Transcript NURSING LEADERSHIP & MANAGEMENT

NURSING LEADERSHIP
& MANAGEMENT
PROFESSOR MARIANNE MCAULEY
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Morning
◦ all students
◦ 8 AM to 12:30 PM
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Afternoon
◦ full-day students
◦ Self-Study
 sign attendance sheet with professional
assistant
 assignment due within one week
 assignments in my mailbox: R106
 assignments returned to your mail folder
DAY WORKSHOP
5:00 PM – 9:50 PM
5 hour workshop is instead of Pediatric
Clinical this week
 L/M Clinical – instead of Pediatric clinical
those weeks
 2 full shifts for L/M Clinical
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◦ Receive a night off from Pediatric Clinical
◦ Arrange with Pediatric Instructor
EVENING WORKSHOP
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Review Agency Schedules
Directions
Uniform Policy
Health Forms in Trunk of Car
HIPPA Privacy Compliance
Attendance & Lateness Policy
◦ absences
 call unit & me (451-4152)
◦ Department of Health or JCAHO Visit
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Late Assignment Policy
THE CLINICAL EXPERIENCE
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Complete preceptor evaluation form
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Collect student evaluation form from
preceptor on last day – sealed envelope
◦ Include comments!!!!!
◦ Separate one for each preceptor is required
◦ Appendix A
◦ Appendix B
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RETURN BOTH TO MRS. MCAULEY
◦ Put in your brown envelope with your
assignment
ROLE OF PRECEPTOR
CLINICAL OBJECTIVES
See appendix C
 Bring these with you to clinical
 Change of Shift Report
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◦ Report all abnormal findings
◦ Report normal physical findings relevant to
patient’s diagnosis
◦ Describe nursing interventions done during
your shift
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Delegation
◦ review CNA assignment sheets
◦ Issues to consider
Interdisciplinary Team Meetings
 Documentation
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◦ 24 hour reports, Medicare Notes, Admissions,
Discharges, Transfers, Incident Reports
Preceptor co-signs your signature
 No medications
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CLINICAL OBJECTIVES
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Picking up of doctor’s orders
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Staff education: in-service project for
CNAs (certified nursing assistants)
◦ 15 minutes – done on 2nd day
CLINICAL OBJECTIVES
WHY L & M?
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Economics of health care
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Staff Redesign
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NCLEX
NCLEX-RN TEST PLAN
Physiological integrity needs of clients
Psychosocial integrity needs of clients
Promotion and maintenance of health
Management and coordination of the care
environment
 www.ncsbn.org
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Leaders Are Mostly Made
NOT Born
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Integrating Leadership/Management
into an Associate Degree Nursing
Program
◦ Management introduced 1st semester
◦ Capstone in last year
 Workshop
 2 full shifts with a preceptor running a patient care unit
What are the Skills of
Effective Leaders?
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The Great Communicator
◦ listening skills
◦ articulation skills
 oral
 writing
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Be An Assertive Communicator
The Team Player
understands the work of others
 appreciates the work of others
 credible - performs well
 persuasive, enthusiastic
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◦ increases cohesiveness among team
members
The Motivator
Inspires others to reach goals
 Uses power to motivate others
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A nursing task is transferred to an
individual competent to perform the task
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The delegator remains accountable for the
task
The Delegator
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Follow the five rights of delegation
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National Council of State Boards of Nursing
Right task
Right person
Right communication
Right supervision
Right circumstances
How to Increase Your
Expertise as a Delegator?
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What is the difference between the scope
of practice of the RN & LPN?
◦ Look at the NYS Nurse Practice Act
◦ Article 139 of the Education Law
◦ http://www.emsc.nysed.gov/sss/LawsRegs/Health_Services/Nurse_Practice_
◦ Act-full.htm
Is It the Right Task?
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What tasks can be delegated to the
UAP?
◦ Health-related activities not in the legally
protected scope of nursing practice
◦ Do not involve professional judgment or critical
thinking
◦ Results are predictable
Is It the Right Task?
