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Week 4
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Chapter 14Chapter 14 Budgeting and Budgeting and Managing Fiscal Managing Fiscal ResourcesResources
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Medicare: Government’s largest health care financing program Paid out more than $313.5 billion in
2006 (CMS, 2007)
Private InsuranceSelf-pay
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Pay a provider a set amount for a specific patient condition
Pay a stipulated amount ahead of time, instead of paying the bill after care is rendered
Implemented in the 1997 Balanced Budget Act to control Medicare expenditures
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Reimbursement of predetermined amount for Medicare patients
Negotiated rates, such as per diemNegotiated discountsCapitation
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The process of planning and controlling future operations by comparing actual results with planned expectations
Budget Detailed plan that communicates
expectations to actual results Reflects how well resources are managed
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Population demographicsRevenue sources Statistical dataProjected salary Supply and equipment price
increasesRegulatory and organizational
changes
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Ensures that resources necessary to achieve budget objectives are
available at appropriate timesHelps management control
organizational expenses
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Monitors effectiveness of plan and adjusts accordingly for next budget cycle
Allows manager to identify resource problems early and adjust for changing situations
Uses organization’s resources to best provide quality patient care
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Approach Varies Cost center Revenue center Profit center
Incremental BudgetZero-Based BudgetFixed or Variable Budget
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Finance department distributes a budget worksheet listing each expense item or category on a separate expense line
Expense line divided into salary and nonsalary items
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Assumes base for projecting next year’s budget is zero
Requires managers to justify all activities and programs as if they were being initiated for the first time
Requires expenditures to be justified under current environment and organization’s objectives
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Fixed budgets- amounts are set without
regard to changes that may occur during the year, such as patient volume or program activities
Variable budgets- adjusted based on changes in revenues, patient
census, utilization of supplies, and other
expenses
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Revenue Budget Based upon volume, patient mix,
discounts, reimbursement ratesExpense Budget by Cost Center
Cost Classifications▪ Fixed versus variable▪ Fixed costs remain the same▪ Variable costs are in proportion to pt volume and
acuity
▪ Direct versus indirect▪ Direct costs are directly related to pt care▪ Necessary costs that do not directly affect pt care
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BenefitsShift DifferentialsOvertimeOn-Call HoursPremiumsSalary Increases
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SuppliesRental FeesMaintenance CostsEquipment Service Contracts
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Physical RenovationsNew ConstructionNew/Replacement EquipmentCapital Items: Expected to be used
for more than one year; cost more than $500
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Manager obtains data and estimates budget
Evaluation hierarchy reviews proposal
Governing board reviews and approves
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Types of variance Volume▪ Difference of budgeted and actual workload
requirements Efficiency▪ Difference of nursing care hours provided,
census related Rate▪ Based on hours paid
Salary varianceNonsalary variance
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Monitoring tool used by nurse managers to
compare actual numbers of employees to
number of budgeted FTEs.List of approved, budgeted FTE
positions by category or job classification for the nursing cost center
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Identify items over or under budgeted amounts
Determine reason for varianceMaintain information in preparation
for future budgetsExamine payroll, monitor overtime;
use of agency personnel
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Managers can share budget reports with
staff and label the cost of itemsStaff can become aware of costs, not
to prevent use of appropriate supplies,
but to use the right product for the right
purpose
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Determine hours of replacement time per staff memberDetermine FTE requirementDivide replacement time by annual
FTE
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Accredits health care organizationsEvaluates institution to determine
that it is adhering to the level of staffing to maintain a safe patient care environment
NOTE: Some states have mandated staffing levels.
