Leadership

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mmcgraw
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137104
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Leadership
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2012-02-25 17:42:25
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Nursing Leadership
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Midterm NURS4810
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  1. 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)
  2. 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)
  3. . 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)
  4. 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)
  5. 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.
  6. 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.
  7. . 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.
  8. 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)
  9. 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)

    • · (Yoder-Wise
    • p. 62)

    • 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.
  10. 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)
  11. 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.
  12. 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)
  13. 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
  14. Privacy and Confidentiality
    • The nurse
    • manager is cautioned to ensure that staff members both understand and abide by
    • rules regarding patient privacy and confidentiality
  15. 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
  16. 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.
  17. 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
  18. 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
  19. 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
  20. 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
  21. 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
  22. Parternalism
    • may be used
    • to assist persons to make decisions when they do not have sufficient data or
    • expertise
  23. Fidelity
    • keeping
    • one’s promises or commitments
  24. Respect for others-
    • acknowledges
    • the right of individuals to make decisions and to live by these decisions
  25. 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
  26. 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
  27. 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)

    • Finkleman p
    • 81-82

    • 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
  28. 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
  29. . 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

    • · Yoder-Wise p
    • 88

    • 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.
  30. 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
  31. 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

    • Finkleman p
    • 157

    • 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.
  32. 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.
  33. 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.
  34. 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)
  35. 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)
  36. 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])
  37. 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)
  38. 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
  39. 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.
  40. 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.
  41. 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.
  42. 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.
  43. 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.
  44. 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.
  45. 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
  46. 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)
  47. 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.
  48. 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.
  49. . 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
  50. 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.
  51. 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.
  52. 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.
  53. 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.
  54. 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
  55. . 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).
  56. 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.
  57. 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)
  58. A good follower should..
    • identify problems
    • complete tasks
    • provide feedback
  59. 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
  60. key management functions
    • planning
    • organizing
    • leading
    • controlling
    • *maintains day to day functions. Thinks short term.
  61. 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
  62. 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)
  63. levels of management
    • first level : unit manager or charge nurse
    • middle level: director of critical care services
    • upper level: chief nurse executive
  64. 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
  65. 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
  66. Transactional leadership
    • traditional boss
    • no imput from lower level employees
    • performance will be rewarded or punished depending
  67. 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
  68. 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.
  69. 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.
  70. 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.
  71. 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.
  72. 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.
  73. 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.

    • ·

  74. 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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