CNML cheat sheet

SBAR = Situation, Background, Assessment, Recommendation; standardization reduces omitted or misordered information during handoffs and escalation.

Thomas-Kilmann modes: competing (win-lose), collaborating (win-win), compromising (partial gain), avoiding (withdraw), accommodating (yield). Collaborating fits high-stakes issues with adequate time and high relationship value.

Channel richness ordering: face-to-face > video > telephone > email > written memo/report. Rich channels suit ambiguous or emotionally charged messages; lean channels suit routine data.

Active listening sequence: attend, paraphrase, reflect feeling, clarify, summarize before responding.

BATNA is the best alternative to a negotiated agreement; it sets the reservation point. ZOPA is the overlap between the buyer's maximum and the seller's minimum.

Integrative negotiation expands the pie by trading on differing priorities; distributive negotiation divides a fixed pie and produces win-lose outcomes.

DESC script: Describe the situation, Express the concern, Specify the desired change, state the Consequences.

Tuckman stages: forming, storming, norming, performing, adjourning; conflict peaks at storming and is expected, not a sign of team failure.

Task conflict can improve decision quality; relationship (personal) conflict degrades it. Structured interdisciplinary rounds and daily huddles are associated with shorter length of stay and fewer communication failures.

Transformational leadership = the four I's: idealized influence, inspirational motivation, intellectual stimulation, individualized consideration.

Transactional leadership = contingent reward plus management by exception (active or passive); it manages compliance rather than commitment.

Hersey-Blanchard situational leadership matches style to follower readiness: S1 directing, S2 coaching, S3 supporting, S4 delegating, aligned to R1-R4 competence and commitment for the specific task.

Delegation requires the right task, right circumstance, right person, right direction/communication, and right supervision/evaluation; the delegating nurse keeps accountability and cannot delegate the nursing process itself.

Lewin change: unfreeze → move/change → refreeze. Kotter's eight steps begin with creating urgency and end with anchoring new approaches in culture.

Goleman's emotional intelligence: self-awareness, self-regulation, motivation, empathy, social skill.

Path-goal theory (House) directs the leader to use directive, supportive, participative, or achievement-oriented behavior to clear followers' paths to goals.

Magnet Model components: transformational leadership, structural empowerment, exemplary professional practice, new knowledge/innovation, empirical outcomes; shared governance operationalizes structural empowerment.

Span of control is the number of direct reports; wider spans fit routine, homogeneous, stable work, narrower spans fit complex, variable, high-risk work.

The ANA Code of Ethics has nine provisions; Provision 1 addresses compassion and respect for inherent dignity, Provision 2 the nurse's primary commitment to the patient, and Provision 9 the profession's obligation to social justice.

Just culture triage: human error → console and fix the system; at-risk behavior → coach and remove incentives; reckless behavior → disciplinary action. It is not a blame-free culture.

Each state's Nurse Practice Act defines scope of practice, licensure requirements, and disciplinary authority; the state board of nursing enforces it.

Ethical principles: autonomy (self-determination), beneficence (act for the patient's good), nonmaleficence (avoid harm), justice (fair distribution), veracity (truthfulness), fidelity (keep promises).

HIPAA Privacy Rule minimum-necessary standard limits disclosure to the least PHI needed for the purpose; access is restricted to those with a legitimate need to know.

Licensure is mandatory and legally granted by the state; certification is voluntary, time-limited, and validates specialty expertise.

Mandatory reporting duties typically cover suspected abuse/neglect, impaired practice, and specified communicable diseases; exact requirements are state-specific.

Workplace incivility is low-intensity deviant behavior with ambiguous intent to harm; it is linked to communication breakdown, errors, turnover, and patient-safety risk, and accreditation standards require a code-of-conduct policy.

IOM Crossing the Quality Chasm six aims (STEEEP): safe, timely, effective, efficient, equitable, patient-centered.

To Err Is Human (IOM, 1999) estimated 44,000-98,000 deaths per year from preventable medical errors and reframed error as a system problem.

IHI Triple Aim: improve population health, improve the patient experience of care, and reduce per-capita cost.

Medicare adopted the inpatient prospective payment system in 1983, paying a fixed amount per MS-DRG discharge rather than cost; complications that add cost without adding payment create financial risk.

Value-based programs include Hospital Value-Based Purchasing (clinical process, outcomes, patient experience/HCAHPS, efficiency), the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition Reduction Program.

ACA mechanisms include Medicaid expansion (state option), health insurance marketplaces, essential health benefits, and accountable care organizations.

A sentinel event triggers root cause analysis (retrospective); failure mode and effects analysis (FMEA) is prospective risk assessment.

Accreditation (Joint Commission, DNV) can confer deemed status for CMS; ANCC Magnet and Pathway to Excellence are nursing-specific credentials.

Care continuum: acute inpatient, ambulatory/outpatient, post-acute (SNF, inpatient rehab, LTACH), home health, hospice, and palliative care.

Operating budget covers recurring 12-month expenses (salaries, supplies, purchased services); capital budget covers long-lived assets above a defined dollar threshold and is depreciated.

Variance = actual minus budget. For expenses, actual above budget is unfavorable; for revenue, actual below budget is unfavorable.

One FTE = 2,080 paid hours per year (40 hours × 52 weeks); FTEs = total paid hours ÷ 2,080.

Nursing hours per patient day (NHPPD) = total nursing hours ÷ total patient days, computed over the same period.

Paid hours = productive (worked) + nonproductive (vacation, sick, education, orientation); productivity is measured as worked hours per unit of service.

Break-even volume = fixed costs ÷ (price − variable cost per unit); contribution margin = revenue − variable costs.

ROI = (benefit − cost) ÷ cost, expressed as a percentage; it ranks competing projects by financial return.

Skill mix = RN hours ÷ total nursing staff hours; staffing plans combine patient acuity, volume, skill mix, and benchmark NHPPD.

Revenue cycle: registration → charge capture → coding → billing → collections; days in accounts receivable = net A/R ÷ average daily net revenue, and payer mix drives net revenue.