Decision Making
-Choosing between 2 courses of action
-Usually triggered by a problem but is often handled in a matter that does not focus on eliminating the underlying problem
Problem Solving
-Is part of decision making and is a systematic process that focuses on analyzing a difficult situation.
-Always includes a decision-making step
-Attempts to identify the root of the problem
Successful Decision Makers
Self-aware
Courageous
Sensitive
Energetic
Creative
Marquiz-Huston Critical Thinking Teaching Model
circular cycle of :
assess-->diagnose-->plan-->implement--evaluate
Experiential Learning
-Provides mock life experiences to learn from
-Allows learners to apply leadership and management theory
-Promotes whole-brain thinking and improved problem-solving skills
Principles for Effective Use of Case Studies
-There must be an adequate number of cases to draw generalizations or recognize patterns.
-There is no right or wrong answer to a case study. The goal is to produce a number of solutions, although some may be more successful than others.
-Group process is
Which is NOT a factor in solving a case successfully?
A. Being self-aware
B. Doing all work independently
C. Assessing all information given
D. Watching for faulty logic
*B
Doing all work independently.
Rationale: It is important to use group process in some way to increase solutions
Questions Asked in Data Gathering
What is the setting?
What is the problem?
Where is it a problem?
When is it a problem?
Who is affected by the problem?
What is happening?
Why is it happening? What are the causes of the problem? Can I prioritize the causes?
What are the basic underlying i
Questions Asked in Analyzing Solutions
What factors can you influence? How can you accentuate the positive factors and minimize the negative factors?
What are the financial, political, time, and resource implications of each possible solution?
What are the criteria (goals) for action?
What are
***Problem Solving vs. Decsion Making
a. 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.
� Implement solution.
� E
Practice Question:
What is the first step in managerial decision-making model?
A. Identify the problem
B. Evaluate alternatives
C. Gather data
D. Set objectives
Answer: D. Set objectives
Rationale: While the traditional model begins with identifying the problem, in managerial decision-making model one approaches the issue by first deciding on the objectives.
Nursing Process Model
Assess
Diagnose
Plan
Implement
Evaluate
***IDEALS Model
Facione, 2006
-->Identify the problem.�"What's the real question we're facing here?"
-->Define the context.�"What are the facts and circumstances that frame this problem?"
-->Enumerate choices.�"What are our most plausible three or four options?"
-->Analy
Recognition-Primed Decision (RPD) Model for Intuitive Decision Making
Why the critical thinking movement?
-->Serious decline in the ability of young adults to problem solve/do inferential reasoning
-->We've been busy teaching facts, not how to think!
Practice Question:
Tell whether the following statement is True or False:
Information in nursing becomes obsolete quickly.
A. True
B. False
Answer: A. True
Rationale: Information in nursing is constantly changing, which is why critical thinking is such an important skill for nurses.
Characteristics of a successful thinker
Energy�action-oriented
Courage�willing to take risks
Sensitivity
Creativity�innovative
Good track record
Self-awareness
Open to new ideas
Intuitive
Analytically
Practice Question:
Which is a characteristic of a successful thinker?
A. Impulsiveness
B. Courage
C. Decisiveness
D. Whimsy
Answer: B. Courage
Rationale: A successful thinker should be willing to take risks.
Frequent Errors in Decision Making
-No clear objective or goal for decision
-Faulty data gathering
-Faulty logic or "crooked thinking"
-Too much time spent identifying the problem
-Not considering enough alternatives (the greater number of alternatives that can be generated, the great the
*** Definition: Evidence-Based Nursing Practice
the process of shared decision-making between practitioner, patient, and others significant to them based on research evidence, the patient's experiences and preferences, clinical expertise or know-how, and other available robust sources of information.
Strategies for the new nurse to promote evidence-based practice
-Keep abreast of the evidence-subscribe to professional journals and read widely
Use and encourage use of multiple sources of evidence
-Use evidence not only to support clinical interventions but also to support teaching strategies
-Find established sourc
Successful Decision Maker: Understands...
Gender, Personal individual values, Life experience, Preferences, Willingness to take risks, Brain hemisphere dominance, Predominant thinking style
Gender: Decision Making Men vs. Women
-Research suggests that women are more concerned with uncertainty, doubts and dynamism involved in decision making and that "they place more value on time and money," thus they are "more concerned about the consequences that may derive from the decision.
Values and Decision Making
-Value judgments will always play a part in a person's decision making, either consciously or subconsciously.
-Values determine which problems in one's personal or professional life will be addressed or ignored.
Individual Preference and Decision Making
-Physical, economic, and emotional risks and time and energy expenditures are types of personal risk and costs involved in decision-making.
-Those who can do the right but unpopular thing and who dare to stand alone will emerge as leaders.
***Brain Hemispheres and Thinking Styles
Left brain thinkers-typically better at processing language, logic, numbers, and sequential ordering. Do well in math, reading, planning and organizing.*Logic
Right brain thinkers-Excel at a nonverbal ideation and holistic synthesizing. They are better at
Payoff Tables
-Cost-profit-volume relationship and are very helpful when some quantitative information is available, such as an item's cost or predicted use.
-Uses historical data, such as hospital census or a report on the number of operating procedures performed.
***PERT (Program Evaluation and Review Techinque)
Used for timing of decisions. Developed by US Navy and Polaris missile program.
