NURSING LEADERSHIP MANAGEMENT

1. NURSING LEADERSHIP & MANAGEMENT PROFESSOR MARIANNE MCAULEY

2. 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

3. 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

4. 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

5. 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

6. 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

7. CLINICAL OBJECTIVES 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

8. CLINICAL OBJECTIVES Picking up of doctor�s orders Staff education: in-service project for CNAs (certified nursing assistants) 15 minutes � done on 2nd day

9. WHY L & M? Economics of health care Staff Redesign NCLEX

10. 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

11. Leaders Are Mostly MadeNOT 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

12. What are the Skills of Effective Leaders? The Great Communicator listening skills articulation skills oral writing Be An Assertive Communicator

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

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

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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. TYPES OF POWER Referent - follower�s identification with leader confidence power dressing What qualities do you have that give you this power? Expert - leader�s specialized knowledge

25. Effective Leader and Manager Formula Understanding Self self-assessment Knowledge Learning role models Emotional Intelligence assess yourself Understanding: Understand your individual strengths, weaknesses, and potential Knowledge: Have knowledge of basic ingredients for leadership and management Learning; learn from other people and experiences, including your own Use of Self: use your self systematically to get the right things done at the right time Effectiveness: All of these equal effective leadership and managementUnderstanding: Understand your individual strengths, weaknesses, and potential Knowledge: Have knowledge of basic ingredients for leadership and management Learning; learn from other people and experiences, including your own Use of Self: use your self systematically to get the right things done at the right time Effectiveness: All of these equal effective leadership and management

26. 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

27. Great Man or Trait Theory Leaders born, not made Physical, psychological , personal characteristics define leaders Charismatic theory - leaders possess charisma

28. BEHAVIORAL THEORIES Autocratic Democratic Laissez-Faire

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

30. LAISSEZ-FAIRE STYLE Leader is passive, nondirective, inactive All decision making left to group Little, if any, leader guidance or support

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

32. ROLE-PLAYSLEADERSHIP 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

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

34. DEVELOPING NEW SKILLS

35. 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

36. INSERVICE PROJECTA 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

37. INSERVICE PROJECTA WIN-WIN FOR ALL 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

38. INSERVICE PROJECTA 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

39. COMPONENTS OFA 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

40. Checklist for in-service project2 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

41. 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

42. 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

43. TYPES OF OBJECTIVES COGNITIVE PSYCHOMOTOR AFFECTIVE Objectives can be all the same type or a mix

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

45. PSYCHOMOTOR OBJECTIVES Skills Example: CNAs will demonstrate proper handwashing by end of in-service

46. AFFECTIVE OBJECTIVES Emotions, feelings Example: CNAs will express feelings about caring for a dying client by end of in-service

47. 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

48. 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

49. 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 b. proper nutrition Record all intake, assist to feed as needed c. keep skin clean & dry Inspect skin daily, toilet or change frequently

50. 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

51. 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

52. THE CHANGE MAKER How can you be an agent of change rather than a target of change?

53. How do people react to change? threat to self fear of increased responsibility lack of understanding limited tolerance for change

54. What role do you play when it comes to change? Laggard or Adventurer

55. CHANGE THEORY Process of change - force field analysis Three phases required to accomplish change unfreezing moving refreezing

56. STAGES OF CHANGE Unfreezing: recognize need for change loosen the status quo driving factors versus restraining factors Moving: initiate change after planning Refreezing: change becomes operational

57. 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

58. 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

59. TECHNIQUES FOR IMPLEMENTING CHANGE Run productive meetings Use participative decision-making Schedule a brainstorming session when needed quantity, freewheeling, no criticism

60. 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?

61. 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

62. 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

63. 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

64. 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

65. ROLE-PLAYPERFORMANCE APPRAISALS See appendix D Demonstrate an ineffective interview Demonstrate an effective interview

66. 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

67. 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

68. RESPONSES TO CONFLICT Collaboration: Win/Win confront issue openly look for acceptable resolution no dominating, suppressing, compromising

69. 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

70. 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

71. ROLE-PLAYSCONFLICT RESOLUTION See appendix D Competition/Power Smoothing Avoidance Compromising Collaboration

72. 21ST CENTURY LEADERROLE 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