Managing and Improving Quality 69 Learning Outcomes 69
QUALITY MANAGEMENT 70 Total Quality Management 70 Continuous Quality Improvement 71 Components of Quality Management 72 Six Sigma 73 Lean Six Sigma 73 DMAIC Method 74
IMPROVING THE QUALITY OF CARE 74 National Initiatives 74 How Cost Affects Quality 75 Evidence-Based Practice 75 Electronic Medical Records 75 Dashboards 76 Nurse Staffing 76 Reducing Medication Errors 76 Peer Review 76
RISK MANAGEMENT 77 Nursing’s Role in Risk Management 77 Incident Reports 78 Examples of Risk 78 Root Cause Analysis 80 Role of the Nurse Manager 80 Creating a Blame-Free Environment 81
CHAPTER 7 Understanding Power and Politics 86 Learning Outcomes 86
POWER DEFINED 87 POWER AND LEADERSHIP 87 POWER: HOW MANAGERS AND LEADERS GET THINGS DONE 87 USING POWER 88
Image as Power 89 Using Power Appropriately 91
SHARED VISIONING AS A POWER TOOL 92 POWER, POLITICS, AND POLICY 92
Nursing’s Political History 93 Using Political Skills to Influence Policies 93 Influencing Public Policies 94
USING POWER AND POLITICS FOR NURSING’S FUTURE 96
PART 2 Learning Key Skills in Nursing Management 99
CHAPTER 8 Thinking Critically, Making Decisions, Solving Problems 99 Learning Outcomes 99
CRITICAL THINKING 100 Critical Thinking in Nursing 100 Using Critical Thinking 101 Creativity 101
DECISION MAKING 103 Types of Decisions 104 Decision-Making Conditions 104 The Decision-Making Process 106
CONTENTS xi
Decision-Making Techniques 107 Group Decision Making 108
PROBLEM SOLVING 109 Problem-Solving Methods 109 The Problem-Solving Process 110 Group Problem Solving 112
STUMBLING BLOCKS 114 INNOVATION 115
CHAPTER 9 Communicating Effectively 117 Learning Outcomes 117
COMMUNICATION 118 Modes of Communication 118 Distorted Communication 118 Directions of Communication 120 Effective Listening 120
EFFECTS OF DIFFERENCES IN COMMUNICATION 121
Gender Differences in Communication 121 Generational and Cultural Differences in Communication 121 Differences in Organizational Culture 122
THE ROLE OF COMMUNICATION IN LEADERSHIP 123
Employees 123 Administrators 123 Coworkers 125 Medical Staff 125 Other Health Care Personnel 126 Patients and Families 126
COLLABORATIVE COMMUNICATION 126 ENHANCING YOUR COMMUNICATION SKILLS 129
CHAPTER 10 Delegating Successfully 131 Learning Outcomes 131
DELEGATION 132 BENEFITS OF DELEGATION 132
Benefits to the Nurse 132 Benefits to the Delegate 133 Benefits to the Manager 133 Benefits to the Organization 133
THE FIVE RIGHTS OF DELEGATION 133 The Delegation Process 134
ACCEPTING DELEGATION 137 INEFFECTIVE DELEGATION 138
Organizational Culture 138 Lack of Resources 138 An Insecure Delegator 138 An Unwilling Delegate 139 Underdelegation 140
Reverse Delegation 140 Overdelegation 140
CHAPTER 11 Building and Managing Teams 143 Learning Outcomes 143
GROUPS AND TEAMS 144 GROUP AND TEAM PROCESSES 146
Norms 147 Roles 148
BUILDING TEAMS 149 Assessment 149 Team-Building Activities 150
MANAGING TEAMS 150 Task 151 Group Size and Composition 151 Productivity and Cohesiveness 151 Development and Growth 152 Shared Governance 152
THE NURSE MANAGER AS TEAM LEADER 153
Communication 153 Evaluating Team Performance 153
LEADING COMMITTEES AND TASK FORCES 154
Guidelines for Conducting Meetings 155 Managing Task Forces 156
PATIENT CARE CONFERENCES 157
CHAPTER 12 Handling Conflict 160 Learning Outcomes 160 CONFLICT 161 INTERPROFESSIONAL CONFLICT 161 CONFLICT PROCESS MODEL 162
