1. Caring for Older Adults Holistically, 4th Edition Chapter Eleven The Management Role of the Licensed Practical/Vocational Nurse

2. Caring for Older Adults Holistically, 4th Edition Management Roles  Management role of LPNs changes constantly  Work of LPN always involves leadership skills  Always clarify the scope of responsibility and role expected to be fulfilled

3. Caring for Older Adults Holistically, 4th Edition Management Styles  Everyone has a personal management style  Determine an effective but flexible leadership style  Authoritarian  High concern for tasks done  Low concern for the people who perform those tasks  Make all decisions in work place

4. Caring for Older Adults Holistically, 4th Edition Management Styles  Authoritarian  Does not allow for creative thinking or new ideas  This management style is good in emergency situations  Permissive or laissez-faire  Exact opposite of the authoritarian style  Consists of an absence of leadership  Does not require employee accountability

5. Caring for Older Adults Holistically, 4th Edition Management Styles  Democratic or participative  Strong valuing of the people on the team  Gathers information from other team members  Identifies individual responsibilities  Takes more time than other management styles

6. Caring for Older Adults Holistically, 4th Edition Communication  Important skill for a manager  Verbal communication  Change of ideas and understanding through spoken words  Nonverbal communication  Ability to share messages without using words  Body posture, facial and hand expressions

7. Caring for Older Adults Holistically, 4th Edition Communication  Communicating with clients  Normal aging changes that affect communication  Slower speech, presbycusis, presbyopia, slower responses  Successful communication with older adults must be based on respect for them as people

8. Caring for Older Adults Holistically, 4th Edition Communication  Communicating with clients (cont.)  Strategies  Do not approach the person from the side  Place yourself on eye level  Reach out and touch the person if appropriate  Speak at a normal rate  Choose setting without disturbing or distracting noises

9. Caring for Older Adults Holistically, 4th Edition Communication  Strategies (cont.)  Repeat questions or comments  Listen carefully  Communicating with the families  Recognize the emotional environment of the family  Listen to them before you begin providing information  Spend time with family members

10. Caring for Older Adults Holistically, 4th Edition Communication  Communicating with the families (cont.)  Find a quiet place to talk  Facilitate the sharing of information from other health-care providers  Families are as important as the person

11. Caring for Older Adults Holistically, 4th Edition Communication  Interdisciplinary team communication  Important to have effective communication between team members  Be prepared to discuss information with team  Be ready to justify your concerns or requests  Nurse is patient advocate

12. Caring for Older Adults Holistically, 4th Edition Additional Communication Skills  Assertive communication skills  Assertive behavior is the most effective response  Assertive response must not violate the rights of another person  Use statements “I feel,” “When you,” “We should”

13. Caring for Older Adults Holistically, 4th Edition Additional Communication Skills  Active listening  Requires listening to what is being said  Do not prepare a defense  Show support for other person’s feelings  Clarify the problem and negotiate a solution

14. Caring for Older Adults Holistically, 4th Edition Planning Hoop  Planning process never ends  Planning is an intelligent process of thinking based on facts and information  Plan must always be re-evaluated  Planning process consists of assessment, goal setting, implementation, evaluation

15. Caring for Older Adults Holistically, 4th Edition Planning Hoop  Assessment  Identify problem or potential problem that concerns you  Determine what knowledge is lacking  Goal setting  Preparing a plan to resolve a management problem  Goals should be meaningful and carefully thought out

16. Caring for Older Adults Holistically, 4th Edition Planning Hoop  Implementation  Performance of plan  Evaluation  Plan must be evaluated for its effectiveness  Crisis management  Occurs when manager does not take the time to plan

17. Caring for Older Adults Holistically, 4th Edition Priority Setting  Priority is determined after assessment of the situation  Need to think of the entire organization when determining priorities  Two categories  Concerns that relate to patient or resident care  Concerns that relate to the process of running the business of the institution  Concerns need to be listed as a need or a want

18. Caring for Older Adults Holistically, 4th Edition Managing Personnel  Nurse manager is responsible for hiring and evaluating employees  Interview  Exchange of information  Determine applicants  Dependability, skills, willingness to assume responsibilities, adaptability, willingness and ability to work with others

19. Caring for Older Adults Holistically, 4th Edition Managing Personnel  Interview (cont.)  Be specific and direct in your comments  Develop interview guide  Employee evaluation  All organizations have an established process for evaluating employees  First evaluation may come at 3 months, 6 months, or 12 months

20. Caring for Older Adults Holistically, 4th Edition Managing Personnel  Employee evaluation (cont.)  Based on the five basic assumptions  Assist employee to improve the management of the workload  Employee appraisal is a difficult process  No one likes the current form; a perfect form does not exist  Information must be gathered on day-to-day basis  Appraisal made by supervisor

21. Caring for Older Adults Holistically, 4th Edition Managing Personnel  Employee evaluation (cont.)  Should avoid  Leniency error  Recency error  Halo error  Evaluation process is critical to the growth and stability of the organization

22. Caring for Older Adults Holistically, 4th Edition Making Care Assignments  Making effective assignments is critical to any clinical area  Successful care assignments match the worker with the older person in a manner that allows for the best nursing care to be administered and received  When making assignments, consider skills of employees

23. Caring for Older Adults Holistically, 4th Edition Making Care Assignments  Use Benner’s From Novice to Expert theory to assess CNAs’ skills  Novice  Advanced beginner  Competent  Proficient  Expert

24. Caring for Older Adults Holistically, 4th Edition Making Care Assignments  The novice CNA also should be assigned to an expert CNA who can assist with care when needed  Expert CNAs should be assigned to the most challenging older adults  More effective to assign the same employee to an older person for several days in succession

25. Caring for Older Adults Holistically, 4th Edition Making Care Assignments  Delegation  Goal is to delegate tasks while maintaining quality patient and resident care  Familiarize yourself with the Nurse Practice Act for the state where you work  Become familiar with the policy and procedures and job descriptions for your facility

26. Caring for Older Adults Holistically, 4th Edition Making Care Assignments Making Care Assignments  Delegation (cont.)  Five rights of delegation  Right task  Right circumstance  Right person  Right direction  Right supervision  Delegate routine work that can be done by someone else

27. Caring for Older Adults Holistically, 4th Edition Making Care Assignments  Providing education to employees  Assist with continuing education of employees  Assist with increasing and maintaining the skills of the employee  Provide adequate orientation to new employees  Provide mentoring program for new employees

28. Caring for Older Adults Holistically, 4th Edition Managing Quality of Care  Joint Commission on Accreditation of Hospitals (JCAH)  American Nurses Association  National League of Nursing  Total Quality Management (TQM)