1. P&V Section 4
Rita Carey-Nita

2. Health Care Team

3. Goal for the Health Care Team
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
It is necessary for groups of people to work together to provide patients with all the services they need to maintain comprehensive health care.
What are the disadvantages of having a large number of people care for a patient? (poor coordination of service, miscommunication, patient confusion, etc.)
Good communication is an essential component of any health care team that provides care on a 24-hour basis.
Communication includes written items such as medical record notes, flowsheets, and other formats that convey essential information.
When might verbal communication take place? (patient rounds, shift reports, telephone conversations, etc.)
How can the health care team member anticipate problems and avoid them?

4. The Health Care Team: Nursing Personnel
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
The public is unclear as to the different types of nurses on the health care team.
Members of the health care team generally, and nursing specifically, need to know about each other.
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5. Nursing Personnel: RN Associate degree (ADN) program Diploma program
Registered Nurses
Associate degree (ADN) program
2-year educational program
Diploma program
3-year educational program
Baccalaureate nursing program
4-year educational program
Why might someone choose to pursue a 2-year program instead of a 4-year program? (cost, time availability, academic ability, etc.)
What is the difference in the roles of RN’s prepared in 2 and 3 year programs compared to a 4 year program?
What are the advantages of completing a 4-year program?
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6. Nursing Personnel: RN Function independently in nursing Plan care
Role of Registered Nurses
Function independently in nursing
Plan care
Coordinate all the activities of care
Provide care that requires more specialized knowledge and judgment
Teach patients, families, and other members of the health care team
Act as patient advocate
All RNs function under the Nurse Practice Act of the state in which they’re working.
What is meant by “act as a patient advocate”? (represent the patient’s viewpoint, ensure that the patient’s needs are met, support the patient in informed decision making)
The RN plays a pivotal role within a complex health care environment by coordinating the patient’s care.
The RN coordinates care among the nursing staff and all the ancillary staff members.
How many RN’s are there in the United States?
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7. Nursing Personnel: RN BSN completion program Certification
RN postgraduate educational
opportunities
BSN completion program
Certification
Advanced practice registered nurse (clinical nurse specialist, nurse practitioner, etc.)
Master of Nursing programs
Doctoral degree programs
How is certification different from the licensing process? (A license ensures minimal entry competence. A certificate demonstrates advanced or specialized competence, usually after a certain amount of work experience.)
Nurses with master’s degrees can be employed in a variety of settings such as nursing schools, hospitals, and other settings as administrators or clinical specialists.
Nurses with doctoral degrees are usually involved with teaching and research, but some are actively involved in advanced clinical practice, usually within large academic medical centers.
What has the AACN proposed for advanced practice nurses?
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8. Nursing Personnel: LPN
Licensed Practical Nurses
Second-largest group of licensed health care workers in the United States
726,000 LPN in 2004
4.4% of LPN are males
Duration of LPN programs varies from 9-18 months
Focuses on bedside clinical care, including administration of medication.
Critical thinking for LPN/LVN is very important.
LPN/LVNs should be aware of the Nurse Practice Act of the state in which they’re employed.
How many practical/vocational nursing programs are there in the United States?
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9. Nursing Personnel: LPN
Role of LPN
Interdependent role
Provide patient care under general supervision of an RN, physician, podiatrist, or dentist
Assume responsibility for nursing actions within their legal role and competency
What is the major difference between the roles of the RN and the LVN/LPN?
What is meant by “function interdependently”? (Practical/vocational nurses must function safely and be accountable for their own actions while working under the direction of an RN or physician.)
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10. Nursing Personnel: LPN
Sites of Employment
Majority are employed in long-term care settings
Physicians’ offices
Clinics
Ambulatory care centers
Home health care agencies
Industry
Dialysis centers
Group homes
Adult day care centers
In long-term care settings, the patient acuity level is usually less complicated and intense.
The nurse-to-patient ratios are often much higher in these settings than in acute/hospital care settings.
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11. Other Nursing Personnel
Student nurses
Have a responsibility to give safe care and act under instructor supervision
Nursing assistants
Training includes minimum 75 hours of instruction with clinical practice
Unlicensed assistive personnel (UAP)
Trained by health care organizations to function in assistive role to RNs and LPN/LVNs
Who is responsible for patient care when a nursing student is assigned to a patient? (While the nursing student works under the supervision of the instructor, the RN is ultimately responsible for the patient’s care.)
How many nursing assistants are there in the United State?
UAPs may also be known as nurse extenders, patient care technicians, assistive workers, and patient care associates.
A large number of NAs are employed by nursing homes.
Some UAPs are also Nursing Assistants, but many are not.
Why have health care organizations added this level (UAP) to the health care team?
Currently the supply of NAs is not meeting the high demands of employers.
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12. Other Nursing Personnel
Clerk receptionists
Job responsibility is mainly secretarial
Prepare, compile and maintain patient records on a nursing unit
Unit managers
Supervise and coordinate management functions for patient units
Responsible for day-to-day operational issues such as supplies, staffing coordination, etc.
Some nursing units may have both a nurse manager and a unit manager.
If there is a unit manager, then the nurse manager is usually involved in clinical care issues and more long-term planning.
Have you ever worked in a setting that had a unit manager? How did this affect the functioning of the unit?
If a health care organization does not have unit managers, who assumes these responsibilities?
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13. Nursing Shortage 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)
Even though the scope of practice of LPN/LVNs is more limited and they cannot replace or substitute for RNs, they do contribute to the severe need for nursing manpower.
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14. Leadership

