Read Chapters 2 & 3
1.Discuss the differences between a leader and a manager.
2. Which is more important, working for an effective leader or an effective manager? Explain your answer.
3. Observe the nurse manager in a unit to which students have been assigned. What management style is displayed? How does the staff respond to this style
4. What qualities do you think are most important to be a good nurse manager?
1. Interview the nurse manager on your assignment unit. What interpersonal, decisional, and informational activities does he or she complete on a daily basis?
2. You are the nurse manager on your unit. One of the most experienced staffers has been out on sick leave, and another just had a baby. The rest of the staff are working very hard to pick up the slack to avoid using agency personnel. What tangible and intangible rewards might you use to thank the staff?
3. PART 1: Begin by writing a 50-word description of the ideal nurse manger, someone you would like to work for. Describe a real-life nurse manager whom you have encountered in one of your clinical rotations. What qualities of this person meet your ideal? In what ways does this individual not meet your ideal? (Reminder: nobody’s perfect.)
PART 2: Think about becoming an ideal manager yourself. What qualities of an ideal manager do you already possess? What qualities do you still need to develop? How will you accomplish this?
1. Find your own state’s requirements for informed consent. Do elective procedures and emergency situations use the same standard?
2. Obtain a copy of your state’s Nurse Practice Act. Does the act give adequate guidance for nurses to know if an action is within the scope of nursing practice?
1. Explain how the Nurse Practice Act in your state provides for consumer protection and for professional nursing progress.
2. What are your thoughts on multistate licensure? How does it strengthen and weaken professional nursing?
3. As a new nurse, how can you ensure confidentiality in clinical settings?
4. How can nurses safeguard the confidentiality of medical information when sending it by fax or e-mail?
5. Explain the role of the nurse in obtaining informed consent. Do you believe that this is within the scope of nursing practice? Explain your answer.
6. Should nurses carry malpractice insurance? Explain your answer.
7. Should all patients have advance directives? Explain your answer.
8. Should employers be permitted to require nurses to work overtime if there is a shortage of registered nursing staff on a unit? Support your answer with evidence from the literature.
Chapter 2
Manager
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Management
• Getting work done through others
• Doing what is needed to assist employees to
work well
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Management Theories
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Scientific Management
• Efficiency-focused
• Increasing productivity is the goal
• Workflow and time to complete tasks is measured
and evaluated.
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Human Relations-Based Management
Theory X
• Work is something to be avoided.
• People want to do as little work as possible.
• Use: Control
Supervision
Punishment
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Human Relations-Based Management
Theory Y
• The work itself can be rewarding.
• People really want to do their job well.
• Support using
– Guidance
– Development
– Reward
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Servant Leadership
• People have value as people.
• Commit to improving treatment at work.
• Employee first
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Qualities of an Effective Manager
• Leadership
• Clinical expertise
• Business sense
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Management
• Decisional
• Interpersonal
• Informational
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Behavior of an Effective Manager
• Interpersonal
– Networking
– Conflict negotiation and resolution
– Employee development
– Coaching
– Rewards and punishments
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Behavior of an Effective Manager (cont’d)
• Decisional activities
– Employee evaluation
– Resource allocation
– Hiring and firing
– Planning for the future
– Job analysis and design
Behavior of an Effective Manager (cont’d)
• Informational activities
– Spokesperson
– Monitoring
– Reporting
Conclusion
• Nursing management is a complex, responsible
position.
• Ineffective managers may harm
– Employees
– Clients
– Organizations
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Chapter 3
Nursing Practice and the Law
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Objectives
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•
•
•
Identify three major sources of law.
Explain the differences among various types of laws.
Differentiate between negligence and malpractice.
Explain the difference between an intentional tort
and an unintentional tort.
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Objectives (cont’d)
• Explain how Standards of Care are used in
determining negligence and malpractice.
• Describe how nurse practice acts guide
nursing practice.
• Explain the purpose of licensure.
• Explain the difference between internal
standards and external standards.
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Objectives (cont’d)
• Discuss Advance Directives and how they pertain
to patients’ rights.
• Discuss the legal implications of the Health
Insurance Portability and Accountability Act
(HIPAA).
