-
How can Maslow’s
hierarchy of needs be used to evaluate employee satisfaction?
- 1. Maslow’s hierarchy of needs to
- evaluate employee satisfaction can be used by asking; do your employees feel
- safe and secure? Do they feel included or do they feel they belong? Do they
- feel competent? (This reflects self-esteem). Do they feel they are used to
- their full potential? (This reflects self-actualization). If their needs are
- met the employee should feel satisfied and they no longer have that particular
- need motivating them any longer; but if the need is not met the person may feel
- stress, frustration, and conflict and this can affect their performance.( Page
- 339, Finkelman)
-
What factors can
serve as motivators for employees?
- Factors that can serve as motivators for employees are
- as simple as Maslow’s hierarchy of needs. Your employees are motivated by
- satisfiers and dissatisfiers, need for achievement, need for affiliation, the
- need for power, reinforcement( positive and negative) and equity.(Page 339-340,
- Finkelman)
-
. What are strategies
that a nurse manager can use to increase staff job satisfaction?
- Strategies that a nurse manager can use to increase
- staff job satisfaction is; rewarding staff, pay for performance, merit raises,
- spot rewards, skill based pay, recognition awards, job design, empowerment,
- goal setting, positive reinforcement, and lifelong learning. (Page341,
- Finkelman)
-
What is the significance of The Joint
Commission to a healthcare facility?
- The
- significance of The Joint Commission to a health care facility is that if you
- are accredited by TJC this status can be used in marketing and it communicates
- to consumers that your institution provides quality care. Also for schools of
- nursing or medicine to use a hospital as a clinical site it must be accredited.
- (Page 181, Finkelman)
-
What are the primary characteristics of a
nurse leader?
- Primary characteristics of a nurse leader are being
- able to assess, create, guide, direct, and project. (Slideshow 1, slide 2 and 5)
- -Leaders
- have a long-range perspective, focus on people and never want to maintain at
- the current level; leaders have authority from their influence. Key leadership
- roles include: expert, administrator, people person, and strategist.
- Pg.3
- ATI Resource The primary characteristics of a nurse leader are, initiative,
- inspiration, energy, positive attitude, communication skills, respect, and
- problem-solving/ critical thinking skills.
-
What are the primary
characteristics of a nurse manager?
- Primary characteristics of a nurse manager are being
- able to plan, organize, lead, and control. (slideshow1, slide 6)
- -A nurse manager
- guides using evidence-based practice and procedures. Managers maintain the
- current state, focus on efficiency, are concerned with structure, and have a
- short-range view of things. Managers have authority from position in the
- organization. These individuals have roles in planning, organizing, leading,
- and controlling. Five basic functions of a nurse manager include establishes objectives
- and goals for each area and communicates them, organizes and analyzes,
- motivates and communicates, analyzes, appraises, and interprets performance,
- and develops people, including self.
- Pg.
- 3 ATI Resource The primary characteristics of a nurse manager are, formal
- position of authority and power, clinical expertise, network, coach, and
- decision maker.
-
. What are the
characteristics of managed care?
- Characteristics
- of managed care are managing costs of health care, quality of health care, and
- access to health care. ((Page 155, Finkelman)
- The
- goal of managed care is to provide needed services efficiently and at an
- appropriate cost. This includes ensuring safe, effective, and affordable care.
-
How can workplace
violence develop in a healthcare facility?
- Workplace violence
- can develop in a healthcare facility because of individual characteristics,
- interpersonal factors, organizational factors, also facts, goals, approaches,
- and values. (Slide show 4, slide 11 and 15)
- o A significant source of interpersonal conflict in the
- workplace stems from lateral violence (aggressive and destructive behavior or
- psychological harassment of nurses against each other). Lateral violence may be
- a response to the practice environment in which ineffective leadership may
- exacerbate the problem(Yoder-Wise pg 477)
-
How can a nurse
manager successfully use informatics in the workplace?
- A nurse manager
- can successfully use informatics in the workplace by taking leadership in
- selection and implementation and if the nurse manager participates this will
- get buy-in from the other staff. (Page 500, Finkelman)
- o The electronic medical record gives quick and ready
- access to current and retrospective clinical
- patient data. The use of electronic patient classification systems allows
- managers to better measure the acuity of nursing areas, as well as assist in
- budget planning and need for resources.
- o The accessibility and use of the Internet facilitates
- the education of staff, patients, and their families.
-
What are
legal-ethical issues that should concern a nurse manager?
- legal-ethical issues that should concern a nurse manager are Legal:
- Negligence, malpractice, assault, battery, consent, consent implied by law,
- informed consent, Living wills, durable power of attorney, DNR and Ethical:
- Autonomy, beneficence, justice, and veracity.( Page 45, Finkelman)
-
Malpractice
- a. The nurse manager retains personal liability
- for the reasonable exercise of assignment, delegation, and supervision
- activities. The failure to assign, delegate, and supervise within acceptable
- standards of professional nursing practice may constitute malpractice and may
- extend to direct corporate liability for the institution. (pg 75)
- b. Nurse managers also have a duty to orient,
- educate, and evaluate. They and their representatives are responsible for
- the daily evaluation of whether nurses are performing safe and competent care.
