Lindsey GreenRegina LoeraLaura RudaryIldiko Yuryev

LEADERSHIP AND MANAGEMENT

Management: Process of coordinating actions and

allocating resources to achieve organizational goals. Involves planning, organizing and staffing, leading and controlling actions to achieve goals.

Management is about controlling complexity in an effort to bring order and consistency because daily activities are diverse, fast-paced, and full of interruptions.

The nurse manager is like a firefighter: the concerns he/she needs to deal with daily are random, immediate and operational.

A nurse manager’s ability to set priorities, make decisions and interact with others is key.

Management Theories1. Bureaucratic2. Human Relations:

a. the Hawthorne Effect

1. Bureaucratic: Max Weber Hierarchical, impersonal relations, superior

subordinate communication transmitted from top to bottom via clear chain of command.

Merit/skill as basis for promotion and/or reward. Uses rules and regulations. Focuses on technical competence. Limits personal freedom. Emphasizes career service, salaried managers.

2. Human Relations: Focuses on empowerment of the individual worker as the source of control, motivation, and productivity in meeting the organizations goals.

Emphasizes that participatory decision-making increases worker autonomy and provides training to improve work.

Hawthorne Experiments at Western Electric Plant in Chicago led to the belief that relations between workers and managers and among workers are the main determinants of efficiency. Also concluded that the effect of being watched and receiving special attention could alter a person's behavior.

Hawthorne Effect

Hawthorne Effect:the phenomena of being observed or studied, resulting in changes in behavior, the idea that people increase their work output in the presence of others, “social facilitation”. 

Administrative Principles

General principles of management that are relevant to any organization.

PlanningOrganizing and Staffing

LeadingControlling

Stabilization

Planning: involves setting goals and identifying ways to meet them.

Organizing: and staffing is the process of ensuring that the necessary human and physical resources are available to achieve the planning goals. Organizing also involves assigning work to the right person or group and specifying who has the authority to accomplish certain tasks.

Leading: is influencing others to achieve the organization’s goals and involves energizing, directing and persuading others to achieve those goals.

Controlling: is comparing actual performance to a standard and revising the original plan as needed to achieve the goals.

Stabilization: is striving to minimize employee turnover in order to maintain workplace stability.

Human Motivation Theories

Helpful to explain why people act the way they do and how nurse managers can relate to individuals as human beings and workers.

Motivation is a process that occurs internally to influence and direct behavior in order to satisfy needs. 

Knowing what influences peoples’ choices and creates direction, intensity, and persistence in behavior, helps leaders to lead efficiently.

Worker output is greater when the worker is treated humanistically. 

Motivation Theories

Maslow’sTwo-Factor Theory

Theories X,Y,Z

Maslow’s Hierarchy of Needs

Motivation occurs when needs are not met.Certain needs have to be met first, beginning with physiological needs, then safety and security needs, then social needs, followed by self-esteem needs,and then self-actualization needs. Needs at one level must be satisfied before one is motivated by needs at the next higher level of needs.Just like patients needs,management needs to focus on their nurses needs and fulfilling them in order to help them achievethe higher levels of his pyramid.

Two-Factor Theory: Hygiene maintenance factors include adequate salary status, job security, quality of supervision, safe and tolerable work conditions, and relationships with others. If absent it can be the source of job dissatisfaction. When present job dissatisfaction can be avoided, but this alone will not lead to job satisfaction.

Motivator factors include satisfying and meaningful work, development and advancement opportunities, and responsibility and recognition. It is important to recognize that not all people respond to the same ones.

When motivator factors are present people are motivated and satisfied with their job. When motivator factors are absent people have neutral attitudes about their jobs or organizations.

THEORY X

Theory X Leaders must direct and control because

motivation results from reward and punishment. 

Employees prefer security, direction, and minimal responsibility and they need coercion and threats to get the job done. 

Employees have no voice because they are considered unable to offer creative solutions to help the organization advance.

Theory Y Leaders must remove work

obstacles because, under the right work conditions, workers have self-control and self-discipline. The workers' rewards are their involvement in work and in the opportunities to be creative. Employees are motivated by their ties to the group, the organization, and the work itself.

