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Chapter 1

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Decision making, Problem Solving, and Critical Thinking

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Successful decision makers are

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self-aware, courageous, sensitive, energetic, and creative.

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The rational approach to problem solving begins with

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a fixed goal and ends with an evaluation process.

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Naturalistic decision making blends intuition and analysis

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but pattern recognition and experience guide decision makers when time is limited or systematic rational decision making is not possible.

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Evidence-based nursing practice integrates

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the best evidence available to achieve desired outcomes

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The successful decision maker understands the significance that gender, personal and individual values, life experiences, preferences, willingness to take risk, brain hemisphere dominance, and predominant thinking style have on

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alternative identification selection.

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The critical thinker is aware of areas of vulnerability that hinder successful decision making and makes efforts to

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avoid the pitfalls of faulty logic in his or her data gathering.

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The act of making and evaluating decisions

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increases the expertise of the decision maker.

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There are many models for improving decision-making. Using a systematic decision making model or problem solving model reduces

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heuristic trial-and-error, rule of thumb methods, and increases the probability that appropriate decisions will be made.

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Left and right brain dominance as well as thinking styles influence

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at least to some degree, how individuals think.

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Two major considerations in organizational decision-making are

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how power affects decision-making, needs to be only satisficing.

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Management science has produced many tools to help decision makers make better and more objective decisions, but

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all are subject to human error, and many do not adequately consider the human element.

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Chapter 2

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Classical Views of Leadership and Management

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Management functions include

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planning, organizing, staffing, directing, and controlling. Known as the management process.

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Classical, or traditional, management science focused on production in the workplace and on delineating organizational barrier to productivity.

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Workers were assumed to be motivated solely by economic rewards, and little attention was given to worker job satisfaction.

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The human relations era of management science

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emphasized concepts of participatory and humanistic management.

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Three primary leadership styles have been identified:

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authoritarian, democratic, and laissez- faire.

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Research has shown that the leader-manager must assume a variety of leadership styles

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depending on the needs of the workers, the task to be performed, and the situation or environment. This is known as situational or contingency leadership theory.

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Leadership is a process of

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persuading and influencing others towards a goal and is composed of a wide variety of roles.

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Early leadership theories focused on

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the traits and characteristics of leaders.

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Interactional leadership theory focuses more on leadership as a process of

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influencing others within an organizational, culture, and the interactive relationship of the leader and the follower.

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The manager who is committed, has a vision, and is able to empower others with this vision is termed a transformational leader

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whereas the traditional manager, concerned with the day-to-day operations is called a transactional leader.

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Full-range leadership theory suggests that

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context is an important mediator of transformational leadership.

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Integrating leadership skills with the ability to carry out management functions

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is necessary if an individual is to become an effective leader-manager.

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Chapter 3

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Twenty-First Century Thinking about Leadership and Management

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Many new leadership and management theories have emerged in the 21st century to explain the

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complexity of the leader- follower relationship and the environment in which work is accomplished and goals are achieved.

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Strengths-based leadership focuses on the development or empowerment of workers' strengths

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as opposed to identifying problems, improving underperformance, and addressing weaknesses and obstacles.

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Level 5 leadership is characterized by

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knowledge, team building skills, ability to help groups achieve goals, humility, and empowerment of others through servant leadership.

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Servant leadership is

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a contemporary leadership model that puts serving others as the first priority.

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Followers can and do influence leaders

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in both positive and negative ways.

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Principal agent theory suggests that followers may have an informational (expertise or knowledge) advantage over the leader, as well as their own preferences

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which may deviate from those of the principal, This may lead to a misalignment of goals.

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Human capital represents the capability of the individual

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Social capital represents what a group can accomplish together.

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Emotional intelligence refers to the ability to

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use emotions effectively and is considered by many to be critical to leadership and management success.

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Authentic leadership

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suggest that in order to lead, leaders must be true to themselves and their values and act accordingly.

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Thought leadership refers to any situation whereby one individual

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convinces another to consider a new idea, product, or way of looking at things.

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Thought leaders attract followers not by promise of representation, or empowerment, but by

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their risk taking and vision in terms of being innovative.

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Quantum leadership

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suggest that the environment and context in which people work is complex and dynamic and that this has a direct impact on organizational productivity.

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A transition has occurred in the 21st -century from industrial age leadership

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to relationship age leadership.

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Chapter 4

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Ethical Issues

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Ethics is the systematic study of what a person's conduct and actions should be with regard to self, other human beings, and the environment;

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it is the justification of what is right or good, and the study of what a person's life and relationships should be - not necessarily what they are.

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In an era of markedly limited physical, human, and fiscal resources, nearly all decision making by nurse-managers involves some ethical component.

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Multiple advocacy roles and accountability to the profession further increase the likelihood that managers will be faced with ethical dilemmas in their practice.

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Many systematic approaches to ethical problem solving are appropriate. These include the use of

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theoretical problem-solving and decision-making models, ethical frameworks, and ethical principles

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Outcomes should never be used as the sole criterion for assessing the quality of ethical problem solving

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because many variables affect outcomes that have no reflection on whether the problem solving was appropriate.

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Quality, should be evaluated both by the outcome and the process used to make the decision.

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If a structured approach to problem solving is used, data gathering is adequate, and multiple alternatives are analyzed, then regardless of the outcome, the manger should feel comfortable that the best possible decision was made at that time with the information and resources available.

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Four of the most commonly used ethical frameworks for decision-making are

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utilitarianism, duty-based reasoning, rights-based reasoning, and intuitionism.

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Ethical frameworks for decision-making do not solve the ethical problem but assist individuals involved in the problem solving to

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clarify their values and beliefs.

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Principles of ethical reasoning explore and define what beliefs or values form the basis for our decision-making. These principles include

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autonomy, beneficence, nonmaleficence, paternalism, utility, justice, fidelity, veracity, and confidentiality.

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Professional codes of ethics and standards for practice are

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guides to the highest standards of ethical practice for nurses.

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Sometimes it is very difficult to separate legal and ethical issues, although they are not the same. Legal controls are generally clear and philosophically impartial.

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Ethical controls are much more unclear and individualized.

