LEADERSHIP METHODS IN NURSING

Leadership methods in Nursing

LEADERSHIP METHODS IN EXPERT NURSING

Introduction

Nurses comprise the largest proportion of employees in long-term care (LTC). Residents require nursing care more than any other service provided by institutions of LTC. The majority of residents in LTC require custodial care, which consists of assistance with bathing, dressing, feeding, and mobility. Other residents may require a higher level of care called skilled nursing care, which includes treatments to management disease such as tube feedings, stormy care, and rehabilitation services. This wide variation of resident needs serves as the basis for the multiple levels of nurses working in LTC. Registered nurses (RNs) in the United States care for more than 1.4 million older adults in the nation's 16,000 nursing homes. The role of the RN can vary depending on the size of the LTC facility but is primarily a role of management and leadership. An advanced practice nurse, such as a geriatric nurse practitioner (GNP), holds a master's degree in nursing and provides residents with primary care that includes health promotion, maintenance of care, and case management. Licensed practical nurses or licensed vocational nurses (LPNs/LVNs) are the largest providers of skilled nursing care in LTC and represent the largest number of licensed nurses in LTC. The role of the LPN/LVN often entails entry-level management as charge nurses of units within the LTC facility. Certified nursing assistants (CNAs) are not nurses but provide the bulk of custodial nursing care for residents. The American Nurses Association defines a CNA as an unlicensed individual who is trained to function in an assistive role to the licensed nurse in the provision of patient care. To gain the title of CNA, each nursing assistant must complete a course of study and be certified by a national examination that has both a written and clinical component.

Discussion

The role of the RN is the most versatile nursing role in any LTC facility. RNs are directors of nursing (DONs), assistant directors of nursing (ADONs), infection control officers, risk managers, and quality improvement and compliance coordinators. Depending on the size of the LTC facility, these roles may be separate positions or combined into one or more positions. All LTC facilities are required to have an RN who is accountable for the nursing care delivered to residents. The title of this RN is usually the director of nursing, and the areas of responsibility include the coordination and management of the day to-day operations of the nursing department. Other responsibilities include administrating the budget, hiring and supervising the nursing staff, conducting employee performance appraisals, retaining employees, and coordinating interdisciplinary resident care teams. DONs have direct responsible for the clinical activities of preventing and controlling infections in the LTC facility, promoting client safety, and keeping the facility in compliance with federal and state regulatory agencies. In light of the current nursing shortage, qualifications to be a DON are often based on experience in geriatric nursing and LTC rather than on the college degree held. However, there is a growing trend to employ ...