Theory Z Uses collective decision-making,

long-term employment, mentoring, holistic concern, and use of quality circles to manage service and equality.

This is a humanistic style of motivation based on the study of Japanese organizations.

Theories X, Y and Z

Leadership

A process of influence in which the leader influences others toward goal achievement.

Leadership is about creating change; establishing a direction, aligning people through empowerment, and motivating and inspiring them toward producing useful change and achieving the vision.

Leadership Theories:

Behavioral: Autocratic Democratic Laissez-Faire

Situational:

Transformational:

Behavioral Leadership Theories

Kurt LewinIowa State University conveyed

information about three leadership styles that are still widely recognized today:1.2.3.

GUESS THE STYLES!

1.

a. Autocratic Leadership: Involves centralized decision

making, with the leader making decisions and using power to command and control others.

Associated with high-performing groups, but close supervision is necessary, and feelings of hostility often present.

The nurse has recently been assigned to manage a pulmonary progressive unit at a large urban hospital. The nurse's leadership style is participative, with the belief that all staff members assist in decision making and the development of the unit's goals. The nurse is implementing which leadership style?

a) laissez-faireb) autocraticc) democraticd) situational

C. Democratic leadership is defined as participative with focus on the belief that all members of the group have an input into the decision making process. This leader acts as a resource person and facilitator. Laissez faire leaders assume a passive approach, with the decision making left to the group. Autocratic leadership dominates the group, with maintenance of strong control over the group. Situational leadership is based on the current events of the day.

b. Democratic Leadership: is participatory, with authority

delegated to others. To be influential, leaders use expert power and the power base afforded by having close, personal relationships.

Leaders create positive feelings in their groups, and performance was strong whether or not the leader was present.

3.

c. Laissez-Faire Leadership: is passive and permissive and the

leader defers decision making.

Associated with low productivity and feelings of frustration.

Situational Theory Hersey & Blanchard.

Addresses follower characteristics in relation to effective leader behavior. Consider follower readiness as a factor in determining leadership style using task behavior and relationship behavior.

An additional aspect of this model is the idea that the leader not only changes the leadership style according to followers' needs but also develops followers over time to increase their level of maturity.

GUESS THE STYLE:

Transformational Leadership Theory

Burns. A process in which "leaders and followers raise one another to higher levels of motivation and morality." Based on the idea of empowering others to engage in pursing a collective purpose by working together to achieve a vision of a preferred future.

Transformational Leader is the leader who is committed to a vision that empowers others. Motivates others by behaving in accordance with values, providing a vision that reflects mutual values, and empowering others to contribute. "Commits people to action, who converts followers into leaders, and who converts leaders into agents of change."

Transformational leader: change agent, courageous, believes in people, value driven, ability to deal with complexity, ambiguity and uncertainty, is not defined by a position, empowers others. Transformational leader is needed to cause change.

Give examples of great transformational leaders:

The Difference:

Leader

It’s all about the VISION. Creates change.Establishes a direction. Aligns people through empowerment. Motivates, inspires. Requires personal mastery.It’s about values, service, people and relationships.

Manager

It’s about planning and budgeting, staffing and organizing, problem solving and controlling complexity in an effort to bring order and consistency and produce predictability.

SUPERVISION

Supervision is the provision of guidance or direction, oversight, evaluation and follow-up by the licensed nurse for accomplishments of a nursing task delegated. It involves actively monitoring or overseeing activities of others. Focus is on agency goals, patient care and patient safety. Can be done on site (being physically present) or off site (written, verbal, electronic communication)

Supervising the Work of Others

Organizing and staffing, ensuring that the necessary human and physical resources are available to meet the needs of the patient and the nurse.Delegating and assigning the right person to a specific task in order to assure a better outcome and patient satisfaction.Prioritizing activities accordingto urgency and importance.Comparing actual performancesto a standard and working with the staff on ways to meet the standards if necessary.Evaluating staff. Dealing with unexpected problemsthat emerge. Leading and influencing others to achieve the goals.Motivation of employees.

