rita carey-nita p&v section 4. health care team goal for the health care team 3 primary goal to...

RITA CAREY-NITA

P&V Section 4

Health Care Team

Goal for the Health Care Team3

Primary goal To restore optimal physical, emotional, and spiritual health Is accomplished by promoting health, preventing further

illness, and restoring health when illness or accident has occurred

Health care includes a large number of specialized services

It is impossible for one person to provide all the necessary knowledge, expertise, and skills

Good communication ensures that care is coordinated for the patient’s benefit

The Health Care Team: Nursing Personnel

Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.

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Nursing staff on the acute health care team Unit managers Registered nurses (RNs) Licensed practical/Vocational nurses (LPNs) Student nurses Nursing assistants (CNAs) Support staff

Nursing Personnel: RN


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Registered Nurses Associate degree (ADN) program

2-year educational programDiploma program

3-year educational programBaccalaureate nursing program

4-year educational program



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Role of Registered NursesFunction independently in nursingPlan careCoordinate all the activities of careProvide care that requires more

specialized knowledge and judgmentTeach patients, families, and other

members of the health care teamAct as patient advocate



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RN postgraduate educationalopportunities BSN completion programCertificationAdvanced practice registered nurse

(clinical nurse specialist, nurse practitioner, etc.)

Master of Nursing programsDoctoral degree programs

Nursing Personnel: LPN


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Licensed Practical NursesSecond-largest group of licensed health care

workers in the United States726,000 LPN in 2004 4.4% of LPN are males Duration of LPN programs varies from 9-18

months



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Role of LPN Interdependent roleProvide patient care under general

supervision of an RN, physician, podiatrist, or dentist

Assume responsibility for nursing actions within their legal role and competency



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Sites of Employment Majority are employed in long-term care settings Physicians’ officesClinicsAmbulatory care centersHome health care agenciesIndustry Dialysis centersGroup homesAdult day care centers

Other Nursing Personnel


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Student nursesHave a responsibility to give safe care and

act under instructor supervisionNursing assistantsTraining includes minimum 75 hours of

instruction with clinical practiceUnlicensed assistive personnel (UAP)Trained by health care organizations to

function in assistive role to RNs and LPN/LVNs

Other Nursing Personnel


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Clerk receptionistsJob responsibility is mainly secretarialPrepare, compile and maintain patient

records on a nursing unitUnit managersSupervise and coordinate management

functions for patient unitsResponsible for day-to-day operational

issues such as supplies, staffing coordination, etc.

Nursing Shortage


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Shortage of RNs is a national and worldwide problem

Nationwide nursing shortage by 2020 could be over 1 million nurses

LPN’s may help the nursing shortage (Refer to Boxes 11-1 and 11-2 for

causes and solutions of nursing shortage)

Leadership

Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

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LPN as First-Line Leader

Responsible for supervising nursing assistants who deliver care in long-term care situations

Referred to as charge nurse positions Need to develop leadership and management

skillsDirect and supervise others in a manner that

will effectively meet the goals of the employing agency


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Organizational Chart


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Expanded Role of LPN

It is important to review the current Nurse Practice Act in your state Legally defines the exact role and boundaries for

LPNsExpanded role: more administrative and

supervisory responsibilities


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Leadership

Leadership is the manner in which the leader gets along with coworkers and accomplishes the job. The focus of leadership is to produce changes in the

workplace that will meet the goals of the employing agency. Leadership is an informal role that is given to a person by a

group of workers. You become a leader when your team members decide to follow you.

Leaders cannot be appointed. The leader needs to influence others in the work setting to

want to implement desired change. Directions for leadership skills can also be written, but it is

through experience that leadership skills are truly developed.


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What Kind of Leader Are You?

There are several different ways to lead.What is your predominant leadership

style? Autocratic Democratic Laissez-Faire


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Leadership Styles

Autocratic Task-oriented Involves telling people what to do Does not share responsibility with employees Emphasizes policies May reach goals Good in crisis situations, code situations,

emergencies


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Leadership Styles

Democratic Focuses on both the task and the employee Shares responsibility and authority with

employees Enforces policies in the context of concern for

employees Seeks input; encourages problem solving Goals may be achieved with positive staff feelings Good for daily nursing care situations, meetings,

review of care plans, committees


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Leadership Styles

Laissez-faire Purely people-oriented Gives away responsibility to employees; employees act

without any direction Puts employees before policies Tries to please everyone Goals may not be achieved Good when organizational policies and goals are not a

consideration


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Using the Leadership Continuum as a Guide

The value of a continuum is that as you move along the continuum from each extreme toward the center or midpoint, the two extremes begin to blend together.

You have some of each style, depending on where you are on the continuum.

A blend, to some degree, of the two extremes in the appropriate work situation would be the leadership style needed at the moment.


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Continuum of Leadership Styles


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Core Knowledge and Skills Needed for Leadership

Motivate team members to accomplish team goals.

Communicate assertively.Problem solve effectively.Build a team of cooperative workers. Manage stress effectively.


