Defines the title and regulations governing the practice of nursing
Assists the nurse in staying within the legal scope of nursing practice in each state.
Defines the regulations for practical nursing and includes requirements for an approved school of nursing.
Defines requirements for licensure and conditions for which a license may be revoked or suspended
Publish Rules and regulations that expand the law
Set and enforce minimum criteria for nursing education programs – schools have to be approved
Protect the public from dangerous nurses – **most commonly impaired nurses**
They can CLARIFY, CANNOT change the law
**Executive**: Administers nurse practice act
**Legislative**: Adopts necessary rules to implement act
**Judicial**: Authority to discipline a licensee
Can approve or reject applications for new nursing education programs
Schools of nursing must have state approval to operate
Have the power to discipline a licensee
To protect the public from dangerous practice
Most frequent reason for discipline is for practicing while impaired
Primary function is to develop the NCLEX RN & PN licensing exams
A formal statement of the nursing’s profession’s code of ethics.
The Code of Ethics for Nurses with Interpretive Statements (ANA, 2001) is the most recent revision.
Nurse (defendant) practices with specialized knowledge and skills
Through this practice caused patient’s (plaintiff’s) injury.
Uses Advance Directives
Nurse’s primary legal and ethical consideration is safe, effective care for patients
Professional nurses retain accountability for acts delegated to another person; never be delegated.
Most debated area of delegation involves medication administration by unlicensed assistive personnel
Take vital signs, unless known to be unstable
Measure urine output from catheter bag, collect urine specimen from bag
Transport/ambulate, unless new ambulation
REINFORCE previous teaching, NO NEW TEACHING and NO Discharge instruction
Can assist Physician
LPN cannot insert IV (this requires special certification beyond basic licensure) or initiate any step in nursing process.
Impermissible, unprivileged touching
Actual harm may or may not occur as a result
Anyone can be found negligent
**Occurs through commission or omission**
Assumed the responsibility for the patient’s care
Found to have failed to meet the prevailing standard of care
Harm to the patient must be shown to have been caused by the failure to meet the standard of care
Injury is proven
Failure to use equipment in a responsible manner
Failure to communicate
Failure to document
Failure to assess and monitor
Failure to act as a patient advocate
Capacity/competence to understand
Enough information given
**Role of the nurse**
**Witness patient’s signature**
Determine three elements are present to patient’s satisfaction
Provide feedback to provider if patient requires further information or is unable to sign
Make sure the consent form is signed and on the patient’s chart prior to the procedure
First federal privacy standard governing protection of patients’ medical records
Comprehensive legislation providing major patient protections
**Reinforces protection of electronically transmitted information**
Requires all health care providers to ensure patients’ privacy and confidentiality
**Morals becomes an issue when the choice is no longer clear between right or wrong.**
*EX: equal treatment – despite affordability to pay – can’t afford chemo – nurse’s discharge – you advocate for them to be able to stay*
Emphasizes the character of the decision maker
Character traits regarded as virtues:
Honesty, courage, compassion, fairness, integrity, etc.
To make his own decisions.
But the client must accept
The consequences of those
Decisions. The client must also respect the decisions of others.
Faithfulness to the client and to one’s duty.
**Bring about the greatest good for the greatest number of people.**
Examples: triage, Obamacare
“Duty”- towards the good of society
Act Deontology – gather facts
Rule Deontology – principles guide
actions – veracity, fidelity, etc.
Example: good Samaritan law
Ethical theory if moral originates from goodwill.
The phrase “moral courage” suggests there is danger or fear associated with taking a right action, because of the possible personal sacrifice.
“The nurse does what the doctor says”
“The nurse helps the doctor”
1901 men banned from nursing in military
Are gaining their historical position in the profession as nurses
“Obedience” (1868 AMA/Hospital Admin promoted “training”….persisted through 1960’s)
Altruism (less expectation of monetary compensation)
Power of other organizations (AMA, legislation)
a living or how one spends time.**
Most of work is manual
No specific value-system associated
No specific career path
Accountability lies with supervisor/
Develops from an occupation that **specializes** in
Professions develop a **collective identity**
Evidence based practice
**Duty to serve**
Prolonged education, specialized
Orientation (socialization) to beliefs/values
Part of personal identity “I’m a nurse!”
Transcends expectation of material reward
Through education & the workplace.
The process of a nursing student becoming a professional nurse.