**Timing decisions(key)`
Logic Models
Schematics or pictures of how programs are intended to operate. They include resources, processes and desired outcomes and depicts exactly what the relationships are between the 3 components.
Management Functions
planning, organizing, staffing, directing, controlling
Business of Health Care
Now more than ever, there is a greater emphasis on the business of health care, with managers being involved in the financial and marketing aspects of their respective departments.
Characteristics of Managers
-Have an assigned position within the formal organization
-Have a legitimate source of power due to the delegated authority that accompanies their position
-Are expected to carry out specific functions, duties, and responsibilities
-Emphasize control, dec
Practice Question:
What should managers emphasize?
A. Decision Making
B. Analysis
C. Results
D. Control
E. All of the Above
E. All of the above
Rationale: Control, decision making, analysis, and results are all crucial elements of successful management
***Managers vs. Leaders
Leaders:
-Often do not have delegated authority, but obtain their power through other means
-Have a wider variety of roles than managers
-Are frequently not part of the formal organization
-Focus on group process, information gathering, feedback, and empo
Practice Question:
Which is a characteristic of a leader?
A. Always assigned a position of authority
B. Usually part of a formal organization
C. Focus on group process, information gathering, and feedback
D. Focus on decision making and results
C. Focus on group process, information gathering, and feedback
Rationale: While managers are more often part of a formal organization and focus more on results-oriented tasks, leaders tend to focus more on things such as group process.
Good Leaders and Managers
Good Leaders
envision the future
communicate their visions
motivate followers
lead the way
influence others to accomplish goals
inspire confidence
take risks
empower followers
master change
Good Managers:
coordinate resources
optimize resource use
meet or
Managment vs. Leadership
1. Management emphasizes control�control of hours, costs, salaries, overtime, use of sick leave, inventory, and supplies
.
2. Leadership increases productivity by maximizing workforce effectiveness
Practice Question:
Tell whether the following statement is True or False:
Team building is an aspect of staffing.
True
Rationale: While recruiting, interviewing, and hiring are the tasks most often associated with staffing, team building is also an important aspect of the job.
Human Relations Era
Participatory management
Humanistic management
***Definition of Leadership
THE ART OF GETTING WORK DONE THROUGH OTHERS WILLINGLY>
-Leaders are in the front, moving forward, taking risks and challenging the status quo.
-A job title alone does not make a person a leader. Only a person's behavior determines if he or she occupies a
Leadership Requires:
Getting very clear about your values, taking risks, and having a willingness to seek partners and collaborators who will commit to the common good.
Fatal Leadership Flaws
-lack of energy and enthusiam
-acceptance of their own mediocre performance
-lack of a clear vision and direction
-having poor judgement
-not collaborating
-not walking the talk
-resisting new ideas
-not learning from mistakes
-a lack of interpersonal ski
The Evolution of Theory Development:
Taylor
Weber
Fayol
Gulick
Follett
Mayo
McGregor
Argyris
Taylor=Scientific Management
Weber=Bureaucratic organizations
Fayol=Managment functions
Gulick=Activities of management
Follett=Participative managment
Mayo=Hawthorne Effect
McGregor-Theory X and Theory Y
Argyris=Employee Participation
Scientific Management:
(Taylor)
Taylor-"The father of scientific management," was a mechanical engineer in Pennsylvania.
-Frustrated with workers who achieved the minimum standards doing the least amount of work possible
-Workers should be taught the "one best way to accomplish
Can Leadership be Taught?
Leadership cannot be taught because:
Leaders are born and not made
American culture holds that leadership is an elitist and thus an anti-American phenomenon
Leadership training would be too focused on the skills and techniques to get work done, rather tha
Contingency Leadership Styles (white and lipitt-1960)
1. Autocratic or Authoritarian-Strong control, commanding, communication runs downards(ex- military)
2. Democratic or Participative-Less control, Economic and ego rewards, communication flows up and down, decision making involves others
3. Laissez-Faire,
Transactional vs. Transformational Leadership
Transactional Leader: focuses on managment tasks, is a caretaker, uses trade-offs to meet goals, doesn't identify shared values, examines causes, uses contingency reward
Transformational Leader: Identifies common vales, is committed, inspires others with
Twenty-First Century Thinking About Leadership and Managment
-Many new leadership and management theories have emerged in the 21st century to explain the complexity of the leader-follower relationship and the environment in which work is accomplished and goals are achieved.
-With threats such as terrorism, biologic
Organizational and Unit Levels
Managers and leaders are directed to address high turnover rates by staff, an emerging shortage of qualified top-level nursing administrators , growing trends towards unionization, and intensified efforts to legislate minimum staffing ratios and eliminate
***Servant Leadership
-Greenleaf developed this idea 30 years ago, but is used widely today. She worked at AT&T as a director.
-She coined the phrase Servant Leaders
-These leaders put serving others, including employees, customers, and the community as the #1 priority
-This p
Defining Qualities of Servant Leaders
(There are 10 of them)
1. Good listener, 2. Keeping an open mind, 3. Dealing with complex issues, 4. Being honest, 5. Clarity on goals, 6. Servant/helper and teacher, 7. Thinking before reacting, 8. Choosing words carefully, 9. The ability to use foresigh
New Thinking about Leaders and Followers
-Followers can and do mislead leaders, both intentionally and unintentionally
-Make sure followers are allowed to disagree
***Principal Agent Theory
-Emerged in the 60s and 70s
-Suggests that not all followers are inherently motivated to act in the best interest of the leader (principle) or employer.
