Time Management, Prioritization, Delegation (CH.6) Burnout (CH.13)
Discrimination?
Fifth and Fourteenth Amendments to the Constitution Equal Employment Opportunity Commission (E E O C) Civil Rights Act
Models of Care Delivery?
Functional nursing •Each nursing discipline having the focus on specific tasks and not necessarily holistic client care •Efficient & effective but continuity of care is lost Team nursing- Communication Total patient care •requires RNs to engage in non-nursing tasks that might be assumed by NAP (e.q. ICU, CCU) Primary nursing •Provides continuity of care and nursing accountability •Staffing is difficult and expensive •Some view it as ineffective as other personnel could carry out many tasks that consume the time of the RN.
*** Time Management in Summary?
Prioritization Breaking down big projects Automating repetitive tasks are skills that help with time management.
*** Criteria for Delegation (continued)?
Relationship-oriented concerns •Fairness- distributed evenly •Learning opportunities- stimulate motivation, learning •Health- rotating team members •Compatibility- some people work together better than others ---> help people develop better working relationships •Staff preferences- allowing team members to always select what they want to do may cause the less assertive members' needs to be unmet
5 Rights to Delegation?
Right task Right Circumstances Right Person Right Direction or communication Right Supervision or Evaluation Supervision is more direct and requires directly overseeing the work or performance of others. Supervision includes checking with individuals throughout the day.
10. A colleague tells you, "I'm so burned out, I think it's time for me to resign." What can you tell your colleague? a. "You probably need a break from work. Why don't you ask for a 6-month leave of absence?" b. "Why don't you apply for a position at our rival hospital?" c. "Tell me how you take care of yourself and what you like about your work." d. "We're all burned out. Welcome to the club."
c
6. New graduates usually experience a "honeymoon" period at their first job, which is characterized by: a. Extreme criticism from colleagues b. Long hours and low pay c. Feeling undervalued d. Excitement about the new position
d
*** Assignments versus delegation?
‒Making or giving an assignment is not the same as delegation. In an assignment, power is not transferred ‒ Assignment: allocation of duties that each staff member is responsible for during a specific work period (NCSBN, 2006). Assignments relate to situations where an RN directs another individual to do something
*** Definition of delegation?
• The reassigning of responsibility for the performance of a job from one person to another (ANA, 1996).
*** Delegation direct vs indirect?
•Direct delegation- verbal direction by the RN delegator regarding an activity or task •Indirect delegation- an approved listing of activities or tasks that have been established in policies and procedures
*** If you do experience sexual harassment?
-Consult your employee handbook/online published policies -Confront -Report -Document -Support -You can also contact EEOC: only have 180 days
Question Which of the following is a true statement? A. N A P's can replace registered nurses (R N's) if needed. B. There are specific criteria and regulations to consider when delegating. C. Delegation means assigning tasks. D. Supervision in nursing equates to authority.
b
4. A nurse is caring for a patient who is diagnosed with coronary artery disease and sleep apnea. Which action should the nurse delegate to the NAP? a. Discuss weight-loss strategies such as diet and exercise with the patient. b. Teach the patient how to set up the CPAP machine before sleeping. c. Remind the patient to sleep on his side instead of his back. d. Administer modafinil (Provigil) to promote daytime wakefulness.
c
4. The occurrence of sexual harassment may be reported to: a. IHI b. ANA c. EEOC d. CDC
c
*** Organizing the Work?
Setting goals Long-term goals Short-term goals Lists Tickler files Time blocks Filing systems
Addressing Job Stress?
Sources of workplace stress Why is health care a stressful occupation?Responses to stress Managing stress
Addressing Burnout?
Stages of burnout •High expectations or idealism •Pessimism, early job dissatisfaction •Withdrawal or isolation •Detachment, loss of interest Buffers against stress and burnout •Personal control •Commitment to both work and life's activities •Perception of demands and changes
*** Supervision & Delegation (application test question)?
Supervision versus delegation •Supervision is more direct •Requires directly overseeing the work or performance of others •Includes checking with individuals throughout the day
7 components of the delegation decision making grid?
-Level of client acuity -Level of unlicensed assistive personnel capability -Level of licensed nurse capability -Possibility of injury -Number of times the skill has been by the unlicensed assistive personnel -Level of decision making needed for the acuity Client ability for self care
5 Factors for determing if Client care Activity should be delegated?
-Potential for harm to the patient -Complexity of the nursing activity -Extent of Problem solving and innovation required -Predictability of outcome -Extent of interaction
*** ways employer can reduce work stress?
-Provision of well prepared preceptors and mentors for newly employed nurses -Suffiecent staffing -Peer support groups -Debriefing after critical events -Well devloped employee assistance programs (EAP) -Stress reduction training and workshops -On site exercise rooms - On site relaxation rooms
Assigning work can be difficult for several reasons?
1. Thinking they must do everything themselves. 2. Distrust with subordinates to do things correctly. 3. Thinking that if they delegate all the technical tasks, they will not reinforce their own learning. 4. Some nurses are more comfortable with the technical aspects of patient care than with the more complex issues of patient teaching and discharge planning.
