Patient care issues, Management issues and Employment issues.pptx

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2. PATIENT CARE ISSUES, MANAGEMENT ISSUES, & EMPLOYMENT ISSUES 2

3. OBJECTIVES: Explain about the legal issues related to Patient care, management, employment. Describe about the Patient care issues. Classify the management issues. Discuss about the employment issues. Discuss the common causes of legal issues related to patient care, management, employment 3

4. CONT.. Enlist the processes used in professional and legal regulation of nursing practice. Elaborate the legal safe guards and nursing practice. List of do’s and don’t , the guidelines for safe practice. Discuss the Roles and functions of nurse manager in legal issues related to Patient care, management, employment. 4

5. INTRODUCTION Nursing is defined as providing care to the healthy or sick individuals for preventive, promotive, curative and rehabilitative needs. The Consumers are patients with complex needs. With increased awareness of health care, health care facilities and consumer protection Act, patients/clients are getting awareness about their rights. Nurses also have now the expanded role, with the result the legal responsibility is increased. Hence, it is important for nursing personnel working in hospital, community and educational field to develop understanding of Legal and Ethical issues of Nursing. 5

6. TERMINOLOGY Issue: An issue is a topic of interest which leads into a discussion and requiring a decision. Mandatory: Conveying a command,required by law,mandate or compulsory. Fraud: Willful and purposeful interpretation or misinterpreting the outcome of procedure or a treatment. False Imprisonment: A person who cannot be legally forced to remain in health Centers or hospital. Act: Act is a written law. When law is passed in the assembly and is approved by Government it is called as an Act.

7. CONT.. Legal Responsibility: Legal responsibility refers to the ways in which a nurse is expected to follow the rules and regulations prescribed for nursing practice. These responsibilities are described by State, Central Government through service conduct rules based on standards developed by State Nursing Council and National Nursing Council. Legislation: Legislation as ‘the process of making laws’. Legislation is a method of improving public services. To control and maintain standard in nursing education and nursing practice. 7

8. CONT.. Malpractice: Professional misconduct; negligence performed in professional practice; any unreasonable lack of skill in professional duties or illegal or immoral conduct that results in injury or death to the client/consumer. Negligence: Negligence is described as lack of proper care and attention; carelessness. 8

9. Legal issues Law is standard or rules of conduct established & enforced by government. Legal issues in nursing are those in which a person lead to face legal problems, (for eg; nurses facing problem when not meeting proper patient needs.) These laws are intended to protect the public. 9

10. NEED FOR NURSING ETHICS  Helps the students  Helps to differentiate right /wrong behavior.  Helps the nurse Protecting patients . Providing care Staffing patterns  Ethical reasoning .  Guide for a professional behavior .  Help teachers .  Prevent below standard practice.

11. PATIENT CARE ISSUES Nursing covers a wide range of disciplines and health-care issues that are always changing and at the forefront of what guides this career path. Issues such as health-care reform, nursing shortages, low salaries and ethics are some of the issues being faced. 12

12. Nursing Shortage The nursing shortage is a major issue facing the biggest licensed profession in the health- care system. This shortage will affect health care more each day, as it appears not much is being done to stop it. Many emergency rooms have longer wait times due to less nursing staff, and hospital floors are feeling the effects as well. 13

13. Nurses have always been involved with health-care reform as advocates for patients. Health care reform is for the most part governmental policy that affects health care delivery in a given place. Health care reform typically attempts to: Broaden the population that receives health care coverage through either public sector insurance programs or private sector insurance companies. Health-Care Reform 14

14. Low salaries Standard Care State Nurse Practice Act ANA-Standards of Clinical Nursing Practice National Association of School Nurses (NASN) School policy and protocols 15

15. MANAGEMENT ISSUES 16

16. Turnover 17 Maintaining adequate staffing levels is a major issue in nursing management. Representatives working in nurse management and leadership are often faced with the responsibility of controlling turnover rates. Nurses faced with long work hours for relatively little pay have few motivations to remain in one position and often seek employment opportunities at competing hospitals and neighboring clinics.

