Transcript for:
Management of care

all right let's get started so we are going to be discussing management of care my name is Melissa Miner and I'm going to be leading this lecture and we will get going all right so management of care when we talk about managing patient care one of the things that we need to consider is that as nurses we take on a lot of roles we wear a lot of hat and one of those is that of a nurse leader and we're going to be working as leaders in a variety of ways not just amongst our peers but also um being seen as a leader of Patients health and being an advocate for them we take um we take a lot of responsibilities on and with those responsibilities we need to be able to recognize that there are aspects of nursing where we're going to be the lead caregiver um that doesn't mean that the whole healthc care team isn't participating but we need to be able to um work with our patients and assist them as they go through their healthc care Journey also working with our peers um and all those that we come in contact with there may be opportunities for us to lead or to direct so we need to understand what a leader is and what it means to um embody a leader and to have leadership skills these topics are all going to be covered again um as you progress in nursing so this isn't the only time that you you'll hear about leadership um and you as you move into level one uh level two 3 4 um you'll see this over and over but the idea here is that we're laying kind of a foundation or some groundwork so that as you get more information about different leadership styles um that you have something to build off of so you know it's important to read the chapter and to understand all these aspects but I wouldn't worry too much about having a perfect understanding because it will be something that will be built on and we do recognize that you are level one nursing students and so you know we're not saying hey you automatically have to jump into leadership roles right this second but it is good to at least recognize um what the different leadership styles look like so that as you go into the hospitals and the clinical sites you're seeing you know what some of these different leadership styles are some of these different theories on leadership you're kind of seeing those put into play and it may help you to kind of recognize what works and what doesn't work and what kind of nurse leader you want to be um all right so what is a leader uh it's someone who influences people and helps individuals move towards a common goal so there's a lot of different theories on what make up U quality leaders I'm sure that there's probably some division even amongst us as far as you know who we see as being a good leader a bad leader someone that we look up to maybe some someone that we have some negative feelings towards and that's okay because you know there are going to be different personality types that that maybe clash and maybe you work well under a certain style of leadership um some of the main styles of leadership or types of leadership that are out there are these three that I have listed on the slide here so authoritarian leadership Democratic Leadership and Lon Fair leadership these are the three that you'll see over and over um because they kind of are broad generalizations of different styles of leaders so with the authoritarians it's that autocratic you know top down approach where the boss is the boss and they're going to tell you how they'd like things and they're going to expect that it's done and what's said is done and um then you've got your Democrat leadership style which is a little bit more participative so that may be something where you know the nurse leader comes out and says hey uh we see everyone on the floor has been a little upset about the way that we are um handling breaks lunch breaks and and 15-minute breaks we have some ideas we want to get some more so we put out a survey and we'd like you know to get your opinions on how we should move forward and then decisions are made based off of what what is set on the surveys you know so that the individuals are participating and getting involved in making decisions so it's not just coming from up above but people are involved in that and then you have the lay on Fair leadership and this style is kind of more of a kickback see what happens you guys kind of take care of yourself situation and you know it's not always a bad leadership style sometimes it kind of gets this um negative otation of like oh if it's Liz onfair it's negative it's not working well sometimes the leaders can kind of step back and not really direct if individuals are all directing themselves but you know it can go either way it can be positive it can be negative and that that's true for all of these so you know you wouldn't get a question on an exam saying which is the best style of leadership because that's subjective um right you're you're going to have people with different opinions I may say yeah I really appreciate an authoritarian leader because you know exactly what your expectations are when you come into work and you meet those expectations then you do what you need to do you go home and then that's that whereas other people may say that doesn't work for me I don't really like being told what to do I want to be a part of the the decision-making process I like it better when the bosses come to us and we get to kind of collaborate so that Democratic style may work better for them so it just all kind of depends on people's personalities um either way though no matter what style of leadership you're working with or you yourself prefer everybody needs to um incorporate some emotional intell intelligence in their daily life and just be able to um not only have like cognitive awareness of what's going on and how to do things but also how to um be emotionally present and aware and some of the things that help with that are empathy which is