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Learning outcomes for Nurse Practice Act, Management, and Delegation
Examine the significance of the nurse practice act to managing and delegating patient care (think about yourself, then pt, then personnel)
Describe the ROLE of state boards of nursing
Apply principles of time management while providing care
Compare participative and authoritarian leadership styles to person being lead and the specific environment (PEDS/Community, etc)
Differentiate the goals of delegation and when to delegate
Discuss delegation to RNs, LPNs, and unlicensed assistive personnel
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Professionalism + Clinical Knowledge =
Nurse Practice Act
*Advocate (representative for the family)
*Direct Pt Care Provider (provider of activities of patient care)
*Care Coordinator (communicator of info; delegator of activities of patient care)
*Leader (representative for health care team; representative for profession of nursing)
*Teacher (instructor of information and skill to pt/families)
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Practice nursing as registered professional nurse means to practice nursing by performing for compensation any of the following:
Assessing the health status throughout the life span
Establishing a nursing dx
Establishing nursing goals to meet identified health needs
Planning, Implementing, and Evaluating nursing care
Providing for safe and effective nursing care rendered directly or indirectly through delegation
Managing and supervising the practice of nursing
Collaborating with other members of the health care team in the management of care
Teaching the theory and practice of nursing
Administering, Ordering, and Dispensing medications, dx studies, and medical treatments authorized by protocol, when such acts are authorized by other general laws and such acts are in conformity with those laws
Administering meds/treatments as prescribed by physician practicing medicine in accordance with Article 2, Chap 34
Performing any other nursing act in the care and counsel of the ill, injured, or infirm, and in the promotion and maintenance of health with individuals, groups, or both throughout the life span
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What is the point of having a nurse practice act?
Protect, promote, and preserve the public health, safert and welfare through legislation
Control registered professional nursing education and practice
Ensure that any person practicing, offering to practice or using the title registered professional nurse shall be licensed
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Overseer of registered professional nursing (maintains membership in the national council of state boards of nursing NCLEX exam)
State Board of Nursing
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Roles of State Board of Nursing:
Sole professional nursing licensing board
Enforce qualifications and license qualified applicants
Develop and set standards
Approve/Disapprove education programs
Regulate advanced practices
Implement disciplinary process
Provide education and practice consultation
Determine fees
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Process to accomplish organizational goals; Art of getting things done through people
Management
Directing, Coordinating, and Influencing the operation of an organization to obtain desired result and enhance the total organization performance
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Management is the process of:
*reaching organizational goals by working with and through people and other organizational resources
*planning, organizing, leading and controlling the work of organization members
*using all available organizational resources to reach stated organizational goals.
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Key Elements of Nursing Management:
High-quality health services (require skilled management)
Higher Quality Patient Care
- Reduced Patient Complaints
- (there is a direct coorelation between high-quality management and leadership and outcomes)
Management Framework (could provide consistent approach to management development for all health professionals)
Management skills (considered priority for staff development)
Leaders (rise out of need to improve situations)
Managers (take over the day-to-day functions required to sustain the improvement of patient outcomes)
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Management Key Element: provides consistent approach to management development for all health professionals
Management Framework
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Management Key Element: Should be considered priority for staff development
Management Skills
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Management Key Element: rise out of need to improve situation
Leaders
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Management Key Element: Take over Day-to-Day functions required to sustain the improvement of patient outcomes
Managers
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Type of Leadership: Holds on to as much power and decision making process as possible
Authoritarian
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Focus of Power in Authoritarian:
The Manager
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Communication in authoritarian leadership
Top-down; One-way
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Consultation in Authoritarian leadership:
Minimal consultation
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Benefits of authoritarian leadership:
Uses rewards/penalties
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Delegation in an authoritarian leadership:
VERY LITTLE delegation
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Typical result from authoritarian leadership style:
Unskilled subordinates and/or not trusted and the leader's ideas are not valued
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Type of leadership in which the leader decides what is best for employees
Paternalistic
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Focus of power in Paternalistic leadership/ Results when used:
Softer form of authoritarian leadership; which often results in better employee motivation and lower staff turnover
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Communication style of Paternalistic leadership
A kin to parent/child relationship...the leader is seen as mother/father figure
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Delegation in paternalistic leadership style
little delegation
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Consultation during paternalistic leadership
Minimal, Explains the specific reason as to why they have taken certain actions
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Type of leadership in which the focus of power is more with the group as a whole- (MOST POPULAR STYLE of leadership)
Democratic
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Focus of power within democratic leadership:
Shared within the group
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Communication within democratic leadership style
Employees have greater involvement in decision-making with potentially slow-down decision making
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Consultation/Delegation of Democratic leadership:
Emphasis on delegation and consultation with the leader having the final say
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Benefits to a democratic leadership style
Positive emotional connotations of acting democratically; potential trade-off between speed of decision-making and better motivation and morale
