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Chapter 17 Decentralized vs Centralized staffing Decentralized staffing: In organizations with  decentralized staffing , the unit manager is often responsible for covering all scheduled staff absences, reducing staff during periods of decreased patient census or acuity, adding staff during periods of high patient census or acuity, preparing monthly unit schedules, and preparing holiday and vacation schedules. Provides greater autonomy and flexibility for the individual staff member Centralized staffing: In centralized staffing, the manager’s role is limited to making minor adjustments and providing input. For example, the manager would communicate special staffing needs and assist with obtaining staff coverage for illness and sudden changes in patient census. Therefore, the manager in centralized staffing continues to have ultimate responsibility for seeing that adequate personnel are available to meet the needs of the organization. What is the difference between centralized staffing and decentralized staffing? C. Centralized staffing allows decisions to be made by personnel in a central office or staffing center while decentralized staffing entails the unit manager to be responsible for making all decisions regarding scheduling. Types of scheduling DISPLAY   17.3  COMMON STAFFING AND SCHEDULING OPTIONS IN HEALTH- CARE ORGANIZATIONS   10- or 12-hour shifts:  Twelve-hour shifts have become commonplace in acute care hospitals even though there continues to be debate about whether extending the length of shifts results in increased judgment errors related to fatigue and more care left undone. Yet, many nurses report a higher level of satisfaction with 12-hour shifts because they work less days each week and have more consecutive time for leisure and personal obligations, all leading to potentially improved work–life balance.    Premium pay for weekend work   Part-time staffing pool for weekend shifts and holidays   Cyclical staffing, which allows long-term knowledge of future work schedules because a set staffing pattern is repeated every few weeks ( Fig. 17.1  shows a master staffing pattern of 8 3
hour shifts that repeats every 4 weeks.)   Job sharing   Allowing nurses to exchange hours of work among themselves    Flextime: Flextime   is a system that allows employees to select the time schedules that best meet their personal needs while still meeting work responsibilities.   Use of supplemental staffing from outside registries and float pools: generally composed of employees who agree to cross-train on multiple units so that they can work additional hours during periods of high census or worker shortages. These pools are adequate for filling intermittent staffing holes, but like agency or registry staff, they are not an answer to the ongoing need to alter staffing according to census because they result in a lack of staff continuity.     Staff self-scheduling: Self-scheduling   allows nurses in a unit to work together to construct their own schedules rather than have schedules created by management. With self-scheduling, employees typically are given 4- to 6-week schedule worksheets to fill out several weeks in advance of when the schedule is to begin    Shift bidding, which allows nurses to bid for shifts rather than requiring mandatory overtime: another newer method of reducing staff shortages and allowing nurses some control over scheduling extra shifts and to reduce mandatory overtime self scheduling model= employees schedule worksheets to fill out several weeks in advance of when the schedule is to begin Staffing needs and scheduling policies . What is the most fiscally responsible method for determining staffing needs for a hospital unit? C) An agreed-upon staffing formula currently in use
  A staffing formula is the best way to determine staffing needs, provided it is based on an accurate patient classification system (PCS) 1. What term identifies a system that allows employees to select among variations in work start-time schedules to meet their personal needs? B) Flextime 7. Which is the most accurate statement regarding staffing and scheduling policies? B) It is necessary that policies are written in a manner that allows some flexibility What must staff and scheduling policies not violate? 1. Local laws 2. Labor laws 3. State or national laws 4. Union contracts D) 2, 3, 4   What is the advantage of decentralized scheduling? A) Unit manager understands the needs of the unit and staff intimately An increasingly common staffing and scheduling alternative is the use of supplemental nursing staff such as agency nurses or travel nurses. Which statement is correct about agency nurses or travel nurses? A) Work for premium pay What is a leadership role associated with staffing and scheduling? A) Role models the use of evidence in making appropriate staffing and scheduling decisions 6. What is the priority goal for a manager with regard to staffing and scheduling? B) Ensure that there is adequate staff to meet the needs of each patient 11. What term identifies a system that allows employees to select among variations in work start-time schedules to meet their personal needs? B) Flextime 14. There are advantages and disadvantages to each type of scheduling. What is true about extending the workday with 10- or 12-hour shifts? 1 . Requires overtime pay 2. Increases nurse satisfaction
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3. Decreases cost 4. Increases judgment errors B) 1, 2, 4 Chapter 18 Motivational theories-Victor Vroom Victor   Vroom   (1964) , another motivational theorist in the human relations era, developed an   Expectancy Model , which looks at motivation in terms of the person’s valence or preferences based on social values.   In Vroom’s Expectancy Model ( Fig. 18.2 ), people make conscious decisions in anticipation of reward; in operant conditioning, people react in a stimulus–response mode. Managers using the Expectancy Model must become personally involved with their employees to understand better the employees’ values, reward systems, strengths, and willingness to take risks What did motivational theorist Victor Vroom state? D) Employees' expectations about their work environment or a certain event will affect their behavior What did Victor Vroom emphasize the importance of? A) Managers knowing each employee's expectation of reward Intrinsic Vs extrinsic motivation Intrinsic Extrinsic Comes from within the individual Comes from outside the individual Often influenced by family unit and cultural values Rewards and reinforcements are given to encourage certain behaviors and/or levels of achievement -Intrinsic motivation  comes from within the person, driving him or her to be productive -Extrinsic motivation  occurs when individuals are motivated to perform a behavior or engage in an activity to earn a reward or avoid punishment 4
Which statement most accurately defines intrinsic motivation? A)Motivation that is directly related to a person's internal level of aspiration What is intrinsic motivation directly related to? C) Personal aspiration Which reward is an example of intrinsic motivation? D) A staff member is awarded a trip to a nursing conference based on the written request that was submitted Extrinsic motivation is motivation enhanced by the job environment or external rewards. Examples: ) The prized locker is awarded to the staff member voted most helpful by their peers B) An extra vacation day is awarded for every 6 months a staff member is call off free. C) The entire staff is treated to a pizza party each time the unit earns a patient satisfaction award Stretching- Saul Gellerman Saul   Gellerman (1968) , another humanistic motivational theorist, identified several methods to motivate people positively. One such method,   stretching , involves assigning tasks that are more difficult than what the person is used to doing . This includes personal and professional development in areas of vocational knowledge, skills, and expertise. Giving people responsibility often causes them to rise to the challenge . In addition, unleashing their imagination, ingenuity, and creativity often results in their contributions to the organization being multiplied many times over What did the motivational theorist Saul Gellerman argue? D) Employees should be "stretched" intermittently to complete tasks more difficult than what they are used to doing Motivation Hygiene theory -Herzberg’s Herzberg (1987)   maintained that motivators or job satisfiers are present in work itself; they give people the desire to work and to do that work well . Hygiene or maintenance factors keep employees from being dissatisfied or demotivated but do not act as real motivators . It is important to remember that the opposite of dissatisfaction may not be satisfaction. When hygiene factors are met, there is a lack of dissatisfaction, not an existence of satisfaction. Likewise, the absence of motivators does not necessarily cause dissatisfaction.
