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© 2008 www.AlfaroTeachSmart.com 1 Helping Nurses Make Decisions About Increased Responsibilities at the Bedside Rosalinda Alfaro - LeFevre, RN, MSN www.AlfaroTeachSmart.com.

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Presentation on theme: "© 2008 www.AlfaroTeachSmart.com 1 Helping Nurses Make Decisions About Increased Responsibilities at the Bedside Rosalinda Alfaro - LeFevre, RN, MSN www.AlfaroTeachSmart.com."— Presentation transcript:

1 © 2008 www.AlfaroTeachSmart.com 1 Helping Nurses Make Decisions About Increased Responsibilities at the Bedside Rosalinda Alfaro - LeFevre, RN, MSN www.AlfaroTeachSmart.com www.AlfaroTeachSmart.com

2 © 2008 www.AlfaroTeachSmart.com 2 WHAT’S IN YOUR HANDOUTS Power Point Clinical Decision Making Tool Mapping Contributing Factors Tool

3 © 2008 www.AlfaroTeachSmart.com 3 EXPECTED OUTCOMES 1.Discuss nurse’s increased roles related to diagnosis. 2.Address the importance of teaching how to make decisions about taking on increased responsibilities. 3.Identify strategies & tools to improve novices’ abilities to make decisions related to diagnosis and care management.

4 © 2008 www.AlfaroTeachSmart.com 4 How Literate Are You? “The illiterate of the twenty-first century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn.” (Alvin Toffler, Author of Future Shock )

5 © 2008 www.AlfaroTeachSmart.com 5 Bus is Leaving the Station & Now it’s an Airplane Will you be on it?

6 © 2008 www.AlfaroTeachSmart.com 6 Think, Pair, Share* * Developed by Professor Frank Lyman at the University of Maryland in 1981. Read more at: http://www.eazhull.org.uk/nlc/think,_pair,_share.htm

7 © 2008 www.AlfaroTeachSmart.com 7 EXPECTED OUTCOMES 1.Discuss increasing responsibilities of nurses related to diagnosis.

8 © 2008 www.AlfaroTeachSmart.com 8 Quotes From The Trenches

9 © 2008 www.AlfaroTeachSmart.com 9 The public needs to know that nurses -- regular, ordinary bedside nurses, not just nurse practitioners or advanced practice nurses -- are constantly participating in the act of medical diagnosis, prescription, and treatment and thus make a real difference in medical outcomes. Nurses can help the public understand that nursing is a package of medical, technical, caring, nursing know-how -- that nurses save lives, prevent suffering, and save money. If nurses wear not only their hearts, but also their brains on their sleeves. Perhaps the public…. will finally understand what nurses know and do.” (Gordon, 2006)

10 © 2008 www.AlfaroTeachSmart.com 10 How are you all dealing with staff “change fatigue?” Our staff is constantly bombarded with new JCAHO and other requirements. They’re already overwhelmed with work. How do you get new information to them in a timely way at a time when they can handle it? How do you get them to come to educational programs? (Listserv Posting, 2007)

11 © 2008 www.AlfaroTeachSmart.com 11 I was just asked to "investigate" the possibility of starting a RN PICC team. This team would consist of RNs on various units throughout the medical center. Our intensive care nursery just did this, but now the VP wants it to go house-wide. Any ideas, comments, and how to's would be much appreciated as this is not a specialty of mine! (Listserv Posting, 2006)

12 © 2008 www.AlfaroTeachSmart.com 12 I wouldn’t call this a PICC team and would run the other direction as fast as I could. For the past 15 years of training hospitals to place PICCs, I have seen many, many facilities try this approach and fail over and over again. First, PICC insertion is a complex process that demands an advanced body of knowledge about vascular anatomy, central venous catheter technology, and nursing care and complication management. (Listserv Posting, 2006)

