Delegation Skills for the Novice to the Expert Nurse

Today I’ll be talking about Delegation as a nurse and this information helps in other professions and situations where delegation is needed. Some of the information I’ll be talking about comes from an article titled Developing Delegation skills by Alice Weydt RN MS found from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol152010/No2May2010/Delegation-Skills.html.

I’ll be going over the following 1) What is delegation 2) Pros and Cons of Delegation 3) Helpful tips to becoming a better delegator.

What does delegation mean? Delegation is a complex process in professional practice requiring sophisticated clinical judgement and final accountability for patients’ care.  

According to the ANA Code of Ethics, The RN uses critical thinking and professional judgment when following The Five Rights of Delegation: 1. Right task 2. Right circumstances 3. Right person 4. Right directions and communication 5. Right supervision and evaluation.

Pros/Cons to delegation can be numerous here are just a few:

Pros: Delegation is important because this allows the nurse to be more effective and saves on time for other nursing tasks. Effective delegation allows the rest of the unit to run more efficiently.

Cons: Delegation can have its challenges if the tasks are assigned to the wrong person the outcome can be unsafe for the patient. Sometimes delegation is difficult depending on the relationship between the nurse, LPN or CNA.

­­­­­­­­­­­­­­­­­­­­­­­­­­­­Here are some helpful Tips with Delegation

Don’t take bad attitudes personally.

Help out when you can if you have time.

Being polite, respectful, friendly and considerate go a long way and make sure to say “thank you” often.

Include CNAs and LPNs as part of the team.

Try to develop working relationships with the CNAs and LPNs.

Keep in mind that CNAs and LPNs both have just as difficult of a workload as you do, it isn’t possible for one person to get everything done. Create a team approach mindset which allows for a better culture on the unit.

Be the nurse the CNA and LPN WANTS to help, by being willing to help out when you can. Do not be the nurse that just sits at the desk on their phone or gabs too much. Delegation does not give you the right to be lazy.

Delegation skills can also be developed using simulation drills to create practice scenarios reflecting daily practice.

Conclusion

In conclusion delegation has to be practiced before it can be perfected.

Delegation is a complex professional skill requiring sophisticated clinical judgement and being accountable for patients’ care.

Remember to always keep in mind the state nurse practice act to maximize patient care resources.

Staff relationships can influence the delegation potential and process.

When RNs do not effectively delegate to others, quality of care can be lessened and valuable resources can be mismanaged.

Having clarity about what can be delegated helps to define quality professional practice not only for nurses but also for other team members, patients, and families.

Let me know how you’re dealing with delegation as a new nurse or seasoned nurse.

Thank you for watching and I’ll see you next time. 

Work Place Conflict and Violence; Strategies on Awareness & De-escalation

The following techniques and strategies can be found from the following document: “Workplace violence can happen anywhere especially predominant in behavioral health, emergency medicine, nursing homes, long term care and home care.” (Patient and Visitor Violence; What Do We Know? What Can We Do? By Jonathan Rossen, The Online Journal of Issues in Nursing).

Troubles addressing the problem of workplace violence is the assumption that it’s normal or part of the job, and that it’s unpredictable making is nearly impossible to prevent. I’m going to help other nurses including yourselves become more aware of your surroundings regarding possible violent situations and strategies allowing for the safest most peaceful outcomes possible.

According to Ian Miller with thenursepath.com the most effective de-escalators have been found to have the following skills. Honesty, Confidence, Non-judgemental, A permissive non-authoritarian manner and Ability to empathize.

The following 7 strategies will help in de-escalating workplace violence for everyone involved.

1)     Call for help:

a.      Never attempt de-escalation of a patient alone.

b.      Having that 3^rd person available to “take over” if/when needed will be beneficial.

2)     Switch ON your skills:

a.      Take a deep breath and try to remain calm.

b.      Assess your physical environment, remove people not directly involved in the de-escalation situation.

c.      Physical objects: Are the physical objects that could turn into potential weapons such as pens, medical equipment or furniture.

d.      Physical space: Be aware of the layout of the room. Always have a clear pathway to the exit of the room.

3)     Body Skills:

a.      While managing an agitated patient remember to physically step back.

b.      Never attempt to single-handedly block or restrain the patient.

                                                    i.     Assume a relaxed, open stance

                                                   ii.     Keep your hands open, visible and unclenched.

                                                  iii.     Face your body at an angle, this appears less confrontational.

                                                  iv.     Relax your face, make frequent eye contact but do NOT stare.

