Chapter 23Quality Control in Creating a Culture of Patient

Chapter 23
Quality Control in Creating
a Culture of Patient Safety
Copyright © 2021 Wolters Kluwer • All Rights Reserved
1
Learning Objectives
1. Describe the complexity of defining and measuring quality
health care (Text p 621-22)
2. Describe a systematic process (such as FOCUS PDCA) that
could be used to initiate a quality improvement process (ATI p
12—Steps in the Quality Improvement Process) (ATI p 12—
Quality Improvement) (Text 622-25)
3. Determine appropriate criteria or standards for measuri ng
quality (Text p 625-26)
2
Learning Objectives
4. Collect and analyze quality control data to determine whether
established standards have been met (ATI p 13. Audits) )Text p
626-28)
5. Differentiate among outcome, structure, and process audits as
well as concurrent, retrospective, and prospective audits (Text p
626-28)
6. Write nursing criteria for process, outcome, and structure
audits (Text--Learning Exercise 23.2 p 628)

3
Learning Objectives
7. Describe key components of total quality management
(Continuous quality improvement) (Text p 630-31)
8. Debate the importance of articulating “nursing sensitive”
outcome measured in measuring quality of health care (Text
638-39) (NDNQI website)
9. Describe the role of organizations such as The Joint
Commission (TJC), the Centers for Medicare & Medicaid
Services (CMS,) the American Nurses Association (ANA), and
the Agency for Healthcare Research and Quality (AHRQ) in
establishing standards of practice and clinical practice
guidelines for healthcare organizations and healthcare
professionals(Text p 633 & 633-638)
4
Learning Objectives
10. Define and provide examples of sentinel events in
healthcare as defined by TJC (Text p 633-34)
11. Describe the national efforts such as Health Plan Employer
Data and Information Set, the National Database of Nursing
Quality Indicators to standardize the collection of quality data
and make that data more transparent to providers and consumers
(Text 633-36)
5
Learning Objectives

12. Identify the four evidence-based standards the Leapfrog
Group believes will provide the greatest impact on reducing
medical errors (Text p 640-42)
*ATI p 12—Nurse’s Role in Quality Improvement
6
Quality Control: Fifth and Final Step of the Management
Process
Activities that are used to evaluate, monitor, or regulate
services rendered to consumers
Performance is measured against predetermined standards.
Action is taken to correct discrepancies between these standards
and actual performance.
7
Management Controlling Functions
Periodic evaluation of unit philosophy, mission, goals, and
objectives
Measurement of individual and group performance against
preestablished standards
Auditing of patient goals and outcomes
8
Hallmarks of Effective Quality Control Programs
Support from top-level administration
Commitment by the organization in terms of fiscal and human

resources
Quality goals reflect search for excellence rather than
minimums.
Process is ongoing (continuous).
9
Three Steps of the Quality Control Process
The criterion or standard is determined.
Information is collected to determine whether the standard has
been met.
Educational or corrective action is taken if the criterion has not
been met.
10
Steps in Auditing Quality Control
11
Standards #1
Predetermined baseline condition or level of excellence that
constitutes a model to be followed and practiced
Each organization and profession must set standards and
objectives to guide individual practitioners in performing safe
and effective care.

12
Standards #2
The American Nurses Association (ANA) has played a key role
in developing standards for the nursing profession.
13
Quality Gap
The difference in performance between top-performing health-
care organizations and the national average is called the quality
gap. Although the quality gap is typically small in industries
such as manufacturing, aviation, and banking, variation is more
common in health care.
14
Benchmarking #1
The process of measuring products, practices, or services
against best-performing organizations
Organizations can determine how and why their organization
differs from these exemplars and then use the exemplars as role
models for standard development and performance
improvement.
15

Benchmarking #2
Critical event analysis and root cause analysis help to identify
not only what and how an event happened but also why it
happened, with the end goal being to ensure that a preventable
negative outcome does not recur.
16
Audits Frequently Used in Quality Control
Structure—monitor the structure or setting in which patient care
occurs
Process—measure the process of care or how the care was
carried out
Outcome—determine what results, if any, followed from
specific nursing interventions for patients
17
Sample Standardized Nursing
Languages and Measures #1
NANDA International (NANDA-I)
Nursing Interventions Classification (NIC)
Nursing Outcomes Classification (NOC)
Clinical Care Classification
System (CCC)
The Omaha System
Perioperative Nursing Data
Set (PNDS)
International Classification
for Nursing Practice (ICNP)

18
Sample Standardized Nursing
Languages and Measures #2
Systemized Nomenclature of Medicine Clinical Terms
(SNOMED CT)
Logical Observation Identifiers Names and Codes (LOINC)
Nursing Minimum Data
Sets (NMDS)
Nursing Management
Minimum Data Sets
(NMMDS)
ABC Codes
19
Nursing Sensitive Outcomes
There is growing recognition that it is possible to separate out
the contribution of nursing to the patient’s outcome; this
recognition of outcomes that are nursing sensitive creates
accountability for nurses as professionals and is important in
developing nursing as a profession.
20
Clinical Practice Guidelines
Provide diagnosis-based step-by-step interventions for providers
to follow in an effort to promote quality care
Also called standardized clinical guidelines

Should reflect evidence-based practice (EBP); that is, they
should be based on cutting-edge research and best practices
21
Quality Assurance and Quality Improveme nt #1
Over the past three decades, the American health-care system
has moved from a quality assurance (QA) model to one focused
on quality improvement (QI).
The difference between the two concepts is that QA models
target currently existing quality; QI models target ongoing and
continually improving quality.
22
Quality Assurance and Quality Improvement #2
Two models that emphasize the ongoing nature of QI include
total quality management (TQM) and the Toyota Production
System (TPS).
23
Total Quality Management (TQM)
Also referred to as continuous quality improvement (CQI)
Based on the premise
that the individual is
the focal element on
which production and

service depend
Focus is on doing the
right things, the right
way, the first time, and problem-prevention
planning, not inspective
and reactive problem solving.
24
Toyota Production System (TPS) #1
Customer-focused quality improvement model
Production system built on the complete elimination of waste
and focused on the pursuit of the most efficient production
method possible
Adopting TPS in an organization requires a substantial
commitment of leadership time and resources
25
Toyota Production System (TPS) #2
Quality control in health-care organizations has evolved
primarily from external forces and not as a voluntary effor t to
monitor the quality of services provided.
26
Quality Measurement as an Organizational Mandate #1
The Joint Commission
ORYX

Core measures
National Patient Safety Goals
27
Quality Measurement as an Organizational Mandate #2
The Joint Commission is the major accrediting body for
healthcare organizations and programs in the United States. It
also administers the ORYX initiative and collects data on core
measures to better standardize data collection across acute care
hospitals.
28
Centers for Medicare & Medicaid Services (CMS) #1
CMS plays an active role in setting standards for and measuring
quality in health care including pay for performance.
29
The National Committee for Quality Assurance (NCQA), a
private nonprofit organization that accredits managed care
organizations, also developed the Health Plan Employer Data
and Information Set (HEDIS) to compare quality of care in
managed care organizations.

