NU 236: Professional Issues

What are the four C's of initial direction?

Concise - have I confused the direction by giving too much unnecessary information? Correct - do the directions follow policy, procedure, job description and the law? Complete - does it give all the information necessary to complete the task? Clear - is what I'm saying understood?

What is the Silent or Veteran Generation?

1. 1925-1942 2. value loyalty 3. discipline 4. respect for authority 5. like/are autocratic leaders

What is the Baby Boomers or Sandwich Generation?

1. 1943-1960 2. values what others think 3. likes recognition 4. very ambitious 5. organizational loyalty and commitment 6. like autocratic leaders (like to be told what to do)

What is Generation X?

1. 1961-1979 2. innovative 3. hard workers 4. have little loyalty or confidence in leaders and institutions 5. want extensive learning and questions answered immediately 6. like teaching and learning 7. value free time (flexible scheduling) 8. respect democratic leaders 9. majority are managers and directors in healthcare

What is Generation Y/Millennium?

1. 1980-2000 2. educated 3. tech savvy 4. socially responsible 5. value individuality 6. multitaskers 7. creative 8. not team players 9. want to start at the top, not climb the ladder

What is Generation Z/Now?

1. 1995 to present 2. have never lived without the Internet 3. communicate through social media 4. want immediacy 5. see self as leaders

Which of the following clients could the nurse assign to a nursing assistant? Select all that apply. 1.A 3 month old infant originally admitted with dehydration who will be discharged tomorrow 2. A 10 month old infant with bronchiolitis, admitted last night 3. A 5 year old with a fractured humerus going to surgery this morning & returning on your shift 4. An 11 year old in sickle cell crisis 5. A 16 year old with mononucleosis and temperature of 100F 6. A 17 year old with an appendectomy last night with stable VS

1. A 3 month old infant originally admitted with dehydration who will be discharged tomorrow 5. A 16 year old with mononucleosis and temperature of 100F (an expected symptom)

What are some responsibilities of Nursing Assistants?

1. Activities of daily living 2. Bathing & grooming 3. Feeding 4. Positioning 5. Bed making 6. Ambulation 7. Specimen collection 8. I&O 9. Basic skills (VS) 10. Blood draws (some agencies) 11. EKG's 12. Stable clients

Why should shift report be done at the patient's bedside?

1. Allows both caregivers to examine patient 2. Offers the patient and family the opportunity to meet the incoming caregiver and keeps them involved in the plan of care 3. Patients are active members of their own health care team.

What is the Functional Nursing Model?

1. Breaks nursing care into a series of tasks performed by many people (LPN, CNA) 2. Each member is assigned to specific tasks rather than specific clients 3. Charge nurse or nurse manager makes the assignment

What are the disadvantages of Team Nursing?

1. Can cause confusion & lack of responsibility 2. RN needs good delegation, communication, & supervisory skills 3. Can decrease productivity with time required to discuss among team members

What are the disadvantages of the Functional Nursing Model?

1. Care is fragmented 2. Client frequently_____ 3. Client seen as tasks & not an integrated whole 4. Easy to miss things 5. Lack of _______for the total patient 6. Psychosocial & spiritual needs not addressed

What are some responsibilities of Licensed Practical Nurses (LPNs)?

1. Common, well defined health problems 2. Teaching from standard care plan 3. Basic Nursing Care 4. Uncomplicated procedures 5. Passing medications 6. IV therapy & blood draws (some states) 7. Documentation

What is included in a RN's scope of practice?

1. Conducts physical exams & patient assessments to identify & address health problems and unmet patient care needs 2. Develops a patient plan of care 3. RN initiates and provides patient teaching, counseling, referrals and discharge planning 4. Evaluates patient's response to interventions 5. Performs medical treatments as prescribed 6. Supervises care of other team members

What are the advantages of the Patient Focused Care Model?

1. Convenient for patient 2. Expedites services 3. RN functions at a higher level - accountable for a fuller range of services for the patient 4. RN can delegate

What are the disadvantages of the Patient Focused Care Model?

1. Costly 2. Way of reducing RNs

What is the impact of staffing patterns on quality of care?

1. Decreased staffing = increased adverse patient outcomes 2. Increased staffing = decreased adverse patient outcomes and increased quality of care and nurse satisfaction

What tasks can LPNs in New York State not do?

