Midterm Study Guide
Midterm Study Guide NBSN4001
Popular in Leadership and Management for Professional NursingPractice
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This 13 page Study Guide was uploaded by Trisha Riley on Monday October 5, 2015. The Study Guide belongs to NBSN4001 at University of Cincinnati taught by Dr. Pryse in Summer 2015. Since its upload, it has received 18 views. For similar materials see Leadership and Management for Professional NursingPractice in Nursing and Health Sciences at University of Cincinnati.
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Date Created: 10/05/15
NB SN4OO 1002 U HWEEH T 11F Cincinnti mCoHege indiumsing Leadership and Management For Professional Nursing Practice Fa 2015 MIDTERM STUDY GUIDE 1 Traits Responsibilities of the leader A person who in uences and guides direction opinion and course of action Decision maker communicator evaluator facilitator risk taker mentor energizer coach counselor teacher critical thinker buffer advocate visionary forecaster in uencer creative problem solver change agent diplomat role model innovator Leaders do not have delegated authority but obtain their power through other means such as in uence leaders have a wider variety of roles than do managers leaders may or may not be part of the formal organization leaders focus on group progress information gathering feedback and empowering others leaders emphasize interpersonal relationships leaders direct willing followers leaders have goals that may or may not re ect those of the organization have to have followers 3 primary leadership styles authoritarian democratic and laissezfaire A process of persuading and in uencing others toward a goal and is composed of a wide variety of roles In the front moving forward taking risks and challenging status quo 2 Traits Responsibilities of the manager Person who brings things about the one who accomplishes has the responsibility and conducts Guides others Shared responsibilities Position of authority Management functions include planning organizing staffing directing and controlling The Management Process Assigned position within the formal organization Have a legit source of power due to the delegated authority that accompanies their position Expected to carry out specific functions duties and responsibilities Manipulate people the environment money time and other resources to achieve organizational goals Have a greater formal responsibility and accountability for rationality and control than leaders Direct willing and unwilling subordinates 3 Servant Leadership Most successful managers lead in a different way from traditional managers These managers put serving others including employees customers and the community as the numberone priority Foster a service inclination in others that promotes collaboration teamwork and collective activism To be a great leader one must be a servant first Ability to listen on a deep level and to truly understand Ability to keep an open mind and hear without judgement Ability to deal with ambiguity paradoxes and complex issues The belief that honestly sharing critical challenges with all parties and asking for their input is more important than personally providing solutions Being clear on goals and good at pointing the direction toward goal achievement without giving orders Ability to be a servant helper and teacher first and then a leader Always thinking before reacting Choosing words carefully so as not to damage those being led Ability to use foresight and intuition Seeing things whole and sensing relationships and connections Provide others with what they need to be successful 4 Characteristics of the highly emotionally intelligent manager Ability to perceive understand and control one s own emotions as well as those of others Choose to feel useful emotions and regulate them in a strategic ways even if they are unpleasant to experience EI develops with age and consists of three mental processes 0 appraising and expressing emotions in the self and others 0 regulating emotion in self and others 0 using emotions in adaptive ways Have 4 mental abilities perceivingidentifying emotions integrating emotions into thought processes understanding emotions and managing emotions Goleman identified 5 components of El selfawareness selfregulation motivation empathy and social skills Goal in E1 is emotional literacy being selfaware about one s emotions and recognizing how they in uence subsequent action EI can be learned and gets better with age 5 Characteristics of different types of followers Followers in uence the actions of the leader Can mislead leaders both intentionally and unintentionally Also called agents Motivated to act in best interest of leader principal agent theory Can have informational advantage over leader Work with the leader To avoid misleading by the follower Keeping vision and values front and center Cultivating truth tellers Honoring one s intuition Allowing disagreement Setting a good ethical climate Delegating appropriatelyquot 6 LeaderManager s and cultural diversity Recognizes the various aspects of diversity It is not just about race and culture Generational Diversity Values the differences in colleagues 7 Economic man decision making characteristics Management decision maker Makes decisions in a very rational manner Has complete knowledge of problem or decision situation Has a complete list of possible alternatives Has a rational system of ordering preferences of alternatives Selects the decision that will maximize utility Realize that restricted knowledge and limited alternatives directly affect a decision s quality these managers gather as much information as possible and generate many alternatives 8 Characteristics of a critical thinker Open to new ideas Intuitive energetic analytical persistent assertive exible empathetic caring observant risk taker resourceful outsideofthe box thinker creative insightful willing to take action outcome directed willing