Example: For example, salary is a hygiene factor . Although it does not directly motivate, when used with other motivators such as recognition and advancement, it can influence motivation.  Herzberg: The Motivation-Hygiene Theory Can be useful to understand what motivates others. He believed that separating personal motivators from job dissatisfaction is possible -Motivators (job satisfiers) are in the work itself, they make people want to work and work well Hygiene factors- keep employees from becoming demotivated (SALARY) Which is a motivating factor identified in Herzberg's motivation-hygiene theory? B) A chance for promotion Which is an example of a hygiene factor according to Herzberg? C) Salary HERZBERG’S MOTIVATORS AND HYGIENE FACTORS Motivators Hygiene Factors Achievement Salary Recognition Supervision Work Job security Responsibility Positive working conditions Advancement Personal life Possibility for growth Interpersonal relationships and peers Company policy Status Chapter 19 Communication process communication  as “the exchange of thoughts, messages, or information, as by speech, signals, writing, or behavior” Communication can also occur on at least two levels:  verbal  and  nonverbal . Thus, whenever two or more people are aware of each 5
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other, communication begins. In all communication, 1.there is at least one sender, one receiver, and one message.  There is also 2. a mode or medium through which the message is sent —for example, spoken, written, or nonverbal.  What is the best combination that characterizes the communication process? C ) Sender message receiver Therapeutic responses The hospital is facing low census and downsizing. However, the RNs have been assured that everyone on the unit will keep their jobs and downsizing will occur through normal attrition and voluntary absences without pay. Today, the evening charge nurse reported that last evening the staff was discussing various rumors about mass layoffs. What is the best approach to take? B) Hold a meeting for all staff members and tell them that the rumor is not true Which statement describes assertive communication? C) It involves rights and responsibilities for all parties in the communication The RN overhears the nurses' aide speaking in a harsh tone to Mrs. Smith, who has some early Alzheimer's memory loss. Which statement will the RN make to begin addressing this issue? C) ìI am concerned about your conversation with Mrs. Smith. It seemed short and impatient.î Confidentiality in communication . What statement about the maintenance of confidentiality is true? D) It can be breached when necessary for legitimate professional need Use of SBAR report
5. What location of the SBAR charting tool states the patient's problem? C) Assessment  Which method best provides a structured orderly approach to communicating accurate, relevant information, in emergent patient situations as well as routine handoffs? B) SBAR tool Verbal & nonverbal communication, . Which statement concerning nonverbal communication is true? B) It is given more credence than verbal communication when the two are incongruent 18. What communication mode is considered most reliable in conveying the emotional component of the message? C) Nonverbal 9. What is the most significant barrier to effective interpersonal communication? A) Incongruence between verbal and nonverbal messages Use of assertive communication: a ssertive communication  reduces stress, improves productivity, and contributes to a healthy workforce. Assertive communication is a way of communicating that allows people to express themselves in direct, honest, and appropriate ways that do not infringe on another person’s rights. A person’s position is expressed clearly and firmly by using “I” statements as well as direct eye contact and a calm voice. In addition, assertive communication always requires that verbal and nonverbal messages be congruent. To be successful in the directing phase of management, the leader must have well-developed skills in assertive communication. Which statement describes assertive communication? C) It involves rights and responsibilities for all parties in the communication Chapter 19 Use of assertive communication Assertive communication reduces stress, improves productivity, and contributes to a healthy workforce. Assertive communication is a way of communicating that allows people to express themselves in direct, honest, and appropriate ways that do not infringe on another person’s rights. A person’s position is expressed clearly and firmly by using “I” statements as well as direct eye contact and a calm voice.
Misconceptions about assertive communication 1. All communication is either assertive or passive. 2. Second misconception is that those who communicate or behave assertively get everything they want. This is untrue. Being assertive involves both rights and responsibilities. 3. Third misconception about assertiveness is that it is unfeminine 4. Fourth misconception is that the terms assertive and aggressive are synonymous. To be assertive is to not be aggressive, although some cultures find the distinction blurred. Even when faced with someone else’s aggression, the assertive communicator does not become aggressive. When under attack by an aggressive person, an assertive person can do several things: Reflect: Reflect the speaker’s message back to him or her. Focus on the affective components of the aggressor’s message. Repeat the assertive message . Repeated assertions focus on the message’s objective content. Point out the implicit assumptions . This involves listening closely and letting the aggressor know that you have heard him or her. Restate the message by using assertive language . Rephrasing the aggressor’s language will defuse the emotion. Question. When the aggressor uses nonverbal clues to be aggressive, the assertive person can put this behavior in the form of a question as an effective means of helping the other person become aware of an unwarranted reaction. Chapter 21 Stages of conflict 1. Latent stage: first stage in the conflict process, latent conflict, implies the existence of antecedent conditions such as short staffing and rapid change. In this stage, conditions are ripe for conflict, although no conflict has actually occurred, and none may ever occur, for example, change and budget cuts almost invariably create conflict. Such events, therefore, should be well thought out so that interventions can be made before the conflicts created by these events escalate. 2. Perceived stage: Perceived or substantive conflict is intellectualized and often involves issues and roles. The person recognizes it logically and impersonally as occurring but does not feel emotionally involved in it. Sometimes, conflict can be resolved at this stage before it is internalized or felt. In an environment characterized by open communication and mutual support, many conflicts can be resolved simply by pointing out that a potential or actual problem exists. 3. Felt stage (also called affective conflict): felt conflict, occurs when the conflict becomes emotionalized. Felt emotions include hostility, fear, mistrust, and anger. It is possible to perceive conflict and not feel it (e.g., no emotion is attached to the conflict and the person
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views it only as a problem to be solved). A person also can feel the conflict but not perceive the problem (e.g., he or she feels conflict is present but may be unaware of its roots). 4. Manifest stage (also called overt conflict): action may be to withdraw, compete, debate, or seek conflict resolution . Individuals are uncomfortable with or reluctant to address conflict for many reasons. These include fear of retaliation, fear of ridicule, fear of alienating others, a sense that they do not have the right to speak up, and past negative experiences with conflict situations, people often learn patterns of dealing with manifest conflict early in their lives, and family background and experiences often directly affect how conflict is dealt with in adulthood. Gender also may play a role on how we respond to conflict. Historically, men were socialized to respond aggressively to conflict, whereas women were more likely taught to try to avoid conflicts or to pacify them. 5. Conflict aftermath: always conflict aftermath—positive or negative. If the conflict is managed well, people involved in the conflict will believe that their position was given a fair hearing. If the conflict is managed poorly, the conflict issues frequently remain and may return later to cause more conflict Interpersonal conflict Vs Intrapersonal conflict
Interpersonal conflict: happens between two or more people with differing values, goals, and beliefs. - can be defined by the focus and source of the conflict. People-focused conflicts are based on emotions and feelings and often are viewed as a personal attack. Issue-focused conflicts are more likely to be resolved by calmer negotiations. - informational deficiencies are another source of interpersonal conflict. Communications are not always received, may be misinterpreted, or different conclusions may be drawn based on past experiences. In addition, role incompatibility may be a cause of interpersonal conflict because of differences between the goals and responsibilities assigned to an individual and what the individual would rather be doing Intrapersonal conflict: occurs within the person. - It involves an internal struggle to clarify contradictory values or wants. For managers, intrapersonal conflict may result from the multiple areas of responsibility associated with the management role - Managers’ responsibilities to the organization, subordinates, consumers, the profession, and themselves sometimes conflict, and that conflict may be internalized. Being self-aware and conscientiously working to resolve intrapersonal conflict as soon as it is first felt is essential to the leader’s physical and mental health. Smoothing Smoothing is used to manage a conflict situation . Smoothing occurs when one party in a conflict attempts to pacify the other party or to focus on agreements rather than differences. In doing so, the emotional component of the conflict is minimized. Managers often use smoothing to get someone to accommodate or cooperate with another party. Although it may be appropriate for minor disagreements, smoothing rarely results in resolution of the actual conflict. Chapter 22 Collective bargaining Collective bargaining includes activities between organized labor and management regarding employee relations. Such activities include the negotiation of formal labor agreements and day-to-day interactions between unions and management. labor union (hereafter referred to as a union) is an organization of workers, often in a trade or profession, formed to protect their rights and interests and improve their economic status and working conditions through collective bargaining with employers COLLECTIVE BARGAINING TERMINOLOGY Agency shop—also called an open shop. Employees are not required to join the union. Arbitration—terminal step in the grievance procedure where a third party reviews the grievance, completes fact finding, and reaches a decision. Always indicates the involvement of a third party.
