Leadership Midterm

Communication styles

aggressive, passive, , passive-aggressive, assertive

Passive

Failure to assert for themselves, allows others to deliberately infringe on their rights, tend to speak softly or apologetically, failure to express feelings, needs, and opinions

Aggressive

Try to dominate others, use humiliation to control others, criticize, blame, or attack others, speak in a loud, demanding voice, act threateningly and rudely, interrupt frequently

Passive-Aggressive

Mutter to themselves rather than confront the person or issue, have difficulty acknowledging their anger, use facial expressions that don't match how they feel, use sarcasm, deny there is a problem, appear cooperative while purposely doing things to annoy and disrupt others

Assertive

State needs and wants clearly, appropriately, and respectfully, express feelings clearly, use "I" statements, communicate respect for others, feel in control of self, have good eye contact, speak in a calm and clear tone of voice

Active Listening

The practice of fully concentrating on, understanding, and responding to a speaker, rather than just passively hearing them

Crucial Conversations steps

1. Learn to look

2. Start with your heart

3. Make it Safe

4. Master your stories

5. State your path

6. Explore others' paths

7. Move to action

Learn to look

What conversation are we not facing? Notice when a conversation becomes crucial, watch for signs of silence

Start with your heart

What is my agenda/motive? Focus on what you really want for yourself, for the other person, and the relationship, avoid slipping into winning, punishing, or avoiding, understand perception and biases

Make it safe

Safety is about the context of the conversation. Get your mind right first. What is the motive behind the conversation? Use apology, contrasting statements, and shared purpose to rebuild safety

Master your stories

Recognize that emotions come from the stories we tell ourselves about others' actions, and separate facts from stories

State your path

Begin your dialogue with facts, concrete, objective experiences that created concern (facts are the least controversial, most persuasive, and least insulting)

Explore others' paths

Genuinely listen with curiosity, encourage them to share facts, stories, and feelings. Mirror, paraphrase, and prime back, guess gently at what they may be feeling

Move to action

Decide how to turn dialogue into results, be clear about who does what by when. Agree on how you'll follow up

AIDET

Acknowledge, Introduce, Duration, Explanation, Thank you

Acknowledge

Greet the patient by name, make eye contact, smile, and acknowledge family or friends in the room

Introduce

Introduce yourself and explain your role in providing their care

Duration

Give the patient an accurate time frame for the duration of their visit, including information such as when they can expect to see the physician or receive lab results. When this is not possible, let the patient know you will update them

Explanation

Explain each step of their visit, answer questions, and let the patient know how to contact you (call button)

Thank you

Thank the patient, express gratitude for choosing your facility, and their communication and cooperation

Followership

Followship is the response of people in subordinate positions to those in senior ones. It is a social relationship between the leader, followers, and the group

Followership is not subservience or passive obedience to orders, rather, it is a process whereby followers engage in constructively critical thinking and interact with and support the leader to help achieve a task

Constructive critical thinking

Welcoming constructive feedback and criticism allows individuals to learn and grow, demonstrating a willingness to acknowledge areas for improvement and strive for personal development

Benefits to mentors and mentees

Supports personal and professional development

Promotes confidence, competence, and leadership skills

Helps mentees adjust to nursing culture and expectations

Strengthens team collaboration and connection

SMART goals in healthcare

SMART goals in healthcare ensure clarity and focus on priorities, leading to improved patient outcomes and efficient resource allocation

Specific

SMART goals need to be specific to provide clear guidance and direction. They answer the questions of who, what, when, where, and why for the goal

Measurable

Measurable goals allow for tracking progress and determining if the goal has been achieved. They provide concrete criteria for assessing success.

Achievable

Goals should be realistic and attainable within the resources, time, and constraints available. The goal should challenge but not overwhelm

Relevant

Goals should relate to what you want to accomplish

Time bound

Goals should have a responsible time frame

Types of law in nursing

Criminal law

Civil law

Administrative law

Criminal law

Harm to society, prosecuted by the state

Diversion of narcotics, intentional harm

Civil law

Dispute between individuals or entities, often for monetary damages

Malpractice, negligence claims

Administrative law

Licensure and discipline through State Boards

Nursing practice mostly involves which types of law?

civil (malpractice) and administrative law

Intentional torts

Assault, battery, false imprisonment, defamation, invasion of privacy, fraud

Unintentional torts

Negligence, malpractice, failures

Assault

The unjustifiable, intentional attempt to threaten to touch a person without consent that causes the person to fear imminent harm (threatening restraint or harm)

