What qualities do you think are most important to be a good nurse manager?

Read Chapters 2 & 3

1. Discuss the differences between a leader and a manager.

2. Which is more important, working for an effective leader or an effective manager? Explain your answer.

3. Observe the nurse manager in a unit to which students have been assigned. What management style is displayed? How does the staff respond to this style

4. What qualities do you think are most important to be a good nurse manager?

1. Interview the nurse manager on your assignment unit. What interpersonal, decisional, and informational activities does he or she complete on a daily basis?

2. You are the nurse manager on your unit. One of the most experienced staffers has been out on sick leave, and another just had a baby. The rest of the staff are working very hard to pick up the slack to avoid using agency personnel. What tangible and intangible rewards might you use to thank the staff?

3. PART 1: Begin by writing a 50-word description of the ideal nurse manager, someone you would like to work for. Describe a real-life nurse manager whom you have encountered in one of your clinical rotations. What qualities of this person meet your ideal? In what ways does this individual not meet your ideal? (Reminder: nobody’s perfect.)

PART 2: Think about becoming an ideal manager yourself. What qualities of an ideal manager do you already possess? What qualities do you still need to develop? How will you accomplish this?

1. Find your own state’s requirements for informed consent. Do elective procedures and emergency situations use the same standard?

2. Obtain a copy of your state’s Nurse Practice Act. Does the act give adequate guidance for nurses to know if an action is within the scope of nursing practice?

1. Explain how the Nurse Practice Act in your state provides for consumer protection and for professional nursing progress.

2. What are your thoughts on multistate licensure? How does it strengthen and weaken professional nursing?

3. As a new nurse, how can you ensure confidentiality in clinical settings?

4. How can nurses safeguard the confidentiality of medical information when sending it by fax or e-mail?

5. Explain the role of the nurse in obtaining informed consent. Do you believe that this is within the scope of nursing practice? Explain your answer.

6. Should nurses carry malpractice insurance? Explain your answer.

7. Should all patients have advance directives? Explain your answer.

8. Should employers be permitted to require nurses to work overtime if there is a shortage of registered nursing staff on a unit? Support your answer with evidence from the literature.

Manager

Chapter 2

Management

Getting work done through others
Doing what is needed to assist employees to work well

Management Theories

Scientific Management

Efficiency-focused
Increasing productivity is the goal
Workflow and time to complete tasks is measured and evaluated.

Human Relations-Based Management Theory X

Work is something to be avoided.
People want to do as little work as possible.
Use: Control Supervision Punishment

Human Relations-Based Management Theory Y

The work itself can be rewarding.
People really want to do their job well.
Support using
Guidance
Development
Reward

Servant Leadership

People have value as people.
Commit to improving treatment at work.
Employee first

Qualities of an Effective Manager

Leadership
Clinical expertise
Business sense

Management

Decisional
Interpersonal
Informational

Behavior of an Effective Manager

Interpersonal
Networking
Conflict negotiation and resolution
Employee development
Coaching
Rewards and punishments

Behavior of an Effective Manager (cont’d)

Decisional activities
Employee evaluation
Resource allocation
Hiring and firing
Planning for the future
Job analysis and design

Behavior of an Effective Manager (cont’d)

