Assessment—The Registered Nurse (RN) collects comprehensive data relevant to the health or situation of the health care consumer. Outcome Identification—The RN identifies expected outcomes for a plan tailored to the healthcare consumer or situation.
Standardized Nursing Languages Approved by the American Nurses Association
Nursing Minimum Data Sets (NMDS)
One way to better identify nursing-sensitive outcomes has been the development of standardized nursing languages. Currently, 13 standardized nursing languages have been approved by the ANA, of which 1 has been retired.
Nursing Management Minimum Data Sets (NMMDS) 12. ABC Codes
Select at least one of these measures and specify how you would collect the data. A standardized nursing language provides nurses with consistent terminology to describe and document their assessments, interventions and the results of their actions.
Patient Care Data Set (Retired)
It assumes that production and service focus on the individual and that quality can always be better. TQM is based on the premise that the individual is the main element on which production and service depend (ie, it must be a customer-responsive environment) and that the search for quality is a continuous process.
Total Quality Management Principles
- Eliminate slogans, exhortations, and targets for the workforce
- Focus on quality and not just quantity; eliminate quota systems if they are in place
- Promote teamwork rather than individual accomplishments. Eliminate the annual rating or merit system
- Educate/train employees to maximize personal development
- Charge all employees with carrying out the TQM package
Ideally, everyone in the organization should participate in quality control, because every individual is a recipient of the benefits. Even staff friendliness can affect patient satisfaction and the perception of quality care.
Sentinel Events Identified by The Joint Commission
These SC programs should include a review of the care provided by all departments, disciplines and clinical practitioners; coordination and integration of findings of quality control activities; and developing specific plans for known or suspected patient problems. JC also maintains one of the nation's most comprehensive databases of protective (serious adverse) events from health care professionals and their underlying causes.
The Joint Commission Core Measures for 2016
Hospitals that choose not to participate in the Core Measures initiative receive a 2% reduction in their annual Medicare payment. In 2014, the performance measurement requirements for accredited general medical/surgical hospitals were expanded from four to six core measures.
The Five Steps of Medication Reconciliation
Centers for Medicare & Medicaid Services Pay for Performance Programs
Another external force that assesses quality control in healthcare organizations is the National Committee for Quality Assurance (NCQA). Many studies over the past two decades suggest that medical errors are widespread in the health care system.
KEY CONCEPT
Retrieved January 19, 2016 from http://www.ncqa.org/tabid/59/Default.aspx National Coordinating Council for Medication Error Reporting and Prevention. Retrieved January 18, 2016 from http://www.jointcommission.org/assets/1/6/CAMH_24_SE_all_CURRENT.pdf The Just Culture Community.
Introduction
Leadership Roles and Management Functions Associated With Performance Appraisal
- Individualizes performance goals and the appraisal interview as needed to meet the unique needs of a culturally diverse staff
- Role models risk taking in seeking feedback from subordinates and colleagues regarding own work performance to promote self-growth
- Provides frequent informal feedback and coaching on work performance throughout the evaluation cycle to promote employee success
Exploring the Effects of Psychological Contract Fulfillment on the Perceived Fairness of Employee Performance Appraisal in the US. Performance appraisal fairness was based on employees' perceptions of whether their performance was procedurally fair.
Factors Influencing Effective Performance Appraisal
An advantage of MBO—the use of personal goals to measure individual performance—is the way it involves the employee in evaluating his or her work performance and in goal setting. Often the Matthew effect is compared to the saying "the rich get richer and the poor get poorer." Previous assessments thus prejudge an employee's future attempts.
Management Strategies for Successful Performance Appraisals
Often, merit increases are tied to a total point score (ie, an employee must achieve a certain score to receive a salary increase). This technique effectively forces the evaluator to focus on the positive aspects of the employee's performance.
Summary of Performance Appraisal Tools
Make sure that the aforementioned conditions are met (for example, the employee knows the standard by which his or her work will be assessed) and that he or she has a copy of the assessment form. However, coaching does not replace the employee's need for self-motivation. Make sure the feedback is not selfish, but meets the needs of the employee.
The result of the assessment process should provide the manager with information to meet training and educational needs of employees. The employee performance appraisal is a sensitive and important part of the management process, which requires a lot of skill. What additional criteria would you add to the list to help eliminate much of the trauma that often accompanies performance appraisal (even when the appraisal is very good).
Steps in the recovery process and the healthy chemically impaired nurse's re-entry into the workforce are also discussed.
