Final Exam Reviewer NCM 119 PDF

STAFFING & SCHEDULING CONTRIBUTING FACTORS TO NURSING Mandatory overtime Nurse-to-nurse Concepts: hostility Case Method- as...

STAFFING & SCHEDULING CONTRIBUTING FACTORS TO NURSING Mandatory overtime Nurse-to-nurse Concepts: hostility Case Method- assignment of each Poor doctor and Changing nurse relations legislation patient to a nurse for total patient care Budget & staffing Poorly prepared Functional Nursing- hierarchical division cuts managers of labor Negative media Low compensation Team Nursing- system in which RNs stereotyping supervise auxiliary nursing staff SHORTAGE: Modular Nursing- district nursing specific to a geographic area Primary Nursing- system in which RNs STAFFING LEADERSHIP & MANAGEMENT provide total patient care to a few patients Leader: Managed care- delivery of comprehensive health care services >is knowledgeable about staffing and through established networks of scheduling and is accountable for safe staffing hospitals, physicians, and other health >communicates the need for staff mix care providers to give population-wide access to economical, high-quality care >considers the impact of extraneous factors on Case Management- management and staffing coordination of the care a patient >examines the unit standard of productivity receives in all settings during an episode periodically to determine if changes are of illness needed Self-scheduling- staff coordination of their own work schedules >encourages discussion of workload issues Rotating work shifts- alternation of work >encourages a team approach to staffing hours among days, evenings and nights Permanent shifts- shift system in which >enables self-scheduling personnel work the same hours repeatedly Manager: Variable Staffing- determination of the number and mix of staff based on >develops and disseminates fair scheduling patient needs >assumes responsibility for fiscal control and Patient Classification Systems- system quality of staffing for categorizing the acuteness of patients’ conditions to determine >negotiates staff mix coverage staffing needs >provides staffing to meet patient needs >schedules staff in a fiscally responsible way 1 >facilitates discussions of workload issues -this may work satisfactorily during critical staffing shortages. >keeps policies in compliance with laws >matches staff to patient needs CASE METHOD -each patient is assigned to a nurse for total patient care while that nurse is on duty. TEAM NURSING -continuity of care is guaranteed only for one -is based on philosophy that supports the shift. achievement of goals through group action. -the patient has a different nurse each shift and -each member is encouraged to make no guarantee of having the same nurses the suggestions and share ideas. When team next day. members see their suggestions implemented, their job satisfaction increases and they are -the patient care coordinator, supervises and motivated to give even better care. evaluates all care given on the unit. -the team is led by a professional or technical nurse who plans, interprets, coordinates, FUNCTIONAL NURSING supervises and evaluates the nursing care. -personnel of different skill levels are used -team leaders assign team members to according to the complexity of the patients patients by matching patient needs with staff’s care needs. knowledge and skills. They also do the work others members of the team including -team members provide care to a specific unlicensed personnel are not qualified to group of patients under the supervision of an perform such as giving medications, doing RN. complicated treatment, making assessment -the team leader may depend on the charge and teaching. nurse for some clinical decision making and -one of the main features of team nursing is the influences whether the care will be task or NURSING CARE CONFERENCE. Its primary patient-centered. purpose is the development and revision of -implements the classic scientific nursing care plans or the multidisciplinary management principles, which emphasize team’s plans by providing an opportunity to efficiency, division of labor and rigid controls. identify and solve problems. -medication nurse, treatment nurse and -team lead is responsible for planning and bedside nurse are all products of this system. conducting the team conference which should be limited in time and scope. Meeting for 15-30 -it is an efficient system that is least costly minutes at the same time each day. because it requires few RNs. -the nursing care plan is another main feature -RNs may keep busy with managerial and non- nursing duties and nursing aides deliver the of team nursing. It should be realistic, individualized and care must be evaluated. majority of patient care. 2 -Unfortunately, the most educated staff is COLLABORATIVE PRACTICE responsible for supervising the less skilled -can include interdisciplinary teams, nurse- personnel rather than giving care themselves. physician interaction in joint practice, or nurse- The experts are limited to a defined group of physician collaboration in caregiving. patients. DIFFERENTIATED PRACTICE -takes into account the competency, education and skill level of nurses. The aim is to match MODULAR OR DISTRICT NURSING the patient needs with nursing competencies to facilitate the effective and efficient use of -smaller teams care for patients who are nursing resources. grouped geographically. -the RNs role is that of a coordinator and information processor. CENTRALIZED SCHEDULING -when nurses are consistently assigned to the -Pros (fairness is promoted, cost containment same module, continuity and quality of care is facilitated and frees some managerial time) can increase. *Centralized Computer Scheduling-can increase effectiveness and can help match competencies to patient needs. Reduction of PRIMARY NURSING clerical staff and better use of professional -the RN remains responsible for the care of nurses by decreasing the time they spend in those patients 24 hours per day throughout the non-patient care activities. patient’s hospitalization. -Con (there is no individualized treatment) CASE MANAGEMENT DECENTRALIZED SCHEDULING -it focuses on an entire episode of illness, -Pros (managers have authority, staff get including all settings in which the client personalized attention, staffing is easier, receives care. staffing is less complicated) -a case manager identifies, coordinates and -Cons (schedule can be used to punish and monitors services for the patient and family. reward, staffing is time consuming for -the nurse may give care and coordinate it