17. Funding Lack of funding is an issue for many nurse managers who seek to provide sufficient compensation to existing nurses as well as offer suitable compensation in an attempt to recruit new nursing professionals for hire. An underfunded institution cannot attract and provide for the right professionals, and funding inadequacies can also become a detriment to the level of training provided to medical staff, in addition to the needs for medical equipment and supplies. 18

18. Workload Individual nurse manager workload and overall medical workload are issues in leadership. The medical profession is one that never sleeps and has an almost constant need for qualified professionals both in hiring and scheduling. Not only do nurse professionals work long hours and many days per week, but nurse managers and leaders are also faced with an ever-increasing workload. Dealing with patient concerns, providing training and support to nurses, and acting as a liaison between doctors, nurses and medical administration members can be taxing and stressful. 19

19. Issues regarding malpractice in nursing management 20 The failure to delegate and supervise within acceptable standards of professional practice. Issues of delegation and supervision

20. Cont.. 22 Issues related to staffing Inadequate accreditation standards Inadequate staffing Floating staff

21. Ethics Nurses are held to a high standard of ethics when it comes to patients, co-workers and themselves. They provide care, promote human rights and values, and help meet the needs of the less fortunate and vulnerable.A major ethical goal is to also keep patients' information confidential, and this includes not discussing patients in public places.

22. Effect Effects of reform Effects of Shortages Effects of Ethics Effects of Salaries These are issues that keep nurses constantly thinking, growing and changing.

23. Issues in Nursing Curriculum Development Where are we now? As nursing faculty we need to answer the question and analyze the present situation ,which means the validation of curriculum or judgemental process in which an attempts is to be made to ascribe a degree of worth or value to a curriculum in the context of professional education and preparation of participants for their professional role.

24. Where we want to go? This deals with the thinking and aspiration for future. Faculty must think whether the educational program what is designed will help to meet the expectations of individuals, families and communities in accordance with the developed countries or not. 26

25. What we want to achieve? Nurse educators must be able to analyze and think critically that we are preparing the students with the adequate skills to perform their expected roles in all the three domains of professional tasks such as practical, communication and intellectual skills according to the institutional goals and educational objectives. 27

26. How can we achieve? The faculty must think the ways by which the curriculum can be developed and which is relevant to meet the needs of the organization. 28

27. Collaboration issues The nursing profession is faced with increasingly complex health care issues driven by technological and medical advancements ,an ageing population, increased numbers of people living with chronic disease, and spiraling costs. 29

28. SUMMARY 31

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31. 34 EMPLOYMENT ISSUES

32. Issues related to Nursing Shortage This shortage is more noticeable, however and it is lasting longer. The nurse shortage itself is a contributing factor because the shortage creates staffing problems, mandatory overtime, and constant calls for additional shift work. National nursing organizations are making strong efforts at stopping the shortage by mandating better nurse- to-patient ratios, eliminating mandatory overtime, and increasing salaries and benefits for nurses. 35

33. Issues in Nurse Migration Nurse migration has attracted a great deal of political as well as media attention in recent years. The rights to healthcare as well as workers’ rights are paramount to understanding the interests of health sector stakeholders, including the consumer or patient, the government or employer, and the worker or health professional. In this section a discussion on the right to work and the right to practice is, by necessity, followed by a warning that cases of exploitation and discrimination often occur when dealing with a vulnerable migrant population. 36

34. The Right to Work and the Right to Practice For nurses to practice their profession internationally, they need to meet both professional standards and migration criteria. The right to practice, e.g., to hold a license or registration, a professional criteria, and the right to work, e.g. to hold a work permit, a migration criteria, are sometimes linked. Yet they often require a different set of procedures with a distinct set of competent authorities. 37

35. Exploitation and Discrimination One of the most serious problems migrant nurses encounter in their new community and workplace is that of racism and its resulting discrimination . Incidents are, however, often hidden by a blanket of silence and therefore difficult to quantify . Migrant nurses are frequent victims of poorly enforced equal opportunity policies and pervasive double standards. 38