Antecedent Conditions 163 Perceived and Felt Conflict 164 Conflict Behaviors 165 Conflict Resolved or Suppressed 165 Outcomes 165
MANAGING CONFLICT 165 Conflict Responses 166 Filley’s Strategies 168 Alternative Dispute Strategies 169
CHAPTER 13 Managing Time 172 Learning Outcomes 172
TIME WASTERS 173 Time Analysis 174 The Manager’s Time 175
SETTING GOALS 175 Determining Priorities 176 Daily Planning and Scheduling 176
xii CONTENTS
Grouping Activities and Minimizing Routine Work 177 Personal Organization and Self-Discipline 177
CONTROLLING INTERRUPTIONS 178 Phone Calls, Voice Mail, Text Messages 179 E-Mail 180 Drop-In Visitors 181 Paperwork 181
CONTROLLING TIME IN MEETINGS 182 RESPECTING TIME 182
PART 3 Managing Resources 184
CHAPTER 14 Budgeting and Managing Fiscal Resources 184 Learning Outcomes 184
THE BUDGETING PROCESS 185 APPROACHES TO BUDGETING 186
Incremental Budget 186 Zero-Based Budget 187 Fixed or Variable Budgets 187
THE OPERATING BUDGET 187 The Revenue Budget 187 The Expense Budget 188
DETERMINING THE SALARY (PERSONNEL) BUDGET 189
Benefits 189 Shift Differentials 190 Overtime 190 On-Call Hours 190 Premiums 190 Salary Increases 191 Additional Considerations 191
MANAGING THE SUPPLY AND NONSALARY EXPENSE BUDGET 191 THE CAPITAL BUDGET 192 TIMETABLE FOR THE BUDGETING PROCESS 192 MONITORING BUDGETARY PERFORMANCE DURING THE YEAR 193
Variance Analysis 193 Position Control 195
PROBLEMS AFFECTING BUDGETARY PERFORMANCE 195
Reimbursement Problems 195 Staff Impact on Budget 196
CHAPTER 15 Recruiting and Selecting Staff 199 Learning Outcomes 199
THE RECRUITMENT AND SELECTION PROCESS 200
RECRUITING APPLICANTS 200 Where to Look 201 How to Look 202 When to Look 202 How to Promote the Organization 202 Cross-Training as a Recruitment Strategy 203
SELECTING CANDIDATES 204 INTERVIEWING CANDIDATES 205
Principles for Effective Interviewing 205 Involving Staff in the Interview Process 209 Interview Reliability and Validity 209
MAKING A HIRE DECISION 210 Education, Experience, and Licensure 210 Integrating the Information 210 Making an Offer 211
LEGALITY IN HIRING 211
CHAPTER 16 Staffing and Scheduling 217 Learning Outcomes 217
STAFFING 218 Patient Classification Systems 218 Determining Nursing Care Hours 219 Determining FTEs 219 Determining Staffing Mix 220 Determining Distribution of Staff 220
SCHEDULING 221 Creative and Flexible Staffing 221 Automated Scheduling 222 Supplementing Staff 223
CHAPTER 17 Motivating and Developing Staff 227 Learning Outcomes 227 A MODEL OF JOB PERFORMANCE 228
Employee Motivation 229 Motivational Theories 229
MANAGER AS LEADER 231 STAFF DEVELOPMENT 231
Orientation 231 On-the-Job Instruction 232 Preceptors 233 Mentoring 233 Coaching 234 Nurse Residency Programs 234 Career Advancement 234 Leadership Development 235
SUCCESSION PLANNING 235
CONTENTS xiii
CHAPTER 18 Evaluating Staff Performance 239 Learning Outcomes 239
THE PERFORMANCE APPRAISAL 240 Evaluation Systems 241 Evidence of Performance 244 Evaluating Skill Competency 247 Diagnosing Performance Problems 247 The Performance Appraisal Interview 248
POTENTIAL APPRAISAL PROBLEMS 251 Leniency Error 251 Recency Error 251 Halo Error 252 Ambiguous Evaluation Standards 252 Written Comments Problem 252
IMPROVING APPRAISAL ACCURACY 253 Appraiser Ability 253 Appraiser Motivation 253
RULES OF THUMB 255
CHAPTER 19 Coaching, Disciplining, and Terminating Staff 257 Learning Outcomes 257
DAY-TO-DAY COACHING 258 POSITIVE COACHING 259 DEALING WITH A POLICY VIOLATION 259 DISCIPLINING STAFF 260 TERMINATING EMPLOYEES 262