Informational activities
Spokesperson
Monitoring
Reporting

Conclusion

Nursing management is a complex, responsible position.
Ineffective managers may harm
Employees
Clients
Organizations
Copyright © 2015. F.A. Davis Company
Nursing Practice and the Law
Chapter 3
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Objectives
- Identify three major sources of law.
- Explain the differences among various types of laws.
- Differentiate between negligence and malpractice.
- Explain the difference between an intentional tort and an unintentional tort.
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Objectives (cont’d)
- Explain how Standards of Care are used in determining negligence and malpractice.
- Describe how nurse practice acts guide nursing practice.
- Explain the purpose of licensure.
- Explain the difference between internal standards and external standards.
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Objectives (cont’d)
- Discuss Advance Directives and how they pertain to patients’ rights.
- Discuss the legal implications of the Health Insurance Portability and Accountability Act (HIPAA).
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Meaning of Law
- Law refers to any system of regulations that govern the conduct of individuals within a community and/or society in response to the need for regularity, consistency, and justice.
- Law is the rules that prescribe and control social conduct in a formal and legally binding manner.
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Types of Laws
- Statutory law
- Common law
- Administrative law
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Statutory Law
- Created by various legislative bodies
- Congress
- State legislatures
- Examples of federal statutes
- Patient Self-Determination Act of 1990
- The Americans with Disabilities Act
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Statutory Law (cont’d)
- Examples of state statutes
- Nurse Practice Acts
- Good Samaritan Law
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Common Law
- Comes from the traditional unwritten law of England.
- Based on custom and usage.
- Develops within the court system as judicial decisions are made.
- One decision creates the precedence for another.
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Administrative Law
- Procedures created by administrative agencies
- City councils
- County boards
- State government
- Established through the authority given to government agencies by a legislative body
- Boards of Nursing
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Sources of Law
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The Constitution
- Foundation of American law
- The Bill of Rights
- Limits the power of the government and protects citizens’ freedoms
- Constitutional law evolves as issues emerge.
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Statutes
- Localities, state legislatures, and the U.S. Congress create statutes.
- Ordinances
- Local statutes
- Example: noise ordinance
- Nurses can influence the development of statutory laws.
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Administrative Law
- Created by administrative agencies that develop specific rules and regulations that direct the implementation of statutory law.
- Rules must be consistent with statutory laws.
- Specific statutory laws give state Boards of Nursing the authority to issue and revoke licenses.
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Agencies
- Department of Health and Human Services
- Department of Labor
- Department of Education
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Types of Laws
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Criminal Law
- Felony
- Misdemeanor
- Juvenile
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Civil Law
- Tort
- Quasi-intentional tort
- Negligence
- Malpractice
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Other Laws Relevant to Nursing Practice
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Good Samaritan Laws
- Created to encourage physicians and nurses to respond to emergencies
- Protects licensed health-care providers from civil liability as long as they “behave in the same manner as an ordinary, reasonable, and prudent professional in the same or similar circumstances.”
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Confidentiality
- Patients have the right to confidentiality.
- Information should only be shared with others who have a “need to know.”
- Need permission to share information
- HIPAA
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Social Networking
- Use of technology has caused an increase in violations of confidentiality.
- Breach of confidentiality without intent
- Need to be aware of institutional policies on social networking
- Immediate termination
- Cancellation of contracts/affiliation agreements with outside agencies
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Slander and Libel
- Quasi-intentional torts
- Slander refers to the spoken word.
- Libel refers to the written word.
- Can refer to patients, coworkers, or other individuals
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False Imprisonment
- Confining an individual against his or her will
- Restraining
- Detaining
- Removing a patient’s clothes
- Keeping a patient who has been medically discharged for an unreasonable amount of time
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Assault and Battery
- Assault is the threat to do harm.
- Battery is touching without consent.
- The significance of an assault is embedded in the threat.
- Often, the terms are used together.
- Informed consent
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Standards of Practice
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Purpose
- Guidelines to ensure quality of care
- Criteria to determine if quality care has been delivered
- May be specialty directed
- AACN standards of care
- AWHONN standards of care
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Internal Standards
- Developed within institutions
- Usually explained within specific policies
- Included in Policy and Procedure Manuals
- Based on current literature and research
- Nursing responsibility to meet the institution’s standards
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Use of Standards in Nursing Negligence and Malpractice
- One of the elements used to determine liability
- Use of professional standards
