LEADERSHIP EXAM #2

delegation
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Terms in this set (104)
delegation
the process by which responsibility and authority for performing a task is transferred to another individual who accepts that authority and responsibility
goal of delegation
to meet the cost restraints of limited healthcare budgets by using less expensive personnel that maximize the use of time by RNs and promote teamwork
delegation (vs. supervision)
the assignment or designation of a competent individual to the responsibility of carrying out a specific group of nursing tasks in the provision of care for certain clients
supervision
the initial direction and periodic evaluation of a person performing an assigned task to ensure that he or she is meeting the standards of care
responsibility
denotes an obligation to accomplish a task; can be transferred
accountability
accepting ownership for the results (or lack of results); is shared
delegation process
1. define the task
2. decide on delegate
3. determine the task
4. reach agreement
5. monitor performance and provide feedback
define the task
define the complexity of the task and its components; subdivide the task into components and delegate only the components that are within the available delegate's capabilities
decide on the delegate
delegate to the lowest person in the hierarchy who has the capabilities and who is allowed to do the task legally
determine the task
clearly define your expectations for the delegate; delegate needs to know what is expected, when the task is to be completed, where, and how
obstacles to delegationsa non-supportive environment, poor communication and interpersonal skills, insecure delegator, unwilling delegate, unnecessary duplicationunder-delegationwhen full authority is not transferred, responsibility is taken back, or there is a failure to equip and direct the delegatereverse delegationwhen someone with a lower rank delegates to someone with more authorityover-delegationwhen the delegator loses control over a situation by giving too much authority or responsibility to the delegate5 rights of delegation1. right task 2. right circumstance 3. right person 4. right direction and communication 5. right supervisionconflictthe consequence of real or perceived differences in mutually exclusive goals, values, ideas, attitudes, beliefs, feelings, or actionsintrapersonal conflictconflict within one individualcompetitive conflicta victory for one side and a loss for the other sidedisruptive conflictdoes not follow any acceptable set of rules and does not emphasize winning but seeks to reduce, defeat, or eliminate the opponentantecedent conditionsassociate with increases of conflict; propel a situation toward conflict; based on incompatible goals ex: role conflicts, task interdependence, structural conflict, competition for resources, values and beliefsincompatible goalsmost important antecedent condition to conflictrole conflictsother people's expectations regarding behavior and attitudesstructural conflictusually due to poor communication; competition for resources, opposing interests, or lack of shared perceptions or attitudesvalues and beliefsresult from an individual's socialization experienceperceived conflicteach party's perception of the other's positionfelt conflictnegative feelings between two or more partiesresolutiona mutually agreed-upon solution that both parties commit tosuppressionone person or group defeats the otheroptimal solutionboth parties see themselves as winners and the problem is solvedconfrontationproblem-oriented technique in which the conflict is brought out into the open; attempts are made to resolve it through knowledge and reason; MOST EFFECTIVE means for solving conflictsnegotiationinvolves give-and-take on various issues among the parties; seeks to achieve agreement even though consensus will never be reachedcollaborationmutual attention to the problem, in which the talents of all parties are usedcompromiseused to divide rewards between both parties; neither gets everything he or she wantscompetingall-out effort to win, regardless of the costaccommodatingunassertive, cooperative tactic used when individuals neglect their own concerns in favor of others' concernssuppression (approach to conflict)in situations where conflict is discouraged; could include elimination of one of the conflicting parties through transfer or terminationavoidingparticipants never acknowledge that a conflict existswithdrawalsimply removes one partysmoothingcomplimenting opponent, downplaying differences, focusing on areas of agreementforcingmethod that yields an immediate end to the conflict but leaves the cause of the conflict unresolvedconflict management begins witha decision regarding if and when to intervenewin-win (Filley's strategies)focuses on goals and meeting the needs of both parties; consensus involves attention to facts and the position of the other partiesintegrative decision makingfocuses on the means of solving a problem rather than the ends; MOST USEFUL WHEN the needs of the parties are far apartstatistic of how many nurses may be impaired or in recovery from alcohol or drug addiction1 in 10; 10-15% of all nursesresponsibilities of administration w/ substance abuse problemsearly recognition and prompt referral for