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