Leadership & Management Exam 1

How do we divide all requests for our time (3 categories)?

"don't do": problems that will take care of themselves, are already outdated, or are better accomplished by someone else "do later": trivial problems or those that do not have immediate deadlines; thus, they may be procrastinated "do now": a unit's day-to-day operational needs

Short term planning

- 1 hour to 3 years - less complex than strategic or long-range plans - planning may be done annually, quarterly, monthly, weekly, daily, or even hourly

Rules of Delegation

- Always delegate to the right person, at the right time, and for the right reason. - Say no when you must. - Reward subordinates for jobs well done.

LPN Scope of Practice

- Conducting a focused nursing assessment and contributing to the ongoing comprehensive nursing assessment of the patient performed by the RN. - Collaborating in the development and modification of the RN's or APRN's comprehensive nursing plan of care for all types of patients. - Implementing aspects of the plan of care. - Participating in health teaching and counseling to promote, attain, and maintain the optimum health level of patients. - Serving as an advocate for the patient by communicating and collaborating with other health service personnel. - Participating in the evaluation of patient responses to interventions. - Communicating and collaborating with other health care professionals. - Providing input into the development of policies and procedures to support patient safety. (Section 55-30 of the Act)

Daily planning actions that may help the unit manager identify and utilize time as a resource most efficiently:

- Identify key priorities to be accomplished that day what specific actions need to be taken to accomplish those priorities and in what order - Determine the expected level of achievement of a prioritized task. is a maximizing or "satisficing" approach more appropriate or more reasonable? - Assess the staff assigned to work with you. Assign work that must be delegated to staff members - Review the short- and long-term plans of the unit. Include colleagues and subordinates in identifying unit problems or concerns - Plan ahead for meetings. Prepare and distribute agendas in advance - Allow time to assess progress of goal attainment. determine if unanticipated events have occurred or if new information has been received that may have altered your original plan - Take regular breaks integral part of an individual's time and task management; allow both managers and staff to refresh physically and mentally. - Use electronic calendars. can help make a day feel less chaotic - Know and understand how and why you use time or set priorities as you do; make lists

Leadership Roles

- Is self-aware regarding personal blocks and barriers to efficient time management - Recognizes how one's own value system influences his or her use of time and the expectations of followers - Functions as a role model, supporter, and resource person to others in setting priorities for goal attainment - Assists followers in working cooperatively to maximize time use - Prevents and/or filters interruptions that prevent effective time management - Role models flexibility in working cooperatively with other people whose primary time management style is different - Presents a calm and reassuring demeanor during periods of high unit activity - Prioritizes conflicting and overlapping requests for time - Appropriately determines the quality of work needed in tasks to be completed

External Time Wasters

- Open-door policy - Telephone interruptions - Socializing - Meetings - Lack of information - Poor communication - Lack of feedback - Lack of adequately described policies and procedures - Incompetent coworkers - Poor filing system - Paperwork and reading

Causes of Overdelegating

- Poor management of time; spending too much time trying to get organized - Insecurity in the ability to perform a task

Internal Time Wasters

- Procrastination - Poor planning - Failure to establish goals and objectives - Inability to delegate - Inability to say no - Management by crisis - Haste - Indecisiveness

Long term planning

- Strategic - Extends beyond 1-year

Causes of Improperly Delegating

- Wrong time, to the wrong person, or for the wrong reason - Beyond the capability of the person, or something the manager should do - Decision making without providing adequate information

What is included in someone who optimizes their time management?

- able to manage their stress - perform self-care techniques - can understand how they use time and set priorities accordingly

Making Lists

- lists are planning tools and thus must be flexible! - Reexamine items that remain on the list! Perhaps they don't need to be done or they need to be broken down into smaller tasks. - Only put as many items on the daily list as can reasonably be accomplished in a day. - Being punctual implies that you value other people's time and creates an imperative for them to value your time as well.

good reasons for delegating

- to become free to handle problems that are more complex or require a higher level of expertise - someone else is better prepared or has greater expertise or knowledge about how to solve a problem. - used to provide learning or "stretching" opportunities for subordinates. - the leader-manager contributes to employees' personal and professional development (subordinates may become bored, nonproductive, and ineffective)

Two mistakes common in planning

- underestimating the importance of a daily plan - not allowing adequate time for planning.