Arbitration may be voluntary on the part of management and labor or imposed by the government in a compulsory arbitration. Conciliation and mediation—synonymous terms that refer to the activity of a third party to help disputants reach an agreement. However, unlike an arbitrator, this person has no final power of decision making. Fact finding—rarely used in the private sector but used frequently in labor–management disputes that involve government-owned companies. In the private sector, fact finding is usually performed by a board of inquiry. Free speech—Public Law 101, Section 8, states that “the expressing of any views, argument, or dissemination thereof, whether in written, printed, graphic, or visual form, shall not constitute or be evidence of an unfair labor practice under any provisions of this Act, if such expression contains no threat of reprisal or force or promise of benefit.” Grievance—perception on the part of a union member that management has failed in some way to meet the terms of the labor agreement. Lockout—closing a place of business by management in the course of a labor dispute for the purpose of forcing employees to accept management terms. National Labor Relations Board—labor board formed to implement the Wagner Act. Its two major functions are to (a) determine who should be the official bargaining unit when a new unit is formed and who should be in the unit and (b) adjudicate unfair labor charges. Professionals—professionals have the right to be represented by a union but cannot belong to a union that represents nonprofessionals unless the majority votes for inclusion in the nonprofessional unit. Strike—concerted withholding of labor supply to bring about economic pressure on employers and cause them to grant employee demands. Union shop—also called a closed shop . All employees are required to join the union and pay dues UNION MEMBERSHIP: PROS AND CONS Reasons Nurses Join Unions 1. To increase the power of the individual 2. To increase their input into organizational decision making 3. To eliminate discrimination and favoritism 4. Because of a social need to be accepted 5. Because they are required to do so as part of employment (closed shop) 6. Because they believe it will improve patient outcomes and quality of care
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Reasons Nurses Do Not Join Unions 1. A belief that unions promote the welfare state and oppose the American system of free enterprise 2. A need to demonstrate individualism and promote social status 3. A belief that professionals should not unionize 4. An identification with management’s viewpoint 5. Fear of employer reprisal 6. Fear of lost income associated with a strike or walkout Effective labor management relations The attitudes and philosophies of the leaders in management and the union determine the type of relationship that develops between the two parties in any given organization. Acceptance also may run along a continuum. Management may accept the union with reluctance and suspicion. Although managers know that the union has legitimate rights, they often believe that they must continually guard against the union encroaching further into traditional management territory. There is also the type of union acceptance known as accommodation. Increasingly common, accommodation is characterized by management’s full acceptance of the union, with both the union and the management showing mutual respect. With accommodation, leader-managers create open discussion forums with unions to avoid the problems that occur when communication is poor. Thus, labor and management can establish mutual goals, particularly in the areas of safety, cost reduction, efficiency, elimination of waste, and improved working conditions. Affirmative action Civil Rights Act of 1964 laid the foundation for equal employment in the United States prohibits discrimination based on factors unrelated to job qualifications and it promotes employment based on ability and merit. The areas of discrimination specifically mentioned are race, color, religion, sex, and national origin act was strengthened by President Lyndon Johnson’s Executive Order 11246 in 1965 and Executive Order 11375 in 1967. These executive orders sought to correct past injustices, it created an affirmative action component. Affirmative action plans are not specifically required by law but may be required by court order. Affirmative action differs from equal opportunity. The United States Equal Employment Opportunity legislation is aimed at preventing discrimination. Affirmative action plans are aimed at actively seeking to fill job vacancies with members from groups who are underrepresented, such as women, ethnic minorities, and individuals with handicaps. Collective bargaining- manager's role
Clarifying issues begins with the manager examining the motivation of nurses to participate in collective bargaining. The manager must at least try to hear and understand the employees’ points of view. Laws focusing on rights & duties of unions & employer’s relationships Labor relations: These laws relate to the rights and duties of unions and employers in their relationship with each other. National Labor Relations Act: establishes certain protections for private-sector employees who want to form or join a labor union. These protections do not, however, extend to supervisors. The NLRA defines a supervisor as “any individual having authority, in the interest of the employer, to hire, transfer, suspend, lay off, recall, promote, discharge, assign, reward, or discipline other employees, or responsibly to direct them, or to adjust their grievances, or effectively to recommend such action, if in connection with the foregoing the exercise of such authority is not of a merely routine or clerical nature, but requires the use of independent judgment” Title of Legislation Regulation Fair Labor Standards Act (1938); has been amended many times since 1938 Sets minimum wage and maximum hours that can be worked before overtime is paid Civil Rights Act of 1964 (updated 1977) Sets equal employment practices Recognizes sexual harassment as a form of sex discrimination Executive Order 11246 (1965) and Executive Order 11375 (1967) Sets affirmative action guidelines Age Discrimination Act (1967) and 1978 amendment Protects against forced retirement Rehabilitation Act (1973) Prohibits discrimination on the basis of disability Vietnam Veterans Act (1973/1974) Provides reemployment rights The Equal Pay Act of 1963 Requires that men and women performing equal work receive equal compensation California Fair Pay Act (2016) Companies in California must justify any pay disparities between men and women doing “substantially similar” work. (Prior fair pay legislation only required men and women of the same job title to be paid equally.) Also, legally guaranteed employees the right to ask coworkers about pay without retribution from management.
CH. 22 Questions 1. One of the nurses comes to the charge and reports, iI did not receive overtime pay when I acted as ambulance support last week. It is my understanding that our union contract states weget overtime for that type of care. Will you please follow up and see that I get the overtime onmy next check?i What is this an example of? A) Collective bargaining activity appropriate for a first-level manager B) A problem employee griping C) A formal grievance D) A problem that needs to be reported to the director of nurses immediately 2. As a result of downsizing in the 1990s, a nursing surplus appeared in some parts of thecountry. What occurs in this type of situation? A) Nurses tend to join unions to protect their jobs B) No change would be expected in the rapid unionization of nurses C) There would typically be less union activity by nurses D) There is no historical perspective that indicates what nurses would do 3. What event tends to be the primary reason for an increase in the numbers of unions being formed? A) Salaries are not keeping pace with the economy B) Organizations are insensitive to the needs of the worker
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C) There is an economic downturn D) Jobs are scarce 4.Which statement best describes a iclosed shop?i A) A closed shop results in a ilockouti that prevents employees from working until the union contract is signed B) A closed shop results when the employees refuse to work because of unsettled grievances C) A closed shop requires that all employees join the union D) A closed shop allows employees to decide whether or not to join a union 5.What perspectives must the manager have to see collective bargaining and employment legislation? 1. Government 2. Organization 3. Worker 4. Personal A) 1, 2, 3 B) 1, 2, 4 C) 1, 3, 4 D) 2, 3, 4 6.What type of employment law focuses on the rights and duties of unions and employers intheir relationship with each other? A) Labor standards B) Labor relations C) Equal employment D) Civil and criminal 7. An organization is attempting to prevent unionization. Which intervention demonstrates theadministrations lack of understanding regarding employee motivation and satisfaction? A) Establish a well-developed formal procedure for handling employee grievances B) Assure each employee they will receive a 3% raise in base pay
C) Have an effective performance appraisal system in place D) Ensure that all managers are well trained and effective 8. Which statement regarding Affirmative Action legislation is true? A) It requires a quota system B) It aims to prevent workplace discrimination C) It actively seeks underemployed groups to fill job vacancies D) It encourages reverse discrimination 9. How did the Civil Rights Act of 1964 affect employees? A) It eliminated sexual harassment in the workplace B) It allowed veterans to return to jobs they held before their military service C) It prohibited job discrimination based on factors unrelated to job qualifications D) It eliminated racial discrimination in this country 10. What are the four equal pay tests associated with the Equal Pay Act of 1963? A) Equal danger on the job, equal intelligence for hire, equal responsibility, and identical working conditions B) Equal skill, equal effort, equal responsibility, and similar working conditions C) Equal job requirements, same working conditions, equal job duties, and equal responsibilities D) Equal effort, equal working conditions, identical job duties, and equal job Requirements 11. Which statement concerning the 1967 and 1987 Age Discrimination and Employment Acts istrue? A) Maximum age restrictions were limited for almost all job categories B) Employees can be forced to retire at age 70 if their health is poor C) Underage minors can be employed up to 20 hours per week D) Individuals seeking early retirement (before the age of 60) may be exempt from company pension plans 12. A nurse executive wants to decrease the chances of unionization of a nonunionized
nursing service department. To accomplish this goal where should financial and energy resources best bedirected? A) Increasing the nursing salaries and benefits B) Increasing the quality and amount of equipment C) Improving the quality of nursing staff supervision D) Improving nursing and medical staff relationships 13. The National Labors Relations Board (NLRB) requires that at least how many of employees sign an interest card before an election for unionization can be held? A) 25% B) 30% C) 60% D) 70% 14. Why does membership in the American Nurses Association (ANA) pose a conflict in loyalty for some nurses? A) It fails to support male nurses sufficiently B) Minorities are not represented on its Board of Directors C) Membership is based on years of nursing experience D) It acts as a professional association and a collective bargaining agent 15. What do labor standards deal with? 1. Conditions of the employeeis work 2. Pay for continuing education 3. Financial aspects 4. Number of hours worked A) 1, 2, 3 B) 1, 2, 4 C) 1, 3, 4 D) 2, 3, 4 16. Which statement concerning the process of arbitration is true?
