question

What is the problem with just investing in managers

answer

-Staff is left behind -Favoritism -Application limited

question

Career Stages

answer

-Promise -Momentum -Harvest -Reentry (know how the characteristics are demonstrated in milestone)

question

1. Promise Phase

answer

- Milestone: 1-10 yrs -Novice Nurse -Characteristics: less experienced, reality overload building knowledge skills & education base, shock, trying to gain as much experience.

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2. Momentum Phase

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- Milestone: 11-29 yrs - Mastery, *professional track record, strength & passion -BSN nurses know how to establish track record and continue their research * -Characteristics: experienced, expert knowledge, skills & abilities, committed to life long learning, role modeling& career divergence (intuitionism, using managerial decision making model, career divergence)

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3. Harvest Phase

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-Milestone: 30 to 40 yrs -Profession advancement & establishing a legacy -Characteristics: period of reinvention, renew potential value, avoidance of obsolescence

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4. Reentry Phase

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-Milestone: resocialization -Characteristics: Returning from retirement, returning from other professions

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Justification (this will be a select all that apply question)

answer

-Reduces employee attrition -Provides equal opportunity employment -Improves use of personnel -Improves quality of work life -Improves competitiveness of organization -Avoids obsolescence and builds new skills

question

The first socialization to the nursing role occurs during nursing school and continues after graduation. Which of the following responses or occurrences are typical of this process?

answer

SELECT ALL THAT APPLY) a) *Conflict and frustration* b) *Reality Shock* c) Anticipatory regression d) Professional depression

question

Before managers can plan a successful career development program, they need to understand the normal career stages of individuals. Which of the following terms represent the three main stages of a nursing career? ( Select all that apply)

answer

a) *Obsolescence of skills is avoided* b) Increased employee attrition c) *Improved organizational competitiveness* d) *Improved use of personnel*

question

A staff nurse is discussing long-term goals with the nurse manager. The staff nurse explains that she aims to work as a nurse practitioner in a private clinic over the course of five years. Which one of the following statements is an appropriate response by the nurse manager?

answer

" Let us focus on goals that will contribute to your current role here in the hospital." " I can't believe this. We've invested so much in you." **Are you familiar with the incentives that our hospital offers for pursuing higher education?"** " Are you sure you don't want to pursue an internal managerial role here in the hospital?

question

Define Quality Improvement

answer

Used to identify & resolve performance deficiencies

question

what does quality improvement begin with?

answer

Begins with identification of standards & outcome indicators based on evidence

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What is the role of a benchmark?

answer

Goals set to determine at what level the outcome indicators should be met

question

Structure Audit

answer

Evaluate the influence of elements that exist separate from the outside of the client-staff interaction

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Process Audit

answer

Review how care was provided Assume a relationship exists between nurses & quality of care provided

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Outcome audit

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Determines what results occurred as a result of the nursing care provided

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Root Cause Analysis

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-Investigates the consequence & possible causes -Analyzes the possible causes and relationships that may exist -Determines additional influences at each level of relationship -Determines the root cause or causes

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What is Performance Appraisal?

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Supervisor evaluates an employee's performance in relation to job description for that employee's position as well as other expectations

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What measures can be taken to ensure that Performance Appraisal is *unbiased*?

answer

-Various sources of data collected to ensure non biased & thorough evals -Data collected over time & not just isolated incidents -Actual observed behavior documented/used as evidence of satisfactory or unsatisfac (called anecdotal notes & kept in the managers files)

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How can peers participate in Performance Appraisal?

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- Orientation of staff to the peer review process. Their professional responsibility in regard to promoting growth of colleagues & disposition of data collected - Focus on peer's performance in relation to job descriptions or an appraisal tool -Be shared w/ the peer & usually the manager - Part of the data used when completing staff performance appraisal.

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Disciplinary Action: How are deficiencies addressed during a performance appraisal?

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- Should be presented *in writing* - Corrective action should be based on institutional policy (Evidence should support a claim)

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Disciplinary Action: What offenses warrant immediate dismissal of the employee?

answer

- Mistreatment of a client - Use of alcohol or drugs while working

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Disciplinary Action: What should a staff member do if they witness inappropriate behaviors of a coworker

answer

- Report the infraction up the chain of command - This may be the charge nurse and the unit manager should be notified - Written documentation by manager placed in staff's permanent file

question

4 Steps of Progressive Discipline w/ key characteristics

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- *1st Infraction*: Informal reprimand, manager & employee meet, discuss issue, suggestions 4 improvement - *2nd Infraction*: Written warning, manager meets w/ employee to distribute warning, review rules/policy, discussion of potential consequences if infractions continue - *3rd Infraction*: Suspension w/or w/out pay. Time away gives employee opport. to examine the issue & consider alternatives - *4th*: Termination after multiple warnings given, employee continued to violate rules

