Test 1 - Unit A - Chapter 3 - Nursing Leadership and Management Flashcards
Professional responsibilities
obligations
that nurses have to their clients
To meet their professional responsibilities, nurses must be knowledgeable in
client rights,
advocacy,
informed consent,
advance directives,
confidentiality and information
security, information technology,
legal practice,
disruptive behavior,
ethical practice
Client rights
-legal guarantees clients have
with regard to their health care
-Clients using services of health care institution retain rights as individuals and citizens United States.
-American Hospital Association (AHA) identifies client rights in health care settings in the Patient Care Partnership
-Nurses - accountable for protecting the rights of clients
-regardless of age, nursing needs, or care setting
Residents in nursing facilities -participate
in Medicare programs
similarly retain resident
rights under statutes that govern the operation of these facilities
protecting clients rights situations that require particular attention include
informed consent,
refusal of treatment,
advance directives,
confidentiality,
information security.
Nurses must ensure that clients understand
Nurses also must protect
their rights.
clients’ rights during nursing care.
QSEN - Holistic
Each client has the right to the following.
Be informed about all aspects of care and take an active role in the decision‑making process.
◯ Accept, refuse, or request modification to the plan of care.
◯ Receive care that is delivered by competent individuals who treat the client with respect
The Patient Self‑Determination Act (PSDA) stipulates that
on admission to a health care facility, all clients must be informed of their right to accept or refuse care
Competent adults have the right to
refuse treatment,
including the right to leave a health care facility without a prescription for discharge from the provider.
If the client refuses a treatment or procedure, the client is asked to
-sign a document indicating that they understand risk involved refusing treatment or procedure,
-and that they have chosen to refuse it.
When a client decides to leave the facility without a prescription for discharge, the nurse does what
-notifies provider
-discusses with client potential risks - leaving facility prior to discharge.
-documents the information provided to client and that provider notification
-When a client decides to leave the facility without a prescription for discharge,
-The client should be informed of the following.
Possible complications that could occur
without treatment
◯ Possibility of permanent physical or mental impairment or disability
◯ Possibility of other complications that could lead to death
-The client is asked to sign an Against Medical Advice form.
● If the client refuses to sign the form, it is documented by the nurse.
Advocacy refers to nurses’ role in supporting clients by
ensuring they are properly informed,
their rights are respected,
receiving the proper level of care.
Advocacy is one of the most important roles of the nurse, especially when
clients are unable to speak or act for themselves.
● As an advocate, the nurse ensures that the client has …
● Nurses must act as advocates even when
● The complex health care system puts clients in a
-the information they need to make decisions about health care.
-they disagree with clients’ decisions.
-vulnerable position.
Nurses are clients’ voice when the
system is not
acting in the clients best interest.
● The nursing profession also has a responsibility to
-support and advocate for legislation that promotes public policies - protect clients as consumers
-create a safe environment for their care.
As advocates, nurses must ensure that
-clients informed of rights/have adequate information to base health care decisions.
● Nurses must be careful to assist clients with making health care decisions and not
direct or control their decisions.
Nurses mediate on the client’s behalf when
the actions of others are not in the client’s best interest or changes need to be made in the plan of care.
Situations nurses might need to advocate for clients or assist them to advocate for themselves include
◯ End‑of‑life decisions
◯ Access to health care
◯ Protection of client privacy
◯ Informed consent
◯ Substandard practice
Nurses are accountable for their actions even if they are
-carrying out a provider’s prescription.
-It is nurse’s responsibility question a prescription if it could harm client
ie. (incorrect medication dosage,
otential adverse interaction with another prescribed medication,
contraindication due to an allergy or medical history).
ESSENTIAL COMPONENTS OF ADVOCACY
skills
● Risk‑taking
● Vision
● Self‑confidence
● Articulate communication
● Assertiveness
ESSENTIAL COMPONENTS OF ADVOCACY
values
● Caring
● Autonomy
● Respect
● Empowerment
Informed consent
-legal process - client has given written permission for procedure/treatment to be performed.
-Consent is considered informed when client has been provided with and
understands the following.
◯ Reason the treatment or procedure is needed
◯ How the treatment or procedure will benefit the client
◯ Risks involved if the client chooses to receive the treatment or procedure
◯ Other options to treat the problem, including the option of not treating the problem
◯ Risk involved if the client chooses no treatment
-nurse’s role in informed consent process
-witness client’s signature on informed consent form and ensure that informed consent has been appropriately obtained.
The nurse should seek the assistance of an ____________ if the client does not speak and understand the language used by the provider.
interpreter
Consent is required for
-For most aspects of nursing care
- all care given in a health care facility.
- implied consent is adequate
The client provides implied consent when
they comply with the instructions provided by the nurse.
For example, the nurse is preparing to administer a TB skin test, and the client holds out their arm for the nurse.
For an invasive procedure or surgery, the client is required to provide
● State laws regulate who is able to _____ and vary regarding age limitations and emergencies.
Nurses are responsible for knowing
-written consent.
-give informed consent.
-the laws in the state of practice.
● Nurse responsibitlity with regard to informed consent
The nurse must verify that consent is informed and witness the client sign the consent form.
The form for informed consent must be signed by a
-competent adult.
◯ Emancipated minors (minors who are independent from their parents [a married minor]) can provide informed consent for themselves.
The person who signs the consent form must be capable of
-understanding the information provided by the health care professional who will be providing the service.
-person must be able to fully communicate in return with the health care professional.
When person giving the informed consent is unable to communicate due to a language barrier or hearing impairment,
-a trained medical interpreter must be provided.
Many health care agencies contract with professional interpreters who have
additional skills in medical terminology to assist with providing information.
