Nursing Leadership and Management
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Read Chapters 2 & 3 and create a 500 words essay answering the following questions. It has to follow APA guidelines and include 2 or more references.
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.
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Chapter 2 Manager Copyright © 2015. F.A. Davis Company Management • Getting work done through others • Doing what is needed to assist employees to work well Copyright © 2015. F.A. Davis Company Management Theories Copyright © 2015. F.A. Davis Company Scientific Management • Efficiency-focused • Increasing productivity is the goal. Nursing Leadership and Management
• Workflow and time to complete tasks is measured and evaluated. Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company Servant Leadership • People have value as people. • Commit to improving treatment at work. • Employee first Copyright © 2015. F.A. Davis Company Qualities of an Effective Manager • Leadership • Clinical expertise Nursing Leadership and Management
• Business sense Copyright © 2015. F.A. Davis Company Management • Decisional • Interpersonal • Informational Copyright © 2015. F.A. Davis Company Behavior of an Effective Manager • Interpersonal – Networking – Conflict negotiation and resolution – Employee development – Coaching – Rewards and punishments Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company Chapter 3 Nursing Practice and the Law Copyright © 2015. F.A. Davis Company Objectives • • • • 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. Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company 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). Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company Types of Laws • Statutory law • Common law • Administrative law Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company Statutory Law (cont’d) • Examples of state statutes – Nurse Practice Acts – Good Samaritan Law Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company Sources of Law Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company Agencies • Department of Health and Human Services • Department of Labor • Department of Education Copyright © 2015. F.A. Davis Company Types of Laws Copyright © 2015. F.A. Davis Company Criminal Law • Felony • Misdemeanor • Juvenile Copyright © 2015. F.A. Davis Company Civil Law • • • • Tort Quasi-intentional tort Negligence Malpractice Copyright © 2015. F.A. Davis Company Other Laws Relevant to Nursing Practice Copyright © 2015. F.A. Davis Company 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.” Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company Social Networking Nursing Leadership and Management
• 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 Copyright © 2015. F.A. Davis Company Slander and Libel • • • • Quasi-intentional torts Slander refers to the spoken word. Libel refers to the written word. Can refer to patients, coworkers, or other individuals Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company Standards of Practice Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company Internal Standards • • • • • 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 Copyright © 2015. F.A. Davis Company Use of Standards in Nursing Negligence and Malpractice • • • • One of the elements used to determine liability Use of professional standards Institutional policy Standards of the Specialty organization if warranted • Expert opinions Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company Informed Consent (cont’d) Nursing Leadership and Management
• 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. Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company Staying Out of Court Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company Documentation Nursing Leadership and Management
• • • • • Needs to be legally credible Avoid charting by exception. Clear, concise, and accurate Only sign off on medications once administered. Document assessments after completion. Copyright © 2015. F.A. Davis Company Keys to Credible Documentation • • • • Contemporaneous Accurate Truthful Appropriate Copyright © 2015. F.A. Davis Company 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. Nursing Leadership and Management
• Violation of internal or external standards of practice Copyright © 2015. F.A. Davis Company What to Do if Named in a Suit • • • • 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. Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company End-of-Life Decisions and the Law
• • • • • Do Not Resuscitate Orders (DNRs) Advance Directives Patient Self-Determination Act Living Will Health-Care Surrogate Copyright © 2015. F.A. Davis Company 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. Nursing Leadership and Management
Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company CHAPTER 6 THE FLORIDA NURSE PRACTICE ACT AND THE SCOPE OF NURSING I. INTRODUCTION The Florida Nurse Practice Act, Chapter 464, Florida Statutes, was enacted to ensure that every nurse practicing in Florida meets minimum requirements for safe practice. Nursing Leadership and Management