Causes of Underdelegating

-Fear that delegation may be interpreted as a lack of ability to do the job completely or correctly. -A desire to complete the whole job himself or herself. -Fear that subordinates will resent delegated work. -Lack of experience in the job or with delegation; or the need to control or be perfect. -Enjoyment of the work. - It will likely be unnerving (at least initially) to allow a team member to complete a task for which you are ultimately responsible.

A client presents to the ED reporting severe substernal chest pain radiating down his left arm. He is admitted to the coronary care unit (CCU) with a diagnosis of myocardial infarction (MI). What nursing assessment is a priority on admission to the CCU? 1) Begin continuous cardiac monitoring 2) Obtain information about family history of heart disease 3) Auscultate lung fields 4) Determine if the client smokes

1) Begin continuous cardiac monitoring

A nurse is reviewing the hospital's fire safety policies and procedures with newly hired assistive personnel.The nurse is describing what to do when there is a fire in a client's trash can. Which of the following information should the nurse include? (Select all that apply.) 1) Close all doors. 2) Instruct ambulatory clients to evacuate to a safe place. 3) Use a Class C fire extinguisher to put out the fire. 4) The first step is to pull the alarm. 5) Pull the pin on the fire extinguisher prior to use.

1) Close all doors. 2) Instruct ambulatory clients to evacuate to a safe place. 5) Pull the pin on the fire extinguisher prior to use.

A member of the team reports that they have been given too much to do and are not going to be able to complete the work on time. What action will the RN take to effectively manage this situation? 1) Examine the workload and assist the individual in reprioritizing 2) Take on the responsibility of the tasks 3) Have the team member perform only the necessary tasks 4) Assign the work to another team member

1) Examine the workload and assist the individual in reprioritizing

A nurse on an acute care unit is caring for a client following a total hip arthroplasty. The client is confused, is moving his leg into positions that could dislocate the new hip joint, and he repeatedly attempts to get out of bed. After determining that restraint application is indicated, which of the following actions should the nurse take? (Select all that apply.) 1) Have a family member sign the consent for restraints. 2) Use a square knot to secure the restraints to the bed. 3) Get an prescription for restraints from the provider. 4) Secure the restraint to the frame of the bed. 5) Ensure that only one finger can be inserted between the restraint and the client.

1) Have a family member sign the consent for restraints. 3) Get a prescription for restraints from the provider. 4) Secure the restraint to the frame of the bed.

A patient enters the emergency department complaining of chest pain that is radiating down the left arm. The emergent treatment plan for this patient include(s) which nursing action(s)? Select all that apply. 1) Oxygen 2) Aspirin 3) Morphine IV 4) Heparin drip at 100 units per hour 5) Nitroglycerin tablet sublingual

1) Oxygen 2) Aspirin 3) Morphine IV 5) Nitroglycerin tablet sublingual

A nurse is providing care to a patient with delirium. Which interventions would be most appropriate to implement? Select all that apply. 1) Providing a calm, quiet environment 2) Keeping the patient awake as much as possible 3) Supervising nutritional intake 4) Using familiar cues about the environment 5) Administering psychoactive drugs

1) Providing a calm, quiet environment 3) Supervising nutritional intake 4) Using familiar cues about the environment

What are the 3 elements of delegation? 1) Responsibility 2) Authority 3) Accountability 4) Legality

1) Responsibility 2) Authority 3) Accountability

The easiest way to make sure you're delegating properly is to follow the 5 R's. 1) Right Task 2) Right Direction/Communication 3) Right Circumstance 4) Right position 5) Right Person

1) Right Task 2) Right Direction/Communication 3) Right Circumstance 5) Right Person

Which restraining force occurs when a subordinate tests the water to determine what the consequences are of not completing a delegated task? 1) Subordinate inherent resistance to authority 2) Overdelegation of specificity of the task 3) Failure of delegator to see subordinate perspective 4) Subordinate incapable of completing the task

1) Subordinate inherent resistance to authority

Three Basic Steps to Time Management

1. Allow time for planning and establish priorities - the ability to be organized develops from good planning 2. Complete the highest-priority task whenever possible, and finish one task before beginning another 3. Reprioritize based on the remaining tasks and on new information that may have been received - divide all requests for our time into three categories: "don't do," "do later," and "do now."