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Chapter 5

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Legal and Legislative Issues

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Sources of law include

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constitutions, statutes, administrative agencies, and court decisions.

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The burden of proof is required to be found guilty and the punishment for the crime varies significantly between

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criminal, civil, and administrative courts.

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Nurse Practice Acts

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define and limits the practice of nursing in each state.

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Professional organizations generally hold standards of care that are

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higher than those required by law. These voluntary controls often are forerunners of legal controls.

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Legal doctrines such as stare decisis and res judicata

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frequently guide courts in their decision-making.

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Currently, licensing for nurses is a responsibility of State Boards of Nursing or State Boards of Nurse Examiners.

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These state boards also provide discipline as necessary.

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Some professionals have advocated shifting the burden of licensure, and thus accountability, from individual practitioners to an institution or agency.

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Many professional nursing organizations oppose this move.

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Malpractice or professional negligence is the failure of a person with professional training to act in a reasonable and prudent manner.

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Five components must be present for an individual to be found guilty of malpractice.

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Employers of nurses can now be held liable for an employee's acts under the concept of

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vicarious liability.

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Each person, however, is liable for

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his or her own tortuous conduct.

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Managers are not automatically held liable for all acts of negligence on the part of those they supervise, but they may be held liable if

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they were negligent in supervising those employees at the time that they committed the negligent acts.

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While professional negligence is considered to be an unintentional tort

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assault, battery, false imprisonment, invasion of privacy, defamation, and slander are intentional torts.

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Consent can be informed, implied, or expressed.

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Nurses need to understand the differences between these types of consents and use the appropriate one.

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Although the patient owns the information in a medical record, the actual record belongs to the

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facility that originally made it and is storing it.

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It has been shown that despite good technical competence, nurses who have difficulty establishing positive interpersonal relationships with clients and their families are

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at a greater risk of getting sued.

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Each nurse should be aware of how laws such as Good Samaritan immunity or legal access to incident reports

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are implemented in the state in which they live.

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New legislation pertaining to confidentiality (HIPAA) and patient rights (PSDA)

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continues to shape nurse-client interactions in the health-care system.

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Chapter 6

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Strategic and Operational Planning

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The planning phase of the management process

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is critical and precedes all other functions.

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Planning is a

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proactive function required of all nurses.

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A plan is a

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guide for action in reaching a goal and must be flexible.

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Plans should be

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specific, simple, and realistic.

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All planning must include an

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evaluation step, and requires periodic reevaluation, and prioritization.

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All people and organizational units affected by a plan

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should be included in the planning. Stakeholders

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Plans have a time for evaluation built into them so that there can be

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a midcourse correction if necessary.

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New paradigms and trends emerge continuously, requiring leader-managers to

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be observant and proactive in organizational strategic planning

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Because of the rapid changing technology, increasing government regulatory involvement in healthcare, changing population demographics, and reduced provider autonomy,

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healthcare organizations are finding it increasingly difficult to appropriately identify long-term needs and plan accordingly.

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Organizations and planners tend to use one of the four planning modes:

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reactive, inactivism, preactivism, or proactive. A proactive planning style is always the goal.

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Strategic planning tools such as SWOT and balanced scorecard

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help planners to identify those issues most likely to impact a particular organization or situation in the future and then to develop an appropriate plan for action.

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All planning in the organizational hierarchy must

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flow from and be congruent with planning down at higher levels in the hierarchy.

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Planning in the organizational hierarchy typically includes the development of

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organizational vision and mission statements, philosophies, goals, objectives, policies, procedures, and rules. Top-down...

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An organizational philosophy that is not or cannot be implemented is

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useless.

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To avoid ongoing intrapersonal values conflicts,

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employees should have a philosophy compatible with that of their employer.

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Policies and procedures

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should be evidence based.

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Rules are fairly inflexible, so the fewer rules, the better. Existing rules, however,

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should be enforced to keep morale from breaking down and to allow organizational structure.

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Chapter 8

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Planned Change

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Change should not be viewed as a threat but as a

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challenge and a chance to do something new and innovative.

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Change should be implemented

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only for good reason.

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Because change disrupts the homeostasis or balance of the group

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resistance should be expected as a natural part of the change process.

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The level of resistance to change generally depends on the type of change proposed.

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Technological changes encounter less resistance than changes that are perceived as social or that are contrary to established customs or norms.

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Perhaps the greatest factor contributing to the resistance encountered with change is

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a lack of trust between the employee and the manger of the employee and the organization.

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It is much easier to change a person's behavior

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than it is to change an entire group's behavior. It is also easier to change knowledge levels than attitudes.

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Change should be planned and thus implemented

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gradually, not sporadically or sudden.

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Those who may be affected by a change should be

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involved in planning for it. Likewise, workers should thoroughly understand the change and its effect on them.

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The feeling of control

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is critical to thriving in a changing environment.

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Friends, family, and colleagues

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should be used as a network of support during change.

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The successful change agent has the leadership skills of

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problem solving and decision-making and has good interpersonal skills.

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In contrast to planned change, change by drift is

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unplanned or accidental.

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Historically, many of the changes that have occurred in nursing or have affected the profession are

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the results of change by drift.

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People maintain status quo or equilibrium when both driving and restraining forces operating within any field simultaneously occur.

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For change to happen, this balance of driving and restraining forces must be altered.

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Emerging theories such as complexity science suggest that change is

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unpredictable, occurs at random, and is dependent upon rapidly changing relationships between agents and factors in the system and that even small changes can affect an entire organization.

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Organizations are preserved by change and constant renewal.

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Without change, the organization may stagnate and die.

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Chapter 9

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Time Management

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Because time is a finite and valuable resource

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learning to use it wisely is essential for effective management.

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Time management can be reduced to three cyclic steps:

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(a) allow time for planning and establish priorities. (b) complete the highest priority task, and whenever possible, finish one task before beginning another; and (c) reprioritize based on remaining tasks and new information that may have been received.

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Setting aside time at the beginning of each day to plan the day allows the manager

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to spend appropriate time on high-priority tasks.

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Many individuals fall prey to planning fallacies, where they

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are overly optimistic about the time it will take to complete a task.

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Making lists is an appropriate tool to manage daily tasks.