Individuals authorized to grant
consent for another person
● Parent of a minor
● Legal guardian
● Court‑specified representative
● Client’s health care surrogate (individual who has the client’s durable power of attorney for health care/health care proxy)
● Spouse or closest available relative (state laws vary)
INFORMED CONSENT RESPONSIBILITIES
PROVIDER:
CLIENT
NURSE
- Obtains informed consent
- Gives informed consent
- Witnesses informed consent
To obtain informed consent, the provider must give the client the following.
Complete description of treatment/ procedure
● Description of professionals performing /participating in treatment
● Description of potential harm, pain, and/or discomfort that might occur
● Options for other treatments and possible consequences of taking other actions
● The right to refuse treatment
● Risk involved if the client chooses no treatment
CLIENT: Gives informed consent. To give informed consent, the client must do the following.
-Give it voluntarily (no coercion involved).
● Be competent and of legal age, or be an emancipated minor. (If the client is unable to provide consent, an authorized person must give consent.)
● Receive sufficient information to make a decision based on an informed understanding of what is expected
NURSE
● Witnesses informed consent. The nurse is responsible for the following.
Ensuring provider gave client necessary information
◯ Ensuring client understood information
/ competent to give informed consent
◯ Having client sign informed
consent document
◯ Notifying provider if client has more questions/does not understand any information provided (The provider is responsible for clarification.)
The nurse documents the following. with regard to informed consent
◯ Reinforcement of information originally given by the provider
◯ That questions the client had were forwarded to the provider
◯ Use of an interpreter
COMPONENTS OF ADVANCE DIRECTIVES Two components
-living will
-durable power of attorney for health care.
living will is a legal document that expresses
the client’s wishes regarding medical treatment in event client becomes incapacitated and facing
end‑of‑life issues.
Types of treatments often addressed are those that have
Examples of treatments addressed are
–capacity to prolong life.
-cardiopulmonary resuscitation,
-mechanical ventilation, and
-feeding by artificial means.
Living wills are legal in _____ However, state statutes and individual health care facility policies can ___.
Nurses need to be familiar with their state statute and facility policies.
-all states.
-vary
● Most state laws include provisions that
health care providers who follow the health care directive in a living will are protected from liability.
A durable power of attorney for health care/health care proxy is a legal document that designates
a health care surrogate,
-who is an individual authorized to make health care decisions for a client who is unable
The person who serves in the role of health care surrogate to make decisions for the client should be
very familiar with the client’s wishes.
● Living wills can be difficult to interpret, especially in the face of ____
-A durable power of attorney for health care, as an
-unexpected circumstances.
-adjunct to a living will, can be a more effective way of ensuring that the client’s
decisions about health care are honored.
Unless a do not resuscitate (DNR) or allow natural death (AND) prescription is written, the nurse should
initiate CPR when a client has no pulse or respirations.
The written prescription for a DNR or AND must be placed where
in the client’s medical record. The provider consults the client and the family prior to administering a DNR or AND.
DNR
AND
-DO NOT RESUSCITATE
-ALLOW NATURAL DEATH
Additional prescriptions by the provider are based on
client’s individual needs and decisions and provide for comfort measures.
The client’s decision is respected in regard to the use of antibiotics, initiation of Diagnostic tests, and provision of nutrition by artificial means.
NURSING ROLE IN ADVANCE DIRECTIVES
Providing written information regarding advance directives
● Documenting client’s advance directives status
● Ensuring advance directives are current and reflective of client’s current decisions
● Recognizing client’s choice takes priority when Providing written information regarding advance directives
● Documenting the client’s advance directives status
● Ensuring that advance directives are current and reflective of the client’s current decisions
● Recognizing that the client’s choice takes priority when there is a conflict between the client and family, or
between the client and the provider
● Informing all members of the health care team of the client’s advance directives
Providing written information regarding advance directives
● Documenting the client’s advance directives status
● Ensuring that advance directives are current and
reflective of the client’s current decisions
● Recognizing that the client’s choice takes priority in a conflict between the client /family, or between client / provider
● Informing all members of the health care team of the client’s advance directives
there is a conflict between the client and family, or between the client /provider
● Informing all members of the health care team of client’s advance directives
Confidentiality and
information security
Clients have the right to privacy and confidentiality in relation to their health care information and medical
recommendations.
Nurses who disclose client information to an unauthorized person can be liable
for invasion of privacy, defamation, or slander.
The security and privacy rules of the ______________were enacted
to protect the
Health Insurance Portability and Accountability Act (HIPAA)
confidentiality of health care information
and to give the client the right to control the release of information.
Specific rights provided by HIPAA legislation include the following:
rights of clients to obtain copy of their medical record and to submit requests to amend erroneous or incomplete information
◯ A requirement for health care and insurance providers to provide written information about how medical
information is used and how it is shared with other entities (permission must be obtained before information is shared)
◯ The rights of clients to privacy and confidentiality
NURSING ROLE IN CONFIDENTIALITY
It is essential for nurses to be aware of the
Facility policies and procedures are established in order to ensure
compliance with ___________.
It is essential that nurses know and adhere to to the ______________
-rights of clients in regard to privacy and confidentiality.
HIPAA regulations
the policies and procedures.
HIPAA regulations also provide for
penalties in the event of noncompliance with the regulations.
The Privacy Rule of HIPAA requires that nurses protect
all written and verbal communication about clients.
COMPONENTS OF THE PRIVACY RULE
First two
Only care team members directly responsible - client’s care - allowed access - client’s records. Nurses cannot share information w/other clients/staff not involved in care client.
