Leadership Midterm

Decision Making

o A complex, cognitive process of choosing a particular course of action

o The thought process of selecting a logical choice from available options

o Problem solving is included in decision making which is a systematic process following on analyzing a difficult situation involving higher order reasoning and evaluation

Decision making steps

value, your way of thinking, problem solving, critical thinking

Elastic Thinking

o Arises from what scientists call “bottom-up” processes

o Because this kind of processing is nonlinear, it can produce creative ideas that would not have arisen in the step-by-step progression of analytical thinking

Critical thinking 

o The mental process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and evaluating information to reach an answer or conclusion

**o Characteristics of a critical thinker = insight, intuition, empathy, willingness to take action

Clinical reasoning 

o Integrating and applying different types of knowledge to weigh evidence, critically think about arguments, and reflect on the process used to arrive at diagnosis

o Includes trial and error

Economic Man

o Makes decisions in rational manner

o Has complete knowledge of problem or situation

o Considers all alternatives

o Has systematic ordering of alternatives

o Selects maximizing choice

Nursing Process

o Planning = goals and objectives planned

o Organizing

***o Staffing

o Directing

o Controlling

***o Know what each mean

Contingency Leadership

o Know difference between

- Autocratic or authoritarian

- Democratic or participative

- Laissez-faire, permissive, or free rein

Contingency leadership

suggests that no one leadership style is ideal for every situation

Jim Collins Level 5 Leadership

o LEVEL 1: Highly Capable Individual

***o LEVEL 2: Contributing Team Member

***o LEVEL 3: Competent Manager

***o LEVEL 4: Effective Leader

o LEVEL 5: Great Leader

Level 5 leadership is characterized by

knowledge, team building skills, the ability to help groups achieve goals, humility, and the empowerment of others through servant leadership.

● Level 3 Leadership

o Competent Manager = someone who is not only a valuable team member but also possesses managerial skills. These leaders have the ability to organize and manage resources, making them pivotal in achieving team or organizational goals. Their focus is on efficiency and effectiveness

Human and Social Capital Theory

o Human capital represents the capability of the individual.

o Social capital represents what a group can accomplish together

o This is a theory that addresses the complexity of the leader-follower relationship

Thought Leadership #1

Thought leadership refers to any situation whereby one individual convinces another to consider a new idea, product, or way of looking at things.

Reflective Thinking and Practice

o Reflective thinking is a form of self analysis that results in learning and may lead to action (practice) that reflects new perspectives gained.

Authentic Leadership

Authentic leadership suggests that in order to lead, leaders must be true to themselves and their values and act accordingly.

Moral Decision-Making Model

o M—Massage the dilemma (collect data)

o O—Outline options.

o R—Review criteria and resolve.

o A—Affirm position and act.

o L—Look back. Evaluate the decision making

Moral Decision-Making

o A common error made by managers in ethical problem solving is using the outcome of the decision as the sole basis for determining the quality of the decision making.

o If a structured approach to problem solving is used, data gathering is adequate, and multiple alternatives are analyzed, even with a poor outcome, the manager should accept that the best possible decision was made at that time with the information and resources available.

o Perhaps the most important thing a manager can do to create an ethical work environment is to role model ethical behavior.

Principles of Ethical Decision Making

o Self-awareness is a vital leadership role in ethical decision making, just as it is in so many other aspects of management

***o 1. Autonomy = Promotes self-determination/freedom of choice

o 2. Beneficence = The actions one takes should be done in an effort to promote good

o 3. Nonmaleficence = If the actions one takes cannot do good, then one should at least take actions that do no harm

o 4. Paternalism = One individual assumes the right to make decisions for another

o 5. Utility = good of the many outweighs the want/needs of the individual

o 6. Justice = Seeks fairness, treats equals equally and treats unequals according to their differences

o 7. Veracity = obligation to tell the truth

o 8. Fidelity = Keeping promises

o 9. Confidentiality = keeping privileged information private

Know Moral Uncertainty

occurs if the nurse is not sure whether something is a moral issue or even uncertain about what the problem even is

Informed Consent

o Obtained only after the patient receives full disclosure of all pertinent information regarding the surgery, procedure, or treatment and only if the patient indicates they understand the potential benefits and risks related to it

o Know Implied vs Informed (surgery = informed bc they sign) (implied needs to be confirmed by another physician)

Advocacy

o Involves helping others to grow and self-actualize

o The actions of an advocate are to inform others of their rights and to be sure they have adequate information on which to base their decisions

o Nurses must advocate for themselves, clients, subordinates, and their profession

o Advocate for a patient when they are signing out against medical advice

o Advocate for patient when they have terminal diagnosis and make sure they fully understand what is happening (know the extent of the issue)

How nurses can be advocates

▪ Helping others make informed decisions

▪ Acting as intermediaries in the environment

▪Directly intervening on behalf of others

▪ Advocating for social justice

Malpractice

o The failure of a person with professional training to act in a reasonable and prudent manner = also called professional negligence

Five components necessary to be considered malpractice

1. Standard of care is in place (stay in your scope)

2. There is a failure to meet the standard of care

3. Foreseeability of harm must exist

4. There must be a provable correlation between care and harm

5. Actual patient injury must occur

Nurse prevents malpractice by

following their scope of practice in the NURSE PRACTICE ACT

Medical malpractice 

o Being ignorant is not a justifiable excuse, but not having all the information in a situation may impede one's ability to foresee harm

o “Just following physician orders” is not a defense for malpractice.

o Nurses have an independent responsibility to take appropriate steps to safeguard patients.

o Nurses need malpractice insurance not only because of their expanded roles but also because they incur a greater likelihood of being sued if they have malpractice insurance, since injured parties will always seek damages from as many financial resources as possible.

standard of care

To establish a minimum acceptable level of care to protect patients from harm

Intentional Tort

- Assault and battery

- False imprisonment

- Invasion of privacy

- Defamation of character/slander

- The use of physical restraints has led to claims of false imprisonment

Unintentional tort

○ Failure to properly monitor a patient's vital signs.