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This list should not be any longer than what can realistically be accomplished in a day and must include adequate time to accomplish each item on the list and time for the unexpected.

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A common cause of procrastination is

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failure to break large tasks down into smaller ones so that the manager can set short-term, intermediate, and long-term goals.

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Lower-level managers have more interruptions in their work than do higher-level managers.

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This results in situational stress and lowered job satisfaction.

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Managers must learn strategies to cope with

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interruptions from socializing.

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Because so much paperwork is redundant or unnecessary

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the manger needs to develop expertise in prioritizing it, and eliminating unnecessary clutter at the work site.

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An efficient filing system

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is invaluable to handling paper overload.

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Personal time management refers to "the knowing of self." Managing time is difficult if

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a person is unsure of his or her priorities, including personal short-term, intermediate, and long-term goals.

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Being punctual implies that you value other people's time and creates

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an imperative for them to value your time as well.

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Effective time management is an essential part of finding

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that balance between work life and personal life.

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Using a time inventory is one way to gain insight into how and when a person is most productive.

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It also assists in identifying internal time wasters.

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Chapter 10

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Fiscal Planning

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Fiscal planning, as in all types of planning

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is a learned skill that improves with practice.

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Historically, nursing management played a limited role in

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determining resource allocation in health-care institutions.

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The personnel-workforce budget often accounts for

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the majority of health-care organization's expenses because health-care is labor intensive.

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Personnel budgets include actual worked time (productive time or salary expense) and

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time that the organization pays the employee for not working (nonproductive time or benefit time)...pto

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A budget is at best a forecast or prediction; it is a plan and not a rule.

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Therefore, a budget must be flexible and open to ongoing evaluation and revision.

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A budget that is predicted too far in advance is open to greater error. If the budget is shortsighted,

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compensating for unexpected major expenses or capital equipment purchases may be difficult.

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The desired outcome of budgeting is maximal use of resources to meet organizational short- and long-term needs.

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Its value to the institution is directly related to its accuracy.

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The operating budget reflects expenses that

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flex up or down in a predetermined manner to reflect variation in volume of service provided.

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Capital budgets plan for the purchase of buildings or major equipment.

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This includes equipment that has a long life (usually greater than 5 years), is not used daily, and is more expensive than operating supplies.

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Managers must justify their program or needs every budgeting cycle in zero-based budgeting.

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Using a decision package to set funding priorities is a key feature of zero-based budgeting.

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With the advent of state and federal reimbursement for healthcare in the 1960's, providers were forced to submit

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budgets and costs to payers that more accurately reflected their actual cost to provide these services.

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With DRGs, hospitals join the PPS, whereby they receive a specified amount for each Medicare patient's admission, regardless of the actual cost of care.

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Exceptions occur when the provider can demonstrate that a patient's case is an outlier, meaning that the cost of providing care for the patient justifies extra payment.

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Key principles of managed care include the use of

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primary care providers as gatekeepers, a focus on prevention, a decreased emphasis on inpatient hospital care, the use of clinical practice guidelines for providers, selective contracting, capitation, utilization review, the use of formularies to manage pharmacy care, and continuous quality monitoring and improvement.

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The types of plans available within HMOs typically vary according to

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the degree of provider choice available to enrollees.

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Managed care has altered the relationships among insurers, physicians, nurses, and patients, with providers today often having to

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assume a role as an agent for the patient as well as an agent of resource allocation for an insurance carrier, hospital, or particular practice plan.

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Provision of service no longer guarantees reimbursement.

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Clear and comprehensive documentation of the need for services and actual services provided is needed for reimbursement.

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The 2010 PPACA (often shortened to the Affordable Care Act) put in place

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comprehensive insurance reforms, which were to be phased in over a 4-year period.

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With bundled payments, providers agree to accept a discounted payment either retrospectively or prospectively

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which represents a coordinated plan of care for patients over the course of a single episode of illness.

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Accountable Care Organizations (ACOs) are groups of providers and suppliers of service who work together to better coordinate care for Medicare patients (does not include Medicare Advantage) across care setting with the expectation that

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efficiency as well as quality of care will result in shared savings.

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In VBP, providers are held accountable for the quality and cost of the health-care services they provide by

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a system of rewards and consequences, conditional upon achieving pre-specified performance measures.

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The medical home, or PCMH, relies on a team of providers to integrate all aspects of health care

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through well-developed health information technology, including electronic health records.

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Health insurance marketplaces, also called exchanges, are online insurance supermalls, created for

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individuals without access to health insurance through a job or for small businesses who wish to buy affordable and qualified health benefit plans in a competitive insurance marketplace.

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Chapter 11

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Career Development: From New Graduate to Retirement

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There are many outcomes of a career development program

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that justify its implementation.

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Career job sequencing should

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assist the manger in career management.

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Career development programs consist of

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a set of personal responsibilities called career planning and a set of management responsibilities called career management.

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Employees often need to be encouraged to

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make more formalized long-term career plans.

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Career planning should, at minimum,

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a commitment to the use of evidence-based practice, learning new kills or bettering practice though the use of role models and mentors, staying aware of and being involved in professional issues, and furthering one's education.

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Designing career paths is an important part of

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organizational career management.

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Mangers should plan specific interventions

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that promote growth and development in each of their subordinates.

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Most individuals progress through

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normal and predictable career stages.

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Career coaching involves helping others to identify professional goals and career options and

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designing a career plan to achieve those goals. This coaching should be both short and long term.

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Competency assessment and goal setting in career planning should help the employees identify

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how to exceed the minimum levels of competency required by federal, state, or organizational standards.

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Professional specialty certification

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is one way that an employee can demonstrate advanced achievement of competencies.

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To be successful, management development must be planned and supported by top-level management.

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This type of planed program is called succession management.

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If appropriate management attitudes and insight are goals of a management development program,

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social learning techniques need to be part of the teaching strategies used.

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Multiple types of transition-to-practice programs exist,

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but all are focused on helping nursing students bridge from school into employment.

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Maintaining a current, professional resume is

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a career planning necessity for the health-care professional and should not be undertaken lightly.

