sheryl abelew msn rn. introductions syllabus review powerpoint ann marie rivera resume presentation
TRANSCRIPT
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Sheryl Abelew MSN RN
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Introductions
Syllabus Review
PowerPoint
Ann Marie Rivera Resume Presentation
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Health care is a competitive market Health care is not accessible to
everyone Costs are skyrocketing U. S. spends more money on health care
than any other country
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Emerged in the effort to cut costs
Focus on primary care
Deliver a continuum of care
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Leapfrog Group Consortium of public and private purchasers Provide benefits to 37 million Americans Reward positive outcomes based on quality
indicators Quality management
Continuous attempt to improve outcomes and costs Is a preventive approach Involves continuous evaluation and improvement Is implemented through patient satisfaction surveys
Benchmarking Comparison of organizations based on a specific set
of performance indicators Uses results to address weaknesses and enhance
strengths
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Cultural diversity is increasing in the U. S. populationMany barriers
Cost Access Beliefs The challenge is to provide access to health care
regardless of race, ethnic origin, or socioeconomic status
Health care policy makers and organizations face challenges of serving a more diverse population
Nurses need a transcultural focus
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Multiple generations working together is common
Nurse managers encourage mutual respect and teamwork
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Aging patients increase the demand for health care
As aging nurses retire the nursing shortage will grow worse
Demand for nurses will continue to grow
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Decision-making process includes: Identifying the clinical question Finding evidence to answer the question Evaluating the evidence Applying the evidence Evaluating the outcome
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Is criticized by opponents for: Absence of theory to guide decision-
making Lack of time, expertise, and resources to
implement Is expected to continue to be used in
the future Has been implemented successfully by
the U.S. Veteran’s Health Administration (VA) and University of California Los Angeles (UCLA)
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Includes health information from all medical sources
Can be accessed by multiple authorized providers at different locations
Allows for collective data analysis, facilitates a common nursing language, and support evidence-based practice when fully integrated
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BarriersPrivacy and confidentiality concernsCosts of implementing and operating
BenefitsReduced redundancies Improved efficiencyDecreased medical errorsLower health care costs
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Track medications
Record medical interventions
Update medical information
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Point-of-care systems
Hand-held devices
Robots
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Official agencies and health care organizations are not prepared to respond to mass casualties
Health care organizations must prepare for massive emergencies
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Must address nurses’ concerns of being abandoned
Include computer simulations, video demonstrations, and disaster drills
Ensure that nurses understand the communications system and the incident command center
Provide accessible information, support, and opportunities for debriefing
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Movement from hospital care to less expensive settings
New technologies Focus on quality control Access to care affecting policy decisions
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Every nurse must be prepared to manage
Organizations must provide management training for all nurses
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Chapter 2Chapter 2 Designing OrganizationsDesigning Organizations
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Were unexplored until the Industrial Revolution
Include the following theories:ClassicalContingencyHumanisticChaosSystemsComplexity
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Is built around four elements:
Division and specialization of laborChain of commandOrganizational structureSpan of control
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Focuses on social aspects of organizational design
Views social relationships, group pressure, and search for personal fulfillment as motivators
Says formal authority only works with willing participants
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System is interrelated parts arranged in a unified whole
Systems can be open or closed Organization is a recurrent cycle of
input-throughput-output Manager is the catalyst for the process
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Performance is enhanced by matching the organization’s structure to its environment
Environment includes people, objects, and ideas outside the organization that influence it
Optimal form of the organization depends on the environment in which it operates
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Organizations are living, self-organizing systems that are complex and self-adaptive
Creativity and flexibility are necessary to adapt to change
Leader’s role is to build resilience, maintain balance, and encourage creativity
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Random events interfere with expectations No linear cause and effect to explain outcomes The system interacts and adapts to
change Managers must encourage the flow of
information in all directions, not just top to bottom
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Private or government Voluntary (not for profit) Investor owned (for profit) Sectarian or nonsectarian
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Most are acute care facilities May be classified as general or special-
care facilities (e.g., pediatric) Many are teaching institutions
-Role of nurse may differ from teaching to nonteaching hospital