or managers, resources are used less efficiently, just coordinate the care. The nurse may work cost containment is more difficult) across agencies, such as ambulatory clinics, acute care facilities and long term care facilities or may make site visits to the home or SELF-SCHEDULING health care agencies. -typically a grid is developed so nurses can sign up for the shifts they want to work in conformity with the policies. The process might allow 2 3 weeks for staff to indicate the days, shifts, -Cons (most people want dayshift, new weekends, holidays and vacation days that graduates predominantly staff evening and they want. An additional 2 weeks are needed night shifts, difficult to evaluate evening and for negotiations to finalize a schedule that night shift staff, makes it harder for nurses to accommodates both the staff’s and the unit’s appreciate the workload or problems oof other needs. shifts) -Pros (coordinated by staff nurses, saves manager scheduling time, helps develop BLOCK OR CYCLICAL SCHEDULING accountability, increases perception of autonomy, increases job satisfaction, improves -the same schedule is used repeatedly. team spirit, improves morale, decreases -example: 6 days for ward rotation, in which absenteeism, reduces turnover, effective for personnel are scheduled to work 6 consecutive recruitment and retention) days followed by at least 2 days off. The -Con (increases amount of time staff spends schedule repeats itself every 6 weeks. on scheduling) -another example: schedule personnel with every other weekend off and 1 day off during the week so that there are no more than 4 days ROTATING WORK SHIFTS of work. -the frequency of alternating between days and -Pros (sets same schedule repeatedly, leads to evenings or days and nights, or rotating to all 3 less exhaustion, reduces sick time, allows shifts varies among institutions. Some nurses personnel to know schedule in advance, may work all 3 shifts in a week. permits personnel to schedule social events, -Pros (allows rotation of teams, predictable decreases time spent on scheduling, treats schedule) staff fairly, decreases floating, promotes team spirit) -Cons (rotates personnel among shifts, increases stress, affects health, affects quality -Con (rigid) of work, disrupts development of work groups, leads to high turnover) VARIABLE STAFFING -uses census to determine number and mix of PERMANENT SHIFTS staff -relieve nurses of the stress and health-related -results in little need to call in unscheduled problems associated with alternating and staff rotating shifts. -Pros (allows personnel to participate in social activities, promotes job satisfaction, promotes EIGHT-HOUR SHIFT, 5 DAYS WORK commitment to the organization, leads to few -Pros (traditional, shorter time of work per day) health problems, reduces tardiness, decreases absenteeism, reduces turnover) -Con (longer workweek) 4 TEN-HOUR SHIFT, 4 DAYS WORK 2. Checklist-type- divides elements of care routines into activity categories. This is -Pros (time to complete work, long weekends, usually done at each shift or daily. extra days off, decreased overtime) 3. Time Standard or relative value unit- a -Cons (fatigue, difficulty finding substitute) system assigns a value unit (usually a measure of time) to various activities of patient care. It clusters patients into 5 TWELVE-HOUR SHIFTS categories, with 5 indicating the greatest intensity of care. -Pros (lower staffing requirements, lower cost 4. GRASP (Grace Reynolds Application and per patient-day, increased knowledge of Study of PETO)- evaluation have to patients, ability to get new admissions settled, made every 12 hours and may be done less feeling of being rushed, better continuity of using computerized form or manually care, possibility for team development, less with paper and pencil. Widely used in daily reporting, reduced travel time, less time the US. spent in staffing, lower personal expenses for 5. Therapeutic Intervention Scoring gas, meals, babysitting) System (TISS)- determines illness -Cons (greater exhaustion at end of work week, severity by assessing the time and increase in minor accidents, increase in intensity of the required interventions medication errors, home and social life suffer for patient care. From 1-4 points, the the week worked) points are then summed to yield one of 4 classifications. 6. Expert Nurse Estimation Patient FLEXIBLE OPTIONS Classification System (ENEPCS)- it -are important for recruiting and retaining identifies unique patient characteristics nurses and for reducing absenteeism. in 8 categories. -cross training can prepare nurses to work in more than one area to facilitate flexible scheduling. Core Leadership Styles in -Travel Nursing has grown in response to staff Nursing shortage. The nurse can choose location, - Transformational Leadership: Inspires assignments and type of work from per diem to and motivates staff toward shared long term assignments. Pay rates can be goals. competitive and benefits can be good. - Democratic Leadership: Encourages team collaboration and input. PATIENT CLASSIFICATION SYSTEMS - Autocratic Leadership: Clear and 1. Narrative Description- the nurse decisive, often used in crisis situations. classifies the patient into the category - Servant Leadership: Focuses on the that most closely describes the care needs of the team and patients. received. The nurse chooses the category that best describes the patient. 5 CONFLICT RESOLUTION CONTINUING PROFESSIONAL Steps to Resolve Conflicts: DEVELOPMENT - Identify the issue clearly. Lifelong learning to maintain and enhance nursing knowledge. - Encourage open dialogue. Participation in workshops, seminars, - Seek mutually beneficial solutions. and certifications. Focus on evidence-based practices and EVIDENCE-BASED DECISION-MAKING current healthcare trends. Steps: - Assess the situation. DIRECTING - Review relevant data and evidence. Guiding team members to achieve - Collaborate with stakeholders for organizational goals. informed decisions. Effective communication and Example: Implementing a new patient care motivation techniques. protocol. Ensuring alignment with healthcare standards and ethics. BUILDING A CULTURE OF TRUST Strategies: - Be transparent in decision-making. TOOLS IN DIRECTING - Recognize and reward team Clear communication strategies. contributions. Time management tools and - Foster a safe space for feedback. prioritization frameworks. Use of technology for team coordination and task management. SELF-CARE FOR NURSE LEADERS ELEMENTS OF DIRECTING Why It Matters: Supervision: Monitoring