1. Chapter 41
Professional Roles and
Leadership

2. Functioning as a Graduate
The role of a graduate nurse will be exciting and challenging.
The LPN/LVN is a valuable member of the health care team and functions in many settings.
Many opportunities are available from which to choose.

3. Functioning as a Graduate
Letter of Application
It should always be customized, brief, neatly typed, and correctly spelled.
It should be simple and direct.
Its objective is to introduce yourself, announce your interest in employment, briefly state your qualifications, and express your availability.
Your cover letter requires a thorough discussion of your qualifications.

4. Functioning as a Graduate
Résumé
A summary of educational and professional experiences, including activities and honors
A one- or two-page written document that contains certain information about you, your education, and your experience
Should be well-organized, neat, and accurate

5. Functioning as a Graduate
Personal Interview
A meeting of people face to face, as for evaluating or questioning a job applicant
First impressions have a lasting effect.
Contracts
A promise or a set of promises between two or more people that creates a legal relationship between them and a legal obligation that one or more of them must fulfill
May be written or oral

6. Functioning as a Graduate
Keeping Your Job
Keep current and competent.
Look and act professional.
Be on time and ready to start at the beginning of the shift.
Be organized.
Do not spend time with personal telephone calls.
Take only the time allocated for lunch and breaks.
Work hard and give the best care possible.
Be a good leader and a good follower.

7. Functioning as a Graduate
Keeping Your Job
Help others when you can.
Stretch yourself; do not be satisfied with the minimum.
Display a positive attitude and flexibility.
Respect your patients, their family members, your co-workers, and your supervisors.
Encountering Problems
Follow the chain of command.
Be calm and positive in your approach.
Listen carefully.

8. Functioning as a Graduate
Advancement
A rise in rank or importance, a promotion, progress, improvement
May result from additional preparation or additional experience
Usually based on a person’s qualifications, behavior, performance, and preparation
Terminating Employment
A verbal statement and letter of resignation should be completed; proper procedures should be followed.

9. Welcome to Leadership!!!
What direction do you believe nursing is headed in?
What role will L.P.N.’s play in this role?
How will you personally participate in this change? Where do you want to participate?

10. Transition from Student to Graduate
Know Your Role
LPN/LVN is responsible to the RN or physician.
Role of LPN/LVN is constantly changing.
Technical and scientific changes in the health care system have resulted in a multiplicity and complexity of functions placed on the nurse.
Be careful not to lose sight of your principal concern—the patient, a human being!

11. Transition from Student to Graduate
Confidentiality
All information the patient gives is confidential.
Information may be exchanged with other members of the health care team only in the performance of your duties.
Releasing any information to anyone other than the health care team without the consent of the patient is a violation of the right to privacy.

12. Transition from Student to Graduate
Role of the LPN/LVN in the Community
Participates in activities that promote the community’s attitude toward positive health care
Uses community resources to promote a better understanding of the health services available to the general public
Participates in community health projects and other health-oriented activities

13. Transition from Student to Graduate
Professional Organizations
Gives you a voice in your profession
Some provide continuing education
Two national organizations are designed to support and meet the needs of the LPN
National Association for Practical Nurse Educators (NAPNES)
National Federation of Licensed Practical Nurses (NFLPN)
National League for Nursing (NLN)
Involved with all types and levels of nursing

14. Transition from Student to Graduate
Continuing Education
It is critical to keep current on nursing trends and issues.
There are many opportunities for nurses to learn new nursing skills.
Facilities offer employees continuing education.
Internet
Some states require CEUs before you can renew nursing licenses.

15. Transition from Student to Graduate
Certification Opportunities
Certifications
Managed care (CMCN)
Pharmacology
Long-term care (CLTC)
Addiction (CALPN)
Further education

16. Licensure Examination
National Council of State Boards of Nursing
The computerized adaptive testing (CAT) was adopted in 1994.
Examinee takes the CAT exam by sitting at an individual computer and answering questions on the screen.
NCLEX-PN has 85 to 205 questions.
The candidate’s application is approved by the board of nursing in the jurisdiction where the NCLEX is to be taken.
On successful completion of the examination, you can practice as an LPN/LVN.

17. Licensure Examination
Endorsement/Reciprocity
This is recognition of the license of a health practitioner in one state by another state.
Applicant must meet the state’s licensing requirements.
If the nurse travels with a patient from one state to the other or to Canada, the license the nurse has in her or his possession is valid for the length of the stay in the other state or Canada.

18. Licensure Examination
Nurse Licensing Compact/Mutual Recognition
Based on the primary state of residence.
A declared, fixed, permanent, and principal home for legal purposes
A nurse may practice in a compact state using the nursing license from the primary state of residency.
State boards of nursing differ, so you should contact the board of nursing in the state where you are seeking licensing for the specific requirements.

