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Test 1 (leadership)

Terms in this set (70)

Functional nursing is also called?
task nursing
How does functional nursing work?
the needs of a group of patients are broken down into tasks that are assigned to RNs, LPNs, and CNAs so that the skill and liscensure of each caregiver is used to his/her best advantage. For example, the RN assesses while the CNA gives the bath.
Team nursing has what benefit (patient-wise)?
holistic perspective on the needs of the patient
How does team nursing work?
A team of nursing personnel provides total patient care to a group of patients. The team leader speaks for the patient, not any other member of the team.
A key aspect is nursing care conference.
How does total patient care work?
an RN is responsible for all aspects of the care of one or more patients, including ADLs, baths, etc
How does primary nursing work?
Decentralized decision making by staff nurses is the core principle of primary nursing.
The nurse designs, implements, and is accountable for the nursing care of patients in the patient load for the duration of the patient's stay on the unit.
How do practice partnerships work?
The partners work together wit the same schedule and the same group of patients. (p. 34)
How does case management work?
Organizes patient care by major diagnoses or diagnosis-related groups (DRGs).
Focuses on attaining predetermined patient outcomes within specific time frames and resources
Can only be initiated if there are specific patient diagnoses that represent high-volume, high-cost, and high-risk cases..
Critical path AKA?
care map
How do critical paths work?
They provide direction for managing the care of a specific patient during a specified time period.
They accommodate the unique characteristics of the patient and the patient's condition.
What are the "traditional" models of nursing care? (there are 4)
Functional Nursing
Team Nursing
Total Patient Care
Primary Nursing
Which care model is this?:

RNs, LPNs, and UAPs are assigned different tasks

RNs assess patients
Other staff give baths, make beds, take vital signs, administer treatments

Advantages:
Staff become efficient at performing assigned tasks

Disadvantages:
Uneven continuity
Lack of holistic understanding of patient
Problems with follow-up
Functional nursing
Which model:
Team of nursing personnel provides total care to a group of patients
RN leads team that may include other RNs, LPNs, and UAPs
*Team leaders must be skilled in delegating, communicating, problem solving
All members of effective teams are good communicators*

Advantages:
LPNs and UAPs perform tasks that don't require RN's expertise
Care is more easily coordinated
Saves steps and time

Disadvantages:
Time needed for communicating, supervising, and coordinating team members
Affect of changes in team leaders, members, and assignments on continuity of care
Total patient not considered by any one person
Role confusion and resentment
Less control for nurses over assignments
Possibility of unequal assignments
Team nursing
Which model:
RN is responsible for all aspects of care for one or more patients

Advantages:
Continuous, holistic, expert nursing care
Total accountability
Continuity of communication

Disadvantages:
RNs perform tasks that could be done more cost-effectively by less skilled persons
Total patient care
Which model:
RN designs, implements, and is responsible for nursing care for duration of the patient's stay on the unit

Advantages:
Knowledge-based practice model
Decentralization of decisions, authority, and responsibility
24-hour accountability
Improved continuity and coordination of care
Increased nurse, patient, and physician satisfaction

Disadvantages:
Excellent communication required
Accountability of associate nurses
Patient transfers disrupt continuity of care
Compensation and legal responsibility for staff nurses
Unwillingness of associates to take direction
Primary nursing
What are the three Integrated models of care?
Practice Partnerships
Case Management/Critical Pathways
Differentiated Practice
Which model:
RN and partner (UAP, LPN, nursing student, or less experienced RN) work together on same schedule with same group of patients

Advantages:
Improved continuity of care and accountability for care

Disadvantages:
Decreased ratio of RNs to nonprofessional staff
Potential for junior team members to assume too much responsibility
Practice partnerships
Which model:
Case manager supervises care provided by licensed and unlicensed nursing personnel
Critical pathways provide direction for managing care of specific patients

