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UTA NURS 4223 Exam 2

UTA NURS 4223 Trends Exam 2

purpose of §217.20. Safe Harbor Peer Review for Nurses and Whistleblower Protections define process for invoking Safe Harbor; minimum due process; guidance in development/application of plans; assure knowledge of the plan & right to invoke; & provide guidance to PRC in making its determination of the nurse’s duty to the patient.
Safe Harbor process that protects a nurse when a nurse makes a good faith request for peer review of an assignment or conduct the nurse is requested to perform that they believe could result in a violation of the NPA or Board rules
What Safe Harbor protects a nurse from employer retaliation, suspension, termination, discipline, discrimination, and licensure sanction
When Safe Harbor must be invoked prior to engaging in the conduct or assignment for which peer review is requested, and may be invoked at anytime during the work period when the initial assignment changes
Who the Nurse Notifies of Invoking Safe Harbor The nurse must notify the supervisor requesting the conduct or assignment in writing (see Quick Request Form for content requirements).
Initial Request for Safe Harbor contents nurse(s) name making request with signature(s); date and time of request; where conduct or assignment is to be completed; name of person requesting conduct or making assignment; and a brief explanation of why safe harbor is being requested
When Comprehensive Request for Safe Harbor must be submitted before leaving the work setting at the end of the work period
Comprehensive Request for Safe Harbor contents conduct assigned/requested; requestor’s name & title; practice setting; description of potential violation; rationale for not engaging in conduct (if applicable); copies of pertinent documentation; and nurse’s name, title and relationship to requestor
Who determines whether a physician’s order was reasonable the medical staff or medical director
Nurse’s recourse if retaliation occurs after Safe Harbor is invoked nurse has the right to file civil suit to recover damages and/or file a complaint with the appropriate regulatory agency that licenses or regulates the nurse’s practice setting.
Safe Harbor protections ______ (do OR do not) apply to civil action for patient injury that may result from the nurse’s practice Do Not
Exclusions to Safe Harbor Protections invoked in bad faith; conduct engaged in PRIOR to initial request; conduct unrelated to the reason for which the nurse requested Safe Harbor
Conduct or Assignments Nurse’s have the Right to Refuse to Engage in pending Safe Harbor Peer Review one in which the nurse lacks the basic knowledge, skills, and abilities and that would expose one or more patients to an unjustifiable risk of harm; or the conduct or assignment would constitute unprofessional conduct and/or criminal conduct
Responsibilities if Refusing to Engage in Conduct the nurse and supervisor must collaborate in an attempt to identify an acceptable assignment that is within the nurse’s scope and enhances the delivery of safe patient care; and the results must be maintained in peer review records by the chair of the PRC
Timeline for Safe Harbor Peer Review committee to complete its review and notify the CNO within 14 calendar days of when the nurse requested Safe Harbor
Timeline for notifying nurse requesting Safe Harbor of committee’s determination 16 days: 14 days for PRC to report to CNO or nurse administrator + 2 days for CNO or nurse administrator to review PRC findings and notify the nurse requesting safe harbor
When nurse’s Safe Harbor protections expire 48 hours after the nurse is advised of the peer review committee’s determination. The expiration of this protection does not affect the nurse’s protections from retaliation by the facility, agency, entity or employer for requesting Safe Harbor
4 choices RN has when given an assignment Accept; Refuse; Refuse and request Peer Review (if disciplined); File Safe Harbor and accept
Most classic reasons for filing safe harbor too high nurse to patient ratio and inappropriate floats
Safe Harbor Forms Short Form (Quick Request completed prior to engaging in the conduct or assignment); Long Form (Comprehensive Written Request completed before leaving work setting at end of work period); Medical Reasonableness (used when questioning physician’s order)
BON Perspective on Staffing ratios has no authority over workplace or employment issues, such as staffing ratios. Rule 217.11 provides the minimum standards nurses must meet in accepting any assignment, including floating, working short staffed and other practice situations
Who nurse staffing committee reports to directly to the hospital board
