Health AlterationsLearning Plan 1

Introduction to Clinical Nursing Management

Objectives

• Explain the contribution of nursing to quality patient care

• Design a plan to obtain professional goals

• Identify factors impacting role transition from student to practicing graduate nurse

• Explain the impact of selected legal and ethical issues on nursing practice

Quality Patient Care

• Nursing’s role in patient outcomes

(Sasichay-Akkadechanunt et al., 2003)

Professional Nursing

• Caring

• Compassion

• Spirituality

• Community outreach

• Providing comfort

• Crisis intervention

• Going the extra distance(Hudacek, 2008)

COMPETENCY 11Develop a plan for making the transition from student

to practicing nurse

Your Plan

Sources of Law

ConstitutionLegislation (Statutes)

Nurse Practice Acts

Administrative Law

Common Law

Legal/Ethical

• “The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.”

(ANA, 2001, p. 12)

• “The registered nurse systematically enhances the quality and effectiveness of nursing practice.”

(ANA, 2004, p. 33)

Nurse Practice Act

Credentialing

Standards of Care

INFORMED CONSENT

Agreement by a client to accept a course of treatment after being informed of:1. Benefits and risks of treatment2. Alternatives to the treatment3. Prognosis if treatment is declined

Informed Consent

Express

Implied

Exceptions

• Minors

• Unconscious or unresponsive

• Mentally ill

Nurse’s Signature

Competent

Authentic

Voluntary

DELEGATION

The transfer of responsibility for the performance of an activity from one person to another while retaining responsibility for the outcome. (ANA, 1997)

The Big “D”

Mandated Reporter

Abuse

Neglect

Americans with Disabilities Act (ADA)

Clear, comprehensive

national mandate to eliminate

discrimination against people with disabilities

Clear, strong, consistent, enforceable standards addressing

discrimination against people with disabilities

Ensure that the federal

government plays a central

role in enforcing standards

established under the act

Impaired Nurse

Alcohol

DrugsMental Illness

Sexual Harassment

• EEOC, 1987

• Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature

• When submission is considered a condition of an individual’s employment

• When submission or rejection is used as a basis for employment decisions

• “intimidating, hostile, or offensive working environment”

Death and Related Issues

Advance Directives

Autopsy

Certification of Death

DNR or DNI

Organ Donation

Legal Protections for Nurses

•Good Samaritan

•Liability Insurance (respondeat superior)

•Carrying out MD orders

•Nursing Process

•Documentation

• Incident Report

MANAGERS AND LEADERS

Objectives

• Identify different leadership styles

• Explain qualities and behaviors that contribute to effective leadership

• Provide positive and negative feedback in a constructive manner

• Identify conflict resolution strategies

• Discuss the importance of effective communication

Manager– Have an assigned position within

the formal organization– Have a legitimate source of

power due to the delegated authority that accompanies their position

– Assigned functions, duties and responsibilities

– Emphasize control, decision making, decision analysis and results

– Manipulate people, the environment, money, time and other resources to achieve organizational goals

– Greater formal responsibility and accountability for rationality and control than leaders

– Direct willing and unwilling subordinates

Leader– Often do not have delegated

authority but obtain power through other means such as influence

– Have a wider variety of roles than do managers

– May not be part of the formal organization

– Focus on group process, information gathering, feedback and empowering others

– Emphasize interpersonal relationships

– Direct willing followers– Have goals that may or may

not reflect those of the organization

Leadership Styles

What Makes a Good Leader?

Communication

SBAR

•Situation

•Background

•Assessment

•Recommendations

Objectives

• Define management concepts

• Explain the qualities and behaviors that contribute to effective management

• Prioritize patient care needs

• Describe conflict resolution techniques

• Describe the role of the nurse in quality management

Management Concepts

Boss

Everyone Else

Centralized

Management Concepts

BossInput

Input Input

Input

Decentralized

Management Concepts

Nursing Units Accounting

Human Resources Public Relations

Organization

Matrix

Effective Management

Student as Manager

Student as Team Member

Feedback

Student as Team Leader

Team Leading Responsibilities

• Know all patient condition and needs

• Assist team members and provide direct care

• Coordinate patient care with employee strengths

• React to changes in patient and unit needs

• Delegate as appropriate, remain accountable

COMPETENCY 13

Manage care for a group of patients according to the Nurse Practice Act

Functional Nursing

• Tasks, not patients, assigned

• Assigned by qualifications

• Efficient

• Not holistic

• Communication problems and fragmented care

Team Nursing

• RN coordinates patient care

• Ancillary staff collaborate

• Democratic leadership

• RN spends less time with patients

• Lack of continuity of care and RN assessment

Total Patient Care Nursing

• Original mode of care

• RN assumes total care

• Similar to private duty

• Widely used

• High autonomy and responsibility

• Florence Nightingale

Primary Nursing

• 1970’s, depends on a total RN staff

• RN assumes caseload

• Associates cover when RN is not present

• May cost more

• High level of nursing ability, experience, accountability

Case Management

• Coordinator

• Services to patients and families

• Streamlines cost

• Collaborative

• Clinicians oversee specific groups

• Critical pathways

• Less direct patient care

Flood

300 adults, minor injuries, thermoregulation needs

3 RNs, 6 LPNs, 30 CNAs, 30 Volunteers

RN 1:100, LPN 1:50, CNAs and Volunteer 1:10

Time Management

Steps to Take in Time Management

Maslow’s Hierarchy of Needs

The Big “P”

First Order

Second Order

Third Order

Fourth Order

How to Prioritize

What do I have to do?

• Report

• Assessments

• Medications

• Treatment

• Document ASAP

• Rest breaks

How can I save time?

• Gather supplies

• Location

• Estimate needed time

• Document ASAP

• Leave on time

• Prioritize interruptions

Don’t Do Do Later Do Now

Things you can safely delegate to LPN or CNA

Things that can wait a little while

Patient care that must be done by

an RN

Bath, nail care, daily weight Phone messages AssessmentsAirway

BreathingCardiacChanges

Setting PrioritiesFirst-order Second-order Third-order Fourth-order

Immediate threat to physiological or psychological safety

Actual problem for which patient orfamily has requested attention

Relatively urgent potential or actual problem that patient or family does not recognize

Actual or potential problem for which patient or family may need future help

Airway, breathing, cardiac; anxiety attack; suicide; fall risk

Nausea, pain, bath; need to urinate

Monitoring for post-operative complications; anticipated teaching needs

Home care

Change of Shift Report

Quality Management(TQI, TQM, QA, Six Sigma, etc)

• Mission

• Values

• Philosophy

• Professional standards

• Care guidelines

• Outcomes

QI Plan Components

• “Our Pediatric Intensive Care Unit will show 100% compliance regarding daily checks of the crash cart”.

• If the crash cart was checked 96% of the time, a Quality Improvement plan will be instituted.

• A time frame for re-evaluation will be set

• The problem will be resolved/not resolved

• The results will be communicated

Responsibility

Scope of Service

Quality Indicators

Thresholds

Data Collection

Evaluation

Questions?