LPN/LVN Charge Nurse Skills: Management, Including Assignment and Delegation



LPN/LVN Charge Nurse Skills


Management, Including Assignment and Delegation



Objectives


On completing this chapter, you will be able to do the following:


1. Using your state’s Nurse Practice Act, identify the following as they apply to the charge nurse position for practical/vocational nurses:


a. Requirements before assuming the licensed practical/vocational nurse (LPN/LVN) charge nurse position


b. Site of employment


c. Scope of practice


2. Review charge nurse job descriptions.


3. Identify specific institutional policies, regulations, and routines that the practical/vocational nurse needs to clarify when assuming a charge nurse position.


4. Collect a list of data that are needed before reporting a change of condition of a resident to a physician.


5. Discuss strategies for handling the following common LPN/LVN charge nurse problems:


a. When nursing assistants bring problems from home


b. Encouraging nursing assistants to be accountable for learning skills


c. Dealing with the demanding/complaining family


6. Describe elements that need to be focused on when receiving and giving a change-of-shift report as charge nurse in the long-term care facility.


7. Discuss the assignment of tasks versus the delegation of duties with regard to the following factors:


a. Your state’s laws regarding the role of the practical/vocational nurse and the delegation of duties in the charge nurse position


b. Differences between assigning nursing tasks and delegating nursing duties


c. Legal aspects of assigning nursing tasks and delegating nursing duties


d. The following criteria that need to be considered when assigning nursing tasks and delegating nursing duties:


1. Right task


2. Right person


3. Right circumstance


4. Right direction/communication


5. Right supervision (monitoring), feedback, and evaluation


8. Using nursing process as a guide, discuss the method for assigning and delegating the following:


a. Collecting data


b. Planning


c. Implementing


d. Evaluating


e. Putting it all together


f. Reporting at the end of your shift



Key Terms




image   Keep in Mind





Tricia was always a “saver,” as her several well-constructed scrapbooks and boxes of books and papers from nursing school testified. Tricia looked at the carefully clipped classified ad she had saved from 5 years ago, when she had applied for her current nursing position. Five years ago, her husband was transferred to the neighboring state of Oz. After 3 years’ experience as an LVN in a nursing home, postgraduate courses in leadership at the local technical college, seminars, in-service programs, personal reading, and workshops, Tricia thought that she was qualified for a charge nurse position.


Tricia smiled as she pictured herself going in for the interview. That navy blue blazer sure paid off! And all her preparation for the interview served her well. What a sage Mrs. Kelly had been in Personal/Vocational Issues (PVI) class to recommend that a job applicant obtain a copy of the facility’s mission statement before the interview. Although she did not have LPN/LVN charge nurse experience, she was sure her knowledge of the facility’s emphasis on and pride in providing quality care was a big plus in landing the job. And this was in addition to the enthusiasm and positive attitude she displayed to the interviewer about her willingness to learn and her confidence that she would be able to do the job. Also, following the textbook suggestion to obtain the state of Oz’s Nurse Practice Act before employment gave her the opportunity to learn how an LPN/LVN could delegate in the state of Oz and helped her to think of some delegation-related questions to ask at the interview.


Five years had passed since she had gotten the job as LPN/LVN charge nurse. Tricia loved her job and smiled as she remembered many of the challenges she had faced early in her job as charge nurse. She began to page through that old seventh edition of her PVI textbook… .



LPN/LVN


Full-time position available for an experienced LPN/LVN to join our long-term care facility as a charge nurse on the evening shift. Must have excellent communication and customer service skills, needs to be team-oriented, and must have current state of Oz license. We offer a competitive salary and full benefits package. If you qualify, submit resume and cover letter to: cradant@email.abc or Quality Care Home, 982 Brick Lane, Wayback, OZ 00005. For more information, contact Claudette Radant, DON at 987-123-4516 (cell).


