leadership ATI

management

process of planning, organizing, directing, and coordinating the work within an organization
-formal positions of power and authority

leadership

ability to inspire others to achieve a desired outcome

authoritative leadership style

makes decisions for group
motivates by coercion
communication occurs down the chain of command
work output by staff is usually high-good for crisis situations and bureaucratic settings

democratic leadership style

includes the group when decisions are made
motivates by supporting staff achievements
communication occurs up and down chain of command
good when cooperation and collaboration are necessary

laissez-faire

makes very few decisions and does little planning
motivation is largely the responsibility of individual staff members
communication occurs up and chain of command and between group members
work output is low unless informal leader evolves from the group

characteristics of leaders

initiative
inspiration
energy
positive attitude
communication skills
respect
problem solving & critical thinking skills

transformational leaders

empower followers to assume responsibility for a communal vision and personal development is a secondary outcome

transactional leaders

focus on immediate problems, maintaining the status quo and using rewards to motivate followers

emotional intelligence

ability of an individual to perceive and manage emotions of self and others

Characteristics of managers

hold formal position of power and authority
possess clinical expertise
network with members of the team
coach subordinates
make decisions about organization function, including resources, budget, hiring, and firing

5 major management functions

planning
organizing
staffing
directing
controlling

Maslows

physiological > safety and security > love and belonging > self-esteem > self-actualization

Assigning

process of transferring authority, accountability, and responsibility of client care to another member of the HC team

delegating

process of transferring the authority and responsibility to another team member to complete a task while retaining accountability

supervising

process of directing, monitoring, and evaluating the performance of tasks by another member of the HC team

Assignment factors

client factors
-condition of client and level of care needed
-specific care needs
-need for special precautions
-procedures requiring a significant time commitment
health care team factors
-knowledge and skill level
-amount of supervision necessary
-staff

Who can an RN delegate to?

other RN's, LPN's, and UAP

What can RN's not delegate?

the nursing process
client education
tasks that require clinical judgment
(for those that are not also RN's)

Factors to consider when delegating

predictability of outcome
potential for harm
complexity of care
need for problem solving and innovation
level of interaction with client

Considerations for selecting appropriate delegatee

education, training, experience
knowledge and skill level to perform task
level of critical thinking required
ability to communicate with others as it pertains to the task
demonstrated competence
delegate's culture
agency policies and procedures and licen

Tasks that can be delegated to LPN

monitoring client findings
reinforcement of client teaching from a standard care plan
trach care
suctioning
checking NG tube patency
administering enteral feeds
urinary catheterization
medication administration (excluding IV)

Tasks that can be delegated to UAP

ADL's
-bathing
-grooming
-dressing
-toileting
-ambulating
-feeding (w/o swallowing precautions)
-positioning
specimen collection
intake and output
vital signs (on stable clients)

5 rights of delegation

right task
right circumstance
right person
right direction/communication
right supervision/evaluation

Benner 5 stages of nursing ability

novice (students or brand new)
advanced beginner
competent (nurse for 2-3 yrs)
proficient
expert

quality improvement

process used to identify and resolve performance deficiencies

quality improvement process begins with?

identification of standards and outcome indicators based on evidence
-outcome/clinical indicators: reflect desired client outcomes related to the standard under review
-structure indicators: reflect the setting in which care is being provided and the avai

steps in QI process

standard is developed and approved
standards are made available to employees
quality issues are identified
an interprofessional team is developed to review the issue
the current state of structure and process related to the issue is analyzed

root cause analysis

done to critically assess all factors that influence an issue when a benchmark is not met
-investigates the consequences and possible causes
-analyzes possible causes and relationships
-determines additional influences at each level of relationship
-deter

steps in progressive discipline

-informal reprimand
-written warning
-employee placed on suspension
-employee termination

intrapersonal conflict

occurs within a person

interpersonal conflict

occurs between 2 or more people

intergroup conflict

occurs between two more more groups of individuals, departments, or organizations

grievance

wrong perceived by an employee based on a feeling of unfair treatment that is considered grounds for a formal complaint

decision making styles

decisive: team uses a minimum amount of data and generates one option
flexible: the team uses a limited amount of data and generates several option
hierarchical-team uses a large amount of data and generates one option
integrative-team uses a large amount