36. Essential Terms and Conditions in an Employment contract An employment relationship has traditionally been governed by the terms and conditions of the employment contract. Previously, the employer retained sole control in respect of the terms and conditions of employment to be incorporated into the employment contract. However, over the years there has been an increase in the implied terms and conditions which are also read into the contract. Additionally, then there are the statutory terms and conditions which also apply. 39

37. Unsatisfactory work performance and termination of employment W hen an employee has an attitude problem or whose work performance is not up to the expectations he cannot be terminated by the employer simply by invoking the termination clause in the employment contract. The employer has to follow certain rules and procedures and only at the end of it can he terminate the services of a non-performing employee. 40

38. Misconduct and imposition of punishment It has long been held that the employer has the inherent right to discipline his workers. Should misconduct be committed, the employer after a proper inquiry has been instituted can impose a suitable punishment, including dismissal if the offence committed was of a serious nature. The decision on the type of punishment to be imposed is under all circumstances a subjective one. The Courts will interfere if, among others, the action taken by the management was perverse, baseless or unnecessarily harsh or was not just or fair. 41

39. Sexual harassment at the workplace Sometime ago this subject matter received a great deal of attention especially with the launching of the Code of Practice on the Prevention and Eradication of Sexual Harassment at the Workplace by the Ministry of Human Resources. However, the response to the adoption of the Code by employers was not encouraging. Some NGO's have called for the introduction of statutory measures to deal with the problem. Some recent judicial pronouncements appear to make it difficult to prove sexual harassment had indeed taken place. 42

40. Renewal of nursing registration Renewal of nursing registration So that registration office is updated with nurses in practice. Of course re- registration may qualify its periodicity and qualifications of nurses e.g. clinical experience, attendance at continuing education etc. 44

41. Diploma vs degree in nursing for registration to practice nursing This issue need indepth study of merits and demerits as well as its feasibility before it could come on the surface. 45

42. Specialization in clinical area It could be either through clinical experience or education. Specialization in cure and specialized care required for patients demand that nurses be highly skilled in the unit. Generalization of care seems remote and unacceptable for patients under specialized treatment.

43. Nursing care standards Standards must be laid down and followed so that clients understand the quality of care expected from the nurses.

44. COMMON CAUSES OF LEGAL ISSUES Professional negligence. Practicing medical without license in the community. Obtaining nursing license by fraud or allowing others to use your license. Felony conviction for any offence. Participating in criminal abortion. Not reporting substandard medicine or nursing care.

45. CONT..  Providing patient care while under the influence of alcohol or drugs. Giving narcotics without an order. 49

46. PROCESSES THAT CAN BE USED IN PROFESSIONAL AND LEGAL REGULATION OF NURSING PRACTICE Accreditation Certification Standards Licensure Nurse Practice Act

47. LEGAL SAFE GUARDS AND NURSING PRACTICE Physician’s Order Short- staffing Floating Informed consent Contracts Collective bargaining Competent practice

48. List of do’s and don’ts as guidelines for safe practice Do’s  Documention of all unusual incidences. Report all unusual incidences. Know your job description. Follow policies and procedures as established by your employing agency. Keep your registration updated. Protect patients from injuring themselves. Remain alert and focused. Establish and maintain rapport with patients and family. Seek and clarify orders when the patient’s medical condition changes. Practice safety with physician’s verbal orders.

49. Don’t’s Remove side rails from patient’s bed unless there is an order or hospital policy to do so. Accept money or gifts from patients. Give medical advice to friends and neighbours. Worked as a licensed practical/vocational nurse in a state in which you are not licensed.

50. ROLES AND FUNCTIONS OF NURSE IN LEGAL ISSUES 54

51. ROLES AND FUNCTIONS OF NURSE MANAGER IN LEGAL ISSUES Serve as a role model by providing nursing care that meets or exceeds accepted standards of care. Is current in the field and seeks professional certification to increase expertise in a specific field. Reports substandard nursing care appropriate authorities. Joins and actively supports professional organizations to strengthen the lobbying efforts of nursing in health care legislation.

