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RNSG 2138 Final Blueprint - Complete A Score Guide

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1. Explain the relationship of nursing organizations and unions to the concept of professionalism. 2. Describe the potential positive and negative impact of nursing organizations and unions as relat... ed to nursing as a profession. 1.Professionalism Unions Types Unions are used to help achieve a positive change in the workplace for the workers who have paid dues. National Organizations: occur with state & regional chapters State Organizations: regulatory responsibility by the statute for education & practice Workplace Organizations: various nursing units, departments within hospital Unions: no relationship exists unless nurses obtain majority vote of members of their work group (excluding management), once majority vote has been obtained, union can represent them after they have paid their dues, no relationship exists if management is attentive & responsive to nursing employee concerns & complaints, if not & union is voted in, the nurses become responsible to 2 authorities: have to answer to all of the union rules & still have to adhere to hospitals administration policies within their workplace. Open shop: nurses are not required to join or financially support a union as a condition of being hired Closed shop: union security agreement where employer only agrees to hire union members ----> promise to achieve positive changes in the workplace, income, benefits, & working conditions←--- ANA: a union that represents nurses, a collective bargaining agent, has a dual role: organization for nurses & state association as collective bargaining agent. “Participates in establishing, maintaining & improving health care environments & conditions of employment conducive to the provision of quality health care & consistent with the values of the profession through individual & collective action” Collective bargaining: legal process in which representatives of organized employees negotiate with employers about matters such as wages, hours, & working conditions. 2. Describe the potential positive and negative impact of nursing organizations and unions as related to nursing as a profession. 2. Professionalism: labor standards focus Reasons nurses join unions: To increase the power of the individual, To increase their input into organizational decision making, To eliminate discrimination and favoritism, Because of a social need to be accepted, Because they are required to do so as part of employment (closed shop) Because they believe it will improve patient outcomes and quality of care Reasons nurses don’t join unions: A belief that unions promote the welfare state and oppose the American system of free enterprise, A need to demonstrate individualism and promote social status, A belief that professionals should not unionize, An identification with management’s viewpoint, Fear of employer reprisal, Fear of lost income associated with a strike or walkout Positive impact of unions: continuity of care, continual professional growth, active within professional organizations, safe patient environment Negative impact of unions: unsafe patient care, negative patient outcomes, violation of practice standards, suspension or loss of license, consequences within criminal or civil laws Taft Hartley Law: “right to work” laws that prohibited employees from being required to join a union as a condition of employment Least likely to be a standard 3.Describe the potential positive and negative impact of the Role Transition to RN 3.Professionalism: Moral Development Accountability, if there is a med error tell supervisor then MD, be more active in ANA, get involved in professional organizations. Ethical nurses-moral development= ability to behave ethically, must be careful to cultivate it 4. Identify major legislation that has increased the opportunity for nurses to align with nursing organizations and unions. 4.Professionalism: Legislation Interest based bargaining or shared governance: introduced to help solve problems between labor & management, nurses are given a voice in the policy & procedures of the institution--->participate in management Agency for Healthcare Quality & Research: lead national effort to combat medical errors focusing on extended work hours, mandatory overtime, & regulation of nurse staffing levels, resulted in “keeping the patient safe” Bill of Rights for RNs 5.Discuss workplace strategies in 5.Professionalism: Values o++f profession which new graduate nurse participation is encouraged (Commitment to Profession) (to “… incorporate the …values of the profession while maintaining accountability and self-awareness”) given the reality of differences between a nursing organization and unions. Professional values: altruism (well being of others), autonomy, human dignity (protects privacy), integrity (honesty), social justice (non discrimination), Autonomy, nonmaleficence, beneficence, justice, fidelity, Ethical conduct Non maleficence: taking care of issues, Beneficent: to do good, try to prevent harm New nurse-list of violations: Nurse Practice Act 1. Review the concept of Ethical & Legal Practice (including definition, antecedents, and attributes) 6.Ethics & Legal: Whistleblowing Whistle-blowing is a warning from a present or past member of an organization to the public concerning a serious wrongdoing or danger created or masked by the organization. Whistleblowing