CHAPTER 1
Introduction to the nursing
management
Dr Fadwa Alhalaiqa
Learning Outcomes
1.
2.
3.
4.
Describe the forces that are
changing the health care system.
Discuss changes in paying for health
care.
Explain how quality initiatives can
reduce medical errors.
Describe how evidence-based
practice is changing nursing.
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc.
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Learning Outcomes
5.
6.
7.
Explain how to become a Magnetcertified hospital.
Explain what emerging technologies
mean for nursing.
Describe how cultural, gender, and
generational differences affect
management.
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc.
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Learning Outcomes
8.
9.
Explain why preparation is the best
defense against violence and
disasters.
Discuss the changes and challenges
that nurses face now and into the
future.
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Continuing Changes
in Health Care
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including:
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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
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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.
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
The Institute of Medicine (IOM)
published a report in 1999 reporting
that
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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.
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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.

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- Public reporting of health care
organizations, such as the Agency for
Healthcare Research and Quality (AHRQ), is
another strategy to improve quality.
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Quality Management

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Is a preventive approach
Involves continuous evaluation and
improvement
Is implemented through patient
satisfaction surveys
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The Leapfrog Group

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Consortium of public and private
purchasers
Leverages purchasing power
Rewards organizations for quality
measures
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Benchmarking
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Compares an organization's data with
similar organizations
Uses outcome indicators to compare
performance across organizations
Uses results to address weaknesses
and enhance strengths
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Evidence-Based Practice
(EBP)

Evidence-based practice (EBP) is
a strategy to improve quality by
using
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
The best available knowledge integrated
with
Clinical experience and
 The
patient’s values and
preferences to provide care
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Evidence-Based Practice
(EBP)

EBP decision-making steps
Identifying the clinical question
2. Finding evidence to answer the
question
3. Evaluating the evidence
4. Applying the evidence
5. Evaluating the outcome
1.
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
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

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Magnet Recognition
Program

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Certifies health care organizations for
nursing excellence
14 Forces of Magnetism
Patient safety improves when forces
are met
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•
1.
2.
3.
4.
5.
6.
“Forces of Magnetism”:
Quality of nursing leadership
Organizational structure
Management style
Personnel policies and programs
Professional model of care
Quality of care
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1.
2.
3.
4.
5.
6.
7.
8.
Quality improvement
Consultation and resources
Autonomy
Community and the health care
organization partnerships
Nurses as teachers
Image of nurses
Interdisciplinary relations
Professional development
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Electronic Health Records
(EHR)
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Includes health information from all
medical sources
Can be accessed by multiple
authorized providers at different
locations
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Barriers Versus Benefits of
EHR

Barriers
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Privacy and confidentiality concerns
Costs of implementing and operating
Benefits
Reduced redundancies
 Improved efficiency
 Decreased medical errors
 Lower health care costs

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Other Benefits of EHR
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Allows for collective data analysis
Facilitates a common nursing
language
Supports evidence-based decision
making
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Other Technological
Changes

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Virtual care (telehealth)
Robotics
Communication technology, including
social media
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Cultural and Generational
Differences

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Cultural diversity is increasing in the
U.S. population
Diversity in the nursing population
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Ethnicity
Gender
Generations
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Gender

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Female nurses outnumber male
nurses
Nursing shortages might be
alleviated if more men were entering
the profession
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Generational Diversity
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Four generations work side-by-side:
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Traditionals
Baby boomers
Generation X
Generation Y (millenials)
Each generation has different values
and expectations
Generational differences can be
leveraged to produce better
outcomes
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Violence Prevention and
Disaster Preparedness
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Nearly 500,000 nurses victim of
workplace violence
Other threats affecting nurses
include:
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Disasters
Terrorism
Pandemics
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Staff Training for Disasters
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Computer simulations
Video demonstrations
Disaster drills
Preparation a must

Mass casualty event probably will occur
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LEARNING OUTCOME 9
Discuss the changes and challenges
that nurses face now and in the
future
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Aging Patients, Aging
Nurses
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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
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Changes Facing Nurses
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Change will become the one constant
Nurses becoming full partners in
health care
Focus of nursing education changing
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Apply knowledge
Clinical reasoning
Integrating classroom and clinical
Focus on quality control
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Changes Facing Nurses

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Access to care is affecting policy
decisions
Every nurse must be prepared to
manage
Organizations must provide
management training for all nurses
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The Nurse Manager
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Balances the needs of administrators
and employees
Functions as coach, teacher, and
facilitator
Motivates and inspires others
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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.
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