Leadership Exam 2 Study Guide: Cpt.

6, 9, 10
Chapter 6: Patient, Subordinate, and Professional Advocacy:
1. Advocacy:
Advocacy: helping others grow/ self-actualize;
-inform others of rights; protecting one believes for others and self
Leader: use risk taking, vision, self-confidence, ability to articulate needs, assertiveness
Manager: for all
-whistleblower- legislator/media/ influence health policy
-Nurses act as advocates by helping others make informed decision,
By acting as an intermediary in the environ,
Or directly intervening on behalf of others

International Council of Nurses definition of advocacy:

-blending: science/ ethics/ politics
-self-initiated/ evidence based/ strategic action
-help transform systems/ improve environ/policies that shape pts: behave/choices/health
-Nursing values central to advocacy emphasize caring, autonomy, respect,

empowerment.
Leadership Roles:
1. Create Climate-value advocacy + assoc risk taking
2. Seek fairness/justice for those unable
3. Strengthen Pt/ subordinate support systems- encourage autonomy/ decision making
4. Provide info to empower autonomy
5. Assertively advocate for others when needed
6. Participate in proff nursing organize/groups that advance nursing proff
7. Role Model proactive involvement in health-care policy
8. Speak up to advocate for health care practices for safety/ quality improve
9. Help create national/ legal binding Bill of Rights for pts
10. Social justice/ individual pt advocacy
11. Differentiate btwn control pts/ assisting choices--- domination/dependence vs.
freedom
Management Functions:
Advocate for:
1. pt/subordinate adequate info for making decisions
2. Prioritize pt- rights/ values
3. Consultation for pt, if inter/intrapersonal conflict
4. Promote workplace safety/health for all
5. Encourage subord express concerns/ impunity for whistleblowers
6. Demonstrate skills to deal w/ media/ legislators health care issues

7. Aware of current legislative that affects nursing practice/ organizational manage

8. Work environ promotes empowerment to speak up for pts, self, proff
9. Safe/ conducive for proff growth
10. Take immediate action: illegal/ unethical/ inappropriate behave that endangers/

jeopardizes all
Nursing Values Central to Advocacy:
Individuals have right to:
1. Right to autonomy deciding course of action/ health-care goals
2. Right to hold personal values/ make decisions
3. Right to Access of info- to make informed decisions
4. Nurses acts on behalf of those unable to
5. Empower pts/ subordinates to make decision for their own essence of advocacy

Patient Advocacy:
Disease/ Aging/ Physical/ Mental Disability can result in: dec independence, dec

freedom, dec ability to make choices alone advocacy ensures vulnerable protected
Important for pt-advocate to differentiate btwn:
Controlling pt choices (domin/dependence)
Assisting pt-choices (freedom)
Common Areas- Requiring Nurse-Pt Advocacy:
1. End- of life decisions
2. Techn advances
3. Reimbursement- health care
4. Access to health care
5. Provider-pt Conflicts- expectations/ outcomes
6. Withholding info
7, Insurance coverage: authorize/ denials/ delays
8. Pt privacy/ confidentiality
9. Med Errors
10. Pt grievances/ appeals
11. Cultural/ ethnic diversity senility
12. Respect/ dignity for pts
13. Incompetent HCP
14. Inadequate consent
15. Complex social probs: AIDS, teen preg, violence, poverty
16. Aging Pop

Patient Rights:
-Consumer Bill of Rights/ Responsibilities (Pt Bill of Rights): 1998; laying out
rights/responsibilities of pts and hcp

-3 Goals: 1. Pts feel more confident in HCP

2. Stronger pt-hcp relationship
3. Pts play key role in staying healthy-Affordable Care Act 2010: eliminate coverage limits; choice for physician w/in
network plan; child w/ preexisting med conditions can still get health insurance; child can
stay on parents insurance until age 26; health insurance cant rescind/ take back coverage
from honest mistakes on applications.
-Health Insurance Portability and Accountability Act-(HIPPA): 1996

Subordinate/ Workplace Advocacy:

