Unit 4 Delegation/Prioritization/ Nurse as Manager of Care

Question 1

Describe managers and management.

Answer 1

Managers: have formal authority and responsibility to direct the work of employees

Management: is a problem-oriented process to do what is necessary to get the job done by people.

Question 2

What are the functions of a new nurse and management?

Answer 2

Plan
Organize
Direct
Control

Nurse uses it to manage herself
Management uses it to manage everyone

Question 3

What are the types of management styles?

Answer 3

Autocratic - directed, controlling, task oriented

Democratic - planning and decision making is shared, flexible, takes time, people oriented, group decision.

Laissez-faire - Permissive, non directive, little planning or decision making

Question 4

What are the 3 common elements of leadership?

Answer 4

Listening

Patience

Encouraging

Question 5

What is the difference between the problem solving/nursing process and decision-making process?

Answer 5

Problem solving/nursing process follows set of steps

Decision making is based on values, past experiences, and perceptions of the individual involved.
(You need to know profession, yourself, and situation)

Question 6

List what should be prioritized.

Answer 6

1. Immediate threat to survival
2. Threat to safety (Psych needs)
3. Problem for which help has been requested (PT wanting pain meds, sitting on chair, etc)
4. Other problems discovered
5. Potential problems

Question 7

What legislative do nurses work under?

Answer 7

We work under legislative control of the State Board of Nursing (BON): Practice Act

Question 8

What does the NJ Board of Nursing regulate and their purpose?

Answer 8

• Primary Licensure Verification
• Rules and Regulations (Practice Act) - laws that guide their practice, each state has their own
• Scope of our practice

[Purposes is to make sure public is protected]

Question 9

What is standard of care? Who makes it?

Answer 9

Model of established practice that is commonly accepted as correct.

American Nurses Association (ANA)

Question 10

What are external vs internal standards?

Answer 10

External standards are credentialing programs such as:
Joint commission
ANA
Magnent

Internal standard:
-polices and procedures/job descriptions

Question 11

What is the ANA Code of Ethics for Nurses?

Answer 11

Moral statement of accountability

Not a legal document

No judgement of bias towards PTs

Question 12

What are interpersonal skills?

Answer 12

Communication

• verbal
• written

Time Management

• Organization
• Prioritization

Question 13

Describe SBAR.

Answer 13

Provides framework for communication about a patient.

Situation: 5-10 seconds
Background: Brief history, relevant content
Assessment: What I think
Recommendation: What I need and when

Question 14

Describe I Pass the Baton.

Answer 14

Introduction

Patient
Assessment
Situation
Safety Concerns

Background
Actions 
Timing 
Ownership
Next

Question 15

What are the types of conflict resolution?

Answer 15

Avoidance - low cooperation and low competitiveness
Compromise - medium cooperation and competitiveness (ex: trading position)
Collaboration - high cooperation and competitiveness (best conflict resolution)

Accommodation - high cooperation low competitiveness
Competition - high competitiveness and low cooperation

Question 16

What are time management strategies?

Answer 16

1. Learn to say no, use assertive communication
2. Communicate directly with the person with whom you have a problem
3. Delegation! Delegation!
4. Get organized: a place for everything and everything in its place

Question 17

Describe Delegation.

Answer 17

Transfer of authority to a competent individual for the performance of a task or function.

Passes on responsibility for the performance but NOT the accountability for the process or outcome of the task.

[When you delegate you become a supervisor]

Question 18

Describe accountability.

Answer 18

Being answerable for what one has done and standing behind that decision and/or action.

Question 19

What is the delegate responsible for?

Answer 19

Accepting the delegation and for his/her own action carrying out the task.

Question 20

As a RN, what are you accountable for?

Answer 20

Assessing the patient's needs
Planning the desired outcomes
Interdisciplinary collaboration 
Teaching/communicating plan
Evaluation of outcomes

(The nursing process) plus education.

Question 21

Describe assignment/giving an assignment.

Answer 21

The distribution of work including the responsibility and accountability for the performance of the activity or task.

Lateral Move, presumes the skill and judgement are interchangeable between ppl.

Shift of activity from one person to another.

Question 22

What are the elements of Nurse Practice Acts?

Answer 22

Definition of professional nursing
Requirements for licensure
Rule making, scope of practice
Licensure across jurisdictions
Regulation of APN
Disciplinary action and due process requirements
Accreditation of nursing programs

Question 23

Describe the APN practice.

Answer 23

Manage wellness and stabilize long term illnesses by:

1. Initiating lab and other diagnostic tests
2. prescribing or ordering meds and devices

Question 24

What are the steps in the delegation tree?

Answer 24

1. Assessment and plan
2. Communication
3. Surveillance and supervision
4. Evaluation and feedback

Question 25

What are the 5 rights of delegation?

Answer 25

Right task

Right person

Right communication

Right supervision

Right circumstance

Question 26

What is the only IV push Rx that LPN’s can give?

Answer 26

Heparin

Question 27

What can LPN’s NOT do? (Non-delegatable RN tasks)

Answer 27

1. Initiate blood transfusion or blood products
2. Administer IV antineoplastic meds
3. IV push meds except for heparin
4. Administer any experimental Rx
5. Initial PT teaching
6. Accept verbal or telephone orders
7. Independently provide care to an unstable PT
8. Develop or initiate interdisciplinary treatment plan or discharge planning
9. Manually perform defibrillation on a patient
   (can use AED or shock advisory mode)

Assessing
Planning
Evaluations

Question 28

What are the four C’s of communication?

Answer 28

Clear direction
Concise description
Complete information
Correct limits and expectation

Question 29

How do you give feed-back?

Answer 29

Give specific examples

LISTEN as person speaks

Provide directions and goals

Praise publicly, criticize privately

Question 30

What are benefits of delegation?

Answer 30

PT satisfaction
Nurses' satisfaction
Better outcomes
Financial benefits
Recruitment

Question 31

What is the Health Care Professional Responsibility and Reporting Enhancement Act (Cullen Law)?

Answer 31

Organizational and personal responsibility for reporting negligent or criminal conduct.

Question 32

What are the levels of the Health Care Professional Responsibility and Reporting Enhancement Act (Cullen Law)?

Answer 32

Level 1 - always requires reporting to the Board of Nursing (BON)

Conduct that clearly violates expected standards of care and may result in various degrees of harm
Conduct demonstrating pattern of poor judgement or skill
ex: drug diversion, abuse, arrests, med errors

Level 2 - Depending on an analysis of the facts, may require reporting to the BON
(No list for this category, judgement for person making the report based on the relevant factors)

Level 3 -Does not require reporting to the BON
(Low level infractions that do not involve PT care or wrongdoing)
ex: being late to work, general disputes

Question 33

How many hrs every 2 years does an RN and LPN need to complete in CEUs and who mandates it?

Answer 33

30 hrs

Board of Nursing practice act