Introduction: Management of Care – NCLEX-RN®

00:01 Hi, I'm Prof.

00:02 Lawes and I'm going to talk to you about management of care here.

00:05 Now, the definition from NCSBN is providing and directing nursing care that enhances the care delivery setting to protect the client and the health care personnel.

00:16 That's a lot of words, isn't it? Well, first, let me orient you to where it is.

00:20 So you see, management of care is one of two subcategories of safe and effective care environment. Management of care is 15 to 21%.

00:30 And we'll talk about safety and infection control in another video.

00:34 That's 10 to 16%.

00:36 So management of care is one of the eight subcategories.

00:42 Now, let me break it down a little bit more.

00:44 That NCSBN definition is a little long and honestly kind of vague.

00:48 Here's a little more direction.

00:51 Delegate and supervise the care of clients provided by others.

00:55 For example, an LPN 11 an assisted personnel, a UAP other are in.

01:00 See, here is where it gets a little tricky with nursing students because this isn't necessarily always covered in all nursing programs.

01:08 So I'm going to teach you what the chain of command is and let you know how things work.

01:13 But first, I want to define for you in RN world how these roles work.

01:19 So let's start with our RN things that are within the scope of practice of an RN.

01:24 In RN world, there is assessment, initial assessment and assessments that are important or critical have to be done by an RN.

01:33 Teaching initial teaching is really important, has to be done by an R in an LPN, LVN or UAP can reinforce that teaching, but they can't do the initial teaching.

01:44 Now there's a lot of teaching involved in admitting a patient and discharging a patient, which is why both of those have to be done by an r RN.

01:52 So when a patient is admitted, you think, Oh, they just came into the hospital, they're admitted, that makes them an admin.

01:58 That's true. But also let's say the patient goes off your floor for a test, maybe they go have an MRI, and they come back to the room.

02:06 That's also considered a new admin.

02:08 Yes, I hear you laughing because those of you that have worked in a hospital know that every time a patient goes off the floor and comes back, they are not seen necessarily by an RN first.

02:19 But remember, this is NCLEX world.

02:21 It's a perfect world.

02:23 And that's what I'm here to teach you to help you understand what are the rules for this incredible test.

02:28 So. Admit, discharge, RN only.

02:32 Now, we've talked about this earlier, but I want to reinforce with you that RN delegates to the LPN or the LVN and the UAP, they are the team lead.

02:41 They're the one who can delegate to the other team members as long as they are nursing personnel.

02:48 Explain more about that later.

02:49 Now an LPN or an Alvin, whichever is the licensure term in your state.

02:55 The patients they will take are stable patients.

02:58 Well, they don't do initial assessments.

02:59 They can tell normal from abnormal.

03:02 So if I was an RN delegating to an LPN, let's say I wanted them to do a simple dressing change.

03:08 I would tell them what they should expect, what the expected results are when they go to do that dressing change and in RN world they will tell me if it was normal and expected or abnormal. And then if it was abnormal as an RN, I would have to go in and do further assessment. I know that feels weird and honestly, whenever I teach an NCLEX review class, I apologize to the LPNs right up front.

03:32 I always ask in the audience who is a licensed LVN or an LPN, and then I apologize to them because this does not reflect my opinion of my colleagues that are LPNs and LVNs. This is what is on the NCLEX exam.

03:48 Now, all the licenses can be different from state to state and what people can do and can't do. So remember, I would tell my students in Oklahoma, it's not the OCLEX, it's not the Oklahoma nursing exam, it's the NCLEX, the national licensure exam.

04:03 So it may appear different than your state and a little different than what you learned in nursing school. But again, we've got you covered.

04:10 We'll help you know what the standard is for the NCLEX.

04:13 So you've got the RN just for fun.

04:16 See if you can remember what only an RN can do.

04:24 Okay, cool. I hope you said something about assessment or teaching or admit or discharge and delegating.

04:29 That's what only an RN can do.

04:32 Now, stable patients for LPNs, you may get a question that says you're the RN making assignments. Which client is it most appropriate for you to assign to an LPN? Well, you're going to look for the most stable patient, right? Someone who hasn't had a lot of changes.

04:47 They're progressing as expected.

04:49 That's who you would assign to an LPN.

04:52 Also, if you have a transfer nurse, you have a float nurse come for the shift.

04:56 You also want to give them an LPN like assignment.

05:00 They have the same number of patients, but you want them to have the most stable patient since it's a unit they're not used to staffing.

05:08 Now, remember, they know abnormal from normal.

05:10 They don't do admits or discharges.

05:13 They can assist the RN, but they can't do them alone and they can only delegate to a UAP. But for both RNs and LPNs, they cannot delegate to appear.

05:23 So if I'm an LPN, I cannot delegate to another LPN.

05:28 If I'm an RN I cannot delegate to another are RN if I'm not a supervisor.

05:33 So they can reinforce teaching, but they can't do initial teaching.

05:37 I just want to say it one more time because it's sometimes really catches people, even if it's teaching something as simple as an incentive.

05:44 Spirometry, I know that an LPN is more than capable than doing that, but on the exam that would need to be done by an RN if it's initial teaching.

05:54 The other team member is a UAP, an unlicensed assistive personnel.

05:58 Now it's appropriate for someone in this title is to do routine standard skills only things that are covered by hospital protocols.

06:06 They're consistent and they're pretty straightforward.

06:08 So you would do things like a glucometer reading, take a fingerstick blood sugar, routine, vitals, I.A., those types of things.

06:16 They can assist with collecting that data.

06:18 But remember, they can't do an admit, and they cannot delegate to anyone.