-Subordinate Advocacy: leadership role;
-standard 16 of ANA Scope / Standards for Nursing Admin: nurse admin
should advocate for HCP, subord, pts- especially for safety
-Workplace Advocacy: critical manager role; safe/ conducive for personal growth;

prevent workplace violence

-OSHA- Occup Safety/ Health Administration: reports 2 mill victims of workplace
violence/ yrt5
-Common issues for subordinates/ employees:
-health/safety: needle sticks/ blood/body fluid exposures/ workplace violence;
-work hours, staffing ratios, fair/equitable wages/ allowed participation in
organization decisions making
-resources: nursing shortages,

How to Create an Environment that Promotes subordinates:

1. Invite collaborative decision making
2. Listen to staff needs
3. Get to know staff personally
4. Understand challenges faced by staff in delivery of care
5. Face challenges/ solve probs together
6. Advocate for employees
7. Promote shared governance
8. Empower staff

9. Promote nurse autonomy

10. Provide staff w workable systems
-Managers need to establish/utilize: support systems/ ethical committees/ channels to deal
w/ ethical problems.
Whistle blowing as Advocacy:
Present Day Ethical Malfeanse: very high due to: managed care; declining

reimbursement; ongoing pressure for fiscal solvent; risk/fraud/misrepresentation

Whistle blowing needed:
2 Types:
Internal: w/im organizations
External: reporting from media/ elected officials
-Managers must ensure no retaliation taken against whistle blowers
-Speaking out as a whistleblower is often honored more in theory than in fact: public

wants justice, but also sees whistle blowing as distrustful

-Professional duty to: uncover, openly discuss, and condemn shortcuts that threaten pts
-sense of right/wrong. Commitment to allow prob through until accept level of resolution
reached
-Leader- managers must be willing to advocate for whistleblowers, who speak out

about organizational practices that they believe may be harmful/ inappropriate

Professional Advocacy:
-State Nurse Practice Acts and State Listening: result of nurses advocating for proff
accountability
-leaders responsible for: collaborating defining proff; achieving legal recogn;
establishing a culture of proff nursing; proff leadership role; personal/public promise
serve others ; proff issues= always ethical; raise consciousness of colleagues
-A professional commitment means people cant shrink from: duty to question/
contemplate probs that face the profession
-Mangers duties: broaden sociopolitical knowledge; understand bureaucracies; speak out
on consumer issues; attempt to expand legislation; increase membership of govern health
policy-making; influence probs such as: homeless, teen preg, drug/alcohol abuse,
inadequate health care for poor/elderly, med errors

Nurse Advocacy Role in Legislation/ Public Policy:

-Influence public policy by: active in national nursing organizations; directly lobby
legislator in person/by letter; collective influence to impact health care policy
-Nurses must exert their collective influence
-make concerns known to policy makers
-before: having a major impact on political/ legislative outcomes
-Political action Committees (PACs): of Congress of Industrial Organizations- attempt
to persuade legislators to vote certain way; lobbyist of PACs may be from: groups
interested in partic law or paid agents want bill passed/defeated
-Nurses need to be more active in PACS
-Nurse should lobby for: quality of care, access to care, safety, restructuring, direct
reimbursement for advanced practice nurses; funding for nurse education

Key Chapter Concepts:

1. Advocacy= helping others grow/ self actualize; is a leadership role
2. Managers- must advocate for pts, subordinates, profession
3. Pt advocate needs to differentiate btwn controlling/dominating choices vs. assisting
choices/ freedom
4. Since 1960s some advocacy groups/ proff assoc/ states have passed Bill of Rights for
pts; although not legally binding-used as a guide for proff practice
5. Workplace advocacy- manager ensures work environment is safe/ conducive to
proff/personal growth for subordinates
6. Public wants wrongdoing/corruption to be reported; Whistleblowers distrusted/seen as
disloyal/ experience neg repercussions for actions.
7. Leader-managers must be willing to advocate for whistleblowers, who speak out
8. Professional issues are ethical issues. When nurse finds discrepancy btwn perceived
role/ societies expectations; they have a responsibility to advocate for the profession.
9. For nurses to advance as profession; practitioners/ managers must broaden
sociopolitical knowledge base to better understand bureaucracies.
10. Legislators/ Policy makers more willing to deal w nurses in groups-joining/ actively
supporting proff organizations allow nurses to have greater voice in health care issues.
11. Nurses need to exert collective influence/ make concerns known to policy makers
before can have major impact on political/ legislative outcomes.
12. Nurses have great potential to educate public/ influence policy through media as a
result of publics high trust in nurses and because public wants to hear about health care
issues of nursing perspective.
Chapter 9: Time Management

