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258 Cards in this Set

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Org. Theory:
Classical Theory
Division and specialization of labor
-authority
-responsibility
-line authority
-staff authority
-org. structure like military
Orgs. have their own culture that is always evolving...
paradigm shift is always a challenge.
Org. Theory:
Neoclassical Theory
-1930's
-humanistic
-participative
-involved in decisionmaking
-relationship building
-environment based
Hawthorne Effect
Productivity increases because employees are getting attention
Org Theory:
Contingency Theory
-takes environment into consideration
-need to know customers
-staffing needs
Org Theory:
Chaos
-a type of complexity theory
-complicated
-relationships
-complex issues
Leaders are managing mobility...
leaders don't do things, they see that things are done.
Org. relationships:
Integration
vertical - one facility, many services
horizontal - several facilities, same services
Org. relationships:
Diversification
concentric - more of the same services
-conglomerate - branching out into other businesses, joint ventures
Org. Structures:
1.functional
2.service-line
3.hybrid
4.matrix
5.parallel
relationship oriented structures:
shared governance
-interdependency
-accountability: forums, advisory boards, councils
-decentralized
-primary nursing
-peer review
-clinical advancement
-physicians as partners
-empowerment and ownership

*requires mature workers, committees within the nursing structure set policies
Shared governance is a requirement for...
magnet status
Instead of Hierarchy...
Heterarchy (Porter-O'Grady)
-connections
-linkages
-relationships
Restructuring:
purpose
reduce costs and maintain market position
Restructuring:
impact on individual
jobs are redesigned
Restructuring:
impact on organization
-downsizing
-right-sizing (cutting staff)
Restructuring:
impact on systems
re-engineering
Strategic Planning
values
visions
mission
philosophy
goals
Magnet Status
a prestigious recognition given by the American Nurses Credentialing Center (ACCN) recognizing excellence in:
-mgmt., philosophy, practices of nursing services
-adherence to national standards for improving the quality of patient care
-leadership of the nurse administrator in supporting professional practice and continued competence of nurses
-understanding and respecting the cultural and ethnic diversity of patients, family, and health care providers
Magnet Programs:
purpose
-promote quality
-support professional practice
-i.d. excellence in nursing
-provide for best practices in nursing
What creates magnetism?
-clinically competent nurses
-good dr./nurse relationships
-nuse autonomy/accountability
-supportive nurse manager
-control over practice/environment
-support for education
-adequate nurse staff
-paramount concern for pt.
Benefits of magnet status?
-visionary leaders & staff
-environment of constructive change
-can do attitude
-favorable pt. outcomes: lower mortality, higher nurse/pt ratios, higher pt. satisfaction
-enhanced nurse recruitment
-community recognition
-attract better MDs
-reinforce nursing staff satisfaction and productivity
-market edge
-financial benefits of retention
-excellence in nursing
Magnet application process:
assessment
document review
site visit
review & decision
announcement
monitor for adherence
redesignation after 4 years
Nursing Care Delivery Systems:
Functional
-includes RN, maybe LPN, UAP (long term care, tmt nurse, med nurse)
Nursing Care Delivery Systems:
Team Nursing
includes RN x/UAP
Nursing Care Delivery Systems:
Total Patient Care
RN provides all care (other people still help, RNs help each other)
Nursing Care Delivery Systems:
Types
Functional
Team
Total Patient Care
Primary
Practice Partnerships
Case Management (critical pathways)
Differentiated Practice
Patient-centered Care
Nursing Care Delivery Systems:
Functional
1940s
patient needs defined by tasks to be allocated to RNs, LPNs, UAPs
-efficient/effective at regularly performed tasks
-disadvantages:
uneven continuity of care, absence of holism, time-consuming, problems with followup
Nursing Care Delivery Systems:
Team Nursing
most common nursing care delivery system in US
-a team of nursing personnel provides total patient care to a group of patients
-allows use of nonRN staff
-coordination of activities requiring > 1 person
-Disadvantages:
time-consuming communication, continuity of care may be diminished, role confusion and resentment
Nursing Care Delivery Systems:
Total Patient Care
RN is responsible for all aspects of care of one or more pts.
-continuous, holistic, expert nursing care; total accountability; continuity of communication
-disadvantage: less cost effective
Nursing Care Delivery Systems:
Primary Nursing
A nurse designs, implements, and accounts for the nursing care of patients. Care is given by primary nurse/associates.
-knowledge-based practice model
-decentralization of nursing care decisions, authority, responsibility to staff nurse
disadvantages:
requires excellent communication b/w nurses; continuity of care and accountability may be challenged
Nursing Care Delivery Systems:
Practice Partnership
RN & assistant work as practice partners to provide care to same patients
-less expensive
-more satisfying professionally
disadvantages:
decreased ratio of professional to nonprofessional staff, potential for inappropriate delegation to assistant
Nursing Care Delivery Systems:
Case Management
Organizes patient care by major diagnoses and focuses on attaining predetermined patient outcomes within specific timeframes
-all professionals are equal members of team
-emphasis is on managing interdisciplinary outcomes
Disadvantage:
requires essential base-line data to be available to team members
Nursing Care Delivery Systems:
Critical Pathways (part of Case Mgmt.)
-Refers to the expected outcomes and care strategies developed by collaborative team
Provides a daily outline of outcomes to be achieved for each patient
Alterations in expected outcomes are categorized as a variance to be analyzed by the case manager
examples of outcomes include length of stay and expected time frame for specific interventions
Nursing Care Delivery Systems:
Differtiated Practice
Maximizes nursing resources by creating distinct levels of nursing practice based on education, experience and competence.
Scope of nursing practice and level of responsibility are specified for each level.
Nursing Care Delivery Systems:
Patient-Centered Care
Role of nurse is broadened to coordinate a team of multifunctional unit-based caregivers.
Focus is on decentralization and the promotion of efficiency, quality, and cost control.
Responsibilities of caregivers are increased so that service and waiting times are decreased.
Leader:
uses a wide variety of interpersonal skills to influence others to accomplish a specific goal
-has the capacity to earn and hold trust
-must be personally authentic and accountable
-must possess enthusiasm, energy, and commitment
Manager:
responsible and accountable for efficiently accomplishing the goals of the organization
focuses on coordination and integrating resources
uses the functions of planning, organizing, supervising, staffing, evaluating, negotiating, and representing
-has authority, responsibility, accountability, and power
Leadership:
Formal
Informal
-practiced by a nurse with legitimate authority
-exercised by a staff member who does not have a specified mgmt. role
Leadership Theory:
Trait Theories
Trait Theories
Stogdill (1974), Bass (1990), Gilbert (1975)
Leadership Theory:
Behavioral Theories
1.autocratic
2.democratic
3.Lassez-faire
4.bureaucratic
Leadership styles:
1.assumes people are externally motivated; leader decides, employees follow.
2.assumes people are internally motivated; leader uses participation and majority rule.
3.assumes people are internally motivated and can direct self to complete work; leader provides no direction or facilitation. (Employees must be highly mature).
4.assumes individuals are externally motivated; leader trusts no one, relies on org. policies and rules.
Leadership Theory:
System 4 management
(rank low to high)
-involvement of staff in decisions about work is central to effective leadership.
(ranked from low maturity to high maturity)
-autocratic
-benevolent
-consultative
-participant/democratic
Leadership Theory:
Managerial grid (p. 48)
model for depicting leadership along a continuum.
1.impoverished
2.authority compliance
3.country club
4.middle of the road
5.team
concern for production(structure)/concern for people(consideration)
1.low product./low people
2.high product./low people
3.low product./high people
4.moderate/moderate
5.high/high
Leadership Theory:
Continuum of leadership behavior (p. 49)
from high authoritarian (left side) to high lasseiz faire (right side)

