential roles; establish expectations and climate; and anticipate outcomes and likely contingencies
Brief (Team Events)
When problem solving is needed, this ad hoc planning is used to reestablish situation awareness; reinforce plans already in place; and assess the need to adjust the plan.
Huddle (Team Events)
This informal information exchange session is designed to improve team performance and effectiveness. Feedback from the team drives future process improvement.
Debrief (Team Events)
is the process of continually scanning and assessing what’s going on around you to maintain situation awareness
Situation monitoring
Status of the patient
Team members
Environment
Progress toward goal
STEP
is ‘knowing what is going on around you’ and knowing the conditions that affect your work
Situation awareness
result from each team member maintaining his or her situation awareness and sharing relevant facts with the entire team. Doing so helps ensure that everyone on the team is “on the same page”.
Shared mental models
an error reduction strategy that involves monitoring actions of other team members; providing a safety net within the team; ensuring mistakes or oversights are caught quickly and easily; and ‘watching each other’s back”
Cross monitoring
Protect ea. other from work overload situations
Place all offers and requests for assistance in the context of patient safety
Foster a climate where it is expected that assistance will be actively sought and offered
Mutual Support
Complete
Clear
Brief
Timely
Effective Communication
a technique for communicating critical information that requires immediate attention and action concerning a patient’s condition and is especially important during handoff.
SBARQ Situation Background Assessment Recommendation and Request Questions
Using these words is one way to “stop the line” and alert other team members to your concerns.
“CUS” words
I am Concerned
I am Uncomfortable
This is a Safety issue or I don’t feel like this is Safe!
used to communicate important information to all team members simultaneously
Call outs
closed-loop communication to ensure that information conveyed by the sender is understood by the receiver as intended (ie. restate what was said)
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