Week 3: Workforce Issues & Advocacy, Power Sharing Flashcards
Competency Base practice offers you more projection than _______
generation ago
Professional Practice Models _________
Involvement and control of environment/ practice
Issues in nursing
shortages patient acuity RN retention + turnover residencies generational Experience mix
Hospital units can have staffing standards based on
Their patient population standard expected course
Acuity tools
Acuity or Classification System
- can be useful
- data driven
need to really reflect what we do. Acuity tools best for this - can be done previous shift for next shift, or in 4- hour blocks
- If central staffing available, justifies need
- If OT required, justifies need
what is central staffing?
management and other staff that can change to bed side
____________________
Can be useful
Data driven → needs to really reflect what we do, acuity tools best for this
Other tools are used which do not always capture true staffing need
Census based, more standardized pt classification system
Can be done previous shift for next shift, or in 4-hour blocks
If central staffing available → justifies need
If OT required → justifies need
Tools: Acuity or Classification system
ANA Principles for Nurse Staffing
Focus on acuity systems, classification systems, workload measurement (amount of walking between rooms, amount of isolation patients, family input in care)
ANA Principles of Delegation
use of assistive personnel
Principles for Nursing Documentation
Big change now: EHR Documenting in REAL TIME. This takes time. We will discuss in legal issues why this is so important.
You need to advocate for time to document in real time.
It is important to be staffed during residences bc
new nurses need a good learning environment
what is unit culture?
Our culture became, we don’t get breaks, hard to get to eat. It is what it is. How we changes this culture once. Can change it again. What is your unit culture for eating? Los Angeles culture was You get a break. For one full hour on a 12 hours shift. I could LEAVE the building and walk around Hollywood. At CHOP, many days didn’t eat. I added up over my career the number of breaks and meals I did not get. It was over a year of paid time. 21st century nurses need to change your unit culture if it is unhealthy.
________ is the only state with mandated nurse/patient ratios
California
________________: State your limitations and get adjustments to the assignment that acknowledges your limitations. (Can you think of an example?). Gets on record your concern and difference of opinion. You will do assignment and await further input from peers or supervisors.
“Good Faith” acceptance
_________: Texas and New Mexico only states with this legislation in their NPA. Protects from disciplinary action if “good faith” is used.
Safe Harbor
When you are floating to another unit make sure you
Get oriented to unit layout
Have a resource person identified
Formally signed off by charge nurse on safety things : code cart location, fire extinguisher, access codes to restricted rooms.
______ Working more than your scheduled hours in a day or a week.
overtime
Mandating Overtime options
Unit nurses try to work it: Volunteering, bargaining for another shift off. Best option.
“Your turn” by the overtime log. Bad option, but you have some notice.
Draw from a hat. Worst option.
In PA PA: Mandatory OT __________ unless catastrophic event formally declared or “emergency”.
illegal
_____________ will protect nurses who speak out about unsafe/illegal/unethical conditions from being fired or disciplined by their employers
Patient advocacy reasons
Nurse advocacy reasons
Whistle blower protection
___________ are Anonymous via phone call or email
Mandatory training on use is required by all hospital employees yearly
Also report things such as patient information mistakes: mailed wrong patient records
Corporate compliance hotlines
_________ not specific for nurses, public can report as well. Sentinel events “strongly encouraged” not mandated. Must give your name but request it is not shared with employer.
The Joint Commission
risks of whistle blowing
Shunned or ostracized by coworkers: Story from KY
Considered disloyal to the company
Fired by the employer
Sued by the employer or the accused offender
Nurse that reported a doctor for doing histriumists on immigrates
Dawn Wooten
Workforce Advocacy: Professional Practice Models (PPMs)
Definition: A system or framework that supports nurses in their practice
Most common: Shared Governance (evidence- based PPM). Ensures nurses are active participants in decision making and have shared accountability for outcomes of those decision.
Principles or concepts incorporated into PPMs can vary.
Most include several or all QSEN competencies. (A Theme!)
_______ was developed to prepare nurses with the knowledge, skills and attitudes necessary to continuously improve the equality and safety of health care systems
Quality safety and education for nursing (QSEN)
A professional practice model in which nursing-based clinical decisions are made and leadership is shared to ensure high-quality and safe patient care.
Nursing shared governances
_________Nurse sensitive indicators, SG structure and operations, communication, coordination of council work
Steering Committee (SC)
Staffing, retention, recognition, financial stewardship, workflow management, patient and family satisfaction, nurse satisfaction, and philanthropy
Supporting Practice and Management Council (SPM)
_______________Presentation and discussion of clinical practice and related information, evidence-based quality improvements and safety initiatives to strengthen and improve the quality and safety of patient care
Quality Practice and Patient Safety (QPPS)
_________ Competencies, skills, education, CEU‘s, patient-family education, professional development and certification
Advancing Practice and Education (APE)
The scope of the SG example is
having standard color nursing scrubs
During the Industrial Revolution (late nineteenth century) workers needed protection from harsh working conditions ________________
- long work hours
- child labor
unhealthy factory conditions
Early groups sought such basic conditions as work safety and adequate pay
Banding together of workers to accomplish goals was termed ________
trade unionism
Employees given the right to self-organize, form labor unions, and bargain collectively when congress passed the ______
national labor relations act in 1935
what was the goal of the national labor relations act in 1935
Typical goals: reasonable working conditions and formal agreements for wages, and health and retirement benefits
Congress passed the 1947 ____________, exempting charitable institutions, including nonprofit hospitals, from 1935 NLRA. Restricts UNIONS!
Taft-Hartley Act
___________ 28 states have right-to-work laws that allow employees to work without being compelled to join the union
Right to work laws
A nurse in a right-to-work state can choose not to become a union member, but can receive _________
the benefits resulting from the union contract
In right-to-work states, union-member nurses may work alongside ________
nonunion nurses
__________ is the process that labor unions and employers use to reach agreement on terms and conditions of employment
collective bargaining
when a nurse signs a “signing card” then her bargaining agent will be the _______
union
Very important to understand that the nurse’s signature on a union authorization card is automatically authorizing the ________ to serve as his or her legal representative
union
During the pre-election period, the union may not:
inflame racial prejudices
lie about loss of jobs if the union loses the election
forge documents or signatures
meet or distribute literature in work areas during work times
hold meetings within 24 hours of an election
During the pre-election period, management may not:
solicit spying
photograph employees engaged in union activities
visit employees in their homes
lie about what will happen if the union is the victor in an election*
question employees about their preferences regarding union activity*
Nurses eligible to vote are nurses engaged in patient care and are not in ____________ positions
management
In a union a manager is not allow but there are _____
charge nurses or lead nurses
In shared goverance ______
all nurse are helping to manage many aspects of the hospital and unit
how can you report data
- Incident reports
safety nets
Move away from reporting only problems. Potential problems also reportable
Not reserved anymore for just patient harm events – report any event that interferes with your ability to do your job, safety risk, delays in care, broken equipment, ANY systems issue, all injuries even if minor
Nurse managers are our bridge to administration, but without data, “it did not happen”.
components of the research process
- collecting the data
- analyzing the data
- communicating conclusions
