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Role of the nurse

Management versus Leadership

� Discuss what term Advocacy means� Review the following terms: caregiver, teacher, communicator, delegation

� Identify “Standards of Competent Performance”

� Discuss Communication and Documentation� Describe and Discuss developmental, cultural and spiritual assessment tools

� Identify what Clients Perceive as Caring Behavior

� Define and Identify Settings Where Ambulatory Care is Provided

� Review the Responsibilities of the Perioperative Nurse

� Compare and Contrast Management and Leadership

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� Speaking on behalf patient � to protect their rights

� help them obtain needed information and services.

� Assumed by nurses, social workers, and other healthcare providers.

� Some healthcare organizations employ people specifically to assume this role.

� Interpreting information

� Offer additional assistance

� Notify surgeon of need for additional preoperative information

� Find pic

� Teach about

� Hospital

� Procedures

� Medications

� Activity

� Diet

� Rights

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� Teaching older adults

� Memory slower

� Break up complex tasks

� Evidence Based Practice� Care that nurses provide is based on all available research and identified standards.

� Nursing research starts with small pilot studies

� Evidence-Based Practice for Nursing is rated by level of evidence.

� Acute care� Nurse-Patient Ratios/Mandated by law in the state of California

� Ambulatory care� Home care� Long term care� Rehabilitation� Managed Care Setting

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� Types of Delivery Systems� Private duty

� Functional

� Team

� Primary

� Case Management

� Current evolving types

� Ambulatory Care

� Home Care

� Long Term Care

� Transitional Care

� Rehabilitation

� Managed Care

� Medical care delivered on an outpatient basis

� Classified in two groups:� Hospital-based settings

� Non-medical-based settings

� The provided services are episodic, less than 24 hours in duration and may be evidenced by one visit or a series of visits that may last days, weeks, months or even years.

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� Spurred by the enactment of the Health Maintenance Organization Act of 1973.

� Pioneered by HMO’s to help with skyrocketing healthcare costs.

� Now widely used by a variety of private health benefit programs.� Examples of managed care organizational structures are HMOs and PPOs

� A system that provides structure and focus for managing the use, cost, quality, and effectiveness of health care services.

� Uses a variety of strategies to lower costs and optimize value

� Organized around managed care concepts.� Gatekeeper� Prior authorization� Capitation

� A set of selected providers that furnish a comprehensive array of health care services to enrollees

� Explicit standards for selecting providers

� Formal utilization review and quality improvement programs

� An emphasis on preventive care

� Disease management

� Case management

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� Timely discharges� Prompt, efficient use of resources� Achievement of expected outcomes� Collaborative practice� Coordination of care across the continuum:

What does this mean?� Performance improvement activities which lead to optimal patient outcomes

� Certification and accreditation

� Multi-disciplinary team models

� Computer programs for documentation

� Increase in disease management programs

� Establishment of collaborative relationships with physicians

� Case management for government programs

� Push for accountability through standards of care

� Pre-op holding room

� PACU nurse

� Ambulatory care nurse

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� Scrub nurse

� Circulating nurse

� PACU nurse

� Ambulatory Care Nurse

� Critical thinking is an analytical process

� Six Steps of Critical Thinking� 1. Define problem

� 2. Select information needed to solve problem

� 3. Recognize stated and unstated assumptions

� 4. Select relevant hypotheses:

� 5. Draw valid conclusions

� 6. Evaluate conclusion

� 3 Theories Related to Caring:� Madelaine Leininger’s Theory of Cultural Care Diversity

� Jean Watson’s Theory of Human Caring

� Dorothea Orem’s Theory on Self- Care Deficit

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� Patients value nurse effectiveness� Ability to perform tasks

� Also values of nurse affect� Attitude or demeanor while performing the tasks

� Patients are more willing to participate if they sense that they are cared about

� Spiritual� Being aware of & honoring patient’s beliefs

� Presence� Being there

� Physically present� Demonstrating understanding

� Being with� Sharing oneself

� Listening� Taking in patient information� Interpreting what has been taken in

� Touch� Skin-to-skin

� Eye contact (nonverbal)

� Protective – to prevent injury

� Knowing� Understanding the client

� Understanding the planned interventions

� Avoid making assumptions

� Focuses on client

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� List 5 behaviors that you feel you can show your client that show you care about them as a unique person:

� Many tools available

� Rarely in med/surg

� Uses??