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A) Arbitration is the initial step in grievance resolution B) Arbitration involves a third party arriving at a solution C) Arbitration requires both parties to present the facts of the conflict D) Arbitration is reserved for situations that involve the state or federal government Ch. 21 questions 1. A charge nurse assists a group of personnel to resolve their conflict, with the outcome being that the two opposing goals were discarded and new goals were adopted. What is this an example of? A) Smoothing of conflict by the leader B) Facilitating collaboration among personnel C) A majority rule approach D) A good lesson in compromising 2. Which statement reflects the contemporary thinking about conflict? A) It can lead to new ideas B) It leads to decreased motivation C) It should be avoided whenever possible D) It is neither qualitative nor quantitative 3. What term is used when two or more people have conflict about values or goals? A) Intergroup conflict B) Common control C) Intrapersonal conflict D) Interpersonal conflict 4. Which statement is true concerning perceived conflict? A) It develops during the first stage of the conflict process B) It is sometimes referred to as antecedent conflict C) It occurs if the conflict is intellectualized D) It occurs when the conflict is emotionalized
5. When is the competing approach to resolving conflict used? A) When fair play is important to all involved parties B) When one party wins at the expense of the others C) When managers need to control a volatile situation D) When an appropriate political strategy is necessary 6. A registered nurse reports to the nurse-manager that the teams nursing assistant regularly fails to complete assigned tasks. The nurse-manager responds that it is the nurses responsibilityto talk with the nursing assistant about this problem. The manager is engaged in what aspect ofconflict? A) Conflict avoidance B) Conflict smoothing C) Encouraging competitive conflict D) Facilitating conflict resolution 7. Which statement best defines conflict? A) It involves an internal struggle resulting from value-related discord B) Its basis is the violation of personal rights or values C) It centers on either internal or external discord between individuals D) It is the outcome of a visible struggle between individuals 8. What is the name given to the first stage in the conflict process? a) Latent B) Perceived C) Felt D) Manifest 9. What are the least common sources of organizational conflict? A) Communication problems B) Organizational structure C) Individual behavior within the organization D) Self-scheduling
10. Which personal characteristics will best help meet the psychological needs of conflict negotiation? A) Perseverance and assertiveness B) Calmness and self-assuredness C) Compassion and reflectiveness D) Organization and preparedness CH. 19 Questions 1. Which statement describes assertive communication? A) It makes you respect yourself and allows you to get what you want B) Although it is unfeminine, it is a necessary communication skill for female managers C) It involves rights and responsibilities for all parties in the communication D) Assertive communication will never offend anyone Chapter 23- (8 questions) Quality Control Process If defining health-care quality is problematic, then the measurement of health-care quality is even more difficult. To make process more effective and efficient, the collection of both quantitative and qualitative data is used as well as specific and systematic process. It is broken down into three basic steps The criterion or standard is determined. Information is collected to determine if the standard has been met. Educational or corrective action is taken if the criterion has not been met. The first step is the establishment of control criteria or standards .
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1. What is the first step in quality control? A) To take corrective action when standards have not been met B) To collect data to determine whether standards have been met C) To determine criteria and standards D) To determine who will measure the standard 2. Who is involved in quality control measurement functions? Select all that apply. A) Facility staff B) Consumers C) All levels management D) Health-care professionals 3. Which statement is true regarding criteria for assuring that a quality control program will be effective? A) The primary purpose of the program is to satisfy various federal and state standards B) Developed standards should reflect minimally acceptable levels so the organization will score well on self-assessment audits C) A belief in the importance of quality control must be integrated through all levels of the organizational hierarchy D) The process should be reactive; in other words, quality improvement efforts should be initiated after problems are identified Total Quality Management (TQM)
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TQM also referred to continuous quality improvement is a philosophy developed by Edward Deming. TQM is one of the hallmarks of Japanese management systems. It assumes that production and service focus on the individual and that quality can always be better. Is based on the premise that the individual is the focal element on which production and service depend. Because TQM is a never-ending process, everything and everyone in the organization are subject to continuous improvement efforts. In TQM, team efforts are favored over individual accomplishments. Another critical component of TQM is the empowerment of employees by providing positive feedback and reinforcing attitudes and behavior that support quality and productivity. 1. An RN is a supervisor in an organization that has total quality management (TQM) as the backbone of its organizational goals and objectives for quality control. How does the RN practice TQM on the unit? A) Encouraging employees to think of a unit slogan B) Developing a quota system for number of patients cared for C) Explaining to the staff that if its not broke, don’t fix it D) Promoting teamwork rather than individual accomplishments 2. Which is a true statement regarding TQM? A) It is based on the premise that the organization knows what is best for the consumer B) Its guiding purpose is to save the organization money C) It is based on the premise that the customer is the focal element on which production and service depend D) It assumes that inspection and removal of errors lead to the delivery of quality services Ans: C Feedback:
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Leadership Role Associated with Quality Control 1. Which task is a management function associated with quality control? A) Periodic evaluation of unit mission and philosophy B) Making out the daily patient care assignments C) Creating a yearly budget D) Distributing holiday staffing policies Leap Frog Group Standards The leapfrog group is a growing conglomeration of non-health care fortune 500 company leaders who are committed to modernizing the current health-care system. The Leapfrog Group initiatives, reform of the medical liability system and other point-of- care strategies such as bar coding, smart intravenous pumps, and medications . Leapfrog has identified four evidence-based standards that they believe will provide the greatest impact on reducing medical errors. Computerized physician-provider order entry (CPOE)
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Evidence-based hospital referral Intensive care unit physician staffing (IPS) The use of National Quality forum-endorsed Safe practices. 1. What are the four evidence-based standards identified by the Leapfrog Group to reduce medical errors? A) Computerized physician provider order entry, evidence-based hospital referral, ICU physician staffing, and the use of Leapfrog Safe Practices scores B) Computerized physician provider order entry, evidence-based visiting nurse referral, ED physician staffing, and the use of Leapfrog Safe Practices scores C) Computerized primary care provider order entry, evidence-based hospital referral, ICU physician staffing, and the use of Leapfrog Safe Medication scores D) Computerized nurse practitioner provider order entry, evidence-based outpatient referral, ED physician staffing, and the use of Leapfrog Safe Medication scores Continuous Quality Improvement Committee Another external force assessing quality control in health-care organization is the National Committee for Quality Assurance (NCQA). It is a nonprofit organization that accredits managed care organizations.
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1. When working on clinical practice guidelines for a mental health unit, the nursing committee will implement which intervention initially? A) Assessing the medical psychiatric staff for practice suggestions B) Implementing a search of the literature for current related research results C) Reviewing patient satisfaction data to identify the units strengths and weaknesses D) In-servicing all unit nursing staff on the need to adhere to established guidelines Sentinel Events A sentinel event is defined by JC (Joint Commission) as a patient safety event (an event, incident, or condition that could have resulted or did result in harm to a patient) that reaches a patient and results in death, permanent harm, or severe temporary harm and intervention required to sustain life. Such events are called “sentinel” because they signal the need for immediate investigation and response. Medication Errors Medical errors are defined as adverse events that could be prevented given the current state of medical knowledge. Medical errors are the “failure” of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. Medication errors are the most common type of medical error and are a significant cause of preventable adverse events. 1. Which statement is true regarding adverse drug events (ADEs)? A) They occur infrequently in accredited hospitals B) They are responsible for about 20% of hospitalized disabilities C) They usually involve either prescribing or pharmacy errors D) They occur because of individual recklessness 2. Which practice has the U.S. Food and Drug Administration suggested in order to decrease the risk of medication errors? A) Computerized order entry with a drug bar code system B) Medications automatically dispensed to patients at predetermined times C) Use of medication nurses to administer all ordered medications D) Have patient’s medications kept at the bedside for self-administration 3. What is the guiding principle when attempting to address errors made in the delivery of health care? A) Reporting of errors must be both mandatory and voluntary
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B) Errors are a result of faulty organizational processes C) People are the root cause of health delivery errors D) Errors are either unavoidable or result from reckless behavior P4P Program Medicare also established pay for performance also known as quality-based purchasing. P4P initiatives were created to align payment and quality incentives and to reduce costs through improved quality and efficiency. CMS plays and active role in setting standards for an measuring quality in health care including P4P. Multiple P4P programs have been developed and implemented since that time. Nursing Minimum Data Set One of the oldest standardized nursing languages is the Nursing Minimum Data Set (NMDS) represents efforts lasting more than two decades to standardize the collection of nursing data. With the NMDS, a minimum set of items of information with uniform definitions and categories is collected to meet the needs of multiple data users. It creates shared language that can be used by nurses in any care delivery setting as well as by other health professionals and researchers. 1. What is the function of a nursing minimum data set? A) Compares the quality of nursing care and medical care B) Identifies minimal levels of quality necessary for nurses to maintain licensure C) Standardizes the collection of nursing data for use by multiple data users D) Identifies only nursing-sensitive patient outcome measures 2. What is the greatest limitation of the Health Plan Employer Data Information Set (HEDIS)? 1. A) Findings are not released to the public 2. B) Only about half of managed care organizations have chosen to participate 3. C) Performance indicators are process focused rather than outcome focused 4. D) There are only 15 performance measures Delegation Chapter 20- (3 Questions) Delegation can be defined simply as getting word done through others or as directing the performance of one or more people to accomplish organization goals. In delegation, the individual transfers the authority to perform a specific activity from their won practice to an individual qualified to perform that task but retains accountability for the delegated task.