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Results from Democratic leadership style:
Skilled, free-thinking and experienced subordinates
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"Leave Alone" type of leadership style
Laissez-Faire
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Focus of Power in Laissez-Faire
Conscious decision to delegate power (leader has little input in day-to-day decision making)
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Consultation in Laissez-fair leadership:
Managers/employees have freedom to do what they think is best
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Delegation in laissez-faire leadership:
Often criticized for resulting in poor role definition for managers
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Results of Laissez-Faire leadership:
Staff are ready, willing, and motivated to take on responsibility; can be trusted to do their jobs
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____ is NOT the same as abdication (handing over)
Laissez-Faire
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____ leaders direct and control all activities without meaningful participation by other members of the team
authoritarian
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___ leaders encourage group members to participate, but retain the final say over the decision-making process
Participative
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___ leaders give little or no guidance to group members
Delagative or Laissez-Faire
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There is no ____ to leadership
One Right Style
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The leadership style being used depends on ____
The needs of the person you are leading and the needs of the environment
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Stable environment + Inexperienced subordinate
Participative leadership
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Stable environment + capable subordinate =
Participative
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Stable environment + Expert Subordinate
Delegative
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High growing or changing environment + Inexperienced Subordinate =
Authoritarian
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High growing/changing environment + capable subordinate =
Participative
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High growing/Changing environment + expert subordinate =
Participative
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Environment in crisis + Inexperienced subordinate =
Authoritarian
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Environment in Crisis + Capable Subordinate =
Authoritarian
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Environmental Crisis + Expert subordinate =
Participative
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6 leadership styles: (Goleman)
Commanding- do what I tell you (crisis)
Visionary- come with me (clear/new direction needed)
Affiliative- people come first (motivate people)
Democratic- what do you think (get input)
- Pacesetting- do as I do, now (quick results)
- Coaching- try this (help employee improve)
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Overall impact of commanding leadership
Negative
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Overall impact of visionary leadership
Strongly positive
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Overall Impact of Affiliative leadership
positive
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Overall impact of democratic leadership
Positive
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Overall impact of pacesetting leadership
Negative
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Overall impact of coaching leadership
Positive
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Time management tips:
Plan day in advance!
Focus on the most important activities first
Don't let interruptions disrupt your day
Keep yourself and workspace organized
Learn to delegate tasks
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Ways to plan your day in advance:
Planning makes tasks manageable
List everything you must get done and make a note of how long it will take
Rank the jobs in order of importance
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Key to delegation:
Patient safety and personnel competency are key
RN must complete thorough assessment of the total clinical situation
The personnel receiving the delegated task may not reassign the task to someone else (only RN can delegate...not the tech)
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Circle of delegation
- RN assesses
- Delegate Task
- Accountability for delegation is on RN
- Practice Setting
- Patient
(Right task, right person, right directions/monitoring/communication, right supervision/evaluation, right circumstance)
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Example of delegation in "right circumstance"
A tech/unlicensed personnel will not be able to take vital signs during a code
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To delegate to the right person:
Make sure they have the knowledge base and skills to perform the duty
Talk to personnel regarding their competency
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____ is ultimately responsible for task completion after delegation (must evaluate the safety and efficacy of the assigned task)
RN
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Goal of delegation safety:
Give the right task under the right circumstance to the right person
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Steps to assessing and planning out day/delegation:
Needs and condition of patients
Level of clinical decision making/assessment needed
Predictability of the patient's response to care
Potential for adverse outcomes associated with tasks
Cognitive and technical abilities needed to perform tasks
Team member with scope of practice, skills, competencies and experience to perform the task
Context of the situation and the environment (new admit or high acuity)
Level of interaction/communication needed in care of the patient and with whom?
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Goal of communication in delegation:
Give the right direction
- -how is the task to be accomplished?
- -when and what info should be reported?
- -what is the process for seeking clarification about delegated care?
- -what are the communication expectations in emergency situations?
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What needs to be assessed/implemented in supervision during delegation:
Level of supervision/observation needed
Frequency of monitoring/observing care
Verification/documentation of completion of care
Management of unexpected changes in a patient's condition
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Goal of observation/feedback during delegation:
Assess the effectiveness of delegation
- -was the delegation successful
- -is there a better way to meet needs?
- -is there need to adjust the plan of care?
- -were there learning moments for staff/nurse?
- -was appropriate feedback and follow-up care provided?
- -was positive feedback given when appropriate?
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Patient Care and Medications: RN vs LPN
- RN-
- unlimited even though specialized training may be necessary for some areas (ie: chemotherapy); establish/contribute to patient care plans
- LPN:
- -limited under supervision of RN/physician;
- -frequently oral meds and IM/Subcu injections only
- -carry out patient care plans (monitor v/s, IVs, catheters, dressing changes, basic assessments)
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