laws are intended to prevent nurses from being retaliated against job, suspension, detention, harassment, or discharge. Do not blow the whistle for personal gain Have adequate documentation to establish wrongdoing Consult with your state nurses association or legal counsel if possible before taking action to determine how best to document your concerns. You are not protected from retaliation by your employer until you blow the whistle Blowing the whistle means that you report your concern to the national and/or state agency responsible for regulation of the organization for which you work or, in the case of criminal activity, to law enforcement agencies as well. Private groups such as The Joint Commission or the National Committee for Quality Assurance do not confer protection, YOU MUST REPORT TO STATE OR NATIONAL REGULATOR. Put your complaint in writing Keep documentation & interactions objective, keep copies of documentation for personal file Remain calm, do not lose your temper Report unsafe medical devices MD Document he rounded/ assessed patient but did not nurse whistleblower: protected by legislation 2. Analyze conditions which place a patient at risk in situations involving Whistle Blowing, Safe Harbor, Obligation to Report, Risk Management, and Advance Directives. 7.Ethics & Legal: Safe harbor Action must be made before accepting assignment, request must be in writing. A nurse can use a quick request form if he/she does not have time to complete comprehensive request The nurse's supervisor should complete section 2 by end of the work period Must document why assignment is unsafe & send by the end of the work period & before leaving the practice setting KEEP A COPY for your personal file Safe Harbor can also be used when the nurse advocates for the patient & challenges a physician's order. ***if you accept assignment you are held to same competences as other nurses When can you claim safe harbor: before you take the assignment 3. Identify when moral distress (negative consequence) is developing or has developed in relation to Whistle Blowing, Safe Harbor, Obligation to Report, Risk Management, and Advance Directives. 8.Ethics & Legal: Obligation to report Nurses are frequently the first members of the public to detect abuse. Abuse includes a physical, verbal, sexual, or emotional attack; neglect; and abandonment. Targets of abuse include infants, children, and adult men and women of all ages. Abusers are men and women of all ages, races, socioeconomic groups, and religious backgrounds. Nurses are obligated both ethically and legally to report abuse. In many states, the failure to report actual or suspected abuse is a crime in itself. Nurses are protected by law against suits from alleged abusers if they file a report of suspected abuse in good faith that turns out to be erroneous. - You are obligated to report if patient/co worker is chemically impaired, stealing, lying, cheating Report through chain of command first then if needed, report to outside agency such state nurses associations and agencies. Under state Nurse Practice Acts, and the state and federal examples below, perioperative nurses also have a legal obligation to report conduct that’s incompetent, unethical, and illegal. Example is to report child, elder abuse and suspicious deaths. Safe Medical Devices; report unsafe medical devices that may have caused death. ***Report to supervisor first Reporting an incident to the peer review committee satisfies the nurse’s duty to report child says her uncle does not clean her that way-mother tells her to be quiet= report to nursing supervisor & authorities report impaired nurse to =TPAP first 3. Identify when moral distress (negative consequence) is developing or has developed in relation to Whistle Blowing, Safe Harbor, Obligation to Report, Risk Management, and Advance Directives. 9.Ethics & Legal: Obligation to report. SAME as # 8 4. Describe the ethical-legal parameters and requirements for nursing practice related to Whistle Blowing, Safe Harbor, Obligation to Report, Risk Management, and Advance Directives and interventions for each. 10.Ethics & Legal: Risk Management strategies Incident Reports: also called variance or occurrence report is used to document occurrence of anything out of the ordinary that results in, or has the potential to result in harm to the patient, employee, or visitor. It is used as a means for quality improvement & not for disciplinary action, it is a means of identifying risks. The one who is responsible or witness of event is the one to fill out the form Risk Management: provides a structured approach to identifying, assessing, & managing risks; process by which vulnerabilities are identified & changes are made to minimize consequences of adverse patient outcomes & liability. Proactive (anticipating & preventing) & reactive (investigations). Nurse does NOT need to document that an incident report was filed Do NOT state fault, do not elaborate or confess--->facts & objective documentation only risk management strategies= ID practices that need to be changed to EBP, participate in high risk clinical practices, inform nurse manager when staff is not adequate 4. Describe the ethical-legal parameters and requirements for nursing practice related to Whistle Blowing, Safe Harbor, Obligation to Report, Risk Management, and Advance Directives and interventions for each. 11.Ethics & Legal: advance directives Living will, allows people to state in advance what their choices would be for health care should certain circumstances develop. The nurse puts the advance directives in the patients chart, can sign as witness, but family can overturn if comes down to it. advance directive in another state= document is legal in that state (Michigan) 1. Explain the concept of Health Policy (including definition, antecedents, and attributes). 