Leadership Exam #2

Ch 6, 9, 10

Advocacy Ch 6
Blending science, ethics, and politics, advocacy is self-initiated, evidence-based,
strategic action that health professionals can take to help transform systems and
improve the environments and policies, which shape their patients behaviors and
choices, and ultimately their health
Advocacy- helping others to grow self- actualization (critically important leadership
role)
Inform others of their rights and ascertain the correct information they need to
make their decision
To protect and defend what one believes in for both self and others.
Nurses may act as advocates by helping others make informed
decisions, by acting as an intermediary in the environment, or by
directly intervening on behalf of others.
Advocacy= on of the most vital and basic roles of nursing since Florence
Nightingale
Who are nurses advocates for?
o Nurses advocate for themselves,
o Patients
o Subordinates
o The profession
Leadership Roles Associated with Advocacy:
1. Create climate where advocacy and risk taking are valued
2. Seek fairness and justice for individuals who are unable to advocate for
themselves
3. Seeks to strengthen the patient and subordinate support system to encourage
autonomous, well-informed decision making
4. Providing necessary information to promote autonomy in patient
5. A leader will advocate for patient and subordinates even when the
circumstances are uncomfortable
6. Participates in professional nursing organizations that seek to advance
profession of nursing
7. Proactive involvement in health care policy through both formal and informal
interactions with media and legislative representatives
8. Works to establish creation of a national, legally binding Bill of Rights for
Patients
9. Speaks up when appropriate to advocate for health-care practices necessary
for safety and quality improvement
10. Advocate for social justice in addition to individual patient advocacy
11. Differentiates between controlling patient choices and assisting in making
choices (allowing freedom)
Nursing values central to advocacy emphasize caring, autonomy,
respect, and empowerment
Nursing Values Central to Advocacy:
1. Right to autonomy in deciding what course of action is most appropriate to
meet his/her health-care needs.
2. Right to hold personal values and to use those values in making healthcare decisions
3. Access to the information they need to make informed decisions and
choices
4. Nurse must act on behalf of patients who are unable to advocate for
themselves

5. Empowerment of patients and subordinates to make decisions and take

action on their own is the senescence of advocacy
Patient Advocacy:
o The registered nurse is expected to take appropriate action regarding
instances of illegal, unethical and inappropriate behavior that can endanger or
jeopardize the best interests of the health care consumer or situation
o Aging, as well as physical, mental or social disability may make individuals
more vulnerable and in need of advocacy
o Advocacy has a role in the prevention and detection of abuse in safeguarding
vulnerable adults as well as ensuring that those abused can achieve justice
o Managers must advocate for patients with regard to distribution of resources
and the use of technology
o Nurses must advocate for social justice as well as individual patient advocacy
o It is important for the patient advocate to know the difference between
controlling patient choices and assisting patients to choose
o Nurses must not use paternalism as a means to reduce autonomy
Areas that require advocacy :
End-of-life decisions; aging
populations
Technological advances
Health-care reimbursement
Access to health care
Providerpatient conflicts
Withholding of information
Insurance authorization
Medical errors

Patient information disclosure

Patient grievance and appeals
process
Culture and ethnic diversity and
sensitivity
Respect for patient dignity
Inadequate consents; complex
social problems
Incompetent health-care
providers

Patient Rights:
before the 1960s pt.s had few rights, denied basic human rights during a
vulnerable time
Adoption of the Consumer Bill of Rights and Responsibilities, AKA Patients Bill
of Rights in 1998, changed it all
3 Goals of the Patients Bill of Rights:
1. Help patients feel more confidents in the US healthcare system
2. Stress the importance of a strong relationship between patients and healthcare providers
3. Stress the key role patients play in staying healthy by laying out rights and
responsibilities for all patients and health-care providers
Not legally binding, this document guide health-care organizations
and practitioners in terms of professional expectations for patient
advocacy
Affordable Care Act of 2010:
Patient protection against insurance companies
Eliminate annual & lifetime coverage limits
Choice of physician form a plans network
Allow children to stay on parents policy until age of 26 if they meet
requirements
Only for employers with more than 15 employees
Restrict insurance companies from being able to rescind healthcare coverage
due to an honest mistake on application forms
* the government, being the largest provider of health insurance had
influenced the protection of patient rights by linking reimbursements with

patients right provisions- Department of Health and Human Services

mandated that all that hospitals receive Medicare/ Medicaid funding MUST
protect the visitation rights of LGBT patients
Medical Patient Rights Act has been adopted by many states and there is a
penalty for not following their patient rights.
Bottom line: if patients are aware that they have rights they may be more
proactive and more involved in their care
Leaders/Managers have a responsibility to see that all patient rights are met,
including the right to privacy and personal liberty

