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258 Cards in this Set
- Front
- Back
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Org. Theory:
Classical Theory |
Division and specialization of labor
-authority -responsibility -line authority -staff authority -org. structure like military |
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Orgs. have their own culture that is always evolving...
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paradigm shift is always a challenge.
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Org. Theory:
Neoclassical Theory |
-1930's
-humanistic -participative -involved in decisionmaking -relationship building -environment based |
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Hawthorne Effect
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Productivity increases because employees are getting attention
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Org Theory:
Contingency Theory |
-takes environment into consideration
-need to know customers -staffing needs |
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Org Theory:
Chaos |
-a type of complexity theory
-complicated -relationships -complex issues |
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Leaders are managing mobility...
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leaders don't do things, they see that things are done.
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Org. relationships:
Integration |
vertical - one facility, many services
horizontal - several facilities, same services |
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Org. relationships:
Diversification |
concentric - more of the same services
-conglomerate - branching out into other businesses, joint ventures |
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Org. Structures:
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1.functional
2.service-line 3.hybrid 4.matrix 5.parallel |
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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 |
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Shared governance is a requirement for...
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magnet status
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Instead of Hierarchy...
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Heterarchy (Porter-O'Grady)
-connections -linkages -relationships |
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Restructuring:
purpose |
reduce costs and maintain market position
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Restructuring:
impact on individual |
jobs are redesigned
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Restructuring:
impact on organization |
-downsizing
-right-sizing (cutting staff) |
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Restructuring:
impact on systems |
re-engineering
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Strategic Planning
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values
visions mission philosophy goals |
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Magnet Status
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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 |
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Magnet Programs:
purpose |
-promote quality
-support professional practice -i.d. excellence in nursing -provide for best practices in nursing |
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What creates magnetism?
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-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. |
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Benefits of magnet status?
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-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 |
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Magnet application process:
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assessment
document review site visit review & decision announcement monitor for adherence redesignation after 4 years |
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Nursing Care Delivery Systems:
Functional |
-includes RN, maybe LPN, UAP (long term care, tmt nurse, med nurse)
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Nursing Care Delivery Systems:
Team Nursing |
includes RN x/UAP
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Nursing Care Delivery Systems:
Total Patient Care |
RN provides all care (other people still help, RNs help each other)
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Nursing Care Delivery Systems:
Types |
Functional
Team Total Patient Care Primary Practice Partnerships Case Management (critical pathways) Differentiated Practice Patient-centered Care |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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. |
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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. |
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Leader:
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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 |
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Manager:
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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 |
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Leadership:
Formal Informal |
-practiced by a nurse with legitimate authority
-exercised by a staff member who does not have a specified mgmt. role |
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Leadership Theory:
Trait Theories |
Trait Theories
Stogdill (1974), Bass (1990), Gilbert (1975) |
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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. |
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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 |
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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 |
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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 |
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Leadership Theory:
Contigency Theories |
Adapt leadership style in relation to changing situations.
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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 |
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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) |
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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 |
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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. |
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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 |
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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. |
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Management Functions:
Classic description |
Planning (contingency vs. strategic)
Organizing Directing Controlling |
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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 |
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Contemporary Model of managerial work depicts managerial work occuring on 3 levels:
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information
people action |
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American Association of Nurse Executive (AANE) say a nurse manager is accountable for 6 roles and functions:
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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 |
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Levels of management
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first-level
middle-level upper-level charge nurse staff nurse |
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Major changes in healthcare:
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organizational changes
nursing labor forces tech/info systems (ex. computerized charting) reimbursement (correcting wasteful, inequitable systems) |
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Manifestations of resistance to change in healthcare:
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Active-through frustration and aggression
Acceptance(on surface) Organized Passive Indifference(ignoring, diverting attention elsewhere) |
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Why do we resist change?
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-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 |
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Responseds to change:
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innovators (love change)
early adopters (receptive to change) early majority (prefer status quo) late majority (resistive) laggards and rejecters (opppose) |
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What kind of resistance may laggards and rejecters engage in?
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-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 |
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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 |
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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 |
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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 |
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Change Theory:
Roger's Diffusion |
fluidity
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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 |
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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 |
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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 |
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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 |
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Change Theory:
Roger's Diffusion |
fluidity
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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 |
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Change Agent Strategies
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rational-empirical
normative-reeducative power-coercive |
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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 |
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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 |
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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 |
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How do I effect change?
