To Float or Not to Float
You have been an obstetrical staff nurse at Memorial hospital for 25 years. the obstetrical unit census has been abnormally low lately, although the patient census in other areas of the hospital has been extremely high. When you arrive at work today, you are told to float to the thoracic surgery critical care unit. this is a highly specialized unit, and you feel ill prepared to work with the equipment on the unit and the type of critically ill patients who are there. You call the staffing office and ask to be reassigned to a different area. You are told that the entire hospital is critically short staffed, that the thoracic surgery unit is four nurses short, and that you are at least as well equipped to handle that unit as the other three staff who also are being floated. Now your anxiety level is even higher.
You will be expected to handle a full rN patient load. You also are aware that more than half of the staff on the unit today will have no experience in thoracic surgery. You consider whether to refuse to float. You do not want to place your nursing license in jeopardy, yet you feel conflicting obligations.
Assignment: to whom do you have conflicting obligations? You have little time to make this decision. Outline the steps that you use to reach your final decision. identify the legal and ethical ramifications that may result from your decision. are they in conflict?
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117
Patient, Subordinate, and Professional Advocacy
… to see what is right, and not do it, is want of courage, or of principles.
—Confucius
… in our imperfect state of conscience and enlightenment, publicity and the collision resulting from publicity are the best guardians of the interest in the sick.
—Florence Nightingale
CROSSWALK
this chapter addresses:BsN essential ii: Basic organizational and systems leadership for quality care and patient safety BsN essential V: Health-care policy, finance, and regulatory environments
BsN essential Vi: Interprofessional communication and collaboration for improving patient health outcomes
BsN essential Viii: Professionalism and professional values MsN essential ii: Organizational and systems leadership MsN essential Vi: Health policy and advocacy
aONe Nurse executive competency ii: A knowledge of the health-care environment aONe Nurse executive competency iii: Leadership
aONe Nurse executive competency i: Professionalism QseN competency: Patient-centered care
QseN competency: Teamwork and collaboration
LEARNING OBJECTIVES
The learner will:l differentiate between the manager’s responsibility to advocate for patients, subordinates, the organization, the profession, and for self
l identify values central to advocacy
l differentiate between controlling patient choices and assisting patients to choose
l select an appropriate response that exemplifies advocacy in given situations
l identify how the Patient’s Bill of Rights protects patients
l describe ways a manager can advocate for subordinates
l identify ways individual nurses can become advocates for the profession
l identify both the risks and potential benefits of becoming a whistleblower
l specify both direct and indirect strategies to influence legislation
l describe strategies nurses can use to successfully interact with the media
6
Advocacy—helping others to grow and self-actualize—is a critically important leadership role. Many of the leadership skills that will be described in the following chapters, such as risk taking, vision, self-confidence, ability to articulate needs, and assertiveness, are used in the advocacy role.
Managers, by virtue of their many roles, must be advocates for the profession, subordinates, and patients. The actions of an advocate are to inform others of their rights and to ascertain that they have sufficient information on which to base their decisions. The term advocacy can be stated in its simplest form as protecting and defending what one believes in for both self and others (The Free Dictionary, 2013). Nurses often are expected to advocate for patients when they are unable to speak for themselves. Indeed, advocacy has been recognized as one of the most vital and basic roles of the nursing profession since the time of Florence Nightingale.
Nurses may act as advocates by helping others make informed decisions, by acting as an intermediary in the environment, or by directly intervening on behalf of others.
This chapter examines the processes through which advocacy is learned as well as the ways in which leader-managers can advocate for their patients, subordinates, and the profession. The role of “whistleblower” as an advocacy role is discussed. Specific suggestions for interacting with legislators and the media to influence health policy are also included. Leadership roles and management functions essential for advocacy are shown in Display 6.1.