We are pleased to offer our readers this second edition of Essentials of Nursing Leadership and Management. Fannie Jean Spencer, RN, MSN Chair, Department of Nursing Saint Catherine College Saint Catherine, Kentucky.
Delegation 43
The study of leadership and management is essentially the study of how to work with other people. We then discuss the qualities and behaviors that make nurses effective leaders and managers; these qualities and behaviors are the keys to effective leadership and management.
THE DIFFERENCE BETWEEN LEADERSHIP AND MANAGEMENT
In this chapter we define leadership and management and the differences between them. We then discuss the qualities and behaviors that make nurses effective leaders and managers; these qualities and behaviors are the keys to effective leadership.
Management Defined
I was so busy getting our new computer system in place before the surveyors came that I didn't pay attention to it." Billie's nurse manager raised the issue at the next executive meeting and Billie acknowledged bringing it to her attention.
Comparison of Leadership and Management
I just keep hearing our instructor say, 'There is only one leader, but anyone can be a leader if they act on their good ideas.'" If you want to be a leader, you have to act on your idea,” said her friend.
WHAT MAKES A PERSON A LEADER?
Leadership Theories
One of the most influential of these behavioral theories concerns leadership style (White & Lippitt, 1960) (Table 1–2). One of the most important situational factors is the type of organization in which the leader works (discussed in Chapter 7).
Transformational Leadership
They said it was an inhumane schedule and that they have to go to work before the birds get up in the morning. Most of my employees have older children who have a lot of activities in the evening and they all have trouble getting up an hour earlier in the morning.
Qualities of an Effective Leader
With this new schedule, their spouses can take their children to school in the morning and they can be home in time to meet the school bus. In the story of Billie Blair Thomas, for example, Billie needed some courage to talk to her nurse manager about a problem she had noticed.
Behaviors of an Effective Leader
For example, it's much easier to be honest with a co-worker you like than with one you don't like. As new and better ways to care for clients are discovered, it is your responsibility as a professional to critically analyze these new approaches and decide whether they would be better for your clients than current care approaches.
WHAT MAKES A PERSON A MANAGER?
Even better, involving people in creating the vision is not only more satisfying to employees, but also has the potential for the most creative and innovative results (Kerfott, 2000). Effective leaders not only continue to learn, but also encourage others to do the same.
Management Theories
A Theory Y manager emphasizes guidance rather than control, development rather than close supervision, and reward rather than punishment (Fig. 1-2). A lot of effort is put into working out conflicts and promoting mutual understanding between the staff to create an atmosphere in which people can do their best work.
Qualities of an Effective Manager
A human relations-oriented nurse manager is concerned with keeping employee morale as high as possible, assuming that satisfied, motivated employees will do the best work.
Behaviors of an Effective Manager
Most nurse managers participate in or conduct hiring and firing themselves in their units or departments. Nurse managers often find themselves in positions in the organizational hierarchy where they obtain a great deal of information not available to their staff.
CONCLUSION
They also have a lot of information about the work group that is not readily available to the administration, which places them in a strategic position within the information web of any organization. The last person who complained to the director was fired," the nurse manager warned him.
COMMUNICATION
While Inez was on her way to medicate a client suffering from bone cancer, a colleague called to her: "Inez, come with me, please." Inez replied, “I have to medicate Mr. She believed that she had expressed both an interest in her client and a willingness to help her colleague.
Encoder Message Method Decoder Feedback
Although she usually has a caseload of 8 to 12 clients on her shift, she believes in providing safe, competent care to her clients. I needed someone to stay with her while I got her walker." "Why didn't you tell me it was urgent?" asked Inez.
Written Verbal
Cultural influences, communication skills, values, needs, goals, and previous experiences influence the content of communication (Arnold & Boggs, 1995; Fontaine & Fletcher, 1995) (Figure 2–1). Communication includes the spoken word as well as the non-verbal message, the emotional state of the people involved and the cultural background that affects their interpretation of the message (Fontaine & Fletcher, 1995).
THE BASIC LISTENING SEQUENCE
Communication is achieved by writing or speaking in a mutually understood code or language. Telling people that you understand their problem when you appear completely confused or inattentive is an example of incongruence between verbal and nonverbal communication.
