Leadership
ABCDE (RNs may delegate tasks to all of the following, so long as the task is within the scope of practice for the delegatee)
Which of the following hospital staff can RNs delegate tasks to? (Select all) A) PCTs B) Doctors C) LPNs D) Other RNs E) Floor Secretary
Trait theory
A leadership theory that holds that effective leaders possess a similar set of traits or characteristics. *Honesty, Energy, Drive, Flexibility, Visibility, Knowledge, Conceptual skills *Leader must be trusted *Have a vision for the future and put it into operation
AONE (American Organization of Nurse Executives)
A national organization that has provided leadership, professional development, advocacy and research to advance nursing practice and patient care, promote nursing leadership excellence and shape public policy for health care.
IOM (Institute of Medicine)
A nonprofit organization established in 1970 as a component of the US National Academy of Sciences that works outside the framework of government to provide evidence-based research and recommendations for public health and science policy.
A (The transactional leader is concerned with the day-to-day operations of the facility)
A nurse manager is concerned with restocking the emergency cart, creating the staff schedule, requesting floor stock from pharmacy, and checking the orders on patient charts. Which type of leader accurately describes this nurse? A) Transactional B) Situational C) Transformational D) Contemporary
D (The RN must not depend exclusively on the judgment of an LPN because the RN is responsible for supervising those to whom client care has been delegated.)
A registered nurse (RN) has delegated care of a newly postoperative client to a licensed practical nurse (LPN). The LPN notifies the RN that the client's blood pressure and respirations are elevated from the baseline readings and that the client is complaining of pain and dyspnea. The RN takes which action next? A) the RN need not to carry out further assessment because the LPN is very experienced and trustworthy B) the RN requests that the LPN offer the client a opioid analgesic, which has ordered postoperatively C) the RN places a call to the attending surgeon and reports that the client is having pain and dyspneic D) the RN assesses the client, checks the client's surgical notes, and gathers addition data before calling the surgeon
ACE
A registered nurse checks the ANA regulations prior to delegating tasks to UAPs on a burn unit. Which principles regarding the regulation, education, and use of the UAP are recommended by the American Nurses Association? (Select all that apply.) A) It is the role of the assistive personnel to carry out tasks to enable the professional nurse to concentrate on nursing care for the patient. B) It is the health care institution that determines the scope of nursing practice. C) It is the registered nurse who is responsible and accountable for nursing practice. D) It is the role of the LPN to assign nursing duties to the UAP. E) It is the purpose of assistive personnel to work in a supportive role to the registered nurse. F) It is the LPN who supervises any assistant involved in providing direct patient care.
ANCC (American Nurses Credentialing Center)
A subsidary of the American Nurse Association (ANA) with the purpose to certify healthcare providers. Accrediting educational providers, approvers, and programs. Recognizing excellence in nursing and healthcare services. Supporting credentialing through research, education, and consultative serves.
Tridimensional Leader Effectiveness Model
A theory by Hershey and Blanchard that suggests there is no single leadership style that is better than another. Leaders must adjust their styles to their followers and follower's abilities. Leadership is both task and relationship-relevant.
Democratic
A type of leadership style in which the leader... *Includes the group when discussions are made *Motivates by supporting staff achievements *Communication occurs up and down the chain of command *Work output by staff is usually of good quality
Authoritative
A type of leadership style in which the leader... *Makes decisions for the group *Motivates by coercion *Communication occurs down the chain of command *Work output by staff is usually high *Effective for employees w/ no formal edu.
Laissez-faire
A type of leadership style in which the leader... *Makes very few decisions, little planning *Motivation is largely the responsibility of individual staff members *Work output is low unless informal leader evolves from the group *Effective w/ professional employees
Airway, Breathing, Circulation, Disability, Exposure
ABCDE priority setting framework stands for...
C
According to the American Association of Critical-Care Nurses (ACCN), there are five factors that a nurse should assess when making a decision to delegate nursing tasks. These factors are assessing the potential for harm, the complexity of the task, the amount of problem solving and innovation required, the unpredictability of the outcome, and the: A) Amount of time that the task will take B) Degree of comfort the delegatee has with the task C) Level of patient interaction D) Method of measuring outcomes
Scope of practice
Actions, procedures, and processes within the terms of the license (state specific).