● Clients - right to read/obtain copy of medical record, - agency policy should be followed when client requests to read/copy the record.
COMPONENTS OF THE PRIVACY RULE
Next three
-No part client record can be copied except for authorized exchange between health care institutions.
EX: Transfer - hospital to extended care facility
Exchange between a general
practitioner and specialist during a consult
- Client records - kept in secure area -
prevent inappropriate access to the information.
-Using public display boards to list client names and diagnoses is restricted.
COMPONENTS OF THE PRIVACY RULE
-Electronic records password‑protected, –care taken to prevent public viewing of
information.
-Health care workers-only their
own passwords to access information.
-Client information cannot be disclosed to unauthorized -individuals, including family members and individuals who call on the phone.
◯ Many hospitals use a code system in which information is only disclosed to individuals who can provide the code.
◯ Nurses should ask any individual inquiring about a client’s status for the code and disclose information only when an individual can give the code.
COMPONENTS OF THE PRIVACY RULE
Last one
-Communication about a client - take place in a private setting where cannot be overheard by unauthorized individuals. —–practice of “walking rounds,” (other clients/visitors can hear) no longer sanctioned.
-Taped rounds also discouraged - nurses should not receive information about clients they are not responsible. ————-Change‑of‑shift reports can be done at the bedside as long as the client does not have a roommate and no unsolicited visitors are present.
HIPAA
COMPONENTS OF THE PRIVACY RULE
Short n Sweet
-only those in direct care of client
-client can read/copy medical record
- no part of client record can be copied except between institutions providing care
-records kept in secure area
-electronic records password protected
-client info not disclosed to unauthorized persons
-comms about client only in private
Items found on Advance Directive Form
- choice to either prolong or not prolong life
- choices regarding organ donation
-gives agent authority to make health care decisions if client is unable
Health information systems (HIS) are used to manage
The clinical portion of the system is often referred to as the _______.
The CIS can be used to coordinate______________
-administrative functions and clinical functions.
clinical information systems (CIS)
essential aspects of client care.
● In order to comply with HIPAA regulations, each health care facility has
specific policies and procedures
designed to monitor staff adherence, technical protocols, computer privacy, and data safety.
INFORMATION SECURITY PROTOCOLS
● Log off from computer before leaving the workstation -ensure others cannot view protected health information (PHI)
● Never share user ID or password with anyone.
● Never leave client’s chart/ printed / written PHI where others can access it.
● Shred written/printed client information used for reporting after no longer needed.
social media by members of the nursing
profession is __________.
The benefits using social media -
-common practice
-provides a mechanism fornurses to access current information about health care
-enhances communication among nurses, colleagues,/clients/families.
-opportunity for nurses to express concerns and seek support from others.
However, nurses must be cautious about the risk of ___________
via social media.
intentional or inadvertent breaches of confidentiality
The right to privacy is a ___________
Invasion of privacy as it relates to health
care is the __________
Confidentiality is the duty of the ______________
-fundamental component of client care.
-release of client health information to others without the client’s consent.
-nurse to protect a client’s private information.
The inappropriate use of social media can result in a _______
Depending on the circumstances, the consequences can include (5)
-breach of client confidentiality.
-termination of employment
-discipline by board of nursing,
-charges of defamation
-invasion of privacy,
-federal charges for violation of HIPAA.
Protecting yourself and others do
-Become familiar - facility policies about
social media/adhere to them.
-Avoid disclosing client health info online.
-Be sure no one can overhear phone conversations about client
- Don’t take/share photos/videos of client.
-Maintain professional boundaries
interacting with clients online.
-Never post belittling/offensive remark about - client, employer, coworker.
-Report any violations of facility social media policies to nurse manager.
Informatics is ___________.
The use of technology in health care is increasing and most forms of
communication are in ___________
-the use of computers to systematically
resolve issues in nursing
-electronic format.
● Examples of how a nurse can use the electronic format while providing client care include
-laptops - documentation
-use of automated medication dispensing system to dispense medications.
-Databases on diseases/medications
–used as teaching tool when nurses educating clients.
-nurse can review medications, diseases, procedures,/treatments
-Computers beneficial for clients who
have visual impairments.
The Internet is a valuable tool for clients to –
-review current medications/health questions. - especially for clients w/ chronic illnesses.
-Nurses should instruct clients to only review valid/credible websites - verifying author, institution, credentials, how current article is.
—-A disclaimer will be presented if information is not medical advice.
-Clients can access their electronic health record (EHR) - part of e‑health.
-E‑health enables the client to
-The goal of e‑health is
-make appointments online, review laboratory results, refill an electronic prescription, and review billing
information.
-improved health care outcomes due to 24 hr access by the client and provider to the client’s health care information.
In order to be safe practitioners, nurses must understand the
-Understanding the laws governing nursing practice allows nurses to
- legal aspects of the nursing profession.
-protect client rights and reduce the risk
of nursing liability.
-Nurses are accountable for practicing nursing in accordance with
-It is important that nurses know
and _______________
-the various sources of law affecting
nursing practice.
-comply with these laws.
By practicing nursing within the confines of the law, nurses are able to do the following.
◯ Provide safe, competent care
◯ Advocate for clients’ rights
◯ Provide care that is within the nurse’s scope
of practice
◯ Discern the responsibilities of nursing in relation
to the responsibilities of other members of the
health care team
◯ Provide care that is consistent with established
standards of care
◯ Shield oneself from liability
Federal regulations
● HIPAA
● Americans with Disabilities Act (ADA)
● Mental Health Parity Act (MHPA)
● Patient Self‑Determination Act (PSDA)
● Uniform Anatomical Gift Act (UAGA)
● National Organ Transplant Act (NOTA)
● Emergency Medical Treatment and Active Labor
Act (EMTALA)
Criminal law is a subsection of
Violations of criminal law can be categorized as either _____ or ________
-public law and relates to the relationship of an individual with the government.