COMPONENTS OF EFFECTIVE COMMUNICATION
ASSERTIVENESS IN COMMUNICATION
The nurse manager noted that Steve's charting had been of lower quality than expected during the past few weeks. The fourth misconception is that assertiveness and aggressiveness are synonymous, but being assertive is not the same as being aggressive.
EFFECTIVE COMMUNICATION IN THE WORKPLACE
After her break, the nurse manager told Steve, "JCAHO inspectors are coming in several months. If she shook her finger close to Steve's face or used a loud voice, the nurse manager might think she was confident, while her manner was aggressive in the reality.
Physical Barriers
This gives you time to make the necessary corrections and return the charts to me. During passive-aggressive communication, little verbal communication takes place and verbal and non-verbal behaviors are not congruent.
Psychological Barriers
Aggressive individuals express their opinions in a direct and often hostile way that interferes with the rights of others. Assertive communicators have the right to speak, but they must also be willing to listen for a response.
Semantic Barriers
For many people, cool means e.g. interesting, unique, clever or even sharp (eg "This is a cool way to find the vein"). To a person for whom the word cool refers only to temperature (eg, "It's cool outside"), the preceding statement would make very little sense.
COMMUNICATION WITH COLLEAGUES
Telephone Etiquette
Information Systems
COMMUNICATING CLIENT CARE NEEDS
Change-of-Shift Report
Any comments the client has regarding the hospitalization or treatment plan should be discussed for future staff to address. Any changes since the previous day should be noted, especially if the nurse knows the client.
Presenting the Information
COMMUNICATING WITH OTHER DISCIPLINES
The doctor's name, date, time and reason for the call must be entered in the log. When you receive a verbal order, it is necessary to repeat it back to the doctor for confirmation.
COMMUNICATING WITH CLIENTS AND THEIR FAMILIES
The RN assigned an LPN to nurse mr. The LPN reported that although Mr. Richards had been doing well the previous day, he had difficulty swallowing today. Verbal orders are given by the doctor directly to the nurse, either by phone or face to face.
FEEDBACK IS ESSENTIAL
If Herbert's nurse manager regularly provided informal feedback to the staff, Herbert would know where he stood. I'd still be disappointed she wasn't available, but I wouldn't be as hurt by it.
GUIDELINES FOR
He would have had a good idea of ​​his strengths and weaknesses and would not have been afraid of an unpleasant surprise during the review. In this chapter we discuss the do's and don'ts of giving and receiving feedback, how to share constructive, positive and negative evaluative comments with your colleagues, and how to respond constructively when you receive such comments.
PROVIDING FEEDBACK
When they urged him to play anyway, he snapped at them and told them to leave him alone. My annual review was supposed to be today but my nurse manager was sick.
Provide Both Positive and Negative Feedback
Give Immediate Feedback
Provide Frequent Feedback
Give Negative Feedback Privately
Be Objective
Base Feedback on Observable Behavior
Accept Feedback in Return
Active listening and problem solving with this colleague with the goal of relieving his overloaded schedule is a must in this situation. When giving negative feedback, allow time for individuals to express their feelings and for problem-solving to find ways to improve a situation.
Include Suggestions for Change
Communicate in a Nonthreatening Manner
SEEKING EVALUATIVE FEEDBACK
When Is Evaluative Feedback Needed?
You should also seek feedback when you feel unsure about how well you are doing and whether you have correctly interpreted the expectations of the job. Another instance in which you should request feedback is when you feel that your needs for recognition and job satisfaction have not been adequately met.
Responding to Evaluative Feedback
You have been told that good client care is the top priority, but you feel completely frustrated because you never have enough staff to provide good care. If you have only received negative comments, ask, "In what areas have I done well?" If you have only received positive comments, you can ask, "What areas do I need to improve in?" are looking for When you receive feedback from a client, you may ask yourself, “How can I serve you better?”.
PERFORMANCE APPRAISAL
Procedure
The evaluation should be based on both the staff nurse's self-evaluation and the nurse manager's observation of specific behaviors. Both the staff nurse and the nurse manager bring data for use at this session.