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effective change elements
-good diagnostic skills -appropriate leadership stype -work the system ineffective change elements -being defensive -giving advice -premature persuasion |
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How do I effect change?
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-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 |
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Recurring theme in Nursing
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environmental uncertainty
loss of identity changes in roles and responsibility *could mean loss of productivity, poor pt. care, poor fiscal outcomes |
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Total Quality Management (TQM)
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a management philosophy that emphasizes a commitment to excellence throughout the organization
(a theory) |
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4 Characteristics of Total Quality Management (TQM)
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1.customer/client focus
2.total organizational involvement 3.use of quality tools and statistics for measurement 4.identification of key processes for improvement |
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Continuous Quality Improvement (CQI)
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process used to improve quality and performance
(a method) |
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4 Entities involved in Continuous Quality Improvement (CQI)
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1.Resource group (pt. or family)
2.Coordinator (nurse or pt.) 3.Team Leader (nurse or pt.) 4.Team (nurse, pt, family, therapists, MDs) |
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Quality Management Plan
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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) |
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What you need to know in order to plan change:
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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 |
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Leapfrog Mission Statement:
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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 |
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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
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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 |
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Continuous Quality Improvement (CQI):
Standards: Process Standards |
standards connected with the actual delivery of care
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Continuous Quality Improvement (CQI):
Standards: Outcome Standards |
standards that reflect the desired result or outcome of care
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Continuous Quality Improvement (CQI):
Standards: Indicator |
a tool used to measure the performance of structure, process, and outcome standards
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Continuous Quality Improvement (CQI):
Standards: Benchmarking |
the process of comparing data with reliable internal and external sources
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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
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Continuous Quality Improvement (CQI):
Concurrent Audit |
a nursing audit conducted during the patient's course of care
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Continuous Quality Improvement (CQI):
Peer Review |
an evaluation by practicing nurses who have determined the standards and criteria that indicate quality of care
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Continuous Quality Improvement (CQI):
Utilization Reviews |
JCAHO mandated reviews based on the appropriate allocation of resources
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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
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CMS
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Center for Medicare and Medicaid Services
(set prices) |
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JCAHO
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Joint Commission on Accreditation of Healthcare Organizations
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Components of Quality Management
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-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 |
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Six Sigma
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a quality management program that uses measures, goals, and management involvement to monitor performance and ensure progress
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6 Themes of Six Sigma:
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1.customer focus
2.data driven 3.process emphasis 4.proactive management 5.boundaryless collaboration 6.aim for perfection; tolerate failure |
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Risk Management
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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 |
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Functions of a risk management program:
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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. |
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Nursing's role in risk mgmt.
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nursing is the one department involved in patient care 24/7
-it is the staff, with 24/7 contact, who implements the program |
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High Risk Areas in Health Care
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-med errors
-complications from diagnostic or treatment procedures -falls -pt. or family dissatisfaction with care -refusal of treatment or refusal of conset |
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Reportable Incident:
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any unexpected or unplanned occurence that affects or could potentially affect a pt., family member, or staff
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Incident Report
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an accurate and comprehensive report on unplanned or unexpected occurrences that could potentially affect a pt., family member, or staff
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6 Steps involved in reporting incidents:
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1.discovery
2.notification 3.investigation 4.consultation 5.action 6.recording |
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Role of the nurse manager in risk management:
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1.education of staff (staff perceptions vs. client perceptions)
2.prompt action 3.caring attitude |
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Key to risk management:
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Nurse manager must limit the use of incident reports to risk reduction only. This policy must be emphasized and practiced.
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Role of the nurse manager in an actual incident:
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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 |
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Budgeting Objectives:
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-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 |
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Budget
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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.
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Budgeting
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The process of planning and controlling future operations by comparing actual results with planned expectations.
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Information needed for the budgeting process:
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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 |
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Ex: Budgetary Considerations for a new cardiology unit:
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1.Demographics
2.Revenue 3.Statistical data 4.Projected salary increases and price increases 5.Information about regulatory changes 6.Organizational changes |
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Controlling
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The process of comparing actual results with the results projected in the budget.
