Transcript Chapter 34

Chapter 4
The Leadership Role
of the Licensed
Practical Nurse
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Learning Objectives
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Differentiate between leadership and management.
Describe leadership styles.
Discuss leadership theories.
Discuss management theories.
List tips for effective management.
Describe the role of the licensed vocational nurse as a
team leader.
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Leadership versus Management
• Terms leadership and management used
interchangeably but have different meanings
• Leadership is broader and more futuristic;
management is more local and task focused
• Leadership: inspiration; management:
perspiration
• Ideally, leadership and management
complement and build on each other
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Leader
• Creates a vision that energizes others to follow
• Guides or shows the way to others
• Clarifies values for groups that, when combined with
vision, create a mission for the group
• Formal leaders and informal leaders
• Inspires people to strive to accomplish particular goals
by doing the right thing
• Sees beyond the here and now to what might be and is
internally driven toward that vision
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Manager
• Assigned or appointed; focuses on the
organization’s day-to-day work
• Driven by external organizational rewards
• Provides means to achieve organization’s
goals by doing the thing right
• Gets things organized so the leader’s vision
can be achieved
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Leaders and Managers
• Leaders and managers must have certain
characteristics to be effective
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Competence
Ability to gain respect of those who work with them
Ability to communicate with others
Ability to motivate others
Understanding of what others consider important
and why they behave as they do
• Willingness to reinforce motivation, enhance
positive outcomes, and provide multiple motivators
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Leaders and Managers
• Good leaders and managers seem to have
certain characteristics in common
• Ability to set realistic goals
• Willingness to try out new ideas
• Ability to think positively
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Figure 4-2
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Autocratic Leaders
• Authoritarian, directive, or bureaucratic
• Achieve goals by setting objectives and having them
carried out without input from others
• Believe they have complete authority and should not
be questioned
• Do not encourage individual initiative or cooperation
among members of the organization
• Task oriented, making decisions independently and
issuing orders to those working with them
• This style of leadership does not work well in many
situations; in other situations it is necessary
• During an emergency, one person must take charge
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Democratic Leaders
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Focus on the individual abilities of each member
Encourage input into the problem-solving process
Decisions often are made through group consensus
All are informed of the organization’s goals and
direction; input has a direct relationship to attaining
goals
Instead of power struggles, democratic leaders turn
problems over to the group to manage
Lead by suggestion rather than by domination
Persuade and teach rather than rule
Group members are satisfied because they help
manage the decision-making process
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Laissez-Faire Leaders
• Opposite of autocratic leaders
• Provide little or no directive leadership
• Individuals are allowed to do anything they
want with no direction from administration
• Result: people do not know or care about what
they are supposed to do and may lose initiative
and desire for achievement
• May work well with a highly motivated, focused
group
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Multicratic Leaders
• Cross between autocratic and democratic leaders
• Sometimes called situational leaders
• Present their own views to group members, who
provide criticism and comments
• Analyze group feedback and then make final decisions
• Work well within a group as well as in emergency
situations, when events need to be handled quickly
• Response not as quick as under autocratic leadership
• Group members assist the multicratic leader with
setting goals, thereby achieving for themselves a
sense of empowerment and control
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Transformational Leadership
• In a well-functioning group that shares a
common vision, leadership will flow among the
members based on the task or problem at
hand and the members’ individual skills
• All group members are leaders and followers
• May not replace reporting lines or formal job
responsibilities, but it may be very effective in
identifying the best option at the moment and
in energizing others to take action because
they are very involved in the decision-making
process
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Classic Management: Theory X
• Assumes that people in the workplace
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Find no pleasure in their work
Dislike responsibility
Are naturally lazy and prefer to do nothing
Work mainly for the money
Work only because they fear being fired
Are basically childlike and like being told what to do
Do not want to think for themselves
Are not capable of making decisions for themselves
• According to theory X, people have these
characteristics; thus, they want to be directed