- (pg 76)
- c. Failure to warn potential employers of staff incompetencies or impairment. Info about suspected
- addictions, violent behavior, and incompetency is of vital importance to
- subsequent employers. If the institution has sufficient in for and suspicion to
- warrant the discharge of an employee or force resignation, subsequent employers
- should be advised of those issues. (pg 76)
- d. Staffing Issues: Accreditation, state, and federal standards mandate
- that healthcare institutions provide adequate staffing with qualified
- personnel. Nurse managers should exercise sound judgment to ensure patient
- safety and quality care rather than rely on exact nurse-to-patient ratios. To
- prevent nurse manager liability, he or she must show that sufficient numbers of
- competent staff were available to meet nursing needs. (pg 77)
- - Guidelines for nurse managers in inadequate staffing
- issues include alerting hospital administrators and upper-level managers of
- concerns.
- - Before floating staff from one area to another, the
- nurse manager should consider staff expertise, patient-care delivery systems,
- and patient-care requirements. Nurses should be floated to units as comparable
- to their own unit as possible.
- - When using agency or temporary personnel, ensure that
- the temporary staff member is given a brief but thorough orientation to
- institution policies and procedures, is made aware of resource materials within
- the institution, and is made aware of documentation procedures.
-
Protective and Reporting Laws
- Nurse
- managers are responsible for ensuring correct info is reported to the correct
- agencies, thus avoiding potential liability against the institution. (Ex: cases
- of STDs, suspected abuse)
-
Informed Consent
- The nurse
- manager must fully understand informed consent policies because her or she can
- become a staff consultant
- - The NM is
- queried about patients’ rights in research studies that are being conducted in
- the institution
- - The NM must become aware of patient literacy and
- ensure that the info the nurse communicate to the patients is at a level they
- understand
-
Privacy and Confidentiality
- The nurse
- manager is cautioned to ensure that staff members both understand and abide by
- rules regarding patient privacy and confidentiality
-
Policies and Procedures
- Nurse managers should review the policies and
- procedures frequently for compliance and timeliness. If the policies are absent
- or outdated, the nurse manager must request the appropriate person or committee
- to either initiate or update the policy
-
Ethics
- Nurse
- managers must have a deep understanding of ethical principles and their
- application.
- Ethical Principles
Autonomy, Beneficence, Nonmaleficence, Veracity, Justice, Parternalism, Fidelity, Respect for others, and Moral Distress.
-
Autonomy-
- , personal
- freedom and the right to choose what will happen to one’s own person; this principle underlies
- the nurse manager’s clinical practice b/c autonomy is reflected in individual
- decision making about patient care issues and in group decision making about
- unit operations decisions
-
Beneficence
- actions one takes should promote good; Nurse managers
- employ this principle when encouraging employee to seek more challenging
- clinical experiences or to take on additional responsibilities as a charge
- nurse
-
Nonmaleficence
- one should do no harm; For a nurse manager following
- this principle, performance evaluation should emphasize the employee’s good
- qualities and give positive direction for growth. Destroying the employee’s
- self esteem would be considered as doing harm
-
Veracity
- concerns
- telling the truth and incorporates the concept that individuals should always
- tell the truth; Nurse managers employ this principle when they give all the
- facts of a situation truthfully and then
- assist employees to make decisions
-
Justice-
- , the
- principle of treating all persons equally and fairly; Nurse managers use this
- principle when assigning vacation time for staff and deciding who will be
- floated to another unit
-
Parternalism
- may be used
- to assist persons to make decisions when they do not have sufficient data or
- expertise
-
Fidelity
- keeping
- one’s promises or commitments
-
Respect for others-
- acknowledges
- the right of individuals to make decisions and to live by these decisions
-
Moral Distress
- Occurs when
- faced with situations in which two ethical principles compete; The NM may have
- to balance a staff nurse’s autonomy with what the NM perceives to be a better
- solution to an ethical dilemma
-
Explain Drucker’s
functions of management.
- The staff
- should participate in as much of the planning and establishment of goals and
- decision making as possible. Individual autonomy is a critical part of this
- theory of management. Drucker believed that when staff participated in the core
- functions of management the organization would be more effective. Includes the
- assumption that leadership can be learned. Leaders are not born, but rather
- staff can be nurtured to gain greater leadership competency
-
Describe the various
styles of decision-making.