-Short-term planning: specific task, less complex, annual/ quarter/ monthly/ weekly/

daily/ hourly
-not planning= stressful, increased errors,
-managers: need to find time to plan
Time Management: making optimal use if available time
-Good time management skills allow individual to spend time on things that matter
-optimize time manage: prioritize duties; manage/ control crises; reduce stress; balance

work/ personal time

Leadership Roles- Time Management:
1. self-aware of personal blocks/ barriers to efficient time manage
2. Recog own value system influence time use/ expectation of followers
3. Role model/ supporter/ resource person in setting goal setting priorities
4. Assist followers in working cooperatively- max time
5. Prevent/ filter interruptions
6. Role model flexibility w/ diff people/diff time manage styles
7. Calm reassurance during high unit activity
8. Prioritize conflicting/ overlapping requests for time
9. Appropriately determine quality of work needed
Management Functions- Time Management:
1. Prioritize day-to-day planning meet long/short term goals
2. Make time for planning during work schedule
3. Analyze how time managed job analysis/ time-and-motion studies
4. Eliminate environ barriers for employees to effective time
5. Do paperwork prompt/efficiently clean work area
6. Break large tasks into smaller easily accomplishable
7. Appropriate techn for timely communic/ documentation
8. Diff btwn inadequate staffing vs. inefficient use of time
3 Basic Steps: Time Management
1. Time set aside for planning/ establishes priorities
2. Complete Highest Priority task first, then move onto next
3. Reprioritize based on new info
Taking Time to Plan/ Establish Priorities:
-planning= manage by efficiency instead of by crisis
-Planning Fallacies- believing doing the same style will result in diff outcomes, when it
didnt work before
-managers: first step plan; pause/decide how people/ activities/ materials put together for
goal
-Unfortunately, 2 mistakes common in planning are:
Underestimating importance of daily plan
Not allowing adequate time for planning
-SMART plan: think, ablaze data, envision alt, make decisions

Ex: day-day: charge nurse staffing, pt care assign, coord lunch breaks,
EX: staff nurse: how handoff reports given/received, timing/ methods initial assess,
coord of meds, tx, procedures, docum

Smart Approach to Planning:

1. Set specific, clear goals
2. Record progress measurable- maintains interest
3. Id steps needed to accomplish
4. know specific time constraints; set goals accomplishable w/in time constraints
5. set time frame/ plan for this
Time-efficient Work Environment:
1. Gather all supplies/ equipment before starting activity
2. Group Activities that are in same location
3. Use time estimates- complete activates around w/in
4. Document nursing interventions asap after activity completed
5. Always strive to end/begin workday on time
-managers: coordinate how duties carried out; work simpler/ efficient; how supply
ordered/ organized; efficient breaks; facilitate greater productivity/ satisfaction
Planning Actions for unit manager to id/ utilize time:
1. ID key priorities to be accomplishes
2. Determine level of achievement expect from others
3. Asses staff
4. Review short/long term goals regularly
5. Plan ahead for meetings
6. allow time throughout days for assessing progress
7. Take regularly schedule breaks- prevents burnout
8. Use electronic calendar feel less chaotic
-Setting new priorities/ adjusting priorities to reflect ever-changing work situations=

ongoing reality for unit manager

Priority Setting/ Procrastination:
Priority setting is perhaps most important critical skill in good time management,
Because all actions taken have some type of relative importance
Prioritization- 3 categories:
1. Dont Do: probs resolve on own; outdated; accomplish by someone else
2. Do later: trivial, no immediate deadline, ok to procrastinate for now;
3. Do now: day-to-day needs; daily staffing; equip shortages; schedules; hiring

interviews; performance appraisals

Making Lists:
- Prioritizing: do now; planning tool; coord daily operations; realistic to
accomplish in 1 day; educate time; dont confuse importance vs. urgency; reexamine
-

assess
Not all important things are urgent,
Not all urgent things are important

Some projects are not accomplished because they arent broken down into

manageable tasks
Reprioritizing: change when new info received ; if crisis-set aside original priorities for

day/ recognize/ communicate/ delegate new plan

-No amount of planning can prevent occasional crises
Dealing w interruptions: all managers experience; quiet work place needed; develop
skills to prevent interruptions; cope w change
-Lower-Level Managers experience more interruptions than higher-level managers