team - Prevents burnout and improves performance. overall effectiveness. Motivation: Inspiring team members to Techniques: excel. - Mindfulness and stress management. Leadership: Setting examples and - Maintaining work-life balance. guiding behavior. LEADING COMMUNITY HEALTH PROGRAMS 6  Collaborating with stakeholders for Clarify expectations and desired public health initiatives. outcomes. Assessing community health needs and Provide guidance and regular feedback. resources. Foster trust and accountability within Implementing evidence-based the team. interventions. SHARED GOVERNANCE COMMUNITY HEALTH Empowering nurses in decision-making processes. NURSING Promoting accountability and Definition: Community health nursing collaborative leadership. focuses on promoting and protecting the health of populations through Enhancing job satisfaction and education, prevention, and treatment. professional growth. Role of Community Health Nurses: Build trust and relationships within communities. POWER AND POLITICS Address health disparities and improve Understanding the influence of power access to care. dynamics in healthcare. Implement health promotion and Building positive relationships with disease prevention strategies. stakeholders. Navigating organizational politics POWER & POLITICS IN NURSING LEADERSHIP ethically. AND MANAGEMENT Understanding Power Dynamics: DELEGATION Recognize the influence of power structures within healthcare Assigning tasks effectively to team organizations. members. Utilize power ethically to advocate for Ensuring delegation aligns with patients and communities. individual competencies. Navigating Politics: Engage in political Providing necessary resources and advocacy to influence health policy. support. Build coalitions with community stakeholders to address public health issues. EFFECTIVE DELEGATION 7 KEY COMPONENTS OF EFFECTIVE Use active listening skills to understand COMMUNITY HEALTH PROGRAMS community needs. Assessment of Community Needs: Provide regular updates to stakeholders about program progress. -Identify health concerns through data collection and community engagement. Program Development: EVALUATING COMMUNITY HEALTH PROGRAMS -Design interventions based on identified needs (e.g., mobile clinics, Evaluation Methods: educational workshops). Use qualitative and quantitative Implementation Strategies: measures to assess program effectiveness. -Collaborate with local organizations Continuous Improvement: and stakeholders for effective outreach. Gather feedback from participants to refine programs and address gaps. BARRIERS TO EFFECTIVE COMMUNITY HEALTH LEADERSHIP Common Barriers: COMMUNICATION Limited resources and funding. Definition: Communication is the process of exchanging information and Resistance from community members understanding between individuals. or organizations. Importance in Nursing: Enhances Lack of awareness or understanding of patient care and safety. community health issues. Facilitates teamwork and collaboration. Strategies to Overcome Barriers: Improves organizational effectiveness. Advocate for funding and support from government agencies. Foster relationships with community COMMUNICATION PROCESS leaders to build trust. COMPONENTS: Sender: Initiates the message. COMMUNICATION IN COMMUNITY HEALTH Message: The information being Importance of Effective Communication: conveyed. Clear communication fosters Channel: The medium used to transmit collaboration among team members and the message (verbal, nonverbal, community partners. written). Techniques for Improvement: Receiver: The individual or group receiving the message. 8  Feedback: The response from the receiver back to the sender. ESSENTIAL COMMUNICATION SKILLS CHANNELS OF COMMUNICATION Key Skills for Nurse Leaders: Active TYPES OF CHANNELS listening: Fully concentrate on the speaker. Verbal Communication: Face-to-face conversations, meetings. Clarity and conciseness: Articulate messages clearly. Nonverbal Communication: Body language, facial expressions, gestures. Empathy: Understand and relate to others' feelings. Written Communication: Emails, reports, patient charts. Constructive feedback: Provide helpful insights without criticism ***Choosing the Right Channel: Consider the message's urgency and complexity when selecting a communication channel. Organizational, Interpersonal, and Group Communication COMMUNICATION SYSTEMS Organizational Communication: Focuses on the flow of information Formal Systems: Established protocols within the organization. for communication within healthcare settings (e.g., handoff reports). Interpersonal Communication: One-on- one interactions that build Informal Systems: Casual interactions relationships. among staff that can influence team dynamics and morale. Group Communication: Involves discussions among teams to achieve Importance of Systems: Effective common goals. systems ensure timely and accurate information exchange. IMPROVING COMMUNICATION BARRIERS TO COMMUNICATION Techniques to Enhance Effectiveness: Language differences or jargon. Regular training on communication skills for staff. Emotional barriers (stress, anxiety). Foster a culture of transparency where Physical barriers (noise, distance). staff feel safe to express concerns. Cultural differences impacting Implement structured communication understanding. models (e.g., SBAR) for critical Impact of Barriers: Can lead to information sharing. misunderstandings, decreased morale, and compromised patient safety. RECORD MANAGEMENT SYSTEM 9  Definition: A systematic approach to Examples: Enjoyment of nursing tasks, managing patient records and personal growth. communications within healthcare  Extrinsic Motivation: Comes from settings. external sources. Benefits: Ensures accuracy and Often linked to rewards or recognition. accessibility of patient information. Examples: Bonuses, promotions, praise Facilitates better decision-making from supervisors. through organized data management. THEORIES OF MOTIVATION NURSING INFORMATICS Content Theories: Focus on what Role in Communication: motivates individuals. Maslow's -Integrates nursing science with Hierarchy of Needs: Physiological, information management to enhance Safety, Love/Belonging, Esteem, Self- communication processes. Actualization. Key Components: Herzberg’s Two-Factor Theory: Hygiene factors vs. motivators. -Use of electronic health records (EHRs) for streamlined communication among Process Theories: Focus on how healthcare providers. motivation occurs. Expectancy Theory: Individuals act based on expected outcomes. MOTIVATION in nursing Self-Determination Theory: Emphasizes autonomy and competence as key leadership & management factors in motivation. Definition: Motivation is the process that initiates, guides, and maintains goal- Strategies for Enhancing Motivation oriented behaviors. Creating a Supportive Environment: Types of Motivation: Intrinsic Foster open communication and Motivation: Driven by internal rewards feedback. (enjoyment, curiosity). Encourage professional development Extrinsic Motivation: Driven by external opportunities. rewards (money, recognition) Recognition and Rewards: Implement INTRINSIC VS. EXTRINSIC reward systems for achievements.  