Leadership Exam #2Ch 6, 9, 10

Advocacy Ch 6Blending science, ethics, and politics, advocacy is self-initiated, evidence-based, strategic action that health professionals can take to help transform systems and improve the environments and policies, which shape their patients’ behaviors and choices, and ultimately their healthAdvocacy- helping others to grow self- actualization (critically important leadership role)

Inform others of their rights and ascertain the correct information they need to make their decision

To protect and defend what one believes in for both self and others. Nurses may act as advocates by helping others make informed

decisions, by acting as an intermediary in the environment, or by directly intervening on behalf of others.

Advocacy= on of the most vital and basic roles of nursing since Florence Nightingale

Who are nurses advocates for? o Nurses advocate for themselves,o Patients o Subordinateso The profession

Leadership Roles Associated with Advocacy:1. Create climate where advocacy and risk taking are valued2. Seek fairness and justice for individuals who are unable to advocate for

themselves3. Seeks to strengthen the patient and subordinate support system to encourage

autonomous, well-informed decision making4. Providing necessary information to promote autonomy in patient 5. A leader will advocate for patient and subordinates even when the

circumstances are uncomfortable6. Participates in professional nursing organizations that seek to advance

profession of nursing7. Proactive involvement in health care policy through both formal and informal

interactions with media and legislative representatives 8. Works to establish creation of a national, legally binding Bill of Rights for

Patients 9. Speaks up when appropriate to advocate for health-care practices necessary

for safety and quality improvement 10. Advocate for social justice in addition to individual patient advocacy 11. Differentiates between controlling patient choices and assisting in making

choices (allowing freedom) Nursing values central to advocacy emphasize caring, autonomy,

respect, and empowerment Nursing Values Central to Advocacy:

1. Right to autonomy in deciding what course of action is most appropriate to meet his/her health-care needs.

2. Right to hold personal values and to use those values in making health-care decisions

3. Access to the information they need to make informed decisions and choices

4. Nurse must act on behalf of patients who are unable to advocate for themselves

5. Empowerment of patients and subordinates to make decisions and take action on their own is the senescence of advocacy

Patient Advocacy:o The registered nurse is expected to take appropriate action regarding

instances of illegal, unethical and inappropriate behavior that can endanger or jeopardize the best interests of the health care consumer or situation

o Aging, as well as physical, mental or social disability may make individuals more vulnerable and in need of advocacy

o Advocacy has a role in the prevention and detection of abuse in safeguarding vulnerable adults as well as ensuring that those abused can achieve justice

o Managers must advocate for patients with regard to distribution of resources and the use of technology

o Nurses must advocate for social justice as well as individual patient advocacy o It is important for the patient advocate to know the difference between

controlling patient choices and assisting patients to choose o Nurses must not use paternalism as a means to reduce autonomy

Areas that require advocacy :• End-of-life decisions; aging

populations• Technological advances• Health-care reimbursement• Access to health care• Provider–patient conflicts• Withholding of information• Insurance authorization• Medical errors

• Patient information disclosure • Patient grievance and appeals

process• Culture and ethnic diversity and

sensitivity• Respect for patient dignity• Inadequate consents; complex

social problems• Incompetent health-care

providers Patient Rights:

- before the 1960’s pt.’s had few rights, denied basic human rights during a vulnerable time

Adoption of the Consumer Bill of Rights and Responsibilities, AKA Patient’s Bill of Rights in 1998, changed it all

3 Goals of the Patient’s Bill of Rights:1. Help patients feel more confidents in the US healthcare system2. Stress the importance of a strong relationship between patients and health-

care providers3. Stress the key role patients play in staying healthy by laying out rights and

responsibilities for all patients and health-care providers Not legally binding, this document guide health-care organizations

and practitioners in terms of professional expectations for patient advocacy

Affordable Care Act of 2010: Patient protection against insurance companies Eliminate annual & lifetime coverage limits Choice of physician form a plan’s network Allow children to stay on parent’s policy until age of 26 if they meet

requirements Only for employers with more than 15 employees Restrict insurance companies from being able to rescind healthcare coverage

due to an honest mistake on application forms * the government, being the largest provider of health insurance had influenced the protection of patient rights by linking reimbursements with patients right provisions- Department of Health and Human Services mandated that all that hospitals

receive Medicare/ Medicaid funding MUST protect the visitation rights of LGBT patients

Medical Patient Rights Act has been adopted by many states and there is a penalty for not following their patient rights.