Supervisory Functions

Effective Supervision Provide clear direction to the staff about what tasks are to be

performed for specific patients. Identify how and when the task is done and what information must be

collected. Identify what outcomes are expected. Monitor staff performance to ensure compliance with established

standards of practice, policy and procedure. Obtain feedback from the staff and patients and intervene as

necessary to ensure quality nursing care and appropriate documentation.

Ensure working conditions are suitable (i.e. staffing, equipment, supplies) to meet patient care needs.

Three levels of supervision: Unsupervised.

Initial direction and periodic inspection.Continuous supervision.

GIVE EXAMPLES

Characteristics of a Good Supervisor

1. Accepts and appropriately implements the administrative authority in the position in a non-authoritarian manner.

2. Holds workers accountable for assigned work and sensitively but determinedly evaluates supervisees practice.

3. Balances support and clear expectations of work in conformity with clearly defined performance standards.

4. Provides clearly structured procedures and constructive feedback for workers in their relation to the agency and their clinical practice.

5. The "good" supervisor provides direction, confronts when appropriate, and provides constructive, honest, critical feedback in a way that is respectful.

6. Is generally physically available as well as psychologically accessible and approachable.

7. Listens respectfully to the ideas and concerns of supervisees; communicates effectively up as well as down the hierarchical communication ladder.

8. Balances the agency's need for stability with need to change; and is ready to advocate for validated change.

9. Is ready, willing, and comfortable in offering praise and approval for good performance; is equally ready to challengeand confront inadequate work.

10. Establishes full and free reciprocal communication with the supervisee in anatmosphere that permits and encourages the expression of authentic feeling.

Evaluating Patient Care

Evaluation

- a critical appraisal or assessment; a judgment of the value, worth, character, or effectiveness of the nursing process; measurement of progress.

A broad view of evaluation in health care includes three approaches, directed toward structure, process, and outcome, depending on the focus of evaluation and the criteria or standards being used.

Classified Systems to Measure Care

Nursing leaders have recognized the need to establish classifications that can be used to measure nursing care.

Setting standards for appropriate care guideline development should have a basis in validated measures of quality, using reliable performance data, and making appropriate adjustments in care delivery.

Quality Care Standards

Scopes and Standards of Practice (2004) The standards of care as defined by the American Nurses Association describe a competent level of nursing care that are demonstrated through the nursing process.

Within these are the nursing responsibilities for safety, education, health promotion, treatment, diversity, self care, and planning for the continuity of care.

Standards of care are important if a legal dispute arises over whether a nurse practiced appropriately in a particular case.

It is important for a nurse manager to constantly evaluate staff performance and uphold the ANA standards of care.

Quality Assurance

Inspection approach to ensure that minimum standards of patient care quality are maintained in health care institutions.

Quality Improvement

Systematic process of organization wide participation and partnership in planning and implementing continuous improvement methods to understand and meet or exceed customer needs and expectations.

ANA’s STANDARDS OF

PROFFESSIONAL PRACTICE Standard

1. AssessmentThe nurse collects comprehensive data pertinent to the patients health or situation

Criteria Collects data in a systematic and

ongoing process. Data collection involves the patient,

significant others, and health care providers, when appropriate

Priorities data collection activities based on the patients immediate condition or needs determine the priority of data collection

Collects pertinent data using appropriate assessment techniques

Document relevant data in a retrievable form

Standard

2. Diagnosis: The nurse analyzes the assessment data to determine the diagnoses or issues

Criteria

Derives diagnoses from the assessment data

Validates the diagnoses with patient, significant others, and health care providers ,when possible.

Documents diagnoses in a manner that facilitates the determination of expected outcomes and plan of care

Standard

3. Outcomes identification:The nurse identifies expected outcomes for a plan individualize to the patient or the situation

Criteria Derives outcomes from the diagnoses Formulates outcomes mutually with the patient

and the health care providers, when possible. Outcomes are culturally appropriate and

realistic in relation to the patients present and potential capabilities

Defines  expected outcomes in terms of the patient, patient values, ethical considerations, environment, or situation with such consideration as associated risks , benefits , costs, current scientific evidence, and clinical expertise when formulating expecting outcomes.

