Module 1: Discussion Board: Nurse Executive Competency (due Wed.

) Discussion Board: Shared Governance Case Study: Lucille Brown Chapter 1 leadership principles chapter 2 management principles supplemental reading- chapter 1 of Innovation Leadership: Creating the landscape of healthcare 1. 2. 3. 4. 5. how do you define and describe leadership what are leadership styles what is the linkage between follower ship and leadership how does leadership apply to nursing practice how do you define and describe management and nursing management

discussion board 1- Do AONE assessment then post 4 professional goals I want to accomplish in this course as an introduction. assignment on Lucille Brown discussion board 2-shared governance
After reading the critical thinking article, I have found that I posses a few of the required skill to be a critical thinker. I tend to focus the relevant information given when making decisions, I ask many questions and research if something is unclear, weigh the risks and benefits, get others opinions, take charge if need be, and I am assertive, but fair. These are a few of the many skills that help provide great quality of care, and satisfaction for the patients and staff (Brunt, 2005). I have only had one supervisor in my nursing career because all my experience was in a nursing home and the turn over rate was very low. Although she chose to be an authoritarian all the time, she made all the decisions (Huber, 2010). I thought she was an excellent leader, and that is just what I needed when I began my career. The second week on the unit I got report from the night nurse that a patient was up without sleep for the fourth night. Upon making my first round, the patient was sitting in the hallway up against the wall with there eyes close and drool coming out of the mouth. Although there was an apical pulse and visible respiratory pattern, nothing seemed to arouse the patient. My supervisor was there within forty-five seconds, had done a quick assessment to verify my findings, and called a code. The patient was sent out to the hospital and revived three times in the ambulance. In my second year as a licensed practical nurse, I became charge nurse on the psychiatric unit in the nursing home. I was used to working day shift and having a float nurse, but after accepting the night shift position it was only me with thirty-six patients. I had a patient with bipolar who had been in a manic cycle for a few days, this particular evening the patient had got very verbal by cursing and threatening the nurse aides and a few other residents, as well as physically abusing self. I had tried distraction and being assertive, but nothing seemed to be working. After calling the psychiatrist, I was ordered to give the patient an injection of haloperidol to deescalate the destructive behavior. The patient was informed of the order and insisted that it was acceptable only if I gave the cogentin with it to counteract the anti-parkinson effects of the drug. The doctor disapproved the request, despite my encouragement. After researching the adverse effects of the medication, reflecting upon the pros and cons, I made a judgment to call the patient's primary care physician and explained the situation. He was happy to provide the order and follow up with the patient the next morning. The outcome was a positive one. Although I was empathetic and tried other methods, the patient knew that they needed both of the medications to help with the aggression. It only took fifteen minutes to research the adverse effects and call the doctors. In the end the patient calmed down and was able to function properly within the unit and around other patients. Reference: Brunt, B.A. (2005). Critical thinking in nursing: An integrated review. Journal of Continuing Education in Nursing, 36(2), 6067.Retrieved fromhttp://www.medscape.com/viewarticle/707855 on July 27th, 2011. Huber, D. L. (2010). Leadership and Nursing Care Management. (4th ed.). Maryland Heights, Mo: Saunders Elsevier Inc.

Module 2: Discussion Board: Nursing Information Systems or Nursing Management Minimum Data Set Case Study: Mary Lamonico Quiz (Good luck!) Begin Leadership, Teams, Norms Paper Chapter 36 data management and informatics 1 what is the importance of data management to decision making? 2 what are information needs in healthcare? What are the nurses data needs? 3 what is nursing informatics? 4 what is the nursing management minimum data set for administrative practice? 5 how do you integrate effectiveness research with nursing informatics? 6 what are standardized and retrievable management data sets? Assignment 1- case study on mary lamonico discussion board- What is the purpose of an electronic health care records? How can they improve safety for clients?
Com pute riza tion of he alth re cords or as some call it, ele ctronic he alth re cords are now amo ng doctors, data specialists, insurance companies, medical f a c i l i t i e s , d r u g c o m p a n i e s , a m b u l a t o r y, h o s p i t a l s , a n d l o n g - t e r m c a r e f a c i l i t i e s w i t h i n the health system. The goal is to improve patient care and eventually have worldw i d e u s e o f a l i f e l o n g h e a l t h r e c o r d f o r e v e r y o n e t o b e a c c e s s i b l e t o e v e r y p r o v i d e r. The combined use of electronic communication and information technology will transmit, store, and be able to retrieve data for clinical and educational purposes. The data includes patients demographics, progress notes, medications, vital signs, p r o b l e m s , p a s t m e d i c a l h i s t o r y, i m m u n i z a t i o n s , l a b o r a t o r y d a t a a n d r a d i o l o g y reports.

