VN 109: Professionalism VN 109: Professionalism Leadership and Supervision Leadership and Supervision LectureLecture - - Module 7Module 7

Topic I: Professional Roles and LeadershipProfessional Roles and LeadershipReferences

Foundations of Nursing, Christensen and Kokcrow4th EditionChapter 40 Pages: 1026 - 1047

Medical Surgical Nursing (An Integrated Approach)2nd Edition – Lois White and Gena DuncanChapter 36 Pages:974 - 986

Professional Roles and Leadership

Professional Roles and Leadership

TOPIC I: TOPIC I: Professionalism, Professionalism, Leadership and Leadership and

SupervisionSupervision

Functioning as a GraduateFunctioning as a Graduate Applying for a job

Identify employers who match your philosophy and needs

Call the companies and obtain the name of the nursing resources and/or human resources director

Double-check the address to be used in the application

Keep an organized list of the facilities’ addresses, contact info and phone nos.

This list should be accompanied by the info you gather during your phone call

Add the date you sent your letter of application and resume

After you send out your resume and letter of application, follow-up with a phone call to be sure they were received

Functioning as a GraduateFunctioning as a Graduate Applying for a job

Letter of application• Each letter must be

individualized for the company you are applying

• Tailor what you write to fit the organization

• Include:• Statement of interest• Statement of qualification• Statement of availability to

discuss the job

Letter of applicationLetter of application

Example from DHS (http://ladhs.org/nurse/) “Nursing care at each of our facilities is built on a long standing

tradition of providing quality patient care and public health services for nearly 10 million residents. …Our team of highly skilled and highly trained medical and nursing professionals work in collaboration with members of the health care team in achieving the best possible outcomes for our patients...”

In your letter, you can write: “I have a strong commitment to providing quality patient care”…or “I am interested in working in your organization because of your long standing tradition of providing quality patient care and public health service…”

Functioning as a GraduateFunctioning as a Graduate

Interview (see handout)

Functioning as a GraduateFunctioning as a Graduate

Membership in professional organization ANA, NCEMNA,

PNAA, NAHN

Legal Aspects of Legal Aspects of Vocational NursingVocational Nursing Nurse Practice Act - http://www.bvnpt.ca.gov/pdf/vnregs.pdf Law and regulations

Board of Vocational Nursing and Psychiatric Technicians (BVNPT)• The BVNPT regulates the education, practice and discipline of licensed

vocational nurses (LVN) and psychiatric technicians (PT). Consumer welfare is protected by ensuring that only qualified and competent persons are licensed as LVNs or PTs.

• LVNs and PTs are expected to perform within the law governing their practice. Reports of Misconduct

• The Board works diligently with consumers of healthcare, the Board's licensees and other healthcare providers or organizations to identify and address problems relating to its licensees. When reports of misconduct of licensees are received, the Board investigates harmful behavior through the disciplinary process.

• The Board ensures that the public is protected from unprofessional, incompetent and grossly negligent practitioners by investigating complaints filed against LVNs and PTs and taking disciplinary action.

Legal Aspects of Legal Aspects of Vocational NursingVocational Nursing Disciplinary Process

The following summarizes the steps leading to disciplinary action:• The Board reviews complaints to determine jurisdiction and if the alleged action violates the

law or regulations governing the licensee’s practice. • If the two conditions above are met, an investigation is initiated. • If the investigation proves that a violation occurred, the Board determines the level of

discipline warranted by the violation. • The Board may take formal or informal disciplinary action. • Formal action includes revocation or suspension of the license, placing the licensee on

probation or denying an application for licensure. • Informal action may include issuance of a citation and fine or notice of warning and/or

requiring participation in a remediation program. • If formal discipline is required, the case is transmitted to the Office of the Attorney General

(AG) which acts as the Board’s counsel. • The AG prepares a document against the licensee or applicant, called an Accusation or

Statement of Issues. • The licensee or applicant is entitled to an Administrative Hearing. • The Administrative Law Judge (ALJ) who presides over the hearing will propose a decision to

the Board. • The Board considers the proposed decision of the ALJ and renders it’s final decision.