1. Flush any central venous line for patency, including PICC lines, central venous chest ports or central venous arm port devices 2. Draw blood from any central venous access device/line 3. Administer the first dose of any medicated IV solution through any venous access device - this includes peripheral IV's 4. Administer oncology chemotherapy regimens infusion through venous access devices. 5. Change dressings and/or heparin lock caps on any central venous access device/line. 6. Administer IV push meds 7. Assess 8. Triage 9. Create or initiate nursing care plans or nursing care goals

What patient situations support the need for a case manager?

1. Have complicated health care needs 2. Are receiving care that is expensive and complicated 3. Pose discharge planning problems 4. Receive care from multiple providers 5. Are likely to have significant physical or psychosocial problems

What are the disadvantages of the Primary Nursing Relationship Based Practice?

1. High cost - RN staff 2. Travel around unit for their primary pts. 3. RN spends time doing work that could be delegated 4. RNs/Pt ratio needs to be realistic 5. RNs needs to be competent, self-directed & concerned with care

What are the advantages of the Total Patient Care/Private Duty Model of Nursing Care?

1. High quality of care - RN 2. Efficient - saves on communication time, one person performs multi tasks, decreased supervision 3. Consistency of care 4. Develop trusting relationship with family/patient 5. Pick up progression or deterioration 6. High patient satisfaction

What are the disadvantages of the Total Patient Care/Private Duty Model of Nursing Care?

1. Higher number of RN hours 2. Costly 3. Don't have same patients day to day 4. Skills & time wasted doing tasks that can be assigned to others

What are the "do's" of decision making?

1. Make only those decisions that are yours to make 2. Write notes & keep ideas visible to utilize all relevant information 3. Write pros & cons 4. Make decisions as you go along rather than letting them accumulate 5. Consider those affected by your decision 6. Trust yourself

What are the "do not's" of decision making?

1. Make snap decision 2. Waste your time making decisions that do not have to be made 3. Consider decisions a choice between right and wrong but a choice among alternatives 4. Prolong deliberation 5. Regret a decision; it was the right thing to do at the time 6. Always base decisions on the "way things have always been done."

What is the RN's accountability in the delegation process?

1. Making the decision to delegate in the first place 2. Assessing the patient's needs 3. Planning the desired outcome 4. Assessing the competency of the delegate 5. Giving clear direction & obtaining acceptance from the delegate 6. Following up on the completion of the task providing feedback

What is a Nursing Assistant?

1. Not licensed 2. Jobs vary between states and agencies 3. It is a violation of the State Nursing Practice Act to have nursing assistants perform functions outside their scope 4. Nursing assistants can NEVER be asked to assess or evaluate a response to treatment

What tasks should a RN never delegate?

1. Nursing judgment 2. Patient Assessment 3. Unstable patient care 4. Any part of the Nursing Process (ADPIE) 5. Initial patient education 6. IV push meds 7. Central line care

What critical components must be included in shift report?

1. Patient identifiers (typically name and date of birth) 2. Diagnoses 3. Physician/Service on the case 4. Pertinent medical and social history 5. Current physical condition (review of systems) 6. Resuscitation status (no resuscitation, full resuscitation) 7. Nutritional status (nutritional intake, NPO, supplements) 8. Pending or critical issues and tests

What is the Primary Nursing Relationship Based Practice?

1. Primary nurse is responsible for planning & directing the patient's care over a 24 hours period 2. Assisted by an Associate nurse 3. RN manages and coordinates patient's care in hospital and patient's discharge plan

What are some prioritization tips to follow throughout a shift?

1. Prioritize and re-prioritize throughout the day 2. Plan your day around sickest patient 3. ABC's 4. Maslow 5. Dressing changes: Cleanest → Dirtiest 6. Block off med- pass time 7. Maximize number of tasks per patient visit 8. Assess pt/IV site, tubes, give meds, teach - all in 1 visit 9. Hourly rounds for the 3P's: pain, position, potty

What are the advantages of Team Nursing?

1. RN gets work done with help of others 2. Shared responsibility & accountability 3. Work together to achieve goals

What is Team Nursing?