Subordinate Advocacy:
Often a neglected concept in management, but essential part of leadership
ANA (American Nurses Association) states that nurse administrators should
advocate for other health care providers!
Workplace advocacy is a critical role for managers to assume
Seek to see environment is safe and conducive to professional and personal
growth for subordinates
OSHA reports over 2million people are victims of workplace violence
Must help employees find best ways to solve problems while using least amount
of resources
Managers must recognize what subordinates are striving for and the goals and
values that subordinates consider appropriate
Ways that promote subordinate advocacy :
Invite collaborative decision
Go to bat for your staff when
making
needed
Listen to staff needs
promote shared governance
Get to know staff personally
empower staff
Take time to understand the
promote autonomy
challenges faces by the staff in
provide staff with workable
delivering care
systems

in an era of managed care, declining reimbursements and the ongoing pressure to remain
fiscally solvent, the risk of fraud, misrepresentation, and ethical malfeasance in healthcare organizations
has never been higher. As a result a need for whistle-blowing has never been higher.
Whistle-Blowing:

Internal whistle blowing- occurs within an organization, reporting up the chain of command

External Whistle blowing- involves reporting outside the organization such as media and an
elected official.

Ex: nurse reports abuse of a patients by another nurse or care provider

Often times whistle blowing is considered disloyal and may consider repercussions for their
actions, even if done with best intentions
Leaders and managers must be willing to advocate for the whistle-blowers
Speaking out as a whistle blower is often honored more in theory than in fact.
Leader- management must be willing to advocate for whistleblowers, who speak out
about organizational practices that they believe may be harmful or inappropriate.
A professional commitment means that people cannot shrink from their duty to
question and contemplate problems that face the profession
Nurses must exert their collective influence and make their concerns known to policy
makers before they can have a major impact on political and legislative outcomes
Political Action Committees (PACs):
Attempt to persuade legislators to vote in a particular way.
Lobbyists of the PAC may be members of a group interested in a particular low or paid
agents of the group that wants a specific bill passed
Nurses must become more actively involved with PACs to influence health-care legislation
PACs provide one opportunity for small donors to feel like they are making a difference

Time Management Ch 9
* making optimal use of available time
Time management is very important, and as a nurse, prioritizing is something that you
will constantly be doing. As a mid-level manager, one may get interrupted more than a
higher-level manager. Why?

Short-term plans- operational planning focuses on achieving short-term tasks

Managers must recognize what subordinates are striving for and the goals and values that
subordinates consider appropriate
- Period of 1hr- 3years
- Usually less- complex than strategic/long-range plans
- May be done annually, quarterly, monthly, weekly, daily, hourly
- Short-term planning is the foundation of nursing time management
Overwhelmed with work and time constraints leads to increased errors, forgetting important
tasks and general feeling of stress and ineffectiveness
Managers need to be effective with their time in order to direct their employees to be
effective as well. (both must be able to time manage)
Must become expert at planning and implementation of goal attainment
Time management- making optimal use of time
- Many people who are bad at time management burn the candle from both ends and often
blame others and get others to work harder and faster
Good time management skills allows an individual to spend time on things that
matter

Must prioritize duties, managing and controlling crises, reducing stress and balancing
work/personal time

3 Basic steps to Time Management:

First, allow
enough time
for sufficient
daily
planning

Then,
complete the
highestpriority task

Then,
reprioritize

1. set aside time for planning and establishing priorities

2. completing most important task, make sure to finish one task before starting another
3. reprioritize, based on remaining tasks and on new information that may have been
received
planning is essential! fail to planplan to fail
planning fallacies- continue to plan too much even though you know it is unrealistic

- may be because individuals forget that in the past, they were interrupted unexpectedly
or

individuals may not consider all the subcomponents of the task when planning
- people assume that plans will go as planned and nor issues will arise
- this leads to unrealistic assumptions, serious planning errors and poor time management
Planning- should think about how the plan will play out in action
- must decide which people, activities and materials will be needed to execute plan
- some people feel unproductive if they take time out to make plans rather than getting
right to work.not helpful!!