-no one style is right for all situations
Leadership Theory:
Contigency Theories
Adapt leadership style in relation to changing situations.
Leadership Theory:
Contigency Theories:
Fiedler
3 situational factors of leadership
1.Manager-follower - good to poor loyalty of followers
2.Task structure - high to low
3.Manager power - strong to weak legitimate power

Task leader more success under high and low structures

Relationship leader more success under in-between situations
Leadership Theory:
Contigency Theories:
Situational
S1/R1(unwilling)
S2/R2
S3/R3
S4/R4(willing)
Considers the followers' readiness and willingness to perform tasks
1.telling (high task/low relationship)
2.selling (high task/high relationship)
3.participating (low task/high relationship)
4.delegating (low task/low relationship)
Leadership Theory:
Contigency Theories:
Vroom-Yetton Expectancy Model
1.Is all info available to make decision?
2.Is the staff's acceptance required?
3.Will the group make a decision the leader can live with?

5 leadership styles
1.tell-assess prob.
2.sell-gather info./boss decides
3.consult-seek advice/boss decides
4.join-seek suggestions/boss decides
5.delegate-consensus building/group solution
Leadership Theory:
Contigency Theories:
House-Mitchell Path-Goal Theory
1.Expectancy
2.Instrumentality
3.Valence
Remove obstacles to goal attainment, coaching, provide personal rewards to achieve high levels of performance and productivity.
1.the perceived probability that effort will result in success.
2.the perceived probability that performance will lead to desired outcomes.
3.the probability that desired outcomes will lead to a valued reward.
Leadership Theory:
Contigency Theories:
House-Mitchell Path-Goal Theory
4 leadership behaviors

