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Arts and Humanities
Final Exam: Budgeting, HR, Organizing, conflict management, and all previous lectures
Terms in this set (75)
What are the 4 basic elements of nursing care delivery systems?
1. Clinical decision making
2. work allocation
What 5 things should be considered when selecting the appropriate model (organization lecture)?
1. The skill and expertise of all staff
2. The availability of the RN's
3. The economic resources
4. The acuity of the patients
5. The complexity of the tasks
What are the 7 types of nursing care delivery systems?
1. Case method
2. Functional nursing
3. Team nursing
4. Primary nursing
5. Client/Patient centered care
6. Differentiated practice
7. Case management
What is the case method (nursing delivery system)? What are the advantages/disadvantages
TOTAL PATIENT CARE, private duty nursing, oldest method, one nurse assumes responsibility for individual or group. ex: home health care, community health, ICU
Advantages- consistent care from one nurse, unfragmented, increased trust, increased patient satisfaction, client-focused
Disadvantages- COSTLY, largest, decreased efficiency, inexperienced staff
What is functional nursing (nursing care delivery model)? what are the advantages/disadvantages ?
task oriented, thought to be a temporary fix, similar to scientific management. A particular nursing function is assigned to each staff member. no nurse is responsible to total care
Advantages: very EFFICIENT/effective with a specific task, ACCOMPLISH MOST WORK IN WORK LEAST AMOUNT OF TIME, train unskilled workers, decreased cost- LESS RN's, little confusion about roles
Disadvantages: fragmentation of care, psychosocial needs not met, physical needs met, patient confusion, who's my nurse, decreased communication, decreased accountability, dissatisfaction with job.
What is team nursing (nursing care delivery model), and what are the advantages/disadvantages?
developed for decreasing fragmented care, the team leader is responsible for coordinating a small group of staff to care for a small group of patients, The team leader assigns each member a patient or specific responsibility
intent: provide patient centered care, MOST COMMON SYSTEM IN US. democratic leadership style works best
advantages- Increased patient satisfaction, decision making at lower levels, most qualified team member gives care, each member participates in the decision making process, less costly still have less RN;s, increased communication, increased autonomy
disadvantages, could have a poor team leader with poor leadership skills, improper implementation, increased time- patient care conferences, power still lies within RN
**LARGEST DIFFERENCE BETWEEN FUNCTIONAL AND TEAM NURSING IS COMMUNICATION!!!!!
What is primary nursing ?( nursing delivery care model), what are the advantages/disadvantages
developed due to increased desire for increased autonomy and increased quality of care, concern about the fragmentation of care, FIRST FORMAL professional model, DECENTRALIZATION IS THE CORE PRINCIPLE
- a primary nurse is responsible for 24 hour patient care from admission to discharge, 24 hour accountability, prefer bsn, KNOWLEDGE based practice model
-delegates the work to others when not working, has all been eliminated but in acute care/home health
advantages- increased RN autonomy, continuity of care, psychosocial needs met, primary nurse does intial assessment, increased trust, increased communication with other health care professionals, MOST COMMON ALL RN STAFF, increased job satisfaction
disadvantages- COSTLY all rn's similar to case method, burnout from total accountability, poor preparation of RN, improper implementation, part time rns, not enough rn's due to shortage
What is client/patient focused care (nursing care delivery model), what are the advantages and disadvantages?
DECENTRALIZED, unit based and consists of patient care coordinators (RN's), patient care associates (LPNs), unit support assistants (CNA/tech), administrative support personal (unit clerks) and nurse manager
Bring services to the patient rather than to patient to the services, patients are separated according to care requirements, examples are ICU satellite pharmacies, mini labs, meds are all in or near patient rooms.
based on the principles of primary nursing and case management, may use any nursing delivery system, staff needs to be cross trained for multiple skills
advantages- systems and services are closer to the patient, increased patient satisfaction, service and waiting times are decreased, COST EFFECTIVE
disadvantages- fewer number of RNs, increased responsibilities for caregivers, requires a strong nurse manager, increased start up costs, role confusion
What is differentiated practice? (nursing delivery care system) what are the 2 basic care models used to differentiate practice?
a method that maximizes nursing resources by focusing on the structure and functions of nurses according to 3 COMPONENTS, EDUCATION, EXPERIENCE, and COMPETENCE.