Management Functions

1. Appropriately prioritizes day-to-day planning to meet short-term and long-term unit goals 2. Builds time for planning into the work schedule 3. Analyzes how time is managed on the unit level by using job analysis and time-and-motion studies 4. Eliminates environmental barriers to effective time management for workers 5. Handles paperwork promptly and efficiently and maintains a neat work area 6. Breaks down large tasks into smaller ones that can more easily be accomplished by unit members 7. Utilizes appropriate technology to facilitate timely communication and documentation 8. Discriminates between inadequate staffing and inefficient use of time when time resources are inadequate to complete assigned tasks

Assume that you are the registered nurse (RN) leader of a team with one licensed vocational nurse and one nursing assistant on the 7 AM to 3 PM shift at an acute care hospital. The three of you are responsible for providing total care to 10 patients. Prioritize the following list of 10 things that you need to accomplish this morning. Use a "1" for the first thing you will do and a "10" for the last. Be prepared to provide rationale for your priorities. ___ Check medication cards/sheets against the patient medication record. ___ Listen to night shift report 11:00 PM to 7:00 AM. ___ Take brief walking rounds to assess the night shift report and to introduce yourself to patients. ___ Hang four 9:00 AM IV medications. ___ Set up the schedule for breaks and lunch among your team members. ___ Give 8:45 AM preop on patient going to surgery at 9:00 AM. ___ Pass 8:30 AM breakfast trays. ___ Meet with team members to plan the schedule for the day and to clarify roles. ___ Read charts of patients who are new to you._ __ Check 6:00 AM blood glucose laboratory results for 7:30 AM insulin administration.

1. Listen to night shift report from 0700-0720 2. Perform walking rounds to assess the night shift report and to introduce yourself to patients. 3. Check 0600 blood glucose results for 0730 insulin administration. 4. Check MAR against the orders. 5. Pass the 0830 breakfast trays. 6. Give the 0845 pre-ops on the patient going to surgery at 0900. 7. Hang four (4) 0900 IV medications. 8. Read the charts on new admissions that you are responsible for on the unit. 9. Consult with the interdisciplinary healthcare team to develop and/or revise patient plans of care. 10. Set up the schedule for breaks and lunch among your team members

What statement concerning the delegating of tasks by the nurse to unlicensed assistive personnel (NAP) is true? 1.) No federal or community standards have been established for training the broad classification of NAP 2) The nurse is protected from liability when allowing the NAP to perform only those tasks the employee includes in the job description 3) One can safely assume that the NAP has at least a high school diploma as a minimum hiring criterion 4) All unlicensed assistive personnel have achieved at least minimum standardized training pursuant to the Omnibus Budget Reconciliation Act of 1987

1.) No federal or community standards have been established for training the broad classification of NAP

What is a common cause of a manager to underdelegation? 1) A high degree of trust in subordinates 2) A need for perfectionism 3) A democratic leadership style 4) Sufficient time to accomplish unit goals alone

2) A need for perfectionism

Which statement is true regarding the general delegation liability of the registered nurse (RN)? 1) It is avoided entirely by delegating tasks to only other licensed personnel 2) It is reduced when the RN appropriately assesses what and to whom delegation is appropriate and supervises the completion of the tasks 3) It is great because the RN is automatically held liable for the tasks delegated to all recognized subordinates 4) It is minimal because subordinates alone are held accountable for practicing within the accepted scope of practice for their job classification

2) It is reduced when the RN appropriately assesses what and to whom delegation is appropriate and supervises the completion of the tasks

A nurse is observing a newly licensed nurse and an assistive personnel (AP) pull a client up in bed using a drawsheet. Which of the following actions by the newly licensed nurse indicates an understanding of this technique? 1) The nurse's feet are facing inward, toward the center of the bed. 2) The nurse uses his body weight to counter the client's weight. 3) The nurse uses the muscles in his back to lift the client off the bed using the drawsheet. 4) The nurse stands with his feet together.

