Chapter 41

Professional Roles and Leadership

Chapter 41

Professional Roles and Leadership

Functioning as a Graduate• The role of a graduate nurse will be exciting

and challenging.• The LPN/LVN is a valuable member of the

health care team and functions in many settings.

• Many opportunities are available from which to choose.

Functioning as a Graduate• Letter of Application

– It should always be customized, brief, neatly typed, and correctly spelled.

– It should be simple and direct.– Its objective is to introduce yourself, announce

your interest in employment, briefly state your qualifications, and express your availability.

– Your cover letter requires a thorough discussion of your qualifications.

Functioning as a Graduate• Résumé

– A summary of educational and professional experiences, including activities and honors

– A one- or two-page written document that contains certain information about you, your education, and your experience

– Should be well-organized, neat, and accurate

Functioning as a Graduate

• Personal Interview– A meeting of people face to face, as for evaluating

or questioning a job applicant– First impressions have a lasting effect.

• Contracts– A promise or a set of promises between two or

more people that creates a legal relationship between them and a legal obligation that one or more of them must fulfill

– May be written or oral

Functioning as a Graduate

• Keeping Your Job– Keep current and competent.– Look and act professional.– Be on time and ready to start at the beginning of the

shift.– Be organized.– Do not spend time with personal telephone calls.– Take only the time allocated for lunch and breaks.– Work hard and give the best care possible.– Be a good leader and a good follower.

Functioning as a Graduate• Keeping Your Job

– Help others when you can.– Stretch yourself; do not be satisfied with the

minimum.– Display a positive attitude and flexibility.– Respect your patients, their family members, your

co-workers, and your supervisors.• Encountering Problems

– Follow the chain of command.– Be calm and positive in your approach.– Listen carefully.

Functioning as a Graduate• Advancement

– A rise in rank or importance, a promotion, progress, improvement

– May result from additional preparation or additional experience

– Usually based on a person’s qualifications, behavior, performance, and preparation

• Terminating Employment– A verbal statement and letter of resignation should

be completed; proper procedures should be followed.

Welcome to Leadership!!!

• What direction do you believe nursing is headed in?

• What role will L.P.N.’s play in this role?

• How will you personally participate in this change? Where do you want to participate?

Transition from Student to Graduate

• Know Your Role– LPN/LVN is responsible to the RN or physician.– Role of LPN/LVN is constantly changing.

• Technical and scientific changes in the health care system have resulted in a multiplicity and complexity of functions placed on the nurse.

• Be careful not to lose sight of your principal concern—the patient, a human being!

Transition from Student to Graduate• Confidentiality

– All information the patient gives is confidential.– Information may be exchanged with other

members of the health care team only in the performance of your duties.

– Releasing any information to anyone other than the health care team without the consent of the patient is a violation of the right to privacy.

Transition from Student to Graduate• Role of the LPN/LVN in the Community

– Participates in activities that promote the community’s attitude toward positive health care

– Uses community resources to promote a better understanding of the health services available to the general public

– Participates in community health projects and other health-oriented activities

Transition from Student to Graduate• Professional Organizations

– Gives you a voice in your profession– Some provide continuing education– Two national organizations are designed to

support and meet the needs of the LPN• National Association for Practical Nurse Educators

(NAPNES)• National Federation of Licensed Practical Nurses

(NFLPN)– National League for Nursing (NLN)

• Involved with all types and levels of nursing

Transition from Student to Graduate• Continuing Education

– It is critical to keep current on nursing trends and issues.

– There are many opportunities for nurses to learn new nursing skills.

• Facilities offer employees continuing education.• Internet• Some states require CEUs before you can renew nursing

licenses.

Transition from Student to Graduate

• Certification Opportunities– Certifications

• Managed care (CMCN)• Pharmacology • Long-term care (CLTC)• Addiction (CALPN)• Further education

Licensure Examination• National Council of State Boards of Nursing

– The computerized adaptive testing (CAT) was adopted in 1994.

– Examinee takes the CAT exam by sitting at an individual computer and answering questions on the screen.

– NCLEX-PN has 85 to 205 questions.• The candidate’s application is approved by the

board of nursing in the jurisdiction where the NCLEX is to be taken.

• On successful completion of the examination, you can practice as an LPN/LVN.

Licensure Examination

• Endorsement/Reciprocity– This is recognition of the license of a health

practitioner in one state by another state.– Applicant must meet the state’s licensing

requirements.– If the nurse travels with a patient from one state

to the other or to Canada, the license the nurse has in her or his possession is valid for the length of the stay in the other state or Canada.

Licensure Examination

• Nurse Licensing Compact/Mutual Recognition– Based on the primary state of residence.

• A declared, fixed, permanent, and principal home for legal purposes

– A nurse may practice in a compact state using the nursing license from the primary state of residency.