A nurse who falls below the minimum competency or who otherwise present a danger to the public shall be prohibited from practicing in Florida. The statute speaks primarily to the most common classification of nurses: Registered Nurses (RNs) and Licensed Practical Nurses (LPNs). The requirements for licensure and penalties applicable for misconduct shall be set forth below. Other classifications of nurses (Advanced Registered Nurses, RN First Assistants, Retired Nurse Volunteers and Certified Nursing Assistants) are also provided for statutorily. The requirements of each will be discussed below. The Nurse Practice Act contains definitions that include the scope of practice for licensed registered nurses, practical nurses and nurse practitioners. Every nurse who practices in the state of Florida must be familiar with these definitions, as they define the limits on what she is allowed to legally do. II. DEFINITIONS AND SCOPE OF PRACTICE The Florida Nurse Practice Act, Section 464.003, Florida Statutes, provides definitions and sets forth the scope of practice for nurses in Florida. Section 464.003(3)(e), Florida Statutes, defines “nursing diagnosis” to mean “the observation and evaluation of physical or mental conditions, behaviors, signs and symptoms of illness, and reactions to treatment and the determination as to whether such conditions, signs, symptoms, and reactions represent a deviation from normal.” Section 464.003(3)(f), Florida Statutes, defines “nursing treatment” to mean “the establishment and implementation of a nursing regimen for the care and comfort of individuals, the prevention of illness, and the education, restoration, and maintenance of health. Nursing Leadership and Management
” It is important to remember that in many instances, where the physician is present and providing direct supervision to the nurse, she may merely act as “the physician’s hands” and is not providing services strictly under her nursing license. If, for example, the licensed physician could be supervising a nonlicensed person in performing the same tasks (e.g., a medical student, a surgical technician, or a medical assistant), then it should not be considered to be either exceeding the scope of the nurse’s license or the unlicensed practice of medicine, if the nurse performs these. Again, this contemplates that the physician is actually present, looking on and directly supervising and controlling whatever actions the nurse is taking under the physician’s direct supervision. Other definitions and the scope of practice of the different types of nurses are set forth below. © Copyright 2008 by Nursing Law Manual, LLC and George F. Indest III, Altamonte Springs, Florida, U.S.A. All rights reserved. 6-1 FLORIDA NURSING LAW MANUAL _____________________________ III. REGISTERED NURSES Registered Nurses are any persons licensed in Florida to practice professional nursing. The terms “professional nurse” and “registered nurse” are used interchangeably in Florida law, to mean the same thing. “‘Registered nurse’ means any person licensed in this state to practice professional nursing.” Section 464.003(4), Florida Statutes.Nursing Leadership and Management
The scope of practice for a registered nurse is defined in Section 464.003(3)(a), Florida Statutes, as follows: “Practice of professional nursing” means the performance of those acts requiring substantial specialized knowledge, judgment, and nursing skill based upon applied principles of psychological, biological, physical, and social sciences which shall include, but not be limited to: 1. The observation, assessment, nursing diagnosis, planning, intervention, and evaluation of care; health teaching and counseling of the ill, injured, or infirm; and the promotion of wellness, maintenance of health, and prevention of illness of others. 2. The administration of medications and treatments as prescribed or authorized by a duly licensed practitioner authorized by the laws of this state to prescribe such medications and treatments. 3. The supervision and teaching of other personnel in the theory and performance of any of the above acts. IV. LICENSED PRACTICAL NURSES The licensed practical nurse is any person licensed in Florida to practice practical nursing.Nursing Leadership and Management
Florida statutes define practical nursing as the performance of selected acts, including the administration of treatments and medications, in the care of the ill, injured, or infirm and the promotion of wellness, maintenance of health, and prevention of illness of others under the direction of a registered nurse, a licensed physician, a licensed osteopathic physician, a licensed podiatric physician, or a licensed dentist. Section 464.003(b), Florida Statutes. V. ADVANCED REGISTERED NURSES PRACTITIONERS (ARNPS) AND CLINICAL NURSE SPECIALISTS The Advanced Registered Nurse Practitioner (ARNP) is a nurse who, in addition to being licensed to practice professional nursing as defined above, has obtained postbasic specialized education, training, and experience and is certified by the Board of Nursing to perform advanced-level nursing acts. Within the context of advanced or specialized nursing practice, the Advanced Registered Nurse Practitioner may © Copyright 2008 by Nursing Law Manual, LLC and George F. Indest III, Altamonte Springs, Flo …Nursing Leadership and Management