A.

TEAMWORK AND COLLABORATION:

These are some of the most important aspects in health care. Each patient has an interdisciplinary team
that cares for them. It is important that there is good communication between the health care team to
provide the best care for the patient. Patient safety is also large part of teamwork and collaboration.
Having clear communication between the health care team about the care plan, goals for treatment or
change in care is very important. Collaboration is defined as a working practice whereby individuals
work together to a common purpose to achieve business benefit. Whereas, teamwork is the process of
working collaboratively with a group of people to achieve a goal.
Situation: A senior nurse was trying to accomplish work delegated to her by the head nurse in the
surgical unit. There were several admissions during the night shift. Among the admitted patients were
vehicular accidents and gunshot victims. Three of these patients were scheduled for surgical operations.
A student nurse who could only provide basic nursing care under the supervision of a clinical instructor
was assigned to take care of one patient. The unit was managed by one head nurse, two senior nurses,
one registered nurse staff, one nursing aide and one orderly. The unit has a total census of 20 patients.
Out of the patients in the area, three patients who were just admitted were scheduled for surgery in the
morning. Two patients were to be discharged. Eighteen out of twenty patients had IV lines for
monitoring and for medication administration. All patients have their own private room. The Head nurse
made the necessary care plan for the unit. QUESTIONS:
1.Identify the key team member characteristics that the team leader needs to consider as potential
strengths or limitations.
2.What should the team leader remember about delegating to staff nurse, nursing aides or orderly?
3.What should the team leader consider about assignments for the nursing student and
working with the student? What are the priorities?
4.Considering the patients assigned to the team and possible tasks and responsibilities, describe how
the team leader might delegate to the team members.
5.How should the team leader supervise the team members’ work?
B. CONTINUOUS QUALITY IMPROVEMENT
CQI is an approach to quality management that builds upon traditional quality assurance
methods. It focuses on process rather than the individual, recognizes both internal and external
“clients”, and promoted the need for objective data to analyze and improve processes. It is also a
philosophy which contends that most things can be improved. At the core of CQI is serial
experimentation applied to everyday work to meet the needs of those we serve and improve the
services offered.
(http://www.msubillings.edu/cqi/faq.htm.)
Situation: The Quality Assurance Coordinator met with the nurse managers to review data
from nursing units for the last six months. The data revealed medication errors, falls and
nosocomial infection. They identified the need to review the data and make necessary action
plans on how to address concerns identified for continual improvement for safe and quality
care.
QUESTIONS:
1.Based on the data provided, how could you address the problem utilizing the Plan-Do Check-Act
(PDCA) approach to ensure safe environment of care?
2.What best practices can you share to ensure safety?

C.LEADERSHIP AND MANAGEMENT SKILLS:

The following are expected of a professional nurse in the health care organization: Making
good clinical decisions based on safety, quality, cost, legal and ethical aspects of care,
coordinating patient-care activities for the interdisciplinary team, promoting staff satisfaction
and overall unit productivity, creating and sustaining trust between and among management
and staff and providing leadership to maintain compliance with governmental regulations and
accreditation standards. The term organization refers to hospital, home, health agency, post-acute care
facility, ambulatory clinic, managed care company or any other area in which a
nurse might be employed to practice professional nursing.
Situation: Zia Valdez, a new Registered Nurse, has accepted a position in a busy, outpatient
unit. During nursing school, Zia worked in the facility as patient care technician and she is
confident in her clinical skills because of this previous experience. Marie, the nurse manager
of the dialysis unit has scheduled Zia to attend the new-nurse orientation. Although Zia thinks to
herself, “I know what the RN’s do around here; I’d like to jump right in without attending orientation,”
she readily accepts the assignment.
The nurse manager begins the orientation program with the discussion about the mission of the
organization and the RN’s responsibility to ensure that quality patient care is provided in a safe and cost
effective manner. As Zia progresses through the orientation program, her confidence quickly
fades. She becomes overwhelmed as she listens to the description of her responsibilities as an RN. The
RN’s duties involve much more than the expected physical assessment, identifying nursing diagnosis and
developing and implementing care plans. Some of Zia’s new responsibilities as a staff RN are to:
Supervise patient care techniques and manage the task assignments and supply use for a
group of patients, Meet with the social worker, dietician, nephrologist, nurse manager, and the
patient and family to develop the patient’s interdisciplinary care plan and then follow up to coordinate
and
implement the plan of care, serve on a task force charged to develop and implement a new training
and mentoring program for patient care technicians, perform chart audits to review patient
education documentation, identify problems, develop recommendations and report to the quality
management committee.
As Zia is trying to assimilate the information being presented, she almost fails to hear Marie say
that within 6 months of employment, all staff RN’s are expected to begin orientation for the charge
nurse position to provide back-up coverage. At the end of the orientation, Nancy has a new perspective
about professional nursing practice- it seems to be more about managing the delivery of patient
care than actually giving care!

QUESTIONS:
1.What leadership and management skills will assist Zia as she begins her new role as a staff
RN responsible for supervising a group of patient care technicians, managing supply usage
and serving on a task force to implement a new training program?
2.Why is it important for the nursing staff to understand the mission and values of the
organization in order to provide direct patient care?
3.What type of team building skills will help Zia as she learns to work with the interdisciplinary team
and coordinate
the patient’s plan of care with a diverse group of health professionals?
4.What resources are available to help Nancy learn and enhance her management and leadership
skills?
D.DELEGATION AND SUPERVISION:
Effective delegation and supervision are essential skills for the professional nurse I any practice
role or setting. Although there is no definitive list of what can and cannot be delegated, the RN
is guided to safe, effective delegation and supervision through effective communication,
creating an environment of trust and cooperation, fostering customer patient satisfaction and
providing feedback and evaluation. These activities and skills provide the tools the RN needs to
develop a safe and legal delegation practice.
Situation 1:
Consider this scenario: Today you are the charge nurse, and part of your responsibility is to
make patient assignments. There are 18 patients on the unit as well as 2RN’s, 1 LPN and 3 nursing
assistants. You make the following assignments: 1 charge nurse will give the IV medications for the LPN
and help as needed. 2 RN’s will take 6 patients; 1 LPN will take 6 patients, and 3 nursing assistants will
each take 6 patients.
QUESTIONS:
1.Should the nursing assistants be assigned to patients or should they be assigned to a nurse? Why?
2.When assigning patients to the RN’s, should you consider the patient’s physiologic status and
complexity of care? Give examples of patients with more unstable physiologic status or complex care
requirements.
3.When making assignments, how should you consider infection control issues? Would you
assign one nurse an infectious patient and an immunosuppressed patient?
4.When assigning patients to the LPN, would you consider the level of supervision required by the
LPN? Explain.
Situation 2:
You are a novice nurse and today, you are assigned to care for 6 patients and to supervise a
nursing assistant who has worked on this unit for 15 years. At the beginning of the shift you
approach the nursing assistant in order to plan the day so that the patients receive the care
they need. The nursing assistant tells you that she has worked on this unit for 15 years and
does need you to tell her what she is to do today.
QUESTIONS:
1. What is your response? How do you plan to communicate your needs and the patient’s needs?
2. How will you create an environment of trust and cooperation and also promote patient satisfaction?