NURSING LEADERSHIP

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NURSING LEADERSHIP MANAGEMENT

• PROFESSOR MARIANNE MCAULEY

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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

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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

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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

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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

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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

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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

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CLINICAL OBJECTIVES

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

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WHY L M?

• Economics of health care
• Staff Redesign
• NCLEX

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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

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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

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What are the Skills of Effective Leaders?

• The Great Communicator
• listening skills
• articulation skills
• oral
• writing
• Be An Assertive Communicator

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The Team Player

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

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The Motivator

• Inspires others to reach goals
• Uses power to motivate others

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The Delegator

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

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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

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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

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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

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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

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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

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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

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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

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TYPES OF POWER

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

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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

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Effective Leader and Manager Formula

• Understanding Self
• self-assessment
• Knowledge
• Learning
• role models
• Emotional Intelligence
• assess yourself

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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

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Great Man or Trait Theory

• Leaders born, not made
• Physical, psychological , personal
  characteristics define leaders
• Charismatic theory - leaders possess charisma

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BEHAVIORAL THEORIES

• Autocratic
• Democratic
• Laissez-Faire

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AUTOCRATIC STYLE

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

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LAISSEZ-FAIRE STYLE

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

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DEMOCRATIC STYLE

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

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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

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Situational Leadership

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

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• DEVELOPING NEW SKILLS

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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

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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

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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

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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

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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

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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

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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

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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

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TYPES OF OBJECTIVES

• COGNITIVE
• PSYCHOMOTOR
• AFFECTIVE
• Objectives can be all the same type or a mix

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COGNITIVE OBJECTIVES

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

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PSYCHOMOTOR OBJECTIVES

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

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AFFECTIVE OBJECTIVES

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

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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

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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

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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

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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

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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

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THE CHANGE MAKER

• How can you be an agent of change rather than a
  target of change?

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How do people react to change?

• threat to self
• fear of increased responsibility
• lack of understanding
• limited tolerance for change

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What role do you play when it comes to change?

• Laggard or Adventurer

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CHANGE THEORY

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

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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

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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

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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

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TECHNIQUES FOR IMPLEMENTING CHANGE

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

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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?

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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

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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

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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

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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

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ROLE-PLAYPERFORMANCE APPRAISALS

• See appendix D
• Demonstrate an ineffective interview
• Demonstrate an effective interview

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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

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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

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RESPONSES TO CONFLICT

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

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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

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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

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ROLE-PLAYSCONFLICT RESOLUTION

• See appendix D
• Competition/Power
• Smoothing
• Avoidance
• Compromising
• Collaboration

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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