VN 109: Professionalism Leadership and Supervision Lecture - Module 7

VN 109: Professionalism Leadership and Supervision Lecture - Module 7 Topic I: Professional Roles and Leadership References Foundations of Nursing, Christensen and Kokcrow 4th Edition Chapter 40 Pages: 1026 - 1047 Medical Surgical Nursing (An Integrated Approach) 2nd Edition – Lois White and Gena Duncan Chapter 36 Pages:974 - 986

Professional Roles and Leadership TOPIC I: Professionalism, Leadership and Supervision Eliza Rivera-Mitu, RN, MSN Trinity Vocational Center

Functioning as a Graduate • Applying for a job • Identify employers who match your philosophy and needs • Call the companies and obtain the name of the nursing resources and/or human resources director • Double-check the address to be used in the application • Keep an organized list of the facilities’ addresses, contact info and phone nos. • This list should be accompanied by the info you gather during your phone call • Add the date you sent your letter of application and resume • After you send out your resume and letter of application, follow-up with a phone call to be sure they were received

Functioning as a Graduate • Applying for a job • Letter of application • Each letter must be individualized for the company you are applying • Tailor what you write to fit the organization • Include: • Statement of interest • Statement of qualification • Statement of availability to discuss the job

Letter of application Example from DHS (http://ladhs.org/nurse/) “Nursing care at each of our facilities is built on a long standing tradition of providing quality patient care and public health services for nearly 10 million residents. …Our team of highly skilled and highly trained medical and nursing professionals work in collaboration with members of the health care team in achieving the best possible outcomes for our patients...” In your letter, you can write: “I have a strong commitment to providing quality patient care”…or “I am interested in working in your organization because of your long standing tradition of providing quality patient care and public health service…”

Functioning as a Graduate • Interview • (see handout)

Functioning as a Graduate • Membership in professional organization • ANA, NCEMNA, PNAA, NAHN

Legal Aspects of Vocational Nursing • Nurse Practice Act - http://www.bvnpt.ca.gov/pdf/vnregs.pdf • Law and regulations • Board of Vocational Nursing and Psychiatric Technicians (BVNPT) • The BVNPT regulates the education, practice and discipline of licensed vocational nurses (LVN) and psychiatric technicians (PT). Consumer welfare is protected by ensuring that only qualified and competent persons are licensed as LVNs or PTs. • LVNs and PTs are expected to perform within the law governing their practice. • Reports of Misconduct • The Board works diligently with consumers of healthcare, the Board's licensees and other healthcare providers or organizations to identify and address problems relating to its licensees. When reports of misconduct of licensees are received, the Board investigates harmful behavior through the disciplinary process. • The Board ensures that the public is protected from unprofessional, incompetent and grossly negligent practitioners by investigating complaints filed against LVNs and PTs and taking disciplinary action.

Legal Aspects of Vocational Nursing • Disciplinary Process • The following summarizes the steps leading to disciplinary action: • The Board reviews complaints to determine jurisdiction and if the alleged action violates the law or regulations governing the licensee’s practice. • If the two conditions above are met, an investigation is initiated. • If the investigation proves that a violation occurred, the Board determines the level of discipline warranted by the violation. • The Board may take formal or informal disciplinary action. • Formal action includes revocation or suspension of the license, placing the licensee on probation or denying an application for licensure. • Informal action may include issuance of a citation and fine or notice of warning and/or requiring participation in a remediation program. • If formal discipline is required, the case is transmitted to the Office of the Attorney General (AG) which acts as the Board’s counsel. • The AG prepares a document against the licensee or applicant, called an Accusation or Statement of Issues. • The licensee or applicant is entitled to an Administrative Hearing. • The Administrative Law Judge (ALJ) who presides over the hearing will propose a decision to the Board. • The Board considers the proposed decision of the ALJ and renders it’s final decision.

Legal Aspects of Vocational Nursing • Types of Violations There are many types of violations for which an LVN or PT may be disciplined. Most involve unprofessional conduct which includes, but is not limited to: • IncompetenceIncompetence is the lack of possession of and the failure to exercise that degree of learning, skill, care and experience ordinarily possessed by a responsible licensee. • Gross NegligenceGross negligence is a substantial departure from the standard of care which, under similar circumstances, would have ordinarily been exercised by a competent licensee, and which has or could have resulted in harm to the consumer. • Conviction of Serious CrimeThe Board may take action against a licensee who was convicted of a crime substantially related to the qualifications, functions or duties of the licensee. In addition to taking action against licensees, the Board may deny issuing a license to a person with such a conviction in his/her background.

