Leadership/Management in Nursing
description
Transcript of Leadership/Management in Nursing
Leadership/Management in Nursing
Week 5
Announcements
Midterm next week: covers Week 1 through Week 4
Resume assignment: remember to include score sheet from syllabus.
Kaiser: return ID badges and Kaiser evaluations directly to Stacey
SNO Announcements
Topics for Today
Health Care Organizations Delivery of Nursing Care Trends Affecting Nursing Practice Patient Classification Systems The Joint Commission Quality Assurance
Health Care Organizations
Important to consider when beginning your job search. Centralized Decentralized Matrix
Participative Management Shared Governance
Centralized organization characteristics Control comes from a central authority, such
as the CNO. Control of things such as financial management changes regarding nursing care innovations
More common in small organizations Paternalistic
Centralized Organization
Decentralized organization characteristics Staff nurses are given a wide range of
authority that involves decision making policy formulation
At the bedside, the nurse has increased responsibility to make patient care decisions to deliver the highest quality care
Trend toward this system Nurses more empowered
Decentralized Organization
Matrix
A mixture of centralized and decentralized Many hospitals are this – very few are purely
centralized or decentralized Think about how things are done in your
hospital to assess which type of organizational structure it fits into.
Participative Management
Staff nurse participates in and provides advice about issues but does not make actual management decisions.
Shared Governance
A step beyond participative management. Staff nurses begin to share in some
management decisions: Self-scheduling Quality improvement projects Recruitment / retention programs
As healthcare systems are becoming more decentralized, important activities are being transferred to the manager (and, ultimately, the bedside nurse).
Delivery of Nursing Care
Seldom find pure systems of nursing care delivery.
Models change due to fiscal realities. 1970’s to early 1980’s: shift toward more RNs 1990’s: shift toward fewer RNs and more
UAPs Today: patient ratios mandate more RNs…
Models of Nursing Delivery
Private Duty Functional Nursing Team Nursing Primary Nursing Patient Focused Care Case Manager Model
Private Duty
The original system of nursing care delivery RNs hired by the patient / family of the patient Student nurses staffed the hospital
Functional Nursing
Task-oriented Fragmented Impersonal Co$t-effective
Team Nursing
RN takes responsibility for management of patients
Delegates tasks to LVNs, CNAs Requires strong communication skills TL: Usually RN Conferences are vital to ensure the
necessary care is being delivered
Primary Nursing
RN is responsible for care of patients 24 hours a day in partnership with associate nurses
RN designs plan of care RN provides follow-up with referrals and
discharge planning Associate nurses carry out prescribed plan of
care when primary nurse not working
Patient Focused Care
Evolved within past 15 or so years. Centralized tasks on the unit under the
direction of the RN. RN assigns and supervises the performance
of tasks. UAPs are cross-trained to perform more than
one task (increased productivity).
Case Manager Model
Nurse manages a caseload of patients that s/he is responsible from pre-admission to post-discharge.
Focus: outcomes. Case Manager: usually a Master’s prepared
nurse Clinical Pathways: allow everyone to know
where a patient should “be” on any given day of hospital stay
Trends affecting nursing practice in the 21st century.
Nursing is assuming a more dominant role in health care.
Geriatric nursing is becoming more important. Nursing will play major role in health care
policy. Nurses will provide expertise in order to
promote holistic care. Technology provides assistance to the nurse,
providing high quality, cost-effective care.
Trends affecting nursing practice in the 21st century.
Outcome criteria will become important in determining the quality of care.
Case-managed care will replace the traditional sick-care approach.
More women and nurses will be involved in governmental decisions related to health care.
Education will become more user-friendly. Nursing will begin sharing information on a
more global level.
Patient Classification Systems
Provides a basis for staffing and making assignments.
Also known as “acuity” systems. Usually use a formula
Can be “altered” by creative nurses to modify staffing needs…
Types of Patient Classification Systems
Descriptive A set of narrative descriptions to categorize
patient acuity. Example: 1 = minimal, 5 = extensive Forces each patient into a specific category. Very subjective. Example: ICU patient on MV less “work” –
why? Checklist
Reduces subjectivity, but essentially the same.
Types of Patient Classification Systems
Time-Based Acuity based on the time required to complete
various nursing interventions. Does not take into account inefficiency of
ancillary services. Advantage: patient can be billed for nursing
care.
Assignments
Things to consider: Census
More patients = more staff needed Can fluctuate during the shift JC mandates that staffing not be based on census
alone. Staff mix
Higher acuity = need for more RNs Productive vs. nonproductive time
Report time Inservices Evaluations
The Joint Commission
The Joint Commission has been a leader demanding evidence of quality health care
TJC evaluates and accredits more than 15,000 health care organizations and programs in the United States.
The Joint Commission
Mission: “To continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations.”
The Joint Commission
Since 1951, the Joint Commission has maintained state-of-the-art standards that focus on improving the quality and safety of care provided by health care organizations.
The Joint Commission also awards Disease-Specific Care (DSC) Certification to health plans, disease management service companies, hospitals and other care delivery settings that provide disease management and chronic care services.
Continuous quality improvement.
We are continually looking for opportunities to improve.
Even if we think we are doing a good job, we are relentless in our pursuit to do better.
We not only look at nursing, but also how the systems of the unit in the hospital can be improved to provide better care at lower cost.
Quality Assurance
A system of procedures used to evaluate the service and the providers of that service so it can be improved.
Must be unit-based* Must be done by all staff*
*per The Joint Commission
Quality Assurance – 3 Types
Structure Setting and resources Facilities Equipment Staff finances
Process (most commonly done) Actual activities carried out
Outcomes Results of activities, patient teaching, nursing
interventions
Quality Assurance -- Procedures
Many different methods are used: Chart review Interviews Observation Surveys Audits
Quality Assurance -- Implementation
Participative approach is best If generated by employees, likely to be more
enthusiasm
Quality Assurance