Flashcards in Test 2 Deck (48):
How long does a mentorship relationship typically last
A distinctive interactive relationship between two individuals, occurring most commonly in a professional setting
How nurse leaders assist new graduate RNs to adjust to new role. (pg 374)
-Leaders should not assume that anticipatory socialization has occurred in the educational setting and should instead build opportunities for clarifying and sharing values and attitudes about the nursing role into orientation programs.
-Be alert for s/s of role stress and role overload and intervene by listening and helping new grads to develop appropriate coping behaviors.
-Encourage new grads to have a balanced life
-Foster a work environment that has zero tolerance for disrespect
-Strive to create a work environment that promotes interdependency between physicians and nursing staff
-Help the new RN adapt to the culture and help them to develop the skills they need
-Ensure the new RN’s values are supported and encouraged
How do nurse leaders assist their subordinate nurse leaders adjust to new leadership roles?
-Coaching is one of the most important tools for empowering subordinates, changing behavior, and development of a cohesive team
-Coaching is defined as one person helping another to achieve an optimal level of performance
How nurse leaders assist their subordinate nurse leaders adjust to new leadership roles.
-Number of students enrolled in local nursing schools
-Peak staff resignation periods
-Know the source of their nursing pool
-Usual length of employment for newly hired employees
-When is patient census the highest?
-Historical staffing needs and availabilty
-Diversity of the population being served
-Insurance and billing reimbursement and the impact it has on staffing
-Economics; nursing shortages occur when the economy is on the upswing and declines when the economy recedes
-Knowing the education and knowledge level needed for their staff
What are the Outcomes of decentralized staffing?
-Diffuses decision making throughout the organization and allows problems to be solved by the lowest practical managerial level
-Problems can be solved at the level in which they occur
-Some delays may occur in decision making if the problem must be transmitted through several levels to reach the appropriate individuals to solve the problem
-The manager is responsible for covering all scheduled staff absences, reducing staff during periods of decreased patient census/acuity, adding staff during periods of high patient census/acuity, preparing monthly unit schedules, and preparing holiday and vacation schedules.
What does decentralized staffing lead to?
Leads to increased autonomy and flexibility
What are Staffing and scheduling goals for nurse managers?
-The manager has both a physical and ethical duty to plan for adequate staffing to meet patient needs.
-Innovative and creative methods of staffing and scheduling should be explored to avoid under/over staffing as patient census and acuity fluctuate.
-staffing and scheduling policies must not violate labor laws, state, or national laws, or union contracts.
-Use workload measurement tools.
-Mandatory overtime should be used as a last resort.
Be cognicent of mandatory staffing ratios and comply with such mandates
-attempt to have diverse staff to meet all culture and language needs of the population
-fair and uniform staffing and scheduling policies/procedures must be written and communicated to all staff
-Existing staffing policies need to be examined periodically.
Understanding of patient classification system.
-Staffing by acuity-patient classification system
-Also known as workload management, or patient acuity tools
-Suggests that patient acuity systems provide the language nurses need to make their work visible at all level of their organization
-Groupings of patients according to specific characteristics
-Hours of nursing care assigned for each patient classification
-Unique to a specific institution
-Ongoing review critical
-Internal or external forces affecting unit influence classification system
Purpose of legislated minimum staffing ratios.
-Higher use of agency, float pool, or overtime nursing hours correlated with higher patient FAIL rates
-As RN hours decrease, then adverse patient outcomes increase
-Increase medication errors
-Decreased satisfaction with pain management
-The lesser amount of RNS, the higher number of adverse patient outcomes (increased error and patient falls, and decreased patient satisfaction)
-When there are less RNs working, then patient outcomes are not as positive.
-Adequate staffing numbers are needed to provide patient SAFETY!!!
Role of unit managers in recruitment and selection
-Managers should be skilled in planning, conducting, and controlling interviews.
-Be mindful of legal constraints on interviews.