1.Directive
2.Supportive
3.Participative
4.Achievement-oriented
1.for marginally trained employees/give specific directions
2.for experienced employees or routine work
3.employees with moderate skills and ambiguous work (mutual clarification of objectives)
4.skilled employees/innovative or ambiguous work. set challenging goals
Leadership Theory:
Contemporary Theories

1.Quantum
2.Charismatic
3.Transactional
4.Transformational
5.Relational
6.Shared
7.Servant
1.based on chaos theory, future focused, outcomes focused
2.based on charm, ideas, strong convictions
3.social exchange - give and take - economic, meeting needs
4.commitment to vision to change org.; revolutionary
5.collaboration, to achieve org. goals
6.individuals share responsibility to meet org. goals.
7.leader 'serves' other peoples' needs.
Management Functions:
Classic description
Planning (contingency vs. strategic)
Organizing
Directing
Controlling
Management Functions:
Mintzberg's Behavioral Descriptions
1.Interpersonal
2.Informational
3.Decisional
1.the leader, figurehead, liasson
2.monitor, disseminate, spokesman
3.entrepreneur, negotiator, resource allocator
Contemporary Model of managerial work depicts managerial work occuring on 3 levels:
information
people
action
American Association of Nurse Executive (AANE) say a nurse manager is accountable for 6 roles and functions:
1.excellence in the clinical practice of nursing and the delivery of patient care on a selected unit or area within the health care institution
2.managing human, fiscal, and other resources needed to manager clinical nursing practice and patient care
3.facilitate development of licensed and unlicesed nursing and health care personnel
4.ensure institutional compliance with professional, regulatory, and govt. standards
5.strategic planning as it relates to the units, department, and org. as a whole
6.facilitate cooperative and collaborative relationships among disciplines/departments to ensure effective, quality patient care delivery
Levels of management
first-level
middle-level
upper-level
charge nurse
staff nurse
Major changes in healthcare:
organizational changes
nursing labor forces
tech/info systems (ex. computerized charting)
reimbursement (correcting wasteful, inequitable systems)
Manifestations of resistance to change in healthcare:
Active-through frustration and aggression
Acceptance(on surface)
Organized Passive
Indifference(ignoring, diverting attention elsewhere)
Why do we resist change?
-threatened self-interest
-fear of loss of money
-fear of loss of status
-disruption in relations, patterns of work
-fear of failure/incompetence
-perceived loss of work/rewards

*be aware there will be resistance to change

*be proactive
Responseds to change:
innovators (love change)
early adopters (receptive to change)
early majority (prefer status quo)
late majority (resistive)
laggards and rejecters (opppose)
What kind of resistance may laggards and rejecters engage in?
-we tried that before, it wono't work
-lets wait awhile
-we don't have time/can't afford it
-passive aggressive - miss meetings, sabotage
Change Theory:
Lewin's Force Field Model
unfreeze-move-refreeze

when driving forces>restraining forces-->behavioral change

when equal-->status quo

1.UNFREEZE:i.d. need for change, alert others
2.MOVE:motivate, initiate, direct
3.REFREEZE: - continued motivation, delegate responsibility, make it permanent
Change Theory:
Lippitt's Phases of Change
(similar to nursing process)
extended-focus on change agent

1.awareness of need for change
2.building relationship
3.diagnosing problem
4.set goals
5.implement plan
6.stabilize
7.redefine relationship
Change Theory:
Havelock's Six Step Model
(similar to nursing process)
extension

1.building relationship
2.diagnosing problem
3.acquiring resources
4.choosing solutions
5.gaining acceptance
6.stabilize

*needs ownership from the inside
Change Theory:
Roger's Diffusion
fluidity
Change Theory:
Chaos (Wheatley)
-nonlinear
-needs an educated, mature workforce and org. that supports this development

information: air, currency
relationships: pathways
vision: field of vision/org. direction
Change Theory:
Lewin's Force Field Model
unfreeze-move-refreeze

when driving forces>restraining forces-->behavioral change

when equal-->status quo

1.UNFREEZE:i.d. need for change, alert others
2.MOVE:motivate, initiate, direct
3.REFREEZE: - continued motivation, delegate responsibility, make it permanent
Change Theory:
Lippitt's Phases of Change
(similar to nursing process)
extended-focus on change agent

1.awareness of need for change
2.building relationship
3.diagnosing problem
4.set goals
5.implement plan
6.stabilize
7.redefine relationship
Change Theory:
Havelock's Six Step Model
(similar to nursing process)
extension

1.building relationship
2.diagnosing problem
3.acquiring resources
4.choosing solutions
5.gaining acceptance
6.stabilize

