Page 276 - Essentials of Nursing Leadership and Management, 5th Edition

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appendix 3 | Guidelines for the Registered Nurse in Giving, Accepting, or Rejecting a Work Assignment* 263 CikguOnline
It is Nursing Management’s Responsibility to: which the licensee knows or has reason to
know that he or she is not competent to
■ ensure competent nursing care is provided to
perform
the patient
■ performing, without adequate supervision, pro-
■ evaluate the nurse’s ability to provide special-
fessional services which the licensee is author-
ized patient care
ized to perform only under the supervision of a
■ organize resources to ensure that patients
licensed professional, except in an emergency
receive appropriate nursing care
situation where a person’s life or health is in
■ collaborate with the staff nurse to clarify
danger
assignments, assess personal capabilities, joint-
■ abandoning or neglecting a patient or client
ly identify options for patient care assignments
who is in need of nursing care without making
when the nurse does not feel personally com-
reasonable arrangements for the continuation
petent or adequately prepared to carry out a
of such care
specific function
■ failure to exercise supervision over persons who
■ take appropriate disciplinary action according
are authorized to practice only under the
to facility policies
supervision of the licensed professional
■ communicate in written policies to the staff
the process to make assignment and Of the above, the issue of abandonment or neg-
reassignment decisions lect has thus far proven the most legally devastat-
■ provide education to staff and supervisory ing. Abandonment or neglect has been legally
personnel in the decision making process defined to include such actions as insufficient
regarding patient care assignments and observation (frequency of contact), failure to
reassignments, including patient placement assure competent intervention when the patient’s
and allocation of resources condition changes (qualified physician not in
■ plan and budget for staffing patterns based upon attendance), and withdrawal of services without
patient’s requirements and priorities for care provision for qualified coverage. Since nurses at
■ provide a clearly defined written mechanism all levels most frequently act as agents of the
for immediate internal review of proposed employing facility, the facility shares the risk of
assignments, which includes the participation liability with the nurse.
of the staff involved, to help avoid conflict
Application of Guidelines for
Issues Central to Potential Dilemmas Are: Decision Making
Two clinical scenarios are presented for the RN to
■ the right of the patient to receive safe profes-
demonstrate appropriate decision making when faced
sional nursing care at an acceptable level of
with an unsafe assignment. Sometimes an example or
quality
two can help the RN objectively examine legal, ethi-
■ the responsibility for an appropriate utilization
cal and professional issues prior to making a final
and distribution of nursing care services when
decision. Additional resources are listed following the
nursing becomes a scare resource
scenarios.
■ the responsibility for providing a practice
environment that assures adequate nursing Scenario—A Question of Competence
resources for the facility, while meeting the
An example of a potential dilemma is when an
current socioeconomic and political realities of
evening supervisor pulls a psychiatric nurse to the
shrinking health care dollars
coronary care unit because of a lack of nursing
staff. The CCU census has risen and there is not
Legal Issues
additional qualified staff available.
Behaviors and activities relevant to giving, accept- Suppose you are asked to care for an unfamil-
ing, or rejecting a work assignment that could lead iar patient population or to go to a unit for which
to disciplinary action include: you feel unqualified—what do you do?
■ practicing or offering to practice beyond the 1. CLARIFY what it is you are being asked to do.
scope permitted by law, or accepting and ■ How many patients will you be expected to
performing professional responsibilities care for?