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Exam 2

Terms in this set (111)

Conflict
•The internal or external discord that occurs as a result of differences in ideas, values, or beliefs of two or more people.
•Conflict is natural, neither good nor bad.
•Leader's role in conflict
Categories of Conflict
Intrapersonal.
Interpersonal.
Intergroup.
The Stages of Conflict Process
1st stage-- Latent conflict
2nd stage--Perceived conflict
3rd stage-- Felt conflict
4th stage- Overt (manifest) conflict
5th stage-- Conflict aftermath
Common Conflict Resolution Strategies
Compromising
Competing
Cooperating/accommodating
Smoothing
Avoiding
Collaborating
Leadership Roles in Conflict Resolution
-Addresses conflict as soon as it is perceived
-Immediately confronts incivility and bullying
-Seeks a win-win situation
-Assists subordinates in identifying alternative conflict resolutions
-Recognizes and accepts individuality in team members
-Use of communication skills
-Importance of role modeling
Helpful Tips in Conflict Resolution
-Focus on the causes of the disagreement and not on personalities.
-Try to arrive at solutions acceptable to everyone concerned.
-Get all the information possible. Differentiate between facts and opinions.
-Listen carefully and watch nonverbal communication
-Keep an open mind
-Always discuss the conflict
-Be honest
Negotiation
•Frequently resembles compromise when used as a conflict negotiation strategy.
•Emphasis is on accommodating differences between the parties.
•Each party must consider trade-offs to negotiate successfully.
Seeking Consensus
§Always an appropriate goal in resolving conflicts and in negotiation.
§All parties support, or at least do not oppose, an agreement.
§Greatest challenge in consensus building is time.
Attributes that make leaders effective in negotiation
sensitivity to others, the environment and interpersonal communication skills.
Delegation
•Getting work done through others
•Directing the performance of one or more people to accomplish organizational goals
•Delegation = RN accountability for the work delegated
Delegated Tasks
•Delegating can also be used to provide learning or "stretching' opportunities for subordinates.
•Sometimes managers must delegate routine tasks so they are free to handle problems that are more complex or require a higher level of expertise.
•Delegation is based upon the RN's assessment of the situation
•Think about the outcome you want for the patient, think about complications and think about family
Tasks That Can be Delegated to UAP
•Vital signs
•Weights
•Ambulation
•Positioning/turning
•Transporting patients
•Personal hygiene
•Feeding patient
•ADL's
Tasks Prohibited from Delegating to UAP
•Medication administration
•Nursing judgement
•Nursing assessment/intervention
•Formulation of nursing care plans
•Teaching
•Evaluation of patient response to nursing care
LVN versus RN
LVN—Directed nursing practice
•Must be supervised by an RN
•Collects data
•Perform focused assessment—NOT an initial assessment
•Assist in the nursing process

RN—Autonomous nursing practice
Delegation Red Flags
When the RN delegates to the UAP, think of the following:

