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PubMed2004

Negotiating multiple roles: link teachers in clinical nursing practice.

BACKGROUND: The background to this study was a concern about the teacher's role in clinical practice. Experience suggested that teachers believed that their role in practice was important but that there were significant forces which impeded their ability to move with ease between education and practice. A discrepancy between previous research findings and theoretical discussions, and the reality experienced by teachers, led to the adoption of grounded theory as a way of exploring uncertainties in the situation. METHOD: Data were gathered over a period of 7 years and involved 28 in-depth interviews with nurses with a range of educational roles, employed in educational institutions and practice settings in inner city and provincial areas in the South of England. FINDINGS: The data revealed four categories, 'gaining access', 'negotiating credibility', 'being effective' and the core category 'negotiating multiple roles'. The core category is addressed in this article. Experiences of moving from a position of clinical practitioner to link teacher involved: 'disassembling the self' through leaving behind old identities; 'reconstructing the self' through clarifying new ways of being; and, finally, 'realizing the self' through reciprocal interpersonal activity with students, educational and nursing colleagues. CONCLUSIONS: It is inevitable that an individual with a remit for change entering an established social group will experience difficulties in establishing their role. It is also clear that an individual who changes their role within a group to reflect behaviours not congruent with the primary activity in that setting will experience dimensions of social exclusion. Further work needs to address how educational roles can make a significant impact on the everyday lives of students and nurses working in practice. The findings of this study are as relevant for the new roles of practice educator, clinical facilitator and practice placement co-ordinator as they are for link teachers and lecturer practitioners. Several suggestions are made to improve links with practice.

Clinical Competence↗
PubMed1987

An access-oriented negotiated fee schedule. The Caterpillar experience.

This paper describes the system used by Caterpillar Corporation (CAT) in Peoria, Illinois, to reimburse surgeons. The CAT system assures access for Caterpillar employees and their families to a selection of qualified surgeons, while achieving cost savings through improvements in processing of surgical claims and negotiation of selected fees. CPT-4 codes are recorded for greater accuracy, when indicated, surgical services that have been incorrectly unbundled are rebundled, and the appropriateness of surgical assistant charges is reviewed. A "degree of difficulty" relative value scale (DODRVS) of surgical services is periodically revised as technology changes. The DODRVS multiplied by a regional factor, determined by local market research, establishes the fee that CAT will pay the surgeon. Balance billing is permitted if the patient (1) is informed in advance by the surgeon that the fee will be higher than CAT will pay, and (2) knows that the service can be obtained from other local surgeons who will accept the CAT fee. The goal of the CAT method of surgeon reimbursement is to gain physician support for an access-oriented, market-driven negotiated fee schedule. Compared with a resource-based relative value scale RBRVS) methodology, the CAT system is not formula-driven and depends on physician acceptance.

Fee Schedules↗
PubMed1987

A hospital administrator's guide to successful HMO negotiations.

Many issues must be considered when hospitals negotiate with HMOs. Hospital administrators can improve negotiations with HMOs by understanding the philosophy and terminology of alternative delivery programs, as well as their hospital's own operating requirements.

Health Maintenance Organizations↗
PubMed1999

Negotiating couplehood: the process of resolving the December dilemma among interfaith couples.

Christmas forces interfaith couples to address questions concerning holiday observances. The purpose of this investigation was to explore the experience of the "December dilemma," that is, the experience of Christmas and Hanukah among couples in which one partner is Jewish. A qualitative design based on the continuous comparison method of Grounded Theory analysis was used. Participants were solicited through interfaith couples' programs, referral, and snowballing. Unstructured interactive interviews of 22 couples were audiotaped, transcribed, and analyzed. The categories generated were: Ghosts of Christmas and Hanukah Past, Coming Together, and Holiday Observances as a Couple. The basic problem facing these couples was how to bridge religious backgrounds with differing holiday traditions in a way that integrated respect for each partner's needs, heritage, and identity. The basic social process of negotiating "couplehood," that is, moving from individuality to partnership emerged when mutual agreement could be reached to solve problems about how to celebrate the December holidays. The data indicated that exploration of the ways these couples managed the dilemmas created by the December holidays provided a window to how they negotiated other challenges in their relationships.

Adaptation, Psychological↗
PubMed2006

Gastrocnemius muscle fascicle behavior during stair negotiation in humans.

