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CHAPTER 1CHAPTER 1
Introduction to the nursing Introduction to the nursing managementmanagement
Dr Fadwa AlhalaiqaDr Fadwa Alhalaiqa
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 2
Learning OutcomesLearning Outcomes
1.1. Describe the forces that are Describe the forces that are changing the health care system.changing the health care system.
2.2. Discuss changes in paying for health Discuss changes in paying for health care.care.
3.3. Explain how quality initiatives can Explain how quality initiatives can reduce medical errors.reduce medical errors.
4.4. Describe how evidence-based Describe how evidence-based practice is changing nursing.practice is changing nursing.
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 3
Learning OutcomesLearning Outcomes
5.5. Explain how to become a Magnet-Explain how to become a Magnet-certified hospital.certified hospital.
6.6. Explain what emerging technologies Explain what emerging technologies mean for nursing.mean for nursing.
7.7. Describe how cultural, gender, and Describe how cultural, gender, and generational differences affect generational differences affect management.management.
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 4
Learning OutcomesLearning Outcomes
8.8. Explain why preparation is the best Explain why preparation is the best defense against violence and defense against violence and disasters.disasters.
9.9. Discuss the changes and challenges Discuss the changes and challenges that nurses face now and into the that nurses face now and into the future.future.
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 5
Continuing Changes Continuing Changes in Health Carein Health Care
including:including: How we pay for health careHow we pay for health care A focus on qualityA focus on quality Rapid changes in technologyRapid changes in technology Threats from violence and disasters. Threats from violence and disasters.
Cultural, gender, and generational Cultural, gender, and generational differences also affect the delivery of differences also affect the delivery of health carehealth care
Health care not accessible to everyoneHealth care not accessible to everyone Costs are skyrocketingCosts are skyrocketing
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 6
Paying for Health CarePaying for Health Care
The Patient Protection and The Patient Protection and Affordable Care Act (PPACA), Affordable Care Act (PPACA), signed into law March 23, 2010, signed into law March 23, 2010, promises to provide affordable promises to provide affordable and adequate care for more and adequate care for more Americans once it is Americans once it is implemented.implemented.
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 7
The Institute of Medicine (IOM) The Institute of Medicine (IOM) published a report in 1999 reporting published a report in 1999 reporting that that 98,000 Americans die each year from 98,000 Americans die each year from
preventable medical mistakes.preventable medical mistakes. The report focused attention on eliminating The report focused attention on eliminating
errors. errors. As a result, the Centers for Medicare and As a result, the Centers for Medicare and
Medicaid Services have linked payment to Medicaid Services have linked payment to quality of care since 2008, making pay for quality of care since 2008, making pay for performance the norm.performance the norm.
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 8
Quality InitiativesQuality Initiatives Many quality initiatives to reduce errors Many quality initiatives to reduce errors
and improve care have emerged: and improve care have emerged: Quality management is a preventive approach Quality management is a preventive approach
that addresses problems before they become that addresses problems before they become crises. crises.
Continuous improvement of products and Continuous improvement of products and services perfect the process. One example is services perfect the process. One example is the use of patient satisfaction surveys to the use of patient satisfaction surveys to evaluate how well hospitals are meeting their evaluate how well hospitals are meeting their clients’ needs. clients’ needs.
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 9
- Public reporting of health care organizations, - Public reporting of health care organizations, such as the Agency for Healthcare Research such as the Agency for Healthcare Research and Quality (AHRQ), is another strategy to and Quality (AHRQ), is another strategy to improve quality.improve quality.
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 10
Quality ManagementQuality Management
Is a preventive approachIs a preventive approach Involves continuous evaluation and Involves continuous evaluation and
improvementimprovement Is implemented through patient Is implemented through patient
satisfaction surveyssatisfaction surveys
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 11
The Leapfrog GroupThe Leapfrog Group
Consortium of public and private Consortium of public and private purchaserspurchasers
Leverages purchasing powerLeverages purchasing power Rewards organizations for quality Rewards organizations for quality
measuresmeasures
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BenchmarkingBenchmarking
Compares an organization's data with Compares an organization's data with similar organizationssimilar organizations
Uses outcome indicators to compare Uses outcome indicators to compare performance across organizationsperformance across organizations
Uses results to address weaknesses Uses results to address weaknesses and enhance strengthsand enhance strengths
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 13
Evidence-Based Practice Evidence-Based Practice (EBP)(EBP)
Evidence-based practice (EBP) is Evidence-based practice (EBP) is a strategy to improve quality by a strategy to improve quality by usingusing The best available knowledge integrated The best available knowledge integrated
with with Clinical experience and Clinical experience and
The patient’s values and The patient’s values and preferences to provide carepreferences to provide care
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 14
Evidence-Based Practice Evidence-Based Practice (EBP)(EBP)
EBP decision-making stepsEBP decision-making steps1.1. Identifying the clinical questionIdentifying the clinical question
2.2. Finding evidence to answer the Finding evidence to answer the questionquestion
3.3. Evaluating the evidenceEvaluating the evidence
4.4. Applying the evidenceApplying the evidence
5.5. Evaluating the outcomeEvaluating the outcome
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Nurses may find it helpful in Nurses may find it helpful in evaluating research findings to place evaluating research findings to place it into seven categories: it into seven categories: AnecdotalAnecdotal TestimonialTestimonial Statistical Statistical Case studyCase study Nonexperimental design researchNonexperimental design research Quasi-experimental design researchQuasi-experimental design research Randomized control trialRandomized control trial
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 16
