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Arts and Humanities
Nclex delegation, LEADERSHIP KAPLAN (NR 422)
Terms in this set (269)
What things should an RN never delegate?
TIA= Teaching, Interventions, and Assessments
What types of activities should a nurse delegate to NAs?
Standard unchanging procedures and Stable patients only.
Always ask, which patient will die 1st.
What are the rules to remember when delegating to NAs?
Chronic stable patient only.
Assigned tasks defiened in procedures
Can take VS on stable patients and 1/2 hour after blood is started.
NO delegation of tasks where medical knowledge is necessary or required
WATCH KEY WORDS AND STAY AWAY FROM: (show,explain, monitor, teach, check, assess, and demonstrate=NO),
Can walk stable patients, reorient/co-conduct .
NO TO NA :
Assessments including VS on new admits
Feeding choking risk patients
Drugs (even OTC topicals), teaching, chest tubes, art lines, trachs, endo tubes, contagious diseases, or vents.
What are the rules to remember when delegating to an LPN?
HOSPITAL: An LPN works under direct supervision of an RN. IN a nursing home they might be charge nurses and handle all aspects of care.
EX: plan, assess, evaluate, intervene and notify Dr.
GET IN HOSPITAL
Assign: stable chronic conditions with predictable outcomes .(Pts 24 hours after surgery).
NO: discharge planning, admission assessments (including VS).
NO IVs, and NO teaching. CAN: give narcotics.
HAVE patient 72 hours after MI, CVA, SCI (spinal cord injury), Vents, or low coma scale (after 1 week), and may reinforce teaching.
What is the memonic for remembering who to see first (prioritizing patients)?
FIRST= Find hypoxia (oxygenation first-anxiousness and cardiac patient).
Immunocompromised (prevent infection).
Rectal bleeding (hemorrhaging from major artery otherwise don't care- VS changes)
Safety, and Try Infection (Ex: septic and high temperature, need to take blood culture before start the antibiotics).
What are the rules for prioritizing patients?
Acute problems more serious than chronic.
<24 hrs post op= more serious than medical conditions/older surgeries.
Unstable patient more serious (ACUTE) than stable, when in doubt Select the more vital organ (heart or lungs over toes, fingers and legs).
What patients are prioritizing-----life threatening
RLQ (appendix) pain, LLQ (diverticulosis) pain, mid epigastric pain (preg-seizure), spinal cord injury above T6, child drooling (epiglotitis), central line with SOB, compartment syndrome (pain not relieved by drugs/cast or crushing injury c swelling), muffled heart sounds (cardiac tamponade), taking nitro within 1 week of MI (may be another MI), Femur/Pelvis fx c S&S of fat emboli, enlarged veins on Abd (portal HTN), DVT/PE, Immunocompromised pt with nonproductive cough (PCP) or temp, restlessness, abnormal electrolytes, progressive neurological diseases, burns c smoke inhalation, withdrawal symptoms of drugs/alcohol, angina c indigestion=MI, neuroleptic malignant syndrome, toxic levels of medication, and Spinal cord injury (SCI) c autonomic dysreflexia (crazy high BP).
What patients are NOT a priority?
RUQ (gallbladder) pain, Pain in the(CVA) costovertebral angle= (kidney stones), head trauma, bleeding, pain butt to ankle (sciatica), straining to urinate with bloody urine, menieres disease (these people always dizzy), chronic conditions, COPD, cystic fibrosis, laprascopy c chest or shoulder pain, Paperwork (document wait end of shift), calling doctor, teaching, bleeding, high or low BS, Poop, FXs, obtaining lab studies, and Pain.
What causes a non priority patient to become priority if it exits ?
Head trauma with INCREASED ICP, Bleeding FROM MAJOR ARTERY, Increased (blood sugar)BS IN COMA, decreased BS C S&S OF SHOCK, Paperwork FOR PREOP CHECKLIST, Poop FROM AN SCI ABOVE T6 OR APPENDICITIS (STRAIN AND RUPTURE), lab studies- ABGs, chronic conditions C ACUTE LIFE THREATENING PROBLEM.
Angina c decreased LOC, decreased cardiac output = decreased urine output, arrhythmia, dizziness/faint
PAIN- BACK PAIN : abdominal aortic aneurysm, RLQ: appendicitis, (RLQ with rebound tendernessand rigidity over the right rectus muscle or McBurney's point) ectopic pregnancy, or back pain with blood transfusions, .
In what order should patients be removed in the event of a disaster?
ABC= Ambulatory, bed ridden, and critical care patients.
What is the memonic to help you prioritize steps in the event of a fire?
RACE= Remove, Activate, Contain, and Extinguish.
