Essentials of Nursing Leadership & Management, 6th Edition

We are pleased to bring our readers this Sixth Edition of Essentials of Nursing Leadership and Management. The sixth edition of Essentials of Nursing Leadership and Management focuses on the necessary knowledge and skills needed by the staff nurse as an integral member of the interprofessional health care team and manager of patient care.

Communicating With Others and Working With the Interprofessional Team

American Nurses Association Code of Ethics for Registered Nurses Canadian Nurses Association Code of Ethics for Registered Nurses International Council of Nurses Code of Ethics for Nurses Supplement2 Standards published by the American Nurses Association.

Guidelines for the Registered Nurse in Giving, Accepting, or Rejecting a Work Assignment

Leadership and Followership

Manager

Nursing Practice and the Law

Questions of Values and Ethics

Leadership

I was so busy setting up our new electronic health record system before the supervisors came that I wasn't paying attention,” the nurse manager told her. We were so focused on the new electronic health record system that we missed it.

What Makes a Person a Leader?

Management of attention. These leaders communicated a sense of goal direction that
Management of meaning. These leaders created and communicated meaning and purpose
Management of trust. These leaders demonstrated reliability and consistency
Management of self. These leaders knew themselves well and worked within their
Democratic leadership (also called participative). Democratic leaders share

The relational aspects of leadership are also the focus of the work on emotional intelligence and leadership (Goleman, Boyatzes, & McKee, 2002). The leader must spell out the duties and responsibilities of the individual and the group” (Hersey & Campbell, 2004).

Qualities

It is important not to let discouragement keep you and your colleagues from looking for ways to solve the problems. Sharing credit for successes and support when needed are other ways to be a generous leader (Buchanan, 2013; Disch, 2013).

Behaviors

Listening to others. Listening is separate from talking with other people; listening

The only way to find out people's individual wants and needs is to see what they do and to listen to what they say. It's amazing how often leaders fail simply because they didn't listen to what other people were trying to tell them.

Encouraging exchange of information. Many misunderstandings and mistakes occur

Providing feedback. Everyone needs some information about the effectiveness of their

As new and better ways of caring for patients are developed, it is your responsibility as a professional to critically analyze them and decide whether they would be better for your patients than the current ones. Effective leaders not only continue to learn, but also encourage others to do the same.

Followership

This is not a scheme to manipulate your manager or to get more rewards than you have earned. When you bring a problem to your manager's attention, try to have a solution to offer.

Conclusion

Why is it important for nurses to be good leaders? What qualities have you observed from nurses that exemplify effective leadership in action? How do you think these behaviors might
Why are effective followers as important as effective leaders?
Select an individual whose leadership skills you particularly admire. What are some qualities and behaviors that this individual displays? How do these relate to the leadership theories
As a new graduate, what leadership and followership skills will you work on developing during the first 3 months of your first nursing position? Why?
What style of leadership was displayed by Jan, Ronnie, and the nurse manager? How effective was their leadership? Did Jan’s leadership differ from that of Ronnie and the nurse manager? In
In what ways has Ronnie been an effective follower? In what ways has Ronnie not been so effective as a follower?
If an emergency occurred and was not handled well while Ronnie was the only nurse on the unit, who would be responsible? Explain why this person or persons would be responsible
If you found yourself in Ronnie’s situation, what steps would you take to resolve the problem?
chapter 2

Managing up is defined as “the process of consciously working with your boss to achieve the best possible results for you, your boss and your organization” (Zuber & James cited by Turk, 2007, p. 21). Show respect for your manager's authority and appreciation for what your manager does for the staff in your unit.

Management

Management Theories

Nurse managers who apply the principles of scientific management will pay particular attention to the types of assessments and treatments performed on the unit, the equipment needed to perform them effectively, and the strategies that would facilitate the more effective completion of these tasks. Management based on human relations. McGregor's theories X and Y provide a good contrast between scientific management and management based on human relations.

THEORY Y

Taylorism states that there is a better way to do a job, which is usually the fastest way to do the job as well (Dantley, 2005). Like Taylorism, Theory X reflects a common attitude among managers that most people do not want to work hard and that the manager's job is to make sure they do (McGregor, 1960).