06:22 They can reinforce teaching, but they can't do initial teaching.

06:27 Okay, here's what I would recommend you do.

06:29 I would try and make myself a chart and I would write RN, LPN, UAP, and see what you can remember from these videos so that you can have that fresh in your brain when you take the questions.

06:41 What is following the chain of command? Oh, I'm so glad you asked.

06:46 Let me tell you, this is another area that students get tripped up on on the NCLEX exam, because if you've had any experience in the hospital, you're going to make decisions based on what you've seen, and that's not the best option in the end exam.

07:01 So let's take, for example, let's get some players on the field.

07:04 If I'm in our and someone else is an hour in and they do something that is unprofessional or needs to be followed up, can I address that? Can I correct that peer? Nope, not unless I'm a charge nurse or a manager.

07:19 So if I feel that something is inappropriate with another hour RN, I go to the charge nurse or the manager and they will correct the RN, right still on my same team.

07:31 So it's appropriate that someone touch them on our team.

07:35 But it needs to be a charge nurse, a lead nurse or a nurse manager who addresses that nurse. Next, let's take a look at someone who's not on the nursing team.

07:45 So let's say an RN to housekeeper.

07:48 So the housekeeper does something that needs to be followed up on that was inappropriate or maybe could be unsafe.

07:55 Should you just address the housekeeper in an NCLEX question? Nope. You may want to, but that's not following chain of command now, unless it's something imminent in emergency.

08:07 Don't. Don't get crazy.

08:08 We're just thinking about our end to housekeeper.

08:10 There's something that needs to be corrected.

08:12 Who should correct the housekeeper? Well, it's not the RN.

08:16 And honestly, in following chain of command, you should notify your charge nurse or your nurse manager, and they will speak to the housekeeper's manager.

08:25 So that's how you follow the chain of command with someone who's not on the nursing care team. What about our into lab tech? Yeah, I know. You know this one now, right? Nope. And nope, I as the RN would talk to the charge nurse or manager, and then they would talk to the lab techs manager.

08:44 So always follow chain of command.

08:47 That's so important in questions.

08:49 So here's my strategy that I recommend.

08:52 When you're looking at following chain of command questions, ask yourself, Who am I in the question? If you're taking the RN exam, you're likely going to be the r.

09:02 N. Who else is in the question? Is it someone who's in RN? Am I the manager or am I just the RN? What's going on here? So make sure you know who all the players are and ask yourself, Do I have the authority to delegate to this person? If you do, you can correct them.

09:20 If you don't, you keep going up the next level of chain of command.

09:24 That's why RNs don't delegate to other RNs.

09:27 Yep, I get it.

09:28 You see buddies in the hospital trading tests all the time.

09:31 I did it when I staffed but this is NCLEX world.

09:33 So you want to think the only one you can delegate or supervise is not your peer.

09:39 It's got to be someone who is either if I'm an RN, an LPN, or a UAP.

09:46 Okay, There's a lot more in management of care, so I'm going to kind of move through these. You just get a generalized idea.

09:52 I've got the detailed list in your handout that came from the NCSBN, but I wanted to go over some of these things in management of care.

10:00 You're going to get questions that ask you to collaborate with all kinds of multidisciplinary team members.

10:06 So physical therapist, nutritionist, social worker, they may ask you questions about how you would interact with them.

10:13 Let me give you an example of a social worker case.

10:16 If you notice abuse, right.

10:18 You see signs of abuse.

10:20 Let's say you see a child who you believe may have been abused.

10:24 Should you directly address the parents? No, you should not.

10:29 That's usually you're going to talk to your supervisor and your supervisor will help you follow the standards of the hospital.

10:36 Probably what's going to happen is the nurse manager will have the social worker contacted. But remember, it's not your role to address the family and accuse them of child abuse. Another thing about documenting, I would not write personally child abuse in a chart.

10:53 What I would write is clear, concise and objective documentation.

10:57 I'm going to write what the wounds look like.

11:00 I can write in quotes what family members have said, but be very careful about documenting noted child abuse unless that term is used by a family member and you make sure it's very clear the family member said it.

11:14 Now you see managing conflict among clients and health care staff.

11:17 Yeah, that's talking about delegating or something that's happening.

11:20 Always know who's in charge following the chain of command, and that's how you would resolve that. Maintaining client confidentiality and privacy is just following your HIPAA laws.

11:30 And we talked about a possible child abuse case.

11:34 Here's another thing that falls in is it's our responsibility as our ends that we have to report by law conditions that look to be abuse of both children, older adults, anyone.

11:47 Also, you have to report certain communicable diseases.

11:50 Now that may or may not come up on the test.

11:53 Keep in mind, these are just the options that questions could come from.

11:57 It doesn't mean you're going to get every one of these types of options in management of care. Now, scope of practice, really big deal in management of care.

12:05 And we've kind of talked about that when we've talked about what an RN can do, what an LPN can do, and what a UAP can do.

12:11 Now, this last one assessing the need for referrals and obtain necessary orders.

12:17 Critically important.

12:19 That's your analyzing QS prioritizing hypothesis.

12:23 All those steps that fall in there.

12:24 As a nurse, do you recognize when a patient needs a referral for a service that nursing doesn't provide? And do you know how to get the appropriate order? And that's it.

12:36 That wraps up the key strategies that you need to know for management of care.

12:40 Now, hey, I know this was kind of a lot, but I think that this is the area that you can gain the most ground in by looking at these rules in strategies.

12:49 I bet you'll see your scores in management of care really go up.

12:54 So good luck.

12:55 Work your way through all the questions that we have for you here in the NCLEX review course.