CNL Questions – Flashcards
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CNL Roles
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Systems analyst/risk anticipator Team manager Outcomes manager Information manager Clinician Client advocate Member of a profession Educator Lifelong learner
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Organizational Theories
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Classical: focus on structure Neoclassical: structure with human component Systems: everything is interrelated Contingency: organization is contingent on environment Chaos: organization is adapting to environment
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Leadership Theories
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Quantum: fluid leadership (chaos theory) Charismatic: lead by personality attractiveness (e.g. Hitler) Transactional: focuses on tasks, short-term goals, policies and procedures Transformational: strong commitment to organization, empowers followers to reach full potential, visionary Relational/connective: teamwork, collaboration to reach common goal
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Leadership Theories 2
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Servant: followers desire to serve leader Shared: everyone is responsible Autocratic: leader makes all decisions Bureaucratic: follows organizational policies only Directive: gives guidance and directions Supportive: focuses on needs of followers
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Leadership Theories 3
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Trait theory: leaders are born Behavioral theory: leaders can be made Contingency theory: leadership is contingent on internal and external factors, changes with situation
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Relationship Oriented Structures
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Shared governance: nurses have control over their own practice Heterarch structure: lateral connections only, opposite of hierarch Self-organizing: ppl mutually change behaviors w/internal or external demands
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Ethical Theories
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Deontology: motives determine value of act Teology: outcomes determine value of act (e.g. Machiavelli) Justice and Equity: action that is fair to all Relativism: ethics are relative to person, place, time, culture Virtue Ethics: ppl must be developed to act virtuously
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Virtues of Nursing
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Compassion: desire to alleviate suffering Discernment: acuteness of judgement Trustworthiness: trust is well-founded or deserved Integrity: firm adherence to code of conduct or ethical value
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Ethical Principles
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Beneficence: do good to others, maintain balance of benefit & harm Non-maleficence: do no harm Justice: fairness Autonomy: respect for other's rights to self-determination Fidelity: keeping one's promise Respect for others Veracity: telling the truth
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Decision Making
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Group Think: all members think alike Rational/normative: logical, well-rounded choices Descriptive/bounded rationality: limited ability of decision maker to act on decision Delphi: opinions gathered not face to face Normative: elicits questions, ideas, reactions from a group
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Conflict Management Techniques
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Avoiding: ignore conflict Accommodating: 1 side gives in to other Competing: 2 or 3 sides compete for goal Compromising: each side gets and gives up something Negotiating: agreement, but not consensus Collaborating: both sides win - best outcome Confronting: stops conflict immediately
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Power
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Referent: admiration/respect for person Connection: based on person's links to other influential people (e.g. son of senator) Information: based on access to valued data Reward: based on rewards offered by manager Coercive: based on penalties offered by manager Legitimate: based on hierarchical rank Expert: based on possession of skills/knowledge/competence (e.g. IT guy)
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Delegation
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Responsibility: obligation to do task Accountability: accepting results of actions
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Budgeting
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Direct costs: $ that directly affects pt care (e.g. nurse salaries) Indirect costs: $ that doesn't directly affect pt care (e.g. lighting, water, paint) Cost centers: smallest unit of area of cost in an organization (e.g. a department in a company; a unit in a hospital) Fixed costs: $ set regardless of changes Variable costs: $ changes based on census, supplies, revenues, etc.