-Followers may have more expertise or knowledge over the leader
-Principles must provide incentives to
Human and Social Capital Theory
-Human capital refers to the attributes of a person that are productive in some economic context
-Education is an investment
-Refers to a groups collective knowledge, skills and abilities.
-Individuals and/or organizations will invest in education and pro
***Emotional Intelligence
-Emotional intelligence refers to the ability to use emotions effectively and is required by leaders/managers in order to enhance their success.
-Emotional intelligence is critical for building a cooperative and effective team.
Ex: manager listens to each
***Five Components of Emotional Intelligence
1. Self-awareness-recognizing your own mood, as well as its effect on others
2. Self-regulation-control disruptive impulses or moods; suspend judgment
3. Motivation-A passion to work that go beyond $ or status
4. Empathy-ability to understand and accept t
Five Distinguishing Characteristics of an Authentic Leader
1. Purpose-They understand their own purpose and passion as a result of ongoing self-reflection and awareness.
2. Values-Authentic leaders link between purpose and passion by having congruence in beliefs and actions
3. Heart-Leaders care for themselves an
Practice Question:
Which is a Component of emotional intelligence?
A. Self-reliance
B. Assertiveness
C. Self-regulation
D. Charisma
C. Self-regulation
Rationale: The five components of emotional intelligence are self-awareness, self-regulation, motivation, empathy, and social skills. Self-reliance, assertiveness, and charisma are not components of emotional intelligence.
Authentic Leadership
-Authentic leadership suggests that in order to lead, leaders must be true to themselves and their values and act accordingly.
-It is the leaders' principles and their conviction to act accordingly and inspire followers.
-Williams (2005) calls this willin
Practice Question:
What is the definition of transparent integrity?
A. Holding one's employees accountable
B. Standing by one's values at the time of pressure
C. Willingly following the rules of one's organization
D. All of the above
B. Standing by one's values in the face of pressure
Rationale: While the pressure to deliver results can be intense, those possessed of transparent integrity refuse to compromise their principles in the process.
Thought Leadership
-Applies to a person who is recognized among his peers for innovative ideas and who demonstrates the confidence to promote those ideas.
-Refers to any situation in which one individual convinces another to consider a new idea, product or a way of looking
Practice Question:
Tell whether the following statement is True or False.
Thought leaders attract followers by the promise of representation or empowerment.
A. True
B. False
B. False
Rationale: Thought leaders attract followers by their risk taking and vision in terms of being innovative.
Quantum Leadership
-Leaders must work together with subordinates to identify common goals, exploit opportunities, and empower staff to make decisions for organizational productivity to occur.
-Done during periods of rapid change and needed transition
-Suggests that the envi
Cultural Bridging
-The new role of leader/managers as a cultural bridge has become a requirement as our society becomes more diverse.
-Many foreign nurses must be supported through a period of cultural, professional, and psychological dissonance that is associated with anx
Practice Question:
What are some struggles faced by foreign nurses?
A. Cultural acclimation
B. Professional dissonance
C. Isolation
D. All of the above
D. All of the above
Rationale: Foreign nurses often face numerous difficulties, including cultural, professional, and psychological dissonance. It is especially important that they receive sufficient support during this adjustment period.
***Industrial Age vs. Relationship Age
Know the difference between the two
Industrial: Skills based
Relationship: People/communication
***Ethics
The systematic study of what a person's conduct and action should be in regard to self, other humans and the environment.
-Management is a discipline, not a profession, so it does not have clearly set of norms to guide ethical decision making
(should not
Applied Ethics
application of normative ethical theory to every day problems
Bruhn (2005)
contends that it is often the interaction of the culture of the organization and the character of the leader that creates ethical failure
How do manager's make ethical decision?
-Manager must have knowledge of ethical principles and frameworks
-Use a professional approach that eliminates trial and error and focuses on proven decision-making models
-These include institutional review boards (IRB), ethics committees, professional c
Leadership roles associated with ethics
-Being self-aware regarding your own values and beliefs about rights, duties and goals of human beings
-Accepts that some ambiguity and uncertainty must be part of all ethical decision making
-Willingness to accept that negative outcome occur in ethical d
Types of Ethical Issues
-Moral uncertainty-uncertain about what moral principle or values to apply and may even include uncertainty as to what the moral problem is. Also known as moral conflict
-Moral distress-results in knowing the right thing to do, but organizational constrai
Ethical Dilemma
-Defined as making a choice between two or more equally undesirable alternatives.
-The individual who must solve an ethical dilemma is the only person who can ascertain if actions taken were congruent with personal values.
-Self-awareness is vital in ethi
3 Characteristics that cause a problem to be an ethical dilemma
(Leah Curtin 1982)
1. The problem cannot be solved using only empirical data.
2. The problem must be so perplexing that it is difficult to decide what facts and data need to be used in making the decision.
3. The results of the problem should have far-reaching effects.
***Three Approaches to Ethical Decision Making
1. Deontological-duty focused normative approach centered on the rules from which all action is derived.
2. Teological-outcome-focused approach that places emphasis on results and protects the interest of the majority
3. Situational-no prescribed rules, n
Ethical Frameworks for Decision Making
1. Utilitarian- teleological
2. Rights based- deontological
3. Duty Based-deontological
4. Intuitionist-deontological
Utilitarianism/Teleological
-Provides the greatest good for the greatest number of people
-Wants for the individual are diminished
-The end justifies the means
-Ex. Insurance company will a wide range of people but refuses to pay for 2 expensive organ transplants
Rights Based/Deontological
-Individuals have basic inherent rights that should not be interfered with
-Ex. Accused have the right to a fair and impartial trial. All people have the right to the truth.
