Charge Nurse Training USE (In progress)

Charge Nurse Training

Gaining the Confidence to lead

The

ST. LUKE'S ELMORE

Triage/Charge Nurse

Leadership

Adapted from learning to lead, Warren Bennis

Most importantly, the charge nurse will be accountable for being the role model by practicing what they preach.

Nurse Manager

Typical duties of a nurse manager include:

Planning

Organizing

Controlling

Directing

July 23, 2009 in Business,Church,Leadership,Organizational Leadership, team leadership

The Difference Between a Nurse Who Manages and a Nurse Who Leads.

What is the difference?

Make a Plan

And throw them in the bucket!

This is the time when you will meet with Anna Hissong to go over Emergency preparedness and the charge nurses role in an emergency, as well as you unit Managers to discuss the specifics of your unit.

Critical Thinking

Crucial Confrontations

Paraphrasing

Communication

Listening

Asking open ended questions

vs closed

Communication skills are necessary when acting as

Charge Nurse.

You will need communication skills when dealing with

nurses,

patients, patients families, physicians, or other

health care team members of this hospital

as well as outside agencies.

Interpersonal communication....“is

interaction between two or more

people. It helps you share ideas, solve

problems, and make decisions.”

Crucial Conversations

Beginning of Shift

Charge Nurse to Team

Variables that effect

Communication.

“Another variable that affects

communication is generation. Baby

Boomers, Generation X, and

Generation Y each espouse differing

values and life experiences and,

therefore, differing communication

styles” (Grover, 2005, p. 180)

Summarize

Tools for having crucial conversations

Steps to effective communication:

First step...... “begins with a

self-assessment to determine current

effectiveness as a communicator and

manager of conflict and to realize

opportunities for growth” (Thornby,

2006, p. 267).

Seven Principles of Crucial Conversations

Communication:

Disrespectful communication to

another colleague is not acceptable;

it does nothing to contribute to a

supportive learning environment and

so will not help the new employee

achieve the goals of the institution.

To confront means to hold someone accountable, face to face.

The desired result is to resolve problems and improve relationships.

“Give me a lever long enough and I shall move the world” Archimedes

Step two...align resources to assist you in

the ability to communicate. Take a course, Find a mentor.

Third....practice, practice and then practice

more. “It is important to understand that

the skill of effective communication,

confrontation, and managing of

differences are attainable with education,

practice, and commitment, but the

process will take time”

(Thornby, 2006, p.268).

Paraphrasing is repeating in your words what you interpreted someone else to be saying.  Paraphrasing is powerful means to further the understanding of the other person and yourself, and can greatly increase the impact of another’s comments.  It can translate comments so that even more people can understand them.

Variables that impact effective

communication:

Hierarchy...the effect of the perceived

hierarchy of power and authority can

affect communication.

Trust....a critical concept. The degree of

trust between individuals is directly related to

effective communication.

Self-disclosure....instances of sharing a

personal experience, attitude, or feeling

Communication:

“It is the sending and receipt of messages and a shared social

experience between two or more

people, each of whom has his or her own expectations, experiences, and

intentions” (Gran-Moravec, &

Hughes, 2005, p. 131).

It is important to communicate important information to the team and allow the team to communicate information to you.

This can be done in a team meeting just after report. This allows time for the staff to communicate any concerns they may have about the shift or where they may need help.

Charge Nurse to Charge Nurse.

Charge Nurse to team

Team Meeting

Communication skills are vital when dealing with conflict,

safety issues (such as codes)or incidents.

Good communication skills are necessary at

times when assertive leadership is needed

or when you need something from the staff.

Critical Elements for

Skilled Communication....

Healthcare organizations need to provide team

members with educational opportunities to

develop communication skills.

Focus is on finding solutions.

Seek to protect and advance working

relationships.

Invite and hear all relevant perspectives.

Zero-tolerance policy for abusive

communication.

These are the conversations that matter the most.

How do you have these conversations and maintain relationships?

Best way: be entirely candid and entirely respectful!

In team performance:

Disagreement with the “boss”

Peer to peer

Worried about losing relationship

1.Start with Heart

2. Learn to look.

3. Make it safe

4. Master my story’s

5. State my path

6. Explore others paths

7. Move to action

Active Listening

This involves reflecting back the feelings and the situation that you believe the other person is experiencing, to check that you have understood them correctly.

It is closely linked to empathy. It is a basic communication skill that can be developed with practice, and is very useful in an emotionally charged situation.

It allows the other person to vent, and as you are not adding your point of view at this stage, you avoid the danger of "saying the wrong thing" and making the other person even more upset.

Summarizing is an essential skill used in the practice of Mediation and I would say that it is an enormous contributor to the effectiveness of any communication that we have, whether in the role of a Mediator or not.

Article Source: http://EzineArticles.com/1088202

Verbalize the Plan

After you have summarized the situation, make a plan for follow up. Do not let it hang!

Example: When auditing charts at the end of a shift, you notice that charting regarding tolerance of a procedure is not present. You speak to the nurse about it and plan for a follow-up. “I will check back with you before I leave”.