CHAPTER 20 Managing Absenteeism, Reducing Turnover, Retaining Staff 268 Learning Outcomes 268 ABSENTEEISM 269
A Model of Employee Attendance 269 Managing Employee Absenteeism 272 Absenteeism Policies 273 Selecting Employees and Monitoring Absenteeism 274 Family and Medical Leave 274
REDUCING TURNOVER 275 Cost of Nursing Turnover 275 Causes of Turnover 276 Understanding Voluntary Turnover 276
RETAINING STAFF 277 Employee Engagement 277 Healthy Work Environment 277 Improving Salaries 277 Recognizing Staff Performance 278 Additional Retention Strategies 279
CHAPTER 21 Dealing with Disruptive Staff Problems 283 Learning Outcomes 283
HARASSING BEHAVIORS 284 Bullying 284 Lack of Civility 284 Lateral Violence 285
HOW TO HANDLE PROBLEM BEHAVIORS 286 Marginal Employees 286 Disgruntled Employees 287
THE EMPLOYEE WITH A SUBSTANCE ABUSE PROBLEM 288
State Board of Nursing 289 Strategies for Intervention 289 Reentry 290 The Americans with Disabilities Act and Substance Abuse 291
CHAPTER 22 Preparing for Emergencies 294 Learning Outcomes 294
PREPARING FOR EMERGENCIES 295 TYPES OF EMERGENCIES 295
Natural Disasters 295 Man-Made Disasters 295 Levels of Disasters 295
NATIONAL RESPONSES TO EMERGENCY PREPAREDNESS 296 HOSPITAL PREPAREDNESS FOR EMERGENCIES 296
Emergency Operations Plan 296 Disaster Triage 297 Core Competencies for Nurses 297 Continuation of Services 297 Impact on Employees 298
CHAPTER 23 Preventing Workplace Violence 302 Learning Outcomes 302
VIOLENCE IN HEALTH CARE 303 Incidence of Workplace Violence 303 Consequences of Workplace Violence 303 Factors Contributing to Violence in Health Care 303
PREVENTING VIOLENCE 304 Zero-Tolerance Policies 304 Reporting and Education 304 Environmental Controls 304
DEALING WITH VIOLENCE 305 Verbal Intervention 305 A Violent Incident 305 Other Dangerous Incidents 306 Post-Incident Follow-Up 306
xiv CONTENTS
CHAPTER 24 Handling Collective Bargaining Issues 310 Learning Outcomes 310
LAWS GOVERNING UNIONS 311 PROCESS OF UNIONIZATION 311
The Grievance Process 312 The Nurse Manager’s Role 312
STATUS OF COLLECTIVE BARGAINING FOR NURSES 313
Legal Status of Nursing Unions 313 The Future of Collective Bargaining for Nurses 314
PART 4 Taking Care of Yourself 316
CHAPTER 25 Managing Stress 316 Learning Outcomes 316
THE NATURE OF STRESS 317 CAUSES OF STRESS 318
Organizational Factors 318 Interpersonal Factors 318 Individual Factors 319
CONSEQUENCES OF STRESS 320 MANAGING STRESS 320
Personal Methods 320 Organizational Methods 321
CHAPTER 26 Advancing Your Career 325 Learning Outcomes 325
ENVISIONING YOUR FUTURE 326 MANAGING YOUR CAREER 326 ACQUIRING YOUR FIRST POSITION 326
Applying for the Position 327 The Interview 328 Accepting the Position 331 Declining the Position 331
BUILDING A RÉSUMÉ 331 Tracking Your Progress 333 Identifying Your Learning Needs 334
FINDING AND USING MENTORS 336 CONSIDERING YOUR NEXT POSITION 336
Finding Your Next Position 337 Leaving Your Present Position 337
WHEN YOUR PLANS FAIL 337 Taking the Wrong Job 337 Adapting to Change 338
Glossary 340 Index 348
CHAPTER
Changes in Health Care
Paying for Health Care HOW AMERICA PAYS FOR HEALTH CARE
PAY FOR PERFORMANCE
Demand for Quality QUALITY INITIATIVES
THE LEAPFROG GROUP
BENCHMARKING
EVIDENCE-BASED PRACTICE
MAGNET® CERTIFICATION
Evolving Technology ELECTRONIC HEALTH RECORDS
VIRTUAL CARE
ROBOTICS
COMMUNICATION TECHNOLOGY
Cultural, Gender, and Generational Differences
Violence Prevention and Disaster Preparedness
Changes in Nursing’s Future EVEN MORE CHANGE . . .