that ability to make emotional connections with others um some people have you know an outpouring of empathy they're very empathetic other people maybe have a little harder time making those connections and that's okay um but it's just good to know where you stand and that's where self-awareness comes in so recognizing how your own emotions are going to impact the way that you work with others and the way that you collaborate and then once you know what your own emotions are and you can understand how you feel about things it's good to be able to control that to self-manage so for example you know maybe you're a nurse working on a pediatric floor pediatric oncology floor and every day you're working with these young patients who are going through really rigorous um medical situ situations and they're just having to have a lot of lab draws and medications and procedures and maybe um you're very empathetic and able to be compassionate and kind and caring and understanding but maybe you know you get really emotional and and seeing that makes you cry all the time and then if you're on the floor and you're crying all the time you're not really able to control your emotions and you're just sad sad sad and you know the patient asks what's wrong and you're like like I'm so sorry for you and you just cry and cry that's not really going to make anything better you know so it's good to know if if you're someone who has that kind of empathy and that kind of compassion and it makes you respond in that kind of way where you can't control your tears you know is that the best floor for you to be on I don't know so you know you have to have emotional intelligence and kind of see you know what what's going to work for you and and how to um be aware and manage those emotions that you're feeling and then also U be able to manage your relationships so work well with others being able to see you know what's going on with the people around you and develop a sense of trust and respect for each other those are all things that can help someone to become emotionally intelligent all right excuse me now with these leadership styles with um the role of a leader a lot of times you're going to see interactions in the workplace that are either transformational or transactional so um transformational interactions are interactions that are going to engage and Empower people um they have this ability to create a supportive climate where um if you have a transformational leader you you know what the VIS of that organization is or that particular location is and you know what that vision is and you want that to be achieved because you've been inspired by that leader so you know this could be a situation where you go for a job interview and you're talking to the hiring manager and they're saying yeah like you know one thing that we are just very very passionate about here is blank and they start going on and on about all the improvements they're making for the patients and how you know they're doing all these great things and maybe that transforms your Viewpoint of that works situation and and you want to work there because of the experience that you'll have changing lives making things better understanding the vision and the the goal that these individuals are working towards for their team for their patients so if you have a transformational leader you are there because of the vision you're trying to achieve you know and that could be on a um individual level you know they could say hey we're what why we want you here is because we want our nurses to become the best nurses possible and you're like wow that sounds amazing like that's what I want I want to learn I want to grow I want to become you know knowledgeable and empathetic and compassionate and I want to be um able to help people through these difficult times and you know like you're there for the transformation of yourself or the transformation of others for that growth for that um support in a transactional situation when you have um someone who maybe is leading and kind of leading not so much to make these changes but to have a transaction occurred it's going to look a little different it's going to be something where you know the reward isn't so much a change or a growth it's hey well if you come work for us we can give you this much money an hour or we can do this for your salary we've got these benefits we've got these uh you know programs where you can increase every year by doing these little checklists and um you know if you don't show up if you call out for one of your shifts you're going to get points you'll get docked and you know there's like discipline for not meeting goals and benefits and rewards for meeting goals so the leaders are more task oriented and it's more about enforcing rules you know whether that be hey for every three shifts you call out we're going to deduct this or we're going to take away this benefit or for every two shifts that you add on without being asked we're going to give you this and that so it's a transaction it's a what are you going to do for us what are we going to do for you and places that you go to work you may have experienced this already they can be one transformational they could be the other transactional they could be both right it could be somewhere where it's like hey we want you to grow and develop and also here's a bonus right so it doesn't have to only be a transformational um leadership style where it's all just about um this supportive climate and you know that enlightened sense of being it can have that element and still be transactional as well so you know it's just kind of good to understand what these um types of leadership and types of roles look like in the workplace so that you can kind of determine what's going to work best for you and what you prioritize because honestly it's not again it's kind of one of those things where it's not that one is greater than the other it's not oh