Intro to nursing ch. 14 & 17
The LPN/LVN charge nurse notices that a nursing assistant has not weighed her assigned residents. The best statement by the nurse is
"I need to have you weigh your assigned residents and report to me by 10 AM
Which statement shows a personal commitment to work on the goal of devoting more time to coursework for the LPN/LVN program?
"I will say 'no' when people ask me to do things that take time away from my studies."
The LPN/LVN charge nurse asks the nurse manager, "How can I motivate the nursing assistants on my shift?" The best answer would be
"Motivation is an inner force. You can't motivate someone else, but understanding the things that are important to workers can be helpful."
A nurse demonstrates assertive behavior by doing which of the following? Assuming a patient would like to skip the bath when the patient's spouse comes to visit Being unable to continue suctioning a patient because she is concerned the patient will not like her for doing it Experiencing a feeling of devastation when the patient questions her ability to insert an intravenous catheter Requesting to speak with the physician privately when she feels that the physician has ordered an inappropriate treatment
Requesting to speak with the physician privately when she feels that the physician has ordered an inappropriate treatment
A nursing assistant (NA) did an exceptionally good job by encouraging a resident to leave his room and go to an activity. Select the response by the LPN/LVN charge nurse that would best encourage the employee to continue this effort
Tell the NA that the charge nurse knows how hard she worked to get the resident out of his room and how pleased the nurse is that the NA is concerned with the resident's need for socialization
Who is the most important person in the chain of command?
The person on the bottom. Without them, nobody else can do their job.
According to Virginia Henderson, how do you define nursing?
The unique function of the nurse is to assist the individual, sick, or well, in the performance of those activities contributing to health or its recover (or to peaceful death) that he would perform if he had necessary strength, will, or knowledge.
what is the basic hint for successful problem solving?
identfiy the real issue and solve it
being on time is a sign of-
respect toward your coworkers and your patients. Sometimes to correct negative behavior it is helpful to remind them how that behavior communicates to others
Motivators
self accomplishment internal fulfillment being a role model
List the skills that are necessary to function successfully as a first-line manager
-Basic nursing skills, including the nursing process -time management techniques for home and clinical time -how to learn new info, including using evidence for learning and decision making -the power of positive self-talk and thinking -rules for assertiveness -communication skills -ethical aspects of healthcare -legal aspects of healthcare -stress management -participation in clinical evaluation
as a practical/vocational charge nurse, what are your responsibilities when evaluating nursing assistants?
-observing skill performance and attitudes of CNAs -provide daily oral/written feedback, including suggestions for improvement -documenting observations -presenting final evaluation form
to be a leader in long-term care, it is necessary to develop what specific skills
-occupational/clinical skills: the knowledge and skills of nursing -organizational skills: necessary to function in the organization that delivers healthcare. -human relationship skills: the ability to get along with and relate to people
Because registered nurses assign routine care and the care of stable patients to assistive personnel, this allows RNs to complete what specific tasks?
-plan care -coordinate all the activities of care, including care from interdisciplinary health care team members -provide care that requires more specialized knowledge and judgement -teach patients, families, and other members of the healthcare team -act as patient advocate
Leadership
How a person empowers and develops a team to meet and exceed patient and institutional outcomes
When a nurse tells a peer, "You have to watch out for the charge nurse. Sometimes she's OK, but sometimes she's just plain unreasonable. The best thing to do is to tell her off the first time she gets on your back about something. Keep me posted and I'll try to help you." An assertive reply would be
I think it would be best for me to work on my relationship independently.
Which of the following is an example of objective, rational thinking rather than subjective, irrational thinking about nursing assistants whom the LPN/LVN charge nurse supervises?
I want nursing assistants to be on time for report.
What is the major difference between the role of the practical/vocational nurse and the registered nurse
It is the independent role in decision-making that distinguishes RNs from LPNs/LVNs
Explain the difference between a nursing assistant and unlicensed assistive personnel
Nurse assistants are registered and certified by training obtained from an educational facility. A UAP is not certified and is trained on the job.
