1. Health Alterations
Learning Plan 1
Introduction to Clinical Nursing
Management

2. Objectives
• Explain the contribution of nursing to quality
patient care
• Design a plan to obtain professional goals
• Identify factors impacting role transition from
student to practicing graduate nurse
• Explain the impact of selected legal and
ethical issues on nursing practice

3. Quality Patient Care
• Nursing’s role in patient
outcomes
(Sasichay-Akkadechanunt et al., 2003)

4. Professional Nursing
• Caring
• Compassion
• Spirituality
• Community outreach
• Providing comfort
• Crisis intervention
• Going the extra distance
(Hudacek, 2008)

5. COMPETENCY 11
Develop a plan for making the transition from student
to practicing nurse

6. Your Plan

7. Sources of Law
Legislation Administrative
Constitution Common Law
(Statutes) Law
Nurse Practice
Acts

8. Legal/Ethical
• “The nurse • “The registered
promotes, advocates nurse systematically
for, and strives to enhances the quality
protect the health, and effectiveness of
safety, and rights of nursing practice.”
the patient.” (ANA, 2004, p.
33)
(ANA, 2001, p. 12)

9. Nurse Practice Act
Credentialing
Standards of Care

10. Agreement by a client to accept a course of treatment after being informed
of:
1. Benefits and risks of treatment
2. Alternatives to the treatment
3. Prognosis if treatment is declined
INFORMED CONSENT

11. Implied
Exceptions
• Minors
Express • Unconscious or
unresponsive
• Mentally ill
Informed
Consent

12. Voluntary
Authentic
Competent
Nurse’s Signature

13. The transfer of responsibility for the performance of an activity from one
person to another while retaining responsibility for the outcome. (ANA,
1997)
DELEGATION

14. The Big “D”

15. Neglect
Abuse
Mandated
Reporter

16. Americans with Disabilities
Act (ADA)
Clear, Clear, strong, Ensure that the
comprehensive consistent, federal
national enforceable government
mandate to standards plays a central
eliminate addressing role in enforcing
discrimination discrimination standards
against people against people established
with disabilities with disabilities under the act

17. Alcohol
Impaired
Nurse
Mental
Drugs
Illness

18. Sexual Harassment
• EEOC, 1987
• Unwelcome sexual advances, requests for sexual
favors, and other verbal or physical conduct of a
sexual nature
• When submission is considered a condition of
an individual’s employment
• When submission or rejection is used as a basis
for employment decisions
• “intimidating, hostile, or offensive working
environment”

19. Advance
Directives
Organ
Donation Death and Autopsy
Related
Issues
Certification
DNR or DNI
of Death

20. Legal Protections for Nurses
•Good Samaritan
•Liability Insurance (respondeat superior)
•Carrying out MD orders
•Nursing Process
•Documentation
•Incident Report

21. MANAGERS AND LEADERS

22. Objectives
• Identify different leadership styles
• Explain qualities and behaviors that contribute
to effective leadership
• Provide positive and negative feedback in a
constructive manner
• Identify conflict resolution strategies
• Discuss the importance of effective
communication

23. Manager Leader
– Have an assigned position within – Often do not have delegated
the formal organization authority but obtain power
– Have a legitimate source of through other means such as
power due to the delegated influence
authority that accompanies their
position – Have a wider variety of roles
– Assigned functions, duties and
than do managers
responsibilities – May not be part of the formal
– Emphasize control, decision organization
making, decision analysis and – Focus on group process,
results information gathering,
– Manipulate people, the feedback and empowering
environment, money, time and others
other resources to achieve
organizational goals – Emphasize interpersonal
relationships
– Greater formal responsibility and
accountability for rationality and – Direct willing followers
control than leaders – Have goals that may or may
– Direct willing and unwilling not reflect those of the
subordinates organization

24. Leadership Styles

25. What Makes a Good Leader?

26. Communication

27. SBAR
•Situation
•Background
•Assessment
•Recommendations

28. Objectives
• Define management concepts
• Explain the qualities and behaviors that
contribute to effective management
• Prioritize patient care needs
• Describe conflict resolution techniques
• Describe the role of the nurse in quality
management

29. Management Concepts
Boss
Everyone Else
Centralized

30. Management Concepts
Input Input
Input Input
Boss
Decentralized

31. Management Concepts
Nursing Units Accounting
Organization
Human Resources Public Relations
Matrix

32. Effective Management

34. Student as Manager

35. Student as Team Member

36. Feedback

37. Student as Team Leader

38. Team Leading Responsibilities
• Know all patient
condition and needs
• Assist team members and
provide direct care
• Coordinate patient care
with employee strengths
• React to changes in
patient and unit needs
• Delegate as appropriate,
remain accountable

39. Manage care for a group of patients
according to the Nurse Practice Act
COMPETENCY 13

40. Functional Nursing
• Tasks, not patients,
assigned
• Assigned by
qualifications
• Efficient
• Not holistic
• Communication
problems and
fragmented care

41. Team Nursing
• RN coordinates patient
care
• Ancillary staff
collaborate
• Democratic leadership
• RN spends less time
with patients
• Lack of continuity of
care and RN assessment

42. Total Patient Care Nursing
• Original mode of care
• RN assumes total care
• Similar to private duty
• Widely used
• High autonomy and
responsibility
• Florence Nightingale

43. Primary Nursing
• 1970’s, depends on a
total RN staff
• RN assumes caseload
• Associates cover when
RN is not present
• May cost more
• High level of nursing
ability, experience,
accountability

44. Case Management
• Coordinator
• Services to patients and families
• Streamlines cost
• Collaborative
• Clinicians oversee specific groups
• Critical pathways
• Less direct patient care

45. Flood
300 adults, minor injuries, thermoregulation needs
3 RNs, 6 LPNs, 30 CNAs, 30 Volunteers
RN 1:100, LPN 1:50, CNAs and Volunteer 1:10

46. Time Management

47. Steps to Take in
Time Management
Maslow’s Hierarchy of Needs

48. The Big “P”
First Order
Second Order
Third Order
Fourth Order

49. How to Prioritize
What do I have to do? How can I save time?
• Report • Gather supplies
• Assessments • Location
• Medications • Estimate needed time
• Treatment • Document ASAP
• Document ASAP • Leave on time
• Rest breaks • Prioritize interruptions

50. Don’t Do Do Later Do Now
Things you can safely Things that can wait
delegate to LPN or CNA
Patient care that
a little while must be done by
an RN
Bath, nail care, daily weight Phone messages Assessments
Airway
Breathing
Cardiac
Changes

51. Setting Priorities
First-order Second-order Third-order Fourth-order
Immediate threat to Actual problem for Relatively urgent Actual or potential
physiological or which patient or potential or actual problem for which
psychological safety family has requested problem that patient patient or family
attention or family does not may need future
recognize help
Airway, breathing, Nausea, pain, bath; Monitoring for post- Home care
cardiac; anxiety need to urinate operative
attack; suicide; fall complications;
risk anticipated teaching
needs

53. Change of Shift Report

54. Quality Management
(TQI, TQM, QA, Six Sigma, etc)
• Mission
• Values
• Philosophy
• Professional standards
• Care guidelines
• Outcomes

55. • “Our Pediatric Intensive Care
QI Plan Unit will show 100%
Components compliance regarding daily
Responsibility checks of the crash cart”.
Scope of Service
• If the crash cart was checked
96% of the time, a Quality
Quality Indicators Improvement plan will be
Thresholds instituted.
Data Collection • A time frame for re-
evaluation will be set
Evaluation • The problem will be
resolved/not resolved
• The results will be
communicated

56. Questions?