2 basic models are used to differentiate practice
the education model- ADN, BSN, MSN, role differentiation based on education, older model
the competency model, based on ANA standards and Benners 5 levels of practice
In the differentiated practice delivery model what are the 2 types of basic models, what are benners 5 levels of practice? What are the advantages and disadvantages with this model?
Education model & competency model
2. advanced beginner
advantages, decreased cost to the organization, increased efficiency, best use of resources, nurses utilized to their potential
disadvantages, nursing shortage, a nurse is a nurse mentality, increased use of UAP, cna's better delegation
What is case management ( nursing care delivery model) what are the 4 principles it is based off of
A COLLABORATIVE process of assessing, planning, facilitation and advocacy for options and services to meet an individuals health needs through communication and available resources to promote quality cost effective outcomes
Interdisciplinary - involves the patient- uses critical pathways
1. The coordination and integration of a continuum of holistic care
2. The promotion and preservation of health throuhg periods of transition and risk
3. The conversation and allocation of scarce resources
4. The provision of follow up care that tracks and guides service delivery over the long term and across episofes and settings
what are the advantages and disadvantages of care management (nursing care delivery model)?
Advantages: improved patient outcomes, decreased length of stay, increased patient satisfaction, COST EFFECTIVE
Disadvantages: Financial barriers- not revenue generating, but revenue protecting, seen as an expense, lack of administration support, lack of information support, Turf battles, Lack of education
What are critical pathways?What are the components of a critical pathway?
AKA standards of care, protocols, care maps, clinical practice guidelines, not personalized
components: assessments, consults, tests, treatments, medications, activities, nutrition, discharge planning, variants
What are the TWO core components of the care management model of nursing delivery
COORDINATION OF CARE AND
MANAGEMENT OF RISK
What is variance (care management model)?
Deviation from the normal pathway, anything that alters the progress; system, patient, provider, Can be positive . (achieved before expected) or negative (undesired outcome)
What is conflict defined?
internal or external discord that results from differences in ideas, values or feelings between 2 or more people
it is the clash or struggle that occurs when a real or perceived threat or difference exists in the desires, thoughts, attitudes, feelings or behaviors of 2 or more parties
What is a conflict?
A conflict is more than just a disagreement
conflicts continue to fester when ignored
we respond to conflicts based on our perceptions
conflicts trigger strong emotions
conflicts are an opportunity for growth
What are 3 categories of conflict?
Intergroup/Organization : between 2 or more groups of people, departments, or organizations
Intrapersonal: internal struggle to clarify contradictory values or wants ex: should I finish my paper or should i go out
Interpersonal: between people with differing values, wants, beliefs, ex coworker, boss
What are some sources of organizational conflict?
Power divisions, communication misunderstandings, disparate personal and organization, resource allocation, poorly defined role expectations, varying values, beliefs, backgrounds, and goals between members of the healthcare.
poorly defined role expectations- dont understand RN vs FNP, ex: MA on her own, created negative work environment
varying values and beliefs: example- CVU used to be ATU, one nurse opposed to giving end of life medications
What are the levels of conflict resolution?
Top Level: results in strengthened relationship
- resolution meets some individual and shared needs, results in mutual benefits
* what we should shoot for
Middle level: results in temporary agreement
-resolution is mutually acceptable for the time being but there is little enhancement to the relationship
* find resolution or acceptable for time being
Lower level: result is mutual damage
-one person submits to the demands of the other, relationship may dissolve with mutual damage
* one person gives into another
What are the 5 stages in the conflict process?
Latent conflict- when conditions are ready for conflict but no actual conflict as occurred yet ex short staffing
Perceived conflict- maybe theres no obvious conflict yet, just a matter of time, ex budget cuts
Felt conflict- recognizes it and can be resolved before internalized or felt, CONFLICT is emotionalized
Manifest- competing and debating when we act on it.
