criminal case
in these the individual faces charges generally filed by the state or federal attorney general for crimes committed against an individual or society
burden of proof: beyond a reasonable doubt
consequence: incarceration, probation, and fines
civil case
one individual sues another for money to compensate for a perceived loss
burden of proof: based on a preponderance of the evidence
consequence: monetary damages
administrative case
an individual is sued by a state or federal government agency assigned the responsibility of implementing governmental programs
burden of proof: clear and convincing standard
consequence: suspension or loss of licensure
elements of malpractice (professional negligence)
1. standard of care
2. breech of care
3. forseeability of harm
4. Failure to meet the Standard of Care must have Potential to Injure the Patient
5. actual patient injury
how nurses reduce the likelihood of being sued for malpractice
-practice within the scope of the nurse practice act
-observe agency policies and procedures
-model practice after established standards by using EBP
-always put pt rights and welfare 1st
-be aware of relevant law and legal doctrines
-practice within the
joint liability
nurse, physician, and employing organization are liable (current position of the legal system)
express consent
nurses get this from patients by witnessing patients sign a standard consent form- the role of the nurse is to be sure that the patients has received informed consent and to seek remedy if he or she has not
Patient Self-Determination Act
A federal law that requires hospitals and other health care providers to provide written information to patients and families regarding their rights under state law to make medical decisions and execute advance directives.
good samaritan law
Provides limited protection to someone who voluntarily chooses to provide first aid as long as actions taken are not grossly negligent and if the health-care worker does not exceed his or her training or scope of practice in performing the emergency servi
negligence
omission to do something that a reasonable person, guided by the considerations that ordinarily regulate human affairs, would do or as doing something that a reasonable and prudent person would not do
malpractice
the failure of a person with professional training to act in a reasonable and prudent manner also referred to as professional negligence
State board of nursing
Who is responsible for nurse licensure?
strategic planning
Examines purpose, mission, philosophy and goals in the context of its external environment
-SWOT analysis
-balanced scorecard
SWOT analysis
strengths, weaknesses, opportunities, threats
barriers to planning
Lack of planning and goal setting, lack of flexibility, not including all constituents, complexity, too much planning, not enough doing, lack of or too little evaluation
planned change
the deliberate application of knowledge and skills by a leader to bring about change
change by drift
accidental change
change agent
A person skilled in the theory and implementation of planned change
unfreezing
1st phase of planned change- occurs when the change agent convinces members of the group to change or when guilt, anxiety, or concern can be elicited
movement
2nd phase of planned change- the change agent identifies plans, and implements appropriate strategies, ensuring that driving forces exceed restraining forces
refreezing
3rd phase of planned change- the change agent assists in stabilizing the system change so that it becomes integrated into the status quo
driving forces
advance a system toward change
restraining forces
impede change
rational-empirical strategy of change
to give current research as evidence to support the change; used when there is little anticipated resistance to the change
normative- reeducative strategy of change
use group norms and peer pressure to socialize and influence people so that change will occur
power- coercive strategy of change
features the application of power by legitimate authority, economic sanctions, or political clout of the change agent; includes influencing the enactment of new laws and using group power for strikes or sit-ins
planning fallacies
a phenomenon that shows despite the fact that the time allowed to carry out their plan is shown over and over again to be inadequate, most individuals continue to be optimistic that their new forecasts, which are no different, will be realistic
time wasters
Technology
socializing
paperwork overload
a poor filing system
interruptions
Nursing Care Hours Per Patient Day
nursing hours worked in 24 hours/ patient census
personnel budget
the largest of the budget expenditures, use historical data to predict personnel needs, standard set yearly, adjustments made daily, monitor closely, staffing mix, acuity, work time and benefit time
operating budget
expenses that change in response to volume of service, electricity, repairs, maintenance, supplies
capital budget
buildings, major equipment
promise
earliest of the career phases and typically reflects the 1st 10 years of nursing employment
momentum
middle career phase and reflects the nurse with 11-29 years of experience
harvest
