The consequence of real or perceived differences in mutually exclusive goals, values, ideas, attitudes, beliefs, feelings, or actions

It is dynamic. It can positive or negative, healthy or unhealthy

Within one individual

A certain amount of conflict is beneficial to an organization

True or False?

Aggressive behavior can occur.

Scapegoating may occur.

Conflict may be covert and inappropriate.

does not follow any mutually acceptable set of rules and does not emphasize winning.

What are the Filley’s Strategies to manage conflict?

Win-lose - One party exerts dominance; the other party submits and loses.

Lose-lose - Neither side wins.

Win-win- Focuses on goals and meeting needs of both parties. Consensus involves attention to facts and the position of the other parties.

What is Integrative Decision Making

Focuses on the means of solving a problem rather than the ends.

Most useful when the needs of the parties are polarized.

What is Confrontation

Considered the most effective means for solving conflicts.

Problem-oriented technique in which the conflict is brought out into the open.

Attempts are made to resolve it through knowledge and reason.

Goal is to achieve win-win solutions.

Delivered in private, as soon as possible.

What is Negotiation

Involves give-and-take on various issues among the parties.

Seeks to achieve agreement even though consensus will never be reached.

Can be guided by Levenstein’s 10 commandments for negotiators.

Describe conflict and explain the different approaches to managing positive or negative conflict.

What is Collaboration

What is Compromise

Used to divide the rewards between both parties.

Neither gets what he or she wants.

What is Competing

An all-out effort to win, regardless of the cost

What is Accommodating

An unassertive, cooperative tactic used when individuals neglect their own concerns in favor of others’ concerns.

What is Suppression

Used in situations where conflict is discouraged.

Could include elimination of one of the conflicting parties through transfer or termination.

What is Avoiding

What is Withdrawal

What is Smoothing

What is Forcing

Method that yields an immediate end to the conflict but leaves the cause of the conflict unresolved.

What is Role conflicts

other people’s expectations regarding behavior and attitudes

What is Structural conflict

Structural relationships (superior to subordinate, peer to peer) provoke conflict because of poor communication

Competition for resources, opposing interests, or lack of shared perceptions or attitudes

What is Perceived conflict 

Each party’s perception of the other’s position

What is Felt conflict

Negative feelings between two or more parties

What does Managing Conflict begin with?

Conflict management begins with a decision regarding if and when to intervene. Sometimes it is best to postpone intervention- Increased intensity can motivate participants to seek resolution

What are the Rules for Mediating Conflict?

Protect each party’s self-respect

Do not put blame or responsibility for the problem on the participants

Allow open and complete discussion of the problem from each participant

Maintain equity in the frequency and duration of each party’s presentation

Encourage full expression of positive and negative feelings in an accepting atmosphere

Make sure both parties listen actively to each other’s words

Identify key themes in the discussion

Encourage the parties to provide frequent feedback

Help the participants develop alternative solutions

At an agreed-upon interval, follow up on the progress of the plan

Give positive feedback to participants

Why  is Coaching difficult for management?

 is often neglected. It encompasses needs analysis, staff development, interviewing, decision making, problem solving, analytical thinking, active listening, motivation, mentoring, and communication skills. It should last no more than 5 to 10 minutes. requires being specific and clearly stating expectations 

Day-to-day process to assist staff to improve performance.

Used to intervene immediately when problem arises.

Used when performance meets standards and improvement can still be obtained.

Goal is to eliminate or improve performance problems.

What are the Steps of Successful Coaching 

State performance in behavioral terms.

Tie problems to consequences.

Explore reasons for the problem with the employee.

Ask employee for suggestions.

Document required behavioral steps.

Schedule a follow-up meeting.

Get the facts—avoid jumping to conclusions.

How can yo best communicate with difficult people

Put physical distance between you and the difficult person

Psychologically distance yourself from the individual

Identify the person’s feelings and information level

Ask extensional questions

Use physical movement

Try humor

How can yo best communicate with different populations

Subordinates 

Know what you want done and why

Get their attention

Clear, concise , inoffensive language

Verify-get feedback

Follow-up communication

How can yo best communicate with different populations

Superiors

The relationship requires participation from both parties

Keep in mind challenges/pressures the supervisor faces

You can influence and support for good

Present ideas

How can yo best communicate with different populations

Superiors that say NO

Negative inquiry “I don’t understand

Fogging-agreeing with only part of what is said

Negative assertion-accepting some blame

Confrontation is a last resort.  Keep calm, not threatening.  Continue talk at another time

Watch your timing

Come to the point

Listen

Offer to help with the solution

Follow-up appointment

How can you best communicate with different populations

Medical staff-not well trained in communication

Include them in some decisions that impact them; invite them to staff meetings, etc

“Limited interactions contribute to poor communication”

How can you best communicate with different populations

Patients and families

Treat with respect/don’t use medical jargon

Keep communication open and honest

Handle complaints tactfully

Take time to listen to their complaints

Find interpreters if needed

Maintain privacy

How can yo best handel policy or procedure violation 

Determine if staff is aware of policy.