treatmentnursing informaticsa specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practicingclinical informaticsincludes nursing as well as other medical and health specialties and addresses the use of information systems in patient caredomains of clinical informaticshealth systems, clinical care, and information and communication technologiesinformaticsthe science of collecting, managing, and retrieving informationhealth informaticsencompasses the interdisciplinary study of the design, development, adoption, and application of IT-based innovations in healthcare services, delivery, management, and planningNational League for Nursing (NLN) 2008 Position Paperreform nursing education to promote quality education that prepares a workforce capable of practicing in a health care environment where technology continues to increase in amount and sophistication; prepare the next generation of nurses with the necessary informatics competencies to provide safe and quality careTechnology Informatics Guiding Education Reform Initiative (TIGER) recommendationsdevelop a nursing workforce capable of using EHR to improve the delivery of care, include nurses in development of a national healthcare information technology infrastructure, adopt standards-based technology that will make healthcare safer, more efficient, timely, accessible, and patient-centered, develop nursing informatics competencies, educate the existing workforcelevels of competencies: beginning nursecomputer literacy skills, information literacy skills, & technology skillslevels of competencies: experienced nursemake judgements based on data; collaborate with informatics nurselevels of competencies: informatics nurse specialistgraduate level education as an informatics nurse; assists other nurses with informatics and technologylevels of competencies: informatics innovatorgraduate level education as an informatics nurse; conducts informatics research and theory developmentwebsite evaluationaccuracy, authority or source, objectivity, currency or timeliness, coverage or quality, usabilityBobby Approveda service that helped website designers with making a site accessible for people with disabilitiesHealth on the Net Foundation (HON) Code of Conductnon-profit organization that assists people in obtaining accurate health informationHardin MD (Hardin Meta Directory)provides links to websites with accurate information and resources; good site to include in patient educationMedlinePlusconsumer oriented site that includes information from the National Library of Medicine, the National Institutes of Health, government organizations (such as CDC), and health-related organizationschange agentswork to bring about change; are role models for others; stimulate the need for change and help shape its successtraditional change theoriesLewin's Force-Field Model, Lippitt's Phases of Change, Havelock's Six-Step Change Model, Rogers' Diffusion of InnovationsLewin's Force-Field Model3 step process: unfreezing, moving, refreezingdriving forcesbehaviors that facilitate change by pushing participants in the desired directionrestraining forcesbehaviors that impede change by discouraging participants from making specified changesLippitt's Phases of Changeextended Lewin's theory to a 7 step process; focused more on what the change agent must do than on the evolution of change itself; emphasis on participation of key members 1. Dx the problem 2. Assess motivation and capacity for change. 3. Assess resources and motivation of change agent. 4. Choose progressive change objects. 5. The role of change agents should be selected and understood so expectations are clear. 6. Maintain the change. 7. Gradually terminate from the helping relationship.Havelock's Modelmodification of Lewin's Model to a six step process; describes active change agent 1. build relationship w/ client 2. Dx the problem 3. acquire resources for change 4. pick a solution 5. establish, accept, and monitor change 6. maintenance + separationRoger's Modeldescribes a five step innovation-decision process; emphasizes the reversible nature of change 1. knowledge 2. persuasion 3. decision 4. implementation 5. confirmationpower-coercive strategiesstrategies based on the application of power by legitimate authority, economic sanctions, or political clout; useful when consensus is unlikely, despite efforts to stimulate participationempirical-rational modelstrategy based on the assumption that people are rational and follow self-interest if that self-interest is made clearnormative-re-educative strategya change strategy based on the assumption that people act in accordance with social norms and valuesRogers 6 typical responses to change- innovators: love change and thrive on it - early adopters: receptive to change - early majority: prefers the status quo but eventually accepts the change - late majority: resistive, accepting change after most others have - laggards: dislike change and are openly antagonistic - rejecters: actively oppose and may even sabotage changenonverbal signs of resistance to changepoor work habits and lack of interest in the changebullyingthe persistent, repeated, malicious, offensive, and intimidating behavior which humiliates, degrades, and displays a lack of dignity and respect for the target resulting in them feeling vulnerable