Collaboration of all members of team
Identification of expected patient outcomes within specific time frames
Use of principles of continuous quality improvement and various analysis
Promotion of professional practice
Case management
What are the 5 elements of case management?
1. Support of key members of the organization
2. A qualified nurse case manager
3. Collaborative practice team
4. A quality management system
5. Established critical pathways
Which model:
Care map
Expected outcomes and care strategies developed by the collaborative practice team
Provide direction for the team
If outcomes not achieved..case manager notified
Altering time frames or interventions: Variance
Critical pathway
Which model:
Structure of roles and functions differentiated by nurses' education, experience, and competence
Roles, responsibilities, and tasks defined for professional nurses, licensed practical nurses, and unlicensed assistive personnel
Differentiated practice
Which model:
Nurse coordinates team of multifunctional, unit-based caregivers
All patient care services are unit based
Focus is decentralization, promotion of efficiency and quality, and cost control
Patient-centered care
Which model:
Small unit of care that maintains itself
Dynamic, interactive, self-aware, and interdependent
Informational system for both patients and caregivers
Proven to improve teamwork, communication, and continuity of care
Clinical microsystems
Which model:
Changes how daily care is delivered by clinical teams
Self-management support
Decision support
Delivery system design
Clinical information system
Health care organization
Community Resources
instead of reacting to change...team provides proactive interventions
Chronic care
What are the 4 components of classical theory?
Division and Specialization of Labor
-Divides work, decreased # of task employee carries out...increased efficiency/improving product; managers can standardize work to be done

Chain of Command
-Hierarchy of authority (right or power to direct activity) and responsibility (obligation to attain objectives)
-Line (linear hierarchy) /Staff authority (advisory)

Organizational Structure
-Arrangement of the work group...Bureaucracy..."ideal, intentionally rationale, most efficient form of organization"—1958

Span of Control
-How many employees a manager can effectively supervise (Tall vs Flat
Which theory:
....People desire social relationships...respond to group pressures...personal fulfillment—controversial but led theorists to focus on social aspects of work and organizational design
Humanistic

The Hawthorne effect is a part of this theory-"special attention"
Which theory:
Consists of input, throughputs, and outputs.

Managers are the catalyst for in-throughput-output

Limitation.....Does not recognize complexity of organization
systems theory

Closed systems...self-contained...found in physical science

Open systems...interacts both internally and with the environment,,'
Which theory:
theory is a class of behavioral theory that claims that there is no best way to organize a corporation, to lead a company, or to make decisions.
8Instead, the optimal course of action is dependent upon the internal and external environment. "Match an organization's structure to its environment"..environment of a health organization is (patients, potential patients, third party payers, competitors, Medicare, managed-care, personnel. Including schools of nursing/medicine, equipment and pharmaceuticals
Contingency theory-always a plan B
Which theory:
Roles of leadership ...build resilience, maintain balance between tension and order.

Emphasizes creative and flexible formats that can be adjusted as the organization's realities shift

Managers must encourage the flow of information in all directions, not just top to bottom

Based upon the belief in the uncertainty and unpredictability of the environment, this theory asserts that organizations are living, self-organizing systems that are complex and self-adaptive.
Chaos theory
-The system moves between order and chaos and is only stable temporarily.
-No plan B
Which theory:

not defined in linear cause and effect outcome
Every encounter between patient and caregiver offers information about solutions to problems.

Flow of information between/among team members/leaders followers

Useful in health care environment as "rife with randomness and complex tasks

Every aspect of the "System" must be analyzed as it interacts and adapts to changes..i.e patient safety issues
Complexity theory
What are the 4 traditional organizational structures?
Functional
Hybrid
Matrix
Parallel
Which organizational structure:
Centralized decision making

Coordination across functions may be poor

Responses to external stressors may be slow

General management training limited..employees move up organization with functional department

