Exam 1 - Management
Major weakness of all checklists
- no set performance standards; specific components of behavior not addressed. Checklists do focus on a variety of job-related behaviors and avoid some of the bias inherent in the trait rating scales.
LPN scope of practice
- stable and predictable situations (routine!) - may delegate to NACs - has a dependent role in the nursing process - requires supervision by law - may administer drugs, meds, treatment tests, injections and inoculations under the supervision of a RN -Function in an INTERDEPENDENT role to deliver care as directed and assist in the revision of care plans in collaboration with the registered nurse. -Function in a DEPENDENT role when executing a medical regimen under the direction and supervision of MD, ARNP, etc. -Never has an INDEPENDENT role.
Right level of supervision
-Appropriate monitoring, evaluation, intervention as needed, and feedback -FACTORS TO BE AWARE OF: 1. Patient response from the delegated task 2. Performance of activity HOW TO SUPERVISE PROPERLY: 1.Provide supervision expectations 2.Release control - allow the person to complete the task 3.Monitor and give guidance as needed 4.Provide corrective instructions if necessary Ensure proper documentation is completed
Right circumstance
-Appropriate patient setting, available resources, and other relevant factors considered -FACTORS TO BE AWARE OF: 1. Health status of the patient 2. Complexity of the task or activity 3. Supervision available
NAC Scope of practice (what you can delegate)
-CPR -Vital Signs -Height & Weight -Intake & Output -Eating and Hydration -Activities of Daily Living -Recognize normal body functions & deviations* -And timely reporting of the changes to the RN
Considerations in assignments
-Capability of staff member -Scope of Practice -Experience -Special skills -Care needs of patients -Physical environment -Infection control -Anticipated changes in assignment -Special staff needs -Standards of practice
Right Direction/Communication
-Clear, concise description of the task, including its objective, limits, and expectations -FACTORS TO BE AWARE OF: 1.Oral or written clarity 2. Clarity of direction and supervision 3. Reporting requirement 4. Time constraints 5. Re-check for understanding 6. Don't ignore nonverbal communication
Reasons to delegate
-Delegate routine tasks so that you can handle more complex issues -Delegate if someone else is better prepared or has greater expertise of knowledge on how to solve a problem -Provide learning opportunities for subordinates
What RNs may not delegate
-Initial nursing assessment and subsequent assessments if nursing judgment is needed -Decisions/judgments about nursing diagnoses -Decisions/judgments about outcomes -Determination/approval of plan of care -Interventions that require professional nursing knowledge, decisions, or skill -Administration of meds (except within specific provisions) -Piercing of tissues (except insulin) -Evaluation of the plan of care
common delegated tasks to LPN
-Medication pass -Non-invasive procedures: EKG, venipuncture, IV start -Basic nursing skill for a stable, predictable patient
commonly delegated tasks to a NAC
-Non-invasive and non-sterile treatment -Vital signs, height and weight -Intake and output -Capillary blood check -Urine test -Ambulation, positioning, turning -Transporting patient within a facility -Personal care skills -Activities of Daily Living -Feeding
Right task
-One task that is delegable for a specific patient -FACTORS TO BE AWARE OF: 1. Policies & Procedures 2. Scope of Practice 3. Knowledge required 4. Standards of practice 5. Potential for harm 6. Predictability of outcome
NAC competencies
-Personal Care Skills -Mental health and social service needs -Care of cognitively impaired residents -Basic restorative services -Client or resident rights and promotion of independence -Communication and interpersonal skills -Infection control -Safety and emergency procedures -Rules and regulations knowledge
Five Rights of Delegation
-Right Task -Right Circumstances -Right Person -Right Direction/ Communication -Right Level of Supervision
Right person
-Right person (Nurse) is delegating the right task to the right person to be performed on the RIGHT patient. -FACTORS TO BE AWARE OF: 1. Job descriptions 2. Scope of Practice 3. Skills and abilities of delegated person 4. Special competencies *GENERAL RULE* §Do not delegate a task to a person that has never performed the task before. INSTEAD, you can teach them the task and appropriate documentation so that they can perform it independently next time.
trait rating scale
-method of rating a person against a set standard, which may be the job description, desired behaviors, or personal traits. The trait rating scale has been one of the most widely used of the many available appraisal methods -experts argue that quality or quantity of work performed is a more accurate performance appraisal method than employee's traits because rating traits invites subjectivity and is also subject to halo and horns-effect errors.
behaviorally anchored rating scale
-uses specific descriptions of actual behaviors to rate various levels of performance -overcomes some of the weaknesses inherent in other rating systems; requires separate rating form for each job classification -many specific examples are defined for each area of responsibility à these examples are given various degrees of importance by ranking them from 1 to 9 - can be used to improve performance and keep employees focused on the vision and mission of the organization -can be time and resource intensive; primarily applicable to physically observable skills rather than conceptual skills.
