Transcript Learning Objectives (cont`d)

Chapter 16
LPN/LVN Charge Nurse Skills:
Management, Including Assignment and
Delegation
1
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Chapter 16
Lesson 16.1
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Learning Objectives
• Using your state’s Nurse Practice Act,
identify the following as they apply to the
charge nurse position for
practical/vocational nurses:
a. Requirements before assuming the licensed
practical/vocational nurse (LPN/LVN) charge nurse
position
b. Site of employment
c. Scope of practice
• Review charge nurse job descriptions.
3
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Learning Objectives (cont’d)
• Identify specific institutional policies,
regulations, and routines that the
practical/vocational nurse needs to
clarify when assuming a charge nurse
position.
• Collect a list of data that are needed
before reporting a change of condition
in a resident to a physician.
4
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Learning Objectives (cont’d)
• Discuss strategies for handling the
following common LPN/LVN charge
nurse problems:
a. When nursing assistants bring problems from
home
b. Encouraging nursing assistants to be accountable
for learning skills
c. Dealing with the demanding/complaining family
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LPN/LVN 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
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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.
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Policies, Regulations,
Routines
• Charge nurses need information on the
following so that they can fulfill their own
duties and supervise nursing assistants:
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Facility organization/legal aspects
Federal, state, and private agency regulations
Personnel policies
Records and unit routines
Unit administration
Safety policies
Housekeeping, maintenance, and supplies
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Policies, Regulations,
Routines (cont’d)
– Equipment: how to use and where to
obtain
– Food service for residents
– Nursing care procedures/assisting
physician
– Medications
– Documentation
– Special areas
– Miscellaneous
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Facility Organization/
Legal Aspects
• Mission statement
• Organizational chart
• State statutes for all licensed persons on health care
team
• Skills checklists for LPN/LVNs and nursing assistants
• Skills checklists for all cross-trained personnel
• Job descriptions and duties of RNs and LPN/LVNS
• Job descriptions and duties of unlicensed personnel
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Facility Organization/
Legal Aspects
• Federal, State, and Private Agency
Regulations
– Inspection protocols
– Current federal (including HIPPA regulations) and
state regulations
– Regulations of the Omnibus Budget Reconciliation
Act of 1987 (OBRA)
– Regulations of the Centers for Medicare and
Medicaid Services (CMS)
– Regulations of The Joint Commission (if facility
seeks TJC accreditation)
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Personnel Policies
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Employee manual
Time sheets—location and interpretation
Vacation, holiday, sick leave policy
Special request for time off, leave of absence
Communication—reporting: on and off duty,
sickness, absence, memos, bulletin board
Meal and coffee break
Smoking regulations
Use of facility telephones
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Uniform regulations
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Records and Unit Routines
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General shift routine for days, evenings, and nights
Duties of each of the three shifts
Methods of reporting
Procedure manual
Facility policy manual
Procedures specific to each division of the facility
Nursing care plan system
Nursing Kardex and Medix systems
Routine for care planning conferences
Routine for physicians’ visits
System of transcribing physicians’ orders
Location of reference books
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Unit Administration
• Admission, placement, transfer, and discharge of
residents
• Care of clothing and valuables, including personal
property list
• Routine for seriously ill residents
• Routine for death of a resident
• Autopsy permit
• Authorization procedure and forms for diagnostic
tests and surgery
• Visiting hours
• Notary public
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Safety Policies
• Side rails
• Restraints
• Fire regulations: reporting, evacuation plan, fire exits,
location of fire extinguishers, preventive measures,
fire drill procedure
• Use of oxygen
• Transportation of residents by cart, wheelchair
• Body mechanics and back safety policy
• Door alarms
• Standard precautions
• Security policies
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Housekeeping, Maintenance,
and Supplies
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Linen: how supplied, extra linen
Care of contaminated linens and dressings
Unit cleaning procedure and responsibilities
How to obtain supplies: drugs, sterile
supplies, personal care items, kitchen items
• Maintenance and repairs requests
• Conservation of supplies, linen, and
equipment
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Equipment: How to Use
and Where to Obtain
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Oxygen
Suction equipment
Therapeutic beds
Respiratory therapy equipment and
services
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Food Service for Residents
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Ordering diets/diet changes
Tray service
Unit food stock items
Special nourishments
Policy for feeding residents
Policy for dining room
Policy for family trays
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Nursing Care Procedures/
Assisting Physician
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Bathing
Mouth care
Bed making
Temperature (devices used), pulse, and respiration
Blood pressure
Catheterization
Enemas
Suppositories—rectal
Recording intake and output
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Nursing Care Procedures/
Assisting Physician
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Systems used for pressure ulcer care
Collecting, delivering, and labeling specimens
Assisting podiatrist with foot care
Policies for sterile technique procedures
Blood glucose monitoring
Colostomy care
Nasogastric and gastrostomy tubes: flushing, feeding,
administration of medication
• Standard precautions
• Postmortem procedures
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Medications
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Medication system
Policy for reordering
Unit stock
Ordering from pharmacy
Review of metric system, proportions,
abbreviations
• Drug errors: reporting, incident reports
• Narcotics count
• Sources of drug administration
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Documentation
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Method of documenting
Computer system
Forms used
Flow sheets used
Policy for phone orders
Incident reports
Lists for wanderers, hearing aid use, and so on
Federal and state chart forms and requirements
Private organizations’ requirements
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Special Areas
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Emergency supplies
Central supply area
Physical therapy
Occupational therapy
Laundry
Maintenance
Break room
Dining room
Kitchen
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Special Areas (cont’d)
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Business offices
Social services
Director of nurses
Chaplain services/chapel area
Staff educator
Administrator of facility
Conference rooms
Activity department
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Miscellaneous
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Paging system
Call light system
Disaster plan
Routine for residents who desire cardiopulmonary
resuscitation
Volunteer services
On-call schedule
Handling of wanderers
Procedure for signing resident in and out of facility
Hair care services
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Data Collection
• Change-of-shift report provides data for
dividing the work among team members
on the shift.
