Professional Documents
Culture Documents
* Questions often included examples of nursing interventions which DO or DO NOT demonstrate these skills and characteristics.
Clearly defined goals and expectations Verbal/Non-verbal messages congruent Critical to the directing phase of management Assertive communication starts with I need rather than you must.
Motivation
The nurse manager can provide an environment that will promote motivation:
Organizational Skills
Delegation
Responsibility: the obligation to complete a task Authority: the right to act or command the action of others Accountability: the ability and willingness to assume responsibility for actions and related consequences
The nurse transfers responsibility and authority to others.but retains Accountability. Use the 5 rights to determine delegation
5 Rights of Delegation
Supervision Skills
Direction/Guidance:
Clear, concise directions Expected outcome Time Frame Limitations Verification of assignment
Evaluation/Monitoring:
Follow-up:
Communication evaluation findings to the LPN or UAP and other appropriate personnel Determine if teaching/guidance is needed
Assessment: What are the needs/issues? Analysis: What is the highest priority? Planning:
What outcomes/goals must be accomplished? What are the available resources? (staff, team members, time, equipment, space etc.)
Implementation:
Evaluation:
Where the desired outcomes achieved? Was safe, effective care provided?
Any activity requiring nursing judgment CANNOT be delegated Delegating to the right person requires that the nurse be aware of the qualifications of the delegate. (training, skills, education and demonstrated/documented competence)
RN is Accountable for:
Direction, Evaluation and Follow-up for LPNs Graduate nurses Inexperienced nurses Student nurses UAPs
Priorities
Assessed first Significant change in condition Most critically ill Safety and infection control are high priority when determining room assignments
LPNs
Implements basic nursing process after the RN has evaluated client and determined plan of care
LPNs
UAPs
Assist with ADLs Document intake/output Telling Assisting Ambulating Bed making
Unfreezing: Initiation of change Moving: Motivation/moving toward the change Refreezing: Implementation of a change
* Change causes anxiety. The change agent must also show respect, value opinions, and build trust.
2. 3.
Shared goals, commitment and accountability Open and clear communication Respect for the expertise of all team members
Critical Pathways
Interdisciplinary plan of care For diagnoses and care that can be standardized A guide to track client progress Does NOT replace individualized care Positive or negative variance
Case Management
Coordination of care provided by an interdisciplinary team Manages resources effectively Use critical pathways to organize care
Quality Assurance
both are organized approaches to the improvement of: Outcome achievements Quality of care provided
Negligence: Performing an act that a reasonable and responsible person would not do. (Would a reasonable and professional nurse under the same circumstance act in the same manner?) Malpractice: professional misconduct, or unreasonable lack of skill in carrying out professional duties.
2.
3.
4.
Breach of Duty: Failure to perform according to the standards of practice Injury/Damages: causes actual damage or injury to the client (physical or mental) Causation: A connection exists between the conduct and the injury
Hospital policies: provide a guide for nursing actions. They are NOT LAW, but courts generally rule against nurses who do not follow hospital guidelines. Incident reports: alert administration to possible liability claims and the need for further investigation. They DO NOT protect against legal action.
Assault: mental or physical threat, forcing without touching. (forcing a client to take medication..sneaking medication into food or drink. Forcing a client to take treatment. Battery: Touching with or without the intent to harm. (hitting or touching a client). If a competent adult refuses a treatment, and is forced, a battery has occurred.
Invasion of Privacy
Exposure of a Person: Exposure or discussion of a clients case. After death, the client has a right to be unobserved and protected.
Invasion of Privacy
Fraud
Willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property.
Telling a client that the procedure will hurt, when indeed there is pain involved!
Assisting or giving aid to a person in the commission of a crime makes that person equally as guilty of the crime.
Refusing to assist in the birth of a child if such refusal results in an injury to the child.
Voluntary Admission: client admits him/herself to an institution for treatment and retains civil rights.
Involuntary Admission: Someone other than the client applies for admission into an institution.
Emergency Admission: Any adult may apply for emergency detention of another. However, medical or judicial approval is needed to keep them more than 24 hours.
Competency
Competency Hearing: Legal hearing that is held to determine a persons capability to make responsible decisions about self, dependents, or property.
Competency
Persons declared incompetent have the legal rights status of a minor, they cannot:
Vote Make contracts or wills Drive a car Sue or be sued Hold a professional license
Insanity: a legal term meaning the accused is not criminally responsible for the unlawful act committed because of mental illness
1.
2.
3.