Before continuing with Tricia’s story, review the Coordinated Care, Leadership Activity: Determining Your State’s Requirements to Assume the Position of Practical/Vocational Charge Nurse box in Chapter 20.


Tricia looked at the job description the director of nurses gave her during her job interview. It all seems such a routine and comfortable part of her job, but Tricia remembers how overwhelming it was to read through the 12 areas of responsibility, along with the 15 duties of the charge nurse.



Where to begin? job description for charge nurse


Read the Coordinated Care, Management Tool: Reviewing LPN/LVN Charge Nurse Job Descriptions box. The charge nurse job description might seem overwhelming at first, but it illustrates the reason state laws require that practical/vocational charge nurses have education, training, or experience beyond the basic practical/vocational nursing curriculum and documentation of such. It is difficult to prepare health care workers in 1 year or less to be able to function in this position immediately after graduation. After additional education, training, and experience, many LPNs/LVNs become charge nurses, also called first-line managers, in long-term care units and nursing homes. They are doing an excellent job in that role. According to the 2009 practice analysis by NCSBN to gather data for content areas for the NCLEX-PN®, 45.2% of LPNs/LVNs stated they regularly had one or more administrative roles; 65.8% of those respondents worked in long-term care; and 52.8% of those with administrative roles in long-term care indicated the charge nurse position as their administrative role (NCSBN Research Brief, 2010).



Quality Care LPN/LVN Charge Nurse—Job Description


Qualifications


Licensed practical/vocational nurse with a current license to practice in the state of Oz under Chapter 747. The LPN/LVN should have a certificate of successful completion of an approved course in Medication Administration.




Responsible for




• Knowledge of residents’ conditions at all times.


• Assigning actual nursing care tasks to nursing assistants.


• Providing nursing care according to physicians’ orders and in agreement with recognized nursing techniques and procedures, established standards of care as described in Oz state statutes, and administrative policies of this long-term care facility.


• Recognizing symptoms: reporting residents’ conditions, including changes, and assisting with remedial measures for adverse developments.


• Assisting physician in diagnostic and therapeutic measures.


• Administering medications and treatments as prescribed.


• Maintaining accurate and complete records of nursing data collection and interventions, including documentation on the electronic medical record (EMR) and Kardex.


• Efficiency of execution of workload, including neatness and orderliness.


• Delegating duties, as appropriate, to nursing assistants.


• Maintaining a safe and hazard-free environment.


• Ensuring the residents’ right to privacy.


• Maintaining the dignity of residents.



Duties




• Observes and reports symptoms and conditions of residents.


• Administers medications as prescribed by physicians. Gathers data about therapeutic response and side effects of medications.


• Takes and records vital signs when appropriate.


• Maintains charts and Kardexes, including residents’ conditions and medications and treatments received.


• Notifies physician when necessary. Records phone/fax orders.


• Contacts pharmacist for prescription drugs as needed.


• Assists in maintaining a physical, social, and psychological environment for residents that is conducive to their best interests and welfare.


• Receives report at beginning of shift from personnel on previous shift and assigns tasks to nursing assistants under the LPN/LVN charge nurse’s supervision.


• Supervises, assists with, and evaluates delegated duties to nursing assistants.


• Evaluates the completion of nursing assistant assignments in a safe and timely manner.


• Provides report to oncoming shift.


• Evaluates nursing assistants in the performance of their job description and reports same to Director of Nursing.


• Attends supervisory staff meetings.


• Interprets state and federal guidelines to employees. Uses authority as LPN/LVN charge nurse to “follow code.”


• Participates in orientation of all new employees assigned to LPN/LVN charge nurse.



image   Coordinated Care


Management Tool


Reviewing LPN/LVN Charge Nurse Job Descriptions


Resources needed:



Review LPN/LVN charge nurse job descriptions of long-term care facilities at sites at which you affiliate during your student year.



How long will it take me to prepare to be a charge nurse?