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Cover letters (whether by mail or e-mail) should always be used when submitting a resume. Their purpose is to

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introduce the applicant, briefly highlight key points of the resume, and make a positive first impression.

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All nurses should maintain a professional portfolio

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(a collection of materials that document a nurse's competencies and illustrate the expertise of the nurse) to reflect their professional growth over their career.

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Chapter 12 - Organizational Structure

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...

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Many modern health-care organizations continue to be organized around a line or a line-and-staff design and have many attributes of a bureaucracy; however, there is a movement toward less bureaucratic designs, such as

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ad hoc, matrix, and care-centered systems.

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A bureaucracy, as proposed by Max Weber, is characterized by

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a clear chain of command, rules and regulations, specialization of work, division of labor, and impersonality of relationships.

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An organization chart depicts

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formal relationships, channels of communication, and authority through line-and-staff positions, scalar chains, and span of control.

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Unity of command means that

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each person should have only one boss so that there is less confusion and greater productivity.

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Centrality refers to the degree of

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communication of a particular management position.

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In centralized decision-making, decisions are made by a few managers at the top of the hierarchy. In decentralized decision-making,

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decision-making is diffused throughout the organization, and problems are solved at the lowest practical managerial level.

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Organizational structure affects how

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people perceive their roles and the status given to them by other people in the organization.

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Organizational structure is effective when the

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design is clearly communicated, there are as few managers as possible to accomplish goals, communication is facilitated, decisions are made at the lowest possible level, informal groups are encouraged, and future leaders are developed.

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The entities in an organization's environment that play a role in the organization's health and performance, or which are affected by the organization, are called

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stakeholders.

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Authority, responsibility, and accountability differ in terms of

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official sanctions, self-directedness, and moral integration.

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Organizational culture is

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the total of an organization's beliefs, history, taboos, formal and informal relationships, and communication patterns.

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Subunits of large organizations also have a culture.

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These subcultures may support or be in conflict with other cultures in the organization.

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Informal groups are present in every organization.

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They are often powerful, although they have no formal authority. Informal groups determine norms and assist members in the socialization process.

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Shared governance refers to an

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organizational design that empowers staff nurses by making them an integral part of patient care decision making and providing accountability and responsibility in nursing practice.

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Magnet designation is conferred by the ANCC to health-care organizations exemplifying

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well-qualified nurse executives in a decentralized environment, with organizational structures that emphasize open, participatory management.

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Magnet - designated organizations demonstrate

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improved patient outcomes and higher staff nurse satisfaction than organizations that do not have a magnet status.

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The Pathway to Excellence designation, also conferred by the ANCC, recognizes health-care organizations

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with foundational quality initiatives in creating a positive work environment, as defined by nurses and supported by research.

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Too many committees in an organization is a sign of

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a poorly designed organizational structure.

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Committees should have

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an appropriate number of members, prepared agendas, clearly outlined tasks, and effective leadership if they are to be productive.

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Groupthink occurs when

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there is too much conformity to group norms.

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Chapter 13

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Organizational, Political, and Personal Power

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Power and authority are

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necessary components of leadership and management.

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A person's response to authority is

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conditioned early through authority figures, experiences in the family unit, and gender role identification.

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The gap that sometimes exists between a position of authority and subordinate response is called

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the authority- power gap.

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The empowerment of staff

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is a hallmark of transformational leadership. Empowerment means to enable, develop, or allow.

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Power has both a positive

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and negative face.

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Traditionally, women have been socialized to view power differently than men do.

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However, recent studies show that gender differences regarding power are slowly changing.

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Reward power

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is obtained by the ability to grant rewards to others.

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Legitimate power

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is the power inherent in one's position.

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Expert power

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is gained through knowledge or skill.

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Referent power

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is obtained through association with others.

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Charismatic power

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results from a dynamic and powerful persona.

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Information power

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is gained when someone has information that another needs.

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Female - dominated professions such as nursing often exemplify the queen bee syndrome.

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The queen bee is a woman who has struggled to become successful, but once successful, refuses to help other women achieve the same success.

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Even a novice manager or newly graduated nurse

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can begin to build a power base by using appropriate power- building tactics.

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Power gained

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may be lost because one is politically naïve or fails to use appropriate political strategies.

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Politics exist in every organization,

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and leader-managers must learn the art and skills of politics.

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The nursing profession has not been the political force it could be since historically,

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it has been more reactive then proactive in addressing needed policy decisions and legislation.

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Numerous driving forces are in place to increase the nursing profession's power base, including

answer

timing, the size of the profession, nursing's referent power, the increasing educational levels of nurses, nursing's unique perspective, and the desire of consumers and providers for change.

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Chapter 14

answer

Organizing Patient Care

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Total patient care, utilizing the case method of assignment

answer

is the oldest form of patient care organization and is still widely used today.

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Functional nursing organization

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requires the completion of specific tasks by different nursing personnel.

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Team nursing typically

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uses a nurse-leader who coordinates team members of varying educational preparation and skill sets in the care of a group of patients.

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The use of multidisciplinary teams

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increases the likelihood that care will be comprehensive and holistic, although the responsibility for team leadership still typically falls to the nurse.

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Modular nursing uses mini-teams,

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typically an RN and unlicensed health-care worker(s), to provide care to a small group of patients, usually centralized geographically.

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Primary care nursing is organized so that the patient is at the center of the structure.

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One health-care provider (typically the RN) has 24-hour responsibility for care planning and coordination.

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Interprofessional teams now also provide primary care in the form of PHCTs.

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These teams typically include, but are not limited to, physicians, nurse practitioners, nurses, physical therapists, occupational therapist, and social workers collaboratively to deliver coordinated patient care.

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Case management is a collaborative process that

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assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual's health needs through communication and available resources to promote quality and cost-effective outcomes.

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Although the focus historically for case management has been the individual patient the case manager employed in a DM program plans

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the care for populations or groups of patients with the same chronic illness.

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The care MAP is a combination of a critical path and a nursing care plan,

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except that it shows times when nursing interventions should occur as well as variances.

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Delivery systems

answer

may have elements of the various designs present in the system in use in any organization.