Legal Aspects of Vocational Nursing • Rights as a Consumer of Health Care You have the right to: • Be treated by a safe and competent LVN or PT. • Confidentiality and privacy during your care. • File a complaint with the Board if you believe you have received substandard care by a Board licensee. • File a complaint anonymously. • Contact the Board with your questions or concerns, and receive a prompt, accurate and courteous response.

Legal Aspects of Vocational Nursing • Rights as a Licensee You have the right to: • Know about any complaint filed against you. • A thorough investigation if a complaint was filed against you. • Due process of law if formal disciplinary charges are filed against your license. • Contact the Board with your questions or concerns, and to receive a prompt, accurate and courteous answer. • Legal Accountability Extends to the Internet • As delivery of healthcare changes, so do job opportunities. • Healthcare sites on the Internet seek healthcare providers to give information to consumers. • As in other settings, LVNs and PTs working in an Internet environment are dependent practitioners and cannot provide healthcare advice on the Internet without supervision.

Nurse Practice Act Excerpt 2872.2. Interim Permits. An applicant for license by examination shall submit a written application in the form prescribed by the board. After completion of a board accredited or approved nursing program and approval of the application, the board may issue an interim permit authorizing the applicant to practice vocational nursing pending the results of the first licensing examination. If the applicant passes the examination, the interim permit shall remain in effect until an initial license is issued bythe board. If the applicant fails the examination, the interim permit shall terminate upon notice by certified mail, return receipt requested, or if the applicant fails to receive the notice, upon the date specified in the interim permit. A permittee shall function under the supervision of a licensed vocational nurse or a registered nurse, who shall be present and available on the premises during the time the permittee is rendering professional services. The supervising licensed vocational nurse or registered nurse may delegate to the permittee any function taught in the permittee's basic nursing program. An interim permittee shall not use any title or designation other than vocational nurse interim permittee or "V.N.I.P." (Added by Stats. 1986, Ch. 146 urgency effective June 10, 1986.)

Preparation for Licensure • CAT and NCLEX - VN • Application for licensure • www.bvnpt.ca.gov/pdf/method2.pdf

Preparation for Licensure • Renewal Process • Active License -- VN and PT licenses are considered "active" when the license is current (not expired or delinquent) and the 30 hours of continuing education requirements have been met. • Inactive License -- A license is placed on inactive status when the renewal fee is paid and continuing education requirements have not been met. The licensee cannot practice with an inactive license. To activate an "inactive" license, the licensee must submit proof of thirty hours of continuing education during the preceding two years.

Preparation for Licensure • Renewal Process (cont) • Renewal -- LVNs and PTs are required to renew their license every two years. Satisfactory completion of continuing education is required for an "active" license in addition to a social security number. Licensees must also certify under penalty of perjury, whether they have been convicted of a crime since they last renewed. • Renewal notices are mailed 6 weeks prior to the license expiration date. The renewal fee must be received on or before the expiration date in order for the licensee to continue to legally work.

Preparation for Licensure • Renewal Process • Delinquent Licenses -- A delinquency fee is assessed if the renewal fee is not paid within 30 days after the expiration date. A licensee may renew a delinquent license any time within 4 years of the expiration date by submitting payment of all accrued and unpaid renewal fees in addition to any fees due upon renewal of a delinquent license along with proof of continuing education, a social security number, and conviction statement. Please select this link for further information. • Expired Licenses -- A license which is not renewed for 4 years expires. An expired license cannot be renewed, re-issued or reinstated. The licensee is required to submit a new application and retake the licensure examination to receive a new license.

Preparation for Licensure • Renewal Process • Continuing Education -- After the first renewal, LVNs and PTs are required to certify under penalty of perjury, completion of 30 hours of CE within the two years immediately preceding the date of renewal. Courses must be related to the licensee's scope of practice. The licensee must retain the provider certificate for a period of 4 years and produce it if audited by the Board. • A random audit of the current active licensed population is conducted. When audited, licensees are required to submit copies of the provider certificates. Those who have misrepresented CE compliance are referred to the Enforcement Unit for disciplinary action.

Preparation for Licensure • How to obtain license in another state • Contact the State Board of Nursing in the state in which you intend to apply for licensure and request that they mail you the appropriate application packet. • Review the application requirements to be sure that you are eligible for licensure in that state. • The application packet should contain a Verification of Licensure form. Complete the personal information on the Verification of Licensure form, including your California LVN license number. If you were licensed under a different name, please be sure to indicate your previous name(s). • Attach a check or money order in the amount of $75.00 made payable to "BVNPT" and mail the Verification of Licensure form and fee to: California Board of Vocational NursingPsychiatric Technicians2535 Capitol Oaks Drive, Suite 205Sacramento, CA 95833-2945 • You are advised to carefully review the requirements for each out-of-state licensing board to ensure that you meet all of the requirements for licensure in that state before applying to that state

Preparation for Licensure • How to obtain license in another state • California State-Board Constructed Examination • Many State Boards have laws that require applicants to have passed the national examination (National Council Licensure Examination (NCLEX) or National League of Nursing State Board Test Pool Examination.) • The Colorado and Florida nursing boards have reviewed the California State-Board Constructed Examination and deemed it to be equivalent to the national examination. The Board has been contacted by other Boards of Nursing who have expressed an interest in reviewing this examination as well.

