NUR 410 Midterm Review Week 2 PDF

NUR 410 Midterm Review -- Week 2 ================================ **[Week 2 Learning Objectives ]** - *Compare and contrast leadership and management* - *Explain the functions of a nurse manager* - *Discuss management and leadership roles in nursing* - *Describe seven types of power* -...

NUR 410 Midterm Review -- Week 2 ================================ **[Week 2 Learning Objectives ]** - *Compare and contrast leadership and management* - *Explain the functions of a nurse manager* - *Discuss management and leadership roles in nursing* - *Describe seven types of power* - *Examine the differences between psychological and structural empowerment* - *Define shared governance in nursing* - *Identify different organizational structures and cultures* - *Describe quality practice environments* - *Compare and contrast models of care* +-----------------------------------+-----------------------------------+ | **Leadership** | **Management** | +===================================+===================================+ | - The process of influencing | - The accomplishment of tasks | | others | or goals | | | | | - Creative thinking | - Has formal authority to | | | direct the work of a given | | - Establishes a vision, sets | set of employees -- evaluates | | direction, communicates | outcome and assess if care is | | values | cost effective and productive | | | | | - Motivates, inspires and | - Engages in analysis and | | empowers others | problem solving | | | | | - Produces change | - Takes responsibility for the | | | quality and cost of work | | - You can be a good leader, but | | | not necessarily a good | - Produces results | | manager & vice versa | | +-----------------------------------+-----------------------------------+ **Management Functions** - Involves systematic **planning, organizing, leading, coordinating and controlling of staff, resources and services** to ensure the delivery of timely, safe and effective patient care - **Planning** - Choosing appropriate goals and objectives - Determining which strategies to use, which actions to take - Deciding which resources are needed to achieve goals - **Organizing** - Establishing structure to achieve the plan - Determining roles, tasks, and oversight - **Leading** - Articulating a vision - Energizing employees - Inspiring and motivating people using: - Vision - Influence/persuasion - Delegation - Effective communication & conflict management skills - **Staffing** - Recruiting, hiring and retaining employees for positions within teams and departments - Part of career planning and development - **Controlling** - Evaluating how well: - Goals were achieved - Performance was improved - Actions were taken - Establishing standards to measure, compare and make decisions **Leading and managing as point-of-care nurses** - Planning -- plan for clinical goals for the day (e.g. prepping patient for surgery) - Organizing -- work with colleagues to establish plans - Leading -- assign, delegate, or direct work to other clinical staff - Controlling -- change work process based on unexpected clinical events **Why does a nurse/nurse manager need to be both a leader and manager?** +-----------------------------------+-----------------------------------+ | **Nurses as managers** | **Nurses as leaders** | +===================================+===================================+ | - Point-of-care nurses need to | - All forms of nursing practice | | accomplish clinical tasks and | involve influencing others, | | maintain quality within | being persuasive, creative | | finite resources | thinking, and establishing a | | | vision for practice | | - Similarly, nurse managers | | | need to accomplish | | | organizational tasks (e.g. | | | run the unit) and maintain | | | quality within finite | | | resources (e.g. budget and | | | staffing) | | +-----------------------------------+-----------------------------------+ | - Both require influence on | | | others and persuasion skills | | | | | | - Lead team meetings with | | | family, therapy, mental | | | health | | +-----------------------------------+-----------------------------------+ **How might nurse/unit manager positively influence the work life of nurses?** - Exhibit a good combination of being both a manager and leader - Exhibit transformational/relational leadership - Exhibit and support clinical leadership in front-line nurses - Promote a safe, open, and democratic unit culture - Have a good vision to inspire others **Types of management in nursing** +-----------------------------------------------------------------------+ | **Nurse Managers** | | | | ***Titles:*** | | | | - unit manager, nurse manager, nursing unit supervisor, clinical | | manger, nursing unit administrator (NUA) | | | | ***Responsibilities:***\ | | - have a range of complex responsibilities, primarily related to a | | unit, or set of specific clinical services | | | | \- Promote high **quality care** w/r/for patient/family rights and | | preferences (deal with complaints) | | | | \- participate in nursing policy formation and decision making | | | | \- participate in recruitment, selection, and retention of personnel | | (nurses and others) | | | | \- assume oversight for staff performance | | | | \- provide feedback and valuation for staff | | | | \- promote staff and patient safety | | | | \- develop, implement, and monitor unit budget | +=======================================================================+ | ***Performance Appraisal*** | | | | \- individuals evaluations of work performance | | | | \- often performed annually, although may occur more frequently | | | | \- feedback provided to employees aimed at: | +-----------------------------------------------------------------------+ | ***Unit-based performance measures (inpatient surgical unit | | example)*** | | | | A. Clinical Quality | | | | - Patient falls | | | | - Medication errors | | | | - Restraint use | | | | - Infection control reporting of wound and catheter associated | | infections | | | | - Injuries to employees resulting in back injuries | | | | - Chart audits to meet compliance standards | | | | - Competency records of nursing staff | | | | B. Access | | | | - Tracking of time to accept pts from the ED | | | | C. Service | | | | - Pt satisfaction surveys | | | | - \# of complaints against staff | | | | D. Cost | | | | - Nursing staff productivity | | | | - Maintaining or exceeding budgets | | | | - \# of OT hours | +-----------------------------------------------------------------------+ | **Nurse Executives** | | | | ***Titles:*** | | | | - Director of Nursing, Chief Nursing Officer, Chief Nursing | | Executive, Vice President, CEO | | | | \- require masters/more educational training | | | | ***Responsibilities:*** | | | | \- Establish a vision and direction for the nursing practice at an | | organizational lvl | | | | \- ensure that all nursing care is consistent w the objectives of the | | org | | | | \- select, supervise, and develop other execs and managers | | | | \- manage important and/or high-cost operation issues at an org level | | | | \- multi-hospital systems may have a single Chief Nursing Executive | | | | \- Rep nursing interests in top-level meetings | | | | \- sometimes lead other departments in addition to nursing | +-----------------------------------------------------------------------+ | **Point of Care Leadership** -- for staff involved in the direct | | delivery of care | | | | ***Titles:*** | | | | - Charge nurse, head nurse, shift supervisor, team leader, client | | care coordinator | | | | ***Responsibilities:*** | | | | \- Coordinate the activity for staff nurses and supervise other | | healthcare team members | | | | \- may or may not have managerial authority over the nursing staff | | they are leading (i.e., cannot terminate or formally reprimand | | followers) | +-----------------------------------------------------------------------+ | **Nurse Preceptor --** supports the growth and development of | | students and new staff | +-----------------------------------------------------------------------+ | **Nurse Educator --** develops, implements, and evaluates staff | | education | +-----------------------------------------------------------------------+ | **Nurse Champion --** promotes the implementation of either unit or | | organizational change | +-----------------------------------------------------------------------+ **Representation in Nursing Leadership** - Under-representation of racialized and non-binary nursing leaders - Black, indigenous and nurses of colour represent less than 20% of leadership roles - **Barriers:** systemic racism, discrimination, lack of mentorship and networking opportunities, and biased hiring processes - **Strategies to promote representation**: mentoring, inclusive work culture, collaboration, education, and training **Power** - The ability to mobilize resources (human and material) to get things done - Can be seen as positive or negative - May involve influence and authority, can contribute to order and effectiveness **Types of Power in Leadership** - **Legitimate:** based on formal position providing the right to exert influence and expect compliance - **Referent:** informal power where others recognize a person has special qualities and is admired - **Expert:** when a person is respected for their expertise, including knowledge and skills - **Persuasive:** when a person uses persuasion to influence others - **Coercive:** based on punishment when someone does not do what is desired - **Reward:** the ability to reward others when they perform well - **Informational:** power that arises when a person can access and share information **Psychological Empowerment** - **Individual level construct** - Cognitive, subjective,, and motivational process where individuals perceive themselves as having the ability to influence their work environment and outcomes - **Meaning:** degree to which individuals find their work meaningful and aligned with their values - **Competence:** belief in one's capability to perform work activities with skill - **Self-determination:** sense of having control over one's work and the autonomy to make decisions - **Impact:** perception that one's actions can influence organizational outcomes - Psychological empowerment leads to positive work behaviours and influences: - Burnout - Job satisfaction - Retention **Structural Empowerment** - **Organizational level construct** - Focused on the structures, policies and practices within an organization that provide power, authority, and control to staff - Access to opportunity - Access to information - Access to support - Access to resources - Structural empowerment influences: - psychological empowerment - stress levels and burnout - job satisfaction - retention - overall performance ***Span of control*** - the