This is something we do all the time with our patients.

Examples:

How are you doing?

vs

Tell me what's going on with your patients.

Or

Do you need help?

vs

Tell me what I can do for you.

How can you can communicate “In the moment” and maintain HIPAA?

Intrapersonal communication...“is the

constant, conscious dialogue inside

your head.” (Heery, 2000, p. 66).

Lets talk communication!

Where is it appropriate to discuss personal information about employees

Patients

Patient families

The higher levels of reasoning center in the brain has decreased blood supply as result of the stress. Flight or Fight

Best use dialogue

Share everything relevant to the conversation.

Do not understate or withhold from the conversation

Do not overstate or force points of view

Each person shares meanings and each person appreciates the others point of view. That does not mean you have to agree with everything they say, just validated that they feel it is valid.

can result in increased dialogue.

What would you like to know?

EMS

Pharmacy

Central Services

What would you like to know?

Laboratory

Social Services

Radiology

Medical Records

HMS

Housekeeping

Dietary

Department information

Managers from each department of the hospital will be providing information to you next week. This includes important information for you to know as a charge nurse about their department.

TEAMWORK

The Hospital working together, as a whole.

The accountability lies not only with the staff person but also with the Charge/Triage Nurse

Improved staff relationships

Improved Patient care

It is important that the Crucial conversation occurs IN THE MOMENT!

Communication

HIPAA

The Charge nurses role/responsibility

What’s your Communication style?

Clarifying

The conversation

Crucial Conversations

Variables that effect Communication.

“There are several intervening variables

that affect success in communication.

One of the most important is that of………

Assessing non verbal communication

Tools for having crucial conversations

Case scenarios

Charge Nurse to Charge Nurse

Triage Nurse to Triage Nurse

Charge Nurse to Triage Nurse

Types of Communication:

There is verbal and non-verbal. Non-

verbal, “such as personal appearance,

tone of voice, facial expressions, and

body language, carry more weight than

verbal communication.”

Barriers to LISTENING

Case scenarios

Communication:

Ambiguous or general feedback is

unlikely to lead to improvement in

performance and may actually

discourage additional effort. Effective

communication skills are essential if

feedback is to be provided in a

constructive way that will lead to

improved performance” (Lehman, &

Taylor, 1991, p. 307).

The importance of conversation or confrontation

It is important that the charge nurse nurtures an environment of accountability and ownership to share ideas.

Clear and professional communication, no matter what the circumstance

Timely communication that is appropriate to the situation

Differs when when you are charge from communication when you are not.

Basic Communication Skills

Include:

Listening.

Asking open-ended questions.

Asking closed questions.

Clarifying.

Paraphrasing.

Assessing non-verbals.

Summarize

gender

Communication:

“The Joint Commission on

the Accreditation of Health Care

Organizations (JCAHO) suggests that

poor communication is a top

contributor to sentinel events

reported to the JCAHO database in

2012. www.jointcommission.org

Communication

What is a crucial conversation?

A conversation turns from casual to crucial when three ingredients come together

We think we are better at it than we are!

QUIZ

QUIZ

What needs to be communicated?

Effective communication strategies

Clarification involves offering back to a speaker the essential meaning, as understood by the listener, of what they have just said, checking that the listener's understanding is correct and resolving any areas of confusion.

The purpose of clarification is to:

Ensure that the listener's understanding of what the speaker has said is correct.

Reassure the speaker that the listener is genuinely interested in them and is attempting to understand what they are saying.

Skilled Communication Standard:

States that Nurses must be as proficient in communication

skills as they are in clinical skills.

Lack of leadership by a nurse in charge is a reportable occurrence to the State Board of Nursing

THERE CAN MANY BARRIERS TO LISTENING INCLUDING:

Hearing what you want to hear

Bias listening

“Hot buttons” or effects of emotions on listening

Physical barriers such as noise, the person is not speaking loud enough, many interruptions, or feeling pressured to get back to work.

“Women and men communicate

differently. Women speak to create a

sense of harmony and use emotional

words, and men are direct and have

more demands” (Grover, 2005, p. 180).

High stakes

Contribution :Allowing others to contribute to the discussion allows them to feel committed to the ultimate decision.

If you have not contributed to the conversation around a change on the unit, how committed do you feel to the change when it is implemented?

Ability- Does our capacity to have candid dialogue effect effect our ability to get results?

If critical information is withheld wrong decisions are made

When decisions are forced upon someone, they are not accepted

Starts with the facts.

State your view of the story

Allow their story

Encourage their view of the story

How to say what’s on your mind:

Arguing usually encourages a person to fight back.

Persuade instead. Advocate effectively with statements that are not expressed without force.

Men are more likely to be aggressive in their language patters.

Try not to exaggerate,

Compete to win, or

Become forceful

It your responsibility to get the information you need at hand off.

Make sure you are comfortable with the information given to you before you move on

Follow up with the charge nurse ASAP

If you find that the information given wasn’t enough

CRUCIAL CONVERSATION

Strong emotions

The HIPAA Privacy Rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes.

