TEST 2 Review
b. Perform the activity himself or herself
. The nurse evaluates a patient's condition and determines that it is inappropriate to delegate a nursing activity to the unlicensed assistive personnel (UAP). What should the nurse do next? a. Ask the UAP to observe and learn how to perform the skill b. Perform the activity himself or herself c. Contact the nursing supervisor d. Consult another nurse
"Tell me how you take care of yourself and what you like about your work" These are good opening questions to lead into learning how to manage stress and burnout.
A colleague tells you, "I'm so burned out, I think it's time for me to resign." ' What can you tell your colleague? 1. "You probably need a break from work. Why don't you ask for a 6-month leave of absence?" 2. "Why don't you apply for a position at our rival hospital?" 3. "Tell me how you take care of yourself and what you like about your work" 4. "We're all burned out. Welcome to the club"
Back Injuries
A common ergonomic occupational-related risk in the health-care environment is: 1. Indoor air pollution 2. Active shooters 3. Nosocomial Infection 4. Back Injuries
CDC The Centers for Disease Control and Prevention is a federal agency that does investigate a wide range of health concerns.
A federal agency that partners with other agencies throughout the nation to investigate health problems, conduct research, implement prevention strategies, and promote safe and healthy environments is known as the: 1. FDA 2. IOM 3. ANA 4. CDC
3. Needs Improvement There are many ways in which the US health care system could be improved
A good description of the present US health care system would be: 1. The best in the world 2. Efficient and effective 3. Needs Improvement 4. Meets everyone's needs
Confront the bullying behavior and discuss strategies for responding to it. Direct but carefully worded confrontation will make it clear that bullying is not tolerated.
A new nurse manager has observed several instances of horizontal violence between staff members on her unit, primarily verbal abuse and malicious gossip. What should she do? 1. Ignore it because it is not physical violence and will not hurt anyone 2. Model this bullying behavior so that staff can see how it affects people 3. Keep a log of observed bullying behavior to discuss during the employees' annual evaluation 4. Confront the bullying behavior and discuss strategies for responding to it
1. The nurse is able to carve out time for a favorite hobby, at least once a week. It is imperative that nurses attend to their own needs, because caring for yourself is reflects how you care for others. As nurses take on multiple commitments to family, work, school, and community, they risk exhaustion, burnout, and stress. None of the other options depict the nurse caring for self, only for other people or trying to stay on top of the many tasks involved in a daily routine.
A nurse educator teaches students about caring nursing practice. Which of the following situations shows that the student nurse is able to implement the whole idea of caring? 1. The nurse is able to carve out time for a favorite hobby, at least once a week. 2. The nurse is a volunteer at church and school events. 3. The nurse makes lists every morning so the day stays organized and planned. 4. The nurse takes care of his elderly parents in addition to providing care to his immediate family.
2. The nurse gains the trust of the client. The nurse is including the client in the process and is demonstrating respect for the client, which will build the client's trust in the nurse. Gaining trust does not help the workload. The client may or may not participate in care; that depends on the client's abilities. The family's participation in the client's care is not in evidence here.
A nurse is discussing the care for the shift with the client. The nurse is including the client in decision-making about when various planned activities would be most convenient for the client. The nurse benefits from this professional behavior because: 1. Work will be completed on time. 2. The nurse gains the trust of the client. 3. The client will do most of the work. 4. The client's family will help with the work.
Allow self-scheduling by staff nurses in each unit Self-scheduling allows staff to consider both their personal needs and the units needs in assigning work shifts Allow staff members to request consistent days off Consistent days off reduce the circadian rhythm disturbance
A suburban hospital recently announced that staff nurses could no longer choose their shift. Instead, they would be assigned to either a 12-hour day shift, or a 12- hour night shift on an as-needed basis. An informal group of staff nurses met to discuss this new policy. They came up with several arguments against it. Which of the following suggestions would help alleviate the deleterious effects of this new policy? 1. Allow self-scheduling by staff nurses in each unit 2. Provide free dinner for nursing staff at the end of the night shift. 3. Allow staff members to request consistent days off 4. End visiting hours before the day shift ends so that the night shift nurses do not have to deal with visitors.
In a health-care facility Few people realize the risks encountered by individuals employed in health care facilities.
A surprisingly dangerous job in the United States is working: 1. In a coal mine 2. As a window cleaner in New York City 3. In a health-care facility 4. As a police officer
Allergic Contact Dermatitis (ACD) NIOSH= National Institute for Occupational Safety and Health
According to NIOSH, a common reaction to latex allergy is: 1. Increased appetite 2. Allergic contact dermatitis 3. Increased falls 4. An increase in violent outbursts
Identifying the factors that contribute to violence and controlling as many as possible One of the first steps in violence prevention is to identify what contributes to violence and devise ways to control these things. Assessing staff attitudes and knowledge regarding responses to violence Learning how much staff members know about handling episodes of violence is essential to preparing staff education programs.
