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What is an Interview?
-A conversation with a purpose.
-Interview goes two ways.
-Selling yourself as an entry level GN.
-Knowing the institution's mission, goals & vision.
-Secure a desired position.uSelecting a place to practice your career.
Prepare for the Interview:
• Prepare for the interview through research.
• Know the company/institution.• Have a list of questions prepared.• Be prepared for questions you may be asked by the interviewer(s). • Review the job description and key nursing service initiatives.
Prepare for the Interview: research
-Research the institution/company on-line (internet, newspaper, friends).
-Query the company website - obtain information on benefit packages, retirement, etc.
-Obtain institutional/company mission, vision and accomplishment statements.
-Review the annual report, if available.
Prepare for the Interview: Do Sweat the Details
• Know where you are going.
• Be on time...ahead of time...15 minutes early.
• Plan ahead - Determine how long it takes to get there.
• Know the route, parking, traffic, and campus/facility map.
• Make a practice run - same route at the same time.
Prepare for the Interview: Your preparation
-Be organized - bring updated copy of resume
(bring several copies for each interviewer), personal reference list, pen and notepad.
-Make sure your resume stands out from the other applicants.
-Outline your strengths, career goals and skills (usually standard questions on most all interviews).
-Provide examples of accomplishments.
-Rehearse the interview with a friend.
-Allow ample time for the interview - usually 2 hours.
How to get to know the institution?
-First line interview is usually with HR consultant.
-Second line interview/tour is usually with the Nurse Manager and/or panel members from the unit/department.
-Panel interviews are common with GN.
-Assess the personalities of the unit.
-Ask questions....look, listen & pay attention.
-Review professionalism charter & committees
Day of the Interview: Facts for and about You
-Dress for success (a jacket is a safe bet)!
-Go easy on the trendy!
-Wear minimal jewelry
-Conceal tatoos, body piercings, etc. (Review the institutional dress code policy, if available).
-Conservative hair style & color, minimal perfume/after shave and makeup.
-When in doubt - always be conservative!
-Dress professionally & don't wear scrubs!
Day of the interview
• Important to be on time.
• Don't bring the entourage!
• Silence cell phones or pagers.
•Be aware of your body language - maintain "eye contact & posture".
•Listen, ask questions and be specific.
•Offer examples that emphasize your answers.
•Don't make derogatory remarks about former employers
Day of the Interview: What to do and what not do...
-Don't boast or brag but do not be wilting either.
-Ask the interviewer to repeat the question or clarify if you don't understand it.
-Don't ramble - be clear and concise.
-Do follow-up with a thank you note within one week of the interview.
-Make sure to pick an institution that is a good fit for you.
Research, Rehearse and Relax
- Nothing takes the place of being prepared!
- There is no question you cannot answer.
- Be thorough and project self-confidence.
- The best jobs go to the best candidates with the best interview!
- There must be a connection between you & the institution/unit.
- Take a deep breath and remember you have a purpose...sell yourself as the "best" candidate!
Looking for the Perfect Position
-Choose your first job, don't let it choose you
-Make certain that you will have professional support:
->Graduate Nurse Residency Programs (University Health System Consortium/American Association of Colleges of Nursing)
-Look at your career goals, possible issues with driving distances, childcare, spousal concerns, shift and holiday work
-Most importantly, the institution should be one you are compatible with.
-Talk with nurses on units
-Be familiar with mission statement of institutions
-You can get a JOB but it is harder to get a career
-Plan to stay at your first job at least one year preferably several years
Role Transitions throughout the lifespan
•Student to RN
•Dependent to independent •Daughter/son to wife/husband •Scholarship recipient to wage earner •College student to professional worker
• Exists when a person prepares for a profession or position and discovers they are not as prepared as expected.
•Marlene Kramer wrote "Reality Shock: Why nurses leave nursing in 1974."
•"New graduates can analyze and synthesize, but can't catheterize".
