Roles of the NurseNUR101 Fall2008 Lecture #18K. Burger, MSED, MSN, RN, CNEPPP By:Sharon Niggemeier RN MSN

Roles of the Nurse CoordinatorCommunicatorTeacherCounselorManagerLeader

Team playerMotivatorDelegatorCritical thinkerInnovatorResearcherAdvocate

CoordinatorCoordinates and plans carePiece together fragmented carePrepares pt. for dischargeLiaison in health care team

CommunicatorEstablish rapportEstablish therapeutic (helping) relationshipBe aware of verbal & nonverbal communicationAssertive communicator

TeacherEducate pt. to develop self-care abilitiesProvide knowledge to allow pt. to make informed decisionsDemonstrate needed skillsPromote health, prevent illness, restore health & facilitate coping

Teaching-Learner ProcessTeaching-planned method to help someone learnLearning- process by which an individual increases their knowledge or changes their behavior as a result of an experience

Learning DomainsCognitive learning- acquiring new knowledgePsychomotor learning- acquiring a new physical skillAffective learning- acquiring /changing values, feelings or attitudes

Developmental Considerations

Children learn through play & experience

Take into account their motor development along with their intellectual development

Adolescents learn through their peers

Take into account their intellectual, developmental, maturity and psychosocial development

Developmental considerations(androgogy)Adults- most must believe they need to learn before they are willing to learnAdults- bring life experiences as resources for learningAdults- believe learning should be useful immediately (rather than in the future). They Want relevance!Adults internally motivated and capable of self-regulation

Developmental Considerations(older adults)

Assess for perceptual impairmentsVisualAuditoryMemoryLonger reaction timesAND ALSOGenerational learning differences

Learning StylesVisualAuditoryTactileCombinationConcrete Versus AbstractActive Versus ReflectiveRight Versus Left BrainMultiple Intelligences Verbal, Logical, Visual, Body, Musical, Inter or Intrapersonal

Principles of teaching-learningCommunication is importantThorough assessment of pt. learning needs and factors affecting their learning Include pt. in planningUse varied teaching strategiesUtilize patients previous life experiencesUtilize nursing process

Barriers to LearningLanguageCognitive levelLack of interestCultural differencesLiteracyHealthStress

Utilizing Nursing ProcessAssessment: Readiness to learnAbility to learnLearning strengthsWhat do they know already???Do they WANT to LEARN?

Analysis:Knowledge deficitPlanning:Who, what, when, where & how. Determine whether cognitive, psychomotor, or affective goal. Write with an action verbGET CLIENT COMMITMENTImplementation:Include written, visual and tactile materials.Select strategy and methods: Content Sequence Timing Demonstration?Discussion?Role Play? Evaluation: has pt. Learned/goal met? Return Demo

CounselorAssist and guide pt. in solving problems or making decisions

Utilize the interpersonal (helping) relationship

Nurse doesnt tell pt how to solve the problem Guides pt to decisions (self-determination)

Utilize the nursing process

Could you just listen

PlansOrganizesDirectsControlsDelegates

Manager

Management ProcessPlanning-Identify needs, dev. goalsOrganizing - Identify resources to meet goalsDirecting- leading others in reaching goals Control- monitoring ongoing evaluationsDelegates

DelegationThe five rights of delegationRight taskRight personRight circumstancesRight communicationRight feedback

DelegationNurse who delegates maintains accountabilityOnly the task is delegated NOT the accountabilityWho can you delegate tasks to?

Managers and LeadersManagersAdministratorsRelies on controlShort term plansEye on bottom lineDoes things rightLeadersInnovatorsInspires trustLong term plansEye on the horizonDoes the right thing

LeaderHave visions to energize othersMotivates others to achieve goalsEncourages others to do their bestWorks collaborativelyHave wider variety of roles then managers

Leadership SkillsCognitive Knowledgable

Interpersonal Genuine Inspires trust

Ethical/legal Integrity always

Communication Open Problem solving Critical thinker; Out of the box Flexible

Management Organized

Self-evaluation Reflects, adapts, changes

Characteristics of Great LeadersIntelligence-knowledge, judgment & decisivenessPersonality- confidence, creativity, adaptability, integrity & independent Abilities- enlist cooperation, diplomacy, social participation & interpersonal skillsA great leader cannot be appointed!

