Nursing Management PDF

## Nursing Management ### Fiscal Planning: - A continuous process which involves decisions about using available resources to achieve organizational goals - A learned skill that improves with practice - An important but often neglected dimension of planning - Should reflect the philosophy, goals,...

## Nursing Management ### Fiscal Planning: - A continuous process which involves decisions about using available resources to achieve organizational goals - A learned skill that improves with practice - An important but often neglected dimension of planning - Should reflect the philosophy, goals, & objectives of the organization - A skill increasingly critical to nursing managers because of increased emphasis on finance & "big business" of healthcare - Managers must monitor & evaluate all aspects of the unit's budget control ### Cost Containment: - Refers to effective & efficient delivery of services while generating needed revenues for continued organizational productivity - The responsibility of every healthcare ### Budget: - A plan that uses numerical data to predict the activities of an organization over a period of time - The desired outcome of budgeting is maximal use of resources to meet organizational short & long-term needs ### Criticisms of HMOs: - Loss of existing physician-patient relationships - Limited choice of physicians for consumers - Lower level of continuity of care - Reduced physician autonomy - Longer wait times for care - Consumer confusion about many rules to be followed ### Moral Hazard: - Refers to the propensity of insured patients to use more medical services than necessary because their insurance covers so much of the cost ### Patient Protection & Affordable Care Act: - Put in place comprehensive insurance reforms that were to be phased in over a 4-year ### Fourth Phase of Management Process: - The "doing" phase of management; AKA directing, coordinating, & activating #### Components Include: - Creating a motivating climate - Establishing organizational communication - Managing conflict - Facilitating collaboration - Negotiating, working with unions - Complying with employment laws ### McGregor: Theory X & Y ### Abraham Maslow's Hierarchy of Needs: - Self-actualization occurs when an individual maximizes his or her potential, doing the best they can do ### Maslow suggested that people are motivated to satisfy certain needs, ranging from basic survival to complex psychological needs, & that people seek a higher need only when the lower needs have been predominantly met ### Herzberg's Motivators & Hygiene Factors: - Used to motivate staff - **Motivators:** achievement, recognition, work, responsibility, advancement, & possibility for growth - **Hygiene Factors:** salary, supervision, job security, positive working conditions, personal life, interpersonal relationships & peers, company policy, & status ### Victor Vroom's Expectancy Theory: - States that a person's expectations about his or her environment or certain event will influence behavior - Therefore, if there is an expectation of a reward & it does not occur, the individual is less likely to repeat that behavior in the future ### David McClelland's Basic Needs Theory: - McClelland argued that people are motivated by 3 basic needs: achievement, affiliation, & power ### Saul Gellerman's Theory of "Stretching": - Suggests that individuals should be periodically "stretched" to do tasks more difficult than they are used to doing - The challenge of "stretching" is to energize people to enjoy the beauty of pushing themselves beyond what they think they can do ### Douglas McGregor's Theory X & Theory Y: - **Theory X Employees:** avoid work if possible, dislike work, must be directed, have little ambition, avoid responsibility, needs threats to be motivated, need close supervision, & are motivated by rewards & punishment - **Theory Y Employees:** like & enjoy work, are self-directed, seek responsibility, are imaginative & creative, have underutilized intellectual capacity, need only general supervision, & are encouraged to participate in problem solving - Theory Y is not a "better" management style than theory X; the style which is "best" depends on the variables inherent in each situation ### Strategies to Create a Motivating Climate: - Motivates clients & increases morale & reward the worker as close to the event as possible ### Recognition: - Recognition for a job well done is the most powerful motivational tool - Positive reinforcement must be specific or relevant to a particular performance - Positive reinforcement must occur as close to the event as possible - Reinforcement of new behaviors should be continuous ### Attitude & Energy of Managers: - The attitude & energy level of managers directly affects the attitie & productivity of their employees ### Self-Care & Preventing Burnout: - A burned-out, tired manager will develop a lethargic & demotivated staff ### Factors Influencing Effective Performance Appraisal: - Appraisal should be based on standard - The appraisal tool must adequately & accurately assess job performance - Employee should have input into development of the standard - Employee must know the standard in advance - Employee must know the source of the data gathered for the appraisal - Appraiser should be someone who has observed the employee's work - Appraiser should be someone who has employee trust & respects - Employee should have a clear understanding of the criteria for perceiving the appraisal as fair - Recency, Halo, & Horns effect: - **Recency effect:** occurs when recent issues are weighed more heavily than past performances - **Halo effect:** occurs when the appraiser lets one or two positive aspects of the employee's behavior of the employee unduly influence all other aspects of the assessment - **Horns effect:** occurs when the appraiser allows some negative aspects of the employee's performance to influence the assessment to such extent that other levels of job performance are not accurately recorded ### Common Pitfalls of Performance Appraisals: - Common pitfalls of performance appraisals are halo, recency, horns effect, & central tendency ### Types of Performance Appraisal Tools: - **Trait rating scales:** rates individual against some job requirements - **Job dimension anchored rating scales:** rates desired standard - **Behaviorally anchored