Qualities of an Effective Manager

When she was invited to be the nurse representative on the committee to search for a new chief nursing officer, she was very excited to be on a committee with so many leadership and administrative people. There is some controversy regarding the amount of clinical expertise versus business acumen required for effective nurse leadership.

Behaviors of an Effective Manager

Nurse managers must also be concerned with the "bottom line", with the cost of providing the care given, especially compared to the benefit received from that care and the funding available to pay for it, whether from private insurance, Medicare, Medicaid, or out of the patient's own pocket. This is a complex task that requires knowledge of budgeting, staffing and measuring patient outcomes.

Informational

Some argue that a person can be a "generic" manager, that the job of managing people is the same no matter what tasks he or she performs. Others argue that managers should understand the tasks themselves, better than anyone else in the work group.

Interpersonal

Decisional

Why should new graduates decline nursing management positions? At what point do you think a nurse is ready to assume managerial responsibilities?
Which theory, scientific management or human relations, do you believe is most useful to nurse managers? Explain your choice
Describe your ideal nurse manager in terms of the person for whom you would most like to work. Then describe the worst nurse manager you can imagine, and explain why this person
List 10 behaviors of nurse managers and then rank them from least to most important. What rationale(s) did you use in ranking them?
What style of leadership and school of management seemed to be preferred by Joe Garcia’s manager?
What style of leadership and school of management were preferred by Joe?
Which of the listed qualities of leaders and managers did the nurse manager display? Which behaviors? Which ones did the nurse manager not display?
If you were Joe, what would you have done? If you were the nurse manager, what would you have done? Why?
Who do you think was right, Joe or the nurse manager? Why?
Why did the director of nursing at Harbordale offer the nurse manager position to Sung Lee?
If Sung Lee does accept the nurse manager position, what do you think her first month will be like? Write a scenario that describes her first month as a nurse manager
If Sung Lee declines this offer, how do you think the director of nursing will respond?
Write a list of typical nurse manager roles and responsibilities. For each one indicate how prepared you are to assume each role or responsibility and what you would need to prepare
chapter 3

Nurse managers often find themselves in positions within the organizational hierarchy where they acquire much information that is not available to their staff. Which theory, scientific management or human relations, do you think is most useful for nurse managers.

General Principles

Statutory laws are created by various legislative bodies, such as state legislatures or Congress

This expectation requires that nurses have professional knowledge at their expected level of practice and are proficient in technological skills. A working knowledge of the legal system, client rights, and conduct that can result in litigation helps nurses act as client advocates.

Common law is the traditional unwritten law of England, based on custom and usage, which

She was charged with malpractice, with the possibility of criminal charges if found guilty of contributing to the client's death.

Administrative law includes the procedures created by administrative agencies

If the bill is not approved by the executive branch of the government, the president can veto it. These rules must be reasonable and in accordance with the existing statutory law and the intention of the legislator.

Types of Laws

Felony: the most serious category, including such acts as homicide, grand larceny, and nurse

Nurses have the opportunity to influence the development of legal law both as citizens and as health care providers. The Department of Health and Human Services, the Department of Labor, and the Department of Education are the federal agencies that administer the laws related to health care.

Misdemeanor: includes lesser offenses such as traffic violations or shoplifting of a small dollar

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. Administrative agencies are staffed with professionals who develop the specific rules and regulations that guide the implementation of statutory laws.

Juvenile: crimes carried out by individuals younger than 18 years; specific age varies by

However, if a nurse administers the appropriate pain medication but fails to deploy the side rails of the patient's bed and the client falls and breaks a hip, all four elements are satisfied. Three doctrines, the superior answers, the borrowed servant doctrine, and the captain of the ship doctrine fall under vicarious liability.

Other Laws Relevant to Nursing Practice

Instead of approaching the manager or following the chain of command, they decided to send a written statement to the chief executive officer (CEO) of the hospital. Failure to follow these guidelines may result in greater harm to the client and possibly legal action by the staff.

Standards of Practice

A violation occurred when the nursing staff failed to notify the physician of the client's condition and follow the institution's standard of practice regarding the use of restraints. Some institutions require the physician or independent practitioner to obtain their own informed consent by obtaining the client's signature at the time the explanation for the treatment is given.

Staying Out of Court

Right drug 2. Right dose
Right documentation 8. Right form
Right response
Delay in transferring the client to the neurological unit
Failure to advocate for the client

After the client was in the unit, the nurses called one physician about the client's status. Read verbal orders back to the doctor, and confirm the client's identity as written on the chart.