13 © 2008 www.AlfaroTeachSmart.com 13 In regards to LPNs and narcotics, IVs, etc... as you know, states have varying regulations regarding the LPN roles in medication administration. Besides checking your nurse practice act for your state, you may want to log on to a great resource, at the National Council of State Boards of Nursing website (www.ncsbn.org) click on to the Business Book NCSBN Annual Meeting 2005, Section II, attachment C, Practical Nurse Scope of Practice White Paper. Good luck! (Listserv Posting, 2006)www.ncsbn.org

14 © 2008 www.AlfaroTeachSmart.com 14 WORRIED WELL & WALKING WOUNDED Many patients today are the “worried well” (people who don’t need a doctor, but think they might) and “walking wounded” (people who are living with---or recovering from-- complex injuries or chronic illnesses at home). Knowledgeable staff with highly skilled thinking, communication, and coaching abilities are cost-effective coaches who help people manage their health at home, reducing costs & improving quality of life. (Alfaro-LeFevre, 2006, p. 15)

15 © 2008 www.AlfaroTeachSmart.com 15 CRISIS IN CRITICAL THINKING Only 35% of new RN graduates, regardless of educational preparation and credentials, meet entry expectation for clinical judgment. Although well-versed in content, the majority are unable, or have considerable difficulty translating knowledge and theory into practice. (DelBueno, 2005, p 279)

16 © 2008 www.AlfaroTeachSmart.com 16 INCREASED RESPONSIBILITIES  APNs – RNs – LPNs (LVNs) – Techs  Pharmacy – Radiology – PT – Dietary  Risk Managers – QI – Infection Control  Leaders – Managers – Educators  Triage – Diagnostic Orders

17 © 2008 www.AlfaroTeachSmart.com 17 WHAT DO LAWS SAY? Unless you’re an Advanced Practice Nurse state laws prohibit you from making medical diagnoses independently. (Buppert, 2008) You are, however, accountable for giving high priority to assessing for---and reporting--- signs and symptoms that may indicate the need for attention from a professional more qualified than you are. (Alfaro-LeFevre, In Press)

18 © 2008 www.AlfaroTeachSmart.com 18 INCREASED RESPONSIBILITIES 1.Not expected to make definitive dx 2.Are expected to recognize when signs and symptoms may indicate a common problem (Diabetes, MI, CHF, Pulmonary Embolus). 3.They are the first in the chain of command and a lot of responsibility goes with this.

19 © 2008 www.AlfaroTeachSmart.com 19 EXAMPLE If the patient has signs and symptoms of an MI (chest pain--shortness of breath), you’re accountable for: suspecting that this could be the problem recognizing that it’s a high priority, doing what you can to address the problem (e.g. raise the head of the bed) reporting it immediately

20 © 2008 www.AlfaroTeachSmart.com 20 ACTIVATING THE CHAIN OF COMMAND Follow policies and procedures for getting help Be persistent---stay with the problems until the patient gets the qualified help they need.

21 © 2008 www.AlfaroTeachSmart.com 21 INCREASED RESPONSIBILITIES  Health promotion: smoking cessation, obesity management  Screening: Depression, diabetes  IV management  Outcomes management (eg. Airway management)

22 © 2008 www.AlfaroTeachSmart.com 22 DISEASE MANAGEMENT Arthritis Asthma CHF COPD Depression Diabetes Hypertension Kidney Disease Wounds

23 © 2008 www.AlfaroTeachSmart.com 23 Identifying Problems, Risks, Signs & Symptoms Requiring Independent Management Identifying Reportable Problems, Risks, Signs & Symptoms PATIENT ASSESSMENT

24 © 2008 www.AlfaroTeachSmart.com 24 OLD vs NEW THINKING Old Thinking  We must be creative  Staff must remember  Tools are crutches New Thinking  We need more evidence  Staff will forget  We ALL need tools

25 © 2008 www.AlfaroTeachSmart.com 25 CLINICAL WORKSHEET Name______________ Room_____ Age____ Religion___ Culture____ Diet____ Activity_______________ Neuro: Resp: Oxygen: Cardiac: Circ: Skin: GI: Medical Dx_____________________ Dr.____________________________ Allergies_______________________ Medications/IV’s: Potential Complications: Nursing DX/problems:

