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NURSING LEADERSHIP

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Title: NURSING LEADERSHIP


1
NURSING LEADERSHIP MANAGEMENT
  • PROFESSOR MARIANNE MCAULEY

2
DAY WORKSHOP
  • Morning
  • all students
  • 8 AM to 1230 PM
  • 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

3
EVENING WORKSHOP
  • 500 PM 950 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
  • Receive a night off from Pediatric Clinical
  • Arrange with Pediatric Instructor

4
THE CLINICAL EXPERIENCE
  • 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
  • Late Assignment Policy

5
ROLE OF PRECEPTOR
  • Complete preceptor evaluation form
  • Include comments!!!!!
  • Separate one for each preceptor is required
  • Appendix A
  • Collect student evaluation form from preceptor on
    last day sealed envelope
  • Appendix B
  • RETURN BOTH TO MRS. MCAULEY
  • Put in your brown envelope with your assignment

6
CLINICAL OBJECTIVES
  • See appendix C
  • Bring these with you to clinical
  • Change of Shift Report
  • Report all abnormal findings
  • Report normal physical findings relevant to
    patients diagnosis
  • Describe nursing interventions done during your
    shift

7
CLINICAL OBJECTIVES
  • Delegation
  • review CNA assignment sheets
  • Issues to consider
  • Interdisciplinary Team Meetings
  • Documentation
  • 24 hour reports, Medicare Notes, Admissions,
    Discharges, Transfers, Incident Reports
  • Preceptor co-signs your signature
  • No medications

8
CLINICAL OBJECTIVES
  • Picking up of doctors orders
  • Staff education in-service project for CNAs
    (certified nursing assistants)
  • 15 minutes done on 2nd day

9
WHY L M?
  • Economics of health care
  • Staff Redesign
  • NCLEX

10
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

11
Leaders Are Mostly MadeNOT Born
  • 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

12
What are the Skills of Effective Leaders?
  • The Great Communicator
  • listening skills
  • articulation skills
  • oral
  • writing
  • Be An Assertive Communicator

13
The Team Player
  • understands the work of others
  • appreciates the work of others
  • credible - performs well
  • persuasive, enthusiastic
  • increases cohesiveness among team members

14
The Motivator
  • Inspires others to reach goals
  • Uses power to motivate others

15
The Delegator
  • A nursing task is transferred to an individual
    competent to perform the task
  • The delegator remains accountable for the task

16
How to Increase Your Expertise as a Delegator?
  • Follow the five rights of delegation
  • National Council of State Boards of Nursing
  • Right task
  • Right person
  • Right communication
  • Right supervision
  • Right circumstances

17
Is It the Right Task?
  • 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/Laws-Regs/Health_Ser
    vices/Nurse_Practice_
  • Act-full.htm

18
Is It the Right Task?
  • 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

19
Is It An Appropriate Health Related Activity?
  • 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/
  • practice/scope/rn_uap_guidelines03.pdf

20
More Skills of Effective Leaders
  • 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

21
How Do Leadership Management Differ?
  • Management
  • Working with and through others
  • Achieve organizational objectives
  • Leadership
  • Influencing the activities of a group
  • Toward goal achievement
  • Best manager is a good leader

22
Differences between Managing and Leading
  • 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

23
TYPES OF POWER
  • Legitimate - leaders formal position in
    organization
  • Reward underutilized
  • leaders ability to reward followers
  • Coercive dont use this
  • followers fear of punishment

24
TYPES OF POWER
  • Referent - followers identification with leader
  • confidence
  • power dressing
  • What qualities do you have that give you this
    power?
  • Expert - leaders specialized knowledge

25
Effective Leader and Manager Formula
  • Understanding Self
  • self-assessment
  • Knowledge
  • Learning
  • role models
  • Emotional Intelligence
  • assess yourself