○ Failure to follow physician orders or nursing protocols.

○ Failure to properly administer medications.

○ Failure to properly document a patient's condition or care.

Frequent Claims Filed Against Nurses

o Inadequate charting

o Inadequate communication with physician or supervisors about changes in patient conditions

o Leaving potentially harmful items within patient reach

o Unattended patient falls

o Inaccurate counting of operative instruments and sponges

o Misidentifying patients for medications, surgeries, tests

Top 2 Nursing Specialties Most Likely to Get Sued/Charged with Malpractice

o Surgery or labor & delivery

Proactive Planning

o Organizations and planners tend to use one of the four planning modes:

▪ Reactive ▪ Inactive ▪ Preactive ▪ Proactive

o A proactive planning style is always the goal.

o ******Characteristics of Planning = proactive, deliberate, flexible, energetic

Factors Influencing the Future of Healthcare

o Further consolidation of hospitals/systems, medical groups, ancillary services, health plans, and post-acute care providers

o The tension between “value” and “volume” is growing between expected quality outcomes and reimbursement (“this is what we want”)

o The transformation from revenue management to cost management o Physician integration

o Scientific breakthroughs and technologic advancements in precision diagnostics, precision medicine, patient monitoring, and drug discovery and delivery for targeted therapies

o Technology, which facilitates mobility and portability of relationships, interactions, and operational processes

SWOT (Internal vs External)

o Strengths are those internal attributes that help an organization to achieve its objectives. (What does the “S” mean) (apply to context)

o Weaknesses are those internal attributes that challenge an organization in achieving its objectives.

o Opportunities are external conditions that promote achievement of organizational objectives.

o Threats are external conditions that challenge or threaten the achievement of organizational objectives.

Rules Regarding SWOT analysis:

- Be realistic about the strengths and weaknesses of your organization.

- Be clear about how the present organization differs from what might be possible in the future.

- Be specific about what you want to accomplish.

- Always apply SWOT in relation to your competitors.

- Keep SWOT short and simple.

- Remember that SWOT is subjective

Steps in the Supply Chain

o Determine the resources required to meet customer demand for an organization’s products or services

o Choose suppliers to provide the goods and services

o Organize the activities required to accept the products or receive the products

o Pay for them, and charge system users to cover their costs

Young Organization Vs. Aged Organization

o Young - characterized by high energy, movement, and virtually constant change and adaptation.

o Aged - have established boundaries, function in an orderly/predictable fashion, and focus on rules and regulations.

How to appropriately respond to change

Communication, willing acceptance and stress reduction

Lewins theory

Unfreeze( ensures that employees are ready for change)—> change or movement( execute the intended change)—> Refreeze (ensures that the change becomes permanent)

o Driving forces are that push the system toward change while forces that pull the system away from change are restraining forces

Time Management: Importance, what it is, how to make it better, and all parts pertaining to this topic

o Making optimal use of available time

o Close relationship between time management and stress

o Three Steps

1. Allow time for planning and establish priorities.

2. Complete the highest priority task whenever possible and finish one task before beginning another.

3. Reprioritize based on the remaining tasks and on new information that may have been received.

o Priority setting is perhaps the most critical skill in good time management because all actions we take have some type of relative importance; organize in “don’t do, do later, and do now”

Time efficient work environment

- Gather all supplies needed before starting an activity.

- Group activities that are in the same location.

- Use time estimates.

- Document nursing interventions as soon as possible after they are completed.

- Always strive to end the workday on time.

Maximizing Time Management:

- Identify key priorities to be accomplished that day.

- Determine the expected level of achievement of a prioritized task.

- Assess the staff assigned to work with you

- Review the short- and long-term plans of the unit.

- Plan ahead for meetings.

- Allow time to assess progress of goal attainment.

- Take regular breaks and use electronic calendars

time wasters

o Internal Time wasters = procrastination, poor planning, unable to delegate o External Time Wasters = open door policy, phone interruptions, socializing, lack of information, poor communication, lack of feedback

o Procrastination = putting something off until a future time (YOU NEED TO BREAK DOWN INTO MANAGEABLE TASKS)

o Make sure to TAKE BREAK

Budgeting

o A plan that uses numerical data to predict the activities of an organization over a period of time

o Personal Workforce Budget = healthcare is labor intensive; personal budget accounts for majority of most healthcare organizations expenses

o Operating budget = reflects expenses that flex up or down in a predetermined manner to reflect variation in volume of service provided

Budgeting p2

o Capital budgets plan for the purchase of buildings or major equipment that has a long life (about 5+ years), its not used daily and is more expensive than operating supplies

o Know budget methods (incremental, zero-based, flexible, performance budgeting)

o Budget that is least motivating = incremental because its FLAT increase

Fiscal Planning

o Not intuitive; a learned skill that improves with practice (always related to money)

o An important but often neglected dimension of planning

o Should reflect the philosophy, goals, and objectives of the organization

o A skill increasingly critical to nursing managers because of increased emphasis on finance and “big business” of health care

Plan of Care testing

organizational agging

Daily planning

is essential for managing