NRSAD 114 Units 1-3 STUDY EXAM Material

Clinical Nurse Leader

A nurse with an advanced degree who is a clinical expert in the care of a distinct group of patients, and who may provide direct patient care A fundamental function of the role of a clinical nurse leader (CNL) is to evaluate care for evidence- based approaches.

Organizational chart

A visual picture of the organization that identifies lines of communication and authority.

Which component of delegation is retained while the delegator is delegating the clients care task to the nursing aide. ?

Accountability. Accountability is retained by the delegator while delegating a clients care tasks to the nursing aide. Every individual on the health care team has authority for the delegated tasks. The nursing aide is only responsible for the delegated task, so the delegator retains the accountability. Supervision is a right of delegation.

functional model of nursing

Providing patient care by which each licensed and unlicensed staff members performs *specific tasks* for a large group of patients. In a functional model of nursing care delivery, the nurse manager is responsible for achieving client outcomes.

quantum theory

Quantum theory states that leaders must embrace uncertainty and understand behaviors before changing them. Quantum leaders represent change catalysts and innovators.

Which health care team member is responsible for analyzing the knowledge and work of newly hired unlicensed assistive personnel before delegating a task

RN The RN must analyze any individuals knowledge before delegating a task. The charge nurse mainly functions as a liaison between team leaders and other health care providers. The associate nurse follows the care plan in the ansence of a RN The nursing manager is responsible for more than 1 unit and has other managerial responsibilities.

which health care team member supervises unlicensed nursing personnel (UNPs) in providing care to the client?

RN The RN supervises UNPs and licensed practical nurses (LPNs) in providing care to the client. The charge nurse and the nurse manager may supervise RNs. The charge nurse delegates tasks to the LPN and UNP when the RN does not. The nursing manager is in charge of the RN, LPN, and UNP. The PCA does not supervise UNPs and is delegated tasks by an RN.

In providing effective nursing care to clients from different cultural backgrounds, which strategy would the nurse follow?

Provide care that fits the clients cultural beliefs.

McGregor's Theory X

describes the workforce motivation by assuming that people basically do not life their work and must be coerced by their manager to perform.

Followership

followership means that each member of a team contributes optimally but acquiesces to a leader or manager to ensure the best clinical decision making.

Competent Manager

Competent is defined as having the skill/knowledge to do something well.

Cultural Competence

Cultural competence is the process in which the health care provider strives to achieve the ability to work effectively within the cultural context of a client, individual, family, or community. Cultural diversity describes a vast range of cultural differences among individuals or groups. Cultural sensitivity describes the affective behaviors in individuals such as the capacity to feel, convey, and react to ideas, habits and customs or traditions unique to a group of people. Cultural imposition is defined as the tendency of an individual or group to impose their values, beliefs, and practices on another culture for various reasons.

What is delegation ? Transfer of authority and responsibility for implementation of an activity or set of activities to a person trained and competent to perform the activity.

Delegation is a legal and management concept that involves 1-assessment, 2-planning, 3-intervention, and 4-evaluation. Delegation, as defined by the American Nurses Association (ANA, 2015b), -the transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome. Delegation is the transfer of authority to perform some type of task or work Delegation is the transfer or responsibility for the performance of an activity.

When delegating, the RN delegator is accountable for

Delegation is a two-way process in which the RN requests that a qualified staff member perform a specific task. When delegating, the RN delegator is accountable for • Determining patient needs and when to delegate. • Being available to the delegatee. • Assessment and follow-up evaluation. • Any intervention or corrective actions that may be required to ensure safe and effective care.

legitimate power

A legitimate power is based on an official position

veracity

Veracity concerns telling the truth and demand involved, driving all the facts of a situation truthfully, and then assisting employees to make appropriate decisions.

When delegating tasks, the nurse should understand the delegatee's

1) competencies, 2) communicate succinctly, 3) offer clear guidelines in advance, 4) monitor progress, and 5) remain accountable for the final outcomes of care.

