The Role of LPNs January 16, 2006
Posted by manthey in Professional Practice, Staffing.Tags: decision-making, LPN, nurse/patient relationship
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For years, we’ve expanded or contracted their roles based on the supply of RNs (and the money to pay them). As a group, few have contributed as much, or been valued as little as these folks. In my opinion, there is no doubt that we need skilled technicians to act as assistants to RNs. Why? Logic dictates that with today’s acuity levels we need more skilled technicians than patient care aides. When RN energy is consumed with clinical activities, it is not available for the professional work of nursing. Making decisions about the amount degree and kind of nursing care a patient will receive, in the context of a therapeutic relationship with the patient.
This is what RNs are licensed to do. The license does not say RNs have to give 100% of the care tasks patients receive…but is does say we are the only care providers in the whole system with specific responsibility to make decisions about nursing care. And yet, this is the activity most often given up in order to perform tasks. This is the activity most often given up in order to ‘fix’ a system problem with dietary…or with lab…or with pharmacy…etc. etc.This is the activity most often given up in order to do almost anything else. Albeit some tasks require the high skill level of an RN. Others however are routine or of lower skill level. And yet, often regardless of staffing levels, the exercise of professional authority regarding the amount degree and kind of nursing care a particular patient will receive is on the lowest rung of any RNs work-priority rating.
The pressure to perform tasks and to ‘fix’ system problems is almost overwhelming. The pressure to accept professional responsibility for managing the care of a patient is totally underwhelming. No one asks about nursing decisions. Everyone asks if the tasks were performed and documented. Job descriptions are even silent about decision-making!
You may ask “What does this have to do with LPNs?” My answer is “If I were a chief nurse today, I would hire well-trained LPNs to work in partnerships with experienced RNs!” When this is the arrangement, LPNs can safely contribute high-quality, highly -skilled bedside care to the maximum of their ability within the framework of effective delegation. RNs as senior partners can contribute to deliver bedside care, and have the time and energy to evaluate individual patients and decide on the amount and kind of nursing care they will receive. We have seen the benefits of well-designed and well-executed partnership systems. We have also seen that often logistical problems exist in terms of union rules, schedule preferences or employment practices. These are problems that need to be solved in order to create staffing paradigms that will benefit patients today and the profession tomorrow. As long as RNs are running around performing countless tasks in high-pressured environments, nursing will not develop as a profession.
Leading for Change December 16, 2005
Posted by manthey in Leadership, Primary Nursing, Relationship-Based Care.Tags: change, decision-making, empowerment
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Recently a graduate student in nursing asked if she could interview me for an assignment on Leadership. As I answered her questions …”when did you first know you were a leader?”, “where did you learn how to be a leader?” “what is the most important thing you learned?” … I was led into some
Recently a graduate student in nursing asked if she could interview me for an assignment on Leadership. As I answered her questions …”when did you first know you were a leader?”, “where did you learn how to be a leader?” “what is the most important thing you learned?” … I was led into some insightful reflections about change I’d like to share with you. I hope the readers will share their own insights as we ‘blog-on’ together.
First of all, when Primary Nursing was originally implemented, I knew nothing about change. If I had, Primary Nursing might not have started when it did. We were trying to do something else, called Unit Management. A few roadblocks along the way led us to change directions dramatically, with the result that the staff of real unit actually implemented the delivery system before we knew they were changing delivery systems. They didn’t know it either…none of us understood the profound change the staff was creating as they moved from traditional team nursing into what we eventually called Primary Nursing.
I didn’t know about PERT charts and force field analysis….or about how to deal with resistance, or any of the theories commonly taught as part of the change process. Therefore, we didn’t have steps outlined, with time tables, goals, benchmarks, etc…. and were thus free to support the staff throughout this period of change. All we had to guide us was common sense.
Which leads to the first learning. Decentralized Decision-Making is the core of Primary Nursing. As I came to understand how this organizing principle works, I eventually constructed the following equation: Change:Empowerment = Empowerment:Change. This equation is founded on the truth that the people who know the most about the work being done are the people doing the work. Therefore, their knowledge needs to be used in deciding how to improve the work.
What role does that leave Leaders? And how can Leaders get people to agree on how to improve their own work?
The second learning has to do with the use of visioning and inspiration as leadership tools. One of the most important roles of a leader is to be able to paint a picture of a foreseeable future that is more desirable than the present, in language that inspires others to follow. A ‘good’ leader will base this vision on values that are positive universal human values.
And the third learning has to do with infrastructure. A good change project (one that is successful) will incorporate a structural design that provides clear roles/expectations for appropriate decision-making at the various levels of authority. The design of the structure must be carefully thought-out……be based on the current role responsibilities throughout the department/institution with decision-making carefully allocated to the appropriate authority levels.
Those of you who have read Relationship Based Care: A Model for Transforming Practice will recognize in the above paragraph two of the four elements of Jayne Felgen’s theory of change…..Inspiration, Infrastructure, Education and Evidence. Our extended experience with operational change will hopefully extend educational realms.