Remove the client, Activate the fire alarm, confine the fire and extinguish the fire).
What is the memonic to remember how to use the fire extinguisher?
PASS= Pull Pin, Aim, Squeeze, and Sweep
What is important to remember with room assignments?
RISK= Radiation (isolation), Infection/Immunocompromised/Isolation, Safety/Sex, and Know growth and development.
If older than 6= must have a same sex roommate and must be both children have the same disease( example: one child has a fractured femur and another child with a fracture or a post-procedure with no infection = best room placement.
HOWEVER, there is another 6 years old child but the child has an infection, this would not be an appropriate roomate for the child due to the risk of transmitting the infection.
With which conditions are airborne precautions important?
TB, varicella, or measles.
With which conditions are droplet precautions important?
Neisseria meningitis, mycoplasma pneumonia, strep group A, or pertussis.
WHAT IS THE MEMONIC TO REMEMBER THE PROPER TRIAGE PRIORITIES? (NEED TO KNOW WHO TO HELP!)
TRIAGE= Trauma-no internal injuries (breathing, bleeding, broken bones, burns), Respiratory (1st)/ Cardiac (2nd), ICP (Head trauma, LOC/seizure-airway or numerous head and facial abrasions and lacerations), AN Infection (septic shock).
NOT MPORTANT: meaning not priority
GI (bleed, pain, and distention-not impt),
Elimination- (pyelonephritis or trouble voiding) these client should be triaged.
What should be done if someone is brought in with fixed and dilated pupils, not breathing and no heart rate present?
Nothing they are dead so go to the next person.
What should you be concerned about first with someone who experienced burns?
Airway and breathing bc if they were close enough to get burned they were close enough to inhale smoke.
What should be done if someone presents with dilated pupils and decreased LOC?
They probably have increased ICP so sit them up to help decrease the pressure.
What two things should you use to help determine appropriate delegation tasks for a UAP?
Their ability and demonstration of the task.
Who should ambulate a newly admitted post-op/acutely ill patient?
Who should ambulate a one day P/O patient?
An LPN or an NA
Who should ambulate a stable medical & surgical patient?
Who should ambulate an acutely ill, chronic condition patient?
Who should evaluate an initial post op patient's pain?
Who should evaluate a patients pain after a narcotic?
An RN or LPN
Who should establish a patient's initial plan of care?
Who should up date a patient's plan of care?
An RN or LPN
Who should manage a patient's on a vent for the first week (acute)?
Who should manage a patient on a vent after a week (chronic/stable)?
Who should manage IVs for regular infusions, TPN, ABX, and drips?
The RN (LPN or NA should never manage IVs)
Who should take care of an SCI patient during their first week (acute)?
Who should take care of an SCI after a week (chronic/stable)?
Who should transcribe orders?
Who should complete sterile procedures?
An RN or LPN
Who should teach self injections, dressing changes, or diets (except DM and CRF)?
Who should change sheets, get water for, enemas, stool spec/I&O for stable patients?
Who should transport a patient to an area within the hospital?
Who should feed a person with chronic parkinson's?
Who should feed a patient with an acute CVA?
Who should feed a patient with a chronic CVA?
Who should feed a new trach patient?
Who should feed a stable trach patient on a vent?
Who should do an assessment on a new admit and new P/O patient?
Who should do an assessment on a stable acute patient?
Who should do an assessment on a stable chronic patient?
Who should take care of patients with airborne, droplet, or contact precautions?
Who should administer medications?
An RN or LPN (no IVs)
Who should do the steps of the nursing process (assess, plan, interventions, outcomes)?
RNs should delegate to what level of a person's confidence? Based on?
Highest level of confidence and based on experience, training, and licensure.
What does it mean if the glucometer isn't giving a reading?
There isn't enough blood to get a reading.
What does it mean if a PCA pump isn't delivering medication to the patient?
The may be asking to often or not enough medication to control the pain.
What does it mean if the vent is beeping with a high pressure alarm?
The patient is causing problems (fighting the vent- holding breath,etc.).
What does it mean if the vent is beeping with a low pressure alarm?
There is a problem with the machine so get a new one and send the broken one to biomed engineering to have it fixed.
What does it mean if an O2 mask with a rebreather bag deflates during inspiration?
The bag should NEVER deflate so get new equipment.
What does it mean if there is no pulse ox reading?
It's on too fat of a finger or no light is seen through the finger. Put it on another location.
What does it mean if the pulse ox is not alarming when O2 is at 92%?
Check the alarm level settings. May be too low and need readjusted.
What does it mean if the pulse ox read 100% but patient is restless?
Patient may have been exposed to carbon monoxide.