to change knowledgeable circular thinking The mental process of actively and skillfully conceptualizing applying analyzing synthesizing and evaluating information to reach an answer or conclusion 9 How various decision making tools are used ie decision trees decision grids Decision Grids allows one to visually examine the alternatives and compare each against the same criteria Useful when many alternatives have been generated or a group or committee is collaborating on the decision Useful when changing the method of managing care on a unit or when selecting a candidate to hire from a large interview pool Payoff Tables decision aid Costprofitvolume relationship and are very helpful when some quantitative information is available To use this one must determine probabilities and use historical data such as a hospital census and a report on the number of operating procedures performed Decision Tree use this for decisions that are tied to the outcome of other events Consequence Table demonstrate how various alternatives create different consequences It lists the objectives for solving a problem down one side of the table and rates how each alternative would meet the desired objective Logic Models schematics or pictures of how programs are intended to operate Typically includes resources processes and desired outcomes and depicts exactly what the relationships are between the three components Program Evaluation and Review Technique PERT determines the timing of decisions A owchart that predicts when events and activities must take place if a final event is to occur 10 Traditional problem solving model Identify the problem gather data to analyze the causes and consequences of the problem explore alternative solutions evaluate the alternatives select the appropriate solution implement the solution evaluate the results 1 1 Ethical Terms 9962 E39th g Veracity obligation to tell the truth Utility the good of the many outweighs the wants or needs of an individual Fidelity need to keep promises lustice seek fairness treat equals equally and treat unequals according to their differences Beneficence actions are taken in an effort to promote good Paternalism one individual assumes the right to make decisions for another Autonomy promotes selfdetermination and freedom of choice 12 Purpose of the Code of Ethics a Outlines important general values duties and responsibilities that ow from the specific role of being a nurse function as a guide to the highest standards of ethical practice for nurses and as an aid for moral thinking they are not legally binding 1 3 Legal Terms a b Civil case one individual sues another for money to compensate for a perceived loss Criminal case individual faces charges generally filed by the state or federal attorney general for crimes committed against an individual or society Tort case legal wrongs committed against a person or property independent of a contract that render the person who commits them liable for damages in a civil action i Professional negligence is considered to be unintentional tort ii Intentional tort includes assault battery false imprisonment invasion of privacy defamation and slander direct invasion of someone s legal rights Stare decisis let the decision stand uses precedents as a guide for decision making gives nurses insight into ways that the court has previously fixed liability in given situation Res judicata means a thing or matter settled by judgementquot applies only when a competent court has decided a legal dispute and when no further appeals are possible keeps the same parties in the original lawsuit from retrying the same issues that were involved in the first lawsuit Vicarious liability employers are now held liable for the nurse s acts employer should be held legally liable for the conduct of employees whose actions he or she has a right to direct or control 14 Steps in strategic planning Clearly define the purpose of the organization Establish realistic goals and objectives consistent with the mission of the organization Identify the organization s external constituencies or stakeholders and then determine their assessment of the organization s purposes and operations Clearly communicate the goals and objectives to the organization s constituents Develop a sense of ownership of the plan Develop strategies to achieve the goals Ensure that the most effective use is made of the organization s resources Provide a base from which progress can be measured Provide a mechanism for informed change as needed Build a consensus about where the organization is going Strategic planning is not static involves various actions and reactions that are partially planned and partially unplanned 15 Purpose of strategic planning examines an organization s purpose mission philosophy and goals in the context of its external environment forecasts the future success of an organization by matching and aligning an organization s capabilities with its external opportunities 16 SWOT one of the most commonly used tools for strategic planning S strengths are those internal attributes that help an organization to achieve its objectives W weaknesses are those internal attributes that challenge an organization in achieving its objectives 0 opportunities are external conditions that promote achievement of organizational objectives T threats are external conditions that challenge or threaten the achievement of organizational objectives 17 Difference between a policy and a procedure a Policies plans reduced to statements or instructions that direct organizations in their decision making derived from the organization s philosophy goals and objectives explains how goals with be met and guide the general course and scope of organizational activities Procedures plans that establish customary or acceptable ways of accomplishing a specific task and delineate a sequence of steps of required action established procedures save staff time facilitate delegation reduce cost increase