1. Staff is divided into teams led by an RN 2. Responsible for the total care of a given number of clients 3. Success of the team depends on the ability to communicate and work together 4. Team conference is vital

What role can LPNs play in IV therapy in NYS?

1. The practice of intravenous therapy by LPNs in acute care settings requires RN supervision 2. The RN must be assigned to the patient care unit at all times when intravenous therapy is being provided by the LPN 3. The RN must document, at least every shift, assessment of the patient's condition relative to the intravenous therapy

What is the Patient Focused Care Model?

1. Traditional nursing interventions handled by ancillary workers under direction of RN 2. Moves RNs to higher level of functioning 3. Requires care & services be brought to the patient e.g. radiology, dietary, pharmacy, respiratory 4. Nursing assistants are cross-trained to perform more than one function

What are the advantages of the Primary Nursing Relationship Based Practice?

1. Trusting relationship 2. Defined accountability & responsibility 3. Holistic approach to care 4. Professionally rewarding 5. Good for Home Care Agencies

What are some responsibilities of a RN?

1. Unstable patients/acute 2. Complex procedures 3. Physical Assessment 4. Diagnosis 5. Planning Care 6. IV lines & Blood draws 7. Central lines 8. Medications 9. Teaching 10. Evaluation - follow up of care delivered 11. Documentation

What is included in a LPN's scope of practice?

1. Varies from state to state 2. Job description varies among agencies 3. Collect data during the health history and physical exam 4. Contributes to or updates the plan of care 5. Reinforces patient teaching and discharge instructions 6. Starts peripheral IV's (Not PICC Lines) 7. May administer saline & hep-lock IV push

What is the Total Patient Care/Private Duty Model of Nursing Care?

1. When one nurse assumes responsibilities for the complete care of a group of patients on a 1:1 basis, providing total patient care during the shift 2. Many nurses prefer this method.

What process must be completed when obtaining verbal orders?

1. a verbal order should only be accepted during an emergency or during a procedure - otherwise, ask the physician to write it/input it 2. order must be written down verbatim 3. written order is read directly back to the person who gave it for confirmation that it is accurate

How can written communication be improved for patient safety?

1. avoid the trailing "0" when referring to numbers 2. avoid unapproved abbreviations 3. provide written and verbal information to patients in their native language to avoid cultural variances

What is the definition of accountability?

1. being answerable for what was done and standing behind the decision and/or action 2. being responsible and answerable to actions or inaction of self or others in the context of delegation

What are the advantages of the Functional Nursing Model?

1. caregivers can care for ____numbers of clients 2. Utilizes other health care workers with nursing shortage

Describe authoritarian management

1. centralized decision making (commands, controls) 2. tells others what to do 3. emphasis on task completion, not group feelings 4. associated with high performing groups, but need close supervision 5. stifles creativity 6. functions well in crisis/code 7. motto: "my way or the highway"

What tools are used to support case management?

1. clinical pathways (Care Maps) 2. disease management protocols 3. both are generally based on clinical guidelines incorporating nationally acceptable ways to care for a specific disease

What does management problem solving involve?

1. data gathering 2. definition of the problem 3. identification of alternative solutions 4. implementation of a plan 5. evaluation of solution

How do you communicate when it is critical? (ex: critical patient tests)

1. include critical high/low lab results and dx values 2. notify physician of critical test result, and document results of conversation 3. if physician cannot be reached, initiate chain of command policy at your institution

What is the transformational theory of management?

1. involves a strong vision, learning, inspirational motivation and partnership 2. sees the bigger picture and communicates their vision to others 3. cohesiveness

What is the traditional (beurocratic) theory of management?

1. organization divided into hierarchies 2. strong lines of authority and control (chain of command)

Describe laissez-faire management

1. passive - little planning, decision making, involvement by leader 2. leader allows group to set goals and methods to achieve them 3. low productivity 4. team is confused and frustrated b/c of no guidance 5. motto: "whatever"

What is the transactional theory of management?

1. punishment and incentives used to motivate 2. not the best leaders to work for

Describe democratic management

1. shared planning, decision making, responsibility for outcomes with the group 2. guidance rather than control 3. fosters motivation and creativity 4. works well with groups who have relatively equal status and methods to achieve them 5. motto: "let's have a show of hands"

What are the 5 rights of delegation?