and threatened; usually directed at a specific personincivilitybehavior that is rude, disrespectful, impolite, or ill-mannered; ex: yelling, swearing, spreading rumors, and destroying or taking another's propertylateral violenceharassment between employees of equal rankhighest risk for bullyingnew graduates; incidence highest in the ORlowest risk for bullyingmen; more likely to speak up when experiencing lateral violencecontributing factors of bullyinggender, generational differences, enabling behaviors, complacency, fear of retaliationpsychological effects of bullyingsleep disorders, low morale, apathy, feeling disconnected, burnout, withdrawal, decreased self-esteemphysical effects of bullyingfatigue, headache, weight loss/gain, PTSD, anxiety disordersconsequences of bullying for bystanderssame symptoms as bullying victims; feelings of being afraid, powerless, and guilty for not acting; can become desensitizedconsequences of bullying for the organizationdecreased productivity, increased absenteeism, decreased nurse retention rates, poor reputationprofessional socializationthe process by which a person acquires the knowledge, skills, and sense of identity that are characteristic of a profession; involves internalization of values and norms of the professionformationthe development of perceptual abilities, ability to draw on knowledge and skilled know-how, and way of being and acting in practice and in the worldgoals of professional socializationto learn the technology of the profession, to learn to internalize the professional culture, to find a personally and professionally acceptable version of the role, to integrate this professional role into all of the other life roles(Benner) stage 1: novicelack of knowledge and experience; task-oriented and focused on rules; requires guidance(Benner) stage 2: advanced beginnerunderstand rationales for nursing actions; lack ability to prioritize; remains focused on the rules and lack the ability to alter or adjust the rules; still requires guidance; new graduates typically fit this category(Benner) stage 3: competentcan analyze problems and prioritize; can draw on prior knowledge and experience; new graduates who had additional experiences during school may enter at this stage(Benner) stage 4: proficientcan identify variations of the norms; sees that the rules don't apply to everyone; problem solves with alternative approaches(Benner) stage 5: expertintuitively knows what is going on with patients based on experience and knowledge; demonstrates a desire to always learn and questions aspects of nursing care; some nurses never achieve this stagepurpose of orientationto introduce the new hire to policies, procedures, and the social milieu of the hospital and to ensure competency with skill sets so that safe, competent care is deliveredreality shockdisparity between what is learned in nursing education (based on theory, ideals, and research), and what is the reality in the clinical area/practice (based on theory, research, emotion, policies, procedures); results in role confusion and difficulty finding a personally and professionally acceptable version of the nursing rolepreceptorcompetent, formally trained, experienced staff nurse who is responsible for educating new staff nurses, while still performing his or her own job responsibilitiespreceptors responsibilities include assisting the new graduate to become competent in:- communication: healthcare team, patient and families, documentation, delegation - judgement: decision making, critical thinking, self-direction - psychomotor: skill performance - teaching-learning: patient education, documentation - caring: advocacy, professionalism, work-role relationships, self-care as a professionalmentoringongoing, collaborative relationship between two professionals where the mentor is more experienced/senior than the menteeformal mentoringa person is assigned to be a mentor to a new nurse for a specified period of timeinformal mentoringa mentoring relationship develops and may last a lifetimeworkplace violenceany violent act, including physical assaults and threats of assault, directed toward persons at work or on duty (threatening actions, verbal or written threats, physical attacks, violent assaults)consequences of violenceaffects staff morale, increases staff stress, causes mistrust of administration, exacerbates hostile work environmentfactors contributing to violenceunrestricted visiting hours, patient with head trauma, seizure disorders, dementia, alcohol or drug withdrawal, or who are homeless, inadequate security, family stressEHRmeant to provide a means to more effective communication and collection of patient information which should result in more effective patient care; allows for remote access by many providers at the same time; provides clinical alerts, reminders, identification of abnormal lab and assessment data, reminders of protocols and recommended tasks; for nurses, EHR should allow more time for direct patient care, improve accuracy of documentation, decrease medication errors, and promote patient safetycomponents of EHRadmission, discharge, and transfer, financial systems, order entry, ancillary systems, clinical documentation (e.g. scheduling applications, acuity applications, communication systems, & critical pathways)