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Fundamentals - Ch. 10 Delegation, Leadership, and Management
Terms in this set (50)
The Chain of Commands
Learn the organizational structure of your facility; know the chain of command for your area. (Who is your supervisor? To whom does you supervisor report? To whom should you report changes in patient? Whom is in charge of scheduling your hours? Who should you call if you cannot make it to work?)
a permissive leader, does not attempt to control the team and offers little if any direction.
the authoritarian leader, tightly controls team members. The leader closely supervises the work of each staff member, and when mistakes are made they are quickly pointed out.
consults with staff members and seeks participation in decision making; this leader is a part of the team, not above it, and accepts responsibility for the team's actions.
working together; essential for patient care. As an LPN, you will be expected to work with other members of the health care team.
unlicensed assistive personnel; includes unit secretaries, nursing assistants, homemaking aides, housekeeping personnel, technicians.
To collaborate with UAPs, you must learn to..
delegate tasks appropriately and effectively
a good grasp of management techniques, effective communication skills, clinical competence, knowledge of the agency's organizational's structure, and an understanding of yourself and communication style on others
Keys to effective leadership
clinical competence and confidence
Communicating in direct, concise terms in a tactful, friendly, nonthreatening way is essential to create a supportive and healthy ________________ ____________________.
a connection between two people; showing care and concern for team members will develop positive interpersonal relationships that promote team cooperation
When assigning tasks,
be specific about what is to be done and when task is to be completed.
in the manner you prefer to be treated
settle differences, by communicating openly
resolving a conflict; chose the option that offers the best outcome
must demonstrate being well qualified (in your nursing skills)
belief in yourself (in the ability to perform those skills is essential to gain the respect of the other team members)
pride in yourself (to readily admit when a mistake was made or you don't know something). Announcing "I don't know, but I will find out" is the best way to handle these situations.
Being a leader requires good organization. Plan each day carefully; the plan should have some built-in flexibility for unforeseen events. Decision-making ability is needed to quickly divide up patients and assign tasks.
LPN transfers authority to perform a nursing duty in a selected patient situation; you are, in essence, "sharing" power with your UAPs.
You are accountable
(must answer) for the tasks you delegate, if in fact you are permitted by to delegate.
Competencies of UAP must be -
documented before tasks are delegated to them. This requires evidence of a training program and written evidence by a qualified nurse or instructor that the person has demonstrated competence in that task/skill.
Must be familiar with state's nurse practice act. Assessment or aspects of the analysis, planning, or evaluation phases of the nursing process must be performed by the registered nurse (RN) -- these tasks can cannot be delegated to UAPs. Also interventions that require professional judgements should not be delegated.
Cannot delegate when a patient is unstable or has a mental status change.
What is the goal and purpose of delegation?
Nurses delegate to complete more work in the same time frame. However, delegated work must be done safely, correctly, and cost effectively.
What does effective delegation include?
Feedback on how the task was performed. Give praise where it is due; share favorable comments from patients about the UAP's work and interactions. If the delegated task did not go well, communicate what went wrong in a supportive manner. Provide privacy before giving criticism. Be tactful.
Begin by tactfully acknowledging feelings or expressing empathy.
Beginning Leadership Roles
Initially, new LPNs will perform leadership functions with UAPs. Later on, team leading may be required.
Advanced Leadership Roles
Charge nurse. Some training and experience in nursing administration and preparation in a specialized area in many states & responsible for total nursing care of patient on the unit during the shift
The Charge Nurse
is the manager's designee and has the manager's authority for the shift; has ability to recognize significant changes in patient condition and to take necessary action is a primary quality.
Management skills for the LPN
Use a computer
Place phone calls to physicians and families
Process verbal orders
Documentation for reimbursement
An LPN working in a home care agency may be asked to assign and supervise nursing assistants and home health aides, including making pt care assignments, assisting with orientation and evaluation, verifying that paperwork ensuring reimbursement is correctly completed, and giving and receiving reports on assigned patients
Make a "to-do" list before the shift begins
(list 1 or 2 broad goals for the day)
List depends on where tasks are accomplished
-Clinic, hospital ward, home health, skilled nursing, facility, physician's office
Before making rounds, devise a time schedule for the work of the shift
At the end of the workday, evaluate the effectiveness of your time management
Documentation is a critical task in all settings and must be considered a ____________________________________________________________________________.
critical task in all settings and must be considered a priority to be done as soon as possible when organizing to accomplish the daily workload.
Nurses use computers to:
place orders to the various departments (supplies, medications, diets, laboratory, and diagnostic tests, engineering and housekeeping needs), schedule surgery, construct nursing care plans, track patient acuity levels, obtain lab levels
Receiving written orders:
When receiving written orders, first read all of the orders out. Write STAT orders first, verbally tell them to the nurse responsible for carrying them out. Transfer the orders to the Kardex and MAR. Check each off after transferred.
Signing off on doctor's order
red line across the page under the physician'c signature, and your first initial, last name, and official designation, or according to agency policy. (refer to notes)
All orders written preoperatively are considered _____________ at the time the patient enters surgery.
The Joint Commission _______________verbal and telephone orders unless ______________ necessary because they can be __________ unless _____________ ______________ are followed.
discourages ; absolutely ; specific ; guidelines
What Computer Assisting Method does the Joint Commission prefer?
Why can verbal or telephone orders be unsafe?
The individual giving the order can misspeak, and the individual hearing the order can mishear, misunderstand, or misinterpret the order due to numerous factors such as distractions, background noise, different pronunciations or accents or cell phone noise.
If implementation of an order is time critical and the physician is not available in person, then
a telephone order may be the most appropriate and efficient way to provide expedient care to patient.
Where is the nurse expected to write telephone or verbal orders?
The nurse is expected to write the orders in the chart for the physician to sign later.
Verbal orders can only be taken by
licensed nurses, and in some states on by an RN.
What type of form will the nurse use for a verbal or telephone order?
physician's order sheet; the nurse will mark "V.O." (verbal order) or "T.O." (telephone order) with the date, time, first initial, last name, and professional designation. The physician must sign the written form of the verbal order as soon as possible (this must be done in 48 hours in most agencies).
Documentation for Reimbursement:
All nurses must document care delivered and equipment used for a patient; otherwise the hospital may not be reimbursed. Reimbursement rates depend on documentation. A charge nurse or supervisor makes certain the all staff are documenting correctly.
Documentation for Reimbursement in LTC facility:
the minimum data set (MDS) must be filled in as accurately as possible for the facility to receive the maximum Medicare or Medicaid payment for services rendered
Many facilities use a special minimum data set coordinator to ensure that these multiple page forms are filled in correctly. Poor documentation may lead to
fines imposed by the U.S. Department of Health and Human Services, as well as decreased reimbursement.
is the attempt to decrease patient harm, occurrence of lawsuits, or excessive damage awards by juries; attempt to prevent unfavorable events or to reduce the agency's liability.
A key tool of risk management
is practicing according to the agency's policy and procedure manual
Attending to patients complaints and showing concern when patients are upset can help
decrease the risk of a patient suing if something goes wrong