You are probably thinking, “How long will it take for me to get to this point in my practical/vocational nursing career?” The answer is individual to the person asking it. The law of some states specifically dictates that the LPN/LVN charge nurse functions in a nursing home and under the direct supervision of a registered nurse. In these states the practical/vocational nurse could not function as a charge nurse in a medical clinic or an acute care facility. Also, the LPN/LVN could not function under general supervision until after passing the NCLEX-PN® examination. Be sure to check your state’s Nurse Practice Act. Some practical/vocational nursing programs offer a postgraduate course that prepares graduates for an expanded role. The answer to the question “How long will it take for me to get to this point in my practical/vocational nursing career?” depends on your state’s Nurse Practice Act, additional education, your motivation to learn the manager role, your ability to be a risk taker, and how you use your nursing experience.



How this text can help you to prepare for a future charge nurse position


This text is unable to provide you with a concise recipe of how to function in the role of charge nurse as an LPN/LVN. This chapter begins with a discussion of areas of responsibilities, problems, and concerns that affect the LPN/LVN charge nurse in a long-term care unit or nursing home. Through active learning and an interactive format, this chapter also presents 12 Management Tools. These tools involve you with the many areas that need to be considered, understood, and investigated when assuming an LPN/LVN charge nurse position. The chapter also includes 10 Management Hints that provide concise information about concepts being presented. Seven critical-thinking exercises present the opportunity to apply learning in the area of assignment and delegation.


Scenarios for three residents are interspersed throughout the nursing process guide for assigning and delegating. You will be expected to be self-directed, to problem solve, and to think critically as you apply the information in Chapter 20. These are the very attributes employers expect of you as an LPN/LVN charge nurse. References to specific resources that you will need to work through the Management Tools are provided. You are encouraged to use the information from the entire text, your other classes, and your Learning Resource Center to work through the self-directed Management Tools. Your instructor is a valuable resource. Remember, also, the usefulness of peer group discussion.


At times we will flash back to Tricia as she reminisces about her early days in the LPN/LVN charge nurse position. Her initial experiences and adjustment to the charge nurse role will show you the challenges and opportunities the LPN/LVN charge nurse role provides.


Tricia thought back to the orientation phase of her job. It seemed so overwhelming at the time. The thought of going through those thick manuals of policies, regulations, and routines was enough to give her a headache. However, they sure did contain valuable information. Mrs. Kelly gave the class the following sample checklist as a guide when reviewing these manuals.



A checklist of policies, regulations, and routines for the LPN/LVN charge nurse


Not all the areas included in this checklist are the responsibility of the LPN/LVN charge nurse in a nursing home/long-term care facility. However, LPN/LVN charge nurses need to have information for all the areas included so they can carry out their management duties. Because the LPN/LVN charge nurse has the responsibility to supervise nursing assistants, these personnel also need information about policies and routines. Orientation to your facility needs to include these items.
















Miscellaneous




See the Coordinated Care, Management Tool: Reviewing Policies and Routines box.



image   Coordinated Care


Management Tool


Reviewing Policies and Routines


Resources needed:



All policies, regulations, and routines of a health care facility are important. After reading the checklist, complete the following:



Tricia came across a data list. Mrs. Kelly had stressed the importance of the LPN/LVN’s assisting role in collecting data. Mrs. Kelly always said that what the LPN/LVN did with that data really separated the licensed nurse from unlicensed personnel. Mrs. Kelly had provided a helpful list of signs and symptoms to be aware of in various patient situations. She stressed it would not be a complete list but would be something to get us started. It had been some time since Tricia updated that list.



Collecting data as a charge nurse


As LPN/LVN charge nurse, the change-of-shift report when coming on duty provides data for dividing the work of the shift among team members. Baseline data of residents for whom you are in charge also must be obtained. This involves a quick visit of each resident to compare the status of residents to the status reported at change of shift. You will also collect data periodically during your shift. The frequency of data collecting depends on patient condition. Following is a list of signs and symptoms that may indicate illness, exacerbation of a previous disease condition, injury, or decline in prior functioning.


