Important Notes for Clinical Nurse Leader (CNL) Exam

Virtue Ethics:
Example: Right-to-Die laws.
Virtues: What do they look like?
Compassion
Discernment
Trustworthiness
Integrity
Ethical Principles:
What are they? Match the virtues
Beneficence
Non-maleficence
Justice
Autonomy
Fidelity
Respect for others
Veracity
Legal Issues:
Licensure- RN and others, NPA, BRN
Legislature (What is the law?) Regulatory body (Implementing)?
Nurse Practice Act: Legislature
BRN (Regulating Body) Implementation of the law is Regulations.
Policies and Procedures (hospital dictates what a licensed person
may or may not do).
Patients rights: HIPPA, informed consent: (capacity, voluntariness,
information).
Ex: Mentally challenged individual is asked to sign a consent
form: capacity
Language barrier: information
Management: delegation and supervision
Employment: ADA (American Disability Administration); FERP (Federal
Employee Right to Privacy); OSHA (Occupational Safety and Health
Administration); FMLA (Federal Maternity Leave Act).
Decision Making
Group think: all members think-alike (e.g., group becomes very
click-e).
Rational/normative: logical, well-grounded choices (e.g., what we
should do)
Descriptive/bounded rationality (e.g., cant afford what needs
and should be done).

Delphi: (e.g., surveys that help a group make decisions).

Normative: (e.g., brainstorming; how are we going to do this?).

Source of Conflict
Intrapersonal: manage of moral dilemmas within a person
Interpersonal: conflict with other nurses, doctors, etc.
Organizational: CNL want to change something and system says
NO.
Conflict Management Techniques
Avoiding (ignoring conflict).
Accommodating (smoothing- 1 sides gives in to the other side).
Competing (2 to 3 compete for goal).
Compromising: something is given up.
Negotiating: agreement but no consensus.
Collaborating: win-win.
Confronting: Stops conflict immediately.
RN Care Delivery Systems
Functional: Medications, IVS, Vital Signs, and drawing blood (seen
more in nursing home).
Team Nursing: doing care for a group of patients.
Total Patient Care: ICU nurses (care is complete).
Primary nursing: 24 hrs. a day (from beginning to end you see
the care of the patient).
Practice Partnerships: Nurses take on students.
Case Management: population based and makes sure they get
what they need.
Critical Pathways: algorithm how to manage the care of patient
(e.g., cardiac thoracic patient with urinary cath) For example: if
an order has not been rewritten in 24 hours you as a nurse
remove the catheter).
Differentiated Practice: LVN versus RN- practices are different.
Patient-centered care: everyone on the team focuses on the care
of the patient.
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Delegation
Responsibility:
Accountability:

Benefits to delegate
Obstacles:
Liability and delegations: (5 rights: right task, circumstances,
person, direction and communication and right supervision).

Budgeting
Revenue Budget:
Reimbursement: fixed cost/case pre-determined amount
(Medicare) DRGs (private companies); negotiated discounts;
capitation: one rate/member/month (regardless of service
provided). Ask for variance when patient DRG is not related to
condition. Read: Steven Brills Book.
Budget Terms
Direct Costs
Indirect Costs
(# of patients come out of the unit. Low census, low employed
staff).

Financial Information
Operating Budget: doing business.
Capital Budget: growing business.
Cash Flow Budget: in and out cash flow of business
Zero-based budgeting: next budget is zero; all expenses justified
for each period (no money for carryover).
All budgets: over time.
Revenues (payers: insurance companies, government and the
people).
Volume (days, visits, procedures).
Expenses (staff/supplies).
Variances (pay for them).
CNL justification costs (decrease costs by evidence-based
practice, decreases recidivism rates, no more readmission,
patient milestones are met, decrease the poor outcomes).
Having a CNL decrease expenditures!