scales:** rates performance on job expectations on a scale of important, anchored rates the performance - **Checklists:** rates performance against a set of desirable job behaviors - **Essays:** a narrative appraisal of job performance - **Self-appraisals:** an appraisal of performance by the employee - **Management by objectives:** employee & management agreed upon goals of performance to be reached - **Peer evaluation:** assessment of work performance carried out by peers ### 360 Degree Performance: - Includes being assessed by all individuals within the sphere of influence of the individual being appraised ### Coaching as Part of the Performance Appraisal Process: - During the performance appraisal, the manager should coach regarding performance - Effective manager & astute leader are aware that day-to-day feedback regarding entire performance of the best methods for improving work performance & building a team role ### Manager Approach in Controlling Subordinates: - Distinguish between employees who need progressive discipline & those who are not capable. - It is essential that the employee who should be disciplined so that the employee can be disciplined while being supported - "not demoralizing, psychologist approach, or original employees jeopardizes an organization's moral" - To meet organizational goals, discipline must be used when needed; "manager must also follow rules, policies, & procedures ### Destructive Discipline: - Punitive - Use of threats & fear to control behavior - Employee always alert to impending penalty or termination - Arbitrarily administered & either unfair in the application of rules or in the resulting punishment ### Self-Discipline: ### McGregor’s (Hot Stove Rule): - Four elements must be present to make discipline as fair & growth-producing as possible: - Forewarning - Immediate consequences - Consistency - Impartially - Growth can only occur when employees perceive that feedback & discipline are fair & just ### Strategies to Create an Environment of Self-Discipline: - Clearly written & communicated rules & regulations - Atmosphere of mutual trust - Judicious use of formal authority - Employee identification with organizational goals ### Rules: KNOW ALL OF EM - Define course of action - If a rule or regulation is worth having, it should be enforced - When rule breaking is allowed to go unpunished, groups generally adjust to & replicate the low-level performance of the rule breaker - As few rules & regulations as possible should exist in the organization - Rules are the least flexible type of planning - All rules, regulations, & policies should be regularly reviewed to see if they should be ### Common Steps in Progressive Discipline: - Verbal admonishment - Written admonishment - Suspension from work without pay - Dismissal - If there is a risk of patient/staff/organizational safety these steps can be skipped resulting in immediate dismissal ### Profile of Impaired Nurse: - May vary greatly - Typically, behavior changes are seen in the following three areas: - personality/behavior changes - Job performance changes - Time & attendance changes - Defensive & denial of charges when confronted ### Chemicals Most Commonly Abused by Nurses: - Alcohol (most frequently used), demerol, oxycontin, klonopin, valium, & morphine ### Confronting the Chemically Impaired Employee: - Gather as much evidence as possible of the employee's impairment - Immediate confrontation is necessary if manager suspects employee may be impaired & thus poses a risk to clients - Denial of the impairment or use of defense mechanisms should be expected; manager should not nurture or counsel the employee - The manager should outline the plan for the employee to overcome chemical impairment - As a rule, a staff nurse DOES NOT confront a chemically impaired nurse it should be reported to a nurse manager ### Decision Making, Problem Solving, Critical Thinking, & Clinical Reasoning: - **Decision Making:** complex, cognitive process of choosing a particular curse of action; the thought process of selecting a logical choice from available options - Making choices or reaching a conclusion, choosing between courses of action - Quality of decisions is influenced by the questions & alternatives that are generated from the process - **Problem Solving:** part of decision making; systemic process focusing on analyzing a difficult situation involving higher-order reasoning & evaluation ### Time Management: - Making optimal use of available time - Because time is a valuable resource, learning to use it wisely requires both leadership skills & management functions - There is a close relationship between time management & stress - Good time-management skills allow an individual to spend time on things that matter - Good time-management results in an increase in productivity in healthcare organization; poor time management can result in decreased patient satisfaction ### Organizational Communication Strategies: - Leader-managers assess organizational communication - Leader-managers understand the organization's structure & recognize who is affected by decisions - Communication is not a one-way channel; communication must be clear, simple, & precise - Senders should seek feedback whether communication is received - Multiple communication methods should be used; this increases the likelihood the message is being interpreted correctly ### Two Types of Negligence: - Ordinary negligence - Professional negligence (AKA malpractice) - Failure of a trained professional to act in a reasonable & prudent manner ### Criteria to Meet when Handling Understaffing Issues: - Decisions made must meet state & federal labor laws & organizational policies - Staff must not be demoralized or excessively fatigued by frequent or extended overtime requests - Long-term as well and short-term solutions must be sought - Patient care must not be jeopardized ### Training VS Education: - **Training:** organized method of ensuring that people have knowledge & skills for a specific purpose & that they have acquired the necessary knowledge to perform the duties of the job - **Education:** more formal & broader in scope than training - Training has immediate use; education is designed to develop individuals in a broader sense - One of the best indicators in knowing that learning has occurred is that they are now having a behavioral change.