Professional Responsibility Flashcards
Who defines the NP’s scope of practice?
the State Nurse Practice Acts!!*
What does the State Nurse Practice Act provide?
guidelines for nursing practice and legal allowance to practice
Are all State Nurse Practice Acts the same?
No, they vary from state to state
According to the NP scope of practice, what are key elements of the NP role (5)
- integration of care across the acute illness continuum with collaboration and care coordination
- research-based clinical practice
- clinical leadership
- family assessment
- DC planning
Who delineates the standards of advanced practice?
ANA (1996)
How did the ANA delineate the standards of advanced practice?
Authoritative statements by which to measure QUALITY of practice, service, or education
What kind of standards of advanced practice exist?
Generic and specific specialty
What do the State Practice Acts authorize?
Authorize the BON in each state to establish statutory authority for licensure of RNs
What does BON authority include?
- use of title
- authorization of scope of practice (including prescriptive authority)
- disciplinary grounds
Do states vary in specific practice requirements?
Yes (ex: certification)
The ability and extent of the NP to prescribe meds is dependent on __
State Practice Acts*
Even though the DEA has permitted APRNs to obtain registration numbers, ___ dictate the level of prescriptive authority allowed.
State Practice Acts
What does an NP credential establish?
The minimal level of acceptable performance
What do credentials encompass?
Education, licensure, and certification to practice as a NP
Why is credentialing necessary (2)?
- To ensure safe health care is provided by qualified individuals
- to comply with Fed and State laws r/t advanced practice nursing
What do credentials acknowledge?
The scope of practice of the NP
What do credentials mandate?
Accountability
What do credentials enforce
Professional standards for practice
What does licensure establish?
That a person is QUALIFIED to perform in a particular professional role
Who grants licensure?
the State Board of Nursing!
*Licensure is granted as defined by rules/regulations set forth by GOVERNMENTAL regulatory body
What does certification establish?
That a person has met certain standards in a particular practice that signify MASTERY of specialized knowledge and skills
Who grants certification?
NON governmental agencies (ANCC)
When were non-MD providers granted the possibility of hospital staff membership?
1983 by the Joint Commission
What is credentialing and privileging?
The process by which an NP is granted permission to practice in an inpatient setting
Who grants credentialing with hospital privileges?
the Hospital Credentialing Committee (comprised of MDs who hold privileges at the given hospital where NP has made the request)
How might privileges be granted?
In full or part
Who makes stipulations regarding the allowance of future privileges?
Credentialing Committee
ie, number of additional supervised hours required before a certain privilege is granted
What is patient medical abandonment?
Results when the caregiver-patient relationship is terminated WITHOUT MAKING REASONABLE ARRANGEMENTS with an appropriate person so that care by others can be continued
What factors help determine patient abandonment?
- Did the NP accept the assignment? (formally creates the practitioner-patient relationship)
- Did the NP provide reasonable notice before terminating the relationship?
- Did the NP make reasonable arrangements for the patient’s care to be continued when the adequate notification was given?
T/F this case qualifies as medical abandonment: NP refuses to accept responsibility for pt assignment when the NP has given reasonable notice to the proper authority that the NP lacks the competence to carry out the assignment.
F
T/F this case qualifies as medical abandonment: NP refused a double shift assignment or additional hours beyond posted work schedule when proper notification has been given
F
A systematic effort to reduce risks begins with ___
A formal, written risk management plan
What should a formal risk management plan include? (5)
- Organization’s goals
- Delineation of program’s scope, components, and methods
- Delegates responsibility for implementation and enforcement
- Demonstrates commitment by the board
- Articulates guarantee of confidentiality and immunity from retaliation for those who report sensitive information
What is the most common method of risk management documentation?
Incident reports
What should incident report policies address (6)
- Persons authorized to complete a report
- Persons responsible to review a report
- IMMEDIATE ACTIONS needed to minimize the effects of the report’s event
- Persons responsible for f/u
- A plan for monitoring aftermath of report’s event
- Security and storage of completed incident report forms
Why are satisfaction surveys important?
They help ID problems before they develop into actual incidents or claims
Should satisfaction surveys be tracked and analyzed like incident reports?
Yes
What are type types of satisfaction surveys?
- patient satisfaction
2. employee/practitioner satisfaction
What info do complaints provide?
A key source for potential risk management info
What should a risk management plan involve in terms of complaints?
Tracking, analyzing, and managing complaints by identifying…
- ppl notified after receiving a complaint
- ppl responsible for responding to the complaint
- ppl responsible for monitoring the f/u resolution of the complaint
What are 5 examples of action taking initiatives?
- Prevention
- Correction
- Documentation
- Education
- Department coordination
What does the Prevention action taking initiative consist of?
Proactive risk awareness and safety programs in place
What does the Correction action taking initiative consist of?
Post-incident remediation to minimize the impact and prevent future occurrences
(these corrective steps must be monitored and audited)
What does the Documentation action taking initiative consist of?
Essential for LEGAL defense
Thorough medical records and institutional policies
What does the Education action taking initiative consist of?
In-services of all staff at orientation and annually, at minimum
What does Departmental coordination action taking initiative consist of?
Encouraging departments and managers to work together for the COMMON GOAL OF IMPROVED PT AND STAFF SAFETY
What is medical futility?
Refers to interventions that are unlikely to produce any significant benefit for the patient
“does the intervention have any reasonable prospect for helping this patient?”
What are 2 kinds of medical futility?
- Quantitative futility
2. Qualitative futility
What is Quantitative medical futility?
Where the LIKELIHOOD that an intervention will benefit the patient is extremely poor
What is Qualitative medical futility?
Where the QUALITY of benefit of an intervention will produce is extremely poor
What is competence?
Decisional capability: A state in which a patient is able to make personal decisions about his or her care
What does competence imply?
The ability to understand,
reason,
differentiate good and bad, and
communicate!!
What is informed consent?
A state indicating that a patient has received adequate instruction or information regarding aspects of care to make a prudent, personal choice regarding treatment
What does informed consent discussion include?
Discussing all of the risks and benefits with a patient in order to make a truly informed decision
When is consent assumed?
If the patient’s condition is life-threatening
What is the Danforth Amendment (1991)?
The right to refuse care
When must patients be advised of their right to refuse care?
At the time of their admission to a federally funded institution (such as a hospital, nursing home, hospice, HMO)
What care might a patient refuse? And what is the caveat?
Some, any, or ALL of care
*As long s the patient has decisional capability (competence)
