ATI LEADERSHIP NURSING PDF

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@ShopWithKey on Etsy ATI RN LEADERSHIP PROCTORED: FOCUS REVIEW Chapter 1, Managing client care: 

Prioritizing client care: o Systemic before local o Acute before chronic o Actual problems before potential ones o Listen carefully to clients and do not assume o Recognize and response to trends vs transit findings o Recognize indications of medical emergencies and complications vs expected findings o Apply clinical knowledge to procedural standards to determine the priority action

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Client care assignments: o Assigning is performed in a downward or lateral manner with regard to members of the healthcare team o Client factors are:  Condition of client and level of care needed  Specific care needs such as cardiac monitoring or ventilation mechanical  Special precaution needs such as isolation or fall precautions or seizures, procedures requiring time commitments o Health care team factors:  Knowledge and skill levels of the team members  Supervision that is necessary  Nurse to client ratio  Experience with similar clients  Familiarity of staff member with unit o Additional factors;  If receiving an unsafe assignment, the nurse should bring the unsafe assignment to the attention of the scheduling charge nurse and negotiate new assignment, if the issue is not resolve, take the concern up the chain of command  Nurse should file a written protest to the assignment such as an assignment despite objection (ADO) or document of practice situation (DOPS) with the appropriate administrator  If not follow proper failure to accept the assignment following proper channels could be considered client abandonment. o Delegations to an assistive personnel:  ADLS  Bathing, dressing, toileting, ambulating, feeding if pt has no problems with swallowing  Positioning  Routine task, bed making  Specimen collection

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Intake and output Vital signs for stable clients

Quality improvement: o Standards of care should reflect optimal goals and based on evidence  Outcomes indicators-client outcomes related to standard under review  Structure indicators- setting in which care is provided and the available humand and material resources  Process indicators- how client care is provided and are established by policies and procedures (clinical practice guidelines)  Benchmarks- are goals that are set to determine at what level the outcome indicators should be met  Focuses on assessment of outcomes and determines ways to improve the delivery of quality care.  All levels of employees are involved in the quality improvement method  Joint Commission accreditations standards require institutions to show evidence of quality improvement in order to attain accreditation status Key Points 

Leadership Styles: Authoritative, Democratic, Laissez-faire  Emotional intelligence is the ability of an individual to perceive and manage the emotions of self and others.  Nurses must continuously set and rest priorities in order to meet the needs of multiple clients and to maintain client safety.  Nurses must organize care according to client care needs and priorities. Assigning: transfers authority, accountability and responsibility of client care to another member of the health care team. Delegating: is the process of transferring the authority and responsibility to another team member to complete a task while retaining accountability. Supervising: directs, monitors, and evaluates performance of tasks by another member of the health care team. Key Points       

The quality of care provided is directly related to the education and level of competency of health care providers. Nurse leaders should respect and recognize diversity. Educational programs should following this sequence: identify and respond, analyze, research, plan, implement, and evaluate. Quality Improvement is the process used to identify and resolve performance deficiencies. Outcome Indicators reflect desired client outcomes related to standard under review. If benchmarks are not met, root cause analysis is warranted. Nurses must use reliable sources of information in the quality improvement process.

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Conflict is inevitable; nurses can use problem-solving and negotiation strategies to prevent a problem from evolving into conflict. Resources are critical to accomplishing the goals and objectives of a health care facility, so it is essential for nurses to understand how to effectively manage resources.

Prioritization and Time Management Systemic before local (“life before limb”), acute vs. chronic, actual vs. potential, urgent vs. nonurgent, listen don’t assume, trends vs. transient, expected vs. unexpected, Maslow’s, ABC, ABCDE, safety/risk reduction, ADPIE, survival potential, least to most invasive. Time Management Time Savers: document as soon as possible; group activities together; estimate; envision procedure; prioritize; delegate; complete difficult tasks when energy is high; say “no”; set realistic standards; complete one task at a time; break large tasks into smaller ones; use an organizational sheet; socialize with staff on breaks (not during client care time). Night Shift Dark shades or room darkening blinds will block the sunshine and allow for darkness when sleeping during the daytime hours. Wear sunglasses on the drive home from work to reduce the melatonin-reducing effect of sunshine. It is best to eat light, balanced meals during the night. Sedatives and alcohol should not be used as an aid to sleep. Allow time to unwind after work before going to bed and try to follow the same routine daily. Nurse Practice Act Delegation Factors  Nurses can only delegate tasks appropriate for the skill and education level of the team member receiving the assignment.  RN’s cannot delegate the nursing process, client education, or tasks that require clinical judgment to PNs or AP.  Each nurse practice act varies by state.  Simplified guideline: if the person you are delegating a task to did not learn it in school, you cannot delegate that task.  Rule of thumb: in a multiple-choice delegation question, the most simplistic task is often the answer. RN Nurse Practice Act (Section 2725.3) (The RN) shall not assign unlicensed personnel to perform (tasks) (…) that require a substantial amount of scientific knowledge and technical skills, including, but not limited to, any of the following: (1) Administration of medication. (2) Venipuncture or intravenous therapy. (3) Parenteral or tube feedings. (4) Invasive procedures including inserting nasogastric tubes, inserting

