Nr203 Test 2 Communication/collaboration

Front 1

Leadership / Management Are the Concepts Different?

Back 1

Leadership
.:. May refer to people who embrace change and lead the organization through the change for the betterment of all stakeholders .
.:. Sets the direction and then influences others to follow that direction.

Management
.:. Managers work toward the organization's goals using its resources in an effective and efficient manner.
• :. Enhances the leader's abilities to plan and organize the effort

Front 2

Leading versus Managing

Back 2

Leading
• Proactive with goals
• Develop new approaches to long-standing problems
• Seeks high risk positions out of dislike for mundane work
• Relate to others in an intuitive way

managing
• Reactive with goals
• Continually coordinating and balancing opposing views, mediating conflicts
• Tolerates mundane work
• Prefers collaborative relationships

Front 3

Describe Leadership

Back 3

Exceptional Leaders exhibit five behavioral commitments that support the development of a successful leadership process:
challenges the process
Inspires a shared vision
Enables others to act
model the way
encourage the heart

Front 4

What are some qualities commonly found in effective Leaders

Back 4

Qualities commonly found in effective Leaders:

.•. Creativitiy
• Motivation
• Consistency
• Team Spirit
• Ability to empower and grow people

Front 5

There is a direct relationship between _____________ behavior and __________ sense of professionalism

Back 5

There is a direct relationship between management's behavior and staff's sense of professionalism

Front 6

Management:
Financial Responsibilities

Back 6

• Understanding What is
Required to Remain Financially Sound
• Knowing Costs and Reimbursements
• Payor Mix (How people pay, through medicare, private insurance, etc).
- Fee for Service
- Capitated Environment
• Productivity Sstandards (# of staff)

Front 7

Nursing Care Where is it billed?

Back 7

Medical/Surgical Room: $667.00 Semiprivate $696.00 Private lCU:
$1,976.00
Nursing Service may be viewed as an expense!

Front 8

How to manage Costs and Budgets

Back 8

• Top 20 most frequently used supplies on unit
• Routine practices on unit: Changing Linens, Pre-assembled Supply Kits
• How do changes in patient acuity and census affect staffing requirements?
• How does turnover, sick calls, vacations affect staffing expenses?

Front 9

Capital versus Operations Expense

Back 9

Capital Expenses:
- Funds spent for the acquisition of a long-term asset
- Funds used by a company to acquire or upgrade physical assets such as
property, industrial buildings, or equipment.
• This can include everything from repairing a roof to building a fire escape. - Must have a useful life of more than 1 year and must exceed a cost level specified by the organization (usually $300 to $1000)
Operation Expenses:
- Expenses related to day to day activities of the department
- The essential things that a company must purchase in order to maintain
business .
• For example, the payment of employees wages are an operating expense.
Also known as OPEX.

Front 10

SALARY
Name different ways we get money

Back 10

• Benefits:
- Vacation, Sick Leave, Personal Days, Holidays, Insurance, SS, Retirement
• Shift Differentials
• Overtime
• On-Call
• Bonuses
• Salary Increases

Front 11

Variable versus Fixed Costs

Back 11

Variable Costs: Fluctuates with the # of pts.
• Salary, Supplies, Dietary, Linen
Fixed Costs: Not related to the # of pts.
• Overhead costs: electricity, heating/ cooling, facility upkeep
• Exempt staff
• Support departments (accounting, human resources, administrative departments, information services)

Front 12

Allocating Staff / Resources

Back 12

• Staffing and Scheduling
- Patient Classification Systems
- Nursing Hours per Patient
- Staffing Mix
- Shift Distribution
- Supervision/ Delegation

Front 13

Staffing / Budget

Back 13

Productive hours: Hours that are actually worked
Nonproductive hours: Refers to time paid for benefit hours such as vacation, holiday, sick leave, education, personal time.

Front 14

JCAHO Standards related to Staffing Effectiveness

Back 14

• Standard HR.2: The hospital provides an adequate number of staff members whose
qualifications are consistent with job responsibilities
• Staffing is defined as the number, competency, and skill mix of staff related to the provision of needed services.
Standard HR.2.1:
- The organization uses data on clinical/service screening indicators in combination with human resource screening indicators to assess staffing effectiveness

• Standards implemented on July 1, 2002 address the hospital's monitoring of staffing effectiveness by relying on the use of screening indicators.
- Clinical/Service Screening Indicators: (ex. adverse drug event)
- Human Resomce Screening Indicators: (ex. overtime and staff vacancy rate)

Front 15

Unit Work Load

Back 15

• # Daily Admits/
Dismissals
• # Available Beds
• #Occupied Beds
• Average Daily Census
(ADC)
• Average Length of Stay (LOS)
• Average Acuity of Patients
• # Transfers
• Support services (transportation, IV,
W/S/O, Rehab, PT/OT

Front 16

Staffing Pattern / Matrix

Back 16

• Shift distribution
• Skill mix
• Day to day shifts in patient population
• Staff experience
• Geographies of unit

Front 17

Staff Development

Back 17

• How does a manager develop new staff?
- Appropriate orientation / internship
- Motivated preceptors / mentors
- Being available
- Scheduled "check-in"
points especially throughout first 6 months

Front 18

Performance Appraisals

Back 18

• The "Tool" used is not nearly as important as how the information is used and shared with the employee.
• Proper planning is
1st step in preparing for a successful appraisal.
• Very important to document throughout year of all critical incidents, positive and the not so positives!