Opposing opinions

Roles,

Responsibilities

and Delegation

Chain of Command

Plan

What is the big picture?

How many patients?

Any staffing issues

Any environmental concerns

What is the desired outcomes?

What do you hope to accomplish?

If unexpected setbacks occur, what can the nurse, staff, and patients really accomplish?

What are Priorities?

Who is the greatest risk for potential complications?

Has all emergency equipment been checked?

Are patients at high risk of falls or suicide identified and are measures being taken?

Who are the patients suffering from significant symptoms-airway, breathing, circulation?

Tools for Handoff

Shift Action Plan

Plans for discharge: Expected date of d/c, referrals needed, progress toward self care and readiness for discharge.

Care Support: Availability of family or friends to assist in ADL.

Priority interventions: Interventions that must be done.

Making Assignments

Shift Action Plan

Tools for Handoff

Shift Action Plan

INTERVENTIONS

What are the tasks to be accomplished?

Monitoring?

Meds?

Treatments?

Teaching?

Counseling?

Shift Action Plan

Diet/IV/Fluid Restrictions: Diet, fluid restrictions, IV fluid rate/site/date, tube feedings- type of tube, contents, rate, & toleration.

O2: Rate, route, other tubes (chest, NG, Foley and drainage)

Expected Shift outcomes: Priority outcomes, patient learning outcomes

Tools for Handoff

Tasks to be accomplished:

Physical and functional care?

Unit support, e.g. stocking, maintenance?

Staff available:

What can the RN, LPN, CNA do?

RN: teaches, counsels, and supervises all nursing care

Shift Action Plan

Demographics: Room number, name, sex, age doctor

Diagnosis's: Primary, secondary, nursing and medical, admission date, pertinent history.

Patient Status: DNR?, VS, ABCs, LOC, Safety, Allergies, O2 sat, pain score, systems review, ambulation, fall risk, suicide risk, presence/absence of S/S, and any new orders

Patient Handoff Report

LPN: Medication administration and treatments

CNA: Physical care such as bathing, oral care, vital signs.

Assign and delegate accordingly.

Give set time for completion of all tasks

When should staff breaks/lunches be scheduled?

What information must be shared with staff? Who is covering?

Staff available:

At best, a complete report is given to the oncoming shift by the outgoing shift and this leads to a smooth and effective start of the next shift.

At worst, an incomplete report can leave the oncoming shift with inadequate or old data with which to start the patient plan of care.

Evaluate

Are the shift outcomes achieved?

How will you check throughout the shift and at the end of the shift?

Is your team in need of assistance?

Has anything unexpected happened to change your plan?

Has patient status changed?

At the end of your shift, did you accomplished outcomes?

Effective use of Available Time

To plan effective use of available time, you must understand the big picture and decide on priority patient outcomes.

Set priorities to achieve safe patient outcomes.

Do first things first: Prioritize interventions that will prevent life threatening emergencies or save a life when a life threatening event occurs.

Nurses must protect their patients by maintaining both patient and staff safety, as well as ensure that essential activities of nursing and medical care plans are followed.

EVALUATE

Strategies

Factors Considered in Making Assignments

Interruptions: Respond, delegate or throw it out.

Procrastination: Break down tasks into manageable segments, and return to it again and again until it is complete.

Perfection: Pursue excellence not perfection as you pursue your personal goals.

Priority of patient needs

Geography of patient rooms

Complexity of patient needs

Other responsibilities of staff

Attitude and dependability of staff

Strategies

Factors Considered in Making Assignments

Unplanned Phone Calls: Set a time to return calls if possible.

Low priority jobs: Say “no” to jobs with little value. Let low priority tasks undone if necessary

Requests for assistance: Encourage others to be more independent.

Clutter: Clear work areas. Organize and prepare the work area for the next shift.

Need for continuity of care by same staff

Need for fair work distribution among staff

Skill, education, and competency of staff, i.e. RN, LPN, CNA.

Need to protect patient and staff from injury

Patient care standards

Strategies

Unplanned Phone Calls: Set a time to return calls if possible.

Low priority jobs: Say “no” to jobs with little value. Let low priority tasks undone if necessary

Requests for assistance: Encourage others to be more independent.

Clutter: Clear work areas. Organize and prepare the work area for the next shift.

At best, a complete report is given to the oncoming shift by the outgoing shift

and this leads to a smooth and effective start of the next shift.

At worst, an incomplete report can leave the oncoming shift with inadequate or old data with which to start the patient plan of care.

Strategies

Strategies for avoiding time wasters

Casual visitors: Make your environment less inviting.

Remain standing

Remove your visitor chair

Keep a pen in your hand

Factors Considered in Making Assignments

To plan effective use of available time, you must understand the big picture and decide on priority patient outcomes.

Set priorities to achieve safe patient outcomes.

Do first things first: Prioritize interventions that will prevent life threatening emergencies or save a life when a life threatening event occurs.

