Chapter 41 Professional Roles and Leadership

Organizational chart

Despite the best intentions, problems may arise during employment. It is important to follow the chain of command. Be aware of the organizational chart of your facility, as well as the grievance process for circumstances that cannot be resolved easily or if treatment is perceived to be unfair. Open communication is the best way to resolve most disagreements.

Terminating Employment

Employers sometimes raise questions about a résumé that reflects frequent job changes; therefore it is in your best interest to remain at the first place of employment for at least 1 year. If this is impossible, follow the proper procedure for resignation. The exit interview may include returning any items that have been assigned to you, such as an identification badge or cell phone, discussing areas of improvement suggested for the organization and reviewing benefits available after termination such as insurance. Failing to provide adequate notice may harm your reputation or leave the employer with an inadequate amount of time to find a replacement for the position.

Breach of contract.

Failure on the part of the nurse or the employer to perform these duties. It is possible for a breach of contract to result in a lawsuit, in which the court may order the breaching party to perform the obligations of the contract or to pay money to the party who suffered damage because of the breach.

Certification in Intravenous Therapy

For nurses who desire to enhance their practice skills in intravenous (IV) therapy and phlebotomy, NAPNES offers IV therapy certification.

Registration for the Examination

Graduation from the program of nursing does not provide licensure. Licensure is granted by the state. The state board has the authority to accept or reject a candidate's request to take the licensure examination. Each state enforces its own nurse practice act that addresses various issues, including licensure.

Team Leading

Sometimes an LPN/LVN is assigned the role of team leader. This role entails assisting and guiding the nursing team in providing care for a select group of patients. Duties of a team leader include the following: • Receiving reports on assigned patients • Making assignments for team members • Making rounds and assessing all assigned patients • Giving team members reports about assigned patients • Assisting in administering medications and treatments • Providing time in the early part of the shift to have a conference with team members

Symptoms of Burnout

Physical • Fatigue • Changes in sleeping, eating • Lack of energy • Loss of interest in sex Psychological • Irritability • Hypersensitivity • Frustration • Negative outlook • Forgetting Spiritual • Loss of commitment • Loss of meaning • Loss of integrity

Job shadowing

Provides a means for the individual to follow a nurse during a normal shift.

Situational Leadership

Situational leadership is a comprehensive approach to the issue of management that takes into account the style of the leader, the group being managed, and the situation at hand. Supporters of situational leadership contend that no single leadership style is best but rather that the best style for the manager to use is contingent on the situation at hand.

The three primary types of résumés

1. Chronologic In the chronologic résumé, the applicant's job history is listed in reverse chronologic order, with the most recent job listed first. It requires a recall of work- and education-related activities. 2. Functional The functional résumé promotes the applicant's skills and experiences. It does not reference the dates of the experiences listed. 3. Combination. The combination type of résumé blends the two types.

Key components of the cover letter

1. Identification of interest in employment, 2. A brief statement of qualifications, and 3. Availability for the position being sought.

Procedure for Discontinuing or Changing a Medication

1. If the medication administration record (MAR) is not on the computer, the discontinued medication should be marked off on the MAR by crossing through with a highlighter and documenting the discontinue date on the MAR. If the order is being changed, a new order should be written.

Work Schedule

Mandatory overtime is sometimes a concern. If no nurses are available for the oncoming shift, those who worked the preceding shift are obliged to remain on duty.

Further Education: LPN/LVN-to-RN Programs

Many community colleges, private schools, and universities have programs that offer a specialized curriculum that leads to obtaining an RN license for LPN/LVNs who wish to further their education or career. There are degree programs such as the associate of science in nursing (ASN) and baccalaureate of science in nursing (BSN).

Certification in Long-Term Care

NAPNES offers certification in long-term care that addresses issues across the lifespan for individuals faced with chronic illness and for elderly patients.

Certification in Pharmacology

NAPNES pharmacology certification addresses principles of pharmacology and medication administration, including dosage calculation.

Mentor or preceptor

Person who supports a new or transferred employee through clinical orientation)

The Five Rights of Delegation

a) Right Task The right task refers to delegating care for a specific patient and ensuring that the task delegated is within the health care professional's scope of practice. b) Right Circumstance Consider the appropriate patient setting, available resources, and other relevant factors. c) Right Person The right person is delegating the right tasks to the right employee for performance on the right patient. d) Right Direction/Communication Give a clear, concise description of the task, including its objective, limits, and expectations. e) Right Supervision and Evaluation Provide appropriate monitoring, evaluation, intervention as needed, and feedback.