What should be done if an IV pump (IVAC) set to run 1 liter of fluid at 150 ml/hr after 6 hours there is 200 ml left in the bag?
Send to biomed engineering and obtain another pump.
What does it mean if the doppler isn't reading?
Patient may not have pulses
What does it mean if the bladder scanner doesn't produce a reading?
Bladder is empty
What does it mean if there is continuous bubbling in the H20 seal chamber of a chest tube?
There is an air leak so a new Plurovac should be used.
What should be done if there is no drainage from an NG tube?
Reposition patient or tube
What does it mean if the patient with an NG tube complains of N&V?
NG may be occluded so irrigate.
What should be done if a peritoneal dialysis machine (CAPD) shows 2000 ml in and 1500 ml cloudy output?
Reposition patient and call MD.
What should be done if the pyxis doesn't deliver a stat medication?
Filled Q24 hours so call the pharmacy for the med.
What should be done if a cooling blanket is on a patient with a temp of 38 C (100.4 F), then after three hours their temp is 102F?
Send to biomed engineering and obtain a new cooling blanket.
What should be done if a pressure ulcer vacuum device has no suction?
Check to see if the tape is loose.
What should be done if an Oto thermometer isn't registering?
Check charge or send to biomed engineering and obtain new.
What does it mean if a patients pacemaker is set at 75 and the patients rate is 80?
It OK and working fine. The patients heart can do better than the pacemaker just no worse!
What does it mean if the patients pacemaker is set at 75 and the patient's rate is 60?
It is defective and the MD should see the patient.
What should be done if staff turns of alarms on equipment?
What should be done if staff uses extension cords for equipment?
What should be done if staff applies restraints to a patient to keep them from falling or wandering?
What should be done if staff doesn't recognize false imprisonment such as gerichair c tray, not allowing patient to leave w/o MD orders, or anything preventing freedom to move about?
What should be done if staff breaches confidentiality (taking in public areas, giving D/C instructions with others in room, teaching with family in room, calling support groups w/o pt permission?
MORE EDUCATION. NURSE MANAGER OFFICE IS NOT OPEN TO THE GENERAL PUBLIC (=safe place to discuss).
Who does an interdisciplinary team consist of?
MD, RN, PT, Social worker, etc.
For whom does the interdisciplinary team meet?
For those with chronic non compliance issues (Ex: sickle cell admitted 3x for crisis, DM admitted for hyperglycemia, celiac not gaining weight, asthma admitted for bronchospasms several times a year).
What types of conditions doesn't the interdisciplinary team not meet for?
Chronic stable conditions that are compliant and/or resolved by surgery or medical management (Ex: Pyloric stenosis, cleft lip, nephritis, glomerulonephritis, multiple fx after MVA, and acute leukemia on chemo).
What should be taught regarding home safety?
Bikes & skateboards should not be ridden in the street, guns should not be in homes with children even if they are locked up, <1 year old=sit in back seat facing backward >1 yr & <12 yrs= sit in back seat facing forward, home oxygen should be kept away from flames (stove, fireplace, no wool blankets, and no smoking- the smoke itself won't cause an explosion).
Who is at risk for falling blind/deaf patients or those with canes/walkers/or small animals?
Those with canes/walkers/small animals (geriatrics) are at risk for falling.
What should be done if someone is pulling out their IVs?
Put a mitten on them (least restrictive).
Who should an NA never position?
Total Hip replacement, total knee replacement, Increased ICP, acute CVA, or Above knee/below knee amputations.
What should be your response to Non-patient/non-medical issues that arise?
Tell direct supervisor (Ex: staff eating off of patient's trays).
What should be your response when a patient will be harmed d/t lack of intervention?
Intervene immediately and do procedure correctly. (Ex: Staff contaminating foley).
What should be your response if a staff members action is incorrect but will not harm the patient?
Wait until they are finished then teach the correct procedure to them.
If there is a problem that requires immediate attention when should you call the doctor?
After you have initiated an ACTIVE INTERVENTION. If it is serious enough to call the Dr. then need something to keep them alive until Dr. gets there.
What should be included in change of shift report?
Changes in condition, new medications, complications, diagnostic procedures, treatments (lasix for crackles, etc.)
Which of these is within the RN scope of practice? Starting IVs, Isolation placement, Problem w/NGs, and Room assignments.
All are within the RN scope of practice.
What three things should the Dr. be called for?
Acute epiglottitis, back pain (Abdominal Aortic Aneurysm (triple A)), and Eye Pain (glaucoma or cataract surgery). Only call MD for abnormal situations not what is expected.
What is important to remember about prioritizing in the ER?
It won't be the obvious answer and don't be swayed by adjectives.