Standards for Evaluation
Six months later, the staff nurse and the nurse manager sit down again and evaluate the staff nurse's performance in relation to previously established goals. This data should include a self-assessment by the staff nurse and observations by the evaluator of the employee's activities and their results.
PEER REVIEW
A copy of the performance interview and the new goals should be available to employees so they can refer to them and check their progress. Most of the guidelines for providing informal evaluative feedback discussed earlier apply to the conduct of performance appraisals.
Fundamentals of Peer Review
New goals for the next 6 months and plans for achieving them can be agreed upon at the time of the appraisal or in a separate meeting (Beer, 1981). Using a committee defeats the purpose of peer review if the committee members are not actually peers of the individual being reviewed.
A Comprehensive Peer Review System
You like to be waited on, but that's not why you're here." The woman started to cry. After a conversation with the charge nurse from the previous shift, she realizes that's not an option.
INTRODUCTION TO DELEGATION
She sits down to evaluate the acumen of clients and the abilities of her employees. Perhaps one of the clients needed more care than expected, or the care assistant needed to run an errand from the floor.
THE NURSING PROCESS AND DELEGATION
Regardless of where you work, you cannot assume that only those in the upper echelons of the organization delegate work to other people. You will also sometimes be responsible for delegating some of your work to other nurses, to technical staff or to another department.
Coordinating Assignments
For example, activities that are usually grouped include bathing, changing linens, and parts of the physical assessment. Consider special situations when coordinating client care and deciding who will perform some of the activities.
THE NEED FOR DELEGATION
Using the RN to provide all the care a client needs may not be the most efficient or cost-effective use of professional time. The ANA cautions against delegating nursing activities that comprise the foundation of the nursing process and require specialized knowledge, judgment, or skills (ANA, 1996).
SAFE DELEGATION
However, non-nursing functions (Hayes, 1994), such as clerical/receptionist duties, trips or errands outside the unit, cleaning floors, saving beds, collecting trays and ordering supplies, should not be performed by the highest paid and most trained member of the team. It is the RN's responsibility to be well versed in the state Nursing Practice Act and regulations issued by the state Board of Nursing regarding unlicensed assistive personnel.
CRITERIA FOR DELEGATION
State laws and regulations take precedence over any publications or opinions of professional organizations. As previously mentioned, the National Council for State Boards of Nursing provides criteria to assist nurses with delegation.
TASK-RELATED CONCERNS
Ability
Priorities
Efficiency
Appropriateness
RELATIONSHIP-ORIENTED CONCERNS
Fairness
Learning Opportunities
Health
Compatibility
Preferences
BARRIERS TO DELEGATION
Experience Issues
Licensure Issues
Quality-of-Care Issues
Assigning Work to Others
What are the responsibilities of a professional nurse when delegating tasks to an LPN or CNA. The following is an overview of past, present, and future nursing management models.
THE ECONOMIC CLIMATE IN THE HEALTHCARE SYSTEM
The search for ways to provide safe and effective health care without spending too much money has led to the creation of new models of nursing management. This chapter will help you understand and develop your role in customer care management.
TRADITIONAL MODELS OF CARE DELIVERY
Total Care
Functional
Team
Primary Care
This registered nurse is responsible for developing the care plan and managing the associated nurses and other staff members who provide additional care for the client. However, primary nursing severely limits the number of clients each nurse can serve and can put the client at risk if the primary nurse is unable to meet the client's needs (Loveridge & . Cummings, 1996).
CONTEMPORARY MODELS OF CARE DELIVERY
Primary nursing reduces the number of persons who have contact with each client and usually increases accountability and client satisfaction.
Case Management
Timely discharge within future payment guidelines. Grouping medical conditions into categories with allowable lengths of stay and payment schedules designated by Medicare has been in effect since the 1980s. She emphatically said, “I will never experience what I went through when I had that surgery again, so don't even mention it!” The doctor asked the nurse case manager to visit Maria.
Client-Focused Care
As Maria's condition worsened, she experienced liver enlargement, sleep apnea, and petechiae on her face. The case manager helped Maria and her husband evaluate their options for treating Maria's illness.
Product Line Management
The hospital worked in partnership with the local community college to offer certificates for the two clinical assistant levels. The hospital predicted savings in recruitment, orientation and training costs as well as increased job satisfaction for all participants.