It will improve patient care and safety through health maintenance, disease management, lab testing, procedures, and ordering medications. Medical information this crucial, should be organized, accurate, and readily at hand, for convenience and especially when there is an emergency. The physicians can immediately record improvements, changes, and any other necessary data in the records. They can flag important information so other care givers will be alerted to something like an allergy to a medication. When a patient's electronic medical record is accessible by more than one doctor, it will reduce the incidence of medication errors, prevent delays in treatment, and duplication of testing, which in turn will result in better health decisions being made on behalf of the patient (U.S. Department of, June 2011).
References: U.S. Department of Health and Human Services, Center for Medicare and Medicaid services. (June 2011). Electronic health records overview. Baltimore, MD: Retrieved on 7/31/2011 from: http://www.cms.gov/EHealthRecords/

Quiz assignment 2- short paper on leadership, teams and norms

Module 3: Discussion Board: Communication Tools Case Study: Janet Menovich Leadership, Teams, Norms Paper Due Begin Productivity Paper Chapter 8 communication, persuasion, and negotiation chapter 9 motivation chapter 10 team building and working with effective groups chapter 12 power and conflict 1.what is the role of nursing leadership in goal setting, communicating, and negotiating? 2.how do leadership and other related theories apply to communication in the healthcare setting? 3.how do you, a nurse leader, facilitate appropriate communication networks in a task group process? 4.how do you define and describe motivation? 5.what is the link between motivation and leadership and management? 6.how do you define group, committee, team and team building? What are the elements and dynamics of group interaction? 7.why is the concept of power important to the nursing profession? 8. what are the causes, core process, and effects of conflict? Assignment 1- case study on janice menovich Assignments 2- leadership, teams, and norms assignment 3- 3 page paper in APA format discussion board- Community Systems1. discuss what actions created a positive outcome in this case study? 2. Who were the individuals who managed the intervention? 3. Define the communication process for what happened? 4. In your opinion, what are the pros and cons of this process? 5. If faced with a similar situation, how would you approach the communication issues brought up in the case study? After reading the case study, and how the patient got her chemotherapy without the diluent along with how the oncologist and management team handled the situation I was surprised. The fact that the oncologist chooses to fully disclose the mistake to Dr. Smith and her husband after being notified by the investigational pharmacist was the first step in the communication process. Honesty should be of high priority to any care giver. He ensured the patient's safety, and assumed the responsibility of the mistake and began working with the Dr. Smith, her husband, and the multidisciplinary team to evaluate trouble spots and develop effective ways of dealing with the possibility of future problems, thus maximizing the possibility of success (Duclos et al., 2005). There are several pros that came from this incident. Because the oncologist chose to be honest and up front about the mistake, they were able to maintain the close patient-doctor relationship. This mistake led to the staff getting further education and putting prevention methods in place so that another patient would not encounter the same problem that Dr. Smith did. I believe that the situation from the perspective of the multidisciplinary team, and the patient could not have been handled in a more graceful manner. I hope that I am never in a situation similar to this one, but will think back and

remember the way the team communicated with the patient and hope I can be as respectful and efficient. Reference: Duclos, C.W., Eichler, M., Taylor, L., Quintela, J., & Main, D.S. (2005). Patient perspectives of patientprovider communication after adverse events. 17(6):479-86. Retrieved on August 9th, 2011 from: http://intqhc.oxfordjournals.org/content/17/6/479.abstract doi: 10.1093/intqhc/mzi065

Module 4: Discussion Board: Quality and Costs Case Study: Sue Nugyet Quiz (Good luck!) Productivity paper due Chapter 28 staffing and scheduling chapter 30 financial management chapter 31 budgeting chapter 32 productivity and costing out nursing 1. what types of factors influence staffing management? Why? 2. what are the frameworks for staffing management? 3. what is forecasting workload? Staffing patterns? Position control? Demand management? Staffing allocations? And caregiver assignment? 4. what are the impact of staffing on different types of outcomes? 5. what role does the nurse leader play in managing the convergence of operations? 6. how do you differentiate between changes and cost? 7. how do you define and describe a budget? What are the different types of budgets? 8. what are the stages of the typical budgetary process? 9. how can you use the production process model to analyze productivity? Assignment-case study on sue nugyet assignment 2- productivity Quiz discussion board- quality and cost1. define an issue at your own hospital where you must improve quality and lower costs 2. 2. discuss which stakeholders you need to speak with in order to facilitate this plan 3. determine the cost and the benefits of your solution 4. calculate the financial impact and the return on investment 5. what communication processes would you use to disseminate findings?
One of the major problems in hospitals is healthcare associated infections (HAI). It prolongs the suffering of an individual, and it also increases the cost healthcare and as well as direct and indirect economic impact and lack of productivity. Even though the actual cost for HAI is not easy to obtain, it is very high. It is estimated by the United States Institute of Medicine that preventable severe patient occurrences, inclusive of acquired infections account for 1.7 million infections and 99,000 deaths each year in the United States, with an approximated cost of $17-$29 billions (Department of Health, 2010).

