Leadership and Management in Nursing – Test 2

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Factors Contributing to Rising Costs
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best health care in the world longer life spans prescription drugs chronic health problems
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leader
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anyone who uses interpersonal skills to influence others to accomplish a specific goal
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manager
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an employee who is responsible and accountable to efficiently accomplishing the goals of the organization
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functions of leaders
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– achieve consensus within the group about goals – maintain structure that facilitates accomplishing goals – supply information that helps provide direction and clarification – maintain group satisfaction, cohesion and performance
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functions of managers
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– clarify the organizational structure – choose the means to achieve goals – assign and coordinate tasks – evaluate outcomes and provide feedback
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formal leadership
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practiced by a nurse with legitimate authority described in a job description
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informal leader
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exercised by a staff member who does not have a specified management role
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functions of nurse managers
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planning organizing directing – the process of getting the organization’s work done controlling – establishing standards of performance, measuring performance, evaluating performance, and providing feedback
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leadership styles
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autocratic democratic laissez-faire bureaucratic
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American Organization for Nurse Executives (AONE) Core Competencies
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Leadership: – communication and relationship management – professionalism – business skills and principles – knowledge of health care environment
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Nursing Roles
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Staff Nurse Charge Nurse First-Level Manager Clinical Nurse Leader Director VP CNO
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Leaders
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– need followers to lead – need followers to accomplish goals and help team succeed – are followers too
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Followers
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– influence leaders – vary from passive to active, dependent and uncritical, to independent and critical – share qualities with leaders
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Authentic Leaders
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– connect to pressures of front-line staff – are passionate about creating quality work environment – generate energy to do the impossible
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Emotional Leaders
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– have emotional intelligence and social competence – maintain positive environment – emphasize the importance of emotions and relationships in success
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4 generations work side by side
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– traditionals – baby boomers – generation X – millenials (generation Y)
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the Nurse Manager
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– balances the needs of administrators and employees – functions as coach, teacher, and facilitator – motivates and inspires others
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Leadership
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Leadership involves influencing other people, usually in some type of group, to work toward the achievement of the group’s goals. Leaders hope others develop a sense of what’s important or a sense of direction and of purpose.
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Management
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A manager has the formal authority to direct the work of a given set of employees and is formally responsible for the quality of that work and what it costs to do it. Leadership is an essential part of effective management.
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Great Man Theory
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– leader by birthright – great leaders are born with ability to lead – leadership cannot be developed
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Trait Theory
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Leadership exists as an attribute of a personality. An individual is a leader if certain traits are exhibited. Successful traits vary between situations, so no exhaustive trait list was produced.
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Common Traits
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honesty, trustworthiness, integrity, fair, skilled communicator, goal-oriented, dedicated, committed, hard working
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Qualities of an Effective Leader
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– communication – both verbal and non-verbal – listening skills – positive attitude – clinical expertise – it is important to be able to assess the effectiveness of the work in terms of patient outcomes
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Behaviors of an Effective Leader
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Interpersonal: networking, conflict negotiation and resolution, employee development, and rewards and punishments
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Task verse relationship: Lewin’s Behavioral Theories
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Authoritarian Democratic Laissez-faire
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Authoritarian
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– autocratic – made decisions alone – directive controlling – concerned with the task rather than the people
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Democratic
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– participative, involves followers indecisions – people or relationship oriented rather than the task – focuses on Teamwork
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Laissez-faire
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– neither task nor relationship focused – essentially lack of leadership – usually results in low productivity and employee frustration
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Contingency Theories – Fiedler
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Assumes that group performance depends on: 1. Leadership style – task motivation and relationship motivation 2. Favorableness, determined by three factors: leader-member relations, task structure, and position power
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Contingency Theory
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– no single personality typifies a leader; traits differ according to the situation – leadership is a relationship existing among people in a social situation, so a person could be leader in one situation and not in another – relationship-motivated leaders are most effective in moderately favorable situations. – task-motivated leaders are most effective at either end of the scale
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Situational Leadership Theory
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Situational theory: – using different types of leadership styles after understanding all of the factors affecting the group – consider the follower’s readiness and willingness to perform the assigned tasks