composition of nurse staffing committee members representative of services provided; the CNO; and at least 60% RNs who provide direct patient care at least 50% of the time and that are selected by their nurse peers who also provide direct patient care at least 50% of the time
Nurse staffing committee responsibilities identifying the nurse-sensitive outcome measures to be used in evaluating the staffing plan; evaluate and report on the staffing plan’s effectiveness at least semiannually to the hospital board
Frequency of nurse staffing committee meetings at least quarterly
Frequency nurse staffing committee reports on staffing plan effectiveness to the hospital board semiannually
Frequency hospitals are required to report data about nurse staffing plan to TDSHS annually
4 TX Health & Safety Code §257. Nurse Staffing purpose to protect patients, support greater retention of RNs, and promote adequate nurse staffing, the legislature intends to establish a mechanism whereby nurses and hospital mgmt shall participate in a joint process regarding decisions about nurse staffing
§257.003. NURSE STAFFING POLICY AND PLAN The governing body of a hospital shall adopt, implement, and enforce a written nurse staffing policy to ensure that an adequate number and skill mix of nurses are available to meet the level of patient care needed
§257.004. NURSE STAFFING COMMITTEE A hospital shall establish a nurse staffing committee as a standing committee of the hospital.
mandatory overtime requirement that a nurse work hours/days in addition to those scheduled, regardless of the length of scheduled shift or number of scheduled shifts/week; doesn’t include prescheduled on-call time or time immediately before or after a scheduled shift
exceptions to prohibition of mandatory overtime a health care disaster; federal, state, or county declaration of emergency; emergency or unforeseen event; nurse is actively engaged in an ongoing medical or surgical procedure
protections for refusing to work mandatory overtime A hospital may not suspend, terminate, or otherwise discipline or discriminate against a nurse who refuses to work mandatory overtime
National Labor Relations Act (NLRA) Allowed workers to have elections to decide if they want to be represented; Established laws protecting employees from discrimination based on union- or group-related activity; Created the NLRB as an administrative organization to enforce the law
National Labor Relations Board (NLRB) administrative organization that enforce labor laws
Fair Labor Standards Act 1938 (Wages & Hours Bill): established a national minimum wage, time-and-one-half for overtime in certain jobs, prohibited most employment of minors in "oppressive child labor”
Texas Right to Work Laws allows individuals at a unionized company to decide whether or not to join the union and pay dues; 22 states have right to work laws
Labor-Management Reporting and Disclosure Act 1947 imposed a code of conduct upon unions, union officers, members, employers and management consultants so that all actors would behave fairly.
Taft-Hartley Labor Act 1947 (Labor Management Relations Act) enlarged National Labor Relations Board, established control over labor disputes, authorized 80-day injunction against strikes thought to be a danger to public health/security, and outlawed union contributions to political campaigns
Labor Management Reporting and Disclosure Act of 1959 established a "Bill of Rights" for union members; provisions include freedom of speech and assembly, protection from undeserved punishment, a vote in determining dues and fees, and the right to file suit and to participate in union activities.
Reason the Labor Management Reporting and Disclosure Act of 1959 was passed passed because of a concern about union involvement in organized crime, a lack of transparency in union activities and a lack of democracy within unions
Occupational Health and Safety Act (OSHA, 1970) ensures safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance
Reason employers agree to be organized by a union The corporation may conclude that it is cheaper, easier, or more efficient to just yield to the unions demands so they can get on with business (may be especially true of organizations that have some groups, e.g. hospitals, already unionized).
neutrality agreement contract between unions and employers where employer agrees to support union’s attempt to organize; the union is allowed free access to employees and the employer remains silent regarding its view of unionization or its effect on the workplace
Neutrality Agreement common provisions gag rule; access to premises; access to personal information; captive audience speeches (employees only hear one perspective—that of the union)
Percent of employees that must sign cards for union to file with NLRB 30% (most wait until 50-60% though to improve chances of winning election.
