2Functioning 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.
3Functioning as a Graduate Letter of ApplicationIt 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.
4Functioning as a Graduate RésuméA summary of educational and professional experiences, including activities and honorsA one- or two-page written document that contains certain information about you, your education, and your experienceShould be well-organized, neat, and accurate
5Functioning as a Graduate Personal InterviewA meeting of people face to face, as for evaluating or questioning a job applicantFirst impressions have a lasting effect.ContractsA 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 fulfillMay be written or oral
6Functioning as a Graduate Keeping Your JobKeep 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.
7Functioning as a Graduate Keeping Your JobHelp 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 ProblemsFollow the chain of command.Be calm and positive in your approach.Listen carefully.
8Functioning as a Graduate AdvancementA rise in rank or importance, a promotion, progress, improvementMay result from additional preparation or additional experienceUsually based on a person’s qualifications, behavior, performance, and preparationTerminating EmploymentA verbal statement and letter of resignation should be completed; proper procedures should be followed.
9Welcome 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?
10Transition from Student to Graduate Know Your RoleLPN/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!
11Transition from Student to Graduate ConfidentialityAll 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.
12Transition from Student to Graduate Role of the LPN/LVN in the CommunityParticipates in activities that promote the community’s attitude toward positive health careUses community resources to promote a better understanding of the health services available to the general publicParticipates in community health projects and other health-oriented activities
13Transition from Student to Graduate Professional OrganizationsGives you a voice in your professionSome provide continuing educationTwo national organizations are designed to support and meet the needs of the LPNNational 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
14Transition from Student to Graduate Continuing EducationIt 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.InternetSome states require CEUs before you can renew nursing licenses.
15Transition from Student to Graduate Certification OpportunitiesCertificationsManaged care (CMCN)PharmacologyLong-term care (CLTC)Addiction (CALPN)Further education
16Licensure Examination National Council of State Boards of NursingThe 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.
17Licensure Examination Endorsement/ReciprocityThis 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.
18Licensure Examination Nurse Licensing Compact/Mutual RecognitionBased on the primary state of residence.A declared, fixed, permanent, and principal home for legal purposesA 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.
19Nurse Practice Act Licensing law Defines the title and regulations governing the practice of nursingAssists the nurse in staying within the legal scope of nursing practice in each stateDefines the regulations for practical nursing and includes requirements for an approved school of nursingDefines requirements for licensure and conditions for which a license may be revoked or suspendedThe document in which the role and responsibilities of the LPN/LVN are identified is the Nurse Practice Act.
20State Board of NursingBoard 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 nursingBoard issues and renews licenses.Board has the authority to suspend or revoke a license.
21Career 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.
22Figure 41-5(From Polaski, A.L., Warner, J.P. . Saunders fundamentals for nursing assistants. Philadelphia: Saunders.)Various positions are available in the hospital setting on the health care team.
23Career Opportunities Long-term Care Facilities Home Health LPN/LVN is the backbone of long-term care facilitiesCan advance to charge nurse and supervisory capacity with RN supervisionA facility for those who require long-term careHome HealthHealth care in the home settingRN supervision must be availableRelaxed atmosphere, decreased patient load, primarily daytime hours
24Career 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 personnelInsurance CompaniesPreadmission and claims assessmentsUsually require experience in medical-surgical nursing
25Career 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 OpportunitiesNurse 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.