19. Nurse Practice Act Licensing law
Defines the title and regulations governing the practice of nursing
Assists the nurse in staying within the legal scope of nursing practice in each state
Defines the regulations for practical nursing and includes requirements for an approved school of nursing
Defines requirements for licensure and conditions for which a license may be revoked or suspended
The document in which the role and responsibilities of the LPN/LVN are identified is the Nurse Practice Act.

20. State Board of Nursing
Board consists of members who represent different levels of nursing and are appointed by the governor.
The purpose of the board is to protect the public by administering the nurse practice act.
Board is responsible for approving schools of nursing
Board issues and renews licenses.
Board has the authority to suspend or revoke a license.

21. Career Opportunities Hospitals
LPN/LVN is under the supervision of the RN.
LPN /LVN is legally able to provide most bedside care to patients in the hospital setting.
LPN /LVN is responsible for supervising the nursing assistants.
There are a number of different types of hospitals.

22. Figure 41-5
(From Polaski, A.L., Warner, J.P. [1994]. Saunders fundamentals for nursing assistants. Philadelphia: Saunders.)
Various positions are available in the hospital setting on the health care team.

23. Career Opportunities Long-term Care Facilities Home Health
LPN/LVN is the backbone of long-term care facilities
Can advance to charge nurse and supervisory capacity with RN supervision
A facility for those who require long-term care
Home Health
Health care in the home setting
RN supervision must be available
Relaxed atmosphere, decreased patient load, primarily daytime hours

24. Career Opportunities Physician’s Office or Clinic Insurance Companies
Some of the skills required may not be included in the LPN/LVN educational program.
Laboratory testing, ECGs, computer skills, insurance coding, billing, supervision of other office personnel
Insurance Companies
Preadmission and claims assessments
Usually require experience in medical-surgical nursing

25. Career Opportunities Temporary Agencies Travel Opportunities
These agencies provide nurses to meet the staffing needs in a variety of health care facilities.
Advantages are the right to refuse and the wealth of variety available.
Disadvantage is the uncertainty of work available.
Travel Opportunities
Nurse can work for specified periods in areas in need of nurses through a temporary agency.
Experience is required.
Lodging is provided in addition to salary.

26. Career Opportunities Pharmaceutical Sales Other Medical Sales
LPN/LVN makes contacts with physicians, pharmacists, and nurses in various clinical settings.
Presents the advantages of products
Teaches about side effects and precautions
Experience in specific areas and an expertise in science and pharmacology are required.
Other Medical Sales
Sell medical supplies
May perform in-service programs at facilities to demonstrate product use

27. Career Opportunities Outpatient Hotels The Military
Provides patient teaching and assists with preparation for tests; available for emergencies
Hotel is usually owned by a hospital.
Patient/guests stay while they undergo testing before surgery and/or for postsurgical care.
The Military
Active duty or reserves are options.
Educational opportunities
Additional education
May help repay loans

28. Career Opportunities Adult Day Care Schools Public Health
Provide medical supervision for adults while their family members work or take a break from the responsibility of care
Schools
Perform health screenings, emergency care, and health teaching
Public Health
Work in clinics and home visits; may also participate in health inspections

29. Career Opportunities Outpatient Surgery Private Duty Government
Prepare patients for surgery, as a scrub nurse, or to work in the recovery room under the supervision of an RN.
Private Duty
Give total care to one patient
May be in the hospital, home, other facility, or while traveling
Government
May work in a Veterans Administration hospital or other government hospitals

30. Career Opportunities Industrial Rehabilitation
Focuses on promoting wellness and preventing accidents
Safety is emphasized, and usually is first aid–oriented.
May do physical assessments, health surveys, insurance forms preparation, health education, and intervention for patients injured in industrial accidents
Rehabilitation
Guides the patient toward health and independence

31. Career Opportunities Psychiatric Hospice
Provides care for the mentally ill patient
Requires a mature person
Hospice
Provides care for the terminally ill patient
Institution or home setting
Must have a clear understanding of his or her own feelings about death

32. Leadership and Management
The art of getting others to want to do something you are convinced should be done
Management
Handles the day-to-day operations to achieve a desired outcome

33. Leadership and Management
Leadership is important in determining the effectiveness of an undertaking
“Styles” refer to the approach or manner a leader uses to influence others
Styles relate to the amount of control or freedom the manager allows the group
Styles range from total control by the manager to extreme permissiveness

34. Leadership and Management
Autocratic Style
Retains all authority and responsibility
Concerned primarily with tasks and goal accomplishment
Assigns clearly defined tasks
Establishes one-way communication with the group
Excels in times of crisis (cardiac arrest) and in situation of disorder (natural disasters)

35. Leadership and Management
Democratic Style
People-centered approach
Allows employees more control and participation in the decision-making process
Emphasis is on team building and collaboration
Works best with mature employees who work well together as groups