Differentiated Practice
Master's degree in nursing. This advanced practice role may include the advanced registered nurse (ARNP), advanced practice nurse (APN), and certified nurse midwife (CNM). The role of the skilled nurse extends beyond acute care and encompasses multiple healthcare arenas.
MONITORING AND EVALUATING THE QUALITY OF CARE
Key elements of the critical pathway include discharge planning, patient education, consultations, activities, nutrition, medications, diagnostic tests, and treatment (Crummer & Carter, 1993). When deviations occur, the reasons are discussed with all members of the healthcare team and the appropriate changes in care are made.
QUALITY IMPROVEMENT
Days Cardiology or Medical Unit
Days Cardiology or Medical Unit (Continued)
ASPECTS OF HEALTH CARE TO EVALUATE
Structure
Process
Outcome
The outcome of client teaching by a home visiting nurse is influenced by the client's interest and ability to learn, the quality of teaching materials, the presence or absence of family support, information provided by other caregivers (which may conflict), and the environment in which it takes place teaching. If the teaching is successful, can we give the nurse full credit for the success.
CONTINUOUS QUALITY IMPROVEMENT
You can see that it would be necessary to evaluate the process as well as the outcome to determine why an intervention such as client teaching succeeds or fails.
QUALITY IMPROVEMENT AT THE UNIT LEVEL
The criteria, or threshold, establishes a predetermined level of the indicator that is considered an acceptable level of care (Betta, 1992). Sofia surveyed the department, looked at the number of staff available and assessed the client level of the department.
THE TYRANNY OF TIME
Business leaders, managers, students and nurses know that time remains a valuable resource. Many nurses feel like they never have enough time to complete the tasks that need to be completed.
HOW DO NURSES SPEND THEIR TIME?
In a large hospital with 600 full-time nurses, the result would be an additional 307 hours of direct client care per day. Calculating the results of this time-saving strategy in another way shows an even greater impact: the changes would contribute the equivalent of 48 additional full-time direct client care nurses.
ORGANIZING YOUR WORK Setting Your Own Goals
Prescott (1991) provides the following example: If more unit management responsibilities could be shifted from nurses to non-nursing staff, approximately 48 minutes per nursing shift could be spent caring for the client. Once this was determined, she was asked which tasks could be assigned to someone else (e.g., her husband), which tasks could be clustered (e.g., cooking for several days in a row), and which tasks could be shared.
Lists
How can you get somewhere if you don't know where you want to go. First, she was asked to list what she does each day and for how long each day.
Tickler Files
If you find yourself putting off an item for a few days, decide whether it should be given top priority the next day or crossed off the list as an unnecessary task. The list itself should be in a user-friendly form: in your electronic organizer, in your pocket, or on a board.
Schedules and Blocks of Time
For example, if you are a morning person, schedule your demanding work in the morning. If you get energy spikes later in the morning or early afternoon, plan to work on larger or heavier tasks at that time.
Filing Systems
The higher your stress level, the less effective you will be at work. So don't take your work home with you.
SETTING LIMITS
Saying No
Eliminating Unnecessary Work
However, too much socialization can reduce productivity in the workplace, so judgment must be used in deciding when socialization interferes with work. How many times have you walked into a client's room instead of using the intercom, only to find that you have to go back to where you were to get what the client needs.
STREAMLINING YOUR WORK
The use of by-exception diagrams, flowcharts, and computer notations are attempts to overcome some of these problems. Do staff provide personal care to clients who are well enough to meet some of these needs themselves.
Keeping a Time Log
This means that you will have to pay close attention to what you are doing so that you can record it accurately. It is suggested that you repeat the process again in 6 months, both because work situations change and to see if you have made any long-term changes in your time use.
Reducing Interruptions
Figure 6–1 is an example of a time log in which you enter your activities every half hour.
Categorizing Activities
Finding the Fastest Way
Automating Repetitive Tasks
Let's look at the bigger picture next month,” their nurse manager suggested at one of their meetings. It would be a good change to look at the way they have organized customer care in their department.