The LPN/LVN nursing home charge nurse usually tells nursing assistants what to do and offers little opportunity for input or suggestions for how to improve care. This leadership style is called
autocratic
The term advanced practice registered nurse (APRN) identifies the advanced practice of what specific roles?
clinical nurse specialist, nurse practitioner, a nurse anesthetist, certified nurse midwife
Any person who holds a license to practice as a Licensed Practical Nurse in this state shall have the right to use both the title "Licensed Practical Nurse" and to the abbreviation "L.P.N." No other person shall assume such title or use such abbreviation or any other words, letters, signs, or figures to indicate that the person using the same is a Licensed Practical Nurse. Any individual doing so shall be.....
guilty of a misdemeanor, which shall be punishable, upon conviction, by imprisonment in the county jail for not more than one (1) year or by a fine of not less than One Hundred Dollars ($100.00) nor more than One Thousand Dollars ($1,000.00), or by both such imprisonment and fine for each offense.
the 4 "I"s
idealized influence- the leader acts as a charismatic role model, promoting desirable behavior and establishing trust and respect of the team Inspirational motivation- the leader establishes a clear, focused vision and creates collective pursuit of this vision intellectual stimulation- the leader encourages creative thinking and problem solving and is supportive of taking risks based on knowledge individualized consideration-The leader communicates genuine concern for all followers, providing personal attention and individualized coaching and mentoring, supporting the development of followers
A student nurse is assigned to care for a patient who is known to be angry. During the caregiving process, the patient hits the student nurse. The action the student nurse should initially take is to
leave the patient in a safe situation and immediately report the event to the instructor
The LPN/LVN reads this statement, "Stress is the body's reaction to the mind's analysis of a situation." The LPN/LVN concludes that the critical factor to teach nursing assistants to help them control their stress levels is to
manage how they think about a situation
A newly graduated LPN/LVN who is orienting to the unit tells a peer, "You should have seen that new associate degree RN trying to take care of three patients! She was so disorganized that it made me glad I'm an LPN/LVN." The LPN/LVN is demonstrating
projection
as a charge nurse, what may be a helpful reminder to those on your floor?
that there is a person behind every task.
What is the major characteristic of the primary care method
the responsibility and accountability of the primary nurse. The primary nurse is assigned to a patient on admission, develops the nursing diagnoses after the admission interview, develops a plan of care, and is responsible for the care of that patient 24 hours a day until he or she is discharged.
communication of the LPN/LVN charge nurse
verbal, nonverbal, written, telephone
autocratic leadership
thrives on power. it involves telling someone what to do, with little regard for the employee as a person who may have ideas about how to improve resident care or reach the goals of the employer.
when documenting unacceptable behavior, give examples of objective information that should be included in the evaluation.
-days and times late for shift -days of oral warning -seriousness of the situation -consequences
what are the requirements of the quality improvement organization program
-improve quality of care for beneficiaries -protect integrity of medicare trust fund -protect beneficiaries by expeditiously addressing individual complaints, notices, and appeals such as non coverage
identify five core areas of knowledge and skills that are necessary for the practical/vocational charge nurse to be an effective leader
-motivate team members to accomplish team goals -build a team of cooperative workers -communicate assertively -problem solve effectively -manage stress effectively
An applicant for a license to practice as a Licensed Practical Nurse shall submit to the Oklahoma Board of Nursing certified evidence that the applicant:
1. Has successfully completed the prescribed curricula in a state-approved program of practical nursing and holds or is entitled to hold a diploma or certificate therefrom, or equivalent courses in a state approved program of nursing; 2. Has never been convicted in this state, the United States or another state or territory of any felony, unless five (5) years have elapsed since the date of the criminal conviction or the termination of any probation or other requirements imposed on the applicant by the sentencing court, whichever shall last occur, or a presidential or gubernatorial pardon for the criminal offense has been received, provided that the provisions of this paragraph shall not be effective until November 1, 2003; 3. Has submitted a criminal history records search that complies with Section 567.18 of this title; 4. Is a minimum of eighteen (18) years of age; and 5. Has met such other reasonable preliminary qualification requirements as the Board may prescribe.
