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
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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
Nursing Personnel: RN
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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
Nursing Personnel: RN
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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
Nursing Personnel: LPN
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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
Nursing Personnel: LPN
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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)
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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.
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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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Common Problems of Charge Nurses
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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Common Problems of Charge Nurses
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.
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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.