UNDERSTANDING ORGANIZATIONS
The nurse manager found a wealth of information about different models for organizing nursing care. When the plan was presented, both the nurse manager and staff thought it was excellent.
Types of Healthcare Organizations
Organizational Climates
Goals
Without the people at the bottom of the ladder, the organization could not function. People at the top depend on people lower down the ladder to do most of the work.
Processes
This reduces complexity and allows each division to be better integrated when integration of the organization as a whole becomes practically impossible due to sheer size, complexity and diversity. A client can use just one or all of them in developing a personal wellness plan.
POWER
Definition
Sources
Careful observation of the most experienced, “systems-oriented” individuals in your organization will eventually reveal them to you. However, imagine how the work of the organization (e.g. hospital, nursing home) would be hampered if all nurses did not show up one morning.
EMPOWERING NURSES
Nurses have expertise, power, and authority over licensed practical nurses, assistants, and other staff by virtue of their position in the hierarchy. Assistants and technicians seem relatively powerless due to their low position in the hierarchy.
Professional Organizations
Florence Nightingale showed very graphically in the 1800s that wherever her nurses were, far fewer died, and wherever they were not, far more died. The third is representation in state legislatures and Congress when issues of importance to nursing arise.
Collective Bargaining
Participation in Decision Making
Shared Governance
I think it's time I share my ideas on this topic with the rest of the nursing staff." Under shared governance, staff nurses are included in the highest levels of decision-making within the nursing department through representation on various boards that govern practice and management issues.
Enhancing Expertise
City Hospital is also a good place to work," said her other friend, "It is a strong, stable institution where traditions are valued. Various pressures and demands in the workplace also cause problems and conflict between people at work.
CONFLICT
As members of both teams pass each other in the hall, they either stare or turn away to avoid eye contact. Arguments break out when members of both teams need the same computer terminal or other equipment at the same time.
SOURCES OF CONFLICT
These differences are a natural part of the fact that we are unique individuals and members of different segments of our society. If several members of team A are sick, no one from team B will help team A with their work.
Tension Between Groups
Consider the following example, the first of three used to illustrate how to deal with problems and conflicts. When Team A's nurse reached for the pulse oximeter at the same moment as Team B's nurse, the other nurse said:
Increased Workload
Each of us brings different experiences, beliefs, values ​​and habits to work. We will return to this example later when we discuss problems and conflicts in the workplace, their sources and how to resolve them.
Multiple Role Demands
This makes many healthcare workers feel that their employers are taking advantage of them (Ketter, 1994) and causes conflict if they believe that others are not working as hard as they are.
Threats to Professional Identity and Territory
Threats to Safety and Security
Scarce Resources
Cultural Differences
Invasion of Personal Space
WHEN CONFLICT OCCURS
RESOLVING PROBLEMS AND CONFLICTS
Win, Lose, or Draw?
Third, a tie (neither side winning or losing) can only be a stalemate; nobody won or lost, but the problem is still there. The answer to the question "Win, lose or draw?" is "none of the above." Instead, try to resolve the problem or conflict whenever possible.
Problem Resolution
Whose solution is probably best: the doctor's or the UAPs (unlicensed emergency personnel). Deloitte, the staff and the nurse manager all felt the problem had been resolved.
Negotiating an Agreement Informally
Finally, someone in the back of the room said, "We don't have enough people, equipment, or supplies to get the job done." The rest of the group nodded in agreement. If what I heard about the meeting yesterday is correct," the representative said, "your plan is in violation of our collective bargaining agreement." The CEO reviewed the contract and found that the representative was correct.
The Pros and Cons of Collective Bargaining
The majority of nurses stated that they wanted and needed to work full-time all year round. The financial officer wanted to put money in the bank "for a rainy day." The chaplain wanted to add a small chapel to the building.
CHANGE
A Natural Phenomenon
Macro and Micro Change
THE PROCESS OF CHANGE
If the nurses do not find a satisfactory alternative, they may remain in a precarious state, in the discomfort zone, caught in a conflict between their professional and personal responsibilities. In the next part, we'll explore the many reasons why change is troubling and why people resist it.
RESISTANCE TO CHANGE
Sources of Resistance
This applies to people everywhere in the organization, not just those at the top. A clerk in the operating room had prepared the operating room for many years.