26
EMOTIONAL INTELLIGENCE
  • 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

27
Great Man or Trait Theory
  • Leaders born, not made
  • Physical, psychological , personal
    characteristics define leaders
  • Charismatic theory - leaders possess charisma

28
BEHAVIORAL THEORIES
  • Autocratic
  • Democratic
  • Laissez-Faire

29
AUTOCRATIC STYLE
  • Leader dominates group
  • Commands rather than makes suggestions
  • Maintains strong control
  • Sometimes punitive

30
LAISSEZ-FAIRE STYLE
  • Leader is passive, nondirective, inactive
  • All decision making left to group
  • Little, if any, leader guidance or support

31
DEMOCRATIC STYLE
  • Group participates in decision making
  • Leader acts as facilitator
  • Leader has concern for group members


32
ROLE-PLAYSLEADERSHIP STYLES
  • 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

33
Situational Leadership
  • Assess the situation
  • Assess the group members
  • Select the style or blending of styles best for
    the situation

34
  • DEVELOPING NEW SKILLS

35
STAFF EDUCATION
  • Required competency of ADN education
  • Follow the Nursing Process when you teach
  • Use the Lesson Plan Rubric as a guide
  • Hand this in with your lesson plan
  • See appendix E

36
INSERVICE PROJECTA WIN-WIN FOR ALL
  • 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

37
INSERVICE PROJECTA WIN-WIN FOR ALL
  • Plan during the week
  • develop the lesson plan - have 2 copies
  • typewritten, professional appearance
  • 1 copy to preceptor
  • LIV Room 307 Margaret Kellys mailbox
  • 1 copy to me (R 106)
  • Implement the second day
  • eating learning is fun
  • use audio-visual aids/handouts
  • absent schedule make-up

38
INSERVICE PROJECTA WIN-WIN FOR ALL
  • 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

39
COMPONENTS OFA LESSON PLAN
  • Cover Sheet
  • topic, date, agency
  • presenter - your name
  • Objectives
  • Content Outline
  • Written Quiz
  • Teacher Evaluation Form
  • Attendance Sheet - GOES TO AGENCY
  • See appendix F

40
Checklist for in-service project2 brown envelopes
  • AGENCY
  • Lesson plan
  • Lesson plan includes a copy of the quiz the
    teacher evaluation form
  • Attendance sheet
  • Give lesson plan to preceptor
  • LIV put in Margaret Kellys mailbox in Room 307
  • MRS. MCAULEY
  • Lesson plan
  • Lesson plan includes a copy of the quiz the
    teacher evaluation form
  • Quizzes completed by CNAs
  • Evaluations completed by CNAs
  • Preceptor evaluation
  • Include comments
  • Student evaluation
  • Leave in my mailbox in R106
  • Returned to your student mail folder in R111

41
HOW TO WRITE OBJECTIVES
  • Focused on the learnerCNAs
  • Measurable - Use action verbs
  • use words like state, describe, list, explain
  • DONT use words like understand or know
  • Time component

42
EXAMPLES OF 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
  • REFER TO EXAMPLES WHEN WRITING YOUR OBJECTIVES

43
TYPES OF OBJECTIVES
  • COGNITIVE
  • PSYCHOMOTOR
  • AFFECTIVE
  • Objectives can be all the same type or a mix

44
COGNITIVE OBJECTIVES
  • Knowledge, facts
  • Example
  • CNAs will state 3 methods to prevent pressure
    ulcers by the end of the in-service

45
PSYCHOMOTOR OBJECTIVES
  • Skills
  • Example
  • CNAs will demonstrate proper handwashing by end
    of in-service

46
AFFECTIVE OBJECTIVES
  • Emotions, feelings
  • Example
  • CNAs will express feelings about caring for a
    dying client by end of in-service

47
CONTENT OUTLINE
  • Outline format dont write a narrative
  • Comprehensive give a detailed outline
  • Number objectives to match the content
  • It should be very clear what content goes with
    each objective