question

Define Organizational Conflict

answer

Disrupt working relationships and create stressful atmosphere

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Organizational Conflict: 4 Common Causes

answer

- Ineffective communication - Unclear expectations of team members in their various roles - Poorly defined or actualized organizational structure - Conflicts of interest & variance in standards

question

Resolution Strategies: 4 Actions that can promote open communication during conflict

answer

1. Use "I" statements & remember to focus on the problem, not on personal differences 2. Listen carefully to what the other people are saying & try to understand their perspective 3. Move a conflict that is escalating to a private location or postpone the discussion until a later time to give everyone a chance to regain control of their emotions. 4. Share ground rules with participants. (ex: every1 is treated w/ respect , only 1 person can speak @ a time, & every1 has a chance to speak)

question

Negotiation: List 4 measures involved in the *Negotiation Process*

answer

- Resolve ongoing conflicts - Agree on steps to take - Bargain to protect individual or collective interests - Pursue outcomes that benefit mutual interets

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Negotiation: Describe a win-win solution

answer

...

question

Negotiation: Describe a win-lose / win-lose solution

answer

...

question

Conflict Resolution Strategies

answer

- Avoiding/Withdrawing - Smoothing - Competing/Coercing - Cooperating/Accommodating - Compromising/Negotiation

question

Avoiding/Withdrawing

answer

- Both parties know there is a conflict, but they reuse to face it or work toward a resolution. - May be appropriate for minor conflicts or when one party holds more power than the other party or if the issue may work itself out over time. - Since the conflict remains, it may surface again at a later date & escalate over time.

question

Smoothing

answer

- One party attempts to 'smooth' another party by trying to satisfy the other party. - Often used to preserve or maintain a peaceful work environ. - The focus may be on what is agree upon, leaving conflict largely unresolved

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Competing/ Coercing

answer

- One party pursues a desired solution at the expense of others - Managers may use this when a quick or unpopular decision must be made - the party who loses something may experience anger, aggravation, and a desire for retribution.

question

Cooperating/ Accommodating

answer

- One party sacrifices something, allowing the other party to get what it wants (opposite of competing) - The original problem may not actually be resolved - the solution may contribute to future conflict

question

Compromising/ Negotiating

answer

- Each party gives something up - Both parties must give up something equally important.

question

Kurt Lewin developed the Change Theory that involved what three stages?

answer

- Stage 1: Unfreezing - Stage 2: Movement - Stage 3: Refreezing

question

Unfreezing

answer

- Gathers data - Diagnoses the problem - Decide if change is needed - Make *others* aware of the need for change, involves tactics - creates awareness, build momentum, MANIPULATE PPL - convince staff that THEY initiate change rather than their management

question

Movement

answer

- Develops a plan - Sets goals & objectives - Identify areas of support & resistance - Includes others affected into planning, target dates - Implements change -SWOT: strength, weakness, opportunity, threats

question

Refreezing

answer

- Support others so that the change continues - change is a journey rather than a step (lewin)

question

Pt with a Colostomy & refusing to go back to work/school due to fear of rejection. How to get them to do ADL's and back to life?

answer

-*Stage 1 Unfreezing*: Homehealth, inform pt that lifestyle is hindered, inform how ppl live a colostomy & maintain a normal life, cons of isolation - *Stage 2 Movement*: Case management checkup, attainable returning to the public goals, discuss how to manage intimacy, one on one support, work half day and slowly get back to norm life -*Stage 3 Refreezing*: Case management thruout entire process or until pt is comfy with bag/living

question

Newly DX diabetic pt, new insulin treatment, fear of needles

answer

-*Stage 1 Unfreezing*: what does the pt know about his DX., does the pt understand what insulin does, understand where the fear of needles comes from, determine learning style Nursing Diagnosis: fear r/t new treatment AEB pt verbalizing fear of needles - *Stage 2 Movement*: Goal, pt will be able to administer insulin w/out fear by the end of the new treatment session. ------assess pt for s/s/ of fear, explain the purpose of insulin in the body, provide a calm environ, include family in teaching, explain need for treatment. - *Stage 3 Refreezing*: Diabetic support group

question

Pt has 2 wks to live, has terminal cancer and is in denial. family is ready

answer

- *Stage 1 Unfreezing*: reality orientation, education of terminal illness - *Stage 2 Movement*: Orient to palliative & hospice care, continue to re-asses coping. Encourage family to support reality - *Stage 3 Refreezing*: Provide counselling for patient and family. advance directives, wills, finances

question

Pt is having sex w/ multiple partners to feel loved, has STDs

answer

- *Stage 1 Unfreezing*: address physical issues, find underlying issue with multiple partners, - *Stage 2 Movement*: Treat infection, prevent spread, contact partners, important to identify underlying issues - *Stage 3*: find support and instill confidence, counselling, use her to help others with the same issue (advocate)