•New grads feel conflicted and frustrated by values taught in nursing school with demands and expectations of nursing administration
Effects of Healthcare Reform and Expectations of Employers
• Emotional exhaustion
• Decreased professional self- confidence
Reality Shock causes
-Absence of positive reinforcement and
-Lack of support
-The gap between ideals taught in school and the actual work setting
-Inability to implement desired nsg care due to circumstances such as heavy case load or time constraints
Reality Shock: How do nurses drop out?
-Disengagement mentally and emotionally
-Driving oneself and others to the breaking point by trying to do it all
-Job hopping- trying to find the perfect job
-Prematurely returning to school
-Burning out- unresolved reality shock with subsequent emotional exhaustion
-Leaving the profession entirely
Phases for Reality Shock
-Dr. Marlene Kramer (1974) Authored: "Reality Shock: Why Nurses Leave Nursing."
-Reality shock theorizes that those new to the nursing profession go through a learning and growing transition
The four phases are:
• Initially there is a period of euphoria & excitement; everything is great
• "I am great! This is a wonderful place to work. I am learning so much! This is fun!"
• The focus of this stage is learning people on unit and work routine
•New grads begin to recognize there are flaws in the system
•Adoption of the path of least resistance and do whatever the older nurse is doing, taking shortcuts, not knowing meds
•Discover their preceptor doesn't know everything
•Begin to see poor professional behavior in other nurses
•Negative feelings about their chosen profession begins to surface
•Felt embarrassed by physician or bullied by other nurses
• Runaways, they change fields, they go immediately to grad school
• Rutters: Just consider nursing a JOB; do what I have to do
Shock Phase : RN results during this phase
-Frequent job changes
Burned out: Bottling up conflict
until they become symptomatic: -High fatigue
-Poor work quality
-Depression and anger
-Begins an upward climb back to the positive side
-Able to look at all sides & see the realities with a more open perspective
-Important to receive constructive criticism which can be provided by strong mentors
-Sense of humor & acceptance returns
-Can see the role in prospective & fully contributes to the profession
-Understanding new culture
-New grads have opportunity to define the nurse they want to be
-Danger - might adopt values that are less than ideal to fit in with co-workers
Reducing Burnout during Role Transition from Student to RN
• Recognize that schools cannot provide enough clinical experience to make new grads comfortable on first day of work
•Take responsibility for obtaining practical experience outside of school ( avoiding work during the school week, or keep to a minimum)
•Find a mentor
•Work with a preceptor
•Take care of yourself
•Maintain a balance between work and personal lives
•You are responsible for your own lifelong professional socialization
•Develop emotional intelligence skills
•Exercise: Helps fight off negative thoughts and emotions
Novice to Expert Theory
-Dr. Patricia Benner, (1984)
Nurses grow in their career through stages:
Novice - Stage I
-Few clinical experiences
-Taught general rules to help perform tasks
-Rule-governed behavior is limited and inflexible
-Skills are learned by memorization
-"Tell me what I need to do -
and I'll do it"
Advanced Beginner - Stage II
-Advanced beginners perform adequately
-Enough experience to recognize recurring meaningful components
-Make some judgments based on experience
-Experience begins to guide actions
Competent - Stage III
• Competent nurse can see long range goals and are mastering skills, typically two-three years after graduation
• Uses conscious, abstract and analytical thinking
• Greater efficiency and organization
Proficient - Stage IV
•Proficient nurses able to view whole situations rather than parts and develop a solution
•More holistic understanding improves decision making
•Learns from experiences what to expect in situations and how to modify plans
Expert - Stage V
•Expert nurses who have intuition and decision making that is instantaneous
•No longer relies on principles, rules, or guidelines to connect situations and determine actions
•Much more background of experience
•Performance is now fluid, flexible and highly proficient
Special needs of Novice Nurses
-Interpersonal skills and communication skills
-Priority Setting skills
Interpersonal skills and communication skills
Novice nurse has beginning knowledge of making rounds, clarifying orders, participating in interdisciplinary conferences
Novice nurse has a basic knowledge but no innate confidence in their ability; needs much more practice
Novice nurse has usually not cared for as many patients as they will be assigned as a member of the profession; also has low skills in prioritization
Must have a foundation and working knowledge on what can or can not be delegated to team members on the unit
Priority Setting skills
Make a to do list at work and cross off tasks as completed; what tasks were unnecessary and unproductive
Don't be mislead by nursing administration into thinking that you are more advanced than you really are and, therefore, miss out on essential orientation opportunities.
