What are Professional Standards of Care?
guidelines describing the minimal nursing care that can reasonably be expected to ensure high-quality care in a defined situation"
-Board of Registered Nurning (BRN)
-American Nursing Association (ANA)
-LAC+USC Medical Center - policies and procedures
-N
What is the purpose for Standards of Care?
-describe responsibilities for which nurses are accountable (acculturation to nursing)
-reflect values & priorities in the nursing profession (accountability)
-provides direction for nursing practice
What is competent performance?
*major legal safeguard for nursing
*nurses must:
-provide care within legal boundaries of their practice
-utilize & apply the nursing process
*competency involves care that protects the client from harm
BRN Definition of Competent Care
shall be considered compentent when he/she CONSISTENTLY demonstrates the ability to transfer scientific knowledge from:
-social
-biological
-physical sciences
-nursing process
Institutional Standards
provide professional standards for nursing services in health care facilities (policies & procedures)
*HCF policies can vary
*JHACO (joint commission)
-safeguards for patients
-yearly safety goals
-evaluates facilities
-issues citations
What are community Standards?
what are other health care facilities doing in their community? (er time, lab results, etc)
What is the role of the BRN?
-regulates nursing practice
-responsible for the implementation & enforcement of the Nurse Practice Act
*sets educations standards
*evaluates licensure applications
*issues & renews licenses
*takes disciplinary actions
What is the Nurse Practice Act?
*regulate the practice of nursing in the US
*purpose is to protect the public
*nurses are expected to know their state's NPA
Nurse Practice Act & Title 16
these laws authorize the BRN to interpret the legal boundaries of safe nurse practice
Entry into practice
diploma
associates degree
baccalaureate degree (1985 ANA endorses BSN to be entry level professional practice)
Entry into practice: section 2736
requirements:
-completed an accredited program
-successively pass NCLEX
-application has been approved
This means:
-applicant has met the minimal degree of competency to ensure public health, welfare and safety
Accreditation for School of Nursing
-accreditation is a legal requirement
Function of the State Board of Nursing
ensure that schools preparing nurses maintain a minimum standard of education
NCLEX pass rates for LAC School of Nursing
2009 - 95.3%
2010 - 97.67%
2011 - 95.79%
What is the student's responsibility?
responsibility to society to learn the academic theory & clinical skills needed to provide nursing care.
Title 16 Section 1428. Student Participation
Students shall be provided opportunity to participate with the faculty in the identification of policies and procedures related to students including but not limited to:
(a) Philosophy and objectives;
(b) Learning experience; and
(c) Curriculum, instructi
Primary objective of the BRN licensure requirement
ensure protection by determining that individuals possess the knowledge and qualifications necessary to competently and safely practice registered nursing"
*students are held to the same responsibility as an RN
Licensure
*mandatory in all states
*it is a privilege that can be revoked
Nursing License Compact (NLC)
*agreement between two or more states
*allows for multistate licensure
*as of 2006, 20 states implemented the NLC
What is credentialing?
*process of maintaining competence in nursing practice
*BRN requires 30 hours (CEU's) of nursing education every 2 years to maintain license.
What are some disciplinary issues?
*67% of disciplinary actions related to chemical dependency (access/stress)
-look at your coping mechanisms
Examples of Unprofessional Conduct
-incompetence
-gross negligence
-practicing w/o a license
-falsification of client's records
-controlled substances
-having personal relationships w client, esp vulnerable client
Professional Organizations
*provide leadership that affects many areas of Nursing
-American Nurses Association
-National League for Nursing
-International Council of Nursing
-National Student Nurses' Associations
ANA Professional Standards of Care
-quality of care
-professional practice evaluation
-education
-collegiality
-ethics
-collaboration
-research
-resource utilization
-leadership
What is the goal of professional socialization?
instill in individuals the norms, values, attitudes and behaviors deemed essential for the survival of the profession
Essential Nursing Values & Behaviors
*altruism
*autonomy
*human dignity
*integrity
*social justice
PROVIDER OF CARE
caregiver (provide safe nursing care to individuals, families, groups and communities
*holistic
MANAGER OF PATIENT CARE
*coordination of care for groups of patients/clients
*a nurse may provide care directly or delegate it to other caregivers
COORDINATOR OF PATIENT CARE
*process of ensuring that plans are carried out and evaluating the outcomes
SETTINGS FOR NURSING
hospitals
community agencies
client's homes
ambulatory clinics
long-term care facilities
PATIENT ADVOCATE
*nurse represents the clients needs & wishes to other health care professionals
* overall goal to protect client's rights (informed decisions)
*encourage clients to communicate with all disciplines (have pt. write questions down)
VALUE TRANSMISSION
*values are learned through observation and experience
* heavily influenced by sociocultural environment, religion, family and peers.
*keep in mind the influence of values on health
-folk healer vs. physician
-pain management
PUBLIC ADVOCACY
*nursing has a strong political voice
*to develop & improve health policy at an institution & government level
*goal is to achieve better health care for the public
CODE OF ETHICS: Moral Implications
*moral development: process of learning to tell the difference between right and wrong, begins in childhood
*ANA Standards V
-the nurses's decision and actions on behalf of patients are determined in an ethical manner.
MORAL FRAMEWORKS
*consequence based - was the outcome right or wrong
*utilitarianism - act that does the most good & least harm to the most amount of people
-healthcare decisions (mass casualty)
-funding - heath care delivery
*principles based - emphazise individual right
Scenario: pt. does not want surgery but family & surgeon insist
Nurse A: (consequence-based reasoning)
-surgery will cause him more suffering & he probably won't survive
Nurse B: (principle based theory)
-violates the principle of patient's autonomy
Nurse C: (caring-based reasoning)
-commitment to my patient, support
Code of Ethics: LEGAL IMPLICATIONS
nurses need to distinguish between morality and law
*you must follow the law, reflects values of society, offer guidelines to determine what is moral
Code of Ethics: GUIDELINES
decisions should be based on ethical principles & codes
-maximize client's well being
-support each family member & enhance the family support system
-carry out hospital policy
ETHICS:
nurses have been voted the most ethical & honest profession in America in Gallup's annual survey for 13 of 14 years
*people connect with nurses and trust them to do the right thing
LAC+USC Ethics Committee
goal: to assist health care providers, patients & families, upon request to deal with difficult ethical decisions
*consists of physicians, nurses and clergy
*contact via hospital pager