Faculty Notes - University of Phoenixmyresource.phoenix.edu/secure/resource/NUR492r7/nu… · Web...

School of Nursing

Faculty Notes

NUR/492 Version 7Senior Practicum: Leadership and Management

Copyright

Copyright © 2015, 2013, 2010, 2008 by University of Phoenix. All rights reserved.

University of Phoenix® is a registered trademark of Apollo Group, Inc. in the United States and/or other countries.

Microsoft®, Windows®, and Windows NT® are registered trademarks of Microsoft Corporation in the United States and/or other countries. All other company and product names are trademarks or registered trademarks of their respective companies. Use of these marks is not intended to imply endorsement, sponsorship, or affiliation.

Edited in accordance with University of Phoenix® editorial standards and practices.

Faculty NotesNUR/492 Version 7

2

Module Revision History

MODULE CODE REVISION DETAIL

nur492r1 Original Course

nur492r2 Text Edition Update

nur492r3 Assignment Added

nur492r4 Assignment Removed

nur492r5 Added Regulated States information and alternative clinical assignment instructions,. Academic Questionnaire and Academic Survey, moved all materials to current templates, TEU on Effective leadership and management in nursing.

nur492r6 Rubrix tool added for signature assignment.

nur492r7 Rubrix tool added for signature assignment. Removed verbiage associated with other Programmatic Assessments. Updated some formatting and verbiage for New Classroom.

Programmatic Assessment

In Week 5, there is a programmatic assessment titled “Human Resource Policy Presentation.” This assignment is “locked” meaning that faculty may not modify this assignment in any way. The details of this assignment are noted on the Classroom Syllabus for Week 5. Clinical Educational Experience

This course includes 25 clinical hours and a programmatic assessment. It is important to note that students may earn either clinical hours or didactic points for an activity, but not both.

The Classroom Syllabus outlines specific clinical activities with a minimum number of clinical hours for each week. Students must log the hours that they complete on their specific activities. Following each clinical activity, students are instructed to develop a follow-up assignment based on the clinical experience. Any documentation or materials students develop, as part of the clinical activity, must be submitted with the class assignment.

Please note: Online students who reside in a Regulated State of the United States cannot complete ground-based, in-person clinical hours. Before class begins, review the Regulated States document and determine if any of your students live in a Regulated State. Students also review this document and determine if they live in or work in a regulated state. If they live or work in a regulated state, they are to contact you to discuss and obtain alternate clinical assignment instructions. Online students in a regulated state must follow the Alternate Clinical Assignment Instructions provided. This document is currently housed as faculty view only as it is an option only for students who live in Regulated States (this is for regulatory reasons). All other students must follow the normal assignment guidelines provided in the class.

If you have a regulated state student, please copy the Regulated State Student Alternate Assignment Instructions into a private message to the student; they are not otherwise viewable to the student. Also, review the same documents. These students only have a few alterations in their assignments. They select a case study family, but complete a neighborhood survey in a real neighborhood.


3

Week 1 Faculty NotesAdministrative Notes

All modalities

Distribute course syllabus. Discuss policies, procedures, expectations, and assignments. Be sure that students have copies of the Student Program Handbook. Provide any directions

necessary for finding it on the student website. Preview the major assignments for the course, week by week. Include suggested times to

start preparation for these assignments. Preview the learning objectives and content for this week. Discuss clinical requirements. At the end of the class or week, review key content points and preview the content of the next

week.

Content Notes

TOPICS AND OBJECTIVES

Leadership and Management

Identify theories and styles of leadership. Examine the theories and functions of management. Differentiate between leadership and management roles and functions.

