1. Building Nursing Management Skills
Chapter 11
Building Nursing Management Skills

2. Nursing Management Skills
Analyze effective communication as it relates to patient safety
Discuss TeamSTEPPS Tools as an evidenced-based teamwork system to optimize patient outcomes
Identify current methods of transcribing physician’s orders
Utilize a standardized handoff communication tool (SBAR) for receiving and giving change of shift report
The bullets are larger in this chapter, but I do not know how to change the size of them.

3. Communication and Patient Safety
Communication failures are leading cause of preventable patient deaths
To increase patient outcomes―integration of teamwork skills is imperative for nursing practice
Development of an evidenced-based teamwork system
TeamSTEPPS

4. TeamSTEPPS
Team Strategies and Tools to Enhance Performance and Patient Safety
Goals
Reduce clinical errors
Improve patient outcomes
Improve process outcomes
Improve patient satisfaction
Increase staff satisfaction
Reduce malpractice claims

5. The baby was delivered, the cord clamped and cut and handed to the pediatrician, who breathed and cried immediately. Exam of genitalia reveals that he is circus sized. The skin was moist and dry. She stated that she had been constipated for most of her life until 1989 when she got a divorce. The patient lives at home with his mother, father, and pet turtle, who is presently enrolled in day care three times a week. Bleeding started in the rectal area and continued all the way to Los Angeles

6. Both breasts are equal and reactive to light and accommodation
Both breasts are equal and reactive to light and accommodation. She is numb from her toes down. While in the emergency room, she was examined, X-rated and sent home. The lab test indicated abnormal lover function. Occasional, constant, infrequent headaches. Examination reveals a well-developed male lying in bed with his family in no distress. Patient was alert and unresponsive. When she fainted, her eyes rolled around the room

7. How Can I Improve Patient Safety In My Verbal Communication?
Order is communicated verbally
Order is written down verbatim
Written order is read directly back to the person who gave it for confirmation that it is accurate
Read back and repeat all written orders to verify accuracy

8. How Can I Improve Written Communication for Patient Safety?
Legibility is key
Avoid the trailing “0” when referring to numbers
Avoid unapproved abbreviations
Provide written and verbal information to the patient in their native language to avoid cultural variances

9. ACTUAL DR. ORDER

10. Transcribing Written Orders
All orders must include the patient’s identifying information, and the current date and time
Make sure the order is implemented correctly
Must be clearly understood and legible
If discrepancy noted, contact physician for clarification

11. Transcribing Written Orders (cont’d)
Read all of the orders
Determine if all request forms (laboratory, medication, diagnostic test) and/or phone calls have been initiated
Review Kardex/Medex for order entries
Follow institution policy for rechecking orders and signing off

12. Transcribing Written Orders (cont’d)
Types of Written Orders
One-Time-Only
PRN
Standing
STAT

13. Communicating When It Is Critical – What Do I Do?
Critical Client Tests
Includes critical high/low laboratory and diagnostic values
Notify physician of critical test result and document results of conversation
If physician cannot be contacted – initiate the chain of command policy at your institution

14. Communicating When It Is Critical – What Do I Do? (cont’d)
Critical Hand-off Communication
Implementation of a communication tool to reinforces the clinician’s responsibility to provide accurate information and safe patient care
SBAR
S – Situation: What is happening at the present time?
B – Background: What are the circumstances leading up to this situation?
A – Assessment: What do I think the problem is?
R – Recommendation: What should we do to correct the problem?

16. Change of Shift Report So much to say…So little time
Critical components to include in shift report:
Patient Identifiers (typically name and date of birth)
Diagnoses
Physician on the case
Pertinent medical/social history
Current physical condition (review of systems)
Resuscitation status (no resuscitation, full resuscitation)
Nutritional status (nutritional intake, NPO, supplements)
Pending or critical issues and tests

17. Change of Shift Report So much to say…So little time (cont’d)
Bedside Report
Allows both caregivers to examine patient
Offers the patient and family to meet the on-coming caregiver and keeps them involved in the plan of care

18. How Can I Deal With All the Interruptions?
Remain focused on the task at hand
Spend a few minutes with no interruptions to gather your thoughts on what is happening and what needs to happen next
Take a deep breath and relax…will allow for more productive use of time

19. What Skills Do I Need to Use the Telephone Effectively?
Say who you are right away
Do not apologize for phoning
State your business briefly but completely
Ask for specific orders when appropriate
If you want the doctor to assess the patient, say so
If the doctor is coming, ask when to expect him or her
If you get cut off, call back
Document attempts to reach a doctor
If a doctor is rude or abusive, tell him or her so
If you cannot reach a doctor or get what you need, always tell your manager

20. Managing Time In the Clinical Setting
Get organized before the change of shift report
Develop a flow sheet to write down information you need to coordinate care for your patients
Prioritize your care
Remember Maslow’s Hierarchy of Needs
Use the ABCD System

21. Managing Time In the Clinical Setting (cont’d)
Organize your work by patient
Multitask to accomplish several objectives in one visit to the patient’s room
Managing others
Use assertive communication techniques
Delegate tasks to other assistive personnel

22. What About Delegating and Time Management?
Have an understanding of the delegation rules and regulations of your state’s nursing practice act
Delegate stable patients with a predictable progress first
Delegate tasks such as feeding, bathing and dressing to unlicensed assistive personnel
Patient teaching and discharge planning ― Responsibility of the RN

23. Criteria For Supervising Others
Directions with clear expectations of how the task is to be performed
Assure the tasks is being performed according to standards of practice
Monitor the task being performed, intervene if necessary
Evaluate the status of the patient
Evaluate the performance of the task
Provide feedback as necessary
Reassess the plan of care and modify as needed