Magnet Recognition Magnet Recognition ProgramProgram
Certifies health care organizations for Certifies health care organizations for nursing excellencenursing excellence
14 Forces of Magnetism14 Forces of Magnetism Patient safety improves when forces Patient safety improves when forces
are metare met
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 17
• ““Forces of Magnetism”:Forces of Magnetism”:
1.1. Quality of nursing leadershipQuality of nursing leadership
2.2. Organizational structureOrganizational structure
3.3. Management styleManagement style
4.4. Personnel policies and programsPersonnel policies and programs
5.5. Professional model of careProfessional model of care
6.6. Quality of careQuality of care
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 18
1.1. Quality improvementQuality improvement
2.2. Consultation and resourcesConsultation and resources
3.3. AutonomyAutonomy
4.4. Community and the health care Community and the health care organization partnershipsorganization partnerships
5.5. Nurses as teachersNurses as teachers
6.6. Image of nursesImage of nurses
7.7. Interdisciplinary relationsInterdisciplinary relations
8.8. Professional developmentProfessional development
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 19
Electronic Health Records Electronic Health Records (EHR) (EHR)
Includes health information from all Includes health information from all medical sourcesmedical sources
Can be accessed by multiple Can be accessed by multiple authorized providers at different authorized providers at different locationslocations
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 20
Barriers Versus Benefits of Barriers Versus Benefits of EHREHR
BarriersBarriers Privacy and confidentiality concernsPrivacy and confidentiality concerns Costs of implementing and operatingCosts of implementing and operating
BenefitsBenefits Reduced redundanciesReduced redundancies Improved efficiencyImproved efficiency Decreased medical errorsDecreased medical errors Lower health care costsLower health care costs
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 21
Other Benefits of EHROther Benefits of EHR
Allows for collective data analysisAllows for collective data analysis Facilitates a common nursing Facilitates a common nursing
languagelanguage Supports evidence-based decision Supports evidence-based decision
makingmaking
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 22
Other Technological Other Technological ChangesChanges
Virtual care (telehealth)Virtual care (telehealth) RoboticsRobotics Communication technology, including Communication technology, including
social mediasocial media
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 23
Cultural and Generational Cultural and Generational DifferencesDifferences
Cultural diversity is increasing in the Cultural diversity is increasing in the U.S. populationU.S. population
Diversity in the nursing populationDiversity in the nursing population EthnicityEthnicity GenderGender GenerationsGenerations
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GenderGender
Female nurses outnumber male Female nurses outnumber male nursesnurses
Nursing shortages might be Nursing shortages might be alleviated if more men were entering alleviated if more men were entering the professionthe profession
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 25
Generational DiversityGenerational Diversity
Four generations work side-by-side:Four generations work side-by-side: TraditionalsTraditionals Baby boomersBaby boomers Generation XGeneration X Generation Y (millenials)Generation Y (millenials)
Each generation has different values Each generation has different values and expectationsand expectations
Generational differences can be Generational differences can be leveraged to produce better leveraged to produce better outcomesoutcomes
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 26
Violence Prevention and Violence Prevention and Disaster PreparednessDisaster Preparedness
Nearly 500,000 nurses victim of Nearly 500,000 nurses victim of workplace violenceworkplace violence
Other threats affecting nurses Other threats affecting nurses include:include: DisastersDisasters TerrorismTerrorism PandemicsPandemics
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Staff Training for DisastersStaff Training for Disasters
Computer simulationsComputer simulations Video demonstrationsVideo demonstrations Disaster drillsDisaster drills Preparation a mustPreparation a must
Mass casualty event probably will occurMass casualty event probably will occur
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LEARNING OUTCOME 9LEARNING OUTCOME 9 Discuss the changes and challenges Discuss the changes and challenges
that nurses face now and in the that nurses face now and in the futurefuture
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 29
Aging Patients, Aging Aging Patients, Aging NursesNurses
Aging patients increase the demand Aging patients increase the demand for health carefor health care
As aging nurses retire, the nursing As aging nurses retire, the nursing shortage will grow worseshortage will grow worse
Demand for nurses will continue to Demand for nurses will continue to growgrow
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 30
Changes Facing NursesChanges Facing Nurses
Change will become the one constantChange will become the one constant Nurses becoming full partners in Nurses becoming full partners in
health carehealth care Focus of nursing education changingFocus of nursing education changing
Apply knowledgeApply knowledge Clinical reasoningClinical reasoning Integrating classroom and clinicalIntegrating classroom and clinical
Focus on quality controlFocus on quality control
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Changes Facing NursesChanges Facing Nurses
Access to care is affecting policy Access to care is affecting policy decisionsdecisions
Every nurse must be prepared to Every nurse must be prepared to managemanage
Organizations must provide Organizations must provide management training for all nursesmanagement training for all nurses
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The Nurse ManagerThe Nurse Manager
Balances the needs of administrators Balances the needs of administrators and employeesand employees
Functions as coach, teacher, and Functions as coach, teacher, and facilitatorfacilitator
Motivates and inspires othersMotivates and inspires others
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Nurse managers today are Nurse managers today are challenged tochallenged to
Monitor and improve quality careMonitor and improve quality care Manage with limited resourcesManage with limited resources Help design new systems of careHelp design new systems of care Supervise teams of professionals and Supervise teams of professionals and
nonprofessionals from a variety of nonprofessionals from a variety of culturescultures
Teach personnel how to function well in Teach personnel how to function well in the new system.the new system.
The nurse manager balances the needs of The nurse manager balances the needs of administrators, colleagues in other administrators, colleagues in other
disciples, and employeesdisciples, and employees. .
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