4)     Verbal Skills:

a.      There should only be one primary person communicating with the person being de-escalated.

b.      Be authentic, concise (no rambling), simple, repeat as necessary and be prepared to listen twice as much as you talk.

                                                    i.     Begin by introducing yourself, ask what the patient prefers to be called when addressing them.

                                                   ii.     Your voice should be clear with a soft tone.

                                                  iii.     When requesting information from the patient you may need to repeat yourself several times allowing for the information to be processed by the patient.

                                                  iv.     Encourage the patient to communicate their wants and feelings.

                                                   v.     Allow them to vent their anger.

                                                  vi.     Usage of humor may be helpful, but be careful the patient may think you’re coming off condescending or belittling to them.

5)     Listening skills:

a.      It’s important to understand what the patient is truly saying without putting your own interpretation or agendas into the mix.

b.      Even if the patient is delusional, everyone has their own sense of truth.

6)     Set clear careful boundaries:

a.      Setting clear and defined boundaries should happen early on in the situation but not used as a threat or show of power.

b.      The most important boundary to set is that of physical violence being unacceptable.

c.      Present each boundary with care, repeat as necessary respecting the other person’s dignity.

d.      Aggression sometimes happens as a response to feelings of lost dignity, disrespect and being frightened.

7)     RED ZONE:

a.      If the situation continues to escalate consider your options:

                                                    i.     Give the person options other than violence. Suggest offering the person something you can realistically deliver on that may help them calm down.

b.      If all of the above options fail, withdraw from any further attempts of de-escalation.

                                                    i.     At this point communication move from discussing the person’s feelings or actively listening to more of an authoritative approach.

                                                   ii.     The focus is now on ensuring everyone’s safety.

                                                  iii.     Escorting a team of individuals like police or security to help remove or place the person in a safer environment may be necessary.

                                                  iv.     Moving to the authoritative approach should be anticipated by staff. For example, reminding everyone that if things don’t work out peacefully this is the next step.

Ultimately this is a very stressful situation for everyone involved. This can be the cause of nursing burn out for some nurses, questioning whether they want to continue bedside nursing.

Make sure you sit down for a debriefing on the events that happened and be prepared to vent to a co-worker and get off your chest what happened to you so you don’t bottle up the experience which can be very stressful. Sometimes replaying and saying out loud what just happened to you can be very therapeutic. Allow others to acknowledge your feelings and discuss how you handled the situation. It’s okay to cry.

Do your best to leave work and these situations at work, so you can come home and not take it out on your family.

Thank you for watching, and I’ll see you next time. 

Different Stages of Labor ~ Including Dilation, Pushing, Delivery & Placental Birth

When I was an Obstetric nurse one thing that had me all tripped up were all the different stages and sub set of stages there are to labor.  I've recently made 6 videos on my youtube channel that explains all the different stages of labor.  You can find the first of 6 by clicking the video below.

 

Otherwise I'll briefly break it down for you here:

 

Stage 1 = Early Labor: This stage lasts the longest ranging anywhere from 6-12 hours. For some women they hardly know their bodies are changing and getting ready. The cervix can dilate up to 3cm.

 

Stage 1 = Active Labor: This stage seems to be for some women the most difficult especially if their pain is not controlled. This stage could last anywhere from 3-5 hours. This stage the Labor nurse needs to step up her game and stay strong not only for herself but for the patient too. Be supportive and let the woman know she can get through this and that she is strong!  The cervix can dilate up to 7cm.

 

Stage 1 = Transition: This stage is nearing the time when it comes to start pushing. The laboring patient doesn't think she can handle one more ounce of pain or one more hour of waiting for her cervix to dilate. This stage ranges anywhere from 30 minutes to 2 hours.  The cervix dilates to complete aka 10cm.

 

Stage 2 = Pushing: This is SHOW TIME!  Yahoo the laboring patient's cervix is finally 10cm dilated, some women seem to get a second wind of adrenaline that gives them exactly enough energy to push the baby out. Now as a Labor nurse you need to find the strength to help get the laboring patient through this time mentally. She needs the most encouragement during this stage because with each push the baby moves forward but then slips back behind and under the pelvic bone. Which can last up anywhere from 20 minutes to 2 hours.

 

Stage 2 = Birth: FINALLY the baby's head has made it past the pelvic bone and is crowning. Phew, what felt like forever will be done in another couple pushes. Boom a miracle is born. Sometimes the reaction at birth can be anywhere from immense crying with tears of joy and shouts of happiness to exhaustion to complete and utter silence. The nursing staff and doctors can be emotional too.