ACEF (Anything that deals with assessments, educating, evaluating, developing a plan of care, IV medications, unstable patients, or invasive/complex procedures where there is unpredictability the RN is responsible for doing it, and these tasks can't be delegated)
As the registered nurse, which tasks below should you NOT delegate to the LPN? (Select all) A) Performing an assessment on a new admission B) Collecting a urine sample from an indwelling Foley catheter C) Developing a plan of care for a patient who is admitted with Guillain-Barré Syndrome D) Auscultating lung and bowel sounds E) Starting a blood transfusion F) Administering IV Morphine 2 mg for pain G) Providing wound care to a stage 3 pressure injury
BF (RNs are responsible for performing assessments on new admissions, teaching, evaluating, flushing and maintain central lines, and updating the patient's plan of care)
An RN has a critical patient that needs constant monitoring. However, the RN also has other patients in need of care. Which tasks below could the RN delegate to the LPN to help continue the process of patient care? (Select all) A) Admitting and assessing the new admission B) Obtaining a routine 12-lead EKG C) Flushing a central line with normal saline D) Updating and evaluating the patient's plan of care E) Completing the discharge teaching to a patient going home F) Administering subcutaneous Heparin
NCSBN (National Council of State Boards of Nursing)
An independent, not-for-profit organization through which nursing regulatory bodies act and counsel together on matters of common interest and concern affecting public health, safety and welfare, including the development of nursing licensure examinations (NCLEX). *Outline the delegation process and "5 Rights"
Task, Circumstance, Person, Communication (direction), Supervision
Five rights of delegation = ?
C (Leadership trait theory describes intrinsic traits of leaders and is based on the assumption that leaders were born with particular leadership characteristics)
Florence Nightingale is attributed with being intelligent (she developed statistical methods to evaluate health care), dependable (she often worked long hours to care for the injured), and ambitious (she fought against society's perception of nursing). Those who depict her as a leader on the basis of these qualities are practicing which leadership theory? A) Bureaucracy B) Attitudinal C) Trait D) Chaos
Planning, Organizing, Directing, Controlling
Four Steps of Management Process: (Hint: "Point Of Directing Change")
Country club leader
High people concern, low production concern.
Authority compliance leader
High production concern, Low people concern. Strives for efficacy.
C (Laissez-faire leadership is best used with professionals that are self motivated and know their roles without having to be told)
In which setting is the Laissez-faire leadership style best utilized? A) Code Blue B) RN that delegates a task to a LPN C) Interdisciplinary rounds w/professional RNs, Doctors, Case managment D) Nurse manager taking a survey on how to improve the culture of the floor
Impoverished leader
Low production AND people concern. Minimal effort to get things done.
Physiological, Safety, Love (Belonging), Self esteem, Self actualization
Maslow's Hierarchy of Needs (Hint. P.S. I Love You)
Organizational leader
Need to balance task and morale.
Trend, Actual, Systemic, Acute, Infection
Prioritize.... ____________ vs Isolation ABCDE ___________ vs Potential _____________ vs Local ____________ vs Chronic Maslow's Hierarchy of needs Time Management ________________ control (LAST)
Assigning
Process of transferring authority, accountability, and responsibility of client care to another.
Delegation
Process of transferring the authority and responsibility to another team member to complete a task, you retain the accountability.
C (Implied power arises when a person who has no official assigned role, assumes a leadership role by virtue of the force of her/his personality and charisma)
Sara (RN) is the designated charge nurse on the telemetry unit. She organizes and facilitates the unit meetings; however, during most of the meetings, Betsy (RN) runs the show and influences staff decisions just by her charisma and personality. Betsy's power to lead is defined by which of the following terms? A) Democratic B) Situational C) Implied D) Explicit
Emotional Intelligence
The ability of the nurse to perceive and understand their own emotions in order to provide client-centered care.
Clinical Judgement
The decision made regarding a course of action based on a critical analysis of data. Considers the client's needs when deciding to take an action, or modify an intervention based on the client's response.