Inability to stand trial: not mentally capable of standing trial. He/She: Cannot understand the charge against him/her Must be sent to a psychiatric unit until legally determined competent for a trial Once the individual is mentally fit, he/she must stand trial and serve any sentence, is convicted
Patient Identification
Use at least 2 patient identifiers whenever taking blood samples, admin. meds, or admin. blood products. Patient room number MAY NOT be used as a form of identification.
Surgical Permit
Consent to operate, must be obtained prior to any surgical procedure, however minor it might be.
1. 2. 3.
Legally, the surgical permit must be: Written Obtained voluntarily Explained to the client (informed consent) must be obtained
Surgical Permit
Surgery Permits: 1. Must be witnessed by an authorized person such as a healthcare provider or a nurse.
2. Protect the client against unnecessary surgery and protect the healthcare provider/surgeon, hospital, and hospital staff against possible claims of unauthorized operations
Surgical Permit
3. Adults and emancipated minors may sign their own operative permits if they are mentally competent. 4. Permission to operate on a minor child or an incompetent adult or unconscious adult must be obtained from a responsible family member or legal guardian.
Surgical Permit
The ans: The Provider The nurses responsibility is to make sure it is signed and on the chart before the procedure, it is NOT the nurses responsibility to explain the procedure
Consent
The law does not require written consent to perform medical procedures. Client must be fully informed Can be treated with verbal consent If informed consent can not be obtained, emergency laws can be applied (if treatment means to save life or limb) Ex: unconscious patient arrives in ED
Verbal Consent
Describes in detail how and why verbal consent was obtained Placed in the clients record Witnessed and signed by 2 persons
Alert, coherent, competent adults Parent or legal guardian Person having right to make decisions for the client
Consent of Minors
Minors 14 years of age and older must agree to treatment along with their parent of guardian Emancipated minors can consent for treatment themselves
Protects health practitioners against malpractice claims for care provided in emergency situations The nurse is required to perform in a reasonable and prudent manner
Prescriptions/Orders
What if ???????
Inform the healthcare provider/physician Record the physician was informed Inform nursing supervisor Refuse to carry out the prescription
What if ????????
poor judgment?
Record provider was notified and questioned Carry out the order (nursing judgment cannot be substituted for medical judgment)
What If???????
The nurse is asked to perform a task of which they have not been educationally prepared for or that is out of their scope of practice?
Inform the provider that he/she does not have education or experience Refuse to carry out the prescription
Restraints
Restraints of any kind can be considered false imprisonment without an order Freedom from restraints is a basic human right and is protected by law
Restraints
In an emergency For a limited time For the limited purpose of protecting the client from injury
Nurse must notify the provider/physician immediately that the client has been restrained Document the facts regarding the rationale for restraining the client Use restraints after exhausting all reasonable alternatives
Restraints
Apply restraints properly Check frequently to ensure no damage or injury to the client Remove restraints as soon as possible
HIPAA
Which client(s) would be appropriate to assign a newly graduated RN, who has recently completed orientation? (Choose all that apply)
An anxious chronic pain client who frequently uses the call button A second day post-op who needs pain medication prior to dressing changes A client with HIV who reports a HA and abdominal and pleuritic chest pain A client being discharged with a surgically implanted catheter
You are caring for a patient with esophageal cancer. Which of the following can be delegated to the nursing assistant?
a.
b. c. d.
Assist the patient with oral hygiene Observe the patients response to feedings Facilitate expression of grief or anxiety Initiate daily weights
In caring for a patient with oral cancer, which task would be appropriate to delegate to the LPN/LVN? (Select all that apply)
a.
b.
c. d.
Assist the patient to brush and floss Explain when flossing and brushing are contraindicated Give antacids and sucralfate suspension as ordered Recommend saliva substitutes
You are the charge nurse. Which client is most appropriate to assign to the step-down unit nurse pulled to the intensive care unit?
a. b. c.
d.
A 68-year-old client with acute respiratory failure and respiratory acidosis A 72-year-old client with COPD and normal ABGs who is ventilator dependent A 56-year-old new admit with DKA on an insulin drip A 39-year-old client on a ventilator with narcotic overdose and respiratory alkalosis
Which of the following cancer patients could potentially be placed together as roommates?
a. b.
c.
d.
A patient with a neutrophil count of 1000/mm3 A patient who underwent debulking of a tumor to relieve pressure A patient receiving high-dose chemotherapy after a bone marrow harvest A patient who is post-op laminectomy for spinal compression
In caring for a patient with neutropenia, what tasks can be delegated to the CNA? (Choose all that apply)
a. b. c. d. e. f.