Legal Aspects of Legal Aspects of Vocational NursingVocational Nursing Types of Violations

There are many types of violations for which an LVN or PT may be disciplined. Most involve unprofessional conduct which includes, but is not limited to:

IncompetenceIncompetence is the lack of possession of and the failure to exercise that degree of learning, skill, care and experience ordinarily possessed by a responsible licensee.

Gross NegligenceGross negligence is a substantial departure from the standard of care which, under similar circumstances, would have ordinarily been exercised by a competent licensee, and which has or could have resulted in harm to the consumer.

Conviction of Serious CrimeThe Board may take action against a licensee who was convicted of a crime substantially related to the qualifications, functions or duties of the licensee. In addition to taking action against licensees, the Board may deny issuing a license to a person with such a conviction in his/her background.

Legal Aspects of Legal Aspects of Vocational NursingVocational Nursing Rights as a Consumer of Health Care

You have the right to: Be treated by a safe and competent LVN or PT. Confidentiality and privacy during your care. File a complaint with the Board if you believe you have

received substandard care by a Board licensee. File a complaint anonymously. Contact the Board with your questions or concerns, and

receive a prompt, accurate and courteous response.

Legal Aspects of Legal Aspects of Vocational NursingVocational Nursing Rights as a Licensee

You have the right to: Know about any complaint filed against you. A thorough investigation if a complaint was filed against you. Due process of law if formal disciplinary charges are filed against your

license. Contact the Board with your questions or concerns, and to receive a

prompt, accurate and courteous answer.

Legal Accountability Extends to the Internet As delivery of healthcare changes, so do job opportunities. Healthcare sites on the Internet seek healthcare providers to give

information to consumers. As in other settings, LVNs and PTs working in an Internet environment are

dependent practitioners and cannot provide healthcare advice on the Internet without supervision.

Nurse Practice Act ExcerptNurse Practice Act Excerpt2872.2. Interim Permits.An applicant for license by examination shall submit a written application in the form

prescribed by the board.

After completion of a board accredited or approved nursing program and approval of the application, the board may issue an interim permit authorizing the applicant to practice vocational nursing pending the results of the first licensing examination.

If the applicant passes the examination, the interim permit shall remain in effect until an initial license is issued bythe board. If the applicant fails the examination, the interim permit shall terminate upon notice by certified mail, return receipt requested, or if the applicant fails to receive the notice, upon the date specified in the interim permit.

A permittee shall function under the supervision of a licensed vocational nurse or a registered nurse, who shall be present and available on the premises during the time the permittee is rendering professional services. The supervising licensed vocational nurse or registered nurse may delegate to the permittee any function taught in the permittee's basic nursing program.

An interim permittee shall not use any title or designation other than vocational nurse interim permittee or "V.N.I.P." (Added by Stats. 1986, Ch. 146 urgency effective June 10, 1986.)

Preparation for LicensurePreparation for Licensure

CAT and NCLEX - VN Application for licensure

www.bvnpt.ca.gov/pdf/method2.pdf

Preparation for LicensurePreparation for Licensure Renewal Process

Active License -- VN and PT licenses are considered "active" when the license is current (not expired or delinquent) and the 30 hours of continuing education requirements have been met.

Inactive License -- A license is placed on inactive status when the renewal fee is paid and continuing education requirements have not been met. The licensee cannot practice with an inactive license. To activate an "inactive" license, the licensee must submit proof of thirty hours of continuing education during the preceding two years.

Preparation for LicensurePreparation for Licensure Renewal Process (cont)

Renewal -- LVNs and PTs are required to renew their license every two years. Satisfactory completion of continuing education is required for an "active" license in addition to a social security number. Licensees must also certify under penalty of perjury, whether they have been convicted of a crime since they last renewed.

