NURS 461 ATI CH. 1 Flashcards
Authoritative Leadership
motivates by coercion
comm. happens down the chain of command
work output by staff is usually high: good for crisis situations and bureaucratic settings
effective for employees with little or no formal education
Democratic leadership
- includes the group when decisions are made
- Motivates by supporting staff achievements
- comm. occurs up and down the chain of command and between group members
- work output by staff is usually good quality when cooperation and collaboration are necessary
Laissez-faire leadership
makes very few decisions, and does little planning
motivation is largely the responsibility of individual staff members
comm. occurs up and down the chain of command and between group members
work output is low unless an informal leader evolves from the group
effective with professional employees
Transformational leaders
empower and inspire followers to achieve a common, long-term vision
transactional leaders
focus on immediate problems, maintaining the status quo and using rewards to motivate followers
authentic leaders
inspire others to follow them by modeling a strong internal moral code
The emotionally intelligent leader:
has insight into the emotions of members of the team
understands the perspective of others
encourages constructive criticism and is open to new ideas
manages emotions and channels them in a positive direction, which in turn helps the team accomplish its goals
is committed to the delivery of high-quality client care
refrains from judgment in controversial or emotionally charged situations until facts are gathered
Five major management functions
- planning
- organizing
- staffing
- directing
- controlling
- Planning
the decisions regarding what needs to be done, how it will be done, and who is going to do it
- Organizing
the organizational structure that determines the lines of authority, channels of communication, and where decisions are made
- staffing
the acquisition and management of adequate staff and staffing mix
- derecting
the leadership role assumed by a manager that influence and motivates staff to perform assigned roles
- controlling
the evaluation of staff performance and evaluation of unit goals to ensure identified outcomes are being met
characteristics of managers
- hold formal positions
- possess clinical expertise
- network with members of the team
- coach subordinates
- make decisions about the function of the organization, including resources, budget, hiring, and firing
characteristics of a leader
initiative
inspiration
energy
positive attitude
communication skills
respect
problem-solving & critical thinking
personality traits & leadership skills
influence followers to move towards goal
may have goals that differ from organization
Maslow’s hierarchy of needs
1 physiological
2 safety and security
3 love and belonging
4 self-esteem
5 self-actualization
Prioritization and Time management
- systemic before local (life before limb)
- acute before chronic
- actual problems before potential problems
- don’t assume
- respond to trends vs. transient findings
- emergencies vs. expected findings
- determine priority actions
Priority-Setting Frameworks
Maslow’s hierarchy
ABC (DE)
Safety/risk reduction
Assessment/ data collection: gather information prior to making decisions.
Survival potential: like in mass casualties
Least restrictive/ least invasive
acute vs chronic, urgent vs nonurgent, stable vs unstable
evidence-based practice
least restrictive/ least invasive example
move client near nurses station before applying restraints
bladder train before indwelling catheter
Task Factors when deligating care
Predictability of outcome
Potential for harm
Complexity of care
Need for problem-solving and innovation
level of interaction with the client: is there a need to provide psychosocial support or education
Five rights of delegation
1- right task
2- right circumstance
3- right person
4- right direction and communication
5- right supervision and evaluation
examples to be delegated to a LPN
- monitoring findings (input to an RNs ongoing assessment)
- reinforcing client teaching from a standard care plan
- performing tracheostomy care
- suctioning
- checking NG tube patency
- administering enteral feedings
- inserting a urinary catheter
- administering medication (excluding IV)
examples to delegate to an AP
ADL activities
bathing
grooming
dressing
toileting
ambulating
feeding (w/o swallowing precautions)
positioning routine tasks
bed making
specimen collection
I&O
vital signs (stable clients)
steps in providing educational programs
identify and respond- determine need for knowledge
analyze- look for deficiencies, develop learning objectives
research- resources available
plan- program to address objectives
implement- conducive to staff availability. consider online programs
evaluate- measure behavior changes secondary to objectives
mentor vs preceptor vs coach
mentor: can serve as preceptor but relationship lasts longer and focuses on assumption of the role as well as socialization to practice.
preceptor: assist in orienting, supervise performance, assigned for a limited amount of time.
coach: collab. relationship to help nurse establish goals. Relationship is task-related and typically time limited.
Patricia Benner 5 stages of nursing ability
- novice nurse
- advanced beginner
- competent nurse
- proficient nurse
- expert nurse
Novice nurse
students or newly licensed nurses
- minimal clinical experience
- approach situations from theoretical perspective relying on context-free facts and established guidelines.
