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Transcript of Healthcare
Shared governance: structured to involve employees in decisions related to work processes, resource allocation and work environment
Healthcare has changed dramatically since the late 1990's. Board of Directors Autonomy for nurses
Nursing Administration The uniting of employees to increase their ability to influence their employer and improve work conditions
Primary goal is to equalize the power between labor and management
Formal collective bargaining was first legally recognized in 1935 with the passage of the National Labor Relations Act (NLRA). The nurse must ask: Negotiation Adam Collins, Allison Daugherty, Breana Justus, Elisabeth Stacy, Jessica Tate Objectives: The Student Will Learn: The arrangement of the power hierarchy within an organization and how that power flows through the organization (Chapter 17).
Nursing roles and changes through the Patient Protection and Affordable Care Act (Chapter 18).
A nurse's role in politics and the importance of nursing organizations (Chapter 20).
The role of a forensic nurse in trauma and crime (Chapter 23). One of the most beneficial outcomes has been the new view of important contributions nurses and other direct-care staff make to client safety and quality outcome, Hospital Administration Medical Staff Nurses Chief Nursing Officer
Staff Nurses Models for Nursing Governance Shared governance
Counselor and Congressional Models
Unit Based Model Taft-Hartley Act
In April 1991. the NLRA defined 8 bargaining units that were appropriate in hospitals
Goals were to protect the employee against arbitrary treatment and unfair labor practices and to maintain and promote professional practice Is it unprofessional?
Is it unethical?
Is it divisive?
Closed shop or Open Shop?
Is there a threat to job security? Representation
Power and Benefits
Good-Faith Bargaining Mediation or Arbitration
Prospect of Strike
Ratifying Contract Concerns? Representation
Nursing Supervisors: Employees or Management? Healthcare Delivery Systems "In 2010, the passage of the landmark Patient Protection and Affordable care Act (PPACA) set the standard for the largest overhaul of the United States health-care system in 50 years." Health-Care Delivery System Cont. Politics in Nursing: It is NOT this. What Politics Have to do in Nursing IS: Nursing Shortage
Legalities in Practice
License Protection Nursing Shortage: Just What Are We Facing? Nurses across the US are aging.
New nurses are more and more commonly "late-entry nurses, meaning they are late 20's, early 30's, and older before they enter nursing school.
Nurse-to-Patient ratios are high
The current solution in many areas is foreign recruitment, and they have institutional licensure. What Are We Supposed To Do About It? Question... The Political Realm:
Who Do We Speak With? "Know the Structure to Play the Game" (p. 398) Why Be Active? Are you going to use your voice, or are you going to be in the "sleeping giant"? To gain control
To gain support
To increase numbers of licenses
To educate clients better, even with the shortened stays at the hospital The Process of Becoming Politically Active Know how laws are passed
Join your state nursing organization
Use the media, it is your friend and foe
Find your voice!
Find your place
Know your resources: Money
Volunteers Work with the public, earn their trust
Know the issues
Learn all the tactics
Organize, organize, organize How Are Bills Passed? Scheduled Debate
Passage or Veto?
The Fiscal Note
Executive Orders What Drives Legsislation? Funding
Constituent-Specific Issues Forensic Nursing What Is Forensic Nursing? Different Types of Forensic Nursing Sexual Assault Nurse Examiner (SANE) Forensic Nursing is the application of nursing science to public or legal proceedings. Forensic Nursing combines the bio-psycho-social education of the RN with the scientific investigation and treatment of trauma and/or death of victims and perpetrators of abuse, violence, criminal activity and traumatic accidents The role of the SANE nurse includes:
Interviewing the client
Completing physical exams
Documenting Findings Legal Nurse Consultant The legal nurse consultant is an RN who critically evaluates and analyzes health care issues in medically related lawsuits Forensic Nurse Death Investigator The role of the forensic death nurse is to advocate for the deceased. Forensic Psychiatric Nursing The role of forensic psychiatric nursing is to work with clients who have mental health issues. These nurses normally practice in psychiatric institutions, jails, and prisons. Forensic Correctional Nurse The forensic correctional nurse provides health care for inmates in correctional centers. This nursing job offers a high level of autonomy compared with other jobs. How Do I Become A Forensic Nurse? There are no official certifications for forensic nursing except for the SANE nurse.
To become a SANE nurse one must complete the adult/adolescent educational program. This program includes a minimum of 40 contact hours of instruction or 3 semester units of classroom instruction. The nurse must also have supervision by a licensed SANE nurse until time of the nurse-in-training's certification examination. Before you sign the dotted line.. Goals:
-The primary goal of the PPACA is to provide affordable healthcare to U.S. citizens who were previously unable to pay for or obtain health insurance.