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Each unit's care delivery structure should

answer

facilitate meeting the goals of the organization, be cost-effective, satisfy the patient, provide role satisfaction to nurses, allow implementation of the nursing process, and provide for adequate communication among health-care providers.

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When work is redesigned it frequently has personal consequences for employees that must be considered.

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Social interactions, the degree of autonomy, the abilities and skills necessary, employee evaluation, and communication patterns are often affected by work redesign.

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The nurse navigator assists

answer

patients and families to navigate the complex health-care system by providing information and support as they traverse their illness.

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The CNL, is an experienced, nurse possessing a graduate degree

answer

who provides clinical leadership in all health-care settings, implements outcomes-based practice and quality improvement strategies, engages in clinical practice, and creates and manages microsystems of care that are responsive to the health-care needs of the individuals and families.

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The philosophy of patient-and family-centered care is based on

answer

the premise that care should be organized first and foremost around the needs of patients and family members.

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Chapter 15

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Employee Recruitment, Selection, Placement, and Indoctrination

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The first step in the staffing process is

answer

to determine the type and number of personnel needed.

question

A number of factors are contributing to a projected, severe nursing shortage, including

answer

the aging of the nursing workforce, accelerating demand for professional nurses, inadequate enrollment in nursing programs of study, and the aging of nursing faculty.

question

Successfully recruiting an adequate workforce depends on many variables, including

answer

financial resources, an adequate nursing pool, competitive salaries, the organization's reputation, the location's desirability, and the status of the national and local economy.

question

Effective recruiting methods include

answer

advertisements, career days, literature, and the informal use of members of the organization as examples of satisfied employees.

question

Despite their limitations in terms of reliability and validity

answer

interviews continue to be widely used as a method of selecting employees for hire.

question

The limitations of interviews are reduced when

answer

a structured approach is used in asking questions of the applicants.

question

The interview should

answer

meet the goals of both the applicant and the manager.

question

Mangers must be skilled in

answer

planning, conducting, and controlling interviews.

question

Because of numerous federal acts that protect the rights of job seekers,

answer

interviewers must be cognizant of the legal constraints on interviews.

question

Selections should be based on the requirements necessary for the job;

answer

these criteria should be developed before beginning the selection process.

question

Leaders should seek to proactively recruit and hire staff with

answer

age, gender, cultural, ethnic, and language diversity to better mirror the rapidly increasing diversity of the communities they serve.

question

New employees should be placed

answer

on units, departments, and shifts where they have the best chance of succeeding.

question

Indoctrination consists of

answer

induction, orientation, and socialization of employees.

question

A well-prepared and executed orientation program

answer

educates the new employee about the desired behaviors and expected goals of the organization and actively involves the new employee's immediate supervisor.

question

Chapter 16

answer

Socializing and Educating Staff for Team Building in a Learning Organization

question

The philosophy of Los is the concept that

answer

collective learning goes beyond the boundaries of individual learning and releases gains for both the individual and the organization.

question

The leader

answer

is a role model of the lifelong learning.

question

Training and education

answer

are important parts of staff development.

question

All staff development activities should

answer

be evaluated for quality control and fiscal accountability.

question

There is a shared responsibility for the promotion of

answer

evidence-based nursing practice.

question

Mangers and education department staff have a shared responsibility for the promotion of

answer

evidence-based nursing practice.

question

Theories of learning and principles of teaching

answer

must be considered if staff development activities are to be successful.

question

Social learning theory suggests

answer

that people learn most behavior by direct experience and observation.

question

The socialization of people into roles

answer

occurs with all professions and is a normal sociological process.

question

Socialization and resocialization are often neglected areas of the

answer

indoctrination process.

question

New graduates, international nurses, new managers, and experienced nurses in new roles

answer

have unique socialization needs.

question

Difficulties with re-socialization usually centers on

answer

unclear role expectations (role ambiguity), an inability to meet job demands, or deficiencies in motivation. Role strain and role overload contribute to the problem.

question

The terms role model, preceptor, and mentor are not synonymous,

answer

and all play an important role in assisting with the socialization of employees.

question

People from different cultures and age groups

answer

may have different socialization and learning needs.

question

Chapter 17

answer

Staffing Needs and Scheduling Policies

question

The manager has both a fiscal and an ethical duty

answer

to plan for adequate staffing to meet patient care needs.

question

Innovative and creative methods of staffing and scheduling should be explored

answer

to avoid understaffing and overstaffing as patient census and acuity fluctuate.

question

Staffing and scheduling policies must

answer

not violate labor laws, state or national laws, or union contracts.

question

Workload measurement tools include NCH/PPD, PCS, and workload measurement systems.

answer

All workload measurement tools should be periodically reviewed to determine if they are a valid and reliable tool for measuring staffing needs in a given organization.

question

Mandatory overtime should be a last resort

answer

not a standard operating procedure because an institution does not have enough staff.

question

Research clearly shows that as

answer

professional nursing representation in a skill mix increases, patient outcomes generally improve and adverse incidents decline.

question

Those with staffing responsibility

answer

must remain cognizant of mandatory staffing ratios and comply with such mandates.

question

Mangers should attempt to have a diverse staff that will

answer

meet the cultural and language needs of the patient population.

question

Fair and uniform staffing and scheduling policies and procedures

answer

must be written and communicated to all staff.

question

Existing staffing policies

answer

must be examined periodically to determine if they still meet the needs of the staff and the organization.

question

Chapter 18

answer

just trucking along

question

Because human beings have constant needs and wants

answer

they are always motivated to some extent. However, what motivates each human being varies significantly.

question

Managers cannot intrinsically motivate people

answer

because motivation comes from within the person. The humanistic manager can, however, create an environment in which the development of human potential can be maximized.

question

Maslow stated that

answer

people are motivated to satisfy certain needs, ranging from basic survival to complex physiological needs, and that people seek a higher need only when the lower needs have been predominately met.

question

Skinners research on operant conditioning and behavior modification demonstrates

answer

that people can be conditioned to behave in a certain way based on a consistent reward or punishment system.

question

Herzberg maintained that motivators, or job satisfiers

answer

are present in the work itself and encourage people to want to work and to do that work well. Hygiene or maintenance factors keep the worker from being dissatisfied or demotivated but do not act as true motivators for the worker.