Describe behavior that violated policy.

Determine staff’s reason for behavior.

Manager and staff explore alternative solutions.

Decide on a course of action

Inadequate management support/training

Overlook past inappropriate behavior

Rationalize behavior to avoid discipline

Previous poor experiences with attempts to discipline

Fear that staff will respond negatively 

What is the best way of Disciplining Staff 

Communicate with human resources staff.

Determine policy violations.

Teach new skills and encourage staff to behave professionally in the future.

Clearly communicate policies/procedures.

Ensure that consequences are progressive. 

What is Progressive Discipline 

Process of communicating increasingly severe warnings for repeated violations.

Minor violations may progress from oral warning to a written warning placed in staff’s personnel folder.

Major violations may lead to immediate suspension or termination

Steps are similar to disciplining, but no plans to correct behavior and no follow-up.

Seek approval from HR and administration.

Prepare before terminating employee.

Observation and documentation are crucial to avoid legal challenges.

Preferable to have employee resign.

What preparation needs to be done before termination 

Were expectations stated clearly?

Did you review job description, performance appraisal criteria, pertinent policies/ procedures?

Did you document performance on a continuous basis using critical incident or similar method?

Did you keep staff informed about performance?

Did you communicate violations in a timely manner?

Were you honest about poor performance?

Were you specific about behaviors that failed to meet standards?

Was the expected performance stated in behavioral terms?

Were you consistent about performance?

Did you follow up?                     

Did coaching sessions address behaviors?

Did you document everything in writing? 

Don’t blame yourself.

Learn how to bully-proof yourself.

Confront the bully.

Avoid the bully if possible.

Keep a record.

Increasing sensitivity to an issue.

Inspiring people to develop new ideas or identify new methods for solving problems.

Helping people become more aware of tradeoffs especially costs versus benefits.

Motivating people to improve performance, effectiveness, and satisfaction

What are Time Wasters 

Staff interruptions

Meetings without a clear purpose

Goals, objectives, and priorities that are not measurable

Plans without time parameters

Disorganized files or papers

Time logs, not analyzed

Tasks/activities that can be delegated

Waiting for others

Inability to say no 

How might Time Logs help manage time

Use your planner or appointment book to determine how you spend your time.

Determine time wasters and activities that could be delegated to others or eliminated.

Utilize critical thinking to incorporate organizational techniques and the nursing process in personal care delivery.

What facters need to be considered when Determining the  Best Use of Time 

myself and my goals

my staff and their goals

the organization and its goals 

How does Self-Discipline help with time management 

Establish realistic commitments to effectively manage time.

Explain to your superior how being overloaded will have consequences on your assignments.

Communicate your own needs to others. 

provides direction, vision, and a timeline in which activities will be accomplished. 

Identify specific activities necessary to achieve objectives.

Determine the amount of time required for each activity.

Differentiate between activities that can be planned and scheduled for concurrent action, and which must be planned and scheduled sequentially.

Determine which activities can be delegated.

Prioritize tasks and situation according to the following categories: urgent and important, important but not urgent, urgent but not important, busywork, wasted time.

the process by which responsibility and authority for performing a task is transferred to another individual who accepts that authority and responsibility.

ô  Delegator remains accountable for the task

How is Responsibility and Accountability assinged when delegation occures

Responsibility can be transferred.

Accountability is shared.

What is Authority r/t delegation?

Authority is the right to act.

By transferring authority, the delegator is empowering the delegate to accomplish the task

In assignment no transfer of authority occurs.

Assignments are a bureaucratic function that reflect job descriptions.

Effective delegation benefits the delegator, the delegate, and the organization

Delegate because it is the best use of time.

Don’t not dump an undesirable task.

Role-modeling delegation and giving staff opportunities to experience delegation from another’s point of view can improve the work of the team.

treat patients, educate patients and the public about various medical conditions, and provide advice and emotional support to patients’ family members. RNs record patients’ medical histories and symptoms, help perform diagnostic tests and analyze results, operate medical machinery, administer treatment and medications, and help with patient follow-up and rehabilitation.

What types of task can't be delegated ny the nurse?

task requiring the specialized knowledge, judgment and skill of a

licensed nurse

verify and evaluate the orders

perform a nursing assessment

the patient's nursing care needs including, but not limited to, the complexity

and frequency of the nursing care, stability of the patient, and degree of immediate risk to the patient if the task is not carried out;

the nature of the task: degree of complexity, irreversibility, predictability of outcome, and potential for harm.

the availability and accessibility of resources, including appropriate equipment, adequate supplies. 

the availability of adequate supervision of the delegatee.

act within the area of the nurse's responsibility;

act within the nurse's knowledge, skills and ability;

determine whether the task can be safely performed by a delegatee or whether it requires a licensed health care provider. 

verify that the delegatee has the competence to perform the delegated task prior to performing it;

What factors need to be evaluated to determine the level of supervision

needed?

the stability of the condition of the patient;

the training, capability, and willingness of the delegatee to perform the

delegated task;

the nature of the task being delegated; and

the proximity and availability of the delegator to the delegatee when the

task will be performed.

