Chapter 4  Making Professional Goals a Reality

1. Chapter 4Making Professional Goals a Reality

2. Employment Opportunities Today • Hospital inpatient settings • Outpatient settings • Home care • Long-term care • Community settings

3. Competencies of the New Graduate • Competencies identified by nursing organizations • National Council of State Boards of Nursing Competencies • National League for Nursing Competencies • Competencies expressed by other groups • Employers’ expectations regarding competencies

4. Top Ten Nursing Activities Rank Ordered by Average Total Group Frequency • Apply principles of infection control • Provide care within the legal scope of practice • Ensure proper identification of client when providing care • Practices in a manner consistent with a code of ethics for registered nurses • Prepare and administer medications, using rights of medication administration

5. Top Ten Nursing Activities Rank Ordered by Average Total Group Frequency (cont.) • Prioritize workload to mange time effectively • Use approved abbreviations and standard terminology when documenting care • Maintain client confidentiality/privacy • Provide individualized/client centered care consistent with standards of practice • Review pertinent data prior to medication administration

6. Employers Expectation Regarding Competencies • Possess the necessary theoretic background for safe client care and for decision-making • Use the nursing process in a systematic way • Recognize own abilities and limitations • Use communication skills effectively with clients and coworkers

7. Employers Expectation Regarding Competencies (cont.) • Work effectively with assistive personnel, delegating, and supervising nursing care tasks in an appropriate manner • Provide accurate and complete documentation • Possess proficiency in the basic technical nursing skills • Possess basic skill in information technology

8. Worker Related Competencies • Demonstrate a commitment to a work ethic • Function with acceptable speed

9. Personal Career Goals • Focusing your goals • Setting your goals • Short-term goals—encompass what you want to accomplish this month and this year • Long-term goals—where you want to be in your profession five or more years from now • Maintaining and enhancing your competence

10. Letter of Application • Letter of inquiry • Excellent way to approach many prospective employers • Sent with resume • Present yourself positively through a well-written letter

11. Preparing an Effective Resume • Appearance • Content • Objective • Credentials • Education • Employment history • Additional experience • References

12. Successful Interviewing • Learn about the potential employer • Preparing questions for the interviewer • Dressing for the interview • Things to take on the interview • Arriving at the interview • Anticipating interview questions • Telephone and online interviews • Interview errors

13. Question • Is the following statement true or false? It is not necessary to follow up after an interview has been completed with a note of thanks.

14. Answer • False • Rationale: Following up after the interview has been completed includes sending a note of thanks to the key decision makers, and checking back to learn of decisions about the position, and maintaining contact with the institution if not selected if you still would like to be considered for a position there.

15. Follow-Up Strategies • Send a thank-you note to the key decision makers • Check back to learn of decisions about the position • Maintain contact with the institution if you are not selected and still would like a position

16. Question • Is the following statement true or false? When resigning from a position, communicating your plans to the head of the department with a sufficient time interval to allow the organization to find a replacement is important.

17. Answer • True • Rationale: When resigning from a position, communicating your plans to the head of the department with a sufficient time interval to allow the organization to find a replacement to fill your position leaves a professional impression and may result in a more positive reference.

18. Resignation • Communicate plans to the head of the department • Provide sufficient time interval to allow the organization to find a replacement

19. Chapter 5The World of Healthcare Employment

20. Understanding Organizations • Mission statement and philosophy • Organizational structure • Types of structure

21. Mission Statement • Includes information about critical elements of the organization • Explicitly outlines the purpose of the organization • May contain the philosophy and goals of the group • Serves as standard against which an organization’s performance can be evaluated

22. Organizational Structure • Outlines formal working relationships • Identifies who is accountable and responsible for the various jobs within the organization • Defines the division of labor—breaking work into pieces or tasks, which are assigned to various individuals or groups

23. Types of Structure • Centralized—authority to make decisions is vested in a few individuals • Decentralized—individual employees are responsible for making decisions in areas in which they have expertise • Matrix—a second structure overlies the first, creating two directions for lines of authority, accountability, and communication

24. Authority and Accountability • Authority—individual has the power or the right to take action, give directions or commands, and make final decisions • Accountability—being obligated to answer for one’s actions and, when certain tasks are delegated, for the actions of others

25. Organizational Relationships • Organizational chart • Chain of command • Channels of communication • Job descriptions • Policies, protocols, procedures, and standards of care

26. Question • Is the following statement true or false? Written job descriptions outline the roles and responsibilities for all employees.