Employee Free Choice Act (EFCA) proposes to eliminate the secret ballot election; unions would be able to request certification of the union based on 50% + 1 signed cards. (Cards are not secret or confidential).
Union organizing process strategy/targeting/contacts > building support > card signing > NLRB filing > Secret ballot election > Certification of vote by NLRB
Collective bargaining process election of negotiating committee > develop contract proposal > negotiations (begins with “blank slate”) > contract agreement > ratification by union members
Mandatory Hospital Staffing Committees committees that involve direct care nurses to determine the nurse to patient ratios for their facility based on their nurse and patient populations. Texas was the first state in the country to implement staffing requirements.
What a signature card indicates interest in a particular union and desire for a formal vote
% of voting that determines outcome of union elections 50% plus one of those voting
Nursing malpractice (or negligence) failing to do what a reasonable and prudent nurse would do in the same or similar circumstance or doing something that a reasonable and prudent nurse would not do in the same or similar circumstance
civil (malpractice) vs. criminal court if the act is unintentional, a civil suit can be brought against the person accused of being negligent; if it was intentional, it would be tried in a criminal court of law
number of preventable deaths that occur each year d/t medical errors between 48,000 and 100,000
Protections for non-work, emergency situations protected by the Good Samaritan Law, if interventions were reasonable and prudent
Protections for non-work, non-emergency situations (e.g., friend asking for advice) no protections afforded; always include statement to go see PCP
Lunsford v. Board of Nurse Examiners the court in affirming the disciplinary action of the Board, held that a nurse has a duty to the patient which cannot be superseded by hospital policy or physician's order.
Good Professional Character, §§213.27-213.29 explains client’s vulnerability and nurse’s “power” differential over the client by virtue of the client’s status and by the nature of the nurse:client relationship (client defers decisions to and relies on nurse to protect)
When duty to the patient is established once nurse:patient relationship is formed (includes assessment prior to admission and non-work situations); A nurse who has knowledge that a situation places a patient at risk of harm has a duty to the patient or potential patient
Elements of malpractice claims nurse owes a duty to the patient; nurse breached the duty or failed to conform to the Standard of Care; patient suffered an actual injury; causal connection exists between injury and nurse’s conduct
Most frequent malpractice allegations failure to ensure safety; incorrect treatment/treatment done incorrectly; failure to monitor and report; medication errors; failure to follow policies/procedures
Ways nurses participate in malpractice cases fact witness; expert witness; or defendant
Only witness that gives an opinion expert witnesses
One of most frequent reasons nurses are sued improper treatment or improper performance of treatment
Single most important action to safeguard patient care and provide a good defense against malpractice claims and license investigations documentation
Professional liability insurance benefits provides attorney to work in YOUR best interest; pay the plaintiff if you are found liable (up to limits); pay the bond if you want to appeal
Types of Insurance occurrence-based policy; claims-made policy
Important insurance coverage reimbursement for attorney’s fees and personal expenses for defense before the licensing board; not included in every policy, remember to check they policy
BON proposed position statement on nurse fatigue (IOM recommendations) limits 12.5 hrs/day; 60 hrs/wk; and no more than 3 consecutive shifts
Reasons nurses disagreed with proposed position statement staffing issues; financial hardship; family obligations; physical requirements; right to work
Rogers, Hwang, Scott, Aiken, and Dinges study results error rates increase to a level of significance when nurses work shifts of 12 hours or more
affects of fatigue according to the National Sleep Foundation (NSF) decreased alertness, problems with task completion, problems with concentration, irritability, unsafe actions, and unsafe decision making
VA fatigue comparison to blood alcohol Fatigue causes equivalent of blood alcohol level of 0.10%
Jha, Bradford, Duncan, and Bates literature review results when adults get less than 5 hours of sleep over a 24-hour period, peek mental abilities decline. After two nights of missed sleep, cognitive performance can fall to nearly 40% of baseline.