What are the NCSBN Five Rights of Delegation

ô  Right task

ô  Right circumstances

ô  Right person

ô  Right direction and communication

ô  Right supervision

based on personal characteristics and traits, results, behaviors, and/or a combination of criteria.

Specific methods used:  traditional rating scales, essay evaluations, forced distribution evaluation, behavior-oriented rating scales, and results-oriented evaluations

leniency, recency, and halo errors, ambiguous evaluation standards, and problems with written comments.

If a performance rating can be shown to be inaccurate, it will be difficult to defend in court.

day-to-day manager–employee interactions, documenting staff’s behavior, completing the performance appraisal form, meeting with staff for the formal appraisal, and follow-up sessions. 

investigate and remedy the situation. The goal of intervention should be to enhance performance rather than to punish the employee.

Assesses and validates skills for beginning nurses at orientation and skills required for nurses at advanced levels. 

What is Total Quality Management

Use of quality tools and statistics for management

Identification of key processes for improvement

uses audits, Peer review.

 and Utilization review

What is a Utilization review

Retrospective audit is conducted after a patient’s discharge and involves examining records of a large number of cases.

Concurrent audit is conducted during the patient’s course of care.

Peer review

What is Outcomes management

New technology in which costs and quality are concurrently and retrospectively measured and evaluated in order to improve clinical practice.

Outcomes are statistically analyzed

Process to improve quality and performance

Evaluation, actions, and mind-set to strive for excellence

Four major players:

÷  Resource group

÷  Coordinator

÷  Team leader

÷  Team

Plan

Benchmarking standards

Performance appraisals

Assessment

Improvement

Utilization review

Outcomes management

What is the Six Sigma process

Uses quantitative data to monitor progress

Customer (patient) focus

Greater emphasis on management monitoring performance and ensuring results

Process emphasis

Boundary-less collaboration

Aim for perfection; tolerate failure

What is the Lean Six Sigma

Focuses on improving process flow and eliminating waste

Provides tools that can be used with Six Sigma system

Improving Quality of Care

Organizational approach to health care’s problems by focusing on the patient

What is Kaissi philosophy

Culture of safety, rather than a culture of blame, characterizes an organization where everyone accepts responsibility for patient safety.

What are the National Initiatives

Culture of safety and quality permeates many efforts at the national level

Joint Commission has adopted mandatory national patient safety goals

What are the Institute of Healthcare Improvement (IHI) goals

No needless deaths

No needless pain and suffering

 No helplessness in those served or serving

 No unwanted waiting

 No waste

 Quality measures can reduce costs

True or False?

Increased nurse staffing results in better patient outcomes

Patients must become more involved in managing their own care.

True or False

True

Providers must help educate patients as well as helping them to educate themselves

What are Risk Management Programs

Are problem focused

Identify, analyze, and evaluate risks

Develop a plan for reducing the frequency and severity of accidents and injuries

Involve all departments of the organization

Monitor laws and codes related to patient safety

What is the Nurse’s Rolein Implementing  risk management program

Need clear understanding of the purposes of the incident reporting process

Objective reporting necessary

Never use report for disciplinary action

What is the Reporting Incidents process

Discovery

Notification

Investigation

Consultation

Action

Recording

Is an aggregate of individuals who interact and mutually influence each other.

Can be formal or informal.

May be permanent or temporary.

Is a group that works to achieve a goal.

Has command or line authority to perform tasks.

Bases membership on the skills needed to accomplish task.

Forming,Storming,Norming,Performing,Adjourning,
Reforming

both task and relationship aspects of a group’s functioning and is intended to increase efficiency and productivity

Forming

Individuals assemble into a well-defined cluster

Group members are cautious in approaching each othe

Storming

Members wrestle with roles and relationships.

Conflict, dissatisfaction, and conflict arise.

Members often compete for power and status.

Informal leadership emerges.

The leader helps the group to acknowledge the conflict and to resolve it in a win-win manner.

Identify group and team processes

Norming 

Group defines goals and rules of behavior.

Group structure, roles, and relationships become clearer.

Cohesiveness develops.

Performing

Members agree on purposes and activities and carry out work.

Cooperation improves, and emotional issues subside.

The leader provides feedback

Adjourning

The group dissolves after achieving its objectives

Re-forming

A major change requires the group to refocus its activities and recycle through the four stages

Explain the concept of the nurse manager as a team leader. Discuss ways in which the nurse manager can support group productivity and cohesiveness.

Influencing group processes toward the attainment of organizational objectives is the direct responsibility of the nurse manager. 

What is the roll of the Nurse Manager as Team Leader

The manager can increase the perceived value of the group.

The manager’s communication style affects group cohesiveness.

The manager controls what information is received and who receives it.

Only after diagnosing the problems of the team can the leader take actions to improve team functioning.