chp 1 leadership & management chp 1
Leadership & Management in Client Care
Leadership & Management Definitions
Management: The process of planning, organizing, directing, and coordinating the work within an organization.
Managers hold formal positions of power and authority.
Leadership: The ability to inspire others to achieve a desired outcome.
Leadership Styles
Autocratic/Authoritarian:
Makes decisions for the group.
Coercive style, where communication occurs downward (from highest management to employees).
Democratic:
Includes the group in decision-making.
Motivates by supporting achievements; communication occurs both upward and downward.
Laissez-faire:
Very few decisions made, little planning required.
Motivation comes from employees themselves; communication occurs upward, downward, and across.
Types of Leaders
Transactional Leaders: Focus on immediate problems and use rewards to motivate.
Transformational Leaders: Empower and inspire followers towards a common goal.
Laissez-faire Leaders: Permissive, encouraging group decision-making.
Bureaucratic Leaders: Inspire by modeling strong moral codes.
Situational Leaders: Flexible and adapts style based on the situation at hand, combining both autocratic and democratic styles.
Management Functions
Planning:
Involves decisions on what needs to be done, how it will be done, and who will do it.
Organizing:
Determines lines of authority, channels of communication, and decision-making locations.
Staffing:
Ensures adequate staff and proper mix of staff skills.
Directing:
Influences and motivates staff to perform assigned roles effectively.
Controlling:
Involves evaluating staff performance and unit goals to ensure outcomes are met.
Clinical Decision Making
Critical Thinking:
Foundation for clinical decision-making, involving skills like analyzing patient issues and problems, aligned with the nursing process.
Critical thinking influences which patient to assess first based on one's assignment.
Clinical Reasoning:
Mental process for analyzing elements of a clinical situation and making decisions.
Clinical Judgment:
Decisions regarding the course of action based on a critical analysis of data.
Clinical Judgment Models: Include assessment, analysis, planning, implementation, and evaluation.
Prioritization & Time Management
Nurses' decisions are based on:
Shift reports, team communications, document reviews, continuous and accurate data collection.
Continuous set and reset priorities to meet client needs and maintain safety.
Priority Decisions Include:
Who to see first,
Which assessments are necessary,
Which interventions to complete,
Steps in procedures, and
Client care completion.
Prioritization Principles
Systematic before Local: General shock versus localized injury.
Acute before Chronic: New injury versus long-term illness exacerbation.
Actual before Potential: Medication for acute pain versus ambulation of a client at risk for DVT.
Listen & Don’t Assume: Understand client concerns about their conditions.
Recognize & Respond to Trends vs. Transient Problems: Gradual deterioration in level of consciousness.
Recognize Medical Emergencies & Complications vs. Expected Problems: Increasing intracranial pressure versus expected findings of a stroke.
Apply Clinical Knowledge: Determine priorities based on the timing of interventions (e.g., antibiotic administration).
Priority-Setting Frameworks
Maslow’s Hierarchy: Physiological needs prioritized over other levels.
Airway Breathing Circulation (ABC) Framework: Focus on life-supporting functions.
Safety/Risk Reduction: Focus on greatest risk of injury; ask, “If I don’t do this, what will happen to the client?”
Assessment/Data Collection: Gather relevant data before acting.
Survival Potential: Determine who has the highest probability of surviving in disaster contexts.
Least Restrictive/Least Invasive: Aim for minimal intervention while ensuring patient safety.
Assessing Client Condition: Acute vs. Chronic, Urgent vs. Non-urgent, Stable vs. Unstable.
Evidence-Based Practice: Utilize current data to inform decisions.
Time Management
Organize Care Based on:
What needs to be done immediately (e.g., pain medication),
Specific timing (e.g., vital signs), and
End of shift tasks (e.g., ambulation, discharge teaching).
Delegation: Identify tasks that can be delegated to RN, PN, or UAP appropriately.
Time-Saving Strategies: Document ASAP, group activities, envision tasks, plan care, and avoid interruptions.
Implications of Poor Time Management
Leads to:
Impaired productivity,
Feelings of being overwhelmed,
Omitting important tasks,
Dissatisfaction with patient care provided.
Assigning, Delegating, and Supervising
Assigning: The process of transferring authority, accountability, and responsibility of client care to another team member.
Delegating: Transferring the authority and responsibility to another but retaining accountability.
Supervising: Directing, monitoring, and evaluating the performance of tasks by another team member.