1. the right task 2. under the right circumstances 3. to the right person 4. with the right directions and communication 5. under the right supervision and evaluation

Following shift report, which of these clients would you tell your RN to assess first? 1.An older adult with COPD who continues to have bilateral crackles in both lung bases 2.An older adult with a history of CHF who has gained 5 pounds since yesterday morning 3.A patient with a hip replacement who needs health teaching prior to transfer to a rehab facility 4.A post-op patient from yesterday with a Hbg of 7.1 who is receiving a blood transfusion

2. An older adult with a history of CHF who has gained 5 pounds since yesterday morning

You are the nurse caring for a postoperative appendectomy patient who had surgery 6 hours ago. The following tasks need completing: 1.Assess the patient's ability to drink clear liquids. 2.Determine the amount eaten. 3.Document the patient's tolerance of clear liquids. 4.Assess the patient's tolerance for sitting at the side of the bed. 5.Assess the patient's tolerance for ambulating. 6.Measure and document the patient's weight 7.Show the patient how to use their incentive spirometer 8.Provide education about activity levels. Which of the above tasks can you delegate to your nursing assistant?

2. Determine the amount eaten (I&O) 6. Measure and document the patient's weight

You are the charge nurse on a skilled unit of a nursing home. Which of these nursing tasks would be best to assign to a nursing assistant? 1. Gastrostomy feeding for a client with advanced stage Alzheimer's disease 2. Urinary catheterization for a man with BPH 3. Discharge teaching for a client who has received stroke rehab 4. Skin care for a client with a Stage I sacral pressure ulcer 5. None of the above

4. skin care for a client with a stage I sacral pressure ulcer

What does the nursing process involve?

ADPIE: Assessment - looking for cues Diagnosis - formulate a hypothesis, develop a problem list Planning - development of a plan Implementation - implement the plan and nursing actions Evaluate - evaluation and reassessment

Lee is always busy. When he is not working, he is providing care for his older mother who lives with him, his wife, and their three young children. What generation is Lee?

Baby Boomer/Sandwich Generation

The RN is preparing the assignment. Two nursing assistants are assigned to make beds and bathe clients. Another is told to fill water pitchers and pass out breakfast and lunch trays. An RN is assigned to administer all medications. Based on these assignments, which type of nursing care is being implemented?

Functional Nursing - each person has their own job/function to complete

LaShay is also a new employee, although she has been a nurse for 10 years. This is her fifth nursing position at four different hospitals. She says she loves the challenges that the new positions bring and loves how this hospital uses self-scheduling. What generation is LaShay?

Generation X - hopping jobs, has little loyalty to an institution, likes flexible scheduling

Dawn has been in her position for a year. She is the unit champion for computerized charting and documentation systems. She is pursuing a master's degree in Nursing Informatics. What generation is Dawn?

Generation Y - has only been in position for a year and already pursuing her Master's Degree and is tech savvy

Ben is a new graduate. During orientation, he used his smart phone to find answers to the questions posed. He shared apps with others that related to nursing practice, explaining how the apps could help nurses at the point of care. What generation is Ben?

Generation Z/Now

What tool can be implemented during critical hand-off communication?

I-SBAR-R: 1. I - Identification: Identify yourself and your patient (two identifiers to be used). 2. S - Situation: What is happening at the present time? 3. B - Background: What are the circumstances leading up to this situation? 4. A - Assessment: What do I think the problem is? 5. R - Recommendation: What should we do to correct the problem? 6. R - Read back or response: The receiver acknowledges the information given, and what is the response?

There have been several patient complaints that the staff members of the unit are disorganized and that "no one seems to know what to do or when to do it." The staff members concur that they don't have a real sense of direction and guidance from their leader. Which type of leadership is this unit experiencing?

Laissez-faire

How do the NCSBN and ANA define delegation?

NCSBN - nurse transferring authority ANA - transfer of responsibility -both stress that the nurse retains accountability

What is the most effective model of nursing care?

Several key characteristics identified in research study of 30 different nursing care models 1. RN serves as "primary care manager." 2. More focus on patient 3. Greater patient and family involvement → faster recovery and compliance 4. Specialized tools for assessment 5. Integration of technology to enhance communication and reduce wasted time 6. Reliable indicators to measure satisfaction

Mary is a nurse who others describe as being present when they built the hospital. She has over 35 years of experience on the medical-surgical unit. What generation is Mary?

