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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

answer

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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