30
The Hospital Consumer Assessment of Healthcare Providers and
Systems (HCAHPS) survey is the first national, standardized,
publicly reported survey of patients’ perspectives of hospital
care. It measures recently discharged patients’ perceptions of
their hospital experience.
31
Medical Errors #1
A plethora of studies across the past two decades suggests that
medical errors are rampant in the health-care system.
Ignoring the problem of medical errors, denying their existence,
or blaming the individuals involved in the processes does
nothing to eliminate the underlying problems.
32
Medical Errors #2
A “just culture” deemphasizes blame for errors and focuses
instead on addressing factors that lead to and cause near misses,
medical errors, and adverse events.
33

Strategies to Prevent Medical Errors
Better reporting of the errors that do occur
The Leapfrog initiatives
Reform of the medical liability system
Other point-of-care strategies
Bar coding
Smart IV pumps
Medication reconciliation
34
Leapfrog Group Initiatives
Computerized physician–provider order entry
Evidence-based hospital referral
ICU physician staffing
The use of Leapfrog safe practices scores
35
Six Sigma Approach
Sigma is a statistical measurement that reflects how well a
product or process is performing.
Higher sigma values indicate better performance.
Historically, the health-care industry has been comfortable
striving for three sigma processes in terms of health-care
quality, instead of six.
36

TEACHING
TOLERANCE
A PROJECT OF THE SOUTHERN POVERTY LAW CENTER
TOLERANCE.ORG
TEACHING
The New Jim Crow
THE NEW JIM CROW by Michelle Alexander
CHAPTER 2
The Lockdown
We may think we know how the criminal justice system works.
Television is overloaded
with fictional dramas about police, crime, and prosecutors—
shows such as Law & Order. A
charismatic police officer, investigator, or prosecutor struggles
with his own demons while
heroically trying to solve a horrible crime. He ultimately
achieves a personal and moral
victory by finding the bad guy and throwing him in jail. That is
the made-for-TV ver-
sion of the criminal justice system. It perpetuates the myth that
the primary
function of the system is to keep our streets safe and our homes
secure by
rooting out dangerous criminals and punishing them.

Those who have been swept within the criminal justice system
know that
the way the system actually works bears little resemblance to
what happens
on television or in movies. Full-blown trials of guilt or
innocence rarely occur;
many people never even meet with an attorney; witnesses are
routinely paid and
coerced by the government; police regularly stop and search
people for no reason whatso-
ever; penalties for many crimes are so severe that innocent
people plead guilty, accepting
plea bargains to avoid harsh mandatory sentences; and children,
even as young as fourteen,
are sent to adult prisons.
In this chapter, we shall see how the system of mass
incarceration actually works. Our focus
is the War on Drugs. The reason is simple: Convictions for drug
offenses are the single most
important cause of the explosion in incarceration rates in the
United States. [M]ore than 31
million people have been arrested for drug offenses since the
drug war began.1 To put the mat-
ter in perspective, consider this: there are more people in
prisons and jails today just for drug
offenses than were incarcerated for all reasons in 1980.2
Nothing has contributed more to the
systematic mass incarceration of people of color in the United
States than the War on Drugs.
Before we begin our tour of the drug war, it is worthwhile to get
a couple of myths out of the

way. The first is that the war is aimed at ridding the nation of
drug “kingpins” or big-time
dealers. Nothing could be further from the truth. The vast
majority of those arrested are
not charged with serious offenses. In 2005, for example, four
out of five drug arrests were
for possession, and only one out of five was for sales.
Moreover, most people in state prison
for drug offenses have no history of violence or significant
selling activity.3
The second myth is that the drug war is principally concerned
with dangerous drugs. Quite
to the contrary, arrests for marijuana possession—a drug less
harmful than tobacco or alco-
hol—accounted for nearly 80 percent of the growth in drug
arrests in the 1990s.4
Abridged excerpt
from The New Jim
Crow: Mass Incar-
ceration in the Age
of Colorblindness —
Copyright © 2010,
2012 by Michelle
Alexander. Reprinted
by permission of
The New Press.
thenewpress.com
BOOK
EXCERPT
LESSON 6

http://www.tolerance.org
http://www.thenewpress.com/
soulikone sengvongdeuane
2
TEACHING THE NEW JIM CROW
LESSON 6
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The percentage of drug arrests that result in prison sentences
(rather than dismissal, com-
munity service, or probation) has quadrupled, resulting in a
prison-building boom the likes
of which the world has never seen. In two short decades,
between 1980 and 2000, the num-
ber of people incarcerated in our nation’s prisons and jails
soared from roughly 300,000 to
more than 2 million. By the end of 2007, more than 7 million
Americans—or one in every 31
adults—were behind bars, on probation, or on parole.5
We begin our exploration of the drug war at the point of entry—
arrest by the police—and
then consider how the system of mass incarceration is structured
to reward mass drug
arrests and facilitate the conviction and imprisonment of an
unprecedented number of
Americans, whether guilty or innocent.
Rules of the Game
Few legal rules meaningfully constrain the police in the War on
Drugs. This may sound
like an overstatement, but upon examination it proves accurate.

The absence of significant
constraints on the exercise of police discretion is a key feature
of the drug war’s design. It
has made the roundup of millions of Americans for nonviolent
drug offenses relatively easy.
With only a few exceptions, the Supreme Court has seized every
opportunity to facilitate
the drug war, primarily by eviscerating Fourth Amendment
protections against unreason-
able searches and seizures by the police.
Most Americans do not know what the Fourth Amendment of
the U.S. Constitution actu-
ally says or what it requires of the police. It states, i n its
entirety:
The right of the people to be secure in their persons, houses,
papers, and effects, against
unreasonable searches and seizures, shall not be violated, and
no warrants shall issue, but
upon probable cause, supported by oath or affirmation, and
particularly describing the
place to be searched, and the person or things to be seized.
Until the War on Drugs, courts had been fairly stringent about
enforcing the Fourth
Amendment’s requirements.
The Fourth Amendment is but one example. Virtually all
constitutionally protected civil
liberties have been undermined by the drug war. The Court has
been busy in recent years ap-
proving mandatory drug testing of employees and students,
upholding random searches and
sweeps of public schools and students, permitting police to