Tips for Successful Time Management

"1. Clarify objectives, put them in writing, and establish a priority list to work from. 2. Focus on objectives, not on activities. 3. Set at least one major objective for each day and achieve it. 4. Record a time log periodically to analyze how time is used and to document bad habits. 5. Analyze everything in terms of objectives. 6. Make a to-do list every day that includes daily objectives and priorities and time estimates to accomplish them. 7. Schedule time every day to ensure that the most important things are accomplished first. 8. Make sure the first hour of every workday is productive. 9. Set time limits for every task undertaken. 10. Take the time to do the task right the first time so that time will not be wasted doing it over. 11. Institute a quiet hour of uninterrupted time each day to work on the most important tasks. 12. Develop the habit of finishing whatever task is started. 13. Conquer procrastination and learn to do tasks now. 14. Make better time management a daily habit. 15. Never spend time on less important things when it could be spent on more important things. 16. Take time for yourself—time to relax, time to live, time to just be. 17. Develop a personal philosophy of time that is consistent with your values. 18. Know how you currently spend your time. 19. Identify your "prime productive time." 20. Do tomorrow's planning tonight. 21. Ask yourself often, "Why am I doing what I am doing right now?" 22. Handle each piece of paper only once. 23. Delegate whenever possible and delegate wisely. 24. Identify your high payoff items (80-20 principle).

What priority setting principles can increase safety and efficiency?

- High, medium, and low priority diagnoses - Maslow's Hierarchy of Needs - ABCs - Threat to life - Patient preference - Erikson's Developmental Stages

What is are the differences between what and RN can do and what an LPN can do?

- LPN may work with the RN to update a NCP, RN must initiate - RN completes initial assessment and validates assessment changes noted by LPN - RN initiates client teaching, LPN may reinforce teaching or follow a standardized teaching plan - Legal limits regarding IV administration for LPNs can vary from state to state and by institution

Describe how priority setting and time management are utilized in patient care. PRIORITIZING:

- Most critical care is met first! - High, medium, and low priority diagnoses - Maslow's Hierarchy of Needs =ABCs =Threat to life =Patient preference =Erikson's Developmental Stages Airway ----> Breathing-----> Circulation----Disability ( neurologic assessment, deformities, pain)------> Exposure and environmental control. PRIORITIZING: • Urgency of a situation • Demands of others • Closeness of deadlines • Existing time frame • Your level of familiarity with the task • Ease of the task • Amount of enjoyment involved "• Consequences involved • Size of the task • Congruence with personal goals • Intrinsic importance: Very important and must be done; important and should be done; not so important and may not be necessary, but may be useful; or unimportant and can be eliminated entirely. • Urgency: Very urgent and must be done now; urgent and should be done soon; not urgent and can wait; time is not a factor. • Delegation: Must be done by me because I am the only one who can do it; can be delegated to A or B; can be dumped because task does not need to be done or delegated. • Visitations and conferences: People I must see each day; people to see frequently but not daily; people to see regularly but not frequently; people to see frequently

Describe the delegation process. Apply the 5 rights of delegation to various clinical situations.

1. Task 2. Circumstance 3. Person 4. Direction & communication 5. Supervision D- Direction & Communication U- (person) C- Circumstance T- Task S - supervision Task - delegated tasks must conform to established guidelines Circumstances - delegated tasks do not require independent nursing judgment Person - one who is qualified and competent Direction & Communication - clear explanation about the task and outcomes and when the delegatee should report back to the RN Right Supervision & Evaluation - feedback to assess and improve the process; evaluate patient outcomes 1. Identify exactly what is to be delegated and why. 2. Select the best person for the task; this may be the person most qualified or it may be the person whose development the delegator chooses to contribute to. 3. Communicate the assignment in detail, perhaps even including written instructions. 4. Involve the delegatee in establishing the objectives and deadlines for the task. 5. Have the delegatee repeat the details of the task. 6. Give the delegatee the authority for accomplishing the task. 7. Provide adequate resources and support as needed. 8. Follow-up regularly for progress reports. 9. Establish controls, and monitor the results. 10. Evaluate the process and progress of the delegatee. 11. Let the delegatee do the job.

Leadership Skills and Practices Leadership: can be defines as the use of individual traits and abilities in relationship to others and the ability ro interpret the context where a situation is emerging. ( LEADERSHIP: Leadership is an earned honor and an action oriented responsibility. Leadership is an earned honor, right, and privilege and an action oriented responsibility that requires a time commitment.) Example of leadership ability: " Supervising the tasks assigned to unlicensed nursing personnel". The RN as a leader would supervise the tasks assigned to UNP to ensure the clients safety.