- Autocratic- make decisions independent of the input or
- participation of others; has been referred to as an authoritative style
- - Appropriate for crisis situations or when groups are
- likely to accept this type of decision style
- o Democratic (participative)- involves the appropriate personnel in the
- decision-making process
- o Brainstorming- team
- decision making; list all ideas as stated without critique or discussion. The
- group leader or facilitator should encourage people to tag onto or spin off
- ideas from those already suggested. The goal is to generate ideas, no matter
- how seemingly unrealistic or absurd (pg 105) Nominal
- group- participants are asked not to talk
- to each other as they write down their ideas. Next each member is asked to
- share an idea. Comments and elaboration are not allowed during this phase. Then
- each member privately assigns a priority rank to each option (pg 105)
- o Focus groups- purpose is
- to explore issues and generate info. Can be used to identify problems or to
- evaluate the effects of an intervention; the groups meet face-to-face to
- discuss issues (pg 105)
- o Delphi technique- involves systematically collecting and summarizing opinions and
- judgments from respondents, such as expert panels, on a particular issue
- through interviews, surveys, or questionnaires; the goal is to achieve
- consensus (pg 105)
- o Unilateral- one person
- makes decisions with limited or no input from others
- o Individual- one person
- makes decisions with limited or no input from others
o Authoritarian- one person makes decisions with limited or no input from others
o Participative- including others in decision making
- o Consensus- including
- others in decision making
- o Decisive- depends on
- less data to arrive at one decision
- o Integrative- uses all
- available data and identifies multiple alternatives
- o Hierarchic- focuses on
- a large amount of info but arrives at one alternative solution
- o Flexible- uses a
- small amount of data while generating multiple alternatives and may change as
- info is reinterpreted
- o Systematic- decisions
- are formed logically and uses a structural approach
- o Intuitive-
- trial-and-error; may ignore info and change their alternatives if it does not
- feel right; “gut” approach
- Team- focuses on
- synergy, which is the combination of people’s efforts that results in a output
- which is greater than the sum of the parts. Multiple ideas and experiences come
- together to form a decision
-
14. Describe the steps in the problem-solving
process.
- Define the
- problem- Problem
- identification is influenced by the info available; by the values, attitudes,
- and experiences of those involved; and by time
- o Gather data- Objective
- (facts) and subjective (feelings) information. Info should be valid, accurate,
- relevant to the issue, and timely
- o Analyze Information- Further refines the problems statement and identifies possible
- solutions or options; important to differentiate a problem from the symptoms of
- a problem
- o Develop solutions- The goal of generating options is to identify as many choices as
- possible; being flexible, open-minded, and creative –attributes of a critical
- thinker—is critical to being able to consider a range of possible options Choose a solution- Criteria for evaluation might include variables such as
- cost-effectiveness, time, and legal or ethical considerations; the solution
- selected should be the one that is most feasible and satisfactory and has the
- fewest undesirable consequences
- o Implement the solution- carryout the decision; be prepared to institute “plan
- B” if necessary
o Evaluate the result- important to help guide future actions
-
. How does a nurse
function as a “whistle-blower”?
- Whistleblower-
- someone who exposes federal fraud
- o Nurses can be whistleblowers by reporting or filing
- lawsuits when they are concerned about unsafe practice
- o In “whistleblowing” cases, the healthcare provider in
- terminated for one of three distinct reasons: (1) speaking out against unsafe
- practices, (2) reporting violations of federal laws, or (3) filing lawsuits
- against employers. Essentially, whistleblower laws state that no employer can
- discharge, threaten, or discriminate against an employee regarding
- compensation, terms, conditions, location, or privileges of employment because
- the employee in good faith reported or caused to be reported, verbally or in
- writing, what the employee had a reasonable cause to believe was a violation of
- a state or federal law, rule, or regulation.
-
How does a nurse
manager use the evaluation process?
- A nurse
- manager can judge if a change process is moving acceptable toward desired
- outcomes or goals and whether an outcome has been fully or partially met
-
What are the
characteristics of a health maintenance organization?
- A configuration of healthcare agencies that provide
- basic and supplemental health maintenance and treatment services to voluntary
- enrollees who prepay a fixed periodic fee without regard to the amount of
- services used. To be federally qualified, an HMO company must offer inpatient
- and outpatient services, treatment and referral for drug and alcohol problems,
- laboratory and radiology services, preventive dental services for children
- younger than 12 years, and preventive healthcare services in addition to
- physician services
- o The original model or prototype of managed care, which
- integrates the delivery of service with reimbursement for those services. The
- HMO pays the bills for its members’ health services, but it also manages and
- provides care to its members. An enrollee in an HMO such as Group Health goes
- to one site to receive care, both primary and usually specialty care. Most HMOs
- require that the patient/enrollee pay a small co-payment. There may be limited
- provider choice. The HMO develops incentives to encourage its providers to
- provide the lowest-cost care to the HMO members.
-
How does a nurse
manager utilize budgeting?