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Tasks that can be delegated to RN The RN who delegates care to another competent RN does not have the same legal obligation to closely supervise that person’s work as when the care is delegated to a NAP. 1. Which statement is true regarding the general delegation liability of the registered nurse (RN)? A) It is minimal because subordinates alone are held accountable for practicing within the accepted scope of practice for their job classification B) It is great because the RN is automatically held liable for the tasks delegated to all recognized subordinates C) It is reduced when the RN appropriately assesses what and to whom delegation is appropriate and supervises the completion of the tasks D) It is avoided entirely by delegating tasks to only other licensed personnel 2. Which task would the director of a home health agency not delegate another staff RN? A) Assigning home health aides to specific patient care B) Serving on a diabetic study committee of community resources C) Meeting with the agencies administration regarding budget cuts D) Reviewing staff timecards for completion and accuracy 3. Which organization is actively engaged in clarifying the delegation parameters for RNs? A) American Hospital Association (AMA) B) The federal government C) National League for Nursing (NLN)
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D) State Boards of Nursing Licensure 4. What must managers delegate to another RN in order to assure completion of a task? A) Time and space B) Leadership and creativity C) Authority and responsibility D) Personnel and knowledge Tasks that can be delegated to LVN IV therapy is within the scope of practice of both RN and LPNs/LVs in most states, but some states require a complete course in IV to administer solutions. Some states allow LPN/LVN to add vitamins to an IV solution but not to give antibiotics. In the state of California, the duties of the LVN include provisions of basic hygiene and nursing care, measurements of temperature, pulse, respirations, and blood pressure, basic assessment, documentation of data, performance of prescribed medical treatments, nursing interventions, observation and documentation of patient’s responses to treatments and interventions, participation in the development of nursing care plans, administration and documentation of prescribed medications; performance of skin testing, patient education, and performance of nonmedicated IV therapy. In New York, and LPN cannot perform patient assessments independently, develop a nursing care plan, administer IV chemotherapy, or give any medications by direct IV push. In Nebraska, an LPN cannot perform triage coordinate and manage care, or perform activities that require independent nursing judgment. Nor can he/she insert a cathether for Iv therapy or give IV fluids to pediatric patients Tasks that can be delegated to UAP
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1. Which assessment must the RN do initially when assigning tasks to non-licensed personnel (NAP)? A) Evaluating the NAPs skills and knowledge level B) Assessing which tasks the NAP is interested in assuming C) Evaluating how patients rate the NAPs performance D) Assessing how team members like working with the NAP Chapter 24 (8) Performance appraisal interview • When used correctly, performance appraisal can be one of the greatest tools an organization has to develop and motivate staff. • It can also encourage staff and increase retention and productivity. • In the hands of an inept or inexperienced manager, the appraisal process may significantly discourage and demotivate workers. • The term performance appraisal implies an appraisal of how well employees perform the duties of their job as delineated by the job description or some other prespecified criteria . • The employee must believe that the appraisal is based on a standard to which other employees in the same classification are held accountable. This standard must be communicated clearly to employees at the time they are hired and may be a job description or an individual goal set by staff for the purpose of performance appraisal. ❖ The performance appraisal does provide an opportunity to document specific criteria for
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salary increases, promotions, or disciplinary actions, but it should also involve ongoing communication, setting achievable goals with clear expectations, and having a plan of action for the next period. Strategies of performance appraisal • Appraisal should be based on a standard which the employee should be aware of. • The appraisal tool must adequately and accurately assess job performance. • The employee should have input into development of the standard. • The employee must know the sources of data gathered for the appraisal. • The appraiser should be someone who has observed the employee’s work. • The appraiser should be someone who the employee trusts and respects. • Employer support and clarity of expectations are critical to the employee perceiving the appraisal as fair. • If employees believe that the appraisal is based on their job description rather than on whether the manager approves of them personally, they are more likely to view the appraisal as relevant. Management Strategies for Successful Performance Appraisals ❖ Develop self-awareness regarding own biases and prejudices: This helps to guard against subjective attitudes and values influencing the appraisal. ❖ Use appropriate consultation: Consultation should be sought frequently. Another manager should be consulted when a question about personal bias exists and in many other situations. ❖ Gather data adequately over time: Many different sources should be consulted about employee performance, and the data gathered needs to reflect the entire time period of the appraisal. ❖ Keep accurate anecdotal records for the length of the appraisal period: The recording of both positive and negative performance behavior throughout the performance period is also known as critical incident recording ❖ Collect positive data and identify areas where improvement is needed: Nothing delights
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employees more than discovering that their immediate supervisor is aware of their growth and accomplishments and can cite specific instances in which good clinical judgment was used. ❖ Include employee’s own appraisal of his or her performance: Self-appraisal may be performed in several appropriate ways. Employees can be instructed to come to the appraisal interview with some informal thoughts about their performance, or they can work with their managers to complete a joint assessment. ❖ Guard against the halo effect, horns effect, central tendency trap, and Matthew effect: The halo effect occurs when the appraiser lets one or two positive aspects of the assessment or behavior of the employee unduly influence all other aspects of the employee’s performance. The horns effect occurs when the appraiser allows some negative aspects of the employee’s performance to influence the assessment to such an extent that other levels of job performance are not accurately recorded. The manager who falls into the central tendency trap is hesitant to risk true assessment and therefore rates all employees as average. The Matthew effect is said to occur when employees receive the same appraisal results, year after year. Those who performed well early in their employment are likely to do well. Those who struggled will continue to struggle. These appraiser behaviors lead employees to discount the entire assessment of their work. ❖ Ask the employee how the organization or the manager can help the employee be successful: Performance appraisals should always include asking the employee how the organization or the manager can make work easier to achieve better quality, greater volume, and improved outcomes. Performance appraisal tools A competence assessment evaluates whether an individual has the knowledge, education, skills, or experience to perform the task, whereas a performance evaluation examines how well that individual actually completes that task. A trait rating scale ❖ Is a method of rating a person against a set standard, which may be the job description,
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desired behaviors, or personal traits. ❖ The trait rating scale has been one of the most widely used of the many available appraisal methods. Rating personal traits and behaviors is the oldest type of rating scale. ❖ Rating scales are also subject to central tendency and halo- and horns-effect errors and thus are not used as often today as they were in the past. ❖ Instead, many organizations use two other rating methods, namely, the job dimension scale and the behaviorally anchored rating scale (BARS). Job Dimensions Scale ❖ A Job dimension scale requires that a rating scale be constructed for each job classification. ❖ The rating factors are taken from the context of the written job description. ❖ Although job dimension scales share some of the same weaknesses as trait scales, they do focus on job requirements rather than on ambiguous terms such as “quantity of work.” Behaviorally Anchored Rating Scales ❖ BARS, sometimes called behavioral expectation scales, overcomes some of the weaknesses inherent in other rating systems. ❖ As in the job dimension method, the BARS technique requires that a separate rating form be developed for each job classification. ❖ However, in BARS, many specific examples are defined for each area of responsibility; these examples are given various degrees of importance by ranking them from 1 to 9. ❖ If the highest ranked example of a job dimension is being met, it is less important than a lower ranked example that is not. ❖ Separate BARS are needed for each job, the greatest disadvantage in using this tool with large numbers of employees is the time and expense. ❖ Additionally, BARS are primarily applicable to physically observable skills rather than to conceptual skills. Yet, this is an effective tool because it focuses on specific behaviors, it allows employees to know exactly what is expected of them and reduces rating errors.
