Nursing Management - Exam 3 (part 1)

olanjones's version from 2017-06-24 14:35

Selecting, Developing, & Evaluating Staff Ch 15

Question Answer
Performance appraisal session – what should employee by allowed to do???? Ask questions, give his/her side of the story, perform self-eval?
Recency biasWhen managers focus on what employee appears to have done in the last weeks or months, rather than looking at entire eval period – can be positive or negative
Halo effectWhen managers form a generalized positive impression of employee, & give a high rating on all criteria even if they don't really deserve it – employee may not get needed feedback
Evaluation tools• Narrative – requires manager to write a statement about employee’s performance
• Forced distribution - eval sentences requires manager to choose btwn 2-3 choices to describe employee actions/tasks/performance (e.g. always, usually, never)
• Traditional rating – highly structured scale that includes employee attributes which are ranked (usu btwn poor - excellent)
Performance appraisal tools – ‘ideal’ formShould be based on mission & goals of the organization – a combination of several methods is prob superior to any one method; primary success lies in the skills & communication abilities of the manager (pg 287)
Anecdotal notes – written behaviors, used for what?Provide input for annual eval, Document negative & positive work; Should be brief, concise, & objective, written as close the incident as possible, & include behaviors & plan for change
Objective measurementsmost objective possible – NCLEX?
Subjective measurementsno ranking criteria given; more opinion based

Costs & Budgets Ch 12

Question Answer
GNP in US for healthcare(Supposed to be GDP?)• The large portion of the GDP that is spent on health care diverts funding from needed social programs such as childcare, housing ,education, transportation, & the environment
• ↑Price of goods & services compromises the country’s ability to compete in the international marketplace – as amount of GDP healthcare expense rises, the healthcare industry becomes more vulnerable to external influences (i.e. regulation)
Health care cost per person in US annually$8000 (pg 212)
How many trillion dollars are spent on healthcare in the US annually?$2.6 trillion; 17% of the gross domestic product (in 2011); projected cost for 2021 is $4.8 trillion
LOSLength of stay (pg 215)
PPSProspective payment system – third-party payer decides in advance what will be payed for a service or episode of care; if costs are greater than payment, provider absorbs the loss; if costs are less than payment, provider makes a profit
DRGsDiagnosis related groups – classification system that groups pts into categories based on average number of days of hospitalization for specific medical dx, considering factors such as age, complication, & other illnesses; payment includes expected costs for diagnostic tests, therapies, surgery, & length of stay (often do NOT reflect the variability of pt intensity or acuity)
NTK Managed care as cost containmentBrings together delivery & financing into one entity; Major goal is to ↓unnecessary services which ↓costs
NTK Clinical pathwaysTask-oriented care plan that details essential steps in care of pts w/ a specific clinical problem & describes the pts expected clinical course; Goal is to standardize care, improve outcomes & reduce cost
NTK Differentiated practiceDefined or differentiated by level of education, expected clinical skills or competencies, job description, pay scale, & participation in decision making; i.e. Assoc. degree RN primarily works at bedside, BSN intervenes to design & facilitate comprehensive d/c based on pt need, APRN provides continuum of care across all settings
BudgetA detailed financial plan, stated in dollars, for carrying out the activities an organization wants to accomplish within a specific period
How nurse managers affect budgetsThey are responsible for meeting the fiscal goals r/t personnel & supply/expense part of operations budget; Managers can control some factors that cause variances but not all - may have to look for other areas budget can be cut when unavoidable costs go up (such as supply costs)
factors that can cause budget variances include: pt census, acuity, vacation & benefit time, illness, orientation, staff meetings, workshops, employee mix, salaries, & staffing levels
3 types of budgets (operating, capital, cash)1. Operating budget: for day to day activities, personnel, supplies, indirect costs (lights, water, cleaning)
2. Capital expenditure budget: expenses r/t purchase of major items such as equipment - items must have a useful life of more than 1 year & must exceed a cost level specified by the organization, anything below that is considered routine operating cost (minimum usu from $300 - $1000)
3. Cash budget: operating plan for monthly cash receipts & disbursements – the financial officer prepares the cash budget in large organizations; understanding cash budget helps manager to discern: when constraints on spending are necessary (even when expenditures are budgeted) & importance of carefully predicting when budgeted items will be needed
Variances – positive and negative & causesThe difference of real "minus" projected; used to be in the red (losing money) or in the black (making money), now negative values are put in parenthesis; causes - personnel, supplies, economy, patient acuities (usu things that vary in direct proportion w/ workload volume)
FTE calculations & definitionEquivalent of one full-time employee working for one year; Calculated as one employee working 8 hours a day, 5 days a week, 52 weeks a year or a total of 2080 paid hours
1 FTE = 2080 hrs/yr (8 hrs X 5 days X 52 wks); = 40 hrs/wk (8 hrs X 5 days); = 80 hrs/2 wks (for nursing sched)
Non-productive timePaid non-worked time (still comes out of the budget) - vacations, holidays, sick time
Indirect costsCosts within a unit that are not incurred for direct patient care but are indirect costs of patient care -examples Delivery systems influence practice decisions