Outcomes are attainable in relation to resources available to the person

Outcomes include a time estimate for attainment for expected outcome.

Outcomes provide direction for continuity of care

Modifies expected outcomes based on changes in the status of the patient or evaluation of the situation.

Documents outcomes as measurable goals.

Standard

4. Planning: The nurse develops a plan that prescribes strategies and alternatives to attain expected out comes

Criteria The plan is individualized to the patient and

patients condition or needs Develops the plan with the patient, significant

others, and health care providers, when appropriate.

Includes strategies within the plan that address each of the identified diagnosis or issues, which may include strategies for promotion and restoration of health and prevention of illness, injury, and disease.

Provides for continuity within the plan. Incorporates an implementation pathway or

timeline within the plan. Utilizes the plan to provide direction to other

members of the health care team. Defines the plan to reflect current status , rules,

and regulations and standards. Integrates current trends and research affecting

care in the planning process. Considers the economic impact of the plan. Uses standardized language or recognized

terminology to document the plan.

Standard

5. Implementation:The nurse implements the identified plan of  care

Criteria

Interventions are consistent with the established plan of care

Implements interventions in a safe and appropriate manner, documents interventions

Utilizes evidence –based interventions and treatments specific to the diagnosis or problem.

Collaborates with nurse colleagues to implement the plan

Utilizes community resources and systems to implement the plan

Standard

5A. Coordination of care. The registered nurse coordinates care delivery.

Criteria

1.Coordinates implementation of the plan.2.Documentation of the care.

5B. Health teaching and health promotion

1.Provides health teaching that address such topics as healthy lifestyles , risk reducing behaviors, developmental needs, activities of daily living, and preventive self-care.

2. Uses health promotion and health teaching methods appropriate to the situation and the patient’s developmental level, learning needs , readiness, ability to learn , language preference , and culture.

3. Seeks opportunities for feedback and evaluation of the effectiveness of the strategies used.

Standard

5C. Consultation: the advanced practice registered nurse and the nursing role specialist provide consultation to influence the identified plan, enhance the abilities of others and effect change. 

Criteria

1.Synthesizes clinical data, theoretical frameworks, and evidence when providing consultation.

2.Facilitates the effectiveness of a consultation by involving the patient in decision-making and negotiating role responsibilities.

3.Communicates consultation recommendations that facilitates change.

Standard

5D. Prescriptive Authority and Treatment: the advanced practice registered nurse uses prescriptive authority, procedures, referrals, treatments, and therapies in accordance with state and federal laws and regulations.

Criteria

1.Prescribes evidenced-based treatments , therapies, and procedures considering the patient’s comprehensive health care needs.

2.Presribes pharmacological agents based on a current knowledge of pharmacology and physiology and based on clinical indicators, the patient’s status needs , and the results of diagnostic and laboratory tests.

3.Evaluates therapeutic and potential adverse effects and potential adverse effects of pharmacological and non pharmacological treatment.

4.Provides patients with information about intended effects and potential adverse effects of proposed prescriptive therapies.

5.Provides information about costs, alternative treatments and procedures , as appropriate.

Standard

6. Evaluation:The nurse evaluates progress towards attainment of outcomes

Criteria

1.Evaluation is systematic, ongoing and criterion-based

2.Involves the patient, significant others ,and the health care providers in the evaluation process, when appropriate

3.Uses ongoing assessment data to revise diagnoses, outcomes and plan of care as needed

4.Documents revisions in diagnoses, outcomes, and the plan of care.

Evidence Based PracticeIs defined as the conscientious, explicit, and judicious use of

current best evidence in making decisions about care of individual patients

Uses outcomes research and other current research findings to guide the development of appropriate strategies to deliver quality, cost effective care. Evidence-based practice has evolved from a nice to know perspective to a need to know essential strategy in health care.

Outcomes

Outcome strategies used in EBP by nurses and members of the health care team include creation of clinical protocols, guidelines, pathways, algorithms, and so on, which become the tools for health care interventions.

Patients, health care providers, and payers recognize the significance of collecting data and analyzing outcomes to achieve safe, quality, cost- effective care.