CONTENT OUTLINE

1. Identify theories and styles of leadership. a. Early leadership theories (early 20th century) focused on the premise that leaders were

bornb. Leadership theories have evolved since then and focus much more on the development

of leadersc. Leadership theories and styles

1) Trait theorya) Theories tried to identify leadership personality traitsb) These were studied around 1900 - 1950c) Have continued to be used as bench markers

2) Behavioral theorya) Focused on the abilities and behaviors of leadersb) Three styles of leaders emerged (autocratic, democratic, and laissez-faire)c) Fourth style added – bureaucratic leadership

3) Contingency or situational theorya) These theories emerged in the 1960s to 1970sb) Leadership style adapts to the situationc) Strong relationship to motivation, performance and the accomplishment of a goal

4) Contemporary theories


4

a) These arose at the end of the 1990s because of the impact of globalization and other organizational impacts

b) Quantum leadership(1) Related to concepts chaos theory and unpredictability of events(2) Constant change is expected and health care is an excellent example of this

rapidly changing environment(3) To be successful followership and relationship building are needed

c) Charismatic leadership(1) Leadership personality – often related to powerful people

(a) Often can lead to followership that is negative not positived) Transformational leadership

(1) Inspires and motivates followers(2) Leader is a role model(3) Encourages moral and ethical development

e) Shared leadership(1) Assumes a workforce of more than one leader(2) Examples – shared governance, work teams

f) Servant leadership(1) Looks at how we contribute not just in the workplace but in the community(2) Servant leaders listen and also learn from their employees (3) Promote diversity and realize that the task cannot be accomplished alone

2. Examine the theories and functions of management. a.Fayol in 1916 looked at management as functional

1) Encompassed how the organization should operate to function effectivelya) Planningb) Organizingc) Directingd) Controlling

2) Mintzberg's model takes a behavioral approach to management a) Interpersonal rolesb) Informational rolesc) Decisional Roles

3. Differentiate between leadership and management roles and functions.a. Leaders do not always have a title (informal leader) b. Leader functions are often predominantly associated with a title or position

1) Envisioning goals2) Setting agendas 3) Representing the organizational beliefs4) Affirming values5) Motivating – share the rewards!6) Developing trust – being accountable7) Lifetime of growth and development8) Community and Profession

c. Manager functions 1) These can be the same as above but often are more patient or unit focused


5

2) Communication skills are an essential component of this role3) Conflict management is a vital managerial function 4) Managing and evaluation of outcomes (risk management) expanding function in

today’s health care arena d. External influences and standards

1) American Association of Nurse Executives (AONE) a) Identified six roles and functions for nurse managers

2) American Nurses Credentialing Center – magnet criteria e. Organizational influences

1) Structure of the organization2) Culture of the organization3) Scope of roles may vary – but need to be within the scope of practice

f. Impacts of power1) Can have positive and negative implications2) Power (principle centered) can motivate and influence others 3) Nine types of power

a) Reward powerb) Punishmentc) Legitimated) Experte) Referentf) Informationg) Connectionh) Positioni) Personal

4) Image of power – conveyed, perception a) Again this can have negative or positive influences depending on the attitudes

and messages being sent to others 5) Using the least amount of power to accomplish the goal is best6) Use of power often has effects long after the event

FIRST MESSAGES

Is leadership an inherited trait or a developed skill? Support your opinion. How can the elements of transformational leadership enhance a manager’s approach to

problem solving and managing a department? Look at the functions of management described in your reading. How are they implemented

in your work setting? In the current health care setting, what management functions and behaviors are essential for

nursing managers to perform? Do leaders always have positions of power? If not, then who are the various leaders in your

work setting and what makes them informal leaders? How is leadership important to the role of the professional nurse? How is leadership different from management? Can leaders perform management functions?


6

Required Learning ActivitiesThemes and Findings


7


All modalities

Answer any content or logistical questions resulting from the previous week. Preview the major assignments for the course, week by week. Include suggested times to

start preparation for these assignments. Preview the learning objectives and content for this week. At the end of the class or week, review key content points and preview the content of the next

week. Be sure that you have received all assignments that are due. Review clinical logs.

Content Notes


Organizational Structure and Culture

Describe the characteristics and models of organizational structures. Examine various organizational theories and their implications in health care. Identify social and cultural aspects affecting health care organizations.