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Financial Information
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Operating budget: cost of doing business Capitol budget: cost of growing business Cash flow budget: amount going in and out over a time period Zero-based budgeting: all expenses are justified, no $ left at the end of each period
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Change Theories
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PDSA - Plan Do Study Act: cycle of evaluating change Lewin's Unfreeze-Change/Move-Refreeze - change agent, driving forces, restraining forces Roger's Diffusion of Innovation - innovators, early adopters, early majority, late majority (largest group), laggards (will never change)
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Roger's Diffusion of Innovation
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Knowledge: 1st exposed, but not inspired (e.g. hears about harmful effects of smoking) Persuasion: interested and seeking info (e.g. asks HCP about effects of smoking/steps to quitting) Decision: decides whether to adopt or reject change (e.g. tells HCP decision to quit smoking) Implementation: uses the innovation (e.g. stops buying packs of cigarettes, chewing gum instead) Confirmation: decides to use innovation fully (e.g. lung capacity increased, pt reports being smoke-free for 3 months)
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Change Agent Strategies
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Power-coercive: applies power from authority, economic sanctions, or political clout (e.g. don't text and drive or you'll get a ticket) Empirical-rational: assumes ppl are rational and will follow self-interest (e.g. don't text and drive or you will get hurt) Normative-reeducative: assumes ppl act in accordance with social norms and values (e.g. don't text and drive - "everyone's doing it')
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Research Terms
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Internal validity: results are not due to bias or confounding factors Confounding: distortion due to mixing of effects External validity: results are applicable in other populations Confidence Interval (CI): the reliability of an estimate, usually 95% Odds Ratio (OR): ratio of two odds (e.g. odds of exposure in cases vs odds of exposure in controls) Relative Risk (RR): absolute risk of disease among exposed vs absolute risk of disease among unexposed
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Quantitative Researh
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Descriptive Correlation Quasi-experimental Experimental
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Qualitative Research
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Phenomenological: captures the "lived experience" Grounded Theory: explores how ppl define reality and how their beliefs are related to their actions Ethnographic: describes culture Historical: examines past
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Measurement Tools
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Root Cause Analysis (RCA): process to evaluate potential causes after a serious/sentinel event occurs Failure Models and Effects Analysis (FMEA): studies potential failures in process and analyzes consequences of those failures; done prior to serious event occurrence
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Tables & Charts
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Bar graph: displays categorical data (e.g. demographics of area) Histogram: displays continuous data, usually bars are touching (e.g. weight of adults 18-35 in an area) Pareto chart: have descending bars (individual values) and ascending line graph (totals) Fishbone diagram: cause and effect analysis Control chart: upper and lower control limits are horizontal lines, data is plotted as dots and a line is drawn connecting the mean values Scatter diagram: data is plotted as dots
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Types of preventable errors
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Medications-nurse last line of defense Surgery-wrong site Diagnostic inaccuracy-wrong treatment Equipment failure-IV pump System failure-lack of double check Transfusion error Laboratory-mislabeled Security-child abduction
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Crossing the Quality Chasm
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Recommends reinvention of the health care system to foster innovation and improve delivery of care.
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What is a Clinical Nurse Leader?
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A generalist, expert nurse who: Is accountable for clinical and cost outcomes for a specific group of patients on a unit Designs, implements and evaluates plans of care Coordinates, delegates and supervises the care provided by the interdisciplinary health care team
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Ten Assumptions of the CNL role
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1.Practice at the microsystems level 2.Client care outcomes are the measure of Quality Practice 3.Practice guidelines are based on evidence 4.Client-centered care is intra- and interdisciplinary 5.Information will maximize self-care and client decision making 6.Nursing assessment is the basis for theory and knowledge development 7.Good fiscal stewardship is a condition of quality care 8.Social justice is an essential nursing value 9.Communication technology will facilitate the continuity and comprehensiveness of care 10. The CNL must assume guardianship for the nursing profession
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Practice at the microsystems level
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Accountable for outcomes of clinical populations Coordinates direct care activities of nursing staff & other care providers Lateral integration of care services Leadership skills Unit & systems level
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2. Client care outcomes are the measure of Quality Practice
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Improve › Safety › Effectiveness › Timeliness › Efficiency › Quality › Client-centeredness Compare outcomes to benchmarks › Nurse-sensitive indicators- Practices that nurses "own", such as falls, pressure ulcers, restraints
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3. Practice guidelines are based on evidence
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Application of research to the clinical setting Resolution of clinical problems Dissemination of results Seek evidence that challenges current practice
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4. Client-centered care is intra- and interdisciplinary
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CNL coordinates variety of team members › Includes nurses in other areas Effective communication
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5. Information will maximize self-care and client decision making
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CNL responsible for educating clients & families CNL must teach other care providers
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6. Nursing assessment is the basis for theory and knowledge development
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Assess individual, health problem, & context in which those problems are manifested Assessment data are classified, stored, retrieved, analyzed & integrated into information systems
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7. Good fiscal stewardship is a condition of quality care
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CNL accountable for cost-effective & efficient use of human, environmental & material resources Understand context of practice › Identify high cost/high volume activities › Compare to benchmarks
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8. Social justice is an essential nursing value
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Social justice addresses health disparities CNL responsible for addressing variations in clinical outcomes among various groups May influence policy at the systems level or higher
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9. Communication technology will facilitate the continuity and comprehensiveness of care
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Use of distance technologies › Sustain therapeutic relationships › Monitor the course of illness & health on a continuous basis › Provide care
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10. The CNL must assume guardianship for the nursing profession
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CNL expected to assume positions in › Professional, policy & regulatory organizations › Leadership positions in healthcare facilities & practice plans › Faculty
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Clinical Nurse Leader role
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Clinician Outcomes manager Client advocate Educator Information manager Systems analyst/Risk anticipator Team manager Member of a profession Lifelong learner
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Types of Medical Errors
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Medications-nurse last line of defense Surgery-wrong site Diagnostic inaccuracy-wrong treatment Equipment failure-IV pump System failure-lack of double check Transfusion error Laboratory-mislabeled Security-child abduction
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what is crossing the quality of chasm
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Recommends reinvention of the health care system to foster innovation & improve delivery of care
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What is a CNL?