Actions to address violence in the health-care workplace include: SATA 1. Identifying the factors that contribute to violence and controlling as many as possible 2. Allowing the violence to escalate 3. Assessing staff attitudes and knowledge regarding responses to violence 4. Providing weapons training to those identified as having a potential for physical violence
b. Delegation
Allowing persons to perform a specific nursing activity, skill, or procedure that is outside the traditional role and basic responsibilities of the delegatee's current job is the definition for which of the following terms? a. Supervision b. Delegation c. Responsibility d. Accountability
Provide equal opportunities for advancement Providing equal opportunities for raises and promotions is an excellent approach to managing a diverse team.
An effective way to help a diverse staff work together is to: 1. Provide equal opportunities for advancement 2. Pretend there are no cultural differences 3. Promote uniformity in a communication styles 4. Establish an English-only policy institution-wide
Telling jokes about sexual identity issues Many people would find this offensive in the workplace Demanding a daily kiss for writing a favorable evaluation This could be interpreted as a quid pro quo
An incident of harassment as identified by the EEOC is: SATA 1. Telling jokes about sexual identity issues 2. Separate restrooms 3. Providing coffee and doughnuts to the nursing staff 4. Demanding a daily kiss for writing a favorable evaluation
4. All of the above Physical barriers- such as the absence of the charge nurse to answer questions-could prevent the staff from following policies Emotional barriers-such as a nurse's fear of retribution from a colleague-can cause nurses to seek out answers, which can delay care or compromise safety. Semantic barriers- such as acronyms or nicknames-can confuse or mislead staff unfamiliar with their meaning
As Jane (nurse manager) speaks with the team, she learns why the staff members have had difficulty following policies. Which of these would be considered barriers to effective communication? 1. The charge nurse is unavailable to help nurses when they have questions about policies 2. Some staff are afraid to ask particular charge nurses for help for fear of retribution 3. The use of acronyms is confusing to staff members who are new to the unit 4. All of the above
-infectious diseases -physical violence -ergonomic injuries related to the movement and repositioning of patients -exposure to hazardous chemicals and radiation -sharps injuries pg. 182
Be able to identify and understand threats to safety in the workplace. What are examples of safety threats to employees?
Power plays and competition between groups (Bullying and Nurse-to-Nurse Lateral Violence, NNLV) Increased workload (do more in less time, cut costs - feel taken advantage of) Multiple role demands (cleaning rooms, fixing phones, etc) Threats to safety, scarcity, and security (layoffs) Scarce resources (between departments or individuals) Cultural differences (language barriers, work ethics, time, etc) Ethical conflicts (recording care not given, no informed consent, etc.) Invasion of personal space (work space issues)
Be able to identify and/or recognize examples of sources of conflict including: Power Plays, Competition, Bullying, NNLV, Increased Workload, Safety and Security, Cultural Differences and Ethical Conflicts (page 118-120).
(from box 13-5) -Spend time on outside interests and take time for yourself -Increase your professional knowledge -Identify problem-solving resources -Identify realistic expectations for your position. Make sure you understand what is expected of you; ask questions if anything is unclear -Assess the rewards your work can realistically deliver -Develop good communication skills and treat coworkers with respect -Join rap sessions with coworkers. Be part of the solution, not part of the problem -Do no exceed your limits-you do not always have to say yes -Deal with other people's anger by asking yourself, "Whose problem is this" -Recognize that you can teach other people how to treat you review pages 204 to 205. Especially Box 13-5 and the section on burnout. from PP: Prevent burnout: Recognize your stress Identify situations that produce stress Take steps to reduce the stress To reduce stress: Relaxation and exercise Assertiveness Accept errors and failures as learning experiences Accept what cannot be changed To reduce stress: Get involved in creating positive change Develop collegial support groups Participate in professional organizations Counseling
Be able to identify ways to reduce stress
2. Introducing the client and his or her diagnosis to the oncoming nurse Introducing the client and his diagnosis ensures that the sender and receiver of the communication are familiar with the client and share pertinent care needs, nursing interventions, and client progress with goals of care.
Bedside shift report is one of the things that Jane (nurse manager) reviews at the staff meeting. She stresses the way she would prefer the report to start. Which of these would be the most important to share with the oncoming nurse? 1. Telling the oncoming nurse what happened on the unit during the shift 2. Introducing the client and his or her diagnosis to the oncoming nurse 3. Sharing the nurse's personal opinion of the client 4. Reviewing new medication orders and the medication administration record (MAR)
Expressions of frustration and powerlessness
Burnout at work can be identified best by: 1. Expressions of frustration and powerlessness 2. Fatigue and refusal to work double shifts 3. Allergic reactions 4. A preference for efficiency
Role Conflict A situation in which a person is expected to play two incompatible roles. Culture shock Occurs when people are immersed into a culture different from that with which they are familiar and comfortable
CAUSES OF REALITY SHOCK
1. Disrespect and incivility Disrespect and incivility are the leading cause of conflict within health-care teams
Differences in status and authority within the health-care team can generate conflict. What is the most common cause of conflict? 1. Disrespect and incivility 2. Inappropriate language and sarcasm 3. Blaming and finger pointing 4. Physical violence
Do not chart in a nursing note an incident report was completed! This will create liability and allow legal teams to access the incident report. Only chart the facts in the patient chart report the incident to those who need to know.
