Gender Differences in Communication Styles and Nursing Leadership, Exams of Nursing

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BSN425 exam 3 QUESTIONS WELL

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Affordable Care Act (ACA) - correct answer ✔✔signed March 23, 2010 Promise of providing adequate and affordable care to Americans on the horizon. Tighter budgets and staffing Affects nurses: understaffed, use ED as clinic and less payment Good b/c: many more openings outside of hospital, opening up jobs other than acute care, more NP Throughput - correct answer ✔✔A performance measure related to moving patients into and out of health care systems. Steps (3): input (all of your employees), Throughput (patient stay), and output (how well they do outside of the hospital) EX: if emergency departments are on divergence, the number or readmissions and how long they wait in ED Benchmarking - correct answer ✔✔Compares an organizations data with similar organizations comparing their performance. Identifies weakness Leapfrog groups compare hospitals EX: wait time in ED at one hospital vs. others TCAB quality management (transforming care at the bedside) - correct answer ✔✔Beside nurse more involved in research. Four main points: safe and reliable care, vitality and team work, patient center care, value added care process What's been created: rapid response, communication model, nutritional plans

SIMPLY: take nurses at the bedsides opinions/research and make care better budgets - correct answer ✔✔all hospitals have cost center number, where you get paid from. overtime is 1.5 over your hourly wage, for overtime you have to work 4 additional hours on top of your 3, twelve hour shift. Nurses impact budget: clocking in and out on time, taking breaks, wasteful w/ supplies shared governance - correct answer ✔✔movement as an attempt to empower nurses (really draws in a nurse) creates an environment where nurses have ownership of his/her ownership hallmark: participative decision making and is a standard for magnet certification EX: the manager in a shared governance organization takes the role of a facilitator RATHER than a supervisor/boss transactional therory - correct answer ✔✔theory; maintaining the equilibrium, expecting something back. Ex: the charge nurse asking nurse to pick up shift transformation theory - correct answer ✔✔chief nursing officer goes beyond transactional, pushing people to do better. Pushing your followers. ** this decreases burnout and makes a happier work environment SIMPLY: transactional is the now, transformation is in the future ex: transactional: day to day, Transformation: shared vision for future McGregor's Theory X - correct answer ✔✔motivational theory; the idea that what the manager believes about his/her employees affects employees motivation and work performance Lazy w/ constant supervision and direction: Manger will treat them as lazy and will provide constant super vision and direction. These people are NOT motivated and fearful of manager

McGregor's Theory Y - correct answer ✔✔motivational theory; the idea that what the manager believes about his/her employees affects employees motivation and work performance manager believes employee enjoys their work and willing to work hard, employee will be motivated to do a great job situational theory - correct answer ✔✔expansion of fielders theory Leadership is dependent on the leader and their relationship with their followers, the task and the leader's interpersonal skills, and if there is favorable work situation. Want employee motivated and willing to do the task Incident reports - correct answer ✔✔You must report incidents, peer review is valuable tool for incidents SHOULD NOT punish employees, these reports provide evidence that systems need to be revised Traditional (oldest) - correct answer ✔✔Generations of nurses in workplace: values loyalty and respect Formal and always follow the chain of command without question baby boomers - correct answer ✔✔Generations of nurses in workplace: value professionalism and personal growth expect their work is making a difference Enjoy group problem solving and decision making

generation X - correct answer ✔✔strive to balance work with family life believe that they are not rewarded for all of their responsibilities "get to the point" kind of people generation Y (millennials) - correct answer ✔✔"savvy" (ability to make good judgements) expect immediate access to information electronically primary care - correct answer ✔✔type of healthcare organization patient's first encounter with healthcare system Ex: physician's office, ED, public health clinical, or retail medicine retail medicine - correct answer ✔✔walk in clinical that provides convenient services for low acuity illnesses without scheduled appts. acute care hospitals - correct answer ✔✔type of healthcare organization: hospitals are usually classified by length of stay and type of service ex: teaching hospital teaching hospital - correct answer ✔✔hospital associated with a medical school that maintains house staff of residents on call 24 hours a day home health care - correct answer ✔✔type of healthcare organization: intermittent, temporary delivery of healthcare in the home by skilled or unskilled providers and they also provide hospice care