Nurses must protect their patients by maintaining both patient and staff safety, as well as ensure that essential activities

of nursing and medical care plans are followed.

Strategies for avoiding time wasters

Casual visitors: Make your environment less inviting.

Remain standing

Remove your visitor chair

Keep a pen in your hand

Patient Handoff Report

Value of Nursing Time

Avoid Time Wasters

Remember when delegating a task:

You may have to spend more time initially to delegate a task to others than do it yourself, but this investment of time should save time and energy in the future.

Effective use of

Available Time

Nurses often undervalue their time.

Consider salary and benefits then add workers compensation and payroll taxes then add in amount spent by the hospital for orientation and development.

Example: Salary 26.00 per hour. Add 3.50-7.50 per hour for benefits. Then Add 29.00 to 33.25 per hour in payroll taxes and workers comp.

Equals- 58.50 to 66.75 per nurse per hour.

Creating more Time

20% of focused efforts results in 80% of desired outcomes or results or conversely 80% of unfocused efforts results in 20% of results.

It is important to analyze how your time is being used to manage available time to achieve desired outcomes.

Environmental concerns

Insurance education programs

Lunch/break times

Unit routines

Accreditation regulations

Agency organizational system

State laws

Prioritize

Delegate

Eliminate tasks that add no value

Strategies

Interruptions: Respond, delegate or throw it out.

Procrastination: Break down tasks into manageable segments,

and return to it again and again until it is complete.

Perfection: Pursue excellence not perfection as you pursue your personal goals.

General Time Management Techniques

Time management has been defined as “a set of related common-sense skills that help people use their time in the most effective and productive way possible”.

Time management requires a shift from being too busy to getting things done and focusing on the process of work, to focusing on achieving a good work outcome.

How do you use your time?

Nurses are often unaware of the time spent on personal activities as well as time spent working, socializing with colleagues, drinking coffee, snacking, and so on

Nursing Time is a Valuable Commodity

Keeping this in mind will be invaluable when considering work that can be delegated to personnel who receive less compensation

Or

When considering spending time on completing a task that does not support achieving an outcome.

Avoid Time Wasters

Charge Nurse to Charge Nurse

Charge Nurse to Triage Nurse

Staff handoff form caregiver to caregiver

At the end of each shift, the Charge/Triage Nurse reexamines the assignments. Did the staff and patients achieve outcomes? If not, why?

Were there staffing problems or patient crises?

What was learned from this for future shifts?

Remember when delegating a task:

You may have to spend more time initially to delegate a task to others than do it yourself, but this investment of time should save time and energy in the future.

Patient Care Rounds

Creating more Time

Tools for Handoff

Plans for discharge: Expected date of d/c, referrals needed, progress toward self care

and readiness for discharge.

Care Support: Availability of family or friends to assist in ADL.

Priority interventions: Interventions that must be done.

Prioritize

Delegate

Eliminate tasks that add no value

Tools for Handoff

Diet/IV/Fluid Restrictions: Diet, fluid restrictions, IV fluid rate/site/date, tube feedings

- type of tube, contents, rate, & toleration.

O2: Rate, route, other tubes (chest, NG, Foley and drainage)

Expected Shift outcomes: Priority outcomes, patient learning outcomes

Tools for Handoff

Shift Action Plan

Demographics: Room number, name, sex, age doctor

Diagnosis's: Primary, secondary, nursing and medical, admission date, pertinent history.

Patient Status: DNR?, VS, ABCs, LOC, Safety, Allergies, O2 sat, pain score, systems review, ambulation, fall risk, suicide risk, presence/absence of S/S, and any new orders

Plan

What is the big picture?

How many patients?

Any staffing issues

Any environmental concerns

What is the desired outcomes?

What do you hope to accomplish?

If unexpected setbacks occur, what can the nurse, staff, and patients really accomplish?

ANA Principles for Nurse Staffing

Patient Care Unit Related

Staff Related

Institution/Organization Related

Making Assignments

Case Scenarios

Shift Action Plan

Apply your skills

How do you use your time?

Nurses are often unaware of the time spent on personal activities as well as time spent working, socializing with colleagues, drinking coffee, snacking, and so on

Keeping this in mind will be invaluable when considering work that can be delegated to personnel who receive less compensation

Or

When considering spending time on completing a task that does not support achieving an outcome.

Nursing Time is a Valuable Commodity

Shift Action Plan

Tasks to be accomplished:

Physical and functional care?

Unit support, e.g. stocking, maintenance?

Staff available:

What can the RN, LPN, CNA do?

RN: teaches, counsels, and supervises all nursing care

Shift Action Plan

INTERVENTIONS

What are the tasks to be accomplished?

Monitoring?

Meds?

Treatments?

Teaching?

Counseling?

Factors Considered in Making Assignments

Environmental concerns

Insurance education programs

Lunch/break times

Unit routines

Accreditation regulations

Agency organizational system

State laws

Shift Action Plan

EVALUATE

What are Priorities?

Who is the greatest risk for potential complications?

Has all emergency equipment been checked?

