Professional Roles and Leadership Chapter 58 Mosby items and derived items © 2011, 2006, 2003,...

Professional Roles and Leadership

Chapter 58Chapter 58

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.


Functioning as a GraduateFunctioning as a Graduate

• The role of a graduate nurse will be exciting and challenging.

• The LPN/LVN is a valuable member of the health care team and functions in many settings.

• Many opportunities are available from which to choose.



• Letter of Application It should always be customized, brief, neatly typed,

and correctly spelled. It should be simple and direct. Its objective is to introduce yourself, announce your

interest in employment, briefly state your qualifications, and express your availability.

Your cover letter requires a thorough discussion of your qualifications.



• Résumé A summary of educational and professional

experiences, including activities and honors A one- or two-page written document that contains

certain information about you, your education, and your experience

Should be well-organized, neat, and accurate



• Personal Interview A meeting of people face to face, as for evaluating or

questioning a job applicant First impressions have a lasting effect.

• Contracts A promise or a set of promises between two or more

people that creates a legal relationship between them and a legal obligation that one or more of them must fulfill

May be written or oral



• Keeping Your Job Keep current and competent. Look and act professional. Be on time and ready to start at the beginning of the

shift. Be organized. Do not spend time with personal telephone calls. Take only the time allocated for lunch and breaks. Work hard and give the best care possible. Be a good leader and a good follower.



• Keeping Your Job (continued) Help others when you can. Stretch yourself; do not be satisfied with the minimum. Display a positive attitude and flexibility. Respect your patients, their family members, your

co-workers, and your supervisors.

• Encountering Problems Follow the chain of command. Be calm and positive in your approach. Listen carefully.



• Advancement A rise in rank or importance, a promotion, progress,

improvement May result from additional preparation or additional

experience Usually based on a person’s qualifications, behavior,

performance, and preparation

• Terminating Employment A verbal statement and letter of resignation should be

completed; proper procedures should be followed.


Transition from Student to GraduateTransition from Student to Graduate

• Know Your Role LPN/LVN is responsible to the RN or physician. Role of LPN/LVN is constantly changing.

• Technical and scientific changes in the health care system have resulted in a multiplicity and complexity of functions placed on the nurse.

• Be careful not to lose sight of your principal concern—the patient, a human being!



• Confidentiality All information the patient gives is confidential. Information may be exchanged with other members of

the health care team only in the performance of your duties.

Releasing any information to anyone other than the health care team without the consent of the patient is a violation of the right to privacy.



• Role of the LPN/LVN in the Community Participates in activities that promote the community’s

attitude toward positive health care Uses community resources to promote a better

understanding of the health services available to the general public

Participates in community health projects and other health-oriented activities



• Professional Organizations Gives you a voice in your profession Some provide continuing education Two national organizations are designed to support

and meet the needs of the LPN• National Association for Practical Nurse Educators

(NAPNES)

• National Federation of Licensed Practical Nurses (NFLPN)

National League for Nursing (NLN)• Involved with all types and levels of nursing



• Continuing Education It is critical to keep current on nursing trends and

issues. There are many opportunities for nurses to learn new

nursing skills.• Facilities offer employees continuing education.

• Internet

• Some states require CEUs before you can renew nursing licenses.



• Certification Opportunities Certifications

• Managed care (CMCN)

• Pharmacology

• Long-term care (CLTC)

• Addiction (CALPN)

• Further education


Licensure ExaminationLicensure Examination

• National Council of State Boards of Nursing Computerized adaptive testing (CAT) was adopted in

1994. Examinee takes the CAT exam by sitting at an

individual computer and answering questions on the screen.

NCLEX-PN has 85 to 205 questions.

• The candidate’s application is approved by the board of nursing in the jurisdiction where the NCLEX is to be taken.

• On successful completion of the examination, you can practice as an LPN/LVN.



• Endorsement/Reciprocity This is recognition of the license of a health

practitioner in one state by another state. Applicant must meet the state’s licensing

requirements. If the nurse travels with a patient from one state to the

other or to Canada, the license the nurse has in her or his possession is valid for the length of the stay in the other state or Canada.



