Week 11 Student Nursing Notes PDF

Professional Rights and Obligations NURS 72050 Agenda Warm up Personal Rights Workplace Violence EIDM Moment Work Environment Workplace Safety Unions Warm Up Nurses Rights Professional rules and regulations and ethical responsibilities may limit individual rights, May not...

Professional Rights and Obligations NURS 72050 Agenda Warm up Personal Rights Workplace Violence EIDM Moment Work Environment Workplace Safety Unions Warm Up Nurses Rights Professional rules and regulations and ethical responsibilities may limit individual rights, May not refuse care unless conscientious objection Vaccine mandates for infectious diseases Nurses also have rights and 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 for them Examples of such circumstances 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 RN of 5 years works in an obstetrical department in a large urban center. M.F is deeply religious and opposed to abortion. When they commenced working in O.B it was with the understanding that no therapeutic abortions would be performed or if they were it was done in another department of the hospital. Due to cutbacks the hospital has had to change the location of where the procedure is performed. When M.F learns that the assignment for the day includes assisting with a therapeutic abortion, they become angry and upset. M.F. approaches the manager to let them know that "there is no way I am going to assist with this" (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 the nursing standards of practice, scope of practice, and code of ethics when providing abortion care. a) Provides culturally safe abortion care; b) Articulates the importance of maintaining patient/client confidentiality across the continuum of care; c) Demonstrates understanding of the registered nurse scope of practice as it pertains to abortion care; and d) Demonstrates understanding of the professional responsibilities associated with conscientious objection as outlined in the CNA Code of Ethics. (CASN, 2024) Conscientious Objection A proactive approach to addressing these potential conflicts involves: employers informing prospective employees of the expectations of the role reassignment to other areas if the nature of responsibilities change nurses who anticipate a conflict with their conscience notify their employers so that alternative arrangements can be made Workplace Discrimination Agencies and workplaces have prioritized a more inclusive workplace since 2020. RNAO and CNA have acknowledged and recognized racism, and discrimination is embedded in the nursing profession and it impacts 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 the issues of racism and discrimination within the nursing profession. The graph is a summary of the number of publications found with a focus on racism and discrimination. (CNA, 2024) EIDM Moment-Scoping Review A scoping review is typically selected to investigate a broad research question that aims to identify and map all the available and emerging evidence. A scoping review aims to provide a descriptive summary of the sources of evidence without necessarily assessing the quality of the sources. Therefore, assessing the quality and risk of bias of the included studies is not required, however, some researchers choose to do so. The purpose of a scoping review: o identify the types of available evidence in a given area; o summarize the existing evidence; o identify gaps in the literature; o make recommendations for future research. An example of a research question used for a scoping review is: ‘What blended learning approaches are currently used in undergraduate nursing education?’ (Rodger, 2024) Key areas of workplace discrimination Within the scoping review the following were identified as key areas for 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 employees, such as exposure to harmful agents and infectious diseases (e.g., COVID-19 pandemic) increased stress disrespectful and non-supportive coworkers risk of physical harm from patients (Keatings, 2024) Right to a Healthy Work Environment In order to ensure a healthy culture, leaders should Ensure the resources and structures are available to support nursing care. These include appropriate staffing ratios optimizing full time positions, while offering flexible opportunities for nurses at various stages of their career. (Keatings, 2024) Right to a Healthy Work Environment Foster nursing engagement by rewarding effort and achievement creating a learning environment that supports leadership and professional development developing orientation programs that ensure a new graduate’s effective transition to practice Promote workplace health and safety Personal protective equipment 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)  Workplace Injuries (CFNU, 2020)​ Small Group Activity Review the next two slides related workplace quality and workplace injuries. Discuss your experience and thoughts related to safety in the workplace. When looking at the data what questions could you ask to critically appraise the data? A Healthy Work Environment A healthy work culture results in improved patient safety reduced absenteeism an improved ability to attract and retain employees high levels of staff satisfaction and engagement Several models exist to guide the creation of healthy work environments (Keatings, 2024) Group Activity Visioning the