Nursing Management - Exam 2 (part 1)

olanjones's version from 2017-06-24 14:34

Making Decisions & Solving Problems: difference in 2 processes

Question Answer
Define problem solving and decision makingProblem solving: is focused on trying to solve an immediate problem (can be viewed as a gap btwn “what is” & “what should be”)
Decision making: purposeful & goal-directed effort that uses a systematic process to choose among options (hallmark of decision making is the ID & selection of options)
Before attempting to solve a “problem” ask1. Is it important?; 2. Do I want to do something about it?; 3. Am I qualified to handle it?; 4. Do I have the authority to do anything?; 5. Do I have the knowledge, interest, time, resources to deal w/ it?; 6. Can I delegate it to someone else?; 7. What benefits will be derived from solving it?
Problems solving- includes the decision-making processTime: take time to discover the real issue
Exposure: learn what others have done
Assistance: have members of the team investigate all aspects of issue
Creativity: brainstorm to identify possible solutions
Hit it: implement w/ best solution
List the phases of the decision making processdefining objectives, generating options, identifying advantages/disadvantages of each option, ranking the options, selecting the one most likely to achieve the objectives, implementation, & eval of the results - similarity with change & nursing process
Approaches for fairly routine, predictable decisionsNormative or prescriptive approach - agency policy, standard procedures, analytical tools can be applied to situation that are structured & in which options are known
Approaches for non-routine, unpredictable, unstructured decisionsDescriptive or behavioral approach – must gather more info, use creativity, experience, & group process
Pros & cons to ‘satisficing’decision maker selects solution that minimally meets the objective of standard for a decision – allows for quick decisions, may be most appropriate when time is an issue
Pros & cons to optimizingdecision maker selects the option that is best, based on analysis of pros & cons assoc. with each option; better decision is more likely but takes longer
Values affect all aspects of decision makingValues are determined by cultural, social, & philosophical background & provide a background for one’s ethical stance – Affects from statement of the problem all the way though to the evaluation process
Criteria of effective decision making1. “High quality” decisions achieve the predefined goals, objectives, & outcomes
2. Those who are responsible for its implementation must accept the decision
Achieving both is possible but requires more involvement and approval from those affected by the decision
List advantages of group decision makingMore ideas can be generated, Followers included in the process are more likely to accept the decision, Implementation is often easier, better if consensus is used (requires that all participants agree to go along with the decision) *Watch out for group think & sabotage!*
List disadvantages of majority ruleOnly 51% group approval is needed – Individuals may follow formal leader even if they don’t agree d/t fear of reprisal; If informal leaders fall into the minority opinion, they may not support the decision of the majority; Certain members may build coalitions to gain support for their position to block the majority choice
Decision-making techniques- Brainstorming: list of ideas states without critique or discussion – emphasis is on volume not quality
- Brain writing/nominal group technique: 1. participants silently write down ideas (not usu >10 mins), 2. discuss of merits/clarification after all ideas are presented, 3. members privately rank each option & highest rank is chosen
- Focus groups: face-to-face discussion where ideas are validated or disagreed with by members
- Delphi technique: systematic collection and summarization of opinions & judgments from respondents (e.g. expert panels); opinions are repeatedly fed back to respondents w/ request for more refined options, btwn rounds the results are tabulated & analyzed – goal is to achieve consensus
Describe decision-making tools- Decision grids- facilitate visualization of the options under consideration & allow comparison using common criteria
- Fishbone cause & effect diagram- graphically displays all possible causes r/t a problem to try to discover its root causes; the “effect” is problem statement at the “head” of the fish & major categories of cause are main bones, which are supported by smaller bones (issues that contribute to main causes)
Meaning of SWOT & when it is usually usedStrengths, Weaknesses, Opportunities, & Threats; used in strategic planning, marketing efforts, by individuals & groups in decision making
Process (include ID of problem in a short statement; most important step)1. ID the problem
2. Gather assessment data
3. Plan based on analysis of data
4. Implement a solution
5. Evaluate the result
Intentionally not making a decisionpurposeful inaction- might be indicated when other persons should resolve problems or when the problem is beyond one’s control
Shared governance – who participates, how are decisions made, role of nurse execnecessary levels of authority & accountability is vested in the nurses who deliver care, management serves to coordinate & facilitate the work of the practicing nurses


