- a focus on limited activites for quality and accountability

- target resources

- requires continual evaluations to stay the best

true or false

registered nurses provide individualized, compassionate, holistic, optimal and culturally appropriate care for patients that protects their health, safety and legal rights

true or false

registered nurses execute care that is based upon scientific and ethical principles and includes evidenced based practice

* clinical expertise

* levels of education and the highest integrity

* competence and qualifications of all health care providers

- risk management

- infection control data

- cost effective analysis

- society expectations

- patient preferences

- practitioner consensus

- international, national, and local standards

- medical record data

* provides quality patient care and outcomes

* contributed to the science of nursing

* keeps practice current and relavent

* increases confidence in decision making

* increases JCAHO readiness

- excellence in quality nursing care

- successfullyrecruit and retain good nurses

- have participative management and shared governance

- reward system for nurses who are safe decision makers, ceative, independent and autonomus

- quality control

- technology

- movement

 quality improvement systems looks at:

- assessed from multiple locations

- needs to be nationalized

- decreases errors, repitition, redundancy

- allows collective data analysis

- facilitates common medical language

- provides medical information to be updated

(use of robotics)

 smart medical capsules:

(use of robotics)

 robotized surgery:

precision that facilitates minimally invasive surgery

(CABG surgery)

(use of robots)

intelligent prosthetics:

( use of robots)

robotized motor coordination analysis and therapy:

- simulations

- disaster drills (CERT)

- evaluations of outcomes

- critical incident stress debriefing (CISD)

* generational- baby boomers, generation X, millennials (Y)- different values, experiences

* gender- female dominated profession

* cultural diversity of nurses- influx of immigrants or existing second generation minorities reflect cultural diversity in our population

- effectiveness

- cost efficiency

- quality

- consumers preference

1- breaks nursing care into series of tasks

2- assembly line approach

3- accountablility is not put on one person

- group patients assigned to a team with a team leader- develops NCP

- determines work assignments based upon skill levels

1- plans/directs care > 24 hour period (develops care plan) for entire stay

2- accountable for all patient care

3- maintians close contact with patient and family/support systems

1- care for one patient at a time

2- total patient care

3- does not delegate any thing associated with 24 hour care

4- continuous, holistic, total accountability

1- services brought to patient

2- cross training of personnel

3- RN coordinates and is accountable for a larger range of services rendered to patient

4- RN manager responsible for a more diverse staff

1- gatekeeper of confusing health care services

2- reduces costs and unnecessary hospital admissions and/or ER visits

3- uses resources in community

4- collaborates with medical and non-medical personnel

5- doesnt give bedside care

critical pathways/care maps

( hospice care teams)

multidisciplinary plans- collaborative practice team

- time outlining specific care

- timeline outlining specific care

- prevents patient from being overwhelmed

- designated outcomes to be achieved

- variances call for revision of plan or care

organizational structure

 grouping is generally done according to similarity of duties:

- administrative services

- informational services

- theraputic services

- diagnostic services

-support services

* large hospitals have complex organizational structures

- and organizational chart represents the structure of an organization in terms of rank

- it is a diagram that depicts the structure of an organization in terms of relationships amoung personnel or departments

- an organizational chart also represents lines of authority and responsibility

centralized decision making by the specialist who has authority to mandate the line manager to implement any of their instructions, groups are by specialty, poor coordination, outdated

--> [ each department is seperate, i.e. dietary, nursing, physical therapy, social work]

traditional organizational structure

- hybrid-

self contained units and functional units occurs when organization grows, but can be top heavy with corporate staffs, conflicts with top administration and managers

(in addition to the nurse manager being a service line executive, the nurse is given organizational authority to set standards and enforce practices necessary for patient safety and consistency in practice)

traditional organizational structures

- parallel-

parallel structures

the parallel design is appropriate for:

- participative management

- empowerment and partnership amoung staff

- control over major decisions about practice

- works best without highly structured or bureaucratic systems

- staff are all accountable as partners of a multidisciplinary team

new service complements existing services

( day care center in pediatric hospital)

new service that is differnt than the service line

(medical equipment store)

costs and productivity

- health care is not accessible to everyone

- costs are skyrocketing

- united states spends more money on health care than any other country

- health care is a competitive market

- emerged in the effort to cut costs

-focus on primary care

- deliver a continuum of care

a process that focuses on consumer needs as essential to success of the organization

a preventative approach to problem solving and employee empowerment to address front line issues is key in QM

continuous improvement, for example constant evaluation of consumer satisfaction by use of a survey, aids in the evaluation of individual quality measures

compares an organizations data with similar organizations

comparisions across disciplines or organizations can address strengthens and weaknesses to enhance outcomes

- cultural diversity is increasing in the U.S. populations

- health care policy makers and organizations face challenges of serving a more diverse population

- nurses need a trans- cultural focus

- multiple generations working together is common

- nurse managers encourage mutual respect and team work

- aging patients increase the demand for health care

- as aging nurses retire the nursing shortage will grow worse

- demand for nurses will continue to grow

- identifying the clinical question

-finding evidence to answer the question

-evaluating the evidence

- applying the evidence

-evaluating the outcome

- absence of theory to guide decision making

-lack of time, expertise, and resources to implement

- is expected to continue to be used in future

-has been implemented successfully by the US veteran's health administration (VHA)

* organizational goals

*size ;)

*technology

*environment

>functional structure

> service-line structure

>hybrid structure

>matrix structure

>parallel structure

-susyems

-contingency

-chaos

-complexity theories

*partnership

*equity

* accountability

*ownership

-heterarchy structures

-self organizing structures

Traditional Organizational Structures

-functional:

Traditional Organizational Structures

-service line:

Traditional Organizational Structures

-hybrid:

Traditional Organizational Structures

-matrix:

Traditional Organizational Structures

-parallel:

functional nursing

team nursing

total patient care

primary nursing

-RN's, LPN's, and UAPs are assigned differnt tasks

-RN assess patients

-other staff give baths, make beds, take vital signs, administer treatments

-team of nursing personnel provides total care to a group of patients

- RN leads team that may include other RN's, LPN's, and UAP's

-team leaders must be skilled in delegating, communicating, and problem solving

-all team members of effective teams are good communicators

-decision making

-quality imperitives

- collaboration among disciplines

practice partnerships

case management

differentiated practice

patient centered care

*the mission statement states the "reason for being" for the organization and is the first step in creating an organizational plan

* the statement of philosophy is a written statement that reflects the organization' values, vision and mission

> system-wide conditions that contribute to a positive or negative work setting

> a positive environment directly affects better patient outcomes

 > the nurse manager plays a key role in maintianing a positive envirnoment

basic assumptions and values held by members of the organization

- varies amonginstitutes, subcultures, and counter cultures

designate organizations that recognize excellence in providing nursing care

* magnet hospitals have successfully recruited and retained nurses despite the nursing shortage