This page intentionally left blank Patricia Kelly Professor Emeritus Purdue University Calumet Hammond, Indiana Australia • Brazil • Japan • Korea • Mexico • Singapore • Spain • United Kingdom • United States Essentials of Nursing Leadership & © 2010 Delmar, Cengage Learning Management, Second Edition ALL RIGHTS RESERVED. No part of this work covered by the copyright Patricia Kelly herein may be reproduced, transmitted, stored, or used in any form or by any means graphic, electronic, or mechanical, including but not limited to Vice President, Career and Professional photocopying, recording, scanning, digitizing, taping, Web distribution, Editorial: Dave Garza information networks, or information storage and retrieval systems, except Director of Learning Solutions: Matthew as permitted under Section 107 or 108 of the 1976 United States Copyright Kane Act, without the prior written permission of the publisher. 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Printed in the United States of America 1 2 3 4 5 XX 11 10 09 Contents Contributors | xii Organizational Management Reviewers | xvi perspectives | 16 Motivation | 16 Preface | xvii Benner’s Model of Novice to Expert | 19 Acknowledgments | xxi Chapter 2 About the Author | xxii The Health Care Dedication | xxiv Environment | 33 How to Use This History of U.S. Health Care | 35 Book | xxv Structuring Hospitals Around Nursing Care | 35 Collecting Data | 36 UNIT I Infl uence of External Forces on Health Introduction Care | 36 Political Infl uences on Health Chapter 1 Care | 36 Nursing Leadership, Organization of Health Care | 38 Management, and U.S. Health Care Rankings | 40 Motivation | 1 Universal Health Care | 40 Emphasis on Hospital Care | 41 Leadership and Management | 2 Need for Primary Health Care | 42 Leadership | 3 Public Health Versus Medical Management | 14 Care | 42 vi Contents The Federal Government | 43 Health Care Ratings | 87 State and Local Governments | 44 Importance of Evidence, Outcomes, and Home Health Care | 44 Ratings | 89 Health Care Disparities | 44 Population-Based Health Health Care Spending | 45 Care | 90 Rising Health Care Costs | 46 Accreditation | 91 Health Care Insurance | 47 State Regulation of Health Chapter 4 Insurance | 47 International Perspective | 47 Decision Making, Factors Contributing to Rising Health Critical Thinking, and Care Costs | 50 Technology | 101 Health Care Quality | 52 Decision Making | 102 Health Care Variation | 52 Clinical Application | 102 Improvements in the Process of Limitations to Effective Decision Care | 56 Making | 104 Performance and Quality Measurement | 57 Critical Thinking | 104 Public Reporting of Health Care Refl ective Thinking | 105 Outcomes | 58 Intuitive Thinking and Problem Other National Public Quality Solving | 105 Reports | 59 Decision-Making Tools and Disease Management | 59 Technology | 106 Patient Safety | 59 Dos and Don’ts of Decision Magnet Program | 59 Making | 108 Improving Quality Through Health Group Decision Making | 108 Professions Education | 60 Techniques of Group Decision Challenges and Opportunities Making | 110 for Nurses | 60 Use of Technology in Decision Making | 112 Chapter 3 Joint Commission National Patient Nursing Today | 75 Safety Goals | 113 Leapfrog Group | 113 Evolution of Nursing | 76 The National Quality Forum | 114 Nursing Theorists | 76 The Specialty of Nursing Profession of Nursing | 76 Informatics | 114 Using the Internet for Decision Professional nursing organizations | 81 Making | 114 Subcultures of Health Professionals | 81 Evaluation of Information Found on the Evidence-Based Practice | 84 Internet | 117 Evidence-Based Practice Model | 84 Nurse-Sensitive Patient Outcomes | 87 Contents vii UNIT II Change Promotion | 155 Leadership and Response to Change | 155 Management of the Innovation | 157 Interdisciplinary Confl ict | 159 Team The Confl ict Process | 159 Methods of Confl ict Management | 160 Chapter 5 Negotiation in Confl ict Management | 160 Strategies to Facilitate Confl ict Health Care Management | 161 Communication | 123 Confl ict Management, Change, and Teams and Communication | 124 Innovation | 161 Communication Process | 125 Chapter 7 Health Insurance Portability and Accountability Act (HIPAA) of 1996 | 127 Power and Politics | 169 Stages of Group Process | 127 Power | 170 Common Team Member Roles | 130 Sources of Power | 171 Myers-Briggs Type Indicator | 130 Use of Power | 173 Power and the Media | 173 Great Team Guidelines | 131 American Nurses Association | 176 Teamwork on a Patient Care Whistle-Blowing | 180 Unit | 