Task factors
The following are _________ _____________: 1) Predictability of outcome 2) Potential for harm (stable, unstable) 3) Complexity of care 4) Need for problem solving/innovation 5) Level of interaction w/ client (need for psychosocial support or education)
D (This patient is your most acute patient and is exhibiting s/s of shock. Prioritize ABC, Acute before chronic, Acute episodes of pain, Systemic before local, Actual vs potential problems, and Trends vs transient findings)
The following patients are in your assignment for the night. After reviewing their diagnoses and using the prioritization model, Which patient would you see first? A) Patient complaining of mild-moderate knee pain with a hx of Osteoarthritis B) Patient at risk for DVT who the night nurse wasn't able to ambulate C) Patient with a diagnosis of stroke who complains of left side weakness, facial droop, and tingling D) Patient whom the PCT recently reported has a fever of 104, BP of 80/60, HR of 167, RR of 30, and appears restless
Clinical reasoning
The mental process used when analyzing elements of a clinical situation and using the analysis to make a decision.
Contingency theory
Theory of leadership effectiveness views the pattern of leader behavior as dependent upon the interaction of the personality of the leader and the needs of the situation.
Delegatee
These are responsibilities of.... *Must accept the delegated responsibilities *Maintain competency to perform the activity *Must communicate with the delegator *Accountable for carrying out the delegated responsibility correctly, in a timely manner, and with accurate documentation per policy
Delegator
These are the responsibilities of.... *Determine when/what to delegate *Must communicate w/ delegatee including any specific information about the patient's condition *Must be available to the delegatee for questions *Follow up with the delegatee after completion *Must provide feedback
Employer/NL
These are the responsibilities of.... *Must identify a nurse leader responsible for oversight of delegated responsibilities *Determine which responsibilities may be delegated, to whom, and under what circumstances *Policies/Procedures must be developed *Communicate info about delegation to the LPN and UAP, as well as educate them *Providing access to training programs for delegated activities *Must periodically review the delegation process and report any incidences jeopardizing safety *Promote a positive culture on the unit
AD
Which of the following are examples of "Time Savers" when performing time management? (Select all) A) Mentally envisioning the procedure and gathering all necessary supplies before entering the room B) Beginning another task before finishing a bigger one to save time C) Documenting at the end of the shift D) Completing more strenuous, difficult tasks at the beginning of the shift E) Offering help to other nurses when you haven't finished with your patients yet
Task, Relationship
Types of Leadership Behaviors: ___________ Behavior = Organize and define roles, explain activities, and determine where/when/how things will be accomplished. ___________ Behavior = Maintain personal relations by opening communication and providing psycho-emotional support and facilitating behaviors.
D
What must be done by the RN who delegated the task of suctioning a patient to the LPN? A) Praise the LPN B) Talk to management about the LPNs work C) Write an evaluation of the LPN D) Evaluate that the task was done and follow up with the LPN about their observations
Teach, Assess, Plan, Evaluate, Cannot give, Stable, Routine
When an RN is delegating to a LPN: *CANNOT _________, ________, ________, _________ (Hint: "TAPE") *(Can give/Cannot give) blood transfusions *Give Meds (NOT IV meds...) *Takes the most _____________ patients *Performs __________ procedures (ostomy care, catheter insertion, wound care, check blood glucose, obtaining EKG)
B (Be specific! Sometimes ask for a verbalization back)
When considering the 4th out of 5 Rights of Delegation (Communication/direction), which of the following would be correct way for the RN to assign a task to the UAP? A) Can you take the blood sugar in room 206? B) Can you take another BP in room 206 around 11:30AM before he heads down for surgery at noon? C) Can you make sure the patient in room 206 is washed up? He will be going home today. D) The patient in room 206 needs a urine sample.
Collected, Method, Time frame
When delegating a task, in terms of "Right Directions/Communication", the RN would need to include data that must be ________________, the _______________ of collecting the data, and the ______________ __________ for reporting the results.
C (This is the least restrictive/least invasive procedure to deal with this patient on top of an already heavy load)
Your 87 year old patient with Alzheimer's disease begins to sundown and get out of bed. The patient is frequently incontinent and her daughter has gone home for the night. Which of the following interventions is most appropriate for the nurse to take? A) Apply wrist and leg restraints to the patient B) Medicate the patient with 5 mg Haldol, 2 mg Ativan, 1 mg Cogentin (521 cocktail) C) Move the patient's room closer to the nurse's station D) Call the daughter to come back and sit with the patient until her sundowning resides E) Have the doctor order a foley catheter to prevent skin breakdown
Transformational
________________ leadership is a style that focuses on immediate problems, maintaining the status quo and motivating followers. *Motivates followers beyond expectations
Transactional
_______________________ leadership is a style that promotes compliance of followers through rewards and punishments. *Empowers *Aids in personal development *Good in emergency situations