Future of Health Care in Kitchener- Waterloo You are assigned to support the development of the new hospital being developed in the Waterloo Region. Your job is to develop a nursing workplace that supports optimal patient care, and allows nurses to thrive in a safe and encouraging work culture. Determine what is needed to support a thriving nursing workforce. Healthy Work Environment Group Activity Consider the following when developing your workplace: o Staffing levels o Professional Development o Workplace Safety o Recruitment and Retention o Psychological Well-Being o Occupational Health and Safety o Health and Lifestyle Practices o Corporate Social Responsibility  Break National Quality Institute Model Developed with Health Canada in 2006 Three dimensions of a healthy work environment in this model are Organizational Culture (focus on leadership, opportunity, openness, and transparency) Physical Environment (meets and exceeds safety legislation) Health and Lifestyle Practices (encouraging healthy behaviours, work/life balance) (Keatings, 2024) Occupational Health and Safety Mandates health and safety committees to identify potential hazards and recommend solutions Workers have the right to refuse to work in unsafe circumstances, unless risk is inherent in the work Caring for persons with infectious disease (COVID-19) Refusal would endanger the life, health, or safety of others Employers have a legal responsibility to minimize risks (Keatings, 2024) RNAO Healthy Work Environment Best Practice Guidelines Evidence-informed guidelines facilitate the creation of healthy work environments A healthy work environment (HWE) is described as “a practice setting that maximizes the health and well-being of nurses, quality patient/client outcomes, organizational performance, and societal outcomes” Conceptualizes a HWE as a complex system with multiple interacting dimensions and components highlights the interdependence between the individual, the organization, and the external system interventions focus on these dimensions and their interactions with each other (Keatings, 2024) Workplace Violence Nurses are at risk of violence from patients, visitors, leaders, and coworkers Disrespectful behaviour, discrimination, bullying, and harassment are forms of violence Safeguards can be put into place, such as determining areas of risk Introducing prevention strategies providing knowledge and skills to defuse situations when they arise (Keatings, 2024) Workplace Violence Nurses must have the knowledge and skills to: identify clients predisposed to violence recognize triggers initiate prevention strategies manage violent behaviour when it occurs Nurses working in high-risk communities require additional support and security (Keatings, 2024) Critical Thinking Scenario K. K. was recently transferred from working in a labour and delivery unit to the emergency department of the same hospital. K. K. has been employed with the hospital for almost 5 years so was given a limited orientation to the emergency department. It was assumed that K. K. had experience and understood the policies and processes of the hospital. A few days after starting, K. K. admitted a young male patient who was clearly intoxicated. He was rude and belligerent. When he made a sexual advance toward K. K., they called out his inappropriate behaviour. He became extremely angry, grabbed K. K., and threw them across the room. K. K. sustained a head injury and required emergency interventions. After a few months, K. K. recovered but developed post-traumatic stress disorder (PTSD). Critical Thinking Questions How could this whole scenario have been avoided? What factors contributed to this traumatic event? Do you think that K. K.’s limited orientation was a factor? Who was ultimately responsible for this tragic event: K. K., the hospital, or the patient? What resources should be in place to support K. K. with the challenging recovery going forward? What are the risks that K. K. will leave nursing? How can this be prevented? How can K. K.’s traumatic experience assist others? Peer to Peer Violence Bullying is behaviour that is intimidating lacking in respect coercive critical or belittling often underreported Examples of bullying include passive-aggressiveness personal diminishment incivility, such as rudeness or gossip (Keatings, 2024) Labour Relations and Collective Bargaining A union is a provincially certified group of employees with a common employer or industry a bargaining agent for its members Decertification occurs when a union is dissolved or loses the right to negotiate on behalf of its members (Keatings, 2024) Collective Bargaining Establishes processes and rules whereby the terms and conditions of employment are negotiated for wages, hours of work, schedules, vacation pay, sick leave, etc. for settling disputes and grievances Collective agreements contain mechanisms for resolving disputes between management and workers The usual three-step process involves: a written submission a meeting with the grievance committee and if not resolved binding arbitration (Keatings, 2024) Disputes Regarding Workload In situations where nurses are concerned about their workload the The “Obey and grieve” rule applies, which means that the rights and needs of patients come first nurses must continue to provide care for patients failure to provide care is considered professional misconduct nurses may formally address or grieve the situation after care has been provided (Keatings, 2024) Workload Scenario Scenario: Nurse Emily arrives for her evening shift at the medical-surgical unit. As she checks the assignment board, she notices that the unit is severely understaffed. Instead of the usual five nurses, only three are scheduled to cover the entire floor, which includes several high-acuity patients. Details: Patient Load: Emily is assigned to care for ten patients, including two who require frequent monitoring due to unstable conditions. Support Staff: There is only one nursing assistant available for the entire unit, and no additional support staff like unit clerks or transporters. Resources: The unit is running low on essential supplies, and the pharmacy is delayed in delivering medications. Emily's Concerns: Patient Safety: With such a high patient load, Emily worries she won't be able to provide the necessary care and attention to each patient, potentially leading to missed medications, delayed treatments, and overlooked changes in patient conditions. Personal Safety: The physical and emotional strain of managing so many patients could lead to burnout, mistakes, and increased stress levels. Professional Responsibility: Emily is concerned about her ability to meet professional standards and hospital policies under these conditions, which could impact her nursing license and career. Workload Monitoring Review and complete to the ONA Professional Responsibility and workload report form based on the information provided in the scenario. 20211021_prwrf_hospital.pdf Identify the CNO Standards/Guidelines you believe to be at risk. Right To Strike For nurses the right to strike varies depending on the nature of their employment It is illegal for nurses and other hospital employees to strike, as their services are deemed essential. It is also illegal for employees to strike when a collective agreement is in place an employer to lock out employees when a collective agreement is in place employers to discipline employees for lawful union activities (Keatings, 2024) Professional Accountability Nurses are accountable to their profession, regulatory body, patients, and employers At times union membership may conflict with these accountabilities Ethical, legal, and professional responsibilities must remain paramount (Keatings, 2024) Case Scenario 11.4 (Right or Privilege) C.D., a nurse in a busy critical care unit is scheduled to work nights on a weekend and is subsequently invited to attend an informal class reunion. C.D. knows that it is too late to ask for the weekend off and that other nurses are unlikely to switch shifts on such short notice willingly. C.D. has taken little sick leave, and because of this decides to call in sick. That night several emergency room patients are admitted to the unit because of C.D.'s absence the nurses on duty must take on a double assignment. One of the nurses aware of CD's reason for calling in sick is upset and discloses this information to the nurse manager the following Monday Case Questions Is C.D., entitled to take this time off? If not, what disciplinary action may ensue? If the manager chooses to discipline C.D., can this action be grieved? What ethical principles, if any, were breached? How could this situation have been prevented? Case Scenario 11.6 (Right to Strike) R.B., is a registered nurse working in a long-term care facility. Recently, contract discussions between the union and the facility have broken down. Neither side is willing to compromise, and the staff have voted to strike. A plan is in place for a minimal number of nurses to be available in emergencies. R.B., is concerned about the strike decision and is worried about the residents. Knowing how difficult and confusing the strike will be for them, R.B., decides to cross the picket line and go to work, and while entering the building is heckled by colleagues. Case Questions What are R.B’s., rights and responsibilities in this situation? Is the behavior of the 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 practise in an environment that is safe, and free from harm discrimination and abuse. As nurses have obligations to patients, employers have obligations to protect the rights of nurses. Nurses must be aware of their rights and acquire the knowledge to address challenges in the work environment. (Keatings, 2024)  References Canadian Association of Schools of Nursing (2024). Entry-to-Practice Abortion Care Competencies for Undergraduate Nursing and Nurse Practitioner Education in Canada. https://www.casn.ca/wp-content/uploads/2024/03/CASN-Abortion-Care-Competencies-2024 -EN.pdf Canadian Federation of Nurses Unions, (2020)​. Outlook on Nursing: A snapshot from Canadian nurses on work environments pre-Covid 19. https://nursesunions.ca/wp-content/uploads/2020/12/CFNU_outlook_ENfinal_web.pdf Canadian Nurses Association, 2024 Racism and Discrimination Among Nurses in Canada and the Impacts of the COVID-19 Pandemic: A Scoping Review. Racism and Discrimination Among Nurses in Canada and the Impacts of the COVID-19 Pan demic: A Scoping Review | Canadian Association of Schools of Nursing / Association canadienne des écoles de sciences infirmières (CASN / ACESI). Keatings, M., & Adams, M., (2024). Ethical and Legal Issues in Canadian Nursing. (5th ed). Elsevier Rodger D, Admani A, Thomas M (2024)., What is a scoping review? Evidence-Based