Professional Liability Insurance

However, the court ruled that doctors and nurses can rely on information from the client. The other aspect of the case revolved around the client's insistence on leaving the facility and driving himself.

End-of-Life Decisions and the Law

Of crucial importance for the appointment of a health surrogate is a clear understanding of the client's wishes, should the need arise to know them. In these situations, the healthcare surrogate can make treatment decisions on behalf of the client.

Legal Implications of Mandatory Overtime

It is the responsibility of the healthcare institution to educate staff about its policies so that nurses and others involved in client care can inform healthcare consumers of their choices. Nurses who are unsure of the policies in their healthcare facility should contact the appropriate department.

Licensure

How do federal laws, court decisions, and state boards of nursing affect nursing practice? Give an example of each
Obtain a copy of the nurse practice act in your state. What are some of the penalties for violation of the rules and regulations?
How does your clinical institution handle medication errors?
If a nurse is found to be less than proficient in the delivery of safe care, how should the nurse manager remedy the situation?
Discuss where appropriate standards of care may be found. Explain whether each is an example of an internal or external standard of care
Explain the importance of federal agencies in setting standards of care in health-care institutions
What is the difference between consent and informed consent?
What are the most common errors nurses commit that lead to negligence and/or malpractice?
What impact would a law that prevents mandatory overtime have on nurses, nursing care, and the health-care industry? Find out if your state has mandatory overtime legislation
List all the problems you can find with the nursing care in this case
What were the nursing responsibilities in reporting information?
If you worked in risk management, how would you discuss this situation with the nurse manager and the staff ?
If you were Juan, how would you respond to the nurse manager?
What options does Juan have in this situation?
What information should Juan find out regarding “mandatory overtime”?
If Juan makes an error that results in harm to a patient, can he be held accountable?
chapter 4

A major achievement in the history of nurse licensure was the creation of the Bureau of State Boards of Nurse Examiners. This gives candidates a comprehensive overview of the types of questions they can expect on the exam.

Values

Prizing. Once the choice was made, you were satisfied with it and told your friends about it

Later in your career, you may decide to return to school for a bachelor's or master's degree in nursing. As you progressed through school, you probably began to develop a new set of values—your professional values.

Belief Systems

Although they were given different names by different cultures, it is very interesting that most of the deities had similar purposes. For example, the Greeks viewed Zeus as the king of the gods, and Thor represented the king of the Norse gods.

Ethics and Morals

To whom do you owe your duty: the family or the patient?

What information would you communicate to the family members, and how can you assist

Conflicts between a nurse's professional values and the organization's values result in moral distress for the nurse. No matter what decision he made, Hugo would be "stuck on the horn of the lemma".

Resolving Ethical Dilemmas Faced by Nurses

Identify the decision makers. As mentioned earlier, nurses may or may not be decision
What is the true definition of a persistent vegetative state?
How is cognitive recovery determined?
What role do the courts play when there is a family dispute? Who has the right to make
What are the duties of surrogate decision makers? (Hook & Mueller, 2005)
What is the difference between intrinsic and extrinsic values? Make a list of your intrinsic values
Consider a decision you made recently that was based on your values. How did you make your choice?
Describe how you could use the valuing process of choosing, prizing, and acting in making the decision considered in Question 2
Which of your personal values would be primary if you were assigned to care for an anacephalic infant whose parents have decided to donate the baby’s organs?
The parents of the anacephalic infant in Question 4 confront you and ask, “What would you do if this were your baby?” What do you think would be most important for you to consider in
How should Andy respond?
What are the ethical principles in conflict?
What are the long-term effects of Andy’s decision?
unit 2
Organizations, Power, and Empowerment
Communicating With Others and Working With the Interprofessional Team
Delegation and Prioritization of Client Care
Dealing With Problems and Conflicts
People and the Process of Change
chapter 5

During the implementation phase, the patient or surrogate decision maker(s) and members of the health care team reach a mutually acceptable decision. At other times, healthcare providers are unable to recognize the value of the patient's perspective.

