Podcast
Questions and Answers
Which dimension of a healthy work environment emphasizes leadership, opportunity, and transparency?
Which dimension of a healthy work environment emphasizes leadership, opportunity, and transparency?
What is not considered a form of workplace violence against nurses?
What is not considered a form of workplace violence against nurses?
Which component is vital to encourage healthy behaviors and work/life balance in a healthcare setting?
Which component is vital to encourage healthy behaviors and work/life balance in a healthcare setting?
In the context of occupational health and safety, what is a worker's right in unsafe circumstances?
In the context of occupational health and safety, what is a worker's right in unsafe circumstances?
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What should be a primary focus when developing a workplace to support a thriving nursing workforce?
What should be a primary focus when developing a workplace to support a thriving nursing workforce?
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Which of the following is a necessary skill for nurses in high-risk environments concerning workplace violence?
Which of the following is a necessary skill for nurses in high-risk environments concerning workplace violence?
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What is an outcome of a healthy work culture in a healthcare setting?
What is an outcome of a healthy work culture in a healthcare setting?
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What type of strategy is essential for minimizing risks in workplace health and safety?
What type of strategy is essential for minimizing risks in workplace health and safety?
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In the context of creating a healthy workplace, what is the goal of employee retention strategies?
In the context of creating a healthy workplace, what is the goal of employee retention strategies?
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Which guideline is aimed at facilitating healthy work environments specifically for nurses?
Which guideline is aimed at facilitating healthy work environments specifically for nurses?
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What is the primary purpose of collective agreements in a workplace?
What is the primary purpose of collective agreements in a workplace?
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In the context of nursing, what does the 'Obey and grieve' rule stipulate?
In the context of nursing, what does the 'Obey and grieve' rule stipulate?
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What is a significant concern for Nurse Emily due to high patient load?
What is a significant concern for Nurse Emily due to high patient load?
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Which of the following actions can be taken when a nurse is concerned about workload?
Which of the following actions can be taken when a nurse is concerned about workload?
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What aspect of Emily's situation poses a risk to her professional responsibility?
What aspect of Emily's situation poses a risk to her professional responsibility?
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Which type of workplace issue can collective agreements address?
Which type of workplace issue can collective agreements address?
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In a scenario where resources are limited, how should a nurse prioritize her duties?
In a scenario where resources are limited, how should a nurse prioritize her duties?
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What could be a long-term negative outcome for a nurse if workload issues are not addressed?
What could be a long-term negative outcome for a nurse if workload issues are not addressed?
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Which of the following is an example of a research question suitable for a scoping review?
Which of the following is an example of a research question suitable for a scoping review?
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Which of the following types of discrimination is NOT identified as a key area in the context of workplace discrimination?
Which of the following types of discrimination is NOT identified as a key area in the context of workplace discrimination?
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What is a potential risk to nurses highlighted in the discussion on the right of nurses to be protected from harm?
What is a potential risk to nurses highlighted in the discussion on the right of nurses to be protected from harm?
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Which of the following strategies is essential for fostering a healthy work environment for nurses?
Which of the following strategies is essential for fostering a healthy work environment for nurses?
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Which of the following best describes a method to promote nursing engagement within healthcare settings?
Which of the following best describes a method to promote nursing engagement within healthcare settings?
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What proactive strategy can be implemented to address nurse retention in the workplace?
What proactive strategy can be implemented to address nurse retention in the workplace?
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Which of the following types of discrimination is recognized as a key area in workplace environments?
Which of the following types of discrimination is recognized as a key area in workplace environments?
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Which of the following is a key action for leaders to ensure a healthy work environment for nurses?
Which of the following is a key action for leaders to ensure a healthy work environment for nurses?
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Study Notes
Course Information
- Course code: NURS 72050
Agenda
- Warm up
- Personal Rights
- Workplace Violence
- EIDM Moment
- Work Environment
- Workplace Safety
- Unions
Nurses' Rights
- Professional rules and regulations, and ethical responsibilities may limit individual rights
- Nurses may not refuse care unless conscientious objection, which may include vaccine mandates for infectious diseases.
- Nurses are entitled to respect from colleagues and patients
- Freedom from discrimination, racism, harassment, and physical or sexual abuse
- A work environment where the risk of harm is minimized. (Keatings, 2024)
Conscientious Objection
- Nurses may face situations where the care they are expected to provide raises moral or religious conflicts
- Examples include pregnancy terminations and medical assistance in dying
- In such situations, nurses must provide emergency care until alternatives are available
- These objections cannot contravene the Charter of Rights and Freedoms related to discrimination based on religion, race, national or ethnic origin, colour, sex, age, or mental and physical disability. (Keatings, 2024)
Text Case Scenario 11.1
- M.F., a 5-year RN in an obstetrical department, is deeply religious and opposed to abortion.