Documenting falls: What to chart and what not to chart.
Encouraging critical thinking and new ideas Opportunities to express ideas and make suggestions are empowering.
Enhancing the quality of work life can be achieved by: 1. Encouraging critical thinking and new ideas 2. Discouraging a working relationship with one's peers 3. Being negative 4. Endangering a client's health or safety
Ability to provide quality care One of nurse's greatest sources of satisfaction derived from their work is providing high quality care Civility and respect On the other hand, showing civility and respect to one another creates an environment in which most nurses can thrive
Factors found to increase nurse's joy at work include: SATA 1. Ability to provide quality care 2. Consistently high workload 3. A pattern of continuous conflict and disagreement 4. Civility and respect
2. Engage in problem resolution Problem resolution is the best answer. Florence has addressed both of her staff members about their behavior, and there has been no improvement. Problem resolution will help the two parties identify the issue and agree on a solution to the problem.
Florence has two team members who continually criticize each other despite being told to stop. Which approach is the most appropriate for this situation? 1. Refer each of them for employee counseling 2. Engage in problem resolution 3. Bring in a union representative 4. Engage in a formal negotiation process
SBARQ
For the SBARQ, be able to identify what information you would include in each category? And, make sure to Review the section on Hand-Off communication in chapter 7 Communicating with others, but also review page 106 to 111.
1. Requiring everyone to have some form of health insurance Many believe that people have a right to forgo insurance if they wish.
Health-care reform encompasses many issues and concerns. Which of the following is probably the most controversial goal? 1. Requiring everyone to have some form of health insurance 2. Developing school-based healthcare centers 3. Eliminating preexisting condition rules in insurance coverage 4. Eliminating lifetime limits to insurance coverage
In the modern nursing era, nurses are viewed as collaborative members of the health-care team. Nurses are considered the most trusted group of professionals because of their knowledge, expertise, and ability to care for diverse populations
How are nurses viewed in the world?
c. By providing support, guidance, and instructions
How does the nurse supervise a delegated activity? a. By observing the delegatee perform the activity b. By encouraging autonomy, creativity, and self-discipline c. By providing support, guidance, and instructions d. By assessing the staff member's knowledge, skills, and abilities
Native: Adopts ways of least resistance and mimics other nurses Runaway: Real world too difficult; leaves profession or returns to school Rutter: Considers nursing just a job Burned out: Bottles up conflict; fatigued, depressed, angry Compassion fatigue: Decline in compassion over time from exposure to events that have traumatized patients Loner: Adopts the attitude to "just do the job and keep your mouth shut" New nurse on the block: Changes jobs frequently and is always the "new" nurse who has to be taught
INAPPROPRIATE APPROACHES FOR DEALING WITH THE SHOCK PHASE
3. Introduce, Situation, Background, Assess, Recommend, Readback
ISBARR provides a framework for communicating critical client information. ISBARR is an acronym for: 1. Identify, Study, Background, Assess, Recognize, Readback 2. Issue, Situation, Better, Advise, Refer with Recommendations 3. Introduce, Situation, Background, Assess, Recommend, Readback 4. None of the above
3. Deal with the feelings first The first step in any negotiation is to manage emotions. Emotions should be acknowledged and never responded to with added emotion. Once acknowledged, the team can move forward.
If an informal negotiation session becomes too highly emotional, what should the nurse manager do? 1. Let the feelings flow 2. Cancel the negotiations 3. Deal with the feelings first 4. Tell them to ignore the feelings and deal with the issues
4. All of the above Implicit bias forms during a lifetime It is formed based on an individual's culture, which shapes attitudes, beliefs, and actions. Implicit bias can influence clinical decision making and treatment It is automatic and subconscious during our interactions with others and can influence our clinical decision making and even treatment Implicit bias contributes to an individual's social behavior Because it is derived from an individual's cultural norms.
Implicit bias affects our understanding in an unconscious manner. A person's ability to recognize these biases can improve communications with patients and colleagues alike. Which of the following statements is about implicit bias? 1. Implicit bias forms during a lifetime 2. Implicit bias can influence clinical decision making and treatment 3. Implicit bias contributes to an individual's social behavior 4. All of the above
3. Government entities and employers Government entities (state and federal) and employers together pay for most of the cost of health care in the United States.