Intrinsic Motivation: Comes from within. Celebrate team successes to boost Associated with personal satisfaction morale. and engagement. Empowerment: Involve staff in decision- making processes. 10  Provide autonomy in their roles to Follett Participative Management enhance engagement Mayo Hawthorne Effect Teamwork and Group Processes McGregor Theory X & Theory Y Importance of Teamwork in Nursing: Enhances collaboration and Argyris Employee Participation communication among staff. Leads to improved patient outcomes MANAGEMENT FUNCTIONS IDENTIFIED through collective effort. (1925) Strategies for Effective Teamwork: 1. PLANNING- encompasses determining Regular team meetings to discuss goals philosophy, goals, objectives policies, and challenges. procedures and rules; carrying out long Team-building activities to strengthen and short-range projections; relationships. determining a fiscal course of action and managing planned change. LEADERSHIP & 2. ORGANIZING- establishing the MANAGEMENT THEORIES structure to carry out plans, determining o SCIENTIFIC MANAGEMENT Intelligence Knowledge Ability (1900-1930) Judgment Adaptability Able to enlist cooperation -Frederick Taylor, the “Father of Scientific Management” Decisiveness Creativity Tact -He postulated that if workers could be taught Oral Fluency Cooperativeness Diplomacy the one best way to accomplish a task, productivity would increase. (optimizing & Emotional Alertness Prestige Intelligence simplifying jobs) Independence Self-confidence Social participation THEORIST THEORY Personable Emotional balance Personal and control Integrity Taylor Scientific Management the most appropriate type of patient Weber Bureaucratic organizations care delivery and grouping activities to meet unit goals. Fayol Management Functions 3. STAFFING- consist of recruiting, interviewing, hiring and orienting staff. Gulick Activities of Management Scheduling, staff development, employee socialization and team 11  building are also included as staffing functions. AUTHORITARIAN LEADER 4. DIRECTING- entail human resource Results in well-defined group actions that are management responsibilities, such as usually predictable, reduced frustration and motivating, managing conflict giving members a sense of security. delegating, communicating and facilitating collaboration. Useful in crisis situations and is frequently found in the armed forces. 5. CONTROLLING- include performance appraisal fiscal accountability, quality A PERSON’S LEADERSHIP STYLE HAS A GREAT control, legal and ethical control, and DEAL OF INFLUENCE ON THE CLIMATE AND professional control. OUTCOME OF THE WORK GROUP. o THE GREAT MAN THEORY/ (1900-1940) DEMOCRATIC LEADER -asserts that some people are born to lead AUTOCRATIC DEMOCRATIC LAISSEZ- whereas others are born to be led. Great FAIRE leaders will arise when the situation demands Strong control Less control No control it. Gives orders Offers Non- suggestions directive o CHARISMATIC THEORY Does decision- Makes Abdicates -The charismatic leaders inspires others by making suggestions decision- emotional commitment from followers and by making arousing strong feelings of loyalty and Leader does Group does No planning enthusiasm. planning planning -Followers may idolize and worship Directive Participative Uninvolved charismatic leaders as spiritual figures or superhumans. Fosters Fosters Fosters dependency independence chaos -Ex. Mahatma Gandhi and Adolf Hitler Appropriate for groups who work together for extended periods, promotes autonomy and TRAIT THEORIES growth in individual workers. -assume that some people have certain This type is particularly effective when characteristics or personality traits that make cooperation and coordination between groups them better leaders than others. are necessary. Democratic Leadership is less efficient than authoritative leadership. LAISSEZ-FAIRE LEADER 12 Is non-directed leadership, this can be frustrating, group apathy and disinterest can occur. However, when all group members are highly motivated, this leadership can result in much creativity and productivity. This is appropriate when problems are poorly defined and brainstorming is needed to generate alternative solutions. SITUATIONAL THEORY -suggests that the traits required of a leader differ according to varying situations. INTERACTIONAL LEADERSHIP THEORY THE BASIC PREMISE OF INTERACTIONAL THEORY IS THAT LEADERSHIP BEHAVIOUR IS GENERALLY DETERMINED BY THE RELATIONSHIP BETWEEN THE LEADER’S PERSONALITY AND THE SPECIFIC SITUATION. TRANSACTIONAL VS. TRANSFORMATIONAL TRANSACTIONAL LEADER- concerned with the day-to-day operations. Sets goals, gives directions, and uses rewards to reinforce employee behaviors. They emphasize process and in setting goals and giving directions and controls both the situations and followers. TRANSFORMATIONAL LEADER- have a view of the future that will excite and convert potential followers. ***VISION IS THE ESSENCE OF TRANSFORMATIONAL LEADERSHIP. TRANSACTIONAL TRANSFORMATIONAL LEADER LEADER 13 Focuses on Identifies common COLLABORATION management values tasks Collaboration in nursing leadership and management is essential for providing high- Is a caretaker Is committed quality patient care, improving healthcare outcomes, and fostering a supportive work Uses trade-offs to Inspires others with environment. It involves leaders, managers, meet goals vision and staff working together toward common goals by leveraging diverse perspectives, skills, Does not identify Has long-term vision and expertise. shared values KEY COMPONENTS: Examines causes Looks at effects 1. Effective Communication: Clear, open, and respectful communication is the Uses contingency Empowers others foundation of collaboration. reward 2. Shared Goals: Aligning objectives across team members ensures everyone works toward the same outcomes. 