productivity and provide a means of control identify the process or steps needed to implement a policy and are generally found in manuals at the unit level of the organization 18 Barriers to effective planning 19 Strategies to implement change Encourage subordinates to speak openly so that options can be identified to overcome objections Encourage workers to talk about their perceptions of the forces driving the planned change so the leader can assess change support and resources Leader must understand the vision of what the future state will be life after the change happens to be able to share that vision with others Change agents should be aware of life history variables and risktaking propensity when assessing an individual or groups willingness to change Early on assess which workers are most likely to promote or resist specific change by observation and direct communication then collaborate with promoters to convert resisters to change Remember most workers think of how change will affect them personally rather than how it will affect the organization as a whole Organizational stability team leadership skills and exibility in implementation are key factors in uencing the success of change 20 Planned change versus change by drift a Planned change results from a well thoughout and deliberate effort to make something happen versus change by drift which is accidental change 2 1 Change strategies a Rationalempirical 0 give current research as evidence to support the change 0 assuming resistance is due to lack of knowledge and that humans are rational beings when given factual information documenting the need for change 0 used when there is little anticipated resistance to the change and the change is perceived as reasonable b Normativereeducative C 0 uses group norms and peer pressure to socialize and in uence people so that change will occur 0 assuming humans are social creatures more easily in uenced by others than by facts 0 change agent does not need a legitimate power base rather gains power by skill in interpersonal relationships focuses on noncognitive determinants of behaviors ie roles relationships perceptual orientations attitudes and feelings to increase acceptance Powercoercive 0 application of power by legitimate authority economic sanctions or political clout of change agent 0 include in uencing the enactment of new laws and using group power for strikes or sitins 0 assumes people are set in their ways and will only change when rewarded or when forced by some powercoercive method accept it or leave 22 Leadership styles Laissezzfaire a Is permissive with little or no control Motivates by support when requested by the group or individuals Provides little or no direction Uses upward and downward communication between members or the group Disperses decision making throughout the group Places emphasis on the group Does not criticize Democratic Less control is maintained Economic and ego awards are used to motivate Others are directed through suggestions and guidance Communication ows up and down Decision making involves others Emphasis is on we rather than I and you Criticism is constructive Authoritarian Dictatorial Strong control is maintained over the work group Others are motivated by coercion Others are directed with commands Communication ows downward Decision make does not involve others Emphasis is on difference in status 1quot and youquot o Criticism is punitive d Autocratic 23 The nurse leader and change skills View change positively and to impart this view to subordinates Embrace change as a challenge and the chance to do something new and innovative DO NOT VIEW CHANGE AS THREAT Actively engage change in their own work and model this behavior to staff Assist staff members in making the needed change requirement in their work Believe they can make a difference confidence and the feeling of control 24 Operating Budget Second area of expenditure that involves all managers Re ects expenses that change in response to the volume of service ie cost of electricity repairs and maintenance and supplies Personnel costs lead the hospital budget cost of supplies runs a close second Effective unit managers should be aware of types and quantities of supplies used in their unit Be aware of relationship between supply use and patient mix occupancy rate technology requirements and types of procedures performed on unit Saving unused supplies from packs trays reducing obsolete and slow moving inventory eliminating pilferage and monitoring the uncontrolled usage of supplies and giveaways are potential cost savings Rental vs facilityowned equipment stocking products on consignment and justintime stockless inventory are ways to cut supply costs justintime ordering is where inventory is delivered to the organization by suppliers only when it is needed and is immediately used 25 Characteristics of ethical theories ie deontological a Teleological Theory utilitarianism or consequentialist o Encourages decision making based on what provides the greatest good from the greatest number of people needs and wants of the individual are diminished o Suggests the end can justify the means b Deontological Ethical Theory 0 Iudges whether the action is right or wrong regardless of the consequences and is based on the philosophy of Emanuel Kant in the 18th century 0 Uses both dutybased reasoning and rightsbased reasoning as its basis 0 Dutybased reasoning ethical framework stating that some decisions must be made because there is a duty to do something or to refrain from doing something 0 Rightsbased reasoning belief that some things are a person s just due ie each individual has basic claim or entitlements with which there should be no interference rights are different from needs wants or desires o IntuitionistFramework C I Allows the decision maker to review each ethical problem or issue on a casebycase basis comparing the relative weights of goals duties and rights I Weighting is determined primarily by intuition