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Checklists ❖ The weighted scale, the most frequently used checklist, is composed of many behavioral statements that represent desirable job behaviors. Each behavior statement has a weighted score attached to it. Employees receive an overall performance appraisal score based on behaviors or attributes. Often, merit raises are tied to the total point score (i.e., the employee needs to reach a certain score to receive an increase in pay). ❖ The forced checklist requires the supervisor to select undesirable and desirable behavior for each employee. Both desirable and undesirable behaviors have quantitative values, and the employee again ends up with a total score on which certain employment decisions are made. ❖ The simple checklist comprises numerous words or phrases describing various employee behaviors or traits. These descriptors are often clustered to represent different aspects of one dimension of behavior, such as assertiveness or interpersonal skills. The rater is asked to check all those that describe the employee on each checklist. A major weakness of all checklists is that there are no set performance standards and specific components of behavior are not addressed. Checklists do focus on a variety of job-related behaviors and avoid some of the biases inherent in the trait rating scales. Essays ❖ The essay appraisal method is often referred to as the free-form review. ❖ The appraiser describes in narrative form an employee’s strengths and areas where improvement or growth is needed. ❖ This method can be unstructured, but it usually calls for certain items to be addressed. ❖ This technique does appropriately force the appraiser to focus on positive aspects of the employee’s performance. ❖ Greater opportunity for personal bias undoubtedly exists. ❖ It is time-consuming, and some appraisers simply write better than others. Summary of Performance Appraisal Tools
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➢ Trait rating scales: rates an individual against some standard ➢ Job dimension scales: rates the performance on job requirements ➢ Behaviorally anchored rating scales (BARS): rates desired job expectations on a scale of importance to the position ➢ Checklists: rates the performance against a set list of desirable job behaviors ➢ Essays: a narrative appraisal of job performance ➢ Self-appraisals: an appraisal of performance by the employee ➢ Management by objectives: employee and management agree on goals of performance to be reached ➢ Peer review: assessment of work performance carried out by peers 360-degree evaluation ❖ An adaptation of peer review, the 360-degree evaluation, includes an assessment by all individuals within the sphere of influence of the individual being appraised. ❖ It is a mechanism for evaluating someone’s performance based on feedback from everyone with whom the individual comes in contact—supervisors, coworkers, partners, subordinates, the general public. ❖ Most 360-degree feedback tools include a self-assessment. ❖ Getting feedback from multiple individuals provides a broader, more accurate perspective of the employee’s work performance. ❖ When done properly, 360-degree evaluation is highly effective as a development tool. ❖ The feedback process gives people an opportunity to provide anonymous feedback to a coworker that they might otherwise be uncomfortable giving. ❖ Feedback recipients gain insight into how others perceive them and have an opportunity to adjust behaviors and develop skills that will enable them to excel at their jobs. ❖ When done haphazardly or because everyone else is doing it, 360-degree feedback can create a disaster. ❖ In most 360-degree evaluations, somewhere between 8 and 12 people fill out an anonymous online feedback form that asks questions covering a broad range of
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workplace competencies. ❖ The most challenging aspect of the 360-degree evaluation typically is the evaluators’ concerns about confidentiality Significance of signature on performance appraisal Performance appraisals should be signed to show that feedback was given to the employee. ❖ Both the manager and the employee need to sign the appraisal form to document that the conference was held, and that the employee received the appraisal information. ❖ This does not mean that the employee agrees to the information in the appraisal, but it means that the employee has read the appraisal. ❖ There should be a place for comments by both the manager and the employee. Self-appraisal ❖ Employees are increasingly being asked to submit written summaries of their workrelated accomplishments and productivity as part of the self-appraisal process. ❖ Self-assessment is an important part of reflective practice. ❖ Reflective practice is a form of problem solving that is used to resolve issues in a practical context. It is a process that turns experience into knowledge as the result of thinking about why and how things happen. ❖ Introspection and self-appraisal result in growth when the person is self-aware. ❖ Some employees undervalue their own accomplishments or feel uncomfortable giving themselves high marks in many areas. ❖ To avoid under- or overvaluing their accomplishments, employees should detail their accomplishments as objectively as possible in the self-appraisal. ❖ By being specific about the scope of their success, their involvement in work-related activities, and by avoiding soft terms (like “great,” “good,” and “a lot”), the manager can better assess the accuracy of the self-appraisal. ❖ Employees should never state a weakness or a problem without a solution. ❖ When self-appraisal is not congruent with other data available, the manager may wish to pursue the reasons for this discrepancy during the appraisal conference
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Leadership roles and management functions associated with performance appraisal ➢ Leadership Roles in Performance Appraisal 1. Uses the performance appraisal process to motivate employees and promote growth 2. Uses appropriate techniques to reduce the anxiety inherent in the performance appraisal process 3. Involves employees in all aspects of performance appraisal 4. Is aware of own biases and prejudices in the performance appraisal process 5. Develops employee trust by being honest and fair when evaluating performance 6. Encourages peer review among professional staff 7. Uses performance appraisal interviews to facilitate two-way communication 8. Provides ongoing support to employees who are attempting to correct performance deficiencies 9. Uses coaching techniques that promote employee growth in work performance 10. Individualizes performance goals and the appraisal interview as needed to meet the unique needs of a culturally diverse staff 11. Role models risk taking in seeking feedback from subordinates and colleagues regarding own work performance to promote self-growth ➢ Management Functions in Performance Appraisal 1. Uses a formalized system of performance appraisal 2. Gathers fair and objective data throughout the evaluation period to use in employee’s performance appraisals 3. Uses the appraisal process to determine staff education and training needs 4. Bases performance appraisal on documented standards 5. Is as objective as possible in performance appraisal 6. Includes suggestions for growth in performance appraisals as well as recognitions of employee accomplishments 7. Maintains appropriate documentation of the appraisal process 8. Follows up on identified performance deficiencies
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9. Conducts the appraisal interview in a manner that promotes a positive outcome 10. Provides frequent informal feedback and coaching on work performance throughout the evaluation cycle to promote employee success Effects of vague/ambiguous feedback ❖ When used correctly, performance appraisal can be one of the greatest tools an organization has to develop and motivate staff. ❖ Performance appraisal in the hands of an inept or inexperienced manager, may significantly discourage and demotivate workers. ❖ Using a formal system of performance review reduces, but does not eliminate, the appraisal’s subjectivity. ❖ Indirectness and ambiguity are more likely to inhibit communication than enhance it, and the employee is left unsure about the significance of the message. The employee is not likely to feel positive about the process. ❖ When the feedback is present appropriately, the manager will not be viewed as too negative but rather honest and helpful ATI: Informed Consent (2) ❖ Informed consent is a legal process by which a client has given written permission for a procedure or treatment to be performed. ❖ Informed consent should include the reason for treatment/procedure, benefits, risks, alternative options, and risks involved if refusal of treatment. ❖ The nurse’s role in the informed consent process is just to witness the client’s signature on the informed consent form and to ensure that informed consent has been appropriately obtained. ❖ Informed consent form must be signed by a competent adult, emancipated minors, parent of a minor, legal guardian, court-specified representative, or the client’s health care surrogate (power of attorney). ❖ The nurse should ensure that the client understood the information and is competent to give informed consent.