Understanding Organizations

Public. Government-operated health service organizations range from county public health
Artifact level: visible characteristics such as patient room layout, paint colors, lobby design,
Espoused beliefs: written goals, philosophy of the organization
Underlying assumptions: unconscious but powerful beliefs and feelings, such as a

Many CEOs also want their healthcare organization to be recognized as the best in its field, for example, having the best transplant unit, having the shortest emergency room wait time, having doctors world-renowned, offering "the best nursing care in the community" (Frusti, Niesen, & Campion, 2003), offering gourmet meals, or having the most attractive birthing rooms in town. Although it seems like everyone complains about "bureaucracy", not everyone is clear about what bureaucracy actually is.

Power

However, careful observation of the most experienced "system wise" individuals in an organization will eventually reveal these processes. They are essential to the operation of most healthcare organizations and can cause significant.

Empowering Nurses

Discuss ways in which nurses can become more empowered. How can you use your leadership skills to do this?
How would the organizational culture of each hospital affect a new graduate?
Which organizational culture do you think would be best for a new graduate, Central’s or City’s?
Would your answer differ if Tanya were an experienced nurse?
What do you need to know about Tanya before deciding which hospital would be best for her?
What else would you like to know about the two hospitals?
chapter 6

Most healthcare professionals, including nurses, are empowered to some extent by their professional knowledge and competence. Effective communication between all members of the healthcare team is essential to providing safe patient care.

Communication

Other disciplines involved in direct patient care include pharmacists, physical and occupational therapists, speech-language pathologists, and unlicensed aides. Based on the changes in health care, the Institute of Medicine (IOM) report, and the movement toward an interprofessional model of health care delivery, this chapter focuses on the communication skills necessary to work with members of the interprofessional team and provide information in a multicultural community.

Assertiveness in Communication

Interpersonal Communication

Noise can take many forms, such as background conversations in the workplace or even spam or instant messages in the electronic environment. Transactional models also include the concept of time, as communication between and between individuals changes over time and recognizes that communication occurs within systems.

Barriers to Communication Among Health-Care Providers and

Health-Care Recipients

Electronic Forms of Communication

Health care providers' lack of ability to identify and consider cultural practices Health care communication skills. Many systems make it easy to send e-mail to everyone in the healthcare facility.

Reporting Patient Information

Faxed orders come directly from the health care provider's office and must be initialed by the provider. Telephone orders, e-mail orders and faxed orders must also be signed when the health care provider arrives at the nursing unit.

Figure 6.1 Organization and time management schedule for patient care.

Teams

Some medical institutions are studying the possibility of receiving medical orders via e-mail. If the healthcare professional speaks too quickly, ask him to speak more slowly.

Interprofessional Collaboration and the Interprofessional Team

A health-care provider orders “Potassium Chloride 20 milliequivalents IV over 20 minutes.”
If you decided to pursue the issue, with whom should you speak? What would you say?
What do you think is the reason Corel speaks to patients this way?
chapter 7

On your first day she tells you, "The only difference between you and me is the salary." Show how you would respond to this statement, using assertive communication techniques. You like being served, but that's not why you're here.' The woman started to cry.

Introduction to Delegation

For example, the RN assigns the NAP responsibility for taking vital signs on three patients. The RN is responsible for personal actions related to the nursing process.

The Nursing Process and Delegation

Perhaps one of the clients needed more care than expected, or the NAP needed to complete an assignment outside the unit. Regardless of where you work, you cannot assume that only those in the upper echelons of the organization delegate work to other people.

The Need for Delegation

You will also sometimes be responsible for delegating some of your work to other nurses, to technical staff or to other members of the interprofessional team. The ANA warns against delegating nursing activities that include the foundation of the nursing process and that require specialized knowledge, judgment or skill (ANA.

Safe Delegation

Expert in knowing the nursing needs/activities of the defined client population and expert in the delegation process 1. Experienced in knowing the needs/activities of the defined client population and competent in the delegation process 3.

Criteria for Delegation

These differences need to be discussed with team members so that decisions can be made based on team priorities. It is important to clarify the rationale for delegation decisions so that all team members can understand the needs of the unit or organization.

Barriers to Delegation

Some nurses think they must do everything themselves
Some nurses distrust subordinates to do things correctly
Some nurses think that if they delegate all the technical tasks, they will not reinforce their
Some nurses are more comfortable with the technical aspects of patient care than with the

Nurses expressed concern about the quality of patient care when tasks and activities are delegated to others. Remember Nightingale's words earlier in the chapter, "Do not imagine that if you, who are in charge, do not look to all these things yourself, those under you will be more careful than you are." She added that you don't have to do everything yourself to see that it's done right.

