Tag Archives: delegation in nursing

to teach delegation part 4 – getting “street smart” Jan 3 2014

note: be sure to click on the hyperlinks, the highlighted text. A prize awaits….

Street Smart is the goal.

My favorite definitions of Street Smart are to be found on Urban Dictionary. warning: adult language and content at times, but funny. Possibility of not politically correct. Street Smart is always contrasted with “Book Smart”

Delegation is key to NCLEX success

To teach delegation is to teach “Street Smart” skills, only they never call it that.  This series is to share with faculty colleagues my views on how to teach delegation skills.  In a final-semester-before-graduation course, sometimes the curriculum will mash together content from “Issues and Trends”  “Career Development” and “Leadership and Management” – this is a widely disparate clump of content. Add this to the idea that the students may be having “senioritis” during the second half of the semester.  Finally, students often need to be convinced that the course is relevant – they want something like ACLS or PALS or more pharmacology.

In one of the earlier blogs in this series I gave the rationale for all this emphasis on delegation, but it bears repeating.

read this carefully:

Every Nurse Practice Act includes rules of delegation which are based on the definition of nursing.

The NCLEX content is not solely determined by NCLEX corporation. it is dictated by NCSBN, which uses a sophisticated process to determine the “test plan”

NCSBN test plan says that 20% or more of the exam will be on – delegation.

NCSBN defines delegation and also publishes their own documents to support their definition. Working with Others is the main one. Every nursing students needs this!

therefore,

it makes sense to devote time in nursing school to the specific materials from NCSBN. This is not rocket science.

If your class work on “legal & ethical issues” focuses only on  such things as how not to get sued, or defining “beneficence” or “utilitarianism” – you are wasting your students’ time.  You need to focus on what the rules say.

As an aside, I think one reason that faculty go astray is that few of the nurses who actually managing a ward want to  become faculty members. they are paid too well doing what they do!

and now for today’s Pearl of Wisdom

first, as the NCSBN monograph says: The key to effective delegation is to have assertive interpersonal skills in conflict resolution. So – don’t just teach this by lecture or directed reading. Find ways to make up exercises for the students to role play.

second, when a student is new, they just focus on their own assignment, and the goal here is to develop the skills to analyze how the assignments of all the nurses mesh with each other. Predicting not just what will happen with your patient, but predicting how many nurses will be needed by the unit overall. Figuring out how to work together as a team, how to help each other.

Too often this is taught by just assigning  the student to multiple patients, and watching them flounder around – “sink or swim.”  I guess some students will only start to pay attention when they see that they are not as good as they think they are – but a better way is to teach all the stuff I am listing here.

Friday Night at the E.R.

all this leads me to the subject of today’s blog. Friday Night at the E.R. is a resource for nursing students, and I think every nursing student should play it, especially if they are thinking of a hospital career. I see that for January 2014 the company that makes and sells it, has upgraded the game board a bit to make it easier to play.

An Excellent Simulation Learning exercise

we tend to define simulation learning narrowly these days, as if it can only be done with a high-fidelity manikin and a room with a two-way mirror. That is an artificial constraint IMHO.

FNER was developed as an interactive game to teach teamwork and decisionmaking, not necessarily limited to nurses. It is used by people interested in Organizational Development. It is a board game with a gazillion small parts. It’s expensive but worth it IMHO. It does have complicated directions and requires a facilitator who knows what it is about. (the company has a policy of only selling it to people or agencies that have a registered facilitator.) if you are going to use it, you need to carefully manage the logistics of it – for example, if you have a class of thirty students you need eight game boards. for a class of sixty you may need to have half the group do it one week, the other half the next. You need to schedule extra time – it can not be done in just three hours – the debriefing is as important as the game itself. Simply critical to debrief.

The most important thing about this simulation game, is that the students learns things about their own problemsolving, which is a reason why the makers of the game are a bit vague about the exact conduct of it. I went to YouTube to see if there was anything there that might entice you to seek further information.  I found a gem in which the professor seems to be trying to teach the students “the right way” to do it prior to playing – the exact opposite of it’s intended lesson. And better yet – it’s in French!

If you buy the game, you do get a DVD that tells a lot more. The idea behind that strategy is to allow the students to discover certain things for themselves and not over-teach.

Achieving Street Smarts?