- Budgeting
- done annually in relation to organization’s fiscal year which can begin at any
- point on the calendar. The process
- includes gathering information and planning, developing unit budgets,
- developing the cash budget, negotiating and revising, and using feedback to
- control budget results and improve future plans. A timetable with specific
- dates for implementing the budgeting process is developed by each organization.
- .
- -Budgets
- may be the direct responsibility of nurse managers. Most decentralized organizations allow nurse
- managers to allocate fiscal resources for their designated unit. Managers must have the business and financial
- skills to be able to prepare and justify a detailed budget that reflects the
- short-term and long-term needs of the unit.
- The most important aspect of budget is the provision for a mechanism
- that allows some self-control, such as decision making at the point of service
- (POS), which does not require hierarchical approval and a rationale for
- budgetary spending.
-
19. Describe the various models of
hospital governance.
- Functional structures—arrange
- departments and services according to specialty. Departments providing similar functions
- report to a common manager or executive. (e.g. vice presidents for each major
- function: nursing, finance, human resources, and information technology)
- Service-Line structures (aka product lines)—functions needed to produce
- a specific service are under one unit under one manager (e.g. all
- cardiovascular areas in the hospital are under one manager)
- Matrix—combination of function and service (e.g. pediatric nurse could
- report to a vice-president for pediatric services [the service-line manager]
- and a vice-president of nursing [the functional manager])
- Flat—decentralized decision-making: staff can make decisions while
- providing patient care. Removal of
- hierarchical layer thereby placing authority to the professionals doing the
- work (e.g. Magnet hospitals in their nursing satisfaction and patient outcomes)
- Shared governance—nursing staff have more autonomy resulting in higher
- levels of staff satisfaction, enhanced productivity, and improved retention.
- (Read Yoder-Wise pp. 150-151 for a good example)
- Shared
- governance is described as a democratic concept; it is a dynamic process
- resulting from shared decision making & accountability. Basic principles
- include partnerships, equity, accountability, and ownership. It is more
- accurate to say that shared governance demands participation in decision making
- rather than provides for participation. Characteristics that empowered nurses were
- career ladders, access to power, participation in decision making, recognition
- of accomplishments, and EBP.
- · Workplace advocacy is an umbrella
- term encompassing activities within the practice setting. The choice of
- advocacy to reflect the framework in which nurses control the practice of
- nursing is consistent with the goals of the profession. Includes activities to
- address the challenges faced by nurses in their practice setting. The focus is
- on career development, employment
- opportunities, terms and conditions of employment, employment rights and
- protections, control of practice, labor-management relations, occupational
- health and safety, and employee assistance. The objective is to equip nurses to
- practice in a rapidly changing environment.
o These manifestations include:
§ Ensuring relevant information
- § Enabling the selection of
- information
Disclosing a personal view
- § Providing support for making and
- implementing decisions
§ Helping determine personal values
- · Collective bargaining is the performance
- of the mutual obligation of the employer and representatives of the employees
- to meet at reasonable times and confer in good faith with respect to wages,
- hours, and other terms and conditions of employment or the negotiation of any
- agreement or any question arising from those terms and conditions. The purpose
- is to secure reasonable and satisfactory conditions of employment, including
- the right to participate in decisions regarding their practice.
-
Functional structures
- arrange departments and services according to
- specialty. Departments providing similar
- functions report to a common manager or executive. (e.g. vice presidents for
- each major function: nursing, finance, human resources, and information
- technology)
-
Service-Line structures (aka product lines)—
- functions needed to produce a specific service
- are under one unit under one manager (e.g. all cardiovascular areas in the
- hospital are under one manager)
-
Matrix
- combination of function and service (e.g.
- pediatric nurse could report to a vice-president for pediatric services [the
- service-line manager] and a vice-president of nursing [the functional manager])
-
Flat
- decentralized decision-making: staff can make
- decisions while providing patient care.
- Removal of hierarchical layer thereby placing authority to the
- professionals doing the work (e.g. Magnet hospitals in their nursing
- satisfaction and patient outcomes)
-
Shared governance
- nursing staff have more autonomy resulting in
- higher levels of staff satisfaction, enhanced productivity, and improved
- retention. (Read Yoder-Wise pp. 150-151 for a good example)
- described as a democratic concept; it is a dynamic
- process resulting from shared decision making & accountability. Basic
- principles include partnerships, equity, accountability, and ownership. It is
- more accurate to say that shared governance demands participation in decision
- making rather than provides for participation. Characteristics that empowered
- nurses were career ladders, access to power, participation in decision making,
- recognition of accomplishments, and EBP
-
Workplace advocacy
- is an
- umbrella term encompassing activities within the practice setting. The choice
- of advocacy to reflect the framework in which nurses control the practice of
- nursing is consistent with the goals of the profession. Includes activities to
- address the challenges faced by nurses in their practice setting. The focus is
- on career development, employment
- opportunities, terms and conditions of employment, employment rights and
- protections, control of practice, labor-management relations, occupational
- health and safety, and employee assistance. The objective is to equip nurses to
- practice in a rapidly changing environment.
o These manifestations include:
§ Ensuring relevant information
- § Enabling the selection of
- information
Disclosing a personal view
- § Providing support for making and
- implementing decisions
§ Helping determine personal values
- · Collective bargaining is the performance
- of the mutual obligation of the employer and representatives of the employees
- to meet at reasonable times and confer in good faith with respect to wages,
- hours, and other terms and conditions of employment or the negotiation of any
- agreement or any question arising from those terms and conditions. The purpose
- is to secure reasonable and satisfactory conditions of employment, including
- the right to participate in decisions regarding their practice.