What should pregnant nurses avoid?
5th disease (slapface/Parovirus), measles, varicella, internal radiation, isotopes, and chemo drug handing.
What information do you need to know prior to starting your shift?
Blood sugars, pre-ops, post-ops, change of condition on last shift, and new admits.
What is important to know about evaluating a treatment?
All drugs/tx are used to bring a pt back to normal. A successful tx will always reverse the presenting signs and symptoms (ask why treatment initiated).
How are patients on the psych ward prioritized?
1st: Physiological, 2nd: Change in psych behavior, 3rd: Safety
Who should floaters be assigned to?
To patients with a condition similar to what they would see on their own floor, and most stable person possible, NEVER cardiac patients or borderline/antisocial patients (will eat them up bc so manipulative).
What kinds of patients could be assigned to an OB float nurse?
Closed abdominal surgeries, HTN, DM, Epidurals, and IV drips. If cardiac maybe telemetry bc similar.
What kinds of patients could be assigned to a medical surgical float nurse?
DM, DVT, HTN, SURGERIES, CHRONIC CONDITIONS, AND SEIZURES.
What types of patients should never be transferred from the OB floor to the med surg floor?
Moms c babies, in labor, or c complications
What patients are immunocompromised?
HIV, cancer, chemo, steroids, organ transplants, cushings, addisons, and radiation.
What kills the immunocompromised patients?
Infection, live viruses (oral polio or varicella), Pneumocystis Carnii Pneumonia (PCP) (danger to immcprd pts only).
What are examples of progressive neurological diseases? What kind of death do they suffer from?
Multiple Sclerosis, Amynotrophic lateral Sclerosis (ALS), Parkinsons, Huntingtons Chorea, Gullian Barre Syndrome, Myasthenia Gravis, and Scleroderma (hardening). THEY DIET A RESPIRATORY DEATH.
What are interventions for a patient with a progressive neurological disease who may have respiratory problems as a result?
Use peak flow meter, get advanced directive, mechanical soft diet, and thickened liquids.
What should be done for effective infection control?
ID type of precautions required (airborne, droplet, contact, or standard), put infected patients in private rooms or with patient c same organism, airborne in private room with negative pressure (TB), Droplet (mask within 3 feet), contact (gown & gloves), and infected patients can leave room as long as wear same PPE out of room as ppl wear going into the room.
Who should be isolated?
Pt with night sweats/temp/ and cough (TB), Pt with HA and stiff neck (meningitis), adult patient with rash or blisters (shingles), and any patient showing S&S of infection (increased temp, rash, increased WBCs) until verified. Follow CDC guidelines.
What type of patient should be discharged during an emergency?
Select patient with stable chronic condition. DO NOT discharge acute surgical patients. Pressure ulcers are considered chronic.
What should be done 1st and 2nd if the event of a med error, pt injury, or attempted suicide?
1st provide care, and 2nd notify MD.
What meds/herbs should you make sure to ask patients if they are taking (so can implement bleeding precautions)?
NSAIDS, ASA, Heparin, Coumadin, Garlic, Ginkgo, Ginseng, and Vitamin E.
What patients are on bleeding precautions?
On coumadin/heparin, hemophilia, problems with bone marrow, chemo, liver disease, HIV, DIC, ASA/NSAIDS, and Cancer.
Patients on/with what should never be sent to surgery?
ANTICOAGULATED PATIENTS: With low platelets, high PT or PTT, or on coumadin/heparin.
What should be given to a patient on coumadin before they have surgery? When should it be given?
Aqua Mephyton (Vitamin K) is needed b4 surgery for someone on coumadin so they don't bleed out (it helps coagulation). If it is D/C 24 hours before they may still bleed because it's not long enough prior to surgery so Vit K will help.
What needs to be done prior to transferring patient to another unit?
Receiving unit must be familiar with the disease/treatment, be alert for gender specific wards (OB), don't transfer (unstable pts, unknown diagnosis pts, or pt whose condition is made worse with stress (addisons, lupus, RA, raynauds, asthma, etc.).
What adults should be transferred to the Peds ward if necessary?
Adult with condition/tx similar to that which is seen in the pediatric population. (COPD is like cystic fibrosis, pneumonia is pneumonia).
How should Peds patients be transferred to the Med Surg floor?
Oldest child 1st, No communicable diseases, Not immunocompromised, and No teaching needed.
What conditions require seizure precautions?
Cirrhosis encephalopathy, PIH (HTN), DTs, ICP, CVA, Meningitis, Brain surgery, and Head trauma.
What interventions are needed to prevent aspiration?
HOB elevated to eat, bed in low position, place on right side after eating, call bell in reach, suction available, and side rails elevated.