In the U.S. health care system, who is the real "customer"? That is, who actually pays most of the healthcare bill? 1. The US government 2. The head of the household 3. Government entities and employers 4. Employees and their families
4. Expensive
In the United States, health-care insurance can best be described as 1. Universal 2. Available to all 3. Free 4. Expensive
Reality Shock Students Taught to Provide Holistic Care; Work Reality May Be Different Partial task system in the work world: nurse ensures that tasks are carried out but is not the sole provider of care Whole task system in the academic world requires complete knowledge, encourages loyalty to the profession, and is consistent with what is taught in school
Inconsistency between the academic world and the world of work Occurs in new graduates when they discover a work environment toward which they worked for several years and suddenly realize that they are not prepared. Often new nurses are concerned about technical skills.
3. Listening Listening to staff is the most critical communication skill because it helps the manager understand the situation and the staff's rationale for their actions. It also demonstrates empathy and openness, which can lead to agreement on better adherence to the policies.
Jane is a new nurse manager who will be holding her first staff meeting tommrow. She has learned that the staff members have not been following important patient care policies. What is the most important communication skill that she should use at the meeting? 1. Talking to the staff 2. Laughing with them 3. Listening 4. Crying
3. Talk with friends, explaining her concerns Talking only with one's friends is less likely to be effective
Janice Mendoza is settled in her nursing position and wants to devote some time to one of the issues facing the nursing profession. Which of the following activities would probably have the LEAST impact on advocating for the nursing profession? 1. Contribute to ANA's PAC 2. Visit the representatives when the state legislature is in session 3. Talk with friends, explaining her concerns 4. Speak on radio and television programs
Most employers have policies regarding reporting behaviors that affect the workplace environment. Code for Nurses (2001) is specific regarding this responsibility.
Know what to do if someone you work with has signs of drug diversion. If you are suspicious of an employee, who would you contact first?
DO: -Begin with questions about the employers expectations of you. this gives the impression that you want to know how you can contribute to the organization -Ask questions about the organization as a whole. This information is useful to you and demonstrates that you are able to see the big picture. DO NOT: -Begin with questions about vacation, benefits, or sick time. This gives the impression that these are the most important part of the job to you, rather than the work itself pg 228
Know what to say and not say during the interview process
pg 105
Know when you should use informal and formal email communication, and what each of those emails would look like.
Excitement about the new position
New graduates usually experience a "honeymoon" period at their first job, which is characterized by: 1. Extreme criticism from colleagues 2. Long hours and low pay 3. Feeling undervalued 4. Excitement about the new position
4. Work intensification Work intensification causes everyone involved to increase their workloads to accommodate the job cuts. Nurses and respiratory therapists adjusting to this change may be unable to request service or respond to a request for service in a timely manner.
Nursing and respiratory departments both experienced job cuts. The nurse manager notices that members of his staff are having more trouble getting a fast response from a respiratory therapist. What source of conflict is probably operating here? 1. Union-management conflict 2. Interpersonal problems 3. Cultural differences 4. Work intensification
2. Creating an adversarial relationship between staff and management Discussion between management and union representatives about the issues may create conflict, which can be constructive or become emotional and competitive. If emotions are not managed, the interaction can become adversarial and delay resolution.
Nursing management and the nursing union are having differences on several issues. There may be a need for negotiation. Which of the following is a serious disadvantage to using collective bargaining to resolve this conflict? 1. Protecting the right to fair treatment 2. Creating an adversarial relationship between staff and management 3. Lacking professionalism on the part of the collective bargaining unit members 4. Failing to uphold important standards of care
Developing and enforcing workplace safety and health regulations.
OSHA, a federal government agency, is responsible for: 1. Providing training to handle difficul clients and their families 2. Providing research and education training 3. Upholding the standards of nursing practice 4. Developing and enforcing workplace safety and health regulations
interprofessional collaboration
Occurs when multiple healthcare workers from different professional backgrounds work together with patients, families, caregivers, and communities to deliver the highest quality care
Honeymoon Everything in the work world is just as the new graduate imagined Most often occurs during the orientation period Shock/Rejection Come into contact with: Conflicting viewpoints Different ways of performing skills Lack of security of an expert available as a resource Recovery Novice nurse begins to understand the new culture Novice nurse experiences less anxiety, and healing begins Resolution Novice nurse adjusts to the new environment Work expectations are more easily met The nurse has developed the ability to elicit change
Phases of Reality Shock
1. ABCs plus V (airway, breathing, circulation or changes in VS) 2. Other medical problems (look for changes in mental status, abnormal lab values, pain, untreated medical issues, etc.) 3. Chronic problems, teaching and coping
Remember the 3 levels of priority setting? PowerPoint. What would happen to your patient if you did not do the task or waited to do the task?
1. If you were face to face, would you say this? 2. Follow the same rules of behavior online that you would follow when dealing with individuals personally 3. Send information only to those individuals that need it 4.Avoid flaming; that is, sending remarks intended to cause a negative reaction 5. Do not write in all capital letter; this suggests anger 6. Respect other people's privacy 7. Do not abuse the power of your position 8. Proofread your e-mail before sending it pg 105
Rules of Email etiquette
You feel uncomfortable Members of your team are having trouble working together Team members stop talking with each other Team members begin "losing their cool" and attacking each other verbally
SIGNS THAT CONFLICT RESOLUTION IS NEEDED
1. Nurses should never post protected health information on a social media site Protected health information (PHI) must be protected and never shared without expressed written permission. A patient's privacy and confidentiality are paramount.