Prioritization

Although it may be convenient for the nurse to fill the feeding container with enough supplement to last 6 hours, this is not standard practice and may be unsafe for the patient. Some activities must be done at a certain time, and their timing may be beyond the nurse's control.

Models of Care Delivery

What are the responsibilities of the professional nurse when delegating tasks to an LPN/LVN or NAP?
What factors need to be considered when delegating tasks?
What is the difference between delegation and assignment?
What are the nurse manager’s legal responsibilities in supervising nursing assistive personnel?
Bring the patient diagnosis census from your assigned clinical unit to class. Using the
What type of nursing delivery model is implemented on your assigned clinical unit? Give examples of the roles of the personnel engaged in client care to support your answer
How should Julio organize his day? Set up an hourly schedule
Make a priority list based on the ABC plus V method
What type of client management approach should Julio consider in assigning staff appropriately?
If you were Julio, which clients and/or tasks would you assign to your staff ? List all of them, and explain your rationale
Using the Delegation Decision-Making Grid, make staff and client assignments
chapter 8

The organization of the team is based on the number of personnel available and the skill mix of the team. Nursing prioritizes the patient's need for care: tacit knowledge embedded in the clinical decision-making literature.

Figure 7.3 Personalized patient worksheet.

Conflict

Many Sources of Conflict

When members of the two teams pass each other in the hall, they either stare at each other or turn away to avoid eye contact. Arguments occur when members of the two teams need the same computer terminal or other equipment at the same time.

When Conflict Occurs

Such tasks can lead to disputes about who does what task and who is responsible for the outcome. Limited resources almost inevitably lead to competition to get a fair share (or more), often resulting in conflict between individuals and between departments (Isosaari, 2011).

Resolving Problems and Conflicts

Ms. Deloitte is fired
Allow Ms. Deloitte to take her vacation as planned
Allow everyone to take vacations between December 20 and January 5 as requested
Allow no one to take a vacation between December 20 and January
Reimburse Ms. Deloitte for the cost of the tickets
Allow Ms. Deloitte to take one last vacation between December 20 and January 5
Allow Ms. Deloitte to take her vacation during Thanksgiving instead
Allow Ms. Deloitte to begin her vacation on December 26 so that she would work on
Allow Ms. Deloitte to begin her vacation earlier in December so that she could return
What am I trying to achieve? The nurse manager in Case 1 is very concerned about the tensions
What is the environment in which I am operating? The members of Teams A and B
What problems am I likely to encounter? The nurse manager knew that she had allowed the
What does the other side want? In this situation, the nurse manager was not certain what either
Manage the emotions. When people are very emotional, they have trouble thinking clearly
Set ground rules. Members of Teams A and B began throwing accusations at each other as
Clarification of the problem. The nurse manager wrote a list of problems raised
Continue the negotiations. The discussion should continue in an open, nonhostile manner
Debate the question of whether conflict is constructive or destructive. How can good leadership affect the outcome of a conflict?
Give an example of how each of the seven sources of conflict listed in this chapter can lead to a serious problem. Then discuss ways to prevent the occurrence of conflict from each of the seven
What is the difference between problem resolution and negotiation? Under what circumstances would you use one or the other?
Identify a conflict (actual or potential) in your clinical area, and explain how either problem resolution or negotiation could be used to resolve it
In what ways does collective bargaining increase conflict? How does it help resolve conflicts?
In your analysis of this situation, identify the sources of the conflict that are developing in this facility
What kind of leadership actions are needed to prevent the escalation of this conflict?
If the conflict does escalate, how could it be resolved?
Which idea do you think has the most merit? Why did you select the one you did?

We don't have enough people, equipment or supplies to get the job done.” The rest of the group nodded in agreement. Of course, your employer will probably make a counter offer, such as: “The best I can do is 3%.”.

Figure 8.1 The process of resolving a problem.

Change

The change can be small, affecting only one care practice or one aspect of system operation, or sweeping, revolutionizing the structure and operation of the entire organization. The basic stages of the change process, originally described by Kurt Lewin in 1951, are unfreezing, changing, and refreezing (Lewin, 1951; Schein, 2004).