what the decision maker believes is right for that particular situation I Potential for subjectivity and biasness Ethical Relativism o Suggests the individuals make decisions based only on what seems right or reasonable according to their value system or culture d Ethical Universalism 0 Ethical principles are universal and constant and that ethical decision making should not vary as a result of individual circumstances or cultural differences 26 Organizational Charts a Span of control 0 Refers to the number of people directly reporting to any one manager and determines the number of interactions expected of him or her 0 Inverse relation between the span on control and number of levels in hierarchy in an organization 0 Too many reporting to one manager delays decision making and too few reporting causes an inefficient topheavy organization Unity of command 0 Indicated by vertical solid line between positions on organizational chart 0 One person one boss employees have one manager to whom they report and to whom they are responsible o Greatly simplifies the manageremployee relationship 0 Difficult to maintain in some large healthcare organizations because the nature of health care requires an interprofessional approach Chain of command 0 Solid vertical lines between positions 0 Formal paths of communication and authority 0 Those with the greatest decisionmaking authority are at the top those with the least are at the bottom 0 Level of position on the chart also signifies status and power Degree of centrality o Refers to the location of a position on an organization chart where frequent and various types of communication occur 0 Middle manager often has a broader view of the organization that other levels due to their large degree of centrality because this manager receives information upward downward and horizontally 0 Communication involves sender and receiver messages may not be received clearly because of the sender s hierarchical position 0 Status and power often in uence the receiver s ability to hear information accurately o Principle Syndromequot adults find discomfort in communicating with certain people who hold high status which can interfere with clear communication like a schoolage child getting called to the principal s office 27 Firstlevel manager a b c d Examples charge nurse team leader primary nurse Scope of responsibility Focus primarily on daytoday needs at unit level Primary planning focus shortrange operational planning Communication ow more often upward generally relies on middlelevel managers to transmit communication to toplevel managers 28 Shared governance model Developed in the mid19805 as an alternative to the traditional bureaucratic organizational structure one of the most innovative and empowering organization structures Organization s governance is shared among board members nurses physicians and management altering decision making and communication channels Group structures are formed joint practice committees to assume the power and accountability for decision making and professional communication takes on an egalitarian structure Gives nurses more control over their nursing practice by being an accountabilitybased governance system for professional workers Stated aim of shared governance is the empowerment of employees within the decisionmaking system 29 Organizational culture versus mission Organizational culture is the total of an organization s beliefs history taboos formal and informal relationships and communication patterns system of symbols and interactions unique to each organization ways of thinking behaving and believing that members of a unit have in common An organization mission identifies why the organization exists identifies the organization s constituency and addresses its position regarding ethics principles and standards of practice 30 Advantages and disadvantages of a b Total Patient Care Model 0 Disadvantage occurs when the nurse is inadequately prepared or too inexperienced to provide total care to the patient 0 Advantage care provided in patient s home Provides nurses with autonomy and responsibility Assigning patients is simple and direct and does not require the planning that other methods of patient care delivery requires Functional Care Model 0 Advantage RNs became managers of care rather than direct care providers economical and efficient means of providing care efficiency tasks are completed quickly with little confusion regarding responsibilities Used in OR Frees the nurse for more highly skilled duties Started using UAP o Disadvantage time needed to supervise the UAP negates any time savings that may have occurred c Modular Nursing 0 Uses a miniteam two or three members with at least one member being an RN 0 patient care units are divided into modules and assignments are based on the geographical location of patients 0 Advantage should allow the professional nurse more time for planning and coordinating team members Small team requires less communication allowing members better use of their time for direct patient care activities 0 Disadvantage d Team Nursing 0 Ancillary personnel collaborate in providing care to a group of patients under direction of a professional nurse 0 Advantage comprehensive care can be provided for patients despite a relatively high proportion of ancillary staff No more than 5 people in team Democratic leadership Group members get autonomy team shares responsibility collectively allows group members to contribute their own special expertise or skills 0 Disadvantage associated primarily with improper implementation rather than with the philosophy itself Insufficient time for team care planning and communication and can lead to blurred lines of responsibility errors and fragmented patient care e Primary Nursing 0 Also known as relationshipbased nursing 0 Uses some concepts of total patient care and brings the RN back to the bedside to provide clinical care 0 explicit responsibility and authority for