Battery

the unlawful, harmful, or unwarranted touching of another or the carrying out of threatened physical harm (giving treatment without consent)

False imprisonment

The unjustifiable restraint of a person within fixed boundaries, or an act intended to result in such confinement without consent and without authority of law (restraining a patient without justification)

Defamation

damaging a reputation, diminishes others' value or esteem

Invasion of privacy

sharing patient information without a need-to-know

Fraud

deliberate deception for the purpose of securing an unfair or unlawful gain

Negligence

failure to exercise ordinary care that a reasonable person would

Malpractice

professional negligence, specific to licensed providers

Failures

Medication errors

Any preventable adverse drug events involving inappropriate medication use by a patient or health care professional; they may or may not cause the patient harm.

Failure to communicate

Not reporting abnormal labs to the provider, omitting chest pain in handoff

Failure to assess/monitor

Ignoring declining O2 sat, missing neuro checks after pain meds

Failure to act

Ignoring alarms, delaying rapid responses

Failure to use equipment properly

Incorrect IV pump programming, not turning/repositioning patients

Failure to evaluate care

Giving morphine but not reassessing pain, ignoring worsening infection despite antibiotics

Failure to plan/administer care

Improperly supervising patients, inappropriately delegating nursing tasks, and failing to supervise subordinates

Torts examples

Assault → threatening to restrain a patient

Battery → giving medication without consent

False imprisonment → restraining AMA patient

Defamation → harming reputation (libel = written, slander = spoken)

Negligence → car accident from texting

Malpractice → failure to assess a postoperative patient

Malpractice elements

duty, breach, foreseeability, causation, damages

Duty

nurse owed a duty of care

Breach

nurse failed to meet the standard of care

Forseeability

harm was predictable

Causation

breach directly caused harm

Damage

patient suffered damage or injury

Good Samaritan Laws: what protections they give, when they apply

Generally, a nurse is not liable for injury that occurs as a result of emergency treatment that:

Care is provided at the scene of the emergency

The care is not grossly negligent

If you delivered care at the scene, stay on site until professional help arrives

What constitutes a breach of HIPAA?

A breach occurs when protected health information is accessed, used, or disclosed without proper authorization in a way that compromised its security or privacy

Unauthorized access, improper disclosure, lost or stolen devices, wrong recipient, social media sharing

Consequences for breaching HIPAA

Consequences vary based on intent and if the case was accidental

Internal disciplinary actions (employer-based)

Verbal or written warnings

Mandatory retraining

Suspension

Termination

Civil penalties (by Office for Civil Rights)

Fines

Given a tier which determines fine type and amount ($100-$50,000+)

Criminal penalties (Department of Justice)

Jail time

What can Boards of Nursing do regarding licensure?

RN licensing

Monitoring of RN educational standards

Rn continuing education

Disciplining RNs

State-specific rules

Boundaries for practice are defined in the Nurse Practice Act of each state

Who determines nursing scope of practice?

Nursing scope of practice is primarily determined by state Nurse Practice Acts

Nurse Practice Act

A legal instrument that defines what the function of nursing shall be and sets standards for licensure

It grants the nurse the authority to carry out those functions

Each state has its own Nurse Practice Act, but all must be consistent with provisions or statutes established at the federal level

Revenue

The total amount of money a business generates from its operations over a set period of time. It's also known as sales or gross income and is the first line on a company's income statement

Calculated by multiplying a company's average sales price by the number of units sold. It can come from a variety of sources

Revenue is different from income, which is a company's total earnings after subtracting expenses. To calculate a company's net income or profit, you subtract expenses from revenue

Expenses

a cost incurred to generate revenue, typically involving an outflow of money for a good or service

Ex. workers, drugs, equipment, supplies, facilities, and utilities

FTEs

Full time equivalents

Number of hours of work for which a full-time employee is scheduled for a weekly period. 1.0 FTE = five 8 hour days of staffing (40 hours)

Workload units

In nursing, workloads are usually the same as patient-days. For some areas, however, workload units might refer to the number of procedures, tests, patient visits, injections, and so forth

Staffing mix

Ratio of registered nurses, licensed vocational nurses, and unlicensed workers- hospitals vary in their staffing mixes

Personnel budget

The largest of the budget expenditures

Healthcare is labor-intensive

To handle fluctuating patient census and acuity, managers need to use historical data about unit census fluctuations in forecasting short and long-term personnel needs