Preparation for Licensure • Equivalency and/or Military Experience Applicants • California LVN's who obtained their initial license in California through equivalent education/experience or military methods of qualifying may not be eligible for licensure in some states. Many State Boards have laws that require applicants to have graduated from an accredited or approved nursing program to be eligible for licensure. • It is very important that you make sure that the Board of Nursing will accept your experience and/or examination method prior to submitting the Verification of Licensure form to the California Board for completion. Once the Board has processed your verification of licensure request, the $75.00 Verification of Licensure fee is non-refundable. • For FAQs, go to http://www.bvnpt.ca.gov/faq.htm

Professionalism • Styles of leadership (see ATI book) • Autocratic Style – leader makes decision, most effective in emergencies, externally motivated • Democratic Style – collaborative decision-making, individuals are empowered to make decisions • Laissez-Faire Style (non directive, permissive, ultra-liberal) – hand-off approach, internal motivation

Professionalism • Bureaucratic – externally motivated, does not trust self or others, leader relies on organizational rules and policies, taking an inflexible approach • Charismatic – evokes strong feelings of commitment, forms emotional relationships with group members • Transactional – focused on day-to-day task, provides incentives to promote loyalty and performance

Professionalism • Transformational – fosters creativity, risk-taking, commitment, and collaboration • Facilitates individual independence, growth and change, converts followers into leaders through shared values, honesty, trust, and continued learning • Connective – promotes collaboration and teamwork within organization and other organizations in the community

Professionalism • Shared (participatory, inclusive) – leader assumes work force contains many leaders • Staff nurses and nurse managers share a vision of their preferred future

Professionalism • Burnout • Some known examples of physical symptoms of job burnout include • headaches • sleep problems • gastrointestinal problems • chronic fatigue • muscle aches • high blood pressure • frequent colds • sudden weight loss or gain

Professionalism • Burnout symptoms of emotional nature include, but are not limited to, prolonged periods of • apathy • frustration • depression • anger • negative or cynical attitude • being unexcited about life • inclinations to high risk behaviors • high emotional volatility • high irritability

Professionalism • Burnout • when you see a combination of burnout symptoms, it is time to take a break and have a careful look at your life style and work habits. Especially when your life situation contains burnout threats (such as never ending excessive workload at your job) or your occupation has higher job burnout risk (for example, manager, entrepreneur, medical doctor or nurse, teacher, social worker, sales person).

Professionalism • Telephone manners • Good afternoon, good am • Name, name of facility • How may I help you, or direct your call

Team Leading and Supervision • Role of charge nurse (see handout) • Ensure that residents receive nsg care, tx, and meds per MD order • Coordinate resident’s care • Assist DON with orientation • Evaluate work performance of nsg assistant • Assignments • Receive reports • Assisting MD • Delegating duties

5 Rs of delegation • Right person • circumstance • task • supervision • evaluation

Team Leading and Supervision • Team leader • Evaluations

Career Opportunities • LVN or Licensed Psych Tech • Gateways Hospital & Mental Health Center • Job Snapshot Location: 437 N.Hoover StreetLos Angeles, CA 90004 ( Map it ) • Base Pay: $17.24 - $19.04 /Hour • Other Pay: $2.00 per hour charge pay; excellent employee benefits • Employee Type: Full-Time Employee • Industry: Healthcare - Health ServicesNot for Profit - Charitable • Manages Others: No • Job Type: Health CareNurseNonprofit - Social Services • Experience: At least 2 year(s) • Travel: Negligible • Relocation Covered: No • Posted: 6/4/2009 • Contact Information Contact: Brett Morana, Psy.D. • Phone: 323-644-2030x210 • Ref ID: LVN/LPT-0609-SAT • Fax: 323-660-6866

Career Opportunities Responsibilities include but are not limited to: • Administers personal care, medications, treatments, and other nursing procedures to selected clients as authorized by Hospital policy, LPT License, and Standards of Practice. • Supervises, encourages, and teaches the client personal hygiene and dietary needs as well as medication actions and reactions. • Monitors and ensures clients take prescribed psychotropic medications and records medications accurately. • Observes and records and communicates resident and outpatient behavior and activities to treatment team including medication side effects. • Bill all applicable medication passes, consultations with psychiatrist or other clinical staff for all residents. Community Reintegration Program (CRP) only. • Document groups on medication management for both Conditional Release (CONREP) and CRP programs in a timely fashion including the billing for these programs. • Supervises and monitors client activities in main building, womens’ and mens’ cottages.

