Chapter 58
Professional Roles and
Leadership
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Functioning as a Graduate
• The role of a graduate nurse will be exciting and
challenging.
• The LPN/LVN is a valuable member of the health
care team and functions in many settings.
• Many opportunities are available from which to
choose.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 2
Functioning as a Graduate
• Letter of Application

It should always be customized, brief, neatly typed,
and correctly spelled.
 It should be simple and direct.
 Its objective is to introduce yourself, announce your
interest in employment, briefly state your
qualifications, and express your availability.
 Your cover letter requires a thorough discussion of
your qualifications.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 3
Functioning as a Graduate
• Résumé

A summary of educational and professional
experiences, including activities and honors
 A one- or two-page written document that contains
certain information about you, your education, and
your experience
 Should be well-organized, neat, and accurate
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 4
Functioning as a Graduate
• Personal Interview


A meeting of people face to face, as for evaluating or
questioning a job applicant
First impressions have a lasting effect.
• Contracts

A promise or a set of promises between two or more
people that creates a legal relationship between them
and a legal obligation that one or more of them must
fulfill
 May be written or oral
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 5
Functioning as a Graduate
• Keeping Your Job

Keep current and competent.
 Look and act professional.
 Be on time and ready to start at the beginning of the
shift.
 Be organized.
 Do not spend time with personal telephone calls.
 Take only the time allocated for lunch and breaks.
 Work hard and give the best care possible.
 Be a good leader and a good follower.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 6
Functioning as a Graduate
• Keeping Your Job (continued)

Help others when you can.
 Stretch yourself; do not be satisfied with the minimum.
 Display a positive attitude and flexibility.
 Respect your patients, their family members, your
co-workers, and your supervisors.
• Encountering Problems



Follow the chain of command.
Be calm and positive in your approach.
Listen carefully.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 7
Functioning as a Graduate
• Advancement

A rise in rank or importance, a promotion, progress,
improvement
 May result from additional preparation or additional
experience
 Usually based on a person’s qualifications, behavior,
performance, and preparation
• Terminating Employment

A verbal statement and letter of resignation should be
completed; proper procedures should be followed.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 8
Transition from Student to
Graduate
• Know Your Role


LPN/LVN is responsible to the RN or physician.
Role of LPN/LVN is constantly changing.
• Technical and scientific changes in the health care
system have resulted in a multiplicity and complexity of
functions placed on the nurse.
• Be careful not to lose sight of your principal concern—
the patient, a human being!
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 9
Transition from Student to
Graduate
• Confidentiality

All information the patient gives is confidential.
 Information may be exchanged with other members of
the health care team only in the performance of your
duties.
 Releasing any information to anyone other than the
health care team without the consent of the patient is
a violation of the right to privacy.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 10
Transition from Student to
Graduate
• Role of the LPN/LVN in the Community
Participates in activities that promote the community’s
attitude toward positive health care
 Uses community resources to promote a better
understanding of the health services available to the
general public
 Participates in community health projects and other
health-oriented activities

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 11
Transition from Student to
Graduate
• Professional Organizations

Gives you a voice in your profession
 Some provide continuing education
 Two national organizations are designed to support
and meet the needs of the LPN
• National Association for Practical Nurse Educators
(NAPNES)
• National Federation of Licensed Practical Nurses
(NFLPN)

National League for Nursing (NLN)
• Involved with all types and levels of nursing
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 12
Transition from Student to
Graduate
• Continuing Education


It is critical to keep current on nursing trends and
issues.
There are many opportunities for nurses to learn new
nursing skills.
• Facilities offer employees continuing education.
• Internet
• Some states require CEUs before you can renew
nursing licenses.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 13
Transition from Student to
Graduate
• Certification Opportunities

Certifications
•
•
•
•
•
Managed care (CMCN)
Pharmacology
Long-term care (CLTC)
Addiction (CALPN)
Further education
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 14
Licensure Examination
• National Council of State Boards of Nursing

Computerized adaptive testing (CAT) was adopted in
1994.
 Examinee takes the CAT exam by sitting at an
individual computer and answering questions on the
screen.
 NCLEX-PN has 85 to 205 questions.
• The candidate’s application is approved by the
board of nursing in the jurisdiction where the NCLEX
is to be taken.
• On successful completion of the examination, you
can practice as an LPN/LVN.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 15
Licensure Examination
• Endorsement/Reciprocity

This is recognition of the license of a health
practitioner in one state by another state.
 Applicant must meet the state’s licensing
requirements.
 If the nurse travels with a patient from one state to the
other or to Canada, the license the nurse has in her or
his possession is valid for the length of the stay in the
other state or Canada.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 16
Licensure Examination
• Nurse Licensing Compact/Mutual Recognition

