Study Guide Chapter 1 Leadership Management

ATI Chapter 1 Nursing Skills to Effectively Manage Client Care: leadership, management, critical thinking, reasoning, clinical judgement, prioritization, time management, assigning, delegating, supervising, staff education, quality improvement, performance appraisal, peer review, disciplinary action, conflict resolution, and cost-effective care. Leadership: ability to inspire others to achieve a desired outcome. Characteristics of Leaders : initiative, inspiration, energy, positive atÝtudes, communication skills, respect, problem-solving and criticalthinking skills, combo of personality traits and leadership skills, leaders influence willing followers to move toward a goal, leaders have goals that might differ from those of the organization. Emotional intelligence is a characteristic of a successful nurse leader. Emotionally intelligent leader : insight into team emotions, understands others perspective, encourages constructive criticism/open to new ideas, manages emotions, and challenges them positively helping team accomplish goals, committed to delivery of high-quality patient care, refrains from judgement. Characteristics of Leader Types: (1) Transformation Leaders: empower and inspire followers to achieve a common, long-term vision. (2) Transactional Leaders: Focus on immediate problems, maintaining the status quo and using rewards to motivate followers . (3) Authentic Leaders: inspire others to follow them by modeling a strong internal moral code. Leadership Styles: (1) Authoritative: makes decisions for group, coercive motivation, communication is down chain of command, work output by staff is high (good for crisis situations/bureaucratic setÝngs), and effective for employees with little/no experiences. (2) Democratic: includes group when decisions are made, motivates by supporting staff achievements, communication up and down chain of command, work output by staff is good when cooperation/collab needed. (3) Laissez-faire: little decision making, little planning, motivation is responsibility of individual, communication up and down chain of command and group members, work output is low unless informal leader evolves, effective for professionals. Management: planning, organizing, direction, & coordinating the work within an organization. Five Major Management Functions: Planning (decisions regarding what needs to be done, how, and who to do it); Organizing (organizational structure that determines lines of authority, channels of communication, and where decisions are made); StafÏng (acquisition and management of adequate staff and stafÏng mix); Directing (leader that influences and motivates staff to perform roles); Controlling (evaluation of staff performance and unit goals to ensure outcomes met.) Manager Characteristics: hold formal positions of authority and power, possess clinical expertise, network with team members, coach subordinates, make decisions about the function of organization (resources, budget, hiring, firing.) Prioritization and Time Management: Priority setÝngs requires that nurses make decisions about order in which clients are seen, assessments completed, interventions provided, steps in client procedure completed, and components of client care are completed. Prioritization Principles in Client Care: (1) Prioritize systemic before local (life before limb); ( 2) Prioritize acute (less opportunity for physical adaptation) before chronic (greater opportunity for physical adaptation); (3) Prioritize actual problems before potential future problems ( ex: give meds to a client with acute pain over prioritizing ambulation of a client at risk of thrombophlebitis); (4) Listen carefully to clients and don’t assume; (5) Recognize and respond to trends vs. transient feelings ( ex: recognize pt. deterioration and/or Glasgow coma score); (6) Recognizing indications of medical emergencies and complications vs. expected findings; (7) Apply clinical knowledge to procedural standards to determine the priority action (ex: recognize timing administration of antidiabetic meds and antimicrobial meds more important than some others.) Priority SetÝng Frameworks: (1) Maslow’s hierarchy of needs: physiological needs, safety security, love and belonging, self-esteem, and self-actualization. (2) ABC Framework: first is airway (3-5 min w/out oxygen causes irreversible brain damage secondary to cerebral anoxia); second is breathing; third is circulation; fourth is disability (assess for current/evolving disability like neuro deficits, strokes); and fifth is exposure (remove clients clothing to allow complete assessment/resuscitation, implement measures to reduce hypothermia like warm blankets, IV solutions or cooling for extreme heat.) (3) Safety/Risk Reduction: look first for a safety risk like is there airway obstruction, hypoxia, bleeding? Then ask what is the risk to the client and how significant risk compared to other risks? Give priority to greatest risk to client physical well-being. Time Management How-To: (1) Organize care according to patient care needs and priorities: What must be done immediately (give analgesic or antiemetic, unstable pt. assessments); What