Bottom line: if patients are aware that they have rights they may be more proactive and more involved in their care

Leaders/Managers have a responsibility to see that all patient rights are met, including the right to privacy and personal liberty

Subordinate Advocacy: Often a neglected concept in management, but essential part of leadership ANA (American Nurses Association) states that nurse administrators should

advocate for other health care providers! Workplace advocacy is a critical role for managers to assume Seek to see environment is safe and conducive to professional and personal

growth for subordinates OSHA reports over 2million people are victims of workplace violence Must help employees find best ways to solve problems while using least amount

of resources Managers must recognize what subordinates are striving for and the goals and

values that subordinates consider appropriate Ways that promote subordinate advocacy :

Invite collaborative decision making

Listen to staff needs Get to know staff personally Take time to understand the

challenges faces by the staff in delivering care

“Go to bat” for your staff when needed

promote shared governance empower staff promote autonomy provide staff with workable

systems

“in an era of managed care, declining reimbursements and the ongoing pressure to remain fiscally solvent, the risk of fraud, misrepresentation, and ethical malfeasance in healthcare organizations has never been higher. As a result a need for whistle-blowing has never been higher.”

Whistle-Blowing: Internal whistle blowing- occurs within an organization, reporting up the chain of

command External Whistle blowing- involves reporting outside the organization such as media

and an elected official. Ex: nurse reports abuse of a patients by another nurse or care provider

Often times whistle blowing is considered disloyal and may consider repercussions for their actions, even if done with best intentions

Leaders and managers must be willing to advocate for the whistle-blowers Speaking out as a whistle blower is often honored more in theory than in

fact. Leader- management must be willing to advocate for whistleblowers, who

speak out about organizational practices that they believe may be harmful or inappropriate.

A professional commitment means that people cannot shrink from their duty to question and contemplate problems that face the profession

Nurses must exert their collective influence and make their concerns known to policy makers before they can have a major impact on political and legislative outcomes

Political Action Committees (PACs):

Attempt to persuade legislators to vote in a particular way. Lobbyists of the PAC may be members of a group interested in a particular

low or paid agents of the group that wants a specific bill passed Nurses must become more actively involved with PACs to influence health-

care legislation PACs provide one opportunity for small donors to feel like they are making a

difference

Time Management Ch 9* making optimal use of available time

Time management is very important, and as a nurse, prioritizing is something that you will constantly be doing. As a mid-level manager, one may get interrupted more than a higher-level manager. Why?

Short-term plans- operational planning focuses on achieving short-term tasks Managers must recognize what subordinates are striving for and the goals and

values that subordinates consider appropriate - Period of 1hr- 3years- Usually less- complex than strategic/long-range plans- May be done annually, quarterly, monthly, weekly, daily, hourly- Short-term planning is the foundation of nursing time management

Overwhelmed with work and time constraints leads to increased errors, forgetting important tasks and general feeling of stress and ineffectiveness

Managers need to be effective with their time in order to direct their employees to be effective as well. (both must be able to time manage)

Must become expert at planning and implementation of goal attainment Time management- making optimal use of time

- Many people who are bad at time management burn the candle from both ends and often blame others and get others to work harder and faster

Good time management skills allows an individual to spend time on things that matter Must prioritize duties, managing and controlling crises, reducing stress and

balancing work/personal time

3 Basic steps to Time Management:

1. set aside time for planning and establishing priorities2. completing most important task, make sure to finish one task before starting

another3. reprioritize, based on remaining tasks and on new information that may have

been received planning is essential! “fail to plan—plan to fail” planning fallacies- continue to plan too much even though you know it is unrealistic

- may be because individuals forget that in the past, they were interrupted unexpectedly or individuals may not consider all the subcomponents of the task when planning

- people assume that plans will go as planned and nor issues will arise- this leads to unrealistic assumptions, serious planning errors and poor time

management Planning-

- should think about how the plan will play out in action- must decide which people, activities and materials will be needed to execute

plan- some people feel unproductive if they take time out to make plans rather than

getting right to work….not helpful!!Unfortunately, to mistakes common in planning are underestimating the importance of a daily plan and not allowing adequate time for planningExamples a charge nurse might make for day-day planning:

staffing schedules patient care assignments coordination of break schedules interdisciplinary coordination of patient care