Example: Variance Analysis and Position Control |
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Incremental (line-by-line) budget
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A budget worksheet listing expense items on separate lines that is usually divided into salary and non-salary expenses.
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Zero-based budget
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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.
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Fixed-budget
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A budget in which budgeted amounts are set regardless of changes that occur during the year.
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Variable Budget
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A budget developed with the understanding that adjustments to the budget may be made during the year.
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Operating Budget
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The organization’s statement of expected revenues and expenses for the upcoming year.
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Fiscal Year
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A specified 12-month period during which operational and financial performance is measured.
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Revenue Budget
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A projection of expected income for a budget period based on volume and mix of patients, rates, and discounts.
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Expense Budget
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A comprehensive budget that lists salary and non-salary items that reflect patient care objectives and activity parameters for the nursing unit.
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Cost Center
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The smallest area of activity within an organization for which costs are accumulated.
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Profit
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The difference between revenues and expenses.
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Fixed Costs
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Expenses that remain the same for the budget period regardless of the activity level of the organization.
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Variable Costs
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Expenses that depend on and change in direct proportion to patient volume and acuity.
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Direct Costs
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Expenses that directly affect patient care.
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Indirect Costs
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Necessary expenditures that do not affect patient care directly.
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Salary (personnel) budget
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A budget that projects salary costs to be paid and charged to the cost center during the budget period.
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Benefit Time
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Paid time, such as vacation, holidays, and sick days for which there is no work output.
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Capital Budget
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A component of the budget plan that includes equipment and renovations needed by an organization in order to meet long-term goals.
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Variance
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The difference between the amount that was budgeted for a specific cost and the actual cost.
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Volume Variances
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Differences in the budget as a result of increases or decreases in patient volume.
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Efficiency variance
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The difference between budgeted and actual nursing care hours provided.
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Rate variance
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The difference between budgeted and actual hourly rates paid.
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Non-salary expenditure variance
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Deviation from the budget as a result of changes in patient volume, supply quantities, or prices paid.
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Position control
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A monitoring tool used to compare actual numbers of employees to the number of budgeted FTE’s for the nursing unit.
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Nursing units are typically considered...
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...cost centers, but may be considered revenue centers, profit centers, or investment centers
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A nurse manager may be responsible for...
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...may be responsible for service lines and staff from multiple disciplines and departments.
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A nurse manager may have input into...
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...have input into capital expenses and are responsible for salary and operating costs related to new equipment.
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FTE
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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.
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What is the position control?
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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.
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The shift from a revenue to a cost based accounting system requires...
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... nurses to remain cost conscious and to demonstrate nursing’s cost effectiveness.
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Staffing involves determining...
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nursing care hous
FTEs staffing mix distribution of staff (block staffing) |
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staff needs to decide together...
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boundaries and guidlines for scheduling that all members can buy into.
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Types of Scheduling
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creative
flexible self supplemental (internal pool, external pool, use existing staff) |
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Tools for handling staffing and scheduling
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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. |
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Recruiting and Selecting Staff:
Elements of the selection process |
job analysis
methods of recruiting selection techniques legal considerations |
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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 |
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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 |
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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 |
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Recruiting and Selecting Staff:
other considerations |
-education
-experience -licensure -physical exams -can you reasonable accommodate them (disability) |
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Recruiting and Selecting Staff:
Integrating the information |
-prioritize qualities required for job
-weigh qualiities by data reliability -weigh job dimensions by trainability |
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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 |
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Tools for Recruiting and Selecting Staff
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-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 |
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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 |
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Motivating and Developing Staff:
Motivational Theories: CONTENT |
-Maslow's hierarchy of needs
- Existence-Relatedness-Growth Theory (Alderfer) -Two-Factor Theory (Herzberg) Fig. 19-1 |
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Motivating and Developing Staff:
Motivational Theories: PROCESS |
-Reinforcement Theory (Skinner)
-Expectancy Theory (Vroom) -Equity Theory (Adams) -Goal-Setting Theory (Locke) Fig. 19-2 |
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Maslow
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(read bottom to top)
self-actualization esteem needs belonging (social needs) safety physiological |
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Alderfer
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(read bottom to top)
Growth Relatedness Existence |
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Herzberg
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(read bottom to top)
Motivating factors Hygiene factors |
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Staff Development
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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 |
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Turnover: Measurement issues
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the exiting employee's supervisor is asked why the person left in an exit interview
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Dysfunctional turnover
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When nurses who are high quality and are difficult to replace leave the organization.
