N471 Midterm Flashcards by Andrea Wehrle

What is the situation and how will the leader respond
Leader is a MOTIVATOR
Performance and Productivity
Uses PROBLEM-SOLVING process
Has vision, able to EMPOWER, & INSPIRE staff
Manager models behavior, encourages, shared values
Leaders and followers share same passion for work

Interactional Leadership and Transformational Leadership

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Interactional Leadership Theory
Transformational Leadership
Strengths-Based Leadership

Leadership Today

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Empower the worker
Recognize uniqueness
Provide safe work environment
Learning ready
Positivity and FOCUS ON STRENGTHS
Service to others

Strengths-Based Leadership

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Modeling: values, self-awareness
Inspiring a shared vision: inspirational vision, follows want to work with leader on goals
Challenging the process: sees the changes needed and makes it happen
Empowering others: foster collaboration, trust and the sharing of power
Encouraging the heart: celebrate others and their achievements toward the goal

Five Practices for Exemplary Leadership

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Long term vision
See the bigger picture
Influential
Recognize the effect of interactions with others; team oriented
Deal with conflict well
Sees necessary changes as positive

Manager Traits of a Transformational Leader

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Ability to perceive, understand, and control one’s emotions and the effects those emotions have on others
Self-awareness- own emotions, recognize self
Self-regulation- handling emotions
Motivation
Empathy
Social skills

Emotional Intelligence

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Control, coercion, closed-minded, criticism, focus on “I” or “me”, sometimes necessary in urgent/emergent situations

Authoritarian (Autocratic) leadership style

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Less control, motivated by rewards, OPEN COMMUNICATION, COLLABORATIVE decision making, constructive feedback, focus on “we”, transformational leadership

Democratic leadership style

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Lack of control and direction, permissive, open communication, group focus, not typically seen as productive

Laissez faire leadership style

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Quality and safety in healthcare (HC)
Limited accessibility to HC
HC disparities
Workload/staffing
Patient satisfaction
Sustainability of HC system and financing
Increase in HC cost
Long waiting times and congestion
Changes in more strict legislations, regulations, and enforcement of such
Increase disease burden, promotion and prevention, people are living longer
Pandemic controls

Leadership Challenges Today

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Transferring responsibilities to another staff member
RN still ultimately responsible for those tasks
RNs in leadership roles delegate to RNs working with/under them

Delegation (leadership role)

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Taking responsibility for the tasks others perform
Review of workload, understanding skills and knowledge level of staff
RNs in leadership roles supervise RNs and other unlicensed personnel working under/with them
Evaluate job performance

Supervision (leadership role)

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Organizing care for patients between two or more participants
Should include the patient/family
Facilitate appropriate delivery of healthcare services

Coordination (leadership role)

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Healthcare team comes together
Reach common goal in patient care

Collaboration (leadership role)

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A problem exists
A report was filed
A complaint
Something does not fit/work
An idea is born/an innovation
Community/global threats

Why Change is Necessary

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What? A person who initiates change within a group
Who? a person who understands and implements the required change process

Change Agent

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What? People involved and interested in the change process
Who? People involved in the change, those the change affects

Stakeholder

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Unfreezing
Movement (change)
Refreezing
Driving forces (to reach a goal)
Restraining forces (from reaching the goal)

Phases of Lewin’s Change Theory

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Determine what needs to change
Ensure there is strong leadership support
Create the need for change
Manage and understand the doubts and concerns

Unfreezing (Change Theory)

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Communicate often
Dispel rumors
Empower action
Involve people in the process

Movement (Change Theory)

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Anchor the changes into the culture
Develop ways to sustain the change
Provide support and training
Celebrate successes

Refreezing

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Mandates/legal
Fiscal
Resources (lack or too many)
Promotion/recognition
Social gain
Personal goals
Support family

Driving forces (to reach a goal)

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Lack or resources
Lack of data
Lack of knowledge
Fear of liability
Intrapersonal conflicts
Interpersonal/group conflicts

Restraining forces (from reaching the goal)

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Evidence-based practice, what does the literature say; what supports are there?
I.e. hourly rounding, bed-side report, chlorhexidine gluconate baths (CHG)

Rational Empirical Strategy (strategies for successful change)

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Develops relationships, builds confidence and peer support, change agent more of a team player, change due to social norms, becomes part of the group I.e. uniforms, 12-hr shifts, self-schedule

Normative Re-educative Strategy (strategies for successful change)

Authority, legal changes, new laws, policies, must accept it or leave I.e. CMS enacted policy changes for reimbursement- DVT, postop infections, pressure injuries, state mandated changes, JACHO mandates

Power Coercive Strategy (strategies for successful change)

Complacency Fear of the unknown Too comfortable/habits Not broke, don't fix it attitude

Why do we resist change?