Based on the primary state of residence
• A declared, fixed, permanent, and principal home for
legal purposes


A nurse may practice in a compact state using the
nursing license from the primary state of residency.
State boards of nursing differ, so you should contact
the board of nursing in the state where you are
seeking licensing for the specific requirements.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 17
Nurse Practice Act
• Licensing law
• Defines the title and regulations governing the
practice of nursing
• Assists the nurse in staying within the legal scope of
nursing practice in each state
• Defines the regulations for practical nursing and
includes requirements for an approved school of
nursing
• Defines requirements for licensure and conditions for
which a license may be revoked or suspended
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 18
State Board of Nursing
• Board consists of members who represent different
levels of nursing and are appointed by the governor.
• The purpose of the board is to protect the public by
administering the nurse practice act.
• Board is responsible for approving schools of
nursing
• Board issues and renews licenses.

Board has the authority to suspend or revoke a
license.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 19
Career Opportunities
• Hospitals




LPN/LVN is under the supervision of the RN.
LPN /LVN is legally able to provide most bedside care
to patients in the hospital setting.
LPN /LVN is responsible for supervising the nursing
assistants.
There are a number of different types of hospitals.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 20
Figure 58-4
(From Polaski, A.L., Warner, J.P. [1994]. Saunders fundamentals for nursing assistants. Philadelphia:
Saunders.)
Various positions are available in the hospital setting on the health care
team.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 21
Career Opportunities
• Long-term Care Facilities



LPN/LVN is the backbone of long-term care facilities
Can advance to charge nurse and supervisory
capacity with RN supervision
A facility for those who require long-term care
• Home Health



Health care in the home setting
RN supervision must be available
Relaxed atmosphere, decreased patient load,
primarily daytime hours
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 22
Career Opportunities
• Physician’s Office or Clinic

Some of the skills required may not be included in the
LPN/LVN educational program.
• Laboratory testing, ECGs, computer skills, insurance
coding, billing, supervision of other office personnel
• Insurance Companies


Preadmission and claims assessments
Usually require experience in medical-surgical nursing
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 23
Career Opportunities
• Temporary Agencies

These agencies provide nurses to meet the staffing
needs in a variety of health care facilities.
 Advantages are the right to refuse and the wealth of
variety available.
 Disadvantage is the uncertainty of work available.
• Travel Opportunities



Nurse can work for specified periods in areas in need
of nurses through a temporary agency.
Experience is required.
Lodging is provided in addition to salary.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 24
Career Opportunities
• Pharmaceutical Sales

LPN/LVN makes contacts with physicians,
pharmacists, and nurses in various clinical settings.
• Presents the advantages of products
• Teaches about side effects and precautions

Experience in specific areas and an expertise in
science and pharmacology are required.
• Other Medical Sales


Sell medical supplies
May perform in-service programs at facilities to
demonstrate product use
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 25
Career Opportunities
• Outpatient Hotels


Provides patient teaching and assists with preparation
for tests; available for emergencies
Hotel is usually owned by a hospital.
• Patient/guests stay while they undergo testing before
surgery and/or for postsurgical care.
• The Military


Active duty or reserves are options.
Educational opportunities
• Additional education
• May help repay loans
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 26
Career Opportunities
• Adult Daycare

Provide medical supervision for adults while their
family members work or take a break from the
responsibility of care
• Schools

Perform health screenings, emergency care, and
health teaching
• Public Health

Work in clinics and home visits; may also participate
in health inspections
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 27
Career Opportunities
• Outpatient Surgery

Prepare patients for surgery, as a scrub nurse, or to
work in the recovery room under the supervision of an
RN.
• Private Duty


Give total care to one patient
May be in the hospital, home, other facility, or while
traveling
• Government

May work in a Veterans Administration hospital or
other government hospitals
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 28
Career Opportunities
• Industrial



Focuses on promoting wellness and preventing
accidents
Safety is emphasized, and usually is first aid–oriented
May do physical assessments, health surveys,
insurance forms preparation, health education, and
intervention for patients injured in industrial accidents
• Rehabilitation

Guides the patient toward health and independence
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 29
Career Opportunities
• Psychiatric


Provides care for the mentally ill patient
Requires a mature person
• Hospice



Provides care for the terminally ill patient
Institution or home setting
Must have a clear understanding of his or her own
feelings about death
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 30
Leadership and Management
• Leadership

The art of getting others to want to do something you
are convinced should be done
• Management

Handles the day-to-day operations to achieve a
desired outcome
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 31
Leadership and Management
• Autocratic Style

Retains all authority and responsibility
 Concerned primarily with tasks and goal
accomplishment
 Assigns clearly defined tasks
 Establishes one-way communication with the group
 Excels in times of crisis (cardiac arrest) and in
situation of disorder (natural disasters)
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 32
Leadership and Management
• Democratic Style