obtain search warrants based on
an anonymous informant’s tip, expanding the government’s
wiretapping authority, legiti-
mating the use of paid, unidentified informants by police and
prosecutors, approving the use
of helicopter surveillance of homes without a warrant, and
allowing the forfeiture of cash,
homes, and other property based on unproven allegations of
illegal drug activity.
These new legal rules have ensured that anyone, virtually
anywhere, for any reason, can be-
come a target of drug-law enforcement activity.
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Unreasonable Suspicion
Once upon a time, it was generally understood that the police
could not stop and search
someone without a warrant unless there was probable cause to
believe that the individual
was engaged in criminal activity. That was a basic Fourth
Amendment principle. In Terry v.
Ohio, decided in 1968, the Supreme Court modified that
understanding, but only modestly,
by ruling that if and when a police officer observes unusual
conduct by someone the officer
reasonably believes to be dangerous and engaged in criminal

activity, the officer “is entitled
for the protection of himself and others in the area” to conduct a
limited search “to discover
weapons that might be used against the officer.”6 Known as the
stop-and-frisk rule, the Terry
decision stands for the proposition that, so long as a police
officer has “reasonable articulable
suspicion” that someone is engaged in criminal activity and
dangerous, it is constitutionally
permissible to stop, question, and frisk him or her—even in the
absence of probable cause.
Justice Douglas dissented in Terry on the grounds that
“grant[ing] police greater power
than a magistrate [ judge] is to take a long step down the
totalitarian path.”7 His voice was
a lonely one. Most commentators at the time agreed that
affording police the power and
discretion to protect themselves during an encounter with
someone they believed to be a
dangerous criminal is not “unreasonable” under the Fourth
Amendment.
History suggests Justice Douglas had the better of the argument.
In the years since Terry,
stops, interrogations, and searches of ordinary people driving
down the street, walking
home from the bus stop, or riding the train, have become
commonplace—at least for people
of color. Today it is no longer necessary for the police to have
any reason to believe that
people are engaged in criminal activity or actually dangerous to
stop and search them. As
long as you give “consent,” the police can stop, interrogate, and
search you for any reason or
no reason at all.

Poor Excuse
So-called consent searches have made it possible for the police
to stop and search just
about anybody walking down the street for drugs. All a police
officer has to do in order to
conduct a baseless drug investigation is ask to speak with
someone and then get their “con-
sent” to be searched. So long as orders are phrased as a
question, compliance is interpreted
as consent. “May I speak to you?” thunders an officer. “Will
you put your arms up and stand
against the wall for a search?” Because almost no one refuses,
drug sweeps on the sidewalk
(and on buses and trains) are easy. People are easily intimidated
when the police confront
them, hands on their revolvers, and most have no idea the
question can be answered, “No.”
But what about all the people driving down the street? How do
police extract consent from
them? The answer: pretext stops.
Like consent searches, pretext stops are favorite tools of law
enforcement in the War on
Drugs. A classic pretext stop is a traffic stop motivated not by
any desire to enforce traffic
laws, but instead motivated by a desire to hunt for drugs in the
absence of any evidence of
illegal drug activity. In other words, police officers use minor
traffic violations as an ex-
cuse—a pretext—to search for drugs, even though there is not a
shred of evidence suggest-
ing the motorist is violating drug laws. Pretext stops, like
consent searches, have received
the Supreme Court’s unequivocal blessing.

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Kissing Frogs
Court cases involving drug-law enforcement almost always
involve guilty people. Police
usually release the innocent on the street—often without a
ticket, citation, or even an apol-
ogy—so their stories are rarely heard in court. Hardly anyone
files a complaint … For good
reason, many people—especially poor people of color—fear
police harassment, retaliation,
and abuse. After having your car torn apart by the police in a
futile search for drugs, or be-
ing forced to lie spread-eagled on the pavement while the police
search you and interrogate
you for no reason at all, how much confidence do you have in
law enforcement?
The inevitable result is that the people who wind up in front of
a judge are usually guilty of
some crime. The parade of guilty people through America’s
courtrooms gives the false im-
pression to the public—as well as to judges—that when the
police have a “hunch,” it makes
sense to let them act on it.
The truth, however, is that most people stopped and searched in
the War on Drugs are per-
fectly innocent of any crime. The police have received no
training that enhances the likeli-
hood they will spot the drug criminals as they drive by and
leave everyone else alone. To the

contrary, tens of thousands of law enforcement officers have
received training that guaran-
tees precisely the opposite. The Drug Enforcement Agency
(DEA) trains police to conduct
utterly unreasonable and discriminatory stops and searches
throughout the United States.
Perhaps the best known of these training programs is Operation
Pipeline. The DEA
launched Operation Pipeline in 1984 as part of the Reagan
administration’s rollout of the
War on Drugs. Officers learn, among other things, how to use a
minor traffic violation as a
pretext to stop someone, how to lengthen a routine traffic stop
and leverage it into a search
for drugs, how to obtain consent from a reluctant motorist, and
how to use drug-sniffing
dogs to obtain probable cause.8
The program’s success requires police to stop “staggering ”
numbers of people in shotgun
fashion.9 This “volume” approach to drug enforcement sweeps
up extraordinary numbers
of innocent people. As one California Highway Patrol Officer
said, “It’s sheer numbers.
… You’ve got to kiss a lot of frogs before you find a
prince.”10 Accordingly, every year, tens
of thousands of motorists find themselves stopped on the side of
the road, fielding ques-
tions about imaginary drug activity, and then succumbing to a
request for their vehicle to
be searched—sometimes torn apart—in the search for drugs. It
has been estimated that 95
percent of Pipeline stops yield no illegal drugs.11
The “drug-courier profiles” utilized by the DEA and other law

enforcement agencies for
drug sweeps on highways, as well as in airports and train
stations, are notoriously unreli-
able. The profile can include traveling with luggage, traveling
without luggage, driving an
expensive car, driving a car that needs repairs, driving with out-
of-state license plates, driv-
ing a rental car, driving with “mismatched occupants,” acting
too calm, acting too nervous,
dressing casually, wearing expensive clothing or jewelry, being
one of the first to deplane,
being one of the last to deplane, deplaning in the middle, paying
for a ticket in cash, using
large-denomination currency, using small-denomination
currency, traveling alone, travel-
ing with a companion, and so on. Even striving to obey the law
fits the profile!
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The Supreme Court has allowed use of drug-courier profiles as
guides for the exercise of
police discretion. Although it has indicated that the mere fact
that someone fits a profile
does not automatically constitute reasonable suspicion
justifying a stop, courts routinely
defer to these profiles, and the Court has yet to object.