Resistance to Change

A later review of the research noted that it depends on the concentration used (Hossainian, Slot, Afennich, & Van der Weijden, 2011). Provide assurance (if possible) that no one will lose his or her position as a result of the change.

Figure 9.2 Maslow’s hierarchy of needs. Based on Maslow, A.H. (1970). Motivation and Personality

Leading Change

You can apply some pressure to get people to pay attention to the change process, but not so much pressure that they become overstressed. After the change is made, make sure everyone has moved into a new comfort zone.

Personal Change

Why is change inevitable? What would happen if no change at all occurred in health care?
Why do people resist change? Why do nursing staff seem particularly resistant to change?
How can leaders overcome resistance to change?
Describe the process of implementing a change from beginning to end. Use an example from your clinical experience to illustrate this process
What evidence of resistance to change can you find in this case study?
What kind of resistance to change did the staff members exhibit?
Why did staff members resist this change?
If you were a staff nurse at this facility, how do you think you would have reacted to this change in administration?
How do you think the director of nursing handled this change? What could the nurse managers and staff nurses do to improve the situation?
How could the new administrator have made this change more acceptable to the staff ?
unit 3
Issues of Quality and Safety
Promoting a Healthy Work Environment
chapter 10

James Prochaska, a psychologist at the University of Rhode Island, developed a highly influential model of "stages of change." What stage are you in. Leading a culture of change. ed.), Center for Creative Leadership Handbook of Leadership Development.

Overview

Quality can be defined and measured;
Quality problems are serious and extensive;
Current approaches to quality improvement (QI) are inadequate; and
There is an urgent need for rapid change

Explain the importance of quality improvement (QI) to the nurse, patient, organization, and health care delivery system. Promote the role of the nurse in delivering safe, effective quality care in today's healthcare environment.

Quality in the Health-Care System

Service occurrence. A service occurrence is an unexpected occurrence that does not result in a

Serious incident. A serious incident results in a clinically significant interruption of

Sentinel events. A sentinel event is an unexpected occurrence involving death or

Nursing Shortages and Patient Safety The value of registered nurses to the health care system cannot be minimized. The need to control rising health care costs, along with the issues of supply and demand for nursing services, will continue.

Safety in the U.S

As health care moves to a variety of community settings, only the most acutely ill patients remain in the hospital. In his closing remarks at the University of Wisconsin, Buerhaus (2013) challenged nurses to “become a student of health care reform.

Health-Care System

Determine what influenced the consequences, i.e., determine the necessary and sufficient
Establish tightly linked chains of influence
At every level of analysis, determine the necessary and sufficient influences
Whenever feasible, drill down to root causes
Know that there are always multiple root causes
How have historical, social, political, and economic trends affected nursing practice? Give specific examples and their implications
What problems have you identified during your clinical experiences that could be considered issues to be addressed using CQI?
What SCMs have you seen implemented in practice? Which ones might you use to assist you in planning care? If you have not seen any, ask the nurse manager what is used on the unit
How do nursing organization care models affect quality and safety outcomes?
Discuss the role of the nurse in CQI and risk management
Based on patient safety goals for the current year, what will you do to ensure adherence to these goals?
What are evidence-based practices that promote quality and safety within the health-care system?
Describe how regulatory agencies and accrediting agencies affect patient care and outcomes at the bedside
Review the nonprofit organizations and government agencies that influence and advocate for quality and safety in the health-care system. What do the organizations or agencies do that
Plan and report outcomes. Emphasizing results is a necessary part of managing
Make introductory rounds. Begin each shift with the interprofessional team members
Plan in partnership with the patient. In conjunction with the introductory rounds,
Communicate the plan. Avoid confusion among members of the interprofessional team
Evaluate progress. Schedule time during the shift quickly to evaluate outcomes and the
Why were these people selected for the team?
What data need to be collected to evaluate this situation?
What are the potential outcomes for patients with who have had hip replacements?
Develop a flowchart of a typical hospital discharge and readmission rate for patients who have had hip replacements
Explain how technology enhances and promotes safe patient care, educates patients and consumers, evaluates health-care delivery, and enhances the nurse’s knowledge base in your
How would you begin discussion on quality and safety issues with the nurse manager or colleague?
What issues may arise when the care delivery system is changed? What does the RN need to consider when implementing these changes?
Chapter 11

What are the evidence-based practices that promote quality and safety in the health care system. What quality and safety organizations or agencies do in the health care system.