-Deontological-judges whether the action is right or wrong regardless of the cons
Duty Based/Deontological
-Ethical framework stating that some decisions are made because there is a duty to do something or refrain from doing something.
-Ex. Supervisor has the duty to hire the most qualified person for the job, even if the cost is high.
-Ex. A nurse having to w
Intuitionist/Deontological
-Each case is weighed on a case-by-case basis to determine relative goals, duties and rights.
-Done mostly on intuition
-Has the potential to be very subjective and bias and many theorist have questioned this ethical framework
Ethical Relativism
-The belief that specific culture's ethical principles cannot be generalized to individuals who do not share that culture
-Ex. The way someone dresses
***Principals of Ethical Decision Making
1.Autonomy: Promotes self-determination/freedom of choice. Accepting responsibility for one' choice.
2. Beneficence: (doing good) The actions one takes- should be done in an effort to promote good.
3. Paternalism: one individual assumes the right to make
***ANA Code of Ethics
-Code of ethics-a set of principles, established by a profession, to guide the individual practitioner.
-ANA Code of Ethics-outlines the general values, duties, and responsibilities that flow from the specific role of being a nurse. It's a professional co
MORAL Model (another decision making model)
-M-massage the dilemma-Collect data about the ethical problem and who should be involved in the decision-making process
-O-outline the options-Identify alternatives and analyze the causes and consequences of each
-R-Review criteria and resolve-Weigh the o
The following forces ensure that ethics will become an even greater dimension in management decision making in the future:
-Increasing technology, regulatory pressures, and competitiveness among healthcare providers;
-National nursing shortages;
reduced fiscal resources;
-Spiraling costs of supplies and salaries;
-And the public's increasing distrust
of the healthcare deliver
***Difficulty in making ethical decisions
-Much of the difficulty in making ethical decisions results from the lack of formal training and education about problem solving.
-Research at the University of Pennsylvania found that 25% of nurses and social workers reported having no training on ethics
Nurse Practice Act
The Nurse Practice Act is a legal instrument that defines what the functions of nursing shall be and sets standards for license.
-It grants a nurse the authority to carry out those functions.
-Each state has its own Nurse Practice Act, but all must be con
Sources of Law:
The constitution
The highest law in the United States; interpreted by the US Supreme Court; gives authority to other three sources of law
Sources of Law:
Statutes
Also called statutory law or legislative; laws that are passed by the state or federal legislators and that must be signed by the president or governor. Many statutes affect malpractice.
Sources of Law:
Administrative agencies
the rules and regulations established by appointed agencies of the executive branch of the government.
Sources of Law:
Court Decisions
Also called tort law; this is court mode law and the courts interpret the statutes and set precedents; in the United States; there are 2 levels of court; trial court and appellate court.
Types of Law:
1. Criminal
2. Civil
3. Administrative
4. The burden of proof
1. Criminal-Beyond a reasonable doubt
2. Civil-Based on a preponderance of evidence-monetary damages
3. Administrative-Clear and convincing standard-Suspension or loss of license
4. The burden of proof required for conviction as well as the type of punish
Types of Negligence:
1. Ordinary:
2. Professional
1. Ordinary negligence (the omission to do something that a reasonable person would do)
2. Professional negligence (also called malpractice)The failure of a person with professional training to act in a reasonable and prudent manner
Professional Negligence
As roles have expanded, nurses are being sued more
Do all nurses need malpractice insurance? Can be a double-edged sword (not if you work in a hospital, if you have personal insurance it is more encouraging for lawyers to sue b/c they can get more money)
Standard of Care
Represents the skills and learning commonly possessed by members of the profession and are the minimal requirements that define acceptable levels of care
Nurses Responsibility- Professional Negligence
Nurses are being sued more and more for not attempting to notify health care providers of changes in a patient's condition or to convince the providers of the seriousness of a patient's condition (foreseeability of harm)
Nurses Are at Increased Legal Liability in the 21st Century Due to:
-More authority and independence in decision making.
-Increased legal accountability for decision making.
-Doing more things that used to be in the realm of medical practice.
-Making more money.
-More of them carrying malpractice insurance.
-The question
Being Sued for Malpractice
-"Just following physician orders" is NOT a defense for malpractice.
-Nurses have an independent responsibility to take appropriate steps to safeguard patients
Intentional Tort: Assault and Battery
Tort= a legal wrong
1. Assault-(threaten the person)conduct that makes a person fearful and produces a reasonable apprehension of harm..threatening the person
2. Battery(actually touching them)-an intentional and wrongful physical contact with a person th
Intentional Tort: False Imprisionment
1. The restraint of a person's liberty of movement by another party who lacks legal authority or justification to do so.
Ex. Involuntary commitments to mental health facilities, keeping a patient in the hospital who wants to sign out AMA
**The use of phys
Other Intentional Torts: Invasion of Privacy and Defamation of Character
-Defamation-communicating to a third party, false information that injures a person's reputation.
-When defamation is written, it is called libel.
-When defamation is spoken, it is called slander.