Be observant with each resident interaction. When nursing assistants report that “something does not seem right,” visit the resident to collect your own data. After collecting the data, record it on the proper form and report all abnormal observations according to agency policy. The actual data-collecting parameters given here are guidelines. Follow specific parameters given for the resident.



Signs and symptoms




1. Weight: Increase or decrease of 5 to 10 lb in 1 week.


2. Temperature: Elevation over 100 °F orally or 100.6 °F rectally; temperature under 96.6 °F orally.


3. Upper respiratory: Head congestion, headache, sore throat, ear pain, runny nose, postnasal drip.


4. Lower respiratory: Acute onset or worsening of shortness of breath, dyspnea with exertion, orthopnea, cough (productive or nonproductive), wheezing or other abnormal sounds on inhalation or exhalation.


5. Cardiac: Blood pressure over 135/85 (new symptom); blood pressure below 80/50; irregular pulse (new symptom); chest, neck, shoulder, or arm pain; fatigue; increased frequency of angina; shortness of breath; orthopnea; peripheral edema; sacral edema or distended neck veins.


6. Breast: Lump found on palpation, discharge from nipple.


7. Abdomen: Localized or generalized pain, especially of acute onset; epigastric burning or discomfort; constipation; diarrhea; nausea; vomiting; bloody or tarry stools; loss of appetite.


8. Musculoskeletal: Swollen and tender joints, loss of strength in limbs, pain, loss of motion, ecchymosis, edema.


9. Reproductive system: Vaginal discharge, abnormal vaginal bleeding.


10. Genitourinary: Urgency, frequency, dysuria, nocturia, hematuria, incontinence. Male: Dribbling, inability to start or stop stream.


11. Sleep and rest patterns: Changes from normal routine, requirement of medication for sleep, nightmares or dreams.


12. Appearance of skin: Changes in color, turgor, contusions, abrasions, lacerations, rashes, lesions.


13. Mobility and exercise: Need for support in ambulation, changes in posture, weakness of extremities, changes in coordination, vertigo.


14. Hygiene status:



15. Communication: Verbal, nonverbal, and affective, aphasia, level of understanding.


16. Sensory-perceptual: Ability to hear, condition of hearing aid; ability to see, condition of glasses; ability to feel in all extremities; ability to discriminate odors; ability to distinguish tastes.


17. Cultural/religious: Food preferences, wellness/illness beliefs, religious practices (e.g., rosary, prayer beads, Bible, Koran, Torah, religious readings, medals, icons, communion, clergy visits, confession, sacrament of the sick).


18. Psychological status: Level of consciousness, disorientation, intelligence, attention span, vocabulary level, interests, memory, affect.


Tricia remembered how Mrs. Kelly stressed the importance of getting to a room and personally collecting patient data, especially when there was a change of condition. Tricia found the example Mrs. Kelly gave so that members of the class could avoid the same situation.



The report that wasn’t


A nursing assistant (NA) reported to the LPN/LVN charge nurse (CN) that Mr. Jones “doesn’t look too good to me.” The charge nurse immediately called the physician.



Doctor Grimm: What seems to be the trouble?


CN to NA: What seems to be the trouble?


NA to CN: I don’t know. He just doesn’t look right.


CN to doctor: He just doesn’t look right.


Doctor: How long has he looked like this?


CN: I don’t know. We just noticed.


Doctor: What’s his temperature?


CN: Just a minute. I’ll find out.


CN to NA: Take Mr. Jones’s temperature.


Doctor: What are his other vital signs?


CN: I don’t know. The nursing assistant is going to check them.


Doctor: How much fluid has he had?


CN: Just a minute. (She puts the telephone down and goes to check Mr. Jones’s IV.)


CN: He’s getting an IV now.


Doctor (with sarcasm in his voice): Is he breathing? Never mind, don’t send anyone to check. I will be over to check him myself. (The doctor hangs up abruptly.)