Conflict aftermath- what happens after the conflict can be negative or positive
What are some positive and negative effects fo Conflict?
Positive: releases tension, provides intellectual stimulation and creativity, facilitates change, improves decision making, improves group performance
Negative: Increases conflict, decreases communication, decreases cohesiveness, decreases performance, increases absenteeism and turnover
What are some common conflict strategies ?
* depending on conflict, all styles can be effective
Conflict style used depends on the nurse managers values regarding work production and human relationships
What are some positive uses of avoiding? (low results/low people)
-when people need to cool down
-when more important issues are pending
-for trivial disagreements or when the problem will It resolve itself
-when more information needs to be gathered
-When the cost of dealing with the conflict exceeds the benefit of solving it
-when one party is more powerful than the other
What are some positive uses for accommodating (high people/low results)
- when other ideas are better or you have made a mistake
-when the issue is more important to the other party than it is to you
- when letting others learn from there mistakes is possible
-when preserving harmony is more important
What are some positive uses of Competing (high results/low people)
-when quick, decisive action is necessary
-when important, unpopular action needs to be taken
- when an individual, or group is right about issues that are vital
What are some positive uses of Compromising ( medium results/medium people)?
-when collaborating and competing fail
-when time pressures people to expedite a workable solution
-when temporary solutions to complex issues need to be implemented
What are some positive uses of collaborating? (high results/high people)
-when there is a need to identify, share, and merge vastly different view points
- when there is a need to be honest about and work through difficult issues interfering with morale, productivity and growth
-when seeking creative, integrative solutions where both sides goals and needs are important
What are some actions to avoid in conflict resolution?
Do not avoid the conflict hoping it will go away
Do not meet separately with people in conflict
Do not believe the only people affected are the participants
What are unhealthy responses to conflict?
an inability to recognize and respond to the things that matter to the other person
explosive, angry, hurtful, and resentful actions
the fear and avoidance of conflict, the expectation of bad outcomes
______ a detailed financial plan aimed at controlling allocation of resources
_____ Income or amounts coming into an organization-private pay, insurance, interest on loans, grants, donors
____ cost assigned to a unit elsewhere in an organization or those within a unit not Incurred in the direct care of the client
____ cost of the organizations operations, nurse salaries, supplies building maintenance, loans
____costs that can be attributed to a specific source such as goods and services includes elements nursing time, cost of resources used in direct care of patient or client (treatments, supplies, medications)
D Direct Costs
E Indirect Costs
a detailed financial plan aimed at controlling allocation of resources
__C Revenues__ Income or amounts coming into an organization-private pay, insurance, interest on loans, grants, donors
___E indirect costs_ cost assigned to a unit elsewhere in an organization or those within a unit not Incurred in the direct care of the client
__B Expenses cost of the organizations operations, nurse salaries, supplies building maintenance, loans
_D direct costs__costs that can be attributed to a specific source such as goods and services includes elements nursing time, cost of resources used in direct care of patient or client (treatments, supplies, medications)
D Direct Costs
E Indirect Costs
What are the 3 types of budgets? (matching question)
Personnel budget- Salaries Nurse managers tend to have the most intensive involvement in this process
Operating budget- expenses that change in response to the volume of service
Capital budget-**exam expenses related to the purchase of capital assets or long term investments (buildings, land or equipment)
What are the 3 budgeting methods?
Traditional - simplest, (incremental or flat % increase), process based on budget from previous year plus %
Zero-based budgeting- MOST USED, the entire budget is rebuilt from zero to each year pr budget cycle. All EXPENSES justified EACH YEAR. challenges thinking and forces justification
Performance budgeting- emphasizes outcomes and results instead of activities
What are the 4 components for the importance of budgeting and financial management? (exam)
1. budgeting is focused on money as a strategic resourse
2. control over money significantly impacts on nursing practice and nursing care delivery
3. nurses role in budgeting includes becoming informed and participating in the decision making process
4. knowing budgets helps nurses to make better decisions regarding provision pf care and supply and equipment utilization
What is the Unit managers job? *exam question, 4 components
1. advocate for high quality and appropriate numbers of staff
2. communicate the unit needs to administration
3. communicate the budget to the staff- have them participate in solutions
4.bargain for scarce resources
T/F managers can delegate budget duties
F, only the manager can do budget
What should be done weekly/monthly for monthly budget report?