•UAP may refuse task—ask yourself why and what you are going to do about it.
•UAP may be unable to understand instructions based upon education
•UAP is unable to verbalize the understanding of the task
Five Rights of Delegation
1.Right task
2.Right circumstance
3.Right person
4.Right direction and communication
5.Right supervision
Strategies for Delegation
•Plan Ahead
•Identify skill and educational level
•Select capable personnel
•Communication
•Empower the person being delegated to
•Set deadlines/Monitor progress
•Evaluate
•Reward
Steps of Delegation Process- monitoring
•providing guidance and re-direction if needed
•RN is responsible for monitoring subtle changes
•Timely intervention if needed
•Awareness of UAP's need for coaching and further direction
Steps of Delegation Process- evaluation
•were the objectives achieved
•Was delegation successful?
•Was there a better way to meet patient's needs?
•Did UAP need any further education and coaching?
Integration of Delegation in Leadership/Management Roles
•Delegation requires highly developed leadership skills
•Never delegate anything to subordinates that would be considered as professional nursing practice
•Using delegation skills appropriately reduces personal liability
Causes of Underdelegating
•Fear that delegation may be interpreted as a lack of ability to do the job completely or correctly.
•A desire to complete the whole job himself or herself.
•Fail to anticipate the help they will need (delegate before you become overwhelmed)
Causes of Overdelegating
•Poor management of time; spending too much time trying to get organized
•Insecurity in the ability to perform a task
Key Concepts in Delegation
•Delegation is not an option, but necessity.
•Should be used for assigning routine tasks in which manager does not have time.
•Clear communication with what manager wants done, including purpose.
•RN's who are asked to assume role of delegator need preparation to assume these leadership tasks.
•Assuming role of delegator to the UAP increases scope of liability for the RN.
•When subordinates resist delegation, ascertain why the task was not accomplished and take appropriate action
•Transcultural sensitivity in delegation needed to create a productive multicultural work team.
Why Is Scheduling So Difficult in Nursing?
•Erratic and unpredictable health care demand.
•High-level expertise required 24/7.
•Stress of job requires balanced work-recreation schedule.
•Staffing mix varies with acuity.
Centralized Staffing
•Staffing decisions made by nursing service office by aide of computerization
•Tends to be fairer because policies are implemented more consistently
•Frees manager to complete other functions.
•Most cost effective - maximizes use of human resources
Decentralized Staffing
•Staffing decisions made at unit level
•Allows person who knows unit best to make staffing decisions
•Allows staff to request directly to their manager, giving them more autonomy
•Increases the risk of unequal treatment
•Time-consuming for unit manager.
Flexible Time (Flex Time)
A system that allows employees to select the time schedules that best meet their personal needs while still meeting work responsibilities.
Per Diem Employees and Float Pools
Float pools:
•Hired per-diem (per day)
•Internal supplemental staff
•Pay By Letter (PBL)

• Reduced costs of agencies
Agency and Travel Nurses
•
•External nursing broker contracts with hospital
•Nurses work for premium pay (often 2-3 times higher than regular nurses)
•Don't get benefits
•Provides scheduling relief, but is expensive
•Can result in poor continuity of care
Self-Scheduling
•Nurses make their own work schedules
•Nurses work within teams/matrix to decide shift sharing
•Nurse Manager or designee must have final approval of schedules
•Teams cover the staffing needs to ensure safe adequate staffing per shift
•Can be appealing to nurses who interview for RN jobs on that unit
Closed-Unit Staffing
•Staff members make a commitment to cover all absences/call ins on the unit
• In return - they do not get pulled from the unit in times of low census
•Can build a strong team among the nurses but can cause resentment if "all" team members commit to it
•On-call schedules (1st. & 2nd.) may need to be implemented to ensure coverage for last minute call ins
•A good recruitment tool for nurses
Shift Bidding
•Might be at a higher rate of pay than the hourly wage of some nurses

•Organization sets the opening price for a shift

•Nurses may bid down the price in order to be assigned the overtime shift

•Organization will choose nurse to work the shift who bid lowest

•Some organizations may deny bids to nurses who work too much overtime
Examples of Staffing Standards
•Inpatient units: NCH/PPD
•Surgery: minutes per case
•Emergency departments: total visits
•Labor and delivery: number of births
•Home health agencies: visits per month
Staffing by Acuity: Using a Patient Classification System (PCS)
•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.
Patient Classification System
•Critical indicator PCS: Broad indicators such as bathing, diet, intravenous fluids and medications, and positioning to categorize patient care activities.
•Summative task PCS: Requires the nurse to note the frequency of occurrence of specific activities, treatments, and procedures for each patient.
•PCS is condition for participation in Medicare
•PCS required by the Joint Commission for certification
The Relationship Between Staffing and Quality of Care
•Staffing mix
•Staffing ratios
•Number of staff

Current evidence shows that as RN hours decrease, there are more adverse patient outcomes: more falls, more errors, more dissatisfaction with care.
Increased staffing ratios lead to same problems
Effect of Decreased Hours
As RN hours decrease in NCHPPD,
adverse patient outcomes increase,
including increased medication errors &
patient falls and decreased patient
satisfaction with pain management.
Nurse-Patient Ratios
•The simplest option for staffing