133 Politics | 181 Status Differences | 134 Stakeholders and Health Care | 182 Crew Resource Management | 135 Nurse as Political Activist | 182 Communicating with Supervisors | 136 Communicating with Coworkers | 136 UNIT III Communicating with Other Nursing and Medical Practitioners | 138 Leadership and Communicating with Patients and Management of Families | 140 Patient Centered Mentor and Prodigy | 140 Care Organizational Communication | 141 Overcoming Communication Barriers | 143 Chapter 8 Delegation of Patient Avoiding Groupthink | 143 Care | 187 Chapter 6 Delegation | 188 Change, Innovation, and ANA and NCSBN | 189 Conflict | 151 Accountability and Change | 152 Responsibility | 189 Traditional Change Theories | 152 Direct Patient Care Activities | 191 Emerging Change Theories | 154 Indirect Patient Care Activities | 191 viii Contents Underdelegation | 191 Scheduling | 219 Overdelegation | 191 Patient Need | 221 Experience and Scheduling of Staff | 221 Authority | 193 Shift Variations | 221 Supervision | 193 New Options in Staffi ng Patterns | 221 Assignment | 194 Self-Scheduling | 221 Competence | 194 Nurse-Sensitive Patient Delegation Decision-Making Outcomes | 224 Tree | 195 Nurse Staffi ng and Nurse Outcomes | 226 Models of Care Delivery | 226 The Five Rights of Delegation | 198 Case Method and Total Patient Care | 226 Knowledge and Skill of Delegation | 198 Functional Nursing Care | 226 Responsibilities of Health Team Team Nursing | 227 Members | 199 Primary Nursing | 228 Nurse Manager Responsibility | 199 Patient-Centered or Patient-Focused Registered Nurse Responsibility | 199 Care | 229 Licensed Practical/Vocational Nurses Patient Care Redesign | 229 Responsibility | 202 Care Delivery Management NAP Responsibility | 202 Tools | 230 Organizational Accountability for Clinical Pathways | 231 Delegation | 204 Case Management | 231 Chain of Command | 206 Disease Management | 231 Transcultural Delegation | 207 Chapter 10 Budgeting for Patient Chapter 9 Care | 237 Effective Staffing | 213 Some Perspectives on the Cost of Determination of Staffi ng Health Care | 239 Needs | 214 The Cost Equation: Money = FTEs | 214 Mission = Money | 240 Nurse Intensity | 216 Business Profi t | 241 Patient Classifi cation Systems | 216 Information Technology, Salary and Utilization of Classifi cation System Medication Costs | 241 Data | 217 Pay-for-Performance Projects | 242 Considerations in Developing a Nursing Cost | 242 Staffi ng Pattern | 218 Types of Budgets | 243 Regulatory Requirements | 218 Operational Budget | 244 Skill Mix | 218 Capital Budget | 244 Staff Support | 219 Construction Budget | 244 Historical Information | 219 Budget Overview | 244 Establishing a Staffi ng Pattern | 219 Budget Preparation and Scope of Staffi ng an Inpatient Unit | 219 Service | 244 Contents ix UNIT IV Marketing | 246 Quality Strategic Plans, Goals, and History | 248 Expense Projections | 249 Improvement of Budget Approval and Patient Outcomes Monitoring | 253 Chapter 13 Chapter 11 Quality Improvement and Planning Care | 259 Evidence-Based Patient Care | 299 Assessment of External and Internal Environment | 260 Quality | 300 Community and Stakeholder Quality Improvement | 301 Assessment | 261 Evidence-Based Care (EBC) | 302 Development of Values and Nursing and EBC | 302 Philosophy, Mission, Vision, The University of Colorado Hospital and Goals | 261 model | 302 The Mission Statement | 261 Benchmarking | 303 Vision Statement | 263 Methodologies for Quality Goals and Quality Measures | 263 Improvement | 303 Structures, Processes, and Outcomes | 263 The Model for Improvement | 303 Organizational Structure | 267 The FOCUS Methodology | 306 Types of Organizational Structures | 267 Other Quality Improvement Shared Governance | 272 Strategies | 307 Purpose of the Councils | 273 Regulatory Requirements | 307 Magnet Hospitals | 273 Sentinel Event Review | 308 The Magnet Recognition Program | 273 Measurements | 309 Storyboard: How to Share Your Chapter 12 Story | 309 Time Management and Setting Using Data | 310 Patient Care Priorities | 281 Organizational Structure for QI | 310 Time Management Concepts | 282 Chapter 14 Analysis of Nursing Time | 283 Create More Time | 283 Legal Aspects of Health Care | 319 Setting Priorities | 285 Shift Hand-Off Report and Sources of Law | 320 Assignments | 288 Public Law | 320 Make Patient Care Rounds | 290 Civil Law | 323 Evaluate Outcome Achievement | 292 Protections in Nursing Practice | 331 Find Personal Time for Lifelong Good Samaritan Laws | 331 Learning | 294 Useful Health Records | 331