question

Couple trying to conceive- male doesn't know he has to have sex on specific days

answer

- *Stage 1 Unfreezing*: husband has knowledge deficit re: peak conception days. change is needed so increase education on conception, inform wife of husbands need for further education. - *Stage 2 Movement*: send couple togeth to preg planning classes & weekly therapy, hubby needs to understand ovulation cycle, wife is supportive & resistance to conflict, couple on same pg re planning - *Stage 3 Refreezing*: contact couple in 3 months to check on status, report back

question

New onset of HTN, overweight, complains of no energy so pt drinks coffee and redbull

answer

- *Stage 1 Unfreezing*: educate on dx since doesnt know effects of caffeine and meds, educate client if he continues to be overweight on health risk it has in the future. - *Stage 2 Movement*: plan, meet w/ client to discuss realistic goals, have taper off slowly, family support involving the wife maybe same diet - *Stage 3 Refreezing*: set scheduled appt, weekly goals, support groups. set alternatives: decaf coffee, non caffeinated teas.

question

Client coping with CVA, weak on right side, stubborn and wants to drive when they shouldnt

answer

-*Stage 1 Unfreezing*: awareness, no driving, ensure safety, make him aware of the dangers of driving w/ weak side - *Stage 2 Movement*: show info videos, teachnew coping skills, family support, by the end of the month pt will attend @least 1 support group, hotline for help, video games to play for driving - *Stage 3 Refreezing*: set follow appointment 3-6 months to assess prgress, complience

question

Male pt, COPD 10 years, smokes while on O2 tank, uneducated, dr says okay to smoke without oxygen

answer

-*Stage 1 Unfreezing*: knowledge deficit, effects of smoking while on O2, explain to dr the need for education to his pt, pt needs to be aware of the need for change - *Stage 2 Movement*: education, goal for pt to stop smoking while on oxygen & understand why. educate that they will catch on fire, use videos, encourage vape, patch gum while on oxy tank, assess understanding. - *Stage 3 Refreezing*: Continuous support until change is fully complete from fam/wife, healthcare team

question

Male Hispanic dx HEMORRHOIDS, loves hot sauce, dr is white

answer

-*Stage 1 Unfreezing*: knowledge deficit on effects of spicy foods, explain to dr about pts cultural dietary habits -*Stage 2 Movement*: therapeutic communication, explain path of hemorrhoids, capsaicin & acid irritate his condition, include family support and foods that arent spicy, support is key -*Stage 3 Refreezing*: cooking classes with wife, measure impact of change (also at risk for esophageal varices)

question

Rugby playing on Coumadin & needs to quit playing sport

answer

-*Stage 1 Unfreezing*: knowledge deficit to the medication, refusing to stop playing, educate re the risk of bleeding & playing,educate pt & family that this is a heavy contact sport may put him at risk for hemorrhage if injured -*Stage 2 Movement*: Find a new hobby, make him understand the side effects, make sure family coach & teammates support him, Brochure, videos, consultation, followup on understanding of med - *Stage 3 Refreezing*: continue to be supportive, reinforce risk of taking coumadin

question

Prego teen 32 weeks who smokes, decrease amniotic fluid

answer

-*Stage 1 Unfreezing*: knowledge deficit, change is needed, bring other teen moms to show effect on baby - *Stage 2 Movement*: education on effects of smoking, pt will stop smoking, pt will have clear understanding of effects of smoking, pt wil have natural labor, have support from family, address personal concerns, - *Stage 3 Refreezing*: continue to check in with pt to make sure she is staying on track

question

26 weeks gestation and experiencing early contractions, self confidence

answer

- *Stage 1 Unfreezing*: is self conscious and uses guilt to convince husband to contribute to the change. Continues to have sex and needs to lay off - *Stage 2 Movement*: educate couple of dangers of intercourse during 3rd trimester, causes early contractions, goal is to get her to gain more confidence. support from husband. remind her that shes not fat shes just prego - *Stage 3 Movement*: encourage husband to make her feel confident

question

Diabetic pt wont comply with diet

answer

- *stage 1 Unfreezing*: give pt info on benefits of following diet , let his supporters know the importance of diet change, get pt involved - *stage 2 Movement*: develop a diet plan, together set SMART goals, prep for potential obstacles - *stage 3 Refreezing*: encourage at follow up appointments, non food rewards, possible call in for follow ups

question

Medicare

answer

- Must be a US citizen, Funded by Federal Gov't - 65+ years old, catastrophic or CHRONIC illness such as renal failure, requiring dialysis regardless of age. - 4 parts of coverage: *A*) hospital insurance program *B*) supplemental med insurance for labs/xrays/out pt, *C*) medicare advantage or more choices for participating in managed care, *D*) allows pt to purchase limited prescription drug coverage/name brand is temporary and expensive - *Strength*: coverage 4 elderly, can choose type of coverage $, lost costing - *Weakness*: harder to get a referral, doesnt recomm the best dr, cant get funding if ure fired before 65

question

If medicare goes to Dr's office and only accepts 75% of coverage, what plan does this fall under?