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Floating
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Reassignment to a unit other than the one on which the nurse normally works.
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Functional turnover
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When poorly performing nurses leave the organization.
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Horizontal promotion
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A program to reward an high-performing employee without promoting the employee to a management position.
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Involuntary turnover
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The employee is terminated by the employers.
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Mentor
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A more experienced person who guides, supports, and nurtures a less experienced person.
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Performance-driven clinical ladder
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A system of using performance indicators to advance an employee within the organization.
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Salary compression
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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.
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Turnover
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The number of staff members who vacate a position.
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Voluntary turnover
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The employee chooses to leave the organization.
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Turnover: Measurement Issues
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1.Understanding causes
2.Using exit interviews 3.Functional versus dysfunctional turnover |
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Turnover: Consequences
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1.Effects on patients
2.Effects on coworkers 3.Dollar costs 4.Desirable effects |
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Turnover: Voluntary Turnover
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1.Ease of movement
2.Opportunities 3.Nurse manager's role |
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Turnover: Strategies for Controlling
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1.Reduce dysfunctional turnover
2.Facilitate movement within 3.Influence work characteristics |
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Turnover: A Systems Perspective
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1.Reduce absenteeism
2.Evaluate work scheduling 3.Changing policy |
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Retaining Staff
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A.Financial Considerations
B.Pay-for-Performance 1. Clinical ladder 2. Horizontal promotion 3. Magnet Hospital 4. Floating 5. Mentoring |
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Employee Performance: The Performance Appraisal
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1.Process
2.Evaluation Philosophy 3.Components to Be Evaluated |
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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 |
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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 |
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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 |
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Employee Performance:
The Appraiser |
Peer Review
Documenting Performance Diagnosing Performance Problems The Performance Appraisal Interview |
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Employee Performance:
The Appraiser: Documenting Performance |
Critical incidents
Advantages and disadvantages |
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Employee Performance:
The Appraiser: Diagnosing Performance Problems |
Lack of ability
Lack of motivation |
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Employee Performance:
The Appraiser: The Performance Appraisal Interview |
Preparation
The interview Follow-up |
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Employee Performance:
Improving Appraisal Accuracy |
Appraiser Ability
Appraiser Motivation Rules of Thumb |
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Absolute judgment
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An evaluation method based on reasonable and acceptable standards set by the organization.
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Ambiguous evaluation standards problem
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The tendency of evaluators to place differing connotations on rating scale words.
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Behavior-oriented rating scales
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A type of scale used in evaluation that focuses on specific behaviors and uses critical incidents grouped into performance dimensions.
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Comparative judgment
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An evaluation method in which employees are compared with one another.
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Critical incidents
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Reports of employee behaviors that are out of the ordinary, either positive or negative.
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Essay evaluation
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An evaluation method in which an employee's performance is described through a detailed written narrative.
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Forced distribution evaluation
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An evaluation method in which employees are rated in a fixed method, similar to grading on a curve.
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Group evaluation
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An evaluation process whereby a group of managers compare individual and group performance to organizational standards.
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Halo error
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The failure to differentiate among the various performance dimensions when evaluating.
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Leniency error
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Leniency error
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Peer review
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A process by which other employees assess and judge the performance of professional peers against predetermined standards.
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Performance appraisal
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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.
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Recency error
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The tendency of a manager to rate an employee based on recent events, rather than over the entire evaluation period.
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Traditional rating scale
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An evaluation method that uses performance dimensions to rate employees.
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Written comments problem
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The tendency of evaluators not to include written comments on appraisal forms.
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A Model of Job Performance
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1.Employee Motivation
2.Motivational Theories 3.Employee Ability |
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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 |
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Staff Development
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Needs Assessment
Planning Implementation Evaluation |
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Staff Development:
Planning |
Social learning theory
Relapse prevention Adult education theory |
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Staff Development:
Implementation |
Orientation
Staff development methods Other educational techniques *Designing Staff Development Programs for a Multicultural Staff |
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Adult education theory
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A theory, described by Knowles, that children and adults learn differently.
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Content theories
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Motivational theories that emphasize individual needs or the rewards that may satisfy those needs.