• Evaluations should be strong enough to stand up in court.
• Performance evaluation should reflect the
Philosophy and mission of the
organization.

Environment of the Appraisal
• 1 on 1
• Uninterrupted
• Open body language
• Reflective listening techniques
• Professional and positive
• Specifics given related to behavior/performance expectations

Front 19

Performance Issues

Back 19

• Absences
• Tardiness
• Performance Problems
• Substance Abuse/ Diversion
• Disgruntled Employees
• Personal Issues Impacting Work
• Termination

Primary Purpose for
Disciplinary Action is to assist employee to improve
performance And productivity

Front 20

7 Actions to Reduce Turnover

Back 20

• Show them you care
• Be lean-not mean
• Walk the talk
• Measure "soft" skills
• Fight attrition with smart training

• Weed out poor managers
• Eliminate weak performers in non¬management ranks

Front 21

Substance Abuse/ Diversion

Back 21

• United States makes up approximately 6% of the world's population, yet consumes over 60% of the world's illegal drugs.
• 70% of drug users are employed and are between the age of 19-36

• Suspicious activity/behavior must be reported immediately.
• Denial is usually the first response when confronted about the problem.
• Must follow state and organizational guidelines for reporting substance abuse
• KNAP Kansas Nurses Assistance Program

Front 22

Disgruntled Employees

Back 22

• Motivational
• Skill Based
• Clinical Incompetence
• Emotional Problems
• Manager's Role

Front 23

Terminating an Employee

Back 23

• Documentation of performance is essential
• Consult with Human Resources (and Legal if necessary) to ensure all proper steps are followed.

Front 24

Workplace Violence in Health Care

Back 24

• One of the most complex and dangerous occupational hazards facing nurses today.
• Majority of threats and assaults originate from patients.
• Result from:
- exposure to violent individuals
- absence of strong violence prevention programs and
protective regulations - staff shortages
- increased patient acuities

Front 25

• Primary Violent Patient Population/ Locations

Back 25

• Agitated clients in mental health facilities
• Emergency room
• Demented elderly patients
• Nursing homes and rehab centers
• Patients with a history of assault

Front 26

Work Place Violence

Back 26

• Defined as violent acts such as physical assaults and threats of assault directed toward employees while working.
• Includes:
- Physical and psychological violence
-Abuse
- Mobbing or bullying
- Racial harassment
- Sexual harassment

Front 27

Types of Workplace Violence

Back 27

• Type I: Criminal Intent
• Type II: Customer/ Client
• Type III: Worker-on-Worker
• Type IV: Personal Relationship

Front 28

Broken Window Theory

Back 28

• Tolerating low-level crimes will foster an environment in which more serious crimes will follow.
- Concept applies to work place violence
• May start with tolerated verbal abuse / threats and progress to higher levels of violence.

Front 29

Work Place Violence-cases

Back 29

• 1993 -1999 1.7 million cases
• 2000: 48% of all nonfatal injuries from workplace violence were suffered by health care workers
• Nurses, nurse's aides, orderlies
• Bruises, lacerations, broken bones, concussions
• Median number of lost days of work: 5
• 70% of Canadian nurses do not report violent incidents

Front 30

SELF CARE

Back 30

• When did you last go out to eat in a nice eating
establishment?
• When did you go to the movies last?
• When did you last read a fun book?
• When did you last go for a walk in the park or along the water?

Front 31

Absenteeism

Back 31

• One of the major problems managers must confront
• Clear standards/ expectations must be communicated and adhered to
• Absenteeism may be linked to role stress/ strain or personal issues
• Casual Call Ins


Consequences of staff absenteeism: • Direct:
Working "Short", Floating, Financial Increases if replacement staff are agency or travelers
• Indirect:
Decreased morale of unit, lack of trust among co-workers, increase work load for staff

Front 32

Turnover
Consequences

Back 32

• Decreased morale
• Short-staffing
• . Decreased continuity of care
• Decreased quality of care
• High cost to organization for "revolving" orientation cycle

Front 33

What are the three primary tasks of a leader?

Back 33

The three primary tasks of a leader are to help people develop a sense of direction and purpose, to build the group's commitment to its goals, and to face the numerous challenges that arise in a health care setting:
1. Set direction, mission, goals, vision, purpose
2. Build commitment: motivation, spirit, teamwork
3. Confront challenges: innovation, change, turbulence