# data[].attributes.body
Role: Supervision, delegation, conflict resolution.

Policies: Yes, The Nursing Home Reform Act, Laws against discrimination, cultural competency.

Delegation: RN is the supervisor and is responsible to ensure the rights of delegation are followed. The RN must also be involved in ensuring the LNA understands her responsibility, role, and professionalism.

SDOH: Racism, language barrier, lack of diversity in workplace.

Immediate legal or healthy concerns: Risk for patient harm and negligence.

Immediate safety: risk of harm due to delay in care. Hostile behavior affecting staff and patient care.

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A quality improvement process typically involves the following steps:

Identify issues: Recognize the problems and their context

Analyze data: Interpret relevant data to help understand the issues

Develop strategies: Research and create possible solutions to address the issues

Choose solutions: Select specific solutions to implement

Define measurements: Determine how to measure the success or failure of the solutions

Build a team: Create a team to implement the plan

Prepare a plan: Document the plan in writing

Train stakeholders: Educate all relevant parties on how to implement the plan

Implement and measure: Put the plan into action and measure the results

Make changes: Adjust the plan as needed until the desired results are achieved

Communicate: Share the successes of the quality improvement process

People who would benefit the quality improvement team are other nurses, unit manage/nurse manager, administrators, a patient or resident. Important characteristics of a team are effective communication, clear goals, mutual trust, strong leadership, adaptability, collaboration and conflict resolution. Diversity within the team would improve the change process by mitigating bias and holding space for the underrepresented population that was effected during the incident. Diversity also welcomes different opinions and thought processes into the group.

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There was inadequate staffing on the floor prior to the LPN going on break. Mandated staffing laws could impact the situation. Delegation was not accepted by the LNA when the LPN left the floor. The LPN should have asked the LNA if they were ok with caring for the patients on the unit before leaving and the LNA should have accepted. Additionally, the LPN should have notified the RN that they were going on break so the RN could supervise and assist the LNA. SDOH impacted the situation due to race, language, lack of support from family and friends. The RN needs to to address the LNA using inappropriate language and racial slurs immediately. Yelling as a form of communication on the unit also needs to be addressed. There are patient safety and outcome concerns because the patient was left unattended for more than 20 minutes while screaming for help.

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Why is evidence-based research important in this situation?

Being able to adequately identify the root cause of the problem

Supports the solution

Keeps bias's out of the solution/problem

Promotes positive patient outcomes

Form a PICOT question

Residents within the facility

Call lights

Patients are being ignored

Quick and timely responses to promote positive patient outcomes/safety

This needs to be addressed as quickly as possibly, preferably within 1-5 minutes, and see results within a 3 month period

Residents within the facility who use call lights, does implementing a protocol to respond within 1-5 minutes, compared to current response times without the protocol improve patient safety and promote positive patient outcomes within a 3 month period?

What level of evidence and types of studies would you look for in your research?

Quantitative studies- Will give control, scientific method based, numeric, and empirical evidence base as well as generalizable

Evaluating studies- Descriptive, correlational, quasi-experimental and experimental based research

Level 1 type of evidence and studies, which is systematic reviews, as well as level 4 which is case controlled/cohort studies, and level 7 which is expert opinion/case reports

# data[].attributes.body
1. Adequate staffing.

2. Maintaining the safety and dignity of the patient. ANA nurse bill of rights- not treating patients equally, ensuring respect, equity.

3. Poor deligation from the LPN to the LNA. LNA should have spoken up about not feeling comfortable with that certain patient.

4. language barriers, racism, lack of diversity in staff, and sensitivity education

5. Yes, racism, negligence, patient abandonment.

6. Yes, risk of patient harm due delay in care, racism

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An interpreter should be used to communicate safely and effectively with the patient. This can be done on an iPad through video or over the telephone. Picture tools could be created or downloaded to be used to communicate with the patient.

Artificial intelligence could be used to assist with cultural barriers and to give ideas to help build rapport.