Social media is commonly used to update friends and groups on things we have going on in our lives. Health-care organizations routinely use social media to promote medical facts, services, and recognitions. What is important for nurses to remember when deciding to post something work-related on a social media site? 1. Nurses should never post protected health information on a social media site 2. Stories with good outcomes can be posted to your media page 3. Stories and photos can always be shared if the patient's name or face is not visible 4. Posting stories on personal time is OK because the nurse is not working
Report the incident and obtain post-exposure prophylaxis (PEP) within 2 hours PEP (post-exposure prophylaxis) includes the necessary actions to be taken
Stephanie Beals was a little nervous during her first week of work as a licensed nurse. Distracted by a lead nurse behind her, her hand slipped, and she was stuck by the needle she had just used. What is most important for Stephanie to do? 1. Disinfect the site of the needlestick 2. Apologize to the patient, clean the site, and properly dispose of the needle 3. Update her hepatitis B immunization 4. Report the incident and obtain post exposure prophylaxis (PEP) within 2 hours
True Delegation may be direct or indirect. Direct - Usually verbal direction. RN decides which staff member is capable of performing a specific task. Indirect - Contained in an approved listing of tasks established by an institution. Permitted tasks may vary from institution to institution
T/F Delegation may be direct or indirect
2. Poor hand-off communication Ineffective hand-off communication or miscommunication between caregivers during the transfer of care is estimated to contribute to 80% of serious medical errors. Poor hand-offs can lead to delays in treatment, inappropriate treatment, and prolonged hospital stays.
TJC attributes 80% of all medical errors to: 1. Poor hygiene and hand washing 2. Poor hand-off communication 3. Poor work environment 4. Lack of care
EMRs are usually practice or hospital-specific, so the patient's information would not be accessible to Jane
The EMR has many advantages compared with paper charting. It helps track data through time and can help monitor things such as preventative care in primary practices. Jane is the office nurse in a local practice. She is meeting a new patient for the very first time who informs her that he was recently hospitalized. Jane pulls up the patient's EMR and sees no information regarding his recent hospital stay. How could this have happened? 1. The patient's discharge was so recent that it is not available yet. 2. EMRs are usually practice or hospital-specific, so the patient's information would not be accessible to Jane 3. The patient was hospitalized out of state 4. The patient has not signed the necessary consents to give Jane access
4. All of the above
The hospital has recently reorganized, therefore, several departments were closed. The patient census on the unit has increased. The staff has always had a strong team spirit, but the nurse manager knows workflow changes can cause conflict. What can the nurse manager do to reduce the possibility of conflict among her team? 1. Monitor the quality of patient care 2. Ensure that supplies and equipment are readily available 3. Assess the equity of nursing assignments 4. All of the above
c. Assignment
The nurse asks the unlicensed assistive personnel to measure blood pressure, temperature, pulse, and respiration. This is an example of: a. Delegation b. Supervision c. Assignment d. Authorization
1. A member of generation X. The most likely candidate to be late is the generation X nurse because this group believes that having control of their time is an important need. A millennial generation nurse might be the second most likely one to be late, but this group is highly motivated to succeed and highly productive. The veteran nurse and baby boomers are loyal and have a respect for authority, recognizing that tardiness causes disruption in the unit functioning.
The nurse manager is talking with a charge nurse who tells the manager that there is difficulty with a staff nurse who consistently is a few minutes late for work every time the nurse is scheduled to work. The nurse manager suspects this person is: 1. A member of generation X. 2. A member of the millennial generation. 3. A veteran. 4. A baby boomer.
4. Committed to socializing the student to the unit. One of the best ways to show commitment to nursing is to treat students and new nurses in a way that makes them feel welcome to the profession. One way to demonstrate that is to socialize new student nurses by introducing them to unit members. The student would be unable to determine the competence or knowledge of the charge nurse from this exchange. The charge nurse may be following the unit manager's orders, but if performed in a warm manner, the conduct would be seen as a positive by the student.
The nursing student is on the unit for clinical for the first time. After the report, the charge nurse takes the student around to introduce the student to the other nurses and the physicians. The student recognizes that the charge nurse is: 1. Competent at nursing care. 2. Knowledgeable about the clients on the unit. 3. Following the orders of the manager. 4. Committed to socializing the student to the unit.
EEOC (Equal Employment Opportunity Commission) This government agency is charged with investigating employment issues such as sexual harassment.
The occurrence of sexual harassment may be reported to: 1. IHI 2. ANA 3. EEOC 4. CDC
-identifying the problem or issues -generating possible solutions -reviewing suggested solutions and choose the best solution -implement the solution chose -evaluate: is the problem resolved?