1. A nurse is helping an NAP provide a bed bath to a comatose patient who is incontinent. Which of the following actions requires the nurse to intervene? a. The nursing assistant answers the phone while wearing gloves. b. The nursing assistant log-rolls the client to provide back care. c. The nursing assistant places an incontinence diaper under the client. d. The nursing assistant positions the client on the left side, head elevated. .
A
3. A nurse is caring for a patient who has chronic obstructive pulmonary disease (COPD) and is 2 days postoperative after a laparoscopic cholecystectomy. Which intervention for airway management should the nurse delegate to an NAP? a. Assisting the patient to sit up on the side of the bed b. Instructing the patient to cough effectively c. Teaching the patient to use incentive spirometry d. Auscultating breath sounds every 4 hours
A
Time Management?
A method of organizing and monitoring time so that client care tasks can be scheduled and implemented
2. A nurse is caring for a patient who has a pulmonary embolus. The patient is receiving anticoagulation with IV heparin. What instructions should the nurse give the NAP who will help the patient with activities of daily living? Select all that apply. a. Use a lift sheet when moving and positioning the patient in bed. b. Use an electric razor when shaving the patient each day. c. Use a soft-bristled toothbrush or tooth sponge for oral care. d. Use a rectal thermometer to obtain a more accurate body temperature. e. Be sure the patient's footwear has a non-slip sole when the patient ambulates.
A,B,C,E
Brusie, 2019?
According to the report, 15.6% of all nurses reported feelings of burnout, with the percentage rising to 41% of "unengaged" nurses. What's really interesting as well, is that 50% of nurses who reported feeling burned out also reported that they had no plans to leave their organization—pointing to the importance of supporting and meeting nurses where they are at in the workforce.
Perception of Time affects?
Affects our use of time Affects our response to time Affects how we calculate time Culture and environment interact to influence our perception of time
The Nursing Process and Delegation?
Assessment •Client care requirements and goals •Skills of person assigned Plan •Think it through now to prevent problems later Implementation •Assign tasks to the appropriate person Evaluation •Have client care needs been met?
Prioritization-Coordination?
Coordinating assignments •Coordination of daily activities •Using a personalized worksheet
5. A nurse is assigned to care for the following patients. Which patient should the nurse assess first? a. A 60-year-old patient on a ventilator for whom a sterile sputum specimen must be sent to the laboratory b. A 55-year-old with COPD and a pulse oximetry reading from the previous shift of 90% saturation c. A 70-year-old with pneumonia who needs to be started on IV antibiotics d. A 50-year-old with asthma who complains of shortness of breath after using a bronchodilator
D
6. A respiratory therapist performs suctioning on a patient with a closed head injury who has a tracheostomy. Afterward, the NAP obtains vital signs. The nurse should communicate that the NAP needs to report which vital sign value or values immediately? Select all that apply. a. Heart rate of 96 beats/min b. Respiratory rate of 24 breaths/min c. Pulse oximetry of 95% d. Tympanic temperature of 101.4°F (38.6°C)
D
A new nurse manager observes instances of horizontal violence between staff members on her unit, mainly verbal abuse and malicious gossip. What should she do? A. Ignore it. It's not physical violence and will not hurt anyone. B. Model this bullying behavior so staff can see how it affects people. C. Keep a log of observed bullying behavior to discuss during the employees' annual evaluation. D. Confront the bullying behavior and discuss strategies for responding to it.
D
*** Prioritization-Setting Priorities?
Definition of prioritization Three levels of priority setting •Most critical: A B C's plus V •Next: Mental status, pain, untreated medical issues, abnormal laboratory results •Next: Chronic problems, health education, coping
Professional Growth and Innovation?
Encouraging staff growth and creativity •Continuous learning •Opportunities for improvement Encouraging new ideas and critical thinking Rewarding professional growth Staff recognition programs
Barriers to Delegation?
Experience issues Licensure issues- personal risk when delegating inappropriately. Courts have usually ruled that nurses are not liable for the negligence of other individuals, provided delegation is appropriate. Legal issues and delegation- RNs are held accountable when delegating; obligation to intervene. Quality-of-care issues Assigning work to others
Cultural Diversity?
Importance of examining possible biases Diversity in health care Ethnicity, race, culture, gender, sexual orientation, lifestyle, primary language, age, physical capabilities, and career stage
*** Horizontal Violence?
Incivility, bullying, verbal abuse, punishment, humiliating comments, and malicious gossip The Joint Commission (TJC) characterizes horizontal violence as a sentinel event because it may pose a threat to patient safety and... Common occurrence
*** Setting Limits?
Learning to say "No" Eliminating unnecessary work
Sexual Harassment?
Major contributors •Sex-role stereotypes, persistent societal tolerance of sexual harassment, and the unequal balance of power between men and women although can happen vice versa. Two forms •Quid pro quo- sexual favors are solicited in exchange for favorable job benefits •Hostile work environment- most common sexual harassment claim and the most difficult to prove
Saying "No"?