Efforts based on control and prevention are seriously required to focus on all healthcare collectives at regional, local, and national levels and should consider the various roles they play and other functions to control the further spread of the people coming into and out of the facility. Providing a high priority on implementation of infection-control measures within the entire healthcare environment for all the activities within the health care like guidelines for hand hygiene policies to protect healthcare workers and patients. As well as, routine management of equipment as well as patient environment among other aspects like, sanitation clean sterilization, as well as disinfection procedures, disposable equipment among many others (Burde, 2002). The healthcare's institution management should nominate an infection prevention and control team to foster education training research as well as prevention and control of HCAIs. Most of the patients who are infected by the HCAI are already to burden to meet their daily healthcare costs, and some of them depend on welfare. As such every institution, the state and other concerned stakeholders need to invest particularly on the epidemiology research to come up with a better solution to this problem. Meanwhile public awareness together with the elementary precautions should be done to contain the problem. The cost of not including and maintaining quality can very well be more expensive than providing quality in the products and services offered to prevent it. Many say that building quality takes money and time. However, authors and practitioners like Crosby argue that Quality is Free (1980), meaning that an organization can establish a quality program and will be saving more money than what they would pay for a quality program. Research on the efficiency of hospital associated infection control and the study of the efficacy of nosocomial infection control(SENIC) approximated that injection costs of control terms stood at about only 7 percent of the total costs of infection (Wenzel & Edmond, 2001). So if the control programs of infections were forward to be effective in the prevention of about 7 percent of HAI then it can be conducted that the program costs would be covered already. Reference: Burde H. 2002 The Implementation of quality and safety measures:from rhetoric to reality. J Health Law,Spring. Crosby, P. 1980. Qualityis Still Free:The art of making quality certain.New York. McGraw-Hill Company. Retrieved on August 15, 2011 from: http://www.philipcrosby.com/secure/bookcc02.htm Department of Health, 2010. Bureau of Epidemiology. Healthier people through excellence in epidemiology. Healthcare-associated infection prevention program.Retrieved on August 15, 2011 from:http://www.doh.state.fl.us/disease_ctrl/epi/HAI/HAI.html Wenzel, R.P., & Edmond, M.B. (2001). The impact of hospital-acquired bloodstream infections. Emerging Infectious Diseases,7(7), Retrieved on August, 15, 2011 from: http://www.cdc.gov/ncidod/eid/vol7no2/wenzel.htm

Module 5: (Due Saturday 8am) Discussion Board: Assessment of Outcomes Case Study: CQI Assessment Chapter quality improvements and health care safety chapter 25 measuring and managing outcomes 1. what is health care quality? What is your role in health care quality? 2. what are performance measurement selection criteria? 3. what is the emerging health care quality model? 4. what are the costs of poor quality care? 5.what are the key terms related to outcomes research and outcomes management? 6.what are the fundamental issues in analyzing data on patient outcomes? 7. what are the steps involved in outcomes management in clinical practice?

activity- OQIA assessment assignment- CQI assessment discussion board- conduct a short interview with a nurse and a charge nurse or administrator and ask week 5 questions. List outcomes in two categories: nurse sensitive and non-nurse sensitive. If there are more non-nurse sensitive outcomes, what outcomes could be added to measure nursing interventions effectively?
The nurse sensitive process used in this long-term care facility to collect data is a combination of questionnaires, interviews, and observation. The questions gather specific data from the patients which will be used to analyze and plan care. These are very useful because they can be done easily and are not costly. In addition, they can be used to collect different types of information, including qualitative and quantitative data at the same time. Qualitative data will be used mostly to identify or describe the participants of the study. On the other hand, quantitative data will be used mostly to assess the program outcomes (Mitchell & Jolley, 2010). The outcome measurements help form objective evidence about the results of the health care process. Outcome measurements can provide insights about the care processes that may influence the quality of care provided. This information is collected on admission and continuously throughout the patient's stay at the facility. Outcome measurement begins at the unit level and actively involves all nurses and is used as a framework for the purpose of making decisions and improving the quality of care. Training will have to be available for all data collectors so that questions can be answered, and reliability can be assured through team development. Data collected by these employees include pressure ulcer prevalence, skin integrity risk assessment, falls, injury, bruising, restraint use, urinary catheter related infections, weight monitoring, nurse skill mix, nursing hours per patient day and staff to patient ratio. Outcome data is communicated to on-coming staff, supervisors, and administration by each shift daily through verbal and written reports, as well as in monthly quality assurance team meetings. Copies of these written data collection plans are available in the patient's charts and on the nursing minimum data set. Mitchell, M. & Jolley, J. (2010). Research design explained (7th ed.). Belmont, CA: Wadsworth, Cengage Learning.