*needs ownership from the inside
Change Theory:
Roger's Diffusion
fluidity
Change Theory:
Chaos (Wheatley)
-nonlinear
-needs an educated, mature workforce and org. that supports this development

information: air, currency
relationships: pathways
vision: field of vision/org. direction
Change Agent Strategies
rational-empirical
normative-reeducative
power-coercive
Change Agent Strategies:
rational-empirical
belief:people are rational, self-interest will drive change

methodology:impart info/knowledge

example: technologies that save time, improve efficiency and maintains high quality care (computer order entry), or new evidence-based practice recommendations
Change Agent Strategies:
normative-reeducative
belief:people will act according to cultural norms, attitudes, and values of an organization

methodology: give information, focus on relationships and organizational values (sell the change)

example: change in pt. care delivery model-->affects staff skill in interpersonal relationships
unit reorganization
mergers/acquisitions
Change Agent Strategies:
power-coercive
belief: application of power, either positional, political, or economic

methodology: expected resistance, power needed to effect change

example: changes in benefits package
staff reductions
How do I effect change?
effective change elements
-good diagnostic skills
-appropriate leadership stype
-work the system

ineffective change elements
-being defensive
-giving advice
-premature persuasion
How do I effect change?
-introduce change gradually
-allow participation and buy in (ownership)
-improve communications (off-shift mtgs., post minutes, open mtgs.)
-develop trust
-be willing to revise/modify
-provide necessary education
-provide incentives
-confront resistance
-minimize coercion
-provide regular feedback
Recurring theme in Nursing
environmental uncertainty
loss of identity
changes in roles and responsibility

*could mean loss of productivity, poor pt. care, poor fiscal outcomes
Total Quality Management (TQM)
a management philosophy that emphasizes a commitment to excellence throughout the organization

(a theory)
4 Characteristics of Total Quality Management (TQM)
1.customer/client focus
2.total organizational involvement
3.use of quality tools and statistics for measurement
4.identification of key processes for improvement
Continuous Quality Improvement (CQI)
process used to improve quality and performance

(a method)
4 Entities involved in Continuous Quality Improvement (CQI)
1.Resource group (pt. or family)
2.Coordinator (nurse or pt.)
3.Team Leader (nurse or pt.)
4.Team (nurse, pt, family, therapists, MDs)
Quality Management Plan
systematic method to design, measure, assess, and improve organizational performance.
-i.d.'s processes and systems that represent goals and mission of organization
-i.d.'s the customers (internal & external)
What you need to know in order to plan change:
Change Knowledge: low difficulty, short time
Change Attitudes: med difficulty, med time
Change Individual Behaviors: high difficulty, long time
Change Group Behaviors: very high difficulty/very long time
Leapfrog Mission Statement:
to trigger giant leaps forward in the safety, quality, and affordability of health care by:
-supporting healthcare decisions by those who use and pay for healthcare
-promoting high-value healthcare through incentives and rewards
Continuous Quality Improvement (CQI):
Standards
written statements that define a level of performance or a set of conditions determined to be acceptable by some authority
Continuous Quality Improvement (CQI):
Standards:
Structure Standards
standards that relate to the physical environment, organization, and management of an organization
ex: fire codes, bldg. codes, org. hierarchy
Continuous Quality Improvement (CQI):
Standards:
Process Standards
standards connected with the actual delivery of care
Continuous Quality Improvement (CQI):
Standards:
Outcome Standards
standards that reflect the desired result or outcome of care
Continuous Quality Improvement (CQI):
Standards:
Indicator
a tool used to measure the performance of structure, process, and outcome standards
Continuous Quality Improvement (CQI):
Standards:
Benchmarking
the process of comparing data with reliable internal and external sources
Continuous Quality Improvement (CQI):
Retrospective Audit
a nursing audit conducted after a patient's discharge that involves examining records of a large number of cases
Continuous Quality Improvement (CQI):
Concurrent Audit
a nursing audit conducted during the patient's course of care
Continuous Quality Improvement (CQI):
Peer Review
an evaluation by practicing nurses who have determined the standards and criteria that indicate quality of care
Continuous Quality Improvement (CQI):
Utilization Reviews
JCAHO mandated reviews based on the appropriate allocation of resources
Continuous Quality Improvement (CQI):
Outcomes management
a system in which costs and quality are concurrently and retrospectively measured and evaluated in order to imrpove clinical practice
CMS
Center for Medicare and Medicaid Services

