I Glossary

Accountability: Being answerable to oneself and others for one’s own choices, decisions, and actions as measured against a standard.^[1] (Chapter 1.8)

Actual versus potential nursing problems: A prioritization strategy that considers the type of nursing problem when prioritizing care. Actual problems refer to a clinical problem that is actively occurring with the client. A risk problem indicates the client may potentially experience a problem, but they do not have current signs or symptoms of the problem actively occurring. (Chapter 1.9)

Acuity: The level of client care that is required based on the severity of a client’s illness or condition. For example, acuity may include characteristics such as unstable vital signs, oxygenation therapy, high-risk IV medications, multiple drainage devices, or uncontrolled pain. A “high-acuity” client requires several nursing interventions and frequent nursing assessments. (Chapter 1.9)

Acuity-rating staffing models: A strategy for making patient assignments to equitably assign clients to nursing staff according to their acuity ratings. This means that when comparing client assignments across the nursing team on a unit, similar acuity team scores should be seen with the goal of achieving equitable and safe division of workload across the nursing team. (Chapter 1.9)

Acute versus chronic conditions: A prioritization strategy that considers acute versus chronic medical conditions. Acute conditions have a sudden and severe onset. These conditions occur due to a sudden illness or injury, and the body often has a significant response as it attempts to adapt. Chronic conditions have a slow onset and may gradually worsen over time. (Chapter 1.9)

Airway, breathing, and circulation (ABCs): A prioritization strategy, similar to Maslow’s Hierarchy of Needs, that guides nursing decision-making based on the most critical needs for preserving human life. (Chapter 1.9)

Authentic leaders: Leaders who have an honest and direct approach with employees, demonstrating self-awareness, internalized moral perspective, and relationship transparency. They strive for trusting, symmetrical, and close leader–follower relationships; promote the open sharing of information; and consider others’ viewpoints. (Chapter 1.3)

Authoritarian leadership: The leader has full power. Authoritarian leaders tell team members what to do and expect team members to execute their plans. (Chapter 1.3)

Basic nursing care: Care that can be performed following a defined nursing procedure with minimal modification in which the responses of the patient to the nursing care are predictable.^[2] (Chapter 1.7)

Basic patient situation: A situation determined by an RN, physician, podiatrist, dentist, or optometrist that meets the following three conditions^[3]:

• The patient’s clinical condition is predictable.
• Medical or nursing orders are not changing frequently and do not contain complex modifications.
• The patient’s clinical condition requires only basic nursing care. (Chapter 1.7)

Bedside Handoff Report Checklist: Similar to an ISBARR report but contains additional information to ensure continuity of care across nursing shifts. (Chapter 1.2)

Board of Nursing: A state-specific licensing and regulatory body that sets standards for safe nursing care and issues nursing licenses to qualified candidates. (Chapter 1.7)

Closed-loop communication: A communication strategy used to ensure that information conveyed by the sender is heard by the receiver and completed. Closed-loop communication is especially important during emergency situations when verbal orders are being provided as treatments are immediately implemented. (Chapter 1.2)

Complex patient situation: An act determined by an RN, physician, podiatrist, dentist, or optometrist where one or more of the following conditions exist in a given situation^[4]:

• The patient’s clinical condition is not predictable.
• Medical or nursing orders are likely to involve frequent changes or complex modifications.
• The patient’s clinical condition indicates care that is likely to require modification of nursing procedures in which the responses of the patient to the nursing care are not predictable. (Chapter 1.7)

Conflict resolution: Respectful dialogue and active listening to address conflicts promptly and constructively. Through mediation and negotiation, a nurse leader can help team members find common ground, reach compromises, and maintain harmonious working relationships. (Chapter 1.5)

Constructive feedback: Providing feedback to team members in a manner that focuses on their behavior or performance rather than criticism of the individual. The purpose of constructive feedback is to help the team member identify areas for improvement and offer suggestions for development. By providing specific and actionable feedback, team members can gain valuable insights into their strengths and weaknesses, reflect on their actions, create personal goals, and plan strategies for personal and professional growth. (Chapter 1.6)