Methodology to meet Novice Nurse Needs
-Preceptorships during final semester - Capstone course
-Mentoring by experienced nurses
-Self-mentoring- you are ultimately responsible for your self.
-Joining professional organizations - give leadership skills and meet nursing leaders.
• American Nurses Association • Sigma Theta Tau, Int.
• Specialty Organizations, such as: CCRN; ENC; RNC, CNOR, etc.
Career Development and Educational Opportunities
• Set one year, three year and five year goals
• Write down the goals in order of importance
• Make them ones that you yourself really want
• Make a concentrated effort to begin working on your one year & three year goals immediately on graduation.
The RN takes responsibility and accepts accountability for practicing within the legal scope of practice and is prepared to work in all healthcare settings, and may engage in independent nursing practice without supervision by another healthcare provider. The RN is responsible for providing safe, compassionate and comprehensive nursing care to patients and their families with complex healthcare needs
Practice of Professional Nursing
The performance of an act that requires substantial specialized judgment and skill, the proper performance of which is based on knowledge and application of the principles of biological, physical and social science as acquired by a completed course in an approved school of professional nursing. The term does not include acts of medical diagnosis or the prescriptive of therapeutic or corrective measures
Law Governing Nursing in Texas
The Nursing Practice Act
Texas Nursing Practice Act
-Act is generally amended every two years during regular session of Texas legislature in the odd years
-Chapters 301, 303, 304, & 305 of the Texas Occupations Code contain the Nursing Practice Act
Major Provisions of NPA
*duty to report
•Nurses must report other nurses
•Who violate NPA or BON Rule and contribute to death or serious injury of a patient
•Whose practice is impaired by chemical dependency or drug or alcohol abuse
•Who's conduct constitutes abuse, exploitation, fraud, or a violation of professional boundaries
•Who lack knowledge, skill, judgment, or conscientiousness and could result in harm to a patient
•Nurses must report nursing students whose ability to perform the services of the nursing profession would be impaired by chemical dependency
Mission of the BON
-Protect and promote the welfare of the people of Texas
-Ensures that licensed nurses are competent to practice safely
Difference Between BON and Nursing Associations (ANA, NLN, Etc.)
•Nursing associations generally promote the welfare of nursing and practice
•BON has authority over all nurses licensed in state
•Nursing association have voluntary membership
Role of Legislature and BON
•Legislature passes changes to NPA
•BON interprets the NPA and develops rules and regulations to implement the NPA
Major Provisions of the NPA
•Definition of Nursing
•Establishes the BON and sets administrative functions and process
•Requirements for licensure and renewal of licensure
•Whistleblower protection for nurses
Mandatory Continuing Education
•Requirement is to have 20 hours of continuing education every two years
•You will be asked on license renewal if you have done required CEU's
•BON randomly audits nurses for verification
Texas Board of Nursing Membership (Members)
6 members from nursing practice
•2 RN's who are not APN's
•1 APN from practice or education
3 members from nursing education
•Associate degree education
•4 members who are consumers
Functions of the BON
•Establishes standards of practice
•Interprets NPA & Rules & Regulations to nurses and the public
•Investigates possible violations of NPA
•Disciplines violators through legal action
•License qualified applicants to practice nursing - RN, LVN, APN
•Grants licensure to nurses from other states
•Recommends to legislature appropriate changes in NPA
•Establishes standards for nursing education and approves nursing education programs
•Provides consultation to nursing education programs
•Provides advice and counsel to faculty, staff of health agencies utilizing nurses, and to nurses to improve professional service
Licensure with History of Criminal Convictions: Examples of Absolute Bars to Licensure
•Child Endangerment or Abandonment
•Robbery - Aggravated
•Cruelty to Animals
•Prostitution - 3 or more counts
•Use of Deadly Weapon
•Online Solicitation of a Minor
•Improper relationship between Educator and Student
Issued with application received, background check complete, director affidavit received and Pearson Vue paid
•Renew license every 2 years
•Must renew by end of month of your birth month
•If 90 days late, renewal fee plus late charge
•If more than 90 days late, renewal fee plus double late charges
•If more than a year late, BON will investigate
Possible Disciplinary Actions of BON
•Denial of application for a license
•Issue a written warning
•Administer a public reprimand
•Limitation on the license that might limit practice or specific activities or stipulate periodic BON review
•Suspension of the license
•Assessment of a fine
•Require counseling, continuing education, practice be under supervision of another RN, or public service
•May be referred to TPAPN
Texas Peer Assistance Program for Nurses
The TPAPN program is operated by the Texas Nurses Association. The program offers licensed nurses who are impaired by chemical dependency or mental illness an opportunity to undergo treatment and to safely return back to their nursing practice — all under the protection of confidentiality.