centralized hierarchy

nurses at top of organizational chart make most of the decisions

decentralized hierarchy

staff nurses who provide client care are included in the decision making process

behavioral change strategies

rational-empirical: uses factual information to support change, used when resistance is minimal
normative reeducative: manager focuses on interpersonal relationships to promote change
power-coercive: the manager uses rewards to promote change, used when r

veteran 1925-1942

support status quo
accept authority
appreciate hierarchy
loyal to employer

baby boomer 1943-1960

accept authority
workaholics
some struggle with technology
loyal to employer

generation X 1961-1980

adapts easily to change
personal life and family are important
proficient with technology
makes frequent job changes

generation Y 1981-2000

optimistic and self-confident
value achievement
technology is a way of life
at ease with cultural diversity

roles in case management

coordinate care
facilitate continuity of care
improve efficiency of care and utilization of resources
enhancing quality of care provided
limiting unnecessary costs and lengthy stays
advocating for client and family

advocacy

ensuring clients are properly informed, rights are respected, and that they are receiving the proper level of care

informed consent should include

reason the treatment or procedure is needed
how the treatment or procedure will benefit the client
risks if the client proceeds
risks if the client rejects
other options

individuals who can grant consent for another person

parent of a minor
legal guardian
court specified representative
spouse of closest available individual who has durable power of attorney for HC
(emancipated minors can provide for themselves)

Client role in informed consent

client must:
give it voluntarily
be competent and of legal age or be emancipated
receive sufficient information to make a decision based on an informed understanding of what is expected

nurse role in informed consent

witness
ensure the provider gave the necessary info
ensure the client understood and is competent
have the client sign
notify provider if client has more questions or does not understand
documenting: reinforcement of info originally given by provider, que

advance directive

communicates clients wishes regarding end of life care if client cannot do so
2 components: living will & durable power of attorney

living will

legal document expressing the clients wishes regarding medical tx in the event the client becomes incapacitated and is facing end of life issues

durable POA

legal document designates a HC proxy, who is an individual authorized to make HC decisions for a client who is unable to do so

DNR or AND orders

provider administers them after consultation

unintentional torts

negligence
malpractice (professional negligence)

quasi-intentional torts

breach of confidentiality
defamation of character

intentional torts

assault: conduct of one person makes the other person fearful and apprehensive (ex: threats)
battery: intentional and wrongful physical conduct with a person that involves injury or offensive contact
false imprisonment: restraining or confining against a

Malpractice/professional negligence

failure of a person with professional training to act in a reasonable and prudent manner

5 elements to prove negligence

1. duty to provide care as defined by a standard (care that should be given)
2. Breach of duty by failure to meet standard (failure to give care that should have been given)
3. Forseeability of harm (knowing that failing to give the proper standard of car

autonomy

ability of client to make personal decisions, even when those decisions may not be in the clients own best interest

beneficence

care that is in the best interest of the client (benefits them)

fidelity

keeping your promise

justice

fair treatment and use of resources

nonmaleficence

do no harm

veracity

telling the truth

Uniform determination of Death Act UDDA
2 criteria

-irreversible cessation of circulator and respiratory function
OR
-irreversible cessation of all functions of the entire brain including brain stem

QSEN 6 core competencies

safety
patient centered care
evidence based practice
informatics
quality improvement
teamwork and collaboration

Rules of restraints

provider must prescript based on face to face assessment
if emergency: nurse can apply restraints but must get prescription within I hr
prescription must be re-written q 24 hrs.
prescription must state: reason for restraint, type, location, length of allo

RACE for fire safety

R-rescue
A-alarm
C-contain
E-extinguish

PASS for extinguisher use

P-pull
A-aim
S-squeeze
S-sweep

incident reports

should be completed by person who identifies an event occurred
should be completed within 24 hours
considered confidential and are not shared with client
DO NOT PLACE in health care record or mention in record
just describe the incident itself in the reco

INFO to include in incident report

patients name and hospital number
date,time, location of incident
factual description
witnesses
corrective actions taken
detail of medications or equipment involved

Discharge of clients in a disaster

ambulatory clients requiring minimal care go first
clients requiring assistance are next
clients who are unstable or require nursing care should not be discharged