• Visit each resident quickly to compare
status to that on change-of-shift report.
• Frequency of data collection depends
on resident’s condition.
• Be observant with each resident
interaction.
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Data Collection (cont’d)
• Guidelines of signs and symptoms to assess
(but follow parameters specific to resident):
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Weight
Temperature
Upper and lower respiratory
Cardiac
Breast, abdomen, musculoskeletal, reproductive,
genitourinary systems
– Sleep and rest patterns
– Appearance of skin
– Mobility and exercise
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Data Collection (cont’d)
– Hygiene status (mouth, body, hair, nails)
– Communication
– Sensory-perceptual
– Cultural/religious
– Psychological status
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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.
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Common Problems of Charge
Nurses (cont’d)
• 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.
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Common Problems of Charge
Nurses (cont’d)
• 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.
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Chapter 16
Lesson 16.2
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Learning Objectives
• Discuss the assignment of tasks versus
the delegation of duties with regard to
the following factors:
a. Your state’s laws regarding the role of the
practical/vocational nurse and the delegation of
duties in the charge nurse position
b. Differences between assigning nursing tasks and
delegating nursing duties
c. Legal aspects of assigning nursing tasks and
delegating nursing duties
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Learning Objectives (cont’d)
d. The following criteria that need to be
considered when assigning nursing tasks
and delegating nursing duties:
1) Right task
2) Right person
3) Right circumstance
4) Right direction/communication
5) Right supervision (monitoring), feedback, and evaluation
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Learning Objectives (cont’d)
• Describe elements that need to be focused on when
receiving and giving a change-of-shift report as
charge nurse in the long-term care facility.
• Using the nursing process as a guide, discuss the
method for assigning and delegating the following:
a. Collecting data
b. Planning
c. Implementation
d. Evaluation
e. Putting it all together
f. Reporting at the end of your shift
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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
– Appendix B: NAPNES Standards of Practice for
LPN/LVNs
– Appendix C: NFLPN Nursing Practice Standards for
the LPN/LVNs
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Tasks vs. Duties
• Tasks
– 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.
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Assigning vs. Delegating
• Assigning
– 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.
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Assigning vs. Delegating
(cont’d)
• 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.
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Benefits of Delegation
• Can increase effectiveness and
efficiency of the LPN/LVN
• Can help achieve patient outcomes in a
cost-effective manner
• Can help nursing assistants improve
their job skills
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Legality of Delegating
• Respondeat Superior
– The nursing act delegated is the act of the
supervising nurse.
– Registered nurse is ultimately responsible
for the supervision of nursing assistants.
– LPN/LVN charge nurse assists in the
supervision of these health care workers
and shares accountability with the RN for
their actions.
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Legality of Delegating
• Scope of Practice for the LPN/LVN
– 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/LVN
– 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.
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Nursing Process: Delegation
• Collecting data: change-of-shift report
• Planning: establishing goals/outcomes
for the shift, setting priorities, and
assigning/delegating
• Implementation: monitoring, assisting,
being available, intervening when
necessary
• Evaluation: two-way feedback
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Collecting Data
• Oncoming Report
– Change-of-shift report allows the LPN/LVN charge
nurse to collect data to determine how the work of
the shift will be divided
• Report When Starting Your Shift
– A way to pass pertinent data to the oncoming shift
• Assessment of Patients
– Allows the charge nurse to note any changes in
condition of residents or discrepancies that may
have occurred since report
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Planning: Before
Assigning/Delegating
• Before Assigning Tasks/Delegating
Duties to Nursing Assistants
– Identifying Resident Goals (Outcomes)
– Setting Priorities
– Criteria for Assigning/Delegating to Nursing
Assistants
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Right task (duty)
Right person
Right circumstance
Right direction/communication
Right supervision
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Right Task/Duty
• Right Supervision, Feedback, and
Evaluation
– The National Council defines supervision as “the
provision of guidance or direction, evaluation, and
follow-up by the licensed nurse for accomplishment
of a nursing task delegated to unlicensed assistive
personnel.
– This definition is interpreted to include appropriate
monitoring, intervention, and evaluation of the
nursing assistant, as needed, while providing the
delegated duty and feedback after the delegated duty
is completed.
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Right Person
• The “right person” is a competent nursing
assistant who can:
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Communicate effectively
Collect basic data
Safely perform noncomplex nursing activities
Seek guidance when necessary
• Prior to assigning/delegating, the
LPN/LVN should:
– Review job descriptions
– Know the nursing assistant’s level of competence
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Right Circumstance
• 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/LVN might not be available,
if needed
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Right
Direction/Communication
• Inadequate communication: delegated duties
will 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.
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Implementation:
Right Supervision
• Appropriate monitoring, intervention,
and evaluation of the nursing assistant
• Monitoring frequency depends on
situation
• LPN/LVN must be available for
questions
• Intervene if necessary to ensure safety
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Evaluation
• Legally, the LPN/LVN 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.
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Reporting at the End of Your
Shift
• Obtain reports from the nursing assistants
before you can tape or give report.
• Set priorities in deciding pertinent information
to give to the next shift.
• Be sure to personally assess residents who
have the following:
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Changes in condition
Current ongoing problems
New orders (and resident response to new orders)
Suspected side effects to medications
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