Nurse executive
A clinical and business leader concerned with maximizing quality of care and cost-effectiveness while maintaining relationships and professional satisfaction of the staff
Most important responsibility of nurse executive
Establish a philosophy for nursing that enables managers and staff to provide quality nursing care
Magnet recognized hospital
Transformed culture with a practice environment that is dynamic, autonomous, collaborative, and positive for nurses; staff feels valued; improves patient quality outcomes
Team nursing characteristics
RN leads team and develops care plans and coordinates care; team members provide care; hierarchical communication
Team nursing advantages
Collaborative style; high autonomy for team leader; decision making at clinical level
Team nursing disadvantages
RN leader does not spend time with patients; leader takes time to delegate work
Total patient care characteristics
RN responsible for all aspects of care during shift; care can be delegated; RN works directly with patient and family
Total patient care advantages
Patient satisfaction is high; RNs plan care; high degree of collaboration
Total patient care disadvantages
Continuity of care is a problem if no communication between RNs; low cost effectiveness due to high number of RNs needed
Primary nursing characteristics
One RN assumes responsibility for a caseload of patients; RN provides care for same patients during their shift; RN assess patient, develops care plan, and provides care; lateral communication
Primary care advantages
Model is flexible; high level of autonomy and authority; promotes collaboration with physician; continuity of care; reduces errors that occur when relaying errors
Primary care disadvantages
Associate nurse can not charge care plan without discussing with primary nurse; model does not decrease cost of care
Decentralized management
Decision making is moved down to the level of staff; very common within health care organizations
Responsibility
Duties and activities that an individual is employed to preform; reflects ownership
Autonomy
Freedom of choice and responsibility for their choices
Authority
Legitimate power to give commands and make final decisions specific to a given position
Accountability
Individuals being answerable for their actions
Shared governance councils
Review and establish standards of care, develop policy and procedures, resolve patient satisfaction issues, or develop new documentation tools; promote empowerment in staff nurses and enable them to control their nursing practice
Nurse physician collaborative practice
Sharing of different perspectives that are then synthesized to better understand complex problems; outcome is a shared solution that could not have been accomplished by a single person; improves patient safety and outcomes and reduces errors
Interdisciplinary collaboration
Brings all members of the team together to decrease mistakes and increase knowledge, skills, and attitudes; leads to decreased patient mortality, decreased health care costs, and increased nurse satisfaction
Staff communication
A manager's greatest challenge; newsletters, staff meetings, committees
Staff education
Planning in-service programs, sending staff to continuing education classes and professional conferences, and having staff present case studies or practice issues during staff meetings
High priority patient problems
An immediate threat to a patient's survival or safety such as a physiological episode of obstructed airway, loss of consciousness, or a psychological episode of an anxiety attack
Intermediate priority patient problems
Non life threatening actual or potential needs that the patient and family members are experiencing; anticipating teaching needs of patients related to a new drug and taking measures to decrease post operative complications
Low priority patient problems
Actual or potential problems that are not directly related to the patient's illness or disease; often related to developmental needs or long term needs
Effective use of time
Doing the right things
Efficient use of time
Doing things right
Goal setting
Review the patient's goals for the day and any goals you have to accomplish for the day
Time analysis
Keep track of how you use your time in different activities
Priority setting
Set priorities that you have established for patients within set time frames
Interruption control
Don't let issues with colleagues interrupt patient care
Evaluation
At the end of each day take time to think and reflect about how effectively you used your time
Strategies to improve communication with physicians
Addressing the physician by name, having the patient and chart available, focusing on patient problem, being professional and not aggressive
Delegation
Transferring responsibility for the performance of an activity or task while retaining accountability for the outcome
Five rights of delegation
Right task, right circumstances, right person, right direction, right supervision