MOC Exam 1 Weeks 1-3 Study Guide

Key Terms • • • • • • • Chief Nursing Executive (CNE): The highest-ranking nurse in a health system; oversees nursing practice across all facilities and ensures alignment with strategic goals. Chief Nursing Officer (CNO): The top nurse in a single organization; responsible for all nursing practice and part of the executive leadership team. First-Level Manager: Also called nurse manager or head nurse; supervises staff directly and manages day-to-day operations of a specific unit. Middle-Level Manager: Director or assistant director; supervises multiple units and first-level managers, ensures department goals align with organizational strategy. Upper-Level Manager: CNO or CNE; responsible for developing the nursing division’s strategic plans, policy development, and executive decision-making. Leadership: Using personal traits (vision, influence, inspiration) to guide teams toward future goals. Management: A formal role focused on organizing, staffing, planning, directing, and controlling activities to meet current goals. Leadership vs. Management • • • • • Leadership is future-oriented, drives change, empowers others, and sets a vision. Management is present-focused, maintains structure, and ensures daily operations run smoothly. Leadership is earned, not given by title. Management roles can be assigned and taught. Leadership = Effectiveness, trust-building, motivation Management = Efficiency, order, consistency Leadership Theories • • • • Trait Theory: Certain traits (e.g., confidence, intelligence, initiative) make someone naturally suited for leadership. Behavioral Theory: Focuses on how leaders behave, not just what they do. o Autocratic: Makes decisions without input; controls via authority o Democratic: Seeks staff input; promotes collaboration o Laissez-faire: Hands-off; assumes team can self-direct o Bureaucratic: Relies on policies/rules to manage Contingency Theory: The best leadership style depends on the situation; leaders must adapt. Modern Styles: o Charismatic: Inspires through personality o Connective: Builds coalitions and relationships o Shared: Leadership is team-based o Servant: Prioritizes team needs before their own Transactional vs. Transformational Leadership Transactional Leadership: • • • • Based on reward-for-performance Hierarchical (top-down structure) Clear roles and expectations Short-term focus on tasks and goals Transformational Leadership: • • • Focuses on collaboration and shared vision Encourages innovation, personal growth, and change Empowers staff, values input, and models change Transformational “4 I’s”: 1. 2. 3. 4. Idealized Influence: Acts as ethical role model and earns trust Inspirational Motivation: Builds a compelling vision and optimism Intellectual Stimulation: Challenges assumptions and supports creativity Individualized Consideration: Mentors, supports, and recognizes individual needs Shared Governance • • • • Nurses are involved in decision-making on clinical practice, QI, staffing, and education Based on partnership, shared accountability, and equity Encouraged in Magnet hospitals Supports nurse autonomy, professionalism, and leadership at all levels Levels of Management • • • First-Level (e.g., nurse manager): Directly oversees bedside staff, manages schedules, daily operations, evaluations, and budgeting for unit Middle-Level (e.g., director): Supervises multiple units/managers, develops department goals, supports staff growth, and aligns unit goals with system goals Upper-Level (e.g., CNO/CNE): Focuses on big-picture planning, strategic initiatives, professional practice models, and system-wide nursing performance Roles & Responsibilities by Level First-Level Manager: • • • • • Staff scheduling, shift assignments Participates in hiring, orientation, and evaluations Oversees patient rounds, meetings, and quality initiatives Responds to real-time unit changes like call-outs or high acuity Monitors unit performance indicators (NDNQI, infection rates, etc.) Middle-Level Manager: • • • • Creates and revises policies Analyzes unit needs and staffing outcomes Leads interdisciplinary committees and change initiatives Supports managers with coaching, development, and shared governance Upper-Level Manager: • • • • Develops nursing mission, vision, and practice models Works with executive leadership to influence system-wide goals Minimal direct patient care involvement Advocates for nursing on a broader organizational level Patient Care Manager (Charge Nurse) • • • • • A staff nurse temporarily or permanently assigned managerial duties during a shift Makes staffing decisions, rounds on patients, handles personnel issues Supports team with prioritizing care and resource use Acts as a liaison between night/weekend staff and nurse manager May contribute to evaluations depending on organization policy Competencies of Patient Care Managers • • • • • • Manages time and shift flow effectively Communicates and collaborates with interdisciplinary teams Makes critical decisions in high-pressure situations Delegates tasks safely and legally Resolves conflicts and leads calmly Shows flexibility, initiative, and leadership during change Resource Nurse Role • • • • • Highly experienced clinical nurse (often with certification or ladder status) Guides staff with complex patient care Serves as a mentor and clinical expert Helps improve outcomes and supports evidence-based practice Supports nurse growth and development on unit Functions of Management 1. 2. 3. 4. 5. 6. Planning: Set priorities and goals (unit schedule, yearly objectives) Staffing: Hire, assign, and schedule personnel Organizing: Structure teams, coordinate roles, and manage workflow Directing: Motivate and guide staff toward goals Controlling: Monitor outcomes, ensure standards and policies are followed Decision-Making: Identify problems, explore options, and act on best solution Nursing vs. Management Process Nursing Process: Assess, analyze, plan, implement, evaluate Management Process: Identify needs, assess resources, plan, organize/direct, control • Both are cyclical and involve critical thinking, but the nursing process is clinical, while the management process is operational Key Terms • • • • • • • • Accountability: Responsibility for decisions, actions, and outcomes. The RN is always accountable, even after delegation. Assignment: Distribution of patient care responsibilities based on scope and role. Authority: Legal or organizational right to perform duties; based on nurse practice acts and policies. Delegation: Transferring task performance to another person while retaining accountability. Supervision: Directing and evaluating a delegated task. Direct Care: Hands-on patient care (e.g., hygiene, feeding, vital signs). Indirect Care: Unit support tasks (e.g., stocking supplies, clerical work). UAP (Unlicensed Assistive Personnel): Staff trained to assist with basic care tasks under RN supervision. Five Rights of Delegation 1. 2. 3. 4. 5. Right Task – Appropriate and within scope Right Circumstance – Stable patient, right setting Right Person – Competent and trained staff Right Direction/Communication – Clear, specific instructions Right Supervision – Follow-up, monitoring, and evaluation What Can Be Delegated To UAPs (under RN supervision): • • • • • • • • • • • • • • Vital signs on stable patients Daily weights Measuring intake and output Hygiene care: bathing, oral care, grooming Ambulation and repositioning Feeding patients without aspiration risk Specimen collection (non-sterile) Blood glucose checks (if trained and allowed by policy) Postmortem care Set up oxygen, assist with incentive spirometer Basic respiratory support (not assessments) Cleaning equipment and restocking supplies Transporting patients Answering call lights, clerical tasks To LPNs (under RN supervision): • • • • • • • • • • Administer medications (except IV push in most states) Perform wound care and dressing changes Insert and manage NG tubes, Foley catheters Suctioning, tracheostomy care Ostomy care Monitor stable patients Collect data (but not assess or interpret) Reinforce teaching (but not provide initial education) Administer enteral feedings Participate in care planning, but not create or evaluate care plans What Cannot Be Delegated Not to UAPs or LPNs: • • • • • • • • • • • Initial or ongoing patient assessments Nursing diagnoses Planning or evaluating nursing care Developing or updating care plans Patient or family education Triage or admission assessments Communication with physicians or making clinical decisions Administering IV push medications (LPN in most states) Documentation requiring clinical judgment (e.g., assessment findings) Unstable patients or patients requiring complex care Tasks requiring nursing judgment, decision-making, or critical thinking RN Responsibilities in Delegation • • • • • • Assess the patient's condition before delegating Know the delegate’s competency and training Provide clear, complete directions (who, what, when, how) Supervise performance and evaluate outcomes Intervene if care is inadequate or unsafe Document delegated task performance and patient response if applicable Delegation Factors to Consider • • • • • • • Nurse practice act of your state Facility policies and job descriptions Patient acuity and stability Complexity of the task Delegate’s training, experience, and competency Ability to provide supervision Availability of time and resources Barriers to Delegation From the RN: • Perfectionism • • • • • Lack of trust or confidence in others Inexperience with delegating Fear of mistakes or being disliked Insecurity or preference to work alone Poor communication or unclear instructions From the Delegatee: • • • • Lack of skill or experience Fear of responsibility Disorganization or overload Unwillingness to perform delegated tasks From the Environment: • • • • Understaffing Time constraints Culture that discourages teamwork Emergency or high-acuity situations Delegation Models Unit-Based: • • NA or PCA assigned a task list (e.g., take all vitals) Minimal communication or prioritization Pairing: • • RN works with LPN or UAP for a shift Delegation is more flexible; priorities discussed Partnering: • • RN and LPN/UAP consistently scheduled together Strong working relationship and shared goals Levels of Clinical Experience • • • Novice: Needs rules; minimal experience Advanced Beginner: Recognizes patterns; still needs guidance Competent: 2–3 years of experience; handles daily priorities • • Proficient: Sees the big picture; efficient decision-maker Expert: Acts quickly, manages care teams effectively Priority Setting • • Ask: What is most important for patient safety right now? Use the “3 I’s”: o Identify top priorities o Interact efficiently to reduce distractions o Initiate action through clear delegation SMART Goals in Delegation: • • • • • Specific Measurable Attainable Relevant Time-bound Legal Considerations • • • • Know your state’s nurse practice act Know what LPNs and UAPs can do based on policy and scope Never delegate beyond someone’s legal or institutional scope RN is ultimately responsible for all care and outcomes Key Terms • • • • • • • • • • Advance directive: Document outlining a patient's future health care preferences. Autonomy: Right of individuals to make their own decisions. Beneficence: Duty to do good and act in the patient’s best interest. Bioethics: Ethics related specifically to health care. Corporate liability: Hospital’s responsibility for its own actions. Durable power of attorney: Assigns a surrogate to make decisions when the patient is incapacitated. Ethics: Principles of right/wrong that guide conduct; based on personal values. Informed consent: Patient agrees to treatment after being informed, competent, and voluntary. Institutional Review Board (IRB): Oversees research to protect human subjects. Justice: Fair and equal treatment regardless of status. • • • • • • • • • • Living will: Type of advance directive detailing life-sustaining treatment preferences. Morality: Conduct based on customs or religion. Nonmaleficence: Obligation to do no harm. OBRA (1987): Prohibits unnecessary restraints for convenience or discipline. Patient Self-Determination Act: Requires facilities to inform patients of their right to make decisions. Personal liability: Responsibility for one’s own actions or inactions. Policies/procedures: Institutional rules guiding practice. Restraint: Restriction of movement by physical or chemical means. Risk management: Identifying and reducing potential harm to patients/staff. Tort: Civil wrong (e.g., negligence, battery) that results in damages. Ethical Principles • • • • • • • Beneficence: Do good (e.g., proper infection control) Nonmaleficence: Do no harm (e.g., maintain skill competency) Justice: Fairness and equity Autonomy: Respect patient’s decisions (e.g., informed consent) Fidelity: Keep promises and contracts Respect for others: Let patients make their own choices Veracity: Obligation to tell the truth (e.g., admit mistakes) Common Ethical Dilemmas • • • • Refusing life-saving treatments (e.g., dialysis refusal) Family withholding information from patient (conflict between beneficence and autonomy) Futility of care (treatment unlikely to benefit patient) Resource allocation (e.g., ventilators, organ transplants) Ethical Theories • • • Utilitarianism: Greatest good for the greatest number Teleology: Ethics judged by consequences Deontology: Ethics judged by intent, not outcome Ethical Resources • • • • ANA Code of Ethics (2015): 9 provisions supporting advocacy, integrity, accountability ICN Code of Ethics (2012): Global guidelines for rights, standards, and collaboration Hospital Ethics Committees: Handle policy development, education, and case reviews Ethical Decision Model: Identify the issue, gather data, explore alternatives, choose best option Advance Directives • • • • • Living will: Specifies what life-sustaining treatments are desired or refused Durable power of attorney: Assigns someone to make decisions if patient is incapacitated Health care proxy: Person legally designated to make health decisions POLST: Physician Orders for Life-Sustaining Treatment; a medical order that follows the patient across care settings Nurse’s role: Ask about directives, place in chart, follow state-specific laws Organ Donation • • • • • • Declared on driver’s license or written directive Family may disagree, but legal documentation usually prevails OPO (Organ Procurement Organization): Legally responsible for recovering organs Organs that can be donated after death: heart, lungs, liver, kidneys, pancreas, intestines Tissues: corneas, skin, bone, valves, etc. Religious views vary but most support donation as an act of charity Legal Concepts for Nurses • • • • • Nurse Practice Acts: State-specific rules on what nurses can do Licensure: Granted after NCLEX; must follow rules of practicing state Telenursing: Must comply with practice laws in state where care is delivered Disciplinary actions: Can result from fraud, abuse, scope violations, etc. Good Samaritan Laws: Protect providers who offer emergency care in good faith Tort Law • • • Unintentional torts: Malpractice, negligence Intentional torts: Assault, battery, invasion of privacy, false imprisonment Elements of malpractice: • 1. Duty 2. Breach of duty 3. Causation 4. Injury 5. Damages Common nursing errors: Med errors, patient falls, misuse of restraints, improper documentation Negligence • • • Failure to act as a reasonable nurse would Examples: not following protocol, failure to act, equipment misuse Nurses can be liable even when not the primary caregiver (e.g., poor supervision) Charting Guidelines (F-L-A-T) • • • • Factual – Objective info only Legible – Clear handwriting or digital input; no erasures Accurate – Detailed and specific (e.g., “clear yellow drainage”) Timely – Document ASAP Informed Consent • • Must include: o Diagnosis o Treatment options and risks/benefits o Right to refuse o Voluntary choice without coercion o Patient must be competent and understand Nurse’s role: Witness signature, ensure patient understands (not to explain in depth unless trained and allowed) Patient Rights • Under AHA Patient Care Partnership: o High-quality care o Clean, safe environment o Involvement in care decisions o o o Privacy Help with discharge Billing transparency Patient Restraints • • • Only used when necessary to prevent harm Must have: o Physician order (no PRN) o Time-limited duration o Ongoing assessment o Consent from patient or proxy Improper use = false imprisonment or assault HIPAA • • • • Patients control their health information Info shared only with authorized individuals Social media risks: Nurses can face discipline for breaches online Do not leave screens open or share info in hallways Incident Reports • • • • • Used to document errors, near misses, and adverse events Not part of medical record Completed by involved or discovering staff Should be objective and factual Used by risk management to improve safety processes