CH 1 integration of leadership and management in nursing

leadership in healthcare

management base or bedside leader

Institute of Medicine Reports (IOM) that resulted in awakening to the problems in healthcare

1. to err in human: building a safer health system

2. crossing the quality chasm: a new health system

3. health professions education: a bridge to quality

4. keeping pts safe: transforming work enviornment of nurses

to err is human: building a safer health system IOM resulted in

the start of patient safety movement

to err is human IOM found

medical errors as the leading cause of death in US, more than motor vehicle accidents (MVAs)****

there are errors in healthcare; we need to solve this!!

Medical errors= leading cause of death!!!

to err is human IOM brought attention to

errors in healthcare

crossing the quality chasm: a new health system for the 21st century IOM

outlines 6 aims for healthcare improvement to prevent errors

6 aims for healthcare improvement to prevent errors are….

safe systems (minimize harm to patients), effective (based on scientific knowledge), patient centered, timely, efficient (make sure we have equipment/supplies), equitable

safe systems in healthcare improvement are…

designed to minimize harm to pts

effective as an aim in healthcare improvement….

based on scientific knowledge. avoid under or over use of healthcare services

patient centered as an aim to healthcare improvement…

responsive to patients to include their preferences and values and involve them in their care

efficient as aim for healthcare improvement…

we should have the equipment and supplies we need but avoid waste to keep cost down

equitable as aim for healthcare improvement….

for anyone without disparities or inequalities

health professions education: a bridge to quality added on

informatics as an aim

keeping patients safe: Transforming the work environment of nurses IOM improved

patient safety by changing nursing working conditions and demands. Look for potential improvements

Health profession education: a bridge to quality…what are the five core competencies for health care professionals?

1. Patient Centered Care

2. Interdisciplinary Teams

3. Evidence-Based Practice

4. Quality Improvement (identifying errors and hazards)

5. Informatics

potential improvements found in keeping patients safe IOM

focus on nurses role (with effective staffing of nurses we can improve the quality of care), staffing, hours, environment, resources

nursing response to patient safety movement

Quality and Safety Education for Nurses (QSEN)

idea of QSEN

nursing educators are responsible for every nurse being educated to deliver high quality safe pt care as a member to an interprofessional team

goal of QSEN core competencies

prepare nurses with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of healthcare

QSEN adapted the five competencies outlined in Health Professions Education: A Bridge to Quality what 6th aim/competency did they add??

safety

role of ANA

Set the standard!!!

sets expectations for competent practice across the profession

2 documens used by ANA

1. Nursing scope and standards of practice (what an RN can/cannot do)

2. The code of ethics for nurses

nursing scope and standard

what RN should and shouldn’t do in their role. "job description"

ANA defines the

who, what, where, when, why, and how of nursing

who

educated, licensed, and titled nurses

what (ANA definition)

caring (art & science), protect/promote/optimize health, prevent illness, facilitate healing, alleviate suffering, advocacy (across individuals, families, groups, communities, populations)

when/where

anytime nursing knowledge or care is needed, any environment with need

why

responsibility to society's health needs

ANA how is defined by***

1. ANA scope and standards

2. federal regulations

3. state nurse practice acts

4. agency policies

ANA standards of practice

nursing process (Assessment→Evaluation)

who can take care of unstable pts

only RN

who can assess, evaluate, and teach

only RN

standards of professional performancee

behaviors in and out of professional role can affect us

every nurse is responsible for

ANA standards of professional performance

ANA standards of professional performance

Ethics

Advocacy

Respectful and equitable practice

Communication

Collaboration

Leadership***

Education

Scholarly inquiry

Quality of practice

Professional practice evaluation

Resource stewardship

Environmental health

state law defines

scope and rules/regulations

example of scope and rules/regulations

what can be delegated, who can be a teacher of nursing, who can be a preceptor

board of nursing is responsible for

licensure, discipline, enforcement

board of nursing exists to

protect the public from nurses

board of nursing enforces

rules/roles/regulations, standards for compact license

discipine from board of nursing

reprimand, probation, suspension, revocation

federal regulations

joint commission, Centers for Medicare and Medicaid (CMS)

joint commission

accreditation, safety standards, national pt safety goals

CMS

regulations tied to medicare/medicaid funding

ex: discharge education with HF → readmitted within 30 days - hospitals funding is cut

example of nursing federal regulations

med admin with 2 pt identifiers, readmission rates and funding

agency policy

expected course of action Ex: skin checks

agency procedure

specific steps for a task Ex: foley

agency protocol

detailed plan. ex: hypoglycemia protocols

nurses must follow

agency AND state practice laws. be aware of board of nursing laws so we can see if agency tries to go around it

we are highly regulated by

ANA

ANA sets

ethical and professional foundation of nursing

scope guided by

ANA standards, nurse practice acts (state level), policies (agency), federal regulations

nurses must balance

ethics, competence, advocacy, and safety