36. Leadership and Management
Laissez-Faire Style
“Free-run style” or permissive leadership
Relinquishes control completely
Chooses to avoid responsibility by delegating all decision making to the group
Wants everyone to feel free to “do their own thing”
May work well with highly motivated professional groups

37. Leadership and Management
Situational Leadership
Takes into account the style of the leader, the maturity of the group, and the situation at hand to form a comprehensive approach
Four typical styles
Directing
Provides specific instructions and supervises the accomplishment of tasks
New employees, employees with repeated performance problems, and crisis work situations

38. Leadership and Management
Situational Leadership (continued)
Coaching
Monitors the accomplishment of tasks while also explaining decisions, asking for feedback or suggestions, and recognizing good performance
Typically, leader and staff have have jointly developed a work plan.

39. Leadership and Management
Situational Leadership (continued)
Supporting
Supports the efforts of others, facilitates their goal accomplishment, and shares responsibility for decision making
Values growth and not perfection, collaboration and not competition
Delegating
Gives responsibility for decision making and problem solving to mature staff who have demonstrated their competence

40. Leadership and Management
Team Leading
Assisting and guiding the nursing team in providing care for a select group of patients
Duties
Receive reports on assigned patients
Make assignments for team members
Make rounds and assess all assigned patients
Assist in administering medications and treatments
Confer with team members on priority patients

41. Leadership and Management
Time Management
Using time to good advantage will be of great value.
Learn effective time management skills, and practice them frequently until they become fully developed.
These skills will help you manage not only at work but also in daily living.

42. Leadership and Management
Anger Management
Anger gives you a cue that something is wrong.
Justified
Helps you get your needs met by stimulating you to action
Unjustified or displayed inappropriately
Can get you and others in trouble
See Box (p.1258) Personal Anger Management Techniques

43. Leadership and Management
Burnout
Physical, emotional, and spiritual exhaustion
Nurses are at high risk because they care!
Occurs more often in people who have excessively expectations of themselves
High-risk areas
Intensive care
Hospice
Oncology
Emergency department

44. Leadership and Management
Burnout (continued)
Signs and symptoms
Physical
Fatigue; changes in sleeping and eating
Lack of energy; loss of interest in sex
Psychologic
Irritability; hypersensitivity
Frustration; negative outlook
Forgetting
Spiritual
Loss of commitment, meaning, and integrity

45. Figure 41-7 Symptoms of burnout.
(From Arnold E.N., Boggs, K.U. [2003]. Interpersonal relationships: professional communication skills for nurses. [4th ed.]. Philadelphia: Saunders.)

46. Leadership and Management
Strategies for Burnout Prevention
Awareness
Balance
Choice
Detachment
Altruistic egoism
Focus
Goals
Hope
Integrity

47. Leadership and Management
Transcribing Physicians’ Orders
Written
Recorded on the chart by the physician.
NEVER GUESS: If in doubt, get a second opinion.
If it is a little different than “usual,” clarify it with the physician.
If you still believe the orders to be inappropriate, contact your supervisor and document why the orders are not being carried out.
Nurses are responsible for their own actions regardless of who told them to perform those actions.

48. Clarifying the physician’s order.
Figure 41-8
(From Leahy, J.M., Kizilay, P.E. [1998]. Foundations of nursing practice: a nursing process approach. Philadelphia: Saunders.)
Clarifying the physician’s order.

49. Leadership and Management
Transcribing Physicians’ Orders (continued)
Verbal or via telephone
They may only be taken from a physician or a nurse.
They are more subject to error.
Clarify the order by repeating it to the person giving it.
Ask them to repeat it more slowly if necessary.
Write it down immediately.
Be careful about medications that sound alike.
For example, Zantac and Xanax
P Medication Safety Alert – Precautions for Transcribing orders

50. Computerized system for narcotic distribution.
Figure 41-10
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)
Computerized system for narcotic distribution.

51. Leadership and Management
Change of Shift Report
The report provides the next shift with pertinent information about the patient.
The quality of nursing care the patient receives is contingent on how well each shift communicates with the other.
The report may be given orally in person, by audiotape recording, or with rounds from patient to patient.
Before beginning the report, write down all necessary information.

52. Giving a change-of-shift report.
Figure 41-11
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)
Giving a change-of-shift report.

53. Delegation
Refers to the act of making another person responsible for a specific task
Involves clearly communicating all aspects of the delegated care to the person completing the task
The staff member performing the care has to be able to perform tasks independently and have the ability and knowledge to complete the tasks.

54. Computers in Health Care
Technology for voice-activated charting; customized nursing careplans; assessment of acuity levels; tx/med reminders; developing clinical pathways and maps; and researching drug/food incompatibilities
Challenge: maintaining confidentiality and protect the integrity of the system