and controlled
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Classic Management: Theory Y
• Assumes people are dynamic, flexible, and adaptive
• Believers in this theory assume that people
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Are active and enjoy setting their own goals
Work for personal rewards other than money
Are productive because of their own goals
Are mature and responsible
Are self-directed
Accept responsibility
Care about what they are doing
Are constantly striving to grow
• According to theory Y, people like their work when they
know what is expected of them and when their work
gives them satisfaction
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Classic Management: Theory Z
• An organizational philosophy and structure
• Grew out of the times when most employees were
related to one another and worked together for the
good of the company rather than for individual gain
• Focus is on participative management based on
mutual trust and loyalty
• Employees frequently remain with the same
organization for their entire career, learning all areas of
its operations and merging their individual success with
that of the organization
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Classic Management: Theory Z
• Involves all workers in every phase of the operation of
the company: planning, organizing, decision making,
and problem solving
• All group members have similar abilities and status;
may be rotated to perform different duties
• Group members know and understand organizational
objectives and methods of achieving them
• Results in greater efficiency and satisfaction among
members of the workforce
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Figure 4-1
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Functions in the Management
Process
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Planning
• First step in the management process
• Entails deciding in advance what needs to be
done and how to do it
• A good plan for carrying out their care must be
developed to provide effective care for patients
• Two important components of planning are
decision making and problem solving
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Decision Making and
Problem Solving
• Identify the problem
• Sometimes the problem is obvious, but other times
underlying issues make the real problem less
obvious
• Explore all aspects of the situation to identify the
real problem
• Seek answers to such questions as who, how,
when, and why
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Decision Making and
Problem Solving
• Explore all possible solutions
• This is a creative process that can involve other
people in the health care setting
• Brainstorming sessions may be held to obtain input
from a variety of sources
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Decision Making and
Problem Solving
• Choosing the most desirable action for solving
the problem, to select the best solution
• Consider whether the action is likely to accomplish
the objectives of the organization
• Determine whether the action increases
effectiveness and efficiency and whether it is
realistic to implement it
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Decision Making and
Problem Solving
• Implement the decision
• Communicate with other people who are involved in
the organization to gain their support for the action
• Express the decision in such a way that others
support rather than oppose it
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Decision Making and
Problem Solving
• Determine how the results will be evaluated
• Written tools, such as audits or checklists
• Verbal or written feedback from individuals in the
organization or from patients who are receiving the
care
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Organizing
• Second step in the management process
• Must be a formal structure or organization to
ensure that individuals carry out actions in the
most efficient and effective manner
• Helps develop order, promote cooperation
among workers, and foster productivity
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Organizing
• Develop objectives
• Guide the process of planning and organizing
• Establish policies and procedures
• Provide guidelines for carrying out the objectives
• Make appropriate staff assignments
• The most qualified people should be assigned to
activities and tasks that will achieve the objectives
• May involve the development of job descriptions,
performance standards, and staffing patterns
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Directing
• The third step of the management process
• Make assignments and direct people to carry out
the assignments
• Explain what is to be done, how it is to be done, and why it
is to be done
• Making assignments is related to patient care
• Assignments should be made carefully so that the skills of
assigned personnel match patient needs
• Important to estimate the difficulty of the task and the time
needed to complete the care
• Help and additional instruction should be provided
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Directing
• One person should be responsible for making
assignments, especially with team nursing
• Assignments must be specific, easily understood, and
posted where everyone can see them
• Staff members should be helped to understand their
assignments and the importance of each task
• Directions must be complete and understandable
• Give directions in a clear, logical order and limit the
number of directions given at any one time
• Providing written directions increases understanding
and compliance
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Coordinating