late career- nurses with 30-40 years as having prime experience and nurses with more than 40 years of experience as being legacy clinicians
centralized decision making
a few managers at the top of the hierarchy make the decisions and the emphasis is on top-down control
decentralized decision making
diffuses decision making throughout the organization and allows problems to be solved by the lowest practical managerial level
authority
official power to act
responsibility
duty or an assignment
accountability
individuals agree to be morally responsible for the consequences of their actions
model components required for magnet status
1. transformational leadership
2. structural empowerment
3. exemplary professional practice
4. new knowledge, innovation, and improvements
5. empirical quality results
groupthink
occurs when group members fail to take adequate risks by disagreeing, being challenged, or assessing discussion carefully
stakeholders
those entities in an organizations environment that play a role in the organization's health and performance or that are affected by organization
-internal- employees, physicians, patients, families, union shop stewards, board of directors
-external- loca
total patient care
nurses assume total responsibility during their time on duty for meeting all the needs of assigned patients
funcitonal nursing
evolved as a result of WWII; uses relatively unskilled workers who have been trained to complete certain tasks; care is assigned by tasks rather than by patient
team nursing (modular nursing)
led by an RN, a team of 2-3 people who provide total care to assigned patients; requires extensive team communication and regular team planning conferences
primary nursing
all RN staff, RN primary nurse assumes 24- hour responsibility for planning the care of one or more patients from the start of treatment to discharge; during work hours, the primary nurse provides direct care for those patients; associates provide care fo
case management
collaborative, coordinates care throughout an episode of illness, focus is on individual clients, not populations of clients
goals of case management
Decreased hospital readmission, decreased length of stay, adherence to therapeutic regimen, achievement of desired outcomes, decreased resource use, improved quality of life, improved functional status, increased patient satisfaction, decreased symptom ma
centralized staffing
where staffing decisions are made by personnel in a central office or staffing center
decentralized staffing
the unit manager is often responsible for covering all scheduled staff absences, reducing staff during periods of decreased pt census or acuity, adding staff during periods of high pt census or acuity, preparing monthly unit schedules, and preparing holid
flextime
system that allows employees to select the time schedules that best meet their personal needs while still meeting work responsibilities
self-scheduling
allows nurses in a unit to work together to construct their own schedules rather than have schedules created by management
motivation
the force within the individual that influences or directs behavior
intrinsic motivation
comes from within the person, driving him or her to be productive
extrinsic motivation
occurs when individuals are motivated to perform a behavior or engage in an activity to earn a reward or avoid punishment
overjustification effect
the tendency of extrinsic motivation to interfere with intrinsic motivation
positive reinforcement
validates the workers' effort and can be used to create a motivating climate
internal climate
includes the values, feelings, temperament, and stress levels of the sender and the receiver
external climate
includes status, power, and authority as barriers to manager- subordinate communication
assertive communication
a way of communicating that allows people to express themselves in direct, honest, and appropriate ways that do not infringe on another person's rights
passive communication
occurs when a person suffers in silence, although he or she may feel strongly about the issue
passive-aggressive communication
an aggressive message presented in a passive way
aggressive communication
generally direct, threatening, and condescending
upward communication
from subordinate to superior
downward communication
from superior to subordinate
horizontal communication
from peer to peer
diagonal communication
between individuals at differing hierarchy levels and job classifications
grapevine communication
informal, haphazard, and random, usually involving small groups
ISBAR/ SBAR
Introduction, situation, background, assessment, recommendation
they provide structured, orderly approaches to provide accurate, relevant information, in emergent patient situations as well as routine handoffs
GRRRR listening model
-Greeting- simple respectful greeting,
-Respectful listening- giving each other time to think and transmit critical info w/o interrupting
-Review- occurs when speaker summarizes the info he has conveyed to make sure that the message was understood correct
forming stage (of group forming)
testing occurs to identify boundaries of interpersonal behaviors, establish dependency relationships with leaders and other members, and determine what is acceptable behavior