-Secondary goals are to eliminate the insurance industry's stronghold on the healthcare system, address inequalities in current coverage, and to aide struggling senior citizens.
Goal of Maintaining Health
-Nurses played a role in planning the Health Care Reform Act and will continue to play a key role as the plan progresses.
-The influx of new clients into the health-care system offers new challenges and opportunities for nurses to expand their profession and practice to the level for which they were educated.
-The PPACA is placing emphasis on preventative care. All Americans can receive screening procedures at no out-of-pocket costs. Examples of these procedure include:
o Prostate exams
o Annual physical exams
o Preventative care such as immunizations
-This is a transition in emphasis from illness and disease to prevention and health promotion.
-One commitment that has always differentiated professional nursing from medicine is the goal of maintaining health and preventing disease. Nursing and Healthcare Reform -Over the past decade, training of physicians for primary care has decreased because of low reimbursement rates from insurance companies and government programs. It is unlikely that the current primary physicians will be able to handle the increase in clients seeking preventative care.
-The education of nurse practitioners has increase by 60 percent during the same decade. The PPACA provides some 50 million dollars per year to develop new programs for each of the nurse practitioner roles.
-Nurses have the opportunity to lead the cutting edge of health-care reform.
o Nurses have to continue to do what they have always done, but better.
o They have been the leaders in the development of new systems and models to accommodate change in the past when governmental programs have made changes in health care.
o Nurses are experts in increasing access to care while also maintaining the quality of care.
o They must also work on the political level to increase the ability of advanced practice nurses to provide the services they were educated to provide.
-Nurses can lead the restructuring that will mark the success of health care for decades to come or they can be overrun by the system and become a footnote to healthcare.
-The nurses who chose to learn about the new reforms and seek out opportunities will be the leaders health care requires. Opportunities and Challenges for Nursing
-The nursing shortage can be traced back to the implementation of managed care in the 1990’s as a method to controlling the cost of health-care. Managed care companies set requirements for procedures to be performed outside the hospital setting which lead to clients being sicker when they enter the hospital.
-Healthcare facilities hired less RN’s in favor of less-expensive personnel. Nursing expenses average between 50 to 60 percent of the overall operating budget making nursing services the largest single budget item.
-This was a very expensive mistake because large amounts of RN’s moved to home health and primary care settings. At the same time the population was aging, resulting in a need for more nurses to deliver high-quality specialized care in acute care facilities.
-As a result hospital units have closed due to lack of RN’s. It is estimated that one closed 20 bed general medical surgical unit will cost a hospital around $3 million in lost profits per year.
Stress on the Nurses
-The remaining nurses are discovering work conditions to be less than ideal.
-Factors that are adding to the stress nurses experience include:
o Mandatory overtime
o Short staffing
o Increased acuity of client conditions
-This has resulted in nurses calling in sick more often and leaving for facilities that require less demand.
-Many facilities costs have skyrocketed in relation to sick time, recruitment, and orientation.
Stress on the Facility
-During shortages of RN’s:
o The quality of health care decreases
o Clients are dissatisfied with the care they receive
o Serious mistakes are made in care and in some cases results in injury or death of clients
It only takes a few of these cases with awards of tens of millions of dollars to show the correlation between RN care and high-quality care. The Nursing Shortage -A proposed solution to nursing shortage problems is the institution of laws related to mandatory staffing ratios.
-Hospitals relate these kinds of laws to increased operating costs. Hospitals fail to realize that more RNs will equate with higher quality of care and ultimately reduce long-range health-care costs.
-Hospital associations in several states have challenged the laws and have effectively blocked their institution for the time being.
-Nursing groups generally support these laws and view them as a way to solve staffing shortages by appealing to nurses who are not currently practicing and nurses who are employed in other health-care settings to return to acute care facilities.
-Not everyone, including some in the nursing profession, is convinced that staffing ratio enforcement will cure an ailing health-care system.
-Leaders in the nursing profession hope the new laws related to staffing ratios will help emphasize the importance of the high-quality care nurses play a role in providing.
-The American Nursing Association has been placing attention to the fact that there is a direct correlation between the care RNs provide and positive outcomes for clients.
-The American Hospital Association previously recognized that RNs play a critical role in ensuring good client care.
-Evidence has shown that in hospitals with lower numbers of RNs, clients are more likely to stay longer, suffer more complications, and die from complications that could be treated successfully if identified earlier.
-Some nursing leaders see the passage of staffing ratio laws as an important but short term solution to a broader problem. The primary problem revolves around an overly aggressive policy of cutting costs by managed care, often at the expense of the very clients who support the system with their insurance premiums. Laws Related to Staffing Ratios