Review for errors
What are review variances and what are the 2 types?
review variances are the difference between the amount that was budgeted for a specific revenue or cost and the actual revenue cost
favorable- more revenue than expected/less money spent Ex: patients discharging earlier than projected
unfavorable- less revenue than expected/more money spent
Ex: readmission, no where to take patient, transportation issues
What are the 4 components for promotion of cost control ?
1. DO the job efficiently- the more efficiently and organized the nursing care delivery is, the greater the contribution of individuals to the care provided, the less costly the care will . be
2. Time is money- simple scheduling errors can increase the lenth of a clients stay
3. help motivate clients to recover- improves health status and reduces dependency costs
4. Uses supplies carefully- know the cost of supplies
What is the most efficient nursing care delivery model?
functional and team nursing
Which nursing care delivery method is the most costly?
Primary nursing, all nurse staff NICU,ICU
What are the 4 factors that influence personnel budget?
1. staff mix
What are methods for calculating cost of nursing and productivity- workload measurement tools
Acuity & complexity of care
FTE (fulltime equivalent)
HPPD hours per patient day
Which method is the oldest for calculating cost of nursing and productivity
What is the census method for calculating cost of nursing and productivity?
-average daily census, usually based on historical data (JHACO requires a defined system to be used in staffing)
1 patient per day = 1 patient day
What is DRGs method for calculating cost:
(diagnosis related groups)Provide reimbursement for medical diagnosis care days but do not take into consideration acuity levels & needs to patients
ex medicare pays 3 days regardless on a new hip
What is acuity & complexity of care method for calculating cost:
the acuity and complexity of care used in determining how many hours of care are required for group or unit
What is FTE?
- Full-time equivalent, meaning the amount of time a full-time staffer
- A budget formula to determine the # of personnel providing direct care.
-needed to determine the overall staffing plan
What is the HPPD workload measurement tool?
the hours of nursing care provided per patient per day by various levels of nursing personnel
**all nursing and ancillary staff are created equal and no differentiation is made based on the acuity levels of patients
What is the Patient classification system workload tool(PCS)?
aka patient acuity systems, an objective method of classifying patients by determining the amount of care needed for a group of patients based on the amount and complexity of nursing care required
EACH UNIT DECIDES THEIR OWN NURSING HOURS/ACUITY LEVEL FOR EACH CATEGORY
What are patient classification system also referred to as?
Patient acuity systems
Who mandates the use of Patient Classification System?
Federal and State regulations mandate the use of a PCS to determine staffing levels'
ex: JHACO,Medicare, Magnet status
What is the definition of Human Resource Management ?
The process by which management stimulates the motivation of employees to perform productively
What are performance appraisals?
definition*- A systematic standardized evaluation of an employee by a supervisor for the purpose of evaluating: QUALITY OF WORK, WORK CONTRIBUTION, POTENTIAL FOR ADVANCEMENT
-*one of the greatest tools to develop and motivate staff
-* they are a major responsibility of the controlling function in management
they are designed to measure nursing performance(based on standards) and motivate personnel toward greater achievement, growth, and development
What are the 3 domains competence is assessed in ?
1. Cognitive-critical thinking, decision making, problem solving
2. Affective- interpersonal skills, communication
3. Psychomotor-physical task skills
What are the 7 performance appraisal strategies?
Trait rating scales
Ancedotal/critical incident notes
management by objectives
360 degree evaluation
What are the 2 types of trait rating scales?