See the vision Capture the purpose Strategize for improvement Empower people Positive feedback Build trust/relationships Communication Understand the reason

How do we make change easier?

Role model Good communicator Stay positive Support organization Understand emotional intelligence Believe in change See the bigger picture Fiscal responsibility

Leader/Manager Role in Change

External Internal Differences in values, beliefs, opinions, ideas, backgrounds, goals Expected How do we filter what's important

What is conflict?

Conflict from within oneself

Intrapersonal conflict

Conflict from person to person

Interpersonal conflict

Conflict within a group

Intergroup conflict

There is a potential for a problem, can we stop it before it starts

Latent conflict (antecedent condition) (Conflict process)

Conflict has been identified

Perceived conflict (Conflict process)

Feelings about the conflict

Felt conflict (Conflict process)

Action phase, working through it

Manifest conflict (Conflict process)

Conflict is being solved

Conflict resolution (Conflict process)

Consequences of the conflict

Conflict aftermath (Conflict process)

Compromising- both give up something equally, lose-lose Competing- challenging the other, win-lose Cooperating/Accommodating- one gives to satisfy the other Smoothing- one party pacifies the other, focus on positives, temporary win-win Avoiding- issue not addressed, lose-lose Collaborating- great strategy, work together toward same goal, win-win Negotiation- like collaboration, cooperation, helps develop relationships, watch hidden agendas, win-win

Conflict Resolution Strategies

Confrontation Third-party consultation Behavior change Responsibility charting Structure change Soothing one party Alternative dispute resolution Seeking consensus

Managing conflict

Choosing with a given set of options

Decision making

A process that helps make the decision-making process work Analyzing difficult situations

Problem solving

Process by which nurses make decisions based on nursing knowledge (evidence, theories, ways/patterns of knowing), other disciplinary knowledge, critical thinking, and clinical reasoning

Clinical judgement

Function of Clinical Nursing Identify information, subjective, objective, history. What is relevant? What is most important? Is there anything urgent? Gather info; ASSESS

Recognize cues

Function of Clinical Nursing Organize the cues, how do they reflect the current condition/s? Is there anything that may represent a different problem? Why are these cues concerning? Is there any other information that would help? What do the cues mean/Interpreting Info

Analyze cues

Function of Clinical Nursing Determine urgency of the data, what is most likely happening? Is there anything serious to warrant immediate needs? Prioritization

Prioritize hypotheses

Function of Clinical Nursing Identify what outcomes are expected based on data/what interventions can be done to achieve those outcomes? Does anything need to be avoided? Think of goals and interventions Problem solve; Planning stage

Generate solutions

Function of Clinical Nursing Implement the solutions that have the highest priority first. What interventions must be done first? How are these interventions accomplished? Intervene

Take Action

Function of Clinical Nursing Compare the observed outcomes. Were goals achieved? Were the interventions effective? Does something need to be altered? How does one determine if goals were met?

Evaluate outcomes

Recognize/celebrate differences and diversity Gender differences Values/beliefs Past experiences Personal choice Learning/thinking styles

Supporting others in decision making

1. Appropriate frame- what are we deciding? 2. Create doable alternatives- what choices do we have? 3. Meaningful reliable information- What do we need to know? 4. Clear values and tradeoffs- what consequences do we care about? 5. Logically correct reasoning- are we thinking straight? 6. Commitment to follow through- will we really take action?