Uncommon in rapidly changing HC environment

Employees grouped in departments by specialty
Functional
Which organizational structure:
Decentralized
Potential for rapid change
Client satisfaction high
Coordination across functions may be high
Duplication of service
Coordination across service categories difficult
A Product line
Service line
Which organizational structure:
Simultaneous coordination within product division
Improves alignment between corporate/service goals
Fosters adaptation to environment
Conflict among top administrators is a weakness of this structure
Hybrid
Which organizational structure:
Integration of product/functions structures
Dual authority: major weakness
is time consuming—many meetings
Appropriate structure in a uncertain environment that changes frequently but requires organizational expertise
Matrix
Which organizational structure:
Unique to health care
Formal authority of HC organization and authority of medical staff—two lines of authority
Are becoming less successful as HC organizations integrate into newer models incorporating MD practice under organizational umbrella
parallel
Which organizational structure:
Empowers nurses in the practice setting
Nursing practice best determined by nurses
Participative decision making
Standard for Magnet certification
May have multiple councils (practice/professional development/quality/research)
Shared Governance`
What type of diversification is this:
partnership in which each partner contributes different areas of expertise, resources, or services to create a new product/service.
Such as with an NP and an MD
joint venture
What type of diversification is this:
organization complements its existing services by expanding into new markets or broadening the types of services it currently has available.
Concentric diversification
What type of diversification is this:
expanding into areas that differ from the original product or service.
Conglomerate diversification
Which Managed health care organization:
geographically organized system that provides an agreed-on package of health maintenance and treatment services provided to enrollees at a fixed monthly fee per enrollee (CAPITATION)
Health Maintenance Organizations (HMO):
Which Managed health care organization:
managed care organization contracts with independent practitioners to provide enrollees with established discounted rate
Preferred Provider Organization (PPO):
Which Managed health care organization:
HMO/PPO hybrid—may use network providers or go outside. Use of outside provider usually results in additional costs in copayments, deductibles or premiums
Point of Service Plan (POS):
Which Managed health care organization:
group of health care providers that provide care to a specified group of patients...more flexible than HMO's as consumers may choose providers outside network.
Accountable Care Organizations
Define:
organization's reason for existence
Mission
define:
beliefs/attitudes one has about people, ideas ,objects & actions that form basis for behavior.
values
define:
goal to which an organization aspires
Vision
define:
written statement of mission, values,and vision
philosophy
define:
specific statements of what outcome is to be achieved.
goals
Organizational Environment Vs Culture-which is it?
Basic assumptions and values held by members of the organization. ("rules of the game
Norms and traditions: affects the practices and procedures of the organization
Uniforms or scrubs
When is report given
Is tardiness tolerated
How late is acceptable
culture
Organizational Environment Vs Culture-which is it?
Is the perceived characteristics of the organization
environment
Organizational Environment Vs Culture-which is it?
Uniforms or scrubs
When is report given
Is tardiness tolerated
How late is acceptable
culture
Magnet
ANCC (American Nurses Credentialing Center)
Demonstrate sustained excellence in nursing care
Begun in 1980s
Significant investment of time and financial resources
"Forces of Magnet"
Include research, retention of nurses, EBP
and to a certain extent, staff with advanced education

Promoting quality in a setting that supports professional practice

Identifying excellence in the delivery of nursing services to patients/residents

Disseminating "best practice" in nursing services

Higher ratio of nurses to practice

Flexible schedules

Decentralized administration
Participatory management

Autonomy in decision making

Recognition
Advancement opportunities
Cost of medical errors?
$19.5 billion annually (2008 data....so probably much higher
how much does the US spend on healthcare?
3.0 trillion (or $9,523 per person) in 2014
17.5% of GDP
More than any other country
quality initiatives
Goal to reduce errors
Quality management
Continuous improvement
Benchmarking
What quality initiative is this:
Is a preventive approach
Involves continuous evaluation and improvement
Is implemented through patient satisfaction surveys
quality managment
Define:
Consortium of public and private purchasers
Leverages purchasing power
Rewards organizations for quality measures
Leapfrog group
Define:
Compares an organization's data with similar organizations
Uses outcome indicators to compare performance across organizations
Uses results to address weaknesses and enhance strengths
Benchmarking
What are the 5 steps to evidence-based practice decision making?
1. Identifying the clinical question
2. Finding evidence to answer the question
3. Evaluating the evidence
4. Applying the evidence
5. Evaluating the outcome
What are the barriers of electronic health records? (2)
Privacy and confidentiality concerns
Costs of implementing and operating
What are the benefits of electronic health records? (4)
Reduced redundancies
Improved efficiency
Decreased medical errors
Lower health care costs

Other:
Allows for collective data analysis

Facilitates a common nursing language

Supports evidence-based decision making
What percent of nurses are male?
Female nurses outnumber male nurses (only 9% men)
According to the U.S. Census Bureau: While 3.2 million (91 percent) nurses are female, only 330,000 (9 percent) are male. Men are best represented among nurse anesthetists. In 2011, 41 percent of nurse anesthetists are male.Feb 9, 2016
Traditionals generation values what?
value loyalty, respect authority
Baby boomer generation values what?
Personal and professional growth
Generation X values what?
Balance work/family life...not reward, given responsibilities
generation Y (millennials) values what?
Technically savvy, immediate access to information
How many nurses are victims of workplace violence?
Nearly 500,000 nurses victim of workplace violence
Other threats affecting nurses include:
Disasters
Terrorism
Pandemics
Average age of the nurse?
Average age: 47
85% of nurses practice full/part time
As aging nurses retire, the nursing shortage will grow worse
Demand for nurses will continue to grow
What are the 3 phases of a nursing career?
1. Promise
-Initial experiences, building blocks
2. Momentum
-Learning and growing, multiple experiences, greater visibility
3. Harvest
-Sharing, mentoring, legacy
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