well you have to work at a transformational place or for a transformational leader because that's what motivates people some people may not be motivated by that some people may be motivated by the the bonuses they're getting every shift or whatever so you know it's different for everybody but it is important to recognize the the benefits of each and the pitfalls all right moving on um with leadership delegation is huge so this is something that you're going to see um again throughout throughout nursing this lecture touches on it and kind of will go through some of the things that can be delegated but you'll also hear about it here and there from other um instructors and it's something that pops up of course on the enlex and of course in um your exams you that you'll see different questions about what can be delegated what is delegating um and it is important to to know so let's talk about it for a second first of all when you're trying to determine what you can delegate you need to recognize that adpie or the nursing um process is key when you're working through a situation where you may need to delegate some things because when you walk into the room automatically you're assessing right you're looking around you're seeing what the situation is and then you can start to kind of diagnose like okay I've walked into the room and I see that there's trash everywhere and there's tons of little tissues all over the floor and there's like 17 little emesis bags uh variously filled with items like what's going on okay so that's weird right then you can diagnose as you walk in and you assess you're saying okay I I can see that this person has some kind of issue going on with uh maybe a kind of cold or a mucus thing because they're throwing stuff up they're spitting stuff up they're coughing things out and they've got a lot of tissues all over the place so what's going on here okay now I need to make a plan they need a bunch of tissues they're all over the place make your plan okay what interventions can we do can we give them more tissues should we put a trash can in the room you know should we put the trash close to the bed um you know what what do we need to do and then evaluate if the things you're doing are are helpful so in that situation there are some things that you could have the um other members of the healthcare team help with you don't have to do everything by yourself right you're part of a team so you have to do your assessments so you know maybe they are hacking stuff up you need to be the one who takes the stethoscope and listens to their lung sounds are do you hear any crackles do you hear little um advantageous breath sounds that may indicate that there's some fluid in the lungs or that there's some kind of mucus buildup um you can assess their Nars are they inflamed are they getting a little bloody and red around the edges because they've been wiping their nose with Hospital tissues right so you have to do that assessing um and then any kind of planning that would that would be something that you'd need to do as well any kind of medications um if they're getting some kind of medication to assist with you know the maybe like the infection that they have that's causing this maybe they're getting IV um antibiotics you would need to take that on as the nurse um if there are orders for other types of medications Maybe um some kind of decongestant that would be something that you could carry out um LPN when it comes to delegating most of the time if it's your patient you're not going to say well I'll give the IV antibiotic but I'll have the LPN go in and give them their oral pill um that they're taking for their congestion why would you do that right you're already in the room you're you can just take both medications at the same time A lot of times you won't really be delegating to LPNs um if you're working like on the floor alongside other nurses who are either Reds or lpn's you wouldn't say oh I gave them their IVs but you go give them this pill it's not their patient right um where the LPN delegation comes into play more is if you're a nurse manager and and you need to assign LPNs to certain patients you would want to know based on those nurse practice acts um What patients would be more um applicable for them to take on as opposed to the RNs like you know if you have a patient who is in hyper hypo hypovolemic shock and they are going to be needing a lot of um maybe blood Administration and fluids and uh pushes you probably want to give that to the RN right because otherwise you're going to have to have a lot of sign offs and back and forth and people stepping in to assist with the LPN so maybe in that sense that's where it becomes important to know what the LPN um can and can't do but as a floor nurse or someone who's just working with patients and direct patient care settings you probably won't delegate a lot to LPNs you would probably be delegating more to the uaps the unlicensed assisstive personnels or maybe the CNA certified nursing assistants um sometimes they they're called the text you know anything like that um that would be maybe who you're delegating to a little bit more delegation for um the ancillary Personnel um those will come in the fors of consults so you know for for our patient that's hacking up along and and has a lot of sputum right maybe we want um speech to go in and see them because because they're having all these secretions and we're worried about their Airway so maybe we want to see if they'll assess them and see if they still have a clear Airway right um and that could be something that we could manage with the healthcare team try to put in like a little consult for that or maybe we we want to consult nutrition or PT because we're worried that they're malnourished or that they're not um moving their body actively enough or in a way that they need to approves where they need some assistance from PT so this little chart is helpful it's