CONTENT OUTLINE

4. Describe the characteristics and models of organizational structures.a. Organizational Structure

1) Functional structurea) Departments divided by services providedb) Can create professional expertise but can also create silosc) Conflict and communication can be issues

2) Service-integrated structurea) Integration of all services brought together for one area – cardiology would

include several areas under one managerb) Coordination of services within the area is usually betterc) Can also duplicate services across areas and in the end be more costly to

operate3) Matrix structure

a) Designed to reflect both structure and functionb) Combines the bureaucratic and flat structurec) Complex model and requires well developed collaboration and coordination

4) Flat structurea) Decisions regarding work methods, nursing care, and work conditions are made

where the work is carried outb) Decentralized decision making


8

c) Allowing staff to make decisions is the hallmark of a flat structured) Magnet hospitals have recognized the benefits of this and its impacts on nursing

satisfactione) This structure has its challenges – for example, potential for inconsistent decision

making, managerial challengesf) Development of a unit like this needs transitional time and education for the

manager as well as staff5) Types of health care organizations

a) Hospitals(1) Private (non-government owned)(2) Governmental facilities

b) Long term carec) Ambulatory cared) Managed care organizationse) Prisons f) Home health careg) Hospiceh) Specialty facilities

(1) Surgical centers(2) Endoscopy facilities(3) Alzheimer’s facilities(4) Research (5) Urgent care

5. Examine various organizational theories and their implications in health care.a. Organizational Theories

1) Classicala) Focuses on the organizational structure b) Span of controlc) Division of labord) Chain of command

2) Systemsa) Closed (self contained) b) Open, such as a health care organization interacts with internal and external

elementsc) System is described as having four elements

(1) Structure(2) Technology(3) People(4) Their environment

d) Organizational development in an open system emphasizes adaptation to the external environment which thus generate changes to the internal system (1) Example – prospective payment system of the 1990s was developed

because of the rising cost of health care(2) Payment cap for internal hospital stays made organizations look at

alternative delivery options such as ambulatory surgery, home based care, etc.


9

3) Contingency theory4) Chaos theory

a) The organization must be able to adapt to changes in the environment b) Must be adaptive and able to deal with change to survive and grow

6. Identify social and cultural aspects affecting health care organizations.a. The changing health care organization

1) Cultural diversity2) Consumer empowerment3) Work force shortages 4) Training

a) Demand for ongoing continuing educationb) New equipment and proceduresc) Error management, such as medication errors

5) Impact of external issuesa) Regulations

(1) JACHO(2) HIPAA(3) State licensure requirements and standards(4) Magnet accreditation(5) Legislative mandates

b. Organizational, social, and cultural impacts1) Types of organizational cultures and climates2) Workplace violence 3) Empowerment of the workforce

a) Shared governanceb) Unionization impacts

4) Work force changesa) Generational spans b) Cultural diversityc) Gender – more males in the workforced) More temporary staffing

5) Norms and traditionsa) “Scared cows”

6) Communication with different populations and culturesa) Peersb) Medical staffc) Patients and families

7) Subcultures8) Organizational values

a) Mission, vision, and philosophy of the organizationb) How are they developed?c) How are they shared?d) Are they reflected in the climate of the organization?


10

FIRST MESSAGES

Since organizational theories describe how organizations function, which of these theories best describes you current workplace?

Compare the organizational structures identified in the reading to your workplace. If you could redesign or restructure your work unit, what format would you select?

How are the social and cultural influences of your community integrated into the delivery of care in your organization?

How do generational differences influence the organizational culture of the workplace?

Required Learning Activities

Professional Nursing Organizations


11


All modalities




Content Notes


Change Theory and Models, and Evidence-Based Practice

Examine the theories and stages related to planned change. Assess the responsibilities of leaders and managers as change agents. Examine the utilization of evidence-based research to support change within the

workplace.

