Concepts of Management (Nursing)

00:02 Hi I'm Jessica Spellman.

00:03 We're going to be reviewing concepts of management.

00:07 After taking this course you will be able to compare the roles of managers and leaders, recognize roles of members on the health care team, identify the role of charge nurse, apply and understand the guidelines for determining patient room assignments and nursing assignments, and utilize effective communication and conflict resolution principles.

00:34 So let's start with the definitions of management and leadership.

00:38 Management is the control of resources, human equipment, and fiscal according to established values of an organization.

00:48 The leadership is the vision and values of an organization, and they promote change within the organization.

00:58 So management and leadership- Are managers always leaders? No, but it would be great if they were.

01:06 And are leaders always managers? No, but it is extremely common that leaders also hold management positions in an organization. Let's review the differences in the two roles.

01:20 So managers manage day-to-day tasks or work.

01:24 They're very task-focused.

01:27 They have subordinates.

01:30 They enforce policies.

01:34 They do work on budgets.

01:36 And they maintain stability of a unit or organization.

01:42 Leadership, on the other hand, leads an organization to fulfill mission, vision and values.

01:49 They're more people focused.

01:53 They're involved in strategic planning.

01:56 They have followers and they encourage change.

02:03 So how do leaders lead? There are different types of power.

02:07 There's formal power that's held by a position that you may hold within an organization, and that is seen on the hierarchy of the organization.

02:17 Some examples on the hierarchy of an organization would be the CEO, the CNO, directors and managers all have different levels of power inherent in their position.

02:29 Informal power is not related to the position that you hold within an organization.

02:36 It's not represented on the formal hierarchy.

02:40 An example would be a ten year employee that exhibits a high level of professionalism, excellent communication skills, and is proficient at nursing skills and is considered a leader within their department.

02:55 So nurses and management have formal power over hiring scheduling, and fiscal matters, and they are expected to be informal leaders and maintain a high level of professionalism.

03:08 Nurses that are not in management are also expected to be informal leaders in the nursing profession and in the clinical setting.

03:17 So team building.

03:19 Building an effective team begins with knowing all of the members of the health care team.

03:24 I want to review the roles of all the professions that collaborate on health care teams- physicians, nurses, pharmacists, medical dietitians, therapists such as respiratory, physical, occupational, and speech therapists, social workers, and case managers.

03:49 So physicians are health care profession that's concerned with promoting, maintaining, or restoring health by diagnosing and treating disease, illness, and injury.

04:00 There are various types of specialties.

04:02 As physicians, there's primary care, emergency medicine, surgeons, oncologists, pediatricians, and cardiologists.

04:11 This is not an all-inclusive list, but a variety of specialists you may see in practice.

04:20 Nurses- Nurses are professionals that direct patient care by assessing, planning, implementing and evaluating interventions.

04:31 So there's various types of nurses also.

04:34 There's an RN-it's a registered nurse, an LPN-a licensed practical nurse and an APN-an advanced practice nurse.

04:45 Let's start by reviewing the roles of the RN.

04:48 RN scope of practice includes interpreting assessment data, developing a plan of care independently, determining client needs and priorities, assigning, delegating, and supervising tasks to licensed and unlicensed assistive personnel, or UAPs, evaluating effectiveness of interventions and modifying care plans, developing and evaluating teaching plans.

05:20 They can make referrals and they manage all aspects of nursing care.

05:26 The LPN scope of practice is a little more limited.

05:30 They can collect data on patients that contributes to the plan of care, but they cannot analyze it.

05:39 They can practice under the supervision of an RN.

05:44 They can participate in identifying client needs with the help of the RN.

05:51 They can implement an established plan of care by the RN.

05:56 They can assign tasks to other LPNs.

06:01 They may delegate tasks to unlicensed assistive personnel.

06:07 They may report client response to interventions, but may not modify the plan of care without the RN being involved. And they can participate in teaching and establish care plan as assigned by the RN.

06:23 An advanced practice nurses are registered nurses that have continued their education beyond basic nursing and are certified nationally and recognized by a professional organization.

06:36 They include such types as nurse anaesthetists, nurse practitioners, clinical nurse specialists, and nurse midwives.

06:49 So let's review pharmacist.

06:50 Pharmacist is a professional prepared to formulate, dispense, and provide clinical information on drugs and medications to health professionals and patients.

07:00 They are a great resource for asking about drug interactions and whether doses are correct.

07:09 If patients have such things as renal insufficiency, you could work with your pharmacist to find out if medications are okay to give.

