Week 3: Workforce Issues & Advocacy, Power Sharing

Question 1

Competency Base practice offers you more projection than _______

Answer 1

generation ago

Question 2

Professional Practice Models _________

Answer 2

Involvement and control of environment/ practice

Question 3

Issues in nursing

Answer 3

shortages
patient acuity
RN retention + turnover
residencies generational 
Experience mix

Question 4

Hospital units can have staffing standards based on

Answer 4

Their patient population standard expected course

Acuity tools

Question 5

Acuity or Classification System

Answer 5

• 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

Question 6

what is central staffing?

Answer 6

management and other staff that can change to bed side

Question 7

____________________
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

Answer 7

Tools: Acuity or Classification system

Question 8

ANA Principles for Nurse Staffing

Answer 8

Focus on acuity systems, classification systems, workload measurement (amount of walking between rooms, amount of isolation patients, family input in care)

Question 9

ANA Principles of Delegation

Answer 9

use of assistive personnel

Question 10

Principles for Nursing Documentation

Answer 10

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.

Question 11

It is important to be staffed during residences bc

Answer 11

new nurses need a good learning environment

Question 12

what is unit culture?

Answer 12

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.

Question 13

________ is the only state with mandated nurse/patient ratios

Answer 13

California

Question 14

________________: 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.

Answer 14

“Good Faith” acceptance

Question 15

_________: Texas and New Mexico only states with this legislation in their NPA. Protects from disciplinary action if “good faith” is used.

Answer 15

Safe Harbor

Question 16

When you are floating to another unit make sure you

Answer 16

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.

Question 17

______ Working more than your scheduled hours in a day or a week.

Answer 17

overtime

Question 18

Mandating Overtime options

Answer 18

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.

Question 19

In PA PA: Mandatory OT __________ unless catastrophic event formally declared or “emergency”.

Answer 19

illegal

Question 20

_____________ 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

Answer 20

Whistle blower protection

Question 21

___________ 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

Answer 21

Corporate compliance hotlines

Question 22

_________ 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.

Answer 22

The Joint Commission

Question 23

risks of whistle blowing

Answer 23

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

Question 24

Nurse that reported a doctor for doing histriumists on immigrates

Answer 24

Dawn Wooten

Question 25

Workforce Advocacy: Professional Practice Models (PPMs)

Answer 25

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!)

Question 26

_______ was developed to prepare nurses with the knowledge, skills and attitudes necessary to continuously improve the equality and safety of health care systems

Answer 26

Quality safety and education for nursing (QSEN)

Question 27

A professional practice model in which nursing-based clinical decisions are made and leadership is shared to ensure high-quality and safe patient care.

Answer 27

Nursing shared governances

Question 28

_________Nurse sensitive indicators, SG structure and operations, communication, coordination of council work

Answer 28

Steering Committee (SC)

Question 29

Staffing, retention, recognition, financial stewardship, workflow management, patient and family satisfaction, nurse satisfaction, and philanthropy

Answer 29

Supporting Practice and Management Council (SPM)

Question 30

_______________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

Answer 30

Quality Practice and Patient Safety (QPPS)

Question 31

_________ Competencies, skills, education, CEU‘s, patient-family education, professional development and certification

Answer 31

Advancing Practice and Education (APE)

Question 32

The scope of the SG example is

Answer 32

having standard color nursing scrubs

Question 33

During the Industrial Revolution (late nineteenth century) workers needed protection from harsh working conditions ________________

Answer 33

• long work hours
• child labor
  unhealthy factory conditions

Question 34

Early groups sought such basic conditions as work safety and adequate pay
Banding together of workers to accomplish goals was termed ________

Answer 34

trade unionism

Question 35

Employees given the right to self-organize, form labor unions, and bargain collectively when congress passed the ______

Answer 35

national labor relations act in 1935

Question 36

what was the goal of the national labor relations act in 1935

Answer 36

Typical goals: reasonable working conditions and formal agreements for wages, and health and retirement benefits

Question 37

Congress passed the 1947 ____________, exempting charitable institutions, including nonprofit hospitals, from 1935 NLRA. Restricts UNIONS!

Answer 37

Taft-Hartley Act

Question 38

___________ 28 states have right-to-work laws that allow employees to work without being compelled to join the union

Answer 38

Right to work laws

Question 39

A nurse in a right-to-work state can choose not to become a union member, but can receive _________

Answer 39

the benefits resulting from the union contract

Question 40

In right-to-work states, union-member nurses may work alongside ________

Answer 40

nonunion nurses

Question 41

__________ is the process that labor unions and employers use to reach agreement on terms and conditions of employment

Answer 41

collective bargaining

Question 42

when a nurse signs a “signing card” then her bargaining agent will be the _______

Answer 42

union

Question 43

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

Answer 43

union

Question 44

During the pre-election period, the union may not:

Answer 44

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

Question 45

During the pre-election period, management may not:

Answer 45

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*

Question 46

Nurses eligible to vote are nurses engaged in patient care and are not in ____________ positions

Answer 46

management

Question 47

In a union a manager is not allow but there are _____

Answer 47

charge nurses or lead nurses

Question 48

In shared goverance ______

Answer 48

all nurse are helping to manage many aspects of the hospital and unit

Question 49

how can you report data

Answer 49

• 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”.

Question 50

components of the research process

Answer 50

• collecting the data
• analyzing the data
• communicating conclusions