The process of problem solving is:
2. Resolve conflicts more effectively The use of negotiating skills can resolve conflicts more effectively by helping differing parties see each other as people with similar needs, concerns, and dreams instead of as competitors or blocks inthe way of progress. Being involved in successful conflict resolution can be an empowering experience.
The purpose of learning how to negotiate conflict is to: 1. Eliminate conflict entirely 2. Resolve conflicts more effectively 3. Win 4. Reduce stress
Reviewing the organizational disaster plan. Organizational and/or professional commitment would be best demonstrated by the student nurse reviewing the disaster plan of the hospital and unit. It indicates that the student is committed to the safety of all. Checking with the clients again may disturb the clients from needed rest. Following the charge nurse is good if the charge nurse is agreeable, but reviewing the disaster plan is better. Taking the assigned break early is not a sign of commitment
The student nurse has free time on the unit as client care is completed. The student would best show commitment by: 1. Checking in with each client again. 2. Reviewing the organizational disaster plan. 3. Following the charge nurse. 4. Taking the assigned break early.
The NLN: National league for nursing
The voice of nursing education. Promotes excellence in nursing education, they participate in test services, research and publications, as well as lobby actively for nursing issues.
When Members of team A and Team B begin throwing accusations at each other page 124 to 125.
Understand the negotiation process and when you would use ground rules
NAP delegation: Feeding Hygiene Physical Care Page 88 has a diagram you should study titled delegation-decision making grid. When looking to answer the test questions, think about what the needs and diagnosis are of each specific patient in the moment. Are they stable or are they unstable, or could be unstable if not watched closely?
What can you and cannot delegate to unlicensed assistive personnel?
LPN Delegation: Vital Signs Some IV medication Physical Care Responsibilities: -The licensed nurse must determine when and what to delegate based on the practice setting, the patients' needs and condition, the state/jurisdiction's provisions for delegation, and the employer policies and procedures regarding delegating a specific responsibility. -The licensed nurse must communicate with the delegatee who will be assisting in providing patient care. -The licensed nurse must be available to the delegatee for guidance and questions, including assisting with the delegated responsibility, if necessary, or performing it him/herself if the patient's condition or other circumstances warrant doing so. -The licensed nurse must follow up with the delegatee and the patient after the delegated responsibility has been completed. -The licensed nurse must provide feedback information about the delegation process and any issues regarding delegatee competence level to the nurse leader.
What can you delegate to an LPN? When working with an LPN, what responsibilities do you have as an RN with delegation?
2. Speak out on issues important to nursing Speaking out is being "vocal" 3. Write letters to the editor and email your state and federal representatives Writing letters and emails are also ways to be visible and vocal 4. Look for opportunities to appear on radio and television Likewise, appearing on radio or tv is both visible and vocal
What does "be visible and vocal" mean? SATA 1. Take a course on health-care policy 2. Speak out on issues important to nursing 3. Write letters to the editor and email your state and federal representatives 4. Look for opportunities to appear on radio and television
Using a common language among the professions assists in understanding and overcoming barriers to interprofessional communication.
What does common language or uniform language do for communication in healthcare? Review on pages 112 to 113, chapter 7, communicating with others
-up to date information related to workplace advocacy and safety for all nurses. -continuing education courses, scholarships, professional tools and webinars, journals, -they work for you on a national level providing lobbyists to help with issues important to nursing and healthcare.
What does the ANA provide to its members?
-Identify the patient, including the room and bed numbers -Include the patient diagnosis -Account for the presence of the patient on the unit. If the patient has left the unit for a diagnostic test, surgery, or just to wander, it is important for the oncoming staff members to know the patient is off the unit -Provide the treatment plan that specifies the goals of treatment. -Document patient responses to current treatments. Note goals and critical pathways either achieved or in progress. It is helpful to mention the patients pcp. Include new orders and meds and treatments currently prescribed. -Omit personal opinions and value judgments about patients as well as personal or confidential information not pertinent to providing patient care.
What information would provide in your change-of-shift report. What information is imperative to present?
1. A strategy to encourage the free flow of ideas Brainwriting is a creative approach to problem-solving. Similar to brainstorming, it offers everyone a chance to share ideas; however, by writing their ideas before the discussions, there is less likelihood of being influenced by early ideas.
What is brainwriting? 1. A strategy to encourage the free flow of ideas 2. A mutually beneficial negotiations result 3. A winning approach to formal negotiation 4. A devaluation reaction to negotiation
The transferring of authority
What is the definition of delegation?
Assignment is defined as follows: ⦁ The routine care, activities, and procedures that are within the authorized scope of practice of the RN or LPN/VN or part of the routine functions of the UAP. The above are included in the coursework taught in the delegatee's basic educational program. An example of assignment is an LPN/VN caring for a diabetic patient. He or she takes vital signs, checks the blood sugar level using a blood glucose meter, monitors input and output, documents the information, and reports data to the RN. This is considered an "assignment" because these functions are taught in the LPN program and are part of the LPN/VN scope of practice. Delegation is defined as the reassigning of responsibility for the performance of a task from one person to another. The responsibility of performing the task is transferred. Accountability remains with the delegator.