- Institutional policy
- Standards of the Specialty organization if warranted
- Expert opinions
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Patient’s Bill of Rights
- Created by the American Hospital Association in 1973 and amended in 1992
- In 2003, replaced by the Patient Care Partnership
- The patient rights were derived from the ethical principle of autonomy.
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Informed Consent
- Informed consent is a legal document in all 50 states.
- Requires physicians to divulge the benefits, risks and alternatives to treatment, nontreatment, and/or procedures.
- Allows individuals to be involved in choices about their health care.
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Informed Consent (cont’d)
- Permits health-care providers to “touch.”
- Physicians are responsible for “obtaining” the informed consent.
- Nurses are involved in the process when
- Witnessing a signature
- Clarifying questions
- If a nurse assesses that a patient lacks a full understanding of the risks/benefits, the nurse should notify the physician.
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Criteria for Informed Consent
- A mentally competent adult as voluntarily given the consent.
- The client understands exactly what he or she is consenting to.
- The consent includes the risks involved in the procedure, alternative treatments, and risk of refusal.
- The consent is written.
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Implied Consent
- Occurs when consent is assumed
- Emergency situations
- Child is involved and the health-care institution is unable to reach parents and/or legal guardians
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Staying Out of Court
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Prevention
- Practice caring behaviors.
- Demonstrate an interest in patients and their families.
- Assist patients and families in making choices by providing information.
- Maintain accountability.
- Adhere to Standards of Practice.
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Documentation
- Needs to be legally credible
- Avoid charting by exception.
- Clear, concise, and accurate
- Only sign off on medications once administered.
- Document assessments after completion.
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Keys to Credible Documentation
- Contemporaneous
- Accurate
- Truthful
- Appropriate
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Common Actions Leading to Malpractice Suits
- Failure to assess properly
- Failure to report changes in a patient’s condition to the appropriate personnel
- Failure to document in a patient’s record
- Altering or falsifying a patient’s record
- Failure to obtain an informed consent
- Failure to report a coworker’s negligence or poor practice
- Violation of internal or external standards of practice
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What to Do if Named in a Suit
- Contact the legal department of your institution.
- Answer the complaint.
- Obtain legal guidance/representation.
- Only sign documents after review by legal counsel or malpractice insurance company.
- Maintain a file of all information connected to the case.
- BE HONEST.
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Professional Liability Insurance
- Nurses need to consider obtaining insurance.
- Policies protect nurses against personal financial loss.
- If a nurse is found guilty of malpractice the employing agency has the right to sue the nurse to reclaim damages.
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End-of-Life Decisions and the Law
- Do Not Resuscitate Orders (DNRs)
- Advance Directives
- Patient Self-Determination Act
- Living Will
- Health-Care Surrogate
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Patient Self-Determination Act
- Allows individuals to make decisions regarding treatment in advance of a time when they may be unable to make these decisions.
- Federal law directs that health-care institutions that receive federal funding inform patients of their right to create advance directives.
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Provisions of the Act
- Provide information to every patient.
- Document.
- All patients must be asked if they have a Living Will.
- Ask about a health-care surrogate (Durable Power of Attorney).
- Must be placed in the patient’s record.
- Educate.
- Be respectful of patients’ rights.
- Have cultural humility.
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Nursing Implications
- The Patient Self-Determination Act does not specify who should discuss treatment decisions or advance directives with patients.
- Nurses are patient advocates.
- Nurses need to have knowledge about documents pertaining to the Act.
- Review institutional policies.
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Issues Affecting Practice
- Legal implications of mandatory overtime
- Affects patient safety
- Position statements from nursing organizations
- Nurse Practice Acts
- Licensure
- Qualifications
- Endorsement
- Multistate
- Disciplinary action
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NCLEX-RN
- Preparation
- Review courses
- NCSBN online NCLEX-RN study program
- Test plan
- Test plan blueprint changed in April 2013
- Changes in the blueprint are based on findings from practice.
- Level of difficulty increased
- Alternative question formats
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Preparing for NCLEX-RN
- Be positive.
- Use relaxation techniques.
- Advance planning.
- Pack an “NCLEX bag.”
- Perform a “dry run” at the same time you would leave to get to the test site to familiarize yourself with the area, parking, etc.
- Call the Center and see if you may bring water or snacks.
- Eat well and get a good night’s sleep the night before the test.
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On the Day of the Test
- Eat before you leave.
- Leave early and give yourself sufficient time to arrive at your destination.
- Bring a jacket or sweater.
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Conclusion
- Nurses need to understand the legal issues regarding practice.
- It is important to know and understand the Nurse Practice Acts in your state.
- Patients expect nurses to provide safe, competent, and quality care.

What qualities do you think are most important to be a good nurse manager?

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