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New Theory
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– attention through vision – meaning through communication – trust through positioning – deployment of self through positive self-regard and the Wallenda factor
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Transformational Leadership
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– leaders and followers have the same purpose, and help each other to better their performance. – relies on cooperation and mutuality – emphasis on outcome rather than the process – endorsed by some leadership scholars – studies exploring the effectiveness have either supported or showed no significant difference for transformational leadership
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Connective Leadership
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– based on research – a multidimensional model – focuses on *caring* in order to empower and instill confidence – connects individuals to their goals, one another, the immediate group, and the larger network
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Leadership Theory
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– developed over time – provides framework for understanding how to think about and enact skills
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Leadership Development
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– process of individual’s becoming a leader – begins with an understanding of oneself – aim is to produce an effective leader capable of using proper behavior according to the situation
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Common Leader Personality Traits
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– intelligence – social sensitivity – social participation – communication skills – KEY
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Leadership Behaviors Correspond to Leadership Style
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– telling: what leader says goes – selling: persuasion – testing: leader consults group before finalizing – consulting: leader asks group to form a solution to problem – joining: leader acts as fellow member; whatever group says, goes
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4 actions for leadership from Kouzes and Posner’s Transformational Leadership Survey
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– model the way – inspire a shared vision – challenge the process – encourage the heart
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Transactional Leadership
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– exchange between leader and follower – frequently one sided – i need you to work christmas day and i will authorize you to have 3 days off – work OT and i will give you next friday off
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Process Model of Leadership
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– requires application of theory to determine the best possible action – summarizes essential factors that comprise a leadership decision – identifies the elements considered to produce and appropriate, group-oriented, and measurable leadership action
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Process Model of Leadership – Stage 1, Analysis and Problem Identification (example – meal trays are coming up too late)
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– categorizes elements of the problem – provides framework to select the critical aspects from the broad organizational influences and the actual problem – composed of the following variables: the event, the participants and their perception, the organization factors, interpersonal processes, and controlling forces
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Process Model of Leadership – Stage 2, Determination of Action
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– uses decision making after considering factors that contribute to the situation – many alternatives should be considered (democratic leadership) – weigh positive and negative aspects of all hypothetical outcomes – select the solution with the greatest number of overall advantages
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Process Model of Leadership – Stage 3, Evaluation of Action
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– a judgment that determines with worth of the solution after action was taken based on established criteria – aim to reduce subjectivity and increase objectivity through measurable data – evaluation criteria should be compared in the framework of a variety of issues: the acceptability of action for a particular setting, the psychologic-social acceptance of the selected action, the effect on the quality of nursing care, the possible growth for the group implementing the plan, and the solution’s ability to maintain order
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Standards
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– established norms of expected conduct – provide guidelines for care provided and professional responsibilities, level of excellence – standards of nursing are usually classifed in one of three ways: structure, process, outcome
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Criteria
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– predetermined elements, qualities, or characteristics – used to measure the extent to which a standard is met
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Indicators
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– used when criteria cannot be written because standers are immeasurable – an outcome that in all probability demonstrate that standards were met
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Accreditation
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– received by meeting standards made by the Joint Commission – traditionally focused its standard on quality concerns in order to improve the quality of care provided to the public
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Structure Standards
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– address the integrative mechanisms of an organization, such as, the environment, instrumentation, qualifications of personnel, job categorizations, number of staff, and committee configuration – influenced by federal bodies – for example, if an agency serves a person using Medicare as payment, the agency must meet Medicare regulations
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Process Standards
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– address nursing activities that nurses perform – written statements that include: nursing actions of assessment, diagnosis, intervention, and evaluation – emanate from patient needs – can be found in documents from the American Nurses Association and specialty nursing organizations
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Outcome Standards
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– address the end results of client care – patient-centered – usually identified with process standards – frequently written in terms of client’s behaviors – example – a client’s regular cardiac rhythm indicated by the electrocardiogram strip
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Certification
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– an example of a structure standard – reflects certain qualifications of an *individual* rather than of an agency – credential to enhance one’s professional status – voluntary for some specialities, but required for nurse practitioners – requirements usually include three stipulations: written examination in a specific area of competence, active practice in the specialty, and re-certification at specified periods
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American Nurse Credentialing Center
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– exams in 37 specialized and advanced practice fields – enables all qualified RNs to become certified in 5 specialty areas
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Medicare
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1965, largest single payer in the U.S.