NASA circadian rhythms Circadian rhythm has two times of maximum sleepiness: between the hours of 3 and 5a.m., and 3 and 5 p.m.
symptoms of fatigue begin with errors of omission, progress to errors of commission, and finally result in micro sleep (periods of sleep lasting for seconds or minutes)
Code of Ethics for Nurses provides a framework for nurses to use in ethical analysis and decision-making and establishes the ethical standard for the profession
Who can revise the Code of Ethics for Nurses It is not negotiable in any setting nor is it subject to revision or amendment except by formal process of the House of Delegates of the ANA
Code of Ethics for Nurses purpose succinct statement of the ethical obligations and duties of every individual who enters the nursing profession; the profession’s nonnegotiable ethical standard; and an expression of nursing’s own understanding of its commitment to society
Ethical vs. Moral Ethical are reasons for decisions about how one ought to act. Moral overlaps with “ethical” but is more aligned with personal belief and cultural values
Provisions in the Code of Ethics for Nurses 9 provisions: first 3 describe most fundamental values and commitments; next 3 address boundaries of duty and loyalty; and last three address aspects of duties beyond individual patient encounters.
Professional boundaries the spaces between the nurse’s power and the client’s vulnerability. Power comes from the professional position and the access to private knowledge. Boundaries allow the nurse to control this power differential and allow a safe connection to meet needs
Boundary violations result when there is confusion between the needs of the nurse and of the client (e.g., excessive personal disclosure by nurse, secrecy or a reversal of roles); can cause distress for client (may not be recognized or felt until harmful consequences occur)
Boundary crossings brief excursions across boundaries that may be inadvertent, thoughtless or even purposeful if done to meet a special therapeutic need; can result in return to established boundaries but should be evaluated for potential consequences and implications
Professional sexual misconduct extreme form of boundary violation; includes any behavior that is seductive, sexually demeaning, harassing or reasonably interpreted as sexual by the client; an extremely serious violation of nurse’s professional responsibility and is a breach of trust
zone of helpfulness in the center of the professional behavior continuum (from under-involved to over-involved) where the majority of client interactions should occur for effectiveness and client safety
what to do if confronted with possible boundary violations or sexual misconduct If a health care provider’s behavior is ambiguous, or if unsure of how to interpret a situation, consult with a trusted supervisor or colleague.; thoroughly document incidents in a timely manner; report per mandates
Examples of breaches of patient confidentiality or privacy via social media comments on social networking sites in which a patient is described with sufficient detail to be identified, referring to patients in a degrading or demeaning manner, or posting video or photos of patients
Potential consequences for inappropriate use of social and electronic media may face disciplinary action by the BON; civil or criminal penalties; termination of employment; damage reputation of health care organization or subject them to law suit/regulatory consequences
Entering TPAPN as alternative to being reported to BON vs. being ordered by BON to enter if enters as an alternative to being reported to board, it confidential. Otherwise, it’s a disciplinary action and is public information that has to be divulged to future employers, other boards, and insurance carriers
Basic principles of TPAPN voluntary program, abstinence, and relapse (allowed 1 relapse)
NPA §301.410. Report Regarding Impairment by Chemical Dependency, Mental Illness, or Diminished Mental Capacity A person who is required to report a nurse because the nurse is impaired/suspected of being impaired may report to a peer assistance program approved by the Board instead of reporting to the Board, unless they believe a practice violation was committed
§217.13. Peer Assistance Program identify, monitor, and assist with locating appropriate treatment for nurses whose practice is impaired or suspected of being impaired by chemical dependency, mental illness or diminished mental capacity so that they may return to practice safe nursing
Minimum conditions participants in the peer assistance program must agree to physical and/or psychosocial eval by expert in chemical dependency; substance abuse treatment; abstinence; random drug screens; support groups; employment conditions/restrictions; sign waiver for BON to be told if doesn’t comply with program
Causes for termination for Peer Assistance Program Noncompliance with any aspect of the program agreement; Receipt of info by the board which results in disciplinary action by the board; or Being unable to practice according to acceptable and prevailing standards of safe nursing care.