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Meaning of Law
• Law refers to any system of regulations that
govern the conduct of individuals within a
community and/or society in response to the
need for regularity, consistency, and justice.
• Law is the rules that prescribe and control social
conduct in a formal and legally binding manner.
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Types of Laws
• Statutory law
• Common law
• Administrative law
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Statutory Law
• Created by various legislative bodies
– Congress
– State legislatures
• Examples of federal statutes
– Patient Self-Determination Act of 1990
– The Americans with Disabilities Act
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Statutory Law (cont’d)
• Examples of state statutes
– Nurse Practice Acts
– Good Samaritan Law
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Common Law
• Comes from the traditional unwritten law of
England.
• Based on custom and usage.
• Develops within the court system as judicial
decisions are made.
• One decision creates the precedence for another.
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Administrative Law
• Procedures created by administrative agencies
– City councils
– County boards
– State government
• Established through the authority given to
government agencies by a legislative body
– Boards of Nursing
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Sources of Law
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The Constitution
• Foundation of American law
• The Bill of Rights
• Limits the power of the government and protects
citizens’ freedoms
• Constitutional law evolves as issues emerge.
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Statutes
• Localities, state legislatures, and the U.S. Congress
create statutes.
• Ordinances
– Local statutes
– Example: noise ordinance
• Nurses can influence the development of statutory
laws.
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Administrative Law
• Created by administrative agencies that develop
specific rules and regulations that direct the
implementation of statutory law.
• Rules must be consistent with statutory laws.
• Specific statutory laws give state Boards of
Nursing the authority to issue and revoke
licenses.
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Agencies
• Department of Health and Human Services
• Department of Labor
• Department of Education
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Types of Laws
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Criminal Law
• Felony
• Misdemeanor
• Juvenile
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Civil Law
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•
•
•
Tort
Quasi-intentional tort
Negligence
Malpractice
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Other Laws Relevant to Nursing
Practice
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Good Samaritan Laws
• Created to encourage physicians and nurses to
respond to emergencies
• Protects licensed health-care providers from civil
liability as long as they “behave in the same
manner as an ordinary, reasonable, and prudent
professional in the same or similar
circumstances.”
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Confidentiality
• Patients have the right to confidentiality.
• Information should only be shared with others
who have a “need to know.”
• Need permission to share information
• HIPAA
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Social Networking
• Use of technology has caused an increase in
violations of confidentiality.
• Breach of confidentiality without intent
• Need to be aware of institutional policies on
social networking
– Immediate termination
– Cancellation of contracts/affiliation agreements with
outside agencies
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Slander and Libel
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•
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•
Quasi-intentional torts
Slander refers to the spoken word.
Libel refers to the written word.
Can refer to patients, coworkers, or
other individuals
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False Imprisonment
• Confining an individual against his or her will
– Restraining
– Detaining
• Removing a patient’s clothes
• Keeping a patient who has been medically
discharged for an unreasonable amount of time
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Assault and Battery
• Assault is the threat to do harm.
• Battery is touching without consent.
• The significance of an assault is embedded in
the threat.
• Often, the terms are used together.
• Informed consent
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Standards of Practice
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Purpose
• Guidelines to ensure quality of care
• Criteria to determine if quality care has been
delivered
• May be specialty directed
– AACN standards of care
– AWHONN standards of care
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Internal Standards
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•
•
•
Developed within institutions
Usually explained within specific policies
Included in Policy and Procedure Manuals
Based on current literature and research
Nursing responsibility to meet the institution’s
standards
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Use of Standards in Nursing Negligence
and Malpractice
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•
•
•
One of the elements used to determine liability
Use of professional standards
Institutional policy
Standards of the Specialty organization if
warranted
• Expert opinions
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Patient’s Bill of Rights
• Created by the American Hospital Association in
1973 and amended in 1992
• In 2003, replaced by the Patient Care Partnership
• The patient rights were derived from the ethical
principle of autonomy.
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Informed Consent
• Informed consent is a legal document in all
50 states.
• Requires physicians to divulge the benefits,
risks and alternatives to treatment,
nontreatment, and/or procedures.
• Allows individuals to be involved in choices
about their health care.
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Informed Consent (cont’d)
• Permits health-care providers to “touch.”
