Leadership Seminar: Role of the Licensed Practical Nurse

1. Leadership Seminar:Role of the Licensed Practical Nurse Franchesca Vormawor BSN, RN Adjunct Faculty HACC Nursing Fall 2014

2. Who is an LPN Very important member of the healthcare team Clinician Manager Advocate Educator Counselor Researcher Consultant Collaborator

3. Legal Definition Taken and passed the NCLEX-PN Certified by the State Board of Nursing to practice nursing One who is graduated from an accredited practical nursing program

4. State Nurse Practice Act • Provides: • Legal definition • Scope of practice

5. Points to Ponder If you are asked to perform a task or procedure that you are not familiar with, what should you do? If you are asked to perform a task or procedure for which you have not been properly trained, or which the State Board states you are unable to perform, what do you do?

6. Functions of the LPN The LPN is prepared to function as a member of the health care team by exercising sound nursing judgment based on preparation, knowledge, experience in nursing competency. The LPN participates in the planning, implementation, and evaluation of nursing care using focused assessment in settings where nursing takes place.

7. Role of LPN in PA Revealed through standards of practice Standards of practice determine by State Practice Act State Board of Nursing dictates LPN’s functions and scope of practice State Board regulates and enforces State Practice Act

8. Duties and Responsibilities Providing competent care to residents/patients Using the nursing process Recognizing changes in residents and seeking appropriate intervention Communicating to physician, staff, residents Administers medications and treatment Collaborating with other healthcare team members.

9. PLANNING FOR CONTINUITY OF CARE

10. Report • Make reporting process relevant and efficient • Should address: • Problems • Interventions • Evaluation • Use critical thinking • Develop report form

11. Report • Receiving report – Info you may need • Room #/Name/Age/Dx-surgery • Diet/I&O/Foley/Wounds/Tubes/Drains • Self care level/Activity level • Relevant Labs/Tests/Procedures/Therapy • O2/Resptx/IV’s • VS/Breath sounds/Bowel sounds/Edema • Other pertinent info/Abnormal Assessments • Pertinent Psychosocial Data

12. Report • Rules of giving report • Be succinct • BE PREPARED • Have ALL info • Prepare by thinking of client’s day • Highlight important info. • PRACTICE, PRACTICE, PRACTICE • Ask for critique • Evaluate and improve

13. Delegation Defined

14. What happens in delegation • ACCOUNTABILITY • Being responsible and answerable for actions and inactions of self or others in the context of delegation • DELEGATION • Transferring to a competent individual the authority to perform a selected nursing task in a selected situation • Nurse retains accountability for the nursing task (NCSBN, 1995)

15. Assignment • You can assign tasks and patients to other licensed personnel • You are no longer accountable for the task (if you have assigned appropriately) • Example: Medication Administration

16. Five Rights of Delegation Right task Right person Right circumstances Right direction/communication Right supervision

17. Information Needed to Delegate • Needs of client and family • Goals of client • Nursing activities to help client meet goals • Skills and knowledge level of various nursing personnel • The LAW: Can you legally delegate the task? • Institutional policy: Is the task in that person’s job description?

19. Why Nurses DO NOT Delegate • Belief in fallacy “If you want it done right, you have to do it yourself.” • Lack of confidence or trust in others • Low self-confidence • Fear of being labeled “lazy” • Vague job description • Competitiveness (Super Nurse Syndrome) • Poor examples set by other nurses

20. Why Delegatee DOES NOT Perform Task Too many bosses and too few workers Lack of respect Boring or unpleasant tasks Poor, untimely, or improper feedback Lack of specific directions (poor communication) Directions are too specific and rigid

21. Delegatee's Responsibilities Accountable for accepting task Accountable for own actions when completing task Asking for clarification Communicating any limitations in competency

22. Delegator’s Responsibilities • Nurse retains accountability in 4 areas • Decision to delegate • Verification of delegatee's competency • Completion of delegated task • Providing supervision

23. Scenario • One of your post-op patients has a slight fever. You assess crackles in both lung fields. You re-instruct him in the use of his ISB and remind him of the importance of using his ISB 10 times per hour to prevent pneumonia. • You tell him that the NA will assist and remind him to use his ISB hourly. You return in 3 hours and find the ISB in the alcove and the patient states that he has not used it and that the NA placed it there when his breakfast tray came right after you left. You are irritated with the NA and feel guilty for not checking on your patient sooner.