Culture of safety: An organizational culture that embraces error reporting by employees with the goal of identifying systemic causes of problems that can be addressed to improve client safety. According to The Joint Commission, a culture of safety includes the following components^[5]:

• Just Culture: A culture where people feel safe raising questions and concerns and report safety events in an environment that emphasizes a nonpunitive response to errors and near misses. Clear lines are drawn by managers between human error, at-risk, and reckless employee behaviors.
• Reporting Culture: People realize errors are inevitable and are encouraged to speak up for client safety by reporting errors and near misses. For example, nurses complete an “incident report” according to agency policy when a medication error occurs, or a client falls. Error reporting helps the agency manage risk and reduce potential liability.
• Learning Culture: People regularly collect information and learn from errors and successes while openly sharing data and information and applying best evidence to improve work processes and client outcomes. (Chapter 1.2)

CURE hierarchy: An acronym for a prioritization strategy based on identifying the differences among Critical needs, Urgent needs, Routine needs, and Extras.^[6] (Chapter 1.9)

Data cues: Pieces of significant clinical information that direct the nurse toward a potential clinical concern or a change in condition. (Chapter 1.9)

Delegatee: An RN, LPN/VN, or AP who is delegated a nursing responsibility by either an advanced practice registered nurse (APRN), RN, or LPN/VN, is competent to perform the task, and verbally accepts the responsibility.^[7] (Chapter 1.8)

Delegation: States have different laws and rules/regulations regarding delegation. Delegation is generally defined as allowing a delegatee to perform a specific nursing activity, skill, or procedure that is beyond the delegatee’s traditional role and not routinely performed, but the individual has obtained additional training and validated their competence to perform the delegated responsibility.^[8] However, the licensed nurse still maintains accountability for overall client care.^[9] 

In Wisconsin, the NPA states, “In the supervision and direction of delegated acts, an RN shall do all of the following:

• Delegate tasks commensurate with educational preparation and demonstrated abilities of the person supervised.
• Provide direction and assistance to those supervised.
• Observe and monitor the activities of those supervised.
• Evaluate the effectiveness of acts performed under supervision.” (Chapter 1.8)

Democratic leadership: The leader balances decision-making responsibility between team members and the leader. Democratic leaders actively participate in discussions, but also make sure to listen to the views of others. (Chapter 1.3)

Direct supervision: Immediate availability to continually coordinate, direct, and inspect at first hand the practice of another. (Chapter 1.7)

Five rights of delegation: A method to ensure proper and appropriate delegation, including right task, right circumstance, right person, right directions and communication, and right supervision and evaluation.^[10] (Chapter 1.8)

Handoff report: A transfer and acceptance of patient care responsibility achieved through effective communication. It is a real-time process of passing patient specific information from one caregiver to another, or from one team of caregivers to another, for the purpose of ensuring the continuity and safety of the patient’s care. (Chapter 1.2)

Intensity: The time needed to complete nursing care and interventions such as providing assistance with activities of daily living (ADLs), performing wound care, or administering several medication passes. For example, a “high-intensity” client generally requires frequent or long periods of psychosocial, educational, or hygiene care from nursing staff members. High-intensity clients may also have increased needs for safety monitoring, familial support, or other needs.^[11] (Chapter 1.9)

I-PASS: A mnemonic used to provide structured communication among interprofessional team members. I-PASS stands for Illness severity, Patient summary, Action list, Situation awareness and contingency plans, and Synthesis by receiver. (Chapter 1.2)

ISBARR: A common format used by health care team members to exchange client information; the mnemonic stands for Introduction, Situation, Background, Assessment, Request/Recommendation, and Repeat back. (Chapter 1.2)

Laissez-faire leadership: The leader gives team members total freedom to perform as they please. Laissez-faire leaders do not participate in decision-making processes and rarely offer opinions. (Chapter 1.3)

