explain the differences between a transactional nursing leader and a transformational nursing leader

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CO 7: Apply leadership concepts in the development and initiation of effective plans for the microsystems and system-wide practice improvements that will improve the quality of healthcare delivery. (PO 2 and 3)

The Assignment

Review Appendix A, Sections I–V in Finkelman (2016).

  1. Select one of the sections and share how your chief nurse executive demonstrates expertise in these competencies.  Your comments should be about the “highest nursing leader” in your organization. Typically this is the leader who represents nurses and nursing to the governing board.
  2. In your own words, explain the differences between a transactional nursing leader and a transformational nursing leader. What one is more like your Nurse Executive?
  3. Describe how the Nurse Executive “leads the charge” for transformational leadership in an organization where you work or have done prelicensure clinical experiences.
  4. Take us on a journey where you complete a story about your nurse executive or leader and the change that either has occurred or is necessary.
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explanation of how you would go about finding out how many diabetics are in your practice

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One example of a measurement tool is the Healthcare Effectiveness Data and Information Set (HEDIS) comprehensive care measures. Review the eight components of HEDIS comprehensive diabetes care; then consider the following scenario.

You are a staff nurse working in a private primary care practice. It is a small practice with 2 MDs (internists), 2 nurses, 1 medical assistant, and an office staff for billing. There are approximately 1,000 patients in the practice. You have had no EHR until the last year, but all charts are manual, historically. Your physicians are starting to inquire about quality incentives, particularly regarding patients with diabetes.

By Day 3

Take on the role of the staff nurse in the scenario, and post an explanation of how you would go about finding out how many diabetics are in your practice and how many meet all 8 components of HEDIS comprehensive diabetes care.

Support your response with references from the professional nursing literature. Your posts need to be written at the capstone level (see checklist).

Notes Initial Post: This should be a 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations.  

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Were the strategies effective in creating a sustainable change on your nursing unit

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Imagine that, for about a year, your nursing unit has been involved in an intensive campaign to improve patient satisfaction scores with pain management. You are getting good data from your patients, as the length of stay on this inpatient geriatric medical nursing unit is only about 6 days. Your hospital does 100% survey to inpatients, and the response rate is about 25%, which is higher than it has been. This notwithstanding, the percent of “patient very satisfied” (top box), with a score of 5, has been in the low 70s. The national benchmark for medical surgical units like yours is about 85% very satisfied. Of all the units in your hospital, your unit is the lowest scoring on this HCAPHS survey. But as your unit is the only geriatric medical nursing unit in the hospital, you’d always thought it was the nature of the patient population.

You have been the day shift representative to the QI team, and the scores on your unit are posted monthly. Here are the numerous strategies that have been tried on your unit and the timeframes.

For this Discussion, examine the strategies and interventions tried in your unit and consider the following questions: a) Were the strategies effective in creating a sustainable change on your nursing unit, and b) To what extent can your nurse manager and CNO count on your unit exceeding the national benchmark in the next quarter, the next year? That is, does this run chart have some predictive ability? Does the run chart support the nursing unit’s decision to celebrate? To what extent can the leadership be confident that the trend will continue?

By Day 3

Based on the scenario, explain what was done successfully and where improvement was needed in the quality improvement process. Identify the performance improvement tools, and explain how they contributed to the outcome.

Support your response with references from the Resources and professional nursing literature. Your posts need to be written at the capstone level (see checklist).

Notes Initial Post: This should be a 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations.  

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Analyze the composition of a root cause analysis team in relation to effective practice

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When patient safety is compromised, it is critical to get to the root of the issue in order to determine how to ensure patient safety and avoid risks in the future. Nurses can use analytical techniques to determine root causes related to various types of errors. Medication error is a typical error that can be subject to process improvement in general, and root cause analysis in particular. This process came out of NASA after the Space Shuttle Columbia disaster and has been adopted by the health care industry. This week, you analyze a case related to medication error, and you examine how root cause analysis is applied to prevent future error and formulate process improvement plans.

Learning Objectives

Students will:

  • Analyze the composition of a root cause analysis team      in relation to effective practice
  • Critique the effectiveness of the performance      improvement charts in identifying contributing factors
  • Apply findings from a root cause analysis to prevent      future errors
  • Apply a quality improvement process to an improvement      plan

Learning Resources 

Required Readings

Spath, P. (2013). Introduction to healthcare quality management (2nd ed.). Chicago, IL: Health Administration Press.

· Chapter 4, “Evaluating Performance” (pp. 73–110)

· Chapter 5, “Continuous Improvement” (pp. 111–130)

· Chapter 6, “Performance Improvement Tools” (pp. 131–162)

Note: Although these chapters are previously assigned readings, please review them in preparation for this week’s material.