•Types of patients reviewed for general nursing needs

•Nurse : Patient ratio chosen that will support the nursing care delivery system
Mandatory Minimum Staffing Ratios
• 28 + states have imposed mandatory staffing requirements
• California: legislation requiring mandatory staffing rates for hospitals and long-term care
Texas Mandatory Overtime Laws
•As of September, 2009:

-Hospitals can not force RNs or LVNs to work overtime

-Designed to improve quality of life for nurses

-At least 16 other states have similar legislation
Mandatory Overtime
•Employees forced to work additional shifts
•Not efficient nor effective
•Staff can perceive lack of control
•Impacts mood, motivation, and productivity
Staffing & Staff Development
•In order to recruit and retain nurses, it is necessary to provide a life-long learning environment
•Staff Development can be defined as the processes, programs and activities through which every organization develops, enhances and improves the skills, competencies and overall performance of its employees and workers.
Rationale for Staff Development
•Nurses must have proven competencies in order to perform their duties, many of which are not learned in nursing school.
•As healthcare evolves we are faced with new technologies, new procedures and evolving evidenced based practice that we must learn.
•To satisfy the staff's own personal goals and needs.
Train versus Educate
•Training - organizational methods to make sure that individuals have the knowledge/skills that they need
•Training has immediate use!

•Education - more broader in scope than training.
•Benefits may not be seen for a longer period of time.
•"Develops" individuals skill sets and knowledge
Education of Staff Members
•Staff education is usually housed in the "Education" department
•Can be centralized, decentralized or a combination
•Ultimate responsibility for staff development is the Manager/Director
•Training/Education specific to services provided
•Often driven by regulatory standards or hospital mission
Learning Theories
-Adult Learning Theory - Malcolm Knowles (1913 - 1997)

-Desired to reorient adult educators from educating people to helping them learn

-Attempted to develop a distinctive conceptual basis for adult learning

-"Andragogy"- Adult learning
Adults Learning Principles
•Acquire a mature understanding of themselves
• Learn to distinguish between people and ideas and to challenge others without being threatening
•Develop a dynamic attitude toward life
•Learn to react to causes of behavior
•Achieve their potential
•Understand the value of human experience
•Be skillful in directing social change
Understanding Learner Definitions
-Andragogy: The Study of Adult Learning

-Pedagogy: The Study of How Children Learn
Andragogy: The Study of Adult Learning
•Learners are called participants/learners
•Facilitators/Trainers
•Independent learning
•Objectives are flexible
•Active training methods, exercises/role play
•Participant involvement is crucial
Pedagogy: The Study of How Children Learn
•Learners are called students
•Instructors/Teachers
•Dependent Learning
•Objectives are predetermined
•Passive training methods, lecture/observation
Social Learning Theory
•Albert Bandura: believed the "social" element was vital in learning
•Core concepts are:

People learn through observation and/or vicarious experiences:
•Live Model
•Verbal Instructional Model
•Symbolic Model

•Mental states are important to learning.

Learning does not necessarily lead to a change in behavior!
•Modeling:
•Attention
•Retention
•Reproduction
•Motivation
Strategies for learning
•Strategize to facilitate learning
•What are the learning needs?
•Readiness to Learn
•Motivation to Lean
•Transfer of Learning
•Understanding the adult
• learner needs
Understanding Adult Learners
•Goal oriented/relevancy oriented
•Realistic, know what will work and what won't
•Learn at various rates and in different ways
•Life obligations (energy levels) - want varied mechanisms of learning so not bored
•Logistical considerations
•Learn best in a participatory environment
•Consider themselves mature, don't need to be lectured to
•Insufficient Confidence
Adult Learning Anxiety
•Fear of failure
•Fear of looking foolish
•Fear of technology
•Doubts about coping strategies
•Distrust their own abilities
•Concerns regarding physical impairments
•Distinctions between academic writing and informal writing
•Concern about external influences (e.g. need to acquire a skill for employment purposes)
Motivating Factors to Learn
•Personal Development
•Professional Advancement
•Employment Expectations
•Additional skills for workplace
•To facilitate/accommodate life changes
•Make or maintain social relationships
•For escape, stimulation or interest
Socialization
Socialization: learning of behaviors needed to perform job duties and the understanding of the organization's expectations
•Reality shock
•Role Stress
•Role Overload