-felony (a serious crime [homicide])
-misdemeanor (a less serious crime [petty theft]).
A nurse who falsifies a record to cover up a serious mistake can be found guilty of
breaking a criminal law.
Civil laws
-One type of civil law that relates to the provision of nursing care is
protect the individual rights of people.
-tort law.
Torts can be classified as
unintentional,
quasi‑intentional,
intentional
Unintentional torts (two types
-negligence
-malpractice
● Negligence:
Practice or misconduct that does not meet
expected standards of care and places the client at risk for injury (a nurse fails to implement safety measures for a client who has been identified as at risk for falls).
● Malpractice:
Professional negligence (a nurse administers a large dose of medication due to a calculation error. The client has a cardiac arrest and dies).
Quasi‑intentional torts (3)
● Invasion of privacy:
● Defamation:
● Invasion of privacy:
Intrusion into a client’s private affairs or a breach of confidentiality (a nurse releases the medical diagnosis of a client to a member of the press).
● Defamation:
two types
False communication or communication with careless disregard for the truth with the intent to injure an individual’s reputation.
◯ Libel: Defamation with the written word or
photographs (a nurse documents in a client’s health
record that a provider is incompetent).
◯ Slander: Defamation with the spoken word (a nurse tells a coworker that she believes a client has been
unfaithful to the spouse).
Intentional torts
● Assault:
● Battery:
- False imprisonment:
● Assault:
The conduct of one person makes another
person fearful and apprehensive (threatening to place a nasogastric tube in a client who is refusing to eat).
● Battery:
Intentional and wrongful physical contact with
a person that involves an injury or offensive contact
(restraining a client and administering an injection
against their wishes).
● False imprisonment:
A competent person not at risk for injury to self or others is confined or restrained against their will (using restraints on a competent client to
prevent their leaving the health care facility).
The core of nursing practice is regulated by
state law.
● Each state has enacted statutes that define the
parameters of nursing practice and give the authority
to regulate the practice of nursing to its state board
of nursing.
Boards of nursing have the authority to
- adopt rules and regulations that further regulate nursing practice.
-even though practice of nursing is similar among states, it is critical nurses know the laws/rules governing nursing in the state in which they practice.
◯ The laws and rules governing nursing practice
in a specific state can be accessed at the state
board’s website.
Boards of nursing have the authority to both
for offenses like:
Nurses should review:
-issue and revoke a nursing license.
-practicing without a valid license,
-substance use disorders,
-conviction of a felony,
-professional negligence, and
providing care beyond scope of practice.
-the practice act in their states.
◯ Boards also set standards for _________and further delineate the scope of practice for ___________(3)
-nursing programs
-registered nurses,
-licensed practical nurses,
-advanced practice nurses.
State laws vary as to when an individual can
begin practicing nursing.
-Some states allow graduates of nursing programs to practice under a limited license,
-some states require licensure by passing the
NCLEX® before working.
Good Samaritan laws, which vary from _____
protect nurses who ____________
of the employment location.
The nurse must provide a _____________
-state to state,
-provide emergency assistance outside
-standard of care that is reasonable and prudent.
Until the year 2000, nurses were required to hold a
current license in every state in which they practiced
Unreasonable due to increase in
To address this the____ has been adopted by many states
-electronic practice of nursing
Ie nurse in one state interprets reading of cardiac monitor for client physically located in another state
- also problem for nurses who live near border making home visits in another state
-mutual recognition model of nurse licensure (the Nurse Licensure Compact [NLC])
mutual recognition model of nurse licensure (the Nurse Licensure Compact [NLC]) allows
-nurses who reside in a NLC state to practice in another NLC state.
-Nurses must practice in accordance with the statues and rules of the state in which the care is provided. —-State boards can prohibit a nurse from practicing under the NLC if the license of the nurse has been restricted by a board of nursing.
Nurses who do not reside in a NLC state must practice under the
state‑based practice model. In other words,
if a nurse resides in a non‑NLC state, the nurse must
maintain a current license in every state in which they practice.
Some states now require background checks
with licensure renewal.
It is illegal to practice nursing with an
expired license.
● The Enhanced Nurse Licensure Compact (eNLC) was revised in 2017.
It aligned licensing standards (criminal
history background checks) in an effort to
bring more states into the compact.
Nurses in eNLC states have
one multistate license, with the ability to practice in-person or via telehealth in both their home state and other eNLC states.
Malpractice is the
The terms “reasonable and prudent” are generally used to describe
failure of a person with professional training to act in a reasonable and prudent manner.
-a person who has the average judgment,
foresight, intelligence, and skill that would be expected of a person with similar training and experience. (3.2)
Professional negligence issues that prompt most
malpractice suits include failure to do the following.
◯ Follow either professional or facility established
standards of care
◯ Use equipment in a responsible and
knowledgeable manner
◯ Communicate effectively and thoroughly with
the client
◯ Document care that was provided
Nurses can avoid being liable for negligence by doing
the following.
◯ Following standards of care
◯ Giving competent care
◯ Communicating with other health team members
◯ Developing a caring rapport with clients
◯ Fully documenting assessments, interventions,
and evaluations
Nurses base practice on established standards of care or legal guidelines for care.
These standards of care can be found in the following.