CONTENT OUTLINE

7. Examine the theories and stages related to planned change. a. Describe and define change

1) Impact on nursing and health care2) Lewin’s force field analysis

a) Change involves three elements:(1) Unfreezing(2) Moving(3) Refreezing

3) Awareness of need to change4) Lippitt theory/model of change

a) Diagnosis of problemb) Assessment of motivation to changec) Assessment of change agents motivation and resources d) Selecting progressive change objectivese) Choosing an appropriate role for the change agentf) Maintaining change once startedg) Termination of helping relationship with the change agenth) Havelock model of change

(1) Building a relationship


12

(2) Diagnosing the problem(3) Acquiring relevant resources

(a) Choosing the solution(b) Gaining acceptance(c) Stabilization and self renewal

8. Assess the responsibilities of leaders and managers as change agents.a. Change strategies

1) Assess readiness2) Plan process3) Action steps 4) Encourage questions5) Maintain momentum

b. Role of communication in change process1) Modes2) Direction of communication3) Different populations

a) Subordinatesb) Peersc) Supervisorsd) Patients and families

c. Conflict management1) Conflict process model2) Impact of change and conflict

a) Time involved to affect changeb) Difficulty involved – moving from

(1) Knowledge(2) Attitude (3) Individual behavior(4) Group behavior

3) Resistance to changea) Describe ways resistance to change manifestedb) Actions to avoid when implementing change

(1) Announce change without laying a foundation(2) Ignore or offend powerful/influential people(3) Violate authority and communication lines(4) Overestimate your formal authority(5) Make a poor decision about what change is needed without opening this

decision to critique(6) Put people on defensive(7) Under estimate the perceived magnitude of change

c) Exercise tolerance9. Examine the utilization of evidence-based research to support change within the workplace.

a. Formulate strategies for clinical change based on research1) Change based on research - evidence-based practices (EBP)2) Changing the status quo requires informed solutions that are based on research


13

3) Quality improvement initiatives in health care are increasingly looking at research as the emphasis for making decisions and change

4) Identify strategies to implement EBP 5) Formulate your clinical based question – related to your change issue 6) Review the literature

a) Assess best sources or databases to research (1) CINAHL(2) OVID(3) Some sources are free while others may be offered through the employer

7) Assess your current clinical procedures or process in comparison to the literature8) Apply evidence based research documentation as basis for implementation of the

change process

FIRST MESSAGES

What are the five top qualities needed for an effective leader to facilitate change in an organization?

In today’s health care environment, why is it important to understand the theories related to change?

If you were faced with a situation that requires a major change, what theory or theories would you use to support this process?

What are some major changes occurring in health care today? What are strategies that managers or leaders can use to promote or facilitate a change? How do communication methods or process affect change? How does change occur in your workplace? Will utilization of EBP promote less resistance to change?

Required Learning Activities

Themes and Findings


14


All modalities




Content Notes


Human Resource Management Describe the role of human resource management in health care. Identify issues related to staffing and performance evaluations. Determine methods to motivate and develop staff. Explain factors that support safe and effective delegation.

CONTENT OUTLINE

10. Describe the role of human resource management in health care.a. Managing peopleb. Workplace employment polices and procedures

1) Substance abuse 2) Absenteeism3) Work place violence4) Americans with Disabilities Act5) National Labor Act6) Sexual discrimination7) Other forms of workplace discrimination8) Workplace injuries 9) Retention/educational incentives10) Organizational benefits11) Collective bargaining 12) Staffing

a) Is a function of management planningb) Goal is to provide appropriate and adequate coverage for the patient

classificationc) Determine staffing mix needed to provide care

(1) Staffing models – patient classification systems


15

(a) Determines the patient acuity and staffing (2) Examples include systems like Medicus, GRASP, ARIC(3) National Database for Nursing Quality Indicators (NDNQI®) can be used to

compare like organizations or units as a means to monitor staffing(4) These systems provide trend data – determine nursing care hours(5) Staffing fluctuates based on

(a) Patient services – for example, a short stay surgical unit may not need weekend staffing

(b) Shift time(c) Unit acuity(d) Seasonal trends in some locations – i.e., winter visitors

(6) External staffing influences(a) Legislative mandates for staffing to patient ratios(b) ANA recommended policies for appropriate staffing ratios(c) State licensing standards(d) Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

staffing standards(7) Internal variable to staffing

(a) Flexible scheduling (b) Coverage for staff paid leave time(c) Lack of sufficient full time staff, requiring supplemental agency personnel(d) New hire orientation time – especially new graduates