-Proactively recruit and hire staff with age, gender, cultural, ethnic, and language diversity to better mirror the rapidly increasing diversity of the communities they serve.
-Active recruitment allows institutions to bring in the most qualified personnel for a position
-After applicants have been recruited, managers using specified criteria have a critical responsibility to see the best applicant is hired.
-To ensure all applicants are evaluated are evaluated using the same standards, and that personal bias is minimized. The nurse manager must be skilled in interviewing and other selection processes.
-Leaders should be abreast in changes in the health profession, foresee and plan for shortages.
-Leaders should also terminate the application process with positive information about an organization
Strategies for planning, conducting and controlling interviews.
-All interviewers able to be available at the appointed interview time
-Adequate time for the interview
-All interviewers should review the application prior to the interview time, noting questions or concerns
Strategies for planning, conducting and controlling interviews.
-Introduce yourself and greet applicant
-Make brief statement about the organization and available positions
-Clarify position person is applying for
-Discuss info on application, seek clarification/amplification if needed
-If applicant appears qualified, discuss organization and position further
-Explain the subsequent procedures for hiring
-If applicant not hired at the time discuss how and when he/she will be notified of interview results
Strategies for planning, conducting and controlling interviews.
-Create and maintain a comfortable environment throughout interview but do not forget the interviewer is in charge of the interview
-During the meeting, the manager should pause frequently to allow the applicant to ask questions
-Format should always encourage and include ample time for questions from the applicant
-Remember that the interviewer should have control of the interview and set the tone
Look at BP about legal vs illegal interview Q:
The organization must be sure the application form does not contain questions that violate various employment acts
Avoid unlawful inquiries during the interview. Inquires cannot be made regarding:
-Financial or credit status
*these are all illegal because they are deemed discriminatory
What should be done as follow-up when processing employment applications
-Follow up with applications as soon as possible, thanking them for applying and informing them when they will be notified about a decision
-Candidates not offered a position should be notified of this as soon as possible. Reasons should be provided when appropriate (insufficient education and work experience), and candidates should be told whether their application will be considered for future employment or if they should re-apply
-Applicants offered a position should be informed in writing of the benefits, salary, and placement. This avoids misunderstandings later regarding what employees think they were promised by the nurse-recruiter or the interviewer
-Applicants who accepted job offers should be informed as to the pre-employment procedures such as physical examinations and supplied with the date to report to work
-Applicants who are offered positions should be requested to confirm in writing their intention to accept the position
Induction part of employee indoctrination.
Note: Indoctrination--planned, guided adjustment of an employee to the organization and the work environment
-Takes place after the employee has been selected but before performing the job role.
-Includes all activities that educate the new employee about the organization and employment and personnel policies and procedures.
-Often performed during the placement and pre-employment functions of staffing or may be included with orientation activities
-Employee handbook--assimilation of all induction info at one time
-Followed by a discussion with various employees during employment process (managers)
-First level manager is the most important link in promoting real understanding of personnel policies
-This is SEPARATE from orientation, which is the second stage
Best reinforcement of employee behavior?
-Incentives and rewards
-Positive reinforcement is one of the most powerful motivators the manager can use
-Possibility for growth
-Positive working conditions
-Interpersonal relationships and peers
-Comes from within the person, driving him or her to be productive
-Often influenced by family unit and cultural values
-Directly related to a person’s level of aspiration.
-Often impacted by others!
-Comes from outside the individual
-Rewards and reinforcements are given to encourage certain behaviors and/or levels of achievement
-MOtivation is enhanced by the job environment or external rewards
-Rewards resulting from extrinsic motivation occur after the work has been completed
Note: it is unrealistic for the organization to assume that all workers have adequate levels of intrinsic motivation to meet organizational goals
-Thus, an organization must provide a climate that stimulates both extrinsic and intrinsic drives
What is achievement motivation?
-The need for success or the attainment of excellence.( -Individuals will satisfy their needs through different means, and are driven to succeed for varying reasons both internal and external.)
