Test 2 - Leadership

Front 1

In a typical nursing day, what % of time is spent where?

Back 1

35% - 50% - Hands on patient care
20% - Documentation

All rest: preparing, gathering supplies, interdisciplinary communication: PT, OT, ST, Social Services, Dr's., etc.

Front 2

What causes nurses the most significant problems with time management?

Back 2

* We need to be needed, therefore we can't say "no"
* We don't accurately assess the time needed for tasks
* Stress keeps us from accomplishing anything

Front 3

Define Time Management

Back 3

Optimal use of time
Management of self
Identifying, prioritizing, and doing tasks.
Delegating
It is not intuitive, it must be learned & you will improve with practice.

Front 4

What are the 3 steps to the best time management?

Back 4

1 - Allow time to plan & establish priorities
2 - Complete the highest priority task & finish one task before beginning another
3 - Re-prioritize based on remaining tasks & new information received

Front 5

Which step is the most important for time management?

Back 5

Step 1 - planning & establishing priorities

Front 6

What is the appropriate window for giving meds and not being out of compliance?

Back 6

30 minutes prior to 30 minutes after (unless there is an emergency)

Front 7

What are some time sensitive requirements that you have to plan your priorities around?

Back 7

Med Distribution
Pre-op
Procedures

Front 8

What are some ways in which you can plan & establish priorities effectively?

Back 8

1 - Make a list.
2 - Identify time specific tasks & plan around them.
3 - Plan an estimated schedule; revise & modify as changes occur

Front 9

What is the PQRST method?

Back 9

P - Prioritize (Importance, what must be specific times vs. anytime, emergencies take precedence, Identify events you control vs. those others control, critical thinking to assign priorities)
Q - Question (Effectiveness-best way, Efficiency-efficient way, Efficacy-best result)
R - Recheck (Mentally/Physically recheck unfinished or delegated tasks)
S - Self Reliance (critical think to revise priorities, Go with the flow)
T - Treat (treat to break, time off, education, commit to excellence, treat others courteously w/ respect)

Front 10

What are some various methods to accomplish the 2nd step of time management?

Back 10

* Complete most difficult tasks when you have most energy
* PQRST
* Divide tasks into 3 categories: Don't do, Do later, Do now

Front 11

When completing the third step of time management, what do you NEVER do?

Back 11

NEVER throw out the original list, simply modify it until it is completed.

Front 12

What are some common time wasters?

Back 12

* Technology - facebook/phones
* Socializing (some is ok, but excess is a problem)
* Managing by crisis
* Telephone calls
* Poor planning
* Taking on too much
* Unexpected visitors
* Improper delegation
* Disorganization
* Inability to say NO
* Procrastinating
* Meetings

Front 13

What are some ways to discourage subordinates?

Back 13

Don't make yourself too accessible
Interrupt
Avoid promoting socialization
Be brief
Schedule long winded pests

Front 14

What are some tips for success when managing time?

Back 14

Identify your own time wasters
Discourage subordinates
Delegate
Manage papers: Touch Once
Gather all supplies & equipment b4 starting activity
Group activities in the same location
Use realistic time estimates
Document interventions ASAP after activity is done
Strive to end workday on time
Procrastination is failure to break large tasks into smaller ones

Front 15

What are some outcomes of good time management?

Back 15

Decreased stress & increased productivity
We can do more with less time

Front 16

Define Prioritization

Back 16

An organization of activities according to the order in which they should be done.

***Must be set & reset depending on the circumstances you're face with.

Front 17

What does prioritizing determine?

Back 17

The order in which:
* Clients are seen
* Assessments are completed
* Interventions are provided
* Steps in a client procedure are completed
* Components of client care are completed

Front 18

If, in report, you receive information on 4 patients:
1 - pt who's blood sugar has been running low in a.m.
2 - pt w/ IV bag is about to run out
3 - pt needs a dressing change
4 - pt scheduled for surgery this a.m.
Who do you see first?

Back 18

1 - pt w/ low blood sugar in the a.m. needs the first assessment. This patient may already be experiencing S&S of low blood sugar. This is a more ACUTE problem then the pre-op assessment.

Front 19

From what data do you use to determine your priority list?

Back 19

* Shift report & labs
* Reports from team members: Dr., RT, PT, OT, LPN
* Review of documents: Chart, Drug Books
* Continual assessments of pt(s): Anti-HTN (did bp drop), Pain meds (are they reporting less pain), Repeated BS checks on Diabetic, Pt from surgery (are they waking up yet, dressings...)