• Step of the management process
• Pulls together various activities toward a goal
• Ensures all important activities are being carried out
and helps to identify overlap, duplication, and
omissions
• Involves personnel and services
• You must be sure that proper nursing care is given by the
appropriate people
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Coordinating
• Carried out within a single nursing unit or among units
and departments in a hospital, long-term care facility,
or community agency
• Demands skill in problem solving and decision making
• Requires good communication skills and an ability to
resolve conflicts within an organization
• Requires an assessment of what all individuals and
groups are doing; important for all parts of the
organization to function effectively for the good of the
whole
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Controlling
• The last step in the management process
• Ongoing process: activities are analyzed to make sure
the plans are being carried out
• Efficiency and effectiveness are evaluated
• Purposes of controlling are to determine whether there
are enough staff and supplies, the operation is
economical, and the objectives have been achieved
• Controlling is fundamentally a form of evaluation
• Controlling has three basic steps
• Establishing standards and objectives
• Measuring performance and comparing results with standards
• Remedying any deficiencies in the caregiving operations
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Controlling
• Continuous quality improvement
• Quality assurance (QA), continuous quality improvement
(CQI), and total quality management (TQM) used in relation to
controlling
• Measures performance against set standards and
expectations and alerts the organization when an action falls
below standard
• QA committees set standards for care and evaluate
compliance
• American Nurses Association, American Hospital Association,
and Joint Commission on Accreditation of Healthcare
Organizations set standards for nursing practice and medical
care
• Continually seeks ways to improve nursing practice
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Conflict Resolution
• Conflicts arise from differences in many
factors, such as beliefs, knowledge, opinions,
values, personalities, and backgrounds
• Creates stress and negative feelings that can
adversely affect the work situation
• May be within an individual (intrapersonal
conflict), between two or more people
(interpersonal conflict), or between individuals
and organizations (organizational conflict)
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Four Stages of Conflict
• Stage 1: Frustration
• People who believe their goals are being blocked
feel frustrated
• May become angry or resigned to the situation
• Stage 2: Conceptualization
• Each party formulates a view of the basis for the
conflict
• Typically centers on perceived differences in facts,
goals, how to achieve goals, and the values on
which goals are based
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Four Stages of Conflict
• Stage 3: Action
• The conflict leads to various behaviors that may or
may not help resolve the issue
• Stage 4: Outcomes
• Goals may be reformulated so they are acceptable
to all parties
• One party may “win,” the other may “lose”
• Emotions may be positive or negative
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Modes of Conflict Resolution
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Accommodation
Collaboration
Compromise
Avoidance
Competition
Table 4-5 shows the positive and negative
outcomes of each mode
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Tips for Effective Management
• Managing health care workers is a complex task
• Strategies to improve your management skills
• Take active approach to planning; avoid conflict before it
occurs
• Have a clear vision, communicate it well, listen, and stay
focused
• Emphasize importance of documentation as part of
management
• Treat other health care workers or team members as you
would like to be treated yourself
• Keep confidential information confidential
• Make employees accountable for their actions and be
accountable for yours
• Seek help and support from a variety of sources
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The Licensed Practical Nurse
as a Leader
• Team nursing
• Introduced during the 1950s, when there was a
shortage of professional nurses and an abundance
of auxiliary nursing staff
• The team functions by using the skills and
knowledge of the professional nurse to direct the
care provided by a diverse staff through group
action
• All members have input into the nursing care
process by contributing suggestions and sharing
ideas
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The Role of the Team Leader
• Functions: plan, set priorities, supervise, and
evaluate patient care
• Responsible for ongoing collection of data
about each patient and assistance in
determining nursing interventions
• Ensure that medical orders and plans are
carried out and documented
• Initiate discharge planning, identify referral
needs, and facilitate patient education
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The Role of the Team Leader
• Responsible for keeping care plans current and
documenting the nursing care provided
• Responsible for planning and conducting team
conferences and reporting changes to the RN
supervisor
• An LPN who assumes the position can help
carry out these responsibilities under the
supervision and guidance of an RN
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Making Assignments
• You must be able to assign tasks to others and make
sure that those tasks are carried out
• Delegation allows nurses to accomplish nursing care