It Pays to Play
[I]t is fair to wonder why the police would choose to arrest such
an astonishing percentage
of the American public for minor drug crimes. The fact that
police are legally allowed to
engage in a wholesale roundup of nonviolent drug offenders
does not answer the question
why they would choose to do so, particularly when most police
departments have far more
serious crimes to prevent and solve. Why would police
prioritize drug-law enforcement?
Drug use and abuse is nothing new; in fact, it was on the
decline, not on the rise, when the
War on Drugs began.
Once again, the answer lies in the system’s design. Every
system of control depends for its
survival on the tangible and intangible benefits that are
provided to those who are respon-
sible for the system’s maintenance and administration. This
system is no exception.
At the time the drug war was declared, illegal drug use and
abuse was not a pressing con-
cern in most communities. The announcement of a War on
Drugs was therefore met with
some confusion and resistance within law enforcement … .
Many state and local law en-
forcement officials were less than pleased with the attempt by
the federal government to
assert itself in local crime fighting, viewing the new drug war
as an unwelcome distraction
… from more serious crimes, such as murder, rape, grand theft,
and violent assault—all of
which were of far greater concern to most communities than
illegal drug use.

The resistance within law enforcement to the drug war created
something of a dilemma
for the Reagan administration. In order for the war to actually
work—that is, in order for
it to succeed in achieving its political goals—it was necessary
to build a consensus among
state and local law enforcement agencies that the drug war
should be a top priority in their
hometowns. The solution: cash. Huge cash grants were made to
those law enforcement
agencies that were willing to make drug-law enforcement a top
priority.
In 1988, at the behest of the Reagan administration, Congress
revised the program that
provides federal aid to law enforcement, renaming it the Edward
Byrne Memorial State
and Local Law Enforcement Assistance Program after a New
York City police officer who
was shot to death while guarding the home of a drug-case
witness. The Byrne program was
designed to encourage every federal grant recipient to help fight
the War on Drugs. Millions
of dollars in federal aid have been offered to state and local law
enforcement agencies will-
ing to wage the war.
By the late 1990s, the overwhelming majority of state and local
police forces in the country
had availed themselves of the newly available resources and
added a significant military
component to buttress their drug-war operations.

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Waging War
In barely a decade, the War on Drugs went from being a
political slogan to an actual war.
Now that police departments were suddenly flush with cash and
military equipment ear-
marked for the drug war, they needed to make use of their new
resources. [P]ara military
units (most commonly called Special Weapons and Tactics, or
SWAT, teams) were quickly
formed in virtually every major city to fight the drug war.12
Today, the most common use of SWAT teams is to serve
narcotics warrants, usually with
forced, unannounced entry into the home. In fact, in some
jurisdictions drug warrants are
served only by SWAT teams—regardless of the nature of the
alleged drug crime.
Drug raids conducted by SWAT teams are not polite encounters.
In countless situations in
which police could easily have arrested someone or conducted a
search without a military-
style raid, police blast into people’s homes, typically in the
middle of the night, throwing
grenades, shouting, and pointing guns and rifles at anyone
inside, often including young
children. In recent years, dozens of people have been killed by
police in the course of these
raids, including elderly grandparents and those who are
completely innocent of any crime.
SWAT raids have not been limited to homes, apartment

buildings, or public housing proj-
ects. Public high schools have been invaded by SWAT teams in
search of drugs. In Novem-
ber 2003, for example, police raided Stratford High School in
Goose Creek, South Carolina.
The raid was recorded by the school’s surveillance cameras as
well as a police camera. The
tapes show students as young as fourteen forced to the ground
in handcuffs as officers in
SWAT team uniforms and bulletproof vests aim guns at their
heads and lead a drug-sniffing
dog to tear through their book bags. The raid was initiated by
the school’s principal, who
was suspicious that a single student might be dealing marijuana.
No drugs or weapons were
found during the raid and no charges were filed. Nearly all of
the students searched and
seized were students of color.
Finders Keepers
As if the free military equipment, training, and cash grants were
not enough, the Reagan
administration provided law enforcement with yet another
financial incentive to devote
extraordinary resources to drug law enforcement, rather than
more serious crimes: state
and local law enforcement agencies were granted the authority
to keep, for their own use,
the vast majority of cash and assets they seize when waging the
drug war. This dramatic
change in policy gave state and local police an enormous stake
in the War on Drugs—not in
its success, but in its perpetual existence.
Suddenly, police departments were capable of increasing the
size of their budgets, quite

substantially, simply by taking the cash, cars, and homes of
people suspected of drug use
or sales. Because those who were targeted were typically poor
or of moderate means, they
often lacked the resources to hire an attorney or pay the
considerable court costs. As a re-
sult, most people who had their cash or property seized did not
challenge the government’s
action, especially because the government could retaliate by
filing criminal charges—base-
less or not.
7
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Time Served
Once convicted of felony drug charges, one’s chances of being
released from the system
in short order are slim, at best. The elimination of judicial
discretion through manda-
tory sentencing laws has forced judges to impose sentences for
drug crimes that are often
longer than those violent criminals receive. When judges have
discretion, they may con-
sider a defendant’s background and impose a lighter penalty if
the defendant’s personal
circumstances—extreme poverty or experience of abuse, for
example—warrant it. This
flexibility—which is important in all criminal cases—is
especially important in drug cases,
as studies have indicated that many drug defendants are using or
selling to support an ad-
diction.13 Referring a defendant to treatment, rather than

sending him or her to prison, may
well be the most prudent choice—saving government resources
and potentially saving the
defendant from a lifetime of addiction. Likewise, imposing a
short prison sentence (or none
at all) may increase the chances that the defendant will
experience successful re-entry. A
lengthy prison term may increase the odds that re-entry will be
extremely difficult, leading
to relapse, and re-imprisonment
[I]n Harmelin v. Michigan, the Court upheld a sentence of life
imprisonment for a defen-
dant with no prior convictions who attempted to sell 672 grams
(approximately 23 ounces)
of crack cocaine.14 This ruling was remarkable given that, prior
to the Drug Reform Act of
1986, the longest sentence Congress had ever imposed for
possession of any drug in any
amount was one year. A life sentence for a first-time drug
offense is unheard of in the rest of
the developed world.
Mandatory sentencing laws are frequently justified as necessary
to keep “violent criminals”
off the streets, yet those penalties are imposed most often
against drug offenders and those
who are guilty of nonviolent crimes. In fact, under the three-
strikes regime in California, a
“repeat offender” could be someone who had only a single prior
case decades ago, and one
arrest can result in multiple strikes. For example, imagine a
young man, eighteen years old,
who is arrested as part of an undercover operation and charged
with two counts of dealing
cocaine to minors. He had been selling to friends to earn extra

