Chapter 40 Professional Roles and Leadership

Autocratic Style

- Aggressive communication - used in emergency situations - retains all authority and responsibility - concerned with tasks and goal accomplishment - assigns clearly defined tasks and establishes one way communication - able to take quick action - being able to get difficult assignments completed

Democratic Style

- Assertive communication - used in nonemergic situations - facilitate goal accomplishment while stressing self-worth of each individual - treat each staff member as an adult and expect same in return - criticism focuses on behavior and its purpose is to promote growth and development of the staff - sometimes does not work with ancillary staff - group decision making process sometimes seems slow and frustrating to those who expect prompt action on an issue - tends to demand more of the leader but many employees value it for the sake of the professional growth and development of the staff it facilitates - evident in shared governance, self directed work teams, and staff committees concerned with quality improvement

Delegation

- act of making another individual responsible for a specific task - mandates clear communication of all aspects of the delegated care to the person completing the task - nurse must take into account the job description, legal responsibility, educational level, the ability and knowledge to complete the task

Tasks that cannot be Delegated

- any type of assessment - writing or evaluating care plan - any task that requires nursing judgement or intervention - health teach or health counseling to client and/or family - administration of any meds or IV therapy - receiving or giving verbal or telephone orders

Supervising a Medication Assistant-Certified in Arkansas ( Approved Medication Routes)

- orally - topically - drops for eye, ear, or nose -vaginally - rectally - transdermally - oral inhaler

Time Management

- using time to good advantage will be of great value - learn effective time management skills and practice them frequently until they become fully developed skill will help you manage not only at work but also in daily living

Leadership

influence others to achieve a goal

Team Leading

- assigns patients to each team member and takes responsibility for the delivery of care to patients as well as for supervision of all members of the team including nursing assistants - advantage of team nursing= collaborative style that encourages each member of the team to help others

Situational Leadership

- comprehensive approach to the issue of management that takes into the account the style of the leader, group being managed and the situation at hand - basis is the flexibility of the manager in adapting to the needs of the individual or the work group

Supervising a Medication Assistant-Certified in Arkansas ( Supervision)

licensed nurse shall not supervise more than two medication assistant-certified persons during a shift

Criteria for Delegation

- licensed nurse delegating the task is responsible for the nursing care to the client and for the final decision regarding which nursing task can be safely delegated - licensed nurse must make an assessment of the client's nursing care needs before delegating a task - nursing task must mot require the UAP to use the nursing assessment, judgement, evaluation or teaching skills - written procedures must be available for the proper performance of each task - there must be documentation of the competency of the UAP to perform the task - licensed nurse responsible for documenting the delegated task - licensed nurse will adequately supervise performance of the delegated task - amount of supervision will depend on - client's condition - training and skill level of the UAP - the task - the availability of the nurse to provide assistance during the task

Laissez-Faire Style

- passive communication - "people pleaser" - encourage employee input - relinquishes control completely and chooses to avoid responsibility by delegating all decision making to the group - want everyone to feel free to " do their own thing" leading to no sense of direction unless provided by group or an informal leader - works well with highly motivated professional groups but works seldom well in health care setting because of complexity of the work environment

Supervising a Medication Assistant-Certified in Arkansas ( Tasks not within scope of work)

- receive, have access or administer controlled substances - administer parenteral, enteral or injectable meds - administer any substance by NG or gastrostomy tube - calculate drug doses - destroy meds - receive written/verbal orders - transcribe orders from the medical record - order initial meds - evaluate med error reports - perform treatments - conduct patient assessments or evaluations - engage in patient teaching activities - order or receive meds by a route that the medication assistant-certified can not administer

A client experiences a cardiac arrest. The nurse leader quickly responds to the emergency and assigns clearly defined tasks to the work group. In this situation, the nurse is implementing which leadership style? 1. Autocratic 2. Situational 3. Democratic 4. Laissez-faire