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Health care organizations implement cost-based accounting system
Health care organizations require cost-effectiveness
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Chapter 15Chapter 15 Recruiting and Selecting Recruiting and Selecting StaffStaff
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Job analysisMethods of recruiting applicantsSelection techniquesLegal considerations
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Describes required skills, abilities, and knowledge
Reflects current practice guidelines Includes duties and responsibilitiesLists tasks inherent in dutiesSpecifies personal qualifications Includes competency-based
behaviors
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Create job overviewDetermine job responsibilitiesDetermine necessary qualifications
Weigh desired qualities based on reliability date
Weigh job dimensions based on trainability
Consider impact of training on specific dimensions
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Identify number of staff to be recruited
Interview, select, and orient staffProvide staff developmentEvaluate performance and provide
feedback Implement strategies to retain staffSchedule exit interviews
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Where to lookHow to lookWhen to lookHow to sell the organization
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Depends on organization’s reputation for higher levels of job satisfaction
Satisfied nurses are more likely to speak
highly of the organization
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Review application/résumé Determine discrepancies between
applicant’s qualifications and job description
List specific questions to ask applicant Identify a rapport builder Determine if résumé provides a
balance of strengths and weaknesses
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Develop structured interview guidesPrepare for the interviewOpen the interviewGather informationGive informationClose the interview Involve staff in interview process
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Assemble all materials for interviewUse a quiet, pleasant interview site Verify scheduled time with the
applicantAvoid interruptions
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EducationExperienceLicensurePhysical Examinations
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Determine applicant’s knowledge of work tasks. BUT…..
Avoid leading questions (“We have lots of overtime. Do you mind overtime?”)
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An interview is most effective when information on the pool of interviewees is comparable
Interview guides contain questions, interviewer directions, pertinent information for uniform process, how to gain same basic information from each applicant
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Agreement between two interviews of same measure by same interviewer-HIGH
Ability to predict job performance-LOW Structured interviews-MORE RELIABLE Pressured Interviewers-LESS ACCURATE Race and gender influence interviewers
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AgeRaceColorSexMarital status
Sexual preference
DisabilityNational originAny other
protected factor
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Title VII of the Civil Rights Act of 1964
Equal Pay Act of 1963Age Discrimination Act of 1967Title I of Americans with Disabilities
Act of 1990Bona Fide Occupational QualificationEqual Opportunity Employment
Commission (EOEC)
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Decision-making-What was your most difficult decision in the last month and why was it difficult?
Communication-What do you think is the most important skill in successful communication?
Adaptability-Describe a major change that affected you and how you handled it.
Delegation-How do you make a decision to delegate? Describe a specific situation.
Initiative-What have you done in school or on a job that went beyond what was required?
Motivation-What is your most significant professional accomplishment?
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Negotiation-Give an example of a negotiation situation and your role in it.
Planning and Organization-How do you schedule your time? What do you do when unexpected circumstances interfere with your schedule?
Critical thinking-Describe a situation where you had to make a decision by analyzing information, consider a range of alternatives, and select the best one for the circumstances.
Conflict resolution-Describe a situation where you had to help settle a conflict.
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Chapter 16Chapter 16 Staffing and Staffing and SchedulingScheduling
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Goal: To provide appropriate numbers and mix of nursing staff to match actual or projected patient care needs to provide effective and efficient nursing care
Managers: Examine workload pattern for the designated unit, department, or clinic
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Joint Commission Provide the right number of competent
staff to meet patient’s needs based on organization-selected criteria
American Nurses Association (ANA) Focus on the level of nursing
competency required to provide quality nursing care
Individual state boards of nursing
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Data collected at midpoint for every shift and analyzed before next shift
Problems: Nurses may call in sick; patient’s condition may change
Demand management: Deviations tracked and staffing adjusted accordingly
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Patient workload trends analyzed for each day of the week and each hour in critical care If 26 patients required 161 nursing care hours, then an average of 6.19 nursing hours per patient per day (NHPPD) are required NHPPD: Total nursing care hours