Take VS every 4 hours Report temp > 100.4 Assess for sore throat or cough Gather supplies to prepare the room for protective isolation Report superinfections, such as candidiasis Practice good handwashing technique.
The MD has written the following orders. The clients morning assessment reveals bounding peripheral pulses, a 2 lb weight gain, pitting edema, and moist crackles bilat. What would you do first?
a. b. c. d.
Initiate daily weights Maintain accurate intake and output Restrict fluids to 1000-1500 per day Adminster Furosemide 40mg
You are the charge nurse for the coronary care step-down unit. Which patient is best to assign to an RN who has floated for the day from the general medical-surgical floor?
a. b. c. d.
Patient requiring discharge teaching about a coronary artery stent. Patient receiving IV furosemide to treat acute left ventricle failure Patient just transferred from the radiology dept. after a coronary angioplasty Patient just admitted with unstable angina and who has orders for a heparin infusion and aspirin.
a. b. c.
d.
You are ambulating a cardiac surgery patient who has telemetry cardiac monitoring when another staff member tells you that the patient has developed superventricular tachycardia with a rate of 146 bpm. In which order will you take these actions? Call the patients physician Have the patient sit down Check the patients BP Administer 02 via nasal cannula
During the initial post-operative assessment of a patient who has just been transferred to the PACU after repair of a AAA, you obtain all of the following data. Which has the most immediate implications for the patients care?
a. b.
c.
d.
The arterial line indicates a blood pressure of 190/112 The monitor shows sinus rhythm with frequent PACs The patient does not respond to verbal stimuli The patients urine output is 100 mL of amber urine
A new RN is preparing to administer PRBCs to a client whose anemia was caused by blood loss after surgery. Which action by the new RN requires that you, as the charge nurse, intervene immediately?
a. b. c. d.
The new RN waits 20 minutes after obtaining the PRBCs before starting the infusion The new RN starts an IV access for the transfusion using a 22gauge catheter The new RN primes the infusion set with Lactated Ringers The new RN tells the client that the PRBCs can cause a serious reaction.
a.
b.
c. d.
A group of clients is assigned to an RN-LPN/LVN team. The LPN/LVN is most likely to be assigned to provide client care and administer meds to which of these clients? A client in renal failure who needs epoetin (Procrit) A client who needs Vancomycin with peaks and troughs A client who needs a last dose of chemotherapy A client who needs a blood transfusion
A client is admitted to the ER after a MVA. He does not remember the accident. He is awake and oriented to person only. He is confused regarding time, month and the city he lives in. Pupils are equal and reactive to direct light. He c/o of a severe HA and is becoming restless. What is your priority at this time?
a.
b.
c.
a.
Which assignment would be appropriate for a L&D nurse who will be working for one shift on a Medical-Surgical floor?
a.
b. c. d.
A A A A
3-year-old with croup 30-year-old with malignant hypertension 40-year-old with unstable angina 50-year-old with congestive heart failure
After receiving shift report, which client would you assess first?
a.
A 20-year-old with a possible acute myelogenous leukemia who has arrived on the medical unit. A 38-year-old with aplastic anemia who needs teaching about decreasing risks for infection. A 40-year-old with lymphedema who requests help putting on compression stockings before getting OOB.
b.
c.
d.
a.
b.
c. d.
You are preparing to admit a patient with a seizure disorder. Which of the following actions would you delegate to the LPN/LVN? Document the admission assessment Set up 02 and suction equipment Place a padded tongue blade at the bedside Check the room to make sure it is clean
a. b. c.
d.
After a patient has a seizure, what action can you delegate to the nursing assistant? Document the seizure Initiate neuro checks Restrain the patient Take the patients VS
A patient has been placed in fixed skeletal traction with a halo fixation device. When caring for this patient the nurse will delegate which of the following to the LPN/LVN? (Choose all that apply)
a.
b. c.
d.
Check the patients skin for pressure from the device Assess the patient neurological status Observe the halo insertion sites for signs of infection Clean the halo insertion sites with alcohol
After receiving the am. shift report, which of these clients will you see first?
a.
A 23-year-old with a migraine who is complaining of severe nausea associated with retching
b.
A 45-year-old who is scheduled for a craniotomy in 30 min. and needs preoperative teaching
A 59-year-old with Parkinsons who needs a swallowing assessment before breakfast A 63-year-old with multiple sclerosis who has an oral temp of 101.8 and flank pain
c.
d.