3. Mutual Respect and Trust: Valuing diverse contributions and building trust strengthen relationships within the team. 4. Interdisciplinary Collaboration: Working across various healthcare disciplines enhances holistic care. 5. Conflict Resolution: Constructive handling of disagreements promotes a positive environment. Challenges in Collaboration Hierarchical Barriers: Rigid hierarchies can stifle communication and innovation. Resource Constraints: Limited staff, time, or tools can hinder collaborative efforts. 14  Resistance to Change: Individual 2. Fostering Collaboration: Encourages reluctance to adapt can impede teamwork and partnership across teamwork. levels. Communication Breakdowns: 3. Building Relationships: Establishes Misunderstandings or lack of clarity can trust and rapport among team members lead to errors and conflicts. to enhance coordination. 4. Conflict Management: Resolves disagreements to maintain focus and COORDINATION productivity. Coordination in Leadership and Coordination in Management Management refers to the systematic alignment and integration of resources, 1. Task Delegation: Assigning responsibilities activities, and efforts across an organization to appropriately to ensure balanced workloads. achieve its goals effectively and efficiently. In nursing and healthcare, coordination ensures 2. Resource Allocation: Ensuring staff, that care is consistent, patient-centered, and equipment, and finances are utilized delivered collaboratively across departments effectively. and teams 3. Monitoring Progress: Keeping track of Key Principles of Coordination activities to ensure alignment with goals. 1. Clarity of Objectives: Clear goals guide all team members toward the desired 4. Integrating Technology: Leveraging tools outcomes. such as scheduling systems, electronic health records (EHRs), and communication platforms. 2. Interdependence Awareness: Recognizing how different roles and tasks interconnect within the organization. ORGANIZATIONAL 3. Communication: Facilitates STRUCTURE information sharing, ensuring everyone CONCEPTS: is informed and aligned. ▪ Organizational Chart- a diagram that 4. Flexibility: Allows for adjustments as shows how the parts of an organization circumstances change, ensuring are linked. resilience. ▪ Line Authority- the formal chain of command Coordination in Leadership ▪ Staff Authority- advisory or service- 1. Setting a Vision: Leaders provide a oriented influence clear direction to guide team efforts. ▪ Hierarchy- a group of persons arranged by rank, grade or class. 15  ▪ Matrix- an organizational design that ▪ FIRST LEVEL MANAGERS- is concerned combines project management and with a specific unit’s work flow. They bureaucratic structures. deal with immediate day-to-day operations problems. ▪ Corporation- a legal entity governed by a board of directors or by shareholders. ▪ Team Leader, Charge Nurse, Primary care nurse FLAT VS TALL CONCEPTS: ▪ FLAT- developed along horizontal Centrality- refers to the location of a position in dimensions. There are few levels of an organization where frequent management. communication occurs. ▪ TALL- is developed along vertical Chain of command- is the formal line of dimensions by the use of a scalar authority and communication. process that is the direct line of Unity of command- is represented by the command from top to bottom. vertical and solid line between positions on an organizational chart. It indicates that one person has one boss. Authority- is the official power to act Responsibility- is the duty or an assignment. Accountability- is a moral responsibility. A manager may delegate responsibility but always remains accountable. LEVELS OF MANAGEMENT ▪ TOP LEVEL MANAGERS- generally make decisions with the help of few LINE & STAFF ORGANIZATIONAL guidelines or structures, coordinate STRUCTURE internal and external influences and view the organization as a whole. ▪ The line and staff organizational structure is a framework that combines ▪ CEO, President, Directors, Chief the direct authority and clear hierarchy Nurse, Executives of a line structure with the specialized ▪ MIDDLE LEVEL MANAGERS- conduct expertise and advisory roles of staff day-to-day operations with some departments or individuals. This involvement in long term planning and approach balances the operational policy making. efficiency of traditional management ▪ Unit Manager, Head Nurse, Patient with the flexibility and knowledge Care Coordinator provided by staff functions. 16 Line and Staff Organizational Structure Characteristics: 1. Dual Authority: Line managers hold decision-making authority, while staff members provide advice, expertise, and support. 2. Clear Hierarchy: Authority flows vertically in a clear chain of command, ensuring discipline and accountability. 3. Specialization: Staff roles focus on specific areas such as human resources, finance, or quality assurance. STEPS IN DELPHI METHOD PROCEDURE 4. Support Functions: Staff departments 1. Identify the Panel of Experts: do not directly control operations but 1. Include nurses, physicians, allied influence decision-making. health professionals, social workers, administrators, and community health workers. 2. Ensure a diverse group to represent different perspectives. 2. Design the Survey: 1. Develop open-ended questions for the first round to gather broad input on successful collaboration and coordination practices. 2. Examples of questions: 1. "What are the key factors contributing to effective multidisciplinary collaboration?" 2. "What strategies have improved care coordination in your experience?" 3. Conduct the First Round: 17  1. Distribute the initial survey and collect qualitative responses. 2. Summarize and analyze the DECISION-MAKING responses to identify themes. PROCESS 4. Create the Second Round Survey: ▪ Decision-making in nursing leadership Transform the themes and suggestions and management involves identifying from the first round into specific problems, evaluating options, and statements or practices. choosing the best course of action. The process is typically structured into the Use a Likert scale for panelists to rate following steps: the importance or feasibility of each item. ▪ 1. Define the Problem Clearly articulate the issue to avoid ambiguity. Example: A high patient readmission 5. Iterate and Refine: rate in a hospital. Conduct multiple rounds (usually 2-3) ▪ 2. Gather Information where panelists review and revise their responses based on group feedback. Collect data relevant to the problem, including facts, opinions, and historical Aim for a convergence of opinions. trends. 