Nurse 215: The Healthcare Context

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characteristics of bureaucratic organization:

Division of Labor

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description of jobs that include clearly defined jobs

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characteristics of bureaucratic organization:

Defined Hierarchy

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clear description of reporting relationships

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characteristics of bureaucratic organization:

Detailed rules and regulations

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greater emphasis on policies and procedures; expectations that these will be followed and will guide decision making

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characteristics of bureaucratic organization:

Division of Labor

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description of jobs that include clearly defined tasks

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characteristics of bureaucratic organization:

Defined Heirarchy

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clear description of the reporting relationships

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characteristics of bureaucratic organization:

Detailed Rules and Regulations

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greater emphasis on policies and procedures; expectations that these will be followed and will guide decision making

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characteristics of bureaucratic organization:

impersonal relationships

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expectations that staff will do their jobs and that supervisors will ensure that jobs are done as expected

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horizontal structure

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is decentralized and emphasis is placed on the department and divisions.

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Matrix organization

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if a nurse works in two departments she is considered part of both teams

also called a flatter because decisions do not flow from the top
down

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board of trustees/ directors

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responsible for developing the overall direction of the hospital and ensuring the goals of the organization are met.

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chief executive officer (CEO)

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is hired by the board and reports to the board. the CEO hires the other major leaders for the hospital.

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administration

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this is the leadership for the hospital, the central decision-making source.

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nursing

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this is the largest department in terms of employee numbers.
can also be called patient services.

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medical staff

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physicians who practice in a hospital. their credentials are reviewed, and they are given admitting privileges.
the director or chief of medical staff lead the medical staff.

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admission and discharge

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manages all aspects of admissions and discharge for patients

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Medical Records

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this departament provides oversight of documentation . it is a complex function and one that requires nursing input to ensure that nursing documentation needs are recognized and information is included.

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information Management

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this department ensures that required information is collected, analyzed, monitored, and summarized.
it is directly related to medical records and documentation.

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information Management

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this department ensures that required information is collected, analyzed, monitored, and summarized.
it is directly related to medical records and documentation.

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quality Improvement

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this department is charged with ensuring that the hospital has a quality improvement program, implements it, and evaluate its outcome.

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infection control

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provides services that decreases infection risk. nurses are very active staff members ; they develop policies and procedures, monitor infection rates and train staff.

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research

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this department is led by medicine
this departments purpose is to conduct research studies.

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in-service or staff development

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this department that implements orientation and education for staff

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Environmental Services
(housekeeping)

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staff members interact with the nurse in patient care areas to ensure that areas are clean for patients

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Registered Nurse (RN)

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nurses are the backbone of the acute care hospital. may work in multiple departments within the facility

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Advanced Nurse Practitioner (ANP)

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A RN with a masters degree in a specialty. able to provide care outside of the facility and may have prescription privileges and admitting privileges.

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Clinical Nurse Specialist (CNS)

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a RN with a masters degree who is prepared to provide care in an acute care setting and guide the care provided by other RN's.

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Doctor of Nursing Practice (DNP)

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a RN with a terminal doctoral practice degree. this nurse is prepared to carry out roles similar to the traditional ANP and CNS in addition to focusing at the system level on evidence based practice, quality improvement, leadership, and financing expertise

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Clinical Nurse Leader (CNL)

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a RN with a masters degree and is a provider and a manager of care. the CNL designs, implements and evaluates client care by coordinating, delegating and supervising the care provided by the healthcare team

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Certified Nurse Midwife (CNM)

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a nurse midwife has a masters degree and is prepared to provide women's health services and services to obsterical patients

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Certified Registered Nurse Anesthetist (CRMA)

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an RN with a masters degree who is prepared to provide care to patients who need anesthesia.

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physician

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has a medical degree and typically has a specialty

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physicians Assistant (PA)

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is educated to practice medicine under the supervision of an physician. able to conduct physical exams, diagnostic workups, makes diagnoses and prevents and treat diseases and has some prescribing privileges.

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Licensed Practical/Vocational Nurse
(LPN/LVN)

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a member of the nursing staff who has completed a 1-year nursing program and successfully passed the LPN/LVN exam.