Recognizing Resistance
She had heard how skilled the clerk was and didn't think her review of the charts would be threatening. What appeared to the new supervisor to be a very small change in routine had provoked surprisingly strong resistance because it threatened the clerk's position and power in the organization.
Lowering Resistance
Provide assurance (if possible) that no one will lose his or her position as a result of the change. Suggest ways in which the change can provide new opportunities and challenges (that is, new ways to increase self-esteem and self-actualization).
LEADING THE IMPLEMENTATION OF CHANGE
Get as many people involved as possible in both planning and implementing the change (Hastings &. Communicating a sense of urgency and urgency about the change to be implemented will enhance the use of authority (Kotter, 1999). .
Designing the Change
Now that you understand how change can affect people and have learned some ways to reduce their resistance to change, we can discuss taking a leadership role in successfully implementing change. The entire process of bringing about change can be divided into four phases: designing the change itself, deciding how to implement the change, actually implementing the change, and following through to ensure that the change is implemented in the regular operation is integrated. of the facility (Fig. 9–3).
Planning the Implementation
Implementing the Change
Is this a major change that affects almost everything people do, or is it a minor change with little impact on what people do every day. Is this the only change taking place or is it just one of many changes taking place.
Integrating the Change
Nursing staff quickly learned what the new director meant by his "measurement" approach. What kind of resistance to change did the staff at this nursing home show?
CONSIDER THE STASTICS
STRESS
Effects of Stress
Responses to Stress
REALITY SHOCK
The new graduate is soon expected to behave like everyone else and discovers that the expectations of a professional employed by an organization are quite different from those of a student at school. A new graduate who is not prepared for this change feels confused, shocked, angry and frustrated.
Differences in Expectations
The advantage of orientation programs is that they assist the new nurse in the transition from school to the work environment, thereby mitigating stressors that can lead to reality shock. This also creates a conflict for the new graduate, who was allowed to take as much time as needed to provide good care during school.
Additional Pressures on the New Graduate
Learn more about the organization. The new graduate who understands how organizations function will not be as shocked as the naive individual. Mentors provide guidance to the new graduate as he or she transitions from student to professional nurse.
BURNOUT Definition
Leave the profession. Those who do not give up their professional ideals try to find an organization that will support them. Unfortunately, a significant proportion of those who do not want to give up their professional ideals escape these conflicts by quitting their jobs and abandoning their profession.
Aspects
Much of the burnout experienced by nurses has been attributed to the frustration of not being able to deliver care in the ideal way they were taught in school. She struggles to adapt to the restructuring changes at her hospital and goes home angry and frustrated every day.
Stressors Leading to Burnout Personal Factors
Organizational structure: Characteristics of the organization you work in, such as limited financial resources. There seem to be some differences in how men and women find a comfortable balance.
Consequences
For example, when you are asked to work another double shift or the third weekend in a row, you can say no. If you are the team leader or nurse manager, you must also recognize and accept staff members' need to do this as well.
A Buffer Against Burnout
It's fine if they enjoy working extra hours and taking calls at night and on weekends, but if it drains them, they need to stop doing it or risk serious burnout. At the same time as you set limits at work, you can expand your outside activities so that you live in a big world in which a blow to one part can be cushioned by support from other parts.
STRESS MANAGEMENT
ABCs of Stress Management
As you move forward to step "C," you will need to make a commitment to continue working on stress recognition and reduction. Stress affects both mind and body, and we need to take care of both if we want to be successful in managing stress and preventing burnout.
Physical Health Management
A week later, you go to your mailbox to find a letter waiting for you: “Congratulations, you passed the test and are now a licensed nurse.” You imagine telling your family and friends. It is important to choose an exercise that you enjoy and that fits into your lifestyle.
Mental Health Management
For this reason alone, the quality of the work environment is a major concern. Improving the working environment is more difficult to achieve under these circumstances, but it is more important than ever.
WORKPLACE SAFETY
Much of the responsibility for improving the workplace environment rests with the people at the top level of management, who have the authority and resources to encourage growth and change throughout the organization. These issues, as well as sexual harassment, injured workers, improving the quality of work life and diversity, are the focus of this chapter.