(set prices)
JCAHO
Joint Commission on Accreditation of Healthcare Organizations
Components of Quality Management
-a comprehensive quality plan
-sets standards for benchmarking
1.structure standards
2.process standards
3.outcome standards
-performance appraisals
-focus on interdisciplinary assessment and improvement
-audits
-reviews
-outcomes
Six Sigma
a quality management program that uses measures, goals, and management involvement to monitor performance and ensure progress
6 Themes of Six Sigma:
1.customer focus
2.data driven
3.process emphasis
4.proactive management
5.boundaryless collaboration
6.aim for perfection; tolerate failure
Risk Management
a program directed toward identifying, evaluating, and taking corrective action against potential risks that could lead to the injury of patients, staff or visitors
-improves the quality of patient care
-reduces liability claims
Functions of a risk management program:
1.i.d.'s potential risks for accident, injury, financial loss
2.reviews current org.-wide monitoring systems
3.analyzes freq., severity, causes of general categories and specific types of injuries
4.review and appraises safety and risk aspects of patient care procedures and new programs
5.eliminates or reduces risk
6.reviews work of other committees
7.i.d.'s needs for pt., family, and personnel education
8.evaluates results of a risk mgmt. program
9.provides reports to administrators, medical staff, b.o.d.
Nursing's role in risk mgmt.
nursing is the one department involved in patient care 24/7
-it is the staff, with 24/7 contact, who implements the program
High Risk Areas in Health Care
-med errors
-complications from diagnostic or treatment procedures
-falls
-pt. or family dissatisfaction with care
-refusal of treatment or refusal of conset
Reportable Incident:
any unexpected or unplanned occurence that affects or could potentially affect a pt., family member, or staff
Incident Report
an accurate and comprehensive report on unplanned or unexpected occurrences that could potentially affect a pt., family member, or staff
6 Steps involved in reporting incidents:
1.discovery
2.notification
3.investigation
4.consultation
5.action
6.recording
Role of the nurse manager in risk management:
1.education of staff (staff perceptions vs. client perceptions)
2.prompt action
3.caring attitude
Key to risk management:
Nurse manager must limit the use of incident reports to risk reduction only. This policy must be emphasized and practiced.
Role of the nurse manager in an actual incident:
1.meet w/risk mgmt. team & hospital attny.
2.provide info. to admin. in a timely manner
3.audit documentation to determine if this is an isolated incident
4.provide results of audits to admin.
5.educate staff prn
6.determine is discipline is needed
7.follow up w/risk mgmt., nursing administration, human resources
8.continue to cooperate w/hospital attny. if incident results in litigation
Budgeting Objectives:
-Describe how the budget process works
-Describe different types of budgets that exist
-Explore how to monitor and control budgetary performance
-Explain how to determine budget variance
-Describe how staff affect budgetary performance
Budget
A quantitative statement, usually in monetary terms, of the expectations of a defined area of the organization over a period of time in order to manage financial performance.
Budgeting
The process of planning and controlling future operations by comparing actual results with planned expectations.
Information needed for the budgeting process:
1.Demographics of the population served
2.community, influences, and competitors
3.Sources of revenue
4.Statistical data (number of admissions, length of stay, etc…)
5.Projected salary increases 6.Projected price increases
7.Information about regulatory changes
8.Organizational changes
Ex: Budgetary Considerations for a new cardiology unit:
1.Demographics
2.Revenue
3.Statistical data
4.Projected salary increases and price increases
5.Information about regulatory changes
6.Organizational changes
Controlling
The process of comparing actual results with the results projected in the budget.