McClelland's hot stove rule
1.All employees must be forewarned that if they touch the stove (aka break the rule), they will be burned (disciplined). They must be aware of the rule and the punishment. 2.If a person touches the stove, then there will be immediate consequences (getting burned). Discipline will be enforced immediately. 3.If a person touches the stove again and again, they will get burned and disciplined each time. 4.If any other person touches the stove, they will also get burned (consistency). They will also be disciplined (impartial).
Senge's Learning Organisation
1.Systems Thinking: Encourages staff to see themselves as connected to the whole organization. 2.Personal Mastery: Member commitment to improve his or her personal abilities. 3.Team Learning: Collaboration of team members to achieve organizational goal. Values must be established such as trust and openness, acknowledgement that mistakes are part of the learning process, and using non-punitive errors as a learning experience. 4.Mental Models: Foster organization development through diverse thinking. This is a way to promote full potential of individuals to learn. 5. Shared Vision: Having a shared mission allows employees to be more willing to put aside their personal goals and to focus on teamwork and collaboration.
learning organization
An organization skilled at creating, acquiring, and transferring knowledge, and at modifying its behavior to reflect new knowledge and insights.
Delegation
Directing the performance of one or more people to accomplish organizational goals -transferring authority to perform a selected nursing task in a selected situation to a competent individual - the delegating nurse retains accountability for the delegation - important patient management tool - necessary for efficiency in healthcare
steps in progressive discipline
First infraction: Informal reprimand. Manager and employee meet. Discuss the issue. Suggestions for improvement/correction. Second infraction: Written warning. Manager meets with employee to distribute written warning. Review of specific rules/policy violations. Discussion of potential consequences if infractions continue. Third infraction: Employee placed on suspension with or without pay. Time away from work gives the employee opportunity to examine the issues and consider alternatives. Fourth infraction: Employee termination. Follows after multiple warning have been given and employee continues to violate rules and policies.
Scope of Practice: RN
Independent role -When using the nursing process for complex patients -May revise nursing plan of care independently Interdependent role -Coordinating/evaluating care of client -Executing medical regimen under direction of MD, ARNP, etc. -May not accept delegation of acts outside RN Scope of Practice
scope of practice
Most commonly defined by state law; outlines the care you are able to provide for the patient. - WAC 246-840-805
herzberg motivation factors
Motivated by changing the nature of the work so that people are challenged to develop their talents and fulfill their potential. Lead to longer-term job satisfaction .-Achievement -Recognition -Work -Responsibility -Advancement -Possibility of Growth
outcomes of feedback
OUTCOMES •Done Well -Increase motivation -Increase teamwork -Increase quality of care •Done Poorly -Decrease motivation -Reinforce unproductive behaviors -Increase employee insecurity -Decrease morale
Skinner
Operant Conditioning and Behavior Modification •Behavior that is rewarded will be repeated and behavior that is punished or goes unrewarded is extinguished. •REINFORCERS: elements that encourage good behavior •PUNISHERS: elements that decrease likelihood of good behavior •NEUTRAL OPERANTS: environmental influences that neither encourage nor discourage •
Herzberg hygiene factors
Parts of a job that do not increase job satisfaction but help to remove dissatisfaction, such as reasonable wages and working conditions .-Salary -Supervision -Job Security -Positive Working Conditions -Personal life -Interpersonal relationship and peers -Company policies -Status
RCW
Revised Code of Washington
Scope of practice LPN IV therapy
The LPN may administer fluids, medication, Total Parenteral Nutrition (TPN), blood or blood products via central venous catheters and central lines, access these lines for blood draws and administration of emergency cardiac medications via IV push if the following occurs: (1) Strict guidelines and protocols are in place. (2) The guidelines clearly state all policies and procedures. (3) Annual review and assessment of the LPN's knowledge, skills and abilities is conducted. (4) Emergency cardiac medications given "IV push" shall be administered by the LPN only if: a. The LPN has direct supervision per WAC 246-840-010(22) (a) or b. The LPN has a current ACLS certification. (5) Blood or blood products shall only be given with direct supervision as per WAC 246-840- 010(22)(a). (6) It is within the scope of LPN practice to perform peripheral venipuncture (to start IV or draw blood), flush peripheral, PICC and central lines for the purpose of ensuring patency if the following occurs: a. The LPN completes an annual instructional program on the initiation of peripheral IV. b. Documentation of satisfactory completion of the instructional program and supervised practice is on file with the employer. c. Written policies and procedures are maintained by the employer.