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Problem: Failure to provide safe and timely care due to knowledge deficit with handling a language barrier. Lack of professionalism with use of racial slurs

Possible Solutions: Respond to patient immediately then intervene between LPN and LNA. Review expectations and report as needed. Follow up with management to begin change.

Evaluate and chose solution: Bring forth the need for diversity training, the LNA's behavior, and joining making a change

Implement the solution: Work with management for improve diversity training

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The use of an interpreter is necessary for the safety and care of the patient and the staff. The staff are at risk of negligence because they are scared to enter the room and are not providing appropriate care. To overcome the feeling of imposter syndrome you need to accept that this needs to be done to provide better care for your patient and is a learning experience that will build your confidence. You can talk with a coworker about how to present the topic for additional ideas or to decompress. You can also practice how you will communicate the issue to build your confidence. Exposure will also build confidence.

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For this situation it is really important to first ensure that the patient is safe. Then the LNA needs to be spoked to about her unprofessionalism and unacceptable behavior. The LPN needs to be spoken to about professionalism and reaction as well. Management needs to be alerted of this situation to provide diversity training.

This situation put the patient in harm's way and created a hostile working environment between staff.

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As a new nurse on this unit, my fear is that I won't be taken seriously or may be met with pushback when trying to enact change. In order to reduce the imposter phenomenon, you could practice the delivery of your presentation beforehand. You could also seek support from a mentor or peer. There will be a decrease in litigation if this scenario does not occur again because policies have been put in place to prevent it. Principles of change that can be applied to this situation are providing/receiving effective feedback and conflict resolution.

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What role does staffing have on this scenario?

Adequate staffing, however a nurse should have been covering the nurse that was on break to ensure proper management of the unit

Are there federal or state policies or statues that impact this situation?

Discrimination, negligence, delegation

What role does delegation have on this scenario?

Delegation was not effective since the LNA was not performing their job adequately, nor did they delegate to someone else, or inform the nurse.

What SCOH impact the situation?

Language barrier, racism, discrimination

Are there legal and ethical concerns that the RN must address immediately?

Yes, negligence, discrimination/discriminatory language, and racism, as well as unjust care

Are there patient safety and outcome concerns that the RN must address immediately?

Risk of patient harm due to inadequate timing of answering patient call lights, emotional trauma due to slurs, and negligence of patient care

What methods can you take to decrease feelings of imposter phenomenon?

Reflection on achievements

Meditation

Talking it out

Asking for help/ going to senior staff

Doing your own research

How will this change reduce your risks of litigation?

Nothing reduces the risk of litigation, but this can better prepare you for better patient care/outcomes

What principles of change did you learn in your change project that you can apply to this situation?

Coping skills

Critical thinking

Delegation

Continuing education

Self care

Effective communication

Time management

# data[].attributes.body
Lewin's model of change:

Unfreeze: LNA's ways of handling cultural barriers.

Change: Have access to education and interpreters to help communicate with patients—resources to be educated on how to reach interpreters. Have the LNA come in with the RN next time and treat the patient to role model professional behaviors.

Refreeze: RN goes in with LNA to supervise behaviors with patient. LNA successfully completes cultural sensitivity training. Create a new policy cultural sensitivity training is mandatory.

Motivators for change: Continuing employment. Patient Safety, employee safety. Preventing legal action.

Barriers to change: Racism, willingness/motivation of employee and patient. lack of time and resources.

# data[].attributes.body
1) maintain safety, delegation, conflict resolution

2)Title VI of the civil right act of 1964, healthcare providers receiving federal funding are required to provide language access services.

3)Delegate by switching the LNAs around. The LPN should delegate the aids to call for help if needed, LNA’s should have provided help or asked for help

4)Communication, personal bias, neglect

5)Neglect, patient safety, justice

6)Immediately address patient safety and concerns. Second address why the LNA did not call the supervisor why the LPN was not on break.

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Authoritative style – for immediate action due to patient safely concern

Confronting – Meeting the problem head on.

Assertive Communication is confident but also respectful of others' thoughts and feelings. Assertive communication creates space for honest conversations and promotes healthy connections between individuals.