Acute care staff: determining how handoff reports will be given/received timing and method used for initial patient assessments coordination of medication admin. Treatments/procedures Organization of documentation of day’s activities

Time Efficient Work Environment:o Gather all the supplies and equipment that will be need BEFOREo Group activities that are in the same locationo Use time estimates (if an IV piggyback will take 30mins, then plan to use the

30mins to complete a task that will take <30 mins)o Document the interventions as soon as possible after an activity is completedo Always strive to end the workday ON TIME o Have supplies organized for efficient retrieval (reduces amount of wasted

time)How to plan a work day:

Identify key priorities to be accomplished, and identify specific actions needed to be taken in order to complete the task

First, allow enough time for sufficient

daily planning

Then, complete the highest-priority task

Then, reprioritize

Determine level of satisfaction expected (how will you uphold to full satisfaction)

Assess who you can delegate assignments to and express your expectations to them

Review short and long-term plans on unit regularly, include everyone in identifying problems or concerns so they can be fully involved in planning or need ot change

Plan ahead for meetings, distribute agendas ahead of time Allow time to assess progress through out the day and at the end of the day

Setting new priorities to reflect ever-changing work situations is an ongoing reality for unit managers. PRIORITIZING is the most important step in time management

SELF AWARENESS IS KEY TO PRIORITIZING AND TIME MANAGEMENT

Priority setting is perhaps the most critical skill in good time management, because all actions we take have some type of relative importance

Prioritizing: “don’t do” “do later” “do now” “don’t do” usually reflect problems that will take care of themselves , are

already outdated, or are better accomplished by someone else- either throw away the unnecessary information or pass it on to someone else- remove unneeded clutter from work area

“do later”- items reflect trivial problems that may not have a specific deadline leading to procrastination

- sometimes procrastination is appropriate, usually not- usually a barrier to effective time management - procrastination is hard to solve because there is usually not from one

cause (combination of dysfunctional attitudes, rationalizations and resentment)

- “do later” be sure that larger items broken down into smaller projects- provide a specific time line and plan- plan should include- short-term, intermediate and final deadlines

“ do now”- a unit’s day-to-day operational needs- daily staffing needs- dealing with equipment shortages- meeting schedules- conducting hiring interviews and giving performance appraisals - may be items that were put off earlier, and must be don’t now- helpful to make a list of DO NOW (planning tool) - make list realistically accomplished in the day - try not to put routine tasks on the list (distracts form priority) - lists should have appropriate amount of time allotted and some for

the unexpected - don’t confuse importance and urgency - not all important things are urgent and not all urgent things are

important

- if one task remains on the list for multiple days determine why this has gone unaccomplished and fix the situation

- sometimes tasks need to be removed form the list using a time inventory is a way to determine when a person is most

productive and determining internal time wasters Some tasks aren’t accomplished because they are not broken down into manageable tasks!

Reprioritizing is the last step in the management processDealing with interruptions

No amount of planning can prevent an occasional crisis If a crisis occurs one may need to set aside original priorities for the day- reorganize- communicate- delegate a new plan all managers experience interruptions but lower-level managers experience

the most they are more involved in daily planning in direct contact with subordinates on a daily basis they don’t have a quite place to work or clerical help the filter interruptions may result in lowered job satisfaction managers MUST develop skills in preventing interruptions and threaten

effective time management leader roles must model flexibility and ability to regroup when new

information or tasks emerge as priorities followers often change based on how leader handles situations

Time Waster:1. Technology (internet, gaming, e-mail, social media)

- egg timer to prevent excessive times on time wasters- check phone morning, noon, end of day- without “unplugging”= huge risk to time management

2. Socializing- can help build report in the work place, but hinder productivity

3. Paperwork overload4. Poor filing system5. Interruptions

Personal Time Management: Self-awareness!! If not certain of own short-term or long-term goals time management is

difficult Decide how much time you are willing to and need to dedicate to task

Managing time is difficult if a person is unsure of his or her priorities for time management, including personal, short-term, intermediate and long-term.