Advancement

A rise in rank or importance; a promotion; progress; improvement, is a possible result of additional preparation or additional experience.

Burnout

A state of emotional exhaustion, depersonalization, and reduced sense of personal accomplishment in one's work, seen among human service, education, business, and government professions.

Endorsement

A statement of recognition of the license of a health practitioner in one state by another state; the applicant needs to meet the current state's licensing requirements.

Cover letters

A means of introducing a job applicant to a potential employer. The cover letter should not exceed a single page. It also should contain contact information and a signature line.

Reciprocity

A mutual agreement to exchange privileges, dependence, or relationships, such as an agreement between two governing bodies to accept the credentials of caregivers licensed in each other's state.

Hospitals

Because of health care economics, hospitals are responsible for providing quality care as economically as possible.Under the supervision of an RN, the LPN/LVN is legally able to provide most bedside care to patients in the hospital setting. Because the LPN/LVN salary is lower than that of the RN, it makes economic sense to employ a number of LPN/LVNs.Policies vary by facility and locality. In the hospital setting, the LPN/LVN has responsibility for supervising nursing assistants, whereas overall management of a unit is the responsibility of an RN.

Taking the NCLEX test

Computerized adaptive testing (CAT) for the NCLEX, the maximum time length for the administration of the NCLEX-PN is 5 hours. Alternate-item format is an examination item that takes advantage of new technology through the use of a format to assess candidate ability that differs from the standard one of four multiple-choice options with one correct response. The minimum number of questions for the NCLEX-PN is 85 (60 "real" questions and 25 pilot, or "try-out," questions). The scores on the try-out questions are not counted toward the competence level of the candidate After the candidate has answered 85 questions, the system compares the competence level with the passing standard and determines (1) whether the candidate is clearly above the passing standard (the candidate passes), (2) whether the candidate is clearly below the passing standard (the candidate fails), or (3) whether the competence level is not clear. The system stops asking questions when the competence level is clearly above or clearly below the passing standard when the maximum number of questions has been answered, 205 for the NCLEX-PN), or when the candidate runs out of time.

Transcribing Health Care Providers' Orders

Health care providers convey orders for patient care through writing, telephoning, or verbalizing the orders to the nurse. Principles of Time Management a. Goal setting b. Time analysis c. Priority setting Schedule the priorities that you have established for patients within set time frames. d. Interruption control Everyone needs time to socialize or to discuss issues with colleagues. However, do not let this interrupt important patient care activities. e. Evaluation At the end of each day, take time to think about how effectively you used your time. Orders given by telephone or verbal communication are more subject to error. If you are responsible for accepting this type of order, be certain of its accuracy. Clarify the order by repeating it to the person giving it and document that this was done. This gives both people a chance to hear the order. A telephone or verbal order always must be written down immediately. If the order is given too rapidly, ask the giver to repeat it more slowly.When the nurse transcribes (writes or types a copy of) health care providers' orders, a number of precautions must be used to prevent errors. When there is an order to discontinue or change a medication, take the steps in the Medication Safety Alert box on the procedure for discontinuing or changing a medication Medication dispensing systems, such as computer-assisted or electronic devices, are variations of unit-dose and floor stock systems. For example, the Pyxis MedStation (Care Fusion Products) (Fig. 41.6) has the capacity to carry a variety of medications, housed in individual compartments, that the nurse can access after requesting the medication from a computerized screen.

Schools

Health screening, emergency care, and health teaching are the major responsibilities.Working only during the school year and during school hours is an advantage for nurses who themselves have children.

The interview

It is a face-to-face meeting, an online meeting via a webcam or Skype, or a telephone call during which the employer assesses the potential candidate's qualifications and personality. It is important for the applicant to be prepared for the interview process. First impressions have a lasting effect, so it is imperative to make the most of the initial contact with a potential employer. Applicants should articulate (speak clearly, distinctly, and to the point) and present themselves with clarity and effectiveness to make a good first impression.

The résumé

It is a one- or two-page summary of educational and professional experiences, activities and honors, and concrete skills and interests. A concise, comprehensive, well-prepared résumé will impress future employers; therefore it should be well organized, neat, and accurate.

