2. Mosby items and derived items copyright © 2002 by Mosby, Inc. Workplace Advocacy and Workplace Issues

3. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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

4. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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

5. Mosby items and derived items copyright © 2002 by Mosby, Inc. What is a Plan? Planning is decision making about future activities. Mission or purpose statement A strategic vision for future Operating philosophy Key elements of a plan: Goal Strategies Action steps Performance indicators

6. Mosby items and derived items copyright © 2002 by Mosby, Inc. Nation wide Regional or provincial Service facility Unit Individual Planning Hierarchy Level 1: broadest level of planning which sets strategic direction for 3 – 5 years Level 2: regional or provincial planning (within central office) Level 3: operational focused planning. Also called business or operational plan Level 4: (individual) refers to personal performance

7. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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

8. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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

9. Mosby items and derived items copyright © 2002 by Mosby, Inc. Advocacy Strategic Planning Model Research Issues/ Problems Goals/ Objectives Strategy Development Coalition building Networking Institution building Sensitization Etc. OutputsOutcomes Pre-testing & Piloting Implemen tation Impact Evaluation Monitoring

10. Mosby items and derived items copyright © 2002 by Mosby, Inc. Workplace Advocacy Activities initiated to address workplace challenges Safe and effective workplaces are promoted by knowing where to seek information American Nurses Association’s (ANA’s) Commission on Workplace Advocacy supports workplace advocacy

11. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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

12. Mosby items and derived items copyright © 2002 by Mosby, Inc.

13. Workplace Issues Nursing shortage Appropriate staffing Patient safety Workplace safety

14. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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

15. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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

16. Mosby items and derived items copyright © 2002 by Mosby, Inc. Nurse retention Aging workforce Foreign nurse recruitment Compensation Work environment Nursing Shortage Issues— cont’d

17. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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

18. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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

19. Mosby items and derived items copyright © 2002 by Mosby, Inc. Mandatory Overtime Issues May alleviate the employer’s 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

20. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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

21. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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)

22. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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

23. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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

24. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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

25. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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

26. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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

27. Mosby items and derived items copyright © 2002 by Mosby, Inc. ANA’s 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

28. Mosby items and derived items copyright © 2002 by Mosby, Inc. ANA’s Nursing-Sensitive Indicators—cont’d Patient satisfaction with educational information Patient satisfaction with overall care Patient satisfaction with nursing care Nosocomial infection rate Nurse staff satisfaction

29. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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

30. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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

31. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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

32. Mosby items and derived items copyright © 2002 by Mosby, Inc.