Ineligibility for Peer Assistance Program not currently licensed; currently using/prescribed drug of abuse; medical and/or psychiatric condition, diagnosis, or disorder not adequately controlled; 2 or more chemical dependency programs; board action within last 5 yrs; felonies; sex offenders
Texas Peer Assistance Program for Nurses (TPAPN) created as a non-punitive, confidential and voluntary alternative to reporting RNs and LVNs to the Texas Board of Nursing for chemical dependency or mental illness
Extended Evaluation Program of Texas (EEP) a voluntary monitoring system that can help nurses avoid possible disciplinary action against their nursing licenses by demonstrating to the EEP that they do not have a drug or alcohol problem
Role of Employers or Colleagues in Substance Use Disorder in nurses identification and reporting; intervention; diagnosis and treatment; and monitoring after return to practice
Workplace factors that increase opportunity and risk for addiction stress d/t staffing shortages, increased patient acuity and assignment ratios, demands from administrators and physicians, shift rotation, and long work hours
signs of impairment to watch for behavior changes; physical signs; and diversion of drugs
Behavioral changes seen in substance use disorder unexplained absences, frequent trips to bathroom, arriving late/leaving early, excessive mistakes, changes in appearance, long sleeves in warm weather, increased isolation, inappropriate responses, diminished alertness, confusion, or memory lapses
Signs of medication diversion incorrect counts; large amounts of waste; numerous corrections of records; reports of ineffective pain relief from patients; offers to medicate coworkers’ patients for pain; altered verbal or phone medication orders; and controlled substance discrepancies
Internal investigation elements documenting observations; obtaining witness statements; documenting drug diversion; and referring the nurse for drug screening
TPAPN is available to nurses having one or more of these diagnoses substance abuse, substance dependency, anxiety disorders, major depression, bipolar disorder, schizophrenia, and schizoaffective disorder.
Requirements for participating in TPAPN abstinence from ALL abusable drugs, including alcohol; monitoring compliance with treatment recommendations, return-to-work restrictions, attendance at self-help meetings, and random drug tests; responsible for costs of treatment and drug screens
TPAPN Civil Immunity Texas state law provides civil immunity for all reports made in good faith and for all employers who work with TPAPN nurses in good faith.
TPAPN Relationship to Licensing Boards TPAPN is independent of the licensing boards. The Texas Board of Nursing maintains a service contract with TPAPN.
TPAPN Funding the majority of TPAPN's funding comes from a portion of each nurse's relicensure fee.
TPAPN Administration TPAPN is a nonprofit program and is administered by the Texas Nurses Foundation (TNF), a nonprofit arm of the Texas Nurses Association, that supports Texas health care consumers through professional and educational programs.
When to refer to TPAPN + pre-employment drug screen; 2 people witness alcohol on breath; + blood alcohol or drug screen; visibly/physically impaired on duty; signs of substance abuse; no show/no call; narcotic/controlled substance discrepancies point to nurse
Signs of substance abuse or mental illness pattern of forgetfulness, poor nursing judgment, inability to perform, medication errors, physical deterioration, isolation, moodiness and/or mood swings
TPAPN Mission TPAPN offers life renewing opportunities to nurses for recovery from substance use and certain psychiatric disorders thus promoting professional accountability, protecting the public and returning nurses to safe practice
Requirements for working during TPAPN participation identify supervisor and a workplace monitor; work agreement which includes restrictions on practice
Restrictions on practice while in TPAPN program no functioning in unsupervised role; no work shifts > 12 hrs; no working for multiple employers; no staffing agencies; no working overtime or on-call; no floating or rotating shifts; no access to controlled substances
Length of TPAPN program 3-5 years, but may be extended if an APRN fails to return to their specialty practice area for at least 12 consecutive months or any nurse fails to demonstrate incident-free, safe nursing practice for a minimum of 64 hrs/mo for 12 consecutive months
Reason participant’s are reported to the BON by TPAPN withdraw from TPAPN; have a positive drug screen; demonstrate behaviors inconsistent with good recovery; are noncompliant with their TPAPN agreements; are dismissed from the program for any reason; endanger patients or compromise patient safety