3 major types of skills and practices are required for effective leadership ...THC TECHNICAL HUMAN CONCEPTUAL Technical: for nurses, this type includes clinical expertise and nursing knowledge • Keep your own clinical skills and knowledge current. • Act as a willing expert resource and teacher for clinical problems. • Use sound clinical judgment and critical thinking. Human Skills: Ability and judgement to work with and lead people in compassionate, caring way • Maintain honesty and integrity in work and relationships—trust is essential for effective leadership. • Create a teaching and learning environment—earn a reputation for exceptional teaching and mentoring. • Develop and role model a commitment to excellence. • Create an open, nonthreatening environment—share information, keep staff informed, and encourage them to discuss issues. • Become a proactive problem solver—knowing how to solve problems is more important than knowing all the answers. • Maintain a confident, positive outlook—identify areas in which you are weak, and seek help to learn and grow. Conceptual skills: The ability to understand the complexities of the overall organization and to recognize how and where ones own area of managements fits into the overall organization • Make a commitment to support the mission, vision, and goals of the organization. • Accept the realities of complex health care systems, which are under pressure to improve patient safety and quality while reducing costs. • Understand the needs of external customers (patients, families, physicians, referring facilities) and internal customers (staff, administrators, and other departments).

Democratic Manager

A democratic manager involves staff and provides feedback

When delegating... who remains responsible for overall nursing care?

Although RNs can transfer the responsibility and authority for the performance of an activity, they remain accountable for the overall nursing care.

which entity outline the principles of delegation for registered nurses (RNs)

American Nurses Association ANA The ANA outlines the principles of delegation for RNs. The nurse practice act of each state examines the value of unlicensed personnel in client care delivery and declares that the importance of delegation decisions is the safety and welfare of the public. The multilevel nursing model consists of RNs, licensed practical nurses, and unlicensed nursing professionals. The NCSBN stated that the state boards of nursing should regulate nursing assistive personnel across multiple settings.

which organization provides scope and practice guidelines on the roles and responsibilities for nursing and nursing specialties?

American Nurses association The American Nurses Association develops and publishes scope and standards of practice guidelines for nursing and nursing psecialties. Many professional organizations have state level nursing associations, but they do not publish standards and scope of practice. The national league of nursing is a professional organization related to the education of nurses. The academy of medical surgical nurses publishes scope and standards of practice for general medical surgical nursing, but not nursing and nursing specialties. Quality and safety education for nurses supports development of the knowledge, skills and attitudes needed to improve the quality and safety of the health care system.

satisfying decision-making model

An acceptable solution that minimally meets the decision objective is identified When using a satisfying decision making model, the nurse leader selects an acceptable solution that may minimally meet the decision objective. the tendency to settle for something that is satisfactory, rather than examining numerous options

Identify the various management styles. Describe a clinical situation where each style would be beneficial.

Authoritarian (Autocratic) - Makes all decisions for the group - Gives little feedback or recognitions for work - Ignores subordinates ideas and suggestions - Dictates the work with much control - Makes Fast decisions - Doesn't encourage individual initiative - Believes individuals are externally motivated and are incapable of independent decision making - **BENEFICIAL: during a code, emergency, code, OR, & with employees with little education or training "The autocratic method results in rapid decision-making and is more appropriate in a crisis situation"- evolve Democratic (Participative) [ allows each member to participate in the decision making process] - Encourages group discussion and decision making - Involves staff in planning and developing new ideas and programs - Believes in the best in people - Communicates effectively, and provides regular feedback -Builds responsibility in people - Leader acts as a catalyst or facilitator to keep everybody on track - Actively guides a group toward achieving the group's goals - Productivity and satisfaction are high - Good broadly speaking; not for high or low stakes scenarios...just normal operations - **BENEFICIAL: med surge, when a lot of direction is needed, Nursing home. Works well with competent, highly motivated people Laissez-faire [ your on ur own, unit runs itself, hands off, team members make their own decisions] - Recognizes the groups need for autonomy and self regulation - Does not provide guidance or direction - Unable or Unwilling to make decisions - Does not provide feedback -Initiates little change - Communicates by memos or email - "Hands off" approach - Presupposes the group is internally motivated - Group may act in opposition of one another - **BENEFICIAL: clinical setting, ( not used with new grad students)- Best with groups who have professional/personal maturity and positive focus "Laissez- Faire is a "hands off approach, which is taken by manager who chooses to do nothing when intervention is indicated." - evolve

Which component of delegation is the ability to perform duties in a specific role?

Authority: Authority is the ability to perform duties in a specific role Responsibility refers to reliability, dependability, and obligation to accomplish work. Accountability determines whether a persons actions are appro and provides a detailed explanation of what occurred. Legal authority is the ability to transfer selected nursing activities in a give situation to a competent individual.