CN to NA: I don’t know why he gets so upset every time I call him. What am I supposed to do?


See the Coordinated Care, Management Tool: Reporting Change of Condition to the Physician box.



image   Coordinated Care


Management Tool


Reporting Change of Condition to the Physician


Resources needed:



List the data you would collect and any other pertinent information you would gather before notifying the physician of a “change of condition” in the following residents:



Tricia began to think of the “people problems” she continually experiences in her job as LVN charge nurse. With each day that passes, handling these problems becomes easier and easier. Mrs. Kelly’s basic advice to “treat people as you would like to be treated” has saved the day on many occasions. That was good advice even for reporting change of condition to the doctor: “What information would I need if I was the physician and my patient had a change of condition?” As for dealing with doctors, residents, staff, and families, I sure remember situations that arose as clearly as if they happened yesterday.



image   Professional Pointer


Treat others as you would like to be treated



Common problems of LPN/LVN charge nurse


Tricia recalled one morning during the second week of work after orientation to the charge nurse position. The nursing assistants were all tied up in knots. The babysitter for the three young children of Margarita, one of the nursing assistants, had quit the evening before, and when Margarita got up the next morning for work, her car would not start. All the nursing assistants were talking about Margarita’s problems from the time they hung up their coats, straight through lunch and beyond. It was only the week before that Margarita found out she was overdrawn at the bank because she wrote checks before her paycheck was deposited by Quality Care Home and cleared by the bank. It seemed as though “things always happened to Margarita, and she was such a nice person. It just was not right.” All the nursing assistants were feeling bad because all these problems happened to Margarita. Everyone was involved with how to get Margarita out of her current mess. Several of the nursing assistants forgot to do some of their tasks/duties, and Margarita needed a lot of assistance to get her assignment completed. As Tricia remembered that particular time, a picture flew through her mind. It was Mrs. Kelly standing in the front of the class with a stuffed toy monkey on her back.



When nursing assistants bring problems from home


As an LPN/LVN charge nurse, it is important that you do not fall into the “monkey trap,” as described by Blanchard, Oncken, and Burrows in The One-Minute Manager Meets the Monkey (1991). You fall into the trap each time you take on a responsibility (monkey) that belongs to an employee. Once monkeys are adopted, they take a lot of time in their care and upkeep. LPN/LVN charge nurses can help nursing assistants become aware of this trap and be a role model for avoiding it.


Realize that you do not own any problems that nursing assistants experience. The nursing assistant owns the problem. Avoid feeling bad because you cannot solve the problems of team members. Be supportive and express genuine concern and empathy, but realize that you do not have a license to counsel nursing assistants. Team members need to solve their own problems. Follow facility policies when personal problems interfere with work performance. Report the situation to your supervisor. Professional counseling in the community may be necessary. See the Coordinated Care, Management Tool: When Nursing Assistants Bring Problems from Home box.



image   Coordinated Care


Management Tool


When Nursing Assistants Bring Problems from Home


Resources needed:



Pretend you are the LPN/LVN charge nurse the morning Margarita comes to work with her problems. Identify a way to handle the situation.


Tricia remembered Betty, a nursing assistant who had been employed at Quality Care Home for 6 months when she told Kay, a nursing assistant on her wing, that she did not know how to use the new patient-lifting device. Kay stated she did not really have time, but Betty coaxed her to take the time to get the resident out of bed for her. Tricia had suggested to Kay a way of handling the situation that she had learned in PV class—a tip that would help Betty be more accountable.