Renewal notices are mailed 6 weeks prior to the license expiration date. The renewal fee must be received on or before the expiration date in order for the licensee to continue to legally work.

Preparation for LicensurePreparation for Licensure Renewal Process

Delinquent Licenses -- A delinquency fee is assessed if the renewal fee is not paid within 30 days after the expiration date. A licensee may renew a delinquent license any time within 4 years of the expiration date by submitting payment of all accrued and unpaid renewal fees in addition to any fees due upon renewal of a delinquent license along with proof of continuing education, a social security number, and conviction statement. Please select this link for further information.

Expired Licenses -- A license which is not renewed for 4 years expires. An expired license cannot be renewed, re-issued or reinstated. The licensee is required to submit a new application and retake the licensure examination to receive a new license.

Preparation for LicensurePreparation for Licensure Renewal Process

Continuing Education -- After the first renewal, LVNs and PTs are required to certify under penalty of perjury, completion of 30 hours of CE within the two years immediately preceding the date of renewal. Courses must be related to the licensee's scope of practice. The licensee must retain the provider certificate for a period of 4 years and produce it if audited by the Board.

A random audit of the current active licensed population is conducted. When audited, licensees are required to submit copies of the provider certificates. Those who have misrepresented CE compliance are referred to the Enforcement Unit for disciplinary action.

Preparation for LicensurePreparation for Licensure How to obtain license in another state

Contact the State Board of Nursing in the state in which you intend to apply for licensure and request that they mail you the appropriate application packet.

Review the application requirements to be sure that you are eligible for licensure in that state.

The application packet should contain a Verification of Licensure form. Complete the personal information on the Verification of Licensure form, including your California LVN license number. If you were licensed under a different name, please be sure to indicate your previous name(s).

Attach a check or money order in the amount of $75.00 made payable to "BVNPT" and mail the Verification of Licensure form and fee to:California Board of Vocational NursingPsychiatric Technicians2535 Capitol Oaks Drive, Suite 205Sacramento, CA 95833-2945

You are advised to carefully review the requirements for each out-of-state licensing board to ensure that you meet all of the requirements for licensure in that state before applying to that state

Preparation for LicensurePreparation for Licensure How to obtain license in another state

California State-Board Constructed Examination• Many State Boards have laws that require applicants to have

passed the national examination (National Council Licensure Examination (NCLEX) or National League of Nursing State Board Test Pool Examination.)

• The Colorado and Florida nursing boards have reviewed the California State-Board Constructed Examination and deemed it to be equivalent to the national examination. The Board has been contacted by other Boards of Nursing who have expressed an interest in reviewing this examination as well.

Preparation for LicensurePreparation for Licensure Equivalency and/or Military Experience Applicants

California LVN's who obtained their initial license in California through equivalent education/experience or military methods of qualifying may not be eligible for licensure in some states. Many State Boards have laws that require applicants to have graduated from an accredited or approved nursing program to be eligible for licensure.

It is very important that you make sure that the Board of Nursing will accept your experience and/or examination method prior to submitting the Verification of Licensure form to the California Board for completion. Once the Board has processed your verification of licensure request, the $75.00 Verification of Licensure fee is non-refundable.

For FAQs, go to http://www.bvnpt.ca.gov/faq.htm

ProfessionalismProfessionalism Styles of leadership (see ATI book)

Autocratic Style – leader makes decision, most effective in emergencies, externally motivated

Democratic Style – collaborative decision-making, individuals are empowered to make decisions

Laissez-Faire Style (non directive, permissive, ultra-liberal) – hand-off approach, internal motivation

ProfessionalismProfessionalism Bureaucratic – externally motivated, does

not trust self or others, leader relies on organizational rules and policies, taking an inflexible approach

Charismatic – evokes strong feelings of commitment, forms emotional relationships with group members

Transactional – focused on day-to-day task, provides incentives to promote loyalty and performance