question

Vroom's expectancy model says that

answer

people's expectations about their environment or a certain event will influence their behavior.

question

McClelland's studies state that all people are motivated by three basic needs:

answer

achievement, affiliation, and power.

question

Gellerman states that most managers in organizations over manage,

answer

making their responsibilities too narrow and failing to give employees any decision-making power or to stretch them often enough.

question

McGregor points out the importance of a manager's assumptions about workers on the intrinsic motivation of the worker.

answer

There appears to be a perceived threshold beyond which increasing reward incentives results in no additional meaning or weight in terms of productivity.

question

Offering rewards in defined categories, even when the categories are meaningless, can increase motivation

answer

the very act of segmenting these rewards appears to motivate people to perform better and longer.

question

Positive reinforcement is one of the most powerful motivators the manager can use and is frequently overlooked or underused.

answer

The supervisor or manager's personal motivation is an important factor affecting staff's commitment to duties and morale.

question

The success of a motivational strategy is measured by

answer

the increased productivity and benefit to the organization, by the growth in the person , which motivates him or her to accomplish again.

question

Because of the importance that American society places on promotions, certain guidelines must accompany promotion selection to ensure that the process is

answer

fair, equitable, and motivating.

question

Policies regarding promotion should be

answer

in writing and communicated to all employees.

question

Recruitment from within has shown to have a positive effect on employee motivation

answer

whereas recruitment from outside the organization allows for new ideas and prevents stagnation.

question

It is possible to promote individuals beyond their level of capability. The Peter Principle,

answer

suggests that individuals may rise "to the level of their incompetence."

question

Managers must show their own positive attitude

answer

to demonstrate to employees that there is joy in work.

question

Chapter 19

answer

seems like chapter 91

question

Communication forms the core of management activities

answer

it cuts across all phases of the management process. It is the core of the Nurse-Patient, Nurse-Nurse, and Nurse-Physician relationship.

question

Depending on the manager's position in the hierarchy, the overwhelming majority of managerial time is often directed at some type of organizational communication

answer

thus, organizational communication is a high-level management function.

question

Because most managerial communication time is spent speaking and listening

answer

managers must have excellent interpersonal communication skills.

question

Communication in large organizations is particularly difficult

answer

due to their complexity and size.

question

Managers must understand the structure of the organization and recognize whom their decisions will affect.

answer

Both formal and informal communication networks need to be considered.

question

The clarity of the message is significantly affected by the mode of communication used.

answer

In general, the more direct the communication, the greater the probability of clear communication. The more people involved in filtering the communication, the greater the chance of distortion.

question

Written communication is

answer

used most often in large corporations.

question

A manager's written communication reflects greatly on both the manager and the organization.

answer

Thus, managers must be able to write clearly and professionally and use understandable language.

question

The incongruence between verbal and nonverbal messages

answer

is the most significant barrier to effective interpersonal communication.

question

Effective leaders are congruent in their verbal and nonverbal communication

answer

so that followers are clear about the message they receive.

question

Leaders are sensitive to verbal and nonverbal messages from followers and look for inconsistencies

answer

that may indicate unresolved problems or needs.

question

To be successful in the directing phase of management

answer

the leader must have well-developed skills in assertive communication.

question

SBAR and ISBAR provide

answer

structured, orderly approaches to provide accurate, relevant information, in emergent patient situations as well as routine handoffs.

question

Most people hear or retain only a small amount of information given to them.

answer

about (1/3)

question

Active listening

answer

is an interpersonal communication skill that improves with practice.

question

Using a listening model such as GRRRR (Greeting, Respectful listening, Review, Recommend or Request more information, and Reward)

answer

is especially helpful in organizations where disruptive behavior, toxic environments, and power struggles interfere with listening.

question

Adding new members to an established group

answer

disrupts productivity and group development.

question

Group members perform

answer

certain important tasks that facilitate work.

question

Group members also perform

answer

roles that assist with group-building activities.

question

Some group members will perform

answer

roles to meet their individual needs.

question

Rapidly flourishing communication technologies have great potential to

answer

increase the efficiency and effectiveness of organizational communication. They also pose increasing challenges to patient confidentiality.

question

Chapter 20

answer

keep going

question

Professional nursing organizations and regulatory bodies are actively engaged in

answer

clarifying the scope of practice for unlicensed workers and delegation parameters for RNs.

question

Delegation is not an option for the manager

answer

it is a necessity.

question

Delegation should be used for

answer

assigning routine tasks and tasks for which the manager does not have time. It is also appropriate as a tool for problem solving, changes in the manager's own job emphasis, and building capability in subordinates.

question

In delegation, managers must clearly communicate

answer

what they want to be done, including the purpose for doing so, Limitations or qualifications that have been imposed should be delineated.

question

Although the manager should specify the end product desired, it is important

answer

that the subordinate has an appropriate degree of autonomy in deciding how the work is to be accomplished.

question

Managers must delegate

answer

the authority and the responsibility necessary to complete the task.

question

RNs who are asked to assume the role of supervisor and delegator

answer

need preparation to assume these leadership tasks.

question

Assuming the role of delegator and supervisor to the NAP

answer

increases the scope of liability for the RN.

question

Although he Omnibus Budget Reconciliation Act of 1987 est. regulations for the education and certification of "nurse's aides" (minimum of 75 hours of theory and practice and successful completion of an examination in both areas)

answer

no federal or community standards have been est. for training the more broadly defined NAP.

question

The RN always bears the ultimate responsibility

answer

for ensuring that the nursing care provided by his or her own team members meets or exceeds minimum safety standards.

question

When subordinates resist delegation

answer

the delegator must ascertain why the delegated task was not accomplished and take appropriate action to remove these restraining forces.

question

Transcultural sensitivity in delegation

answer

is needed to create a productive multicultural work team.

question

Chapter 21

answer

nearing the end

question

Conflict can be defined as

answer

the internal discord that results from differences in ideas, values, or feelings of two or more people.

question

Because managers have a variety of interpersonal relationships with people with different values, beliefs, backgrounds, and goals

answer

conflict is an expected outcome.