People-centered approach
 Allows employees more control and participation in
the decision-making process
 Emphasis is on team building and collaboration
 Works best with mature employees who work well
together as groups
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 33
Leadership and Management
• Laissez-Faire Style
“Free-run style” or permissive leadership
 Relinquishes control completely
 Chooses to avoid responsibility by delegating all
decision making to the group
 Wants everyone to feel free to “do their own thing”
 May work well with highly motivated professional
groups

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 34
Leadership and Management
• Situational Leadership


Takes into account the style of the leader, the maturity
of the group, and the situation at hand to form a
comprehensive approach
Four typical styles
• Directing


Provides specific instructions and supervises the
accomplishment of tasks
New employees, employees with repeated performance
problems, and crisis work situations
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 35
Leadership and Management
• Situational Leadership (continued)

Four typical styles (continued)
• Coaching


Monitors the accomplishment of tasks while also
explaining decisions, asking for feedback or suggestions,
and recognizing good performance
Typically, leader and staff have have jointly developed a
work plan.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 36
Leadership and Management
• Situational Leadership (continued)

Four typical styles (continued)
• Supporting


Supports the efforts of others, facilitates their goal
accomplishment, and shares responsibility for decision
making
Values growth and not perfection, collaboration and not
competition
• Delegating

Gives responsibility for decision making and problem
solving to mature staff who have demonstrated their
competence
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 37
Leadership and Management
• Team Leading


Assisting and guiding the nursing team in providing
care for a select group of patients
Duties
•
•
•
•
•
Receive reports on assigned patients
Make assignments for team members
Make rounds and assess all assigned patients
Assist in administering medications and treatments
Confer with team members on priority patients
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 38
Leadership and Management
• Time Management



Using time to good advantage will be of great value.
Learn effective time management skills, and practice
them frequently until they become fully developed.
These skills will help you manage not only at work but
also in daily living.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 39
Leadership and Management
• Anger Management


Anger gives you a cue that something is wrong.
Justified
• Helps you get your needs met by stimulating you to
action

Unjustified or displayed inappropriately
• Can get you and others in trouble
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 40
Leadership and Management
• Burnout

Physical, emotional, and spiritual exhaustion
 Nurses are at high risk because they care!
 Occurs more often in people who have excessively
high expectations of themselves
 High-risk areas
•
•
•
•
Intensive care
Hospice
Oncology
Emergency department
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 41
Leadership and Management
• Burnout (continued)

Signs and symptoms
• Physical


Fatigue; changes in sleeping and eating
Lack of energy; loss of interest in sex
• Psychologic



Irritability; hypersensitivity
Frustration; negative outlook
Forgetting
• Spiritual

Loss of commitment, meaning, and integrity
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 42
Burnout
Symptoms of burnout.
(From Arnold E.N., Boggs, K.U. [2003]. Interpersonal relationships: professional communication skills for nurses.
[4th ed.]. Philadelphia: Saunders.)
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 43
Leadership and Management
• Strategies for Burnout Prevention









Awareness
Balance
Choice
Detachment
Altruistic egoism
Focus
Goals
Hope
Integrity
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 44
Leadership and Management
• Transcribing Physicians’ Orders

Written
• Recorded on the chart by the physician.
• NEVER GUESS: If in doubt, get a second opinion.
• If it is a little different that “usual,” clarify it with the
physician.
• If you still believe the orders to be inappropriate, contact
your supervisor and document why the orders are not
being carried out.
• Nurses are responsible for their own actions, regardless
of who told them to perform those actions.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 45
Figure 58-6
Clarifying the physician’s order.
(From Leahy, J.M., Kizilay, P.E. [1998]. Foundations of nursing practice: a nursing process approach. Philadelphia:
Saunders.)
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 46
Leadership and Management
• Transcribing Physicians’ Orders (continued)

Verbal or via telephone
•
•
•
•
•
•
They may only be taken from a physician or a nurse.
They are more subject to error.
Clarify the order by repeating it to the person giving it.
Ask them to repeat it more slowly if necessary.
Write it down immediately.
Be careful about medications that sound alike.

For example, Zantac and Xanax
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 47
Figure 58-8
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.].
St. Louis: Mosby.)
Computerized system for narcotic distribution.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 48
Leadership and Management
• Change-of-Shift Report

The report provides the next shift with pertinent
information about the patient.
 The quality of nursing care the patient receives is
contingent on how well each shift communicates with
the other.
 The report may be given orally in person, by
audiotape recording, or with rounds from patient to
patient.
 Before beginning the report, write down all necessary
information.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 49
Figure 58-9
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.].
St. Louis: Mosby.)
Giving a change-of-shift report.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 50