What is the difference between assignment and delegation?
3. Win-Win Win-win allows both sides to come together to identify the issue, and each side gains some benefit from the solution. Both sides walk away winners.
What is the most desirable result of a problem resolution? 1. Win-lose 2. Lose-lose 3. Win-Win 4. None of the above
DO INCLUDE: -A clearly stated job objective -Highlighted qualifications -Directly relevant skills and experience -Chronological work history -Relevant education and training DO NOT : -Include pictures, fancy binders, salary information, or hobbies -Include personal information such as weight, marital status, and number of children -Repeat information just to make the resume longer
What should your resume include and not include?
a. Communication and collaboration
What two factors help ensure optimal outcomes in delegation? a. Communication and collaboration b. Licensure and experience c. Training and authorization d. Certification and endorsement
negotiations Review pages 121-126. Refer to "The Informal Negotiation Process" Box 8-2, p. 123 Scope the situation Set the stage Conduct the negotiation (see next slide) Set the ground rules Clarify the problem Make your opening move Continue with offers and counteroffers Agree on the resolution of the conflict
When conflicts first arise, problem-solving can occur. If it becomes to full-blown of a disagreement, then _____ may be needed.
Have your patient verbalize back what you just taught them, ask them questions that require more than a yes or no answer.
When educating your patient, how do you know the patient is fully informed?
The gap between nursing education and nurse practice as the new graduate is expected to have sufficient "know how" to provide nursing care and the fact that it is overly hard to develop a "professional self" at the same time. ? (pg 237)
When it comes to reality shock, what are new graduates concerned about?
When a decision cannot be made, or is a full blown conflict or issue.
When would you need to move over from problem resolution techniques to negotiation techniques?
b. Variation in roles and responsibilities of UAP
Which factor can have a negative impact on delegation? a. Shortage of training programs for unlicensed assistive personnel (UAP) b. Variation in roles and responsibilities of UAP c. Inconsistent use of a decision tree for delegation d. Lack of standardized patient handoffs
2. Less-than-optimum outcomes (quality issues) 3. Number of people who are uninsured 4. High cost of care
Which of the following are the primary current problems with the US health care system? SATA 1. Increased use of EHRs 2. Less-than-optimum outcomes (quality issues) 3. Number of people who are uninsured 4. High cost of care
2. Member of the largest health-care profession Nurses constitute the largest health care profession by numbers
Which of the following best describes the nurse of today? 1. Assistant to the physician 2. Member of the largest health-care profession 3. Member of the most powerful lobby group in health care 4. Woman in white
1. A patient is placed in a broken wheelchair that tips over Unprepared equipment should not be used, as it may cause injury or death. 2. A staff member tells a neighbor about the famous athlete who is a patient This represents a Health Insurance Portability and Accountability Act (HIPPA) violation of patient privacy. 3. An employee reports to work under the influence of alcohol This is an example of an impaired employee
Which of the following events should be reported? SATA 1. A patient is placed in a broken wheelchair that tips over 2. A staff member tells a neighbor about the famous athlete who is a patient 3. An employee reports to work under the influence of alcohol 4. A patient spills her supplemental protein drink on the floor; the CNA mops it up
2. Spread of poliomyelitis and smallpox Both polio and smallpox are relatively well controlled
Which of the following health and safety concerns is NOT one of our greatest concerns currently? 1. "Escape" of health-care-acquired infections into the community 2. Spread of poliomyelitis and smallpox 3. Increase in opiod-related deaths 4. Health disparities (poorer health and treatment outcomes in minority; limited-income, and other groups)
c. Establishing scope of practice guidelines for unlicensed assistive personnel
Which of the following is NOT a responsibility of the employer and/or nurse leader involving delegation? a. Ensuring appropriate policies and procedures regarding delegation are in place b. Ensuring adequate staffing c. Establishing scope of practice guidelines for unlicensed assistive personnel d. Promoting and maintaining a positive culture
a. Right reason 5 Rights of Delegation are: -Right task The activity falls within the delegatee's job description or is included as part of the established written policies and procedures of the nursing practice setting -Right circumstance The health condition of the patient must be stable. If the patient's condition changes, the delegatee must communicate this to the licensed nurse, and the licensed nurse must reassess the situation and the appropriateness of the delegation. -Right person The licensed nurse along with the employer and delegatee are responsible for ensuring the delegatee possesses the appropriate skills and knowledge to perform the activity. -Right directions and communication Each delegation situation should be specific to the patient, the licensed nurse and the delegatee. The licensed nurse is expected to communicate specific instructions for the delegated activity to the delegatee: the delegatee, as part of two-way communication, should ask any clarifying questions. The delegatee must understand the terms of the delegation and must agree to accept the delegated activity. The licensed nurse should ensure that the delegatee understands she or he cannot make any decisions or modifications in carrying out the activity without first consulting the licensed nurse. -Right supervision and evaluation The licensed nurse is responsible for monitoring the delegated activity, following up with the delegatee at the completion of the activity, and evaluating patient outcomes. The delegatee is responsible for communicating patient information to the licensed nurse during the delegation situation. The licensed nurse should be ready and available to intervene as necessary. The licensed nurse should ensure appropriate documentation of the activity is completed.