ProfessionalismProfessionalism Transformational – fosters creativity, risk-

taking, commitment, and collaboration• Facilitates individual independence, growth

and change, converts followers into leaders through shared values, honesty, trust, and continued learning

Connective – promotes collaboration and teamwork within organization and other organizations in the community

ProfessionalismProfessionalismShared (participatory, inclusive) –

leader assumes work force contains many leaders• Staff nurses and nurse managers share

a vision of their preferred future

ProfessionalismProfessionalism Burnout

Some known examples of physical symptoms of job burnout include

• headaches • sleep problems • gastrointestinal problems • chronic fatigue • muscle aches • high blood pressure • frequent colds • sudden weight loss or gain

ProfessionalismProfessionalism Burnout symptoms of emotional nature

include, but are not limited to, prolonged periods of • apathy • frustration • depression • anger • negative or cynical attitude • being unexcited about life • inclinations to high risk behaviors • high emotional volatility • high irritability

ProfessionalismProfessionalism Burnout

• when you see a combination of burnout symptoms, it is time to take a break and have a careful look at your life style and work habits. Especially when your life situation contains burnout threats (such as never ending excessive workload at your job) or your occupation has higher job burnout risk (for example, manager, entrepreneur, medical doctor or nurse, teacher, social worker, sales person).

ProfessionalismProfessionalism

Telephone mannersGood afternoon, good amName, name of facility How may I help you, or

direct your call

Team Leading and Team Leading and SupervisionSupervision Role of charge nurse (see handout)

Ensure that residents receive nsg care, tx, and meds per MD order

Coordinate resident’s care Assist DON with orientation Evaluate work performance of nsg assistant Assignments Receive reports Assisting MD Delegating duties

5 Rs of delegation5 Rs of delegation

Right person circumstance task supervision evaluation

Team Leading and Team Leading and SupervisionSupervision Team leader Evaluations

Career OpportunitiesCareer Opportunities LVN or Licensed Psych Tech Gateways Hospital & Mental Health Center

Job Snapshot Location: 437 N.Hoover StreetLos Angeles, CA 90004 ( Map it )

Base Pay: $17.24 - $19.04 /Hour Other Pay: $2.00 per hour charge pay; excellent employee benefits

Employee Type: Full-Time Employee Industry: Healthcare - Health Services

Not for Profit - Charitable Manages Others: No Job Type: Health Care

NurseNonprofit - Social Services

Experience: At least 2 year(s) Travel: Negligible Relocation Covered: No Posted: 6/4/2009

Contact Information Contact: Brett Morana, Psy.D. Phone: 323-644-2030x210 Ref ID: LVN/LPT-0609-SAT Fax: 323-660-6866   

Career OpportunitiesCareer OpportunitiesResponsibilities include  but are not limited to:   Administers personal care, medications, treatments, and other nursing procedures to

selected clients as authorized by Hospital policy, LPT License, and Standards of Practice.

Supervises, encourages, and teaches the client personal hygiene and dietary needs as well as medication actions and reactions.

Monitors and ensures clients take prescribed psychotropic medications and records medications accurately.

Observes and records and communicates resident and outpatient behavior and activities to treatment team including medication side effects.

Bill all applicable medication passes, consultations with psychiatrist or other clinical staff for all residents. Community Reintegration Program (CRP) only.

Document groups on medication management for both Conditional Release (CONREP) and CRP programs in a timely fashion including the billing for these programs.

Supervises and monitors client activities in main building, womens’ and mens’ cottages.

