fundamentals: chapter 10

Question 1

chain of command

Answer 1

know:
- who is your supervisor?
- to whom does your supervisor report?
- to whom should you report changes in patient
condition?
- to whom do you go with concerns or complaints?
- who is in charge of scheduling your hours?
- who should you call if you cannot make it to
work?

Question 2

laissez-fair leader

Answer 2

• does not attempt to control the team
• offers little (if any) direction

Question 3

autocratic leader

Answer 3

tightly controls team members

Question 4

democratic leader

Answer 4

• frequently consults with staff members
• seeks staff participation in decision making

Question 5

attributes of a good leader

Answer 5

• ability to teach
• active listener
• articulate
• assertive
• calm
• considerate
• consistent
• decisive
• excellent clinical skills
• excellent problem solver
• fair
• flexible
• good role model
• good sense of humor
• objective
• open minded
• organized
• responsive
• sensitive
• strong character
• tactful

Question 6

keys to effective leadership

Answer 6

• collaboration
• effective communication and relationships
• clinical competence and confidence
• organization
• delegation

Question 7

effective communication

Answer 7

• communicate in direct, concise terms in a tactful, friendly, nonthreatening way
• maintain a supportive work environment
• be specific when assigning tasks (what to do, how to do it, when it should be done)
• treat others how you want to be treated

Question 8

clinical competence and confidence

Answer 8

essential to having respect of other team members:
- confidence in your ability to perform skills well
- admit when you make a mistake or don’t know something

Question 9

organization

Answer 9

• plan each day carefully
• have built-in flexibility for unforeseen events
• decision making ability is needed to quickly divide up patients and assign tasks

Question 10

delegation

Answer 10

• a licensed nurse transfers authority to perform a nursing duty in a specific patient situation

Question 11

UAPs

Answer 11

unlicensed assistive personnel

• includes unit secretaries, nursing assistants, homemaking aids, housekeeping personnel, and technicians

Question 12

delegation

Answer 12

• you are accountable for the tasks you delegate
• you must know the capabilities of each person to whom you delegate
• you must know whether the task can be legally delegated
• you must effectively communicate with the person to whom you are delegating

Question 13

CNO

Answer 13

chief nursing officer

Question 14

DON

Answer 14

director of nursing

Question 15

delegation

Answer 15

• you must be familiar with your state’s nurse practice act
• you must know what UAPs can or cannot do
• do not delegate assessment, analysis, planning, or evaluation - these tasks can only be performed by licensed personnel
• interventions requiring judgement should not be delegated

Question 16

delegation

Answer 16

• effective delegation includes the desired result and a timeline for completion
• delegation does NOT mean giving up responsibility for overall patient care
• provide praise or constructive criticism on how the UAP performed a delegated task
• if UAP performance is poor, document specific facts (not opinions)

Question 17

beginning leadership roles

Answer 17

• LPNs will perform leadership functions with UAPs
• later on, team leading may be required

Question 18

advanced leaderships roles

Answer 18

charge nurse:
- training and experience in nursing administration
- responsible for total nursing care of patients on the unit

Question 19

management skills for the LPN

Answer 19

• time management
• computer skills
• receiving new orders
• taking verbal orders
• documentation for reimbursement

Question 20

time management

Answer 20

• make a to-do list before starting shift
• list differs based on setting
• devise a time schedule before making rounds
• evaluate effectiveness of time management at end of shift

Question 21

using the computer

Answer 21

• place orders to various departments
  
  • supplies, meds, labs, housekeeping, etc
• schedule surgery
• construct nursing care plans
• track patient acuity levels
• obtain lab results

Question 22

receiving new orders

Answer 22

• most facilities use EMR and CPOE
• some still use MAR
• read all orders first
• verbally communicate stat orders to the nurse responsible for carrying them out
• acknowledge each order as it is ordered by the provider and verified by the pharmacist

Question 23

taking verbal orders

Answer 23

• the joint commission discourages verbal and telephone orders unless absolutely necessary
• verbal orders can only be taken by licensed nurses (only by RNs in some states)
• nurse enters the verbal order on on the physician’s order sheet and marks it as VO (verbal order) or TO (telephone order) with the date, time, first initial, last name, and professional title
• physician must sign written form of the VO as soon as possible (by next day)
• # of VOs must not exceed 20% of total orders

Question 24

documentation for reimbursement

Answer 24

• all nursing care and equipment used must be documented
• reimbursement rates depend on documentation

Question 25

documentation in long-term care facilities

Answer 25

• MDS (minimum data set) must be filled in as accurately as possible for the facility to receive the max Medicare or Medicaid payment for services rendered

Question 26

risk management

Answer 26

• attempts to prevent patients from engaging in litigation in the event of adverse outcomes
• practicing according to the agency’s policy and procedure manual is essential
• always attend to patients’ complaints

Question 27

interpersonal relationships

Answer 27

• promote team cooperation
• relationships and trust develop over time

Question 28

the two-challenge rule

Answer 28

• voicing your concern at least twice to promote acknowledgment by the receiver
• ensures the concern has been heard, understood, and acknowledged

Question 29

the CUS technique

Answer 29

Concern
Uncomfortable
Safety

state concern, state why you are uncomfortable, state the safety issue involved

Question 30

strategies for communicating information with the team

Answer 30

• briefing
• call-out
• check-back
• huddle
• debrief

Question 31

mediate

Answer 31

settle differences

Question 32

tasks that can be delegated to UAPs

Answer 32

• applying a condom catheter
• applying a hearing aid
• applying cold packs
• applying elastic stockings
• applying warm compresses
• assisting to deep breath and cough
• assisting with ambulation
• giving a bath
• making a bed
• collecting specimens
• emptying drainage containers
• feeding patients
• filling water pitchers
• giving a sitz bath
• administering an enema
• giving a vaginal douche
• measuring height and weight
• measuring vital signs
• performing oral hygiene
• performing range-of-motion exercises
• providing hair/skin care
• recording intake and output
• removing a urinary catheter
• repositioning patients
• stocking supplies
• taking specimens to the lab
• toileting patients
• transferring patient to a chair or bed
• turning patients

Question 33

read back

Answer 33

• institutions must verify a VO/TO by having the person receiving the oder read it back to the prescribing provider
• often requires person to enter the order into the CPOE system in order to read it back

Question 34

CPOE

Answer 34

computerized provider order entry