� Many tools available

� Admission data collection

� Done by nursing, social worker

� What could this include??

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� Many tools available

� Included in admission data screening

� Nursing and chaplain services

� CNA-Certified Nursing Assistant “Omnibus Reconciliation Act” (OBRA) 1987, requires minimum of 75 hours of training

� Licensed Practical Nurse (LPN/LVN) usually varies from a 10- to 15-month program required for practical nursing

� Registered Nurse� Associate Degree 2-year, minimum degree required� Bachelor’s Degree 4-year program within a college or university setting, degree may be a Bachelor of Science or a Bachelor of Science in Nursing

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� Registered Nurse Certified � RN who has completed advanced education/validation within a specialty area

� Advanced Practice Registered Nurse(APRN)� Master’s Degree such as a Nurse Anesthetist, Nurse Practitioner, Clinical Nurse Specialist, or Nurse Midwife

� Other Master’s Degrees and Doctorate Degrees within nursing will prepare nurses for administration, education or other areas but these are not considered APRN.

� Only licensed individuals have a “Scope of Practice” defined by law.

� Questions regarding NPA

� QUESTIONS:

� List main components of each of the three sections

� Explain the process of patient education and the responsibilities of the RN

� Identify the 5 rights of delegation

� Describe the responsibilities of the RN in regards to initiating a plan of care

� Explain the terms: dependent, independent and interdependent nursing actions and give examples

� Describe advocacy and give examples

� Describe areas of care mandated for routine documentation by RN

� Describe standardized procedure (SP) guidelines, who can perform SP and give examples

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� Standards of Competent Performance� Formulates a nursing diagnosis

� Formulates a care plan

� Performs skills essential to the kind of nursing action needed to be taken

� Delegates to subordinates

� Evaluates effectiveness of care plan

� Acts as client advocate

� Standards of Competent Performance� Formulates a nursing diagnosis

� Formulates a care plan

� Performs skills essential to the kind of nursing action needed to be taken

� Delegates to subordinates

� Evaluates effectiveness of care plan

� Acts as client advocate

� When delegating nurses are accountable for following the:� State Nurse Practice Act

� American Nurse’s Association

(ANA) Standards of Practice

� Policies and procedures of health care organization where they work� Institution where nurse works as well as nurse are liable for negligence or malpractice, should these occur

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� Delegation in nursing:� Transferring to a competent individual the authority to perform a selected nursing task in a selected situation

� Delegator: person making the delegation

� Delegatee: person receiving the delegation

� Supervision: provision of guidance or direction, evaluation, and follow-up by the licensed nurse for the accomplishment and outcome of the assigned task

� Five factors to assess when making a decision to appropriately delegate:� 1. Potential for harm

� 2. Complexity of task

� 3. Problem solving

� 4. Innovation required

� 5. Level of patient interaction

� Nurse insures accountability and supervision:� 1. Supervision of performance

� 2. Any necessary intervention

� 3. Evaluation of the task performance

� 5 Rights of Delegation� Right Task

� Right Circumstance

� Right Person

� Right Direction/Communication

� Right Supervision

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� Underdelegation

� Overdelegation

� Improper delegation

� Reverse delegation

� The nurse has just received report on her patient. Which task can she not delegate to an LVN?