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occupational Therapist (OT)

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they provide important services for patients with rehabilitation needs because of impaired functioning such as stroke patients

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Nursing Assistants

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able to provide direct care such as vital signs, bathing, and ADL's.
they are supervised by RN's

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Pharmacists

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has completed professional education and ensures that pharmaceutical care is appropriate for the patients needs

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physicial therapist

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provide musculoskelatal care to patients such as teaching stroke patients how to walk on crutches

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Registered Dietitian

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work with patients to help resolve dietary and nutritional needs

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Respiratory Therapist

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provide care to patients who have a variety of respiratory problems.

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Social Worker

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have professional degrees and assist patients and their families with issues such as reimbursement.

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Hospitalist

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a generalist who covers patients as the primary provider while the patient is in the hospital. he or she coordinates the care

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Intensivists

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this MD focuses on care of patients in intensive care unit

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Financial Status: Macro View

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the major financial support for the U.S. healthcare system.

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financial View: Micro View

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specific healthcare organization and its budget

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Budget

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can be prepared for a specific time frame such as a year.
it describes the expected expenses and projected revenues.

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Reimbursement

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pays the patients bill for services provided

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"in the Red"

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it is not a good position to be in . this means the hospital cannot pay its bills.

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Safety Net Hospitals

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public hospitals that serve the population who have limited or no resources to pay their bill

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thrid-party payer system

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employer based, with healthcare services paid by someone other than the patient. the patient pays part of it and most is paid by the third party provider

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fee-for-service

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the most common reimbursement model.
physicians and hospitals bill separately for each patient encounter or service that they provide rather than receiving a salary or a set payment per patient enrollment

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Deductible

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the part of the bill the patient must pay before the insurer will pay the bill for the services. after the patient pays th amount due per year, the patient pays no additional deductile for that year.

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Copayment and Coinsurance

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fixed amount that a patient may be required to pay per service .

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Annual Limits

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enrollees have a defined amount that they would have to pay-a maximum amount- and after that level is reached, they no longer have to contribute to the payment.

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pre-existing Condition

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a medical condition that a person has developed before he or she applies for a particular health insurance policy

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Managed Care

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method used to reimburse or pay for the healthcare services but it includes more than just payment

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Preferred Provider Organization(PPO)

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enrollee is given a list of providers and to receive reimbursement of services, the enrollee must use a provider on this identifier list.

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Health Maintenance Organizations (HMO)

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typically has less choices about providers

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Medicare

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1965, tittle of XVIII, an amendment to the social security Act
federal insurance program for people aged 65 and older, person with disabilities, and people with end stage renal disease.

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Medicare Part A

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cover hospital services

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Medicare Part B

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covers physicians and outpatient care and offers prescription services but patient must pay a portion

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Medicare Part C

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(medicare Advantage)
covers part A and B but through private insurance companies approved by medicare

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Medicare Part D

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prescription coverage

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CMS, department of health and human services

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sets standards and monitors medicare services and payment

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Medicaid

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1965, title XIX of the social security Act.
the federal/state program for certain categories of low income people.
covers health and long term care services for children, the aged, the blind, disabled persons, and people who are eligible to receive federally assisted income maintenance payments

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military health care

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the government not only pays for the care but also is the provider of the care through military hospitals and other healthcare services

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U.S. Department of Veterans Affair

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the VA provides services to veteran at VA facilities and covers the cost of these services.

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federal Employees Health Benefit Program

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federal employee reimbursement is mandated by law. this is just a reimbursement and insurance it is not involved in the actual delivery of services

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state insurance programs

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state offers health insurance to their state employees.state employees choose from a variety pf plans and contribute to the coverage in the same way that non state employees pay into their employer health programs

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uninsured

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someone who does not have insurance

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underinsured

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someone who does not have enough insurance

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organizational Culture

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embodies the organizational values that implicitly and explicitly specify norms, shape attitudes, and guide the behaviors of the members of the organization.

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Dissonant Culture

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the organization is not functioning effectively

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consonant Culture

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a functioning and effective organization

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upper Level

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responsible for establishing goals, objectives, and strategic plans for the organizational
e.g. V.P. of nursing,

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middle level

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supervise first level managers.
e.g. "director of nursing"
those directors supervise multiple units that have a common function

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first level

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managers who provide the day-to-day or operational directions for the nursing services and unit.
e.g. supervisors and managers