1. CHAPTER 1 Introduction to the nursing management Dr Fadwa Alhalaiqa

2. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 2 Learning Outcomes 1. Describe the forces that are changing the health care system. 2. Discuss changes in paying for health care. 3. Explain how quality initiatives can reduce medical errors. 4. Describe how evidence-based practice is changing nursing.

3. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 3 Learning Outcomes 5. Explain how to become a Magnet- certified hospital. 6. Explain what emerging technologies mean for nursing. 7. Describe how cultural, gender, and generational differences affect management.

4. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 4 Learning Outcomes 8. Explain why preparation is the best defense against violence and disasters. 9. Discuss the changes and challenges that nurses face now and into the future.

5. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 5 Continuing Changes in Health Care  including:  How we pay for health care  A focus on quality  Rapid changes in technology  Threats from violence and disasters.  Cultural, gender, and generational differences also affect the delivery of health care  Health care not accessible to everyone  Costs are skyrocketing

6. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 6 Paying for Health Care  The Patient Protection and Affordable Care Act (PPACA), signed into law March 23, 2010, promises to provide affordable and adequate care for more Americans once it is implemented.

7. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 7  The Institute of Medicine (IOM) published a report in 1999 reporting that  98,000 Americans die each year from preventable medical mistakes.  The report focused attention on eliminating errors.  As a result, the Centers for Medicare and Medicaid Services have linked payment to quality of care since 2008, making pay for performance the norm.

8. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 8 Quality Initiatives  Many quality initiatives to reduce errors and improve care have emerged:  Quality management is a preventive approach that addresses problems before they become crises.  Continuous improvement of products and services perfect the process. One example is the use of patient satisfaction surveys to evaluate how well hospitals are meeting their clients’ needs.

9. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 9 - Public reporting of health care organizations, such as the Agency for Healthcare Research and Quality (AHRQ), is another strategy to improve quality.

10. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 10 Quality Management  Is a preventive approach  Involves continuous evaluation and improvement  Is implemented through patient satisfaction surveys

11. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 11 The Leapfrog Group  Consortium of public and private purchasers  Leverages purchasing power  Rewards organizations for quality measures

12. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 12 Benchmarking  Compares an organization's data with similar organizations  Uses outcome indicators to compare performance across organizations  Uses results to address weaknesses and enhance strengths

13. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 13 Evidence-Based Practice (EBP)  Evidence-based practice (EBP) is a strategy to improve quality by using  The best available knowledge integrated with  Clinical experience and  The patient’s values and preferences to provide care

14. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 14 Evidence-Based Practice (EBP)  EBP decision-making steps 1. Identifying the clinical question 2. Finding evidence to answer the question 3. Evaluating the evidence 4. Applying the evidence 5. Evaluating the outcome

15. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 15  Nurses may find it helpful in evaluating research findings to place it into seven categories:  Anecdotal  Testimonial  Statistical  Case study  Nonexperimental design research  Quasi-experimental design research  Randomized control trial

16. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 16 Magnet Recognition Program  Certifies health care organizations for nursing excellence  14 Forces of Magnetism  Patient safety improves when forces are met

17. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 17 “Forces of Magnetism”: “Forces of Magnetism”: 1. Quality of nursing leadership 2. Organizational structure 3. Management style 4. Personnel policies and programs 5. Professional model of care 6. Quality of care

18. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 18 1. Quality improvement 2. Consultation and resources 3. Autonomy 4. Community and the health care organization partnerships 5. Nurses as teachers 6. Image of nurses 7. Interdisciplinary relations 8. Professional development

19. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 19 Electronic Health Records (EHR)  Includes health information from all medical sources  Can be accessed by multiple authorized providers at different locations

20. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 20 Barriers Versus Benefits of EHR  Barriers  Privacy and confidentiality concerns  Costs of implementing and operating  Benefits  Reduced redundancies  Improved efficiency  Decreased medical errors  Lower health care costs

21. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 21 Other Benefits of EHR  Allows for collective data analysis  Facilitates a common nursing language  Supports evidence-based decision making

22. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 22 Other Technological Changes  Virtual care (telehealth)  Robotics  Communication technology, including social media

23. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 23 Cultural and Generational Differences  Cultural diversity is increasing in the U.S. population  Diversity in the nursing population  Ethnicity  Gender  Generations

24. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 24 Gender  Female nurses outnumber male nurses  Nursing shortages might be alleviated if more men were entering the profession

25. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 25 Generational Diversity  Four generations work side-by-side:  Traditionals  Baby boomers  Generation X  Generation Y (millenials)  Each generation has different values and expectations  Generational differences can be leveraged to produce better outcomes

26. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 26 Violence Prevention and Disaster Preparedness  Nearly 500,000 nurses victim of workplace violence  Other threats affecting nurses include:  Disasters  Terrorism  Pandemics

27. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 27 Staff Training for Disasters  Computer simulations  Video demonstrations  Disaster drills  Preparation a must  Mass casualty event probably will occur

28. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 28  LEARNING OUTCOME 9  Discuss the changes and challenges that nurses face now and in the future

29. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 29 Aging Patients, Aging Nurses  Aging patients increase the demand for health care  As aging nurses retire, the nursing shortage will grow worse  Demand for nurses will continue to grow

30. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 30 Changes Facing Nurses  Change will become the one constant  Nurses becoming full partners in health care  Focus of nursing education changing  Apply knowledge  Clinical reasoning  Integrating classroom and clinical  Focus on quality control

31. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 31 Changes Facing Nurses  Access to care is affecting policy decisions  Every nurse must be prepared to manage  Organizations must provide management training for all nurses

32. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 32 The Nurse Manager  Balances the needs of administrators and employees  Functions as coach, teacher, and facilitator  Motivates and inspires others

33. Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 33 Nurse managers today are challenged to  Monitor and improve quality care  Manage with limited resources  Help design new systems of care  Supervise teams of professionals and nonprofessionals from a variety of cultures  Teach personnel how to function well in the new system.  The nurse manager balances the needs of administrators, colleagues in other disciples, and employees.