-
How does systems
theory affect a nursing unit
- A
- system is an interacting collection of components or parts that together make
- up an integrated whole. The basic tenet of systems theory is that the
- individual components of any system interact with each other and with their
- environment. Professional nurses need to understand the specific part- role and
- function- they play within a system and how they interact, influence, and are
- influenced by other parts of the system. Staff need to understand the mission,
- vision, philosophy and structure at the organization and unit level to maximize
- their contribution to patient care. Major focus of the work to be accomplished
- and the manner in which it will be accomplished. Understanding the philosophy
- provides knowledge of the behaviors that are valued in the delivery of patient
- care and in interactions with persons employed by the organization.
- -It views
- organizations as one entity with multiple elements or components that interact
- interdependently. Feedback is a critical process in a system. Input, process,
- and output all rely on feedback, which is the dynamic process in which an
- organism learns from experiences within the environment. Within a hospital
- system, professional staff, administrative staff, equipment, supplies, and
- patients represent the system inputs. The process is the delivery of health
- care as patients work their way through the system to discharge.
-
How does a facility’s vision statement differ
from its mission statement?
- The mission
- statement defines the organization’s reason or purpose of being. It identifies
- the organization’s customers and the types of services offered, such as
- education, supportive nursing care, rehabilitation, acute care, and home care.
- Identify the kinds of technologies and human resources to be employed.
- · Vision statements are future-oriented,
- purposeful statements designed to identify the desired future of an
- organization. Unify all subsequent statements toward the view of the future and
- to convey the core message of the mission statement. They are brief, consisting
- of only one or two phrases or sentences.
-
what factors can cause a
decrease in staff morale and increase the level of frustration?
- Indifferent,
- tense working environment; frequently unfocused discussion; unclear objectives
- or many personal agendas, judgmental listening – much interruption; premature
- decision making, formal voting occurs frequently, simple majority,
- embarrassing/ destructive criticism; autocratic leadership, unclear
- assignments, hidden or explosive feelings and infrequent self-regulation or
- outside meetings.
- -Different
- conflicts can arise in the hospital that can increase the level of frustration.
- For example there can be conflict between nurses and physicians because nurse
- focus on shorter periods of time whereas physicians do not understand the
- structure of nurses’ work. Also, physicians are not concerned with the staffing
- or finances that take place. Physicians have few patients throughout the
- hospital; nurses have multiple patients admitted by several MDs. Physicians don’t
- understand nursing care delivery models. Physicians usually are independent
- practitioners; nurses usually are salaried at an hourly rate. Conflict can also
- increase frustration from hospital policies, Joint Commission requirements,
- competing goal priorities, and results of personal opinions and beliefs among staff.
-
How should a clinical
nurse educator function?
- to provide
- nursing professional development and education services by assisting nurses in
- preparing for contemporary practice and supporting them in acquiring the
- knowledge and skills so that they can competently collect patient health data,
- analyze the data to determine diagnoses, identify expected outcomes
- individualized to the patient, develop a plan of care that prescribes
- interventions to attain the expected outcomes, implement the interventions identified
- in the plan of care, and evaluate the patient’s progress toward attainment of
- the outcomes in the medical/surgical care settings. The CNE will also be
- involved in the development and education services of the unlicensed assistive
- personnel.
-
Describe the phases
of Lewin’s change process
- Unfreezing
- stage- focuses on developing problem awareness and decreasing forces that
- maintain the status quo. Recognize the problem and whether or not there is a
- feeling that the problem can be improved.
- · Moving stage – problem is clearly
- identified, and goals and objectives are developed. They are implemented, the
- working stage of the process where new values, attitudes, and behaviors are
- promoted.
- · Refreezing stage- when the change is
- incorporated into the work environment and its processes.
-
Describe the process of conflict resolution. ·
- Define the
- problem – know the facts, separate the facts from interpretation, be objective
- and descriptive, determine the scope of the problem
· Gather data- through assessment
- · Develop solutions – identify as many
- choices as possible
- · Select a solution – weigh each
- option: consequences and risks
- · Implement the solution – include a
- contingency plan to deal with negative consequences if they arise.
- · Evaluate the result – take time to
- monitor and evaluate and take responsibility for any mistakes
-
What are some causes
of conflict that can occur on a nursing unit?