Many requests are negotiable You may not refuse to accept an assignment; however, you can discuss possible alternatives to the situation You may refuse to work overtime
The Need for Delegation?
Nursing shortage •Rapid changes in health-care environment •Demanding too much of nursing staff
How Nurses Spend Their Time?
One study showed that nurses spend only 35% of time in client care Documentation accounts for 20% of time Much time is spent on administrative duties
Criteria for Delegation?
Task-related concerns •Abilities- be aware of the different skill levels of caregivers within each discipline •Priorities-based on client needs, team needs, and organizational and community demands •Efficiency- delegating appropriately can increase efficiency •Appropriateness- ex. Nothing can be more counterproductive than, for example, floating a coronary care nurse to labor and delivery.
Job Satisfaction and the Joy of Work?
The work itself •Ability to provide high-quality patient care The health-care team •Higher levels of teamwork and adequate staffing The employing organization •Support most valuable assets (staff) •Employee wellness programs •Leadership-led efforts to improve conditions
The Value of Time?
Time cannot be saved, so it must be used wisely To accomplish a variety of tasks and goals, time management skills are needed
*** Streamlining Work?
Work smarter, not harder Keep a time log Reduce interruptions Categorize activities Find the fastest way Automate repetitive tasks
10. The patient with COPD has a nursing diagnosis of Ineffective Breathing Pattern. Which is an appropriate action to delegate to the experienced LPN under your supervision? a. Observe how well the patient performs pursed-lip breathing. b. Plan a nursing care regimen that gradually increases activity intolerance. c. Assist the patient with basic activities of daily living. d. Consult with the physical therapy department about reconditioning exercises
a
3. Enhancing the quality of work life can be achieved by: a. Encouraging critical thinking and new ideas b. Discouraging a working relationship with one's peers c. Being negative d. Endangering a client's health or safety
a
5. Burnout at work can be identified best by: a. Expressions of frustration and powerlessness b. Fatigue and refusal to work double shifts c. Allergic reactions d. A preference for efficiency
a
7. An effective way to help a diverse staff work together is to: a. Provide equal opportunities for advancement b. Pretend there are no cultural differences c. Promote uniformity in communication styles d. Establish an English-only policy institution-wide
a
9. The nursing assistant tells a nurse that a patient who is receiving oxygen at a flow rate of 6 L/min by nasal cannula is complaining of nasal passage discomfort. What intervention should the nurse suggest to improve the patient's comfort for this problem? a. Suggest that the patient's oxygen be humidified. b. Suggest that a simple face mask be used instead of a nasal cannula. c. Suggest that the patient be provided with an extra pillow. d. Suggest that the patient sit up in a chair at the bedside.
a
Burnout at work can be identified best by what? A. Expressions of frustration and powerlessness B. Fatigue and refusal to work double shifts C. Allergic reactions D. A preference for efficiency
a
Under which model of care is the focus on the task and not necessarily holistic client care? A. Functional nursing B. Team nursing C. Total patient care D. Primary nursing
a
7. An experienced LPN is working under the supervision of the RN. The LPN is providing nursing care for a patient who has a respiratory problem. Which activities should the RN delegate to the experienced LPN? Select all that apply. a. Auscultate breath sounds. b. Administer medications via metered-dose inhaler (MDI). c. Complete in-depth admission assessment. d. Initiate the nursing care plan. e. Evaluate the patient's technique for using MDIs.
a,b
8. Which of the following events should be reported? Select all that apply. a. A patient is placed in a broken wheelchair that tips over. b. A staff member tells a neighbor about the famous athlete who is a patient. c. An employee reports to work under the influence of alcohol. d. A patient spills her supplemental protein drink on the floor; the certified nursing assistant (CNA; aide) mops it up.
a,b,c
1. An incident of sexual harassment as identified by the EEOC is: Select all that apply. a. Telling jokes about sexual identity issues b. Separate restrooms c. Providing coffee and doughnuts to the nursing staff d. Demanding a daily kiss for writing a favorable evaluation
a,d
2. Factors found to increase nurses' joy at work include: Select all that apply. a. Ability to provide quality care b. Consistently high workload c. A pattern of continuous conflict and disagreement d. Civility and respect
a,d
8. An assistant nurse manager is making assignments for the next shift. Which patient should the assistant nurse manager assign to a nurse with 6 months of experience and who has been floated from the surgical unit to the medical unit? a. A 58-year-old on airborne precautions for tuberculosis (TB) b. A 68-year-old who just returned from bronchoscopy and biopsy c. A 69-year-old with COPD who is ventilator dependent d. A 72-year-old who needs teaching about the use of incentive spirometry
d
9. 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? a. Ignore it because it is not physical violence and will not hurt anyone. b. Model this bullying behavior so that staff can see how it affects people. c. Keep a log of observed bullying behavior to discuss during the employees' annual evaluation. d. Confront the bullying behavior and discuss strategies for responding to it.
d