- rules govern practice
Advanced beginner
most new nurses function at this level
- practice independently in the performance of many tasks and can make some clinical judgments
- begin to rely on prior experience to make decisions.
competent nurse
usually have been in practice 2-3 years
- demonstrate increasing levels of skill and proficiency and clinical judgment.
- exhibit the ability to organize and plan care using abstract and analytical thinking
- can anticipate the long-term outcomes of personal actions
Proficient nurse
significant amount of experience
- enhanced observational abilities allow nurses to be able to conceptualize situations more holistically.
- well-developed critical thinking and decision-making skills allow nurses to recognize and respond to unexpected changes.
Expert Nurse
wealth of experience
- view situations holistically and process information efficiently
- make decisions using an advanced level of intuition and analytical ability.
- do not need to rely on rules to comprehend a situation and take action.
Core measures
national standardized measures to improve client outcomes
developed by the Joint Commission
used to measure client outcomes and provides information to support accreditation of hospitals
Core measures include;
stroke
venous thromboembolism
heart failure
acute MI
substance use
structure audits
evaluate the influence of elements that exist separate from or outside of the client-staff interaction
process audits
review how care was provided and assume a relationship exists between nurses and the quality of care provided
outcome audits
determines what results occurred as result of the nursing processs
5 stages of conflict
- latent conflict
- perceived conflict
- felt conflict
- manifest conflict
- conflict aftermath
Steps in Progressive discipline:
First infraction
informal reprimand
manager and employee meet
discuss the issue
suggestions for improvement/ correction
Steps in Progressive discipline:
Second infraction
written warning
manager meets with employee to distribute written warning
review of specific rules/ policy violations
discussion of potential consequences if infractions continue
Steps in Progressive discipline:
Third infraction
employee placed on suspension with or w/o pay. Time away from work gives the employee opportunity to:
examine the issues
consider alternatives
Steps in Progressive discipline:
Fourth infraciton
employee termination
follows after multiple warnings have been given and employee continues to violate rules and policies
Client Factors when Assigning care
- condition of client and level of care needed
- specific care needs (cardiac monitoring, mechanical vent)
- need for special precaution
- procedures requiring a significant time commitment (ex. dressing change)
Health Care team factors when Assigning care
- knowledge and skill level of team members
- amount of supervision necessary
- staffing mix
- nurse-to-client ratio
- experience with similar clients
- familiarity of staff members with unit
These 3 should apply for clients to share a room with an infectious diseae
- have the same active infection
- clients remain at least 3 feet away
- no other infection
Staff Education
Unit managers, staff development educators
- new policies and procedures implemented
- new equipment becomes available
- educational need identified
Staff education
unit manager, charge nurse, preceptor
- can focus on one-on-one approach
Staff education
staff members, supervisors
can use “just in time” training to meet immediate needs for client care
Staff education
higher education degree or certification
staff
Root cause analysis
focuses on variables that surround the consequence
commonly done for sentinel events but also in quality improvement process
investigates the consequence and possible causes
analyzes possible causes and relationships that can exist
determines additional influences at each level of relationship
determines the root cause or causes
Steps in quality improvement process
standards are made available by policies and procedures
quality issues are identified
interprofessional team is developed to review the issue
current state of structure and process r/t issue is analyzed
data collection methods are determined (quantitative)
data is collected, analyzed, and compared to benchmark
if benchmark isn’t met, a root cause analysis is performed
potential solutions are analyzed and one is selected
education is implemented
issue is reevaluated at a preestablished time
Steps in the Problem-Solving Process
IDENTIFY PROBLEM- in objective terms
DISCUSS SOLUTIONS
ANALYZE IDENTIFIED SOLUTIONS
SELECT A SOLUTION
IMPLEMENT SELECTED SOLUTION- procedure and timeline
EVALUATE SOLUTION’S ABILITY TO RESOLVE ORIGINAL PROBLEM
Cost-effective Care
cost-containment
cost-effective
Cost-containment
strategies that promote efficient and competent client care while also producing needed revenues for the continued productivity of the organization
ex. managed care- provides clients with a plan designed to meet their needs eliminating the unnecessary use of resources or extended hospital stays
Cost-Effective
strategies that achieve optimal results in relation to the money spent to achieve those results. “Getting your money’s worth”
spending on staff training for transmission-based precautions, resulting in effective use of PPE. Leads to decrease infection transmission