divided by total census (number of patients)
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One full-time staff works 80 hours (ten 8 hour shifts) in a 2-week period
To staff an 8-hour shift takes 1.4 FTEs, one person working ten 8-hour shifts (1.0 FTE) and another person working four 8-hour shifts (0.4 FTE) to provide for the full-time person’s 2 days off every week
Staff working all 8-hour shifts (1.4 FTEs × 33 shifts = 4.2 FTEs)
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1 FTEs are needed to staff one 12-hour shift each day, each week - Two staff each working three 12-hour shifts and one person working one 12-hour shift each week (0.9 FTE = 0.9 FTE = 0.3 FTE = 2.1 FTEs)
Staff working 12-hour shifts (2.1 FTEs × 32 shifts = 4.2 FTEs)
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Hygiene care, feeding, transferring, turning patients–LPNS or UAPs
Assessments, patient education, or discharge planning–RNs
High RN skill mix allows for greater staffing flexibility
Block staffing – scheduling a set number of staff each shift
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Staff needs vary by shift, day of the week Surgery patient census fluctuates- higher
census Monday through Thursday Surgery patients: Shorter length of stay
than medical patients Medical patient census rarely fluctuates
Monday through Friday, less on weekends (diagnostic tests not done)
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Creative and flexible schedulingSelf-staffing and schedulingSupplemental staff
Internal pools External pools Use of existing staff
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Internal float pools provide staffing at a substantially lower cost than agency nurses
Open shift management allows staff to self-schedule additional shifts
External pools require orientation to agency
Management must verify valid licensure, ensure current malpractice insurance, evaluate agency nurse’s performance
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Chapter 17Chapter 17 Motivating and Motivating and Developing StaffDeveloping Staff
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Daily job performanceAttendancePunctualityAdherence to policies and
proceduresAbsence of incidents, errors, and
accidentsHonesty and trustworthiness
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Are preferred by nurse managersStrive to find the best ways to do
their jobsAre more likely to be productive than
nonmotivated employees
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Emphasize individual needs or rewards that may satisfy those needs
Two types Instinct: Instincts are inherited Need: Motives are learned behaviors
Instinct theories criticized for inability to pinpoint motivating behaviors and variability of strengths of instincts
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Emphasize that motivation works to direct staff’s performance
Process theories include: Reinforcement Expectancy Equity Goal-setting
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People learn through direct experience or observing other people
Anticipation of reinforcement influences what person observes
Behavior is learned through cognitive processes before it is performed
Information conveyed by physical demonstrations, pictures, verbal or written descriptions
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Learners are taught: To anticipate high-risk situations Coping strategies for avoiding high-risk
situations That slips or relapses are predictable and
need not become failures To identify potential failure situations and
ways to cope with them and practice using new skills in neutral environment
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Four conceptual differences between adult and child education: Self-concept Experience Readiness to learn Time perspective
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Teach behaviors to improve effectiveness and efficiency
Maintain patient safety/quality skillsLearn standards about
documentationGain skills when transferring to unitsApply knowledge from evidence-
based practice or new technology
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Learner reactionLearning acquiredBehavior changeOrganizational impact
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Big difference between learning and doing
Behavior must be measured on the job to determine whether the employee has transferred learning to the job
Peer coaching used to ensure transfer of learning to clinical practice Partners observe each other, ask
questions, and provide feedback
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Orientation– Preceptor Model
Staff development methods– On-the-job instruction
Other educational techniques
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Needs Assessment– Regulatory requirements
Planning– Establish objectives– Evaluate present situation and predict
future trends and events– Formulate planning statement– Convert plan into action statement
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Infection controlEmployee fire and patient safetyQuality assurance/quality
improvement (QA/QI)Cardiopulmonary resuscitation (CPR)Handling of hazardous materials
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Eliminate stereotypesRemove barriersPrevent misinterpretationsPromote functioning
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Baby boomers value collegiality, life-long learning, expect rewards for their work
Generation X focus on outcomes, prefer to learn on their own (Sherman, 2006)
Generation X and millenials expect to access information immediately
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Chapter 18Chapter 18 Evaluating Staff Evaluating Staff PerformancePerformance
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Give constructive feedbackStaff knows what is expected and
how well they are doing their jobServe as basis for admin to
determine salary increases, promotions, etc.
