Workplace Advocacy and Workplace Issues

1
Workplace Advocacy and Workplace Issues

• Insert Chapter 12 opening illustration

2
Key Concepts

• Workplace advocacy to improve the quality of
  health care
• Issues affecting professional nursing practice
• Resources to assist in improving the workplace
• Advocating for safe and effective workplace
  environments
• Internal and external workplace strategies for
  quality patient care

3
Overview

• Nurses are struggling to deliver patient care
  against many barriers
• Commitment to quality care and advocacy may place
  nurse in direct conflict with administrators

4
Professional Practice Advocacy

• Umbrella of activities to promote a professional
  practice environment
• Workplace advocacy
• Collective bargaining
• Activities supportive of
• Patient advocacy
• Professional practice self-determination
• Employment rights and responsibilities

5
Professional Practice Advocacy Examples

• Promoting occupational safety and health
• Using political processes to influence and
  protect nurses and patients rights
• Developing public reactions and conflict
  resolution skills
• Building coalitions and support groups

6
Workplace Advocacy

• Activities initiated to address workplace
  challenges
• Safe and effective workplaces are promoted by
  knowing where to seek information
• American Nurses Associations (ANAs) Commission
  on Workplace Advocacy supports workplace advocacy

7
Workplace Advocacy Examples

• Develop conflict resolution models to address
  patient care concerns
• Identify mechanisms for RNs to affect
  institutional policies
• Seek legislative solutions for workplace problems
• Develop legal centers for legal support and
  decision-making advice

8
Workplace Issues

• Nursing shortage
• Appropriate staffing
• Patient safety
• Workplace safety

9
Nursing Shortage Overview

• Managed care influenced cyclic shortages in the
  late 1990s and in early 2000
• Current shortage is more complex and long lasting
• Nursing employment opportunities will grow more
  rapidly than all other U.S. occupations through
  2008
• Planning for an adequate nursing workforce will
  be a critical challenge

10
Nursing Shortage Issues

• Health care is no longer a favored employer
• Decline in nursing school enrollments
• Increasing demands for nurses with specific
  education and skills
• Faculty shortage

11
Nursing Shortage Issuescontd

• Nurse retention
• Aging workforce
• Foreign nurse recruitment
• Compensation
• Work environment

12
Appropriate Staffing

• Factors contributing to inadequate nurse
  staffing
• Nursing shortage
• Cost-cutting initiatives related to managed care
• Absence of data to quantify effect of staffing on
  safety and quality

13
Mandatory Overtime

• Mandatory overtime/mandatory on-call requirements
  have increased
• Mandatory overtime studies
• Increased time lost to absenteeism
• Increased injuries
• Required 3 hours of work to produce an additional
  2 hours of productivity

14
Mandatory Overtime Issues

• May alleviate the employers sense of urgency to
  proactively find more appropriate staffing
• Nurses may feel resentment to bear the personal,
  professional, and legal burden for the staffing
  problem

15
Floating

• Nurses increasingly required to float to other
  patient care units
• Floating issues include
• Questions regarding knowledge, expertise, and
  experience needed to work in the area
• Time for orientation and training
• Availability of support from experienced nurses

16
Chapter Resources

• Questions about safe staffing to ask before
  accepting a position (Table 12-3)
• Resources to help decision making regarding
  adequate staffing and mandatory overtime (Table
  12-4)
• Questions to help make decisions to accept or not
  accept an assignment (Table 12-5)

17
Shared Governance

• Gives nurses an active role in decision making
• Attributes include independence, accountability,
  and autonomy over nursing practice
• Results in increased job satisfaction and
  efficiency and better patient outcomes
• Goes beyond participatory management through
  creation of structures to govern nursing practice

18
Patient Advocacy and Safety

• Patient advocacy is the cornerstone of nursing
• Complex systems and complicated technology lead
  to errors and adverse events
• Nursing must assert its powerful voice to promote
  safer health care systems

19
Errors in Health Care

• Two major studies indicate that errors in health
  care delivery kill 44,000 to 98,000 people in
  U.S. hospitals annually
• Nursing organizations are attempting to
  demonstrate the link between nurse staffing and
  patient adverse events

20
Whistleblower Protection

• Protects nurses who speak out about unsafe
  situations through appropriate channels
• Advocated for at the federal level and has passed
  in some states

21
Nursing Quality Indicators

• Major changes in care and staffing are occurring
  with few data to justify the effects on safety
  and quality
• Professional organizations are working to collect
  and publicize data to link nurse staffing mix
  with patient outcomes

22
ANAs Nursing-Sensitive Indicators

• Mix of RNs, licensed practical nurses (LPNs), and
  unlicensed staff caring for patients
• Total nursing care hours provided per patient day
• Pressure ulcers
• Patient falls
• Patient satisfaction with pain management

23
ANAs Nursing-Sensitive Indicatorscontd

• Patient satisfaction with educational information
• Patient satisfaction with overall care
• Patient satisfaction with nursing care
• Nosocomial infection rate
• Nurse staff satisfaction

24
Workplace Safety

• Needlesticks
• U.S. health care workers experience 800,000
  needlesticks annually
• Legislation is being passed to protect workers
• Ergonomic injuries
• Back injuries affect 38 of all nurses
• Workplace violence
• Major societal issue

25
Advocating to Prevent Workplace Violence

• Organizational assessments to identify high-risk
  environments, psychological conditions, and
  populations that threaten safety
• Staff education to address the identification and
  response to high-risk behaviors that can lead to
  violence

26
ANA's Workplace Advocacy Program

• Advocates for administrative controls
• Adequate staffing
• Health and safety committees
• Engineering controls such as ventilation and
  safer needle-stick devices
• Personal protective equipment such as respirators
  and synthetic gloves