Front 20

What are the principles of prioritization?

Back 20

* Systemic b4 Local
* Acute b4 Chronic
* Actual b4 Potential
* Trends b4 Transient Findings
* Emergencies/Complications b4 Expected Findings
* Maslow's Hierarchy
* ABC
* Severity of Symptoms
* Safety Risks
* Nursing Process (Assessment is 1st)
* Survival of the Fittest
* Least Restrictive for patient safety

Front 21

Pt has a wound that is warm/red around the wound (indicating infection) vs. patient with pneumonia who's temperature is steadily climbing. Who do you see first & why?

Back 21

Pneumonia patient.

Systemic vs. local (infected wound)

Front 22

Pt has BS's of 32 vs. patient complaining of pain 8/10 r/t pinned leg & being in traction. Who do you see first & why?

Back 22

Pt w/ low BS.

Systemic vs. local (pain is important but this is due to a localized problem)

Front 23

Pt has COPD w/ a low pulse ox vs. patient complaining of chest pain. Who do you see first & why?

Back 23

Chest pain

Acute vs. Chronic (COPD is a chronic problem & low pulse ox may actually be normal for them)

Front 24

Patient on bedrest is complaining of horrible leg pain & you suspect DVT vs. COPD patient complaining of dyspnea, shortness of air vs. patient complaining of cardiac pain. Who do you see first & why?

Back 24

COPD patient.

ABC - All are acute problems but ABC says that you need to take care of the airway problem before the DVT (local problem) or cardiac pain.

Front 25

Patient with DM has low blood sugars q a.m. vs. Patient with DM who has steady blood sugar but is experiencing a slight drop this a.m. Who do you see first & why?

Back 25

The low BS q a.m.

Trends vs. Transient (perhaps the steady BS simply took a little too much insulin or exercised this a.m.)

Front 26

If a patient is having a steady climb in temperature, a steady drop in blood pressure, or a steadily widening pulse pressure, these are what kind of findings?

Back 26

Trends

Front 27

What is the priority list for Maslow's Heirarchy?

Back 27

1 - Physiological needs (air, water, food, sleep, shelter, sex, stimulation)
2 - Safety & security (physical safety, trust, stability, assistance)
3 - Love & belonging (acceptance, approval, inclusion, friendship)
4 - Esteem (self-esteem, respect, recognition)
5 - Self-actualization (growth, development, fulfill potential)

Front 28

What is the priority list for ABC?

Back 28

A - Airway - has to be patent to breath
B - Breathing - for oxygenation of blood
C - Circulation - for oxygenated blood to reach tissues

Front 29

Define Delegation.

Back 29

Reassigning of responsibility for a job from one person to another.

* Complex Process
* Requires Judgment
* RN Retains Responsibility/Accountability for outcome

Front 30

What is judgment used for when deciding delegation?

Back 30

Which roles can do what & which is the appropriate patient to assign to a different person.

Front 31

If there is a lawsuit r/t a patient, who are they likely going to go after?

Back 31

The nurse - even if responsibility was delegated to someone else, the nurse is the accountable person.
The institution

Front 32

What are some reasons for delegating?

Back 32

* Frees the RN for more complex tasks
* Someone else is better prepared to do task
* Provides learning opportunities

Front 33

What are the steps to effective delegation?

Back 33

* Plan Ahead
* Identify necessary skills & level of practitioner needed
* Select the most capable personnel
* Communicate goal clearly
* Empower the delegate
* Set deadlines & monitor progress
* Model the role & provide guidance
* Evaluate Performance
* Reward Accomplishment

Front 34

What are the 5 rights of delegation?

Back 34

1 - Right Task
2 - Right circumstance
3 - Right person
4 - Right direction/communication
5 - Right supervision/evaluation

Front 35

What do I have to know in order to determine who I can/cannot delegate to?

Back 35

* Nurse Practice Act
* Scope of Practice for personnel (by title)
* Hospital's Policy
* Job Descriptions

Front 36

What are the 7 components of the delegation decision-making grid?

Back 36

* Level of client acuity
* Level of UAP capability
* Level of licensed nurse capability
* Possibility of injury/harm
* # of times the skill has been performed by the delegate
* Level of decision making needed for the activity
* Client's ability for self-care

Front 37

What does a high or low score on the delegation decision-making grid mean?

Back 37

Low score indicates that the activity may be safely delegated to someone else.

High score indicates that delegation may not be advisable.

Score range (0-23)

Front 38

What are common mistakes that are made when delegating?