Example: Variance Analysis and Position Control
Incremental (line-by-line) budget
A budget worksheet listing expense items on separate lines that is usually divided into salary and non-salary expenses.
Zero-based budget
A budgetary approach that assumes the base for projecting next year’s budget is zero; managers are required to justify all activities and every proposed expenditure.
Fixed-budget
A budget in which budgeted amounts are set regardless of changes that occur during the year.
Variable Budget
A budget developed with the understanding that adjustments to the budget may be made during the year.
Operating Budget
The organization’s statement of expected revenues and expenses for the upcoming year.
Fiscal Year
A specified 12-month period during which operational and financial performance is measured.
Revenue Budget
A projection of expected income for a budget period based on volume and mix of patients, rates, and discounts.
Expense Budget
A comprehensive budget that lists salary and non-salary items that reflect patient care objectives and activity parameters for the nursing unit.
Cost Center
The smallest area of activity within an organization for which costs are accumulated.
Profit
The difference between revenues and expenses.
Fixed Costs
Expenses that remain the same for the budget period regardless of the activity level of the organization.
Variable Costs
Expenses that depend on and change in direct proportion to patient volume and acuity.
Direct Costs
Expenses that directly affect patient care.
Indirect Costs
Necessary expenditures that do not affect patient care directly.
Salary (personnel) budget
A budget that projects salary costs to be paid and charged to the cost center during the budget period.
Benefit Time
Paid time, such as vacation, holidays, and sick days for which there is no work output.
Capital Budget
A component of the budget plan that includes equipment and renovations needed by an organization in order to meet long-term goals.
Variance
The difference between the amount that was budgeted for a specific cost and the actual cost.
Volume Variances
Differences in the budget as a result of increases or decreases in patient volume.
Efficiency variance
The difference between budgeted and actual nursing care hours provided.
Rate variance
The difference between budgeted and actual hourly rates paid.
Non-salary expenditure variance
Deviation from the budget as a result of changes in patient volume, supply quantities, or prices paid.
Position control
A monitoring tool used to compare actual numbers of employees to the number of budgeted FTE’s for the nursing unit.
Nursing units are typically considered...
...cost centers, but may be considered revenue centers, profit centers, or investment centers
A nurse manager may be responsible for...
...may be responsible for service lines and staff from multiple disciplines and departments.
A nurse manager may have input into...
...have input into capital expenses and are responsible for salary and operating costs related to new equipment.
FTE
A full-time equivalent is a full-time position that can be equated to 40 hours per week for 52 weeks, or 2,080 hours per year.
What is the position control?
A list of approved, budgeted FTE’s that compares the budgeted number of FTE’s by classification (RN, LPN, etc…), shift, and status to the actual available employees on the unit.
The shift from a revenue to a cost based accounting system requires...
... nurses to remain cost conscious and to demonstrate nursing’s cost effectiveness.
Staffing involves determining...
nursing care hous
FTEs
staffing mix
distribution of staff (block staffing)
staff needs to decide together...
boundaries and guidlines for scheduling that all members can buy into.
Types of Scheduling
creative
flexible
self
supplemental (internal pool, external pool, use existing staff)
Tools for handling staffing and scheduling
1.Be familiar w/current patient classification or acuity system.
2.# of nursing care hours needed.
3.FTEs needed.
4.Create a schedule that meets patients' needs.
5.Supplement staff prn.
6.Consider self-staffing.
Recruiting and Selecting Staff:
Elements of the selection process
job analysis
methods of recruiting
selection techniques
legal considerations
Recruiting and Selecting Staff:
Job Analysis
Much is done by HR)
-job specification
-supervisory conference
-work sampling
-time and motion studies
-interviewing
-self-report logs
Recruiting and Selecting Staff:
Recruitment
-where, how, when to look
-how to sell the organization
(4Ps product, place, price, promotion)
-cross training as a recruitment strategy
Recruiting and Selecting Staff:
Interviewing Principles
-develop structured interview guides
-prepare for the interview
-open the interview
-gather information
-give information
-close the interview

*involve staff
*interview reliability and validity
Recruiting and Selecting Staff:
other considerations
-education
-experience
-licensure
-physical exams
-can you reasonable accommodate them (disability)
Recruiting and Selecting Staff:
Integrating the information
-prioritize qualities required for job
-weigh qualiities by data reliability
-weigh job dimensions by trainability
Recruiting and Selecting Staff:
Legality in Hiring
-Title VII of the Civil Rights Act of 1964
-Age discrimination age of 1967
-Title I of Americans with Disabilities Act of 1990
-Bona Fide Occupational Qualification
Tools for Recruiting and Selecting Staff
-conduct/modify job analysis prn
-coordinate recruiting efforts of HR
-ensure your area sends the message you want
-prepare for interviews
-conduct interviews
-process information from interview and reference checks to make a final decision
Motivating and Developing Staff:
Model of Job Performance
6 categories of performance
-daily job performance
-attendance
-punctuality
-adherence to policies and procedures
-absence of incidents, errors, accidents
-honesty, trustworthiness

(table 19-1)

Employee Motivation
Motivating and Developing Staff:
Motivational Theories: CONTENT
-Maslow's hierarchy of needs
- Existence-Relatedness-Growth Theory (Alderfer)
-Two-Factor Theory (Herzberg)
Fig. 19-1
Motivating and Developing Staff:
Motivational Theories: PROCESS
-Reinforcement Theory (Skinner)
-Expectancy Theory (Vroom)
-Equity Theory (Adams)
-Goal-Setting Theory (Locke)
Fig. 19-2
Maslow
(read bottom to top)

self-actualization
esteem needs
belonging (social needs)
safety
physiological
Alderfer
(read bottom to top)

Growth
Relatedness
Existence
Herzberg
(read bottom to top)

Motivating factors
Hygiene factors
Staff Development
NEEDS ASSESSMENT (regulatory requirements)
PLANNING
social learning theory (Bandura)
relapse prevention
adult education theory
IMPLEMENTATION
orientation (preceptor model)
staff developemtn methods (OTJ training)
EVALUATION (4 criteria)
learner reaction
learner acquired
behavior change
organizational impact