6. Achieve Consensus: Example: Review patient records and Define a consensus threshold (e.g., 75% survey nursing staff. agreement). ▪ 3. Identify Alternatives Finalize the list of agreed-upon Brainstorm possible solutions or practices or protocols. strategies to address the issue. 7. Report the Findings: Example: Enhanced discharge planning, Summarize the consensus results, patient education programs, or emphasizing actionable increased follow-up care. recommendations for improving multidisciplinary collaboration and coordination. 4. Evaluate Alternatives Assess the feasibility, benefits, and risks of each option using tools like SWOT Concept mapping visually organizes analysis. ideas to develop clear and structured referral and coordination protocols for Example: Weigh the costs and healthcare delivery. effectiveness of each proposed solution. 18  5. Make a Decision 2. Bounded Rationality Theory: Suggests decisions are limited by information, Select the most suitable alternative time, and cognitive constraints. based on evidence and organizational goals. 3. Participative Decision-Making Theory: Involves team members in the decision Example: Implement a comprehensive process to improve outcomes and buy- patient education program. in. 6. Implement the Decision 4. Prospect Theory: Explores how Execute the chosen solution with a individuals perceive risks and rewards, detailed action plan and timeline. influencing their choices. Example: Train staff on the new education protocols. CHANGE PROCESS 7. Evaluate the Outcome The change process involves structured Monitor results to determine if the steps to transition from a current state decision resolved the problem to a desired future state. Kurt Lewin’s effectively. Change Theory is widely used in Example: Measure readmission rates healthcare settings: after implementing the education ▪ 1. Unfreezing program. Identify the need for change and DECISION-MAKING TOOLS prepare the organization by overcoming 1. SWOT Analysis: Evaluates strengths, resistance. weaknesses, opportunities, and threats. Example: Data shows low patient 2. Decision Matrix: Compares multiple satisfaction scores, prompting a need options against set criteria. for improvement. 3. Flowcharts: Visualize steps and ▪ 2. Changing (Transition) potential outcomes in a process. Implement new processes or behaviors. 4. Root Cause Analysis (RCA): Identifies Example: Introduce a new patient underlying causes of problems. feedback system to improve 5. Pareto Analysis: Focuses on solving the satisfaction. most significant problems first (80/20 ▪ 3. Refreezing rule). Solidify changes by integrating them into the organizational culture. DECISION-MAKING THEORIES Example: Make the feedback system a 1. Rational Decision-Making Theory: routine part of patient care. Assumes logical, step-by-step analysis of a problem to find the best solution. 19  2. Example: Acknowledge departments that excel in HANDLING RESISTANCE TO CHANGE adopting new protocols. ▪ Resistance to change is common and can stem from fear, lack of understanding, or perceived threats. PLANNED CHANGE Strategies to handle resistance include: ▪ Planned change is a deliberate effort to 1. Communication: improve systems or processes based on identified goals. Lippitt’s Phases of 1. Explain the rationale, benefits, Change Theory provides a framework and impact of the change clearly. for planned change: 2. Example: Host informational ▪ 1. Diagnose the Problem sessions on the purpose of a new electronic health record (EHR) Identify the issue requiring change. system. Example: Increasing nurse burnout 2. Involvement: rates. 1. Involve stakeholders in planning ▪ 2. Assess Motivation and Capacity for and decision-making to increase Change ownership. Determine readiness and resources for 2. Example: Include nurses in the change. design phase of a new workflow. Example: Survey staff to understand attitudes toward proposed changes. ▪ 3. Develop Change Objectives 3. Education and Training: Set clear, measurable goals. 1. Equip staff with the skills needed Example: Reduce nurse burnout rates to adapt to changes. by 25% in six months. 2. Example: Offer hands-on training 4. Select a Change Agent for new equipment. Identify individuals or teams to lead the 4. Empathy and Support: change. 1. Address concerns and provide Example: Assign a nurse leader to emotional and logistical support. oversee wellness initiatives. 2. Example: Assign mentors to 5. Plan the Change guide staff through the transition. Develop a detailed action plan with 5. Incentives: timelines. 1. Motivate staff with rewards or Example: Launch mindfulness programs recognition for adopting and flexible scheduling. changes. 20 6. Implement the Change 1. Arises within a team or department. Execute the plan, ensuring all stakeholders are informed. 2. Example: Disputes over workload distribution among nursing staff. Example: Roll out wellness initiatives in phases. 4. Intergroup Conflict 7. Monitor and Evaluate 1. Occurs between different departments or teams. Assess the effectiveness of the change and make adjustments as needed. 2. Example: Miscommunication between the emergency Example: Collect feedback on wellness department and inpatient units. programs and track burnout metrics. 5. Organizational Conflict 1. Involves tension between staff CONFLICT MANAGEMENT and organizational policies or ▪ Conflict is a natural aspect of structures. organizational dynamics, including in 2. Example: Resistance to new healthcare settings. Proper conflict electronic health record (EHR) management is essential to maintain a systems. positive work environment and ensure high-quality patient care. MANAGING CONFLICT TYPES OF CONFLICT 1. Identify the Source 1. Intrapersonal Conflict 1. Understand the root cause of the conflict. 1. Occurs within an individual due to internal dilemmas or 2. Example: Is it a communication competing values. issue, resource allocation, or differing expectations? 2. Example: A nurse struggles between professional 2. Encourage Open Communication responsibilities and personal life 1. Create a safe space for all parties balance. to express their concerns without 2. Interpersonal Conflict fear of judgment. 1. Happens between individuals 2. Example: Use structured due to differences in personality, mediation sessions. values, or goals. 3. Choose a Conflict Resolution Style 2. Example: A disagreement (Thomas-Kilmann Model): between a nurse and a physician Competing: Asserting one's position; useful in over patient care decisions. urgent situations. 