A manager must monitor their personnel budget closely to prevent understaffing or overstaffing

Operating budget

Involves all managers, reflects expenses that change in response to the volume of services, such as the cost of electricity, repairs, maintenance, and supplies

Capital budget

Plan for the purchase of buildings or major equipment. Includes equipment that has a long life

Includes call-lights, hospital meds, and medication carts

HPPD (hours per patient day)

total nursing hours ÷ patient days)

Hours of nursing care provided per patient per day by various levels of nursing personnel, HPPD, are determined by dividing total production hours by the number of patients

FTE (full-time equivalent) equation

1.0 = 40 hrs/week = 2,080 hrs/year

Prospective payment system

A hospital payment system with a predetermined reimbursement ratio for services given

DRGs

Diagnosis Related Groups

Rate setting PPS used by Medicare to determine payment rates for an inpatient hospital stay based on the admission diagnosis. Each DRG represents a case type for which Medicare provides a flat dollar amount of reimbursement. The set rate may be higher or lower than the cost of treating the patient in a particular hospital

Medicare

A federally sponsored health insurance program for individuals older than 65 years and for certain groups of people with catastrophic or chronic illness, regardless of age, including ESRD

Medicare part A

the hospital insurance plan

Medicare part B

the supplementary insurance program that pays for outpatient care (includes labs, x-ray services, and physician services)

Medicare part C

allows Medicare-eligible patients to participate in managed care plans

Medicare part D

allows Medicare patients to purchase at least limited prescription drug coverage, either through a standalone prescription drug plans or Medicare Advantage prescription drug plans

Medicaid

A federal-state cooperative health insurance plan created primarily for low-income children and adults, although it also provides medical and long-term care coverage for people with disabilities and assistance with health and long-term care expenses for low-income seniors

Federal Poverty Line

A set of income thresholds issues annually by the Departmetn of Health and Human Services that determines eligibility for various government programs

In 2025 the federal guideline for a single person: $15,650

For a family of four: $32,150

Premium

Monthly cost of the insurance plan

Deductible

Amount paid out of pocket before insurance begins paying

Copayment (Copay)

a predetermined flat fee the insured pays at the time of the service- such as for an office visit, prescription, or urgent-care appointment

Coinsurance

Percentage of a medical bill te patient pays after the deductible has been met

Cost-effectiveness

Cost-effective means producing good results for the amount of money spent

Expensive items can be cost-effective and inexpensive items may not

Cost-effectiveness then takes into account factors such as anticipated length of service, need for such a service, and availability of other alternatives

Personal finance (personal budgeting, retirement planning, and emergency funds)

A good budget fuels your emergency fund and retirement contributions simultaneously- balancing present needs with future goals

Personal budgeting is a plan that should include emergency and retirement funds

Retirement planning involves 40K and IRAs. Emergency funds should not be pulled from retirement savings

Examples: emergency fund should take 5-10% of your net pay and retirement savings should take 5-15% of your gross income

Outpatient shift:

Accessibility and prevention focus

More prevention in the community

Beter connections with primary care providers

Human connectors-nurse navigators and case managers

Telehealth virtual connections

Nurse navigation

A nurse navigator is a registered nurse who acts as a patient advocate and guide, helping them through the complexities of the healthcare system, especially for patients with complex conditions

Supports patients with coordination, scheduling, insurance, symptom management

Originated in oncology; now cardiology, ortho, mental health

Telehealth & digital health

Grew due to rural needs and COVID-19 expansion

Includes remote patient monitoring: BP, weight, glucose, etc.

Telehealth benefits

accessibility, chronic care support, reduced costs

Telehealth barriers

technology access, reimbursement, privacy concerns, building trust remotely

Care transitions:

Importance of warm handoffs

Improves patient safety

Enhances continuity of care

Builds trust and reduce anxiety

Reduces redmissions and unecessary utilization

Suppors team-based care

Ex. a nurse calls the primary caare provider or home health nurse to review the discharge plan with the patient present

Should include

Medication reconciliation, follow-up appointments, patient/family education

Case manager

An RN who coordinates the medical aspects of a patient’s care- especially during hospitalization, rehabilitation, or after discharge. RN case managers work to ensure the patient receives safe, effective, and cose-efficient healthcare acros the continuum

Social worker

A licensed professional who provides psychosocial assessment, counseling and advocacy for patients and families facing barrier to health, safety, or stability. Social workers help patients cope, access resources, and manage emotional or social stressors related to illness