Frequent Causes of Claims Against Nurses
-Inadequate charting
-Inadequate communication with physician or supervisors about changes in patient conditions
-Leaving potentially harmful items within patient reach
-Unattended patient falls
-Inaccurate counting of operative instruments and sponges
-M
The Board of Registered Nursing Protects Citizens by:
1. RN licensing
2.Monitoring of RN educational standards
3. RN continuing education
4. Disciplining RNs
***Boundaries for practice are defined in the Nurse Practice Act of each state.
-Nurse Licensure is a privilege and not a right
-If you have been found
Licensure
-Suspension and revocation proceedings are administrative laws
-Following a complaint, the board of nursing completes an investigation.
-Most of the investigations reveal no grounds for discipline
-If the investigation, supports the need for discipline, n
Common Causes of Professional Nursing License Suspension or Revocation
-Professional negligence
-Practicing medicine or nursing without a license
-Obtaining a nursing license by fraud or allowing others to use your license
-Felony conviction for any offense substantially related to the function or duties of an RN
-Not report
Types of Consents: Informed Consent
-Obtained only after the patient receives full disclosure of all pertinent information regarding the surgery or procedure and only if the patient understands the potential benefits and risks associated with doing so.
-The nurse is NOT responsible for expl
Types of Consents: Implied Consent
-Done in an emergency
-The physician states in the progress notes of the medical record that the patient is unable to sign but that treatment is immediately needed and is in the patient's best interest.
-Must by validated by 2 physicians.
Types of Consents: Express Consent
-Nurses seek expressed consent from patients by witnessing patients sign a standard consent form. The nurse is only responsible for seeing that the right patient signs the right form...not for explaining the risks and benefits.
-In expressed consent, the
Medical Records
Although the patient owns the information in the medical record, the actual record belongs to the facility that originally made the record and is storing it.
Please be aware of what the policy is in your institution. May vary.
The Patient Self Determination Act (PSDA) 1991
Requires health-care organizations that receive federal funding to provide education for staff and patients on issues concerning treatment and end-of-life issues
-Use of advance directives (every patient now over age 18 needs an advanced directive)
Health Insurance Portability and Accountability Act (HIPAA) 1996
Protects the privacy of health information and improves the portability and continuity of health insurance coverage
Good Samaritan Immunity
Generally, a nurse is not liable for injury that occurs as a result of emergency treatment, provided that:
Be careful with giving nonemergent care or advice to family, friends and neighbors because it is not covered!
Incident Reports
-Records of unusual or unexpected incidents that occur in the course of a client's treatment.
-Reports are considered confidential and cannot be subpoenaed by clients or used as evidence in their lawsuits in most states.
-NEVER leave a copy of the inciden
Advocacy
-->Advocacy is the foundation and essence of nursing, and nurses have a responsibility to promote human advocacy.
-Helping others to grow and self-actualize
-Nurses must advocate for themselves, clients, subordinates, and their profession.
-Managers shoul
Goals of the Advocate
To inform
To enhance autonomy
To respect the decisions of others
*Respect decisions of pt's - remember ultimately the decision effects them, not you
How Nurses Can Act as Advocates***
-Helping others make informed decisions
-Acting as intermediaries in the environment
Directly intervening on behalf of others
***The action of advocacy is best described as informing others of their rights and making certain they have sufficient informati
Practice Question:
One way nurses can act as advocates is by directly intervening on behalf of others.
True
False
A. True
Rationale: Sometimes it is advisable for nurses to advocate for patients by directly intervening on their behalf.
Nursing Values Central to Advocacy
1. Each individual has a right to autonomy in deciding what course of action is most appropriate to meet his or her health care goals.
2. Each individual has a right to hold personal values and to use those values in making his or her own health care deci
Controlling Patient Choices vs. Assisting Patient Choices
It is important, however, for the patient advocate to be able to differentiate between controlling patient choices (domination and dependence) and assisting patient choices (allowing freedom).
Advocating for Patients
-Advocating for patients requires that the manager create a work environment that recognizes patients' needs and goals as paramount. This means creating a work culture in which patients are respected, well informed, and empowered.
-Managers also must advo
Bill of Rights
-->Since the 1960s, the NLN, the American Hospital Association, and many states have passed bills of rights for patients. Although these are not legally binding, they can be used to guide professional practice
-->Yet there is still no comprehensive federa
Subordinate Advocacy
In subordinate advocacy, the manager helps subordinates resolve ethical problems and live with the solutions at the unit level.
Workplace Advocacy
In workplace advocacy, the manager ensures that the work environment is both safe and conducive to professional and personal growth for subordinates.
Upper-level managers must also be willing to advocate for whistle-blowers, who speak out about organizati
Internal vs. External Whistle-Blowing
Internal whistle-blowing occurs within an organization, reporting up the chain of command. (inside the hospital)
External whistle-blowing involves reporting outside the organization, such as to the media or an elected official. (to media or gov't official
Whistle Blowing Concern***
While much of the public wants wrongdoing or corruption to be reported, such behavior is often looked upon with distrust, and whistle-blowers are often considered disloyal and experience negative repercussions for their actions.
They are often afraid to s
Practice Question:
Reporting an offense to one's boss is an example of:
A. Internal whistle-blowing
B. External whistle-blowing
A. Internal whistle-blowing
Rationale: Reporting a problem to a higher-up within the organization is called internal
whistle-blowing.
Leader-Managers***
Leader-managers also must be advocates for the nursing profession.
Ensuring that workers have reasonable hours and schedules is a part of the manager's workplace advocacy role.