long term care - correct answer ✔✔type of healthcare organization: professional nursing care and rehab service may be free standing, part of a hospital or apart of an organization Evidence Based practice (EBP) - correct answer ✔✔improved quality by using best available knowledge integrated with clinical experience and patient values/preference provide care critical pathways - correct answer ✔✔successful case management relies on critical pathway to guide their care pre-set care plan based on diagnosis but you can make it customizable for the patient the case manager - correct answer ✔✔has a load of 10-15 patients and follows patient progress through the system from admission to discharge responsibilities: finding ways to improve patient outcome, reduce patient days hospitalized and lowering costs in general unlicensed staff - correct answer ✔✔basic things: vitals, bath, ambulation, I/O, mouth care, cath, can apply restraint after 1st time, transport LPN role - correct answer ✔✔12-18 months of education, renews every 2 years gives meds or hangs some medication can NOT do: change in assessment or initial, formally educate a patient (injections of insulin, SQ, dressing changes) more examples-- titrating IV fluids and meds, adjusting dose of medication, inserting central venous cath, chemotherapy, discharges

CAN do: ongoing assessment, instruct a patient (ex: pee in a cup for specimen), teach about side effects of med or proper ambulation RN's only ones who can do - correct answer ✔✔initial assessments and teaching ASN vs BSN prepared nurses - correct answer ✔✔BSN would be in a supervisory position and the ASN more involved with the technical aspects of care delegation - correct answer ✔✔something you can actually do, the receiving person has to do it and you are responsible and accountable that it is done under-delegating - correct answer ✔✔type of delegation: asking an RN to make a bed over-delegating - correct answer ✔✔type of delegation: asking an RN to prepare a budget, complete patient-nurse assignments, take patient assignment #1: define the task #2: choose the right time #3: choose the right person #4: fully transfer the authority #5: check to make sure the task is completed - correct answer ✔✔what is the model for delegation (5)? right task right person right direction/communication right supervision or feedback

right circumstances - correct answer ✔✔what are the five rights for delegation published by the ANA in 1997? supervision - correct answer ✔✔monitor, evaluate them, give feedback and intervene if necessary manager can be help personally liable for their own acts of delegation and supervision but can't be held liable for the acts of others total patient care - correct answer ✔✔type of delivery system: responsible for all aspects of care (clinical days) ex: getting meds, assessments, everything. you don't worry about them when you go home total patient care, case nursing, team nursing, functional nursing, primary care, patient centered care, practice partnership, differentiated practice - correct answer ✔✔what are the types of delivery systems (8)? case nursing - correct answer ✔✔type of delivery system: one nurse caring for one patient team nursing - correct answer ✔✔type of delivery system: team consists of RN, LPNs, and unlicensed assisted personal it is from the past, but its around at some places still b/c it is cost effective

functional nursing - correct answer ✔✔type of delivery system: you only have ONE function Ex: charge nurses are only responsible for orders, LPNs are only responsible for meds (think of simulation roles) primary care - correct answer ✔✔type of delivery system: responsible for planning care for the patients from admissions to discharge assisted by associated nurses by days and shifts off responsible even when you go home patient centered care - correct answer ✔✔type of delivery system: A care pair: nurse and tech what we do now as techs practice partnership - correct answer ✔✔type of delivery system: Ideally an experienced (senior nurse) is paired with a junior partner who may be an LPN, UAP or less experienced RN. The two work the same hours/days and care for the same group of patients Senior partner plans patient care activities and directs the work of his/her partner. *what we do for orientation

differentiated practice - correct answer ✔✔type of delivery system: different job description for BSN to ASN the BSN: supervisor position ASN: technical care state boards of nursing - correct answer ✔✔regulates the practice of nurses varies by state They give you your licensure, but can also punish you and take it away regulates the practice of the specific state chain of command - correct answer ✔✔director of multiple units-> nurse manager -> charge nurse line authority - correct answer ✔✔going down the line from head honcho staff authority - correct answer ✔✔more of a collaboration of command strategic planning - correct answer ✔✔long term planning for unit, work on where they should be in 5- 10 years who does it? chief office or nurse manager strategy to project an organizations goals and activities to 2-5 years

Based on values, mission and philosophy of that organization Helps staff stay directed and prevent the organization from responding to inappropriate request value - correct answer ✔✔beliefs and attitudes vision - correct answer ✔✔written statement of the organizations goals mission - correct answer ✔✔the purpose of your organization philosophy - correct answer ✔✔the mission, values and goals all written charge nurses - correct answer ✔✔type of nurse that trouble shoots problems going on they help with shift to shift coordination takes 2-3 years for you to acclimate to your role virtue theory - correct answer ✔✔doing what a reasonable person would do in a given situation putting yourself at harm to help someone else ex: firefighters justice - correct answer ✔✔giving each person what they deserve. All person should share the benefits and burdens of a particular situation