52. CONT.. Practices nursing within the area of the individual competence. Prioritizes patient’s rights and welfare first in decision- making. Demonstrates vision, risk taking, and energy in determining appropriate legal boundaries for nursing practices thus defining what nursing is and should be in the future. Understands and adheres to institutional policies and procedures. Monitors subordinates to ensure that they have a valid, current and appropriate license to practice nursing. 56

53. Abstract Ethical problems in nursing management Elina Aitamaa, (2015) conducted a study on Ethical problems in nursing management: The views of nurse managers .Nurse managers have responsibilities relating to the quality of care, the welfare of the staff and running of the organization. Ethics plays significant role in these responsibilities. Ethical problems are part of daily management, but research in this area is limited. The aim of this study was to identify and describe ethical problems nurse managers encounter in their work to get more detailed and extensive view of these problems. 57

54. Cont.. The data consisted of nine interviews with nurse managers at different management levels in primary healthcare and specialized healthcare organizations, and it was analysed by inductive content analysis. Permission to conduct the interviews including ethical approval was given at all participating organizations according to national standards. The respondents were informed about the aim of the study, and voluntary participation, anonymous response and confidentiality were explained to them. Four main categories were found: conflicts in practical situations, lack of appreciation, disregard of problems and experienced inadequacy. 58

55. Cont.. Problems could also be divided to patient-related, staff-related, organization-related and other problems. The findings correspond with results from earlier studies but add knowledge of the nature and details of nurse managers' ethical problems. New information is produced related to the ethical problems with nurse managers' own courage, motivation and values. Nurse managers identified a variety of different ethical problems in their work. This information is useful in the development of ethics in nursing management. 59

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57. There is a correlation between the type of personnel management used and the work efficiency? 62 YES NO

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59. REFERENCE: Books K.Deepak, Textbook on Nursing Management, 2nd edition, Emmess MedicalPublishers, Bangalore,p.p-479-484. BT Basavanthappa, Nursing administration , 2nd edition, New Delhi: Jaypee Brothers Medical Publishers; 2009, p. no-809-13. BT Basavanthappa, Management of Nursing Services & education, 1st edition, New Delhi: Jaypee Brothers Medical Publishers; 2011, p. no-578-80. Masih shabnam, Essentials of Nursing Management,2nd edition, Lotus Publication,2017, New delhi, p. no-334. Raj D. Elakkuvana Bhaskara et.al, Management of Nursing Service and Education, 3rd edition, EMMESS, Bangalore,2015,P No.318-21.

60. CONT.. Journal Elina Aitamaa, Riitta Suhonen,Pauli Puukka, Helena Leino-Kilpi (2019 Jun 24) 'Ethical problems in nursing management', BMC Health Services Research, Volume 19(PMC6591814), pp. 1-11. Elina Aitamaa , Helena Leino-Kilpi, Pauli Puukka, Riitta Suhonen ( 2010 Jul;17) 'Ethical problems in nursing management: the role of codes of ethics', pubmed, VI - 17(PMID: 20610580), pp. 469-82. Joan Kemp BA MSc SRN RCNT RNT (March 1984) 'Nursing at night', Journal of Advanced Nursing onlinelibrary.wiley.com, volume-9(Issue-2), pp. 217-223. Win Tadd (1998) 'Ethical Issues in Nursing and Midwifery Practice', Link.springer.com, 1, pp. 280. 65

61. Cont.. Website Mr. Migron Rubin (Feb 5, 2017) issues related to patient care, Available at: www.slideshare.net (Accessed: Leadership & Management). Sujata Mohapatra (2014) ISSUES IN NURSING, Available at: www.slideshare.net (Accessed: Nov 11, 2014). Mr. Mirgon Rubin (2017) Legal & ethical issues in nursing- issues in india, Available at: www.slideshare.ne (Accessed: 14 Nov. 2017). 66

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