Leadership Roles and Management Functions in Dealing With Problem Employees
- Examines the work environment for stressors that contribute to substance abuse and eliminates those stressors whenever possible
- Keeps patient safety first and foremost when considering how best to intervene with problem employees
- Recognizes that all employees have intrinsic worth and assists them in reaching their maximal potential
- Acts as a resource to chemically or psychologically impaired employees regarding professional services or agencies that provide counseling and support services
- Collects and records adequate objective data when suspicious of employee chemical impairment 12. Focuses employee confrontations on performance deficits and not on the cause of the underlying
- Works with the rule breaker, psychologically or chemically impaired, and/or marginal employee to develop a remedial plan for action; ensures that the employee understands the performance
Discipline is often thought of as a form of punishment, but it is not quite the same as punishment. This approach is also destructive because discipline is often carried out arbitrarily and is unfair either in the application of the rules or in the resulting punishment. Although self-discipline is internalized, the manager plays an active role in developing an environment that encourages self-discipline in employees.
Self-discipline is possible only if subordinates know the rules and accept them as valid. Employees lack the confidence to have self-discipline if they do not trust their managers. If formal discipline is used quickly and widely, subordinates have no opportunity to demand self-discipline.
Certain guidelines must be followed if discipline is to be perceived by subordinates as growth.
McGregor’s Hot Stove Rules for Fair and Effective Discipline
- Forewarning
- Immediate consequences 3. Consistency
- Impartiality
This reprimand involves an informal meeting between the employee and the manager to discuss the rule violation or performance deficiency. The manager suggests ways that the employee's behavior could be changed to prevent them from breaking the rule again. The employee and manager must sign a warning indicating that the problem or incident has been discussed.
One copy of the written warning is then given to the employee, while the other copy remains in the employee's personal folder. Such exclusion gives the employee the opportunity to reflect on the behavior and plan how to change the behavior in the future. However, if the manager has given repeated warnings and the violation of rules or policies continues, the employee should be fired.
In performance deficiency coaching, the manager actively brings areas of unacceptable behavior or performance to the attention of the employee and works with him or her to establish a plan to correct deficiencies.
Performance Deficiency Coaching Scenario
A request for input from the employee. Employee participation in solving the problem. A plan for following up on the problem. Be clear whether the employee and supervisor have a shared responsibility for improving the employee's work performance (Mayhew, 2016). All formal disciplinary discussions should be scheduled in advance at a time that is acceptable to both the employee and the manager.
State the date on which employment is terminated as well as the employee's and organization's role in the process. The employee has the right to a positive work environment, but has the responsibility to communicate needs and dissatisfaction to the manager. Before such transfers, however, both the manager and the employee should talk frankly about the employee's abilities and the manager's expectations.
Other managers simply choose to ignore the problem and try to "bypass" the employee.
Characteristic Changes in Chemically Impaired Employees
The employee can be absent from the department for short periods without a valid reason. In the data or evidence gathering phase, the manager gathers as much hard evidence as possible to document suspicions of chemical disturbances in the employee. The manager must firmly and unemotionally tell the employee that he or she is not allowed to return to the work area because of the manager's perception that the employee has a chemical disability.
The supervisor must ensure that the employee is taken home so that he or she does not drive with a disability. This kind of direct confrontation between the manager and the employee is the second stage in dealing with the employee suspected of chemical disorders. The manager must ensure that the confrontation remains focused on the employee's performance gaps and does not allow the discussion to focus on the cause of the underlying problem or addiction.
The final stage of the confrontation process is to outline the organization's plan or expectations for employees in overcoming the chemical injury.
Additional Learning Exercises and Applications
The manager-leader believes that each employee has the potential to become a successful and valuable member of the unit and intervenes accordingly to meet the specific needs of each employee. None of your staff were within earshot of Joey's room at the time of the alleged incident. You believe Monica is capable of charges, but are reluctant to impose any discipline without proof.
Because all employees are professionals, you have used a very democratic approach to management and leadership. This arrangement allows three nurses to be on duty 1 day a week, if no vacation or other time off is scheduled by either of the other two RNs. Suddenly you notice that one of your employees has changed their schedule for the past two days and only one of the RNs works on Wednesdays.
Assume that additional staff cannot be hired because of the special expertise required to work in this department.
Solutions to Selected Learning Exercises
This way you save some time and go directly to the person in charge. Because the clerk would work in the nursing office, she would have some loyalty to Sally. Once the overall goal is agreed upon, you and Carol will be able to find alternative solutions to the problem.
The designated team leader should initially thank the head nurse for agreeing to the meeting. The team must make a sincere effort to listen to the head nurse and keep up with changes to their plan. Summaries should be forwarded to the individual responsible for quality improvement, in this case the agency director.
Alternative 1 – Although this would provide a quick solution to the problem, there are many negative aspects to this alternative. Alternative 2 – This alternative would immediately remove the problem from the supervisor and would likely please the staff. Alternative 3 – This alternative requires a long-term and time-consuming commitment on the part of the manager.