Time Wasters:
1. Technology- internet, gaming, email, social media
2. socializing
3. Paperwork overload
4. Interruptions
- dont need to check email 100 x per day
How to prevent subordinates from taking manager time:
1. Dont make self overly accessible
2. Interrupt rambling
3. Be brief- stand up when done
4. Schedule long-winded individuals
Personal Time Management: self-knowledge/ aware; clearly id personal goals/

priorities; greater control over expenditure of energy; what needs to be accomplished

-Managing time is diff if person is unsure of his/her priorities for time manage,
Including personal short/ intermediate/ long term goals
Brans 12 Habits to Master: Personal Time Management:

1. Favor trusting relationships

2. Maintain lifestyle to max energy
3. Listen to biorhythms/ organize day accordingly
4. set very few priorities, stick to them
5. Turn down things that inconsistent w/ priorities
6. set aside time for focused effort
7. look for ways to do things
8. build solid processes
9. spot trouble/ solve probs immediately
10. break your goals into smaller units, one at time
11. Finish whets important, stop doing what is no longer worth wild
-Everyone avoids certain types of work/ has method of wasting time
Productivity sweet spot: times of day or certain lengths of times that people work best at
-lack of punctuality suggests that you dont value other peoples time
Integrating Leadership Roles and Management Functions in Time Management:
-managing time well- reduce stress
- must deal with less: status if health care; nursing shortage; decrease reimbursement

-intrapersonal commuic skills;

Chapter 10: Fiscal Planning:
-Fiscal planning is not intuitive; learned skill that improves w/ practice
-Fiscal planning- requires vision, creativity, knowledge pf political/ social/ economic forces that
shape health

Leadership Roles- Fiscal Planning:

1. visionary/ id forecasting short/long-term; proactive instead of reactive
2. Knowledgeable about pol, social, economic factors
3. Flexibility in fiscal goal setting in rapidly changing system
4. Anticipates, creatively solves budget constraints
5. Inspires members to be active in fiscal planning
6. Recog when fiscal constraints have impaired organiz goals; communicate needs
through chain of command
7. Pt safety not jeopardized by cost constraints
8. Role models leadership needed for reform efforts
9. Prepares for changed rt reform + implement patient protect affordable care act
Management Functions:
1. Id important/ develop short/long tern fiscal plan for unit needs
2. Articulate/ documents needs to higher administrators
3. Assess internal/ external environ id driving forces/ barriers fiscal plan
4. knowledge of budgeting / appropriate techniques
5. opportunities for subordinates to [participate in fiscal plan
6. fiscal planning congruent w/ organiz goals/ objectives
7. assess personnel needs pre-determined standers of pt classify systems
8. Document pts needs for services- facilitate organizational reimbursement
9. monitor aspects of budget control
10. collaborate w hc administrators- determine how imitative (VBP, ACOs, Bundled
payment; medical home, health insurance) impact organizational viability.
Balancing Cost and Quality:
-cost containment: effective/ efficient delivery of services while generating revenues for

continual organizational productivity

-cost-effective: producing good results for amt for money spent; worth the cost
-spending more does not always equate to higher quality health outcomes
Responsibility Accounting: organizations revenues, expenses, assets, liabilities, is

someones responsibility
Forecasting: making educated budget estimate by using historical data
Budget: financial plan includes expenses as well as income for period of time