Unfortunately, to mistakes common in planning are underestimating the importance

of a daily plan and not allowing adequate time for planning
Examples a charge nurse might make for day-day planning:
staffing
schedules
patient care assignments
coordination of break schedules
interdisciplinary coordination of patient care

Acute care staff:

determining how handoff reports will be given/received
timing and method used for initial patient assessments
coordination of medication admin.
Treatments/procedures
Organization of documentation of days activities
Time Efficient Work Environment:
o Gather all the supplies and equipment that will be need BEFORE
o Group activities that are in the same location
o Use time estimates (if an IV piggyback will take 30mins, then plan to use the 30mins to
complete a task that will take <30 mins)
o Document the interventions as soon as possible after an activity is completed
o Always strive to end the workday ON TIME
o Have supplies organized for efficient retrieval (reduces amount of wasted time)
How to plan a work day:
Identify key priorities to be accomplished, and identify specific actions needed to be taken
in order to complete the task
Determine level of satisfaction expected (how will you uphold to full satisfaction)
Assess who you can delegate assignments to and express your expectations to them
Review short and long-term plans on unit regularly, include everyone in identifying
problems or concerns so they can be fully involved in planning or need ot change
Plan ahead for meetings, distribute agendas ahead of time
Allow time to assess progress through out the day and at the end of the day

Setting new priorities to reflect ever-changing work situations is an ongoing reality

for unit managers.

PRIORITIZING is the most important step in time management

SELF AWARENESS IS KEY TO PRIORITIZING AND TIME MANAGEMENT

Priority setting is perhaps the most critical skill in good time management, because
all actions we take have some type of relative importance

Prioritizing: dont do do later do now

dont do usually reflect problems that will take care of themselves , are already
outdated, or are better accomplished by someone else
- either throw away the unnecessary information or pass it on to someone else
- remove unneeded clutter from work area
do later- items reflect trivial problems that may not have a specific deadline leading to
procrastination
- sometimes procrastination is appropriate, usually not
- usually a barrier to effective time management
- procrastination is hard to solve because there is usually not from one cause
(combination of dysfunctional attitudes, rationalizations and resentment)
- do later be sure that larger items broken down into smaller projects


tasks!

- provide a specific time line and plan

- plan should include- short-term, intermediate and final deadlines
do now- a units day-to-day operational needs
- daily staffing needs
- dealing with equipment shortages
- meeting schedules
- conducting hiring interviews and giving performance appraisals
- may be items that were put off earlier, and must be dont now
- helpful to make a list of DO NOW (planning tool)
- make list realistically accomplished in the day
- try not to put routine tasks on the list (distracts form priority)
- lists should have appropriate amount of time allotted and some for the
unexpected
- dont confuse importance and urgency
- not all important things are urgent and not all urgent things are important
- if one task remains on the list for multiple days determine why this has gone
unaccomplished and fix the situation
- sometimes tasks need to be removed form the list
using a time inventory is a way to determine when a person is most productive and
determining internal time wasters
Some tasks arent accomplished because they are not broken down into manageable
Reprioritizing is the last step in the management process
Dealing with interruptions
No amount of planning can prevent an occasional crisis
If a crisis occurs one may need to set aside original priorities for the day
- reorganize
- communicate
- delegate a new plan
all managers experience interruptions but lower-level managers experience the most
they are more involved in daily planning
in direct contact with subordinates on a daily basis
they dont have a quite place to work or clerical help the filter interruptions
may result in lowered job satisfaction
managers MUST develop skills in preventing interruptions and threaten effective time
management
leader roles must model flexibility and ability to regroup when new information or tasks
emerge as priorities
followers often change based on how leader handles situations
Time Waster:
1. Technology (internet, gaming, e-mail, social media)
- egg timer to prevent excessive times on time wasters
- check phone morning, noon, end of day
- without unplugging= huge risk to time management
2. Socializing
- can help build report in the work place, but hinder productivity
3. Paperwork overload
4. Poor filing system
5. Interruptions
Personal Time Management:
Self-awareness!!
If not certain of own short-term or long-term goals time management is difficult
Decide how much time you are willing to and need to dedicate to task

Managing time is difficult if a person is unsure of his or her priorities for time
management, including personal, short-term, intermediate and long-term.
- lack of punctuality suggests you do not value other peoples time