1. Absolute- evaluate performance against an INTERNAL STANDARD
an examples is BARS or Behavioral Anchored Rating Scales - a rating form developed for each job classification
2. Comparative- rate employees by comparing with one another (on a grade curve)
What are check lists? (performance appraisal strategies)
Lists of desired characteristics or behaviors, psychomotor skills
ex. IV starts
What are anecdotal/incident notes?(performance appraisal strategies )
written records of observations concerning behaviors. Facts: who, where, when, what, can be negative or positive
What is a peer review? ( performance appraisal strategies)
the evaluation of an individual by his or her colleagues who has similar education, experience, and status. Purpose is to provide feedback to the individual
What is Management by objective? ( performance appraisal strategies)
MBO, meaningful goals written in the form of objectives, create a set of objectives for a given time period. SPECIFIC, MEASURABLE, ATTAINABLE, mutually set with the employee and manager
What is the 360 degree evaluation? ( performance appraisal strategies )
Similar to Peer review, an assessment by individuals within the sphere of influence of the employee being evaluated (4-5 in a circle)
A. Similar to Peer review, an assessment by individuals within the sphere of influence of the employee being evaluated (4-5 in a circle)
B. meaningful goals written in the form of objectives create a set of objectives for a given time period. SPECIFIC, MEASURABLE, ATTAINABLE, mutually set with the employee and manager
C. the evaluation of an individual by his or her colleagues who has similar education, experience, and status. Purpose is to provide feedback to the individual
D. written records of observations concerning behaviors. Facts: who, where, when, what, can be negative or positive
E. Lists of desired characteristics or behaviors, psychomotor skills
ex. IV starts
F. Absolute or Comparative example is BARS or Behavioral Anchored Rating Scales - a rating form developed for each job classification
G. You evaluate your own skills and areas for improvement
___Trait rating scales
___Anecdotal/critical incident notes
___management by objectives
___360 degree evaluation
__F_Trait rating scales
__D_Anecdotal/critical incident notes
__B_management by objectives
__A_360 degree evaluation
What are the common evaluator rating errors?(she said this would be an easy exam question?
Halo effect- the rater lets 1-2 positive aspects unduly influence all other aspects of performance and generalizes it into an overall high rating
Horn effect- The rater lets 1-2 negative aspects unduly influence all other aspects of performance and generalizes it into an overall poor rating
Recent behavior Bias- the rater only recalls and uses recent data, not the range of behavior overtime
Sunflower effect- a rater gives everyone high ratings because they belong to a "great" team
Central Tendency effect- the rater rates everyone as average, does not know much about the person
Rater temperament effect- different raters are strict or lenient. Performance may very depending on the rater
Matthew effect- when employees receive the same appraisal results year after year, perform well, receive good evaluations, those who struggle continue to struggle.
* on final: TO be a good manager, you must be an effective leader, the reverse is not true
What is the difference between transformational and transactional leadership?
Transactional leaders are traditional and focus on day to day operations. They set goals, give directions, and use rewards. Offer promotions to employees who surpass their goals. The leader does not individualize the needs of the followers or focus on their personal development.
contingent award is a fee for service
management by exception-leaders will watch followers closely for mistakes. only react when a problem occurs
Transformational leaders are committed leaders who motivate followers to perform to their full potential over time by influencing a change in perceptions and by providing a sense of direction/vision.
They have 4 factors. CHARISMA, INSPIRATIONAL MOTIVATION, INTELLECTUAL SIMULATION, INDIVIDUAL CONSIDERATION
What are the 4 factors of transformational leaders (kim p)
What are the 4 principles of scientific management by taylor?
developed to enhance organizational performance by maximizing individual productivity
1. Standardize the work
2. Select the right workers
3. Carefully train these workers
4. Support workers by planning their work and removing obstacles
What is shared governance?
a PROFFESIONAL PRACTICE MODEL, that includes an accountability based governance system for professional employees
-shared decision making
-nursing practice is best determined by nurses
-goal is to empower people with the system to increase the control of their practice
What are sources of conflict?##
power divisions, communication misunderstandings, desperate personal and organizational goals and values, resource allocation, poorly defined role expectations, varying values-beliefs-backgrounds-goals between members
What are constructive effects of conflict?##
can release tension, provides intellectual simulation and creativity, facilitates change, improves decision making, improves group performance
Avoiding is ___ results and ___ people
LOW results, LOW people
Accommodating is __ results and __ people
LOW results and HIGH people
Competing is __ results and __ people
HIGH results and LOW people
Compromising is __ results and __ people
MEDIUM results and MEDIUM people
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