*design staff development for a multicultural staff
Turnover: Measurement issues
the exiting employee's supervisor is asked why the person left in an exit interview
Dysfunctional turnover
When nurses who are high quality and are difficult to replace leave the organization.
Floating
Reassignment to a unit other than the one on which the nurse normally works.
Functional turnover
When poorly performing nurses leave the organization.
Horizontal promotion
A program to reward an high-performing employee without promoting the employee to a management position.
Involuntary turnover
The employee is terminated by the employers.
Mentor
A more experienced person who guides, supports, and nurtures a less experienced person.
Performance-driven clinical ladder
A system of using performance indicators to advance an employee within the organization.
Salary compression
The effect of higher starting pay of new nurses or rewarding those with fewer years of experience with higher increases that results in the salaries of long-term employees being at or below those of less-experienced nurses.
Turnover
The number of staff members who vacate a position.
Voluntary turnover
The employee chooses to leave the organization.
Turnover: Measurement Issues
1.Understanding causes
2.Using exit interviews
3.Functional versus dysfunctional turnover
Turnover: Consequences
1.Effects on patients
2.Effects on coworkers
3.Dollar costs
4.Desirable effects
Turnover: Voluntary Turnover
1.Ease of movement
2.Opportunities
3.Nurse manager's role
Turnover: Strategies for Controlling
1.Reduce dysfunctional turnover
2.Facilitate movement within
3.Influence work characteristics
Turnover: A Systems Perspective
1.Reduce absenteeism
2.Evaluate work scheduling
3.Changing policy
Retaining Staff
A.Financial Considerations
B.Pay-for-Performance
1. Clinical ladder
2. Horizontal promotion
3. Magnet Hospital
4. Floating
5. Mentoring
Employee Performance: The Performance Appraisal
1.Process
2.Evaluation Philosophy
3.Components to Be Evaluated
Employee Performance:
The Performance Appraisal
Components to be evaluated
1.Traits and personal characteristics
2.Results-oriented system
3.Behavioral criteria
4.Combining different types of criteria
Employee Performance: The Performance Appraisal
Specific Evaluation Methods
1.Rating scales
2.Essay evaluation
3.Forced distribution
4.Behavior-oriented rating scales
5.Focus on results
Employee Performance: The Performance Appraisal
Potential Appraisal Problems
1.Leniency error
2.Recency error
3.Halo error
4.Ambiguous evaluation standards
5.Written comments problem
Employee Performance:
The Appraiser
Peer Review
Documenting Performance
Diagnosing Performance Problems
The Performance Appraisal Interview
Employee Performance:
The Appraiser:
Documenting Performance
Critical incidents
Advantages and disadvantages
Employee Performance:
The Appraiser:
Diagnosing Performance Problems
Lack of ability
Lack of motivation
Employee Performance:
The Appraiser:
The Performance Appraisal Interview
Preparation
The interview
Follow-up
Employee Performance:
Improving Appraisal Accuracy
Appraiser Ability
Appraiser Motivation
Rules of Thumb
Absolute judgment
An evaluation method based on reasonable and acceptable standards set by the organization.
Ambiguous evaluation standards problem
The tendency of evaluators to place differing connotations on rating scale words.
Behavior-oriented rating scales
A type of scale used in evaluation that focuses on specific behaviors and uses critical incidents grouped into performance dimensions.
Comparative judgment
An evaluation method in which employees are compared with one another.
Critical incidents
Reports of employee behaviors that are out of the ordinary, either positive or negative.
Essay evaluation
An evaluation method in which an employee's performance is described through a detailed written narrative.
Forced distribution evaluation
An evaluation method in which employees are rated in a fixed method, similar to grading on a curve.
Group evaluation
An evaluation process whereby a group of managers compare individual and group performance to organizational standards.
Halo error
The failure to differentiate among the various performance dimensions when evaluating.
Leniency error
Leniency error
Peer review
A process by which other employees assess and judge the performance of professional peers against predetermined standards.
Performance appraisal
The process of interaction, written documentation, formal interview, and follow-up that occurs between managers and their employees to give feedback, make decisions, and cover fair employment practice law.
Recency error
The tendency of a manager to rate an employee based on recent events, rather than over the entire evaluation period.
Traditional rating scale
An evaluation method that uses performance dimensions to rate employees.
Written comments problem
The tendency of evaluators not to include written comments on appraisal forms.
A Model of Job Performance
1.Employee Motivation
2.Motivational Theories
3.Employee Ability
A Model of Job Performance:
Motivational Theories
Content theories
1.Maslow
2.Alderfer
3.Herzberg

Process theories
1.Reinforcement theory
2.Expectancy theory
3.Equity theory
4.Goal-setting theory
Staff Development
Needs Assessment
Planning
Implementation
Evaluation
Staff Development:
Planning
Social learning theory
Relapse prevention
Adult education theory
Staff Development:
Implementation
Orientation
Staff development methods
Other educational techniques