Which actions can an effective mentor expect from an aspiring leader?

Being loyal Assisting with projects Maintaining confidentiality The mentor has a right to expect loyalty, respect, assistance with projects, and confidentiality from aspiring leader, An effective mentor does not expect a fee or rewards and gives guidance to balance the professional and personal work of an aspiring leader.

Accountability

Being responsible and answerable for actions or inactions for the overall nursing care of the patients.

Identify key skills, cares, etc. that you will or will not delegate to a UAP (CNA, PCT, Nurse Intern, Nurse Extern), LPN, or another RN.

Cannot delegate: - Assessment - Evaluation - Nursing judgment ANA lists activities that the RN cannot delegate:! Initial and any subsequent assessment that requires nursing knowledge, judgment, and skill ! Determination of nursing diagnoses ! Establishment of nursing care goals ! Development of nursing plan of care ! Evaluation of patient's progress ! Health counseling or teaching ! Activities that require specialized nursing knowledge, skill, or judgment - Initial and any subsequent assessment that requires nursing knowledge, judgment, and skill - Determination of nursing diagnoses - Establishment of nursing care goals - Development of nursing plan of care - Evaluation of patient's progress - Health counseling or teaching - Activities that require specialized nursing knowledge, skill, or judgment

Chaos Theory

Chaos theory. Chaos theory is a more recently developed organizational theory that attempts to account for the complexity and randomness in organizations. Despite the implications of the word chaos, the theory actually suggests that a degree of order can be attained by viewing complicated behaviors and situations as predictable.

Case model of nursing care delivery

Clients receive consistent care from one nurse, and client care tasks are not delegated.

which action of the nurse leader is appropriate when preparing to share information with followers?

Determining which information is to be shared. The nurse leader would determine the information that has to be shared with followers but should not give all information at once. The nurse leader would give only limited information; giving too much at once can create disinterest in the listeners. The nurse leader would use face to face communication rather than text messages.

Which qualities would an effective leader exhibit

Elicit a vision from people Bring out the best in people Inspire people to bring the vision into reality Leadership is the ability to elicit a vision from people and to inspire and empower those people to do what is takes to bring the vision into reality. A leadership quality is to bring out the best in people. Leaders are not born with the right, stuff; rather they develop these qualities gradually over time when they perform with the right kind of attitude and determination. Leaders must possess the ability to inspire the commitment of followers and allow them to achieve goals autonomously rather than simply engendering discipline and obedience.

Which action would the nurse leader take to promote a health care climate where curiosity reflection, and change are embraced?

Empowering staff to be lifelong learners and risk takers. The nurse leader who empowers staff to be lifelong learners and risk takers is promoting a health care environment where questioning the status quo, reflecting on process, and advocating for change when appropriate are welcome and encouraged. The nurse leader would serve as coach, maintain a good relationship with the team , and collaborate with the team to problem- solve, but these actions are not specific to creating a culture of curiosity, reflection, and change.

Which intervention would be classified as an independent nursing care function ?

Example: Positioning a client to prevent pressure ulcer formation. Independent functions are those that the nurse initiates without supervision or direction from others.

Which qualities would the professional nurse require to lead and manage a team?

Exercising self awareness Motivating self and others Managing emotions in self and others Managing emotions, such as fear, anxiety, and anger, and responding to those feelings in a healthy manner, as well as avoiding passive- aggressive behavior, are traits that the nurse would require to manage a team. The nurse would have the desire to deepen self awareness and encourage others to do the same to follow in a team. Motivating or inspiring self and others toward a goal is another quality that the nurse would have to lead a team. The nurse would be empathetic and able to reveal others perspectives in a situation. Fostering and handling relationships is another one of the abilities the nurse would have when leading and managing a team.