Managing & Personnel Problems Ch 24

Question Answer
5 main types of problems w/ personnelAbsenteeism; Uncooperative, immature, attitude; Clinical incompetence; Emotional problems, Chemical dependency (most difficult to deal with - primary symptom is denial)
Strategies to deal with & prevent each problemUse the nursing process – assess, plan, implement/intervene, evaluate/modify/feedback; talk w/ the person, use good communication skills; do not own the person’s problem; provide feedback and document (if necessary)
Absenteeism – effect on patient care?frustrating to others; how it’s handled initially may not be the same as how it’s handled long-term (how should you handle it when your peers are late?)
Clinical incompetencecannot effectively/efficiently perform tasks; find out the reason for incompetence, may want to use a competency evaluation program, give education & training; may need to terminate if can’t/won’t learn
Clinical skills competency programs & skills checklists3-phase tool to help new RN & manager to determine individual learning needs, verify competency, & plan performance goals
- RN completes self-assessment during first week, manager documents observed competency, RN & manager review inventory to identify goals & plan
Uncooperative, attitudesthey may be defensive, angry, have abusive behavior; remind them of employment expectations, discuss strategies to correct problem (but don’t own the problem for them)
Emotional & personal problems – use your psych nursing skills?these are not minor personal problems but ones that interfere with work performance; talk to the person: use “I” messages, reflecting, paraphrasing, summarizing, non-verbal skills, being present, silence, listening; possibly refer to an employee assistance program/counseling (EAP; removes manager from counseling role, is confidential for employee)
Substance abuse/chemical dependency problems – immediate interventionsMay be actual or suspected, Must remove person from direct patient care if it affects patient care adversely; Talk to the person – not just at a reminder but to document communication; follow facility policy/procedures
How to recognize substance abuseDeviation from normal behavior of employee: mood swings, change from a tidy appearance to untidy, unusual interest in pt's pain control, frequent changes in jobs & shifts, increase in absenteeism & tardiness
Impaired nurse programsComprehensive evaluation, case management, & monitoring for nurses experiencing substance use problems; Phases include in-treatment or outpatient detox; education about the disease; group, individual, & family therapy; & most important a relapse prevention program
Boards of nursing have a responsibility to safeguard the public, so they may suspend the nursing license of an identified nurse if they suspect he/she may pose a danger to pts
When to include legal & police /law enforcement & witness??? when something illegal is happening?; witnesses when you need someone to back you up?
IncivilityDisruptive behavior or communication that creates a negative work environment that interferes w/ quality of pt care & safety (aka lateral violence)
Non-punitive disciplineDiscipline w/out punishment: Start w/ informal talk, if no behavior change document the problem. Follow algorithm; focus on improvement & development, have employee submit written plan of action, give feedback or f/u as needed; hopefully behaviors changes, if not may need to terminate
Progressive disciplineEvaluating performance & providing feedback within a specified structure of increasing sanctions
Documentation of problems – in disciplineDescription of incident (objective statement of facts r/t incident); Actions (statement describing the plan to correct/prevent future problems); Follow-up (dates & times that plan is to be carried out inc required meeting w/ employee) One of the most important but most onerous aspects of nurse manager
Steps in progressive disciplinary process – first to lastStart w/ reminder/counseling (not reprimand); if no change next step is reprimand (1st verbal, then in writing); next step is suspension (may be w/ or w/out pay) after which employee may return to work w/ written stipulations; Terminate if problem recurs
Termination procedures1. Management must be confident that everything possible has been done to help employee correct the problems behaviors
2. Manager must recognize that if employee continues it will have deleterious effect on overall organizational functioning & nursing care
3. Employee must have been made fully aware of the problem performance & the fact that all correct disciplinary steps have been followed
4. Manager should check w/ human resources & legal dept before proceeding to make sure termination is justifiable legally & proper steps have been followed
Make sure you follow procedures of facility

Quality Ch 20

Question Answer
Define qualitythe degree of excellence of something, “you know it when you see it” (e.g. Crystal)
Edward Deming’s contribution & focus on quality processShifted the focus of the process on to providing quality for the consumer, instead of focus being on the providers (CQI shift)
Fishbone diagramschart cause & effect
Flowchartdiagram to follow for procedures (if this, then that)
Decision gridslists pros & cons
Pareto chart/rule80/20 rule; 20% of pts cause 80% of problems
Patient satisfaction as reliable sources & useful in QIPt perspectives on care – communication w/ doctors and w/ nurses, communication about meds (esp pain management), responsiveness of staff, discharge info, clean & quiet environment - Assess w/ surveys, focus groups, telephone, observation
“However, patient cannot always adequately assess the competence of clinical performance, and therefore patient feedback and patient satisfaction surveys must serve as only one data source for QI initiatives.”
Goal of QMImprove the system, NOT to assign blame, Re-educate staff, Root cause analysis of system (not just the individual); Use checklists, decrease fatigue, decrease interruptions
Goal of Continuous Quality Improvement (CQI) – responsibility & no ‘blame’ongoing process; preventing errors; staff development about quality philosophy
Quality Assurance differs from Quality Improvement QA discovers & corrects errors using chart audits; QI prevents errors by system changes
Risk management as part of QI analysisAnalyze problems, minimize losses
Sentinel events & Never events – CMS & TJCWrong site surgery, Foreign object left in pt after surgery, Blood transfusion error, Major med error, Severe pressure ulcers, Preventable post-op deaths, Infant abduction, Inpatient suicide
Quality & Safety Education Nurses (QSEN) 6 competenciesPatient-centered care, Interdisciplinary teams, EBP, Use informatics, Safety, Apply quality improvement

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