Standards of Practice
•Listed in Rules & Regulations relating to Nurse Education, Licensure And Practice
•Guide professional behavior of nurses
•Used as standard in issues related to practice and malpractice
Nurses must know and conform to:
•Rules & Regulations
•Federal, state, local laws affecting their area of practice
•Two kinds of peer review:
•Entities that employ more than 10 nurses must have peer review plan
•All proceedings are confidential
A process that protects a nurse from employer retaliation and licensure sanction when a nurse makes a good faith request for peer review of an assignment or conduct the nurse is requested to perform and that the nurse believes could result in a violation of the NPA or Board rules.
Nursing Incident-Based Peer Review
•Evaluate the nursing services of a nurse
•Evaluate quality of care given by nurse
•Evaluate complaints concerning a nurse or given care
•Conclude with recommendation
•Legal document that allows person to make decision about end-of-life care
•Directs physician about preferences at end-of-life
-All treatments be discontinued
-All treatments to be continued
•Go into effect when person cannot make own healthcare decisions
If no advance directive, and person is incapable or incompetent of communication:
Treatment decision can be made by physician and one of these in order listed:
(1) the patient's spouse;
(2) the patient's reasonably available adult children;
(3) the patient's parents; or
(4) the patient's nearest living relative.
•Order by physician stating you are not to be resuscitated if cardiac arrest
•Must be in chart and progress notes
•Either patient or family must agree to order
Medical Durable Power of Attorney
Grants another person the right to act as legal representative for you to make decision related to medical care
complex, cognitive process of choosing a particular course of action; the thought process of selecting a logical choice from available options
part of decision making; systematic process focusing on analyzing a difficult situation
Identify -> define -> explore -> action -> look back
Characteristics of a Critical Thinker
• Intuition: rt brain thinking
• Empathy: think with their hearts and minds
• Willingness to take action: left brain thinking and use the left side of
the brain when making decisions. More linear and logical
Integrating and applying different types of knowledge to weigh evidence, critically think about arguments, and reflect on the process used to arrive at diagnosis
Vicarious learning to enhance decision making skills
processes by which people change their behaviors because they observed the actions of other people and the consequences that occurred
-also called modeling
-Case studies: provide stories that impart learning
model performs behavior and experiences consequences -> observer sees modeled behavior and consequences -> observer performance of modeled behavior may increase or decrease, depending on modeled consequences
Provides mock life experiences to learn from, learning done in the sim lab
Successful Decision Makers characteristics
• Self-aware: sharing the knowledge we have with others who need it
The Traditional Problem-Solving Process
-Identify the problem.
-Gather data to identify the causes and consequences of the problem.
-Explore alternative solutions.
-Evaluate each alternative
-Select appropriate solution
Managerial Decision-Making Model
-Determine the decision and the desired outcome (set objectives).
-Research and identify options.
-Compare and contrast these options and their consequences.
-Make a decision.
-Implement an action plan.
Critical Elements in Problem Solving and Decision Making
-State a clear objective.
-Gather data carefully.
-Take the time necessary.
-Use an evidence-based approach.
-Generate many alternatives.
-Choose and act decisively.
Nursing Process: A Problem-Solving and Decision-Making Model
Strategies for New Nurses to Promote Evidence-Based Practice
-Keep abreast of the evidence.