-The nurse practice act of each state
-Published standards of nursing practice
-Accrediting bodies (The Joint Commission)
-Originally mandated quality assurance programs
-Sentinel event reporting:
-Failure Mode and Effects Analysis
-National Patient Safety Goals
-Health care facility policies and procedures
The nurse practice act of each state
■ These acts govern nursing practice, and legal
guidelines for practice are established and
enforced through a state board of nursing or other
government agency.
■ Nurse practice acts vary from state to state, making
it obligatory for the nurse to be informed about
their state’s nurse practice act as it defines the legal
parameters of practice.
Published standards of nursing practice:
These are developed by professional organizations
-American Nurses Association,
-National Association of Practical Nurse Education and Services, Inc.)
-American Association of Critical Care Nurses; ———–Wound, Ostomy and Continence Nurses Society;
-Oncology Nurses Society).
Originally mandated quality assurance programs,
which have evolved into
quality improvement
Sentinel event reporting:
“An unexpected occurrence
involving death or serious or psychological injury, or
the risk thereof”
◯ Failure Mode and Effects Analysis:
Examines
all potential failures in a design, including
event sequencing risks, vulnerabilities, and
improvement areas
National Patient Safety Goals: Augments
core
measures and promotes client safety through client
identification, effective staff communication, safe
medication use, infection prevention, safety risk
identification, and preventing wrong‑site surgery
-Health care facility policies and procedures
-These manuals provide detailed information about
how
-Nurses who practice according to institutional
policy are
-Policies and procedures, found in facility’s policy and procedure manual, establish the standard of practice for employees of that institution.
-the nurse should respond to or provide care
in specific situations and while performing client
care procedures.
-legally protected if that standard of care
still results in an injury. EX , client files a complaint with the board of nursing or seeks legal counsel, the nurse who has followed the facility’s policies will not usually be charged with misconduct.
■ It is very important that nurses are familiar with
their institution’s policies and procedures and
provide client care in accordance with these policies.
For example:
☐ Assess and document findings postoperatively
according to institutional policy.
☐ Change IV tubing and flush saline locks according
to institutional policy.
Standards of care guide, define, and direct the _______
They also are used in malpractice lawsuits to determine if __________
-level of care that should be given by practicing nurses.
-that level was maintained.
● Nurses should refuse to
● Nurses should use the
-practice beyond the legal scope of practice and/or outside of their areas of competence regardless of reason (staffing shortage, lack of appropriate personnel).
-formal chain of command to verbalize concerns related to assignment in light of current legal scope of practice, job description, and area of competence.
Impaired health care providers pose ________
-A nurse who suspects a coworker of using alcohol or
other substances while working has
-a significant risk to client safety.
-a duty to report the coworker to appropriate management personnel as specified by institutional policy.
-At the time of the infraction, the report should be made to the immediate supervisor (the charge nurse, to ensure client safety).
Health care facility policies should provide guidelines
for handling employees who
have a substance use disorder.
Many facilities provide peer assistance programs that facilitate entry into a treatment program.
Each state board of nursing has laws and regulations that govern the __________
Depending on the individual case, the boards have the option to _________
-If a nurse is allowed to maintain licensure,
there usually are ________such as
noncritical care areas and being restricted from
administering controlled medications).
-disposition of nurses who have been reported secondary to substance use.
-require the nurse to enter a treatment program, during which time the nurse’s license can be retained, suspended, or revoked.
-work restrictions put in place (working
Health care providers who are found guilty of
misappropriation of controlled substances also can
be charged with
a criminal offense consistent with the infraction.
-Behaviors can be difficult to detect if the impaired nurse is experienced at masking the substance use disorder
BEHAVIORS CONSISTENT WITH A
SUBSTANCE USE DISORDER
-Smell alcohol on breath/frequent use strong
mouthwash or mints
-Impaired coordination, sleepiness, shakiness, and/or slurred speech
-Bloodshot eyes
-Mood swings and memory loss
-Neglect of personal appearance
-Excessive use of sick leave, tardiness, or absences after a weekend off, holiday, or payday
-Frequent requests to leave the unit for short periods of time or to leave the shift early
-Frequently “forgetting” to have another nurse witness wasting of a controlled substance
-Frequent involvement in incidences where a client
assigned to the nurse reports not receiving pain
medication or adequate pain relief (impaired nurse
provides questionable explanations)
-Documenting administration of pain medication to a client who did not receive it or documenting a higher dosage than has been given by other nurses
-Preferring to work the night shift where supervision is less or on units where controlled substances are more frequently given
Elements necessary to prove negligence
- Duty to provide care as defined by a standard
(Care that should be given or what a reasonably prudent nurse would do) - Breach of duty by failure to meet standard
(Failure to give the standard of care that should have been given) - Foreseeability of harm
(Knowledge that failing to give the proper standard of care can cause harm to the client) - Breach of duty has potential to cause harm (combines elements 2 and 3)
(Failure to meet the standard had potential to
cause harm: relationship must be provable) - Harm occurs
(Occurrence of actual harm to the client)
ex of Duty to provide care as defined by a standard
(Care that should be given or what a reasonably prudent nurse would do)
The nurse should complete a fall
risk assessment for all clients upon
admission, per facility protocol.
ex of Breach of duty by failure to meet standard
Failure to give the standard of care that should have been given
The nurse does not perform a fall
risk assessment during admission.
ex of Foreseeability of harm
Knowledge that failing to give the proper standard of care can
cause harm to the client
The nurse should know that failure
to take fall‑risk precautions can
endanger a client at risk for falls.
ex of Breach of duty has potential to cause harm (combines elements 2 and 3)
Failure to meet the standard had potential to
cause harm: relationship must be provable
if a fall risk assessment is not
performed, the client’s risk for falls
is not determined and the proper
precautions are not put in place.
ex of Harm occurs
Occurrence of actual harm to the client
The client falls out of bed
and breaks their hip.