Certification

It is a process by which the nurse is granted recognition for competency in a specific area of nursing.Various certification opportunities are available to LPN/LVNs through seminars or self-guided study courses and successful completion of examinations. Knowledge is the basis for improved nursing skills and safety in patient care. Presently certification is available for the LPN/LVN in pharmacology, long-term care, and intravenous therapy. In many states or agencies, certification is also the basis for salary increases and advancement. Information on certification courses for the LPN/LVN can be found on the NAPNES website

A contract

It is a promise or a set of promises between two or more people that creates a legal relationship with legal obligation between them. The usual contract that LPN/LVNs encounter is the employment contract. The employment contract properly specifies the length of the contract period; hours that the nurse is to work; salary; vacation; sick leave pay; medical, maternal, disability, and liability insurance coverage; educational benefits; and any other benefits or working conditions to which the nurse and employer agree. The employment contract can be terminated legally, without a breach, by completion of all obligations under the terms of the contract or by consent of all parties to the termination.An internship helps with the transition to professional nursing. Some facilities provide a mentor or preceptor to assist the new graduate during this internship period. Probationary policies such as internships or orientation should be discussed during the interview process.

Leadership

It's the art of getting other people to want to do something that the leader believes must be done.Leaders typically have a vision of where to go: a direction in which they influence other people to follow.Managers handle the day-to-day operations to achieve a desired outcome.When determining rules of supervision, team members typically supervise other team members who have a lesser scope of practice. Understandably, an LPN/LVN would not supervise the RN but could be responsible for other LPN/LVNs. Other members of the health team who would be managed by the LPN/LVN would include medical assistants, certified medical assistants, orderlies or transport workers, clerks, and technicians.Leadership styles relate to the amount of control or freedom the manager allows the group.The most common styles are autocratic, democratic, and laissez-faire.

LPN/LVN Refresher Course

LPN/LVNs who have been inactive in their profession, are seeking reactivation of their license, or are seeking to update their knowledge and skills may benefit from this course.

Test Preparation

Testing centers are available in each state, as well as outside of the United States. After submitting an application to the state board of nursing, the candidate, if approved, registers with Pearson VUE to receive authorization to test.

Nursing Informatics

The American Nurses Association (2008) recognized nursing informatics as a specialty that "integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice."

Transition From Student to Graduate- Know Your Role

The LPN/LVN is responsible to a registered nurse (RN) or to the health care provider. The role of the LPN/LVN, like the roles of other health care professionals, is changing constantly.

Temporary Agencies

The LPN/LVN must be very flexible to adjust to various work settings when working for a temporary agency. Advantages of employment with a temporary agency are the right to refuse an assignment and the variety of assignments available.A disadvantage is the uncertainty that work is available. If the number of patients is low in a facility, temporary employees are not called to work,it may be difficult to create friendships or obtain the feeling of being the part of a team.

Endorsement and Reciprocity

The NCLEX-PN makes it possible to practice nursing in states other than the one in which the nurse first qualifies (see Chapter 2). If the nurse moves after successfully passing the examination and fulfilling the educational requirements, it is necessary to apply for a license or temporary practice permit before practicing nursing. Licensure that transfers this way from one state to another is called endorsement, Some states called this licensure reciprocity

National Federation of Licensed Practical Nurses (NFLPN).

The NFLPN also lobbies on the state and national levels for issues that are of interest and concern to its members. Licensed Practical Nurse is its official publication.

Resignation

The act of resigning to give up a position of employment. Resigning from a position properly is another skill with which the LPN/LVN should be familiar. A verbal statement and a written resignation, providing at least a 2-week notice, is considered a professional courtesy and maintains a good relationship with the employer.

Home Health

The advantages of home health care include patient preference, nurse autonomy, and the lower cost of care in comparison with hospital stays. Home health care also allows for continuity of care inasmuch as the nurse often is assigned a caseload that he or she follows during the entire time the patient is receiving home health care.