storming stage (of group forming)
resistance to group influence is evident as members polarizing into subgroups; conflict ensues and members rebel against demands imposed by the leader
norming stage (of group forming)
consensus evolves as group cohesion develops; conflict and resistance are overcome
performing stage (of group forming)
interpersonal structure focuses on task and its completion; roles become flexible and functional; energies are directed to task performance
group building and maintenance roles
Encourager, harmonizer (mediates, resolves conflict), compromiser(yields his/her position in a conflict), gatekeeper(promotes open communication and facilitates participation by all members), standard setter(expresses or evaluates standards to evaluate gr
strategies for successful delegation
Identify necessary skill and education levels to complete delegated task, plan ahead, select and empower capable personnel, communicate goals clearly, empower the delegate, set deadlines and monitor progress, monitor the role and provide guidance, evaluat
5 rights of delegation
right task
right circumstance
right person
right direction/communication
right supervision/evaluation
underdelegation
stems from the individual's false assumption that delegation may be interpreted as a lack of ability on his or her part to do the job correctly or completely
improper delegation
includes such things as delegating at the wrong time, to the wrong person, or for the wrong reason
cultural phenomena to consider when delegating
Communication: especially dialect, volume, use of touch and eye contact
Space: interpersonal space differs between cultures
Social organization: family unit of primary importance in some cultures
Time: cultures tend to be past, present, or future oriented
reasons nurses join unions
1. to increase power of the individual
2. to increase their input into organizational decision making
3. to eliminated discrimination and favoritism
4. because of a social need to be accepted,
5. because they are required to do so as part of employment (c
collective bargaining
Negotiations between representatives of labor unions and management to determine pay and acceptable working conditions.
fair labor standards act
sets minimum wage and max hours that can be worked before overtime is paid
civil rights act
sets equal employment practices
executive order
sets affirmative action guidelines
age discrimination act
protects against forced retirement
rehabilitation act
prohibits discrimination on basis of disability
vietnam veteran act
provides reemployment rights
the equal pay act
requires that men and women performing equal work receive equal compensation
California fair pay act
companies in CA must justify any pay disparities b/w men and women doing "substantially similar" work. Also, legally guaranteed employees the right to ask coworkers about pay w/o retribution from management
Hallmarks of Effective Quality Control Programs
1. support from top-level administration
2. commitment by the organization in terms of fiscal and human resources
3. quality goals reflect search for excellence rather than minimums
4. process is ongoing
management process
1. planning
2. organizing
3. staffing
4. directing
5. controlling functions
audit
a systematic and official examination of a record, process, structure, environment, or account to evaluate performance
standards for practice
established to define the scope and dimensions of professional nursing
clinical practice guidelines
provide diagnosis-based, step-by-step interventions for providers to follow in an effort to promote high-quality care while controlling resource utilization and care
structure audits
assume that a relationship exists b/w quality care and appropriate structure; includes inputs such as the environment in which health care is delivered
outcomes audits
the end result of care; determine what results, if any, occurred as a result of specific nursing interventions for patients
process audits
measure how nursing care is provided; assumes a connection b/w the process and quality of care
halo effect
occurs when the appraiser lets one or two positive aspects of the assessment or behavior of the employee unduly influence all other aspects of the employee's performance
horn's effect
occurs when the appraiser allows some negative aspects of the employee's performance influence the assessment to such an extent that other levels of job performance aren't accurately recorded
Matthew effect
occurs when employees receive the same appraisal results year after year
central tendency
manager rates all employees as average
Trait rating scales
rates an individual against some standard
job dimension scales
rates the performance on job requirements
Behaviorally anchored rating scales
rates desired job expectations on a scale of importance to the position
checklists
rates the performance against a set list of desirable job behaviors
essays
a narrative appraisal of job performance
self-appraisals
an appraisal of performance by the employee
management by objectives
employee and management agree on goals of performance reached
peer review
assessment of work performance carried out by peers