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The guidelines regarding the utilization of
licensed nurses and unlicensed assistive
personnel in the delivery of nursing care
NYSNANYONE – 2003
 http://www.nysna.org/images/pdfs/
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practice/scope/rn_uap_guidelines03.pdf
Is It An Appropriate Health
Related Activity?
More Skills of Effective Leaders
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The Staff Educator: in-services
The Change Maker: institutes change
The Evaluator: evaluates the work of
others
The Problem Solver: resolves conflicts
The 21st Leader: vision
How Do Leadership &
Management Differ?
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Management
◦ Working with and through others
◦ Achieve organizational objectives
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Leadership
◦ Influencing the activities of a group
◦ Toward goal achievement
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Best manager is a good leader
Manager administers, Leader innovates
 Manager relies on control, Leader inspires
trust
 Manager has a short-range view, Leader
a long-range perspective
 Manager does things right, Leader does
the right thing
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Differences between Managing
and Leading
TYPES OF POWER
Legitimate - leader’s formal position in
organization
 Reward – underutilized
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◦ leader’s ability to reward follower’s
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Coercive – don’t use this
◦ follower’s fear of punishment
TYPES OF POWER
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Referent - follower’s identification with
leader
◦ confidence
◦ power dressing
◦ What qualities do you have that give
you this power?
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Expert - leader’s specialized knowledge
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Understanding Self
◦ self-assessment
Knowledge
 Learning
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◦ role models
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Emotional Intelligence
◦ assess yourself
Effective Leader and Manager
Formula
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Set of skills that includes excellence at
listening, empathy, handling upsets
Midbrain – center for emotions
A different set of skills than IQ abilities
Helps workers stay in positive emotional
range
Can learn these skills with practice
EMOTIONAL INTELLIGENCE
Great Man or Trait Theory
Leaders born, not made
 Physical, psychological , personal
characteristics define leaders
 Charismatic theory - leaders possess
charisma
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BEHAVIORAL THEORIES
Autocratic
 Democratic
 Laissez-Faire
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AUTOCRATIC STYLE
Leader dominates group
 Commands rather than makes
suggestions
 Maintains strong control
 Sometimes punitive
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LAISSEZ-FAIRE STYLE
Leader is passive, nondirective, inactive
 All decision making left to group
 Little, if any, leader guidance or
support
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DEMOCRATIC STYLE
Group participates in decision making
 Leader acts as facilitator
 Leader has concern for group members
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See appendix D
Demonstrate an Authoritarian Manager
Demonstrate a Laissez-Faire Manager
Demonstrate a Democratic Manager
◦ Provides privacy, listens, uses open-ended
questions, involves employee in goal setting,
offers suggestions for improvement
ROLE-PLAYS
LEADERSHIP STYLES
Situational Leadership
Assess the situation
 Assess the group members
 Select the style or blending of styles
best for the situation
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DEVELOPING NEW SKILLS
Required competency of ADN education
 Follow the Nursing Process when you
teach
 Use the Lesson Plan Rubric as a guide
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◦ Hand this in with your lesson plan
◦ See appendix E
STAFF EDUCATION
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Use the Nursing Process
Assess: the first day
◦ select topic with guidance of preceptor
◦ Ideas: handwashing, infection control,
nosocomial infections, heat exhaustion
◦ Self Care: stress management, body
mechanics
◦ review procedure manuals
INSERVICE PROJECT
A WIN-WIN FOR ALL
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Plan: during the week
◦ develop the lesson plan - have 2 copies
◦ typewritten, professional appearance
◦ 1 copy to preceptor
 LIV – Room 307 – Margaret Kelly’s mailbox
◦ 1 copy to me (R 106)
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Implement: the second day
◦ eating & learning is fun
◦ use audio-visual aids/handouts
◦ absent: schedule make-up
INSERVICE PROJECT
A WIN-WIN FOR ALL