*****KNOW - schedules and hours is very important! As a leader and a manager y
Profession of Nursing
-Entry into a profession involves a personal and public promise to serve others with the special expertise that a profession can provide and that society legitimately expects it to provide.
-If nursing is to advance as a profession, practitioners and lead
Practice Question:
What are some ways nurses can advance the nursing profession? (Select all that apply)
A. Learn about sociopolitical issues.
B. Participate in professional organizations.
C. Participate in bureaucracy.
A. Learn about sociopolitical issues, and B. Participate in professional organizations.
Rationale: It is important for nurses to participate in the larger social framework in a professional capacity in order to advance the profession as a whole.
Making Concerns Known
-Nurses must exert their collective influence and make their concerns known to policy makers before they can have a major impact on political and legislative outcomes
-Nurses have not yet fully recognized the full potential of political activity.
Writing Letter to a Legislator
--Write a personal letter. Be formal, but polite. The letter should be one page.
--Address the legislator by title.
--Establish your credibility early in the letter as both a constituent and as a health care expert.
--Refer to a specific bill by number.
-
Practice Question:
Which should one not do when writing a letter to a legislator?
A. Be persistent.
B. Write a personal letter.
C. Address the legislator by his or her title.
D. Make the letter at least two pages long.
D. Make the letter at least two pages long.
Rationale: The letter should be succinct and to the point (no more than one page in length).
Media Exposure
Many nurses avoid media exposure because they believe they lack the expertise or because they lack self-confidence.
However, nurses should take every opportunity to appear in newspapers and on radio and television.
Practice Question:
Nurses should avoid media exposure.
A. True
B. False
B. False
Rationale: While many nurses avoid media
exposure out of self-consciousness, in fact
it is advantageous to appear in newspapers and on radio and television when the opportunity arises.
Tips for Interacting with the Media
-Be prepared.
-Stick to three or four key points.
-Provide the media with clear, concise information.
-Stay on track by sticking to predetermined points.
-Don't be afraid to say that you do not have enough information or expertise to answer a question.
Leadership and Management Planning
-Deciding in advance what to do
-All planning involves choice: a necessity to choose from among alternatives
-You have to be proactive, not reactive
-As a manager, you have to identify short and long term goals and changes needed to ensure that the unit w
Principals of Good Planning
-All plans must flow from other plans. Short-range plans must be congruent with long-term plans
-Planning must follow the mission, philosophy, and goals of the overall organization.
-Planning involves the same process regardless of the period involved.
-A
Strategies for Successful Planning
-Start planning at the top
-Keep planning organized, clear and definite
-Don't bypass levels of people
-Have short and long-range goals
-Know when to plan and when not to
-Keep target dates realistic
-Gather data appropriately
-Objectives need to be clear
why do plans fail?
False assumptions
Not knowing the overall goal
Not enough alternatives
Inadequate time or other resources
Low motivation levels
Sound strategies not used
Inadequate delegation of authority
Not recognizing organizational goals and needs
Planning is too nar
Planning Terms:
Reactive Planning
Definition:
-occurs after a problem exists.
-Returning the organization to a previous, more comfortable state
-usually done in response to a crisis
-can lead to hasty decisions and mistakes
Planning Terms:
Inactivism
Definition:
-seek the status quo. Preventing change and maintaining conformity. If change does occur, it's a very slow process
Planning Terms:
Preactivisim
Definition:
-utilize technology to accelerate change and are future oriented. They believe the future is always preferable to the present
Planning Terms:
Proactive Planning
Definition:
-planning/interactive-Consider the past, present and future and attempt to plan for the future of their organization rather than react to it. It's dynamic and adaptation is considered a key requirement since change is frequent.
Forecasting
Using available historical patterns to assist in planning
Examining present clues at projected statistics to determine future needs
-->Looks at past to predict future
Strategic Planning***
-Long range planning (3-10 years)
-Examines an organization's purpose, mission, philosophy, and goals in the context of its external environment
-Requires managerial expertise in healthcare economics, human resource management and political and legislativ
SWOT Analysis
-Strengths, weaknesses, opportunities and threats
-Be realistic about the organization's strengths and weaknesses
-Be specific about what you want to accomplish
-Always apply SWOT in relation to your competitors
-Keep it short and simple
-This IS subjecti
Organizational Planning Heirarchy
**order
1. Mission
2. Philosophy
3. Goals
4. Objectives
5. Policies
6. Procedures
7. Rules
Mission
-Reason an organization exists
-Addresses its position regarding ethics, principles, and standards of practice
-It determines an organizations functions and priorities
-->Example: Miami Children's Mission Statement
-We provide hope through advanced care t
Philosophy
-Delineates the set of values and beliefs that guide all actions of the organization
-Harris and Baliko (2000) maintain the values and principles set forth in the philosophy provide the foundation to determine what is critical
-Nursing: should provide fun
Philosophy Statement
-Societies and organizations have philosophies or sets of beliefs that guide their behavior
-These beliefs are called values
-Values have an intrinsic worth for a society or an individual
-Personal philosophies and values are shaped by the socialization p
Role of Nurse Manager
-When You Take a Position
-Have a copy of the philosophy should be received
-Read and think about the Organization's mission statement
-Applicant should be encouraged to speak to employees in various positions
-->Example; culture diversity and what polici
Goals and Objectives Review
-Ends toward which the organization is working
-How do you fit into this?