MANDATORY REPORTING
In certain situations, health care providers have a legal obligation to report their findings in accordance with state law.
-abuse
-communicable diseases
ABUSE
● All 51 jurisdictions (50 states and the District of
Colombia) have statutes requiring report of ________
● A number of states also mandate that health care
providers, including nurses, report __________
● Nurses are mandated to report any suspicion of
mistreatment _______
-suspicion of child abuse. The statutes set out which occupations are mandatory reporters. In many states, nurses are mandatory reporters.
-suspected violence of neglect against vulnerable persons (older or dependent adults).
-following facility policy.
COMMUNICABLE DISEASES
Nurses are also mandated to report to the proper agency (local health department, state health department) when______
-a client is diagnosed with a communicable disease.
● A complete list of reportable diseases and a description of the reporting system are available through the ________
Each state mandates ________
-Centers for Disease Control and Prevention Web site.
-which diseases must be reported in that state
There are more than __ communicable
diseases that must be reported to public health
departments to allow officials to do the following.
◯ Ensure appropriate medical treatment of diseases
(tuberculosis).
◯ Monitor for common‑source outbreaks (foodborne:
hepatitis A).
◯ Plan and evaluate control and prevention plans
(immunizations for preventable diseases).
◯ Identify outbreaks and epidemics.
◯ Determine public health priorities based on trends.
◯ Educate the community on prevention and treatment
of these diseases.
-60
-◯ Ensure appropriate medical treatment of diseases (tuberculosis).
◯ Monitor for common‑source outbreaks (foodborne: hepatitis A).
◯ Plan and evaluate control and prevention plans
(immunizations for preventable diseases).
◯ Identify outbreaks and epidemics.
◯ Determine public health priorities based on trends.
◯ Educate the community on prevention and treatment of these diseases.
Organ and tissue donation is regulated by
Health care facilities have policies and
procedures to
-federal and state laws.
-guide health care workers involved with
organ donation.
Donations can be stipulated in a _____
-Federal law requires health care facilities to provide
-Nurses are responsible for
-will or designated on an official card.
-access to trained specialists who make the request to clients and/or family members and provide information regarding consent, organ and tissues that can be donated, and how burial or cremation will be affected by donation.
-answering questions regarding the donation process and for providing emotional support to family members.
Nurses might need to receive new prescriptions for client care or medications by verbal or telephone prescription.
When transcribing a prescription into a paper or
electronic chart, nurses must do the following.
◯ include all necessary elements of prescription: date and time prescription was written;
new client care prescription or medication including
dosage, frequency, route of administration; and
signature of nurse transcribing the prescription as
well as the provider who verbally gave the prescription.
◯ Follow institutional policy with regard to time
frame within which the provider must sign the
prescription (usually within 24 hr).
◯ Use strategies to prevent errors when taking a
medical prescription that is given verbally or over thephone by the provider.
■ Repeat back the prescription given, making sure to include the medication name (spell if necessary),
dosage, time, and route.
■ Question any prescription that seems
contraindicated due to a previous or concurrent
prescription or client condition.
Disruptive behavior
Nurses experience incivility, lateral violence, and
bullying at an alarming rate.
The perpetrator can be ______________.
Consequences of disruptive behavior include
Some nurses can choose to leave the
profession due to these_______
-provider or a nursing colleague
- poor communication, (negatively affect client safety and productivity, resulting in absenteeism, decreased job satisfaction, and staff turnover.
-counterproductive behaviors.
●
If disruptive behavior is allowed to continue, it is likely to
escalate. Over time, it can be viewed as acceptable in that unit or department’s culture.
TYPES OF DISRUPTIVE BEHAVIOR
-Incivility
-Lateral violence
-Bullying
-Cyberbullying
Incivility is defined as an
-It includes
action that is rude, intimidating, and insulting.
-teasing, joking, dirty looks, and uninvited touching
Lateral violence is also known as __________
or ____________.
It occurs between individuals who are
For example, a more experienced staff nurse can be abusive to a newly licensed nurse. Common behaviors include
-horizontal abuse
-horizontal hostility
-at the same level within the organization.
-verbal abuse, undermining activities, sabotage, gossip, withholding information, and ostracism.
Bullying behavior is
Bullying occurs when
persistent and relentless and is aimed at an individual who has limited ability to defend themselves.
-the perpetrator is at a higher level than the victim (for example, a nurse manager to a staff nurse). It is abuse of power that makes the recipient feel threatened, disgraced, and vulnerable. For example, a nurse manager can demonstrate favoritism for another nurse by making unfair assignments or refusing a promotion.
Cyberbullying is a type of disruptive behavior
using the
Internet or other electronic means.
INTERVENTIONS TO DETER
DISRUPTIVE BEHAVIORS
-Create environment mutual respect among staff.
● Model appropriate behavior.
● Increase staff awareness of disruptive behavior.
● Make staff aware of offensive online remarks about employers/coworkers are form of bullying and are prohibited even if the nurse is off‑duty and it is posted off‑site from the facility.
● Avoid making excuses for disruptive behavior.
● Support zero tolerance for disruptive behavior.
● Establish mechanisms for open communication between staff nurses and nurse managers.
● Adopt policies that limit the risk of retaliation when disruptive behavior is reported.
Ethics has several definitions, but the foundation of
ethics is based on an
-Morals are
● Ethical theory
-expected behavior of a certain group in relation to what is considered right and wrong.
-the values and beliefs held by a person that
guide behavior and decision‑making
-analyzes varying philosophies, systems,
ideas, and principles used to make judgments
about what is right and wrong, good and bad.