- They were given the understanding that no therapeutic abortions would be performed.
- Facing a change in procedure location due to cutbacks at the hospital, they were assigned to assist with a therapeutic abortion, leading to anger and upset.
- M.F. approached the manager to express their opposition. (pg. 346)
Case Questions
- What are the legal and ethical obligations of M.F.?
- How could M.F. deal with this situation?
Canadian Association Schools of Nursing
- Adheres to nursing standards, scope of practice, and code of ethics when providing abortion care
- Provides culturally safe abortion care
- Articulates the importance of maintaining patient/client confidentiality
- Demonstrates understanding of the registered nurse scope of practice as it pertains to abortion care
- Demonstrates understanding of professional responsibilities associated with conscientious objection. (CASN, 2024)
Conscientious Objection (Proactive Approach)
- Employers inform prospective employees of role expectations
- Reassignment to other areas if responsibilities change
- Nurses notifying employers of anticipated conflicts with conscience so alternative arrangements can be made
Workplace Discrimination
- Agencies and workplaces have prioritized a more inclusive workplace since 2020
- RNAO and CNA have acknowledged racism and discrimination embedded in the nursing profession, impacting care and the health of the nursing workforce
Scope of the Issue
- The Canadian Nurses Association completed a scoping review in June 2024 to explore racism and discrimination within the nursing profession.
- The review summarized publications with a focus on racism and discrimination. (CNA, 2024)
EIDM Moment - Scoping Review
- A scoping review investigates a broad research question, identifying and mapping available and emerging evidence.
- It provides a descriptive summary, not assessing quality or risk of bias of included studies.
- Purpose: Identify evidence types, summarize existing evidence, identify gaps, and recommend future research.
- Example question: What blended learning approaches are currently used in undergraduate nursing education? (Rodger, 2024)
Key Areas of Workplace Discrimination
- Racial discrimination
- Gender-based discrimination
- Indigenous-specific discrimination
- Discrimination based on disability
- Religion
- Age
- Sexual Orientation
The Right of Nurses to Be Protected From Harm
- Health care environments pose multiple risks to nurses
- Exposure to harmful agents and infectious diseases (e.g., COVID-19 pandemic)
- Increased stress and disrespect from coworkers
- Risk of physical harm from patients (Keatings, 2024)
Right to a Healthy Work Environment
- Leaders must ensure adequate resources and structures for nursing care, including appropriate staffing ratios.
- Optimizing full-time positions while offering flexible opportunities for nurses at various stages of their career (Keatings, 2024)
- Foster nursing engagement by: rewarding effort, providing a learning environment for professional development, developing orientation programs.
Promote workplace health and safety
- Personal Protective Equipment, and timely access to vaccines.
- Develop a human resource strategy that addresses retention and proactive recruitment. (Keatings, 2024)
Workplace Quality
- The Canadian Federation of Nurses Unions provided an Outlook of the Canadian Nurses work environment pre-Covid 19 (CFNU, 2020)
- Highlights a contrast between positive ratings of quality of care, and concerns related to the work environment.
Workplace Injuries
- A significant portion of nurses (over one third) experience work-related physical injuries in a year or less. (CFNU, 2020)
Small Group Activity
- Review slides on workplace quality and injuries
- Discuss experiences and thoughts related to safety in the workplace
- Identify critical appraisal questions for the data
A Healthy Work Environment
- A healthy work culture leads to improved patient safety, reduced absenteeism, and improved ability to attract/retain employees and high staff satisfaction/engagement.
- Several models exist to guide healthy work environments (Keatings, 2024)
Group Activity
- Visioning the future of health care in Kitchener-Waterloo
- Developing a nursing workplace for optimal patient care and nurse thriving in a safe, encouraging work culture
- Determine what's needed for a thriving nursing workforce.
Healthy Work Environment Group Activity
- Consider these elements when developing a workplace: staffing levels, professional development, workplace safety, recruitment and retention, psychological well-being, occupational health and safety, health and lifestyle practices, and corporate social responsibility.
Break
National Quality Institute Model
- Developed with Health Canada in 2006
- Three dimensions: Organizational Culture (leadership, opportunity, openness, transparency), Physical Environment (safety legislation), Health and Lifestyle Practices (healthy behaviours, work-life balance) (Keatings, 2024)
Occupational Health and Safety
- Health and safety committees identify potential hazards, recommending solutions
- Workers can refuse unsafe work environments, unless risk is inherent, or actions endanger others' safety. Employers must minimize risks. (Keatings, 2024)
RNAO Healthy Work Environment Best Practice Guidelines
- Evidence-informed guidelines for creating healthy work environments
- Focus on well-being, client outcomes, and organizational performance.