answer

Medicare Plan C (gives pt more options, HMO type of medicare)

question

Medicaid

answer

- Family or individual with low income - Annual income of 22,000 or < per year - Disabled, fam planning services xray services - *Strength*: low co-pay - *Weakness*: referrals to specialist no, men not covered, long term care may not be local

question

Health Maintenance Organization: HMO

answer

- US Citizen - Point Of service: can select providers/cost more -Exclusive Provider Organization: Enroll seek care from HMO provider or pay out of pocket -*Strength*: low cost, set fixed fee, reimbursement -*Weakness*: Restrictive to only see dr w/in HMO, lose freedom to see your own dr., have to have referral , FOR HEALTHY PT, goes thru steps so **need to say what youve done already so that they can treat it** -tubal ligation wont be covered if youre not compliant with depo shot

question

Preferred Provider Organization: PPO

answer

- Approved in medicare A & enrolled in B - NO END STAGE RENAL - Full coverage* - *Strength*: -Freedom, choose Dr, no referrals, pick surgeon - *Weakness*: High deductible, high co pay, difficult to get reimbursements, document everything **While apply, need to be selective with answers-'what other dr have u seen in the past"- theyll contact them to see if youre really healthy

question

Veteran

answer

- If discharged, immediate family - Benefits: drugs, council, rehab, mental health, prosthetic - *Strength*: all necessary care, ER - *Weakness*: Only certain hospitals VA - not a health plan, dont have referral program

question

Health Care for Illegals

answer

- Go to ER since they are not allow to be refused - Emergency medicaid - Social services provided a 1 time treatment --prego's get long treatment - Dr visit is to ER - hospital doesnt get reimbursed - USC/UCLA have special grants for EXPERIMENTS ON ILLEGALS - WORST THING TO DO IS WRITE YOUR CORRECT ADDRESS

question

Foundation (select all that apply q on exam)

answer

- Safety, Comfort, Control - Balance between stability and change - Environmental Identity - Work= Outcomes and Results - Change should be implemented gradually - **Change is a journey not a step **

question

Prerequisites for *Driving Force*

answer

- Desire to please - Eliminate factors that impair productivity - pay raise - recognition

question

Prerequisites for *Restraining Force*

answer

- Fear of the Unknown - Lack of motivation - Complacency - Lack of knowledge

question

SWOT Analysis

answer

- define the desired end state or objective - after its defined, the strength & weakness are discovered and listed

question

5 Stages of Contemporary Model (will be a select all that apply question and be able to differentiate )

answer

1. Precontemplation 2. Contemplation : minimal commitment 3. Preparation : 100% committed, change mental status 4. Action 5. Maintenace

question

New student have to utilize ATI is what stage

answer

Stage 1

question

100% sold on ATI

answer

Stage 3 : Preparation

question

Thinking

answer

Stage 2: contemplation

question

Managing Resistance

answer

- Rational-Empirical Strategies: minimal resistance - Normative-reeducative strategies: emotional intelligence, manipulate individual - Power-coercive strategies: no complient, enforce powers

question

A nurse attends an in-service on intramuscular injections. New protocol guidelines instruct the nurses to omit aspirating after insertion of the needle in the patients muscle. As a result, the nurse leaves with no intention of following the new protocol. Based on the five step adaptation of Kurt Lewin's Change Theory, which of the following stages in the nurse in?

answer

*) Precontemplation Stage b) Preparation Stage c) Acclamation Stage d) Contemplation Stage

question

Forecasting

answer

Fiscal budget, - educated estimates, ready for future based on history

question

3 Major Types of Budgets

answer

- Personnel Budget: - Operating Budget - Capital Budget:

question

Personnel Budget:

answer

- work force - staff - nursing care hours

question

Operating Budget

answer

- Anything it takes to run - Utilities - Supplies - repairs & maintenance - change in response to volume of services

question

Capital Budget

answer

extend the hospital, large machines, expensive,long term, major equipment

question

Critical Pathway

answer

- Reflected predicted pathway of patient progress - DX Based - Uphold & effected EB standards - Determines ALOS- average length of stay - Justifiable Variance: ex pneumonia and dehydration is related or pneu & uti ----not justifiable is uti due to hospital stay

question

Diagnoses Related Group

answer

- Prospective payment system: doesnt give u back $ unless u follow guidelines - cost containment - predetermined payment schedules - outlier - decrease average length of stay - balanced budget act of 1997: Minimizing physician reimbursement, 85% NP of physician fees, restructured REHAB, Home health, and SNF

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