Leadership, Quality Improvement, and Evidence-Based Practice
Leadership and Management
- Styles: transformational (inspire, motivate), transactional (rewards/punishments), democratic, autocratic, laissez-faire.
- Delegation: RN assesses, plans, evaluates; delegate tasks to LPN/UAP based on state law and patient stability.
- Conflict resolution: address early, use “I” statements, focus on problem.
- Staffing and safety: acuity-based staffing, mandatory overtime issues.
Quality Improvement (QI)
- Models: PDSA (Plan-Do-Study-Act), Six Sigma, Lean.
- Measures: structure, process, outcome; benchmarks; root cause analysis (RCA) for sentinel events.
- Patient safety: error reporting (non-punitive), handoffs (SBAR), medication reconciliation.
Evidence-Based Practice (EBP)
- Steps: formulate question (PICO), search literature, appraise evidence, implement, evaluate.
- Levels of evidence: systematic reviews/meta-analyses > RCTs > cohort > case-control > expert opinion.
- Barriers: lack of time, resources, resistance; facilitators: leadership support, education.
Traps in Questions
- Delegating assessment or teaching to UAP.
- Confusing QI (systems improvement) with research (generating new knowledge).
- Overlooking SBAR for handoff communication.
- Selecting expert opinion as strongest evidence.
Worked Example
A nurse wants to reduce falls on a psychiatric unit. What is the first step? Answer: Form a team and analyze current fall data-QI begins with understanding the problem. Rule of thumb: PDSA starts with “Plan” based on data.