Unit based and hospital based.Establishes accountability to deliver care that measures quality and promotes quality outcomes.

Performance Improvement Plan

To assess and monitor outcomes, health care organizations collect and report measures at various levels in the organization.

The terms dashboard, balanced scorecard, report cards, and clinical value compass are often used to describe a concept of measuring performance at both a strategic and operational level.

Performance appraisal, peer review is evaluation of an employee’s performance in relation to the job description, and based on peer feedback.

Such an approach allows those reviewing data to examine all aspects of care.

Patient outcomes are reflected in a patient’s functional status and clinical status.

Measuring Outcomes

Patient satisfaction data.

Health care facilities get feedback from patients by having them fill out a questionnaire that asks how they felt about their health care encounter.

All data is stored in a database, and reviewed.

Having this feedback effectively helps with evaluation of patient care performed by staff.

Measuring Adequacy of Service Provided

The staff at a primary care office is asked to document the time the patient checks in, the time the patient is called into the exam room, and the time the patient is checked out. This is an example of what managed care strategy?1. Provider performance.2. Length of stay management.3. Capitation.4. Formularies.

Rationale 1: Wait time for appointments is an example of an evaluation indicator under the provider performance strategy.

Rationale 2: Length of stay strategy has to do with days in the hospital.

Rationale 3: Capitation is the payment of fixed monthly fees to provide health care.

Rationale 4: Formularies are used to cope with increasing pharmaceutical costs.

1. Provider performance.

Accepting Responsibility for Subordinates

Clarifying Workload ExpectationsCan be done by initiating structure.Keeping focus on what needs to be accomplished and how it will be carried out will provide an organized path towards accomplishment.

If the nurse knows what needs to be done he/she can then determinewhat can be delegated. This allowsthe nurse more time to focus on anynursing assignments he/she might have.

The nurse must always assume responsibilities for one’s own assignments. If the nurse assigns a task to another staff member the nurse’s job is to make sure that the task has been completed.

Evaluation is the RN’s responsibility only. The RN should verify that the task assigned was carried out correctly and the outcomes associated with its completion.

Assuming Responsibility

Holding Staff AccountableThe RN must hold staff members accountable for their actions/non-actions in order to provide feedback and constructive criticism.

This way the RN can provide guidance and ensure proper care of the patients.

If the RN is evaluating the patient and observes that something is not right, he/she should confront the individual who carried out the task in a calm and professional manner. This individual may or may not have been aware of their mistake. By providing them with the correct information they will be less likely to perform the same mistake again.

The RN should always be available for any questions or concerns that the staff might have.

Video on Delegationhttps://www.youtube.com/watch?v=PwL-

qdwv6RE

Delegation is the process of transferring work to subordinates. A nurse-manager can appropriately delegate which task?

1. Scheduling staff assignments for the next month.2. Terminating a nursing assistant for insubordination.3. Deciding on salary increases for licensed practical nurses after they complete orientation.4. Telling a staff nurse to initiate disciplinary action against one of her peers.

Scheduling can be safely and appropriately delegated. Termination, disciplinary action, and salary increases shouldn’t be delegated to staff, which doesn’t have the power and the authority to take such measures.

1.

A nurse-manager delegates responsibility for the review and revision of the surgical unit’s client education materials. Which statement illustrates the best method of delegation?

1. Tell the nursing staff they are responsible for the review and revision and that their recommendations for improving the materials are welcome.

2. Ask two of the best staff nurses to form a task force to review and revise client education materials. Explain that they should solicit input from clients and staff members, complete this task within 6 weeks, and submit recommendations in writing.

3. Tell the nursing staff that the education materials aren’t satisfactory. Explain that the staff should select people to review them and make recommendations for change. Tell them that the nurse-manager will make the final decisions about the changes.

4. Ask the assistant manager to develop a plan for the review and revision of client education materials.

NCLEX

2. Delegation must be done clearly and precisely. The nurse-manager must assign responsibility, identify the task to be accomplished, explain what outcomes are needed, and the time frame for completing the work.

ReferencesBerggren I., Severinsson E. (2003). Nurse supervisors’ actions in

relation to their decision-making style and ethical approach to clinical supervision. Retrieved January 14, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/12622870 Web.