The aim of the present study was to establish the behavior of human medial gastrocnemius (GM) muscle fascicles during stair negotiation. Ten healthy male subjects performed normal stair ascent and descent at their own comfortable speed on a standard-dimension four-step staircase with embedded force platforms in each step. Kinematic, kinetic, and electromyographic data of the lower limbs were collected. Real-time ultrasound scanning was used to determine GM muscle fascicle length changes. Musculotendon complex (MTC) length changes were estimated from ankle and knee joint kinematics. The GM muscle was mainly active during the push-off phase in stair ascent, and the muscle fascicles contracted nearly isometrically. The GM muscle was mainly active during the touch-down phase of stair descent where the MTC was lengthened; however, the GM muscle fascicles shortened by approximately 7 mm. These findings show that the behavior and function of GM muscle fascicles in stair negotiation is different from that expected on the basis of length changes of the MTC as derived from joint kinematics.

Adult↗
PubMed1981

Negotiating with the partners: a role of the HMO mental health director.

The mental health director in a health maintenance organization must successfully negotiate with a number of "partners" in the community and within the HMO in order to deliver high-quality services in a cost-effective fashion. These partners are companies whose employees are members, the members themselves, the HMO's primary care professionals, the mental health professionals, and the HMO administration. In addition, the models of treatment prevalent within a community constitute an intangible partner. Based on his experience in a mixed fee-for-service and HMO mental health department, the author describes negotiations of some difficult issues, which include whether patients can bypass their primary care physician and refer themselves to the mental health department, establishing co-payment rates for outpatient visits to prevent overutilization of mental health services, and dealing with companies who disagree with the HMO's treatment modalities. Although at times compromises are necessary, sometimes the mental health director must maintain a rigid position in order to protect a cost-effective program and promote smooth delivery of services.

Community Mental Health Services↗
PubMedDate not supplied

Who's afraid of national laws? Pesticide corporations use trade negotiations to avoid bans and undercut public health protections in Central America.

The agrochemical industry is using trade agreements to block proposed bans on pesticides identified as the worst occupational health hazards by a multi-country illness surveillance program in Central America. Through privileged access to closed-door negotiations, industry inserted deregulatory mechanisms, including a regional pesticide registry that invalidates national laws, investors' rights protection, and increased intellectual property protections, into the draft Central American Customs Union and the Central American Free Trade Agreement. These agreements undermine health-based national pesticide registration requirements; weaken health ministries' role in pesticide control; block marketing of cheaper, less toxic pesticides; and have a chilling effect on future pesticide regulatory activity. So long as corporations have privileged access to the trade negotiations and civil society is excluded, the resulting agreements will benefit special interests at the expense of public health.

Agriculture↗
PubMed1992

Social validation of component behaviors of following instructions, accepting criticism, and negotiating.

This study evaluated whether behaviors often taught as part of social skills training are judged favorably by others. Community judges evaluated the performances of people in various situations requiring one of three social skills: following instructions, accepting criticism, and negotiating to resolve conflicts. These skills were displayed in videotaped scenes by actors with and without mental retardation who acted out roles that had different types of authority relationships, and when different components or clusters of behavior (nonverbal, specific verbal, or general verbal behaviors) were performed well or poorly. The highest ratings by judges were of videotaped scenes that depicted correct use of all behaviors, regardless of which skill was being examined, whether or not the actor had mental retardation, or what the relationship was between the two actors. The lowest ratings were of videotaped scenes that depicted poor performance of all behaviors, and intermediate ratings were obtained when only some of the behaviors were performed poorly. These results, as well as the verbal responses of judges to questions, indicated that the different behaviors commonly used in teaching the skills of following instructions, accepting criticism, and negotiating are relevant to judgment of social performance, and are likely to be reinforced and maintained by social contingencies.

Activities of Daily Living↗
PubMed1990

The contract process: a methodology for negotiation. Part I.

This is the first of a three-part series on the contract process for acquiring a hospital information system product. Part One addresses negotiation methodology; points which will facilitate effective negotiation. Part Two will cover contract contents focusing on those topics which must be included in a good contract. Part Three will discuss contract philosophy and contract management; subjects which are critical to the good rapport buyers and vendors want. The adversarial approach to the contract process is not the best approach. Rather, the process should be treated as a step in the building of a partnership and relationship in which both parties win.