3. Intragroup Conflict 21 Collaborating: Working together to find a win- 1. Workload: Excessive responsibilities or win solution. long shifts. Compromising: Each party gives up something 2. Role Ambiguity: Unclear job to reach an agreement. expectations or conflicting demands. Avoiding: Delaying the issue temporarily when 3. Interpersonal Issues: Difficult more information is needed. relationships with colleagues or supervisors. Accommodating: Yielding to others to maintain harmony. 4. Organizational Changes: Adjusting to new policies, technologies, or 4. Focus on Interests, Not Positions structures. 1. Address underlying needs rather 5. Patient Care Challenges: Emotional than rigid demands. strain from dealing with critically ill 2. Example: Shift discussions from patients or families. "who's right" to "what's best for the patient." MANAGING WORK-RELATED STRESS 5. Set Clear Expectations 1. Time Management 1. Clarify roles, responsibilities, and acceptable behaviors to 1. Prioritize tasks and delegate prevent future conflicts. responsibilities effectively. 6. Involve a Neutral Party 2. Support Systems 1. Use a mediator or supervisor to 1. Encourage peer support groups facilitate resolution when and provide access to counseling conflicts escalate. services. 7. Provide Training 3. Self-Care 1. Equip staff with communication 1. Promote healthy habits like and conflict resolution skills exercise, sleep, and relaxation through workshops. techniques. 4. Work Environment WORK-RELATED 1. Create a positive workplace with adequate staffing and resources. STRESS 5. Professional Development Work-related stress is common 1. Offer training to improve skills in high-pressure environments and confidence, reducing role- like healthcare and can adversely related stress. affect staff well-being and performance. 6. Organizational Support Sources of Work-Related Stress 22  1. Provide clear communication, Encourage participation in recognition, and flexible work problem-solving and decision- options. making. SUPERVISION Recognize achievements and provide positive feedback. Key Functions of Supervision 1. Guidance: Provide direction to staff on Structural Empowerment work processes and protocols. Focuses on providing resources, tools, and 1. Example: Ensuring compliance opportunities. with infection control measures. Strategies: 2. Support: Offer emotional and professional support to staff. Offer access to training and professional development. 1. Example: Addressing concerns during high-stress situations like Ensure equitable workload understaffing. distribution. 3. Monitoring: Evaluate staff performance Create policies that promote and ensure adherence to standards. autonomy and role clarity. 1. Example: Observing hand CONTROLLING hygiene practices during patient care. ▪ Controlling in management ensures that actual performance aligns with 4. Feedback: Provide constructive input to organizational goals. It involves setting encourage improvement and standards, measuring progress, and development. taking corrective action when 1. Example: Offering suggestions necessary. for better time management in Control Process patient rounds. The control process is a systematic approach PSYCHOLOGICAL EMPOWERMENT VS to monitoring and adjusting performance. It STRUCTURAL EMPOWERMENT involves four steps: Psychological Empowerment 1. Establish Standards ▪ Focuses on internal perceptions of 1. Define clear, measurable autonomy, competence, and benchmarks for performance. meaningfulness. 2. Example: "Achieve a patient Strategies: satisfaction score of 90% or Foster a sense of control over higher." work decisions. 2. Measure Performance 23  1. Collect data to evaluate whether 4. Implement Standards standards are met. 1. Communicate standards to all 2. Example: Use patient surveys stakeholders and integrate them and incident reports. into policies. 3. Compare Performance Against 5. Monitor and Revise Standards 1. Regularly review standards for 1. Identify deviations between relevance and effectiveness. expected and actual performance. Employee Discipline 2. Example: Analyze why patient satisfaction dropped to 85%. Discipline ensures adherence to organizational policies and professional conduct while 4. Take Corrective Action fostering accountability. 1. Address discrepancies by Types of Discipline: implementing changes or providing feedback. 1. Preventive Discipline 2. Example: Conduct staff training 1. Focuses on clear on patient communication skills. communication and proactive measures to avoid misconduct. 2. Example: Providing regular DEVELOPMENT OF STANDARDS reminders about attendance ▪ Steps to Develop Standards: policies. 1. Identify Objectives 3. Corrective Discipline 1. Determine what the standard 4. Addresses existing violations or should achieve. behavior issues. 2. Example: "Reduce medication 5. Example: Issuing a written errors." warning for repeated tardiness. 2. Consult Stakeholders STEPS IN EMPLOYEE DISCIPLINE 1. Include input from staff, 1. Identify the Issue managers, and patients. 1. Gather facts and evidence 3. Define Measurable Criteria regarding the misconduct. 1. Use specific, actionable, and 2. Communicate Clearly realistic metrics. 1. Discuss the issue with the 2. Example: "Medication errors employee in a private, respectful must be below 1% of total doses manner. administered." 3. Apply Progressive Discipline 24  1. Escalate measures only if the 1. Discuss strengths, weaknesses, behavior persists: and opportunities for improvement. 1. Verbal Warning → Written Warning → Suspension → 4. Provide Feedback Termination. 1. Use the "Sandwich Approach": 4. Document Actions 1. Start with positive 1. Maintain accurate records for feedback, address areas legal and organizational for improvement, and purposes. conclude with encouragement. 5. Provide Support 5. Create Development Plans 1. Offer counseling or training to help employees improve. 1. Set actionable goals and offer support through training or PERFORMANCE EVALUATION mentoring. ▪ Performance Evaluation 6. Follow-Up ▪ Performance evaluation assesses 1. Regularly review progress and employee effectiveness and identifies adjust plans as needed. areas for development. It ensures accountability and motivates staff to excel. Continuous Quality Improvement (CQI) and Risk Management ▪ Steps in Performance Evaluation: ▪ CQI is a systematic approach to 1. Set Clear Objectives improving healthcare processes and 1. Define expectations based on outcomes through iterative, data-driven organizational goals. efforts. It emphasizes proactive measures to enhance patient care. 2. Example: "Administer medications with 100% Principles of CQI: accuracy." Focus on patient-centered care. 2. Gather Data Use data to identify problems 1. Use various tools like and measure progress. observation, self-assessment, Engage multidisciplinary teams and peer reviews. to foster collaboration. 