Licensed practical/vocational nurse (LPN/VN): A nurse who has completed a state-approved practical nursing program, successfully passed the NCLEX-PN, and received an LPN or LVN license. LPN/VNs perform basic nursing care for stable clients under the supervision of an RN. (Chapter 1.1, Chapter 1.7)

Maslow’s Hierarchy of Needs: A prioritization strategy based on foundational human needs with progressive steps moving towards higher levels of achievement. This hierarchy of needs is traditionally represented as a pyramid with the base of the pyramid serving as essential needs that must be addressed before one can progress to another area of need.^{[12] (Chapter 1.9)}

Nursing assistants (NAs): A type of unlicensed assistive personnel (UAP) trained to function in a supportive role, regardless of title, to whom a nursing responsibility may be delegated.^[13] In some states, nursing assistants must complete a state-approved nursing assistant training program and successfully pass the state competency evaluation to become a certified nurse assistant (CNA) to work in long-term care centers. NAs provide basic care and help clients with activities of daily living. (Chapter 1.1)

Nurse Practice Act (NPA): Nursing regulations established by each state’s legislature that are enforced by the Board of Nursing. (Chapter 1.7)

Nursing team: The nursing team includes registered nurses (RNs), licensed practical/vocational nurses (LPN/VNs), and assistive personnel (AP).^[14] (Chapter 1.1)

Passive-avoidant leadership: Similar to laissez-faire leadership; the leader avoids taking responsibility and confronting others. (Chapter 1.3)

Prioritization: The ability to assess a client or a group of clients and determine what is critical, what is important, and what is time-sensitive to establish a preferential order of nursing actions. (Chapter 1.9)

Ratio-based staffing models: A strategy for making patient assignments where each nurse or UAP is assigned care for a set number of clients during their shift. (Chapter 1.9)

Registered nurse (RN): A nurse who has completed a required program of study, successfully passed the NCLEX-RN, and received an RN nursing license. RNs utilize the nursing process in the execution of general nursing procedures in the maintenance of health, prevention of illness, or care of the ill. The nursing process consists of the steps of assessment, diagnosis, outcome identification, planning, implementation of interventions, and evaluation. (Chapter 1.1, Chapter 1.7)

Resonant leaders: Leaders who are in tune with the emotions of those around them, use empathy, and manage their own emotions effectively. Resonant leaders build strong, trusting relationships and create a climate of optimism that inspires commitment even in the face of adversity. (Chapter 1.3)

Servant leadership: The leader focuses on the professional growth of employees while simultaneously promoting improved quality care through a combination of interprofessional teamwork and shared decision-making. (Chapter 1.3)

Supervision: After delegating a task to another nursing team member, the nurse verifies and evaluates that the task was performed correctly, appropriately, safely, and competently. (Chapter 1.8)

Time management: Time management in nursing helps nurses organize and prioritize client care, internal administrative tasks, educational responsibilities, and personal needs and obligations. (Chapter 1.10)

Transactional leadership: Both the leader and the follower receive something for their efforts; the leader gets the job done and the follower receives pay, recognition, rewards, or punishment based on how well they perform the tasks assigned to them. (Chapter 1.3)

Transformational leadership: The leader motivates followers to perform beyond expectations by creating a sense of ownership in reaching a shared vision. It is characterized by a leader’s charismatic influence over team members and includes effective communication, valued relationships, and consideration of team member input. (Chapter 1.3)

Unexpected versus expected conditions: A prioritization strategy that considers if a client’s signs and symptoms are “expected” or “unexpected” based on their overall condition. Unexpected conditions are findings that are not likely to occur in the normal progression of an illness, disease, or injury. Expected conditions are findings that are likely to occur or are anticipated in the course of an illness, disease, or injury. Unexpected findings often require immediate action by the nurse. (Chapter 1.9)

Unlicensed assistive personnel (UAP): Any unlicensed personnel trained to function in a supportive role, regardless of title, to whom a nursing responsibility may be delegated.^[15] UAPs provide basic care and help clients with activities of daily living. (Chapter 1.1)