Back 38

* Underdelegating (afraid to give up tasks, lack of trust, control freak, fear of resentment)
* Overdelegating
* Improper delegating (wrong time, person, reason, beyond their capabilities, without proper info/support)

Front 39

What should NOT be delegated?

Back 39

* Anything requiring professional judgement, skill or decision making ability
* Initial assessments
* Follow-up assessments that require judgment about interventions to utilize
* Care planning
* Patient teaching
* Decisions and judgments about client outcomes
* Interpretation of test results
* Counseling
* Triage
* Evaluation of Care

Front 40

What client considerations need to be made when making assignments of patients to nurses?

Back 40

* Conditions
* Specific needs
* Special precautions (isolations?)
* Time required for tasks

Front 41

What staff considerations need to be made (delegatee factors) when making assignments of patients to nurses?

Back 41

* Knowledge level of the nurse, critical thinking req.
* Supervision needed
* Staff mix
* Nurse to patient ratio
* Team member's past experience with similar clients (previously demonstrated competence)
* Ability to communicate w/ others r/t task
* Delegatee's culture
* Familiarity with the unit (agency vs. staff?)

Front 42

What should you do if you are given an inappropriate assignment?

Back 42

1 - Speak to charge nurse/supervisor
2 - House Supervisor or manager over charge nurse
3 - Document for your own records conversations that you had
4 - Ask for lots of help
5 - File an unsafe staffing complaint - Assignment Despite Objection (ADO) or Document of Practice Situation (DOPS) with the administrator

Front 43

Define abandonment

Back 43

Failure to accept an assignment without following the proper channels.

Front 44

What are the 5 delegation factors for determining if a client care activity should be delegated or not?

Back 44

1 - Potential for harm to the patient
2 - Complexity of the nursing activity
3 - Extent of problem solving & innovation required
4 - Predictability of outcome
5 - Extent of interaction

Front 45

Explain critical thinking.

Back 45

The ability to analyze client issues & problems. Includes interpretation, analysis, evaluation inference & explanation. Determines the most appropriate action to take.

Front 46

Explain clinical reasoning.

Back 46

The mental process used when analyzing elements of a clinical situation & using analysis to make a decision.

Front 47

Explain clinical judgment.

Back 47

The decision made regarding a course of action based on critical analysis of data in a clinical situation. Nurse uses clinical judgment to: analyze data, ascertain meaning of data & evidence, determine client outcomes as indicated by EBP.

Front 48

What is the difference between assigning & delegating?

Back 48

Delegating is the process of transferring authority & responsibility to another team member to complete a task while still retaining accountability.

Assigning is the process of transferring the authority, accountability & responsibility of client care to another member of the healthcare team.

Front 49

What is supervising?

Back 49

The process of directing, monitoring & evaluating the performance of tasks by another member of the HC team. RN's supervise client care tasks delegated to AP, LPN's, UAP's & LVN's. (pg. 10 ATI)

Supervision occurs after delegation (pg. 15 ATI)

Front 50

What does ATI state can be delegated to an LPN (pg. 13)?

Back 50

* Monitor client findings (as input to the RN's ongoing assessment of the client)
* Reinforce client teaching from standardized care plans
* Trach care
* Suctioning
* Checking NG tube patency
* Administration of enteral feedings (by digestion)
* Insertion of urinary catheter
* Med administration (excluding IV meds in several states)

Front 51

What does ATI state can be delegated to an AP (pg. 13)?

Back 51

* ADL's (bathing, grooming, dressing, toileting, ambulating, feeding (w/o swallowing precautions), positioning, bed making)
* Specimen collection
* I & O's
* Vital Signs (on stable clients)

Front 52

In the 5 rights of delegation, what is right direction/communication?

Back 52

Must be written or oral including:
* What data must be collected in the task
* Method for collection & timeline for reporting
* The specific task & client specific instructions
* Expected results, timeline, & expectations for follow-up communication

Front 53

How do you determine the "Right Task"

Back 53

A task that is repetitive, requires little supervision, and is relatively noninvasive for the client.

Front 54

How do you determine the "right circumstance"?

Back 54

If the complexity of the task matches with the skill level of the team member.

Front 55

How do you determine the "Right Person"?

Back 55

If it is within the team members "Scope of Practice" & they have completed the necessary competence/training.

Front 56

How do you determine the "Right Supervision/Evaluation"?

Back 56

You give clear directions w/ understandable expectations, you monitor their performance, provide them with feedback, interfere if needed & evaluate if outcomes were met.