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EXAM 2 Flashcards

(93 cards)

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1
Q

Productive Hours

A

Hours doing pt care

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2
Q

Nonproductive hours

A

hours in staff meetings, CEUs, etc

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3
Q

Employee Classifications - Direct care

A

Time spent providing hands-on care to pts

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4
Q

Employee Classifications - Indirect care

A

Time spent on activities related to patient care

EX: documentation, interacting with multidisciplinary team members

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5
Q

Nurse Intensity

A

Measure of amount and complexity of nursing care needed by a patient

  • Patient classification system (PCS) is used to determine workload
  • patient acuity (workload each pt generates)
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6
Q

Utilization of Classification system data

A

acuity data used to plan nursing staffing during next 24-hour period

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7
Q

Considerations in developing a Staffing Plan

A
  • Skill mix (ex ratios of RN to LPN to PCTs)
  • Staff support (pt transport)
  • Historical Information
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8
Q

Average daily census (inpatient unit)

A

Total numbers of pts at census time, usually midnight, over period of time and dividing by number of days in time period.

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9
Q

Units of Service

A

Nursing workload dependent on nursing care needs of patients

Nursing hours per pt day (NHPPD) (required nursing hours for 24hr period, hrs of operation)

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10
Q

Considerations for Staffing

A
  • Staff experience

- Patient need

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11
Q

Shift Variations

A
  • Traditional (8s)
  • 12-hr shifts
  • weekends
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12
Q

Scheduling concerns

A

Financial implications

Impact on pt care

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13
Q

Models of Care Delivery

A
  • Care delivery models organize work of caring for pts

- choose care delivery model based on needs of pts and availability of competent staff

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14
Q

Delegation

A
  • pg 369
  • primarily about entrusting your authority to others
  • at its most basic, it is empowering one person to act for another
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15
Q

Accountability

A 
Being responsible and answerable for actions and inactions of self or others in context of delegation
S - specific
M - measurable
A - achievable
R - realistic
T - time bound
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16
Q

KSBN - 65-1165 - Supervision of delegated nursing procedures

A

All nursing procedures, including but not limited to administration of medication, delegated by a licensed nurse to a designated unlicensed person shall be SUPERVISED.

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17
Q

KSBN - 65-1136 - IV fluid therapy

A

“Supervision” means provision of guidance by a qualified nurse for the accomplishment of a nursing task or activity with initial direction of the task or activity and periodic inspection of the actual act of accomplishing the task or activity.

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18
Q

Responsibility

A
  • Involves reliability, dependability, and obligation
  • Involves people providing pt care to perform at an acceptable level for which they have been educated
  • Nurse transfers responsibility and authority for delegated tasks, but retains ACCOUNTABILITY for delegation process
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19
Q

Authority

A

Right to delegate duties and give directions to unlicensed assistive personnel places RN in position of authority

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20
Q

Assignment

A

Distribution of work each staff member is responsible for performing as condition of employment
-within legal scope

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21
Q

Competence

A

Required to practice safely and ethically in designated role and setting
-Built on knowledge gained in nursing education program, orientation to specific settings, and experiences of implementing nursing

-License = minimal competence

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22
Q

Competence requires application of:

A

Knowledge, interpersonal decision making, and psychomotor skills

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23
Q

Supervision

A

Provision of guidance or direction, oversight, evaluation and follow up by licensed nurse for accomplishment of nursing tasks delegated.