– Classroom Lectures
-Hearing other people discussions
-Unplanned observation of a person(s)
-Participating in an professional organization
-Active listening and active attention
-Avoidance of analyzing, judging, defensiveness, or problem solving
Human Factors – Key components
Steps in the collaboration process
Identify who is responsible
Sessions focused on identifying problematic feelings, mis-perceptions and correcting them
Involve all team members
Build team trust
Goal is patient well-being
Supportive practice setting
Welcome healthy disagreement
Be specific about your needs
Be vulnerable and teachable
Take initiative in learning opportunities
Mentoring & management issues
Nursing shortages / retention
Increased aging population
Increased chronic illness/high acuity patients
Complexity of health care systems
Working conditions / relationships
Under involvement – far left
Zone of Helpfulness – middle
Over involvement – far right
Recognize symptoms of “burning out”
Physical symptoms such as insomnia, diet, and weight changes
Disengagement mentally & emotionally
Boundary violations occur when there is a “confusion between needs of the nurse and needs of the client”
Establish positive relationships
Share thoughts with others
Solicit feedback / reality check with trusted colleagues
Awareness of responses
Be proactive in developing resilience
Focus on self-care
Don’t try to do it all
Healthy foods, exercise, adequate sleep
Recharging of self (coping mechanisms)
**Value contributions you DO make**
Don’t focus on what you are not accomplishing or areas where you feel you do not measure up
All members to the team work together
Based on the theory that the relationship between the manager and the nurse is ever-changing
Both parties are essential to the success of the unit
The leader offers direction instead of controlling
Autocratic: person is task oriented, makes decisions independently without input from the group, motivates with praise, blame and reward
“You know where you stand” with this type of leader
Based on participation and greater equality
Laissez-Faire: “let alone”, leaves workers without direction, supervision or coordination in their projects, don’t give praise, criticism, feedback or information
Can be very frustrating with a high level of dissatisfaction
Processes feedback from the group but makes all decisions. Handles emergencies well
Have a free exchange of ideas
Rely on judgemental decisions from leaders
More reliable and safe from employee and manger abuse because they manage by designed and maintained rules, policies, and procedures designed to ensure quality output with minimal error
Give structure/provide resources
Focus is doing things correctly
Big picture/promote ideas
Focus is doing what is right
Four Principles of Shared Governance:
**Partnership**—links healthcare providers and patients along all points in the system; a collaborative relationship among all stakeholders and nursing required for professional empowerment.
**Equity**—the best method for integrating staff roles and relationships into structures and processes to achieve positive patient outcomes.
**Accountability**—a willingness to invest in decision-making and express ownership in those decisions.
**Ownership** – recognition and acceptance of the importance of everyone’s work and of the fact that an organization’s success is bound to how well individual staff members perform their jobs.
Federal government funded
Medicaid (Title XIX of the Social Security Act)
Federal and state government funded
2. Irritability and anger
3. Attempts to gain control
4. Depression and despair
5. Acceptance and participation
Guidelines according to Talcott Parsons
Includes behavior that is dependent, passive, and submissive
Taught in medical and nursing schools for decades
The current (**CONTEMPORARY**) sick Anglo-American
Accept responsibility for own care
Consumer oriented approach
Suddenness of the illness
Extent of the illness
Duration of required lifestyle changes
Individual and family resources for dealing with stress of illness
Life-cycle of patient and family
Previous experiences with illness or crisis
Spiritual values / beliefs
Definition: “A formal area of study and practice focused on comparative holistic culture care, health, and illness patterns of people with respect to differences and similarities in their cultural values, beliefs, and lifeway with the goal to provide culturally congruent, competent, and compassionate care
practices are best.
-Ask older adults how he or she would like to be addressed.
-Determine the patient’s
preferences for touch.
-Determine the patient’s
preferences for silence.
-Investigate the patient’s
belief about eye contact
-Often referred to as the private sector
-Have shareholders who invest money and expect a return on the investment.
-Taxed by the government
-Often referred to as the public sector.
-Receive tax exemptions based on its benefits to the community.
-Federal, state, or local government agencies govern.
-Operate according to mission statements that usually refer to community service.
Includes early detection
When risk factors are identified
Diagnosis and Treatment
Rehabilitation and Long Term Care
An increase in the use of technology
The rising cost of private health care insurance
The rising cost of medical malpractice insurance
The nursing profession stands to benefit
Found to be cost effective and a high quality alternative to traditional medicine
As a profession, nursing is expected to benefit from reform by expanding roles in prevention, community-based nursing, advanced practice nursing, etc.
It is predicted that nurses will become increasingly active in the development of health policies that improve access, quality, and value in the delivery of health services.
Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to:
-Encourage collaborations across communities and sectors.
-Empower individuals toward making informed health decisions.