question

The most common sources of organizational conflict are

answer

communication problems, organizational structure, and individual behavior within the organization.

question

Conflict theory has changed dramatically during the last 100 years. Currently, conflict is viewed as

answer

neither good nor bad because it can product growth or be destructive, depending on how it is managed

question

Too little conflict results in organizational stasis, whereas too much conflict

answer

reduces the organization's effectiveness and eventually immobilizes its employees.

question

Conflict also has a qualitative component, and the impact of a conflict on any individual

answer

varies significantly in terms of how it is perceived and handled.

question

The three categories of conflict are

answer

intrapersonal, interpersonal, and intergroup.

question

The first stage in the conflict process is called latent conflict

answer

implies the existence of antecedent conditions. Latent conflict may progress to perceived conflict or to felt conflict. Manifest conflict may also ensue. The last stage in the process is conflict aftermath.

question

The optimal goal in conflict resolution is creating

answer

a win-win solution for everyone involved.

question

Common conflict resolution strategies include

answer

compromise, competing, accommodating, smoothing, avoiding, and collaboration.

question

As a negotiator, it is important to

answer

win as much as possible, lose as little as possible, and make the other party feel satisfied with the outcome of the negotiation.

question

Because knowledge is power

answer

the more informed the negotiator has, the greater is his or her bargaining power.

question

The leader, while able to recognize and counter negotiation tactics

answer

always strives to achieve an honest, collaborative approach to negotiation.

question

The manager must know

answer

his or her bottom line but try to never use it.

question

Closure and follow-up

answer

are important parts of the negotiation process.

question

ADR usually involves at least one of the elements of mediation

answer

fact finding, arbitration, and the use of ombudspersons.

question

Seeking consensus (concord of opinion) although time consuming

answer

is an effective conflict resolution and negotiation strategy.

question

Chapter 22

answer

still sucks keep going

question

Historically, union activity increases

answer

during times of labor shortages and economic upswings.

question

Although nurses are still roughly twice as likely to be in a union as other occupations

answer

the percentage of nurses as well as the total number of nurses in unions nationwide is decreasing.

question

Union alliances are becoming increasing commonplace in health care

answer

since increased negotiating power comes with greater membership.

question

The ANA acts as a professional associate for RNs and as a

answer

collective bargaining agent. This dual purpose poses a conflict in loyalty for some nurses.

question

People are motivated to join or reject unions

answer

as a result of their numerous needs and values.

question

Nurses with less than 10-15% (equal to about one shift per pay period) of their time as charge nurse are considered to be staff nurses, while nurses working more than

answer

15% of their professional time as charge nurse are considered supervisors, and therefore, are ineligible for protection under the NLRA.

question

Although all mangers play an important role in establishing and maintaining effective management -labor relationships

answer

the middle-level manager has the greatest influence on preventing unionization in a nonunion organization.

question

Creating a climate in which labor and management work together to accomplish mutual goals is

answer

possible.

question

Labor relation laws concern

answer

the rights and duties of unions and employers in their relationship with each other.

question

Labor standards are regulations

answer

dealing with the conditions of the employees work, including physical conditions, financial aspects, and the number of hours worked.

question

State and federal employment legislation often overlap; as a general rule

answer

the employer must abide by the stricter of the two regulations.

question

Much of the human rights legislation concerning employment practices came about because of

answer

documented discrimination in the workplace.

question

Sexual harassment and other types of nonphysical violence are worldwide problems for nurses, with English-speaking countries exhibiting the highest rates of

answer

both physical violence and sexual harassment in nursing.

question

Although some legislation makes the job of managing people more difficult for managers, it has resulted in

answer

increased job fairness and opportunities for women, minorities, the elderly, and the disabled.

question

Chapter 23

answer

suck it up

question

Controlling is implemented throughout

answer

all phases of management.

question

Quality control refers to activities that are used to

answer

evaluate, monitor, or regulate services rendered to consumers.

question

A standard is a predetermined baseline condition or level of excellence that constitutes

answer

a model to be followed and practiced.

question

Because there is no one set of standards, each organization and profession must set standards and objectives to guide

answer

individual practitioners in performing safe and effective care.

question

CPGs provide diagnosis-based, step-by-step interventions for nurses to follow in an effort to promote

answer

evidence-based, high-quality care and yet control resource utilization and costs.

question

Benchmarking is the process of

answer

measuring products, practices, and services against those of best-performing organizations.

question

The difference in performance between top-performing health-care organizations and the national average is called

answer

the quality gap.

question

While the quality gap is typically small in industries such as manufacturing, aviation, and banking

answer

wide variation in is the norm in healthcare.

question

CEA and Root Cause Analysis help to identify not only what and how an event happened but why it happened, with the end goal being

answer

to ensure that a preventable negative outcome does not occur.

question

Outcome audits determine

answer

what results, if any, followed from specific nursing interventions for patients.

question

Process audits

answer

are used to measure the process of care or how the care was carried out.

question

Structure audits

answer

monitor the structure or setting in which patient care occurs (such as the finances, nursing service structure, medical records, and environmental structure).

question

There is a growing recognition that it is possible to separate the contribution of nursing to the patient's outcome; this recognition of outcomes that are nurse-sensitive

answer

creates accountability for nurses as professionals and is important in developing nursing as a profession.

question

Standardized nursing languages

answer

provide consistent terminology for nurses to describe and document their assessments, interventions, and the outcomes of their actions

question

Quality Assurance models

answer

seek to ensure that quality currently exists, whereas

question

Quality Improvement models

answer

assume that the process is ongoing and that quality can always be improved.

question

Quality control in health-care organizations

answer

has evolved primarily from external forces and not as a voluntary effort to monitor the quality of services provided.

question

Critics of the PPS argue that although DRGs may have helped to contain rising health-care costs,

answer

the associated rapid declines in length of hospital stay and services provided have resulted in declines in quality of care.

question

The JACO is the major accrediting body for health-care organizations and programs in the united states.

answer

It also administers the ORYX initiative and collects data on core measures in an effort to better standardize data collection across acute-care hospitals.

question

The CMS plays an active role in setting standards for and measuring

answer

quality in health care including the HQI and P4P.