in the book um it's helpful there uh there are a lot of resources that are out there that you can use to kind of look up lists and such part of this also will come from your legal where you're looking at you know what specifically you can do here uh in Louisiana versus other states but a lot of it will be pretty much the same across the board as far as what can be delegated and what can't so don't try to ask the unlicensed assisted Personnel to go hang your your blood for you all right let's look at this which activities can be delegated to an unlicensed assisted Personnel select all that apply a administering a subcutaneous injection B making the bed while the patient is in it C assisting the patient to the bathroom D changing a non-sterile dressing e taking vital signs let's take a look here's our answers so the unlist Personnel can help with making the bed while the patient's in it assisting the patient to the bathroom and taking vitals they can't do the subcutaneous injection right that's a nursing skill and they wouldn't be available to change in non-sterile dressing maybe you picked it because you were like oh well it doesn't have to be sterile technique but it doesn't matter um changing addressing you're still going to have to assess right you're going to have to see what's going on with the wound and you don't want someone um to just you don't want to say Hey you know so and so can you go in there and change out that dressing for me I don't have time and then just tell me what it looks like right that would be an assessment and that's something that you need to do okay all right so um I hope that answered some of your questions about delegating I know that it's kind of a complicated subject um but the fact is when you look at those diagrams in the book and you see um what you can delegate and what you can't you're never going to find the perfect list of every single task you can do every single task in LPN can do every single task you know the the unlicensed a Personnel can do because it'll always be General right it'll say things like various patient care activities and it's like well what does that mean and if you think about it you know think about what you've been trained to do or what you're training to do versus what you did before you came into this program so you know if you hadn't been in nursing school would you know what you should be looking what kind of drainage you should see on a bandage normally right would you know uh where uh whether not a pulse as strong or if it's weak I don't know maybe maybe not but if you hadn't had any education on it you shouldn't be the one reporting on it and doing that task so with those skills and um different tasks for different individuals when you're trying to prioritize who should do what you really want to think about like who has received training for this and if they haven't received training for it that's like official right because we're talking about unlicensed assisted Personnel if they haven't received an official training on something it's unlikely that it's going to be something that you can delegate and it's also important to remember that as the individual who's delegating you still have responsibility for it so you know if you delegate that the vitals be taken by um one of the texts or a blood sugar a blood glucose check gets taken by somebody else and you were the one who delegated that and they don't report it back let's say it's the blood glucose you asked someone to go get it one of the CNAs to go get it and the CNA went and got the blood sugar and they put it in the computer and then maybe they didn't come and tell you what it was but they put it in the computer and two hours later you see that that blood sugar was 50 uh that's on you you know because you delegated the task so you should have followed up on it to see what it was and that's something that you know people need to remember as they delegate is it's not just a way to get out of doing things you still have to follow up on it you still need to make sure that you are aware of what uh the other team members are doing so that you don't end up um with something hanging over your head that that was incomplete because you didn't follow through on it so just keep that in mind um all right sorry moving along so with implementing change and conflict resolution um there's a amount set on this but I just want to hit one or two little bullet points and that is that you're going to have change um it's inevitable things change all the time but um you just have to be able to recognize that there's going to be people that accept it and there's going to be people that push back and there's different you know the book will cover different phases and how people work through that I wouldn't stress too much about that but just just know that you know this a lot of this is like very relatable probably for some of you because you could probably think of a time where you got used to something and then it changed and it made it a little hard to deal with and so it's just good to recognize as a leader that um when change occurs you need to be mindful of the fact that not everyone is going to see change in the same way that you do you may think it's a great new enhancement and then people may get upset because they're used to the way things were or you may be the one who's kind of pushing back and say I don't really want to do this and everybody else is thrilled so it can happen in a variety of ways and then the other thing is with conflict resolution you just have to know that it's unavoidable um people will be faced with conflicts and it can happen at the individual level the group level or even organizationally and you have to be able to kind of work through that conflict in a professional manner um nursing is a profession it's not just a casual job it's a profession and you want to make sure that you are professional in the way that you act and react when