The motivation that guides this type of person to action is by the need to achieve
-Focus on improving what is!!
Transform ideas into action, judiciously and wisely take risks when necessary
What are the implications of a needs hierarchy?
-Managers begin to realize that people are complex beings, and rather than just being motivated by economics, their many needs motivating them at any one time
-Motivation is internalized
If productivity is to increase, management must help employees meet lower-level needs
-The shifting focus on what motivates employees has tremendously affected how organizations value workers today
-Maslow’s Hierarchy of Needs
Appropriate time to reward for reinforcement of behavior.
-Positive reinforcement must be specific or relevant to a particular performance
-Must occur as close to the event as possible
-Reinforcement of new behaviors should be continuous
Ways to stay motivated as a nurse leader?
-Self care. The manager should seek time off on a regular basis
-Form relationships outside of the work setting
-Be able to separate personal life from work life
-Proper diet and exercise to maintain physical health
-Find social supports when confronted with stress
Factors influencing employee satisfaction at work
-The attitude and energy level of managers directly affects the attitude and productivity of their employees
-Manager can create an environment that maximizes the development of human potential
When planning a staff development class, what steps would be taken?
-Identify the desired knowledge or skills that the staff should have
-Identify the present level of knowledge or skills
-Determine the deficit of desired knowledge and skills
-Identify the resources available to meet needs
-Make the maximum use of available resources
-Evaluate and test outcomes after use of resources
Determining long term effectiveness of staff development programs.
-Learner’s reaction. How did the learner perceive the orientation, the class, the training, or the preceptor.
-Behavior change. What behavior change has occurred as a result of the learning? Was the learning transferred?
-Organizational impact. Efforts should be made to measure how the training impacted the organization. --Examples include assessing the quality of care, medication errors, accidents, quality of clinical judgement, turnover and productivity.
-Cost effectiveness. All activities should be quantified in some manner
Review The Civil Rights Act of 1964
-The Civil Rights Act laid the foundation for equal employment in the US.
-It prohibits the discrimination based on factors unrelated to job qualifications (sex, religion, race, color, and national origin) and promotes employment based on ability and merit.
-Affirmative action plans are voluntary and not required by law and are designed to actively fill job vacancies with members from underrepresented groups (women, handicapped, or ethnic minorities).
-The USEEOC is responsible for enforcing Title VII of the Civil Rights Act and they have the power to bring civil action against the employer when discrimination occurs
Review The Equal Pay Act of 1963.
-Requires that men and women performing equal work receive equal compensation
-Four equal pay tests exist
-Similar working conditions
Sexual harassment in the workplace.
Sexual harassment is a form of sex discrimination that violates Title VII of the Civil Rights Act
“Sexual harassment”: unwelcome sexual advances, request for sexual favors, and other verbal or physical conduct of a sexual nature when submission to or rejection of this conduct, explicitly or implicitly affects an individual’s employment; unreasonably interferes with an individual’s work performance; or creates an intimidating, hostile, or offensive work environment.
Victim and harasser may be a woman or a man--the victim does not have to be of the opposite sex
The harasser can be the victim’s supervisor, agent of the employer, a supervisor in another area, a coworker, or a non-employee
The victim does not have to be the person harassed but could be anyone affected by the offensive conduct
Unlawful sexual harassment may occur without economic injury to or discharge of the victim
THe harasser’s conduct must be unwelcome
Ways to decrease chances of unionization of a nonunionized nursing service department
Know and care about your employees
Establish fair and well communicated personnel policies
Use an effective upward and downward system of communication
Ensure that all managers are well trained and effective
Establish a well developed formal procedure for handling employee grievances
Have a competitive compensation program of wages and benefits
Have an effective performance appraisal system in place
Use a fair and well communicated system for promotions and transfers
Have an administrative policy on unionization
Use organizational actions to indicate that job security is based on job performance, adherence, to rules and regulations and availability of work
What is fiscal planning?