Leadership StylesAutocratic- leader has complete control of group

Democratic- shared leadership between leader and group Laissez-Faire- leader gives group control

Transformational-charismatic leader creates change by empowering group

Situational leader changes style to fit situation

Increasing Manager/Leader SkillsSelf assessmentDevelop skills-computer, cost containment etc.Think positive

Maintain physical wellnessPsychologically: Strong self conceptBe confidentKnow strengths & limitations

Powerto possess power implies the ability to change the attitudes and behaviors of individual people and groups.Positive Power = power with NOT power over Types of Power:

LegitimateRewardCoerciveReferentExpert

Building PowerExpand personal resources rest and reflectPresent a powerful picture dress, act, speak the partPay the entry fee stand out; do moreDetermine the powerful in the organization know chain of command, names & faces of powerLearn the language/priorities of the organization Learn mission/vision/prioritiesIncrease professional skills & knowledge Perform extraordinarily, continuing education

Building PowerKeep a broad viewBe flexibleDevelop visibility and a voice in the organizationToot your own hornMaintain a sense of humor Empower others (Marquis & Huston 1998)

ChangeThings ALWAYS CHANGE!!!!Planned change- purposeful effect to bring changeResistance to change- threatened, lack of understanding, personality, more workOvercoming resistance to change- leaders use their skills to overcome resistance to changeCHANGE IS GOOD!!!!!!!!!!!!!!!!!!!!!!!!!

Team PlayerNurses are part of a teamDont work in isolationWho are the other team members?What does being a team player mean?

MotivatorMotivation- Internal impulse that allows one to take action or change behaviors.Nurses motivate patients to make changes by: having a positive attitude, listening to patient needs, encouraging, rewarding, and devoting time and energy to assist with changes.

Critical ThinkerA way of looking at problems other than the obviousThinking outside the boxLooking at the big pictureQuestion why something is being doneAsk, what if..Open to new ideas

Innovator

Takes action to make things happenInitiates changeSees a problem and looks for solutions. Instead of , Oh well, theres nothing that can be done about it the innovator will be proactive.

ResearcherCollect data to improve nursing practiceProvides info for evidenced-based practiceStudies are done on nursing practice, education & administrationProvides professionalism to nursing

AdvocateProtect and support the pt.Patient representative for ALL pt.AssertivenessPromote self determination

Summary

The role of the nurse is varied and complexCaring for patients requires that nurses take on different roles at different timesNurses need to fulfill their varied roles as best as possible by understanding their roles and knowing how to improve in each role

Skills requiredorganized- track different health care team members requests along with pt. Needs assertive- pursue pt. Needsability to work well with colleagues

Follow up check arrangements made as a nurse you are responsible for your pt. And will need to coordinate careSkills need Strong people skills Rapport- mutual trust Knowledge of interpersonal relationships Helping relationship- orientation phase, working phase & termination phaseVerbal-what you say , how its said, be nonjudgmental humor, silence etc.Nonverbal touch, gestures, posture etcAssertive not aggressive rather stand up with your opinion backed with knowledge/factsAs nurses pt. Looks to us to provide information and communicate with them as we are in contact with them more than any other health care team memberEducate- self care teach them ways to enhance their healthremove scatter rugs to prevent fallsProvide knowledge not opinions of TX, meds, etcShow how to perform drg changereturn demoPromote health-practices that that allow for a higher level of wellness, aid pt to lose wt., exercise stop smokingspiritual helpPrevent illness- inform pt. About BSE or TSE, cpr, immunizations, to prevent illnessesRestore health- focus on ways to facilitate recovery-fx hip teach ways to become more mobile, walker..include how bones heal, need to prevent complicationsFacilitate coping- aid pt and family on how to come to terms with illness/situations..support groups available, resources, 3 ways in which people learnCognitive- diabetic can tell you the S/S of hypoglycemiaPsychomotor- diabetic is able to demonstrate the proper way to self-administer insulinAffective- diabetic who didnt follow a prescribed diet be cause he didnt believe it would matter changes his thoughts about the need to follow prescribed ADA diet