doing what is right autonomy - correct answer ✔✔the right to choose freedom of choice or accepting responsibility for one's choices. People make choices regarding their behavior and should be responsible for their behavior. These choices determine the decision. beneficence - correct answer ✔✔duty to help others by doing what is best for them nonmaleficence - correct answer ✔✔part of beneficent- beneficence also implies this principle "do no harm"-- one has duty not only to do good but also not to inflict harm or risk harm to others The American Nurses Code of Ethics - correct answer ✔✔•The ANA Code of Ethics for Nurses serves the following purposes: It is a succinct statement of the ethical obligations and duties of every individual who enters the nursing profession. It is the profession's nonnegotiable ethical standard. It is an expression of nursing's own understanding of its commitment to society. •The Code makes it clear that inherent in nursing is respect for human rights, including the right to life, to dignity and to be treated with respect ethics - correct answer ✔✔broadly is right and wrong morals - correct answer ✔✔person's own code of behavior personal liability, vicarious liability, corporate liability - correct answer ✔✔what are legal issues (3)? personal liability - correct answer ✔✔Type of liability:

the individual nurse is responsible and accountable for his/her own actions or lack of action vicarious liability - correct answer ✔✔Type of liability: the assumption of negligence based on association with a negligent person. For example, you could be found liable due to your association with a negligent nurse. The organization can also be held liability for the negligent practice of an employee. corporate liability - correct answer ✔✔Type of liability: the organization can be held liable for its own conduct. Areas of high potential liability are: maintaining a safe environment, appropriate staffing, and hiring and termination issues. Safe amount of staff magnet status - correct answer ✔✔recognized health care organizations that provide nursing excellence improved patient safety at these hospitals improved work life conditions for nurses Hire ratio nurses and patient, fliexible schedules, autonomy, recognition and advancement opportunities RN's have voices, tuition reimbursement, and hospitals work hard to draw nurses to work there but it is expensive to do so climate - correct answer ✔✔the subjective perceptions that employees have of the organization (relaxed or hostile)

how they feel about the environment in which they work for culture - correct answer ✔✔how the employees feel about one another example: if someone is ill is there a consensus or belief that one of the staff should cover for the ill person? What is the relationship between the shifts? Is there a lot of anger or do they value working together? Some times it is difficult for the new employee to identify the cultural values and ways of doing things. There are no guidebooks available that tell the new person about the culture mores. They have to learn though watching and listening. Lewin's change theory: Unfreeze, moving, refreezing - correct answer ✔✔what are the three parts of Lewin's change theory? unfreeze - correct answer ✔✔part of Lewin's change theory: introducing the change moving - correct answer ✔✔part of Lewin's change theory: implementing the change the change is actually put into place refreezing - correct answer ✔✔part of Lewin's change theory: Now has been in place, solidifying the change Roger's theory of change:

Innovator, early adopter, early majority, late majority, laggards, rejecter - correct answer ✔✔What are Roger's theory of Change? (6) Innovator - correct answer ✔✔Roger's theory of change: people who like change and want change they immediately adopt change and may even be the creators of change early adopter - correct answer ✔✔Roger's theory of change: open to change, adopt change early in the process early majoirty - correct answer ✔✔Roger's theory of change: adopt change before the average person late majority - correct answer ✔✔Roger's theory of change: hesitant to adopt change, more questioning, more negative laggards - correct answer ✔✔Roger's theory of change: will eventually accept the change, but reject the majority of the majority of the time, but EVENTUALLY adopt to it last people to usually accept the change rejecter - correct answer ✔✔Roger's theory of change:

do not adopt it, may work against it HIPPA - correct answer ✔✔Invented in 1996 but it was not implemented until 2003 (around the time of AIDs epidemic) philosophy of an organization - correct answer ✔✔A statement of an organization's philosophy includes values, concepts and beliefs. A philosophy statement often begins with "we believe that" ex: We believe that: we have a responsibility to provide learning experiences for all students in health care related fields root cause analysis - correct answer ✔✔when you make an error, management will look back and see what caused the error usually b/c the system fails "tracing back to figure out how the error occurred, and what can we do to present the error from reoccurring" Just Culture - correct answer ✔✔refers to a culture within the organization, where you can admit/report something you did wrong and not fear you will lose your job PIP: process improvement performance (they have to give your warnings you can not get fired) critical thinker - correct answer ✔✔creativity is essential to critical thinking barriers to critical thinking: having habitual way of thinking (having a mindset of that is the way it should be done) misuse of statistics and stereotyping

critical thinking - correct answer ✔✔process of examining assumptions, evaluating, and exploring alternatives change and change agent - correct answer ✔✔the nurse manager/change agent identifies a need for change. The manager/change agent creates disequilibrium any nurse can be a change agent Men - correct answer ✔✔men or women? not into long stories men - correct answer ✔✔men or women? interrupt more frequently men - correct answer ✔✔men or women? talk more, louder, longer and faster men - correct answer ✔✔men or women? disagree more men - correct answer ✔✔men or women? focus more on issue than person men - correct answer ✔✔men or women? need to: listen to objections/suggestions, stop being judgmental until all info is in and explain their reasons women - correct answer ✔✔men or women? tag questions "can't I?"