The nurse who is highly skilled, respected by co-workers and keeps up with new information about practice guidelines, the nurse shoes this type of power

Expert power

Time and Energy Distractions Box 25.1

External Distractions: Interruptions Socializing or visitors Meetings Excessive paperwork Understaffing Lack of information Ineffective communication Lack of feedback Inadequate policies and procedures Poor filing systems Looking for misplaced files, and so on Personnel or coworkers with problems Lack of teamwork Duplicating efforts Confusing lines of authority, responsibility, and communication Bureaucratic red tape Junk mail Waiting, meeting delays Internal Distractions: "Procrastination Inadequate planning Ineffective delegation Failure to set goals and priorities A cluttered desk or mind Personal disorganization Inability to say no Lack of self-discipline Responding to crises Haste Indecisiveness An "open-door" policy Shifting priorities without sound rationale Leaving tasks unfinished Not setting time limits Daydreaming Attempting too much at once "Over-involvement in routine detail Making numerous errors Surfing the Internet Not listening

According to Lewins stage of change, the stage of refreezing is described as

Finding ways to encourage staff and requiring compliance

A transactional leader "A transactional leader is more concerned with day by day operations"

Focuses on day to day management tasks Wait until problems occur Rewards staff for desired goals

Glasgow Coma Scale GCS

Glasgow coma scale while performing a primary survey of a traumatized client to assess the level of consciousness.

Using Unlicensed Assistive personnel UAP

Is a way to increase the cost effectiveness of providing patient care Any unlicensed personnel, regardless of title, who may participate in patient care activities.

The nurse manager on the unit typically does not provide feedback or guidance to staff but works well with professional individuals. This is an example of what type of management style?

Laissez Faire: (An authoritative nurse manager will dictate and provide very little feedback to staff.)

Define the roles of a leader and a manager. How are they different? How are they similar? "Budgeting is the responsibility of the nurse manager. The role of the nurse leaders is to motivate the nursing subordinates. Resolving conflicts is the responsibility of both the nurse leader and the nurse manager. Penalizing for poor performance is a behavior of transactional leadership." - evolve

Leader: {"Ability to guide or influence others"} - Attempt to influence the beliefs, opinions, and behaviors of a person or group - Guide people and groups to accomplish common goals -May not have formal authority but are still able to influence others ( can be formal or informal) Manager: {" Coordination of resources, time, people, supplies to achieve desired outcomes in a defined area "} - Have an appointed management position and a formal line of authority & accountability - Managers focus on coordination of day to day resources. Different: - Leader: ability to guide & influence others (more based on patient care) - Managers: have the responsibility of coordinating , time , people, resources. (more geared towards day to day tasks) Similar: They both have an affect on the group, they both hold power, they can both motivate.

Which Characteristic would be important for the nurse leader to use to be effective?

Problem solving skills: Expertise in problem solving skills is an effective leadership quality that is increased by risk taking behaviors by the nurse leader.

Power and Authority "The right to act or command the actions of others"

Leadership and management require power and authority to motivate people to act in a certain way. Authority is the legitimate right to direct others and is given to a person by the organization through an official position, such as nurse manager. For example, a nurse manager has the authority to direct staff nurses to work a specific schedule. Power is the ability to motivate people to get things done with or without the legitimate right granted by the organization.

trait theory

Leadership trait theory was based on the assumption that leaders were born with certain leadership characteristics. Traits found to be associated with leadership include intelligence, alertness, dependability, energy, drive, enthusiasm, ambition, decisiveness, self-confidence, cooperativeness, and technical mastery Trait Theory is a leadership theory in which leadership traits such as a certain set of physical and emotional characteristics are innate and cannot be learned.

Example of a passive strategy for health promotion

Lobbying for government funds to address potential lead in local water. Passive strategies include public health or government interventions such as clean water legislation. Active strategies are those that actively engage an individual through changes in lifestyle such as nutrition classes, wellness programs, use of child safety seats, and participation in exercise programs.

The nurse leader is setting priorities for achieving success by using the simplest and fastest method of communication. Which rule or responsibility would the nurse fulfill by this action?

Maintaining balance: An effective leader maintains work- life balance in his or her own life, as well as facilitating balance for followers. Making communication as efficient as possible is one way of helping maintain this balance.

Nursing sensitive indicators

Measures that reflect the outcome of nursing action. Nursing sensitive indicators reflect the structure, process, and outcomes of nursing care. Job satisfaction can be used to evaluate the process of nursing care.

Which actions can a mentor take to develop effective leadership qualities in the aspiring leader?

Modeling behavior Giving timely feedback Providing appropriate advice

Which primary task is achieved by a delegator when delegating a task to a delegated for an effective outcome?

Motivating Inspiring the delegated by motivation of the primary task to be achieved by the delegator to reach an effective outcome.

Which health care team member is the designated delegator ?

Nurse Manager The nurse manager is the designated delegator. The RN is answerable to the delegator.