Career Opportunities • LVN • Motion Picture & Television Fund • Job Snapshot Location: Woodland Hills, CA 91364 ( Map it ) • Employee Type: Per Diem • Industry: Healthcare - Health Services • Manages Others: No • Job Type: Health CareNurse • Experience: Not Specified • Relocation Covered: No • Posted: 6/12/2009 • Contact Information Ref ID: 32549820 • Fax: 818/876-1399 instantly fax your resume >> • Description Nursing The Motion Picture and Television Fund is seeking an: LVN On-Call For our Woodland Hills location. Requires CA LVN license, current CPR and outpatient health center experience. Please apply to HR Department: Fax: 818/876-1399 E-mail: [Click Here to Email Your Resumé] equal opportunity employer www.mptvfund.jobs MOTION PICTURE & TELEVISION FUND Los Angeles Times 2009-06-12

Career Opportunities • LVN Hospice W/E evenings Per Diem - US-CA-Torrance • Ref ID: 47779 Company: Providence Health & Services • Base Pay: $17.59 - $28.22 /Hour • Employee Type: Full-Time Employee • Industry: Healthcare - Health Services • Experience: At least 1 year(s)

Career Opportunities • LVN (Part Time) • McKinley Children's Center • Job Snapshot Location: 762 Cypress StreetSan Dimas, CA 91773 ( Map it ) • Base Pay: $15.00 - $25.00 /Hour • Other Pay: Eligible for annual merit increases, up to 4%. • Employee Type: Full-Time Employee

Career Opportunities • Sunbridge Philosophy • http://www.careerbuilder.com/JobSeeker/Jobs/JobDetails.aspx?IPath=JRKGTV&sc_cmp1=JS_JR_ViewJob&ff=21&APath=2.21.0.0.0&job_did=JB957Q70QR3LGRMFTCL

Career Opportunities • LVN, Full-time, benefited, Van Nuys location - View similar jobs Job type: Full-Time Employee | Pay: $17.59 - $28.22/hour ...or vocational nursing program. 2. Currently licensed as an LPN/LVN in the state of California. 3. Possesses and maintains current... Providence Health Services CaliforniaCA - Torrance (4 miles)2 Weeks Ago

Career Opportunities • Charge nurse role (see handout)

Workplace Dynamics • Physician orders • End-of-Shift report • Interpersonal communication • Identifying ways to reduce error and communicate change process

Roles and Responsibilities of Vocational Nursing • Role of the VN in long term care facilities. • Skilled Nursing Facilities • Sub-acute • Retirement Communities • Assisted Living • Adult Day Care Centers • Respite Care • Foster Care • Hospice

VN 109 Professionalism and Leadership Chapter 36 REHABILITATION,HOME HEALTH, LONG-TERM CARE,AND HOSPICE

Nonacute Health Care • There has been a strong emergence in the past decade of nonacute health care services.

Reasons for Growth in Nonacute Health Care • The number of Americans over the age of 65 has tripled in this century. As individuals age, the risk increases of acquiring a chronic disease requiring health care throughout life. • Lives are being saved that would have been lost a few years ago. Ongoing health care services become necessary in such cases. • Discharge from acute-care hospitals is occurring much earlier. • Cost of acute care has reached critical proportions necessitating new forms of care management.

Clients’ and FamilyRights in Home Care (i) • To be treated with dignity, consideration, and respect. • To have their property treated with respect. • To be fully informed on admission of care, cost, and how payment will be made. • To know in advance if they will be responsible for any payment. • To participate in planning care.

Clients’ and FamilyRights in Home Care (ii) • To be informed in advance of any changes in care. • To receive care from professionally trained personnel. • To refuse treatment and be told of consequences of this action. • To expect confidentiality. • To be informed of termination of service. • To know how to make a complaint.

Clients’ & FamilyResponsibilities in Home Care (i) • To remain under a doctor’s care while receiving services. • To provide the agency with a complete health history. • To provide the agency with all requested insurance and financial information. • To sign the require consents and releases for insurance billing. • To participate in care by asking questions, expressing concerns, stating whether information is understood or not.

Clients’ & FamilyResponsibilities in Home Care (ii) • To provide a safe home environment in which care is given. • To cooperate with the doctor, the staff, and other caregivers. • To accept responsibility for any refusal of treatment. • To abide by agency policies that restrict duties the staff may perform. • To advice agency administration of any dissatisfaction or problems with care.

Sources of Reimbursement • Medicare. • Medicaid. • Private insurance.

VN 109: Professionalism Leadership and Supervision Lecture - Module 7