money for shoes and basic
things his mother could not afford. The prosecutor offers him
probation if he agrees to
plead guilty to both charges and to snitch on a bigger dealer.
Terrified of doing prison time,
he takes the deal. Several years later, he finds his punishment
will never end. Branded a fel-
on, he is struggling to survive and to support his children. One
night he burglarizes a corner
store and steals food, toothpaste, Pepsi, and diapers for his baby
boy. He is arrested almost
immediately a few blocks away. That’s it for him. He now has
three strikes. His burglary can
be charged as a third strike because of his two prior felony
convictions. He is eligible for life
imprisonment. His children will be raised without a father.
The Prison Label
Once a person is labeled a felon, he or she is ushered into a
parallel universe in which dis-
crimination, stigma, and exclusion are perfectly legal, and
privileges of citizenship such as
voting and jury service are off-limits. It does not matter whether
you have actually spent
time in prison; your second-class citizenship begins the moment
you are branded a felon.
8
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Most people branded felons, in fact, are not sentenced to prison.
As of 2008, there were
approximately 2.3 million people in prisons and jails, and a

staggering 5.1 million people
under “community correctional supervision”—i.e., on probation
or parole.15
For those released on probation or parole, the risks are
especially high. They are subject to
regular surveillance and monitoring by the police and may be
stopped and searched (with
or without their consent) for any reason or no reason at all. As a
result, they are far more
likely to be arrested (again) than those whose behavior is not
subject to constant scrutiny
by law enforcement.
The extraordinary increase in prison admissions due to parole
and probation violations is
due almost entirely to the War on Drugs. With respect to parole,
in 1980, only 1 percent of
all prison admissions were parole violators. Twenty years later,
more than one third (35
percent) of prison admissions resulted from parole violations.16
In this system of control,
failing to cope well with one’s exile status is treated like a
crime. If you fail, after being
released from prison with a criminal record—your personal
badge of inferiority—to remain
drug free, or if you fail to get a job against all the odds, or if
you get depressed and miss
an appointment with your parole officer (or if you cannot afford
the bus fare to take you
there), you can be sent right back to prison—where society
apparently thinks millions of
Americans belong.
Most ultimately return to prison, sometimes for the rest of their
lives. Others are released

again, only to find themselves in precisely the circumstances
they occupied before, unable
to cope with the stigma of the prison label and their permanent
pariah status. Reducing the
amount of time people spend behind bars—by eliminating harsh
mandatory minimums—
will alleviate some of the unnecessary suffering caused by this
system, but it will not
disturb the closed circuit. Those labeled felons will continue to
cycle in and out of prison,
subject to perpetual surveillance by the police, and unable to
integrate into the mainstream
society and economy. Unless the number of people who are
labeled felons is dramatically
reduced, and unless the laws and policies that keep ex-offenders
marginalized from the
mainstream society and economy are eliminated, the system will
continue to create and
maintain an enormous undercaste.
Endnotes
1 Marc Mauer and Ryan King, A 25-Year Quagmire: The “War
on Drugs” and Its Impact on American Society (Washington,
DC:
Sentencing Project, 2007), 3.
2 Testimony of Marc Mauer, Executive Director of the
Sentencing Project, Prepared for the House Judiciary
Subcommit-
tee on Crime, Terrorism, and Homeland Security, 111th Cong.,
Hearing on Unfairness in Federal Cocaine Sentencing: Is It
Time
to Crack the 100 to 1 Disparity? May 21, 2009, 2.
3 Mauer and King, A 25-Year Quagmire, 2–3.

4 Ibid.; and Ryan King and Marc Mauer, The War on
Marijuana: The Transformation of the War on Drugs in the
1990s (New
York: Sentencing Project, 2005), documenting the dramatic
increase in marijuana arrests. Marijuana is a relatively harmless
drug.
9
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The 1988 surgeon general’s report lists tobacco as a more
dangerous drug than marijuana, and Francis Young, an
administrative
law judge for the Drug Enforcement Administration found there
are no credible medical reports to suggest that consuming
marijuana, in any dose, has ever caused a single death. U.S.
Department of Justice, Drug Enforcement Administration,
Opinion
and Recommended Ruling, Findings of Fact, Conclusions of
Law and Decision of Administrative Law Judge Francis L.
Young,
in the Matter of Marijuana Rescheduling Petition, Docket no.
86-22, Sept. 6, 1988, 56–57. By comparison, tobacco kills
roughly
390,000 Americans annually, and alcohol is responsible for
some 150,000 U.S. deaths a year. See Doug Bandow, “War on
Drugs
or War on America?” Stanford Law and Policy Review 3: 242,
245 (1991).
5 Pew Center on the States, One in 31: The Long Reach of
American Corrections (Washington, DC: Pew Charitable Trusts,
2009).

6 Terry v. Ohio, 392 U.S. 1, 30 (1968).
7 Ibid., Douglas J., dissenting.
8 See U.S. Department of Justice, Drug Enforcement
Administration, Operations Pipeline and Convoy (Washington,
DC,
n.d.), www.usdoj.gov/dea/programs/ pipecon.htm.
9 State v. Rutherford, 93 Ohio App.3d 586, 593–95, 639 N.E.
2d 498, 503–4,
n. 3 (Ohio Ct. App. 1994).
10 Gary Webb, “Driving While Black,” Esquire, Apr. 1, 1999,
122.
11 Ibid.
12 Ibid., 8–9.
13 Christopher J. Mumola and Jennifer C. Karberg, Drug Use
and Dependence, State and Federal Prisoners, 2004 (Washing-
ton, DC: U.S. Department of Justice, Bureau of Justice
Statistics, 2006); and Ashley Nellis, Judy Greene, and Marc
Mauer, Reducing Racial Disparity in the Criminal Justice
System: A Manual for Practitioners and Policymakers, 2d ed.
(Washington,
DC: Sentencing Project, 2008), 8.
14 Harmelin v. Michigan, 501 U.S. 967 (1991).
15 PEW Center for the States, One in 31.
16 Jeremy Travis, But They All Come Back: Facing the
Challenges of Prisoner Reentry (Washington, DC: Urban