Workplace Safety

The first step in development of a workplace safety program is to recognize a potential hazard

For example, employers must offer tuberculosis testing and a hepatitis B vaccine; protective equipment such as gloves, gowns and masks; and immediate post-exposure treatment for all personnel who may come into contact with blood-borne pathogens. For example, a nurse with latex allergies may be placed in an area such as a patient.

The second step in a workplace safety program is a thorough assessment of the amount of risk

The third step is to create a plan to provide optimal protection for staff members without

The second step in a workplace safety program is a thorough risk assessment.

Violence

Box 11-4 lists some additional measures that can be taken to protect staff and patients from workplace violence. Regardless of their position on the organizational chart, they can cause a lot of distress to others in the workplace.

Sexual Harassment

Quid pro quo. Sexual favors are solicited in exchange for favorable job benefits or

Nursing managers in Canada have observed an increase in reporting of horizontal violence as staff have become more aware of their rights and protections as employees (Rocker, 2012). It takes courage to confront these behaviors directly, but failure to do so encourages them.

Hostile environment. This is the most common sexual harassment claim and the most

The employee must demonstrate that he or she had to endure unwanted sexual advances in order to keep the job or the terms and conditions of employment and that rejection of this behavior would have resulted in the loss of a job or the terms and conditions of employment.

Document. Document the incident immediately while it is fresh in your mind—

Discrimination

Latex Allergy

If you develop a latex allergy, take the following precautions (www.cdc.gov/niosh/docs. The number of new cases of latex allergy has decreased due to improved diagnostic methods, better education, more accurate labeling, and the use of powder-free gloves.

Needlestick (Sharps) Injuries

All healthcare facilities should have a written sharps injury prevention plan that is updated annually. Thirty percent of sharps injuries occur here, and the encouraging decline in injuries seen in other areas of the hospital is yet to be seen in a surgical setting.

Ergonomic Injuries

JC inspectors routinely ask whether leaders of healthcare organizations are familiar with the Needlestick Safety and Prevention Act and what measures have been taken to comply (www.osha.gov/ .. needlesticks/needlefaq.html; jointcommission.org/ .. sentinel_event_alert_issue_22_preventing_juries_andries_andries /). The Back Injury Guide for Healthcare Professionals (www.dir.ca.gov/dosh/dosh_publications/backinj .pdf ) and the OSHA Guidelines for Nursing Homes (www.osha.gov/ergonomics/guidelines/nursing-home/index. html) are comprehensive resources.

Natural Disasters and Terrorism Threats

In the 1980s, the National Nurses on Addictions Association (NNSA) and ANA task forces jointly adopted a resolution calling for recognition of substance abuse problems and guidelines for nurse practitioner programs with disorders (Heise, 2003). Many state boards require nurses to report suspected co-worker impairment and accept anonymous reports.

Enhancing the Quality of Work Life

Shift Work Disorders

Mandatory Overtime

In a 2006 position statement regarding nurses working when fatigued, the ANA took the position that, regardless of the number of hours worked, each registered nurse has an ethical responsibility to carefully consider her level of fatigue. fatigue when deciding whether to accept any. duty that extends beyond the regularly scheduled day or week, including a mandatory or voluntary overtime duty (AKSH found that nurses' error rates increase significantly during overtime, after 12 hours, or after working more than 60 hours in week.Currently, half of staff nurses are routinely scheduled to work 12-hour shifts, and 85% of staff nurses routinely work longer than scheduled hours.

Staffing Ratios

Reporting Questionable Practices

Endangering a patient’s health or safety 2. Abusing authority

Violating laws, rules, regulations, or standards of professional ethics

Grossly wasting funds

Case law, federal and state statutes, and the federal False Claims Act may provide some level of protection. You may also (a) arrange for whistleblowing to be addressed at your facility, either through a collective bargaining agreement or workplace advocacy; (b) contact your state nursing association to find out whether your state offers whistleblower protection or has such legislation pending; (c) be politically active by contacting your state legislature and urging them to support a pending bill or by educating your elected state officials about the need for such protections for all health care workers; and (d) contact your U.S.

Social Environment