(8) Forecasting (a) Effectiveness of current staffing(b) Acuity trends(c) New services to be offered or deleted(d) Patient outcomes(e) Basic shift length (f) Maximum work stretch of time per employee(g) Personal and educational time off the unit

(9) Recruitment(a) Now that you have forecast your needs – recruiting and selection begin(b) Jobs to be filled

a. Level of employeeb. Licensed or non licensed personnel

(c) Method to recruit a. Job fairb. Internet (Monster.com or local newspaper’s Web site)c. Nursing schoolsd. Foreign country

(d) Hiring processa. Agency and state requirementsb. Background checksc. Drug testing

(e) Key elements of the interview


16

a. Allowable and non allowable questionsb. Discrimination issuesc. Legal status – work visa, etc.

(f) References 11. Identify issues related to staffing and performance evaluations.

a. Start with clearly defined position requirements b. Formal written appraisal tool – usually completed annuallyc. Employees should have a clear understanding of the content and scoring methods of the

toold. Reviews should include accurate appraisal of the employee’s performance

1) Graphic rating scales can be biased or give a halo effect 2) Employee is on good behavior for the last month and the rater reflects this as the

entire year3) Collection of data during the last month does not show the annual performance4) Anecdotal notes over the year provide a more accurate summary5) The opposite can be true as well – good performance all year long and then the

employee has a bad month before the reviewe. Should provide a mechanism to identify personal as well as organizational goals

1) Organizational support for these goals should mirror the needs of the work unit12. Determine methods to motivate and develop staff.

a. Staff Motivation and Development1) Motivational theories2) Content theory

a) Focus on individual needs or rewards to satisfyb) Major theorists – Maslow, Aldefer, Herzberg

3) Process Theoriesa) Focus on how the motivation process impacts an individual’s performance b) Process theories include

(1) Reinforcement theory(2) Expectancy theory(3) Equity theory(4) Goal-setting theory

b. Staff development1) Needs assessment to determine exactly what educational program is needed2) Some programs are mandatory and required by all staff – successful completion of

the program must be documented3) Some programs may be mandatory for an individual employee, to correct knowledge

deficient or reinforce skills that are not being applied correctly – such as medication errors

c. Educational delivery options1) Classroom based offerings – usually used for orientation or specific learning that may

require hands on interactions – such as a CPR class2) Online – computer assisted modules are becoming more popular and can be

completed as the employee has time – great way to document learning and completion for record keeping

3) Conferences – usually related to enhancing and expanding content knowledge


17

4) Credit bearing certificates for certification or credit bearing classes geared toward a degree offering

d. Staff retention and employees motivated to pursue life long learning are vital to the growth and develop of an organization as well as to the individual employee1) Key element of a learning organization2) Open environment that supports and encourages life long learning3) Providing learning opportunities related to the individuals expertise and experience4) Encourage unit-based nurses to be the lead on an educational offering5) Investment in their employees learning opportunities reduces turnover

a) New graduates strongly benefit from structured orientations, preceptorships b) This is a large investment but studies show it reduces turnoverc) Turn over is a costly item for any agency

6) Staff empowerment to research a problem and work together as a teams to suggest a solution or educational offering to solve the problem

e. Evaluation and review 1) Learner impact – did the program provide learning2) Has learning been applied 3) Did it meet the learning needs of the individual4) How can the program be improved 5) Should the program be repeated

13. Explain factors that support safe and effective delegation.a. Historical Perspective

1) There has been forms of delegation for years2) The 1970s brought a shift of less delegation and more primary care (RN staffing)3) The mid-90s took another turn and care shifted again to a multilevel staffing mix

a) Delegation was now very different than in the pastb) Change occurred with greater emphasis on cost containment and nursing

shortagesc) Agencies have seen an increase in unlicensed personneld) RN role is changing, but safe care is still criticale) ANA and state boards have entered the mix to look at the level of quality and

appropriateness of delegationf) Standing, Anthony, & Hertz (2001) study found that two most common errors

associated with delegation are(1) Giving improper directions(2) Improper follow through of agency protocols