Institute Press,
2002), 32, citing Bureau of Justice Statistics.
http://www.usdoj.gov/dea/programs/
Chapter 16
Educating and Socializing
Staff in a Learning
Organization
1
Learning Objectives
1. Differentiate between education and training (Text p 413-14)
2. Select an appropriate sequence of events for educational
planning (ATI p 11) (Text 418-20)
3. Identify problems that may occur when the responsibility for
staff development is shared (Text p 420)
4. Select appropriate educational strategies that facilitate
learning in a variety of situations (Text p 420)
2
Learning Objectives
5. Discuss criteria that should be used to evaluate staff
development activities (ATI p 11—Staff Education)
6. Demonstrate knowledge of the needs of the adult learner and

describe teaching strategies that best meet his or her needs
(Text p 415)
7. Apply principles of social learning theory (Text 415-16)
8. Identify strategies that could be used to help staff deal
successfully with role transitions (ATI p 11—Nursing Ability)
(Text p 273/Chap 11—Benner) (Text 420-424)
3
Learning Objective
9. Describe strategies that could be used to assist the new
graduate nurse with socialization to the nursing unit (ATI p
11—Socialization) (Text p 421)
10. Contrast the roles of mentor, preceptor and role model (Text
424-26)
*Competence (ATI p 11) (Text 418)
* Staff Education (ATI p 10) (Text 418)
4
Philosophy of Learning Organizations #1
The learning organization (LO) promotes a shared vision and
collective learning in order to create positive and needed
organizational change.
Collective learning goes beyond the boundaries of individual
learning and releases gains for both the individual and the
organization.
5
Philosophy of Learning Organizations #2

A premise of the learning organization is that learning itself
enhances the team.
6
Key Characteristics of Senge’s Model of LOs
Systems thinking
Personal mastery
Team learning
Mental models
Shared vision
7
Training Versus Education #1
Training may be defined as an organized method of ensuring
that people have knowledge and skills for a specific purpose
and that they have acquired the necessary knowledge to perform
the duties of the job.
Education is more formal and broader in scope than training.
Whereas training has an immediate use, education is designed to
develop individuals in a broader sense.
8
Training Versus Education #2
Managers and education department staff have a shared
responsibility for the education and training of staff.

9
Learning Theories
Adult learning theory (Knowles, 1970): Pedagogy versus
andragogy
Social learning theory (Bandura, 1977): learning from
interactions with others in a social context
Other learning concepts: readiness to learn; motivation to learn;
reinforcement; task learning; transfer of learning; span of
memory; chunking; knowledge of results
10
Implications of Knowles’s Work for Trainers and Educators #1
A climate of openness and respect will assist in the
identification of what the adult learner wants and needs to learn.
Adults enjoy taking part in and planning their learning
experiences.
Adults should be involved in the evaluation of their progress.
Experiential techniques work best with adults.
Mistakes are opportunities for adult learning.
11
Implications of Knowles’s Work for Trainers and Educators #2
If the value of the adult’s experience is rejected, the adult will
feel rejected.
Adults’ readiness to learn is greatest when they recognize that

there is a need to know (such as in response to a problem).
Adults need the opportunity to apply what they have learned
very quickly after the learning.
Assessment of need is imperative in adult learning.
12
Obstacles to Adult Learning
Institutional barriers
Time
Self-confidence
Situational obstacles
Family reaction
Special individual obstacles
13
Assets for Adult Learning
High self-motivation
Self-directed
A proven learner
Knowledge experience reservoir
Special individual assets
14
Chunking as a Learning Strategy
Chunking refers to presenting two independent items of

information and grouping them together into one unit.
Although the mind can remember only a limited number of
chunks of data, experienced nurses can include more data in
those chunks than can novice nurses.
15
Three Reasons for Staff Development
To establish competence
To meet new learning needs
To satisfy interests the staff may have in learning in specific
areas
16
Sequence for Developing an Educational Program
Identify the desired knowledge or skills that the staff should
have.
Identify the present level of knowledge or skill.
Determine the deficit of desired knowledge and skills.
Identify the resources available to meet needs.
Make maximum use of available resources.
Evaluate and test outcomes after use of resources.
17
Evaluation Criteria for Staff Development Activities
Learner’s reaction
Behavior change
Organizational impact
Cost-effectiveness

18
Evidence-Based Practice
Facilitating evidence-based practice is a shared responsibility of
the professional nurse, the organization, leader-managers, and
the education or staff development department.
19
Strategies for Promoting Evidence-Based Practice #1
Develop and refine research-based policies and procedures.
Build consensus from the interdisciplinary team through
development of protocols, decision trees, standards of care,
institutional clinical practice guidelines, etc.
Make research findings accessible through libraries and
computer resources.
20
Strategies for Promoting Evidence-Based Practice #2
Provide organization support, such as time to do research and
educational assistance to teach staff to interpret research
statistics and use findings.
Encourage cooperation among professionals.
When possible, hire nurse researchers or consultants to assist
staff.

21
Socialization #1
Learning the behaviors that accompany each role by instruction,
observation, and trial and error
Involves a sharing of the values and attitudes of the
organization
Creates a fit between new staff members and the unit by
introducing them to the norms of the group
22
Socialization #2
The first socialization to the nursing role occurs during nursing
school and continues after graduation.
23
Resocialization
Occurs when individuals are forced to learn new values, skills,
attitudes, and social rules as a result of changes in the type of
work they do, in the scope of responsibility they hold, or in the
work setting itself
24

Role Change
Organizations often fail to address socialization problems that
occur in job, position, or status changes.
Role overload occurs when the demands of the role are
excessive.
25
Team Building via Role Models, Preceptors, and Mentors
These roles help to clarify role expectations through the use of
social interaction and educational processes.
Each role has a different focus and uses different mechanisms.
26
Role Models
Behavior you want to emulate
May be a passive or nonexistent relationship
A person can have many role models.
There is a cumulative effect.
27
Preceptor

An experienced nurse who provides knowledge and emotional
support, as well as a clarification of role expectations, on a one -
to-one basis
Effective preceptors role model and adjust teaching to each
learner as needed.
28
Mentoring
An in-depth supportive and nurturing relationship between an
expert and a novice
Formal relationship typically lasts 2 to 5 years, with mentor
being one generation older than mentee
Many nurses have limited opportunities to have a true
mentoring relationship in their lives.
29
Phases of the Mentoring Process
Exploring whether to begin a mentoring relationship
Negotiating a mentoring agreement, with a goal(s) and
deadline(s)
Implementing the agreement and periodically reviewing
progress made
Summarizing and formally concluding the mentoring
relationship
30