Threats to Safety
According to Linda Rosenstock, MD, MPH, director of the National Institute for Occupational Health and Safety (NIOSH), 9,000 healthcare workers in the United States sustain a disabling injury on the job every day (Slattery, 1998, p. 12). ). Some of the most common threats identified at the conference were latex allergy, back injury, violence, needlestick injuries and pollution.
Reducing Risk
In the past month, several of the employees have been referred to employee health for back pain. Box 11-2 states the nurse's responsibilities in connection with the transmission of blood-borne pathogens.
Violence
Measures to address workplace violence include (1) identifying factors that contribute to violence and controlling as many factors as possible, and (2) assessing employees' attitudes and knowledge about workplace violence (Carroll & Sheverbush, 1996; . Collins, 1994; Mahoney, 1991). Box 11–4 lists some additional measures that can be taken to protect employees and customers from workplace violence.
SEXUAL HARASSMENT
Hostile environment: This is the most common sexual harassment claim and the most difficult to prove. As an employee, you should familiarize yourself with the policies and procedures related to reporting incidents of sexual harassment.
LATEX ALLERGY
Although sexual harassment against women is more common, men can also be victims of sexual harassment. Sexual harassment can cost an employer money, adverse publicity, expensive lawsuits and large damages.
NEEDLESTICK INJURIES
BACK INJURY
IMPAIRED WORKERS
The American Nurses Association has published the Nursing Shift Work Handbook, which includes suggestions for both nurses and managers involved in shift work and scheduling (Trossman, 1999, p. 2).
REPORTING QUESTIONABLE PRACTICES
ENHANCING THE QUALITY OF WORK LIFE
Social Environment Working Relationships
Professional Growth and Innovation
Cultural Diversity
As you begin your career, be alert to signs of cultural diversity or insensitivity where you work. Although organized cultural diversity programs are usually the responsibility of middle and senior managers, you can play a role in raising awareness.
Physical Environment
How can you, as a new nurse, raise awareness regarding cultural diversity issues in the workplace. Nurses' attitude towards aggressive behavior following the attendance of the "The Prevention and Management of Aggressive Behavior Programme.''.
GENERAL PRINCIPLES Meaning of Law
An image of a white rabbit running through the woods, looking at the clock and yelling, “I'm late. Jefferson, the plaintiff's attorney, wanted her undivided attention regarding the fateful day when she mistakenly injected a client with 40 mEq of potassium chloride.
Sources of Law The Constitution
If the bill is not approved by the executive branch of the government, the president can veto it. These rules must be reasonable and consistent with the existing law and legislative intent.
TYPES OF LAWS
At the federal level, conference committees consisting of representatives from both houses of Congress negotiate the resolution of any disagreements between the houses over the wording of the final bill before it becomes law. Passing a new law is often a long process that involves compromising the different views of interested parties.
Criminal Law
Writing to or meeting with state legislators or members of Congress is one way to express interest in such issues and their outcomes in terms of the laws passed. At the state level are the Departments of Health and Mental Health and the licensing authorities.
Civil Law
Nurses have a duty to deliver care in such a way that care consumers are not harmed. Translated literally, this phrase means "let the master speak." The doctrine of vicarious liability holds employers liable for any negligence on the part of their employees when the employees acted within the scope of employment and when the alleged negligent acts occurred in the course of employment (Prosser & Keeton, 1984).
OTHER LAWS RELEVANT TO NURSING PRACTICE
Negligence is the unintentional tort of acting or failing to act as an ordinary, reasonable, prudent person, resulting in injury to the person to whom the duty of care is owed (Black, 1957). The law defines the standard of care as what a reasonable, prudent practitioner with similar training and experience would do or not do under similar circumstances (Prosser & Keeton, 1984).
Good Samaritan Laws
For example, if a nurse administers the wrong medication to a client, but the client is not harmed, the harm element is not met. The nursing teacher was sued under the principle of respondeat superior, even though specific instructions to the contrary had been given to the students.
Confidentiality
However, if a nurse administers appropriate pain medication but fails to put up the side rails and the client falls and breaks a hip, all four elements are satisfied. Luis administered the entire amount without checking the digoxin dose or the client's blood and potassium levels.