2) The nurse uses his body weight to counter the client's weight.

Which assessment must the RN do initially when assigning tasks to non-licensed personnel (NAP)? 1) Evaluating how patients rate the NAPs performance 2) Assessing how team members like working with the NAP 3) Evaluating the NAPs skills and knowledge level 4) Assessing which tasks the NAP is interested in assuming

3) Evaluating the NAPs skills and knowledge level

A nurse is caring for a client who has diabetes mellitus and had a morning blood glucose level of 285 mg/dL. An assistive personnel (AP) reports that a client's finger-stick blood glucose reading 30 min before lunch is 58 mg/dL. Which of the following actions should the nurse take? 1) Administer insulin as prescribed. 2) Inform the AP to give the client 120 mL of orange juice. 3) Recheck the client's blood glucose. 4) Complete a facility incident report.

3) Recheck the client's blood glucose.

What is an inappropriate reason for delegation? 1) To free the manager to address more complex, higher-level unit needs 2) Because someone else is better qualified to do the task that needs to be done 3) When the task is not a challenge for the manager 4) To empower subordinates by stretching them in their work assignment

3) When the task is not a challenge for the manager

A patient in the emergency department states, "I have always taken a morning walk, but lately my leg cramps and hurts after just a few minutes of walking. The pain goes away after I stop walking, though." Based on this statement, which priority assessment should the nurse complete? 1) Assess for unilateral swelling and tenderness of either leg 2) Ask about any changes in skin color that occur in response to cold 3) Check for the presence of tortuous veins bilaterally on the legs 4) Attempt to palpate the dorsalis pedis and posterior tibial pulses

4) Attempt to palpate the dorsalis pedis and posterior tibial pulses

A patient is brought into the emergency department with chemical burns to both eyes. What is the priority action of the nurse for this patient's care? 1) Administering local anesthetics and anti-bacterial drops for 24-36 hours 2) Applying hot compresses at 15 minute intervals 3) Cleansing the conjunctiva with a small cotton-tipped applicator 4) Flushing the lids, conjunctiva, and cornea with tap water or normal saline

4) Flushing the lids, conjunctiva, and cornea with tap water or normal saline

The healthcare provider is caring for a patient diagnosed with a mild cognitive impairment. Which of these would be the most effective intervention for this patient? 1) Relaxation therapy 2) Behavior modification 3) Application of soft restraints 4) Frequent reorientation

4) Frequent reorientation

Which organization is actively engaged in clarifying the delegation parameters for RNs? 1) The federal government 2) American Hospital Association (AMA) 3) National League for Nursing (NLN) 4) State Boards of Nursing Licensure

4) State Boards of Nursing Licensure

DELEGATING AND SUPERVISING

A licensed nurse is responsible for providing clear directions when a task is initially delegated and for periodic reassessment and evaluation of the outcome of the task. ● RNs delegate to other RNs, PNs, and APs. ◯ RNs must be knowledgeable about the applicable state nurse practice act and regulations regarding the use of PNs and APs. ◯ RNs delegate tasks so that they can complete higher level tasks that only RNs can perform. This allows more efficient use of all members of the health care team. ● PNs can delegate to other PNs and APs.

Examples of tasks nurses can delegate to AP

Activities of daily living (ADLs) Bathing Grooming Dressing Toileting Ambulating Feeding (without swallowing precautions) Positioning Routine tasks Bed making Specimen collectionIntake and output Vital signs (for stable clients)

Assigning vs Delegating

Assigning is the process of transferring the authority, accountability, and responsibility of client care to another member of the health care team; distributing work to a qualified person or persons for implementation of a specific activity or set of activities within their job description Delegating is the process of transferring the authority and responsibility to another team member to complete a task, while retaining the accountability.