Management

Nurses ability to plan, direct, control, and evaluate others in different situations Management is defined as the ability to plan, direct, control, and evaluate the nursing staff in various situations. management refers to a particular set of activities

optimizing decision making

Optimizing decision making is when the nurse considers both pros and cons of each position Analyzing the pros and cons to make decisions reflects an optimizing approach to decision making.

Managers are responsible for Managers functions include? POSDC

POSDC Planning Organizing Staffing Directing Controlling Planning includes defining goals and objectives, developing policies and procedures determining resource allocation and developing evaluating methods Organizing includes identifying the management structure to accomplish work, determining communication processes, and coordinating people, time and work Staffing includes those activities required to have qualifies people accomplish work, such as recruiting, hiring, training, scheduling and ongoing staff development Directing encourages employees to accomplish goals and objectives and involves communicating, delegating, motivating, and managing conflict. Controlling processes include performance reviews, analyzing financial activities, and monitoring quality care.

Maslow's Hierarchy of Needs in order PS SES

Physiological needs Safety Social Esteem Self actualizing needs ------------------- The belonging need is fulfilled when the client is provided love and compassion. self esteem needs are fulfilled by providing recognition.

Which guide would the associate nurse use to provide client care within the primary nursing delivery model?

Plan of care The associate nurse provides care using the plan of care developed by the primary nurse. The nurses notes and primary health care providers prescriptions will not provide adequate information to provide client care. The charge nurse will not prove direction for client care within primary nursing.

How is motivation used for clients and staff? What are motivating strategies for the RN and/or patients?

Positive reinforcement - Be specific; praise for a specific reason - Close to the time of achievement - Spontaneous and unexpected - Be given for a genuine accomplishment Establish trust and respect Role model expected behaviors Shared goal-setting, decision-making Listening; take an interest in others Manage conflict and facilitate collaboration Herzberg said that being offered opportunities for achievement and advancement are motivators that would lead to job satisfaction.

Identify the different types of power and how power can be utilized in nursing leadership and management.

Reward power: Giving them something positive. Praises, incentives......("comes from the ability to reward others for complying and may include such rewards as salary, desired assignments, and acknowledgment of accomplishments." Coercive power: Using fear, aggression, or something negative. based on fear and punishment "termination"......("the opposite of reward power, is based on fear of punishment for failure to comply. Sources of coercive power include withholding of pay increases, undesired assignments, verbal and written warnings, and termination.") Legitimate power: Having given authority........("based on an official position in the organization. Through legitimate power, the manager has the right to influence staff members, and staff members have an obligation to accept that influence.") Referent power: Having strong personal skills......("comes from the followers' identification with the leader. The admired and respected nurse is able to influence other nurses because of their desire to emulate him or her.") Expert power: Having experience......("based on knowledge, skills, and information. For example, nurses who have expertise in areas such as physical assessment or technical skills or who keep up with current information on important topics will gain respect from others.") Informational power: Having information.....("based on a person's possession of information that is needed by others.") Connection power: Having a relationship.....("based on a person's relationship or affiliation with other people who are perceived as being powerful.")

Role Theory

Role theory is a collection of concepts that predict circumstances under which certain types of behaviors are expected.

To establish a safe, effective delegation practice, the RN must seek guidance and integrate information regarding each of these areas

State Nurse Practice Acts: Patient Needs Job descriptions and competencies Organizational policies and procedures Clinical situation Professional standards of nursing practice Each state's nurse practice act provides the legal authority for nursing practice, including delegation. However, each state's nurse practice act expresses delegation criteria differently, and the criteria often are not clearly spelled out in the act, or they may be presented in various parts of the act. It is absolutely essential that every RN be familiar with his or her state nurse practice act and know the delegation criteria contained within it

Strategic Planning

Strategic planning is long-range planning, extending 2 to 5 years into the future. The strategic plan is a written document that details organizational goals, allocates resources, assigns responsibilities, and determines time frames. It results from an in-depth analysis of (1) the business, community, regulatory, and political environment outside the organization; (2) customer and patient needs; (3) technology changes; and (4) strengths, problems, and weaknesses internal to the organization. The purposes of strategic planning are to: • Identify strategies to respond to changes in customer needs, technology, health care legislation, the business environment, and the community. • Dedicate resources to important services and new programs. • Eliminate duplication, waste, and underused services.

Required practices for effective leadership are

THC Human, conceptual, technical

What if the nurse practice act does not provide clear direction regarding delegation?