- lack of punctuality suggests you do not value other people’s time

Ch 10 Fiscal Planning Fiscal planning, as in all types of planning, is a learned skill that improves with

practiceRequires vision and creativity through knowledge of the political, social and

economical forces that shape health care. Historically, nursing management played a limited role in determining resource

allocation in health-care institutions The personnel—workforce budget often accounts for the majority of health-care

organization’s expenses because health care is labor intensive

Personnel budgets include actual worked time (productive time or salary expense) and the time that the organization pays the employee for not working (nonproductive time or benefit time)

A budget is at best a forecast or prediction; it is a plan and not a rule. Therefore, a budget must be flexible and open to ongoing evaluation and revision

If a budget is predicted too far in advance is open for greater error. If a budget is shortsighted, compensating for unexpected major expenses or capital equipment purchases may be difficult

Fiscal Planning o The Patient Protection and Affordable Care Act (PPACA) provided the first real

hope for Americans of significant reductions in numbers of uninsured, greater access to coverage for those with preexisting conditions and mandated health care insurance provision by employers

o The shifting in reimbursement from volume to VALUE has accelerated with health care reform

Value – function of quality, efficiency, safety and cost o FISCAL PLANNING IS IS AN ACQUIRED SKILL THAT IMPROVES WITH PRACTICE

AND USE

What is it? A LEARNED SKILLWho does it? The unit manager is responsible to monitor and evaluate all aspects of

the unit’s budget.

Balancing Cost and Quality –o Dual goals of fiscal planning are Cost Containment and Quality Care o Cost Containment – Effective and efficient delivery of services while

generating needed revenues for continued organizational productivityo Cost Effective – Producing good results for the amount of money spent

- the product is worth the priceo In terms of health care, cost and quality do not have a linear relationship o America does not use the resources we have available in a cost effective

manner Spending more does not always mean higher quality of care

Responsibility Accounting and Forecasting o Responsibility Accounting – Each of an organizations revenue, expenses,

assets and liabilities is someone’s responsibility The person with the most direct control or influence on any financial

elements should be held accountable for them o Forecasting – Involves making an educated budget estimate by using

historical data

Medicare and Medicaid Medicare – Federally sponsored health insurance program for the elderly (older than 65) and for certain groups of people with catastrophic or chronic illness, regardless of age

o Who is Eligible U.S citizens LPR with 5 consecutive years of residence in U.S.

Must have paid payroll taxes in the U.S. for 40 quarters AND:

Age 65, or disabled and on SSDI, for 24 months No waiting period for Amyotrophic Lateral Sclerosis (ALS) End Stage Renal Disease

Medicaid – Federal-state cooperative health insurance plan created primarily for the financially indigent (low-income children and adults) although it also provides medical and long term care coverage for people with disabilities and assistance with health and long term care expenses or low income seniors

PPACA – (aka ACA or Obamacare)

What is it? o Comprehensive insurance reformo Includes a new Patient Bill of Rights

When was it passed?o 2010

What is an ACO?o Groups of providers and suppliers of service who work together to better

coordinate care for Medicare patients across care settings o The goal of an ACO is to deliver seamless, high quality care in an environment

that is truly patient centered and where patients and providers are partners in decision making

o Medicare Shared Savings Program will reward ACO’s that lower growth in health-care costs while meeting performance standards on quality of care and putting patients first

What is the Health Insurance Marketplace?o Also called Exchanges o Created for individuals without access to healthcare through their jobo Small businesses were also eligible to buy affordable and qualified health

benefit planso Online insurance supermalls that cannot turn down prospective clients as a

result of preexisting conditions o Every insurance plan offers comprehensive coverage from doctors to

medications to hospital visits and options can be compared based on price, benefits and quality

Medicaid Expansion

o Medicaid covers individuals and families with up to 133% of the Federal Poverty Level. This means more adults without children and parents will now be able to qualify for free or low cost coverage through Medicaid.  

Medicare and Medicaid Managed Care

o The Centers for Medicare and Medicaid Services is now the largest purchaser of managed care in the country

o MCOs receive reimbursement for Medicare-eligible patients based on a formula established by the CMS, which looks at age, gender, geographic region, and the average cost per patient at a given age. Then, the government gives itself a 5% discount and gives the rest to the MCO