Not intuitive; a learned skill that improves with practice
· An important but often neglected dimension of planning
· Should reflect the philosophy, goals, and objectives of the organization
· A skill increasingly critical to nursing managers because of increased emphasis on finance and “big business” of health care
Responsibility of unit manager in fiscal planning.
1. Identifies importance of and develops short- and long-range fiscal plans that reflect unit needs
2. Articulates and documents unit needs effectively to higher administrative levels
3. Assess the internal and external environment of the organization is forecasting to identify driving forces and barriers to fiscal planning
4. Demonstrates knowledge of budgeting and uses appropriate techniques to budget effectively
5. Provides opportunities for subordinates to participate in relevant fiscal planning
6. Coordinates unit-level fiscal planning to be congruent with organizational goals and objectives
7. Accurately assesses personnel needs by using predetermined standards or an established patient classification system
8. Coordinates the monitoring aspects of budget control
9. Ensures the documentation of patient’s need for services and services rendered is clear and complete to facilitate organization reimbursement
10. Collaborates with other health-care administrators to proactively determine how health-care reform initiatives such as VBP, ACOs, bundled payments, the medical home, and the health care insurance marketplace may impact organizational viability and provision of services.
Types of budgets: incremental, zero-based.
- Incremental: simplest method for budgeting
o Each multiplying current-year expenses by a certain figure, usually the inflation rate or consumer price index, the budget for the coming year may be projected
o Requires little budgeting expertise on the part of the manager
o No motivation to contain costs and no need to prioritize programs and services
o Hospitals have historically used incremental budgeting in fiscal planning
- Zero-based: must re-justify their program or needs every budgeting cycle
o Does not automatically assume that because a program has been funded in the past, it should be continue to be funded
o However, it is labor intensive for nurse-managers
o Key components:
§ Listing of all current and proposed objectives or activities in the department
§ Alternative plans for carrying out these activities
§ Costs for each alternative
§ Advantages and disadvantages of continuing or discontinuing an activity
Controlled verses uncontrolled expenses.
- Controllable expenses:
o Can be controlled or varied by the manager
o Example: unit manager can control the number of personnel working on a certain shift and the staffing mix
- Non- controllable expenses:
o Expenses cannot be controlled
o Example: unit manager cannot control equipment depreciation, the number and type of supplies needed by patients, or overtime that occurs in response to an emergency
Budget expenditures for health care organizations.
Budget: A plan that uses numerical data to predict the activities of an organization over a period of time
o The desired outcome of budgeting is maximal use of resources to meet organizational short- and long-term needs
o A budget provides a mechanism for planning and control, as well as for promoting each unit’s needs and contributions
o Goal of a budget: predicts an organization’s activities, to maximize the use of resources, to help with planning and control
Measurement of NCH/PPDs and what information is provided.
Nursing Care Hours (NCH) per patient-day (PPD)
o Nursing hours worked in 24 hours/ patient census
- A unit manager is an acute care facility might use this formula to calculate daily staffing needs
PPOs, HMOs, DRGs. Know the differences.
PPOs: preferred provider organization. In a PPO Plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network . You pay more if you use doctors, hospitals, and providers outside of the network.
- HMOs: a corporate body funded by insurance premiums
o Criticisms of HMOs:
§ Loss of existing physician–patient relationships
§ Limited choice of physicians for consumers
§ Lower level of continuity of care
§ Reduced physician autonomy
§ Longer wait times for care
§ Consumer confusion about the many rules to be followed
- DRGs: Diagnosis-related groups are predetermined payment schedules that reflect historical costs for the treatment of specific patient conditions
What is capitation?
Providers receive a fixed monthly payment regardless of services used by that patient during the month
- Goal for the capitated provider is to see that patients receive the essential services to stay healthy or to keep from becoming ill but to eliminate unnecessary use of health-care services
Description of critical pathways.