-Goal: direct result toward which effort if directed
-Change with time and require periodic examination
-Should clearly delineate the end product (just a few)
-->Example: All nursin
Objectives
-Similar to goals: motivate people to a specific end.
-Difference: explicit, measurable (time frame with certain criteria), observable, and retrievable, and obtainable'
-Unit manager: writing job descriptions: remember they must be all of the above.
-Can
Policies, Procedures and Rules
-Plans reduced to statements or instructions.
-Policy: statement of expectations that sets boundaries for action taking and decision making.
-Explain how goals will be met and guide the general course and scope of the organizational activities.
-Types: ex
Planned Change
-It's the deliberate application of knowledge and skills by a leader to bring about a change
-Today, most organization's find themselves undergoing continual change directed at organizational restructuring, quality improvement, and employee retention
-Wel
Management vs Leadership
A fundamental difference in management and leadership is that managers continue the status quo and leaders embrace change!
Planned vs Accidental Change
-Regardless of the type of change, all major change brings feelings of achievement, pride, loss and stress.
***Planned change, in contrast to accidental change, is change that results from a well-thought -out and deliberate effort to make something happen
Need for Change in Nursing Profession:
Bednash
-Bednash (2003) maintains that change is needed in both the practice of nursing and in the systems that nurses deliver it.
-All types of change: bring feelings of achievement, loss, pride, and stress
-Initiating change requires well developed leadership a
Change Theory
Kurt Lewin
-Classic Change Theory by Kurt Lewin (1951)
-He stated change should be implemented for good reason
-It should be gradual
-Should be planned, and not sporadic or sudden
-All individuals who would be affected by the change, should be involved in the planni
Change Theory:
Unfreezing Phase
-Change agent unfreezes the forces
that maintain the status quo
-People become discontented and aware of a need for change. People may feel anger.
-The change agent convinces members of the group to change when guilt, anxiety, or concern can be elicited a
Change Theory:
Movement Phase
-Change agent identifies, plans, and implements appropriate strategies
-Ensures that driving forces exceeds restraining forces
-Change should be implemented gradually and for good reason
-Must allow enough time for those to be fully assimilated in that ch
Change Theory:
Refreezing Phase
-Change agent assists in stabilizing the system change so that it becomes integrated into the status quo
-Be supportive
-Reinforce
-Takes 3 - 6 months to be accepted
-Change must make a commitment to be available until the change is complete
-Refreezing d
Change Theory Related to the Patient
-Must feel a need for change (unfreezing)
-A helping relationship between the change agent and his patient (Movement)
-Problem is identified and clarified
-Alternatives for change are examined
-Resources are assessed
-Active modification occurs
-Movement
Emotions Encountered with Change
Equilibrium
Denial
Anger
Bargaining
Chaos
Depression
Resignation
Openness
Readiness
Reemergence
Lewins Driving and Restraining Forces**
-Driving forces (facilitate)-The forces that push the system towards change
-desire to please your boss, eliminate a problem, pay raises, and receiving recognition, healthcare (private health insurance program premiums are above what consumers can afford)
Resistance to Change
-Because change disrupts the homeostasis or balance of the group, resistance should always be expected
-It's a natural and expected response to change
-Encourage subordinates to speak openly so that options can be identified to overcome objections
-*Chang
Time Managment
-Biggest obstacle for new nurses
There is a close relationship between time management and stress
-Trying to do more with less time
-Good time-management skills allow an individual to spend time on things that matter
Symptoms of Poor Time Management
Constant rushing
Caught in "crisis mode"
Fatigued or listlessness, "overwhelmed" feeling
Constantly missing deadlines
Insufficient time for rest or personal relationships
Sense of being overwhelmed by demands and details
Having to do what you don't want t
Management by Crisis
Without adequate planning, the manager finds getting started difficult and begins to manage by crisis
Always remember that time management should be proactive, not crisis driven. Allowing time at the beginning of the day to plan will help reduce the need
3 Steps to Time Managment
1. Time be set aside for planning and establishing priorities
2. Finish one task before starting another
3 Must reprioritize what tasks will be accomplished based on new information received-This is a cyclic process
Time Management:
Time for Planning
Fail to plan - plan to fail"
Some managers find it unproductive if they sit at their desk designing the plan for the day
However, there is no sense of achievement if the goals are not delineated
Planning takes time
Think, analyze, envision, decide
The tw
Time Management:
Priority Setting
1. The most critical skill in good time management is priority setting
2. Traps (Vacarro, 2001)
Whatever hits first-responds to things as they happen
Path of least resistance-does not delegate appropriately
Squeaky wheel-he who makes the most noise, wins.
Time Managment:
Reprioritize
Periodically review and revise lists from previous days.
If crisis does occur, it is OK to set aside the original priorities for the day and reorganize, communicate, and delegate a new plan.
Managing Time at Work
-Being overwhelmed at work leads to errors, forgetting important tasks, and stress.
-Daily planning allows for time management
-Disorganization results from poor planning
-Examples include staffing schedules, patient care assignments, coordination of lunc
Managing Time at work Cont
-Taking breaks
Necessary part of workday
Refreshes mind & body, reduces stress
Overworked people make more mistakes and 'burnout' quicker.
-Dealing with interruptions
Lower level managers have more interruptions and interact more with subordinates
-Create
How to Avoid Social Time Wasters
1. Do not make yourself overly accessible
Don't 'work' at nurses station
Shut your office door (if you have an office)
When charting, sit with your back to others (if possible)
2. Interrupt
Don't allow people to ramble on and on
Casually break in and ask
Personal Time Managment
-Refers in part to self-knowledge
-Self-awareness is a leadership skill
-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.