– State boards of nursing differ, so you should contact the board of nursing in the state where you are seeking licensing for the specific requirements.

Nurse Practice Act

• Licensing law• Defines the title and regulations governing the

practice of nursing• Assists the nurse in staying within the legal scope of

nursing practice in each state• Defines the regulations for practical nursing and

includes requirements for an approved school of nursing

• Defines requirements for licensure and conditions for which a license may be revoked or suspended

State Board of Nursing

• Board consists of members who represent different levels of nursing and are appointed by the governor.

• The purpose of the board is to protect the public by administering the nurse practice act.

• Board is responsible for approving schools of nursing

• Board issues and renews licenses.– Board has the authority to suspend or revoke a license.

Career Opportunities

• Hospitals– LPN/LVN is under the supervision of the RN.– LPN /LVN is legally able to provide most bedside

care to patients in the hospital setting.– LPN /LVN is responsible for supervising the nursing

assistants.– There are a number of different types of hospitals.

Figure 41-5

Various positions are available in the hospital setting on the health care team.

(From Polaski, A.L., Warner, J.P. [1994]. Saunders fundamentals for nursing assistants. Philadelphia: Saunders.)

Career Opportunities

• Long-term Care Facilities– LPN/LVN is the backbone of long-term care facilities– Can advance to charge nurse and supervisory capacity

with RN supervision– A facility for those who require long-term care

• Home Health– Health care in the home setting– RN supervision must be available– Relaxed atmosphere, decreased patient load, primarily

daytime hours

Career Opportunities

• Physician’s Office or Clinic– Some of the skills required may not be included in

the LPN/LVN educational program.• Laboratory testing, ECGs, computer skills, insurance

coding, billing, supervision of other office personnel

• Insurance Companies– Preadmission and claims assessments– Usually require experience in medical-surgical

nursing

Career Opportunities

• Temporary Agencies– These agencies provide nurses to meet the staffing needs in

a variety of health care facilities.– Advantages are the right to refuse and the wealth of variety

available.– Disadvantage is the uncertainty of work available.

• Travel Opportunities– Nurse can work for specified periods in areas in need of

nurses through a temporary agency.– Experience is required.– Lodging is provided in addition to salary.

Career Opportunities

• Pharmaceutical Sales– LPN/LVN makes contacts with physicians, pharmacists,

and nurses in various clinical settings.• Presents the advantages of products • Teaches about side effects and precautions

– Experience in specific areas and an expertise in science and pharmacology are required.

• Other Medical Sales– Sell medical supplies– May perform in-service programs at facilities to

demonstrate product use

Career Opportunities

• Outpatient Hotels– Provides patient teaching and assists with preparation

for tests; available for emergencies– Hotel is usually owned by a hospital.

• Patient/guests stay while they undergo testing before surgery and/or for postsurgical care.

• The Military– Active duty or reserves are options.– Educational opportunities

• Additional education• May help repay loans

Career Opportunities

• Adult Day Care– Provide medical supervision for adults while their

family members work or take a break from the responsibility of care

• Schools– Perform health screenings, emergency care, and

health teaching• Public Health

– Work in clinics and home visits; may also participate in health inspections

Career Opportunities

• Outpatient Surgery– Prepare patients for surgery, as a scrub nurse, or to work

in the recovery room under the supervision of an RN.• Private Duty

– Give total care to one patient– May be in the hospital, home, other facility, or while

traveling• Government

– May work in a Veterans Administration hospital or other government hospitals

Career Opportunities

• Industrial– Focuses on promoting wellness and preventing accidents– Safety is emphasized, and usually is first aid–oriented.– May do physical assessments, health surveys, insurance

forms preparation, health education, and intervention for patients injured in industrial accidents

• Rehabilitation– Guides the patient toward health and independence

Career Opportunities

• Psychiatric– Provides care for the mentally ill patient– Requires a mature person

• Hospice– Provides care for the terminally ill patient– Institution or home setting– Must have a clear understanding of his or her own

feelings about death

Leadership and Management

• Leadership– The art of getting others to want to do something

you are convinced should be done• Management

– Handles the day-to-day operations to achieve a desired outcome

Leadership and Management

• Leadership is important in determining the effectiveness of an undertaking

• “Styles” refer to the approach or manner a leader uses to influence others– Styles relate to the amount of control or freedom

the manager allows the group– Styles range from total control by the manager to

extreme permissiveness

Leadership and Management

• Autocratic Style– Retains all authority and responsibility– Concerned primarily with tasks and goal

accomplishment– Assigns clearly defined tasks– Establishes one-way communication with the

group– Excels in times of crisis (cardiac arrest) and in

situation of disorder (natural disasters)