Every family and every laboring woman is different. Each with a different story. Other women have a different reaction, where tears may not be made of joy instead sadness fills the air. Every road can be immensely intense and needs a strong nurse to help each patient along the way. 

 

Stage 3 = Placental Birth: Baby's out and doing well. Now all the laboring woman has to do is deliver the placenta.  Some women are just as nervous about this step as they are about delivering the baby. But trust me, most times delivering the placenta is much much easier than delivering the baby.

This is the best time to initiate skin-to-skin and breastfeeding. Otherwise if the woman would rather have the baby cleaned up first, then the Labor nurse can get a lot of the other to-do items completed at this time like "eyes and thighs" or footprints, weight and length etc etc.

Nursing Hiarstyles~~Under 1 min Each~~Quick & Easy

Watch as I style my hair quickly with 4 different options for the on-the-go nurse who doesn't have a lot of time for fuss.

Watch my video and please let me know if you have any questions!

All up

Half up half down

Ponytail

Thanks for watching :-)

~Rachel RN

Million Excuses

As I sit here I could find a million excuses as to why not to write today including these:
-computer is too fickle to work with
-no Word program
-the kitty litter amongst other things needs to be cleaned
-the extra weight I've put on around my middle beckons to be exercised off
-I haven't gotten ready for the day
-etc, etc, etc.
However, I proceed on and continue this post because what I think most important for me right now is to get out how I'm doing.

There seems to be a lot of things going on in my life right now.  Especially BIG life changes that I'm not so sure I can/want to handle.  I prefer to have a normal scheduled day with predictable outcomes but I also love to live each day to it's fullest.  Hence I have new and exciting changes happening all around me.

For example:
-my daughter is graduating high school :-() in 6 days
-said daughter is starting college this summer, in 4 weeks (plus we are having her grad party the day before we move her out)
-same daughter is moving out of our nest...
-I have officially given my 28 day notice at my job and am frightened to death (more to come on that huge piece of news and chapter in my life)
-my son is going to start driver's ed this summer
-my husband was offered an opportunity of a lifetime and going forward with that decision (more on that in a future post)

Ugh more than ever I need this blog as an outlet to vent all that is ever-changing around me.
Thankfully I am working on spending more time relying on my relationship with Christ to help me get through my days.  I cannot even imagine us doing any of this on our own.  In fact recently I read from Lysa and her team at www.proverbs31.org who is developing an app called "First Five".  It's a bible devotional app for your phone basically giving God the first 5 minutes of your day will help transform your day drastically.  They're in the works of fundraising for this app to get it off the ground and running smoothly for when they plan to unveil this summer. Check out more here www.first5.org  The app will be available for free for anyone interested.
HOW WONDERFUL RIGHT!  Either way I think this app will help remind me what to focus on before my feet even touch the floor each day.  Amen to Lysa and her team!

This feels good to be able to organize my thoughts today.  Thanks for listening.

How to Locate and Find the Cervix

One of the hardest things I had to learn when I first became an Obstetrics Nurse was how to locate and find the cervix.  This was difficult because until you find it, you're always in a state of guessing or thinking you're close to it.

The vaginal wall is very strong (being a muscle and all) but can be easily mistaken for the cervix depending on how far you advance your fingers.  And just like the cervix you can stretch and move the vaginal wall and really believe you're at the cervix.

BUT, unlike the cervix that has a thinner wall all the way around it that feels like when you poke your finger through a deflated water balloon hole, the vaginal wall does not.

If any of this sounds confusing or right on to you beginner OB nurses, go ahead and watch my video that explains more.

And if any of you are wondering how to check for dilation, station, or effacement check out my other post here

Hand Lettered Challenge Week 5/52 - Places to Visit

This week's hand lettered challenge prompt is places to visit.  This hand lettered challenge comes from a blogger named Miranti at www.penandpeplum.com

Oftentimes I think I would love to travel. I'll read an article or listen to someone's story about their experience overseas to another country.  I think I'd love to go there and do that.  But then they mention what they ate and immediately I become ill just thinking about their food options.  I'm not a big fan of exploring different food tastes or meals.  I'm too picky!  I would have to travel somewhere inside the US where American cooking is available.

I have 5 beautiful and wonderful places I've painted in this week's video you can watch below to find out more of each location.  And maybe if I ever overcome my fear of eating different foods, I may just visit them.

Thanks for watching and reading and we'll see you next time,
Rachel Anne