-When individuals lac
Personal Organization
-How do you waste time?
-What type of work do you avoid?
-What is the best time of day for you to work?
-How long can you work before becoming nonproductive?
Internal Time Wasters
Procrastination
Poor planning
Failure to establish goals and objectives
Inability to delegate
Inability to say no
Management by crisis
Haste
Indecisiveness
Open-door policy
External Time Wasters
Telephone interruptions
Socializing
Meetings
Lack of information
Poor communication
Lack of feedback
Lack of adequately described policies and procedures
Incompetent coworkers
Poor filing System
Paperwork and reading
Improving Productivity Through Time Managment
-Maintain a time log
-Discover time wasters
-Establish daily goals & prioritize them
-Daily to do lists
-Questioning procedures if they no longer serve any valid purpose
-Stop multitasking: Realize that it takes less time to do one thing at a time. Multit
Integrating Leadership Roles and Management Functions in Time Managment
-is self-aware regarding personal blocks and barriers to efficient time management as well as having one's own value system influences his/her use of time and the expectations of followers
-functions as a role model, supporter, and resource person to subo
Case Study Example
Joanne Burns is a new graduate and has begun her career in the cardiac thoracic intensive care unit (ICU). Joanne has finished her orientation and is working with experienced professional nurses.
Joanne feels relatively secure with the
During the first day of her new position, Joanne is assigned to two postoperative patients. Everything proceeds smoothly until one patient's blood pressure drops and bleeding is suspected. Joanne is a wreck. She becomes disorganized and anxious. The other
Finscal Planning
**responsibility lies with manager b/c directly control of budget
-Is not intuitive. It is a learned skill that improves with practice. It is not reactive, it is proactive!!!!
-Requires vision, creativity and a thorough knowledge of the political, social
Balancing Costs and Quality of Care
-How do we do this????
-Do not always have a linear relationship
-Cost containment-refers to effective and efficient delivery of services while generating needed revenues for continued organizational productivity.
-Cost containment is the responsibility o
Fiscal Planning Forecasting
-Forecasting-involves making an educated budget estimate using historical data
-Unit managers are involved in the daily operations and see firsthand their unit's functioning
-See trends in census, as well as supplies and equipments
-The manager should be
Basics of Budgets
-Budget: is a plan that uses numerical data to predict the activities of an organization over a period of time
-Provides a mechanism for planning and control
-Requires flexibility, ongoing evaluation, and revision
-A budget predicted too far in advance ha
Types of Budgets**
1. Fixed: do not vary with volume Example: manager's salary, mortgage payments
2. Variable: do vary with volume Example : payroll of hourly wage employees or cost of supplies
3. Controllable expenses can be controlled by a manager (staff mix)
4. Uncontrol
Steps in the Budget
1. Assess what needs to covered in the budget. Should be using different resources in the organization
2. Develop a plan-12 month budget-fiscal year budgets.
****a budget too far in advance has a greater probability for error
3. Implementation-ongoing mon
Types of Budgets for Unit Managers***
1. The Personnel Budget-Workforce, Staffing mix (UAP, LPN, RN's)...Largest part of the budget!
2. The Operating Budget-Reflects change in response to the volume of service (electricity, repair, maintenance, supplies)...second largest part of the budget!
3
Budgeting Methods
1. Incremental Budgets-simplest method. Multiplying current year expenses by a certain figure (usually inflation rate) to determine next year's budget.
2. Zero-Based Budgeting-the program has to justify itself and why it's necessary.
3. Flexible Budgeting
Critical Pathways Method
Critical Pathways-relatively standardized predictions of patient's progress for a specific diagnosis or procedures or after a specific surgery
Medicare
-Established in 1965
-Primary populations are elderly, disabled and renal dialysis patients
-Two parts: A and B
-Part A-funded by social security tax and federal taxes
-Part B-subsidized 75% by federal government and 25% by subscribers
Medicare Part A
1. Financed primarily through employee payroll deductions and employer contributions
2. Covers inpatient hospital care, limited skill nursing facility, home health and hospice care, although beneficiaries pay a deductible for each inpatient benefit period
Medicare Part B
1. Is financed largely from federal general funds
2. A supplementary insurance that covers primary care provider services, outpatient diagnostic tests, certain medical supplies and equipment, and (since 1998) home health care.
3. Is optional for beneficia
Medicaid
-Also established in 1965
-Primary population-financially indigent
-Majority of these recipients are women and children
-Administered by the states under broad federal guidelines
-Covers about 18% of the US population
Diagnosis Related Groups and Proscpective Payments System
Diagnosis Related Groups-predetermined payment schedules that reflect historical costs for treatment of specific patient conditions
With DRGs, hospitals join the prospective payment system, whereby they receive a specified amount for each Medicare patient
Managed Care
-Broadly defined as a system that attempts to integrate efficiency of care, access, and cost of care
-Utilization Review is a process used by insurance companies to assess the need for medical care and to assure that payment will be provided for the care
Moral Hazard
Refers to the propensity of insured patients to use more medical services than necessary because their insurance covers so much of the cost
Nursing Care Hours Per Patient Day
Total hours worked by staff in a 24 hour period....Divided by...The patient census at the end of the 24 hour period.