New groups in hospitals include hospitalists and intensivists
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Provide professional nursing care and rehabilitative services
May be freestanding or part of hospital. Limit length of stay May be residential care facilities
(nursing homes) where care is supervised by RNs and LPNs
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Are increasingly being used to deliver health care
Include physician’s offices, emergency rooms, surgical centers, clinics in pharmacies, and family planning centers
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Provide intermittent, temporary health care in the home by skilled or unskilled providers
May offer services other than nursing such as physical therapy or medical equipment
May offer hospice care
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Provide ambulatory care in shopping centers, pharmacies, and discount stores
Are staffed by nurse practitioners
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Provide nurses and other health care workers to hospitals
Provide private duty nurses to patients in the hospital or at home
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Deliver services through a formal arrangement with a group of individuals
Include HMOs, PPOs, and POS plans Have declined because of dissatisfaction
with limitations and inflexibility
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Horizontal integration: Organizations in a network provide the same or similar services; e.g., all hospitals provide comparable services
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Vertical integration: Dissimilar but related organizations in a network provide a continuum of services
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Corporate health care network
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Organization expands into new arenas Two common types: Concentric
diversification and conglomerate diversification
Joint venture: Partnership in which each partner contributes different areas of expertise, resources, or services to create a new product or service
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Functional: Employees grouped in departments by specialty
Service-line: All functions needed to produce a product or service grouped together in self-contained unit
Hybrid: Contains both self-contained and functional units
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Matrix: Integrates product and functional structures in one overlapping structure
Parallel: Unique to health care; involves two lines of authority—the authority of the organization and the authority of its medical staff
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Shared governance supports decision making, quality imperatives, and collaboration among disciplines
Heterarchy structure is based on the concept of connections
Self-organizing structures are flexible and able to respond to change
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Philosophy Values Vision statement Mission Goals Objectives
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System-wide conditions that contribute to a positive or negative work setting
A positive environment directly affects better patient outcomes
The nurse manager plays a key role in maintaining a positive environment
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Encompasses basic assumptions and values held by members of the organization
Varies among institutions, subcultures, and counterculturesConsonance occurs when the subculture’s
norms and traditions agree with the organization’s
Dissonance occurs when they are not in agreement
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ANCC designates organizations that provide nursing excellence
Magnet hospitals successfully recruit and retain nurses despite the nursing shortage
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Promote quality in a setting that promotes professional practice
Identify excellence in the delivery of nursing services
Disseminate best practices in nursing services
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Chapter 3Chapter 3 Delivering Nursing CareDelivering Nursing Care
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Provide structure for delivering care Assess care needs Formulate plan of care Implement plan Evaluate patient’s responses
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Effectiveness Cost efficiency Quality Needs of consumers and practitioners
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RNs, LPNs, and UAPs are assigned different tasks
RNs assess patients Other staff give baths, make beds, take
vital signs, administer treatments
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Team of nursing personnel provides total care to a group of patients
RN leads team that may include other RNs, LPNs, and UAPs
Team leaders must be skilled in delegating, communicating, problem solving
All members of effective teams are good communicators
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Structure of roles and functions differentiated by nurses’ education, experience, and competence
Roles, responsibilities, and tasks defined for professional nurses, licensed practical nurses, and unlicensed assistive personnel
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Nurse coordinates team of multifunctional, unit-based caregivers
All patient care services are unit based Focus is decentralization, promotion of
efficiency and quality, and cost control
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Advantages:Staff become efficient at performing
assigned tasks Disadvantages:
Uneven continuityLack of holistic understanding of patientProblems with follow-up
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Advantages:LPNs and UAPs perform tasks that don’t
require RN’s expertiseCare is more easily coordinatedSaves steps and time
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Disadvantages:Time needed for communicating,
supervising, and coordinating team members
Affect of changes in team leaders, members, and assignments on continuity of care
Total patient not considered by any one person
Role confusion and resentmentLess control for nurses over assignmentsPossibility of unequal assignments
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Advantages:Continuous, holistic, expert nursing careTotal accountabilityContinuity of communication