� Assessment

� Do a fingerstick

� Initiate bowel protocol on a patient and give Colace PO

� Hang NS as MIV

� Do a complex dressing change as outlined by the wound nurse

� Compile MRD

� Start IV

� The RN must delegate care of an assigned client to a CNA for the shift. Which of the following clients would be most appropriate to delegate.

A. A client who would benefit from talking about the

recent death of her husband.

B. A client with a FC and NGT who is on bedrest.

C. A client with an ostomy who has persistent problems

with leakage.

D. A client who was transferred from the critical care

unit 3 days ago and who is ambulatory.

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� Which of the following tasks would not be appropriate for the RN to delegate to LVN or CNA?

A. Ask the LVN to reinforce teaching of the RN’s client prior to discharge

B. Assign CNA to complete VS and document and report changes in client status

C. Ask CNA to assess and evaluate client’s response to IV pain meds

D. Instruct LVN to remove a dressing from post-op client’s abdominal wound

� Management: is defined as the coordination and integration of resources through:

� 1. Planning

� 2. Organizing

� 3. Coordinating or directing

� 4. Controlling

Function of a leader - to guide people and groups to accomplish common goals

� Leaders have 3 essential traits:� 1. A vision for the future

� 2. Trust of colleagues and co-workers

� 3. Excellent communication skills

� Leadership can occur at all levels

of an organization

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� Leadership� More people focused

� More process focused

� More concerned with motivation

� More based on use of self and personality

� Management� More task focused

� More goal focused

� More concerned with plans, policies, rules, procedures

� More based on position

� Transactional

� Focuses on management task

� Is a care taker

� Gives dierctions

� Tries to meet preset goals

� Uses rewards to meet goals

� Transformational

� Identifies common values

� Long term vision

� Motivates performance beyond expectations

� Inspires

� Authoritarian or Autocratic� Directive behaviors

� Activities determined by leader, dictated to followers

� Decisions made solely by the leader

� Characterized by giving orders

� “Do as I say because I am the leader”

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� Laissez-faire� Promotes complete freedom for group

� Minimum of leader participation

� This style is based on noninterference

� Let events take their own course

� Passive decision-maker

� “Do what you feel is best”

� Democratic� Implies a relationship and person orientation

� Group discussion and decision

� Leader encourages and assists discussion and group decision making

� “We are going to talk about and decide this together”

� Active, interpersonal process of participating by following a leader or manager

� The effective follower displays:� Cooperation

� Collaboration

� Teamwork

� Action aligned with leader

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� Team

� A small number of people with similar skills who are committed to a common purpose

� Group

� Any collection of interconnected individuals working together for some purpose

� Committee

� A group that meets periodically, has an identified purpose, and is part of the organizational structure

� Advantages of groups� Group Problem Solving

� 1. Greater knowledge and information� 2. Increased acceptance of solutions� 3. More approaches to a problem� 4. Individual expression� 5. Lower costs

� Disadvantages of groups:� Premature decisions� Individual domination� Disruptive conflicts

� Group Decision Making

� Autocratic

� Consultative

� Joint

� Delegated

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� Shared governance models also known as “nursing practice models”

� Structures that facilitate nurse autonomy in decision-making that governs nursing practice

�Identify and focus on the activities needed to accomplish tasks and goals� Starts with self-awareness

� Analyze time wasting behaviors

� Examine own personal attitude towards time

� Develop better time management skills

�Keep a time log�Analysis of time log to identify problems�Self assessment�Setting goals and establishing priorities�Develop an action plan� Implement your action plan�Develop solutions to improve time management

�Re -analysis

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� Stress is defined as a “physical, mental, psychological, or spiritual response to a stressor”� Stressor is defined as an experience that is taxing or threatening to a sense of well-being

� Job stress is defined as a tension arising in a person that is related to the demands of a person’s role or job

� Burnout is defined as a response to chronic emotional stress� Emotional and physical exhaustion� Lowered job productivity� Overdepersonalization

�Regular exercise

�Nutrition and diet

�Rest

�Support system

�Stress management plan