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❖ The nurse should notify the provider if the client has more questions or does not understand any of the information provided (THE PROVIDER IS RESPONSIBLE FOR GIVING CLARIFICATION OF THE PROCEDURE, NOT THE NURSE). ❖ If language barriers or disabilities are involved the nurse must only seek a trained medical interpreter and NOT use coworkers or family to translate. Questions 1.What should the manager do in completing an annual performance appraisal? A) Consider good intentions as well as actual performance B) Base the appraisal on a standard to which all are held accountable C) Always make an effort to include subjective data D) Closely observe the employee for the 2 weeks preceding the appraisal conference 2. Although some subjectivity is inescapable in performance appraisals, what action can the manager take to arrive at a more fair and accurate assessment? A) Written anecdotal notes regarding the employees’ performance should be maintained throughout the evaluation period B) Evaluation criteria that reflect on the employee as a person rather than just on work performance should be used C) Data gathered by the manager in preparation for the performance appraisal should be limited to not more than two sources, so no conflicting information is received D) The manager should rate all employees using central tendency whenever possible 3. Which statement accurately reflects self-appraisals? A) Self-appraisals are more objective than the other types of appraisals B) Self-appraisals provide an opportunity to give positive feedback to employees C) Self-appraisals usually require some introspection on the part of the employee D) Self-appraisals should be read before the supervisor does an appraisal 4. Which statement is true regarding the Behaviorally Anchored Rating Scale (BARS)? A) Has long been used as a performance appraisal tool in the health-care industry B) Requires that a separate rating form be developed for each job classification
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C) Is often referred to as a free-form review D) Is a rapidly scored and administered performance appraisal tool 5. Which statement correctly describes using self-appraisal as a performance appraisal tool? A) It should always be totally unstructured so employees can write about whatever they want to B) It is effective because most employees are self-aware and rate themselves accurately and appropriately C) It works best when used in conjunction with other appraisal tools D) It relieves the manager of the responsibility for preparing the performance appraisal 6. What is the term used to identify the effect that results when some negative aspect of an employee’s performance unduly influence all other aspects of performance? A) A halo effect B) A horns effect C) Central tendency D) A job dimension scale 7.What does the employees signature on the performance appraisal form denote? A) The employee agrees with everything written on the form B) The employee objects to what is written on the form C) The employee agrees that a merit raise is due D) The employee has read the appraisal information 8.What does a competence assessment evaluate? 1. Knowledge and education to perform the task 2. Skills to perform the task 3. Experience to perform the task 4. How well the individual completes the task A) 1, 2, 3 B) 1, 2, 4 C) 1, 3, 4
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D) 2, 3, 4 9. Which method rates a person against a set standard, which may be the job description, desired behaviors, or personal traits? A) Trait Rating Scale B) Checklist C) Essay D) MBOs 10. How does a leader effectively use a performance appraisal? A) To motive staff B) To identify staff educational needs C) To follow up on identified deficiencies D) To provide feedback on work performance 11. What factor contributes most to a performance appraisal being viewed as relevant by the employees? A) Its influence on whether a raise will be awarded B) Belief that it is based on the performance of job description related tasks C) The perception that the manager truly likes and approves of them personally D) The formality with which the appraisal is conducted and presented 12. What is the primary goal of a performance appraisal? A) Promotion of employee growth B) Compliance with stated regulations C) Identification of ineffective staff D) Providing a basis for staff wage increases 13.What is the outcome when a manager provides vague and ambiguous feedback to an employee during a performance appraisal? A) The employee receives the information in a positive manner B) The manager is able to avoid the appearance of being too negative C) The employee is uncertain of the value of the feedback
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D) The manager is viewed as being an ineffective communicator Chapter 25 (8) McGregor’s Hot Stove Rule McGregor (1967) developed four rules to make discipline as fair and growth producing as possible. These rules are called “hot stove” rules because they can be applied to someone touching a hot stove. 1. All employees must be forewarned that if they touch the hot stove (break a rule), they will be burned (punished or disciplined). They must know the rule beforehand and be aware of the punishment. 2. If the person touches the stove (breaks a rule), there will be immediate consequences (getting burned). All discipline should be administered immediately after rules are broken. 3. If the person touches the stove again, he or she will again be burned. Therefore, there is consistency ; each time the rule is broken, there are immediate and consistent consequences. 4. If any other person touches the hot stove, he or she also will get burned. Discipline must be impartial , and everyone must be treated in the same manner when the rule is broken. The enforcement of rules using McGregor’s hot stove rules keeps morale from breaking down and allows structure within the organization. Which statement accurately describes the initial deterrent against breaking a rule according to McGregor’s Hot Stove Rules? 1. A) All discipline should be administered immediately after rules are broken 2. B) Each time the rule is broken; there are immediate and consistent consequences 3. C) All employees must know the rule beforehand and be aware of the punishment 4. D) Everyone must be treated in the same manner when the rule is broken Constructive Vs Destructive Discipline Discipline involves training or molding the mind or character to bring about desired behaviors. Positive or constructive discipline seeks to explain to the employee what positive actions the employer is looking for, opting to focus on the wanted behaviors and outcomes instead of the problems. The idea is to provide motivation for employees to improve. When discipline is constructive, it can assist employee growth. Constructive discipline then requires leadership and management skills. Punishment, however, has long been a part of standard employment disciplinary strategies. Scientific management theory viewed discipline as a necessary means for controlling an unmotivated and self-centered workforce. Because of this traditional
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philosophy, managers primarily used threats and fear to control behavior. This “big stick” approach to management focused on eliminating all behaviors that could be considered to conflict with organizational goals. Although this approach may succeed on a short-term basis, it is usually demotivating and reduces long-term productivity because people will achieve goals only up to the level that they believe is necessary to avoid punishment. This approach is also destructive because discipline is often arbitrarily administered and is unfair either in the application of rules or in the resulting punishment. What is the principle that guides constructive discipline? 1. A) Constructive discipline is punitive in its nature 2. B) The focus of constructive discipline is employee growth 3. C) Constructive discipline employs the manager as a resource not a helper 4. D) Behavior modification is the desired outcome of constructive discipline What is the primary difference between constructive and destructive discipline? A) The manager is friendlier to the employee in constructive discipline than in destructive discipline, so that the employee likes the manager as a person B) Constructive discipline includes verbal and written reprimands, whereas destructive discipline includes suspension without pay and termination C) The person who has received constructive discipline always appreciates and believes the feedback given, whereas it is resented and disbelieved in destructive discipline D) Constructive discipline helps the person to grow and to behave in a manner that allows him or her to be self-directive in meeting organizational goals. Destructive discipline focuses more on punishment Confronting The Chemically Impaired Employee An impaired registered nurse (RN) is defined as a licensee who is unable to practice with professional skill and safety by reason of habitual or excessive use or abuse of drugs, alcohol, or other substances that impair ability or by reason of a mental disorder or physical ability. Chemically impaired nurses and physicians tend to obtain their drugs of choice through channels such as legitimate prescriptions that were written for them or diversionary measures on the job rather than purchasing them illegally on the street. Opioids have also become a drug of choice for impaired nurses. The profile of the impaired nurse may vary greatly, although several behavior patterns and changes are noted frequently. These behavior changes can be grouped into three primary areas: personality/behavior changes, job performance changes, and time and attendance changes . The bottom line is that chemically impaired employees should be removed from the work setting.
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The manager should arrange for the employee to be taken home so that he or she does not drive while impaired. A formal meeting to discuss this incident should be scheduled within the next 24 hours. What is the most common initial response of an employee to a managers confrontation regarding suspected chemical impairment? 1. A) Emphatic denial and defensiveness 2. B) Reluctant acceptance 3. C) Gratefulness for finally being discovered 4. D) Silence Feedback: Employee denial and defensiveness are common behaviors in those who are confronted with their impairment. Often, these individuals are in self-denial. Which statement concerning the recognition of chemical impairment in an employee is correct? 1. A) It is relatively easy to identify employees who are chemically impaired 2. B) It is easier to recognize if the employee is impaired by alcohol than by drugs 3. C) Impairment should result in an immediate intervention by the manager 4. D) Impairment must be supported by data gathering before intervention occurs Feedback: For safety reasons and to protect clients, employees should be confronted as soon as possible after chemical impairment is recognized. Which statement is true regarding chemical addiction among nursing professionals? 1. A) Most chemically impaired nurses obtain drugs by stealing them from work 2. B) Morphine is the most commonly abused drug by nurses 3. C) Most nurses obtain their drugs on the street and avoid taking drugs from work 4. D) Most chemically impaired nurses cannot be diverted from drug use Reentry Of A Chemically Impaired Employee Back To Practice Success in reentering the workforce depends on factors such as the extent of the recovery process and individual circumstances. The following are generally accepted reentry guidelines for the recovering nurse: 1. No psychoactive drug use will be tolerated. 2. The employee should be assigned to day shift for the first year. 3. The employee should be paired with a successfully recovering nurse whenever possible. 4. The employee should be willing to consent to random urine screening with toxicology or alcohol screens. 5. The employee must give evidence of continuing involvement with support groups such as Alcoholics Anonymous and Narcotics Anonymous. Employees should be encouraged to attend meetings several times each week.