Right direction/communication:

Communicate either in writing or orally. o Data that needs to be collected o Method and timeline for reporting, including when to report concerns/findings o Specific task(s) to be performed; client‑specific instructions o Expected results, timelines, and expectations for follow-up communication

DELEGATEE FACTORS

Considerations for selection of an appropriate delegatee include the following. ● Education, training, and experience ● Knowledge and skill to perform the task ● Level of critical thinking required to complete the task ● Ability to communicate with others as it pertains to the task ● Demonstrated competence ● The delegatee's culture ● Agency policies and procedures and licensing legislation (state nurse practice acts)

How can subordinates can be discouraged from taking up a manager's time

Do not make yourself overly accessible. Interrupt Avoid promoting socialization Be brief. Schedule long-winded pests.

decision tree created by the National Council of State Boards of Nursing (NCSBN) that is used to determine appropriate tasks for UAPs

Is the task within the scope of practice for a licensed nurse? yes RN assessment of patient's nursing care needs is complete? Yes Is the RN/LPN competent to make delegation decisions? Yes Is the task of testing the patient's blood glucose consistent with the criteria for delegation to UAP? Yes The nurse will supervise the delegation of the task? Yes Proceed with delegation

Name the key differences between what roles and responsibilities exist for RNs and contrast that with those of LPNs

Licensed Practical Nurse Job duties · Provide basic medical and nursing care such as checking blood pressure and inserting catheters · Ensure the comfort of patients by helping them bathe or dress · Discuss health care with patients · Report status of patients to registered nurses and doctors. Registered Nurse Job duties · Administer medication and treatment to patients · Coordinate plans for patient care · Perform diagnostic test and analyze results · Instruct patients on how to manage illnesses after treatment · Oversee other workers such as LPNs, nursing aides, and home care aides

Examples of tasks nurses can delegate to PN

Monitoring findings (as input to the RN's ongoing assessment) Reinforcing client teaching from a standard care plan Performing tracheostomy care Suctioning Checking NG tube patency Administering enteral feedings Inserting a urinary catheter Administering medication (excluding IV medication in some states)

LICENSED PERSONNEL:

Nurses who have completed a course of study, successfully passed either the NCLEX‐PN® or NCLEX‐RN® exam, and have a nursing license issued by a board of nursing.

TASK FACTORS

Prior to delegating client care, consider the following. Predictability of outcome ● Will the completion of the task have a predictable outcome? ● Is it a routine treatment? ● Is it a new treatment? Potential for harm ● Is there a chance that something negative can happen to the client (risk for bleeding, risk for aspiration)? ● Is the client unstable? Complexity of care ● Are complex tasks required as a part of the client's care? ● Is the delegatee legally able to perform the task and do they have the skills necessary? Need for problem solving and innovation ● Is nursing judgment required while performing the task? ● Does it require nursing assessment skills? Level of interaction with the client ● Is there a need to provide psychosocial support or education during the performance of the task?

most critical skill in good time management

Priority setting - all actions we take have some type of relative importance

Name the 5 rights of delegation

Right task Right circumstances Right person Right direction/communication Right supervision

ASSISTIVE PERSONNEL:

Specifically trained to function in an assistive role to licensed nurses in client care activities. These individuals can be nursing personnel (certified nursing assistants [CNAs] or certified medical assistants [CMAs]), or they can be non‐nursing personnel to whom nursing activities can be delegated (dialysis technicians, monitor technicians, and phlebotomists). Some health care entities can differentiate between nurse and non‐nurse assistive personnel by using the acronym NAP for nursing assistive personnel.

Common Delegation Errors

Underdelegating Overdelegating Improper delegating

Delegation can be defined simply as:

getting work done through others or as directing the performance of one or more people to accomplish organizational goals. - NOT the same as assignment

Time management can be defined as

making optimal use of available time. - There is a close relationship between time management and stress.

Right person:

o Assess and verify the competency of the health care team member. -The task must be within the team member's scope of practice. - The team member must have the necessary competence/training. o Continually review the performance of the team member and determine care competency. o Assess team member performance based on standards and, when necessary, take steps to remediate a failure to meet standards.

Right circumstances:

o Assess the health status and complexity of care required by the client. o Match the complexity of care demands to the skill level of the health care team member. o Consider the workload of the team member.

Right supervision:

o Provide supervision, either directly or indirectly (assigning supervision to another licensed nurse). o Provide clear directions and expectations of the task to be performed (time frames, what to report). o Monitor performance. o Provide feedback. o Intervene if necessary (unsafe clinical practice). o Evaluate the client and determine if client outcomes were met. o Evaluate client care tasks and identify needs for quality improvement activities and/or additional resources.

