learning plan 1 ha ppt
TRANSCRIPT
Health AlterationsLearning Plan 1
Introduction to Clinical Nursing Management
Objectives
• Explain the contribution of nursing to quality patient care
• Design a plan to obtain professional goals
• Identify factors impacting role transition from student to practicing graduate nurse
• Explain the impact of selected legal and ethical issues on nursing practice
Quality Patient Care
• Nursing’s role in patient outcomes
(Sasichay-Akkadechanunt et al., 2003)
Professional Nursing
• Caring
• Compassion
• Spirituality
• Community outreach
• Providing comfort
• Crisis intervention
• Going the extra distance(Hudacek, 2008)
COMPETENCY 11Develop a plan for making the transition from student
to practicing nurse
Your Plan
Sources of Law
ConstitutionLegislation (Statutes)
Nurse Practice Acts
Administrative Law
Common Law
Legal/Ethical
• “The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.”
(ANA, 2001, p. 12)
• “The registered nurse systematically enhances the quality and effectiveness of nursing practice.”
(ANA, 2004, p. 33)
Nurse Practice Act
Credentialing
Standards of Care
INFORMED CONSENT
Agreement by a client to accept a course of treatment after being informed of:1. Benefits and risks of treatment2. Alternatives to the treatment3. Prognosis if treatment is declined
Informed Consent
Express
Implied
Exceptions
• Minors
• Unconscious or unresponsive
• Mentally ill
Nurse’s Signature
Competent
Authentic
Voluntary
DELEGATION
The transfer of responsibility for the performance of an activity from one person to another while retaining responsibility for the outcome. (ANA, 1997)
The Big “D”
Mandated Reporter
Abuse
Neglect
Americans with Disabilities Act (ADA)
Clear, comprehensive
national mandate to eliminate
discrimination against people with disabilities
Clear, strong, consistent, enforceable standards addressing
discrimination against people with disabilities
Ensure that the federal
government plays a central
role in enforcing standards
established under the act
Impaired Nurse
Alcohol
DrugsMental Illness
Sexual Harassment
• EEOC, 1987
• Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature
• When submission is considered a condition of an individual’s employment
• When submission or rejection is used as a basis for employment decisions
• “intimidating, hostile, or offensive working environment”
Death and Related Issues
Advance Directives
Autopsy
Certification of Death
DNR or DNI
Organ Donation
Legal Protections for Nurses
•Good Samaritan
•Liability Insurance (respondeat superior)
•Carrying out MD orders
•Nursing Process
•Documentation
• Incident Report
MANAGERS AND LEADERS
Objectives
• Identify different leadership styles
• Explain qualities and behaviors that contribute to effective leadership
• Provide positive and negative feedback in a constructive manner
• Identify conflict resolution strategies
• Discuss the importance of effective communication
Manager– Have an assigned position within
the formal organization– Have a legitimate source of
power due to the delegated authority that accompanies their position
– Assigned functions, duties and responsibilities
– Emphasize control, decision making, decision analysis and results
– Manipulate people, the environment, money, time and other resources to achieve organizational goals
– Greater formal responsibility and accountability for rationality and control than leaders
– Direct willing and unwilling subordinates
Leader– Often do not have delegated
authority but obtain power through other means such as influence
– Have a wider variety of roles than do managers
– May not be part of the formal organization
– Focus on group process, information gathering, feedback and empowering others
– Emphasize interpersonal relationships
– Direct willing followers– Have goals that may or may
not reflect those of the organization
Leadership Styles
What Makes a Good Leader?
Communication
SBAR
•Situation
•Background
•Assessment
•Recommendations
Objectives
• Define management concepts
• Explain the qualities and behaviors that contribute to effective management
• Prioritize patient care needs
• Describe conflict resolution techniques
• Describe the role of the nurse in quality management
Management Concepts
Boss
Everyone Else
Centralized
Management Concepts
BossInput
Input Input
Input
Decentralized
Management Concepts
Nursing Units Accounting
Human Resources Public Relations
Organization
Matrix
Effective Management
Student as Manager
Student as Team Member
Feedback
Student as Team Leader
Team Leading Responsibilities
• Know all patient condition and needs
• Assist team members and provide direct care
• Coordinate patient care with employee strengths
• React to changes in patient and unit needs
• Delegate as appropriate, remain accountable
COMPETENCY 13
Manage care for a group of patients according to the Nurse Practice Act
Functional Nursing
• Tasks, not patients, assigned
• Assigned by qualifications
• Efficient
• Not holistic
• Communication problems and fragmented care
Team Nursing
• RN coordinates patient care
• Ancillary staff collaborate
• Democratic leadership
• RN spends less time with patients
• Lack of continuity of care and RN assessment
Total Patient Care Nursing
• Original mode of care
• RN assumes total care
• Similar to private duty
• Widely used
• High autonomy and responsibility
• Florence Nightingale
Primary Nursing
• 1970’s, depends on a total RN staff
• RN assumes caseload
• Associates cover when RN is not present
• May cost more
• High level of nursing ability, experience, accountability
Case Management
• Coordinator
• Services to patients and families
• Streamlines cost
• Collaborative
• Clinicians oversee specific groups
• Critical pathways
• Less direct patient care
Flood
300 adults, minor injuries, thermoregulation needs
3 RNs, 6 LPNs, 30 CNAs, 30 Volunteers
RN 1:100, LPN 1:50, CNAs and Volunteer 1:10
Time Management
Steps to Take in Time Management
Maslow’s Hierarchy of Needs
The Big “P”
First Order
Second Order
Third Order
Fourth Order
How to Prioritize
What do I have to do?
• Report
• Assessments
• Medications
• Treatment
• Document ASAP
• Rest breaks
How can I save time?
• Gather supplies
• Location
• Estimate needed time
• Document ASAP
• Leave on time
• Prioritize interruptions
Don’t Do Do Later Do Now
Things you can safely delegate to LPN or CNA
Things that can wait a little while
Patient care that must be done by
an RN
Bath, nail care, daily weight Phone messages AssessmentsAirway
BreathingCardiacChanges
Setting PrioritiesFirst-order Second-order Third-order Fourth-order
Immediate threat to physiological or psychological safety
Actual problem for which patient orfamily has requested attention
Relatively urgent potential or actual problem that patient or family does not recognize
Actual or potential problem for which patient or family may need future help
Airway, breathing, cardiac; anxiety attack; suicide; fall risk
Nausea, pain, bath; need to urinate
Monitoring for post-operative complications; anticipated teaching needs
Home care
Change of Shift Report
Quality Management(TQI, TQM, QA, Six Sigma, etc)
• Mission
• Values
• Philosophy
• Professional standards
• Care guidelines
• Outcomes
QI Plan Components
• “Our Pediatric Intensive Care Unit will show 100% compliance regarding daily checks of the crash cart”.
• If the crash cart was checked 96% of the time, a Quality Improvement plan will be instituted.
• A time frame for re-evaluation will be set
• The problem will be resolved/not resolved
• The results will be communicated
Responsibility
Scope of Service
Quality Indicators
Thresholds
Data Collection
Evaluation
Questions?