Resocialization - when individuals need to learn new skills, values, attitudes and social rules

Socialization of International Nurses
•Verbal/Non-verbal behaviors
Evaluation of Learning
•Learner's Reaction to learning
•Behavior Change
-Positive sanctions
-Negative sanctions
-Was the learning transferred?
•Organizational Impact
•Cost Effectiveness
Organizational Planning
•Setting Objectives for Organizational planning
•Deciding How to Attain Objectives
•Determine short and long range goals

•If you don't know where you are going, any path will get you there!
Think Ahead!
•Administrative Management Principle:
•Planning is a proactive & deliberate process

•WHAT to do
•WHERE will it be done
•WHEN will it be done
•WHO will do it
•HOW will it be done
Rationale for Organizational Planning
•Organizational needs and objectives cannot be met without focused planning
•Reduces organizational uncertainty
•Cost-effective for organizations
•Necessary for effective controls within an organization
Principles of Organizational Planning
•All plans must flow from other plans. Short-range plans must be congruent with long-range plans
•Planning in all areas of the organization focuses on the mission, vision, philosophy, and goals/objectives of the overall organization
•Planning involves the same process regardless of the period involved
•The length of the organizational plan is determined by what actions are necessary to make the plan successful
•All organizational plans must include a regular review process (an evaluation step)
Strategies for Successful Planning
•Start planning at the top
•Keep planning organized, clear, and definite
•Don't bypass levels of people (stakeholders involvement is important)
•Have short- and long-range plans and goals
•Know when to plan and when not to
•Keep target dates realistic and reasonable
•Gather data appropriately
•Be sure objectives are clear and concise
•Remember, interpersonal relationships are important
Why Do Organizational Plans Fail?
•False assumptions
•People not knowing overall goals & objectives
•Not enough alternatives for the plan
•Inadequate time or other resources
•Low motivation levels
•Sound strategies not used
•Inadequate delegation of authority
•Not recognizing organizational goals and needs
•Planning too narrow in scope — not recognizing community, legal, and licensing requirements
Primary Planning Modes
•Reactive- planning after a problem exists
•Inactivism - consider the status quo as the stable environment and they spend a great deal of energy preventing change and maintaining conformity
•Preactivism - planners utilize technology to accelerate change, are future-oriented and unsatisfied with the past or present
•Proactive - Is dynamic, interactive, and adaptation is considered to be a key requirement since the environment changes so frequently
Strategic Planning Hierarchy
•Mission (why) and Vision (what)
•Philosophy
•Goals
•Objectives
•Policies
•Procedures
•Rules
Important Steps in Strategic Planning
Research and Analysis to determine:
◦Internal Analysis
◦External Analysis
SWOT Analysis- Ann Effective Tool
•Strengths- internal attributes that assist an organization to achieve its objectives
•Weaknesses- internal attributes that challenge an organization to achieve its objectives
•Opportunities- external conditions that promote achievement of organizational objectives
•Threats- external conditions that challenge/threaten achievement of organizational objectives
Steps of Strategic Planning
•Formulate mission/vision statement
-Influences all other aspects of the overall plan
•Philosophy
-Set of values and beliefs
-Each department should have a philosophy that is congruent with the overall philosophy
Philosophy Statement
A person should be able to identify exactly how the organization is implementing its philosophy by observing members of the nursing staff, reviewing the budgetary priorities, and talking to patients, staff and family members.
Steps of Strategic Planning cont
•Vision statement
•Statements used to describe future goals or aims of an organization
•Mission statement
•Statements used to identify the reason an organization exists
•Analyze options - how to achieve goals
•Goals and objectives- generally 3-5 years
•Develop policies - plans reduced to statements
•Procedures - step-by-step process
•Rules- Best to have few!
•Contingency plans and redefine the plan
Fostering Individual Input into Strategic Plan
•Individual team members/stakeholders
•Increased participation into plan development increases support of plan
•More support of plan increases chance of successful implementation
•Elicit input from all stakeholders
Rules in Strategic Planning
•Rules are the least flexible type of planning.
•Because of this, there should be as few rules as possible in the organization.
•Existing rules, however, should be enforced to keep morale from breaking down and to promote organizational structure.
Fourth Phase of Management Process: Directing/Coordinating/Activating
•The "Doing" Phase of Management
• Components Include:
~Creating a motivating climate
~ Establishing organizational communication
~ Managing conflict
~ Facilitating collaboration
~ Negotiating, working with unions
~ Complying with employment laws
Motivation
~ Defined as the force within the individual that influences or directs behavior.