Right task:

o Tasks that are appropriate to delegate for each specific client. o A right task is repetitive, requires little supervision, and is relatively noninvasive for the client. o Delegate tasks to appropriate levels of team members (PN, AP) based on standards of practice, legal and facility guidelines, and available resources.

The keys to optimizing time management must include

prioritizing duties managing and controlling crises reducing stress balancing work and personal time

Name 5 tasks that are generally considered appropriate for delegation to UAPs.

· ADLs (bathing, grooming, dressing, toileting, ambulating) · Feeding (without swallow precautions) · Positioning · I&Os, VS (for stable patients) · Specimen collection - Noninvasive and nonsterile treatments - Collecting, reporting, and documenting data including, but not limited to, vital signs, height, weight, intake and output, and capillary blood and urine tests - Ambulation, positioning, turning - Transportation of a client within a facility - Personal hygiene, elimination, including vaginal irrigations and cleansing enemas - Feeding, cutting up of food, placing of meal trays - Socialization activities - Activities of daily living

Major symptoms related to poor time management

· Constant rushing · Caught in crisis mode · Fatigue or listlessness, "overwhelmed" feeling · constantly missing deadlines · Insufficient time for rest or personal relationships · Sense of being overwhelmed by demands and details · Having to do what you don't want to, most of the time

What does the NPA (Nurse practice act) contain as the essential elements regarding delegation?

· Definition of delegation: the process of transferring the authority and responsibility to another team member to complete a task, while retaining the accountability · Items that cannot be delegated · Items that cannot be routinely delegated · Guidelines for RNs about tasks that can be delegated · Description of professional nursing practice · Description of LVN/LPN nursing practice and unlicensed nursing roles · Degree of supervision required to complete a task · The guidelines for lowering delegation risks · Warnings about inappropriate delegation · If there is a restricted use of the word nurse to licensed staff

Time wasters

· Documenting at the end of the shift all client care provided and assessments done · Making repeated trips to the supply room for equipment · Providing care as opportunity arises regardless of other responsibilities · Missing equipment when preparing to perform a procedure · Failing to plan or managing by crisis · Being reluctant to delegate or under‚ delegating · Not asking for help when needed or trying to · provide all client care independently · Procrastinating: delaying time‚ consuming, less desirable tasks until late in the shift · Agreeing to help other team members with lower priority tasks when time is already compromised · Setting unrealistic standards for completion of care and level of performance within constraints of assignment and resources · Starting several tasks at once and not completing tasks before starting others · Not addressing low level of skill competency, increasing time on task · Providing care without a written plan Socializing with staff during client care time

Time savers

· Documenting nursing interventions as soon as possible after completion to facilitate accurate and thorough documentation · Grouping activities that are to be performed on the same client or are in close physical proximity to prevent unnecessary walking · Estimating how long each activity will take and planning accordingly · Mentally envisioning the procedure to be performed and gathering all equipment prior to entering the client's room · Taking time to plan care and taking priorities into consideration · Delegating activities to other staff when client care workload is beyond what can be handled by one nurse · Enlisting the aid of other staff when a team approach is more efficient than an individual approach · Completing more difficult or strenuous tasks when energy level is high · Avoiding interruptions and graciously but assertively saying "no" to unreasonable or poorly‐timed requests for help · Setting a realistic standard for completion of care and level of performance within the constraints of assignment and resources · Completing one task before beginning another task · Breaking large tasks into smaller tasks to make them more manageable · Using an organizational sheet to plan care Using breaks to socialize with staff

What are 5 relevant interventions that can be taken to mitigate internal/external time-wasting activities?

· Gather all supplies needed before starting an activity. · Group activities that are in the same location. · Use time estimates. · Document nursing interventions as soon as possible after they are completed. · Always strive to end the workday on time.