Yoder-Wise, P. S. (2015). Leading and managing in nursing (6th ed.). St. Louis, MO: Mosby.

· Chapter 17, “Leading Change” (pp. 305–320)

· Chapter 23, “Conflict: The Cutting Edge of Change” (pp. 431–447)

Required Media

Laureate Education (Producer). (2016a). Root cause analysis at Downtown Medical [Interactive file]. Baltimore, MD: Author.

Laureate Education (Producer). (2016b). RCA dramatization 1 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 4 minutes.

Case scenario involving medication error including pharmacy, physician, and nurse—interdepartmental collaboration.
Interactive media—students select options that generate chart based on choices
(Voiceover reads the document aloud—include a downloadable pdf).

Discussion: Root Cause Analysis

Review the case scenario included in this week’s media resources, and examine the process flow chart, cause/effect diagram, and Pareto chart related to the case scenario. 

In the scenario, the nurse manager and the director of pharmacy blame each other for the error. The facilitator (quality assurance person) asks everyone to avoid blaming and focus on applying the tools to analyze the data and get to the root cause of the error. While all of these tools contribute, for this Discussion, select one tool to analyze.

By Day 3

Post each of the following:

  • Analyze the composition of the RCA team. Explain what      knowledge they can contribute to the RCA.
  • Describe the collaboration in the case study that led      to effective problem solving. Identify the evidence you observe in the      scenario that demonstrates effective collaboration and the avoidance of      blaming.
  • Explain the team’s process in testing for and      eliminating root causes that were not contributing.
  • Select one of the performance improvement charts      presented in the scenario and critique its effectiveness by explaining how      it contributes to identifying the root cause and determining a solution to      prevent repeat medication errors.
  • Identify the contributing factors, and discuss how to      prevent this kind of error from occurring in the future.

Support your response with references from the professional nursing literature. Your posts need to be written at the capstone level (see checklist)

Notes Initial Post: This should be a 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations.  

Practice Experience: Stakeholder Analysis

The next step in the process is to begin identifying the challenges and impediments to implementing a quality improvement plan. In the analysis consider the individuals affected by the change as well as the cost of implementing the quality improvement plan.

By Day 4

Post a description of some of the proposed action steps for implementing improved practice, and explain where potential challenges might compromise your proposed improvement project. Describe what resources are needed for your solution, and explain whether or not those resources are cost-effective. Continue to collaborate with the selected individuals in your practice environment as needed in the development of the Practice Experience Project, and share this information with your group.

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How would you go about figuring out what could be done at the nursing home to prevent avoidable ED visits?

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As a nurse, you serve an important role in identifying strategies to effectively manage health care resources and in leading health care quality improvement. You must be able to decide what leadership style or strategy to apply in a given situation to achieve an effective resolution of the issue. Read the following two scenarios and select one to focus on in this Discussion. Consider the leadership style or strategy that might be most effective in the scenario you selected.

Scenario 1

You work in a for-profit nursing home, with about 100 beds, on a 20-bed unit that is largely patients with Alzheimer’s disease. Your patient mix is predominantly Medicare and Medicaid patients. Your nursing home is part of a larger system that includes a major medical center, as well as VNA, outpatient dialysis, and a fully integrated network. Your nurse manager is getting feedback from the hospital that your nursing home is sending too many patients to the ED who really don’t need to go. How would you go about figuring out what could be done at the nursing home to prevent avoidable ED visits?

Scenario 2

You’ve been associated with an outpatient cardiology clinic that is part of a large academic medical center. Your patients are mostly charity care and managed Medicaid. Most have a prescription plan, but none have a “family doctor” and use the clinic (and the ED) regularly. Most are unfamiliar with their medications and do not have the resources for care coordination in their family/social network. About 25 CHF patients have been “lovingly,” but inappropriately, called “frequent fliers” because of their inability to manage their own care, their frequent visits to the ED, and their “one night stays” paid at the observation rate. As a staff nurse in this clinic, describe the strategies you could devise for you and your fellow staff nurses targeting these 25 patients. Find at least one article from the professional literature to corroborate your recommendations.

By Day 3

Select one of the scenarios, and post the following:

Describe the most appropriate leadership style and/or strategy to apply in the scenario you chose in order to implement the recommendations successfully. Justify your selection.

Support your response with references from the professional nursing literature. Your posts need to be written at the capstone level (see checklist)

Notes Initial Post: This should be a 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. 

The final step is to develop the plan discussing the steps clearly and succinctly. The plan must be evidence based .

By Day 4

Post an explanation of how you could apply key interventions supported by the scholarly research evidence to potentially help resolve the issue in measurable ways. Continue to collaborate with the selected individuals in your practice environment as needed in the development of the Practice Experience Project, and share this information with your group.