it comes to different situations that may arise so you want to make sure you can identify what the source of the conflict is generate possible solutions evaluate what Solutions you've come up with and then choose which one you think is best Implement that change and then evaluate did your solution actually solve the problem and this can be done um on a really really small level or on a bigger level but it's kind of a good um process for working through conflict and it's something that a lot of you are probably already doing you know you think about it um think about something that happened at home recently right maybe you got mad because there was only one bowl of cereal left and you and somebody else in the family wanted it all right the source of the conflict is we've only got one bowl of cereal available what are the solutions either I have it you have it or we split it in half that's those are what I see as the possible solutions let's evaluate if I take it you don't get anything if you take it you don't get any I don't get anything if we split it we don't get as much as we wanted but we get some all right let's go with splitting it we split the bowl I got half a bowl you got half a bowl we may need to eat lunch a little earlier but at least we got to enjoy so we implemented that how did it work let's evaluate I'm happy that I got a little bit of it would have been really bummed out if you took all the cereal all right next time um what we'll do is we'll just keep more cereal on hand and when it starts to get halfway to the end we'll buy another box to avoid this in the future there you go we've managed the conflict so it's not always that simple but it is good to have a process to work through so that you're not just stuck all right and then one of the last things I want to work through with you guys is time management it's a struggle okay a struggle for me it's a struggle for probably a lot of people but it is something that you need to work on and need to get a grip on as you go through nursing school for one thing and then as you go into the nursing field so when you're looking at how you manage your time you need to have your short-term and your long-term goals determined and um top of mind so that you can recognize what it is you're trying to accomplish so for the short-term goals you know that may be in the space of this 12-h hour shift what do I need to make happen Okay I need all my patients to get their meds on time I need all my patients to be assessed in an orderly manner and I need to be able to chart everything that I'm doing okay that should be able to happen in 12 hours you may hear sometimes about people who are like oh I stayed for like two hours after work to get all this charting done if you're using your time management wisely that shouldn't happen now of course there are not um there are situations where you're like in a non ideal work environment or there are factors that are working against you but ultimately you should be able to um complete your tasks in the amount of time that you have designated for those tasks and if it's not getting done it you have to kind of look back and reevaluate well what happened during the shift that made it so that I couldn't get everything done and like I said there may be times where it's like wow like I would I had all my patients were just crashing and I was just constantly in the rooms I never got a chance to sit down and chart that happens you know but other times it's things like oh yeah it was a crazy shift I didn't really chart and you're like well weren't you like talking to that respiratory therapist for like three hours you know like there are some sometimes things that you can avoid or that you can um work around so that you can get your things done that you need to get done so that could be one short example of a short-term goal is like just within that day and then also you have some other goals like staying on top of your education modules for example that could be a short-term goal you know different companies will have you do these little modules that you have to work through they'll set some kind of goal of like hey have it done by December 30th or whatever and so that could be you know depending on how far out that is that could be a short-term goal as well long-term goals that you might want to manage could be things about you know reaching certain milestones in your career like hey by next year I want to be the charge nurse or I'm really working towards getting some extra experience because eventually I want to become the director of nursing at this facility you know so that would be more of a long-term goal and you could try and manage your time and your work efforts to to reach those could also have something to do with your continued education if you wanted to um get a further degree that may be another long-term goal as well that would utilize time management skills to accomplish all right so with time management you really need to um think about how you're organized time management is just about organizing your time so take an inventory of your time what are your time wasters um what is holding you back you could log how much time various activities are are taking you um and then determine what time of day or what time of your shift is going to be your more productive time where you have more energy or maybe when you have that drive to get something finished for some people it's like right at the start for some people they maybe don't get that really good push until towards the end um so when when are you more productive and then also it can be helpful to make list and schedules to keep you on task and be aware of upcoming deadlines so if you have had any access to Epic charting you'll see that they have those work lists and um the brain has a timeline already set up in it so that you can be aware of when things need to happen to so utilize those you know use those so that you stay