Priority setting in clinical settings where decisions need to be made for patient care

· Life before limb: client in shock over client with localized limb injury · Acute before chronic · Actual problems before potential future problems · Respond to trends vs transient findings · Recognize emergencies and complications vs expected findings · Listen carefully to clients and don't assume · Apply clinical knowledge to procedural standards and determine the priority action

Name three ways nurses establish priorities in nursing practice (as in ATI)

· Maslow's Hierarchy · ABC-DE (airway, breathing, circulation, disability, exposure) · Acute vs chronic, urgent vs nonurgent, stable vs unstable

specific strategies for successful delegation

· Plan ahead. · Identify necessary skill and education levels to complete the delegated task. · Select capable personnel. · Communicate goals clearly. · Empower the delegate. · Set deadlines and monitor progress. · Monitor the role and provide guidance. · Evaluate performance. · Reward accomplishment.

example of each of the 5 rights of delegation.

· Right task: Delegate an AP to assist a client who has pneumonia to use a bedpan. o WRONG TASK: Delegate an AP to administer a nebulizer treatment to a client who has pneumonia. · Right circumstances: Delegate an AP to measure the vital signs of a client who is postoperative and stable. o WRONG CIRCUMSTANCE: Delegate an AP to measure the vital signs of a client who is postoperative and received naloxone to reverse respiratory depression. · Right person: Delegate a PN to administer enteral feedings to a client who has a head injury. o WRONG PERSON: Delegate an AP to administer enteral feedings to a client who has a head injury. · Right direction: Delegate an AP to assist the client in room 312 with a shower before 0900 and to notify the nurse when complete. o WRONG DIRECTION AND COMMUNICATION: Delegate an AP to assist the client in room 312 with morning hygiene. · Right supervision: Delegate the ambulation of a client to an AP. Observe the AP to ensure safe ambulation of the client and provide positive feedback to the AP after completion of the task. o WRONG SUPERVISION: Delegate the ambulation of a client to an AP without supervision to determine the need for intervention and failing to provide feedback to the AP.

Describe the criteria for delegation to unlicensed assisted personnel (UAP).

· Use nursing judgment and knowledge related to the scope of practice and the UAP's skill level · Consider predictability of outcomes, potential for harm, complexity of care, need for problem solving and innovation, and level of interaction with client · Be aware of state regulations regarding use of UAPs

TIME MANAGEMENT AND TEAMWORK

● Be cognizant of assistance needed by other health care team members. ● Offer to help when unexpected crises occur. ● Assist other team members with provision of care when experiencing a period of down time.

TIME MANAGEMENT - Use time-saving strategies and avoid time wasters.

● Good time management: ◯ Facilitates greater productivity. ◯ Decreases work-related stress. ◯ Helps ensure the provision of quality client care. ◯ Enhances satisfaction with care provided. ● Poor time management: ◯ Impairs productivity. ◯ Leads to feelings of being overwhelmed and stressed. ◯ Increases omission of important tasks. ◯ Creates dissatisfaction with care provided.

DELEGATION FACTORS

● Nurses can only delegate tasks appropriate for the skill and education level of the health care team member who is receiving the assignment. ● RNs cannot delegate the nursing process, client education, or tasks that require clinical judgment to PNs or APs.

TIME MANAGEMENT AND SELF‐CARE

● Take time for yourself. ● Schedule time for breaks and meals. ● Take physical and mental breaks from work and the unit.

Time Management as a cyclic process.

● Time initially spent developing a plan will save time later and help to avoid management by crisis. ● Set goals and plan care based on established priorities and thoughtful utilization of resources. ● Complete one client care task before beginning the next, starting with the highest priority task. ● Reprioritize remaining tasks based on continual reassessment of client care needs. ● At the end of the day, perform a time analysis and determine if time was used wisely.

TIME MANAGEMENT - Organize care according to client care needsand priorities.

● What must be done immediately (administration of analgesic or antiemetic, assessment of unstable client)? ● What must be done by a specific time to ensure client safety, quality care, and compliance with facility policies and procedures (routine medication administration, vital signs, blood glucose monitoring)? ● What must be done by the end of the shift (ambulation of the client, discharge and/or discharge teaching, dressing change)? ● What can the nurse delegate? ◯ What tasks can only the RN perform? ◯ What client care responsibilities can the nurse delegate to other health care team members (practical nurses [PNs] and assistive personnel [APs])?