Assigning Factors
Client Factors:
Condition and level of care needed, special considerations (isolation, fall precautions), time-consuming procedures.
Healthcare Team Factors:
Knowledge and skill of team members, needed supervision, staffing mix, and ratios.
Client Room Assignments:
Considerations such as disease precautions, privacy concerns, and environmental factors.
Delegating Tasks
Right Task: e.g., administering enteral feeding or bedside tasks.
Right Circumstance: e.g., assessing stable patients.
Right Person: e.g., tasks appropriate for skill levels of UAP, PN.
Right Direction/Communication: Providing specific direction about tasks.
Right Supervision/Evaluation: Ensuring nurses retain accountability for delegated tasks.
Supervising After Delegation
Assess if the task was completed, note any unexpected findings, and provide assistance as needed.
Staff Development
Ensures staff competency and accommodates a diverse workforce, involving:
Orientation process for new nurses,
Socialization processes,
Continuous education and training.
Stages of Nursing Ability (Patricia Benner, 1984)
.Novice Nurse
Advanced Beginner
Competent Nurse
Proficient Nurse
Expert Nurse
Professionalism in Nursing
Effective communication,
Respect for boundaries,
Patient-centered care,
Maintaining confidentiality,
Respecting patient autonomy,
Promoting trust within the healthcare team.
Quality Improvement
Joint Commission Accreditation Standards: Requires evidence of quality improvement for accreditation of healthcare facilities.
Effectiveness involves policies & procedures, interprofessional teams, data collection, and root cause analysis of issues.
Audits: Structure audits, process audits, and outcome audits.
Core Measures: Include diagnostic outcomes and patient satisfaction metrics.
Press Ganey Surveys: Assess patient satisfaction.
Nurse's Role in Quality Improvement
Participation in committees,
Utilizing reliable resources,
Thorough documentation,
Data collection and analysis related to quality,
Educating staff on needed improvements,
Acting as a role model.
Performance Appraisal & Peer Review
Ongoing performance data and behavioral documentation are essential.
Peer review includes feedback from colleagues regarding performance against the job description and input in evaluations.
Disciplinary Action in Nursing
Common discrepancies are to be documented and presented in writing.
Actions warranting immediate dismissal must be reported as necessary.
The disciplinary process generally follows a progressive discipline approach:
First Infraction: Meet with supervisor, oral warning with documentation.
Second Infraction: Written warning and potential consequences discussion.
Third Infraction: Possible suspension and investigation.
Fourth Infraction: Termination.
Conflict Management
Causes: Include ineffective communication, unclear expectations, conflicts of interest, diversity-related issues, among others.
Categories of Conflict:
Intrapersonal
Interpersonal
Intergroup.
Resolution Steps:
Identify the problem.
Discuss potential solutions.
Analyze identified solutions.
Implement the chosen solution.
Evaluate effectiveness.
Communication Styles: Utilize assertive communication, maintain eye contact, build trust, use 'I' statements, and be culturally sensitive.
Cost Effective Care
Cost Containment Strategies: Promote efficient patient care that generates revenue.
Cost Effective Strategies: Aim for optimal results relevant to spending.
Education Examples: Educate patients on managing conditions to reduce future care costs (e.g., diabetes management).
SMART Outcome Process
SMART:
Specific: Clearly defined outcomes.
Measurable: Criteria for measuring progress.
Achievable: Realistic yet challenging goals.
Relevant: Goals aligning with other objectives.
Time-Bound: Clear deadlines to create urgency.
Example Outcomes
Specific: Completing a nurse residency program.
Measurable: Weight loss goal with specifics listed.
Achievable: Summarizing nursing journals to enhance knowledge.
Relevant: Earning educator certification.
Time-Bound: Saving money for a health program within a defined period.
PIE Charting Model
Problem: Client's issues and treatment goals.
Intervention: Steps taken by the clinician.
Evaluation: Client's response to the interventions.
Sample Questions for Management Styles
Match management scenarios with styles:
Democratic: Collaborative policy development.
Autocratic/Authoritarian: Leading in critical situations.
Laissez-Faire: Implementing policy with independent, motivated teams.
Sample Questions On Delegation
Identify tasks suitable for delegation to LPNs or assistive personnel.
Assess how to include elements in the orientation plan for newly licensed nurses.
Additional Questions
Clarify the definition of SMART goals.
Confirm knowledge of SMART as Specific, Measurable, Achievable, Relevant, and Time-bound.