Behavioral Sanctions
The bestowing of rewards and punishments
Used to show employees what behavior is rewarded or eschewed
in an organization
Rarely carried out on a systematic and planned basis
31
Group Norms
The manager should know what the group norms are and should
be observant of the sanctions used by the group to make
newcomers conform.
The manager should take appropriate intervention if group
norms are not part of the organizational culture.
32
Meeting the Educational Needs of a Culturally Diverse Staff
Respect cultural diversity—recognize its desirability.
Recognize different perceptions of classroom and instruction
learning.
33
Unique Socialization Needs of International Nurses
Often experience cultural, professional, and psychological
dissonance
Communication problems

Anxiety, homesickness, and isolation
34
Coaching
One person helping another to achieve an optimal level of
performance
Tool for empowering subordinates, changing behavior, and
developing a cohesive team
Emphasis on assisting the employee to recognize greater
options, to clarify statements, and to grow
35
Chapter 15
Employee Recruitment,
Selection, Placement, and Indoctrination
1
Learning Objectives
1. Identify variables that impact an organization’s ability to
recruit candidates successfully for job openings (Text p 377 &
379)

2. Delineate the relationship between recruitment and retention
(Text p 383)
3. Describe interview techniques that reduce subjectivity and
increase reliability and validity during the interview process
(Text p 384-86)
2
Learning Objectives
4. Develop appropriate interview questions to determine
whether an applicant is qualified and willing to meet the
requirements of the position
5. Differentiate between legal and illegal interview questions
6. Select appropriate activities to be included in the
recruitment, selection, placement and indoctrination of
employees (Text 392-400)
*Orientation to the Institution, To the Unit (ATI p 10) (Text
400-402)
3
Staffing—The Third Phase of the Management Process #1
In staffing, the leader-manager recruits, selects, orients, and
promotes personnel development to accomplish the goals of the
organization.
4
Staffing—The Third Phase of the Management Process #2
Staffing is an especially important phase of the management
process in health-care organizations because such organizations

are usually labor intensive (i.e., many employees are required to
accomplish organizational goals).
5
Sequential Steps in Staffing #1
Determine the number and types of personnel needed to fulfill
the philosophy, meet fiscal planning responsibilities, and carry
out the chosen patient care delivery system selected by the
organization.
Recruit, interview, select, and assign personnel based on
established job description performance standards.
6
Sequential Steps in Staffing #2
Use organizational resources for induction and orientation.
Ascertain that each employee is adequately socialized to
organization values and unit norms.
Use creative and flexible scheduling based on patient care needs
to increase productivity and retention.
7
Factors Affecting Staffing Needs #1
Source of nursing pools
Number of students enrolled in local nursing schools
Usual length of employment of newly hired staff

Patient care delivery system in place
Knowledge level of
needed staff
Budget constraints
Times of high patient
census
Peak staff resignation
periods
8
Historically, when the economy improves, nursing shortages
occur. When the economy declines, nursing vacancy rate decline
as well.
9
Numerous factors are contributing to significant future nursing
shortages, including the aging of the nursing workforce,
accelerating demand for professional nurses, inadequate
enrollment in nursing programs of study, and the aging of
nursing faculty.
10
Leaders should seek to proactively recruit and hire staff with

age, gender, cultural, ethnic, and language diversity to better
mirror the rapidly increasing diversity of the communities they
serve.
11
Seeking Employee Diversity
Diversity also brings new perspectives to thinking and problem
solving.
12
Recruitment
The process of actively seeking out or attracting applicants for
existing positions
Should be an ongoing process
13
Factors That Affect Recruitment
Financial resources
Adequate nursing pool
Competitive salaries
The organization’s reputation
The location’s desirability
The status of the national and local economy

14
Recruitment Methods
Advertisements
Career days
Literature
Word of mouth by satisfied employees
15
Recruitment and Retention
Recruitment is not the key to adequate staffing in the long term.
Retention is, and it occurs only when the organization is able to
create a work environment that makes staff want to stay.
16
Turnover
Some turnover is normal and in fact desirable.
It infuses the organization with fresh ideas and reduces the
probability of groupthink.
However, excessive or unnecessary turnover reduces the ability
of the organization to produce its end-product and is expensive.
17
Interviewing as a Selection Tool

The most common method for employee selection used by
managers
Also the most time-consuming and thus one of the costliest
selection tools
It generally requires an interviewer to use judgments, biases,
and values to make decisions based on a short interaction with
an applicant in an unnatural situation. Thus, reliability and
validity are always suspect
18
Purposes of the Selection Interview #1
The interviewer seeks to obtain enough information to
determine the applicant’s suitability for the available position.
The applicant seeks to obtain adequate information to make an
intelligent decision about accepting the job, should it be
offered.
The interviewer seeks to conduct the interview in such a manner
that, regardless of the interview’s result, the applicant will
continue to have respect for and good will toward the
organization.
19
Purposes of the Selection Interview #2
The structured interview is a much better predictor of job
performance and overall effectiveness than the unstructured
interview.

20
Reliability and Validity Issues of the Selection Process
Validity increases with a team approach.
Negative information tends to be weighed more heavily than
positive information.
The same standards should be used for all applicants.
Selection should be based on established criteria, not value
judgments.
Personal bias should be minimized because negative feelings
likely have no relation to the criteria necessary for success in
the position.
21
Limitations of the Interview Process as a Selection Tool #1
Subjectivity can never be totally eliminated.
High interview assessments
do not necessarily correlate
with high-level performance
on the job.
Mixed reliability and validity
Intrarater reliability high
Interrater reliability low in
unstructured interviews
Interrater reliability is better if interview is structured and same
interview format is used by all interviewers.
22

Negative information about the applicant
is weighed more heavily than positive information, and the
earlier in the interview, the greater the negative effect.
Most decisions about the applicant are made in the first 30 to 60
seconds.
23
In unstructured interviews, the interviewer generally does most
of the talking. In structured interviews, the interviewer talks
less.
The environment is artificial, and it is difficult for many
interviewees to relax and be natural.
24
The interviewer may have poor communication skills and be
unable to generate a discussion.
Physical appearance often contributes substantially to an
interviewer’s opinion about an applicant.
Interviewers frequently ask questions that demonstrate a self-
fulfilling prophecy regarding their first impression of the
applicant.

25
The major defect of the interview is subjectivity.
26
Overcoming Interview Limitations
Use a team approach.
Develop a structured interview format for each job
classification.
Use scenarios to determine decision-making ability.
Conduct multiple interviews.
Provide training in effective interviewing techniques.
27
Suggested Interview Format
Introduce yourself and greet the applicant.
Make a brief statement about the organization and position and
clarify the position for which the person is applying.
Discuss the information on the application and seek
clarification or amplification as necessary.
Discuss employee qualifications and proceed with structured
interview format.
If applicant is qualified, discuss the position further.
Explain hiring procedures
Terminate the interview.