Ch 10 Fiscal Planning
Fiscal planning, as in all types of planning, is a learned skill that improves with practice
Requires vision and creativity through knowledge of the political, social and economical forces
that shape health care.
Historically, nursing management played a limited role in determining resource allocation in
health-care institutions
The personnelworkforce budget often accounts for the majority of health-care organizations
expenses because health care is labor intensive
Personnel budgets include actual worked time (productive time or salary expense) and the time
that the organization pays the employee for not working (nonproductive time or benefit time)
A budget is at best a forecast or prediction; it is a plan and not a rule. Therefore, a budget must
be flexible and open to ongoing evaluation and revision
If a budget is predicted too far in advance is open for greater error. If a budget is shortsighted,
compensating for unexpected major expenses or capital equipment purchases may be difficult
Fiscal Planning
o The Patient Protection and Affordable Care Act (PPACA) provided the first real hope for
Americans of significant reductions in numbers of uninsured, greater access to coverage
for those with preexisting conditions and mandated health care insurance provision by
employers
o The shifting in reimbursement from volume to VALUE has accelerated with health care
reform
Value function of quality, efficiency, safety and cost
o FISCAL PLANNING IS IS AN ACQUIRED SKILL THAT IMPROVES WITH PRACTICE AND USE

What is it? A LEARNED SKILL

Who does it? The unit manager is responsible to monitor and evaluate all aspects of the
units budget.

Balancing Cost and Quality

o Dual goals of fiscal planning are Cost Containment and Quality Care
o Cost Containment Effective and efficient delivery of services while generating needed
revenues for continued organizational productivity
o Cost Effective Producing good results for the amount of money spent
- the product is worth the price
o In terms of health care, cost and quality do not have a linear relationship
o America does not use the resources we have available in a cost effective manner
Spending more does not always mean higher quality of care

Responsibility Accounting and Forecasting

o Responsibility Accounting Each of an organizations revenue, expenses, assets and
liabilities is someones responsibility

 The person with the most direct control or influence on any financial elements
should be held accountable for them
Forecasting Involves making an educated budget estimate by using historical data

Medicare and Medicaid

Medicare Federally sponsored health insurance program for the elderly (older than 65)
and for certain groups of people with catastrophic or chronic illness, regardless of age

o Who is Eligible
U.S citizens
LPR with 5 consecutive years of residence in U.S.
Must have paid payroll taxes in the U.S. for 40 quarters
AND:
Age 65, or disabled and on SSDI, for 24 months
No waiting period for Amyotrophic Lateral Sclerosis (ALS)
End Stage Renal Disease
Medicaid Federal-state cooperative health insurance plan created primarily for the
financially indigent (low-income children and adults) although it also provides medical and
long term care coverage for people with disabilities and assistance with health and long
term care expenses or low income seniors

PPACA (aka ACA or Obamacare)

What is it?
o Comprehensive insurance reform
o Includes a new Patient Bill of Rights

When was it passed?

o 2010

What is an ACO?
o Groups of providers and suppliers of service who work together to better coordinate care
for Medicare patients across care settings
o The goal of an ACO is to deliver seamless, high quality care in an environment that is truly
patient centered and where patients and providers are partners in decision making
o Medicare Shared Savings Program will reward ACOs that lower growth in health-care
costs while meeting performance standards on quality of care and putting patients first

What is the Health Insurance Marketplace?

o Also called Exchanges
o Created for individuals without access to healthcare through their job
o Small businesses were also eligible to buy affordable and qualified health benefit plans
o Online insurance supermalls that cannot turn down prospective clients as a result of
preexisting conditions
o Every insurance plan offers comprehensive coverage from doctors to medications to
hospital visits and options can be compared based on price, benefits and quality

Medicaid Expansion

o Medicaid covers individuals and families with up to 133% of the Federal Poverty Level.
This means more adults without children and parents will now be able to qualify for free
or low cost coverage through Medicaid.

Medicare and Medicaid Managed Care

o The Centers for Medicare and Medicaid Services is now the largest purchaser of managed
care in the country
o MCOs receive reimbursement for Medicare-eligible patients based on a formula
established by the CMS, which looks at age, gender, geographic region, and the average
cost per patient at a given age. Then, the government gives itself a 5% discount and
gives the rest to the MCO