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24
Q

Levels of supervision

A
  • Unsupervised
  • Initial direction and periodic inspection
  • Continuous
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25
Assistive Personnel Scope
bathing, feeding, toileting, ambulating | -Cannot assess or evaluate response to treatment
26
LPN responsibilities
- Provides care for STABLE patients, with predictable outcomes - Cannot complete initial patient assessment
27
Rights of delegation
``` Right task Right circumstance Right person Right direction/communication Right supervision ```
28
Tasks that can NEVER be delegated
- Patient assessment - Triage - Nursing diagnosis - Nursing plans of care - extensive teaching or counseling - Telephone advice - Outcome evaluations - patient discharges
29
Successful organization of patient care requires:
- Governance structures - Patient care delivery process - Measures of outcome of care delivery
30
External and Internal
.
31
Environmental assessment
SWOT analysis
32
Stakeholder
any person, group or organization that has vested interest in program or project under review -could be its, nurses, docs, community reps, insurances companies, hospital administrators, or accreditation agencies.
33
Philosophy
Statement of beliefs based on core values
34
Values
-Stated in mission statement
35
Mission statement
Formal statement of purpose or reason for organizations existence
36
Three elements of a mission statement
- No longer than a couple sentences - States organizations PURPOSE using ACTION words - Simple and from the heart
37
Four elements of a Vision Statement
- Written down - Present tense as though it were already accomplished - Covers variety of activities Balances needs of providers pts and environment
38
Goal
Specific aim or target that unit wishes to attain with in time span of ONE year
39
Objective
Measurable step taken to reach goal
40
Shared Governance
Organizational framework grounded in philosophy of decentralized leadership that fosters atonomous decision making and professional nursing practice -Implies allocation of control, power or authority among mutually vested parties
41
Five main arenas of Shared governance model
- Clinical practice - Quality - Education - Research - Management of resources
42
Responsibility of Clinical practice council
Establishes nursing practice standards for workgroup
43
Responsibility of Quality council
Makes recommendations about hiring, promoting, and credentialing nursing staff -Oversees unit's quality management initiatives
44
Responsibility of Nursing Education council
Assesses learning needs of unit staff, develops and implements programs to meet needs
45
Responsibility of Research council
Advances research utilization with intent of incorporating EBP findings into clinical practice
46
Responsibility of Management council
Ensures upholding of standards of nursing practice and governance agreed upon by unit staff and adequate resources to deliver patient care
47
Responsibility of Coordinating council
Facilitates and integrates activities of other councils, usually composed of first-line pt care manager and chairpersons of other councils - facilitates annual review of unit mission and vision - develops annual operational plan
48
Benner's Novice to Expert - Five levels
- Novice nurses - Advanced beginner - Competent - Proficient - Expert
49
Novice
Task-oriented and focused on rules
50
Advanced beginner
Demonstrate marginally acceptable independent performance
51
Competent
Have developed ability to see own actions as pare of long-range goals for patients
52
Proficient
Can perceive whole situation
53
Expert
Intuitively knows what is going on with patients
54
Situational Leadership
There is no one best leadership style | -effective leadership lies in matching leadership style to individual's or group's level of task-relevant readiness
55
Accountability-based care delivery
Focuses on roles, their relationship to work to be done, and outcomes they are intended to achieve
56
Accountability
Is about OUTCOMES rather than processes Is individually defined Inherent in roles, but delegated Foundation for evaluation
57
Time management
Set of related commonsense skills that help people use time in the most effective and productive way possible
58
Pareto Principle (time management concept)
Time management requires shift from wasting time on process of being busy to organizing time to achieve desired outcomes 80/20 rule
59
Time analysis
Consider what tasks can be delegated to personnel who receive less compensation than nurses
60
Prioritizing use of time
1. Life threatening or potentially life-threatening conditions 2. Activities essential to safety 3. Activities essential to plan of care
61
Internal climate
How you perceive yourself
62
External climate
How others perceive you
63
Levels of communication
Public Intrapersonal Interpersonal
64
Group communication - Forming
interpersonal relationships, expectations, directions
65
Group communication - Storming
comfortable enough to disagree; can lead to increased trust, positive competition, effective barganing
66
Group communication - Norming
establishes rules and define the work; doesn't come if can't agree
67
Group communication - Performing
the work gets done
68
Barriers to communication
-Use of language -Anger DEFENSIVENESS -false reassurance -Stereotyping -interrupting -being inattentive -being stressed -unclear expectations -giving incongruent responses -illiteracy
69
Workplace communication
Nurses' diverse roles and relationships require different communication patterns with supervisors, co-workers, practitioners, etc
70
Workplace communication- GRRRR
``` Greeting Respectful listening Review Recommend or request more info Reward ```
71
Communication skills
.
72
Assertiveness
A ways of communicating that allows people to express themselves in direct, honest and appropriate ways that do not infringe on another person's rights
73
Passive communication
a person suffers in silence although they may feel strongly
74
Aggressive communication
express themselves in a direct and hostile manner that infringes on others' rights- demonstrating self-excellence
75
Passive-aggressive communication
An aggressive message presented in a passive way
76
Strategic planning
sum total or outcome of processes by which organization engages in environmental analysis, goal formulation and strategy development for purpose of organizational development
77
Steps in Strategic planning
-Environmental assessment Situational assessment, external assessment, internal assessment -SWOT analysis -Community and stakeholder assessment
78
SWOT analysis
Strengths Weakness Opportunities Threats
79
Organizational climate
How employees perceive the organization
80
Cultural traits
- Adaptability - Involvement - Consistency - Mission
81
Division of labor
way labor force is divided or organized has impact on how mission is accomplished
82
Factors that influence organizational structure
-Experiencing severe problems -Technology -Diversity -Size of organization -Other reasons to rethink structure ie EXTERNAL REVIEW PROBLEMS
83
Lewin's Force-Field Model (Change theory)
- Unfreeze - Move to a new level - Refreeze
84
Lippitt's Phases of Change (Change theory)
- Dx problem - Assess motivation and capacity for change - Assess change agents motivation and resources - Select progressive change objective - Choose role of change agent - Maintain change - Terminate helping relationship
85
Havelock's Six step change model
- Build relationship - Dx problem - Acquire resources - Choose solution - Gain acceptance - Stabilize and renew
86
Roger's Diffusion of Innovations theory
``` Five steps: Awareness Interest Evaluation Trial Adoption ```
87
Stages of Change model (SCM)
``` 5 steps: Precontemplation Contemplation preparation action maintenance ```
88
Steps in the change process
``` A- assessment P-planning I-implementation E-evaluation Stabilization Adjourning ```
89
Stabilization of change
Change is no longer pilot or experimental | -should occur as soon as change process complete
90
Adjourning
Final stage of change process | Termination and consolidation occur
91
Natural and expected response to change
Resistance
92
Factors that affect staff responses to change:
Trust Predictability Ability to cope with change
93
Leadership & Management roles in conflict management
``` S- share the facts T- tell your story A- ask for opinions T- talk tentatively, value for person E- encourage testing ```

Leadership & Management (4 decks)

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