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The Bennett Amendment
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– established professional standards review organizations – provided a review of medical care at institutions receiving federal reimbursement – two purposes: utilization review, quality review – unfortunately, no effect on medical effectiveness or control of costs
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The National Health Planning and Resources Development Act of 1974
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– purpose was to correct the poor distribution of health care facilities and personnel – health care agencies were established – focused on maintenance and quality health care through governmental regulation
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The Social Security Act Amendments of 1983
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– most significant impact of governmental regulation – changed the way hospitals were reimbursed for Medicare clients – attempted to limit cost increases in hospital health care – reorganization of the Medical Trust Fund – Introduction of DRGs, Diagnosis Related Groups – utilization review and quality assessment have taken on new meanings
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Clinical Practice Guidelines
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– assist practitioners in the prevention, diagnosis, treatment, and management of clinical conditions – provide the patterns of practice for a particular condition – used for evaluating quality of care, implementing improvement strategies, and reducing cost of care
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Relationship between Clinical Practice Guidelines and Outcome Standards
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– interrelated – following CPG will ensure normal outcome standards and positive client feedback
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Negligence
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– carelessness or failure to act as a prudent person would ordinarily act under the same circumstances – professional personnel are obligated to provide reasonable care to clients – professional is liable
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Conditions that Must be Met to claim injury due to negligence
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– proof that the nurse owed a duty to the patient – proof that failure to act properly would cause harm to the patient – proof that the prevailing standard was not met – proof that the injury directly resulted form the nurse’s actions
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Nurse Practice Act
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look at your state _ PA
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Systems of nursing care delivery
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– ways nurse manager can organize nurses’ work
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Case Method
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– earliest – nurses assigned to give total care to each client and reported to the head nurse – disadv – not all personnel were qualified to deliver all care and too many people reporting to head nurse
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Function Method
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– way to deal with multiply levels of caregivers – care was provided by assignment of tasks, math than of clients – each caregiver performed certain tasks in keeping with her education and experience – Disadvantage – fragmentation of care, leads to reduction in quality of care and staff is dissatisfied
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Team Nursing
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– influx of post- WWII nurses and the head nurse’s overextended span of control – teams consisted of: the senior prof nurse becoming the leader, RNs, LPNs, nurse aides and orderlies – disadv:
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Other types
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Primary nursing – 24 hr accountability for patient but had help; the nurse had to be available for consult 24 hrs Total patient care – primary nurses for each patient and associate nurse assigned – accountable for the hours you are at work… Differentiated Practice – spoke to different education levels on a unit – work together, but BSN nurse had additional responsibilities Partners in practice – constantly scheduled with partner…BSN with same LPN…manage patient workload together – every shift together Case management – multidisciplinary team; mostly nurses are case managers, patients put into clinical pathways and they are tracked along timeline Total quality management – data driven; whole hospital contributes to care of patient; facilitate changes toward quality care based on data; looks at entire system
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Essential elements to consider when analyzing a management situation
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external environment – what factors impact the current situation missions and goals of org resources barriers
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management assessment guide
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– the proper ratio must be assessed so a manager can mange the work and adequacy of the personnel and the resources to provide prepared employees – after assessment, the managerial decision and plan can be made – guide highlights essential variables to consider

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