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Motivation: Role of Charge Nurse

Assists managers to influence and direct employees to act in certain ways to benefit the employer, as well as meet personal needs

Meeting needs of nursing assistants will help to retain staff Encourage internal motivation Channel motives of employees to meet organizational

goals Reward desired behaviors


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Applying Communication Skills as an LPN Leader

Effective use of verbal and nonverbal communication

Principles of communication are building blocks for communication skills for a practical/vocational charge nurse.


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Applying Problem Solving as an LPN Leader

Identify the real issue and solve it.Avoid spending precious time on finding

solutions for what is not really the problem.

The nursing process can be used to solve resident problems as well as staff problems.


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Team Building

Mission Statement Defines the purpose and goals of the

organization You are a role model for attitudes and

behavior. Your team will model the attitudes and

behavior you expect of them. Most employees want to do a good job at

work.Most employees want to reach their full

potential.

ROLE OF THE LPN


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LPN Job Description

Will vary by facilityWill list qualifications, responsibilities, and

dutiesCheck your state’s Nurse Practice Act for

specific requirements related to scope of practice.

Preparation for charge nurse depends on your state’s Nurse Practice Act. additional education. your motivation to learn the manager role. your ability to be a risk taker. how you use your nursing experience.


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Common Problems of Charge Nurses

Nursing assistant brings a problem from home Don’t take on responsibility that belongs to the

employee; team members need to solve their own problems.

Don’t feel guilty that you cannot solve the problem.

Be supportive; express genuine concern. Follow facility policies when personal

problems affect work performance. Remember: you do NOT have a license to

counsel nursing assistants.


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Encouraging personal responsibilities in nursing assistants If a nursing assistant cannot perform a task

in his or her job description, it is his or her problem—not a staff problem.

Encourage nursing assistants to report problems with fulfillment of an assignment.

Encourage nursing assistants to help devise a solution.

If necessary, request additional training for the nursing assistant.


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Dealing with demanding/complaining families Common complaint involves physical care. Employ the problem-solving process (collect

data, identify problem, correct problem). Continued complaints following problem

resolution may stem from family upset or guilt; do not personalize the situation.

Try to identify unconscious issue and resolve it. Spend time with the family and establish

rapport. Encourage communication and involvement.

DELEGATION


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Assignment and Delegation

Can you delegate duties? Need to check:

Your state’s Nurse Practice Act Your state’s Board of Nursing for its

interpretation of delegation Your facility’s policy


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Tasks vs. Duties

Tasks Activities carried out by nursing assistants Nursing assistants learn how to perform a

task.Duties

Functions that are performed by LPN/LVN who passed a licensing exam

Duties are included in state’s Nurse Practice Act

Duties are the LPN/LVN’s scope of practice.


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Assigning vs. Delegating

Assigning Assignment is the method by which work is

distributed at the beginning of and during the shift.

Assignment involves allotting tasks that are in the nursing assistants’ job description.

Nursing assistants cannot refuse, except when they feel unqualified to accept assignment.

Nursing assistants are responsible and accountable for performing these tasks correctly, safely, and in a timely manner.


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Assigning vs. Delegating

Delegating Delegation involves transferring the authority to perform

duties that are in the LPN/LVN’s job description. Delegation allows LPN/LVN to perform other duties, with

the ultimate goal of improving resident care. The authority to delegate is conferred by LPN/LVN license. Delegation is NOT asking nursing assistants to do duties

that are disliked by the LPN/LVN. Nursing assistants cannot be forced to accept the

delegated duty.


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Benefits of Delegation

Can increase effectiveness and efficiency of the LPN

Can help achieve patient outcomes in a cost-effective manner

Can help nursing assistants improve their job skills


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Legality of Delegating

The nursing act delegated is the act of the supervising nurse.

Registered nurse is ultimately responsible for the supervision of nursing assistants.

LPN charge nurse assists in the supervision of these health care workers and shares accountability with the RN for their actions.


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Legality of Delegating

Scope of Practice for the LPN Never delegate what is in your legal scope of

practice. Legal scope of practice is what you are able to do

because you are an LPN Unlicensed assistive personnel obtain data

while caring for residents; they do not have the nursing education to make a judgment about nor interpret that data.

Your license is at stake in the matter of delegating nursing duties.


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Prior to assigning/delegating, the LPN should: Review job descriptions Know the nursing assistant’s level of competence

The competent nursing assistant is one who can: Communicate effectively Collect basic data Safely perform noncomplex nursing activities Seek guidance when necessary


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Assignment/delegation should NOT occur if: Resident is unstable Unit does not have proper

equipment/supplies to safely carry out the procedure

The nursing assistant would face safety issues (i.e., infection control)

Supervision would not be adequate Assistance from LPN might not be available,

if needed


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Communication with Delegation

Inadequate communication may cause delegated duties to not be completed as expected.

A two-way process of communication is necessary.

Give specific, concise, complete directions.Provide a rationale for duties assigned/

delegated.State whether a report is expected, and when.Be specific about results expected.


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Follow Up with CNA

Appropriate monitoring, intervention, and evaluation of the nursing assistant

Monitoring frequency depends on situation

LPN must be available for questionsIntervene if necessary to ensure safety


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Legally, the LPN may not delegate a duty without checking the outcome. Was the task/duty performed? Was it performed safely? Have resident goals been met?

The nursing assistant should be given feedback regarding performance. Encourage the nursing assistant to offer input.

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