Fair employment practice law
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Focus on personal characteristicsSeldom used because of charges
that they discriminate against some groups
Organization should be able to demonstrate job-relatedness of system
Not useful for employee development
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Organizational focus on the bottom line
Objectives quantifiable, objective, easily measured
Employees know in advance what is expected
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Focus on what employee doesEmployees given specific information
on behavior expectationsLegal problems less likelyFacilitates employee developmentDrawbacks:
Time consuming to develop Tied to only one job or narrow range of
jobs
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Developed as a result of concerns about employee productivity
Employee evaluation based on: Accomplishment of major objectives General personal characteristics Behaviorally specific criteria
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General performance dimensions not necessarily based on job description
Equally weighted dimensionsAbsolute judgment standards Judgments based on supervisor’s
idea of satisfactory performance
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Narrative describing performance: Details strengths and weaknesses Can provide great deal of data
Disadvantages: Time consuming to write Difficult to defend in court because
comments may not be closely tied to job performance
Best used in combination with other evaluation formats
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Similar to grading on a curveManagers required to spread staffs’
ratings equally over categories listedGreatly dislikedNot commonly used
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Employees and managers develop the tool Critical incidents stated as measurable,
quantifiable job behaviorsTime consuming and expensive to
developGenerally used only when large
number of individuals doing the same job
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Work objectives established at beginning of evaluation period Defined in concrete, quantifiable terms Have specific time frame
Focus of appraisal is how well employee has accomplished objectives
Being used more frequently in health care with emphasis on outcomes
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Leniency errorRecency errorHalo errorAmbiguous evaluation standardsWritten comments
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Managers overrate staff’s performance “I want my nurses to like me.” “It’s
difficult to justify giving someone a low rating.”
Problems If mediocre staff have lenient ratings, it
is difficult to take corrective action or discipline
Demoralizing to the best staff nurses
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Evaluator recalls recent performance and tends to forget more distant events
Performance rating reflects what staff demonstrated lately rather than over entire evaluation period
Problems: Legal and motivational
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Manager assigns ratings based on overall impression
Some staff rated above average across dimensions, others rated average, others rated below average on all dimensions
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Managers attach different meanings to words such as “outstanding.”
Addressed in two ways: Group of managers agrees on level of
performance necessary for each dimension and communicates that to employees
Rating form includes example of behavior for each level of performance
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Written comments tend to be few, vague, and general
Task is difficult and time consuming when left to the end of the evaluation period
Regular note taking can lessen the problems
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Reports of behaviors that are out of ordinary, either positive or negative
Include four items: Employee’s name Date and time of incident Brief description of what occurred Nurse manager’s comments
Recorded as they occur Increase accuracy of appraisals
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Make notes about staff’s behaviorComplete performance appraisal
formSchedule, document results of
formal appraisal interviewProvide follow-up sessions with
coaching and/or discipline
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Performance-Based Development System (PBDS): Assesses skills for beginning nurses at orientation, skills required at advanced levels
Peer evaluation at point of care with specially selected staff using competency validator based on observations
Skills evaluated to reflect changes in evidence-based
practice
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Chapter 19Chapter 19 Coaching, Disciplining, and Coaching, Disciplining, and Terminating StaffTerminating Staff
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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
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State performance in behavioral terms
Tie problems to consequencesExplore reasons for the problem with
the employeeAsk employee for suggestionsDocument required behavioral stepsSchedule a follow-up meeting
Get the facts–avoid jumping to conclusions.
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Determine if staff is aware of policyDescribe behavior that violated
policyDetermine staff’s reason for
behaviorManager and staff explore
alternative solutionsDecide on a course of action
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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
(Anderson & Pulich, 2001; White, 2006)
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Communicate with Human Resource Staff
Determine policy violationsTeach new skills and encourage staff
to behave professionally in the future
Clearly communicate policies/procedures
Ensure that consequences are progressive
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Process of communicating increasingly severe warnings for repeated violations
Minor violations may progress from oral warning to written warning placed in staff’s personnel folder
Major violations may lead to immediate suspension or termination
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Steps are similar to disciplining, but no plans to correct behavior and no follow-up
Seek approval from HR and administration
Prepare before terminating employeeObservation and documentation are
crucial to avoid legal challengesPreferable to have employee resign
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Were expectations stated clearly? Did you review job description,
criteria, pertinent policies/ procedures?
Did you document performance on a continuous basis?
Did you keep staff informed?Did you communicate violations?