Question Answer
Historical perspective of delegationUntil early 1970s was common; Team nursing used, staffing ratios were such that often few RNs on unit, direct care (simple treatments) often provided by LPNs. As care became more intricate, staffing moved to more RNs; knowledge of delegation↓ because nurse’s provided all pt care
Delegation isThe transfer of responsibility for the performance of a task from one individual to another while retaining the accountability for the outcome
Delegation is notHaving someone else do unpleasant tasks; To get rid of tasks you don’t have time for; Telling someone how to/to do their job; Supervising other’s work/techniques; Being bossy
Define accountabilityDetermines if the actions were appropriate and provides a detailed explanation of what occurred
State laws & delegation, to include CNAsState boards of nursing are vested in protecting the public; they regulate the educational preparation & practice of professional nursing - Includes certified nurses aides (Article 4 of Act)
Differentiate btwn assignment & delegationDelegation is task related – cannot transfer accountability
Assignment is reasoning & judgement based – transfers accountability, authority, & responsibility
Importance of delegationPt care in a timely and cost-effective manner
Legal authority to delegateby virtue of the professional nursing license, is the ability to transfer selected nursing activities in a given situation to a competent individual
Selecting & supervising the delegateeSelect a competent & capable delegatee for the task – NOT just someone who is willing (delegatee should be qualified to do the task)
Delegation decision-making in terms of which tasks may be safely delegated to whom-Safety: Assess the pt first! If the patient is unsafe for any reason delegation may not be appropriate - pt's medical condition must be stable & predictable
-Education: Assess that delgatee is adequately trained/certified to perform delegated task
-Critical thinking: Nurse determines if delegation is appropriate and then either assigns task & monitors or does not assign task & educates/supervises
*Seek & report deviations/issues (patient & performance); Provide feedback, Act on data
Delegation-process challengesCommunication and Direction; should be open and clear
When there is a clear understanding btwn delegator & delegatee about a particular situation, the greater the change it will produce a positive outcome.
Steps of the delegation process1. Select delegate
2. Communicate
3. Give authority and responsibility
4. Communicate again after the task is completed
Benefits of delegationAllows more staff availability to assist w/ ADLs; Helps others develop skills & confidence; An effective team utilizes members of the team to conserve time (but that should not be sole consideration)
Basic principles of delegation1. Legally appropriate to delegate
2. Plans intervention and determines whether the delegatee is competent to perform safely
3. Implements plan including observation of the delegatee
4. Evaluates whether the delegation process was completed safely and effectively
Indirect delegationtasks assigned to a UAP defined through job description (VS, glucose meter) - AKA passive delegation
State Nurse Practice ActRules & regulation that provides the legal structure for delegation (Code of Ethics for Nurses provides ethical structure)
3 things that RN can never delegateInitial assessments, Education (teaching), Anything that requires nursing judgement
3 things that manager can never delegateFormal praise/recognition, Disciplinary actions, Management accountability

Collective Action

Question Answer
Collective actionpower in numbers, teamwork (ex. unionization)
Discuss the benefits of collective actionPower in #of voices, ↑wages & working conditions, Formal way to negotiate w/ management; Improve patient quality of care, patient assignments; Right to defend self against disciplinary processes, Can’t be terminated unless manager proves employee is wrong/in error
Responsibilitythe ‘charge to act’
Authorityuse of nurses’ power to advocate for patient
Autonomyfreedom to make independent decisions
Discuss governance in an organization, especially shared governance- Bureaucracy: centralization of authority in administrative bureaus or government depts (inflexible approach to decision making w/ lot of red tape)
- Matrix: reflect both function & service in integrated organizational structure (enables timely response to forces in external environment; facilitates internal cooperation)
- Flat: removal of hierarchy layers, authority placed at action level (can makes changes in real time but potential for inconsistent decision making, loss of growth opportunity)
- Shared governance: professional autonomy, are accountable and have authority to make decisions (AKA professional practice models)
Collective bargaining, what it is & history- Mutual obligation of employer & reps of employees to meet at reasonable times & confer in good faith w/ respect to wages, hours, other terms & conditions of employment or negotiation of any agreement/question arising from those terms; Secure reasonable & satisfactory working conditions of employment, inc right to participate in decisions
- Historically a "good" nurse was obedient & acquiesced to authority; served the physician; was considered altruistic & self-sacrificing (in religious orders/nuns)
Nat'l Labor Relations Act (NLRA) in 1935
(AKA Wagner Act)
Established election procedures for employees to able to choose their collective bargaining reps freely
National Labor Relations Board (NLRB)independent agency of US gov’t charged w/ conducting elections for labor union representation & w/ investigating & remedying unfair labor practices
Taft-Hartley amendments of 1974Removed non-profit hospital exemption from the 1947 Taft-Hartley Act (which affirmed the right of states to enact Right to Work laws)
Describe nurses as knowledge workersskilled workers with college degrees/certifications - When they unionize they are more similar to associations that traditional unions; As knowledge content increases the practice of the worker is guided more by science that by procedure; shared governance is a reframing of knowledge work
Discuss union & at will employment- Union: labor contract that requires management to follow due process; must provide written statement outlining disciplinary charges, penalty, & reasons for penalty; employee has right to defend themselves w/ rep present
- At will: may be terminated at any time for any reason except discrimination (nurses in these positions need to know their rights & accountability)
Discuss Right to Work States - Alaska is not oneRight to Work law guarantees that no person can be compelled, as a condition of employment, to join or not to join, nor to pay dues to a labor union
Discuss whistleblower & legal protection- 1989 protection act that refers to a warning issued to the public by a current or former employee of an organization about serious wrongdoing or danger created by org.
- Whistleblower act protects federal workers but does not cover the private sector; Some states have specific laws (whistleblowers need to understand the consequences of action & inaction)
Adversarial relationships, role of nurse manager & director of nurses, supervisor per NLRBOrganizations want all nurses to be considered managers (aka not in union) so that the union will hold less sway; Unions want it recognized (as supreme court did 1996) that RNs are not statutory supervisors - "Supervisors" must have authority to hire/fire (charge nurses are not supervisors)
What do nurses want in the workplace for job satisfaction?Respect, A future-focued direction, Control of decisions that will affect them, Rewards & recognition, Balance of life & work, Professional development guidance
AKA - Good Leadership!