26 © 2008 www.AlfaroTeachSmart.com 26 Digoxin 0.25 mg po OD1000 CIPRO 500 mg po BID1000 2000 KCl Elixir 20 mEq po OD1000 Multivitamin po OD1000 Ambien 5 mg po hs2000 MOM 30 cc po hs2000

27 © 2008 www.AlfaroTeachSmart.com 27 QUICK PRIORITY ASSESSMENT (QPA) Start with patient “snap shot”:  Allergies – Meds – Medical Problems  Age - Height – Weight – Hydration  Risk for Infection – Injury  Breathing – Comfort – Communication  Other Relevant Specialty Data

28 © 2008 www.AlfaroTeachSmart.com 28 Interventions aimed at the person Interventions aimed at the disease CARE MANAGEMENT

29 © 2008 www.AlfaroTeachSmart.com 29 SOLUTIONS  Mentor-Preceptor-Teacher  Independent learner  Needs Assessment  Tool Development  Informatics

30 © 2008 www.AlfaroTeachSmart.com 30 Think, Pair, Share* * Developed by Professor Frank Lyman at the University of Maryland in 1981. Read more at: http://www.eazhull.org.uk/nlc/think,_pair,_share.htm

31 © 2008 www.AlfaroTeachSmart.com 31 Summary

32 © 2008 www.AlfaroTeachSmart.com 32 EXPECTED OUTCOMES 1.Discuss nurse’s increased roles related to diagnosis. 2.Address the importance of teaching how to make decisions about taking on increased responsibilities. 3.Identify strategies & tools to improve novices’ abilities to make decisions related to diagnosis and care management.

33 © 2008 www.AlfaroTeachSmart.com 33 Bibliography Alfaro-LeFevre, R. (In Press). Applying nursing process: A tool for critical thinking (7th ed.). Philadelphia: Lippincott- Williams & Wilkins Alfaro-LeFevre, R. (2008). Giving and Taking Constructive Criticism in: Critical Thinking and Clinical Judgment: A practical approach to Outcome-focused thinking, 4thed.). Philadelphia: Elsevier-Saunders Alfaro-LeFevre, R. (2008). Evidence-based Critical Thinking Indicators. Available at http://www.alfaroteachsmart.com/cti.htm http://www.alfaroteachsmart.com/cti.htm Buppert, C. (2008). The legal distinction between the practice of medicine and the practice of nursing. The Journal for Nurse Practitioners, 4(1), 22-24

34 © 2008 www.AlfaroTeachSmart.com 34 Class, P (2006) The Walking Wounded. Nursing Spectrum (FL ED), 9(21), p. 3 Henneman, E., & Roche, J. Eight ways to nurture a new student. Retrieved June 2, 2002 from http://community.nursingspectrum.com/MagazineArticles/article.cfm ?AID=5948 http://community.nursingspectrum.com/MagazineArticles/article.cfm ?AID=5948 Rich, P. Giving and receiving feedback. Retrieved 2/20/2008 from http://www.selfhelpmagazine.com/articles/growth/feedback.html http://www.selfhelpmagazine.com/articles/growth/feedback.html Walters, J. The 4-1-1 On Constructive Criticism. Retrieved 2/20/2008 from: http://www.inc.com/articles/2001/08/23257.html http://www.inc.com/articles/2001/08/23257.html

35 © 2008 www.AlfaroTeachSmart.com 35 NP Book(2006) NP Book (2006)Lippincott www.lww.com USA: 800-638-3030 CANADA: 800-223-2300

36 © 2008 www.AlfaroTeachSmart.com 36 CT Book (2008) Saunders/Elsevier USA: 800-325-4177 USA: 800-325-4177 www.us.elsevierhealth.com www.us.elsevierhealth.comwww.us.elsevierhealth.com CANADA: 866-896-3331 CANADA: 866-896-3331 www.elsevier.ca www.elsevier.cawww.elsevier.ca


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