Costs and Fees associated with TPAPN participation participants are responsible for payment of: assessment, treatment, drug testing, participation fees, and facilitated support groups
TPAPN Update Meetings Quarterly Update meetings are held for the purpose of reviewing each participant’s past three months’ work performance, practice, compliance in TPAPN, progress in recovery and to document continuous employment in nursing
Frequency of TPAPN Update Meetings every 3 months from date of return to work in nursing
CE Requirements complete 20 contact hours within 2 years OR demonstrate the achievement, maintenance, or renewal of an approved national nursing certification in the nurse’s are of practice
Forensic Evidence Collection CE Requirements If employed in an ER, complete minimum of 2 hours r/t forensic evidence collection (one time requirement)
Criteria for Acceptable Continuing Education Activity must be approved by a credentialing agency or an affiliated entity of one of these agencies. Proof of successful completion shall contain the name of the provider; the program title, date, and location; number of contact hours; provider number; and creden
Requirements for CE obtained for academic courses The course shall be within the framework of a curriculum that leads to an academic degree in nursing or any academic course relevant to nursing practice, completed with a grade of “C” or better, or a “Pass” on a Pass/Fail grading system
Courses only in BSN programs Leadership & Management; Health Promotion; Community Health; and Research
Graduate Education in Nursing degrees Masters of Science in Nursing (MSN); Doctorial of Nursing (PhD); and Doctoral of Nursing Practice (DNP)
Masters Roles Educator, Administrator, APRN, Clinical Nurse Leader, or Community Health
Advanced Practice Registered Nurses (APRNs) Nurse practitioners, Clinical nurse specialists, Nurse anesthetists, and Nurse midwives; In TX all APRNs can have prescriptive authority through collaborative practice with a physician
Clinical nurse specialists specialized in a clinical area; employed by the hospital; responsibility to patients on a specific unit or having certain diagnoses; responsible for staff development and clinical resource person
Nurse anesthetist 2 years experience in critical care; hired by facility or as part of anesthesiology practice
Doctorial in Nursing (PhD) areas of practice Research and Education
Doctoral of Nursing Practice (DNP) nurse practitioner first; continue in clinical practice; goal 2015 all NP to DNP
What to look for in graduate education programs national accreditation; program success (placement of jobs, pass rate on certification exams); admission criteria; types of degrees & specialties available; program delivery
When GN temporary authorization expires (1) when the candidate passes the NCLEX-PN® or NCLEX-RN® test; (2) when the candidate fails the NCLEX-PN® or NCLEX-RN® test; (3) or on the 75th day following the effective date of the temporary authorization
When examination results can be released Staff cannot release results over the telephone until at least 21 days after testing have elapsed.
"Direct supervision" of a GN the licensed nurse is physically present in the facility or practice setting and is readily available to the GVN or GN for consultation and assistance.
CEs for academic courses 1 academic semester hour is equal to 15 contact hours; 1 academic quarter hour is equal to 10 contact hours. Prerequisite courses, such as mathematics, government, anatomy, and physiology cannot be counted to meet any part of the required CE for a nurse
Code of Ethics Provision 1 In all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or nature of health problems
Code of Ethics Provision 2 The nurse’s primary commitment is to the patient, whether an individual, family, group, or community.
Code of Ethics Provision 3 The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.
Code of Ethics Provision 4 The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care
Code of Ethics Provision 5 The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth.
Code of Ethics Provision 6 participates in establishing, maintaining, and improving healthcare environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.
Code of Ethics Provision 7 The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development.
Code of Ethics Provision 8 The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs.
Code of Ethics Provision 9 The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.
Patient-centered outcome measures surgical deaths; pressure ulcers; falls; restraints; CAUTI; BSI; VAP
Nursing-centered intervention measures smoking cessation counseling
System-centered measures skill mix; nursing care hours/patient day; practice environment scale; voluntary turnover
Created by: camellia