A strategy for assessing, implementing, and evaluating the cost-effectiveness of patient care
- Pathways reflect relatively standardized predictions of patients’ progress for a specific diagnosis or procedure
- They are predetermined courses of progress that patients should make after admission for a specific diagnosis or after a specific surgery
Decision making processes.
A complex, cognitive process often defines as choosing a particular course of action
- Critical Elements in Decision making:
1. Define objectives clearly
2. Gather data carefully
3. Take the time necessary
4. Generate many alternatives
5. Think logically
6. Choose and act decisively
- Traditional Problem-Solving Process: setting a decision goal helps to prevent the decision marker from becoming sidetracked
§ Amount of time needed for proper implementation
§ Less effective when time constraints are a consideration
§ Lack of an initial objective-setting step
- Managerial Decision-Making Models:
o To counteract traditional model’s weakness adds an objective-setting step
o Problem solvers must identify the decision to be made, who needs to be made in the decision process, the timeline for the decision, and the goals or outcomes that should be achieved
o Identifying objectives to guide the decision making helps the problem solver determine which criteria should be weighted most heavily in making their decision
- Nursing Process:
§ Multiple venues for feedback; constant input into the process; decision making continues throughout the process via feedback mechanism
§ Does not require clearly stated objectives
§ Goals should be clearly stated in the planning phase of the process, but this step is frequently omitted or obscured
- Integrated Ethical Problem-Solving Model
o Developed primarily for use in solving ethical problems, the model also works well as general problem-solving model
o Provides a structured approach to problem solving that includes an assessment of the problem, problem identification, the analysis and selection of the best alternative, and a means for evaluation
o Goes one step further in requiring the learner to specifically identify strategies that reduce the likelihood of a problem recurring
. What’s involved with critical thinking.
Reflective Thinking; related to evaluation and has a broader scope than decision making and problem solving
- “The mental process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and evaluating information to reach an answer or conclusion”
- Characteristics of critical thinker
o Intuition “hunch” about something
o Empathy- put yourself in someone else’s shoes
o Willingness to take action
Phases of planned change – unfreezing, movement, refreezing
- Unfreezing: the change agent convinces members of the group to change or guilt, anxiety, or concern are elicited
o Trying to encourage change “unfreeze”
- Movement: the change agent identifies, plans, and implements appropriate strategies, ensuring that driving forces exceed restraining forces
o Implement whatever has been planned and hopefully you can overcome those that have been resistant
- Refreezing: the change agent assists in stabilizing the system change so that it becomes integrated into the status quo
Change strategy – power-coercive, normative-re-educative, rational-empirical
Rational–empirical strategies: used when there is little anticipated resistance to the change or when the change is perceived as reasonable
- Normative–re-educative strategies: use group norms and peer pressure to socialize and influence people so that change will occur
- Power-coercive strategies: feature the application of power by legitimate authority, economic sanctions, or political clout of the change agent
1. Forecasts unit needs with an understanding of the organization’s and unit’s legal, political, economic, social, and legislative climate.
2. Recognizes the need for planned change and identifies the options and resources available to implement that change.
3. Appropriately assesses and responds to the driving and restraining forces when planning for change.
4. Identifies and implements appropriate strategies to minimize or overcome resistance to change.
5. Seeks subordinates’ input in planned change and provides them with adequate information during the change process to give them some feeling of control.
6. Supports and reinforces the individual effects of subordinates during the change process
7. Identifies and uses appropriate changes strategies to modify the behavior of subordinates as needed.
8. Periodically assess the unit/department for signs of organizational aging and plans renewal strategies
9. Continues to be actively involved in the refreezing process until the change becomes part of the new status quo.
Concept of successful change agent.
Change should never be attempted unless the change agent can make a commitment to be available until the change is complete
- The successful change agent has the leadership skills of a problem solving and decision making and has good interpersonal skills
- Change should be planned and thus implemented gradually, not sporadically or suddenly
- Change should only be implemented for a good reason