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Were you honest about poor performance? Were you specific about behaviors that failed
to meet standards? Was 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?
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Chapter 20Chapter 20 Reducing Turnover, Reducing Turnover, Retaining StaffRetaining Staff
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Cost estimates range from $23,000 to $67,000 or 1.2 to 1.3 times the RN salary
Effects on nurses who remain at job: Morale, overtime, postponement of new
ventures Positive aspects of turnover:
Performance may improve Administration may be challenged to improve
work environment Newly hired nurses may be more enthusiastic
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Did staff leave of her or his own accord, or was the person asked to leave?
Was the staff member who left performing at an exceptional or mediocre level?
Did staff leave for career development or dissatisfaction with the organization?
Will staff be easy or difficult to replace?
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Reducing turnover and retaining staff begins with recruitment and selection
Length of stay at previous jobs is indicator of how long individual will stay at this job
Perceptions of ease of movement and desirability of movement influence turnover
Job satisfaction influences turnover
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EducationArea of specializationAgeGeographic mobilityContacts at other hospitalsTransportation Job openings at other organizations
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Relationships with nurse manager, staff, patients, and physicians
Shift worked Fit between nurse values and
institutional cultureExpectations of practice settingCompensation levelEqual/fair rewards and punishments
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Skilled communicationTrue collaborationEffective decision makingAppropriate staffingMeaningful recognition
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Salary compression Results in salaries of long-term
employees being at or below that of less-experienced nurses
Pay scales must reflect achievement and accomplishment Methodist Hospital, Houston, Texas
successfully implemented pay for performance
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Provide a realistic job preview to new hires
Facilitate movement within organization
Improve work environment Coordinate with other managers to
influence organizational policiesAdapt to turnover rate
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Enrich or redesign staff nurse’s jobFacilitate all communicationLink rewards with performanceDevelop group cohesivenessHelp resolve interpersonal conflictsProvide training/educational
opportunities
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Performance indicators used to advance employees
Concepts guiding decision making: Horizontal promotion Clinical ladder Clinical mentor
Novice-to-expert conceptsClinical excellence rewarded
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Apprentice—new nurse or new to area Clinical colleague—full partner in care Clinical mentor—demonstrates
preceptor ability Clinical leader—demonstrates
leadership in practice Clinical expert—combines teaching,
research, practice
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Higher ratios of nurses to patientsFlexible schedulesDecentralized administrationParticipatory managementAutonomy in decision makingRecognitionAdvancement opportunities
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Mentor: A wiser and more experienced person who guides, supports, and nurtures a less experienced person
Stages of relationship Initiation Protégé Breakup Lasting friendship
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Is often a nurse or human resources staff member prepared to help resolve conflicts
Helps staff focus on problem solving to promote job satisfaction
Helps resolve conflicts between two nurses, between a nurse and a patient, or between a nurse and a physician
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Evidence-based, 18-month nurse residency program designed to reduce RN turnover rate
Nurse partners maintain ongoing relationships, teach professional accountability, critical thinking
Nurse residents participate in emotional support groups to share experiences and feelings
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Chapter 21Chapter 21 Managing Managing Absenteeism and Absenteeism and Other Staff ProblemsOther Staff Problems
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ExpensiveDetrimental to work lives of other staffCauses other staff to work shorthanded;
creates physical, mental strainForces staff to skip breaks, hurry
through meals, abbreviate interactions with patients, cancel nonwork activities
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Voluntary absenteeism–Under employee’s control Example: Not coming to work in order to
finish one’s income taxes Involuntary absenteeism-Outside
employee’s control Example: Taking a sick day because of
food poisoningTotal time lost versus absence
frequency
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Personal illness or injuryFamily responsibilities (sick child)Transportation problems (unreliable
car)
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Staff in enriched jobs are less likely to be absent than those with mundane jobs
Enriched jobs may increase attendance motivation because staff believe that what they are doing is important and others depend on them
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Offer wellness programs Employee assistance programs Van pools On-site child care
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Some work units have an absence culture that reflects a tolerance for excessive absenteeism
Other units have a culture in which being absent is frowned upon
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Nurses from Generation X and Y (termed millennials) have different expectations in the workplace
Millenials expect to have flexible scheduling (Clausing et. al, 2003) and may use absenteeism to achieve flexibility
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Degree of responsibilityParticipation in decision makingDecisions about personnelConsistency with organizational practicesEmphasis on good attendance
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Staff attitudes-job satisfactionValues-personal work ethicGoals-desire to get promotedExample–staff with high personal
work ethic, goal of getting promoted are more highly motivated to attend work than those who lack such a work ethic
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Is absenteeism equally distributed across staff nurses?