Decision Making Process

Skydiving without a parachute Assumptions overtake real data Overconfidence can be detrimental- ASK questions Not considering other points of view Shooting from the hip with no data to support- KNOW EBP Doing the first thing that comes to mind bc you PANIC

Results of rushing decisions

Linear thinker; black & white, no gray React quickly, lack data for rationale Need clear instructions/guidelines Task oriented Learning to delegate and prioritize Internships and preceptor models well received

Novice nurse qualities

Organize data well Assess early, put all the pieces together, then act, prioritizes Know when and how to get things done Confident, leadership qualities Pays close attention to patient responses Vast knowledge, great preceptor/mentor

Expert nurse qualities

Know who the leaders are in an organization; is there equality What kind of management structure does the organization have? How can staff implement change; is there shared governance? Does the organization value nurse decision making? Magnet hospitals Many tools can be used to help guide decision making

Administrative Decision Making

Prioritization Leads to clinical reasoning More time with patients Focus goals of care Protects your license

Importance of time management in nursing

Crises Pressing Problems Deadline driven projects, meetings, preparations

Urgent Important Tasks

Preparations Presentations Values clarification Planning Relationship building True Recreation

Not Urgent Important Tasks

Interruptions, some phone calls Some mail, some reports, some meetings Many proximate pressing matters Many popular activities

Urgent Not Important Tasks

Trivia, busy work Junk mail Some phone calls Time wasters "Escape activities"

Not Urgent Not Important Tasks

Organization is key Group activities Estimate time gaps Document in real time Use tools (i.e. report sheets, time grids, etc.) Complete work on time Work time is work time

Time management strategies for staff nurse

Unit and personal priorities for the day Identify goals Know the staff (strengths/needs) Evaluate changes/needs of the unit Keep planner/calendar updated for meetings Prepare meetings with agenda items in advance Allow time for unexpected issues Anticipate changes and needed adjustments often Plan in breaks Leave on time

Time management strategies for nurse leaders

Deal with interruptions Avoid procrastination Be mindful of personal time Set limits

How to prioritize time

A dynamic process that assesses, plans, implements, coordinates, monitors, and evaluates to improve outcomes, experiences, and value Professional and collaborative process that occurs in a variety of settings In pursuit of health equity, priorities include identifying needs, ensuring appropriate access to resources/services, addressing social determinants of health, and facilitating self care transitions

Case management definition

Utilization management (medical necessity and provide clinical information to insurance companies via AI software)

Case management responsibilities

Regulatory requirement outlined in the CMS conditions of participation Must be available to ALL patients Must be reassessed regularly to ensure the needs of the patient have not changed Initiated by care management within 24 hours of admission

Discharge planning by case management

Patient's ability to participate in the plan Lack of support network Lack of payor or payor-approved services Complexity of the discharge needs (wound care, IVAB, etc.) Limited availability of resources (skilled nursing facilities, home care, etc.)

Barriers to discharge planning

Send referrals online to homecare/skilled nursing facilities Arrange equipment needed: oxygen, wound vac, IVAB, BiPap Assistance providing medications if needed (meds to beds or transitional care pharmacist) Make transitional care management appointments

Establish a care management plan

An independent nonprofit organization that works outside the government to provide unbiased and authoritative advice to decision makers and the public Over 2000 members from all disciplines 75 members chosen every year to serve on committee SAFETY SAFETY SAFETY

Institute of Medicine (IOM)

How safe are you in the hospital 44,000-98,000 deaths each year due to preventable medical errors Medication errors are the #1 cause of preventable medical errors Lessons: Errors are usually NOT the fault of people Error contributed by: FLAWED SYSTEMS, lack of proper training, perverse incentives

To Err is Human

The healthcare system is in need of improvement Six goals for improvement: safe, effective, patient-centered, timely, efficient, equitable

Crossing the Quality Chasm

Provide patient-centered care- identify, respect, and care about patient's differences Work in interdisciplinary teams- cooperate, collaborate, communicate, and integrate care in teams Employ evidence-based practice Apply quality improvement Utilize informatics

5 Core Competencies

Culture of safety Blame-free work environment Staff safety (needle sticks, infections, violence) Institute for healthcare improvement (IHI) Transforming Care at The Bedside (TCTB) Joint Commission Annual Safety Goals

IOM Recommendations

A formal approach to the analysis of performance and systematic efforts to improve it

Quality Improvement (QI)

Hospitals strive for this Organizations that function well with minimal patient/system error in outcomes Health services that improve outcomes Organizations can provide this but still have poor outcomes- therefore it is difficult to define Challenged by the definition of quality and reliability

High-Reliability Organizations

Older term Retrospective process- target currently existing quality Policing and often punitive Determine who's at fault

Quality Assurance (QA)

Newer term Involves prospective and retrospective views- target ongoing and continually improving quality Goal is improvement Attempts to avoid blame Create systems to prevent errors PREVENTION

Quality Improvement (QI)

Improve accuracy of patient identification Improve effectiveness of communication between caregivers Improve safety of using medications Reduce harm associated with clinical alarm systems etc.