Disadvantages:RNs perform tasks that could be done more
cost-effectively by less skilled persons
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RN is responsible for all aspects of care for one or more patients
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Advantages:Knowledge-based practice modelDecentralization of decisions, authority, and
responsibility24-hour accountability Improved continuity and coordination of
care Increased nurse, patient, and physician
satisfaction
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Disadvantages:Excellent communication requiredAccountability of associate nursesPatient transfers disrupt continuity of careCompensation and legal responsibility for
staff nursesUnwillingness of associates to take direction
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RN designs, implements, and is responsible for nursing care for duration of the patient’s stay on the unit
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Advantages: Improved continuity of care and
accountability for care Disadvantages:
Decreased ratio of RNs to nonprofessional staff
Potential for junior team members to assume too much responsibility
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RN and partner (UAP, LPN, or less experienced RN) work together on same schedule with same group of patients
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Case manager supervises care provided by licensed and unlicensed nursing personnel
Critical pathways provide direction for managing care of specific patients
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Small unit of care that maintains itself Dynamic, interactive, self-aware, and
interdependent Proven to improve teamwork,
communication, and continuity of care
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Segmenting hospital into smaller units Primary Care Team model Collaborative Patient Care Team model Transitional Care model Hospital at Home model
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Communication skills Ability to delegate Problem-solving skills
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Chapter 4Chapter 4
Leading, Managing, FollowingLeading, Managing, Following
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Are Managers Direct work of professionals and
nonprofessionals to achieve desired outcomes
Can use leadership skills to be effective and successful
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Leader: Anyone who uses interpersonal skills to influence others to accomplish a specific goal
Manager: An employee who is responsible and accountable for efficiently accomplishing the goals of the organization
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Achieve consensus within the group about goals
Maintain structure that facilitates accomplishing goals
Supply information that helps provide direction and clarification
Maintain group satisfaction, cohesion, and performance
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Clarify the organizational structure Choose the means to achieve goals Assign and coordinate tasks Evaluate outcomes and provide
feedback
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Formal: Practiced by a nurse with legitimate authority described in a job description
Informal: Exercised by a staff member who does not have a specified management role
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Trait theories Inborn traits of successful leaders
Behavioral theoriesLeaders made through education,
training, and life experienceLeadership stylesDimensions of behavioral styleSystem 4 managementManagerial gridContinuum of leadership behavior
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Contingency theoriesLeaders adapt style to situationFiedler’s contingency theorySituational leadership theoryVroom-Yetton expectancy modelHouse-Mitchell path-goal theoryExpectancy theory of motivation
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Contemporary theoriesQuantum leadershipCharismatic leadershipTransactional leadershipTransformational leadershipRelational leadershipShared leadershipServant leadership
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Situations Tasks Individuals Future expectations
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Autocratic Individuals are motivated by external forces i.e.
power, authority, and a need for approval Democratic
Individuals are motivated by internal drives and impulses, and want active participation in decisions
Laissez-faire Individuals motivated by internal drives and need
to be left alone to make decisions. Bureaucratic
Assumes employees are motivated by external forces
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Planning Organizing
Process of coordinating the work to be done
DirectingProcess of getting the organization’s work
done Controlling
Establishing standards of performanceMeasuring performanceEvaluating performanceProviding feedback
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Interpersonal roles Informational roles Decisional roles
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Information, people, actionCommunication and control at the
information levelLeading and linking at the people levelDoing at the action level
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Communication and relationship management
Knowledge of the health care environment
Leadership Professionalism Business skills
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Staff nurse First-level manager Charge nurse Clinical nurse leader
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Need followers to lead Need followers to accomplish goals and
help team succeed Are followers too
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Influence leaders Vary from passive to active, dependent
and uncritical, to independent and critical
Share qualities with leaders
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Energy Enthusiasm Commitment Ability to inspire others to commit to
goals
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Connect to pressures of front-line staff Are passionate about creating quality
work environment Generate energy to do the impossible
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Have emotional intelligence and social competence
Maintain a positive environment Emphasize the importance of emotions
and relationships in success