Are patients at high risk of falls or suicide identified and are measures being taken?

Who are the patients suffering from significant symptoms-airway, breathing, circulation?

Factors Considered in Making Assignments

Evaluate

Are the shift outcomes achieved?

How will you check throughout the shift and at the end of the shift?

Is your team in need of assistance?

Has anything unexpected happened to change your plan?

Has patient status changed?

At the end of your shift, did you accomplished outcomes?

Need for continuity of care by same staff

Need for fair work distribution among staff

Skill, education, and competency of staff, i.e. RN, LPN, CNA.

Need to protect patient and staff from injury

Patient care standards

Staff available:

Factors Considered in Making Assignments

LPN: Medication administration and treatments

CNA: Physical care such as bathing, oral care, vital signs.

Assign and delegate accordingly.

Give set time for completion of all tasks

When should staff breaks/lunches be scheduled?

What information must be shared with staff? Who is covering?

Priority of patient needs

Geography of patient rooms

Complexity of patient needs

Other responsibilities of staff

Attitude and dependability of staff

ANA Principles for Nurse Staffing

Patient Care Unit Related

Staff Related

Institution/Organization Related

Patient Care Rounds

Charge Nurse to Charge Nurse

Charge Nurse to Triage Nurse

Staff handoff form caregiver to caregiver

At the end of each shift, the Charge/Triage Nurse reexamines the assignments.

Did the staff and patients achieve outcomes? If not, why?

Were there staffing problems or patient crises?

What was learned from this for future shifts?

Value of Nursing Time

Nurses often undervalue their time.

Consider salary and benefits then add workers compensation and payroll taxes then add in amount spent by the hospital for orientation and development.

Example: Salary 26.00 per hour. Add 3.50-7.50 per hour for benefits. Then Add 29.00 to 33.25 per hour in payroll taxes and workers comp.

Equals- 58.50 to 66.75 per nurse per hour.

20% of focused efforts results in 80% of desired outcomes or results or conversely 80% of unfocused efforts results in 20% of results.

It is important to analyze how your time is being used to manage available time to achieve desired outcomes.

Pareto Principle

General Time Management Techniques

Time management has been defined as “a set of related common-sense skills that help people use their time in the most effective and productive way possible”.

Time management requires a shift from being too busy to getting things done and focusing on the process of work, to focusing on achieving a good work outcome.

The role of the charge Nurse

Course objectives Organization & Prioritizing

1. Present a structured, Documentation

standardized role of the

Charge Nurse. 3. Define the charge Nurses

2. To provide skill competency role in an emergency

with : 4. Provide an understanding of the

Communication Charge nurses role with legal issues

Conflict Resolution 5. Define role in Survey

Leadership 6. Determine where and when to

Decision making access policies

Mentoring/teaching 7. Define the Charge nurse role in

Delegation drills

Coordination and delivery of patient care

Supervision and delegation

Be a resource

Value of Nursing Time

Nurses often undervalue their time.

Consider salary and benefits then add workers compensation and payroll taxes then add in amount spent by the hospital for orientation and development.

Example: Salary 26.00 per hour. Add 3.50-7.50 per hour for benefits. Then Add 29.00 to 33.25 per hour in payroll taxes and workers comp.

Equals- 58.50 to 66.75 per nurse per hour.

Pareto Principle

General Time Management Techniques

20% of focused efforts results in 80% of desired outcomes or results or conversely 80% of unfocused efforts results in 20% of results.

It is important to analyze how your time is being used to manage available time to achieve desired outcomes.

Time management has been defined as “a set of related common-sense skills that help people

use their time in the most effective and productive way possible”.

Time management requires a shift from being too busy to getting things done and focusing on the process of work, to focusing on achieving a good work outcome.

Creating more Time

Prioritize

Delegate

Eliminate tasks that add no value

How do you use your time?

Nurses are often unaware of the time spent on personal activities as well as time spent working, socializing with colleagues, drinking coffee, snacking, and so on

Nursing Time is a Valuable Commodity

Keeping this in mind will be invaluable when considering work that can be delegated to personnel who receive less compensation

Or

When considering spending time on completing a task that does not support achieving an outcome.

Strategies

Unplanned Phone Calls: Set a time to return calls if possible.

Low priority jobs: Say “no” to jobs with little value. Let low priority tasks undone if necessary

Requests for assistance: Encourage others to be more independent.

Clutter: Clear work areas. Organize and prepare the work area for the next shift.

Strategies

Strategies for avoiding time wasters

Casual visitors: Make your environment less inviting.

Remain standing

Remove your visitor chair

Keep a pen in your hand

Avoid Time Wasters

Remember when delegating a task:

You may have to spend more time initially to delegate a task to others than do it yourself,

but this investment of time should save time and energy in the future.

Patient Handoff Report

At best, a complete report is given to the oncoming shift by the outgoing shift and this leads to a smooth and effective start of the next shift.

At worst, an incomplete report can leave the oncoming shift with inadequate or old data with which to start the patient plan of care.