When I have done the Friday Night at the ER  exercise with students, they come back to class after a week or two and tell me that up until then they did not know what the manager of their unit, or the house supervisor, actually did during a work day. “Didn’t have a clue” they say.

But now their eyes are opened and they see their own role as part of the larger team.  They are more focused on admission/transfer/discharge. They have a better sense of their own “agency” – ability to shape their destiny. They are more able to describe the parameters of problemsolving. all kinds of good stuff like that.

I would love to hear from others who have used this…..

Advertisements

3 Comments

Filed under NCLEX, Nurses Brain, nursing education, Uncategorized

teaching delegation and the Nurse Practice Act, part 3 Jan 1 2014

Third in a series.

Background: How did I get involved with the topic of delegation?

Yes folks, I have fifteen years of critical care nursing  experience, and I am a former ACLS Instructor and ACLS Regional Faculty. I love those subjects, they are exciting and fun.

By contrast, delegation is boring, a sort of grind-it-out, eat-your-spinach-and-take-your-medicine area of nursing.  At least, up until the time you get in trouble with it somehow.

In 2002 I took a faculty job at a school of nursing on the east coast where they were having a low pass rate on the NCLEX exam for first-time takers. At the time of hire I was tasked with re-evaluating course content for the leadership and management class I would teach, to strengthen the NCLEX first-time takers pass rate. (I detest the idea of using in-class time to do review questions.)  After researching this, I found the resources I list here in these blog entries. And by the way, that school on the east coast had a timely and gratifying increase in our pass rates once we gave proper attention to this material.

The first part of the this series dealt with a way to conceptualize the definition of nursing in a way that makes “delegation” easy to understand, using a short YouTube video;

The second part dealt with how a teacher can use certain in-class simulation exercises to show a practical way that nurses implement the Nurse Practice Act every day at work. Summary: give them a list of patients on an imaginary ward and have them make out the nurse’s assignment. then discuss and critique. this takes the content beyond a dry lecture about styles of ward organization. In that blog I recommended the resources from Ruth Hansten, RN PhD, especially her YouTube videos.

Today – the third part of the puzzle. Working With Others from the NCSBN.  This is a 40-page FREE publication of NCSBN that goes into the subject of delegation-  in detail. Originally published in 1998 and updated in 2005.

The next piece from NCSBN is one I recommend highly. it is a package. First a video“Delegating Effectively: Working Through and With Assistive Personnel,” and also a set of overheads. It costs $299. If you click on the hyperlink with the title above, you can see the video broken into five-minute clips on the www.learningext.com website. Now I hate to criticize, but the video(s)  are not the most exciting ever. It’s the accompanying overhead package that is valuable. I used to omit presenting the video and go straight to the overheads.

I always preface it with the following disclaimer:

“This is not the most exciting. in fact, it is as boring as things get. BUT, the material comes straight from the NCSBN, and they are the ones who dictate the content on the NCLEX exam. It says in the exam map that 20% or more of the content of NCLEX is “delegation.” If you wanted to do well on the exam, doesn’t it make sense to go to NCSBN, find out what teaching materials they have provided, and then incorporate those exact teaching materials into this curriculum?”

Usually that short speech creates student buy-in.

ROLE PLAY ROLE PLAY ROLE PLAY ROLE PLAY ROLE PLAY ROLE PLAY ROLE PLAY ROLE PLAY ROLE PLAY ROLE PLAY ROLE PLAY ROLE PLAY

In the Working With Others paper, there is a section on interpersonal skills, in which the point is made that “the best set of delegation rules will not be effective if the RN lacks the interpersonal and conflict-resolution skills to carry them out.” (sic).   and so the Working With Others paper has a lot of emphasis on communication and interpersonal skills. This is excellent, very practical. In the package with the overheads and video, you will find a set of seven suggested role play exercises dealing with conflict arising out of delegation. These are pure gold. I always use them. they provide excellent fodder for in-class discussion of delegation.

Cultural comfort with perceived aggressive behavior?

As a complete aside, while in Hawaii I volunteer as a guest lecturer for NAMI and friends, a group in Waipahu that works with newly arrived immigrants from the Philippines who attended nursing school there and now wish to prepare for the USA NCLEX. I always provide this content for that group. When I do the role-plays with recent immigrants in the class, they invariably have difficulty showing assertive behavior. There seems to me to be a cultural component in the reluctance to deal with conflict.  this is in sharp contrast with the more-acculturated students of Asian descent who are educated here in USA.