number of individuals supervised by a manager - span of control impacts manager's ability to supervise - as span of control increases, organizations may experience increased adverse outcomes (patients and staff) and decreased job satisfaction **Organizational Structure** - **design of organization** - Characterized by: - **Complexity:** division of labour, specialization on labour, number of hierarchical levels, and geographic dispersion - **Formalization:** degree to which an organization is guided by rules and policies that define a member's function - **Centralization:** location where decisions are made - **Centralized organizations** make decisions at the top -- more common in larger organizations - Decisions are made at or closer to the level of patient care in **decentralized organizations** - **Flat organizations:** few layers of manager between staff and senior administrators - **Tall organizations:** many layers of managers -- aka hierarchical structure **Shared Governance** - Shared decision making among different roles in an organization - Sometimes referred to as professional practice model - Allows nurses within organization to be involved in decision making related to their professional practice - Might include a council structure -- where different unit level committees influence care policies and procedures, and address practice issues **Mission, Vision, and Values** - **Mission:** described the organization's purpose or focus - **Vision:** describes the long-term goals and aspirations of where the organization wants to be in the future - **Values:** guiding principles and beliefs that shape behaviour and decision making within the organization **Organizational Culture** - Based on shared experiences of members - Socially constructed - Helps to make sense of workplace & experiences - Invisible, intangible - Every organization has a unique culture - Impacts employee productivity, commitment, and morale - *Safety Culture:* - Leadership commitment to safety - Open communication founded on trust - Organizational learning - Non-punitive approach to adverse event reporting and analysis - Teamwork - Shared belief in the importance of safety - *Just Culture:* - An atmosphere of trust in which healthcare workers are supported and treated **fairly** when something goes wrong with patient care - Open communication - Repairing harm - Learning vs. blaming **Quality practice environments** - A quality practice environment supports the delivery of safe, compassionate, competent, and ethical care while maximizing the health of clients and nurses - Communication and collaboration - Responsibility and accountability - Safe and realistic workloads - Leadership - Support for information and knowledge management - Professional development - Organizational culture **Healthy Work Environments** - Healthy work environments in nursing are workplaces that promote the physical, mental, and emotional well-being of nurses. - Characterized by: mutual respect, effective communication, and a commitment to safety and quality care - Quality/effective leadership - Relational exchange - Communication and collaboration - Effective teamwork - Professional autonomy - Environmental elements - Contextual factors **Sample Strategies** - Regular staff meetings and opportunities to provide input and feedback - Create brave spaces and address bullying - Implement policies that support the mental health of providers (code lavender) - Implement policies that promote a healthy balance between work and personal life (e.g., self-scheduling) - Staff wellness programs - Mentorship programs - Acknowledge and celebrate staff success **Models of care:** - **Collaborative practice/team-based care, functional, individual, primary** **Collaborative practice/team based care** - Diverse inter/intra-professional teams supporting patients, typically led by a nurse team leader - Seen by some as the ideal model - May be used in times of nursing shortages - **Benefits**: - Improved patient satisfaction and patient outcomes - **Drawbacks**: - Potential for fragmented care if leadership skills are lacking **Functional** - Work is divided up by task, includes both regulated and unregulated care providers - For example, one nurse does vital signs for all patients - **Benefits**: - Staff become more efficient at completing their tasks - **Drawbacks**: - Care may become fragmented -- psychological and emotional needs may not be met & changes in patient status may not be noticed - Can become complicated to implement and challenging for patients and families to know who to consult - May result in staff dissatisfaction **Individual** - Oldest care delivery model - Single nurse takes full responsibility for a patient or group of patients during a shift - **Benefits:** - Consistency for patients, may result in improved satisfaction. - Easier to detect changes in patient status - **Drawbacks:** - Costly for organizations - Challenging to implement during nursing shortages **Primary** - A single nurse is assigned accountability for managing all aspects of a patient's care plan - Other **nurses** follow the primary nurse's plan of care - **Benefits:** - Improved relationship w patients and families, which results in increased satisfaction - **Drawbacks:** - Not all nurses will have sufficient exp to function in this role - Potential for communication gaps - Challenging when shortage of nursing staff exists