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A generalist, expert nurse clinician who: >Designs, implements and evaluates plans of care >Coordinates, delegates and supervises the care provided by the interdisciplinary health care team
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Who are CNL's accountable for?
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for clinical and cost outcomes for a specific group of patients on a unit
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What are the ten assumption of the CNL Role?
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1. practice at the Microsystem levels 2. Client care outcomes are the measure of quality practice 3 Practice guidelines are based on evidence 4. client centered care is intra & interdisciplinary 5. Information will maximize self-care and client decision-making 6. Nursing assessment is the basis for theory and knowledge development 7.Good fiscal stewardship is a condition of quality care 8.Social Justice is an essential nursing value 9.Communication technology will facilitate the continuity and comprehensiveness of care 10.The CNL must assume guardianship for the nursing profession
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Describe Practice at the microsystem levels?
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Accountable for outcomes of clinical populations Coordinates direct care activities of nursing staff & other care providers Lateral integration of care services Leadership skills Unit & systems level
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nurse sensitive indicators?
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something related to nursing care - practices that nursing owns i.e. IV filtration; pressure ulcers; fall risk; braden test
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Describe Client care outcomes are the measure of quality practice
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Improve › Safety › Effectiveness › Timeliness › Efficiency › Quality › Client-centeredness Compare outcomes to benchmarks › Nurse-sensitive indicators
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Describe Practice guidelines are based on evidence
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Application of research to the clinical setting Resolution of clinical problems Dissemination of results Seek evidence that challenges current practice
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describe client centered care is intra & interdisciplinary
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CNL coordinates variety of team members › Includes nurses in other areas Effective communication
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Describe - Information will maximize self-care and client decision-making
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CNL responsible for educating clients & families CNL must teach other care providers
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Describe - Nursing assessment is the basis for theory and knowledge development?
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Assess individual, health problem, & context in which those problems are manifested Assessment data are classified, stored, retrieved, analyzed & integrated into information system
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Describe- Good fiscal stewardship is a condition of quality care
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CNL accountable for cost-effective & efficient used of human, environmental & material resources Understand context of practice › Identify high cost/high volume activities › Compare to benchmark
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Describe - Social Justice is an essential nursing value?
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Social justice addresses health disparities CNL responsible for addressing variations in clinical outcomes among various groups May influence policy at the systems level or higher
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Describe - Communication technology will facilitate the continuity and comprehensiveness of care
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Use of distance technologies › Sustain therapeutic relationships › Monitor the course of illness & health on a continuous basis › Provide care
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Describe - The CNL must assume guardianship for the nursing profession
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CNL expected to assume positions in › Professional, policy & regulatory organizations › Leadership positions in healthcare facilities & practice plans › Faculty
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Describe the Clinical Nurse Leader Role
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Clinician Outcomes manager Client advocate Educator Information manager Systems analyst/Risk anticipator Team manager Member of a profession Lifelong learner
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Healthcare should be:
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safe effective patient-centered timely efficient equitable