specific patients were clearly allocated to a specific registered nurse 0 The primary nurse assumes 24 hour responsibility for planning the care of one or more patients from admission or the start of treatment to discharge or the treatment s end Nurse provides all direct care When primary nurse is not on duty associate nurses provide care and follow the primary nurse s plan of care 0 Can succeed with a diverse skill mix just as team nursing or any other model can succeed with an all RN staff 0 Disadvantage difficult to implement improper implementation Can be difficult to recruit and retain enough RNs to be primary nurses Shorter lengths of stay increasing numbers of parttime positions and variable shift lengths combined with the ongoing pragmatic need to provide holistic coordinated care to human beings f Differentiated Nursing Model 0 Advantage o Disadvantage 31 Clinical Nurse Leader role 0 More responsive to the realities of the modern healthcare system master s degree in nursing Expected to provide clinical leadership at the point of care in all healthcare settings implement outcomesbased practice and quality improvement strategies engage in clinical practice and create and manage Microsystems of care that are responsive to the healthcare needs of individuals and families Assumes accountability for healthcare outcomes for a specific group of clients within a unit or setting through assimilation and application of researchbased information to design implement and evaluate client plans ofcare key role in collaborating with interdisciplinary teams 32 Case Manager role Case Management Model Nurses address each patient individually identifying the most costeffective providers treatments and care settings possible Identifies any barriers to adherence Helps patient s access community resources learn about their medication regiment and treatment plan and ensures that they have recommended tests and procedures This is not only while patient is in the hospital it is also extended to outpatient also 33 Strategies for building personal power Maintain personal energy to take care of others you must first take care of you Selfcare is most important Nurse must cultivate to stay grounded avoid burnout and cope with the stress of nursing Take sufficient time to unwind rest re ect and have fun with they feel tired Mistakes are possible when you do not take care of self Take time for significant relationships and developing outside interests are important Present a powerful picture to others how people look act and talk in uence whether others view them as powerful or powerless Choose attitudes and behaviors wisely Pay the Entry Fee newcomers who stand out and appear powerful are those who do more work harder and contribute to the organization They are not nine to fiversquot they attend meetings and inservice opportunities do committee work and take their share of night shifts and weekend and holiday assignments Determine the Powerful in the Organization understanding and working successfully within both formal and informal power structures are important strategies for building a personal bower base Must be cognizant of their limitations and seek counsel appropriately One should know the names and faces of those with both formal and informal power Learn the language and Symbols of the Organization know the culture and value system because it is their story Learn how to use the organization s priorities every group has its own goals and priorities for achieving those goals Know the goals and use the priorities to reach the goals Increase professional skills and knowledge one s performance must be extraordinary to enhance power Improve to an expert level Maintain a broad vision vision is one of the most powerful tools that a leader has in herhis toolbox Serves as a driving force for goal attainment Use experts and seek counsel seek out role models Aligning oneself with appropriate veterans in the organization is excellent for building power Be exible be able to compromise Develop visibility and a voice in the organization be active in committees or groups that are recognized by the organization as having clout Strive for visibility and voice well Learn to Toot your own horn accept compliments Maintain a sense of humor ability to laugh at oneself and not take oneself too seriously is a most important power builder Empower others leaders need to empower others and followers must empower their leaders When empower other we gain referent power Also timing size of the profession nursing s referent power increasing educational levels of nurses nursing s unique perspective and the desire of consumers and providers for change 34 How empowerment is achieved Communicate their vision allow employees to Give employees opportunity to make the most of their talents Learning creativity and exploration Plants seeds of leadership collegiality selfrespect and professionalism Assure that all individuals in organization are treated with dignity Delegate assignments to provide learning opportunities and allow employees to share in the satisfaction derived from achievement Creates and sustains a work environment that speaks to values such as facilitating the employee s choice to invest in and own personal actions and behaviors that result in positive contributions to the organization s mission Enable develop or allow 35 Strategies to build political strength Develop information acquisition skills Communicate astutely Become proactive Assume authority Network Use legitimate power wisely 36 Union activity Increases sharply during times of high employment and prosperity and decrease sharply during economic recessions and layoffs Changes in response to workforce excesses and shortages Healthy national economy is tied to increased union activity When nursing vacancy rates are low activity tends to decline Nurses are roughly twice as likely to be in a union as are other workers
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