McGregor's Theory Y
The assumption that employees are creative, enjoy work, seek responsibility, and can exercise self-direction
WAC
Washington Administrative Code
McClelland's Theory of Needs
a theory that states achievement, power, and affiliation are three important needs that help explain motivation •ACHIEVEMENT-ORIENTED: quantity over quality; focus on improving task, transforming ideas into action, taking risks when necessary •AFFILIATION-ORIENTED: quality over quantity; overt productivity is less, focus their energies on families, friends, relationships •POWER-ORIENTED: motivated by power, they want to command attention, get recognition, and control others
Vroom's Expectancy Theory
argues that work motivation is determined by individual beliefs regarding effort-performance relationships and work outcomes
McGregor's Theory X
assumes people dislike work, lack ambition, act irresponsibly, and prefer to be led
essay style of performance appraisal
free form review; appraiser describes in narrative form employee's strengths and areas for improvement or growth; forces appraiser to focus on positive aspects of employee performance; opportunity for personal bias; time consuming.
Benner's stages of nursing proficiency
novice, advanced beginner, competent, proficient, expert
Herzberg's Two-Factor Theory
proposed that work satisfaction and dissatisfaction arise from two different factors - work satisfaction from so-called motivating factors and work dissatisfaction from so-called hygiene factors Motivation-Hygiene Theory
job dimension scale
rates the performance on job requirements (Nursing Process elements plus teaching, collaboration, coordination, etc. Text uses industrial nurse - fitness, health promotion, annual physicals, and record-keeping) -rating scale is constructed for each job classification; taken from context of the written job description; share some of same weaknesses as trait scales.
responsibility
reliability, dependability and obligation to accomplish work when an assignment or delegation is accepted
Accountability
responsible and answerable for actions or inactions of self and others in the context of delegation
nurse practice act
statute in each state and territory that regulates the practice of nursing -WAC 246-840-700
self-appraisal performance review
written summaries of own work-related accomplishments and productivity; not easy, people don't see the point of it, don't know what to say, is it going to be used against me; can be used to remind supervisors of the accomplishments of the employee; part of reflective practice - process for assessment of one's practice to identify and seek learning opportunities to promote continued competence
performance appraisal
•A way to let employees know the level of their job performance as well as any expectations that the organization may have of them. •Generate information for salary adjustments, promotion, transfers, disciplinary actions, and terminations. oUsually occurs at designated times oUses many resources oLegally defensible
delegation in the community setting
•Delegation of nursing care tasks in community-based care settings and in-home care settings is ONLY allowed for individuals who have a stable and predictable condition. -•a situation in which the individual's clinical and behavioral status is known and does not require the frequent presence and evaluation of a registered nurse.
good feedback characteristics
•Descriptive •Specific versus general •Focuses on behavior, not on the individual •Timely •Given in private if possible •Appropriate to needs of the situation •Useable feedback is seen as interest or concern •Needs to be clear and honest •Gives information to another about behaviors •Assertive behavior is one type of feedback •Neutral attitude helps the receiver hear the message versus respond only to the affect
principles of effective feedback
•Immediate, frequent, and private •Specific •Behavior that can change •Needs of sender and the receiver •Suggestions for improvement •Accurate •Observed behavior •Representative of work •Consistently applied
goals and purpose of feedback
•Motivate •Relieve anxiety •Develop skills - helps grow employees •Improve function of organization •Meet accreditation requirements •Basis for termination Change or reinforce a behavior
Supervision
•Provision of guidance, oversight, evaluation, and follow-up by the Licensed Nurse for accomplishment of a delegated nursing task by assistive personnel.
types of performance appraisals
•Trait Rating Scale •Job Dimension Scale •Behaviorally Anchored Rating Scale •Checklist •Essay •Self-Appraisal •Management by Objective •Peer Review •360 Evaluation
checklist performance appraisal types
•Weighted scale - most frequently used, composed of many behavioral statements that represent desirable job behaviors that have weighted scores attached. Gives an overall performance appraisal score based on behaviors or attributes; merit raises often tied to total point score. •Forced checklist - requires supervisor to select an undesirable and a desirable behavior for each employee; have quantitative values and employee ends up with total score. •Simple checklist - numerous words or phrases describing various employee behaviors or traits; often clustered to represent different aspects of one dimension of behavior (assertiveness or interpersonal skills); rater asked to check all those that describe the employee.
RN responsibilities in delegation
•is responsible and accountable for the provision of nursing care •is responsible for assessment, diagnosis, care planning, and evaluation (we do not delegate ADPIE) •is responsible for the patient outcome related to delegation •is aware of strengths and limitations of other team members •does not require supervision