12.Health Policy: nursing regulation Government oversight provided by each state; health policy is a form of public policy, goal directed decision making about health that is the result of an authorized, public decision making process. It focuses on how organizations function within context of socioeconomic political environment at every level (state, federal, national). Developing health policy is similar to nursing process (problem solving, decision making framework). Nurses are at the frontline in a position to influence healthcare policy issues both at the bedside & decision making levels. Policy Advocating: professional organizations promote the development of the profession. Professional nursing organization functions: define standards of practice & professional behaviors, support nursing research, & participate in policy development at all levels. Advocate: join organization, participate in functions, be involved NCLEX: regulated by the state 2. Analyze processes by which health policies are developed, implemented, evaluated, changed and maintained. 13.Health Policy: NPA purpose. Health Policy PPT slide 9. Practice of nursing is regulated at the state level through a Nurse Practice Act (NPA). An NPA is a series of state statues that define the scope of practice, standards for education programs, licensure requirements & grounds for disciplinary actions. Each state’s NPA is enforced and administered by a state board of nursing (BON). Each BON oversees the administration of a licensure examination that measures the competencies needed to perform safely and effectively as a newly licensed, entry level nurse. EXTRA Licensing & regulation of health professionals, including nurses are the responsibility of the state governments. States create laws that establish professional practice acts meant to regulate health professionals. NPA is a series of state statutes that define the scope of practice, standards for education programs, licensure requirements, & grounds for disciplinary action. establishes BON; contain general statements of appropriate professional nursing, practice to protect public from unsafe and unlicensed practice NPA- scope of practice= stands, licensure, grounds for disciplinary 4. Discuss the following Health Policy exemplars: Regulatory Agencies (OSHA, Licensure, DHHS, DHSR, CMS); Types of Reimbursement (Medicare, Medicaid, Private); Professional Organizations, Accrediting Bodies.) 14.Health Policy: Medicare reimbursement. Health Policy PPT slide 16-17. When Medicare was established in 1965, Congress adopted the private health insurance sector’s “retrospective cost-based reimbursement” system to pay for hospital services. Under this system, Medicare made interim payments to hospitals throughout the hospital’s fiscal year. At the end of the fiscal year, the hospital filed a cost report and the interim payments were reconciled with “allowable costs” which were defined in regulation and policy. Medicare’s hospital costs under this payment system increased dramatically; between 1967 and 1983, costs rose from $3 billion to $37 billion annually.1 Medicare: federally funded health insurance for people 65 & older, younger people with disabilities & people with end-stage renal disease. Eligibility for premium-free Part A (hospital insurance) requires that the individual covered be aged 65 or older & that either the individual or the individual’s spouse was employed & paid Medicare taxes for at least 10 years. There are 4 parts to Medicare; each covering a different aspect and all but part A has some co-payment attached. There is also a Medigap policy which is a Supplemental Insurance to Medicare that covers healthcare costs that the various Medicare parts do not cover. EXTRA Diagnosis-related groups DRGs- rate setting PPS used by Medicare to determine payment rates for an inpatient hospital state based on admission diagnosis. Each DRG represents a particular case type for which Medicare provides a flat dollar amount of reimbursement. Congress mandated the creation of prospective payment system PPS to control costs. HMO: PCP, low cost, only allowed to see members inside network, provides greater benefits at lower cost, PCP as gatekeeper PPO: does not need PCP, more costly, larger network of providers, increase co payments, financial incentive to use network providers Affordable Care Act: to give everyone healthcare coverage, keeps young adults covered DRG-Medicare- 3 days stay but was 5 instead= will get paid for 3 days 3. Identify regulatory agencies and accrediting bodies that develop, administer or implement health policy 15.Health Policy: Nursing Regulatory agencies. Health Policy PPT. slide 10. State & Local Agencies…Every state has its own department of health & human services with various titles among states. These departments oversee regulation of county health departments, health care settings (hospitals & long-term care facilities, clinical labs etc.). In addition, they oversee planning construction of medical facilities & receive complaints regarding facilities that they regulate. Local