• Nurse Licensing Compact/Mutual Recognition Based on the primary state of residence

• A declared, fixed, permanent, and principal home for legal purposes

A nurse may practice in a compact state using the nursing license from the primary state of residency.

State boards of nursing differ, so you should contact the board of nursing in the state where you are seeking licensing for the specific requirements.


Nurse Practice ActNurse Practice Act

• Licensing law

• Defines the title and regulations governing the practice of nursing

• Assists the nurse in staying within the legal scope of nursing practice in each state

• Defines the regulations for practical nursing and includes requirements for an approved school of nursing

• Defines requirements for licensure and conditions for which a license may be revoked or suspended


State Board of NursingState Board of Nursing

• Board consists of members who represent different levels of nursing and are appointed by the governor.

• The purpose of the board is to protect the public by administering the nurse practice act.

• Board is responsible for approving schools of nursing

• Board issues and renews licenses. Board has the authority to suspend or revoke a

license.


Career OpportunitiesCareer Opportunities

• Hospitals LPN/LVN is under the supervision of the RN. LPN /LVN is legally able to provide most bedside care

to patients in the hospital setting. LPN /LVN is responsible for supervising the nursing

assistants. There are a number of different types of hospitals.


Figure 58-4Figure 58-4

Various positions are available in the hospital setting on the health care team.

(From Polaski, A.L., Warner, J.P. [1994]. Saunders fundamentals for nursing assistants. Philadelphia: Saunders.)



• Long-term Care Facilities LPN/LVN is the backbone of long-term care facilities Can advance to charge nurse and supervisory

capacity with RN supervision A facility for those who require long-term care

• Home Health Health care in the home setting RN supervision must be available Relaxed atmosphere, decreased patient load,

primarily daytime hours



• Physician’s Office or Clinic Some of the skills required may not be included in the

LPN/LVN educational program.• Laboratory testing, ECGs, computer skills, insurance

coding, billing, supervision of other office personnel

• Insurance Companies Preadmission and claims assessments Usually require experience in medical-surgical nursing



• Temporary Agencies These agencies provide nurses to meet the staffing

needs in a variety of health care facilities. Advantages are the right to refuse and the wealth of

variety available. Disadvantage is the uncertainty of work available.

• Travel Opportunities Nurse can work for specified periods in areas in need

of nurses through a temporary agency. Experience is required. Lodging is provided in addition to salary.



• Pharmaceutical Sales LPN/LVN makes contacts with physicians,

pharmacists, and nurses in various clinical settings.• Presents the advantages of products

• Teaches about side effects and precautions Experience in specific areas and an expertise in

science and pharmacology are required.

• Other Medical Sales Sell medical supplies May perform in-service programs at facilities to

demonstrate product use



• Outpatient Hotels Provides patient teaching and assists with preparation

for tests; available for emergencies Hotel is usually owned by a hospital.

• Patient/guests stay while they undergo testing before surgery and/or for postsurgical care.

• The Military Active duty or reserves are options. Educational opportunities

• Additional education

• May help repay loans



• Adult Daycare Provide medical supervision for adults while their

family members work or take a break from the responsibility of care

• Schools Perform health screenings, emergency care, and

health teaching

• Public Health Work in clinics and home visits; may also participate

in health inspections



• Outpatient Surgery Prepare patients for surgery, as a scrub nurse, or to

work in the recovery room under the supervision of an RN.

• Private Duty Give total care to one patient May be in the hospital, home, other facility, or while

traveling

• Government May work in a Veterans Administration hospital or

other government hospitals



• Industrial Focuses on promoting wellness and preventing

accidents Safety is emphasized, and usually is first aid–oriented May do physical assessments, health surveys,

insurance forms preparation, health education, and intervention for patients injured in industrial accidents

• Rehabilitation Guides the patient toward health and independence



• Psychiatric Provides care for the mentally ill patient Requires a mature person

• Hospice Provides care for the terminally ill patient Institution or home setting Must have a clear understanding of his or her own

feelings about death


Leadership and ManagementLeadership and Management

• Leadership The art of getting others to want to do something you

are convinced should be done

• Management Handles the day-to-day operations to achieve a

desired outcome



• Autocratic Style Retains all authority and responsibility Concerned primarily with tasks and goal

accomplishment Assigns clearly defined tasks Establishes one-way communication with the group Excels in times of crisis (cardiac arrest) and in

situation of disorder (natural disasters)