1. Autocratic

A nurse employed in a long-term care facility is planning the client assignments for the shift. Which of the following clients would the nurse appropriately assign to the nurse assistant? 1. a client who requires a 24 hr urine commection 2. a client who requires twice-daily dressing changes 3. a diabetic client who requires daily insulin and the reinforcement of dietary measures 4. A client who is on a bowel management program and requires rectal suppositories and a daily enema

1. a client who requires a 24 hr urine commection

Which actions demonstrate effective time management skills for the nurse? ( Select all that apply.) 1. Meeting all of the patient's major needs in the early morning hours 2. Anticipating possible interruptions in the plan of care for the day 3. Doing each of the patient's assessments and treatments individually at separate times 4. Leaving each day unplanned to allow for adaptations in treatments 5. Planning care based on prioritizing the needs of the patient

2. Anticipating possible interruptions in the plan of care for the day 5. Planning care based on prioritizing the needs of the patient

Management in nursing uses different leadership styles. What style is a people-centered approach allowing employees more control and individual participation in the decision-making process? 1. Autocratic 2. Democratic 3. Laissez-faire 4. Situational

2. Democratic

The style of leadership that takes into account the style of the leader, the maturity of the groups, and the circumstances at hand is which type of leadership style? 1. Autocratic 2. Situational 3. Democratic 4. Laissez-faire

2. Situational

A licensed practical nurse is planning the client assignments for the day. Which of the following is the is the most appropriate assignment for the nursing assistant? 1. a client who requires wound irrigation 2. a client who requires frequent ambulation 3. a client who is receiving continuous tube feedings 4. a client who requires frequent vital signs after a cardiac catherization

2. a client who requires frequent ambulation

A nurse has delegated several nursing task to staff members. The nurse's primary responsibility after the delegation of the tasks is to: 1.Document 2. assign tasks that were not completed to the next nursing shift 3. allow each staff member to make judgments when performing tasks 4. perform follow up with each staff member regarding performance of the task and the outcomes related to the implementation of the task

4. perform follow up with each staff member regarding performance of the task and the outcomes related to the implementation of the task

Management

accomplishment of tasks or goals by oneself or by directing others

Coordinated Care-Supervision: Responsibilities of the Nurse Manager pg. 1241

- assist staff in establishing annual goals for the unit and determining the systems needed to accomplish goals - monitor professional nursing standards of practice on the unit - develop an ongoing staff development plan including one for new employees - recruit new employees (interview and hire) - conduct routine staff evaluations - establish yourself as a role model for positive customer service ( customers include patients, families, and other members of the health care team) - submit staffing schedules for the unit - conduct regular patient rounds with health care providers - establish and support necessary staff and interdisciplinary committees

Coordinated Care- Supervision: The Five Rights of Delegation pg. 1243

1. Right Task: delegating care for a specific patient and ensuring that the task delegated is within the health care professional's scope of practice 2. Right Circumstance: appropriate client setting, available resources, etc. 3. Right Person: right person delegating right task to the right person to be performed on the right person 4. Right Direction/Communication: clear, concise description of the task including its objective, limits and expectations 5. Right Supervision: appropriate monitoring, evaluation, intervention as needed and feedback

Which statement best reflects the autocratic style of leadership? 1. " Everyone knows their work assignment, so let's not meet together unless we have an unexpected crisis." 2. " Let's discuss this case study thoroughly and decide on a plan of action as a group." 3. " I'll consider each of your requests and then give you the guidelines for establishing new acuity ratings for our patients." 4. " I'll try to pair you in comparable work teams, and we'll evaluate the success of this approach in 2 weeks."

3. " I'll consider each of your requests and then give you the guidelines for establishing new acuity ratings for our patients."

To settle a conflict between two staff members, the nurse manager should focus on which strategy? 1. Developing a compromise solution to solve the conflict 2. Investigation what the conflict parties want to achieve as an outcome 3. Identifying the real issues and assisting in solving them 4. Limiting the number of possible solutions to the conflict

3. Identifying the real issues and assisting in solving them