-Use multiple sources of evidence.
-Use evidence to support clinical interventions and teaching strategies.
-Find established sources of evidence.
-Implement and evaluate nationally sanctioned clinical practice guidelines.
-Question and challenge nursing traditions.
-Dispel myths and traditions not supported by evidence.
-Collaborate with other nurses locally and globally.
-Interact with other disciplines to bring nursing evidence to the table.
Successful Decision Maker understnads
• Personal individual values
• Life experience
• Willingness to take risks
• Brain hemisphere dominance
• Predominant thinking style
• Decision grids
• Payoff tables
• Decision trees
• Consequence tables
• Logic models
• Program evaluation and review technique
•Makes decisions in rational manner
•Has complete knowledge of problem or situation
•Considers all alternatives
•Has rational systematic ordering preference of alternatives
•Selects the decision that will maximizing utility
-makes decisions that are good enough
-because complete knowledge is not possible, knowledge is always fragmented
-because consequences of alternatives occur in the future, they are impossible to predict accurately
-usually chooses from among a few alternatives, not all possible ones
-the final choice is satisficing rather than maximizing
Integrating Leadership Roles and Management functions
The effective manager recognizes the difficulties inherent in advisory positions and uses leadership skills to support staff in these positions
•Often do not have delegated authority but obtain their power through other means
•Have a wider variety of roles than managers and may have different personal goals
•Are frequently not part of the formal organization
•Focus on group process, information gathering, feedback, and empowering others
• Are always assigned a position within an organization
• Have a legitimate source of power due to the delegated authority that accompanies their position
• Are expected to carry out specific functions
• Emphasize control, decision making, decision analysis, and results
Ten Fatal Leadership Flaws
1. A lack of energy and enthusiasm
2. Acceptance of their own mediocre performance
3. Lack of a clear vision and direction
4. Having poor judgment
5. Not collaborating
6. Not walking the talk
7. Resisting new ideas
8. Not learning from mistakes
9. A lack of interpersonal skills
10. Failing to develop others
Characteristics of Managers
-Hold formal position of authority and power
-positive and negative consequences
-behavior and taught
-climate of management
-Envision the future
-Communicate their visions
-Lead the way
-Influence others to accomplish goals
-Optimize resource use
-Meet organizational goals and objectives
-Plan, organize, control, and direct
-Use reward and punishment effectively to achieve organizational goals
Frederick W. Taylor, Scientific Management
-science, not rules of thumb
-scientifically train employees
-ensure most efficient ways of working are used
-divide work between managers and workers
-pay based on results
Henri Fayol Management Functions
Henri Fayol Management Functions: Planning
Encompasses determining philosophy, goals, objectives, policies, procedures, and rules
Henri Fayol Management Functions: Organizing
-Includes establishing the structure to carry out plans, determining the most appropriate type of patient care delivery, and grouping activities to meet unit goals
-Other functions involve working within the structure of the organization and understanding and using power and authority appropriately.