Which of the following is NOT one of the Five Rights of Delegation? a. Right reason b. Right person c. Right task d. Right communication
1. Aging of the nursing workforce
Which of the following is a current concern related to the nursing profession? 1. Aging of the nursing workforce 2. Oversupply of nurses versus decreasing demand for nursing care 3. Emphasis on evidence-based practices 4. Expansion of EHR use into the community
Modification of the work schedule Adjustment of work procedures
Which of the following is considered reasonable accommodations for an employee with a disability? SATA 1. Modification of the work schedule 2. Salary reduction to reflect lower output 3. Additional days off and extended vacations 4. Adjustment of work procedures
4. All of the above
Which of the following issues may be addressed in a collective bargaining agreement? 1. Shift differentials 2. Safe working environment 3. Grievance procedures 4. All of the above
More powerful ventilation systems and air filtration Improved ventilation and filtration may reduce indoor air pollution
Which of the following procedures and modifications contributes to reducing indoor air pollution? 1. Windows that may be opened by staff as needed 2. More powerful ventilation systems and air filtration 3. Selecti ofon products with more polyvinyl chloride (PVC) 4. Increased use of medical waste incinerators
d. Nurses cannot delegate any element of the nursing process.
Which statement about delegation is correct? a. Nurses are accountable for predicting adverse outcomes. b. Unlicensed assistive personnel (UAP) must accept any delegated nursing activity. c. UAP work under the license of the delegating nurse. d. Nurses cannot delegate any element of the nursing process.
d. APRNs can delegate to RNs, LPN/VNs, and UAP.
Which statement about members of the nursing team and delegation is correct? a. Unlicensed assistive personnel (UAP) can delegate to other UAP. b. Licensed practical/vocational nurses (LPN/VNs) can delegate to registered nurses (RNs) and UAP. c. RNs can delegate to advanced practice registered nurses (APRNs), LPN/VNs, and UAP. d. APRNs can delegate to RNs, LPN/VNs, and UAP.
d. Some states prohibit LPN/VNs from delegating and supervising UAP.
Which statement about regulation and scope of practice is correct? a. Any licensed nurse can delegate and supervise unlicensed assistive personnel (UAP). b. Only registered nurses can delegate and supervise UAP. c. All states prohibit licensed practical/ vocational nurses (LPN/VNs) from delegating and supervising. d. Some states prohibit LPN/VNs from delegating and supervising UAP.
LPNs and RNs
Who can provide teaching to patients?
OSHA? (is responsible for developing and enforcing workplace safety and health regulations). Review page 183.
Who is in charge of terrorism in the workplace?
3. Professional nurse
Who is responsible for accepting, transcribing, and implementing physician orders? 1. Unit clerk 2. Medical intern or resident 3. Professional nurse 4. Medical assistant
d. The nurse who delegates the activity
Who is ultimately accountable for the outcome of the delegation? a. The health care provider b. The health care employer c. The nurse leader d. The nurse who delegates the activity
4. Jot down notes about the situation as it is presented to you, review the patient's history, focus your assessment, and determine what you need for the patient. Describing the situation, background, assessment, and reccomendation (SBAR) is best. Reporting on situational change is designed to provide concise, pertinent, and factual information to members of the health care team. This approach to a sudden change in patient condition allows you to communicate information, your concerns, and the need for action.
You are working on the trauma unit today, and your new patient with a femur fracture complains of leg pain and seems a little diaphoretic and short of breath. You assess the patient and prepare to contact the surgeon. In preparation for contacting the physician you: 1. Immediately page the MD; it could be pulmonary embolism, and time is of the essence. You will give him the particular when the MD arrives. 2. Wait for the MD to round on his patient because it should be within the next hour or so 3. Medicate the patient for pain and plan to contact the MD when he rounds 4. Jot down notes about the situation as it is presented to you, review the patient's history, focus your assessment, and determine what you need for the patient.
informative publications group life and health insurance access to malpractice insurance continuing education courses Page 240-244. One thing I can share about my experience being an ANA member is with my monthly nursing journals. Just reading the articles helps me to stay up to date and gain an understanding on what other hospital systems are doing.
reasons for why you would join a professional organization, especially a specialty practice organization
The case manager will help you coordinate care and needs for your patient, while in the hospital and with planning for discharge.
what is the role of the case manager with collaboration of patient care.