- They are
- exposed to high stress levels from increased demands on an ever-limited and
- aging workforce, a decrease in available resources, a more acutely ill and
- underinsured patient population, and a profound period of change in the
- practice environment.
- -Conflict
- can be caused by almost anything, including inadequate communication, incorrect
- facts, lack of trust, unclear position descriptions, misunderstanding of roles
- & responsibilities, unclear or conflicted goals and objectives, inadequate
- action plans, directions, unstable leadership, receiving direction from 2 or
- more “bosses”, inability to accept change, lack of leadership, lack of or
- limited staff participation in decision making, & power issues.
- Three major
- causes of inter-group conflict:
- 1. Groups that
- must work interdependently and compete for resources will experience more
- conflict. (ex: units competing for funding)
- 2. Groups
- working together may have different goals, or different ideas on the best way
- to accomplish shared goals.
- 3. Conflict may
- surface when there is inadequate differentiation (or too severe
- differentiation) between co-workers. (such as between LPNs and RNs)
-
Describe the various
types of conflict that can occur. ·
- Role
- – occurs when there is incompatibility between one or more role expectations
- (ex: conflict between role as a mother with a sick child and as a staff nurse
- scheduled to work the night shift), also when staff do not fully understand the
- roles of other staff
- Intrapersonal- occurs within a
- person when confronted with the need to think or act in a way that seems at
- odds with one’s sense of self. Conflict over priorities, ethical standards, and
- values.
- · Interpersonal – transpires between
- and among patients, family members, nurses, physicians and other staff. Focuses
- on difference of opinion, priority or approach with others
- · Organizational – arises when discord
- exists about policies and procedures, personnel codes of conduct, or accepted
- norms of behavior and patterns of communication. Related to hierarchical
- structor and role differentiation among employees. Major source of it stems
- from strategies that promote more participation and autonomy of staff nurses.
- -Covert
- vs overt conflict: Covert conflict is
- often unacknowledged, and usually destructive.
- It can be difficult to acknowledge covert conflicts, but this is a
- necessary step. Overt conflict is
- obvious, and it is easier to resolve.
- Overt conflict can be positive, as an agent of innovation and change.
-
Describe positive and
negative ways of resolving conflict.
- Negative-
- avoiding, accommodating, competing, bullying, backstabbing, withholding
- information
- · Positive- Compromising,
- collaborating
- -Examples of
- destructive behavior are ignoring a policy, denying a problem, avoiding a staff
- member, and criticizing staff in public.
- Examples of constructive behavior are encouraging the group to identify
- and solve the problem, expressing appropriate feelings, and offering to help out
- a co-worker.
-
. Describe styles of
conflict management. ·
- Avoiding –
- very unassertive and uncooperative because people who avoid neither pursue
- their own needs, goals, or concerns immediately nor assist others to pursue
- theirs. It only ensures that conflict is postponed and has a tendency to
- escalate in intensity.
- · Accommodating – people neglect their
- own needs, goals and concerns (unassertive) while trying to satisfy those of
- others (cooperative). It has element of being self-sacrificing and simply
- obeying orders or serving. People who use this may feel disappointment and
- resentment.
- · Competing – people pursue their own
- needs and goals at the expense of others. They use whatever power, creativeness
- that are available to “win”.
- · Compromising- involves both
- assertiveness and cooperation on the part of everyone and requires maturity and
- confidence. Negotiating is a learned skill that is developed over time and it
- is more like trading. Compromise is very often the exchange of concessions as
- it creates a middle ground.
- · Collaborating- the most
- time-consuming approach, is the most creative stance. It is both assertive and
- cooperative because people work creatively and openly to find the solution that
- most fully satisfies all important concerns and goals to be achieved
-Goals of conflict management:
- 1. to eliminate
- or decrease the conflict
- 2. to meet the
- needs of the patient, family/significant others, & the organization
- 3. to ensure that all parties feel
- positive about the resolution so that future work together can be productive
-
How does bullying
behavior sometimes manifest itself on a nursing unit? ·
- Bully is associated with psychological and physical
- stress, underperformance, professional disengagement, increased job turnover,
- and the potential for diminished quality of care. Verbal abuse toward others
- like putting down another. New graduates reported feeling undervalued by other
- nurses and reported having learning opportunities blocked; many felt neglected
- and given too much responsibility without the appropriate support.
-
How does assigning
and delegating differ? ·
- Assignment
- refers to the work each person is to accomplish in a designated work period. It
- consists of patient care expectations and unit-related activities. Another
- meaning relates to assignment as the transference of both responsibility and
- accountability. Assigning—ANA states that assignments is
- the distribution of work that each staff member is responsible for during a
- given work period. The staff member is assigned both the accountability and
- responsibility. The nurse manager is accountable only for making the
- assignment and selecting who will be responsible for the care of the patients.