@ShopWithKey on Etsy catheters, or tracheal suctioning. (5) Assessment of patient condition. (6) Educating patients and their families concerning the patient’s health care problems, including postdischarge care. (7) Moderate complexity laboratory tests. Conflict Resolution  Different categories, stages, and strategies to resolve conflict. Chapter 2 coordinating client care  Reporting info. to the provider o Assessment data integral to changes in client status o Recommendations for changes in the plan of care o Clarification of prescriptions  The nurse role regarding consultation: o nurse initiates necessary consults or notify provided of clients needs so the consul can be initiated. Provide the consultant with all pertinent info. about the problem and incorporate the consultant’s recommendations in the clients plan of care.  The nurse role regarding Referrals: o is a formal request for a service by another care provider, made so the client can access the care identified by the provider or the consultant. o The nurse role regarding referrals:  Begin discharge planning upon client’s admission  Evaluate client and family competencies in relation to home care prior to discharge  Involve the client and family in care planning  Collaborate with other health care team to ensure all health care needs are met and necessary referrals are made  Complete referral forms to ensure proper reimbursement for prescribed services  Priority for discharge planning: o Starts in admission o Conduct discharge plan with patient and family o Discharge planning serves as a starting point for continuity of care o Need for additional services can be address before discharge so services is in place when client arrives home o Leaving without prescription (AMA) nurse should notify the provider. Nurse needs to explain the risk of leaving. Individual should sign a form and nurse should document all communication as well as advice that was provided for the client. o Nurses can be charged with legal charges of assault, battery and false imprisonment. Key Points  Coordination and management of client care in collaboration with a health care team is necessary to provide high-quality health care to provide cost-effective and time-efficient manner. Case management is the coordination of care provided by an interprofessional team from the time a client starts receiving care until she no longer receives services.

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Care must be continuous as client moves through health care system. Communication hand-off tools include I-SBAR, PACE, I PASS the BATON, Five P’s. All detrimental client changes must be reported to the provider, A consultant is a professional who provides expert advice. A referral is a formal request for service by another care provider. Discharge planning begins at the time of admission.

Chapter 3 professional responsibilities  Mandatory reporting of sexually transmitted infections o Gonorrhea o Trichinosis o Syphilis o AIDS/HIV o Chlamydia trachomatis Key Points  Nurses must ensure that clients understand their rights and protect those rights during nursing care (advocacy).  Nurses are accountable for their actions even if they are carrying out a provider’s prescription.  Informed consent vs. implied consent.  Nurses may only witness informed consent.  The nurse must seek an interpreter if the client does not speak and understand the language used by the provider.  Advanced directives communicate a client’s wishes regarding end-of-life care should the client be incapacitated.  A client who does not have advance directives must be given information of rights and how to formulate advance directives. HIPAA Guidelines Nurses must know HIPAA regulations comply with policies and procedures.  Only health care team members directly responsible for the client’s care can access the client’s chart.  Clients have the right to read and obtain a copy of their medical record.  No part of the record can be copied except for authorized exchange of documents between health care institutions.  Records must be kept secure.  Electronic records must be password-protected.  Client information may not be disclosed to unauthorized individuals  “Walking rounds” are prohibited and report must be given in private.  Log off of computers, never share user ID or password, do not post information on social media. Legal Practice  Nurses must understand the legal aspects of the nursing profession.  Criminal law include felonies and misdemeanors.  Civil laws protect the rights of people.  Unintentional torts include negligence and malpractice.

@ShopWithKey on Etsy Quasi-intentional torts include invasion of privacy, defamation (slander and libel). Intentional torts include assault, battery, and false imprisonment. To qualify as negligence, it must be proved that a prudent member of the profession would have acted differently. Signs of an Impaired Coworker  Smell of alcohol or breath mints on breath; impaired coordination; sleepiness, shakiness, or slurred speech; bloodshot eyes; mood swings and memory loss; personal neglect; excessive use of sick leave, tardiness, or absences after a weekend off, holiday, or payday; frequently “forgetting” to have another nurse witness wasting controlled substances; reports of patients being unrelieved of pain; falsified documentation; preferring to work nightshift.  A nurse who suspects a coworker of using alcohol or other substances while working has a duty to report the coworker to the appropriate management personnel as specified by institutional policy. Mandatory Reporting  All states require nurses to report any suspicion of child abuse and certain communicable diseases.  Most states mandate nurses to report suspected abuse of vulnerable persons such as older or dependent adults.  Nurses are mandated to report any suspicion of abuse following facility policy. Ethical Practice Autonomy: the ability of the client to make personal decisions even when those decisions might not be in the client’s own best interest. Beneficence: care that is in the best interest of the client. Fidelity: keeping one’s promise to the client about care that was offered. Justice: fair treatment in matters related to physical and psychosocial care and use of resources. Nonmaleficence: the nurse’s obligation to avoid causing harm to the client. Veracity: the nurse’s duty to tell the truth   -

