There are many barriers nurses face when trying to maintain an effective workflow on the unit. By keeping a few things in mind, and working a few steps ahead, time can be managed more efficiently.

Ineffective multitasking is a culprit for wasting time.  This includes ensuring all supplies are gathered before entering a patient room, and by making an attempt to cluster activities when tolerated by the patient.

Charting in real time can also help save time.  It may seem difficult to stop and document after every task's completion, but it will save hours of charting at the end of a shift, while ensuring patient safety.

Discussion question:  What are some negative outcomes of waiting to document until the end of a shift?

Being proactive in communicating with physicians and pharmacy can also help maintain the workflow.  Check for needed medications before you need to give them, call the doctors ahead of time if you know you need something. Give yourself the extra time to get in touch with pharmacy over a missing medication, or a doctor when you know you will be needing an order in the near future.

             

Primary Nursing: All nursing care for a patient is managed by one nurse for a 24-hr period. Includes scheduling of activities, tests, and procedures.  Often seen with critical patients, potential a 1:1 ratio.

Patient Focused: Allows the patient to play a large role in determining the path of their healthcare.  Also allows for unlicensed assistants to perform more tasks than traditionally, such as perform blood draws.

Discussion Question: Which of these models do you find most appealing?  Which ones seem least effective?  Why?

Barriers to delegation:

A.  Use a lift sheet when moving and positioning the patient in bed
B.  Use an electric razor when shaving the patient each day
C.  Use a soft-bristled toothbrush or tooth sponge for oral care
D.  Use a rectal thermometer to obtain a more accurate body temperature
E.  Be sure the patient's footwear has a firm sole when the patient ambulates

2.  A patient with chronic obstructive pulmonary disease (COPD). Which intervention for airway management should you delegate to a nursing assistant (PCT)?

A.  Assisting the patient to sit up on the side of the bed
B.  Instructing the patient to cough effectively
C.  Teaching the patient to use incentive spirometry
D.  Auscultation of breath sounds every 4 hours

3.  After the respiratory therapist performs suctioning on a patient who is intubated, the nursing assistant measures vital signs for the patient. Which vital sign value should the nursing assistant report to the RN immediately?

A.  Heart rate of 98 beats/min
B.  Respiratory rate of 24 breaths/min
C.  Blood pressure of 168/90 mm Hg
D.  Tympanic temperature of 101.4 F (38.6 C) 

3.  The charge nurse is making assignments for the next shift. Which patient should be assigned to the fairly new nurse (6 months experience) pulled from the surgical unit to the medical unit? 

A.  A 58-year old on airborne precautions for tuberculosis (TB)
B.  A 68-year old just returned from bronchoscopy and biopsy 
C.  A 72-year old who needs teaching about the use of incentive spirometry
D.  A 69-year old with COPD who is ventilator dependent 

4.  Which intervention for a patient with a pulmonary embolus could be delegated to the LPN on your patient care team?

A.  Evaluating the patient's complaint of chest pain
B.  Monitoring laboratory values for changes in oxygenation
C.  Assessing for symptoms of respiratory failure
D.  Auscultating the lungs for crackles

5.  Which intervention for a patient with a pulmonary embolus could be delegated to the LPN on your patient care team?

A.  Evaluating the patient's complaint of chest pain
B.  Monitoring laboratory values for changes in oxygenation
C.  Assessing for symptoms of respiratory failure
D.  Auscultating the lungs for crackles

6.  The director of a medical-surgical unit notices that nurses are frustrated with the overcrowded, disorganized supply room. She holds a meeting to discuss possible solutions with the team. This is an example of:

A) Autocratic Leadership
B) Laissez-Faire Leadership
C) Democratic Leadership
D) Tea Party Leadership


7) Which of the following are principles of effective leadership (select all that apply)

A) Commitment to budget
B) Fair and equal punishment
C) Build a culture around service
D) Communicate on all levels
E) Create and develop leaders

8) Which of the following statements is the best description of the importance of organizational culture?

A) Organizational culture plays a role in employee satisfaction by creating a positive environment that fosters teamwork and enhanced patient outcomes.
B) Organizational culture ensures a democratic working environment.
C) Organizational culture ensures that the policies and procedures of the workplace are clear and easy to follow.  
D) Organizational culture helps keep organizations on track in terms of budgeting and finances.

9) Which of the following scenarios empowers leadership

A) A bulletin board displaying efforts the unit makes to prevent CAUTIs
B) A clipboard kept in the break room listing current press-ganey results
C) An email from the unit director about a recent rise in tardiness
D) A weekly newsletter including staff spotlights and notes of thanks

Which of the following is an example of leadership?

A) Raising expectations
B) Having subordinates
C) Maintaining status quo
D) Giving Directions