Questions and Answers
What is the chain of command?
The line of authority and responsibility along which orders are passed within the nursing department, the hospital, and between different units.
Why is starting the chain of command necessary?
To obtain attention to the patient's condition and/or change in condition.
What are situations that may demand instituting the chain of command?
- The provider has not responded to a deteriorating patient condition. 2) The nurse disagrees with a provider's order or believes patient discharge is premature.
What is the purpose of the chain of command?
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Concerns may be related to which of the following? (Select all that apply)
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What is step 1 in starting the chain of command?
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What should you do if step 1 in the chain of command fails?
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In a critical situation involving a physician, who is your top advocate?
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What is essential to document when starting the chain of command?
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What does the typical hierarchy in a hospital setting include?
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What does SBAR stand for in healthcare communication?
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What is the primary purpose of SBAR?
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What information is included in a handoff?
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What should you have available when speaking with the physician?
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What should you do prior to calling a physician?
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What is the nurse's responsibility when calling the physician about a situation?
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Study Notes
Chain of Command
- Defined as the line of authority and responsibility for order transmission within nursing departments and hospitals.
- Ignoring the chain of command can result in job loss or loss of nursing licenses.
Initiating the Chain of Command
- Necessary to start the chain when a patient's condition warrants attention or change.
- Nurses hold responsibility for ensuring patient care is addressed until resolved.
Situations Requiring Chain of Command
- Lack of response from a provider to a deteriorating patient.
- Disagreement with a provider's order, care plan, or assessment discrepancies.
- Concerns over unprofessional behavior affecting patient care.
- Suspected impairment of a team member or premature patient discharge.
Conflict Resolution
- Chain of command serves to seek satisfactory resolutions to various issues within healthcare settings.
Concerns Addressed
- Issues can stem from workflow, staffing, individual needs, patients, and visitors.
Steps in Starting the Chain of Command
- Step 1: Contact head nurse or charge nurse to expedite response or authorization.
- Step 2: If unavailable, escalate to the Unit or Department Nursing Director.
- Step 3: In critical scenarios involving a physician, contact the Chief Nursing Officer (CNO).
- Step 4: Document all steps taken, including difficulties faced in obtaining authorizations.
Hierarchical Structure
- Established hierarchy includes staff, charge nurse, unit manager, department director, CNO, and organizational president.
Communication Barriers
- Nurses are encouraged to use both nursing and medical chains effectively, despite discomfort in escalating issues.
- Critical situations may arise when a provider does not grasp the seriousness of a patient's condition, necessitating the chain of command.
SBAR Communication Tool
- SBAR stands for Situation, Background, Assessment, Recommendation; promotes structured communication among healthcare professionals.
Purposes of SBAR
- To report urgent situations, define handoff elements, and provide structured communication methods.
Importance of Effective Communication
- Nurses act as patient advocates and frontline caregivers, yet often face barriers in effective communication with physicians.
- Collaborating effectively can protect patients from harm and streamline care processes.
Handoff Process
- A critical transition that ensures complete and accurate patient information transfer between caregivers.
Information Shared During Handoff
- Includes patient's current condition, treatments administered, and anticipated changes in care.
Rapid Response Team
- Any healthcare member may initiate a rapid response, bypassing the usual command structure to quickly intervene in urgent situations.
Contact Protocols for Physicians
- Sequence of contact methods includes direct paging, physician services, office calls, home phone, and cell phones, with specific timings for each.
Pre-call Preparation for Physicians
- Assess patient condition, discuss with resource nurse, review charts, and gather relevant clinical information before contacting a physician.
Required Information During Physician Communication
- Patient's chart, medication lists, vital signs, recent lab results, and code status must be readily available when speaking to physicians.
Elements of Communication with Physicians
- Situation: Identify self, unit, and briefly explain the current issue.
- Background: Provide necessary background information including diagnosis, medications, vital signs, and lab data.
- Assessment: Share the nurse's assessment of the current situation.
- Recommendation: Clearly articulate the desired action or response needed from the physician. Document all communication and changes in patient condition.
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Description
Explore the essential concepts of the chain of command within the nursing department. This quiz will help you understand the importance of authority and responsibility in healthcare settings. Ensure that you're aware of the proper procedures to follow for effective communication and patient safety.
