Monthly Archives: December 2013

2013 in review for Nursing In Hawaii blog

Hi – did you ever wonder how many readers these things get?

The total for this blog for 2013 was 21,748 page views.  Average of 90 per day.

when you own a blog you can check the statistics day-by-day if you wish.

The statistics include such things as the most often used search terms that brought people to your site.  very entertaining.

The stats helper monkeys prepared a 2013 annual report for this blog. I am sharing it with you. I am humbled to see that it is read in 113 countries. After all, It’s a specialized topic. Thank you for reading!

Here’s an excerpt:

The concert hall at the Sydney Opera House holds 2,700 people. This blog was viewed about 33,000 times in 2013. If it were a concert at Sydney Opera House, it would take about 12 sold-out performances for that many people to see it.

Click here to see the complete report.

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How to teach delegation and the Nurse Practice Act, part 2 dec 30 2013

today’s blog is not as fancy as yesterday.

The feature of yesterday’s blog was to drive traffic to a YouTube video on delegation I made in 2011 and dug up out of the past. Alas, I don’t have another YouTube to share today.

Executive Summary:

If you teach management and leadership, and you want the students to do well on the section on NCLEX, you need to get this  book by Ruth Hansten et al. If you aren’t covering this content, your students are missing a chance to score better on NCLEX. Is that important to you? then read on!

Course outline

To teach the management skills for surviving as a staff nurse, I deliver a series of lectures and in-class exercises early on the semester. the sequence is:

1) definition of nursing according to Nurse Practice Act ( see my YouTube link above)

2) delegation. MD-to-RN; RN-to-RN; RN-to-UAP.

3) staffing systems (team, primary, functional) (usually this is straight from the textbook, but for some reason students always think this is boooorinnnnggggg – until somebody shows them it is not) and making out the actual assignment.

Note: I am a devotee of Ruth Hansten, RN, PhD of Washington state, who has written a lot of really excellent practical examples of this in her books. While researching this blog, I came across her 2011 book, Prioritization, Delegation, and Assignment: Practice Exercises for the NCLEX Examination, 3e. I confess I have not read this specific one, but I highly recommend that you check out the 29 reviews on Amazon. If you are teaching this material at a school of nursing you need to own a copy and consider adopting it. Also a copy  of her book Clinical Delegation Skills on your shelf. (1994, which is “old” but a classic).  It’s the clearest discussion of how the Nurse Practice Act translates in to clinical bedside decisions. Dr Hansten’s consultant work on delegation has informed the national dialog on this subject. Her website is

4) conflict resolution ( as inspired by the NCSBN materials on this subject, more on this in a future blog).

5) bed control and unit-to-unit coordination. ( which uses Friday Night at the ER. I will do a separate blog on this gem of a resource, later).

The overall idea is to give the neophyte nurse an idea as to the context by which care is delivered. if they have this, they think only of their own assignment and they don’t develop the predictive ability they need. If students don’t get these, they are less likely to show initiative in these issues, and the preceptor and staff will notice. workload estimation and priority setting are skills that can be learned, and this is a place where it is is the problem. Neophyte nurses can become “situationally aware.”

For each of the areas listed above,  I have an in-class hands-on exercise.

Does your school of nursing do this?

If not, they should. hate to be the know-it-all, tell-you-what-to-do-guy, but – that is who I am today.

I know I am old school, because of the fact that I was a nurse-manager for ten years, have  worked on “charge nurse development” when I was a staff development director, and also spent a lot of time dealing with “house supervision” (which I always disliked).

making out the assignment

so, the Pearl of Wisdom for today is an  in-class exercise you can use. it goes like this:

pre-prep required – write a list of  a dozen or so patient summaries such as would be used during a taped shift-to-shift report. the kind that would be done from charge nurse to charge nurse in the report room. bring blank transparencies, marker pens, and templates for writing the report as it is received.

each student gets a paper that has space for them to copy down the report as they go along.

the class begins with a lecture on types of staffing systems (team nursing, functional nursing, primary nursing) and the rationale for each. I like to do the short lecture on this the week before, and assign the reading so the students will be prepared. Also, if they are doing clinical on a ward that does report this way, to find a copy of the assignment sheet and bring it in so we can see an example of how it’s done. if their ward does nurse-to-nurse report, I tell them to ask if they can attend the charge nurse to charge nurse report for a day.

