NURSING LEADERSHIP & MANAGEMENT

PROFESSOR MARIANNE MCAULEY

Morning

Afternoon

all students 8 AM to 12:30 PM 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

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

Review Agency Schedules Directions Uniform Policy Health Forms in Trunk of Car HIPPA Privacy Compliance Attendance & Lateness Policy
absences

THE CLINICAL EXPERIENCE

Late Assignment Policy

Department of Health or JCAHO Visit

call unit & me (451-4152)

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 patients diagnosis Describe nursing interventions done during your shift

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

Picking up of doctors orders

Staff education: in-service project for CNAs (certified nursing assistants)
15 minutes done on 2nd day

CLINICAL OBJECTIVES

WHY L & M?

Economics of health care Staff Redesign NCLEX

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

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

What are the Skills of Effective Leaders?

The Great Communicator

listening skills articulation skills
oral writing

Be An Assertive Communicator

The Team Player

understands the work of others appreciates the work of others credible - performs well persuasive, enthusiastic

increases cohesiveness among team members

The Motivator
Inspires others to reach goals Uses power to motivate others

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

The 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?

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/LawsRegs/Health_Services/Nurse_Practice_ Act-full.htm

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

Is It the Right Task?

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

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

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 - leaders formal position in organization Reward underutilized

leaders ability to reward followers

Coercive dont use this

followers fear of punishment

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

Understanding Self
self-assessment

Knowledge Learning
role models

Emotional Intelligence
assess yourself

Effective Leader and Manager Formula

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

BEHAVIORAL THEORIES
Autocratic Democratic Laissez-Faire

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

LAISSEZ-FAIRE STYLE

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

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

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-PLAYS LEADERSHIP STYLES

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

DEVELOPING NEW SKILLS

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

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 PROJECT A WIN-WIN FOR ALL

Plan: during the week

develop the lesson plan - have 2 copies typewritten, professional appearance 1 copy to preceptor

1 copy to me (R 106)

LIV Room 307 Margaret Kellys mailbox

Implement: the second day

eating & learning is fun use audio-visual aids/handouts absent: schedule make-up

INSERVICE PROJECT A 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

INSERVICE PROJECT A WIN-WIN FOR ALL

Cover Sheet

Objectives Content Outline Written Quiz Teacher Evaluation Form Attendance Sheet - GOES TO AGENCY
See appendix F

topic, date, agency presenter - your name

COMPONENTS OF A LESSON PLAN

AGENCY
Lesson plan
Lesson plan includes a copy of the quiz & the teacher evaluation form

MRS. MCAULEY Lesson plan

Attendance sheet Give lesson plan to preceptor LIV put in Margaret Kellys mailbox in Room 307

Quizzes completed by CNAs Evaluations completed by CNAs Preceptor evaluation

Include comments

Lesson plan includes a copy of the quiz & the teacher evaluation form

Student evaluation Leave in my mailbox in R106 Returned to your student mail folder in R111

Checklist for in-service project 2 brown envelopes

Focused on the learner:CNAs Measurable - Use action verbs

use words like state, describe, list, explain DONT use words like understand or know

Time component

HOW TO WRITE 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

COGNITIVE PSYCHOMOTOR AFFECTIVE

Objectives can be all the same type or a mix

TYPES OF OBJECTIVES

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

COGNITIVE OBJECTIVES

Skills

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

PSYCHOMOTOR OBJECTIVES

Emotions, feelings

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

AFFECTIVE OBJECTIVES

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

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

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

creates pressure on skin over bony prominences

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 Record all intake, assist to feed as needed Inspect skin daily, toilet or change frequently

b. proper nutrition

c. keep skin clean & dry

EXAMPLE OF CONTENT OUTLINE

 a. b. c. d.

Quiz

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

multiple-choice, true-false state in positive, all choices same length

EVALUATION OF KNOWLEDGE

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

EVALUATION OF TEACHER

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

THE CHANGE MAKER

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

How do people react to change?

What role do you play when it comes to change?

Laggard or Adventurer

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

CHANGE THEORY

Unfreezing: recognize need for change

loosen the status quo driving factors versus restraining factors

Moving: initiate change after planning Refreezing: change becomes operational

STAGES OF CHANGE

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

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

Run productive meetings Use participative decision-making Schedule a brainstorming session when needed

quantity, freewheeling, no criticism

TECHNIQUES FOR IMPLEMENTING CHANGE

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

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

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

Coaching Role

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

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

USE THE SANDWICH APPROACH

ROLE-PLAY PERFORMANCE APPRAISALS

See appendix D Demonstrate an ineffective interview Demonstrate an effective interview

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

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 CONFLICT

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

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

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

See appendix D Competition/Power Smoothing Avoidance Compromising Collaboration

ROLE-PLAYS CONFLICT RESOLUTION

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 LEADER ROLE OF VISION