fundamentals: chapter 10 Flashcards
chain of command
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?
laissez-fair leader
- does not attempt to control the team
- offers little (if any) direction
autocratic leader
tightly controls team members
democratic leader
- frequently consults with staff members
- seeks staff participation in decision making
attributes of a good leader
- 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
keys to effective leadership
- collaboration
- effective communication and relationships
- clinical competence and confidence
- organization
- delegation
effective communication
- 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
clinical competence and confidence
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
organization
- plan each day carefully
- have built-in flexibility for unforeseen events
- decision making ability is needed to quickly divide up patients and assign tasks
delegation
- a licensed nurse transfers authority to perform a nursing duty in a specific patient situation
UAPs
unlicensed assistive personnel
- includes unit secretaries, nursing assistants, homemaking aids, housekeeping personnel, and technicians
delegation
- 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
CNO
chief nursing officer
DON
director of nursing
delegation
- 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
delegation
- 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)
beginning leadership roles
- LPNs will perform leadership functions with UAPs
- later on, team leading may be required
advanced leaderships roles
charge nurse:
- training and experience in nursing administration
- responsible for total nursing care of patients on the unit
management skills for the LPN
- time management
- computer skills
- receiving new orders
- taking verbal orders
- documentation for reimbursement
time management
- 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
using the computer
- place orders to various departments
- supplies, meds, labs, housekeeping, etc
- schedule surgery
- construct nursing care plans
- track patient acuity levels
- obtain lab results
receiving new orders
- 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
taking verbal orders
- 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
documentation for reimbursement
- all nursing care and equipment used must be documented
- reimbursement rates depend on documentation
documentation in long-term care facilities
- 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
risk management
- 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
interpersonal relationships
- promote team cooperation
- relationships and trust develop over time
the two-challenge rule
- voicing your concern at least twice to promote acknowledgment by the receiver
- ensures the concern has been heard, understood, and acknowledged
the CUS technique
Concern
Uncomfortable
Safety
state concern, state why you are uncomfortable, state the safety issue involved
strategies for communicating information with the team
- briefing
- call-out
- check-back
- huddle
- debrief
mediate
settle differences
tasks that can be delegated to UAPs
- 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
read back
- 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
CPOE
computerized provider order entry