~ Motivation comes from within a person; therefore, Managers cannot directly motivate subordinates.

~ The Humanistic Manager can, however, create an environment that maximizes the development of human potential.
Intrinsic Versus Extrinsic Motivation
~ Intrinsic Motivation: Internal drive to do or be something

~ Extrinsic Motivation: Motivation enhanced by the job environment or external rewards
Maslow
Hierarchy of needs

Maslow suggested that people are motivated to satisfy certain needs, ranging from basic survival to complex psychological needs, and that people seek a higherneed only when the lower needs have been predominantly met.
Skinner
Operant conditioning/behavior modification
Herzberg
Motivator/hygiene theory
Vroom
Expectancy model

expectancy -> effort -> performance -> reward -> valence -> expectancy

Vroom argued that a person's expectations about his or her environment or a certain event will influence behavior. Therefore, if there is an expectation of a reward and it does not occur, the individual is less likely to repeat that behavior in the future.
McClelland
Basic needs

McClelland argued that people are motivated by three basic needs:
~ Achievement ~
~ Affiliation ~
~ Power ~
Gellerman
"Stretching"

-Gellerman suggested that individuals should be periodically "Stretched" to do tasks more difficult than they are used to doing.

-The challenge of "Stretched" is to energize people to enjoy the beauty of pushing themselves beyond what they think they can do.
McGregor
Theory X and Y
Motivational Theorists
~ Maslow - Hierarchy of needs
~ Skinner - Operant conditioning/behavior modification
~ Herzberg - Motivator/hygiene theory
~ Vroom - Expectancy model
~ McClelland - Basic needs
~ Gellerman - "Stretching"
~ McGregor - Theory X and Y
Herzberg's Motivators Factors
~ Achievement
~ Recognition
~ Work
~ Responsibility
~ Advancement
~ Possibility for growth
Herzberg's Hygiene Factors
~ Salary
~ Supervision
~ Job security
~ Positive working conditions
~ Personal Life
~ Interpersonal relationships and peers
~ Company policy
~ Status
Theory "X" Employees
~ Avoid work if possible
~ Dislike work
~ Must be directed
~ Have little ambition
~ Avoid responsibility
~ Need threats to be motivated
~ Need close supervision
~ Are motivated by rewards and punishment
Theory "Y" Employees
~ Like and enjoy work
~ Are self-directed
~ Seek responsibility
~ Are imaginative and creative
~ Have underutilized intellectual capacity
~ Need only general supervision
~ Are encouraged to participate in problem solving
Strategies toCreate a Motivating Climate
~ Have clear expectations for workers.
~ Be fair and consistent with employees.
~ Encourage teamwork.
~ Know the uniqueness of each employee.
~ Allow employees as much control as possible.
~ Stretch employees intermittently.
~ Reward desired behavior.
Incentives
~ Organizations must be cognizant of the need to offer incentives at a level where employees value them.
~ This requires that the organization and its managers understand employees' collective values and devise a reward system that is consistent with that value system.
Recognition:A Powerful Motivational Tool
~ Positive reinforcement must be specific or relevant to a particular performance.

~ Positive reinforcement must occur as close to the event as possible.