Does your unit have a high absenteeism rate?
Are most absences of short or long duration?
Does absenteeism have a consistent pattern?
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Reduce job stressCreate a norm of excellent
attendanceEnhance advancement opportunities Improve co-worker relationsSelect staff satisfied, committed to
jobs
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Be a good role model–rarely take sick days
Discuss attendanceReward good attendanceEnforce absenteeism control policies
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Overachievers and superachievers Disgruntled staff Overstressed staff Staff with a substance abuse problem
Identifying signs of abuse Strategies for intervention Treatment Reentry Americans with Disabilities Act and substance
abuse
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Set and communicate standards of performance
Keep notes about incidentsTake action early and be consistentUse coaching behaviorsFollow up
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Detrimental to impaired nurse Jeopardizes patients’ careExposes employer to greater liabilityEarly recognition of alcohol or drug
dependency and prompt referral for treatment are responsibilities of manager
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Denial Frequently incorrect narcotics counts Alteration of narcotics vials Reports of ineffective pain medications Inaccurate recording of pain
medication administration Narcotic wastage Marked shift variations in drug
quantities
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Once impaired nurse identified, proceed with intervention
Review relevant organizational policies, procedures and state practice act
Diversion programs with referral, assistance, and monitoring may be offered in lieu of disciplinary action
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Carefully plannedRecognize threat that access to
drugs may pose to recoveryReturn to work recommended Important that nurse returns to same setting
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Chapter 22Chapter 22 Preventing Workplace Preventing Workplace ViolenceViolence
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Any violent act, including physical assaults and threats of assault, directed toward persons at work or on duty (Ray, 2006)
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Threatening actions–waving fists, throwing objects, or threatening body language
Verbal or written threats Physical attacks–slapping, hitting,
biting, shoving, kicking, pushing, beating
Violent assaults–rape, homicide, and attacks with weapons, such as knives, firearms, or bombs
(Gilmore, 2006; Clements et. al., 2005)
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Clements and colleagues found between 35% and 80% of hospital staff had been victims of at least one assault during their careers
NOTE: May and Grubbs (2006) report that fewer than 50% of nurses who were victims reported their assault
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Affects staff morale Increases staff stressCauses mistrust of administrationExacerbates hostile work
environment
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Patients with head trauma, seizure disorders, dementia, alcohol or drug withdrawal, or who are homeless
Crime victims and perpetratorsFamily members’ stress and fear,
long waits
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Working understaffedLong waiting timesOvercrowded waiting roomsWorking alone Inadequate securityUnlimited public accessPoorly lit corridors, rooms, and
parking lots (NIOSH, 2003)
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Health care organizations: Required to provide safe work
environment Must develop adequate policies to
address violence in the workplace Inadequate policies may result from lack
of awareness
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Anyone who becomes violent or who exhibits threatening behavior must be removed from the setting and the authorities contacted
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Educate staff to recognize warning signs of violence and potential assailants or agitators
Educate staff about conflict resolution skills and de-escalation tactics
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Adequate lighting Security devices Bullet-resistant barriers (Emergency
Rooms) Curved mirrors in hallways Adequate staffing Judicious use of restraints or seclusion Alert staff about patients with histories
of violent behavior, dementia, or intoxication
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Clenched fistsBlank stareFighting stanceArms raised in fighting positionStanding too close or advancingHolding weapon of any kindOvert intentMovement toward exit
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Verbal threats often precede a physically violent event
Abuser might be encouraged by a crowd or afraid to lose face
Watch body language and keep distance
Use clear, direct words or silenceKeep tone calm
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Notify security immediatelyNever try to disarm someone If person is not armed, enlist staff to
help in restraining violent personPut a barrier between violent person
and yourself
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Be certain everyone is safeArrange treatment for injuredComplete injury and incident reportsFollow up with human resourcesContact securityContact injured employee at home to
express concern and answer questions