-The budgets value is directly rt its accuracy

Fixed expenses: dont vary w/ vol

Variable: do vary w/ vol
Controllable expense: varies by manager- ex: control number of staff
No controllable expense: cant be varies, ex: number/type of supply needed by pt
Steps in Budgetary Process:
1. Assess what needs to be covered in budget
2. Dx- goals and create cost efficient budget to get there
3. Develop plan- 12 months-fiscal year budget; perpetual budget- each month
4. Implementation- ongoing monitoring / analysis- monthly statements/ deviations
5. Evaluation- reviewed periodically/ adjusted
-Budget that is predicted too far in advance has greater probability for error
Fiscal Terminology:
1. Accountable Care Organizations (ACOs): group of providers/service work
together to coordinate care for Medicare patients
2. Acuity Index: weighted stat measurements, refer to illness severity to patient in
given time. Classified by acuity; four categories. Acuity index=total acuity/#of
patients
3. Affordable Care Act: passed march 2010; all Americans have: access to
affordable health care, reduced barriers to obtaining coverage, access to services
4. Assets: financial resources received by healthcare orgs, ex: accnt receivable
5. Baseline data: historical info on $ spent, acuity level, census, resources needed,
hours of care, etc. future needs projected
6. Breakeven point: point at which revenue = cost. Must maintain high vol to
decrease unit cost
7. Bundled Payment: hcp receives a sum for treating overall condition instead of
individ treatments. Rewards for coordinating care, prevent complications/errors,
reduce unnecess tests.
8. Capitation: prospective payment sys (pps) pays health plans fixed amount
per enrollee per month, regardless of num of services used
9. Case mix: type of patient served by place. Acuity levels, dx, tx
10. Cash flow: rate of $ recvd /dispersed
11. Controllable costs: varying costs. Ex: wage levels, qual of materials
12. Cost-benefit ratio: value of activity: benefits; expressed in fraction
13. Cost Center: nursing unit, ortho center, cast room
14. Diagnosis-related groups (DRGs): rate setting pps used by Medicare to
determine payment rates for inpatient hosp stay based on diagnosis; flat dollar
reimbursement; costs may be higher or lower than actual costs
15. Direct Costs: costs attributed to specific source; goods or service

16. Fee for service system (ffs): reimbursement sys after service delivered
17. For profit org (fpo): financial contributors have ownership interest; own stocks;
dividends on profits
18. Full-time equivalency (FTE): number of hours worked by ft employee for one
week. FTE 1.0=5 8 hour days = 40 hours per week
19. Health maintenance organization (HMO): prepaid org; healthcare providers
receive preset money on per person per month basis; managed care
20. Hours per patient day (hppd): hours of nursing care/ patient/day; various level
of nursing personnel
21. International Classification of Disease codes (icd): coding used to record
severity and treatment of dx, illness, injuries; determines reimbursement; revision
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22. Indirect Costs: example housekeeping. You know this.
23. Managed care: healthcare plans that contain costs of services, maintain qual
24. Medicaid: fed assisted, state administered; low income indiv; groups: elderly,
blind, disabled, families, pregnant women
25. Medicare: nationwide; title 18 of ssact, 65 and older; catastrophic chronic
illness: als, renal failure,
26. Noncontrollable costs: indirect expenses, ex: rent, lighting, wear and tear of
equip.
27. Not for-profit organization: financed by several sources, contributors have no
ownership interests; profits generated go back to hosp for expansion/capital
28. Operating Expenses: daily costs
29. Patient classification system: different criteria; classification of patients; acuity
30. Pay for performance programs (P4P): incentives pay to each cp to get top
clinical performance; for specific patient pop
31. Pay for Value programs: payment incentives to hcp for specific setting; increase
qual efficiency
32. Preferred provider organization (PPO): contracts to give service on fee for
service sys. Incentives for consumers to use select group of preferred hcp, pay
less for services. Insurance companies promise certain vol of patients/prompt
payment for fee discounts
33. Production hours: total amount: reg time, temp time, over time.
34. Prospective payment system: predetermined reimbursement for services
35. Revenue: source of income/reward for patient services
36. Staffing mix:
37. Third-party: usually ins co, govt agency pays patient bill
38. Turnover ratio: (employees leaving/#empl remaining)x100

39. Value-Based Purchasing: rewards qual of care through payment

incentives/transparency. Function of: qual, efficiency, safety, costs

40. Variable Costs: vary with volume, example: payroll
41. Workload units: patient days, #of procedures, tests, visits
Medicare:
Part A: Hospital insurance
Part B: supply med insurance- outpatient care
Part c: more choices for participating in managed care
Part D: 2006; pt can buy least limited prescription drug coverage