28
Two Aspects That Carry the Most Weight When Making Hiring
Decisions
The requirements of the job
Qualified versus overqualified
Personal bias
Examine any
negative feelings occurring in the
interview for
personal bias.
29
Common Job Interview Mistakes of Applicants #1
Arriving so early you appear overanxious
Saying too much
Wearing a coat/hat during the interview
Wearing psychologically intimidating colors or patterns
Sitting down before the interviewer does or addressing the
interviewer by his or her first name
Asking about salary, vacation, or promotions too early in the
interview
30
Common Job Interview Mistakes of Applicants #2
Bad-mouthing or revealing confidential information about a
former or current employer

Not having any questions
Overstating your accomplishments
Having a “what can you do for me?” attitude
Being vague, rambling, or evasive; all show poor
communication skills
Lacking clear direction regarding what you want in your career
Showing apathy or lack of motivation
31
Tips for the Applicant During the Interview #1
Avoid a bad first impression!
Don’t be late.
Don’t avoid eye contact.
Avoid a cold, clammy handshake.
Don’t sit down until the interviewer does.
Don’t fidget with personal belongings.
32
Tips for the Applicant
Do your homework about the organization you are applying to.
Practice the interview and rehearse answers to foreseeable
questions about your education and experience.
Be prompt on the day of the interview.
Look your best for the interview. Dress conservatively and
make sure you are neatly groomed.
33

Tips for the Applicant During the Interview #2
Do not slouch or fidget.
Do not chew gum or smoke cigarettes.
Bring a paper and pencil to take notes.
Answer the questions with confidence and watch the interviewer
for nonverbal cues.
34
Practice Interview Questions
Why do you want this job?
What is your philosophy of nursing?
What strengths and weaknesses do you bring to this job?
Why should we hire you? Why us?
What is your 20-year career plan?
Can you define professionalism in nursing practice?
What do you know about our organization?
35
Illegal Interview Inquiries
Age
Marital status
Children
Race
Sexual preference
Financial or credit status
National origin

Religion
36
After the Interview #1
Send a thank-you note to the interviewer.
If offered the job, send a formal letter accepting or rejecting the
job.
Personally critique the interview experience. Review in your
mind what you did well and what you would do differently the
next time.
37
After the Interview #2
Selection should be based on the requirements necessary for the
job; these criteria should be developed before beginning the
selection process.
38
Placement
The astute leader is able to assign a new employee to a position
within his or her sphere of authority where the employee will
have a reasonable chance for success.
39

Phases of Employee Indoctrination
Induction: includes all activities that educate the new employee
about the organization and employment and personnel policies
and procedures
Orientation: teaches activities that are more specific to the
position
Individual orientation to each department: Specific departments
are responsible for developing their own orientation program.
40
Chap 23—Quality Control in Creating a Culture of Safety
1. What is quality control and what is its importance to
healthcare?
2. Describe the functions of management as it relates to quality
improvement.
3. What criteria define Effective Quality Control programs?
4. Define the three steps associated with the Quality Control
Process?
5. Define the steps in auditing Quality Control
6. What are the standards associated with Quality Control?
7. What role does the ANA play in quality control?
8. Define Benchmarking and its role in an organization’s
approach to quality control/improvement
9. What is a Root Cause Analysis (RCA)?
10. Name three standardized nursing measures—what do they
measure and how does this contribute to quality control?
11. What are the nursing-sensitive outcomes? Give 3 examples.
12. What are clinical practice guidelines and what does EBP
have to do with them?
13. Define Quality Assurance and its evolution to Quality

Improvement—what is the difference?
14. What are the main features of the Total Quality Management
(TQM) system?
15. Why is the Toyota Production System (TPS) valuable as a
tool for healthcare quality?
16. The Joint Commission (TJC) has much to say about quality
improvement in healthcare. Define and name TJC Core
Measures
17. TJC—National Patient Safety Goals---name 3 current
NPSGs
18. Define and describe the role of TJC in accreditation of
healthcare facilities
19. The Centers for Medicare and Medicaid Services (CMS)—
how do their standards influence healthcare outcomes?
20. What is the mnemonic HEDIS? What is its mandate for
healthcare quality?
21. What is the mnemonic HCHAPS? What does it measure that
is important to patient care?
22. What is the “Just Culture” system and how does it work to
decrease medical errors?
23. Define strategies to prevent medical errors—name examples
of errors that have been addressed
24. What are Leapfrog Initiatives?
25. What is the Six Sigma Approach and its relationship to
quality improvement?
Chapter 16—Educating and Socializing Staff in a Learning
Organization
1. Define a learning organization
2. According to Senge’s model, what are the key characteristics
of the learning organization?
3. Compare and contrast the concepts of training vs education
4. In adult learning theory, define pedagogy an andragogy—
what are the differences and similarities?
5. Define social learning theory and name three learning
concepts that contribute to learning success

6. Describe barriers to adult learning
7. What characteristics support adult learning?
8. Describe the three most important reasons for staff
development
9. Define the sequence for developing an educational program
10. How do you determine that learning has occurred in staff
development?
11. Name and describe five strategies for promoting evidence-
based practice in nursing
12. What are the principle tenets of socialization in nursing?
13. Who benefits from resocialization and why is it important to
nurse managers?
14. What is the role of a preceptor?
15. Describe the mentoring characteristics
16. Why is it important to monitor for group norms? What are
the risks when there are behaviors outside the norms?
Chap 15
1. Describe the sequential steps in staffing—why are these
important to know?
2. Discuss the factors affecting staffing needs, particularly
those around nursing shortages
3. What type of nursing staff should leaders plan to hire—why
is this important to patient care?
4. Name factors that affect nurse recruitment
5. Define nurse retention and describe its importance to overall
health of an organization
6. Turnover—describe the good, the bad and the ugly of this
important factor in nurse staffing
7. Compare and contrast the structured vs unstructured
interview process
8. Describe the advantages of using a team approach to
interviewing candidates
9. What is unconscious bias and how does it affect the hiring
process?
10. Name/define two aspects that define the hiring process

11. Name 5 common job interview mistakes that you are most
worried about for yourself (or have done at some point)
12. Name 5 tips that help applicants during job interviews—
which ones will serve you best as you anticipate job interviews?
13. What specific questions may not be asked on a job
interview?
14. Describe one behavioral type interview that you can expect
to see in an interview—how will YOU answer it?
15. Define the induction and orientation phases of employment

Chapter 23Quality Control in Creating a Culture of Patient

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