What are the 2 general rules for vaccines?
No vaccine given if pt temp > 101 or on an antibiotic.
What is given to anyone with acute exposure to any infection or enlarged lymph nodes?
What should be done for pain and discomfort?
Avoid drugs, use nursing interventions (positioning, heat, etc.), when in doubt flush the patient out.
What is contraindicated with an allergy to egg?
MMR and flu shot
What is contraindicated with an allergy to iodine/shellfish?
Diagnostic test with dye/ cleaning solution for foleys/surgery.
What is contraindicated with an allergy to yeast?
Hepatitis B vaccine
What is contraindicated with an allergy to bananas, kiwi, chesnuts, an avocado?
What should you NEVER Massage?
Veins, Z-track, Pressure ulcers, SQ heparin, Wilm's tumor, and intradural (PPD TB test).
For what things should you use massage?
To decrease PAD pain, claudication (pain with walking) and increase circulation= increased O2 and decreased pain, prevent hemorrhage after delivery, decrease neuropathy, after bleeding stop hemophiliac.
What procedures are done sterile in the home?
IVs, dressings, and peritoneal dialysis.
What procedures are done non-sterile in the home?
Foley catheter, trach suctioning, insulin, injections, intermittent, and suprapublic catheters.
RULES TO WATCH THE PATIENT WHEN THE PATIENT HAVE SERIOUS PROBLEMS
Anytime a forgien object inserted into the body the complication may be rupture of the organ.
Cold/ Dehydrated baby is the DEAD BABY.
Drunks and druggies commit SUICIDE
Never discharge a WHEEZER
watch for MUSCLE and WEAKNESS.
A PATIENT WITH GLAUCOMA IS TREATED WITH MANNITOL?
DIAMOX is used for glaucoma patient to decrease aqueous humor.
But here mannitol used for PAIN (eye).
MISC: FACTS ON PSYCH WARD
SUICIDE: highest in patient with drinkand /or take drugs.
ALWAYS bring the patient back to reality
--- avoid selecting answers that advise----giving meds or using restrains
When choosing nursing intervention for patient problems------STAY AWAY FROM CRY BABIES.
STRESS RELATED CONDITION PATIENT
Multiple sclerosis (MS), Lupus, psoriasis
Addison, Rheumatoid arthritis, Rayanuds
Crohn's and asthma
These patient need relaxation technoques:
Meditation, quite environment, imagery, music, breathing exercise and regular exercise.
FLOATERS (NRSES WHO FLOAT FROM THE OTHER UNITS)
Assign the float nurse a condition they would see their own ward.
Give them the most stable patients.
Float nurses NEVER get Cardiac pts, Borderline/ Antisocial
RULE: ASSIGN OB FLOAT NURSE (telemetery)
1. Closed abdominal surgeries
3. Diabetes Mellitus
5. IV drips
RULE: MED SURGE ASSIGN MED SURGE FLOAT NURSE
1. Diabetes mellitus
2. DVT( deep vein thrombosis)
WHAT IS THE MEANING OF PHYSIOLOGICAL SIGN IN PSYCH PATIENT
.Anxiety (also called angst or worry) is a psychological and physiological sign and also including vital signs of the patient...
3 Levels of Power
6 Sources of Power
1. Expert Power
derived from knowledge and skills
2. Legitimate Power
derived from the position
a nurse holds in a group
3. Referent Power
derived from how much others respect and like
any individual, group, or organization.
4. Reward Power
derived from the ability to reward others
to influence them to change their behavior.
5. Connection Power
derived from the extent in which nurses are connected with others
6. Information Power
derived from the ability to influence others with the information
they can provide.
increasing the capacity of individuals or groups to make quality choices on their own
and to transform those choices into desired actions and outcomes.
Types of Change
Traditional Change Theories
A. Lewin's Force-Field Model
B. Lippitt's Phases of Change
C. Havelock's Six-Step Change Model
D. Rogers' Diffusion of Innovations Theory
E. Chaos Theory
F. Learning Organization Theory
-The current or old way of doing something is flawed
-The intervention or change is introduced and explained
-The new way of doing is incorporated into the routines or habits of the people affected
Phases of Change
of the problem
Assessment of capacity for change
Assessment of the change agent's
motivation and resources
of progressive change objectives
Choosing an appropriate role for the change agent
of the change once it has been started
Termination of the helping relationship
Six-Step Change Model
-Build a relationship, diagnose the problem, and acquire resources
-Choose the solution and gain acceptance
-Stabilization and self-renewal
Diffusion of Innovations Theory
Five-step innovation/decision-making process
-Awareness, interest, evaluation, trial, adoption
change can be rejected initially and adopted at a later time
-Believes change is reversible and initial rejection does not mean the change will never be adopted
-Belief that chaos is
random, but may have order
Order emerges through fluctuations and chaos
-Nurses and organizations must be able to organize and implement change quickly and forcefully
-Does not work well for linear change
Learning Organization Theory
-Emphasis is on interrelationships of all parts of the organization
Organizations respond to changes by using a learning approach
Focus on education
, communication, and cooperation among all parts of organization
The Change Process
-Planned change in the work environment is similar to planned change on a personal level
-Basic reasons to introduce change
-To plan change, one has to know what has to be changed
Steps in the Change Process
-Change embracers. Enjoy the challenge of change and often
Open and receptive to change
... but not obsessed with it.