on task so that you're not the nurse who's like oh yeah that's right I had a vom myosin I was supposed to give three hours ago it's a Time specific medication right so you want to be on top of things um you don't want things to slip away from you or to get out from underneath you and the more organized you can be the better because that will help you to stay on task and to not end up with all these extra things you have to do without enough time to get it done time management is one of the hardest things going into nursing especially if you go into some of the busier units it's hard to get everything done you have a lot of patience you have a lot of tasks and you have to be able to prioritize um prioritizing is huge so when you're prioritizing look at what needs to be done now and what can be done later some of those things are um you know time consuming some of the tasks you may have you may say well I have to give the medications now because they're due for this time and I had one hour before one hour after this little window so I really need to prioritize my Med pass and then after I've done my Med pass then I can go ahead and you know reorganize all the clothes in my patient's closet because she wanted help reorganizing them but you just communicate that hey I'd be happy to help you with that um at this point in my shift it's really important I get these medications out some of these are time specific so I need to get this done and then I can help with that other task so what can be done later what needs to be done now um all right let's take a look at a practice question for this so which patients should the nurse see first the 18-year-old female patient complaining of six out of 10 pain the 86-year old male patient with a stage four pressure injury the 44 year old female patient asking for a new hospital gown or D the 62y old male patient complaining of a new pressure in his chest what do you think now this type of question um it's not like this chapter on uh management of care is going to be the end all Beall chapter for this type of question these types of prioritizing questions will come up in a variety of um units you know you may have questions about assessment that from your assessment lecture that are prioritizing or questions about wound care where you're prioritizing who to go see which wound to change first right so the prioritizing it it isn't only specific to managing care but you'll see it everywhere it's just important to be able to recognize and a lot of that recognization comes from utilizing clinical judgment which you'll gain as you get more and more experience in the clinical sites and understanding different patient conditions and what is the priority and what can wait but ultimately you have to kind of think about what has to happen now what can be pushed back because you're always going to be faced with these situations where you have multiple people with multiple needs all throughout your shift it's rarely is it ever oh nobody needs anything and uh when they do it's one at a time you know it you've probably experienced this where it's like ah why does everybody need something right now right maybe if you've worked in fast food it's like nobody comes through the drive-thru and then all of a sudden there's 10 cars you're like are you kidding me it's kind of the same in nursing you know and we have to be able to to look at these patients say oh okay gosh all this is happening right now who should I go see first and the answer is oops I went by it too fast the answer is D um so the patient that we should see first is going to be the patient who has the new pressure in this chest because this is a new finding so the condition has changed right maybe you said we should go see the the patient with the six out of 10 pain because that hey six is higher than five so it's on the worse scale than the better scale I don't know it's it's getting kind of high we should go see what that's about that's not a bad idea but maybe she's been in six out of 10 pain for a while we don't know all we know is what the test gives us so we don't know how long that's been going on but we know that this 62y old patient has a new pressure so this is new and so we need to figure out why is it happening what's this pressure from is he having a heart attack is does he have shortness of breath so he can't breathe are we worried about Airway here right those are kind of like time critical things being in six out of 10 pain is not good but unless it's something that just started which we don't know because it's not told to us that's something that we can maybe go find out next but this new pressure we need to address so that we can assess it and determine where it falls you know because maybe once we go in there we see oh yeah the reason he has a new pressure on his chest is because he set his laptop on his chest and he didn't recognize let me just put your laptop here on the side bam problem solved but if he doesn't recognize that then that's you know something we need to be aware of so we just need to look and see what is the um priority and in this situation it's the new symptom um pain is not good but we can address that later the pressure injury it's not good to have but we're going to change that dressing later we'll get to it and the new hospital gown not our priority but of course we want that patient to be comfortable so we'll get to it but prioritize what has to happen now what can I do five minutes from now right because we're not saying that you're not going to go see these other people people but you just have to think first what's the priority all right um I didn't make a cute final slide it's just black but uh just a nice blank little slate there but that's the end and um if you have any questions or you want to discuss further feel free to reach out through the discussion board and we can talk about any of this that you want to clarify thank you guys and goodbye