must be done by a specific time to ensure client safety, quality of care, and compliance with facility policies and procedures (routine med administration, vitals, blood glucose levels); What must be done at the end of shift (ambulation, discharge/discharge teaching, dressing changes); What can the nurse delegate. (2) Use time-saving strategies to avoid time wasters: good time management facilitates greater productivity, decreases work-related stress, helps ensure the provision of quality client care, and enhances satisfaction with care provided ( poor time management impairs productivity, leads feeling overwhelmed/stressed, increases omission of important tasks, and creates patient dissatisfaction.) (3) Time Management as a Cyclic Process: Spend time developing plan to save time and avoid crisis management style. Set goals and plan care based on priorities, utilizing resources. Complete one client tasks at a time before beginning next, start with highest priority task. Reprioritize remaining tasks and continually reassess. At the end, perform time analysis and assess if time used wisely. Assigning: transferring authority, accountability, and responsibility of client care to another member of health care team. Assigning is performed in a downward/lateral manner. Delegating : transferring the authority and responsibility to another team members to complete a task, while retaining accountability. Supervising: directing, monitoring, and evaluating the performance of tasks by another member of health care team. Unsafe Assignment How-To: Bring unsafe assignment to attention of scheduler/charge nurse and negotiate new assignment and if no resolution arrives go up chain of command. If satisfactory resolution still not arrived at, file written protect to assignment (assignment despite objection [ADO]/document of practice situation [DOPs].) Not accept assignment without following proper steps can be considered client abandonment. Client Room Assignment: consider pt. age, dx., pt. safety, comfort, privacy, and infection control when planning room assignments. Private rooms are for those with airborne precautions or for pts that require a protective environment. Private rooms are preferred for droplet/contact precautions. Patients on droplet/contact precautions can board together if no private rooms are available and if they have the same infection, remain at least 3 ft. away from each other, and have no other existing infection. Private rooms may be needed for agitated pts., dementia/hx of wandering pts., pts who need quiet environment like stroke, traumatic injuries/increased intracranial pressure, risk for sensory overload, and who need privacy (dying pts.) Delegating: RNs delegate to other RNs, PNs, and APs. PNs can delegate to other PNs and APs. Nursing Considerations for Delegation: predictability of outcome, potential for harm, complexity of care, need for problem solving and innovation, and level of interaction with the client. Factors to Consider with Delegating: education, training, experience, knowledge/skill needed to perform task, level of critical thinking required to complete task, ability to communicate with others, demonstrated competence, culture, and agency policies/procedures and licensing legislation (state NPAs.) Five Rights of Delegation: Right task, right circumstance, right person, right direction and communication, and right supervision and evaluation. Staff Education and Training: goal of staff education is to ensure that staff members have and maintain most current knowledge and skills necessary to meet the clients of clients. Increase in knowledge and competence is the goal of staff education. Steps for Educational Programs: (1) identify and respond: determine need for knowledge/skill proficiency. (2) Analyze: look for deficiencies and develop objectives to meet need. (3) Research: resources available to address learning objectives based on EBP. ( 4) Plan: program to address objectives using available resources. (5) Implement: programs at a time conducive to staff availability/consider online modules. (6): Evaluate: use materials and observations to measure behavior changes secondary to learning objectives. Five Stages of Nursing Ability: (1) Novice nurse can be student or newly licensed with minimal clinical experiences who approach situations from a theoretical perspective relying on context-free facts and established guidelines. Rules govern their practice. (2) Advanced beginner is level that most new nurses function. Practice independently in performing tasks and make some clinical judgement. Rely on pripr experience to make practice decisions. (3) Competent Nurse is 2-3 years of nursing practice and demonstrate increasing level of skills/proficiency and clinical judgement. Organize and plan care using abstract and analytical thinking. Can anticipate long-term outcomes of personal actions. (4) Proficient Nurses have significant amount of experience and enhanced observational abilities to provide holistic care. Well-developed critical thinking and decision-making skills allow nurses to recognize and respond to unexpected changes. (5) Expert Nurses have wealth of experience and view