for more clients than one individual could provide alone
• Delegation (defined by the NCSBN): “the act of
transferring to a competent individual the authority to
perform a selected nursing task/activity/function in a
selected situation, the process for doing the work”
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Making Assignments
• Involves identifying specific tasks needed to provide
care for a specific person
• Based on patient needs, available staff, job
descriptions, scope of practice for licensed nurses, and
scope of functions for nursing assistants
• When delegating a task, your duty is patient safety
• Effective delegation: delegating a clearly identified
task, identifying patient needs, empowering the staff
person to carry out activities to complete the task, and
monitoring staff performance
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Making Assignments
• Essential elements of effective delegation
• Know your state nurse practice act statements on
delegation and your institution’s policy and
procedures manual
• Know the training and background of people to
whom you delegate tasks
• Decide which tasks can be safely delegated
• Evaluate the patient’s response
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Making Assignments
• Delegate tasks only to licensed personnel
• Do not delegate nursing processes to unlicensed
personnel. Assessment, planning, evaluation, and
judgment cannot be delegated
• Delegation is specific to each client
• An unlicensed person who completes a task for one
patient cannot do the same task for all patients
• Delegation is also situation specific
• You delegate a task for one patient in one situation
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Accident Prevention and Safety
• Every health care facility must meet minimal
safety regulations established by law in
addition to those adopted by the agency to
meet its unique needs
• All staff members, particularly the team leader,
should learn these regulations during job
orientation
• The team leader should know the regulations
and be sure that staff members are aware of
them
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Accident Prevention and Safety
• Everyone must understand procedures to
follow in case of disasters such as fires,
tornadoes, and hurricanes
• Everyday safety issues related to handling
equipment, using proper procedures, and
working with potentially dangerous drugs must
constantly be addressed to be sure that
knowledge and skills are up to date
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Accountability
• Team leaders demonstrate accountability for their own
actions as well as those of their staff
• Individuals are answerable for their actions and may be
called on to explain or justify them
• Team leaders are legally responsible for all nursing
care and documentation
• RN team leader is responsible for ensuring that proper and
accurate charting is carried out for all nursing assessments,
interventions, and evaluations
• Involves communicating patient needs to others
through both oral and written interactions
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Accountability
• Guidelines for clear and complete reporting
• Organize the report before beginning
• Give the patient’s room number, name, age (if
appropriate), diagnosis, and physician
• Provide a brief account of each patient’s condition,
including new or changed orders
• Refer to vital signs, temperature elevations,
intravenous fluids, and intake and output as relevant
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Accountability
• Guidelines
• For patients receiving pain medication, note the
drug name, dosage, prescribed frequency, time of
last administration, and effectiveness
• Cover the necessary information for preoperative
patients, including the preoperative teaching, the
time of preoperative medications, completion of
surgical checklists and the like
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Accountability
• Guidelines
• Give information about postoperative patients,
including the time of arrival from the operating or
recovery room, general condition, vital signs,
intravenous fluids required (e.g., kind, rate of flow,
fluids to follow), dressings, voiding, diet, nature of
breathing, coughing, and type, location, and patency
of tubes
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Characteristics of an
Effective Team Leader
• Has skills in leadership, management, and
supervisory techniques
• Communicates effectively, both orally and in
writing
• Works well with others; shows that others’ input
and suggestions are valued
• Understands how to build an effective team
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Characteristics of an
Effective Team Leader
• Strategies to build an effective team
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Establish a clear purpose
Listen actively
Be compassionate
Be honest
Be flexible
Be committed to conflict resolution
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The LPN as Charge Nurse
• Depends on LPN’s state nurse practice act
• Common for LPNs in long-term care to fill this
role
• Most states require that written protocols and
procedures be in place and that the LPN work
under the general supervision of an RN
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The LPN as Charge Nurse
• LPN must have adequate preparation to
perform competently
• Requires education, training, and/or experience
beyond the basic LPN educational program
• LPN must assign patient care, assess patients,
delegate tasks (as permitted by state law),
receive and give shift reports, and handle
common workplace issues
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