Effective Nursing TeamsWho is in Charge Here?

Role ClarificationMyths and Facts

by Janice Bergin, MSN & Charmaine Coombs, MSN

GOAL

�To build an effective team each team member must first know all participants scope of practice and capabilities and be able to quickly ascertain who is in charge

OBJECTIVE

Clarify the roles of nursing team members in a mental health & addiction facility

�Head Nurse (HN)

�Charge Nurse

�Licensed Practical Nurse (LPN)

�Lead Mental Health Assistant(LMHA)

Connecticut Nurse Practice ActRN

The practice of nursing by a registered nurse is defined as the process of diagnosing human responses to actual or potential health problems, providing supportive and restorative care, health counseling and teaching, case finding and referral, collaborating in the implementation of the total health care regimen, and executing the medical regimen under the direction of a physician, dentist or APRN.

Head Nurse

Who is in charge here?

�a nurse who has the overall accountability for the supervision of the administrative and clinical aspects of nursing care

Head Nurse

The Head Nurse is responsible for the supervision of professional nurses, paraprofessionals and other staff involved in direct nursing care of patients

Head Nurse Responsibilities

�Leads the planning of care

�Implements the nursing process

�Plans unit workload

�Determines priorities

�Approves assignments

�Oversees and reviews work

Head Nurse

Implements the Nursing Process

�Assessment(what is the situation?)

�Diagnosis(what is the problem?)

�Plan(how do we fix the problem?)

�Implementation/Intervention

(putting the plan into action)

�Evaluation (did plan work?)e Responsibility

Head Nurse Responsibilities

Assess the acuity & staffing needs of the unit.

Notify supervisors

Are all assigned staff present at the beginning of the shift for inter-shift report?

Head Nurse

Communicates with Supervisors,APRNs & MDs, Pharmacist

�Initiates and/or responds to a medical emergency

�May initiate restraint or seclusion procedure

�Completes assessments and admission paperwork

Head Nurse Responsibilities

� Identifies staff development needs and provides for staff training and assistance

� Attends & participate in the interdisciplinary meetings to promote and ensure adjustment and continuity of patient care programs

Head Nurse Responsibilities

� Maintains a safe and therapeutic milieu

� Completes performance appraisals

� Complete individual staff supervision

� Conducts staff meeting

The Role of the Licensed Practical

Nurse(LPN)

LPN works under the Supervision of the RN

The Connecticut Nurse Practice Act: LPN

�The practice of nursing by a licensed practical nurse is defined as the performing of selected tasks and sharing of responsibility under the direction of a registered nurse and within the framework of supportive and restorative care, health counseling and teaching, case finding and referral.

Shared ResponsibilitiesRN & LPN

�Medication Administration

�Treatment Application

�Medication Transcription

� Participation in the treatment planning process

� Documenting incidental notes

Shared ResponsibilitiesRN & LPN

�Assist MD/APRN with patient physicals�Communicate clinical issues with the MD/APRN�Facilitate patient care oriented groups�Assists in medical & psychiatric emergencies

Shared ResponsibilitiesRN & LPN

�Provide therapeutic and emotional support to patients and their family members

�Educate patients on prescribed medications

�Ensures least restrictive therapeutic patient interventions during stressful times

RN Differences LPN

� The RN needs to pass the NCLEX-RN to become licensed.

� A minimum of 2-4 years of nursing education is required.

� The RN can assess and make independent decisions.

� The LPN needs to pass the NCLEX-PN to become licensed.

� A minimum of 1 year of nursing education is required.

� The LPN can not assess or make independent decisions but can relay observations to the RN.

RN Differences LPN

�The RN assesses and initiates restraints and seclusion procedures

�Completes patient assessments and monthly RN summaries

� The RN can take charge of a unit & can take telephone orders from the MD / APRN.

�The LPN cannot assess or initiate restraint and seclusion procedures.

�The LPN cannot complete patient assessments or monthly summaries.

� The LPN can not take charge of a unit & cannot take telephone orders from the MD / APRN.

RN Differences LPN

�The RN is a essential participate in the integrated patient treatment planning process.

�The RN is responsible for patient admissions, transfers and discharge paperwork.

�The LPN can contribute to but is not an essential participate in the treatment planning process.

�The LPN is not responsible for patient admissions, transfers and discharge paperwork although, can assist in other areas.

The Role of the Lead Mental Health Assistant (LMHA)

LMHA

PARAPROFESSIONAL

�LMHA supervises Mental Health Assistant (MHA1).

LMHA reports directly to Head Nurse / Charge Nurse

Role of the Lead Mental Health Assistant(LMHA)

�Does not float off the unit. Does maintain a float book for Mental Health Assistant(MHA1).

�Completes environmental rounds for previous and oncoming shifts.

�Is present for shift report and for inter-shift report.

Role of the Lead Mental Health Assistant(LMHA)

�Completes daily assignment sheet. Meets with all MHA1’s concerning their daily assignment and their assigned break.

�Ensures that a MHA is scheduled for attendance and participation in patient treatment plan meetings.

Role of the Lead Mental Health Assistant(LMHA)

�Reports to the Head Nurse/Charge Nurse inappropriate staff behavior or incidents and documents accordingly.

�Assigns weekly/shift notes to MHA’s and follow thru with completion of notes.

Role of the Lead Mental Health Assistant(LMHA)

�Assigns weekly/shift notes to MHA’s and follow thru with completion of notes.

�Completes or collaborates with Head Nurse on annual staff Performance Appraisals.

Role of the Lead Mental Health Assistant(LMHA)

�Maintains a therapeutic and safe milieu

�Responds to fire drills and/or psychiatric emergencies.

�Reports to the Head Nurse clients behavior or incidents and documents accordingly.

Assignment Sheet Duties

�Escorting clients to group, activities, meals and medical appointments.

�Observation of patients on Special observations(Q15,Continuous observations, 1:1).

Assignment Sheet Duties

�Completing the daily census.

�Attendance at treatment plans.

�Assisting with patient admissions, transfers and discharges.

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