Kelly, P. (2012). Nursing leadership & management. (3rd ed.) Clifton Park, NY: Delmar.

Nursing Standards. ANA Standards of Professional Performance. (2010). Retrieved January 19, 2015 from

http://currentnursing.com/nursing_management/nursing_standards.html Web.

Silvestri, L. A. (2013). Saunders comprehensive review for the NCLEX RN examination. (6th ed.) St. Louis. MO: Elsevier Health

Sciences.

Case Studies

Case Study 1You have been employed as a new graduate nurse in a busy community clinic. Your job is to: 1) prevent diseases through promotion of positive health practices and 2) assist with early detection of diseases by teaching patients about diagnostic procedures. Many patients have gender, ethnic, and spiritual beliefs different from yours, are underemployed, and have no private health insurance. Your co-workers are middle class Americans from the suburbs. They often express frustration for the “lack of motivation” of these patients. What do you think the nurse manager should do to help her nursing staff work more effectively with these patients? Specifically:

What human motivation theories might be appropriate and why? Give examples of how these theories might be used with staff in order to decrease their job frustration and improve patient care.

Using the two-factor theory, the supervisor first needs to make sure that the staff feels job security by having adequate salary, the tools needed to do their job, quality supervision and good relations amongst the staff. These are termed hygiene maintenance factors. Second, motivating factors, which are different for everyone, need to be achieved through meaningful work, development and advancement opportunities, and responsibilities and recognition. Theory Y can also be effective in this case. The workers' rewards are their involvement in work and in the opportunities to be creative. Employees are motivated by their ties to the group, the organization, and the work itself, so if these nurses can find a challenge in their job, and are given an opportunity to get involved and be creative, the work environment can become a very productive one. Let the team develop teaching plans and strategies to promote health practices and early detection of disease, let them experiment with what works and what not versus sticking to agency guidelines. Allowing creativity can bring surprising changes in both staff motivation and patient satisfaction.

What type of organizational structure would best help the nurse manager to manage her staff? 

A flat organizational structure would best help the nurse manager since there are less layers of management. This style empowers the workers as they are expected to take more responsibility in their daily routines. This allows them to achieve more meaning and autonomy in their work and provide some type of input.  How could this nurse manager strengthen her staff’s caregiving behaviors? 

The nurse manager could offer an in-service to enhance the nursing staff’s cultural competence. It is important that the nursing staff be trained to enhance their cross-cultural communication to be able to have appropriate interactions with the patient population they serve. Cultural competence is the integration of knowledge, attitudes and skills in one’s professional practice. 

Case Study 2 Your NA allowed a discharged cataract patient with a history of CHF to go home prior to talking to you. This patient had been told by you not to leave prior to reviewing discharge instructions with you. The facility policy states that all patients mustreview discharge instructions with a RNprior to discharge. You are faced with two problems: 1) no discharge instructions were given re: prescribed medications, activity restrictions, and when to see the doctor 2) the patient’s potassium level was 5.0.

What type of leadership style would be most effective in this situation?

Hersey & Blanchard’s situational leadership theory would be most effective in this case. A serious mistake has been made that could endanger the discharged patient’s life, therefore adequate measures have to be taken to correct the problem and prevent future errors. Patient’s safety is of most concern, therefore a more autocratic leadership style needs to be implemented until the case is safely solved.

Situational leadership changes according to the employee’s actions, and it addresses follower characteristics. Task behavior and relationship behavior determines the leadership style used in the situation.

Autocratic leadership is also effective in this case, involving centralized decision making, with the leader making decisions and using power to command and control the team until the problem is solved. When quick decisions have to be taken this type of leadership is most effective. This leadership theory is associated with high-performing groups, but close supervision is necessary, and feelings of hostility are often present. 