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6. The employee should be encouraged to participate in a structured aftercare program. 7. The employee should be encouraged to seek individual counseling or therapy as needed. These guidelines should be a part of the employee’s return to work contract. Mandatory drug testing, however, invokes questions about privacy rights and generally should not be implemented without advice from human resources personnel or legal counsel. Which statement identifies a truth regarding the generally accepted plan for the reentry of the chemically impaired employee into the workplace? 1. A) It is successful in only a small number of cases despite active treatment programs 2. B) It is discouraged by the board of registered nursing 3. C) It should not occur until 3 years after the employee has completed the treatment program 4. D) It often includes an employer requirement that the employee agree to random urine screening on request by the employer Feedback: Most nurses successfully return to work following a treatment program, and this generally takes 1 year. Often, the conditions that the employee has successfully changed his or her lifestyle and will submit to random drug tests must be met before the employee can be allowed to return to work. Performance Deficiency Coaching Performance deficiency coaching is another strategy that the manager can use to create a disciplined work environment. Problem-centered coaching is less spontaneous and requires more managerial planning than ongoing coaching. In performance deficiency coaching , the manager actively brings areas of unacceptable behavior or performance to the attention of the employee and works with him or her to establish a plan to correct deficiencies. Performance deficiency coaching helps employees, over time, to improve their performance to the highest level of which they are capable. Which statement is accurate when describing performance deficiency coaching? 1. A) It is less spontaneous and requires more planning than ongoing coaching 2. B) It is a one-time way of solving problems 3. C) It requires the manager to assume the role of enforcer rather than supporter or enabler 4. D) It occurs as a component of an employee’s annual performance appraisal Feedback: This form of coaching is less spontaneous and requires more managerial planning than ongoing coaching. In performance deficiency coaching, the manager actively brings areas of unacceptable
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behavior or performance to the attention of the employee and works with him or her to establish a plan to correct deficiencies. Assisting Employees With Abuse Problems The manager must be very careful not to assume the role of counselor or treatment provider for the impaired nurse. Although the manager may suggest appropriate help or refer the impaired employee to someone, a manager’s primary responsibility is to protect patients and then to see that the employee becomes functional again and can meet organizational expectations before returning to work. The manager can play a vital role in creating an environment that decreases the chances of chemical impairment in the work setting. This may be done by controlling or reducing work-related stressors whenever possible and by providing mechanisms for employee stress management. The manager also should control drug accessibility by implementing, enforcing, and monitoring policies and procedures related to medication distribution. Finally, the manager should provide opportunities for the staff to learn about substance abuse, its detection, and available resources to help those who are impaired. Which statement represents a correct statement regarding the identification and assisting interventions provided employees with substance abuse problems? 1. A) It is done as an altruistic and benevolent action by the organization 2. B) It should not be undertaken by management or the personnel department 3. C) It should include screening that focuses on early detection 4. D) Is best handled through disciplinary action of the personnel department Feedback: The personal and professional cost of chemical impairment demands that nursing leaders and managers recognize the chemically impaired employee as early as possible and provide intervention since such behavior is a serious safety issue associated with patient care. The Disciplinary Conference When coaching is unsuccessful in modifying problem behavior, the manager must take more aggressive steps and use more formal measures, such as a disciplinary conference. The following steps are generally part of the disciplinary conference : 1. Reason for Disciplinary Action= Begin by clearly specifying why the employee is being disciplined. 2. Employee’s Response to Disciplinary Action= Give the employee the opportunity to explain why the rule was not followed. 3. Rationale for Disciplinary Action= Explain the disciplinary action that you are going to take and why you are going to take it. 4. Clarification of Expectations for Change= Present a performance improvement plan to be sure employee expectations for remediation are clear.
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5. Agreement and Acceptance of Action Plan= Get agreement and acceptance of the plan. 6. The Environment for Discipline= The leader must be sensitive to the environment in which discipline is given. 7. Timing and Conference Length= All formal disciplinary conferences should be scheduled in advance at a time agreeable to both the employee and the manager. In addition to privacy and advance scheduling, the length of the disciplinary conference is important. 8. Closure= On ending the disciplinary conference, provide the employee with a copy of the disciplinary action and place a copy of the documentation in the personnel file. Which statement accurately describes a disciplinary conference? 1. A) It is generally a highly charged emotional event, so the manager should try to soften criticisms to reduce the employees defensiveness 2. B) It should be scheduled in advance at a time agreeable to both the employee and the manager 3. C) When it is held in front of peers it can be used as a teaching tool 4. D) It requires the manager to adopt nurturing and counseling roles Feedback: All formal disciplinary conferences should be scheduled in advance at a time agreeable to both the employee and the manager. Both will want time to reflect on the situation that has occurred. Allowing time for reflection should reduce the situations emotionalism and promote employee self-discipline, because employees often identify their own plan for keeping the behavior from recurring. What is the fundamental rational for conducting a disciplinary conference for a staff member who has failed to significantly modify the practice of arriving late for assigned shifts? 1. A) This behavior disrupts the efficiency of the nursing team 2. B) The tardiness is costing the facility money 3. C) This behavior encourages other staff to disregard rules 4. D) The problem will get worse if it is ignored Feedback: Disciplinary problems, if unrecognized or ignored, generally do not go away; they only get worse. The other options are likely outcomes of the staff members unacceptable behavior but not the fundamental rational for the disciplinary action. Transferring Employees A transfer may be defined as a reassignment to another job within the organization . A lateral transfer describes one staff person moving to another unit, to a position with a similar scope of responsibilities , within the same organization. A downward transfer occurs when someone takes a position within the organization that is below his or her previous level . It may be in a nurse’s interest to consider a downward transfer because it can increase the chances of long-term career success.
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In some circumstances, the manager may need to intervene and use a downward transfer to alleviate temporarily a nurse’s overwhelming stress. These accommodating transfers generally allow someone to receive a similar salary but with a reduction in energy expenditure. Finally, there is the inappropriate transfer. Some managers solve unit personnel problems by transferring problem employees to another unsuspecting department. All types of transfers should be individually evaluated for appropriateness. A nurse has been transferred to another unit in the hospital to perform the same type of duties. What type of transfer is this called? A) Accommodating B) Lateral C) Diagonal D) Downward Feedback: Doing the same type of duties in another location is called a lateral transfer. Why would an experienced nurse voluntarily opt for a self-selected downward transfer? A) Doing so increases the chances of long- term career success B) It allows for keeping a similar salary while decreasing energy expenditure C) In times of downsizing, it allows a nurse to stay employed D) It occurs when a nurse is physically impaired and productivity is affected Feedback: For individuals to gain experience in a new area and to enhance long-term career goals, a self-selected downward transfer may be used. What is a management function associated with career development? A) ls self-aware of personal values influencing career development B) Encourages employees to take responsibility for their own career planning C) Identifies, encourages, and develops future leaders D) Works cooperatively to arrange intra-organizational transfers Prioritization of Care (ATI) (2) Priority Nursing Action In Your Patient According To The Scenario Prioritize systemic before local. Prioritize acute before chronic. (mental confusion, chest pain) Prioritize actual problems before potential future problems. (give pain medication to client experiencing acute pain over ambulating a client at risk for thrombophlebitis) Listen carefully, don’t assume. Recognize and respond to trends versus transient findings. (recognizing a gradual deterioration in a client’s level of consciousness)
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Recognize indications of medical emergencies and complications versus expected findings. (recognizing indications of increasing intracranial pressure in a client who has a new diagnosis of a stoke versus the findings expected following a stroke) The nurse should consider Maslow’s hierarchy of human needs when prioritizing interventions. ABC framework. (4 th is disability and 5 th is exposure) A nurse enters the room of a client and finds the client lying on the floor. Which of the following actions should the nurse take first? A) call the provider B) ask a staff member for assistance getting the client back in bed C) inspect the client for injuries D) instruct the client to ask for help if they need to get out of bed Priority Nursing Action In A Pool Of Patients-Whom To Assess First A client who has an acute problem takes priority over a client who has a chronic problem. A client who has an urgent need takes priority over a client who has a non-urgent need. A client who has unstable findings takes priority over a client who has stable findings. Other stuff: quality control over med error, review events prior to med error. First thing to do is set standard centralized staffing, staffing decisions are made by personnel in a central office or staffing center. In decentralized staffing, each department is responsible for its own staffing • The roots of union activity lie in poor relationships between employees & management • The middle manager has the greatest impact on the quality of the relationship that develops between labor and management, get question from bank 3 steps of quality control The criterion or standard is determined Information is collected to determine whether the standard has been met. Educational or corrective action is taken if the criterion has not been met Constructive discipline: Helps the employee to grow
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Is carried out in a supportive, corrective manner Employee is reassured that punishment is given because of actions and not because of who he or she is as a person. Primary focus is to assist employees to be self-directed in meeting organizational goals. Destructive discipline: Use of threats and fear to control behavior Employee always alert to impending penalty or termination Arbitrarily administered and either unfair in the application of rules or in the resulting punishment 13. Which level of manager has the greatest influence on preventing unionization in a nonunionorganization? A) First B) Middle C) Top D) CEO
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