07:20 Medical dietetics is the branch of therapeutics concerned with the practical application of diet in relation to health and disease.

07:29 Sometimes these are also referred to as nutritionists or dietitians.

07:34 These are a helpful part of the team when you have questions about tube feeding, caloric intake of patients, types of diet patients should be on.

07:44 This is the person you would want to refer to.

07:50 There are a couple different types of therapists.

07:52 We'll start with a physical therapist who is an allied health professional, is licensed to treat, evaluate, and examine physical impairments through special exercise, application of heat and cold, and other physical modalities.

08:09 So patients that maybe have had a recent knee replacement would definitely be involved with a physical therapist.

08:16 An occupational therapist-another allied health professional who uses purposeful activity and interventions to maximize the independence and health of a client who is limited by physical injury or illness, cognitive impairment or psychological dysfunction, mental illness, or developmental or learning disability.

08:38 Occupational therapy is more the fine motor skills and patients after strokes may need help learning to squeeze, lift items, learn how to use their fingers and hands to manipulate objects. That is a type of patient that would be referred to an occupational therapist.

08:58 Recreational therapist is also an allied health professional.

09:02 They help reduce the effects of disability or illness on patients and help them function more independently.

09:09 A lot of developmentally disabled patients use recreational therapy as part of their treatment plan.

09:19 Speech therapists are another allied health professional trained to evaluate and treat the voice, speech, language, or swallowing disorders.

09:29 If a patient is extubated, a lot of times they will order a swallowing consult, which would be referred to your speech therapist and they would be involved in, um, in helping you with that task. Social worker-a professional with training in dealing with social, emotional, and environmental problems associated with an illness or disability.

09:54 A medical social worker has completed a program that includes experience in counseling patients and their families in a hospital setting where a psychiatric social worker may specialize in counseling individuals and families dealing with emotional, social, or environmental problems related to mental illness.

10:15 A case manager is a healthcare professional responsible for formulating a coordinated, comprehensive plan for individuals who need long term health management.

10:25 The case manager works with healthcare providers, the patient, the family and third party payers, and health care facilities in order to identify and meet the patient's needs outside of the hospital setting after they are discharged. Unlicensed assistive personnel (UAP)- these are healthcare workers who don't who are not licensed, but they do provide care to patients in certain elements, but do require supervision by a registered nurse.

10:56 So licensed practical nurses may also supervise UAPs, but only in making sure that they follow the policy for that task, but not evaluating the patient data or the outcomes that the patient has after that task is administered.

11:12 So unlicensed assistive personnel also include patient care technicians, nurses aides, and certified nursing assistants. Now that we've reviewed all the members of the health care team, it's important to talk about effective communication within the members of the health care team.

11:28 To work effectively as a team, you have to understand what fosters effective communication.

11:33 The first part of an effective communication is active listening.

11:38 You need to listen and be able to restate what you hear others are saying.

11:43 You need to feel like you're in a safe environment.

11:46 You need members of the team need to feel that they're not going to get in trouble or be attacked for what they are saying or sharing while discussing patient plans of care.

11:59 Non-verbal communication-majority of the message that you send is non-verbal, so watching your own body language, eye contact, facial expressions, gestures to understand the message as well as watching others' eye contact, body language, etc.,not just listening to what is being said.

12:21 Verbal communication is the tone of what you're saying, and that sometimes sends a louder message than just what you are saying. Emotional intelligence-it's just a subset of social intelligence that involves the ability to monitor your own and others' feelings and emotions, to decide how you should react to others and what you should do to promote communication with them. Managing stress-feeling high levels of stress affects the ability to communicate clearly and rationally.

12:56 So being able to control and manage your level of stress will help you communicate more effectively.

13:03 When communication is not as effective as we would have liked, conflict resolution techniques may be needed to help resolve conflict.

13:13 It doesn't need to come from formal positions.

13:17 RNs are expected to be able to know how to manage conflict resolution with team members and patients and their peers.

13:28 So an important thing to remember is to be proactive in conflict resolution, identifying the issue as early as possible may prevent the issue from escalating.

13:37 It's important to identify the problem.

13:41 What is the issue? It is important to identify the people involved.

13:48 It's also important to be prepared in conflict resolution or have your facts in order.

13:54 What items do you want to discuss? How do you want to approach the people involved.

13:58 Formal? Informal? Privacy is important.