Two common types of ethical theory are
utilitarianism
and deontology.
-Utilitarianism (teleological theory):
-Deontological theory:
- Decision‑making based on what provides the greatest good for the greatest number of individuals
-Decision‑making based on obligations, duty, and what one considers to be right or wrong
●Unusual or complex ethical issues might need to be
dealt with by
a facility’s ethics committee
ethical principles-
ethical principles pertaining to the treatment of clients include the following.
-are standards of what is right or wrong with regard to important social values and norms.
● Autonomy:
● Beneficence:
● Fidelity:
● Justice:
● Nonmaleficence:
● Veracity:
autonomy
The ability of the client to make personal
decisions, even when those decisions might not be in
the client’s own best interest
beneficence
Care that is in the best interest of
the client
fidelity
Keeping one’s promise to the client about care
that was offered
justice
Fair treatment in matters related to physical
and psychosocial care and use of resources
nonmaleficence
The nurse’s obligation to avoid causing
harm to the client
veracity
The nurse’s duty to tell the truth
Ethical dilemmas are problems for which
more than one choice can be made,
and the choice is influenced by the values and beliefs of the decision‑makers.
These are common in health care, and nurses must be prepared to apply ethical theory and decision-making.
A problem is an ethical dilemma if:
It cannot be solved solely by a review of scientific data.
◯ It involves a conflict between two moral imperatives.
◯ The answer will have a profound effect on the
situation/client.
Nurses have a responsibility to be
◯ Doing so through the chain of command offers
◯ Some state nurse associations offer protection for
advocates, and to identify and report ethical situations.
-some protection against retribution.
-nurses who report substandard or unethical practice.
Ethical decision‑making is the process
by which a decision is made about an ethical issue. Frequently, this requires a balance between science and morality.
There are several steps in ethical decision‑making:
-Identify whether the issue is an ethical dilemma.
-State the ethical dilemma, including all surrounding
issues and individuals involved.
-List and analyze all possible options for resolving the dilemma, and review implications of each option.
-Select the option that is in concert with the ethical
principle applicable to this situation, the decision
maker’s values and beliefs, and the profession’s
values set forth for client care. Justify why that one
option was selected.
-Apply this decision to the dilemma and evaluate
the outcomes.
Where can you find resources for ethics
(identify sets of standards for nursing practice)
The American Nurses Association Code of Ethics for Nurses
International Council of Nurses’ Code of Ethics for Nurses
The Code of Ethics for Licensed Practical/
Vocational Nurses issued by National Association for Practical Nurse Education and Services
available at the organizations’ websites.
The Uniform Determination of Death Act (UDDA) _____________
◯ The UDDA provides two formal definitions of death (developed by the National Conference of
Commissioners on Uniform State Laws.
Death is determined by one of two criteria.
◯ A determination of death must be made in accordance with
-can be used to assist with end‑of‑life and organ donor issues.
-■ Irreversible cessation of circulatory and
respiratory functions
■ Irreversible cessation of all functions of the entire
brain, including the brain stem
-accepted medical standards.
The nurse’s role in ethical decision‑making
An agent for the client facing an ethical decision
Ex’s
Caring for an adolescent client who is deciding whether to undergo an elective abortion even though their parents believe it is wrong
Discussing options with parents who have to decide whether to consent to a blood transfusion for a child when their religion prohibits such treatment
The nurse’s role in ethical decision‑making
A decision‑maker in regard to nursing practice
Ex’s
Assigning staff nurses a higher client load than recommended because administration has cut the number of nurses per shift
Witnessing a surgeon discuss only surgical options with a client without informing the client about more
conservative measures available
Describe another term used for lateral violence.
NURSING INTERVENTIONS: Describe at least four
interventions to deter disruptive behavior.
-Lateral violence is also known as horizontal abuse or horizontal hostility.
-Create an environment of mutual respect among staff.
-Model appropriate behavior.
-Increase staff awareness about disruptive behavior.
-Make staff aware offensive online remarks about employers /coworkers are a form of bullying and is prohibited even if the nurse is off‑duty and it is posted off‑site of the facility.
-Avoid making excuses for disruptive behavior.
-Support zero tolerance for disruptive behavior.
-Establish mechanisms for open communication
between staff nurses and nurse managers.
-Adopt policies that limit the risk of retaliation
when disruptive behavior is reported.
A nurse manager is observing the actions of
a nurse they are supervising. Which of the
following actions by the nurse requires the nurse
manager to intervene? (Select all that apply.)
A. Reviewing the health care record of a client assigned to another nurse
B. Making a copy of a client’s most current laboratory results for the provider during rounds
C. Providing information about a client’s condition to hospital clergy
D. Discussing a client’s condition over the phone with an individual who has provided the client’s information code
E. Participating in walking rounds that involve the exchange of client‑related information outside clients’ rooms
A. CORRECT: To maintain confidentiality, client
information is disseminated on a need‑to‑know basis only. A nurse who is not assigned to care for a client should not access the client’s information.
B. CORRECT: Paper copies of confidential information create a risk for breach of confidentiality.
C. CORRECT: Information about a client’s condition is disseminated on a need‑to‑know basis. It is inappropriate to share this information with the hospital clergy.
D. The nurse can share information with an individual who has been provided the information code.
E. CORRECT: Sharing information in the hallway where it can be overheard by others can result in a breach of confidentiality.
A nurse is caring for a client who is scheduled for
surgery. The client hands the nurse information about advance directives and states, “Here, I don’t need this. I am too young to worry about life‑sustaining measures and what I want done for me.” Which of the following actions should the nurse take?
