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 http://www.hansten.com

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 taught.here 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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1 Comment

Filed under classroom management, NCLEX, nursing education, Uncategorized

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

  1. Note: This has been edited. I did not change the words from Dr. Hansten but I did add the hyperlinks to the resources she lists here. Please do check these out.

    Hi Joe, and I thank you for letting folks know about our work! Our Clinical Delegation Skills is in its 4th edition (2009) and my Relationship & Results Oriented Healthcare Planning and Implementation Manual (2008) is still 1st edition (www.amazon.com or lulu.com) in which I use 10 best practices to help RNs incorporate delegation/supervision into their daily work life while focusing on patient/family preferred outcomes using the healing practices of presence.
    I have been working across the nation to help nurses see the implications of improper delegation/supervision in related to missed care in terms of patient sequelae. The stories I hear on a weekly basis are not indicative of all RNs being skilled at point-of-care leadership! It’s my goal to help resolve some of the confusion and knowledge deficit.
    BTW, check out my Making Assignments course (part 3 of 3 parts) on my Hansten Learning Center. There is a webinar, PPT slides, course handouts, videos! would be a great adjunct to your class, Joe!
    Thanks again!
    Ruth Hansten

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