THE STATES NURSE PRACTICE ACT IS THE DECIDING FACTOR REGARDING WHAT CAN LEGALLY DE DELEGATED. The state board of nursing may be able to offer guidance. The board of nursing may have developed definitions, rulings, advisory opinions, or interpretations of the law to provide guidance regarding delegation activities. Many state boards of nursing may also have practical tools available, such as delegation decision trees or delegation checklists. — 1) assessment and planning, 2) communication, 3) surveillance and supervision, and 4) evaluation and 5) feedback.

One goal of the nursing care delivery model is to enhance communication between staff and the inter professional team

TRUE

Transformational leader spends time coaching and teaching

TRUE

State Nurse Practice acts defines....

The RN must know that the profession defines the scope and standards of practice, and that the state nurse practice acts define the legal parameters for nursing practice (NCSBN, 2016). It is important that the RN work closely with nonclinical administrators and managers to make sure they understand that the nursing process cannot be delegated to anybody other than the RN.

What should and should not be delegated

The answer varies depending on the (1) nurse practice acts and other applicable state laws, (2) patient needs, (3) job descriptions and competencies of staff members, (4) policies and procedures of the health care organization, (5) the clinical situation, and (6) professional standards of nursing practice. No definitive list of what can and cannot be delegated Varies among states, organizations, and specific situations Assessment, evaluation, and nursing judgment cannot be delegated

charge nurse

The charge nurse is involved in the coordination and assignment of care to individual clients. The charge nurse is the only person familiar with all the needs of any individual client under care. Charge nurse functions as a liaison between team leaders and other health care provides.

When Rn delegates, delegatee is accountable for

The delegatee is accountable for: • His or her own actions. • Accepting delegation within the parameters of his or her competency level. • Communicating the appropriate information to the delegator. • Completing the task.

Understand what delegation is and who maintains accountability for the activities and outcomes of nursing care.

The delegator is responsible for: - The act of delegation - Supervising the performance of the delegated task - Assessment and follow-up evaluation - Any intervention or corrective action that may be required to ensure safe and effective care The delegatee is responsible for: - His or her own actions - Accepting delegation within his/her training and education - Communicating the appropriate information to the delegator - Completing the task

Which strategy of the nurse leader regarding the quality improvement (QI) process requires revising?

The focus is on correcting errors The QI process focuses mainly on preventing errors rather than correcting them. The tasks of the QI process includes staff development. The team of the QI process involves the inter professional team and the outcomes are set with the input of clients and the staff.

wastebasketry

The goal is to handle a paper only once, whether it be an actual paper or email...you should trash it, reply to it, send it, etc....... delete or in trash

The nurse leader is a member of the human resource committee. Which role tasks would this support?

The nurse is staying clear on group outcomes When the nurse participates as a leader in any leadership opportunities such as on human resource committees, it indicates that she or he is staying clear on group outcomes. Participating on human resource committees does not indicate an involvement in malpractice. Active participation on human resource committees does not indicate pursuing a higher degree. Participating on human resource committees indicates that the nurse is thinking beyond her or his personal needs.

Bureaucratic style of supervision

The supervisory style that emphasizes strict compliance with organizational policies, rules, and directives The bureaucratic style is focused on organizational rules and policies.

Analytic tools

The use of analytic tools or agency policy and procedures to make the decision reflects a normative or prescriptive decision making mode.

Expert opinion

The use of expert opinion and stakeholder input is reflects a descriptive or behavioral approach to decision making.

Identify time wasters and ineffective time management. What are time management strategies the nurse can employ in practice to improve efficiency and productivity?

Time wasters ( delegate appropriately) - Doing too much - Inability to say "no" - Procrastination - Complaining - Perfectionism - Interruptions - Disorganization - Too much information-OVERLOAD! - Many others... Time Management Planning, organizing, and implementing - Important to engage in planning before beginning any task, project, or the day's activities - Requires priority-setting, scheduling, and "to do" lists to be prepared prior to the start of the clinical day - Personal organization is an important component of time management - Avoid the stacked desk syndrome - keep your clipboard organized - Eliminate clutter from the patient's room so that care can be more efficient - Practice "no detourism" to organize the mind - Learn the art of "wastebasketry" - Attacking priorities - Finding "extra" time - Handle paperwork appropriately - Avoid procrastination - Delegate appropriately - Control interruptions - Learn the art of saying "no" - Reward oneself - Using technology (+/-)

Compare transactional and transformational leaders. How might these leadership roles look in the practice setting?