~ Reinforcement of new behaviors should be continuous.
Promotion:Elements to PreventNegative Outcomes
~ State whether recruitment will be internal or external
~ Define the promotion and selection criteria
~ The pool of candidates that exists
~ How employee releases are to be handled
~ Handling rejected candidates
Attitude and Energy of Managers
The Attitude and Energy level of managers, directly affects the Attitude and Productivity of their employees.
Self-Care:Preventing Burnout
A burned-out, tired manager will develop a lethargic and demotivated staff. Be Positive!
There is a close relationship between time management and stress.
...
Three Cyclic Steps
•Allow time for planning and establishing priorities.
•Complete the highest priority task whenever possible.
•Try to finish one task before beginning another.
(Note: Reprioritize based on remaining tasks and new information that may have been received)
Two mistakes common in planning are underestimating:
~The importance of a daily plan
~Not allowing adequate time for planning.
SMART approach to studying
1. Set specific, clear goals to be accomplished
2. Record your progress as measurable progress maintains your interest
3. Identify the steps needed to accomplish your goals
4. Be realistic about your time constraints and set goals that can be accomplished within these constraints
5. Set a time frame and plan for this
Creating a Time-Efficient Work Environment
•Group activities that are in the same location.
•Gather all supplies needed before starting an activity.
•Document nursing interventions as soon as possibleafter they are completed.
•Always strive to end the workday on time.
•Use time estimates.
Daily Planning Actions to Utilize Time
•Identify key priorities to be accomplished that day.
•Determine the expected level of achievement of a prioritized task.
•Assess the staff assigned to work with you.
•Review the short- and long-term plans of the unit.
•Plan ahead of time for meetings.
•Allow time to assess progress of goal attainment.
•Take regular breaks and use electronic calendars.
Procrastination
•Putting off something until a future time, postponing, or delaying needlessly

•Not a character flaw, but a set of behaviors that develop over a period of time and that can be changed

•The dread of doing a task uses more time and energy than doing the task itself
Three Categories of Prioritization
1. "Don't do"
2. "Do later"
3. "Do now"
"DO NOW"=Setting Priorities
•Priority setting is perhaps the most critical skill in good time management because all actions we take have some type of relative importance.

•Making lists
Making Lists
•Remember that lists are planning tools and thus must be flexible!

•Reexamine items that remain on the list day after day. Perhaps they do not need to be done or they need to be broken down into smaller tasks.

•Only put as many items as possible on the daily list as can reasonably be accomplished in a day.
Managing Time
Managing time is difficult if a person is unsure of his or her priorities for time management, including personal short-term, intermediate, and long-term goals.
Internal Time Wasters
1.Accessibility to others
2.Technology (Internet, gaming, e-mail, and social media sites)
3.Socializing
4.Interruptions—be brief
5.Paperwork overload
6.A poor filing system
Personal Time Management
Managing time is difficult if a person is unsure of his or her priorities for time management, including personal short-term, intermediate, and long-term goals.
Personal Characteristics of Time Wasting
•Does not understand time planning
•Cannot distinguish what is important from what is not
•Underestimates time and effort needed to accomplish tasks
•Makes too many rules or procedures or approvals
•Anxiety about planning robs energy
•Does not look at the standard of work necessary
Discouraging Socialization
•Do not make yourself overly accessible.
•Interrupt a rambling person.
•Avoid promoting socialization.
•Schedule long-winded pests.
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Manageable Tasks
Some projects are not accomplished because they are not broken down into manageable tasks.
Bran's 12 Habits to Master Time Management #1
1.Strive to be authentic.
2.Favor trusting relationships.
3.Maintain lifestyle that gives you maximum energy.
4.Organize day by your biorhythms.
5.Set very few priorities and stick to them.
6.Turn down things inconsistent with your priorities.
7.Set aside time for focused effort.
8.Always look for ways of doing thing better and faster.
9.Build solid processes.
10.Spot trouble ahead and solve problems immediately.
11.Break goals into small units of work and think only about one unit at a time.
12.Finish what is important and stop doing what is no longer worthwhile.
The Time Inventory
•Helps the individual determine how much time he or she spends on a particular task and what time of day he or she is most productive.
•It is important to maintain the time inventory for several days or even weeks and to repeat it annually to see if long-term changes have been made.
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