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providing feedback, providing research regarding solutions to the problem, and petitioning for change

Union:

pros- workplace safety, professional development, able to bargain

cons- change occurs slow, union dues, strike can occur

MAGNET

pros- high nurse engagement and satisfaction, nurse autonomy

cons- lack collect bargaining, staff ratios, unsafe working environement

In terms for better staffing ratios, it would cost more to pay additional employees.

If the staffing ratio were to stay the same, no financial cost would occur.

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What methods can you take to decrease feelings of imposter phenomenon?

Reflection on achievements

Meditation

Talking it out

Asking for help/ going to senior staff

Doing your own research

How will this change reduce your risks of litigation?

Nothing reduces the risk of litigation, but this can better prepare you for better patient care/outcomes

What principles of change did you learn in your change project that you can apply to this situation?

Coping skills

Critical thinking

Delegation

Continuing education

Self care

Effective communication

Time management

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Alex, Sue, Brooke, Amber, Ashlee, Haley G.

What role does staffing have in this scenario?

-       There could be an extra LPN to help ensure there is enough help on the floor, but staffing doesn’t seem to be the main problem in this scenario.

-       There was no nurse on the floor when LPN took break- should’ve been covered by RN overseeing facility.

Are there federal or state policies or statutes that impact this situation?

-       No federal law that regulates the number of patients a nurse can care for.

o   CMS and Medicare have regulations for nursing service per day:

Licensed Nurse- 1.1 hrs

CNA- 2.4 hrs

What role does delegation have on this scenario?

-       The LPN didn’t delegate their nursing care to the RN overseeing the facility.

-       Proper delegation wasn’t done because the LNA was left in an uncomfortable situation without the proper information or tools to do the job efficiently.

What SDOH impact the situation?

-       Language proficiency

-       Support systems

-       Income level

Are there legal and ethical concerns that the RN must address immediately?

-       Legal: patient neglect, abandonment by LPN

-       Ethical: non-maleficence, discrimination

Are there patient safety and outcome concerns that the RN must address immediately?

-       RN must go check in with patient immediately after being ignored for approx. 20 min

-       LNA racial slurs against patient

-       LPN leaving floor without notifying RN

# data[].attributes.body
Adequate staffing ensures there are ethical staff-to-patient ratios. It could be abandonment issues since the staff member accepted the assignment and refused to help a resident in need. The LPN delegated care to an LNA who was not willing to perform the duty. SDOH are language barriers, race, and potentially education. Ethical concerns is that the LNA did not go help the patient. There may be legal ramifications for the racial slurs. There are definitely safety concerns in this scenario. The patient was in distress and no one was there to help. They could've fallen or gotten injured.

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You can reduce your feeling of imposter syndrome by being organized, conducting quality research, avoiding negative self-talk, and practicing presentation skills.

Having a plan of action in place would reduce the risk of litigation. Address the issue with the staff. Ensuring patient safety.

The principles of change we learned in our change projects utilizing role models, effective communication, time management, and holistic care.

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Patient safety is more important than being liked by staff. Being a supervisor doesn’t include being mean, but it is important to make sure the patients safety comes first.

To lessen imposter syndrome, maybe speak to a co-supervisor and ask if the situation was handled well and how to handle it better.

The LNA’s were switched because of racism. An interpreter will be placed so there is no barrier to communication.

Proper leadership will lead to an effective patient care and positive outcomes

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Alex, Sue, Brooke, Amber, Ashlee, Haley G.

I am nervous that I will get pushback or not be taken seriously as I am a new graduate nurse.

What methods can you take to decrease the feelings of imposter phenomenon?

-       Acknowledge your feelings and validate that you are allowed to feel this way

-       Avoid negative self-talk

-       Receive support from coworkers or friends

-       Acknowledge achievements already made

-       Find a mentor

How will this change reduce your risks of litigation?

-       It will increase effective communication, documentation, employee training

What principles of change did you learn in your change project that you can apply to this situation?

-       Effective communication

o   Therapeutic communication techniques

-       Proper delegation