Competitive Bidding↗
PubMed1983

General and procurement by negotiation--DHHS. Proposed rule.

The Office of the Secretary, Department of Health and Human Services, is proposing to amend 41 CFR 3-1.453, Establishment of cost rates, to identify officials delegated authority to approve indirect cost rates and special rates for commercial organizations. Part 3-3, Procurement by negotiation, is proposed to be amended by adding a new Subpart 3-3.7. Negotiated overhead rates, which sets forth policies and procedures concerning the approval of indirect cost rates and special rates for use in the pricing and administration of contracts.

United States↗
PubMed1983

How to negotiate successfully a reimbursement contract for day hospital services.

Reimbursement from third-party payers has been identified as a major problem facing partial hospitalization programs. This paper provides an overview of the process by which a contract to reimburse for day hospital services in a general hospital setting was negotiated with the Department of Social Services and Housing in the State of Hawaii. The paper details the specific program development, the determination of direct and indirect cost components, the establishment of costs and charges, the comparative cost data developed, and the nature of the negotiations that ensued with the Department of Social Services and Housing in the State of Hawaii.

Contract Services↗
PubMedDate not supplied

Strategies for successful interpersonal negotiating.

Human resources managers frequently find themselves in positions in which they must negotiate--with applicants, employees, subordinates, superiors, or peers. It is important, therefore, that they know the techniques that will enable them to wind up in an win/win situation. Authors Colette A. Frayne, doctoral candidate at the University of Washington, and Phillip L. Hunsaker, professor of management and director of management programs at the University of San Diego, spell out techniques to be used before, during, and after negotiations to reach the best possible solution for both sides.

Administrative Personnel↗
PubMedDate not supplied

Capital equipment negotiation: a systematic checklist.

A number of systematic procedures and guidelines can be established to provide the negotiating agent with the proper tools to achieve a cost-effective purchase. The checklist presented here is an example of one such tool which offers some important considerations for negotiating capital equipment contracts. Other considerations include qualitative analysis of competing companies, analysis of the validity of the real reasons behind the purchase, the true life of the equipment, all operating costs to be incurred, biomedical review, renovation costs, code requirements, and much more. No matter what the considerations, the purchasing agent is responsible for critiquing the overall purchase, and for performing a good value analysis. These activities can help protect the hospital from excess expense and ensure that it receives the maximum value over the life of the capital equipment purchased.

Capital Expenditures↗
PubMed1987

The physician/hospital joint venture: developing a win/win strategy for success. Part III: Structuring and negotiating the deal.

This four part series, "The Physician/Hospital Joint Venture: Developing a Win/Win Strategy," examines the philosophical basis of marketing to physicians, the options for the organization in formulating a strategy for joint venture development, structuring and negotiating the deal, and finally how to build the physician loyalty and commitment essential for the joint venture's continued success. In this third part of the series, the author examines the elements essential to structure a successful joint venture and key issues that need to be addressed during the negotiation process.

Hospital Administration↗
PubMed1992

What issues should be considered when negotiating an employment contract? Employment contracts for CRNAs: protecting yourself amid the new economic realities.

Severe imbalances in the supply and demand for nurse anesthesia services are giving CRNAs a new and substantial economic worth in the health care provider marketplace. As a result, CRNAs are using written employment contracts increasingly to delineate their scope of practice, limit their liability, and protect their new economic value. This article discusses basic points that every anesthetist should consider in negotiating such contracts. Practical suggestions are offered for conducting negotiations as both an employee and independent contractor.

Contract Services↗
PubMedDate not supplied

Implementing negotiating strategies into teen parenting programs.

New parents need information and support to provide care for an infant. When that new parent is a teenager, teen parenting classes can provide the necessary information and support. In addition to basic infant care information, the inclusion of negotiation skills into teen parenting classes enhances the teenager's ability to communicate effectively with immediate family, successfully access preventive health care, and promote positive interactions with other social systems. Steps for incorporating negotiation strategies into teen parenting programs are offered.

Adaptation, Psychological↗
PubMed1988

Enhancing self care through active negotiation.

The concept of self care, increasingly popular over the last decade, is based on a return of individual power and control. The use of an active negotiation process can increase the client's participation and sense of control, thus enhancing self care. A three-phase active negotiation model is presented that suggests specific behaviors that nurse practitioners can use to facilitate client involvement in decisions about their care.

Humans↗