-Enjoy and prefer the status quo but do not want to be left behind. They
adopt change before the average person
-Often known as the
adopt change after expressing negative feelings
and are often skeptics.
Last group to adopt to a change
. They prefer tradition and stability to innovation. They are somewhat suspicious of change.
oppose and reject change
. May be surreptitious or covert in their opposition. They may hinder the change process to the point of sabotage.
1) Power-coercive change
Do it or get out
-Based on power, authority, or control
-Believes that social
relationships are important
people will go along with a change if the social group sanctions it
-Belief that humans are rational people and
will use knowledge to embrace change
. Educate them and they will follow logical evidence for change.
Sources of conflict
-Allocation/availability of resources
-Differences in values
-Differences in goals
-Issues of personal/professional control
Types of Conflict
1) Intrapersonal Conflict
within the individual, usually when opposing values or differences in priority arise
within an individual
2) Interpersonal Conflict
-Source of disagreement is
between two people
or groups or work teams.
3) Organizational Conflict
-Often referred to as
. Competition for resources etc.
The Conflict Process
-Move disagreement to conflict level
Perceived and/or felt conflict
-Frustrations felt as a result of antecedent condition
-Responses result in resolution or suppression
-Smoothing or cooperating
One side gives in
to the other side
-The two or three sides are
forced to compete
for the goal, winner take all
-Each side gives up something
-High-level discussion that
Not necessarily consensus
-Both sides work together to develop rational and
(BEST CONFLICT RESOLUTION STRATEGY!)
Immediate movement to stop conflict at the very start
What is emphasis of a Manager?
What is the emphasis of a Leader?
How did Scientific management theory say employees should be paid?
By how much work they do
2 Theories of managers' thinking/POV
1. Theory X - people do not want to work (authoritarian/punishment)
2. Theory Y - work can be motivating (guide employees)
Which theory of managers' POV says that people do not want to work?
Which theory of managers' POV says that work can be motivating?
3 Qualities of an effective manager
2. Clinical expertise
3. Business sense
3 Types of behaviors of an effective manager
1. Interpersonal - relationships
2. Informational - communication
Ex of types of Interpersonal management behaviors (4)
2. Conflict resolution
3. employee development
Ex. of types of informational management behaviors(3)
Ex. of types of decisional management behaviors (7)
1. Resource allocation
3. Planning for future
4. Job analysis & redesign
5. Giving direction
7. Disturbance handling
Ex. of Leadership theories (3)
1. Great Man Theory
2. Trait Theory
3. Behavioral Theory (Lewin, White, Lippitt) 1940-1980
3 Leadership styles
Which leadership theory talks about this?
1. Authoritarian (aka Autocratic)
Which leadership style focuses on control
Authoritarian (aka autocratic)
Which leadership style focuses on participative management, teamwork, & guiding
Which leadership style is a lack of leadership
the ability to influence the behavior of others
traits of leaders: intelligence, initiative, creativity, and risk taking
-management of attention
-management of meaning
-management of self
-management of trust
focus on what the leader does
-Autocratic leadership: gives orders/makes decisions for group; efficient, but reduces creativity and team member motivation
-Democratic leadership: shared leadership, important plans and decisions are made as a team
-Laissez-Faire (permissive): does very little planning/decision making and minimal control
Explain task vs. Relationship
the most effective leader is able to balance interpersonal aspects of the job (attitudes) and the task at hand (administering meds) in order to succeed as a leader
Describe Motivational theories
It is more about the attention given to the workers than the condition of work
Explain Emotional Intelligence
leaders should understand his/her emotions, accept constructive criticism, and listens to others
involves deciding how one ought to remain honest, fair, and socially responsible under any circumstance
servant leaders (choose to serve first and lead second) and emotional intelligence (especially aware of their own feelings, as well as the feelings of others)
Name 11 Qualities of an effective leader
3. positive attitude,
9. balance, and
10. ability to handle stress, and
Getting work done through other; Doing what is needed to assist employees to work well
Scientific Management Theory
Efficiency-focused; Increasing productivity is the goal; Workflow and time to complete tasks is measured and evaluated
Human-Relations-Based Management Theory
X: Work is something to be avoided; People want to do as little work as possible; Use: Control, Supervision, and Punishment
Y: The work itself can be rewarding; People really want to do their job well; Support using: Guidance, Development, and Reward
Servant Leadership Theory
people have value as people (not just as workers); manager is committed to improve the way employees are treated at work; "employee first"
3 Qualities of an Effective Manager
2. clinical expertise,
3. business sense
DECIDE (Decision making model)
Define the problem
Consider all the alternatives
Identify the best alternatives
Develop and implement a plan of action
Evaluate and monitor the solution
Explain Delegation of Care
the reassigning of responsibilities for the performance of a job from one person to another; The responsibility of the task is transferred; Accountability remains with the delegator; Delegation may be direct or indirect
what is Direct Delegation
Usually verbal direction; RN decides which staff member is capable of performing a specific task.