26Career Opportunities Pharmaceutical Sales Other Medical Sales LPN/LVN makes contacts with physicians, pharmacists, and nurses in various clinical settings.Presents the advantages of productsTeaches about side effects and precautionsExperience in specific areas and an expertise in science and pharmacology are required.Other Medical SalesSell medical suppliesMay perform in-service programs at facilities to demonstrate product use
27Career Opportunities Outpatient Hotels The Military Provides patient teaching and assists with preparation for tests; available for emergenciesHotel is usually owned by a hospital.Patient/guests stay while they undergo testing before surgery and/or for postsurgical care.The MilitaryActive duty or reserves are options.Educational opportunitiesAdditional educationMay help repay loans
28Career 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 careSchoolsPerform health screenings, emergency care, and health teachingPublic HealthWork in clinics and home visits; may also participate in health inspections
29Career 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 DutyGive total care to one patientMay be in the hospital, home, other facility, or while travelingGovernmentMay work in a Veterans Administration hospital or other government hospitals
30Career Opportunities Industrial Rehabilitation Focuses on promoting wellness and preventing accidentsSafety 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 accidentsRehabilitationGuides the patient toward health and independence
31Career Opportunities Psychiatric Hospice Provides care for the mentally ill patientRequires a mature personHospiceProvides care for the terminally ill patientInstitution or home settingMust have a clear understanding of his or her own feelings about death
32Leadership and Management The art of getting others to want to do something you are convinced should be doneManagementHandles the day-to-day operations to achieve a desired outcome
33Leadership and Management Leadership is important in determining the effectiveness of an undertaking“Styles” refer to the approach or manner a leader uses to influence othersStyles relate to the amount of control or freedom the manager allows the groupStyles range from total control by the manager to extreme permissiveness
34Leadership and Management Autocratic StyleRetains all authority and responsibilityConcerned primarily with tasks and goal accomplishmentAssigns clearly defined tasksEstablishes one-way communication with the groupExcels in times of crisis (cardiac arrest) and in situation of disorder (natural disasters)
35Leadership and Management Democratic StylePeople-centered approachAllows employees more control and participation in the decision-making processEmphasis is on team building and collaborationWorks best with mature employees who work well together as groups
36Leadership and Management Laissez-Faire Style“Free-run style” or permissive leadershipRelinquishes control completelyChooses to avoid responsibility by delegating all decision making to the groupWants everyone to feel free to “do their own thing”May work well with highly motivated professional groups
37Leadership and Management Situational LeadershipTakes into account the style of the leader, the maturity of the group, and the situation at hand to form a comprehensive approachFour typical stylesDirectingProvides specific instructions and supervises the accomplishment of tasksNew employees, employees with repeated performance problems, and crisis work situations
38Leadership and Management Situational Leadership (continued)CoachingMonitors the accomplishment of tasks while also explaining decisions, asking for feedback or suggestions, and recognizing good performanceTypically, leader and staff have have jointly developed a work plan.
39Leadership and Management Situational Leadership (continued)SupportingSupports the efforts of others, facilitates their goal accomplishment, and shares responsibility for decision makingValues growth and not perfection, collaboration and not competitionDelegatingGives responsibility for decision making and problem solving to mature staff who have demonstrated their competence
40Leadership and Management Team LeadingAssisting and guiding the nursing team in providing care for a select group of patientsDutiesReceive reports on assigned patientsMake assignments for team membersMake rounds and assess all assigned patientsAssist in administering medications and treatmentsConfer with team members on priority patients
41Leadership and Management Time ManagementUsing 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.
42Leadership and Management Anger ManagementAnger gives you a cue that something is wrong.JustifiedHelps you get your needs met by stimulating you to actionUnjustified or displayed inappropriatelyCan get you and others in troubleSee Box (p.1258) Personal Anger Management Techniques
43Leadership and Management BurnoutPhysical, emotional, and spiritual exhaustionNurses are at high risk because they care!Occurs more often in people who have excessively expectations of themselvesHigh-risk areasIntensive careHospiceOncologyEmergency department
44Leadership and Management Burnout (continued)Signs and symptomsPhysicalFatigue; changes in sleeping and eatingLack of energy; loss of interest in sexPsychologicIrritability; hypersensitivityFrustration; negative outlookForgettingSpiritualLoss of commitment, meaning, and integrity
45Figure 41-7 Symptoms of burnout. (From Arnold E.N., Boggs, K.U. . Interpersonal relationships: professional communication skills for nurses. [4th ed.]. Philadelphia: Saunders.)
46Leadership and Management Strategies for Burnout PreventionAwarenessBalanceChoiceDetachmentAltruistic egoismFocusGoalsHopeIntegrity
47Leadership and Management Transcribing Physicians’ OrdersWrittenRecorded 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.
48Clarifying the physician’s order. Figure 41-8(From Leahy, J.M., Kizilay, P.E. . Foundations of nursing practice: a nursing process approach. Philadelphia: Saunders.)Clarifying the physician’s order.
49Leadership and Management Transcribing Physicians’ Orders (continued)Verbal or via telephoneThey 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 XanaxP Medication Safety Alert – Precautions for Transcribing orders
50Computerized system for narcotic distribution. Figure 41-10(From Elkin, M.K., Perry, A.G., Potter, P.A. . Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)Computerized system for narcotic distribution.
51Leadership and Management Change of Shift ReportThe 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.
52Giving a change-of-shift report. Figure 41-11(From Elkin, M.K., Perry, A.G., Potter, P.A. . Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)Giving a change-of-shift report.
53DelegationRefers to the act of making another person responsible for a specific taskInvolves clearly communicating all aspects of the delegated care to the person completing the taskThe staff member performing the care has to be able to perform tasks independently and have the ability and knowledge to complete the tasks.
54Computers 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 incompatibilitiesChallenge: maintaining confidentiality and protect the integrity of the system