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Nursing Management - Exam 3 (part 2)

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

Care Delivery Systems Ch 13

Question Answer
Delivery systems influence practice decisionsAffected by: Pt volume, high-risk pts, acuities; Nurse staff shortages/sched; Budgets
1. Case or private duty (Florence Nightingale)Total care of patient & environment (open windows, clean water, etc); Care is consistent & holistic but very costly
2. FunctionalDifferent tasks assigned by skill set, “assembly line” nursing care; became popular after WWII (very cost effective, each nurse became expert in an aspect of care, but very ↓pt & nurse satisfaction)
3. TeamCoordinate patient assignments to RN, LPN, & UAPs: similar to functional but a small functional group is assigned to small group of pts (pt know who their nurse is); efficient & less costly but not used as much now
4. Primary24 hour accountability: similar to the way doctors function (nurses never get a break because they are responsible for the pt even when they are off shift)
5. Case managementCoordinate of care for multiple needs for a patient: involves looking at pts across their life-span; hard to get payment coverage even though it prob keeps people out of the hospital; May use critical pathways & differentiated practice
Hospital systems can be hybridsMay have some type of patient-focused or partnership model delivery systems
Least expensive, most cost effective, & most efficientFunctional (but also least satisfying for all)
Most & least fragmented care; effect on patient and nurse job satisfactionMost fragmented care = functional (team also has potential to be fragmented); Least fragmented = Case manager or case/private duty???; the more fragmented and structured delivery systems seem to have a negative effect on both nurse & pt satisfaction (care seems less holistic & more ‘manufactured’)
Patient: ‘who is my nurse?’Some care delivery systems make it difficult for the pt to know who is directly responsible for care (esp. functional delivery system)
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Staffing & Scheduling

Question Answer
Percent occupancy of unitsTotal # of actual patient days divided by the total # of bed days available
Make 12 & 8 hour schedules, similar to ones in class• Remember to always have appropriate coverage (not too many hours, nor too few)
• Full-time employees must have 80 hrs every two weeks
• Work part-time as little as possible & you should respect times they don’t want to work (don’t sched them for those – they may not show up)
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Power – Influencing Ch 10

Question Answer
Types of power - Personal & Professional (i.e. b/c you’re an RN)May include: Coercive (low-level but most powerful), reward, expert, legitimate, referent, connective, informational, perceived
Most effective in short term & long termShort Term - Coercive may work in short term but is a highly unsatisfactory basis for long term (from Handbook of Management and Leadership)
Long Term - Power that you share? That or maybe expert or professional (from my head - guessing)
Professional organizations & powerNursing does not exist in a vacuum, nor do nurses work in isolation (power in numbers); Collaboration & collegiality require that nurses work collectively to ensure that the voice of nursing is heard in the workplace & the legislature - Volunteer to serve on committees/task forces, Become active members of nursing organizations, get involved in councils (pg 177)
Powerlessnessan imbalance of power btwn the consumer & the system can result in value systems being forced on the recipient of care
Oppressed group behaviorWhen a population is dominated by another group it begins to take on the dominant group’s characteristics & rejects the characteristics of its own group often bullying/abusing its own peers
Horizontal violenceConflictual behavior among individuals who consider themselves peers w/ equal power but who have little power w/in the system (AKA lateral violence)
Robert’s Rulesmay seem overly structured but are particularly helpful when diversity of opinion is likely or important (help the chairperson set limits on discussion & provide order of priorities for concerns)
“I” messages in managementShould describe Behavior, Effect, Feeling; Since it is you who have the problem, you need to take ownership of it in an assertive, self-disclosing, open, honest, & direct way with your team members. Usually it’s not enough to describe the other person’s behavior and tell them you’re upset about it; they need to know why (from Gordon training int'l)
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Careers - Trajectory Ch 29

Question Answer
CV vs. resume – difference, includes what? What is order of entriesPrimary differences btwn a resume & a curriculum vitae (CV) are length, what is included, & what each is used for; Typically both are listed in reverse chronological order
CV: 2-3 pages; provides a summary of one’s experience & skills (inc academic background, experience, research, awards, publications, etc); used when applying for international, academic, education, scientific, medical or research positions or when applying for fellowships or grants
Resume: 1 page; summary of education, work history, credentials, may have an objective; most common document requested of applicants in job applications
*Reason or goal for having a CV or resumeto outline your qualifications & acknowledgements that make you a good candidate for a job (e.g. to be a preceptor)
Interview questions – behavioral focusQuestions that focus more on experiences, behaviors, knowledge, skills & abilities (e.g. Give me an example of your previous role when you displayed leadership abilities)
Certification; passing NCLEXThe Board of Nursing states you are competent after you have passed the NCLEX
Patricia Benner’s work & stages of novice to expert5 levels of nursing experience: 1. Novice, 2. Advanced beginner, 3. Competent, 4. Proficient, 5. Expert
Each step builds on the previous one as abstract principles are refined & expanded by experience and the learner gains clinical expertise
Reality shock stages from honeymoon to resolution1. Honeymoon phase: new grad perceives work environment w/ rose colored glasses; focus on learning unit routine, developing new skills
2. Shock phase: encounter discrepancies & inconsistencies in work environment; concerns w/ practice of other nurses
3. Recovery phase: sees balance btwn what works well & what needs improvement; realizes that every nurse defines their own practice and it is their job to be the nurse they want to be (once this is defined good feelings usu return)
4. Resolution phase: new grad has opportunity to define the nurse they want to be; some caution in this stage as they may consider adopting other nurses’ values in attempt to fit in
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