what is Indirect Delegation
An approved listing of tasks established by an institution; Permitted tasks may vary from institution to institution
an individual hold authority over others; usually more direct than delegation; It requires directly overseeing the work or performance of others; It includes checking with individuals during the day; It may entail delegation of tasks and activities; The nurse manager performs both.
Nursing process of Delegation
Assessment (match skills of person assigned with the tasks needing to be done)
Plan (think it through to prevent later problems)
Implementation (assigning tasks to appropriate person)
Evaluation (nurse oversees care and decides whether needs were met; allow for feedback)
Unlicensed Assistive Personnel
Individuals trained to function in an assistive role to the nurse; Perform delegated tasks; Under direct supervision of the RN; May or may not be certified
Delegation to AP. What can they do?
Skills learned through special training
--> Blood drawing
Measuring intake and output
7 Components of Delegation Decision-making Grid
1. level of client acuity
2. level of unlicensed assistive personnel capability
3. level of licensed nurse capability
4. possibility for injury
5. number of times the skill has been performed by the unlicensed assistive personnel
6. level of decision making needed for activity
7. client's ability for self care
Factors Determining if Client Care Should be Delegated
1.) potential for harm
2.) complexity of nursing activity
3.) extent of problem solving and innovation required
4.) predictability of ourcome
5.) extent of interaction
Barriers to Delegation
-Experience: added responsibility of delegations creates discomfort for a lot of nurses
-Licensure: delegation is within a nurses scope of practice
-Quality of Care: people think they do things better themselves
-Assigning work to others: some nurses distrust others and feel they can do everything themselves 1
5 Rights of Delegation
1. Right task
2. Right circumstance
3. Right person
4. Right communication
5. Right supervision
Name 6 RN skills
2. IV meds
3. Blood admin
4. Planning care
5. Physician orders
Name some LPN skills
Some IV meds (depending on states)/PO meds
physical care (trach care, enteral feeding)
Name 6 Nursing AP skills
4. physical care
5. documentation of I&Os
-collecting, reporting, and assisting in collection of data
Name 5 things the nurse should NOT delegate:
1. admission assessments,
2. developing care plans, and
3. making nursing diagnoses
4. acute, unstable, complicated tasks,
5. tasks that require nursing judgement
Legal Issues with Delegation
RN remains legally responsible, RN is accountable, organization is liable for negligence, UAP cannot supervise another UAP, and UAP can not delegate
Rn's CAN delegate what?:
chronic, stable, uncomplicated/routine, and patients that do not require nursing judgement
7 things an LPN can NOT do
1. cannot do admission assessments
2. cannot give IV push meds
3. cannot write nursing diagnoses
4. cannot initiate teaching (can reinforce it)
5. annot do complex skills
6. cannot take care of clients with acute conditions
7. cannot take care of unstable clients
use "I" rather than "noone/everyone"; specific; private; be prepared
Written policies and procedures present in all health care organizations
Not written and not often discussed; "shadow" organization that is harder to see but important to recognize and understand; ex: call and let x-ray know that the patients are coming is an unwritten rule that they will get things done faster
the ability to influence other people despite their resistance
the power granted to an individual or group to control resources and decision making by virtue of position within the organizational hierarchy
the promise of money, goods, services, recognition, or other benefits
Threat of pain or some type of harm which may be physical, economical, or psychological
includes self-determination (freedom to decide how to do work), Meaning (caring about the work you do), Competence (confidence in ability), and impact (feeling that people listen to your ideas)
uses the power of numbers for a common cause, employee protection, and employee benefit
A process of influence in which the leader influences others toward goal achievement.