Career OpportunitiesCareer Opportunities LVN Motion Picture & Television Fund Job Snapshot Location: Woodland Hills, CA 91364 ( Map it ) Employee Type: Per Diem Industry: Healthcare - Health Services Manages Others: No Job Type: Health Care

Nurse Experience: Not Specified Relocation Covered: No Posted: 6/12/2009 Contact Information Ref ID: 32549820 Fax: 818/876-1399     instantly fax your resume >> Description Nursing The Motion Picture and Television Fund is seeking an:

LVN On-Call For our Woodland Hills location. Requires CA LVN license, current CPR and outpatient health center experience. Please apply to HR Department: Fax: 818/876-1399 E-mail: [Click Here to Email Your Resumé] equal opportunity employer www.mptvfund.jobs MOTION PICTURE & TELEVISION FUND Los Angeles Times 2009-06-12

Career OpportunitiesCareer Opportunities LVN Hospice W/E evenings Per Diem - US-CA-

Torrance Ref ID: 47779 Company: Providence Health & Services Base Pay: $17.59 - $28.22 /Hour Employee Type: Full-Time Employee Industry: Healthcare - Health Services Experience: At least 1 year(s)

Career OpportunitiesCareer Opportunities LVN (Part Time) McKinley Children's Center Job Snapshot Location: 762 Cypress Street

San Dimas, CA 91773 ( Map it ) Base Pay: $15.00 - $25.00 /Hour Other Pay: Eligible for annual merit increases, up to 4%. Employee Type: Full-Time Employee

Career OpportunitiesCareer Opportunities Sunbridge Philosophy http://www.careerbuilder.com/JobSeeker/Jobs/JobDetails.aspx?

IPath=JRKGTV&sc_cmp1=JS_JR_ViewJob&ff=21&APath=2.21.0.0.0&job_did=JB957Q70QR3LGRMFTCL

Career OpportunitiesCareer Opportunities

LVN, Full-time, benefited, Van Nuys location - View similar jobs Job type: Full-Time Employee | Pay: $17.59 - $28.22/hour ...or vocational nursing program. 2. Currently licensed as an LPN/LVN in the state of California. 3. Possesses and maintains current... Providence Health Services California CA - Torrance (4 miles)2 Weeks Ago

Career OpportunitiesCareer Opportunities Charge nurse role (see

handout)

Workplace DynamicsWorkplace Dynamics

Physician orders End-of-Shift report Interpersonal communication Identifying ways to reduce error

and communicate change process

Roles and Responsibilities Roles and Responsibilities of Vocational Nursingof Vocational Nursing Role of the VN in long term care facilities.

Skilled Nursing Facilities Sub-acute Retirement Communities Assisted Living Adult Day Care Centers Respite Care Foster Care Hospice

VN 109 Professionalism VN 109 Professionalism and Leadership and Leadership Chapter 36Chapter 36

REHABILITATION,HOME HEALTH,

LONG-TERM CARE,AND HOSPICE

Nonacute Health CareNonacute Health Care

There has been a strong emergence in the past decade of nonacute health care services.

Reasons for Growth in Reasons for Growth in Nonacute Health CareNonacute Health Care

The number of Americans over the age of 65 has tripled in this century. As individuals age, the risk increases of acquiring a chronic disease requiring health care throughout life.

Lives are being saved that would have been lost a few years ago. Ongoing health care services become necessary in such cases.

Discharge from acute-care hospitals is occurring much earlier.

Cost of acute care has reached critical proportions necessitating new forms of care management.

Clients’ and FamilyClients’ and FamilyRights in Home Care (i)Rights in Home Care (i)

To be treated with dignity, consideration, and respect.

To have their property treated with respect. To be fully informed on admission of care,

cost, and how payment will be made. To know in advance if they will be

responsible for any payment. To participate in planning care.

Clients’ and FamilyClients’ and FamilyRights in Home Care (ii)Rights in Home Care (ii) To be informed in advance of any changes in care. To receive care from professionally trained

personnel. To refuse treatment and be told of consequences

of this action. To expect confidentiality. To be informed of termination of service. To know how to make a complaint.

Clients’ & FamilyClients’ & FamilyResponsibilities in Home Responsibilities in Home Care (i)Care (i)

To remain under a doctor’s care while receiving services.