National Patient Safety Goals (Created by Joint Commission)

How do we identify what's best Measure products, practices, and services against best performing organizations (compare to industry standards) Allows organizations to compare performance within the organization and with others Data drives improvement

Benchmarking

How do we identify what's best? A program or protocol relating to improvements to quality of life, quality of care, staff development, or cost-effectiveness practices Institutions submit outcomes related to quality improvement initiatives; and may be designated a "best practice"

Best practices

Assumes a relationship exists between quality care and appropriate structure The physical environment in which healthcare is delivered

Structure (measure of quality)

Used to measure the process of care or how the care was carried out; assume that a relationship exists between the process used by the nurse and the quality of care delivered Policies/procedures/protocols, critical pathways Standards of care tools used to measure deviations from best practice standards

Process (measure of quality)

End result of care or patient's health status changes as a result of an intervention Non nursing sensitive outcomes (mortality, morbidity, LOS) Nursing sensitive outcomes (falls, nosocomial infections, pressure injuries, patient satisfaction scores)

Outcomes (measure of quality)

Founded by ANA GOLD STANDARD for nursing quality data Tracks up to 19 nursing sensitive quality measures based on structure, outcome, and process Hospitals can compare their nursing quality against national, regional, and state norms for hospitals of the same type and down to the unit level

National Database of Nursing Quality Indicators

Plan- create an action plan for implementation, including a list of required steps, the implementation schedule, ownership, responsibilities, and desired outcomes Do- start implementing the plan, following the plan steps, and adhering to the schedule to stay on track Check- take measurements against the success criteria set when selecting the strategy to ensure implementation is progressing as it should be Act- based on check results, determine if the process was successfully changed

Plan, Do, Check, Act (quality model)

Define, Measure, Analyze, Improve, Control involved management of greater extent in monitoring performance and ensuring favorable results 1. customer focus 2. data driven 3. process emphasis 4. proactive management 5. boundary-less collaboration 6. aim for perfection; tolerate failure

Six Sigma (quality model)

Focus: collect data Analyze: what can we change? Develop: IV Execute: initiate IV Evaluate: measure

FADE (quality model)

The conscientious use of current best practice in making decisions about patient care A problem solving approach to clinical practice that integrates a systematic search for and critical appraisal of the most relevant answer to a clinical question, clinical expertise, patient preferences & values, etc.

Evidence based practice

QI (no theoretical underpinnings, evaluates a work process to improve practice, data collected and reported internally) EBP (uses theory, seeks to generate new knowledge or test interventions, results add to the body of knowledge)

Difference between QI and EBP

Level I- Systematic Review of RCTs Level II- RCTs Level III- Controlled trials w/o randomization Level IV- Case control and cohort studies Level V- Systematic reviews of descriptive or qualitative studies Level VI- Single descriptive or qualities study Level VII- Expert opinions

Hierarchy of evidence

Process of aligning an organization's structure with its mission

Organizational design

Emphasis on organizational positions and formal power; framework for providing managerial authority, responsibility, and accountability Roles and functions defined Rank and hierarchy are evident i.e manager --> nurse --> nursing assistant

Formal organizational structure

Focus on naturally forming social network of employees and their relationships Typically based on camaraderie Rely on the informal structure if the formal structure becomes ineffective "Grapevine" communication within the informal group i.e. nurse to nurse colleagues

Informal organizational structure

Max Weber- founder of organizational theory Bureaucracy = the ideal, intentionally rational, most efficient form of organization *Efficiency through design*

Classical Theory

1. Division and specialization of labor 2. Chain of command 3. Organizational structure 4. Span of control

Four elements of Classical theory

N471 Midterm Flashcards

(97 cards)