When a person in a position of authority or in a sanctioned, assigned role within an organization that connotes influence, such as a clinical nurse specialist.
An individual who demonstrates leadership outside the scope of a formal leadership role or as a member of a group rather than as the head or leader of the group. Considered to have emerged when they are accepted by others and are perceived to have influence.
___________________ is about creating change; establishing a direction, aligning people through empowerment, and motivating and inspiring them toward producing useful change and achieving the vision.
__________________________ is about controlling complexity in an effort to bring order and consistency. Planning and budgeting, organizing and staffing, problem solving, and controlling complexity to produce predictability and order.
4 Leadership Values
3 Fundamental Qualities of Effective Leaders
1. Guiding vision
3 leadership styles still recognized today
Explain Autocratic Leadership
Involves centralized decision making, with the leader making decisions and using power to command and control others. Associated with high-performing groups, but close supervision necessary, and feelings of hostility often present.
Explain Democratic Leadership
Is participatory, with authority delegated to others. To be influential, they use expert power and the power base afforded by having close, personal relationships. Engendered positive feelings in their groups, and performance was strong whether or not the leader was present.
Explain Laissez-Faire Leadership
is passive and permissive and the leader defers decision making. Associated with low productivity and feelings of frustration.
Effective leadership described as having focus on the human needs of subordinates
Seen as less effective leadership because of their focus on schedules, cost, and efficiency resulting in lack of attention to developing work groups and high performance goals.
Directive Style of Leadership
provides structure through direction and authority, with the leader focusing on the task and getting the job done
Experience may serve as a substitute for leadership. True or False?
Explain Servant Leadership
-1970's, Robert Greenleaf
-Wanting to put needs of others above all else as #1 priority
-Characteristics: listening, empathy, healing, awareness, persuasion, foresight, stewardship, growth, and building community
-Demotes self for the benefit of others
-Not a weak form of leadership
-Ex: Woody from Toy Story
Nurses are what kind or leader
A servant and a leader
3 ways nurses use knowledge
1. recognize even subtle changes in patient's conditions
2. anticipate patient care problems
3. intervene appropriately to minimize/avoid complications
-knowing what you are feeling in the moment and using your preferences to guide your decision making
-having a realistic assessment of your own abilities and a well grounded sense of self-confidence.
-Handling your emotions so that they facilitate rather than interfere with the task at hand
-Being conscientious and delaying gratification to peruse goals
-Recovering well from emotional distress
Using your deepest preferences to move and guide you toward your goals, to help you take initiative and strive to improve, and to persevere in the face of set backs and frustration
-Sensing what people are feeling
-Being able to take their perspectives
-Cultivating rapport and being in tune with a broad diversity of people.
influencing others to achieve the organization's goals and involves energizing, directing, and persuading others to achieve those goals
Comparing actual performance to a standard ad revising the original plan as needed to achieve the goals
The phenomena of being observed or studied, resulting in changes in behavior
-the idea that people increase their work output in the presence of others
Vroom's Expectancy Theory
-Centers around what people want and thier prospect of getting it.
-Can be demonstrated in the form of an equation. This theory proposes that this equation can help to predict the motivation, or force, of an individual to achieve a goal as negative, neutral, or positive.
-Has 3 variables that are subdivided into 3 indicators:
-Force, Valence, and Expectancy
What is Valence
-speaks to the level of attractiveness or unattractiveness of the goal
(+1= highly attractive, -1=highly unattractive, 0= goal does not interest the individual)
What is Expectancy
-the perceived possibility that that the goal can be achieved.
(1= assurance goals will be achieved, 0=individual sees the goal as impossible to achieve)
Vroom's Expectancy Equation
Force= Valence x Expectancy
VIctim of Change
Management is a process that is used today by nurses or nurse managers in health care organizations and is best described as
planning, organizing, coordinating, and controlling
A participative leadership style is appropriate for employees who____________________?
are able to contribute to decisions about getting the work done
If you applied the concepts of Theory Y to describe nurses, which of the following statements would be the best descriptions?
A. Nurses prefer to be directed and want job security more than other things
B. Nurses use self-direction and self-control to achieve work objectives in which they believe.
C. Nurses have a hard time accepting responsibility, but they learn this over time.
D. Nurses don't really want to work and would quit if they could.
B. Nurses use self-direction and self-control to achieve work objectives in which they believe
Consider your role as a staff nurse in a patient care unit of a hospital. What factors are present that may serve as a substitute for your need for leadership for your nurse manager?
Professional nursing standards, code of ethics, and the intrinsic reward you get from this important work.
Leadership is defined as
a process of interaction in which the leader influences others toward goal achievement.
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