the students would have already had the content on the Nurse Practice Act as well as the content on UAP delegation.

the class is divided into smaller groups of about six. they are told that the outcome of the exercise is to produce an assignment sheet that uses the principles of delegation, the skills level of the staff, and the available personnel. this is the kind that would be posted on the unit. then I draw a diagram of the floor plan of a 12-bed unit, and  tell how much staff they have.

next is for me to give the verbal report while they copy it down. a pitfall at this step is that the reporter ought to go as fast as would be done in real life. it’s not unusual for the students to miss half the data the first time around. this is a learned skill.  It helps to have an assistant here to make sure the students are doing it – I once had a group where one guy didn’t write anything – tried to make a joke out of it. (not an acceptable work behavior).

then the students work as a group to  make out the assignment. I give them about 20 minutes. I bring blank sheets of transparencies to use on the overhead projector, and each group submits theirs.  one by one we go through the critique of how they did.

interactive discussion of the exercise

The success depends partially on how clever the teacher is. leave room for serendipitous learning. One group once made out the assignment but left off a patient – I.e., no nurses assigned to that patient for that shift (gotcha!). You can expect that one group will choose functional (task-oriented) nursing; that is acceptable (it’s not the preferred way, but it is on the palette of choices). They need to decide whether the charge RN takes an assignment or not;  One group demanded to transfer two patients to ICU, call for a float, and send out for pizza.

The critique is just as important as the choices. Invariably the question will arise as to “what is the correct answer?” – and the reply is “there is no single correct way to do this.” which is a good illustration of dealing with the ambiguity of staffing.

If you can do this exercise, it transforms a boring lecture (“here are the alternative staffing systems, here is how you do it”) into a stimulating and fun group exercise that creates a lot of discussion.

let me know how you make out…..

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How to teach delegation and the Nurse Practice Act, part 1 dec 29 2013

Delegation is important. A dry topic sometimes but important nonetheless.

important for three reasons

1) it’s on the NCLEX exam;

2) it is something nurses in hospital and longterm settings do every day; and

3) you get in trouble if you do not do it properly.

NCLEX exam re delegation.

I blogged on this before. The focus was for students and it was titled “How to increase your NCLEX score by twenty percent.” 

test map of NCLEX

The NCLEX exam is guided by a map. the map tells the NCLEX corporation how to construct the exam – so many questions on infection control, so many questions on pediatrics, so many of lab tests, etc. the map is made by the NCSBN, and you can find the map on the NCSBN website. It’s not a secret.

Alphabet soup?

If you don’t know who the NCSBN is, click here. Each state has their own Board of Nursing, but the Boards in all 50 states work together to make sure their Nurse Practice Acts are similar.  The NCSBN works to make it happen. Since 2011, NCSBN has begun producing their own videos. Here is the link to their video on the Nurse Licensure Compact.  It’s worthwhile to browse their entire site. NCSBN is not a jazzy internet site I suppose – they are a serious group pursuing legislative and regulatory goals, and their materials reflects the overall mission of protecting the public from incompetent practitioners of nursing.

What the map says

The NCSBN says, roughly, that up to 20% of the NCLEX will be on the subject of delegation and leadership.  Here is the link to the map.  I think a mistake people make in NCLEX prep is to be too medically focused, and to ignore this specific cluster of concepts. Remember – the NCLEX tests nursing, not medicine. If you don’t have a firm grasp of the difference between the two, you get confused. And yes, a nurse needs to know an awful lot about medicine, but the focus is not the same.

So – walk with me…..

Teaching the definition of nursing

The NCLEX exam was recently recalibrated, and it’s important to make sure that the test-taker prioritizes their study to match the map. I was going through my sequence of class materials on the subject of delegation, and remembered that two years ago I made a video to cover “the definition of nursing” as a prelude to discussion of delegation. it’s about twenty minutes long. I did it when I was considering relocation to the East Coast, as a sample of my lecturing style. So ignore the references to Vermont. The meat of it is still current and applicable.

please feel free to share widely.

Over the next few entries, I will post practical examples of what exactly it is that I teach to help soon-to-be-graduating students become confident about the ins and outs of delegation. I draw from  a variety of sources, and I will share those. If you want to make sure that you receive these, please look to the right, and click on the “Subscribe” button.

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