4) Authority for delegationa) Relates to the person who can allocate a work process to someone elseb) Authority also rests with what the licensed or unlicensed individual has the

authority to do5) Accountability

a) The delegator is accountable and responsible for knowing that the delegate is properly qualified to do the assigned work

b) The RN is accountable for the nursing care (state boards, ANA code of Ethics (2001) provision #4)

6) Differentiation of delegation and work allocation


18

a) Two RNs working together sharing work is not delegation – this is assignment (in assignment both have the responsibility and accountability)

b) However if one RN is accountable for an overall outcome – for example, the RN asks another RN to perform a specific component of the overall function – that is delegation (Yoder-Wise, 2007)

c) Usual delegation is RN assigns and LPN/LVN or UAP performs specific task or function

7) Delegation Processa) Identifying and defining the taskb) Levels of delegationc) Determination of who (LPN/LVN, nurse aide, or other unlicensed personnel)d) Defining expectationse) Monitoring performance and feedback

8) Obstacles to delegationa) Non-supportive environmentb) Insecure delegatorc) Negative outcomesd) Unwilling to delegate

9) Ineffective delegationa) Under delegation (do not use assistive personnel to their advantage)b) Reserves delegationc) Over delegation (inappropriate delegation)

10) Liability and delegationa) Understand state board of nursing rules and regulations regarding what may be

delegated b) Understand organizational policies and procedures related to delegation

(1) How does an organization verify knowledge and competence of its personnel?

(2) As new tasks are added, how are personnel checked off prior to assigning task?

(3) Failure to monitor delegation to assure that the function is completed within a safe standard can be cause for malpractice

(4) The delegator remains accountable for the care even if they did not perform all aspects

FIRST MESSAGES

Imagine yourself in a leadership position and you have just been mandated to reduce your department’s labor force by eight percent. o What steps are you taking to identify whom to lay off? o What are the staff roles and regulatory requirements regarding certain staffing patterns,

the roles of assistive personnel, cross training, and anything else you think would help in arriving at a viable solution?

What are the two most commonly used theories of discrimination for claims under the Title VII of the Civil Rights Act of 1964?

What are the major provisions of the Americans with Disabilities Act of 1990? How are staffing mix and levels determined?


19

Are regular performance appraisals completed in your workplace? What is the purpose of these reviews? Are the reviews tied to monetary rewards?



20


All modalities



week. Be sure that you have received all assignments that are due. Review clinical logs. Note: The assignment due this week “Human Resource Policy Presentation” is a locked

programmatic assessment. Do not modify this assignment in any way.

Content Notes


Financial Management

Identify current health care reimbursement sources. Review the types, role, and process of budgeting. Discuss the impact of health care's financial-based mandates. Examine the role of nursing in risk management.

CONTENT OUTLINE

1. Identify the current health care reimbursement sources.b. Health care financed by four main sources

1) Government (36%)a) Most of this comes in the form of Medicare, military and veteran benefits, Native

American benefits, federal prisoner costsb) Medicare is the largest programc) Medicaid – state level programs are paid in part by federal monies; again this is

substantial part of the funding (50-83%)2) Private insurance companies (41%)3) Individuals (19%)4) Philanthropists (4%) (Yoder-Wise, 2007)

c. Health care reimbursements1) Four major payment methods

a) Chargesb) Cost-based (retrospective)

(1) Both charges and cost-based methods are retrospective(2) They are the cost of the service plus a profit


21

(3) Payers often limit the cost based or charges reimbursement based on a survey of the pricing by providers in the area to calculate their payment

c) Flat rate ( prospective)(1) Prices are determined by the payer before the service is provided (2) If the cost is greater that what is reimbursed, the provider of the care loses

money(3) If the cost is less the provider makes money(4) Resource Based Relative Value scale is the flat rate method the federal

government pays physicians(5) DRGs or PPS systems is the flat rate determined to be paid to agencies such

as hospitalsd) Capitated

(1) Method of payment characteristic of an HMO(2) Payment based on provision of services for a year – provider is paid per

person (Yoder-Wise, 2007)1. Review the types, role, and process of budgeting.