women - correct answer ✔✔men or women? seek out more info women - correct answer ✔✔men or women? hold grudges women - correct answer ✔✔men or women? relate to a story and personal experiences women - correct answer ✔✔men or women? ask more questions and wait to be noticed women - correct answer ✔✔men or women? withdrawal from conflict women - correct answer ✔✔men or women? need to: state their message clear and concise, solve problems without personalizing them, say what you want without hinting, eliminate unsure words, don't cry diversity - correct answer ✔✔gender, race, age, culture, religion. Bottom line: we take care of everybody and we treat them all the same. we need more men, paychecks will go up talk to children as young as 5-years old b/c by the time they are in 6th grade, they have already made up their mind and bias - correct answer ✔✔how to promote nursing with children? Situation, background, assessment, recommendation, repeat - correct answer ✔✔SBAR-R stands for?

SBAR-R - correct answer ✔✔should be used for communication between all individuals, offers complete info and reduces errors many times you have less than 10 seconds Mary Breckenridge - correct answer ✔✔Important nurse: introduced midwifery to america, found frontier nursing service (think midwife mary) Mary Mahoney - correct answer ✔✔Important nurse: First african american RN Walt Whitman - correct answer ✔✔Important nurse: volunteer nurse in Civil War poet Florence Blake - correct answer ✔✔Important nurse: pediatric nursing advance pediatric nursing program Lillian Wald - correct answer ✔✔Important nurse:

good hygiene and public health Henry street house Dorothea Dix - correct answer ✔✔Important nurse: treatment of mentallly ill and prisoners Helen Fairchild - correct answer ✔✔Important nurse: helped with WWI Mary Seacole - correct answer ✔✔Important nurse: Denied nursing school b/c she was Jamaican Journey to Crimia and cared for people Think: "sea" -- jamaica Rochester City Hospital - correct answer ✔✔Place: created American Journal of Nursing The Title of Registered Nurse comes from the Nurse Registration Action of 1903 Anna Maxwell - correct answer ✔✔Important nurse:

found the American Army Nurse Core in 1901 In the Spanish American War Hazel W. Johnston Brown - correct answer ✔✔Important nurse: First African American to be Chief of the Army Nurse Core Mary Todd Lincoln - correct answer ✔✔Important nurse: Lincoln's wife Helped in the Civil War with soliders Doctor Loretta Ford and Doctor Henry Silver - correct answer ✔✔created the first NP program Think: only two doctors on SG and they created practitioner position Jane Delano - correct answer ✔✔Important nurse: made the Red Cross (think girl from Tarzan with red hair) Henrietta Lacks - correct answer ✔✔HeLa cells, used her cells and didn't tell her Informed consent came about b/c of this case!!

cells are most famous world-wide and have been used in medical research to develop vaccines, gene mapping, cloning and vitro fertilization The Tuskegee study - correct answer ✔✔Untreated syphilis, told them they were treated for bad blood but weren't treated at all. supposed to last 6 months and lasted 40 years Unethical study: they didn't inform them of the study/purpose of the study and didn't tell them they could quit Six sigma - correct answer ✔✔quality management program that uses quantitative data to monitor progress

1. Gather information
2. Define the problem
3. analyze the info
4. develop solutions
5. make a decision
6. implement the decision
7. evaluate - correct answer ✔✔what are the 7 steps to problem solving?
8. identify the purpose
9. set the criteria (what is the goal)
10. rank the criteria
11. seek alternatives
12. try them out
13. troubleshoot (what problems might occur)
14. evaluate - correct answer ✔✔what are the 7 steps to decision making?