health departments are responsible for disease monitoring & surveillance in their communities. This includes the reporting as well as the prevention efforts (immunizations). Typically, they also oversee child care center sanitation & food safety. They also offer a variety of community-wide prevention programs in response to local issues. Examples include: injury prevention, lead poisoning prevention & in some agencies making safety items such as: smoke detectors, bike helmets & infant car seats available at no cost. Generally, they also administer the Women’s Infants and Children’s (WIC) supplemental nutritional program—for pregnant women & children under 5 at risk for malnutrition. (North Carolina Concept-Based Learning Editorial Board p. -2365) Primary Elements Regulated include: License Requirements; License Renewal, Practice by the license holder, reporting of violations & Patient Care Concerns, Prohibited practices & disciplinary actions, administrative penalty Modified from Giddens PPT: relating to: Concepts for Nursing Practice House Bill 581: authorizes a nurse employed by a hospital operated by or on behalf of a state or local entity to sue the governmental entity to recover limited damages for certain retaliatory actions taken against the nurse for fulfilling obligations as a licensed nurse practicing under Texas law…(case that brought this forth: Winkler County nurses trial); articles to reference: http://www.texasnurses.org/displaycommon.cfm?an=1&subarticlenbr=509; http://www.texasnurses.org/displaycommon.cfm? an=1&subarticlenbr=538; http://www.americannursetoday.com/article.aspx?id=9580&fid=9534; etc. Senate Bill 406: eliminates the requirement for on-site physician supervision of Advanced Practice Registered Nurses (APRNs) & increased the number of APRNs a physician can supervise from four to seven & allows delegation of Schedule II controlled substances in hospitals & hospital settings….. http://www.texastribune.org/2013/05/14/house-tentatively-approves-scope-practice-bill/ http://www.mondaq.com/unitedstates/x/277160/Healthcare/Texas+Medical+Board+Adopts+Rules+Required+By+SB+406+To+Ease+Supervision+Of+PAS+And+APRNs Senate Bill 743: requires the BON to suspend a nurse’s license or refuse to issue a license to an applicant on proof that the nurse or applicant has been initially convicted of an offense involving a violation of certain court orders etc. (read bill directly—if applicant has 2 DWI—may not be issued a licensed.) Senate Bill 1058: deals with jurisprudence & ethics as well as for those working with geriatric populations; Criminal background checks mandatory for schools of nursing, drug testing of nursing students etc. http://www.capitol.state.tx.us/tlodocs/83R/billtext/pdf/SB01058F.pdf EXTRA NLN: national league for nursing: first nursing organization in US, to promote excellence in nursing education to build a strong & diverse nursing workforce, offers certification for nurse educators, faculty development programs, & excellence initiatives to strengthen schools of nursing. NPA: Nurse Practice Act: each state's NPA is enforced & administered by the states BON OSHA: mission is to assure safe & healthful workplace by setting & enforcing standards & by providing training, outreach, education, & assistance. Unsafe work environment falls under OSHA. OSHA standards require that employers maintain conditions or adopt practices that are reasonably necessary & appropriate to protect workers on the job. ANA: Code of Ethics 5. Explain how Health Policy influences clinical practice. 16.Health Policy: regulatory agencies and influences, Taylor p. 115. Table 7-1. Source: Federal legislation Example: Medicare and Medicaid provisions related to reimbursement for nursing services Documented Rules: Federal statutes Review documents. Initiated change: Draft desired legislative changes. Obtain support of colleagues, nursing organizations, other healthcare providers, and the public, if appropriate. Obtain support and sponsorship from a U.S. congressperson or senator, who will introduce the bill. Lobby for the bill’s passage. Source: State legislation Example: Scope of practice for RNs, LPNs, advanced practice nurses, Nursing educational requirements, Composition and disciplinary authority of board of nursing Documented Rules: Nurse Practice Act Medical Practice Act Other statutes Initiated change: Review documents. Draft desired legislative changes. Obtain support of colleagues, nursing organizations, other healthcare providers, and the public, if appropriate. Obtain support and sponsorship from a state legislator, who will introduce the bill. Lobby for the bill’s passage. Source: Board of nursing Example: Delegation, Medication, administration, Unprofessional conduct, Licensing Documented Rules: Rules and regulations, Position statements, Declaratory rulings (as found in meeting minutes or newsletters), which may be specific to a particular setting or institution Initiated change: Review documents. Initiate a formal query to the licensing board. Obtain board support for change. The board may issue a position statement or declaratory ruling or hold a formal public hearing before voting to promulgate new rules or change existing ones. Source: Healthcare institution Example: Clinical procedures, such as wound dressing changes, Policies specific to the institution, specialty, or practice setting, Personnel and employment policies [Show More]

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