To provide the agency with a complete health history. To provide the agency with all requested insurance

and financial information. To sign the require consents and releases for

insurance billing. To participate in care by asking questions,

expressing concerns, stating whether information is understood or not.

Clients’ & FamilyClients’ & FamilyResponsibilities in Responsibilities in Home Care (ii)Home Care (ii) To provide a safe home environment in which care

is given. To cooperate with the doctor, the staff, and other

caregivers. To accept responsibility for any refusal of treatment. To abide by agency policies that restrict duties the

staff may perform. To advice agency administration of any

dissatisfaction or problems with care.

Sources of ReimbursementSources of Reimbursement

Medicare. Medicaid. Private insurance.

LicensureLicensure

A mandatory system of granting licenses according to specified standards.

Regulated by each state. Board of Vocational Nursing and

Psychiatric Technicians (BVNPT) www.bvnpt.ca.gov

CertificationCertification

A voluntary process that establishes and evaluates standards of care.

Required for any provider who seeks reimbursement from government funds.

Standards generated by the federal government.

AccreditationAccreditation

An additional confirmation of quality. Generally indicates that the provider has

gone above the minimum standards in the delivery of care and service.

RehabilitationRehabilitation

A process designed to help individuals reach their optimal level of physical, mental, and psychosocial functioning.

Interdisciplinary Health Interdisciplinary Health Care Team ProcessCare Team Process

Admission Assessment Problem identification Care Plan Conference Evaluation Reassessment

Role of the LP/VNRole of the LP/VN

Rehabilitation nursing is a specialty practice and requires specialized knowledge, skills, and attitudes.

Prerequisite is a sound knowledge base in the anatomy and physiology of the neurological, musculoskeletal, gastrointestinal, and urinary systems.

The nurse must have excellent clinical skills in areas of therapeutic positioning, exercises, transfers, ambulation, and activities of daily living.

Rehabilitation SettingsRehabilitation Settings

Hospital Inpatient Program. Skilled Nursing Facility. Outpatient Rehabilitation. Home Rehabilitation.

Home Health CareHome Health Care

Encompasses a number of services delivered to persons in their homes.

The fastest growing segment of health care delivery.

Role of LP/VN inRole of LP/VN inHome Health CareHome Health Care

Clients and their family caregivers must know: The disease process. Medications. Special skills (changing dressings,

administering of insulin, etc.). Documentation and communication (how to

keep records; when and how to contact nurse/physician/emergency services).

Long-Term CareLong-Term Care

Refers to a spectrum of services provided to individuals who have an ongoing need for health care.

Long-term care facility may be licensed for either intermediate care or skilled nursing care.

Subacute CareSubacute Care

Designed to provide services for clients who are out of the acute stage of their illnesses but who still require skilled nursing, monitoring, and ongoing treatments.

Intended to fill the gap between the acute care hospital and the traditional long-term care facility.

Continuing Care Continuing Care Retirement CommunitiesRetirement Communities

Designed to provide continuing levels of care as individual’s health care needs change.

Levels include: Independent Assisted living Health care, either short-term or

permanent.

Assisted LivingAssisted Living

A combination of housing and services for people who need help with the activities of daily living.

Nursing care is not provided.

Adult Day CareAdult Day Care

Provide a variety of services in a protective setting for adults who are unable to stay alone but who do not need 24-hour care.

Respite CareRespite Care

May be offered by adult day care centers, long-term care facilities, or in private homes.

Intended to provide a break to caregivers and may be utilized a few hours a week, for an occasional weekend, or for longer vacations.

Planned activities, meals, and supervision included.

Foster CareFoster Care

Some states are investigating the use of foster homes for individuals who cannot live independently but who do not require the services of a health care facility.

The legal structure is comparable to the foster home concept for children.

HospiceHospice

Humane, compassionate care provided to clients who can no longer benefit from curative treatment and have 6 months or less to live.

Hospice care may be implemented in the client’s home, a special area of hospitals or nursing homes, or freestanding inpatient facilities.