A nurse demonstrates assertive behavior by doing which of the following? When making an error, the nurse overexplains and overapologizes and is unaware of the right to make a mistake. When asked by the charge nurse to accept an admission, the busy nurse hesitantly responds by saying, "Well, I guess I could." When the nurse is very busy and needs help with an assignment, the nurse says nothing and refrains from expressing the need for help. A patient complains of pain when ambulating and asks not to walk. The nurse respects the patient's feelings and medicates the patient as ordered for pain while supporting the need to carry out the physician's order.
A patient complains of pain when ambulating and asks not to walk. The nurse respects the patient's feelings and medicates the patient as ordered for pain while supporting the need to carry out the physician's order.
What are the differences in credentials among the different types of specialized RN educational programs?
CNS- minimum of MSN in a specialty area, clinical expert in nursing practice based on the latest research and has been certified as a clinical nurse specialist NP- minimum of MSN and certification by a national body CNM- minimum of MSN and certification as a nurse midwife CRNA- Minimum of MSN, is a graduate of an accredited nurse anesthesia educational program, and has certification as a nurse anesthetist Nurse Executive/CNE- certification through AACN or NLN
What is the best possible leadership style for a healthcare environment?
Democratic, but sometimes autocratic is necessary
management
the organization of all care required of patients in a health care setting for a specific period
Which of the four "I"s is most important?
Individualized consideration
Nursing shortage-
It is a reality, but the patient should never know you're short staffed
In healthcare, what is the one type of leadership style that is not beneficial for a work environment?
Laissez-faire
In which situation would the LPN/LVN charge nurse be in violation of OBRA provisions?
Letting the unit secretary, who has completed 30 hours of instruction in a CNA program, bathe and ambulate a resident
Howlett hierarchy
Level 1 (most fundamental)- salary, benefits, working conditions, supervision, and policies off agency level 2- safety in the workplace and job security level 3- affiliation and interpersonal relationships level 4-recognition, growth, responsibility, and nature of the job level 5- achievement and advancement
how does management differ from leadership
Management is a formal position assigned by employers. Management has their eye on the bottom line (day-to-day operation) leadership is informal and is given to a person by a group of workers. you become a leader when your team members decide to follow you. A leader's eye is on the future.
A nursing instructor has instructed a student nurse to document objectively. The student nurse demonstrates understanding when documenting
Odor of alcohol on breath; refuses to stay in assigned room."
To discover the expanded role of the practical nurse, the LPN/LVN should investigate
the state's Nurse Practice Act
Which behavior should the LPN/LVN charge nurse identify as dysfunctional behavior that violates OBRA regulations by threatening resident quality of life, health, or safety?
The nursing assistant uses a sharp tone of voice and body posture, suggesting impatience when feeding a resident.
Patient care philosophies- who comes first in the lineup?
The patient- Nursing has always been concerned with total patient care, focusing on the patient's physical and emotional needs, preferences, and values when giving care
What is the primary goal of health care and how it is accomplished?
The primary goal of healthcare is to restore optimal physical, emotional, and spiritual health to patients. This goal is accomplished by promoting health, preventing further illness and restoring health where illness or accident has occurred.
UAP
Unlicensed assistive personnel- • Nursing assistants • Transport aides • Patient care technicians • Admissions representative • Various other support care staff
A nurse demonstrates nonassertive behavior by doing which of the following? When a patient asks about the nurse's personal life, the nurse responds to the patient's questions out of fear of not being liked by the patient. When a patient asks about the nurse's personal life, the nurse says that the information is personal and chooses not to discuss it. When a nurse feels the team leader has been unfair, the nurse approaches the team leader and asks to speak privately at a time that is convenient for the person. When pressured by staff members to help with their assignments, the nurse, who is too busy to help, refuses without feeling guilty but leaves the door open to help at a future date.
When a patient asks about the nurse's personal life, the nurse responds to the patient's questions out of fear of not being liked by the patient.
