Delegation
Cannot be delegated
Clinical reasoning, nursing judgment and critical decision
Another name for the LVN first-line manager position in LTC
Charge Nurse
Licensed Vocational Nurse continuing education requirement
30 (approved) continuing education units (CEU) every 2 years
_________ thinking is based on facts.
Rational
The basis for payment of resident fees or denial of payment by Medicare, insurance, and/or the state is effective nursing
documentation.
________ duties is asking nursing assistants to help you perform some of your job description so that you may perform other prioritized job responsibilities, with the ultimate goal of improving resident care and meeting resident goals (outcomes).
Delegating
There is shared responsibility for the patient but competency responsibility belongs to
the delegatee
Not a Nursing assistant, another DCW - what is this? give an example
Direct care worker, restorative aide, physical, occupational, speech therapy, social services, activities
Leadership style(s)
characteristic of a task-oriented person - autocratic style
characteristice of a people-oriented person - laissez faire style
It helps to be aware of your own stress level and incorporating "life skills" that help control stress include
1. Massage.
2. Daily exercise: Walking is the easiest and least expensive form of exercise. No special equipment is required, except good walking shoes.
3. Listen to music.
4. Adequate nutrition.
5. Get the amount of rest you need to function at your best.
6. Take scheduled breaks when at work. You will be reenergized and increase your productivity.
7. Develop leisure activities you enjoy (or rediscover activities you put on the back burner during nursing school).
In time management, a "to-do" list of tasks is helpful. Type A task are
new tasks that always surface during the shift requiring modification of priority - unpredictable and cannot be planned
Hansten and Jackson (2008) state, “Fail to plan—...
plan to fail."
The final decision to delegate rests in the hands of
the licensed nurse as he or she has overall accountability for the patient.
The LVN will _____. _______and ________ health care workers as together they strive to meet patient care goals.
It is getting at the real issue and solving it
Problem-solving
The 3 core areas of knowledge to be a leader in long-term care (LTC)
1. Occupational (clinical) skills: The knowledge and skills of nursing.
2. Organizational skills: Skills necessary to function in the organization that delivers health care.
3. Human relationship skills: The ability to get along with and relate to people.
To receive payment, facilities are required to meet conditions of
CMS (Center of Medicaid and Medicare Services), a federal agency of the Department of Health and Human Services (HHS), certifies nursing homes for Medicare and Medicaid reimbursement.
Three essentials in prioritizing care
Life-threatening, essential to safety (of patient, staff and others) and essential to the medical/nursing plan of care (e.g, med pass)
Determination of competency validation
Be specific to the knowledge and skill needed to safely perform the delegated responsibility as well as to the level of practitioner (i.e., RN, LPN/VN, AP) to whom the activity, skill or procedure has been delegated
Four examples of necessary skills for success as front-line manager
1. Basic nursing skills, including the nursing process
2. Time-management skills for home and clinical time
3. Decision-making skills—using evidence
4. Assertiveness skills
5. Empowerment/self-confidence skills
6. Communication skills
7. Ethical aspects of health care
8. Legal aspects of health care
9. Problem solving and critical thinking
10. Stress management
11. Participation in clinical evaluation
1. Decreased performance of nursing assistants
2. Negative interactions with nursing assistants
3. Ineffective communication
4. Inappropriate body cues, such as sharp tone of voice
5. High staff turnover
6. Unhappy residents, families, health care providers, and nursing assistants... IS A LIST OF
Examples of dysfunctional job behaviors related to work-related stress and anxiety
("increased workloads (especially when a nursing assistant calls in sick) and potential conflicts with nursing assistants, health care providers, families, and residents")
organization is to improve quality of care by creating a safe environment for clients through an accreditation process
The Joint Commission (TJC) an independent, not-for-profit organization.
OBRA stands for
The Omnibus Budget Reconciliation Act of 1987. OBRA contains the Nursing Home Reform Act. The basic objective of the Nursing Home Reform Act is to ensure that residents of nursing homes receive quality care that will result in their achieving or maintaining their “highest practicable” (reasonable) physical, mental, and psychosocial well-being. The act also established a Resident’s Bill of Rights.
In 2006, the NCSBN and the ANA issued a joint statement on delegation to assist licensed nurses to delegate safely and effectively in clinical settings. National Guidelines for Nursing Delegation were jointly adopted by NCSBN and ANA in 2019. These guidelines are particularly critical when the NPA is silent to delegation. Who and what is this?
NCSBN is National Council of State Board of Nursing and the ANA is the American Nursing Association. The Delegation Decision-Making Tree for the Licensed Practical/Vocational Nurse.
Five Rights of Delegation
Right: 1. TASK, 2. CIRCUMSTANCE, 3. PERSON, 4. DIRECTIONS & COMMUNICATION, and 5. SUPERVISION & EVALUATION
Difference(s) between management and leadership
Management is the organization of all care required of clients in a health care setting for a specific period (i.e., a 12-hour shift) Leadership is how a person empowers and develops a team to meet and exceed client and institutional outcomes.
How Ellis's ABCD method of controlling irrational thinking applies to stress reduction
A—Activating event: The nursing assistant called in sick with a headache.
B—Belief (self-talk) about the situation: The charge nurse thinks the nursing assistant must have been out partying.
C—Consequences: The LPN/LVN manager was abrupt with the nursing assistant on the telephone. She allowed herself to feel angry about the absence. She allowed it to ruin her whole day. Nursing assistants avoided her like the plague.
D—Dispute irrational thoughts: Choose a more rational, assertive response to the situation. Focus on the objective facts (nursing assistant has a headache). Avoid the subjective judgments that your beliefs (self-talk) call up (the nursing assistant was partying). You will avoid the anger over this incident and its effect on nursing assistants. Stress is avoided for all.
Different from delegation, it's the way work is distributed/allotted among team members and is a skill of the LVN known as,
Assigning
It consists of a national network of experts, clinicians, and consumers working together to improve care to Medicare recipients
The Quality Improvement Organization (QIO) program of the Centers for Medicaid & Medicare Services (CMS). As a LVN consider volunteering for a CQI committee. Policies and nursing procedures are revised based on the input you and your nursing assistants provide regarding resident care and the functioning of the unit. It is personally rewarding to be included in policy and procedure revision because revisions improve resident care. Also document resident information in an objective and specific manner. Your documentation will be used to measure the effectiveness of CQI efforts.
One example of duties of the LPN/LVN/RN would not be delegating
Complex sterile technique procedures: Nursing assistants do not have in-depth training in sterile technique.
Crisis situations - example: a resident who develops chest pain.
Assistive personnel have not been trained to make decisions about or interpret data. They collect simple data only. For example, nursing assistants cannot evaluate results of capillary blood glucose monitoring or determine when vital signs need to be rechecked.
When delegating to a licensed nurse, the delegated responsibility must be within the delegatee’s authorized scope of practice under the NPA.