question

The 27-item HCAHPS survey is the first

answer

national, standardized, publically reported survey of patients' perspectives of hospital care. It measures recently discharged patients' perceptions of their hospital experience.

question

The NCQA, a private organization that accredits managed care organizations

answer

also developed the HEDIS to compare quality of care in managed care organizations.

question

Ideally, everyone in an organization

answer

should participate in quality control activities.

question

In response to the demand for objective measures of quality

answer

a number of health-plans, health-care-providers, employer purchasing groups, consumer information organizations, and state governments have begun to formulate health-care quality report cards.

question

A plethora of studies across the past 2 decades suggest that

answer

medical errors continue to be rampant in the health-care system.

question

The patient safety and quality improvement act, signed into law in 2005, protects medical error information that is voluntarily submitted to new private organizations (patient safety organizations)

answer

from being subpoenaed or used in legal discovery and generally requires that the information is treated as confidential.

question

The Leapfrog Group identified four evidence-based standards that they believe will provide the greatest impact on reducing medical errors:

answer

CPOE, EHR, IPS, and the use of leapfrog safe practices scores.

question

The FDA has suggested that a drug bar code system coupled with a computerized order entry system

answer

would greatly decrease the risk of medication errors.

question

Historically, the health-care industry has been comfortable with striving for three sigma processes (all data points fall within 3 standard deviations) in terms of health-care quality

answer

instead of six (that are adopted by the highest-performing organizations in terms of quality).

question

As direct caregivers, staff nurses are in excellent position to monitor nursing practice by

answer

identifying problems and implementing corrective actions that have the greatest impact on patient care.

question

Chapter 24

answer

Nearing the end

question

The employee performance appraisal

answer

is a sensitive and important part of the management process, requiring much skill.

question

When accurate and appropriate appraisal assessments are performed

answer

outcomes can be very positive.

question

Performance appraisals are used to determine how well employees are performing their job.

answer

Therefore, appraisals measure actual behavior and not intent.

question

Job descriptions often produce objective criteria

answer

for use in the performance appraisal.

question

There are many different types of appraisal tools and methods

answer

the most appropriate one to use varies with the type of appraisal to be done and the criteria to be measured.

question

The employee must be involved in the appraisal process

answer

and view the appraisal as accurate and fair.

question

Management By Observation has been shown to increase

answer

productivity and commitment in employees.

question

Peer review has great potential

answer

for developing professional accountability but it is often difficult to implement.

question

Unless the appraisal interview is carried out in an appropriate and effective manner

answer

the appraisal data will be useless.

question

Because of past experience, performance appraisal interviews are

answer

highly charged, emotional events to most employees.

question

Showing a genuine interest in the employee's growth and seeking his or her input at the interview

answer

will increase the likelihood of a positive outcome from the appraisal process.

question

Performance appraisals should be signed

answer

to show that feedback was given to the employee.

question

Informal work performance appraisals

answer

are an important management function.

question

Leaders should routinely

answer

use day to day coaching to empower subordinates and improve work performance.

question

In performance management appraisals are eliminated.

answer

Instead, the manager places his or her efforts into ongoing coaching, mutual goal setting, and the leadership training of subordinates. ((as per class- performance appraisals are not eliminated b/c of $$ reasons))

question

Chapter 25

answer

last one

question

It is essential that managers are able to distinguish between

answer

employees who need progressive discipline, those who are chemically impaired, psychologically impaired, or marginal employees, so that the employee can be managed in the most appropriate manner.

question

Discipline is a necessary

answer

and positive tool in promoting subordinate growth.

question

The optimal goal in constructive discipline is

answer

assisting employees to behave in a manner that allows them to be self-directed in meeting organizational goals.

question

To ensure fairness, rules should include McGregor's "Hot Stove" components of

answer

forewarning, immediate application, consistency, and impartiality.

question

If a rule or regulation is worth having, it should be enforced.

answer

When rule-breaking is allowed to go unpunished, groups generally adjust to and replicate the low-level performance of the rule-breaker.

question

As few rules and regulations as possible should exist in the organization,

answer

all rules, regulations, and policies should be regularly reviewed to see if they should be deleted or modified in some way.

question

Except for the most serious infractions, discipline should be administered in progressive steps, which include

answer

verbal admonishment, written admonishment, suspension, and dismissal.

question

In performance deficiency coaching, the manager actively brings areas of unacceptable behavior or performance to the attention of the employee and

answer

works with him or her to establish a short-term plan to correct deficiencies.

question

The grievance procedure is essentially a statement of wrongdoing or a procedure to follow when one believes that a wrong has been committed.

answer

All employees should have the right to file grievances about disciplinary action that they believe has been arbitrary or unfair in some way.

question

The presence of a union generally entails

answer

more procedural, legalistic safeguards for administering discipline and a well-defined grievance process for employees who believe that they have been disciplined unfairly.

question

Because chemical and psychological impairment are a disease, traditional progressive discipline is inappropriate because

answer

it cannot result in employee growth.

question

The profile of the impaired nurse may vary greatly, although typically behavior changes are seen in three areas:

answer

personality/behavior changes, job performance changes, and time and attendance changes.

question

Nurses and managers traditionally have been slow to recognize and respond to

answer

chemically impaired colleagues.

question

Confronting an employee who is suspected of chemical impairment should always occur before

answer

the problem escalates and before patient safety is jeopardized.

question

The manger should not assume the role of counselor or treatment provider or feel the need to diagnose the cause of the chemical addiction.

answer

The manager's role is to clearly identify performance expectations for the employee and to confront the employee when those expectations are not met.

question

Strategies for dealing with marginal employees vary with

answer

management level, the nature of the healthcare organization, and the current prevailing attitude toward passive or active intervention.

question

Strategies for dealing with marginal employees vary with

answer

management level, the nature of the healthcare organization, and the current prevailing attitude toward passive or active intervention.

question

Strategies for dealing with marginal employees vary with

answer

management level, the nature of the healthcare organization, and the current prevailing attitude toward passive or active intervention.

question

Strategies for dealing with marginal employees vary with

answer

management level, the nature of the healthcare organization, and the current prevailing attitude toward passive or active intervention.

Chapters 1-25 – Flashcards

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