Encouraging personal responsibility in nursing assistants


When nursing assistants cannot do something that is in their job description—for example, transferring a resident by a lifting device—it is their problem. Staff persons need to avoid assuming it is a staff problem. Be sure to follow the policy of the facility. For safety reasons, encourage nursing assistants to report to the charge nurse when they are having problems carrying out their assignment. This gives the charge nurse the opportunity to determine what staff member is skilled and available to assist in the situation. Encourage the nursing assistant to offer suggestions for learning to do the part of their job that they do not know how to do. Praise them for coming up with a plan, and add to the plan, if necessary. Write a note to your supervisor explaining the situation objectively and how you proceeded to remedy the situation. If necessary, request additional training for the nursing assistant. Learning who owns problems will help you control a large part of the stress you experience as an LPN/LVN charge nurse and help ensure the safety of resident care. See the Coordinated Care, Management Tool: Encouraging Nursing Assistants to Be Accountable for Learning Skills box.



image   Coordinated Care


Management Tool


Encouraging Nursing Assistants to Be Accountable for Learning Skills


Resources needed:



Develop a plan to encourage Betty to approach the lifting-device situation in a more accountable manner.


Tricia remembered instances in her student days and throughout her career when families had complained about care given to their relatives. These complaints troubled Tricia, who had high standards and prided herself on the quality of her nursing care. She would take the complaints seriously and investigate each criticism thoroughly. Sometimes nothing could be found out of order, and sometimes she began doubting her ability to self-evaluate. Once again, Mrs. Kelly offered insight into this common problem, which Tricia still uses today.



Dealing with demanding/complaining families


A common problem in the nursing home is dealing with complaints of family members regarding care of their relatives. A common complaint involves physical care. Sometimes the family members become verbally aggressive, express concerns in an angry manner, and are very critical of the charge nurse. Others will be nonassertive and sarcastic. Remember the problem-solving process. First, collect data to determine the real problem. If there is a problem with physical care, identify and correct it. Sometimes when the problem is identified and solved, the complaints continue. Sometimes when no problem with physical care is identified, the family may continue the attack.


It is necessary to consider the situation in which the family finds itself. They are in a position of seeing their loved one progressively aging and decompensating. This is a time of loss for the family. They may feel guilty about placing a relative in a long-term care facility or about not being able to continue caregiving. They may have grieving issues to contend with. Lashing out may be their attempt at relief. To avoid personal issues, family members may unconsciously project blame onto nursing assistants and other members of the nursing staff. It is similar to looking at skeletons in other people’s closets so you do not have to look at those in your own closet. This behavior may make a family feel better. It is important for staff to understand these issues to avoid hurt feelings. Avoid personalizing the situation. Suggested interventions to deal with the demanding or complaining family are included in the Coordinated Care, Management Tool: Interventions to Use for the Demanding/Complaining Family box. When family complaints surface, investigate them, but remember to keep broad shoulders. The exercise in the Critical Thinking: Dealing with the Demanding/Complaining Family box can help you to practice dealing with the demanding and complaining family.



image   Coordinated Care


Management Tool


Interventions to Use for the Demanding/Complaining Family


See Bauer and Hill’s book Mental Health Nursing (2000) for interventions for additional specific behaviors.



• Develop a sincere, nonpunitive relationship with the resident’s family.


• Encourage the family to ventilate feelings about the resident’s placement in a nursing home, aging, and behavior.


• Try to identify the unconscious issue and address it.


• Determine the needs the family is trying to fulfill through their demands, criticism, and complaints.


• Spend time with the family when demands or complaints are not being made.


• Establish rapport with the family to provide emotional support during this difficult time.


• Explain the resident’s disease and expected behavior.


• Suggest joining a support group. These groups offer explanations for specific diseases, as well as a place to share feelings and frustrations.


• Encourage the family to stay involved with the resident and continue caregiving and visiting.

Related posts:

  1. Critical Thinking: A Lifelong Journey
  2. Time Management: Making Time Work for You
  3. The NCLEX-PN® Examination
  4. Cultural Uniqueness, Sensitivity, and Competence

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Mar 1, 2017 | Posted by in NURSING | Comments Off on LPN/LVN Charge Nurse Skills: Management, Including Assignment and Delegation

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