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NURSING LEADERSHIP & MANAGEMENT. PROFESSOR MARIANNE MCAULEY. Morning all students 8 AM to 12:30 PM Afternoon full-day students Self-Study sign attendance sheet with professional assistant assignment due within one week assignments in my mailbox: R106

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nursing leadership management

NURSING LEADERSHIP & MANAGEMENT

PROFESSOR MARIANNE MCAULEY

day workshop

Morning

    • all students
    • 8 AM to 12:30 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
DAY WORKSHOP
evening workshop

5:00 PM – 9:50 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
EVENING WORKSHOP
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
THE CLINICAL EXPERIENCE
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
ROLE OF PRECEPTOR
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 patient’s diagnosis
    • Describe nursing interventions done during your shift
CLINICAL OBJECTIVES
clinical objectives1

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
CLINICAL OBJECTIVES
clinical objectives2

Picking up of doctor’s orders

  • Staff education: in-service project for CNAs (certified nursing assistants)
    • 15 minutes – done on 2nd day
CLINICAL OBJECTIVES
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
NCLEX-RN TEST PLAN
leaders are mostly made not 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
Leaders Are Mostly MadeNOT Born
what are the skills of effective leaders

The Great Communicator

    • listening skills
    • articulation skills
      • oral
      • writing
  • Be An Assertive Communicator
What are the Skills of Effective Leaders?
the team player

understands the work of others

  • appreciates the work of others
  • credible - performs well
  • persuasive, enthusiastic
    • increases cohesiveness among team members
The Team Player
the motivator

Inspires others to reach goals

  • Uses power to motivate others
The Motivator
the delegator

A nursing task is transferred to an individual competent to perform the task

  • The delegator remains accountable for the task
The Delegator
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
How to Increase Your Expertise as a Delegator?
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_Services/Nurse_Practice_
    • Act-full.htm
Is It the Right Task?
is it the right task1

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
Is It the Right Task?
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

Is It An Appropriate Health Related Activity?
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
More Skills of Effective Leaders
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
How Do Leadership & Management Differ?
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
Differences between Managing and Leading
types of power

Legitimate - leader’s formal position in organization

  • Reward – underutilized
    • leader’s ability to reward follower’s
  • Coercive – don’t use this
    • follower’s fear of punishment
TYPES OF POWER
types of power1

Referent - follower’s identification with leader

    • confidence
    • power dressing
    • What qualities do you have that give you this power?
  • Expert - leader’s specialized knowledge
TYPES OF POWER
effective leader and manager formula

Understanding Self

    • self-assessment
  • Knowledge
  • Learning
    • role models
  • Emotional Intelligence
    • assess yourself
Effective Leader and Manager Formula
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
EMOTIONAL INTELLIGENCE
great man or trait theory

Leaders born, not made

  • Physical, psychological , personal characteristics define leaders
  • Charismatic theory - leaders possess charisma
Great Man or Trait Theory
behavioral theories

Autocratic

  • Democratic
  • Laissez-Faire
BEHAVIORAL THEORIES
autocratic style

Leader dominates group

  • Commands rather than makes suggestions
  • Maintains strong control
  • Sometimes punitive
AUTOCRATIC STYLE
laissez faire style

Leader is passive, nondirective, inactive

  • All decision making left to group
  • Little, if any, leader guidance or support
LAISSEZ-FAIRE STYLE
democratic style

Group participates in decision making

  • Leader acts as facilitator
  • Leader has concern for group members
DEMOCRATIC STYLE
role plays leadership 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
ROLE-PLAYSLEADERSHIP STYLES
situational leadership

Assess the situation

  • Assess the group members
  • Select the style or blending of styles best for the situation
Situational Leadership
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
STAFF EDUCATION
inservice project a 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
INSERVICE PROJECTA WIN-WIN FOR ALL
inservice project a win win for all1

Plan: during the week

    • develop the lesson plan - have 2 copies
    • typewritten, professional appearance
    • 1 copy to preceptor
      • LIV – Room 307 – Margaret Kelly’s mailbox
    • 1 copy to me (R 106)
  • Implement: the second day
    • eating & learning is fun
    • use audio-visual aids/handouts
    • absent: schedule make-up
INSERVICE PROJECTA WIN-WIN FOR ALL
inservice project a win win for all2