There are also generational implications for this. If the RN is fresh out of school, they may be in a situation where everybody they supervise is older than they are. but that is subject for another blog entirely…..

I have one more entry in this series. why not subscribe to this blog and be sure you won’t miss it?

 

1 Comment

Filed under foreign nurses in USA, NCLEX, nursing education, Nursing in Hawaii

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.

1 Comment

Filed under NCLEX, nursing education

how to boost your NCLEX score by twenty per cent

NCLEX fever

This blog entry goes out to all those persons who are now studying for NCLEX.  Congratulations on completing your basic nursing education. Why not treat yourself to a great beach read, and buy my book about nursing in Nepal?  the book itself won’t help you with NCLEX but it will get you to think about something else for a while….

NCLEX secrets

I confess that I get annoyed when I see people studying for NCLEX by reviewing page after page of question in some popular NCLEX books. I wonder whether you achieve a greater comprehension of the underlying material that way. I always compare this method to that of doing crossword puzzles. it keeps your mind busy – but will you be a better nurse? the nursing process is not a collection of sound bites or factoids.

your school wants you to succeed

every nursing school keeps track of the first-time test taker pass rates, and there are mechanisms in place to make sure that they are preparing you for what you will need to know. One question that students do not often ask is, how does NCLEX decide what to put on the exam in the first place?  the answer: NCSBN tells them.

Alphabet soup NCLEX and NCSBN

NCSBN is the National Council of State Boards of Nursing, and if you go to their website, you can read the test blueprint for the NCLEX exam. NCSBN periodically surveys nurses, schools and hospitals around the country, to gather info as to what “any prudent nurse” might be expected to know, and uses this to adjust exam content accordingly.

A 65% pass rate is also a 35% fail rate

A few years back I taught at a school of nursing that was deeply concerned about the pass rate of the class they had just graduated. When a student does not do well on the exam, their focus is on what they did; but from a school perspective,  nobody wants to get calls from angry parents, the Board of Nursing,  or the college’s Board of Governors about the pass rate. When this group of seniors did so poorly it led the school to organize lots of work to revise things and look at what to do.

my own two cents – delegation

I joined that school right after the exam debacle, and I was to teach the leadership and management class. ( I have ten years of hospital middle-management experience.) I did some specific research, and analyzed the existing class syllabus to see what emphasis was being taught. I concluded that we could benefit from beefing up the content on the subject of – delegation.

history of delegation content on NCLEX exam

It turns out that in the mid-nineties, feedback to NCSBN was that new graduates needed to be strong on delegation skills, and NCSBN asked for a higher percentage of the exam to be devoted to this subject area.

three questions

a) if you knew that up to twenty per cent of the NCLEX could be devoted to delegation, wouldn’ t you want to study it more?

b) if you knew that NCSBN did a specific fortyone-page paper on the ins and outs of delegation, wouldn’t you want to know what was in it?

and

c) if NCSBN developed a teaching program on delegation, wouldn’t you want to study that? These are the same folks who said that delegation is an issue, after all. )

My answer to all three was yes. Most textbooks of nursing management cover delegation, but they tend to limit it to four or five pages; my advice is to find the source document from NCSBN and to download the whole thing ( it’s free). Study it from there.

how is your assertiveness skill today?

One of the best and most cogent points made by NCSBN in their paper is that the best rule making related to delegation ( having the best rules in place) is not helpful unless the nurses who are supposed to use the rules for patient care also possess the interpersonal skills to deal with conflict resolution and problemsolving. A surprising amount of the forty-one pages is devoted to ways to communicate effectively in situations where a licensed person is directing unlicensed personnel. The rules are designed to support the RN but if the RN does not assert themselves it’s a problem. Being assertive is not the same as sparking a confrontation. ( see note below – Thanks JPA!) nurses are sometimes so afraid of confrontationthat they won’t speak up even when warranted.

NCSBN even gives you role play scenarios to use in class when you teach this.

final words

in the previous blog entry I wrote about summer internships and being a good follower.  the paper on interpersonal skills applies to you right now as a student nurse and if you communicate effectively you will stand out from the crowd. start reviewing it now and you will be that much further ahead.

3 Comments

Filed under NCLEX, nursing education, Uncategorized