- It is the staff nurse is accountable and responsible for actually provided the
- care. Staff nurses cannot make assignments.
- · Delegation is a critical skill for
- accomplishing care in a timely manner.
- _Delegating—The
- act of delegation requires at least 2 people, work, and some kind of transfer
- of authority and responsibility to perform the work. Accountability is not
- abdicated but instead remains fixed with the delegator. The nurse is
- merely sharing responsibility and legal accountability still rests with
- him/her. Staff nurses can delegate.
-
What are the
differences in leading, managing, and following? ·
- Leadership
- is the process of engaged decision making linked with actions taken in the face
- of complex, unchartered or perilous circumstances present in clinical
- situations for no standardized solution exists
- · Management is an engaged process of
- guiding others through a set of derived practices and procedures that are
- evidence-based and known to satisfy pre-established outcomes based on repeated
- clinical situations.
- · Followership is engaging with others
- who are leading or managing by contributing to problem identification,
- completing tasks, and providing feedback for evaluation.
-
How should a nurse
manager utilize critical thinking?
- When they use delegation decision making and their other functions like
- budgeting. Critical thinking is a process of examining
- underlying assumptions, interpreting and evaluating arguments, imagining, and
- exploring alternatives, and developing relative criticism for the purpose of
- reaching a reasoned, justifiable conclusion. In nursing it means constantly
- striving to find a better way by focusing on two key questions: What are the
- outcomes? And how can we do better? A nurse manager should use critical
- thinking to make decisions and problem solve for those he/she is responsible
- for so that. He/she should use it for direct care, advocating for the patient,
- in coordinating care, working with other staff to resolve issues on the unit,
- to ensure that quality, safe care is provided on the unit, and to collaborate
- with others.
-
Describe Drucker’s
functions of a manager. ·
- Establishes
- objectives and goals for each area and communicates them to the persons who are
- responsible for attaining them
- · Organizes and analyzes the
- activities, decisions, and relations needed and divides them into manageable
- tasks
- · Motivates and communicates with the
- people responsible for various jobs through teamwork
- · Analyzes, appraises and interprets
- performance and communicates the meaning of measurement tools and their results
- to staff and superiors
· Develops people, including self
- (modern
- management, participatory management, leadership learned) Staff should participate in as much of the
- planning and establishment of goals and decision making as possible. Allowing the staff to participate in the core
- functions of management the organization would be more effective. Nurse manager should seek out stagg members
- ideas and ask them to assist with planning.
- The staff can be nutured to gain greater leadership competency. Pg 7 Finkleman
-
. How can a nurse
manager prepare staff members for a visit from The Joint Commission?
- A manager
- can prepare staff members for a visit from TJC by setting up practice
- evaluations of the hospital, let the staff know what is expected for them to
- know, and have in-services for the staff.
- There are many different
- roles the nurse manager may play in this. Examples include: providing feedback
- on performance, participation in their own performance appraisal, collecting
- data, awareness of errors and applying this to their practice, assisting with
- analysis of data, and using conclusions from quality analysis to improve their
- practice. Assign standards to team leaders. Team leaders should delegate work to
- team members. Conduct quarterly "mock" surveys to gauge compliance.
- Fix any opportunities for improvement identified during the mock survey. Form a
- specially designated team to perform weekly rounds in different areas to
- monitor compliance. Monitor progress in a grid-type form, with columns for
- standard, performance, due date, action plan, follow-up and assigned person(s).
-
A nurse leader should be able to...
- Accurately assess, createsolutions, guide employees, direct employees to carry out goals at min risk to patient and themselves., and project an air of confidence.
- motivate and encourage others.
- work with others to achieve goals.
- assess and develop new opportunities for nursing.
- adapt and develop new roles and skills as health system changes.
- understand broader health and socail system within which nursing functions.
- have external awareness.
- use technology
- contribute and influence health and public policy.
-
How does leadership and management differ?
- A leader makes decisions and takes action in situations when there is no bovious solution.
- A manager guides using eveidenced based practice and procedures.(protocol)
-
A good follower should..
- identify problems
- complete tasks
- provide feedback
-
An effective leader has...
- Vision-ideas for the future
- influence- trust from employees
- power- change behaviors, use consistency, tell what you will do and do it.
- values-should be congruent with the facility
-
key management functions
- planning
- organizing
- leading
- controlling
- *maintains day to day functions. Thinks short term.
-
Comparing managers and leaders
- managers maintain current state; leaders focus on change
- managers focus on efficiency, are concerned with structure, and have a short range view of things
- leaders have a long term range perspective(future), focus on people never want to maintain the current level
- leaders have authortiy from their influence
- managers have authority from position in the organization
-
key leadership roles
- expert- have knowlege(power)
- administrator-know how efficient things are, policy and procedures, computer system, budgets, knows peoples strengths.