14:03 What level of privacy is needed? Possible resolutions-Can the issues be dealt with by the individuals, or is it necessary to invite someone from management, maybe a mediator, to discuss the issue in order to resolve it? So you need to decide what is best for each situation.

14:28 The charge nurse role is a role that nurses aren't formally prepared for, but I wanted to take a few minutes to discuss the nurse assigned to manage the operations of patient care in an area for just the shift is called the charge nurse.

14:46 They usually have greater than two years of experience.

14:49 They're not considered a management position and their responsibilities include staffing, admitting and discharging patients, And coordinating of activities in the patient care area.

15:04 The charge nurse role changes shift to shift.

15:08 It requires a high level of clinical competence, flexibility, ability to problem solve, effective communication, and good decision-making skills.

15:20 So in making patient assignments- there's never really been a set formula for how to assign patients and how to assign nursing assignments to nurses.

15:33 So I want to review some things you can keep in mind while making those assignments.

15:40 Some responsibilities of the charge nurse include managing the patient room assignments and creating nursing assignments to care for those patients.

15:50 An article came out in 2013 that researched the issue of assigning patient room assignments and develop some practical guidelines for charge nurses to follow when making these decisions in an acute care setting.

16:06 Let's review some of those guidelines.

16:09 Some of them fell into regulatory and safety factors.

16:12 So the first thing you want to look at is there any state mandated ratios you need to maintain specific organization policies regarding staffing, any isolation requirements of the patient.

16:25 And you want to look at the competency of the nursing care.

16:29 Do you have a mixture of, um, experienced nurses, or do you just have, um, all new graduates on your unit? So taking that into account will also be important in making your assignments.

16:44 Patient safety is another issue you must consider.

16:47 Is the patient a fall risk or do they have drug or alcohol withdrawal? Um that would put them at a little higher risk.

16:56 Other high-risk patients include unstable patients, suicide precaution or complex psychosocial needs, and confused and impulsive patients.

17:09 Acuities and patient needs are important to consider.

17:12 The acuity of the patient-the charge nurse needs to keep that up to date every shift.

17:18 The current level of functioning and self-care activities-a patient that requires more help with activities of daily living is going to have a higher acuity than a patient that is self functioning.

17:31 Also, feedback from patients, families and staff-if a family shares with the charge nurse that they don't feel that their loved one is getting enough care or having enough time devoted to their care, the charge nurse may want to take that into consideration and increase the acuity of that patient, so that the nurse may have more time to care for them.

17:56 If they're not in a private room, consideration of the diagnosis, acuity and needs of the roommate-this is really important when you have patients in contact isolation, droplet isolation, different isolation precautions.

18:11 You have to, um, know whether they can be, should be in a private room or whether they allowed to be in a room with someone of the same precautions, continuity, anticipated flow, and nursing factors to consider when you're the charge nurse.

18:30 So a lot of times nurses get the same patient assignment, um, when they work several days in a row.

18:38 So a nurse may continue to care for a patient when the patient's needs match the nurse's competency level.

18:46 You have to take into account how many discharges that nurse is going to have that day, how many transfers, how many admissions to the unit.

18:53 Um, our patients, a lot of patients are going to be traveling off the unit for tests and do nurse nurses have to go with them? Do we do you have a lot of open beds or an enough allotted staff for the day? The geographical location of patients- you have to take that into consideration.

19:14 And you also have to take into consideration the specific needs of the staff.

19:18 Are there a lot of orientees, new graduates, different levels of experience, nurses or nurses that have students or preceptees? So in summary, managers, they manage the day-to-day work of a unit or department.

19:36 Leaders lead the organization by developing the set of values the organization wants to achieve.

19:43 Nurses do not have to hold management or leadership positions but are expected to be informal leaders in the clinical setting.

19:51 The charge nurse is a unique role that doesn't always receive adequate training, but they should have a certain set of guidelines that they can follow for helping them make their patient assignments and nursing assignments more easily.

20:07 Some guidelines that need to be considered by charge nurses when making those types of assignments.

20:11 Many safety and regulatory issues.

20:14 Patient safety needs and acuity, as well as a lot of nursing factors and staffing issues on the unit.

20:24 There are many team members in the healthcare setting.

20:28 Being able to communicate effectively is imperative to function as part of a team.

20:33 You need to manage your stress level.

20:36 Be an active listener.

20:38 Recognize verbal and nonverbal cues in communication.

20:42 It's also important to be able to recognize when conflict arises and work to resolve those issues.

20:51 This is Jessica Spellman, and this has been reviewing concepts of management