A nurse demonstrates assertive behavior by doing which of the following? Limiting contact with a patient who is dying, because it causes the nurse to feel depressed Routinely telling patients who have questions about their medications to ask the physician When asked about something unfamiliar, admitting to not knowing but agreeing to find out Telling another nurse how ridiculous a doctor is for ordering hourly vital sign assessments
When asked about something unfamiliar, admitting to not knowing but agreeing to find out
The long-term care agency has recently announced that it will soon lay off six LPN/LVNs and hire eight nursing assistants. Today, the RN charge nurse presents the LPN/LVN charge nurse with a certificate recognizing her ability to manage effectively despite short staffing. The LPN/LVN responds somewhat politely but seems more angry than pleased. In terms of the Howlett hierarchy of needs, which of the following is the best explanation for the employee's reaction?
When job security is threatened, recognition needs assume lesser importance
When do RNs function in an interdependent role
When they carry out the legal orders of another healthcare professional or when carrying out decisions about patient care that are made jointly by the members of the interprofessional healthcare team
A staff nurse enters the room in which you're giving care to a patient in traction. She calls you aside and states, "I've watched you all morning. You don't seem to know how to do anything right. Look at you now! You're bathing the patient and it's almost time for lunch." An assertive approach would be to say
You're right. I am still bathing the patient. She was in pain earlier. I waited until her narcotic made her more comfortable."
"Licensed practical nursing" means the practice of nursing under the supervision or direction of a registered nurse, licensed physician or dentist. This directed scope of nursing practice includes, but is not limited to:
a. contributing to the assessment of the health status of individuals and groups, b. participating in the development and modification of the plan of care, c. implementing the appropriate aspects of the plan of care, d delegating such tasks as may safely be performed by others, consistent with educational preparation and that do not conflict with the Oklahoma Nursing Practice Act, e. providing safe and effective nursing care rendered directly or indirectly, f. participating in the evaluation of responses to interventions, g. teaching basic nursing skills and related principles, h. performing additional nursing procedures in accordance with knowledge and skills acquired through education beyond nursing preparation, and i. delegating those nursing tasks as defined in the rules of the Board that may be performed by an advanced unlicensed assistive person;
When a nurse is the target for unwanted behavior that she perceives as sexually harassing, she should first
assertively tell the person that the behavior is unwanted.
During a staff meeting, the charge nurse encourages feedback from staff nurses about improving patient safety. The charge nurse is displaying what leadership style?
democratic
The LPN/LVN nursing home charge nurse encourages nursing assistants to make suggestions regarding improvement of nursing care and shows concern for the staff. This leadership style is called
democratic
The Board may issue a license to practice as a Licensed Practical Nurse without examination to any applicant who has been..
duly licensed or registered as a Licensed Practical Nurse, or is entitled to perform similar services under a different title, according to the laws of another state, territory, the District of Columbia or a foreign country if such applicant meets the requirements for Licensed Practical Nurses in the State of Oklahoma.
The action the LPN/LVN charge nurse takes independently that would most likely require conflict resolution at the unit level is
eliminating morning breaks and adding 10 minutes to the lunch hour.
describe the characteristics of the democratic style of leadership
focusing on both the task and the employee is characteristic of the democratic style leader A democratic leader shares responsibility and authority with employees, enforces policies but with concern for the employees, seeks input from employees and encourages problem solving.
Summarize patient centered care as a method of delivering care
patient centered care is a method of caring for patients in a manner that is respectful and responsive toward all parties involved- patients, families, and coworkers
mission statement
vision statement that defines their purpose (goals) and states their values, culture, and norms, thus providing the foundation for collaborative decision making. Core values and or beliefs can flow from a mission statement and often include topics such as customer service, teamwork, respect, trust, honesty, excellence patient-centered care, cost effective, and safe care.
The applicant for a license to practice as a Licensed Practical Nurse shall be required to pass a...
written examination in such subjects as the Board may require. Upon the applicant successfully passing such examination the Board may issue to the applicant a license to practice as a Licensed Practical Nurse. An applicant who fails such examination shall be subject to reexamination according to the rules of the Board. The passing criteria shall be established by the Board in its rules.
Difference between NP and PA
• PA cannot work independently, must be under physician • NP can work independently • NP requires more school