2. Example: Monitor adherence to Emphasize continuous learning safety protocols. and adaptability. 3. Conduct Evaluation Meetings Examples in Nursing: 25  Reducing medication errors by Standards of Nursing Practice improving electronic health Standards of nursing practice establish the record (EHR) systems. foundation for professional accountability, Enhancing patient discharge competence, and ethical conduct. They ensure processes to lower readmission consistent, high-quality care. rates. Two Main Categories: Risk Management Standards of Care: Describe the Risk management involves identifying, actions nurses must perform to assessing, and mitigating risks that may harm meet patient needs. patients, staff, or the organization. Example: Assessing vital Key Steps: signs, administering medications accurately. Identify Risks: Use tools like incident reports, root cause Standards of Professional analysis (RCA), and patient Performance: Focus on the feedback. nurse's behavior in professional roles. Assess Risks: Evaluate the likelihood and impact of Example: Maintaining potential risks. confidentiality and engaging in lifelong Implement Strategies: Develop learning. policies and training to minimize risks. Source of Standards: Monitor Outcomes: Track the Regulatory bodies (Philippine effectiveness of risk reduction Nurses Association, Joint measures. Commission). Examples in Nursing: Institutional policies. Preventing patient falls through Quality Assurance (QA) vs. Quality regular safety rounds. Improvement (QI) Ensuring compliance with Quality Assurance (QA) infection control protocols. Focus: Ensures services meet established standards through compliance checks. Creating a Patient Safety Culture Approach: Retrospective; identifies ▪ A patient safety culture prioritizes the errors or deviations after they occur. prevention of harm through open communication, collaboration, and a Example: Auditing patient charts for non-punitive approach to errors. documentation accuracy. Quality Improvement (QI) 26  Focus: Proactively enhances processes ▪ Accreditation is a systematic process and outcomes. used to evaluate and certify healthcare organizations, educational institutions, Approach: Ongoing, iterative; identifies and programs against established areas for improvement. quality standards. It ensures Example: Implementing a new workflow compliance with regulatory to reduce patient wait times. requirements and promotes continuous improvement. 1. JCAHO (Joint Commission on Variance Reports and Sentinel Events Accreditation of Healthcare Organizations) Variance Reports Overview: JCAHO, commonly known as Purpose: Document deviations from The Joint Commission, is a U.S.-based expected outcomes or processes, such nonprofit organization that accredits as delays or errors. healthcare organizations globally. It focuses on patient safety, quality care, Types: and organizational improvement. Patient-Related: Falls, Key Standards: medication errors, treatment delays. Patient care quality and safety. System-Related: Equipment Infection control. failures, staffing shortages. Medication management. Sentinel Events Leadership and governance. Definition: Unexpected events leading Benefits: to death or serious harm to a patient. Enhances patient trust and Examples: safety. Surgery on the wrong site. Improves healthcare processes Severe medication errors. through evidence-based standards. Management: Provides recognition and Conduct a root cause analysis competitive advantage. (RCA). ▪ 2. JCIA (Joint Commission Implement corrective actions. International Accreditation) Monitor for recurrence. Overview: The international arm of JCAHO that sets standards for hospitals outside the U.S. ACCREDITATION Focus Areas: 27  International Patient Safety Clinical governance and ethical Goals (IPSG). practices. Rights and responsibilities of Staff qualifications and patients. competencies. Multidisciplinary care and NURSING AUDIT continuity. A nursing audit is a systematic review of Impact: Helps healthcare institutions nursing care to ensure adherence to standards achieve global recognition and improve and identify areas for improvement. cross-border patient care. ▪ Types of Nursing Audits 3. PhilHealth Accreditation 1. Concurrent Audit: Overview: The Philippine Health Insurance Corporation (PhilHealth) 1. Conducted during patient care to accredits healthcare facilities to ensure monitor ongoing compliance. they meet national standards for 2. Example: Checking medication providing care to insured patients. administration accuracy. Requirements for Accreditation: 2. Retrospective Audit: Compliance with Department of 1. Performed after patient Health (DOH) and PhilHealth discharge by reviewing records. standards. 2. Example: Analyzing Adequate staffing, infrastructure, documentation for and equipment. completeness. Quality assurance mechanisms 3. Prospective Audit: in place. 1. Focuses on planning and Benefits: preparation to prevent issues. Access to PhilHealth 2. Example: Ensuring new protocols reimbursement. are followed during Improved service quality for implementation. patients. ▪ Benefits of Nursing Audits ▪ 4. Hospital Accreditation Commission Identifies gaps in care delivery. (HAC) Promotes accountability and Overview: In the Philippines, HAC professional development. evaluates hospitals for compliance with standards set by the DOH and other Enhances patient outcomes and safety. governing bodies. Focus Areas: Facility safety and hygiene. 28 CHED QUALITY ASSURANCE INITIATIVES ▪ The Commission on Higher Education (CHED) ensures quality in nursing education to produce competent healthcare professionals. ▪ Key Initiatives 1. CHED Memorandum Orders (CMOs) 1. Provide policies, standards, and guidelines (PSGs) for nursing programs. 2. Example: CMO No. 15, s. 2017 sets curriculum requirements for Bachelor of Science in Nursing (BSN). 2. Outcomes-Based Education (OBE) 1. Emphasizes student competencies and measurable learning outcomes. 3. Institutional Monitoring and Evaluation for Quality Assurance (IQuAME) 1. A framework to evaluate the performance of higher education institutions (HEIs). 4. Center of Excellence (COE) and Center of Development (COD) 1. Recognizes top-performing nursing schools for their quality programs. 5. Partnerships and Collaboration 1. Encourages linkages with global accreditation bodies and research institutions. 29