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Evaluate:
◦ Develop a written quiz for the CNAs with at
least 1 question for each objective
◦ Staple a copy of this to the lesson plan
◦ a quiz is part of the lesson plan
◦ Develop a teacher evaluation form so that
the CNAs can rate you
◦ Staple a copy of this to the lesson plan
◦ A teacher evaluation is part of the lesson
plan
INSERVICE PROJECT
A WIN-WIN FOR ALL
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Cover Sheet
◦ topic, date, agency
◦ presenter - your name
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Objectives
Content Outline
Written Quiz
Teacher Evaluation Form
Attendance Sheet - GOES TO AGENCY
◦ See appendix F
COMPONENTS OF
A LESSON PLAN
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AGENCY
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Lesson plan
◦ Lesson plan includes a copy
of the quiz & the teacher
evaluation form
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Attendance sheet
Give lesson plan to
preceptor
LIV – put in Margaret
Kelly’s mailbox in Room
307
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MRS. MCAULEY
Lesson plan
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Quizzes completed by CNAs
Evaluations completed by
CNAs
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Preceptor evaluation
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Student evaluation
Leave in my mailbox in R106
Returned to your student mail
folder in R111
◦ Lesson plan includes a copy of
the quiz & the teacher
evaluation form
◦ Include comments
Checklist for in-service project
2 brown envelopes
Focused on the learner:CNAs
 Measurable - Use action verbs
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◦ use words like state, describe, list,
explain
◦ DON’T use words like understand or
know
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Time component
HOW TO WRITE OBJECTIVES
1. By the end of the in-service the CNAs
will be able to state the causes of
pressure ulcers
 2. By the end of the in-service the CNAs
will be able to identify residents at risk
 3. By the end of the in-service the CNAs
will be able to describe methods to
prevent pressure ulcers
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REFER TO EXAMPLES WHEN WRITING
YOUR OBJECTIVES
EXAMPLES OF OBJECTIVES
COGNITIVE
 PSYCHOMOTOR
 AFFECTIVE
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◦ Objectives can be all the same type or a mix
TYPES OF OBJECTIVES
Knowledge, facts
Example:
CNAs will state 3 methods to prevent pressure
ulcers by the end of the in-service
COGNITIVE OBJECTIVES
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Skills
Example:
 CNAs will demonstrate proper
handwashing by end of in-service
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PSYCHOMOTOR OBJECTIVES
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Emotions, feelings
Example:
 CNAs will express feelings about caring for
a dying client by end of in-service
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AFFECTIVE OBJECTIVES
Outline format – don’t write a narrative
 Comprehensive – give a detailed outline
 Number objectives to match the
content
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◦ It should be very clear what content
goes with each objective
CONTENT OUTLINE
Objective:
1. By the end of the in-service the CNA
will list factors that increase the risk for
pressure ulcers
 Content Outline:
 1. a. immobility
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 creates pressure on skin over bony prominences
b. poor nutrition - protein needed to repair
skin
c. incontinence – chemicals break down skin
d. confusion – can’t move self, may be unable
to express pain or discomfort
EXAMPLE OF CONTENT
OUTLINE
Objective:
2. By the end of the in-service the CNA
will state 3 methods to prevent
pressure ulcers
 Content Outline:
 2. a. repositioning
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◦ Every 2 hours
◦ Avoid shearing, dragging
b. proper nutrition
◦ Record all intake, assist to feed as needed
c. keep skin clean & dry
◦ Inspect skin daily, toilet or change frequently
EXAMPLE OF CONTENT OUTLINE
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a.
b.
c.
d.
Quiz
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multiple-choice, true-false
state in positive, all choices same length
Which of the following would be most helpful
to prevent pressure ulcers? (obj 1)
Changing the resident’s position every 2
hours
Having the resident drink milk daily
Keeping the resident OOB for the shift
Using lotion to massage the skin over bony
prominences
EVALUATION OF KNOWLEDGE
List items for CNA to rate
Example: Teacher’s knowledge of
subject?
Ask other questions
Use a rating scale code:
4-excellent
3-very satisfactory
2-satisfactory
1-unsatisfactory
Include a space for comments
EVALUATION OF TEACHER
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How can you be an agent of change
rather than a target of change?