48
EXAMPLE OF 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
  • creates pressure on skin over bony prominences
  • b. poor nutrition - protein needed to repair
    skin
  • c. incontinence chemicals break down skin
  • d. confusion cant move self, may be unable
    to express pain or discomfort

49
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
  • 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

50
EVALUATION OF KNOWLEDGE
  • Quiz
  • 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 residents 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

51
EVALUATION OF TEACHER
  • List items for CNA to rate
  • Example Teachers 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

52
THE CHANGE MAKER
  • How can you be an agent of change rather than a
    target of change?

53
How do people react to change?
  • threat to self
  • fear of increased responsibility
  • lack of understanding
  • limited tolerance for change

54
What role do you play when it comes to change?
  • Laggard or Adventurer

55
CHANGE THEORY
  • Process of change - force field analysis
  • Three phases required to accomplish change
  • unfreezing
  • moving
  • refreezing

56
STAGES OF CHANGE
  • Unfreezing recognize need for change
  • loosen the status quo
  • driving factors versus restraining factors
  • Moving initiate change after planning
  • Refreezing change becomes operational

57
STEPS IN THE CHANGE PROCESS
  • 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
  • Implement the selected strategy

58
HOW TO OVERCOME RESISTANCE TO CHANGE
  • 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

59
TECHNIQUES FOR IMPLEMENTING CHANGE
  • Run productive meetings
  • Use participative decision-making
  • Schedule a brainstorming session when needed
  • quantity, freewheeling, no criticism

60
ROLE-PLAY
  • See appendix D
  • INITIATING CHANGE
  • 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?

61
PERFORMANCE APPRAISALS
  • 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

62
Coaching Role
  • Be seen as trying to be helpful
  • Timing is everything
  • Discuss behavior in relation to standards
  • Dont be preachy or use word should
  • Give specific suggestions for change
  • Recognize praise improvements

63
CONDUCTING THE INTERVIEW
  • Select appropriate time place
  • Begin with small talk
  • Stay job-focused
  • Provide opportunity to improve
  • Pitfalls to avoid
  • social visit
  • charge-excuse cycle

64
USE THE SANDWICH APPROACH
  • Begin with the positive attributes,
    accomplishments
  • Be specific
  • Spend time
  • Identify and address the deficiencies
  • Dont use avoidance or minimize these
  • Finish with a positive statement

65
ROLE-PLAYPERFORMANCE APPRAISALS
  • See appendix D
  • Demonstrate an ineffective interview
  • Demonstrate an effective interview

66
RESPONSES TO CONFLICT
  • Competition/Power Win /Lose
  • manager concerned with work
  • little regard for staff
  • Smoothing Lose/Win
  • manager concerned with relationships
  • secondary concern for work

67
RESPONSES TO CONFLICT
  • Avoidance Lose/Lose
  • Low regard for both tasks relationships
  • Ignores/withdraws from conflicts
  • Compromising Lose/Lose
  • each side makes concessions
  • neither side gets what they want

68
RESPONSES TO CONFLICT
  • Collaboration Win/Win
  • confront issue openly
  • look for acceptable resolution
  • no dominating, suppressing, compromising

69
Strategies for Effective Conflict Resolution
  • Identify the problem
  • Set some ground rules for the discussion
  • Set a time limit for the discussion
  • Encourage free exchange of ideas feelings
  • Create an atmosphere of trust
  • Set firm limits on individuals out of control

70
Strategies for Effective Conflict Resolution
  • 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

71
ROLE-PLAYSCONFLICT RESOLUTION
  • See appendix D
  • Competition/Power
  • Smoothing
  • Avoidance
  • Compromising
  • Collaboration

72
21ST CENTURY LEADERROLE OF VISION
  • How innovative are you?
  • Identify your barriers to innovative action
  • low self-confidence
  • Dislike of risk-taking
  • need for conformity
  • no abstract thinking
  • Lack of time for creativity
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