• Physicians are responsible for “obtaining” the informed
consent.
• Nurses are involved in the process when
– Witnessing a signature
– Clarifying questions
• If a nurse assesses that a patient lacks a full
understanding of the risks/benefits, the nurse should
notify the physician.
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Criteria for Informed Consent
• A mentally competent adult as voluntarily given
the consent.
• The client understands exactly what he or she is
consenting to.
• The consent includes the risks involved in the
procedure, alternative treatments, and risk of
refusal.
• The consent is written.
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Implied Consent
• Occurs when consent is assumed
• Emergency situations
• Child is involved and the health-care institution is
unable to reach parents and/or legal guardians
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Staying Out of Court
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Prevention
• Practice caring behaviors.
• Demonstrate an interest in patients and
their families.
• Assist patients and families in making
choices by providing information.
• Maintain accountability.
• Adhere to Standards of Practice.
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Documentation
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•
•
•
•
Needs to be legally credible
Avoid charting by exception.
Clear, concise, and accurate
Only sign off on medications once administered.
Document assessments after completion.
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Keys to Credible Documentation
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•
•
•
Contemporaneous
Accurate
Truthful
Appropriate
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Common Actions Leading to Malpractice
Suits
• Failure to assess properly
• Failure to report changes in a patient’s condition to the
appropriate personnel
• Failure to document in a patient’s record
• Altering or falsifying a patient’s record
• Failure to obtain an informed consent
• Failure to report a coworker’s negligence or poor
practice
• Violation of internal or external standards of practice
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What to Do if Named in a Suit
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•
•
•
Contact the legal department of your institution.
Answer the complaint.
Obtain legal guidance/representation.
Only sign documents after review by legal counsel or
malpractice insurance company.
• Maintain a file of all information connected to the case.
• BE HONEST.
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Professional Liability Insurance
• Nurses need to consider obtaining insurance.
• Policies protect nurses against personal financial
loss.
• If a nurse is found guilty of malpractice the
employing agency has the right to sue the nurse
to reclaim damages.
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End-of-Life Decisions and the Law
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•
•
•
•
Do Not Resuscitate Orders (DNRs)
Advance Directives
Patient Self-Determination Act
Living Will
Health-Care Surrogate
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Patient Self-Determination Act
• Allows individuals to make decisions regarding
treatment in advance of a time when they may
be unable to make these decisions.
• Federal law directs that health-care institutions
that receive federal funding inform patients of
their right to create advance directives.
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Provisions of the Act
• Provide information to every patient.
• Document.
– All patients must be asked if they have a Living Will.
– Ask about a health-care surrogate (Durable Power of
Attorney).
– Must be placed in the patient’s record.
• Educate.
• Be respectful of patients’ rights.
• Have cultural humility.
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Nursing Implications
• The Patient Self-Determination Act does not specify
who should discuss treatment decisions or advance
directives with patients.
• Nurses are patient advocates.
• Nurses need to have knowledge about documents
pertaining to the Act.
• Review institutional policies.
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Issues Affecting Practice
• Legal implications of mandatory overtime
– Affects patient safety
– Position statements from nursing organizations
– Nurse Practice Acts
• Licensure
– Qualifications
– Endorsement
– Multistate
• Disciplinary action
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NCLEX-RN
• Preparation
– Review courses
– NCSBN online NCLEX-RN study program
• Test plan
– Test plan blueprint changed in April 2013
– Changes in the blueprint are based on findings from
practice.
– Level of difficulty increased
• Alternative question formats
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Preparing for NCLEX-RN
• Be positive.
• Use relaxation techniques.
• Advance planning.
– Pack an “NCLEX bag.”
– Perform a “dry run” at the same time you would leave to
get to the test site to familiarize yourself with the area,
parking, etc.
– Call the Center and see if you may bring water or snacks.
• Eat well and get a good night’s sleep the night
before the test.
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On the Day of the Test
• Eat before you leave.
• Leave early and give yourself sufficient time to
arrive at your destination.
• Bring a jacket or sweater.
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Conclusion
• Nurses need to understand the legal issues
regarding practice.
• It is important to know and understand the
Nurse Practice Acts in your state.
• Patients expect nurses to provide safe,
competent, and quality care.
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