Effective use of Available Time

To plan effective use of available time, you must understand the big picture and decide on priority patient outcomes.

Set priorities to achieve safe patient outcomes.

Do first things first: Prioritize interventions that will prevent life threatening emergencies or save a life when a life threatening event occurs.

Nurses must protect their patients by maintaining both patient and staff safety, as well as ensure that essential activities of nursing and medical care plans are followed.

Strategies

Interruptions: Respond, delegate or throw it out.

Procrastination: Break down tasks into manageable segments, and return to it again and again until it is complete.

Perfection: Pursue excellence not perfection as you pursue your personal goals.

Apply your skills

Case Scenarios

Setting Priorities

Time Management

Tools for Handoff

Plans for discharge: Expected date of d/c, referrals needed, progress

toward self care and readiness for discharge.

Care Support: Availability of family or friends to assist in ADL.

Priority interventions: Interventions that must be done.

Tools for Handoff

Diet/IV/Fluid Restrictions: Diet, fluid restrictions, IV fluid rate/site/date

tube feedings- type of tube, contents, rate, & toleration.

O2: Rate, route, other tubes (chest, NG, Foley and drainage)

Expected Shift outcomes: Priority outcomes, patient learning outcomes

Tools for Handoff

Demographics: Room number, name, sex, age doctor

Diagnosis's: Primary, secondary, nursing and medical, admission date, pertinent history.

Patient Status: DNR?, VS, ABCs, LOC, Safety, Allergies, O2 sat, pain score, systems review, ambulation,

fall risk, suicide risk, presence/absence of S/S, and any new orders

Shift Action Plan

Plan

What is the big picture?

How many patients?

Any staffing issues

Any environmental concerns

What is the desired outcomes?

What do you hope to accomplish?

If unexpected setbacks occur, what can the nurse, staff, and patients really accomplish?

Making Assignments

Shift Action Plan

HIPPA

Factors Considered in Making Assignments

Environmental concerns

Insurance education programs

Lunch/break times

Unit routines

Accreditation regulations

Agency organizational system

State laws

Factors Considered in Making Assignments

Need for continuity of care by same staff

Need for fair work distribution among staff

Skill, education, and competency of staff, i.e. RN, LPN, CNA.

Need to protect patient and staff from injury

Patient care standards

Factors Considered in Making Assignments

Priority of patient needs

Geography of patient rooms

Complexity of patient needs

Other responsibilities of staff

Attitude and dependability of staff

Patient Care Rounds

ANA Principles for Nurse Staffing

Patient Care Unit Related

Staff Related

Institution/Organization Related

Charge Nurse to Charge Nurse

Charge Nurse to Triage Nurse

Staff handoff form caregiver to caregiver

At the end of each shift, the Charge/Triage Nurse reexamines the assignments.

Did the staff and patients achieve outcomes? If not, why?

Were there staffing problems or patient crises?

What was learned from this for future shifts?

Shift Action Plan

Tasks to be accomplished:

Physical and functional care?

Unit support, e.g. stocking, maintenance?

Staff available:

What can the RN, LPN, CNA do?

RN: teaches, counsels, and supervises all nursing care

Shift Action Plan

INTERVENTIONS

What are the tasks to be accomplished?

Monitoring?

Meds?

Treatments?

Teaching?

Counseling?

What are Priorities?

Who is the greatest risk for potential complications?

Has all emergency equipment been checked?

Are patients at high risk of falls or suicide identified and are measures being taken?

Who are the patients suffering from significant symptoms-airway, breathing, circulation?

Shift Action Plan

Evaluate

Are the shift outcomes achieved?

How will you check throughout the shift and at the end of the shift?

Is your team in need of assistance?

Has anything unexpected happened to change your plan?

Has patient status changed?

At the end of your shift, did you accomplished outcomes?

EVALUATE

Staff available:

LPN: Medication administration and treatments

CNA: Physical care such as bathing, oral care, vital signs.

Assign and delegate accordingly.

Give set time for completion of all tasks

When should staff breaks/lunches be scheduled?

What information must be shared with staff? Who is covering?

Planning,

Organizing

and prioritizing

Documentation

& Legal Issues

Staff Nurse

What skills take you from Staff Nurse to Charge Nurse/Triage Nurse?

What do you need to know?

Charge Nurse Expectations

Managing your time

Communication:

“It is the sending and receipt of messages and a shared social

experience between two or more

people, each of whom has his or her own expectations, experiences, and

intentions” (Gran-Moravec, &

Hughes, 2005, p. 131).

Communication:

Disrespectful communication to

another colleague is not acceptable;

it does nothing to contribute to a

supportive learning environment and

so will not help the new employee

achieve the goals of the institution.

Communication

Effective communication strategies

Communication:

Ambiguous or general feedback is

unlikely to lead to improvement in

performance and may actually

discourage additional effort. Effective

communication skills are essential if

feedback is to be provided in a

constructive way that will lead to

improved performance” (Lehman, &

Taylor, 1991, p. 307).

Variables that impact effective

communication:

Hierarchy...the effect of the perceived

hierarchy of power and authority can

affect communication.