THE CHANGE MAKER
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threat to self
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fear of increased responsibility
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lack of understanding
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limited tolerance for change
How do people react to change?
What role do you play when it
comes to change?
Laggard or Adventurer
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Process of change - force field analysis
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Three phases required to accomplish
change
◦ unfreezing
◦ moving
◦ refreezing
CHANGE THEORY
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Unfreezing: recognize need for change
◦ loosen the status quo
◦ driving factors versus restraining factors
Moving: initiate change after planning
 Refreezing: change becomes
operational
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STAGES OF CHANGE
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Recognize need for a change
Define area of concern
Gather & analyze information to
understand
Establish goals: contrast current to ideal
Seek alternatives
◦ identify & rank all possibilities
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Implement the selected strategy
STEPS IN THE CHANGE PROCESS
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Involve everyone affected
establish open communication & trust
list advantages of the change
show your commitment to the change
provide incentives for change
introduce change slowly
HOW TO OVERCOME
RESISTANCE TO CHANGE
Run productive meetings
 Use participative decision-making
 Schedule a brainstorming session
when needed
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◦ quantity, freewheeling, no criticism
TECHNIQUES FOR IMPLEMENTING
CHANGE
See appendix D
 INITIATING CHANGE
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◦ Conduct a staff meeting to address this
situation
◦ Head nurse & LPNs in the fishbowl
◦ Observers outside the fishbowl
 What are the driving & restraining factors for this
change?
ROLE-PLAY
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Base on job description & observation
Written & presented by same person
After 90 days, then annually
Evaluatee involved in setting goals
Evaluatee may comment & receive copy
Opportunity to improve & be re-evaluated
PERFORMANCE APPRAISALS
Be seen as trying to be helpful
 Timing is everything
 Discuss behavior in relation to standards
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◦ Don’t be preachy or use word “should”
Give specific suggestions for change
 Recognize & praise improvements
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Coaching Role
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Select appropriate time & place
Begin with small talk
Stay job-focused
Provide opportunity to improve
Pitfalls to avoid:
◦ social visit
◦ charge-excuse cycle
CONDUCTING THE INTERVIEW
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Begin with the positive attributes,
accomplishments
◦ Be specific
◦ Spend time
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Identify and address the deficiencies
◦ Don’t use avoidance or minimize these
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Finish with a positive statement
USE THE SANDWICH APPROACH
ROLE-PLAY
PERFORMANCE APPRAISALS
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See appendix D
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Demonstrate an ineffective interview
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Demonstrate an effective interview
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Competition/Power: Win /Lose
◦ manager concerned with work
◦ little regard for staff
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Smoothing: Lose/Win
◦ manager concerned with relationships
◦ secondary concern for work
RESPONSES TO CONFLICT
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Avoidance: Lose/Lose
◦ Low regard for both tasks & relationships
◦ Ignores/withdraws from conflicts
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Compromising: Lose/Lose
◦ each side makes concessions
◦ neither side gets what they want
RESPONSES TO CONFLICT
RESPONSES TO CONFLICT
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Collaboration: Win/Win
◦ confront issue openly
◦ look for acceptable resolution
◦ no dominating, suppressing, compromising
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Identify the problem
◦ Set some ground rules for the discussion
◦ Set a time limit for the discussion
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Encourage free exchange of ideas &
feelings
◦ Create an atmosphere of trust
◦ Set firm limits on individuals out of control
Strategies for Effective Conflict
Resolution
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Search for alternative ways to resolve
problem
◦ Shift talk from problem to solution
◦ List points of agreement for all to see
Ask for help from outside as needed
 Set up means to evaluate solutions
 Keep interacting until all want the solution
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Strategies for Effective Conflict
Resolution
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See appendix D
Competition/Power
Smoothing
Avoidance
Compromising
Collaboration
ROLE-PLAYS
CONFLICT RESOLUTION
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How innovative are you?
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Identify your barriers to innovative action
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low self-confidence
Dislike of risk-taking
need for conformity
no abstract thinking
Lack of time for creativity
21ST CENTURY LEADER
ROLE OF VISION