Clinical ladder - correct answer ✔✔system of using performance indicators to advance an employee within an organization ex: Metropolitan Hospital established a clinical ladder system for nursing staff- each quarter, members of the clinical excellence committee meet to review applications from staff nurses who are seeking promotion to the next clinical ladder level clinical ladder - correct answer ✔✔allows nurses who have been in the program for a long period of time to advance to a higher title and get a raise (higher the level, higher the raise) ex: level 2 gets $2500 and level 4 gets $4000 clinical apprentice - correct answer ✔✔Clinical ladder: new nurse or nurse new to the area clinical colleague - correct answer ✔✔Clinical ladder: a full partner in care clinical mentee - correct answer ✔✔Clinical ladder: demonstrates preceptor ability Clinical leader - correct answer ✔✔Clinical ladder: demonstrates leadership in practice clinical expert - correct answer ✔✔Clinical ladder:

combines teaching and research with practice the government and insurance companies (the government - Medicare and Medicaid - and insurance companies reimburse the hospital; the patient may pay if nothing else available) - correct answer ✔✔how are healthcare organizations reimbursed? patient satisfaction, reoccurring admissions (coming back within 30 days, acquired wounds/infections from the hospital) - correct answer ✔✔what is hospital reimbursement based on? problems with reimbursement - correct answer ✔✔-insurance company disputes charges for a patient stay and refuses to pay them; fix it by asking physician to explain the reason for patient stay; negotiate the charge with insurance company; have an internal utilization review group go through the patient's chart and submit to insurance company as an appeal to denial to pay -patient disputes charges during stay and refuses to pay them; fix it by meeting with the patient to discuss his case and explain physician's decision/necessity of the procedure; agree to negotiate charge; agree to drop the charge -patient is not able to obtain resources needed when discharged; fix it by helping patient find a resource to help pay for the required antibiotic, drug, etc. shift differential - correct answer ✔✔some facilities use a set percentage to determined shift differential: 10% for evenings, 15% for nights, 20% for weekends and holidays ex: if a nurse's wage is $18/hour, then cost for nurse working evenings would be $18 plus $1.80 for each hour worked (8 hour shift: $158.40) Other facilities use a set dollar amount as a shift differential: evenings add $2.50 per hour to base pay, night shift $4, weekends $2.50 (BALLIN) merit pay - correct answer ✔✔when you do something outstanding and you get payed for it ex: you work for an organization for several years and you get a bonus

overtime - correct answer ✔✔time and a half over 40 hour work period a projection for the next year can be calculated by determining by staff classification (RN, LPN, nursing assistance, etc.) and historical or typical number by 1.5 times the hourly rate ex: average number of overtime hours paid in a unit for RNs is 35 hours per two-week pay period and the average hourly rate is $18, the projected overtime cost for the year would be $24,570 for the RN category $18 x $1.50= 27 35 x $27= $945 26 x $945 = $24,570 26 pay periods (52 weeks/2=26) $500 - correct answer ✔✔capital budget items generally cost in excess of $$? capital budget - correct answer ✔✔an important component of the plan to meet the organization's long- term goals; large purchases an organization makes or a specific unit identifies physical renovation, new construction, and new or replacement equipment planned within a specified time period must have an expected performance of one year or more and exceed a certain dollar value (such as $500*** or a $1000) some organizations are tightening up and raising that cost variable costs - correct answer ✔✔depend on and change in direct proportion to patient volume and patient acuity, such as patient care supply expenses (more patients equals more supplies which equals higher supply expenses)

fixed costs - correct answer ✔✔that will remain the same for the budget period regardless of the activity level of the organization, such as rental payments and insurance premiums PRN nurse - correct answer ✔✔as needed; fill in, part-time, contract and short-term work by nurses float nurse - correct answer ✔✔nurses may be a part of the hospital's pool (resource nurses) OR floor nurses who take these assignments when their unit's census is low or to fill staffing shortages across the hospital due to absence, vacancies, or high-acuity levels; can be a major source of job dissatisfaction can solve acute staffing problems by establishing internal pools using nursing staff and UAPs; internal float pools of nurses can cause supplemental staffing at a substantially lower cost than external agency nurses all staff participating in the internal float pool must be adequately trained for the type of patient care they will be giving in house registry nurse - correct answer ✔✔They only work at one hospital (or sometimes more if they are sister hospitals run by the same people) sometime they only work on particular floor or unit, other times they go throughout the hospital wherever help is needed. They usually have to have a good amount of previous experience in these areas before they are allowed to be a part of the internal float pool or in-house registry cost less than external agency nurses agency nurse - correct answer ✔✔work for an outside company and are hired as temporary workers in various hospitals; external float pool they choose to work independently from one specific hospital or clinic; instead, they freelance, providing extra nursing help to hospitals or long-term care facilities when their staffing is low must have orientation on the unit and work under the supervision of an in-house nurse