d. Types of budgets1) Operating budgets2) Capital budgets3) Revenue

e. Approaches to budgeting1) Incremental2) Zero-based3) Fixed4) Variable

f. Operating budgets1) Revenues2) Expenses3) Wages and salaries

a) Benefitsb) Shift differentialsc) Overtimed) On calle) Bonuses and premiumsf) Salary increasesg) Turn over/recruitment costsh) Other

g. Budget performance measures1) Variances2) Position control3) Staff considerations4) Acuity systems

h. Resources for nursing care delivery1) Primary2) Functional


22

3) Teams4) Case management

i. Forecasting for addition or deletion of service or product lines is vital in budget planning14. Discuss the impact of health care's financial-based mandates.

a. Health care costs1) Health care cost continues to rise in the US and is about 13 percent of the gross

national product2) This equals $4368 per person and surpasses the per capita rate for other western

countries by 50 percent (Yoder-Wise, 2007)3) Yet we still have many people without access to basic health care4) Legislative mandates for

b. Calculating total health care costs 1) Cost = Pricing x Utilization2) Price is the amount set by the provider for the service3) Utilization is the quantity or volume of services provided4) Prices rise for multiple reasons – administrative inefficiencies, prescription drugs5) Utilization rises because of unnecessary testing, consumer attitudes, pharmaceutical

usage, population and disease demographics6) Health care financing contributes to the rise in costs – no consumer incentive to

reduce costs7) Low co-payment – consumer does not know the actual price that the drug or test

costs (Yoder-Wise, 2007)8) Addition of mandated staffing ratios – health care quality and yet need to control cost9) Legislative mandates of health care funding – children, elderly (Medicare)

15. Examine the role of nursing in risk management.a. Support integration of quality and risk management b. Integration of outcomes management and evidence-based practicec. Essential quality management requires multidisciplinary involvementd. Create a culture of improving patient care

1) Avoid culture of blaming for errors2) Support process to improve outcomes

e. Components of quality management1) Developing a comprehensive plan2) Setting standards and benchmarks3) Defining terms

a) Structureb) Processc) Outcome

f. The role of benchmarkingg. Practical information and application

1) Role of audits2) Types of audits3) Purposes of audits4) Peer review5) Utilization review


23

6) Role of risk managementa) Trends and patternsb) Reports

(1) Incident reports(2) Falls(3) Medical errors and/or adverse drug reactions(4) Agency reports(5) Complaints

c) Regulatory agencies7) Decision-making

a) Types of decisionsb) Decision-making techniques

(1) Seven steps(2) Charting(3) Other techniques

FIRST MESSAGES

What is the purpose of the position control and budgeting? Calculate the FTE required for a unit with six nurses 24/7. What is a replacement factor to

cover three weeks of vacation and five sick days per year per nurse? What is the impact of changing reimbursement on the budget process? Describe the various reimbursement sources of payment in health care today. What role do you or your manager play in the development and management of the

department budget? What is the impact of the uninsured or underinsured on health care resources? How does nursing impact the budget, and should nurses be concerned about the cost of

nursing care? Other than wages, what are the other major budget items that must be considered? Describe the new risk management processes at your facility, in relation to state and federal

mandates? How would utilization of EBP practice in the work place be used to reduce nursing risk

factors?



24


All modalities




Content Notes


Continuous Process Improvement

Describe issues related to quality management in today’s health care arena. Explain the relationship between quality improvement and risk management, exploring

the concepts of systems theory.