Autocratic Style

The autocratic leader retains all authority and responsibility and is concerned primarily with tasks and goal accomplishment. This type of leader assigns clearly defined tasks and establishes one-way communication with the group, is firm, insistent, and dominating. Such a leader stresses prompt, orderly performance and uses power to intimidate or pressure employees who fail to adhere to expectations. This leader displays little trust or confidence in employees and therefore makes all the decisions. The autocratic style of leadership is appropriate in certain situations. In situations in which immediate action is required and there is no time for group decisions, the autocratic leader is able to take quick action. Autocratic leaders excel in times of crisis (e.g., cardiac arrest) and in situations of disorder (e.g., natural disaster); they often have the reputation for being able to get difficult assignments completed. In situations in which safety is of concern this style of leadership is beneficial

Democratic Style

The democratic style is a people-centered approach that allows employees more control and individual participation in the decision-making process. The emphasis is on team building and on collaboration through the joint effort of all team members. Democratic leaders function to facilitate goal accomplishment while stressing the self-worth of each individual.The democratic style works best with mature employees who work well together in a group.The group decision-making process sometimes seems slow and frustrating to those who expect prompt action on an issue.

Certification in Managed Care

The nurse certified in managed care develops and puts into practice wellness and disease prevention/management programs, as well as quality management programs. The certification examination is a national examination, and recertification is required every 3 years.

National Association for Practical Nurse Education and Service (NAPNES)

The purpose of NAPNES, founded in 1941, is to promote an understanding of practical nursing schools and continuing education for LPN/LVNs. The Journal of Practical Nursing is its official publication, and NAPNES Forum is the newsletter that informs members of activities.

Change-of-Shift Report

The purpose of the change-of-shift report is to provide the staff on the next shift with pertinent information about the patient.The change-of-shift report may be given in person or documented on a recording device, or the report may be given by making rounds from patient to patient Oral reports are given in a conference room with nurses from both shifts participating. When a recording device is used, the report is recorded before the end of the shift.

After the NCLEX Test

The test scores are pass or fail. Test administrators print score reports and send them to the board of nursing in each jurisdiction within 24 hours. Each board of nursing schedules its own notification timetable. Most test results are received by candidates in 1 week or less. Candidates who have failed their licensure examination in most states are allowed to retake the test after waiting 45 days. The licensed LPN/LVN is responsible for license renewal and keeping the state board informed of any changes of address, name, and employment (i.e., active or inactive) status. The LPN/LVN is not allowed to practice without a license. Licensure permits nurses to offer special skills to the public, but it also provides legal guidelines for protection of the public.

Adult day services

These facilities are designed for individuals who require medical supervision while their family members work or take a break from the responsibility of care. The pace is relaxed, and the schedule is excellent.

Laissez-Faire Style

This leadership style often is referred to as the "free-run style" or "permissive leadership."This type of leader relinquishes control completely and chooses to avoid responsibility by delegating all decision making to the group.This style sometimes works well with highly motivated professional groups (e.g., a research staff), but it seldom works well in health care settings because of the complexity of the work environment.

Time Management

Time management is an aspect that is sometimes difficult for the new LPN/LVN. For a new nurse, the patient load is often heavier than that during nursing school and there are added responsibilities as a licensed professional.

Malpractice Insurance

To protect their employees and themselves against any legal and financial consequences that have potential to arise from provision of services, institutional employers carry malpractice liability insurance. Because individuals are responsible for their own actions, it is still possible for an employee to be sued personally.Some nurses choose to obtain a personal professional liability (malpractice) insurance policy separate from the employer's policy. The decision about whether to carry malpractice insurance is a personal choice. When making this decision, consider your state's malpractice compensation law, as well as the amount and type of malpractice insurance that your facility carries.

Continuing Education

To renew nursing licenses, some states require a given number of hours per year in continuing education units (CEUs). 30 for LVNs. The LPN/LVN is responsible for acquiring the required number of CEUs and for ensuring that the credits are attained from approved providers.

Professional Organizations

Two national organizations exist to support and meet the needs of the LPN/LVN: 1. The National Association for Practical Nurse Education and Service (NAPNES) 2. The National Federation of Licensed Practical Nurses (NFLPN).

nurse practice act

is the licensing law. It defines the title and the regulations governing the practice of nursing. The act delineates the legal scope of the practice of nursing within the geographic boundaries. Its provisions assist the nurse in staying within the legal scope of nursing practice in each state.The nurse practice act defines the regulations for practical nursing and includes requirements for an approved school of nursing. It also states the requirements for licensure and conditions under which a license may be revoked or suspended