situations holistically and process info efÏciently, make decisions using advanced level intuition and analytical ability. Do not reply on rules to comprehend situation and take action. Quality Improvement: standards of care should reflect optimal goals and be based on evidence. Focuses on assessment of outcomes and determines ways to improve delivery of quality of care (all level employees involved.) Quality improvement is used to identify and resolve performance deficiencies; there is a set of predetermined standards to measure against. QI Process: outcome (clinical) indicators reflect the desired patient outcome related to standard under review. Structure indicators reflect the setÝng in which care is provided and availability of human/material resources. Process indicators reflect how patient care is provided and established by policies/procedures. Benchmarks are goals that are set to determine at what level the outcome indicators should be met. Process indicators=provide important info about how procedure is carried out. Outcome indicators=measure whether that procedure is effective. QI Root Cause Analysis: After collecting data, analyzing, and comparing with established benchmarks, determine if benchmark is met. If benchmark not met, root cause analysis can be done. Root cause analysis focus on variables surrounding the consequence of an action/occurrence and is commonly done for sentinel events (death, serious physical injury related to client care) but can be done routinely. Investigate consequences and causes, analyzing influences and determining a root cause/causes. Core Measures: national standardized measures developed by joint commission to improve patient outcomes and used to measure client outcomes and provide info to support accreditation of hospitals. Core measures developed include stroke, venous thromboembolism, heart failure, MIs, and substance abuse. Audits: provide quantitative data. Types of Audits: (1) Structure audits evaluation influence of elements existing separate from/outside of the client-staff interaction. (2) Process audits review how care was provided and assume relationship exists between nurse and quality of care provided. (3) Outcome audits determine what results (if any) occurred as a result of the nurse care. Outcomes influences include quality of care, level of commitment, managerial staff, and characteristics of facility’s policies and procedures. Nursing-sensitive outcomes are affected by quality of nursing care directly (ex: pt fall rates and nosocomial infection rates.) Conflict: result of opposing thoughts, ideas, feelings, perceptions, behaviors, values, opinions, or actions between individuals. Nurses can use problem-solving and negotiation strategies to prevent a problem from evolving into conflict. Common Causes of Conflict: ineffective communication, unclear expectations of team members in their various roles, poorly defined or actualized organizational structure, conflicts of interest and variance in standards, incompatibility of individuals, management or stafÏng changes, diversity related to age, gender, race, or ethnicity. Categories of Conflict: (1) intrapersonal conflict: occurs within the person and can involve internal struggles related to contradictory values/wants. (2) Interpersonal Conflict: occurs between two or more people with differing values, goals, beliefs. Can be between nurses, patients, family members, and within health care team. Bullying/incivility are forms of interpersonal conflict. Contributes to burnout and work-related stress. (3) Intergroup Conflict: occurs between two or more groups of individuals, departments, organizations and can be caused by policy/procedures, change in leadership, or change in organization structure. Five Stages of Conflict: (1) Latent Conflict-not yet developed conflict but factors that present indicate high likelihood of conflict occurring. (2) Perceived Conflict-problem is present though actual conflict may not exist. (3) Felt Conflict- beginning to feel emotional response to conflict . (4) Manifest Conflict-parties involved aware of conflict and action is taken which can be positive or negative. (5) Conflict Aftermathcompletion of conflict and can be positive or negative. Problem Solving How-To: Identify the problem by stating it objectively and minimizing emotional overlay; Discuss possible solution by brainstorming as a group and encourage creative thinking; Analyze identified solutions by listing pros and cons of each solution and narrow down solutions; Select a solution; implement the selected solution and be sure to list the procedure and time for implementation; and evaluate the solution’s ability to the resolve the original problem. Elements of Assertive Communication: select appropriate location for verbal exchange; maintain eye contact; establish trust; be sensitive to cultural needs; speak using “I” statements and include affective elements of the situation; avoid “you” statements that can indicate blame; stating concerns using open, honest, direct statements; conveying empathy; focusing on the behavior or issue of conflict avoiding personal attacks; conclude with statement that describes fair solution.