Henri Fayol Management Functions: staffing
Consists of recruiting, interviewing, hiring, and orienting staff; scheduling, staff development, employee socialization, and team building are also often included as staffing functions
Henri Fayol Management Functions: Directing
Usually entails human resource management responsibilities, such as motivating, managing conflict, delegating, communicating, and facilitating collaboration
Henri Fayol Management Functions: Controlling
Includes performance appraisals, fiscal accountability, quality control, legal and ethical control, and professional and collegial control
Elton Mayo and the Hawthorne Effect
-The Hawthorne effect is the idea that 'behavior during the course of an experiment can be altered by a subject's awareness of participating in an experiment
-the initial Hawthorne effect took place in the Hawthorne plant of western electric company in the 20s and 30s
-The studies were composed of many long 'investigations into the importance for work behavior and attitudes of a variety of physical, economic and social variables'
Douglas McGregor's Theory X and Theory Y
Douglas McGregor Theory X
represents a pessimistic, negative view of workers
workers are irresponsible, resistant to change, lack ambition, hate work, and want to be led
-We dislike work
-we must be forced or coerced to make the right effort
-we would rather be directed than accept responsibility
-we are motivated mainly by money
-most of us have little creativity
Douglas McGregor Theory Y
represents an optimistic, positive view of workers
Workers are considered capable of accepting responsibility, self-direction, self control and being creative
-We need to work
-we will direct ourselves
-we will seek and accept responsibility
-under the right conditions, we are motivated
-we are highly creative creatures
work life balance
The human relations era
• Risk taker
• Critical thinker
• Creative problem solver
• Change agent
• Role model
• Decision maker
The Evolution of Leadership Theories
• Great Man theory/trait theories
• Behavioral theories
• Situational and contingency leadership theories
• Interactional leadership theories
• Transactional and transformational leadership
• Full-range leadership theories
-management by exception
-maintain status quo
-short term focus
-idealized influence: purpose driven, role model, 'walk the talk'
-inspirational motivation: inspiring, inspire followers
-intellectual stimulation: innovating, challenges followers to be innovative and creative
-individualized consideration: people driven, genuine concern for needs of followers
Factors Affecting Health-Care Trends
• Growing elderly population
• Health-care reform
• Reductions in reimbursements
• New quality imperatives
• Shift in focus of care to community settings
• Technological advances
• Shift to customer-focused care
Leader-Manager's Repertoire for the 21st Century
• Strength-based leadership
• Level 5 leadership
• Servant leadership
• Principal agent leadership
• Human and social capital theory
• Emotional intelligence and authentic leadership
• Quantum and thought leadership
Strength-Based Nursing Leadership
• Works with the whole while appreciating the interrelationships among its parts
• Recognizes the uniqueness of the staff
• Creates work environments that promote nurses' health
• Understands the significance of subjective reality and created meaning
• Values self-determination
• Recognizes that person and environment are integral and that nurses function best in environments where there is a "goodness of fit"
• Creates environments that promote learning and recognizes the importance of readiness and timing
• Invests in collaborative partnerships
Jim Collins's Level 5 Leadership
-Level 1: highly capable individual
-Level 2: contributing team member
-Level 3: competent manager
-Level 4: effective leader
-Level 5: executive
Level 1: highly capable individual
Leader makes high-quality contributions to their work; possesses useful levels of knowledge; and has the talent and skills needed to do a good job
Level 2: contributing team member
Leader uses knowledge and skills to help their team succeed; works effectively, productively, and successfully with other people in their group
Level 3: competent manager
Leader is able to organize a group effectively to achieve specific goals and objectives
Level 4: effective leader
Leader is able to galvanize a department or organization to meet performance objectives and achieve a vision
Level 5: Great leader (executive)
Leader has all of the abilities needed for the other four levels, plus a unique blend of humility and will that is required for true greatness
Focus of Greenleaf's Servant Leadership
-commitment to employees growth
Principal agent theory
Principal hires the agent and the agent performs
Human and Social Capital Theory
• Human capital represents the capability of the individual.
• Social capital represents what a group can accomplish together.
Emotional intelligence is critical for building a cooperative and effective team.
Five Components of Emotional Intelligence
5. social skills
Suggests that in order to lead, leaders must be true to themselves
5 distinguishing characteristics of the authentic leader
-Purpose: understands own purpose and passions as a result of ongoing self-reflection and self-awareness
-Values: authentic leaders link between purpose and passion by having congruence in beliefs and actions
-heart: authentic leaders care for themselves and the people they lead and their compassion is genuine
-relationships: authentic leaders value building relationships and establishing connections with others, not to receive rewards but rather to strengthen the human connection
-self discipline: authentic leaders practice self discipline by incorporating balance into their personal and professional lives
Thought leadership applies to a person who is recognized among peers for innovative ideas.
Thought leadership components
-media relation s
Reflective Thinking and Practice
-Nurse-managers need to continually adapt, reflect on progress and setbacks, and adjust their course.
-Consider what one knows
-Believe and value current situation
-Reframe to develop future responses and actions
-States that leaders must work together with subordinates to identify common goals, exploit opportunities, and empower staff to make decisions for organizational productivity to occur
-Suggests that the environment and context in which people work is complex and dynamic and that this has a direct impact on organizational productivity
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