*Designing Staff Development Programs for a Multicultural Staff
Adult education theory
A theory, described by Knowles, that children and adults learn differently.
Content theories
Motivational theories that emphasize individual needs or the rewards that may satisfy those needs.
Equity
The perception that one's work contribution is rewarded in the same proportion that another person's contribution is rewarded.
Equity theory
The motivational theory that suggests effort and job satisfaction depend on the degree of equity or perceived fairness in the work situation.
Evaluation
The investigative process to determine whether outcomes were achieved and to what extent.
Expectancy
The perceived probability that effort will lead to a specific performance level or behavior.
Expectancy theory
The motivational theory that emphasizes the role of rewards and their relationship to the performance of desired behaviors.
The motivational theory that emphasizes the role of rewards and their relationship to the performance of desired behaviors.
The technique used to eliminate negative behavior, in which a positive reinforcer is removed and the undesired behavior is extinguished.
The technique used to eliminate negative behavior, in which a positive reinforcer is removed and the undesired behavior is extinguished.
The motivational theory that suggests that the goal itself is the motivating force.
Implementation
Bringing together materials, methods, speakers, and learners for education.
Instrumentality
The belief that a given performance level or behavior will lead to some outcome.
Motivation
The factors that initiate and direct behavior.
Needs assessment
An evaluation of learning needs in a select population.
On-the-job instruction
An educational method using observation and practice that involves the employees learning new skills after being employed.
Operant conditioning
Process by which a behavior becomes associated with a particular consequence.
Orientation
A process by which staff development personnel and managers ease a new employee into the organization by providing relevant information.
Planning
The preparation for learning including obtaining materials and matching learner needs with educational methods.
Preceptor
An experienced individual who assists new employees in acquiring the necessary knowledge and skills to function effectively in a new environment.
Process theories
Motivational theories that emphasize how the motivation process works to direct an individual's effort into performance.
Punishment
A process used to inhibit an undesired behavior by applying a negative reinforcer.
Reinforcement theory (behavior modification)
The motivational theory that views motivation as learning and proposes that behavior is learned through a process called operant conditioning.
Relapse prevention
A model that emphasizes learning a set of self-control and coping strategies to increase the retention of newly learned behavior.
Shaping
The selective reinforcement of behaviors that are successively closer approximations to the desired behavior.
Social learning theory
A behavioral theory based on reinforcement theory that proposes new behaviors are learned through direct experience or observation that can result in positive or negative outcomes.
Staff development
The process of enhancing staff performance with specific learning activities.
Valence
The perceived value of an outcome.
The Recruitment and Selection Process
Elements of the Selection Process
Job Analysis
The Recruitment and Selection Process:
Job Analysis
1. Job specification
2. Supervisory conference
3. Work sampling
4. Time and motion studies
5. Interviewing
6. Self-report logs
Recruitment
1. Where to Look
2. How to Look
3. When to Look
4. How to Sell the Organization
5. Cross-Training as a Recruitment Strategy
Interviewing
Principles for Effective Interviewing
Involving Staff in the Interview Process
Interview Reliability and Validity
Interviewing:
Principles for Effective Interviewing
1. Interview guides
2. Preparing
3. Opening
4. Gathering information
5. Giving information
6. Closing
Recruiting and Selecting Staff
Education, Experience, Licensure, and Physical Examinations
Integrating the Information
Legality in Hiring
1. Impact of EEOC Law
2. ADA Requirements
3. Negligent Hiring
Age Discrimination Act
A law prohibiting discrimination against applicants and employees over the age of 40.
Americans with Disabilities Act
A law prohibiting discrimination against qualified individuals who have physical or mental impairments that substantially limit one or more of the major life activities.
Bona fide occupational qualification (BFOQ)
A characteristic that excludes certain groups from consideration for employment.
Business necessity
Discrimination or exclusion that is allowed if it is necessary to ensure the safety of workers or customers.
4 Ps of marketing
Four strategies included in marketing plans: product, place, price, and promotion.
Interrater reliability
Agreement between two measures by several interviewers.
Interview guide
A written document containing questions, interviewer directions, and other pertinent information so that the same process is followed and the same basic information is gathered from each applicant.
Intrarater reliability
Agreement between two measures by the same interviewer.
Job analysis
A process that determines and defines the duties and requirements involved in a particular job.
Job specification
Details the knowledge, skills, and abilities needed, the tasks to be performed, and the behavior required to perform them.
Medium
The agent of contact between the organization and the potential applicant.
Negligent hiring
Failure of an organization, responsible for the character and actions of all employees, to ascertain the background of an employee.
Personnel decisions
Decisions that affect the terms, conditions, and privileges of employment.
Validity
The ability to predict outcomes with some accuracy.
Work sample questions
Used to determine an applicant's knowledge about work tasks and ability to perform the job.