• Democratic Style People-centered approach Allows employees more control and participation in

the decision-making process Emphasis is on team building and collaboration Works best with mature employees who work well

together as groups



• Laissez-Faire Style “Free-run style” or permissive leadership Relinquishes control completely Chooses to avoid responsibility by delegating all

decision making to the group Wants everyone to feel free to “do their own thing” May work well with highly motivated professional

groups



• Situational Leadership Takes into account the style of the leader, the maturity

of the group, and the situation at hand to form a comprehensive approach

Four typical styles• Directing

Provides specific instructions and supervises the accomplishment of tasks

New employees, employees with repeated performance problems, and crisis work situations



• Situational Leadership (continued) Four typical styles (continued)

• Coaching Monitors the accomplishment of tasks while also

explaining decisions, asking for feedback or suggestions, and recognizing good performance

Typically, leader and staff have have jointly developed a work plan.



• Situational Leadership (continued) Four typical styles (continued)

• Supporting Supports the efforts of others, facilitates their goal

accomplishment, and shares responsibility for decision making

Values growth and not perfection, collaboration and not competition

• Delegating Gives responsibility for decision making and problem

solving to mature staff who have demonstrated their competence



• Team Leading Assisting and guiding the nursing team in providing

care for a select group of patients Duties

• Receive reports on assigned patients

• Make assignments for team members

• Make rounds and assess all assigned patients

• Assist in administering medications and treatments

• Confer with team members on priority patients



• Time Management Using time to good advantage will be of great value. Learn effective time management skills, and practice

them frequently until they become fully developed. These skills will help you manage not only at work but

also in daily living.



• Anger Management Anger gives you a cue that something is wrong. Justified

• Helps you get your needs met by stimulating you to action

Unjustified or displayed inappropriately• Can get you and others in trouble



• Burnout Physical, emotional, and spiritual exhaustion Nurses are at high risk because they care! Occurs more often in people who have excessively

high expectations of themselves High-risk areas

• Intensive care

• Hospice

• Oncology

• Emergency department



• Burnout (continued) Signs and symptoms

• Physical Fatigue; changes in sleeping and eating Lack of energy; loss of interest in sex

• Psychologic Irritability; hypersensitivity Frustration; negative outlook Forgetting

• Spiritual Loss of commitment, meaning, and integrity


BurnoutBurnout

Symptoms of burnout.

(From Arnold E.N., Boggs, K.U. [2003]. Interpersonal relationships: professional communication skills for nurses. [4th ed.]. Philadelphia: Saunders.)



• Strategies for Burnout Prevention Awareness Balance Choice Detachment Altruistic egoism Focus Goals Hope Integrity



• Transcribing Physicians’ Orders Written

• Recorded on the chart by the physician.

• NEVER GUESS: If in doubt, get a second opinion.

• If it is a little different that “usual,” clarify it with the physician.

• If you still believe the orders to be inappropriate, contact your supervisor and document why the orders are not being carried out.

• Nurses are responsible for their own actions, regardless of who told them to perform those actions.



Clarifying the physician’s order.

(From Leahy, J.M., Kizilay, P.E. [1998]. Foundations of nursing practice: a nursing process approach. Philadelphia: Saunders.)



• Transcribing Physicians’ Orders (continued) Verbal or via telephone

• They may only be taken from a physician or a nurse.

• They are more subject to error.

• Clarify the order by repeating it to the person giving it.

• Ask them to repeat it more slowly if necessary.

• Write it down immediately.

• Be careful about medications that sound alike. For example, Zantac and Xanax



Computerized system for narcotic distribution.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)



• Change-of-Shift Report The report provides the next shift with pertinent

information about the patient. The quality of nursing care the patient receives is

contingent on how well each shift communicates with the other.

The report may be given orally in person, by audiotape recording, or with rounds from patient to patient.

Before beginning the report, write down all necessary information.



Giving a change-of-shift report.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

Professional Roles and Leadership Chapter 58 Mosby items and derived items © 2011, 2006, 2003,...

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