Transactional - Concerned with the day-to-day-operations of the facility - "I'll give you off a weekend shift if you work on Monday night." - Comfortable with the status quo - Monitor work performance and correct as needed - Wait until problems occur, and then deal with them Transformational (admired and Emulated) - Committed to organizational goals and clearly communicate vision and direction - Empower the work group to accomplish goals - Impart meaning and challenge to work - Acts as a role model - Provide mentoring to individual staff members on the basis of need - Fosters creativity, risk taking, commitment, and collaboration by empowering the group to share in the organization's vision

The nurse manager at a staff meeting tells the nursing staff that she will be available for staff coaching and wants input on the newly implemented staffing grid. This is an example of

Transformational leadership

Understand Lewin's stages of change, the change process and change agent. What are rules to follow when change is necessary? Apply the change process to the practice setting.

Unfreezing: Change agent promotes problem identification and encourages awareness of the need for change Moving: Change agent clarifies the need to change, explores alternatives, defines goals and objectives, plans the change, and implements the change plan Refreezing: Change agent integrates the change into the organization ( Deciding that change is necessary and being available to help) INVOLVEMENT, EDUCATION AND TRAINING ARE KEY TO SUCCESSFUL CHANGE. Rules: - Change should be for a good reason - Should be planned and implemented gradually - Everyone affected should be involved - Clear communication

What are techniques the nurse can use to empower others?

You're sharing your power and control with the expectation that people are responsible for themselves. Give opportunities to... - Education -Role Modeling -Positive Reinforcement - Gain new skills and knowledge - Network - Speak out constructively - Increase involvement in planning and decision-making - Represent on key organizational committees - Develop assertive skills - Advocate in politics - Campaign for a positive image

Coercive power

coercive power is based on fear of punishment.

Personal Liability

defines each persons responsibility and accountability actions or omissions.

Understand delegation criteria as it relates to the Wisconsin Nurse Practice Act and apply concepts to nursing practice.

https://docs.legis.wisconsin.gov/code/admin_code/n/6.pdf (a) Delegate tasks commensurate with educational preparation and demonstrated abilities of the person supervised. (b) Provide direction and assistance to those supervised. (c) Observe and monitor the activities of those supervised. (d) Evaluate the effectiveness of acts performed under supervision.

Information Power

information power is when the person has information that another individual needs

supervision

is defined as the active process of directing, guiding, and influencing the outcome of an individual. Provision of guidance and direction, evaluation, and follow-up for the accomplishment of a delegated activity.

Productivity

is the amount of work produced through the use of a specific amount of resources; it is measured as output divided by input. The amount of output or work produced (e.g., home visits made) by a specific amount of input or resources (e.g., nursing hours worked).

Assignment

is the transfer of both the accountability and the responsibility from one person to another. Designating responsibility for implementation of an activity or set of activities to a person trained and competent to perform the activity; and transfers accountability and responsibility to that person.

Leadership

refers to the ability to influence what goes on in a group or social system Leadership refers to skills.

When delegating, the RN delegator is accountable for

• Determining patient needs and when to delegate. • Being available to the delegatee. • Assessment and follow-up evaluation. • Any intervention or corrective actions that may be required to ensure safe and effective care. --------------------- Which team member is most accountable when delegating a task to the health care team? Registered nurse The RN on the health care team is most accountable when delegating a task to the team. The certifies technician is responsible for assigned tasks, as are the LPN and UAP.

The delegatee is accountable for:

• His or her own actions. • Accepting delegation within the parameters of his or her competency level. • Communicating the appropriate information to the delegator. • Completing the task."

Policies Common to Many State Nurse Practice Acts

• Only nursing tasks can be delegated, not nursing practice. • The RN must perform the patient assessment to determine what can be delegated. • The LPN or LVN and UAP do not practice professional nursing. • The RN can delegate only what is within the scope of nursing practice. • The LPN or LVN works under the direction and supervision of the RN. • The RN delegates based on the knowledge and skill of the person selected to perform the delegated tasks. • The RN determines the competency of the person to whom he or she delegates. • The RN cannot delegate an activity that requires the RN's professional skill and knowledge. • The RN is accountable and responsible for the delegated task. • The RN must evaluate patient outcomes resulting from the delegated activity. • Health care facilities can develop specific delegation protocols, provided they meet the state board delegation guidelines. • Delegation requires critical thinking by the RN.