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Equity
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The perception that one's work contribution is rewarded in the same proportion that another person's contribution is rewarded.
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Equity theory
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The motivational theory that suggests effort and job satisfaction depend on the degree of equity or perceived fairness in the work situation.
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Evaluation
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The investigative process to determine whether outcomes were achieved and to what extent.
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Expectancy
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The perceived probability that effort will lead to a specific performance level or behavior.
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Expectancy theory
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The motivational theory that emphasizes the role of rewards and their relationship to the performance of desired behaviors.
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The motivational theory that emphasizes the role of rewards and their relationship to the performance of desired behaviors.
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The technique used to eliminate negative behavior, in which a positive reinforcer is removed and the undesired behavior is extinguished.
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The technique used to eliminate negative behavior, in which a positive reinforcer is removed and the undesired behavior is extinguished.
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The motivational theory that suggests that the goal itself is the motivating force.
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Implementation
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Bringing together materials, methods, speakers, and learners for education.
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Instrumentality
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The belief that a given performance level or behavior will lead to some outcome.
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Motivation
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The factors that initiate and direct behavior.
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Needs assessment
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An evaluation of learning needs in a select population.
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On-the-job instruction
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An educational method using observation and practice that involves the employees learning new skills after being employed.
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Operant conditioning
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Process by which a behavior becomes associated with a particular consequence.
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Orientation
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A process by which staff development personnel and managers ease a new employee into the organization by providing relevant information.
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Planning
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The preparation for learning including obtaining materials and matching learner needs with educational methods.
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Preceptor
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An experienced individual who assists new employees in acquiring the necessary knowledge and skills to function effectively in a new environment.
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Process theories
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Motivational theories that emphasize how the motivation process works to direct an individual's effort into performance.
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Punishment
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A process used to inhibit an undesired behavior by applying a negative reinforcer.
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Reinforcement theory (behavior modification)
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The motivational theory that views motivation as learning and proposes that behavior is learned through a process called operant conditioning.
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Relapse prevention
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A model that emphasizes learning a set of self-control and coping strategies to increase the retention of newly learned behavior.
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Shaping
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The selective reinforcement of behaviors that are successively closer approximations to the desired behavior.
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Social learning theory
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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.
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Staff development
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The process of enhancing staff performance with specific learning activities.
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Valence
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The perceived value of an outcome.
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The Recruitment and Selection Process
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Elements of the Selection Process
Job Analysis |
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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 |
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Recruitment
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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 |
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Interviewing
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Principles for Effective Interviewing
Involving Staff in the Interview Process Interview Reliability and Validity |
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Interviewing:
Principles for Effective Interviewing |
1. Interview guides
2. Preparing 3. Opening 4. Gathering information 5. Giving information 6. Closing |
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Recruiting and Selecting Staff
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Education, Experience, Licensure, and Physical Examinations
Integrating the Information Legality in Hiring 1. Impact of EEOC Law 2. ADA Requirements 3. Negligent Hiring |
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Age Discrimination Act
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A law prohibiting discrimination against applicants and employees over the age of 40.
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Americans with Disabilities Act
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A law prohibiting discrimination against qualified individuals who have physical or mental impairments that substantially limit one or more of the major life activities.
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Bona fide occupational qualification (BFOQ)
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A characteristic that excludes certain groups from consideration for employment.
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Business necessity
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Discrimination or exclusion that is allowed if it is necessary to ensure the safety of workers or customers.
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4 Ps of marketing
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Four strategies included in marketing plans: product, place, price, and promotion.
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Interrater reliability
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Agreement between two measures by several interviewers.
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Interview guide
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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.
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Intrarater reliability
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Agreement between two measures by the same interviewer.
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Job analysis
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A process that determines and defines the duties and requirements involved in a particular job.
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Job specification
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Details the knowledge, skills, and abilities needed, the tasks to be performed, and the behavior required to perform them.
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Medium
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The agent of contact between the organization and the potential applicant.
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Negligent hiring
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Failure of an organization, responsible for the character and actions of all employees, to ascertain the background of an employee.
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Personnel decisions
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Decisions that affect the terms, conditions, and privileges of employment.
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Validity
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The ability to predict outcomes with some accuracy.
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Work sample questions
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Used to determine an applicant's knowledge about work tasks and ability to perform the job.
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