Chapter 4 maintaining safe environments  Temporary pacemaker- teach client to not touch the dials, keep wires and box dry and client won’t be able to shower  Permanent pacemaker- battery will last 10 years, keep pacemaker identification card, minimize shoulder movement initially to allow leads to anchor, assess clients for hiccups which may indicate the generator placing the diaphragm. Before discharge teach patient about taking pulse daily at the same time each day and notify provider if hear rate is less than 5 beats below pacemaker rate, no contact sports or heavy lifting for 2 months, restrict shoulder move 1-2 weeks to prevent wire dislodgment, never place magnetic items directly over the pacemaker generator, and inform airport security of your pacemaker.  Use of a wheelchair for client transfer: o Lock wheels on beds, wheelchairs and carts to prevent the device form rolling during transfers or stops

@ShopWithKey on Etsy Isolation guidelines: o Ensure proper equipment is available and that isolation procedures are properly carried out by all health care team members o Airborne precautions require private room, mask and respiratory protection, negative pressure airflow exchange in the room of at least 6-12 exchanges per hour o Types of airborne precautions: measles, varicella, pulmonary tb and laryngeal tb o Type of droplet precautions: pneumonia, h. influenza type b, scarlet fever, rubella, pertussis, mumps, mycoplasma pneumonia, meningococcal pneumonia, sepsis, and pneumatic plague o In droplet precautions, private room required with others with same disease, ensure they use their own equipment Key Points  Handling infectious and hazardous materials include infection control, handling toxic, radioactive, and other hazardous waste.  Safe use of equipment refers to appropriate operation of health-care related equipment by trained staff. Equipment-related injuries can occur as a result of malfunction, disrepair, or mishandling of mechanical equipment.  Preventing injury is a major nursing responsibility.  Safety precautions include fall prevention, seizure precaution measures, and seclusion and restraint considerations, fire safety, home safety, community safety, ergonomics, and safety considerations for all developmental stages. 

Chapter 5 facility protocols o Tools to prevent accident with needle sticks; use retractable needles, needles with capping mechanisms, needleless syringe, IV tubing with needleless syringes o How to report a needle stick: by facility protocols and states laws, incident report should be filed, and nurse need to undergo testing o Triage:  Emergent class- highest priority life threat but also have a high survival rate  Urgent class- second highest priority, major injuries that are not yet life threat can wait 45-60minutes  Nonurgent class- minor injuries not life threat and do not need immediate attention  Expectant- lowest priority, not expected to live, comfort measures but restorative care will not be use o Tuberculosis  Therapy full duration 6-12 months  Sputum samples are needed every 2-4 weeks, clients are no longer considered infectious after 3 consecutive negative sputum cultures  Put in negative pressure room  Contaminated tissues should be disposed of in plastic bags  Wear a mask in public places or in contact with crowds.  Ethambutol- need to watch for visual changes due to optic neuritis  Isoniazid- tingling of the hands is an adverse effect

@ShopWithKey on Etsy o Surgical asepsis  Open sterile package with first edge of the wrapper is directed away from the worker to avoid sterile surface touching unsterile cloths, the outside of the sterile package is considered contaminates  A wet field is contaminated if the surface immediately below it is not sterile  Hold sterile objects above the level of the waist  Avoid talking, coughing, or sneezing or reaching over sterile field  Never walk away from or turn your back on a sterile field  Consider the outer 1 inch to be contaminated  Fluids flow in the direction of gravity Key Points  In the event of an incident involving a client, employee, volunteer, or visitor, the nurse’s priority is to assess the individual for injuries and institute any immediate care measures necessary to decrease further injury (fire, severe thunderstorm, biological / chemical / radiological incidents, bomb threats, security breaches).  Nurses must provide data for performance improve studies regarding the incidence of client injuries and care-related errors.  Facilities accredited by the Joint commission must have an emergency operating plan and are mandated to test the plan at least twice a year.  The Hospital Incident Command System (HICS) for disaster management offers a clear structure for disaster management at the facility level....