CONTENT OUTLINE

1. Describe the issues related to quality management in today’s health care arena.h. Need for quality management

1) Improvement is everyone’s responsibility2) Improvement is always desirable3) Pay attention to detail4) Quality requires systematic work5) Create an ongoing exchange and sharing of information6) “Personal mastery is possible only in an environment that encompasses rewards and

improvement at all levels.” i. The role of professional organizations in quality improvement

1) Regulatory related factorsa) Standards of careb) Credentialingc) Utilization reviewd) Clinical guidelinese) Clinical pathwaysf) Benchmarkingg) Evidence-based practice/research utilizationh) National Safety goalsi) Assessment of accessj) Mandated reporting – consumer visibility of organizational outcomes


25

16. Explain the relationship between quality improvement and risk management, exploring the concepts of systems theory.a. Systems improvement and Total Quality Management (TQM)

1) Definition and history of TQM2) Role of regulatory agencies and the Joint Commission on Accreditation of Healthcare

Organizations (JCAHO)a) 1965 Case: Darling v. Charleston Community Hospitalb) Professional Standards Review Organization (PSRO)c) Peer Review Organizations (PROs)d) Joint Commission on Accreditation of Healthcare Organizations (JCAHO)e) Quality Improvement System for Managed Care (QISMC)f) Health Care Quality Improvement Program (HCQIP)

3) Regulatory agenciesa) National Committee of Quality Assurance (NCQA)b) Accreditation processc) NCQA quality improvement d) Health plan employee data and information sete) American Health Care Commission/Utilizationf) Review Accreditation Commissiong) JCAHOh) Foundation for Accountabilityi) Quality report cards

4) TQMa) Demming’s 14 pointsb) Total organizational involvementc) Tools and statisticsd) Use of the PDAC cycle (Plan, Do, Act and Check)

5) Continuous Quality Improvement (CQI)a) Definitionb) Four major players

(1) Resource (CEO)(2) Coordinator(3) Team leader(4) Team

c) Role of JCAHO(1) Improving organizational performance(2) Performance improvement cycle

FIRST MESSAGES

What is the role of benchmarking when planning a quality improvement project or process? Identify a continuous improvement process that is currently going on at a health care facility

of your choice. What methodologies are being utilized and why? What is the connection between systems improvement and TQM? Discuss commonalities

and divergences of the two.


26

Discuss the impact of consumerism on health care. What factors motivate nurses? Have these stayed the same over time or are they different in

today’s health care environment?



27


All modalities

Answer any content or logistical questions resulting from the previous week. Preview the learning objectives and content for this week. Be sure that you have received all assignments that are due. Review clinical logs.

Content Notes


Changing Health Care Systems

Describe challenges facing nursing leadership. Discuss barriers and opportunities for nursing in the future.

CONTENT OUTLINE

1. Describe the challenges facing nursing leadership.b. Technology to advance nursing practice and delivery of care

1) Confidentiality of client information2) Database support systems – can support disease management 3) Electronic medical records – expands patient information4) Reduction of time to get test results, clarity of medication orders5) Expansion of Tele-Health uses and applications

c. Major health care reforms 1) Patient empowerment2) Emphasis on the health promotion

d. Strategic planning e. New services – for changing demographic populations

1) Pediatric emergency departments2) Bariatric units 3) Disease management - holistic approach4) Spa features at agencies for patients

f. Mandated reporting requirements 1) Hospital related infections

g. Changing reimbursement strategies1) Maintaining financial viability

17. Discuss the barriers and opportunities for nursing in the future.a. Globalization of health care

1) Impact on care – disease transmission2) Increase in sharing of technology and products


28

b. Workplace disaster planning 1) Coordination of services2) Management for data recovery

c. Workplace violence1) More incidents being reported

a) Health care industry leads all other industries in nonfatal work place assaultsb) Labor statistics indicated 24 homicides of health and social assistance workers in

2006c) More than half of these were shooting victimsd) Work place security measurese) Polices to support staff from verbal as well as physical abuse of patients and

visitors

FIRST MESSAGES

Discuss the impact of legislative initiatives on the practice and delivery of nursing. Discuss the role of health care consumers as a political force health care change. Discuss the impact of a more diverse workforce as hospitals recruit nurses from other

countries to support their staffing needs.

Faculty Notes - University of Phoenixmyresource.phoenix.edu/secure/resource/NUR492r7/nu… · Web...

Documents

Transcript of Faculty Notes - University of Phoenixmyresource.phoenix.edu/secure/resource/NUR492r7/nu… · Web...