27. Answer • True • Rationale: Written job descriptions outline the roles and responsibilities for all employees and are a necessary and vital part of any organization.

28. Organizational Chart • Graphic, pictorial means of portraying roles, and patterns of interaction among a part of the system • Formal chains of command • Communication channels • Authority for decision-making

29. Chain of Command • Path of authority and accountability from individuals at the top of the organization to those at the base of the organization

30. Channels of Communication • Patterns through which messages are delivered within the organization • Reflects the chain of command

31. Job Descriptions • Written outline of the roles and responsibilities for all employees • Necessary and vital part of any organization • Usually found in policy manuals

32. Policies, Protocols, Procedures, and Standards of Care • Policies—designated plans or courses of action to be taken in specific situations • Protocols—detailed standard plans for patient care • Procedures—written instructions describing the accepted method for satisfactorily performing a particular nursing activity • Standards of care—authoritative statements that describe a common or acceptable level of client care or performance

33. Shared Governance • Form of practice model that involves decision-making in which both the nursing staff and the management participate • Decentralized organization • Often results in greater job satisfaction because of more control over practice • Effect of shared governance on the role of the manager and staff nurse • “Pros” and “cons” of a shared governance model

34. Eight Essentials of Magnet Recognition Program • Support for education • Clinically competent coworkers • Autonomous nursing practice • Positive RN and MD relationships • Supportive nurse manager • Control over nursing practice • Adequate staffing • Culture that values concern for the patient as paramount

35. Nursing Care Delivery Patterns • Case—nurse works with one patient and is expected to meet all of the patient’s needs. • Functional—nursing tasks are assigned to the various employees on the unit according to the level of skills required for performance. • Team—unit has two or more teams composed of variously educated care providers. • Total patient care—nurse is assigned all care needs for patient.

36. Nursing Care Delivery Patterns (cont.) • Primary care—one nurse is assigned the responsibility for the care of each patient from the time the patient is admitted to the hospital until the patient is discharged • Modular care—very similar to team nursing, with each module stocked with own linens, medications, and supplies • Partnership model—patient care is provided to a group of patients by a nurse and unlicensed nursing assistant

37. Case Management • Approach to delivery of all patient care services over entire hospital stay • Nurses may serve as case managers

38. Grievance • Alleged violation of the provisions of the contract or institutional policies • When a grievance arises, all steps must be followed as outlined in order for the grievance to be addressed effectively • Must distinguish between the grievance and the complaint

39. Collective Bargaining • Set of procedures by which employee representatives and employer representatives negotiate to obtain a signed agreement for: • Wages and benefits • Issues of seniority and layoffs • Grievance procedures • Termination procedures • Working conditions

40. History of Collective Bargaining • Passage of the National Labor Relations Act • Further federal legislation • American Nurses Association Activity

41. Bargaining and Negotiating • Negotiate—bargain or confer with another party or parties to reach an agreement • Interest-based bargaining—nontraditional style of bargaining that attempts to problem solving differences between the labor and the industry • Concession bargaining—process in which there is an explicit exchange of reduced labor costs for improvements in job security

42. Understanding the Basic Concepts of Collective Bargaining • Unions and collective action • Contracts • Rules governing labor relations

43. Settling Labor Disputes • Mediation and arbitration • Strikes and lockouts • Reinstatement privilege • Other methods of influencing settlement

44. Issues Negotiated in Contracts • Provisions for shared governance • Mandatory and voluntary overtime • Acuity-based staffing systems • Use of temporary nurses • Protections from reassignments and other issues related to assignment of duties

45. Issues Negotiated in Contracts (cont.) • Provisions for orientation to the work environment and continuing education • Whistleblower protection • Health and safety provisions such as free vaccines and needle safety • “Just cause” language provision for discipline and/or termination • Provisions for nursing and interdisciplinary practice committees

46. Issues Related to Collective Bargaining and Nursing • Collective action and professionalism • Representation for nurses • Activity of the American Nurses Association • Decision to join or not to join • Collective bargaining and the role of supervisor • Changes in the number of bargaining units

47. Changing Trends with Regard to Collective Bargaining • Thrust of collective bargaining in nursing • Elimination of unions and strike breaking • Impact of shared governance on collective bargaining • Looking to the future

48. Chapter 6Understanding the Healthcare Environment and Its Financing

49. Question • Is the following statement true or false? Outpatient care is centered in the work of the traditional hospital, which has become a hub for healthcare in most communities.

50. Answer • False • Rationale: Acute care is centered in the work of the traditional hospital, which has become a hub for healthcare in most communities.