ATI Leadership
(COPD patients with 90% SpO2/patients with pressure ulcers – chronic conditions. NEVER the
priority)
Practice A & B (2010/2013/2016)
Chapter 1:
Leadership Styles
1. Authoritative
a. Leader dictates decision for the team and uses penalties or coercion to promote
behavior ...
ATI Leadership
(COPD patients with 90% SpO2/patients with pressure ulcers – chronic conditions. NEVER the
priority)
Practice A & B (2010/2013/2016)
Chapter 1:
Leadership Styles
1. Authoritative
a. Leader dictates decision for the team and uses penalties or coercion to promote
behavior change
b. No group decision making
2. Democratic
a. Leader involves the team members in decision-making
b. Characterized by team cooperation and collaboration and often results in higher
quality outcomes
3. Lazy bear
a. Leader provides very little direction/planning and emphasis is on group decision-
making
b. Team results may be lacking due to lack of direction and planning
ABCDE Priorities
1. A = airway
a. Ensure patent airway
b. Neck/head trauma = STABILIZE cervical spine
2. B = breathing
a. Assess respirations
3. C = circulation
a. Check HR, BP, cap refill
4. D = disability
a. Assess LOC
5. E = exposure
a. Assess pt’s body for trauma/exposure to heat/cold
Priority
1. Always want to assess before taking action
2. Prioritize patients who are unstable over those who are stable
a. Pts with expected findings for medical diagnosis would NOT be priority
i. COPD pt and SP02 in low 90s = EXPECTED and NOT a priority
b. Pt who had a stroke a couple days ago with dropping on one side of their face =
EXPECTED = NOT be priority
3. Prioritize acute vs chronic conditions
a. Pt wit pressure ulcer/pressure injury = CHRONIC
i. Took months to develop = NOT acute and NOT priority
4. Prioritize systemic over local issues
, a. Systemic symptoms: BP starts to decrease, it is a big deal and you want to give
that patient priority
b. Tachypnea/Tachycardia = SYSTEMIC RED FLAG
c. Local issues = local pain or swelling is more indicative of local problem
5. Prioritize interventions using ABCDE framework
a. Administer O2 to someone with dyspnea takes priority over giving pain
medication to a patient
b. Giving pain meds is NEVER the priority!
6. Choose least invasive and restrictive interventions over more invasive/restricting
interventions
a. High risk fall patients = move the patient closer to nursing station and set a bed
alarm BEFORE putting them in restraints (last resort)
7. In a mass casualty event, prioritize those who have a chance or surviving over those who
are expected to diet
a. BLACK TAG (Class 4) = patients expected to die
b. Focus attention on patients who actually have a chance at surviving
Time Management
1. Complete charting on assessment/interventions ASAP
a. Do not wait until after shift to complete charting
2. Try to group tasks that are for a single patient or for a patient that is located closer
together to prevent repeated trips back and forth to supply room
a. Mentally work through procedure/intervention and gather supplies as you are
thinking about them
3. Complete difficult/time-consuming tasks EARLY on the shift NOT LATER because energy
is higher
4. Perform non-essential tasks later on the day
5. Always complete tasks before starting new tasks
6. Always know when to delegate & when to ask for help
a. If drowning in work, ask mentor nurse/charge nurse before it gets bad
7. Do not help other team members with low-priority tasks while you still have outstanding
tasks to complete
a. If it’s high priority, help them
Delegation
RN
1. As an RN, NEVER delegate anything that requires nursing judgement
a. New admission, evaluate patient’s ability to swallow = ONLY FOR RN
2. Never delegate anything that requires patient education
a. When teaching a patient, education on diagnosis = ONLY FOR RN
3. Nursing assessment
a. Head-to-toe, assessment
4. Blood transfusions
a. Requires 2nd RN to verify all information
, Delegating to LPN/LVN
1. Medication administration
2. Enteral feedings through NG/G tube
3. Urinary catheter insertion
4. Suctioning
5. Trach care
6. Reinforce patient teaching
a. RN needs to do initial teaching, LPN/LVN can reinforce teaching
7. Check NG tube patency
Delegating to UAP/CNA
1. Bathing
2. Dressing
3. Ambulating
4. Toileting
5. Feeding patients without swallowing difficulties
a. If patient has swallowing issues, it should NOT be delated to UAP/CNA
6. Positioning
7. Take vital signs on stable patients
8. Make beds
9. Collect specimens
10. Keep track of I&Os
11. Simple dressing change
12. Suction established tracheostomy
If CNA reports something that is out of the norm, RN has to take measurements again to
confirm finding/reading
Rights to delegation
1. Right task
a. Tasks that are repetitive, non-invasive and don’t require supervision
2. Right circumstances
a. Never delegate a patient who is unstable
i. Patient who just came from PACU, do not delegate to someone else
ii. Assess patient
3. Right person
a. Make sure person you are delegating to is competent and operating within their
own scope of practice
b. Check facility’s job description OR reference skill competency checklist
4. Right direction & communication
a. Communicate specific timeline, expected results, and follow-up communication
expectations
5. Right supervision & evaluation
a. May need to intervene if tasks are not done right
b. Provide feedback if needed
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