-Measure the impact of prevention activities.
**Ideal role image**
society’s expectations of what a nurse should be.includes obligations and responsibilities, rights,privileges.
CLEAR image of what is expected.Often unrealistic.
**Perceived role image**
an individual’s own definition of nurse’s role.
Often more realistic than the ideal role, but not berealistic, either. This is usually the role with which the nursing student usually graduates.
**Performed role image**
what the nurse actually does.
-Raised eye brows
-Refusing to help someone
-Making faces behind someone’s back
– Refusing to only work with certain people or not work with others
A critical thinker:
-Raises questions/problems and formulates them clearly and precisely (INQUISITIVE)
-Gathers and assesses relevant information
(INTERPRETATION, ANALYSIS, TRUTH-SEEKING, EVALUATION)
-Uses abstract ideas for interpretation (ANALYSIS)
-Develops conclusions that are well-reasoned, testing against relevant standards
(INTERPRETATION, INFERENCE, JUDICIOUS, SYSTEMATIC)
-Is open-minded and recognizes alternative views
(SELF-REGULATION, TRUTH-SEEKING, OPEN-MINDED)
-Communicates effectively about solutions to complex problems (EXPLANATION, CONFIDENT in REASONING)
(2) Show confidence
(3) Keep a positive attitude
(4) Maintain eye contact
(5) Watch your body language
A few additional interviewing tips:
Don’t chew gum or breath mints during your interview and don’t speak in slang as it is unprofessional and rude.
Relate your answers to the specific company or interviewer. This will show that you’ve done your research.
Avoid complaining or bad mouthing previous employers or companies.
Don’t ramble or use slang in your answers.
-One nurse is responsible for total care of a number of clients 24 hours a day, 7 days a week.
-Assesses & prioritizes each client’s needs, identifies nursing diagnoses, develops a plan of care with the client, and evaluates the effectiveness of care.
-Incorporates all aspects of the professional role, including teaching, advocacy, decision making, and continuity of care.
-Assist clients through the complex healthcare system with the goal of increasing the quality of life in a cost-effective way.
-Enable patient, their families, and their health care providers to be actively involved in providing for ongoing care needs.
-Combine nursing clinical knowledge, communication skills, and nursing process skills to assist clients in a variety of clinical settings.
-The case management nurse integrate a variety of disciplines and services in coordinating care throughout the client’s duration of illness.
-Is generally no longer used in hospital settings; it may be seen in long-term care settings. One nurse (often an LPN/LVN) administers all the medications on a residential unit
-Delivery of individualized nursing care to clients by a nursing team led by a professional nurse (RN), Consists of registered nurses, licensed practical nurses, and, often, nursing assistants. Responsible for providing coordinated nursing care to a group of clients during an 8- or 12-hour shift.
Focuses on excellence and employee involvement at all levels of an organization
Delivery of excellent nursing care to patients
-Keeps us current with the latest research
-Prevents us from using outdated information
Policy statements set forth a plan
Polices may result in laws, regulations, or guidelines that govern behavior in public or private arena’s.
Policy decisions reflect the values and beliefs of those making the decisions.
Health policy refers to public or private rules, regulations, laws, or guidelines that relate to the pursuit of health and the delivery of health services.
Allocation assumes that there are not enough resources.
Who gets what, is determined through the political process.
Stakeholders and individuals are those with a vested interest and who try to influence those with the power to make the final decisions.
Stakeholders are organizations, the community at large served by the organization, and other groups or individuals affected by those decisions
Politics is what influences those decisions
A person with authority has legitimacy to enforce law
The action or process of producing effects on the actions, behavior and opinions of others
**Broad-purpose professional associations**
**Specialty practice associations**
**Special interest associations**
Organizations define practice standards; take positions on practice issues, and develop ethical guidelines, practice guidelines and policies.
Position statements serve to guide the organization’s work in both the practice and the policy areas.
**Benefits** of belonging to professional organizations:
Development of leadership skills
Certification and Continuing Education
Access to journals, newsletters, and action alerts about topics that need immediate response.
Eligibility for group health and life insurance opportunities, discounts of products and services
Networking with peers
Nursing Practice challenges
Nursing Education challenges
Global health needs
Large-scale public health disaster needs
Unhealthy lifestyles with resulting rise in chronic illnesses
Cost containment needs
Governmental regulation of health care
Health promotion issues
Health care costs
Faculty shortage expected
Fraudulent on-line programs
Adequate and properly supervised clinical experiences
Technology helps some: virtual simulations
Students need to be educated consumers and consider specific options when evaluating programs.
Provide education and support