1. Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Nursing Leadership & Management Patricia Kelly-Heidenthal 0-7668-2508-6

2. Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Chapter 28 Your First Job

3. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company3 Objectives  Upon completion of this chapter, the reader should be able to: Identify key elements to consider in choosing a nursing position. Describe typical components of health care orientation. Discuss types of performance feedback. Compare and contrast organizational responses to performance. Discuss specific strategies to enhance the beginning nursing manager role. Identify mechanisms to enhance professional growth.

4. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company4 Choosing a Position  Patient types Best fit for the nurse in a patient care environment General versus specialty unit  Work environment Smaller or larger setting  Available schedule Shift types Process for changing schedules Self-scheduling

5. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company5 Choosing a Position  Pay Salary policy Differentials Definition of pay week

6. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company6 Orientation Considerations  Identify what the organization offers during orientation.  Organization-wide orientation Information and skills measurement Explanations of human resource policies Safety skills and procedures  Unit-specific orientation Specific competencies a new nurse needs to care for the diagnoses and ages of patients typical to the assigned unit Technical skills as well as beginning mastery of unit-specific processes

7. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company7 Identifying Own Learning Needs, and Socialization  It is important for the beginning nurse to assess his or her own specific learning needs and to establish learning priorities.  It is also important that the beginning nurse be introduced to other members of the unit and to the functions and roles of people who regularly interact with the unit.

8. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company8 Working with Others  Patients Nurses may be intimidated when patients look to them for expertise and guidance. The nurse should work to put the patient at ease and should demonstrate a sense of caring.  Doctors Nurses should establish rapport and introduce themselves to the doctors with whom they work. It is important that nurses not be intimidated by doctors. Nurses should be assertive, yet respectful and considerate. Seeking clarification when orders are unclear is important.

9. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company9 Learning Styles  Understanding one’s own individual learning style  Understanding the learning styles of others

10. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company10 Performance Feedback  Self-evaluation  Preceptor assessment

11. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company11 Formal Evaluation  The individual and the nurse manager meet to review progress.  The formal evaluation should be objective, based on performance. A checklist may be used.  Both the manager and the staff member should have a clear understanding of what needs to happen for the nurse to grow.

12. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company12 Formal Evaluation  The manager evaluation is used: To assure competence in the skills required for safe patient care As an opportunity to recognize the nurse's accomplishment in the evaluation period As an opportunity for the manager to coach, set goals, and identify learning needs

13. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company13 360-degree Feedback  360-degree feedback is a process in which an individual is assessed by a variety of people in order to provide a broader perspective.  It has the potential to provide the individual with a broader, more balanced assessment.  Nurses who are asked to evaluate their peers need orientation to the process and to the specific tool being used.

14. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company14 Setting Goals  Performance appraisal provides the opportunity to set goals for the coming year.  Goals should be measurable and clearly articulated.  Goals should be developed jointly between the nurse being evaluated and the manager.

15. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company15 Organizational Responses to Performance  Many health care organizations have a merit-based compensation structure that is tied to performance evaluations.  Most health care organizations are looking for other ways to create job satisfaction; e.g., employee recognition programs formally recognize good performance through reward or activity, and the recognition is usually public.

16. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company16 Organizational Responses to Performance  Most health care organizations have a prescribed corrective action program when appraisal feedback indicates the need for significant performance improvement.  Corrective action programs may involve: Determination of whether poor performance is developmental or related to a failure to follow policies or procedures Coaching or additional education/mentoring

17. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company17 Disciplinary Corrective Action  Employee receives feedback for failing to follow the organization's policies.  Most organizations have a series of progressive steps for corrective action, in cases where employee performance does not improve.  In progressive discipline, the manager and employee develop the mutual goal of taking steps to correct performance in order to bring it back to an acceptable level.

18. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company18 Nurse as First-line Manager  The registered nurse who is responsible for the direct care of a group of patients is functioning as a first-line manager  Relating to Other Disciplines It is important for nurses to develop strong relationships with representatives of the many other disciplines whose practices interface with the nursing role.

19. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company19 Delegation to Team Members  The registered nurse (RN) needs to refer to his or her state's Nurse Practice Act, which limits or defines the responsibilities that may be delegated. In addition, the RN should: Consider the skills and knowledge of coworkers in order to delegate well Be careful of over- or underdelegating Provide performance feedback to delegatees

20. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company20 Levels of Authority  An agreement to the level of authority at the time the task is delegated prevents each party from making inaccurate assumptions about the other's accountability for the delegated assignment.

21. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company21 The Charge Role  The first-time charge nurse often has high expectations for his or her own performance, and can easily become stressed in the new role.  Success is a matter of perceiving and delegating patient care needs from the perspective of the unit as a whole rather than from that of an individual's assignment.

22. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company22 The Charge Role  The charge nurse should: Concentrate on staying organized Focus on what is best for the patients Recognize and utilize the available resources for problem solving, such as coworkers and the facility supervisor

23. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company23 Articulating Expectations  As a first-time charge nurse, it is important to build relationships with other staff members as well as coworkers from other disciplines.  It is also important to share expectations, which may involve discussing and agreeing to certain behaviors.  Some performance expectations may be more generic, applying to relationships more than specific patient care items.  The charge nurse should keep the doorway for clear communication open.

24. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company24 Strategies for Professional Growth  Use educational opportunities at the institution.  If no formal educational opportunities exist, look for opportunities to learn from other staff.

25. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company25 Strategies for Professional Growth  Cross training While some organizations have strict guidelines to limit the practice of floating nurses, other health care facilities expect nurses to routinely float to either a related unit or an area particularly in need of assistance. A nurse should not accept total responsibility for an area or population in which he or she has not achieved competency. One way to minimize the stress of being asked to float to a different unit is to volunteer ahead of time to cross train to the new area.

26. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company26 Identifying a Mentor  Communicate a willingness to learn and grow.  Seek out a prospective mentor, rather than waiting to be approached by one.

27. Chapter 28Copyright © 2003 Delmar Learning, a Thomson Learning company27 Developing Professional Goals  Clinical ladder Clinical ladders are programs established by many health care organizations to encourage nurses to earn promotion, to gain recognition, and to increase their pay by meeting specific requirements.  Specialty certification Nearly all nursing specialties now offer board certification exams to validate expert knowledge of that particular discipline.