Leadership and Management

• Democratic Style– People-centered approach – Allows employees more control and participation

in the decision-making process– Emphasis is on team building and collaboration– Works best with mature employees who work well

together as groups

Leadership and Management

• Laissez-Faire Style– “Free-run style” or permissive leadership– Relinquishes control completely– Chooses to avoid responsibility by delegating all

decision making to the group– Wants everyone to feel free to “do their own

thing”– May work well with highly motivated professional

groups

Leadership and Management

• Situational Leadership– Takes into account the style of the leader, the

maturity of the group, and the situation at hand to form a comprehensive approach

– Four typical styles• Directing

– Provides specific instructions and supervises the accomplishment of tasks

– New employees, employees with repeated performance problems, and crisis work situations

Leadership and Management

• Situational Leadership (continued)– Coaching

• Monitors the accomplishment of tasks while also explaining decisions, asking for feedback or suggestions, and recognizing good performance

• Typically, leader and staff have have jointly developed a work plan.

Leadership and Management

• Situational Leadership (continued)– Supporting

• Supports the efforts of others, facilitates their goal accomplishment, and shares responsibility for decision making

• Values growth and not perfection, collaboration and not competition

– Delegating• Gives responsibility for decision making and problem

solving to mature staff who have demonstrated their competence

Leadership and Management• Team Leading

– Assisting and guiding the nursing team in providing care for a select group of patients

– Duties• Receive reports on assigned patients• Make assignments for team members• Make rounds and assess all assigned patients• Assist in administering medications and treatments• Confer with team members on priority patients

Leadership and Management

• Time Management– Using time to good advantage will be of great

value.– Learn effective time management skills, and

practice them frequently until they become fully developed.

– These skills will help you manage not only at work but also in daily living.

Leadership and Management

• Anger Management– Anger gives you a cue that something is wrong.– Justified

• Helps you get your needs met by stimulating you to action

– Unjustified or displayed inappropriately• Can get you and others in trouble

– See Box 41-11 (p.1258) Personal Anger Management Techniques

Leadership and Management

• Burnout– Physical, emotional, and spiritual exhaustion– Nurses are at high risk because they care!– Occurs more often in people who have excessively

expectations of themselves– High-risk areas

• Intensive care• Hospice• Oncology• Emergency department

Leadership and Management• Burnout (continued)

– Signs and symptoms• Physical

– Fatigue; changes in sleeping and eating– Lack of energy; loss of interest in sex

• Psychologic– Irritability; hypersensitivity– Frustration; negative outlook– Forgetting

• Spiritual– Loss of commitment, meaning, and integrity

Figure 41-7

Symptoms of burnout.

(From Arnold E.N., Boggs, K.U. [2003]. Interpersonal relationships: professional communication skills for nurses. [4th ed.]. Philadelphia: Saunders.)

Leadership and Management

• Strategies for Burnout Prevention– Awareness– Balance– Choice– Detachment– Altruistic egoism– Focus– Goals– Hope– Integrity

Leadership and Management• Transcribing Physicians’ Orders

– Written• Recorded on the chart by the physician.• NEVER GUESS: If in doubt, get a second opinion.• If it is a little different than “usual,” clarify it with the

physician.• If you still believe the orders to be inappropriate,

contact your supervisor and document why the orders are not being carried out.

Nurses are responsible for their own actions regardless of who told them to perform those actions.

Figure 41-8

Clarifying the physician’s order.

(From Leahy, J.M., Kizilay, P.E. [1998]. Foundations of nursing practice: a nursing process approach. Philadelphia: Saunders.)

Leadership and Management

• Transcribing Physicians’ Orders (continued)– Verbal or via telephone

• They may only be taken from a physician or a nurse.• They are more subject to error.• Clarify the order by repeating it to the person giving it.• Ask them to repeat it more slowly if necessary.• Write it down immediately.• Be careful about medications that sound alike.

– For example, Zantac and Xanax

P. 1261 Medication Safety Alert – Precautions for Transcribing orders

Figure 41-10

Computerized system for narcotic distribution.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

Leadership and Management

• Change of Shift Report– The report provides the next shift with pertinent

information about the patient.– The quality of nursing care the patient receives is

contingent on how well each shift communicates with the other.

– The report may be given orally in person, by audiotape recording, or with rounds from patient to patient.

– Before beginning the report, write down all necessary information.

Figure 41-11

Giving a change-of-shift report.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

Delegation

• Refers to the act of making another person responsible for a specific task

• Involves clearly communicating all aspects of the delegated care to the person completing the task

• The staff member performing the care has to be able to perform tasks independently and have the ability and knowledge to complete the tasks.

Computers in Health Care

• Technology for voice-activated charting; customized nursing careplans; assessment of acuity levels; tx/med reminders; developing clinical pathways and maps; and researching drug/food incompatibilities

• Challenge: maintaining confidentiality and protect the integrity of the system