Trust....a critical concept. The degree of

trust between individuals is directly related to

effective communication.

Self-disclosure....instances of sharing a

personal experience, attitude, or feeling

can result in increased dialogue.

What’s your Communication style?

QUIZ

Communication:

“The Joint Commission on

the Accreditation of Health Care

Organizations (JCAHO) suggests that

poor communication is a top

contributor to sentinel events

reported to the JCAHO database in

2012. www.jointcommission.org

Types of Communication:

There is verbal and non-verbal. Non-

verbal, “such as personal appearance,

tone of voice, facial expressions, and

body language, carry more weight than

verbal communication.”

Steps to effective communication:

First step...... “begins with a

self-assessment to determine current

effectiveness as a communicator and

manager of conflict and to realize

opportunities for growth” (Thornby,

2006, p. 267).

Basic Communication Skills

Include:

Listening.

Asking open-ended questions.

Asking closed questions.

Clarifying.

Paraphrasing.

Assessing non-verbals.

Summarize

Step two...align resources to assist you in

the ability to communicate. Find a mentor

or coach to provide feedback.

Third....practice, practice and then practice

more. “It is important to understand that

the skill of effective communication,

confrontation, and managing of

differences are attainable with education,

practice, and commitment, but the

process will take time” (Thornby, 2006, p.

268).

Interpersonal communication....“is

interaction between two or more

people. It helps you share ideas, solve

problems, and make decisions.”

Barriers to LISTENING

THERE CAN MANY BARRIERS TO LISTENING INCLUDING:

Hearing what you want to hear

Bias listening

“Hot buttons” or effects of emotions on listening

Physical barriers such as noise, the person is not speaking loud enough, many interruptions, or feeling pressured to get back to work.

Intrapersonal communication...“is the

constant, conscious dialogue inside

your head.” (Heery, 2000, p. 66).

Clarifying

Listening

Clarification involves offering back to a speaker the essential meaning, as understood by the listener, of what they have just said, checking that the listener's understanding is correct and resolving any areas of confusion.

The purpose of clarification is to:

Ensure that the listener's understanding of what the speaker has said is correct.

Reassure the speaker that the listener is genuinely interested in them and is attempting to understand what they are saying.

Active Listening

This involves reflecting back the feelings and the situation that you believe the other person is experiencing, to check that you have understood them correctly.

It is closely linked to empathy. It is a basic communication skill that can be developed with practice, and is very useful in an emotionally charged situation.

It allows the other person to vent, and as you are not adding your point of view at this stage, you avoid the danger of "saying the wrong thing" and making the other person even more upset.

Assessing non verbal communication

Asking open ended questions

vs closed

We think we are better at it than we are!

QUIZ

This is something we do all the time with our patients.

Examples:

How are you doing?

vs

Tell me what's going on with your patients.

Or

Do you need help?

vs

Tell me what I can do for you.

Paraphrasing

Paraphrasing is repeating in your words what you interpreted someone else to be saying.  Paraphrasing is powerful means to further the understanding of the other person and yourself, and can greatly increase the impact of another’s comments.  It can translate comments so that even more people can understand them.

Case scenarios

Crucial Conversations

Summarize

What is a crucial conversation?

A conversation turns from casual to crucial when three ingredients come together

High stakes

Strong emotions

Opposing opinions

Summarizing is an essential skill used in the practice of Mediation and I would say that it is an enormous contributor to the effectiveness of any communication that we have, whether in the role of a Mediator or not.

Article Source: http://EzineArticles.com/1088202

Verbalize the Plan

After you have summarized the situation, make a plan for follow up. Do not let it hang!

Example: When auditing charts at the end of a shift, you notice that charting regarding tolerance of a procedure is not present. You speak to the nurse about it and plan for a follow-up. “I will check back with you before I leave”.

Tools for having crucial conversations

Crucial Conversations

These are the conversations that matter the most.

How do you have these conversations and maintain relationships?

Best way: be entirely candid and entirely respectful!

In team performance:

Disagreement with the “boss”

Peer to peer

Worried about losing relationship

Contribution :Allowing others to contribute to the discussion allows them to feel committed to the ultimate decision.

If you have not contributed to the conversation around a change on the unit, how committed do you feel to the change when it is implemented?

Ability- Does our capacity to have candid dialogue effect effect our ability to get results?

If critical information is withheld wrong decisions are made

When decisions are forced upon someone, they are not accepted

The conversation

Tools for having crucial conversations

Starts with the facts.

State your view of the story

Allow their story

Encourage their view of the story

How to say what’s on your mind

Arguing usually encourages a person to fight back.

Persuade instead. Advocate effectively with statements that are not expressed without force.

Men are more likely to be aggressive in their language patters.

Try not to exaggerate

Compete to win

Become forceful

The higher levels of reasoning center in the brain has decreased blood supply as result of the stress. Flight or Fight

Best use dialogue

Share everything relevant to the conversation.