- Conceptualizes a HWE as a complex system with interacting dimensions. Interventions focus on these dimensions and their interactions. (Keatings, 2024)
Workplace Violence
- Nurses face violence from patients, visitors, leaders, and coworkers.
- Disrespectful behaviour, discrimination, bullying, and harassment are types of violence.
- Safeguards include determining risk areas, introducing prevention strategies, and providing knowledge/skills to defuse situations (Keatings, 2024)
- Nurses need knowledge/skills to identify predisposed clients, recognize triggers, initiate prevention strategies, and manage violent behaviours. Additional support needed in high-risk communities. (Keatings, 2024)
Critical Thinking Scenario
- K.K., recently transferred to the emergency department, faced a patient who was belligerent and sexually aggressive
- K.K. was thrown across a room, suffering a head injury that led to PTSD.
Critical Thinking Questions
- How this scenario could have been avoided?
- Was K.K.'s limited orientation a factor? Who was responsible for the event?
- What resources are needed to support K.K.'s recovery and reduce the risk of nurses leaving the profession?
Peer-to-Peer Violence
- Bullying is behaviour that is intimidating, lacking respect, coercive, critical, or belittling.
- Often underreported and includes passive-aggressiveness, personal diminishment, incivility (Keatings, 2024)
Labour Relations and Collective Bargaining
- A union is a certified group of employees with a common employer.
- Decertification occurs when a union dissolves or loses its right to negotiate on behalf of its members.
Collective Bargaining
- Establishes processes for negotiating employment terms (wages, hours, etc.)
- Collective agreement includes dispute resolution mechanisms involving written submission, grievance committee meeting, and if unresolved - binding arbitration.
Disputes Regarding Workload
- "Obey and grieve" rule prioritizes patient needs (rights and needs) over nurse concerns.
- Nurses are expected to continue care, and review or grieve concerns after patient care is provided (Keatings, 2024).
Workload Scenario
- A nurse, Emily, is severely understaffed with a high workload of high-acuity patients and insufficient unit support staff, supplies, and medications, which leads to concerns about patient safety, workplace safety for the nurse, and professional responsibilities.
Workload Monitoring
- Review and complete the ONA Professional Responsibility and Workload Report form, using the supplied scenario details and related information (20211021_prwrf_hospital.pdf)
- Identify any CNO standards/guidelines at risk.
Right To Strike
- Nurses' right to strike varies by employment type. Strikes are generally considered illegal given the essential nature of nursing services - (Keatings, 2024). Collective agreements, however, can prevent striking. Employers cannot lock out employees when there is a collective agreement. Employers should not discipline employees for union activities.
Professional Accountability
- Nurses are accountable to their profession, regulatory body, patients, and employers.
- Ethical, legal, and professional responsibilities remain paramount even when union membership conflicts with workplace responsibilities (Keatings 2024)
Case Scenario 11.4 (Right or Privilege)
- A nurse (C.D.) called in sick on a weekend shift, despite an informal class reunion invitation, which led to an emergency room patient backup.
- A coworker disclosed C.D.'s reason to the nurse manager.
Case Questions
- Is C.D. entitled to take the time off? If not, what disciplinary action may ensue?
- Can the action be grieved if the manager chooses to discipline C.D.?
- Were any ethical principles breached?
- How could the situation have been prevented? (Page 42)
Case Scenario 11.6 (Right to Strike)
- A registered nurse (R.B.) works in a long-term care facility when their union breaks down and a planned strike is to occur.
- R.B. crosses the picket line, worried about residents and enters the hospital, despite receiving heckling from colleagues.
Case Questions
- What are R.B's rights and responsibilities?
- Is the behaviour of nurses on the picket line justifiable?
- What would you do in this situation?
- How could this situation have been prevented?
Summary
- Nurses have the right to be treated with respect, practice in a safe environment free from harm, discrimination and abuse
- Nurses have obligations towards patients, and employers have obligations to protect nurse rights.
- Nurses should be aware of their rights and educated to address workplace challenges. (Keatings, 2024)
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Description
This quiz covers crucial topics related to nurses' rights, workplace safety, and challenges in providing care. It explores professional regulations, workplace violence, and the ethical implications of conscientious objection in nursing. Test your understanding of these vital issues in the healthcare environment.