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
INSERVICE PROJECTA WIN-WIN FOR ALL
components of a 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
COMPONENTS OFA LESSON PLAN
checklist for in service project 2 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 Kelly’s 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
Checklist for in-service project2 brown envelopes
how to write objectives

Focused on the learner:CNAs

  • Measurable - Use action verbs
    • use words like state, describe, list, explain
    • DON’T use words like understand or know
  • Time component
HOW TO WRITE OBJECTIVES
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
EXAMPLES OF OBJECTIVES
types of objectives

COGNITIVE

  • PSYCHOMOTOR
  • AFFECTIVE
    • Objectives can be all the same type or a mix
TYPES OF OBJECTIVES
cognitive objectives

Knowledge, facts

Example:

CNAs will state 3 methods to prevent pressure ulcers by the end of the in-service

COGNITIVE OBJECTIVES
psychomotor objectives

Skills

  • Example:
  • CNAs will demonstrate proper handwashing by end of in-service
PSYCHOMOTOR OBJECTIVES
affective objectives

Emotions, feelings

  • Example:
  • CNAs will express feelings about caring for a dying client by end of in-service
AFFECTIVE OBJECTIVES
content outline

Outline format – don’t 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
CONTENT OUTLINE
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 – can’t move self, may be unable to express pain or discomfort

EXAMPLE OF CONTENT OUTLINE
example of content outline1

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
EXAMPLE OF CONTENT OUTLINE
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 resident’s 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
EVALUATION OF KNOWLEDGE
evaluation of teacher

List items for CNA to rate

Example: Teacher’s 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

EVALUATION OF TEACHER
how do people react to change

threat to self

  • fear of increased responsibility
  • lack of understanding
  • limited tolerance for change
How do people react to change?
change theory

Process of change - force field analysis

  • Three phases required to accomplish change
    • unfreezing
    • moving
    • refreezing
CHANGE THEORY
stages of change

Unfreezing: recognize need for change

    • loosen the status quo
    • driving factors versus restraining factors
  • Moving: initiate change afterplanning
  • Refreezing: change becomes operational
STAGES OF CHANGE
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
STEPS IN THE CHANGE PROCESS
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
HOW TO OVERCOME RESISTANCE TO CHANGE
techniques for implementing change

Run productive meetings

  • Use participative decision-making
  • Schedule a brainstorming session when needed
    • quantity, freewheeling, no criticism
TECHNIQUES FOR IMPLEMENTING CHANGE
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?
ROLE-PLAY
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
PERFORMANCE APPRAISALS
coaching role

Be seen as trying to be helpful

  • Timing is everything
  • Discuss behavior in relation to standards
    • Don’t be preachy or use word “should”
  • Give specific suggestions for change
  • Recognize & praise improvements
Coaching Role
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
CONDUCTING THE INTERVIEW
use the sandwich approach

Begin with the positive attributes, accomplishments

    • Be specific
    • Spend time
  • Identify and address the deficiencies
    • Don’t use avoidance or minimize these
  • Finish with a positive statement
USE THE SANDWICH APPROACH
role play performance appraisals

See appendix D

  • Demonstrate an ineffective interview
  • Demonstrate an effective interview
ROLE-PLAYPERFORMANCE APPRAISALS
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
RESPONSES TO CONFLICT
responses to conflict1

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
RESPONSES TO CONFLICT
responses to conflict2

Collaboration: Win/Win

    • confront issue openly
    • look for acceptable resolution
    • no dominating, suppressing, compromising
RESPONSES TO CONFLICT
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
Strategies for Effective Conflict Resolution
strategies for effective conflict resolution1

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
Strategies for Effective Conflict Resolution
role plays conflict resolution

See appendix D

  • Competition/Power
  • Smoothing
  • Avoidance
  • Compromising
  • Collaboration
ROLE-PLAYSCONFLICT RESOLUTION
21st century leader role 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
21ST CENTURY LEADERROLE OF VISION