15. 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 skills
Direct and supervise others in a manner that will effectively meet the goals of the employing agency
Why do some people make better leaders than others?
What are some of the good qualities of a proficient charge nurse?
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16. Organizational Chart The contemporary chart is a newer type.
What disadvantages could it present?
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17. 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 LPNs
Expanded role: more administrative and supervisory responsibilities
Also review the following for more guidelines related to the expanded role of the practical/vocational nurse:
NAPNES Standards of Practice and Educational Standards of Graduates of Practical/Vocational Nursing Programs
NFLPN Nursing Practice Standards for the Licensed Practical/vocational Nurse
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18. 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.
Who is responsible for the leadership portion of a facility?
What characteristics would a good leader possess?
What type of education or experience would they need?
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19. What Kind of Leader Are You?
There are several different ways to lead.
What is your predominant leadership style?
Autocratic
Democratic
Laissez-Faire
What can another person do that can influence you to follow their lead?
What characteristics do you display that causes others to follow you?
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20. 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
Do you know of individuals who display an autocratic leadership style?
Do they motivate you to follow them or not?
Do they accomplish their goals?
Which leadership style encourages supervised nursing assistants to discuss resident care, make decisions, and problem solve improvements in care?
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21. 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
Do you know of individuals who display a democratic leadership style?
Do they motivate you to follow them or not?
Do they accomplish their goals?
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22. 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
Do you know of individuals who display a laissez-faire leadership style?
Do they motivate you to follow them or not?
Do they accomplish their goals?
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23. 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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24. Continuum of Leadership Styles
Where do you do fall in the continuum?
Would you like to be different in your leadership style?
If yes, how could you accomplish this?
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25. 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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26. 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
What are some examples of motivating tactics that a charge nurse could exhibit?
What types of rewards would be initiated to produce a desired behavior?
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27. 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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28. 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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29. 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.
How are these skills helpful in motivating the team members?
Why is the character of the charge nurse critical in maintaining a well-managed floor?
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30. ROLE OF THE LPN

31. LPN Job Description Will vary by facility
Will list qualifications, responsibilities, and duties
Check 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.
Because the Nurse Practice Act varies from state to state, it is important to be familiar with the guidelines of each state in which the nurse is licensed.
Why is it important to know exactly what job duties are required or expected?
According to the 2006 practice analysis by NCSBN to gather data for content areas for NCLEX-PN, 48.2% of LPN/LVNs stated they regularly had one or more administrative roles; 72.4% of those with administrative roles worked in long-term care; and 58% of those with administrative roles in long-term care indicated the Charge Nurse position as their administrative role.
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32. 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.
Many factors can interfere with one’s work schedule and performance.
When interviewing for a position, why is it important to clearly outline the job responsibilities?
Why is it inadvisable for a charge nurse to counsel a nursing assistant? What types of problems could result from this behavior?
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33. 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.
It is essential that each team member perform his or her functions and responsibilities.
What are some ways in which the charge nurse could encourage nursing assistants regarding their work or personal lives?
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34. 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.
Families can sense when staff members are unhappy with each other; this is reflected in the patient care.
How could a nurse increase a family’s satisfaction?
Developing a friendly relationship with the family will help make them more understanding and in touch with the staff.
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35. DELEGATION

36. 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
Why is it important for a nurse to know if he or she is allowed to delegate duties?
Always stay within the limits of your scope of practice.
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37. Tasks vs. Duties Tasks Duties
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.
Note how tasks and duties are differentiated.
What are some examples of tasks, and what are some examples of duties?
Why is it important to not assign duties to the nursing assistants?
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38. Assigning vs. Delegating
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.
Negative outlook can affect how tasks are performed.
What should the nurse do if a nursing assistant is not performing an assignment in a safe and timely manner?
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39. Assigning vs. 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.
What types of nursing responsibilities should not be delegated to a nursing assistant? (e.g., start IV, chart assessment)
Delegating proper functions can help the LPN/LVN to manage time and patient care.
How should a nurse respond if a nursing assistant refuses to accept a delegated duty?
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40. 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
Some nursing assistants will be more willing to help with delegated duties than others.
What are some different ways to present delegation duties to nursing assistants?
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41. 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.
Why is it important to know exactly what can and cannot be delegated?
What does liable mean, and what repercussions could that mean for the nurse?
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42. 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.
The LPN/LVN Charge Nurse needs to use his/her knowledge and experience to interpret data gathered by these members of the team.
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43. 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
A competent nursing assistant helps the nurse provide high-quality patient care.
How could the nurse ensure that nursing assistants perform their tasks correctly and help them to learn new tasks?
If a nursing assistant refuses a task, that task should be reassigned.
If this occurs, distinguish between “I don’t want to” and “I don’t know how to.” The nursing assistant simply may not feel competent to perform the assigned task.
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44. 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
The LPN/LVN must be available at all times to answer questions or give additional directions or clarification.
How can the nurse prevent these wrong circumstances from occurring?
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45. 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.
Nothing should ever be assumed; always give specific and detailed instructions.
How can the nurse ensure that his or her instructions are understood?
What are some signs that the nursing assistant may not understand the directions? (e.g., confused look, attention wanders, gives vague replies)
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46. Follow Up with CNA
Appropriate monitoring, intervention, and evaluation of the nursing assistant
Monitoring frequency depends on situation
LPN must be available for questions
Intervene if necessary to ensure safety
Right supervision includes feedback, evaluation, and follow-up.
How can the nurse monitor the nursing assistant’s performance? (always be available, make frequent rounds to the residents’ rooms, ask if the NA needs any help)
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47. 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.
If a delegation is made, it must be evaluated.
If the duty has not been done, it is the nurse’s responsibility to complete it.
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