- people person- training, goals
- strategist -change agent (smooth transitions)
-
levels of management
- first level : unit manager or charge nurse
- middle level: director of critical care services
- upper level: chief nurse executive
-
Gardner's Tasks of leadership
- envisioning goals(for staff-realistic)
- affirming values(gives direction and purpose and get priorities straight.)
- motivating-can promote change
- managing-practices
- achieving workable unity
- renewing
- developing trust
- explaining
- serving as a symbol
- representing the group
-
Bleich's tasks of managemnt
- identify processess relating to patient care
- decide max and min standars
- validate knowledge skills and abilities of staff
- develop big pic plan
- eliminate obstacles to work effectiveness
- measure out workload equitably(equally)
- reward and recognize
- recommend ways to improve
- use informal network to engage employees
-
Transactional leadership
- traditional boss
- no imput from lower level employees
- performance will be rewarded or punished depending
-
Transformational leader
- wants employees to think "outside the box"
- considers each employees needs and abilities
- wants to change organization and employees.
- Asks why is it done this way and how can it be done more effectively?
- Helps employees set up realistic goals.
- Extra effort is rewarded and important.
- Is a role model of desired behavior
- pays attention to people and their personal ongoings
- higher level of staff satifaction and patient.
- Able to reatin staff
- has vision and a mission.
- motivates followers
- lets staff be involved in leadership
- has increased recognition of the staff
-
druckers theory
- -modern management; participatory management.
- -staff should participate in planning and goal development
- -Staff should have autonomy
- -leaders are made!
- EXAMPLE: Staff nurses should provide imput into planning and changes that might be necessary Seek out staff ideas and ask them to assist with planning.
-
Fiedlers Contingency theory
- -relationship of leader to team
- - amount of confidence employees have in the leader is critical and inspires loyalty
- - position power -power of leader has becasue of his/her position in the facility.
- -best situation-positive leader-employee relations, highly structured tasks, high level of position of power.
- * situation changes affect of leadership.
-
Ineffective approaches to leadership
- autocratic-* works well in emergencies* issues orders.
- bureaucratic-rigid, gives orders, relies on policies and rules
- Laissez-faire-hands off; can result in no leadership and lack of guidance.
-
Management Grid Model Styles of Leadership
- Impoverished-Leader has limited interest. Work requirements are at minimum level.
- Country CLub-Interested in people. Friendly.Productivity not a concern.
- Authority-obedience- Get job done Not personable.
- Organization man-balance necessityto accomplish with maintaining morale
- Team- very concerned with productitvity and about staff morale and satisfaction.
-
Connective Leadership Theory
- Leader collaborates within the hospital and amoung other oraganizations in the community.
- the more connections that occur, the more successful the leader will be.
-
Emotional Intelligence Theory
- Self- Awareness cluster- understanding
- feelings and applying accurate self assessment. Recognize feelings and how they affect others. Identify strengths and limitations.
- Self-Management Cluster- managing
- internal emotions, impulses and resources.
- Emotional
self control- handle their own emotions and expresses emotions appropriately. - Trustworthiness
- letting others know one’s values and principles, intentions and feelings and - acting in ways that are consistent with them. Forthright about mistakes and confront others about their lapses. Conscientiousness- Leader is careful, self-disciplined, and ensures that responsibilities are met.
- Adaptability- open to new ideas, search out challenges and opportunities, and use them to move forward. “thinks
- outside the box”. Risk is not a barrier to moving forward. Achievement drive-optimistic striving to continually improve
- performance.
- Initiative- a step ahead at all times and seem to seek out opportunities
- before others are aware of them.
- Social Awareness Cluster- empathy- being aware of others feelings,
- needs, and concerns. Service Orientation-ability
- to identify a clients unstated needs and concerns and then match them to
- products or services. Organizational
- Awareness- able to identify group feelings and organizational needs, which
- helps the leader develop coalitions and network.
- Relationship Management Cluster- developing others- leader knows when staff is ready for further development.
- Influence- ability if a leader to persuade others. Communication- ability to communicate emotions and facts, listen, share info, and encourage sharing info.
- Conflict Management- requires negotiation and the ability to see outside the box.
- Visionary leadership- can develop a
- vision and includes staff in the vision for success.
- Change Catalyst- See change as opportunity, recognize barriers to change and remove them whenever possible, challenge the status quo, and involve as many of the staff as possible in change process.
- Building Bonds- make connections with others, build trust, and recognize the importance of
- relationships.
- Collaboration and teamwork.
-
Quantum Thinking Approach
- - multiple solutions
- -input from multiple people on a situation
- -Creativity required for the team to be successful
- -Participative leadership.
- -Future is uncertain.
- -Sensitive to indicators of change
- -Analysis of info
- Leaders
- shouldn’t predict future-no one knows it anyhow. Leaders should be keen to
- hints of change and respond when need be. Be able to translate info to used to
- produce outcomes. Be able to analyze info.
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