Veteran

You are the charge nurse making out shift assignments. You have an RN, LPN, and nursing assistant to work with you today. Who would you assign to the following tasks: a.Administer routine medications to the patients b.Change an abdominal dressing on a patient 2 days post-op c.Obtain VS on the newly admitted patient d.Administer a feeding to the client with a gastrostomy tube e.Administer all prn medications requested by the patients f.Check the toes of a client who just had a cast applied g.Escort a client who has been discharged to the client's vehicle h.Complete the admission for a new patient i.Hang the next bag of 0.9%NS on the patient with dehydration

a. LPN b. LPN c. CNA d. LPN e. RN (assess) f. RN (assess) g. CNA h. RN i. LPN

What are Case Managers/Care Managers?

advocates who guide patients through the health care delivery system; can include nurses, social workers and therapists; knowledgeable about resources available to the patients

What is the deontological model of ethical reasoning?

all life is worthy of respect

What is the situational theory of management?

analyzes the needs of current situation and selects the most appropriate leadership style for particular situation

What are the 3 management styles?

authoritarian, democratic, laissez-faire

How can authoritarian management be described?

autocratic, directive

Which of the following patients would not need to be followed by a case manger? a.A young adult patient in the trauma unit following a motorcycle accident b.Elderly woman who had an ORIF of her left hip following a fall at home c.45 year-old mother of two who had a lap chole following a flare up of her gallbladder d.A teenager who overdosed on fentanyl

c. 45 year-old mother of two who had a lap chole following a flare up of her gallbladder (is an outpatient surgery)

What is the behavioral theory (human interaction theory) of management?

considers the attitudes and needs of employees

What is the situational model of ethical reasoning?

decisions made in one situation cannot be generalized to another situation; each situation creates its own set of rules

What is beneficence?

duty to actively do good for patients

What is nonmaleficence?

duty to prevent or avoid doing harm, whether intentional or unintentional

What is veracity?

duty to tell the truth

What is justice?

duty to treat all patients fairly without regard to age, socioeconomic status, or other variables

What are the responsibilities of a leader?

effectively influence others and way of behaving

What is the focus of a leader?

effectiveness and control

What is the focus of a manager?

efficiency and contol

What should try to always be used when developing management protocols and interventions?

evidence based processes and solutions (peer reviewed literature and research)

How is the role of a manager described?

formal role, assigned or appointed

What is autonomy?

freedom to make choices and decisions without interference

What is the definition of supervision?

guiding, directing, overseeing, evaluating, following up

What are Magnet Hospitals?

hospitals that are recognized by American Nurses Credentialing Center for attracting and retaining nurses, high nurse satisfaction, and delivering high-quality nursing care (Kenmore Mercy is the only Magnet Hospital in Buffalo)

Describe the organizing role of a manager

how it is going to be done; align resources with work to be done

What is the most critical step in management problem solving?

identifying the problem

How is the role of a leader described?

informal role, person selects and assumes the role

The health care team responsible for deciding whether to move a critically ill patient out of the ICU so that a new patient may be admitted to the unit is faced with what principle of an ethical dilemma?

justice

What is fidelity?

keeping information confidential; maintaining privacy and trust

What are the responsibilities of a manager?

organizational goals and tasks, coordinates activities to maintain balance and direction

How can democratic management be described?

participative

What do leaders deal with?

people and relationships

How can laissez-faire management be described?

permissive, non-directive

What are the 4 functions of a manager?

planning, organizing, directing, controlling

What are Integrated Health Care Delivery Systems?

systems that offer prevention services, acute and long term care facilities, home health care, and hospice care; they offer a high degree of continuity of care

What do managers deal with?

systems, controls, policies

What is the teleological model of ethical reasoning?

that which causes a good outcome is a good action; emphasis on results (the end justifies the means)

What is the definition of delegation?

the process for a nurse to direct another person to perform nursing tasks and activities

Describe the planning function of a manager

what is to be done; starts with goals and plan for contingencies

Describe the controlling role of a manager

when and how it gets done; must be cognizant of regulations and standards

Describe the directing role of a manager

who is to do it; accountability