24. Scenario • You are the LPN on a busy rehab unit in a LTC facility. It is 1130 and you know that you have a 1200 med in room 36 with BP parameters. You are also trying to complete the discharge paperwork for a patient whose ride has just arrived and you are expecting an admission within the next 5 minutes. You pass your NA in the hall and ask her to get the BP for you in room 36. • You complete the discharge and get your admission settled in his room. It is now 1230. You ask the NA for the BP and she tells you that she has not gotten it yet because she was passing lunch trays. You “huff” and say I should have done it myself. The NA is confused because she was planning to do the BP after she passed trays.

25. Delegation “Delegation gets the task done – but not the responsibility – off your back. The act of delegating creates a responsibility to supervise” (Rainbow, 1982)

26. CommunicatingWith Healthcare Team Assertive/not aggressive Respectful Clear and concise Put patient/resident at center of concern

27. Do I have everything I need? • Have I seen and assessed this pt myself? • Have I reviewed the pt’s active orders? • Do I have the chart, current meds, recent VS, lab results (current and previous)? • Have I read the most recent MD progress notes? • Is there a need to discuss this call with my supervisor? • What do I expect to happen as a result of this call? • DOCUMENT, DOCUMENT, DOCUMENT

28. Communicating with Other Medical Professionals Situation Background Assessment Recommendations

29. Always Remember • Supervise • Provide guidance or direction, evaluation and follow-up by the licensed nurse for the accomplishment of a nursing task delegated to unlicensed assistive personnel when you delegate.

30. Final Thought on Delegation “Communicate downward to workers with at least the same care and attention as you communicate upward to superiors” Bleker

31. Chain of CommandGoing “UP” the Chain • Where do you go with: • Staffing issues • Coworker problems • Patient plan of care concerns • Client’s family concerns • Unresponsive medical providers

32. Let’ use SBAR Mr. Jones is admitted two days to the medical surgical unit s/p LTHR. PMH is a-fib. Prior to surgery, he was receiving 5 mg daily dose of Coumadin and 0.25 mg digoxin. Last administered dose was prior to surgery. HR has been in the 90’s since admission. Current VS at 120/80, 120-130 range irregular, 20.

33. Using SBAR Situation: “Dr. Thomas, this is Franchesca calling from CGOH. I am caring for Mr. Jones, in room 274. Mr. Jones has had a change in his heart rhythm.” _ Background: “Mr. Jones had his hip surgery two days ago and has been going in and out of controlled A-fib since his surgery, with rates in the high 90’s. Mr. Jones has a history of A-fib and was on Coumadin 5 mg/day and Digoxin 0.25 mg/day prior to his hip replacement. He has not had any Digoxin or Coumadin since his surgery.” _ Assessment: “This morning, Mr. Jones has gone into an uncontrolled A-fib, with a rate in the 120-130 range. He is currently asymptomatic and his vital signs are stable, with a blood pressure of 120/80. He is resting comfortably in his room. _ Recommendation: “I am thinking that a 12-lead should be ordered for Mr. Jones. Would you like his Digoxin and/or his Coumadin to resume? Are there any other tests you would like to order? I will call you if Mr. Jones converts or becomes symptomatic. Would you like me to call you with any changes?

34. Final Thoughts • Respect is earned, not demanded. You will only receive the respect that you give to others. • Become great nurses and leaders. Be honest, competent, fair, courteous, straight forward, imaginative, broadminded, and passionate. Inspire people. M.F. 2006

35. Do Not Forget YOU ARE A NURSE MAKING A DIFFERENCE PRACTICE WITH PRIDE OWN YOUR PRACTICE