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Chapter 23Chapter 23 Handling Collective-Handling Collective-Bargaining IssuesBargaining Issues
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Civil Service Reform Act (1978)–certain federal employees have right to organize, bargain collectively, participate in unions
State and local employees are under state regulations
Some states don't allow employees to strike or form collective bargaining units
Some states don't allow wages or overtime pay to be part of a union contract
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MandatoryProhibitedPermissive
All three categories are addressed in public and private sector bargaining
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Private sector Wages Hours Other terms and
conditions of work considered mandatory subjects
Public sector Scope of
mandatory subjects of bargaining far narrower
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Dissatisfaction with working conditions and administration
Concerns about practice environment
Concerns about decisions affecting quality of care
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Selecting a Bargaining Agent Representation election, presided over by
the National Labor Relations Board Union must demonstrate that interest is
shown by at least 30% of employees affected by this action
Once the 30% level is reached, the union can petition the NLRB to conduct an election
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Registered nurses employed as staff nurses are eligible for collective bargaining, but registered nurses employed as managers are not
Registered nurses who work for an organization, but in a capacity outside the traditional nursing department, such as a clinic, home health care, or in education, may or may not be eligible for membership
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Mandatory Subjects of Bargaining: Rates of pay Wages Hours of employment Conditions of employment Grievance procedures
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Individual designated as union representative
May be an employee of the union or a member of nursing staff
Duty to provide fair and equal representation to all members of the unit
Duty to explain provisions of the contract to union membership and assist in grievance process
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Union members can change union affiliation/remove union by decertifying
Union members must have at least 30% of bargaining unit membership requesting a change
NLRB reviews signatures for authenticity, sets date/time, and conducts election by secret ballot–winner determined by majority of cast ballots.
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Staff talks informally with direct supervisor, as soon as possible after incident occurs
Representative of bargaining agent is present
If grievance is not adjusted in informal discussion, written request for next step is given to supervisor within 10 work days
Written response from supervisor must be received within 5 work days
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Step 2. Written appeal may be submitted within 10 work days to the director of nursing or designee
Step 3. Staff, agent, grievance chairperson, nursing administrator, and director of human resources meet for discussions
Step 4. Arbitration invoked. Neutral third party selected and present at meetings
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Work with one anotherDo not allow disagreements or
disputes to be publicExpedience is a mustStay objectiveGet all facts and information,
witnesses, documentationMeet with grievant’s representatives
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Put the grievant at ease Listen openly and carefully Take notes Discuss problem calmly Get all the facts Consider grievant’s viewpoint Avoid snap judgments Make an equitable decision–respond
promptly
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Contract change or terminations–notification 90 days prior to contract expiration date
If there is no agreement after 30 days from notification, Federal Mediation and Conciliation Service (FMCS) must be notified
FMCS will appoint mediator/inquiry board within 30 days, with recommendations within 15 days
If no agreement after 15 more days, strike vote can be conducted and strike scheduled
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Responsibility to assign includes nurses and assistants
Responsibility to direct includes actions of staff to whom tasks have been assigned
Independent judgment includes nurse’s decision to match staff skills to patient needs
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• Interference with the right to organize
• Domination• Encouraging or discouraging union
membership• Discharging an employee for giving
testimony or filing a charge with the NLRB
• Refusal to bargain collectively
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Nurse manager participates in resolving grievances, using the agreed-upon grievance procedure
Contract violationsViolations of federal or state lawFailure of management to meet its
responsibilitiesViolation of agency rules
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American Nurses Association (ANA) has had an active interest in nurses’ economic security
ANA actively promotes collective bargaining for nurses through Economic and General Welfare Program (This became Department of Labor Relations and Work Place Advocacy)