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The Nurse’s Role in Promoting Quality Health Care

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Discussion: The Nurse’s Role in Promoting Quality Health Care

As you have noted in this course and in your practice, nurses have an integral role in promoting a just culture focused on patient safety in their health care organizations. Determining resources to prevent error and improve patient safety can often be a battle, and this scenario illustrates how one organization makes strides to make sure resources are available in the interest of patient safety. As you review the scenario, consider the nurse’s role in promoting a just culture in your practice setting.

By Day 3

Post a description of the role of the staff nurse for promoting quality in a high-performing health care organization. Define the organizational culture of your health care organization, or one with which you are familiar, and identify the leadership style of the CEO and CNO in your organization. Explain how your senior leadership supports—or does not support—changes that require financing/budget to support patient safety. Describe the strategies you might be able to implement to move your health care organization to a high-performing organization.

Support your response with references from the professional nursing literature. Your posts need to be written at the capstone level (see checklist)

Notes Initial Post: This should be a 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations.  

Practice Experience: Developing a Quality Improvement Plan

Storyboard Instructions

The Practice Experience Project Storyboard is a brief, visual summary of a completed quality improvement initiative. The storyboard highlights key aspects of a quality improvement effort by documenting the Practice Experience Project from beginning to end. 

The course template uses a PowerPoint format to complete this assignment. You only need to provide two slides, no more. The first slide is the summary of your project; the second slide is the reference page. You will need to choose the most pertinent information from your practice experience and Capstone Paper to complete the Storyboard. No voiceover is required.  

The completed storyboard is submitted for grading and also serves as the main post for the Week 6 Practice Experience discussion.  

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Are you aware of your own prejudice and discrimination towards these two populations(foreign workers and visually impaired)?

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Are you aware of your own prejudice and discrimination towards these two populations(foreign workers and visually impaired)? Think about how you acquired these prejudice and discrimination, and why couldn’t you see these discriminatory thoughts? 

• Think of how society (and you as a member of society) worsen the disadvantages faced by individuals through our ACTS OF DISCRIMINATION that we did not know we have?

• List examples that illustrate our society’s discrimination.

• Pay particular attention to the impact of prejudice and discrimination on the healthcare of these two powerless population.

• This SHOULD be supplemented by published reports of discrimination (newspapers, journals or websites of local voluntary welfare organisations (VWOs) such as TWC2 and Migrant Workers’ Centre (MWC), Humanitarian Organisation for Migrant Economics (HOME) and others that you can find).

• Think of how ALL of society including ourselves are HURT by our own invisible discrimination against any less-privileged groups? Think of why should we change, and how by changing, it will be benefit us?

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What are the most important elements of the Affordable Care Act in relation to community and public health?

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The Affordable Care Act was signed into law by President Barack Obama in March 2010. Many of the provisions of the law directly affect health care providers. Review the following topic materials:

  1. “About the Affordable Care Act”
  2. “Health Care Transformation: The Affordable Care Act and More”

What are the most important elements of the Affordable Care Act in relation to community and public health? What is the role of the nurse in implementing this law?

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What are some of the business and financial differences between different types of provider organizations such as academic medical centers

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write 300 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas.

Discuss the following questions:

  • What are some of the business and financial differences between different types of provider organizations such as academic medical centers, community not-for profit hospitals, and for profit organizations?  You can learn more about provider organizations in the HCM Learning Center page for this course.
  • What are some of the business and financial implications that may affect staffing, programs offered, and policies and procedures at community not-for-profit hospitals and large academic medical centers?
  • What are some financial benefits of being an academic facility?
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Discuss why nurses have a responsibility to uphold a standard of conduct

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Social media plays a significant role in the lives of nurses in both their professional and personal lives. Additionally, social media is now considered a mainstream part of the process for recruiting and hiring candidates. Inappropriate or unethical conduct on social media can create legal problems for nurses as well as the field of nursing.

Login to all social media sites in which you engage (Note you can use Illinois State for social media site). Review your profile, pictures and posts. Based on the professional standards of nursing, identify items that would be considered unprofessional and potentially detrimental to your career and that negatively impact the reputation of the nursing field.

In 500-750 words, summarize the findings of your review. Include the following:

  1. Describe the posts or conversations in which you have engaged that might be considered inappropriate based on the professional standards of nursing.
  2. Discuss why nurses have a responsibility to uphold a standard of conduct consistent with the standards governing the profession of nursing at work and in their personal lives. Include discussion of how personal conduct can violate HIPAA or be considered unethical or unprofessional. Provide an example of each to support your answer.
  3. Based on the analysis of your social media, discuss what areas of your social media activity reflect Christian values as they relate to respecting human value and dignity for all individuals. Describe areas of your social media activity that could be improved.

Prepare this assignment according to the guidelines of APA Style Guide

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