2. On what basis would the nurse evaluate this NA’s performance? It would be evaluated on the basis of the agency’s goals and the quality care guidelines, such as agency standards and ANA standards. Specific criteria to measure patient outcomes such as patient satisfaction questionnaires and care maps can be used. The nursing assistant was not following their scope of practice. Chart audit can also be used in this situation to monitor adherence to standards of care.  3. How should criticism be offered? The criticism should be offered immediately by confronting the person as soon as the problem is noticed. Stating precisely what the person did incorrectly, telling the person how one feels about his/her actions, pausing and letting it sink in, remaining supportive by touching the person, showing a caring attitude, and reminding them that their value to the organization does not change, even though the present situation was a serious error in their practice. The RN should always be courteous and professional when providing constructive criticism.

Key Behaviors for Disciplining1. Define the problem in terms of lack of improvement since the previous discussion.2. Ask for and listen openly to reasons for the continued behavior. Respond with empathy.3. Explain why the behavior cannot continue.4. If disciplinary action is called for, indicate what action you must take and why.5. Agree on specific action to be taken to solve the problem. Write them down.6. Set a follow-up date and outline any) further steps to be taken if the problem is not corrected.7. Assure the employee of your interest in helping him or her to succeed.

(Wywialowski, E., 1997, as cited in NURS 2400 Handout)

4. What other strategies could be used to ensure this NA’s performance will continue to improve?

The manager should always give the employee an opportunity to state his or her point of view. As a manager you will need to explain why this type of behavior can’t continue. If there is any disciplinary action that is needed, you will need to indicate what action you must take and why. You will agree on a specific action to be taken to solve the problem, and write it down. After that you will set a follow up date to take any further steps if the problem is not corrected. Assure your employee that you interested in helping him or her succeed.

Case Study 3You are employed in a home-care hospice

program. When patients’ comfort and hydration needs change and cannot be managed by their families, the patients are placed on your inpatient unit. Often major changes in medical management and prescriptions are required. You generally are responsible for 10 such patients on the day shift. You have one LPN and two NA’s to assist you. 

Define supervision.According to the National Council State Board

of Nursing supervision is the provision of guidance or direction, evaluation, and follow up by the licensed nurse for accomplishment of a nursing task delegated to nursing assistive personnel. The American Nurses Association defines supervision as “the active process of directing, guiding, and influencing the outcome of an individual’s performance of an activity” (as cited in Kelly, 2012). Supervision is actively monitoring or overseeing activities of others. In nursing, the nurse must be aware of the agency’s goals, particularly as they relate to patient care. In addition, he/she must monitor the extent to which these goals are met.

Identify common characteristics of effective supervision. 

Common characteristics of effective supervision include providing clear and concise direction and frequent observation to ensure that the delegated task was followed through appropriately. Having knowledge of the situation at hand and familiarization with each individual’s scope of practice allows the supervisor to delegate tasks effectively.

Characteristics of effective supervision for nursing:  Ensure working conditions are suitable (i.e. staffing,

equipment, supplies) to meet patient care needs. What must the staff nurse do if they are not?

Ensure resources are available to meet patient needs (e.g. resources to ensure that the patient can be discharged safely).

Orient/teach/ and guide co-workers, based upon individual backgrounds and needs.

Stimulate desire for self-improvement in others, as well as encouraging the use of unique talents or skills.

Act as a role model with desired attitudes, skills, interests, and work habits.

How can common characteristics of effective supervision be applied in this situation? 

Directing and supervising any assistive personnel or LPNs requires that the RN has the knowledge of the tasks that are within their scope of practice. Assigning a nursing task to any assistive personnel puts the patient’s safety at risk. Therefore, it is important to understand the different roles and responsibilities of each team member. In order for the supervising nurse to provide proficient care to the patient, with the help of LPNs and NAPs, the nurse should be familiar with the patient and their needs. This includes making sure that all of the proper equipment is available as well as knowing which staff members would be most effective in meeting those needs. If the patient is morbidly obese it would be in the nurse’s best interest to assign two staff members when assisting the patient to the bathroom. The nurse should be able to provide proper assignments with clear and concise instructions.

References

Kelly, P. (2012). Nursing leadership & management. (3rd ed.). Clifton Park, NY:Delmar.

Wywialowski, E. (1997). Managing client care. Philadelphia: The C.V. Mosby Co. Accessed on January 19, 2015 through BlackBoard NURS 2400 Handout. Web.