Slander and Libel
Several nurses were discussing the situation in the cafeteria and were overheard by one of Leonard's co-workers who had come to visit. In the process of filing a discrimination lawsuit against his employer, Leonard discovered that information about his medical condition had come from a group of nurses.
False Imprisonment
In addition, there are laws and case law that specifically address the admission of clients to psychiatric institutions. Once admitted, these clients should not be held back unless state law guidelines and facility policy are followed.
Assault and Battery
Careful assessment and documentation of the client's status is also imperative; confusion, irritability, and anxiety often have metabolic causes that need correction rather than restriction. Nurses should be aware of the policies of their state and employing institution.
STANDARDS OF PRACTICE
Use of Standards in Nursing Negligence Malpractice Actions
Patient’s Bill of Rights
Informed Consent
STAYING OUT OF COURT Prevention
Most negligence and malpractice cases arise from a violation of the accepted standards of practice and the policies of the employment agency. If the physician is reached, document the details of the message and the physician's response.
Common Actions Leading to Malpractice Suits
Harrison, the institutional staff was found negligent in direct violation of the institution's standards for the use of restraints.
If a Problem Arises
PROFESSIONAL LIABILITY INSURANCE
END-OF-LIFE DECISIONS AND THE LAW
Do Not Resuscitate (DNR) Orders
Vincent, 58 years old, was admitted to the hospital for a hysterectomy, she specifically stated, "I want to become a DNR." The nurse, quite alarmed by this statement, asked the lady. I won't be able to be the way I am now, I want to be DNR!'' The nurse then explained the concept of a DNR order.
Advance Directives
The role of the healthcare surrogate is to communicate the client's wishes to the medical and nursing staff. In these situations, the health care surrogate can make treatment decisions on behalf of the client.
Nursing Implications
In a novel of the same name, Noah Gordon called this decision-making group "The Commission of Death" (Gordon, 1965). The field of biomedical ethics (or simply bioethics), a subdiscipline of the field known as ethics—or the philosophical study of morality—has evolved.
VALUES
Equipment is scarce, the costs of treatment are prohibitive and it is doubtful whether the treatment will be reimbursed by health insurance. Families and professionals alike face some of the most difficult ethical decisions in times like these.
Value Systems
In a big city hospital, 10 health professionals meet to deal with the cases of three different people. Health professionals have looked to philosophy, especially the branch that deals with human behavior, to solve these problems.
How Values are Developed
Race car drivers risk death or other serious injury because they value competition and winning. For example, if you value work over leisure activities, you will look unfavorably on the colleague who refuses to work on the weekend.
Values Clarification
As you progressed through school, you probably began to develop a new set of values—your professional values. Professional values ​​are those that have been established as important in your practice, such as caring, quality of care and ethical behaviour.
BELIEF SYSTEMS
This choice is most likely influenced by factors such as educational attainment and ability, finances, support and encouragement from others, time factors, and feelings about people. Once the choice was made, you were happy with it and told your friends about it.
ETHICS AND MORALS Morals
Ethical Principles
Other nurses who observe such behavior have an ethical obligation to protect the client according to the principle of non-maleficence. Deliberately omitting part of the truth is deception and violates the principle of truth.
Ethical Codes
Ethical Dilemmas
RESOLVING ETHICAL DILEMMAS FACED BY NURSES
Assessment
Which values ​​are in conflict with each other? To assess values, start by listing each person involved in the situation. You can do this by asking questions like, "What do you think is the most pressing problem here?" and 'Tell me more about your feelings regarding this situation.'" In some cases you will find little disagreement between the people involved, just another way to express their beliefs.
Planning
Implementation
Sometimes the client or the surrogate may make a request that is not institutionally or legally possible. It may be necessary to bring other counselors into the conversation (with the client's consent) to negotiate an agreement.
Evaluation
At other times, caregivers are unable to recognize the value of the client's point of view. In other cases, the client or surrogate may request information from the nurse about illegal acts.
Current Ethical Issues
Remember that an ethical dilemma is not always a choice between two attractive alternatives. When this happens, the nurse should sit down with the patient and family and ask them to consider the consequences of their proposed actions.
Practice Issues Related to Technology