Pedagogy- teaching of children and adolescents Child needs dressing change daily- demo on teddy bear let them use the bear to change the dressing.Adol..may need not have ability to use logical reasoning to solve problemsAndrogogy- teaching of adultsAs nurses we are always teaching pt.The role of the nurse will require you to counsel pt. Think about the head nurse on the floor.. Responsible for the work of others

Achieves the organizations goals

Maintains cost effectiveness

Directs and controls- available human, material and financial resourcesDelegates--transfer responsibility of tasks to another

Needs- What are needs of nurses and pt.Resources-people most qualified and How can we fund themHow will we achieve Task- can it be given to another personPerson qualified to do taskCircumstances- is it the right time to have the task doneCommunication- clear directions of the objective and expectations are givenFeedback timely Evaluation during and after task is completed

Uaps- unlicensed personnel, LON, RN, CAN, NADoes things right - Carries out goals/functions of organization

Does the right thing- may not be goal of the organization ie allow pt. Without ins. To remain in hospital..

Look at your self and see who you are where youre lacking Dev skills you lack think of what youll needBeing neg. will get you nowhere fastStay healthy to keep focused

Perceive yourself as a leader/mangerThe role of nurse will include you being a manager/leader to your pt.Legitimate- Position power/authority power: power gained by title or official position ion an organization Reward- power obtained by granting favors or rewards to others with something they value. The Manager rewards staff with raises/flex time/ medical benefits/ office party will dev. Loyalty and devotion .. A power .that makes change easier.

Coercive opposite of reward behavior, power based on fear or punishment. Manager obtains compliance or change thru layoffs/ cut hrs/ demotion etc.

Referent- power given to others thru association with a leader or what that leader represents. Referent power is enjoyed by those because others accept them as role models . Doctors in the US have referent power as society views them as powerful. (Nurses are developing this)Expert-.power gained thru knowledge, experience, expertise. Limited power to specialized area.

Empowerment-manager/leader shares power, interactive process that dev. Builds and increases power thru cooperation, sharing working together. Leaders communicate their visions and employees are given the opportunity (empowered ) to make the most of their talentsEmpowerment plants the seeds of leadership in others.

Personal resources-_take time for yourself/ relax/ unwind/rest to help prevent making poor decisions/judgments .work can drain you.Powerful picture- dress the part, how you look act , speak effects others views of how powerful you areFee- stand out do more/ volunteer to be on committees/ appear more powerfulOrganization- know the chain of command/know names /faces with power.Language/priorities- each organization has its own values/ culture/taboosgoals/and priorities. Skills/Knowledge..Enhance power by performing extraordinarily, need to keep self on top of the game, continuing ed. Etc

View- be aware of whole organization . Think beyond your unit/ floorFlexible be able to compromise and changebuilds powerVisibility- become recognized by the organization. I Know herToot- accept compliments graciously. Not bragging let others know of your achievementsHumor-be able to laugh at ones self, dont take yourself too seriously.Empower others- youll be viewed as more powerful. Power is used to bring about ChangeChange- -process of modifyingNurse/Leader/ manager/ changes occur in facilities in staff in policy, change is always occurring. Leaders need to get figure out why there is resistance and how to overcome it Planned change uses steps similar to the nrg process

Resistance- threatened things will change and not for the betterLack of understanding- need to understand the reason for change the why?Personality some people find change mentally and emotionally challenging and difficult to cope withFear of more work or change in job statusLeaders need to explain the change.. answer the why, explain advantages so people buy into it Allow for open communication so there is better understandingGradually introduce changeProvide incentivesWillingness to put effort into achieving a goal.Nurses recognize that nursing is a dynamic fieldEvidenced based practice-..evidence that the quality and cost control for services/interventions are warrantedAs nurses you may be involved on different studies taking place in your facility.Not just those who cant represent themselvesSelf determination- determining what is best for yourself..encourage pt. To complete advanced directivesPolitically active to be a voice in the politics of health care