The document discusses leadership at the bedside and the need for change in nursing care delivery models. It notes that current models emphasize teamwork and collaboration more than previous models. The presentation defines key terms related to nursing care delivery and leadership. It discusses progressive patient care models and the roles of licensed practical nurses and health care assistants in leading teams. It argues that LPNs and HCAs are well-educated and able to provide critical thinking and leadership at the bedside.

1. “Leadership at the Bedside
the change that needs to
happen”
Presenters:
Anita Dickson, LPN
Brenda Childs, LPN

2. Lets get started……
First lets see who you would refer to as the leader
in your unit/care home? Why do they stand out?
LPNABC 2017 - Anita Dickson, LPN
Brenda Childs, LPN
2

3. There are so many “buzz” words
about team….about leadership
Who and what do we really mean?
Here are some of the key words we
hear:
LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 3

4. LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 4
Interdisciplinary Model
Team leader
Registered Nurse
Team Work
Collaboration
Staffing Mix
Skill MixManager
Team Huddle
Synergy Model
Collaborative Care Model
Team Based Health Care Delivery Model
Partners
Good Communication
Mentoring
Emotionally Intelligent Leader

5. Staff mix is a component of
nursing care delivery models that
currently includes a greater
emphasis on teamwork and
collaboration.
LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 5

6. LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 6

7. Nursing care delivery model:
 A system for organizing and delivering nursing care
to clients and their families. It represents both the
structural and contextual elements of nursing
practice (Fowler, Hardy, & Howarth, 2006).
LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 7

8. Other “buzz” words regarding
Nursing Care Delivery Models…..
 Collaborative Care Model
 Interdisciplinary Health Care Model
 Primary Health Care Model
 Multidisciplinary Team Model
Team-based Health Care Delivery
Model
LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 8

9. LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 9

10. LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 10
Progressive Patient Care has been
defined as "the right patient, in the
right bed, with the right services, at
the right time" (Haldeman JC, 1964).

11. LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 11
PROGRESSIVE PATIENT CARE
•PPC is a system of nursing care in which patients are placed in
units on the basis of their needs for care as determined by the
degree of illness rather than on the basis of a medical specialty.
• Organization of medical and nursing care according to the degree
of illness and care requirements in the hospital.

12. LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 12

13. Words we heard used about LPNs and
HCAs that are NOT team building…
 LPNs are cheaper
 Health care assistants can work without
nursing supervisors…
 LPNs & HCAs are NOT educated enough to
lead teams….
 LPNs & HCAs Do NOT have critical
thinking skills….
LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 13

14. Reflections on Leadership Practice
 You are a manager or team leader and overhear a conversation in the staff
room or on the unit about how LPNs are replacing RNs and they are not
capable but they are “cheaper”.
 You are a manager who has just held a team huddle stating the unit is
short an RN so they have called in an LPN to be team leader and the HCAs
express distaste?
What would be the best way to handle these
conversations?
LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 14

15. How do we provide good patient &
client care when we are not cared for?
 Health Care Assistants are being recognized by leaders for their contribution
but they still are not a mandated member of team conferences ….. But they
should be!
 Licensed Practical Nurses are not always allowed to Care Plan, the confusion
around their scope of practice and in some cases, culture on the unit prevents
the LPN to do what they are educated to do!
LPNs and HCAs team together to provide EXCELLENT care and have
great outcomes but there remains little to NO mention in articles,
literature and research.
LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 15

16. Patient & Family Centred Care
“….the secret of the care of the patient is
caring for the patient…”
Francis W. Peabody, 1927

17. Do you work in
my home? Or,
do I live in your
workplace?

18. is an approach to care that
consciously adopts the client’s and
family’s perspective about what
matters in the planning, delivery and
evaluation of care.
We see clients and their
families as partners in their
care and actively engage
and empower them.

19. Client-centred care seeks to:
 understand the whole person
 find common ground
 meet each Client’s unique needs
 share information and decision-making at the level
the client & family prefers.

20. It is my RIGHT….to express the true ME
in any way I wish

21. Patient Centred Care:
Who are we really centred on?
LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 21

22. More Seniors today than Children in Canada
as per Census Canada 2016
LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 22
We are living longer
People aged 85 and older: A fast-growing population
Between 2011 and 2016, the number of people aged 85 and
older grew by 19.4%, nearly four times the rate for the
overall Canadian population, which grew by 5.0% during this
period.
http://www12.statcan.gc.ca/census-recensement/2016/as-sa/98-200-x/2016004/98-200-x2016004-eng.cfm

23. Health Care Workers at the point of care
told us we need help ……
LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 23
One in eight seniors is aged 85 or older
In 2016, one out of eight people aged 65
and older (13.0%) was actually aged 85 or
older. By comparison, in 1966, this
proportion was 6.7%, half the proportion
of 2016.

24. LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 24
More than 8,000 centenarians
counted in the census
Of all age groups, centenarians were
the fastest growing between 2011
and 2016, with a growth of 41.3%
during this period. According to the
2016 Census, 8,230 centenarians
were living in Canada.

25. LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 25

26. LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 26

27. LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 27
7 out of the top 10 municipalities are in BC
with seniors aged 85 and older

28. Nearly one in three people aged 85 and older
lives in a collective dwelling
LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 28
About 247,000 people aged 85 and older were living in
collective dwellings such as nursing homes, long-term
care facilities and seniors' residences in 2016.
Since 2011, the population aged 85 and older living in
collective dwellings has grown by 23.0%, compared with
an overall growth rate of 19.4% for the total population
aged 85 and older
Statistics Canada (2011-2016)

29. Interview with Kimberly Riguedell, HCA
from Vernon BC

30. Do we have a nursing shortage or are
we not looking at our human resources
and optimizing them?
LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 30

31. A nursing call to action;
The health of our nation, the future of our
health system; pg. 7
LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 31

32. Scope of Practice and New Competencies
The practical nursing profession faces an exciting future.
The practical nursing scope of practice will continue to
evolve in response to changes in the Canadian health care
system.
CNA's Toward 2020 report (Villeneuve & MacDonald, 2006)
proposed that the structure of the health care system and
the delivery of nursing by regulated nursing professions will
be very different in the future.
LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 32

33. One Patient’s Story

34. The Art of Listening
“Few motives in human experience are as powerful as
the yearning to be understood. Being listened to
means that we are taken seriously, that our ideas
and feelings are known and ultimately that what we
have to say matters”
Nichols, M.P. (1995). The Lost Art of Listening. The Gilford Press: New York. Chapter 1

35. The leaders say LPNs and HCAs are not
“trained to use critical thinking?” is this
really true?
Lets look at what literature says about “critical thinking”
and evidence that it is in both Practical Nurses and Health
Care Assistants education.
 Health Care Professionals are frequently faced with complex situations that
require the application of knowledge and not just
“doing”.
 Health Care Professionals who do not think critically become part of the
problem.
 Easy to switch to “task based” nursing with increased workloads.

36. What are the characteristics of critical
thinkers?
 Good communicators
 Active thinkers, use a systematic approach
 Fair minded, open-minded
 Self-reflective
 Proactive………. Not reactive
I think some of the leaders are not critically thinking when they
do not include the leaders at the bedside….

37. TRADITONAL VS. CRITICAL
 Accepts the obvious
without questioning or
exploring other options
 Problem solves in isolation
 Uses intuition and follows
hunches
 Seeks out experienced
peers to use as a sounding
board when problem-
solving

38. Emotional Intelligence:
 Recognize, understand and manage our own
emotions
 Recognize, understand and influence the emotions
of others
LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 38

39. Thinking about it? Who is
Communicating “person centered” priorities and
preferences?

40. What is the LPN role in the Nursing
Care Delivery Models in BC?
We need to understand our ever changing
“Scope of Practice” and advocate for our role in the
health care team…
LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 40

41. How do we lead when we are not
heard?
LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 41

42. Health care is labour intensive, and the cost
of labour accounts for a high proportion of
total costs (often 75% or more).
Managers and health professionals are thus
striving to identify the most effective skill
mix of staff achievable within available
resources
LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 42

43. Many health systems around the world are coming
under scrutiny for cost containment and quality
improvement, often as a direct or indirect result of
health sector reform.
LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 43

44. Nursing Leadership: Tomorrow’s
Vision
LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 44
That HCA running up the hall to fetch towels is freeing up time for the
nurse on the unit to spend time with patients…..
That LPN that is called in to when there is a staffing shortage….
That LPN that is manages to give medication for over 25 residents ….
That LPN that is gives up their break to help the HCA that is all alone
on the unit to help with a resident or patient who needs help….
We keep saying there is not enough of us, and we don’t have enough
time – and yet we’re not using the human resources that are here….

45. Scope of Practice….
Lets talk !
LPNs and HCAs need to say what they
CAN DO!
LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 45

46. Panel Interview
Leaders at the bedside
bringing change
LPNABC 2017 - Anita Dickson, LPN Brenda Childs, LPN 46