Do not understate or withhold from the conversation

Do not overstate or force points of view

Each person shares meanings and each person appreciates the others point of view. That does not mean you have to agree with everything they say, just validated that they feel it is valid.

The importance of conversation or confrontation

Seven Principles of Crucial Conversations

1.Start with Heart

2. Learn to look.

3. Make it safe

4. Master my story’s

5. State my path

6. Explore others paths

7. Move to action

Crucial Confrontations

To confront means to hold someone accountable, face to face.

The desired result is to resolve problems and improve relationships.

“Give me a lever long enough and I shall move the world” Archimedes

Critical Elements for Standard One:

Skilled Communication....

Healthcare organization provides team

members with educational opportunities to

develop communication skills.

Focus is on finding solutions.

Seek to protect and advance working

relationships.

Invite and hear all relevant perspectives.

Establish zero-tolerance policy for abusive

communication.

Variables that effect

Communication.

“Another variable that affects

communication is generation. Baby

Boomers, Generation X, and

Generation Y each espouse differing

values and life experiences and,

therefore, differing communication

styles” (Grover, 2005, p. 180)

Skilled Communication Standard:

“The first standard, skilled

communication, states that Nurses must be as proficient in communication

skills as they are in clinical skills.”

Beginning of Shift

Variables that effect Communication.

“There are several intervening variables

that affect success in communication.

One of the most important is that of………

Charge Nurse to Charge Nurse.

Charge Nurse to Staff

When rounding

gender

“Women and men communicate

differently. Women speak to create a

sense of harmony and use emotional

words, and men are direct and have

more demands” (Grover, 2005, p. 180).

Communication

It is important that the charge nurse nurtures an environment of accountability and ownership to share ideas.

Clear and professional communication, no matter what the circumstance

Timely communication that is appropriate to the situation

Differs when when you are charge from communication when you are not.

HIPAA

The HIPAA Privacy Rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes.

The conversation

Beginning of Shift

Tools for having crucial conversations

Crucial Conversations

Variables that effect

Communication.

“Another variable that affects

communication is generation. Baby

Boomers, Generation X, and

Generation Y each espouse differing

values and life experiences and,

therefore, differing communication

styles” (Grover, 2005, p. 180)

The importance of conversation or confrontation

Charge Nurse to Charge Nurse.

Charge Nurse to Staff

When rounding

Critical Elements for Standard One:

Skilled Communication....

Healthcare organization provides team

members with educational opportunities to

develop communication skills.

Focus is on finding solutions.

Seek to protect and advance working

relationships.

Invite and hear all relevant perspectives.

Establish zero-tolerance policy for abusive

communication.

What is a crucial conversation?

A conversation turns from casual to crucial when three ingredients come together

High stakes

Strong emotions

Opposing opinions

Case scenarios

Contribution :Allowing others to contribute to the discussion allows them to feel committed to the ultimate decision.

If you have not contributed to the conversation around a change on the unit, how committed do you feel to the change when it is implemented?

Ability- Does our capacity to have candid dialogue effect effect our ability to get results?

If critical information is withheld wrong decisions are made

When decisions are forced upon someone, they are not accepted

Starts with the facts.

State your view of the story

Allow their story

Encourage their view of the story

How to say what’s on your mind

Arguing usually encourages a person to fight back.

Persuade instead. Advocate effectively with statements that are not expressed without force.

Men are more likely to be aggressive in their language patters.

Try not to exaggerate

Compete to win

Become forceful

Communication

HIPAA

Crucial Confrontations

Variables that effect Communication.

“There are several intervening variables

that affect success in communication.

One of the most important is that of………

Crucial Conversations

Tools for having crucial conversations

Seven Principles of Crucial Conversations

To confront means to hold someone accountable, face to face.

The desired result is to resolve problems and improve relationships.

“Give me a lever long enough and I shall move the world” Archimedes

It is important that the charge nurse nurtures an environment of accountability and ownership to share ideas.

Clear and professional communication, no matter what the circumstance

Timely communication that is appropriate to the situation

Differs when when you are charge from communication when you are not.

gender

Skilled Communication Standard:

“The first standard, skilled

communication, states that Nurses must be as proficient in communication

skills as they are in clinical skills.”

These are the conversations that matter the most.

How do you have these conversations and maintain relationships?

Best way: be entirely candid and entirely respectful!

In team performance:

Disagreement with the “boss”

Peer to peer

Worried about losing relationship

1.Start with Heart

2. Learn to look.

3. Make it safe

4. Master my story’s

5. State my path

6. Explore others paths

7. Move to action

“Women and men communicate

differently. Women speak to create a

sense of harmony and use emotional

words, and men are direct and have

more demands” (Grover, 2005, p. 180).

The higher levels of reasoning center in the brain has decreased blood supply as result of the stress. Flight or Fight

Best use dialogue

Share everything relevant to the conversation.

Do not understate or withhold from the conversation

Do not overstate or force points of view

Each person shares meanings and each person appreciates the others point of view. That does not mean you have to agree with everything they say, just validated that they feel it is valid.

The HIPAA Privacy Rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes.