VN 109: Professionalism
Leadership and Supervision
Lecture - Module 7
Topic I: Professional Roles and Leadership
References
Foundations of Nursing, Christensen and Kokcrow
4th Edition
Chapter 40 Pages: 1026 - 1047
Medical Surgical Nursing (An Integrated Approach)
2nd Edition – Lois White and Gena Duncan
Chapter 36 Pages:974 - 986
Professional Roles and
Leadership
TOPIC I: Professionalism,
Leadership and
Supervision
Eliza Rivera-Mitu, RN, MSN
Trinity Vocational Center
Functioning as a Graduate

Applying for a job







Identify employers who match your philosophy
and needs
Call the companies and obtain the name of
the nursing resources and/or human
resources director
Double-check the address to be used in the
application
Keep an organized list of the facilities’
addresses, contact info and phone nos.
This list should be accompanied by the info
you gather during your phone call
Add the date you sent your letter of application
and resume
After you send out your resume and letter of
application, follow-up with a phone call to be
sure they were received
Functioning as a Graduate
 Applying
 Letter
for a job
of application
• Each letter must be
individualized for the
company you are
applying
• Tailor what you write to fit
the organization
• Include:
• Statement of interest
• Statement of qualification
• Statement of availability to
discuss the job
Letter of application
Example from DHS (http://ladhs.org/nurse/)
“Nursing care at each of our facilities is built on a long standing
tradition of providing quality patient care and public health
services for nearly 10 million residents. …
Our team of highly skilled and highly trained medical and
nursing professionals work in collaboration with members of
the health care team in achieving the best possible outcomes
for our patients...”
In your letter, you can write: “I have a strong commitment to
providing quality patient care”…or “I am interested in working
in your organization because of your long standing tradition
of providing quality patient care and public health service…”
Functioning as a Graduate

Interview
 (see
handout)
Functioning as a Graduate

Membership in
professional
organization
 ANA,
NCEMNA,
PNAA, NAHN
Legal Aspects of
Vocational Nursing


Nurse Practice Act - http://www.bvnpt.ca.gov/pdf/vnregs.pdf
Law and regulations

Board of Vocational Nursing and Psychiatric Technicians
(BVNPT)
• The BVNPT regulates the education, practice and discipline of licensed
vocational nurses (LVN) and psychiatric technicians (PT). Consumer
welfare is protected by ensuring that only qualified and competent persons
are licensed as LVNs or PTs.
• LVNs and PTs are expected to perform within the law governing their
practice.

Reports of Misconduct
• The Board works diligently with consumers of healthcare, the Board's
licensees and other healthcare providers or organizations to identify and
address problems relating to its licensees. When reports of misconduct of
licensees are received, the Board investigates harmful behavior through
the disciplinary process.
• The Board ensures that the public is protected from unprofessional,
incompetent and grossly negligent practitioners by investigating complaints
filed against LVNs and PTs and taking disciplinary action.
Legal Aspects of
Vocational Nursing

Disciplinary Process

The following summarizes the steps leading to disciplinary action:
• The Board reviews complaints to determine jurisdiction and if the alleged action
violates the law or regulations governing the licensee’s practice.
• If the two conditions above are met, an investigation is initiated.
• If the investigation proves that a violation occurred, the Board determines the level
of discipline warranted by the violation.
• The Board may take formal or informal disciplinary action.
• Formal action includes revocation or suspension of the license, placing the licensee
on probation or denying an application for licensure.
• Informal action may include issuance of a citation and fine or notice of warning
and/or requiring participation in a remediation program.
• If formal discipline is required, the case is transmitted to the Office of the Attorney
General (AG) which acts as the Board’s counsel.
• The AG prepares a document against the licensee or applicant, called an
Accusation or Statement of Issues.
• The licensee or applicant is entitled to an Administrative Hearing.
• The Administrative Law Judge (ALJ) who presides over the hearing will propose a
decision to the Board.
• The Board considers the proposed decision of the ALJ and renders it’s final
decision.
Legal Aspects of
Vocational Nursing

Types of Violations
There are many types of violations for which an LVN or PT may be disciplined.
Most involve unprofessional conduct which includes, but is not limited to:
 Incompetence
Incompetence is the lack of possession of and the failure to exercise that
degree of learning, skill, care and experience ordinarily possessed by a
responsible licensee.

Gross Negligence
Gross negligence is a substantial departure from the standard of care which,
under similar circumstances, would have ordinarily been exercised by a
competent licensee, and which has or could have resulted in harm to the
consumer.

Conviction of Serious Crime
The Board may take action against a licensee who was convicted of a crime
substantially related to the qualifications, functions or duties of the licensee. In
addition to taking action against licensees, the Board may deny issuing a
license to a person with such a conviction in his/her background.
Legal Aspects of
Vocational Nursing

Rights as a Consumer of Health Care
You have the right to:
 Be treated by a safe and competent LVN or PT.
 Confidentiality and privacy during your care.
 File a complaint with the Board if you believe you have
received substandard care by a Board licensee.
 File a complaint anonymously.
 Contact the Board with your questions or concerns, and
receive a prompt, accurate and courteous response.
Legal Aspects of
Vocational Nursing

Rights as a Licensee
You have the right to:
 Know about any complaint filed against you.
 A thorough investigation if a complaint was filed against you.
 Due process of law if formal disciplinary charges are filed against
your license.
 Contact the Board with your questions or concerns, and to receive
a prompt, accurate and courteous answer.

Legal Accountability Extends to the Internet



As delivery of healthcare changes, so do job opportunities.
Healthcare sites on the Internet seek healthcare providers to give
information to consumers.
As in other settings, LVNs and PTs working in an Internet
environment are dependent practitioners and cannot provide
healthcare advice on the Internet without supervision.
Nurse Practice Act Excerpt
2872.2. Interim Permits.
An applicant for license by examination shall submit a written application in the form
prescribed by the board.
After completion of a board accredited or approved nursing program and approval of
the application, the board may issue an interim permit authorizing the applicant to
practice vocational nursing pending the results of the first licensing examination.
If the applicant passes the examination, the interim permit shall remain in effect until an
initial license is issued bythe board. If the applicant fails the examination, the interim
permit shall terminate upon notice by certified mail, return receipt requested, or if
the applicant fails to receive the notice, upon the date specified in the interim permit.
A permittee shall function under the supervision of a licensed vocational nurse or a
registered nurse, who shall be present and available on the premises during the
time the permittee is rendering professional services. The supervising licensed
vocational nurse or registered nurse may delegate to the permittee any function
taught in the permittee's basic nursing program.
An interim permittee shall not use any title or designation other than vocational nurse
interim permittee or "V.N.I.P." (Added by Stats. 1986, Ch. 146 urgency effective
June 10, 1986.)
Preparation for Licensure


CAT and NCLEX - VN
Application for licensure
 www.bvnpt.ca.gov/pdf/method2.pdf
Preparation for Licensure

Renewal Process


Active License -- VN and PT licenses are considered
"active" when the license is current (not expired or
delinquent) and the 30 hours of continuing education
requirements have been met.
Inactive License -- A license is placed on inactive
status when the renewal fee is paid and continuing
education requirements have not been met. The
licensee cannot practice with an inactive license. To
activate an "inactive" license, the licensee must submit
proof of thirty hours of continuing education during the
preceding two years.
Preparation for Licensure
 Renewal Process (cont)
 Renewal -- LVNs and PTs are required to
renew their license every two years.
Satisfactory completion of continuing education
is required for an "active" license in addition to
a social security number. Licensees must also
certify under penalty of perjury, whether they
have been convicted of a crime since they last
renewed.
 Renewal notices are mailed 6 weeks prior to
the license expiration date. The renewal fee
must be received on or before the expiration
date in order for the licensee to continue to
legally work.
Preparation for Licensure

Renewal Process


Delinquent Licenses -- A delinquency fee is assessed
if the renewal fee is not paid within 30 days after the
expiration date. A licensee may renew a delinquent
license any time within 4 years of the expiration date by
submitting payment of all accrued and unpaid renewal
fees in addition to any fees due upon renewal of a
delinquent license along with proof of continuing
education, a social security number, and conviction
statement. Please select this link for further information.
Expired Licenses -- A license which is not renewed for
4 years expires. An expired license cannot be renewed,
re-issued or reinstated. The licensee is required to
submit a new application and retake the licensure
examination to receive a new license.
Preparation for Licensure
 Renewal


Process
Continuing Education -- After the first renewal, LVNs
and PTs are required to certify under penalty of perjury,
completion of 30 hours of CE within the two years
immediately preceding the date of renewal. Courses
must be related to the licensee's scope of practice. The
licensee must retain the provider certificate for a period
of 4 years and produce it if audited by the Board.
A random audit of the current active licensed population
is conducted. When audited, licensees are required to
submit copies of the provider certificates. Those who
have misrepresented CE compliance are referred to the
Enforcement Unit for disciplinary action.
Preparation for Licensure

How to obtain license in another state





Contact the State Board of Nursing in the state in which you intend to
apply for licensure and request that they mail you the appropriate
application packet.
Review the application requirements to be sure that you are eligible for
licensure in that state.
The application packet should contain a Verification of Licensure form.
Complete the personal information on the Verification of Licensure
form, including your California LVN license number. If you were
licensed under a different name, please be sure to indicate your
previous name(s).
Attach a check or money order in the amount of $75.00 made payable
to "BVNPT" and mail the Verification of Licensure form and fee to:
California Board of Vocational Nursing
Psychiatric Technicians
2535 Capitol Oaks Drive, Suite 205
Sacramento, CA 95833-2945
You are advised to carefully review the requirements for each out-ofstate licensing board to ensure that you meet all of the requirements
for licensure in that state before applying to that state
Preparation for Licensure

How to obtain license in another state

California State-Board Constructed Examination
• Many State Boards have laws that require applicants to have
passed the national examination (National Council Licensure
Examination (NCLEX) or National League of Nursing State
Board Test Pool Examination.)
• The Colorado and Florida nursing boards have reviewed the
California State-Board Constructed Examination and deemed it
to be equivalent to the national examination. The Board has
been contacted by other Boards of Nursing who have
expressed an interest in reviewing this examination as well.
Preparation for Licensure

Equivalency and/or Military Experience Applicants



California LVN's who obtained their initial license in California
through equivalent education/experience or military methods of
qualifying may not be eligible for licensure in some states. Many
State Boards have laws that require applicants to have graduated
from an accredited or approved nursing program to be eligible for
licensure.
It is very important that you make sure that the Board of Nursing
will accept your experience and/or examination method prior to
submitting the Verification of Licensure form to the California Board
for completion. Once the Board has processed your verification of
licensure request, the $75.00 Verification of Licensure fee is nonrefundable.
For FAQs, go to http://www.bvnpt.ca.gov/faq.htm
Professionalism

Styles of leadership (see ATI book)
Style – leader makes decision,
most effective in emergencies, externally
motivated
 Democratic Style – collaborative decisionmaking, individuals are empowered to
make decisions
 Laissez-Faire Style (non directive,
permissive, ultra-liberal) – hand-off
approach, internal motivation
 Autocratic
Professionalism
– externally motivated, does
not trust self or others, leader relies on
organizational rules and policies, taking an
inflexible approach
 Charismatic – evokes strong feelings of
commitment, forms emotional relationships
with group members
 Transactional – focused on day-to-day
task, provides incentives to promote loyalty
and performance
 Bureaucratic
Professionalism
– fosters creativity, risktaking, commitment, and collaboration
 Transformational
• Facilitates individual independence, growth
and change, converts followers into leaders
through shared values, honesty, trust, and
continued learning
– promotes collaboration and
teamwork within organization and other
organizations in the community
 Connective
Professionalism
(participatory, inclusive) –
leader assumes work force contains
many leaders
 Shared
• Staff nurses and nurse managers share
a vision of their preferred future
Professionalism

Burnout

Some known examples of physical symptoms
of job burnout include
•
•
•
•
•
•
•
•
headaches
sleep problems
gastrointestinal problems
chronic fatigue
muscle aches
high blood pressure
frequent colds
sudden weight loss or gain
Professionalism
 Burnout
symptoms of emotional nature
include, but are not limited to, prolonged
periods of
• apathy
• frustration
• depression
• anger
• negative or cynical attitude
• being unexcited about life
• inclinations to high risk behaviors
• high emotional volatility
• high irritability
Professionalism
 Burnout
• when you see a combination of burnout
symptoms, it is time to take a break and have
a careful look at your life style and work
habits. Especially when your life situation
contains burnout threats (such as never
ending excessive workload at your job) or
your occupation has higher job burnout risk
(for example, manager, entrepreneur, medical
doctor or nurse, teacher, social worker, sales
person).
Professionalism
 Telephone
 Good
manners
afternoon, good am
 Name, name of facility
 How may I help you, or
direct your call
Team Leading and
Supervision

Role of charge nurse (see handout)
 Ensure
that residents receive nsg care, tx,
and meds per MD order
 Coordinate resident’s care
 Assist DON with orientation
 Evaluate work performance of nsg assistant
 Assignments
 Receive reports
 Assisting MD
 Delegating duties
5 Rs of delegation
 Right
person
 circumstance
 task
 supervision
 evaluation
Team Leading and
Supervision


Team leader
Evaluations
Career Opportunities


LVN or Licensed Psych Tech
Gateways Hospital & Mental Health Center















Job Snapshot Location: 437 N.Hoover Street
Los Angeles, CA 90004 ( Map it )
Base Pay: $17.24 - $19.04 /Hour
Other Pay: $2.00 per hour charge pay; excellent employee benefits
Employee Type: Full-Time Employee
Industry: Healthcare - Health Services
Not for Profit - Charitable
Manages Others: No
Job Type: Health Care
Nurse
Nonprofit - Social Services
Experience: At least 2 year(s)
Travel: Negligible
Relocation Covered: No
Posted: 6/4/2009
Contact Information Contact: Brett Morana, Psy.D.
Phone: 323-644-2030x210
Ref ID: LVN/LPT-0609-SAT
Fax: 323-660-6866
Career Opportunities
Responsibilities include but are not limited to:

Administers personal care, medications, treatments, and other nursing procedures to
selected clients as authorized by Hospital policy, LPT License, and Standards of Practice.

Supervises, encourages, and teaches the client personal hygiene and dietary needs as well
as medication actions and reactions.

Monitors and ensures clients take prescribed psychotropic medications and records
medications accurately.

Observes and records and communicates resident and outpatient behavior and activities to
treatment team including medication side effects.

Bill all applicable medication passes, consultations with psychiatrist or other clinical staff for
all residents. Community Reintegration Program (CRP) only.

Document groups on medication management for both Conditional Release (CONREP) and
CRP programs in a timely fashion including the billing for these programs.

Supervises and monitors client activities in main building, womens’ and mens’ cottages.
Career Opportunities













LVN
Motion Picture & Television Fund
Job Snapshot Location: Woodland Hills, CA 91364 ( Map it )
Employee Type: Per Diem
Industry: Healthcare - Health Services
Manages Others: No
Job Type: Health Care
Nurse
Experience: Not Specified
Relocation Covered: No
Posted: 6/12/2009
Contact Information Ref ID: 32549820
Fax: 818/876-1399 instantly fax your resume >>
Description Nursing The Motion Picture and Television Fund is seeking an:
LVN On-Call For our Woodland Hills location. Requires CA LVN license,
current CPR and outpatient health center experience. Please apply to HR
Department: Fax: 818/876-1399 E-mail: [Click Here to Email Your Resumé]
equal opportunity employer www.mptvfund.jobs MOTION PICTURE &
TELEVISION FUND Los Angeles Times 2009-06-12
Career Opportunities






LVN Hospice W/E evenings Per Diem - US-CATorrance
Ref ID: 47779 Company: Providence Health & Services
Base Pay: $17.59 - $28.22 /Hour
Employee Type: Full-Time Employee
Industry: Healthcare - Health Services
Experience: At least 1 year(s)
Career Opportunities






LVN (Part Time)
McKinley Children's Center
Job Snapshot Location: 762 Cypress Street
San Dimas, CA 91773 ( Map it )
Base Pay: $15.00 - $25.00 /Hour
Other Pay: Eligible for annual merit increases, up to 4%.
Employee Type: Full-Time Employee
Career Opportunities

Sunbridge Philosophy
 http://www.careerbuilder.com/JobSeeker/Jobs/JobDetails.aspx?IP
ath=JRKGTV&sc_cmp1=JS_JR_ViewJob&ff=21&APath=2.21.0.0.
0&job_did=JB957Q70QR3LGRMFTCL
Career Opportunities

LVN, Full-time, benefited, Van Nuys location - View
similar jobs Job type: Full-Time Employee | Pay: $17.59
- $28.22/hour
...or vocational nursing program. 2. Currently licensed as
an LPN/LVN in the state of California. 3. Possesses and
maintains current...
Providence Health Services California CA - Torrance
(4 miles)2 Weeks Ago
Career Opportunities

Charge nurse role (see
handout)
Workplace Dynamics
Physician orders
 End-of-Shift report
 Interpersonal communication
 Identifying ways to reduce error
and communicate change process

Roles and Responsibilities
of Vocational Nursing

Role of the VN in long term care facilities.
Skilled Nursing Facilities
 Sub-acute
 Retirement Communities
 Assisted Living
 Adult Day Care Centers
 Respite Care
 Foster Care
 Hospice

VN 109 Professionalism
and Leadership
Chapter 36
REHABILITATION,HOME HEALTH,
LONG-TERM CARE,AND HOSPICE
Nonacute Health Care
 There
has been a strong emergence in
the past decade of nonacute health care
services.
Reasons for Growth in
Nonacute Health Care




The number of Americans over the age of 65 has
tripled in this century. As individuals age, the risk
increases of acquiring a chronic disease requiring
health care throughout life.
Lives are being saved that would have been lost a
few years ago. Ongoing health care services
become necessary in such cases.
Discharge from acute-care hospitals is occurring
much earlier.
Cost of acute care has reached critical proportions
necessitating new forms of care management.
Clients’ and Family
Rights in Home Care (i)
 To
be treated with dignity,
consideration, and respect.
 To have their property treated with
respect.
 To be fully informed on admission of
care, cost, and how payment will be
made.
 To know in advance if they will be
responsible for any payment.
 To participate in planning care.
Clients’ and Family
Rights in Home Care (ii)
 To
be informed in advance of any
changes in care.
 To receive care from professionally
trained personnel.
 To refuse treatment and be told of
consequences of this action.
 To expect confidentiality.
 To be informed of termination of service.
 To know how to make a complaint.
Clients’ & Family
Responsibilities in Home
Care (i)





To remain under a doctor’s care while receiving
services.
To provide the agency with a complete health
history.
To provide the agency with all requested insurance
and financial information.
To sign the require consents and releases for
insurance billing.
To participate in care by asking questions,
expressing concerns, stating whether information is
understood or not.
Clients’ & Family
Responsibilities in
Home Care (ii)





To provide a safe home environment in which care
is given.
To cooperate with the doctor, the staff, and other
caregivers.
To accept responsibility for any refusal of treatment.
To abide by agency policies that restrict duties the
staff may perform.
To advice agency administration of any
dissatisfaction or problems with care.
Sources of Reimbursement
 Medicare.
 Medicaid.
 Private
insurance.
Licensure
A
mandatory system of granting licenses
according to specified standards.
 Regulated by each state.
 Board of Vocational Nursing and
Psychiatric Technicians (BVNPT)
 www.bvnpt.ca.gov
Certification
A
voluntary process that establishes and
evaluates standards of care.
 Required for any provider who seeks
reimbursement from government funds.
 Standards generated by the federal
government.
Accreditation
 An
additional confirmation of quality.
 Generally indicates that the provider has
gone above the minimum standards in
the delivery of care and service.
Rehabilitation
A
process designed to help individuals
reach their optimal level of physical,
mental, and psychosocial functioning.
Interdisciplinary Health
Care Team Process
 Admission
 Assessment
 Problem
identification
 Care Plan Conference
 Evaluation
 Reassessment
Role of the LP/VN



Rehabilitation nursing is a specialty practice and
requires specialized knowledge, skills, and attitudes.
Prerequisite is a sound knowledge base in the
anatomy and physiology of the neurological,
musculoskeletal, gastrointestinal, and urinary
systems.
The nurse must have excellent clinical skills in areas
of therapeutic positioning, exercises, transfers,
ambulation, and activities of daily living.
Rehabilitation Settings
 Hospital
Inpatient Program.
 Skilled Nursing Facility.
 Outpatient Rehabilitation.
 Home Rehabilitation.
Home Health Care
 Encompasses
a number of services
delivered to persons in their homes.
 The fastest growing segment of health
care delivery.
Role of LP/VN in
Home Health Care
 Clients
and their family caregivers must
know:
The disease process.
 Medications.
 Special skills (changing dressings,
administering of insulin, etc.).
 Documentation and communication (how to
keep records; when and how to contact
nurse/physician/emergency services).

Long-Term Care
 Refers
to a spectrum of services
provided to individuals who have an
ongoing need for health care.
 Long-term care facility may be licensed
for either intermediate care or skilled
nursing care.
Subacute Care
 Designed
to provide services for clients
who are out of the acute stage of their
illnesses but who still require skilled
nursing, monitoring, and ongoing
treatments.
 Intended to fill the gap between the
acute care hospital and the traditional
long-term care facility.
Continuing Care
Retirement Communities
Designed to provide continuing levels of care
as individual’s health care needs change.
 Levels include:
 Independent
 Assisted living
 Health care, either short-term or
permanent.

Assisted Living
A combination of
housing and
services for people
who need help with
the activities of daily
living.
 Nursing care is not
provided.

Adult Day Care
 Provide
a variety of services in a
protective setting for adults who are
unable to stay alone but who do not
need 24-hour care.
Respite Care
May be offered by adult day care centers,
long-term care facilities, or in private homes.
 Intended to provide a break to caregivers and
may be utilized a few hours a week, for an
occasional weekend, or for longer vacations.
 Planned activities, meals, and supervision
included.

Foster Care
 Some
states are investigating the use of
foster homes for individuals who cannot
live independently but who do not
require the services of a health care
facility.
 The legal structure is comparable to the
foster home concept for children.
Hospice
 Humane,
compassionate care provided
to clients who can no longer benefit from
curative treatment and have 6 months or
less to live.
 Hospice care may be implemented in
the client’s home, a special area of
hospitals or nursing homes, or
freestanding inpatient facilities.