A. Return the papers to the admitting department
with a note stating that the client does not wish to address the issue at this time.
B. Explain to the client that you never know what can happen during surgery and to fill the papers out just in case.
C. Contact a client representative to talk with the client and offer additional information about the purpose of advance directives.
D. Inform the client that surgery cannot be conducted
unless the advance directives forms are completed.
A. The nurse should advocate for the client by ensuring that the client understands the purpose of advance directives.
B. This response is nontherapeutic and can cause
the client to be anxious about the surgery.
C. CORRECT: The nurse should advocate for the client by ensuring that the client understands the purpose of advance directives. Seeking the assistance of a client representative to
provide information to the client is an appropriate action.
D. This statement is untrue and is a barrier to therapeutic communication.
A nurse witnesses an assistive personnel (AP) they are supervising reprimanding a client for not using the urinal properly. The AP threatens to put a diaper on the client if the urinal is not used more carefully next time. Which of the following torts is the AP committing?
A. Assault
B. Battery
C. False imprisonment
D. Invasion of privacy
A. CORRECT: Assault is conduct that makes a
person fear they will be harmed.
B. Battery is physical contact without a person’s consent.
C. False imprisonment is restraining a person against their will. It includes the use of physical or chemical restraints, and refusing to allow a client to leave a facility.
D. Invasion of privacy is the unauthorized release
of a client’s private information.
A nurse is serving as a preceptor to a newly licensed nurse and is explaining the role of the nurse as advocate. Which of the following situations illustrates the advocacy role? (Select all that apply.)
A. Verifying that a client understands what is
done during a cardiac catheterization
B. Discussing treatment options for a terminal diagnosis
C. Informing members of the health care team
that a client has do‑not‑resuscitate status
D. Reporting that a health team member on the
previous shift did not provide care as prescribed
E. Assisting a client to make a decision about their
care based on the nurse’s recommendations
A. CORRECT: Ensuring that the client has given informed
consent illustrates nurse advocacy.
B. Discussing treatment options is not within
the scope of practice of the nurse.
C. CORRECT: Ensuring that the client’s care is consistent with their DNR status illustrates nurse advocacy.
D. CORRECT: Ensuring that all clients receive
proper care illustrates nurse advocacy.
E. Assisting a client to make decisions about their care based on nurse recommendations is inappropriate. The nurse should support the client in making their own decisions.
- A nurse manager is providing information to the
nurses on the unit about ensuring client rights.
Which of the following regulations outlines the
rights of individuals in health care settings?
A. American Nurses Association Code of Ethics
B. HIPAA
C. Patient Self‑Determination Act
D. Patient Care Partnership
- A. The American Nurses Association Code of Ethics provides nurses with a set of standards for nursing practice.
B. The Privacy Rule of HIPAA ensures client
privacy and confidentiality.
C. The Patient Self‑Determination Act is federal legislation that requires that all clients admitted to a health care facility be asked whether they have advance directives.
D. CORRECT: The Patient Care Partnership is a document that addresses clients’ rights when receiving care.
- A newly licensed nurse is preparing to insert an IV
catheter in a client. Which of the following sources
should the nurse use to review the procedure and
the standard at which it should be performed?
A. Website
B. Institutional policy and procedure manual
C. More experienced nurse
D. State nurse practice act
- A. A website might not provide information that is
consistent with institutional policy.
B. CORRECT: The institutional policy and procedure
manual will provide instructions on how to perform
the procedure that is consistent with established
standards. This is the resource that should be used.
C. A more experienced nurse on the unit might not perform the procedure according to the policy and procedure manual.
D. The nurse practice act identifies scope of practice and other aspects of the law, but it does not set standards for performance of a procedure.
- A nurse is caring for a client who is medically unstable. The client’s adult child informs the nurse that the client has a DNR prescription with their primary care provider. Which of the following actions should the nurse take?
A. Assume that the client does not want to be resuscitated, and take no action if they experience cardiac arrest.
B. Write a note on the front of the provider prescription sheet asking that the DNR be represcribed.
C. Write a DNR prescription in the client’s medical record.
D. Call the provider to verify the existence of an active DNR prescription.
- A. Without a current DNR prescription, the nurse must initiate emergency resuscitation, which most likely is not consistent with the client’s wishes.
B. Without a current DNR prescription, the nurse must initiate emergency resuscitation, which most likely is not consistent with the client’s wishes. Writing a note on the prescription sheet likely will result in a delay in resolving the problem.
C. The nurse cannot write a DNR prescription for the client without instruction to do so by the primary provider.
D. CORRECT: The nurse should immediately call
the primary provider to validate whether the
client has a current DNR order in place.
- A nurse is caring for a child who is being treated
in the emergency department following a head
contusion from a fall. History reveals the child lives
at home with one parent. The provider’s discharge
instructions include waking the child every hour to
assess for indications of a possible head injury. In
which of the following situations should the nurse
intervene and attempt to prevent discharge?
A. The parent states they do not have insurance or money for a follow‑up visit.
B. The child states, “My head hurts and I want to go home.”
C. The nurse smells alcohol on the parent’s breath.
D. The parent verbalizes fear about taking the child
home and requests they be kept
- A. Lack of insurance does not warrant a delay in
discharge, but it can indicate the need for referral for social services to assist with client needs.
B. The child’s report of pain is an expected finding.
C. CORRECT: It would be unsafe to discharge a
child who requires hourly monitoring with a
parent who might be chemically impaired.
D. Fear verbalized by the parent does not warrant denial in discharge. The nurse should alleviate the parent’s fears by providing education about how to monitor the child and provide phone numbers for use.
