Ethical challenges, such as professional-personal boundary conflicts, end-of-life decision-making, and maintaining patient privacy and confidentiality, occur in everyday nursing practice. New graduate nurses and those with less experience tend to face these challenges more frequently.
Regardless of where they practice, nurses are always faced with ethical challenges, and they can impact nurses’ day-to-day practice and patient care outcomes. Therefore, it is important that every nurse has knowledge and strategies to manage these challenges appropriately. Here are some tips to guide you:
- Understand the Code of Ethics for Nurses and be able to address and apply them effectively. The Code of Ethics for Nurses, developed and released by the American Nurses Association (ANA), is an important document that can provide direction and guidance for nurse’s day-to-day decisions and actions.
- Be familiar with the hospital/organizational values.
- Identify and use the ethics resources available within your organization, such as the hospital ethics committee, for consultation.
- Consult with others, such as the head/manager of nursing or supervisor, when a complex ethical situation arises.
- Talk with your patient and his or her family to gain perspective or an understanding of their choices.
- Be aware of the effectiveness of nursing interventions and activities – and standards of practice.
- Stay up-to-date with policy changes in your hospital/organization.
- Engage with the hospital ethics committee and attend the meetings when time permits.
- Collaborate and network with professional organizations/associations to gain more insight and understanding of various emerging ethical issues.
- Read nursing ethics articles to gain knowledge and ethics perspective.
- Take ethics education or training to increase ethical competence.
Not only are ethical challenges time-consuming and stressful, but also they can potentially negatively impact the patient’s quality of care and the nursing professional’s role. Managing these challenges will require ethical knowledge, work experience, and personal commitment to do what is right. Continuing ethics education is of the utmost importance to help nurses suitably manage these challenges, providing tools and skills necessary for their ethical decision-making and competence.
The American College of Nurse-Midwives (ACNM) is once again sponsoring National Midwifery Week, which kicks off today, October 1, and lasts through Saturday, October 7.
For centuries, nurse midwives have been partners and guides in women’s healthcare around the world. They carry out their compassionate care wherever it is needed as a woman progresses through her life. Nurse midwives are best known for their care during pregnancy, childbirth, and the post-partum period, but they can assist women throughout each stage of their lives—from the teen years to women past menopause.
Nurse midwives deliver services in homes, hospitals, birth centers, and other healthcare settings. They are there to carry out routine physicals through to newborn care.
Although there are several types of midwives, certified nurse midwives (CNM) have a degree in nursing and a graduate degree in midwifery nursing plus additional training and specific certification (through the American Midwifery Certification Board) in midwifery. CNMs are able to prescribe medication. Certified midwives have degrees in an area other than nursing, but then progress through the same certification process. In the United States, the overwhelming majority of midwives are CNMs.
Midwives have always played an important role in patient-focused healthcare as their care approach is directed on the patient and what she needs at that given point in time. Every woman’s body is as different as her healthcare needs, so midwives are trained in assessing each woman’s individual situation to bring her the best healthcare possible.
Most midwives work as part of a woman’s healthcare team, and spend direct one-on-one time to establish a trusting relationship and to learn what the woman wants from her healthcare. Nurse midwives provide their patients with plenty of education so they can make the best, most informed, and most comfortable decision for themselves.
And a nurse-midwife provides the essential hands-on care during labor and delivery, offering both physical comfort and emotional support. Especially during a low-risk pregnancy and birth, the guidance and presence of a nurse midwife gives a woman a greater sense of control as labor progresses and reduces the occurrence of interventions like a c-section while raising the percentage of new moms who initiate breastfeeding.
According to the ACNM, “In 2014, CNMs/CMs attended 332,107 births—a slight increase compared to 2013.” Those numbers amount to about 8.3 percent of all US births. The expertise provided by nurse midwives coupled with the patient-centered and customized plan of care is becoming an increasingly popular option for women who are seeking more personal care from a highly trained professional.
This week, celebrate the nurse midwives in your life with a acknowledgment of how their steady care helps moms and babies throughout the world. If you are a midwife, this is a good time to share your story and call attention to your profession. Post on social media using #MidwivesMakingStrides and share your patients’ feelings about nurse-midwife care.
The Nurse Professional Liability Exposures: 2015 Claim Report Update reveals that malpractice claims against nurses are on the rise. According to the report, more than $90 million was paid in nurses’ malpractice claims over a five-year period.
Nursing malpractice occurs when a nurse fails to perform his or her medical duties competently and that failure harms the patient. It is true that negligence on part of a nurse can cause serious harm to a patient, but the nurse may not always be at fault.
A number of factors contribute to the quality of care that is provided to patients. For instance, the type of facilities available at the hospital or nursing home, the diagnosis made by the treating doctor, the medical information provided by patients or their families, and so on determine the kind of care to be provided to patients.
However, there may be instances when the nurse might be blamed for someone else’s error. If you’re a nurse and something similar has happened to you, you must proactively try to defend yourself with the help of an experienced attorney.
How Negligence and Malpractice Claims Affect a Nurse’s Career
A nurse is required to adhere to the ‘standards of care’ in nursing. By adhering to the standards of care, the nurse ensures best-quality care for patients and stays away from facing the legal hassles of negligence and malpractice. However, a nurse can be sued even if he/she has complied with the standards of care. If this happens, then the nurse’s career will be in jeopardy. The nurse’s license can also be revoked. A lawsuit brought against a nurse can also wreak emotional havoc and strike a fatal blow to his/her self-confidence and self-esteem.
Moreover, other patients under the care of the same nurse may also be affected severely. Therefore, if you believe that you are wrongfully sued or you were only partly responsible for the harm, then you must work with an experienced lawyer and defend yourself.
Remember, medical malpractice laws are enacted and regulated by individual states, so you must appoint an attorney who is well-versed with the laws in your state. For instance, if you are a nurse in Savannah, then you must work with a Savannah personal injury attorney, who can defend you in court.
Defending Nursing Malpractice Claims
After a lawsuit has been filed against a nurse, various defenses can be raised that can absolve the defendant completely or limit the plaintiff’s claims. Some of the most common defenses used to protect nurses in nursing malpractice cases are:
1. Failure to Prove the Elements of Negligence
Just as in any personal injury case, the plaintiff in a nursing malpractice case is required to prove the four elements of a successful claim. These include:
- Duty to the plaintiff
- Breach of duty
- Damage or injury caused due to the breach of duty and
- Proximate causation
If the defendant is able to prove that any one or more of the above elements is not established by the plaintiff, the case may be absolved.
2. Contributory Negligence
If you can prove that the patient was also partly or fully responsible for his injuries/harm, then you can get the case absolved or at least lower your penalty. Contributory negligence involves not communicating the medical history adequately, not following instructions, and not following up. The attorney will study the case and analyze the various factors involved to determine the factor that led to the injury/harm. It is for this reason that you are required to provide in-depth information about whatever happened. However, some states have adopted the comparative negligence approach. So, it is important that you work with an experienced attorney, who can help you understand the laws in your state.
3. Violation of Statute of Limitations
Most states have enacted statutes of limitations, which determine the time frame within which a plaintiff is required to file a personal injury case. If the plaintiff fails to file the case within this predetermined time limit, then it can be used as a defense by the defending party. However, several exceptions have been made to the statute of limitations and these vary from state to state. Therefore, only a seasoned attorney can help you understand whether or not you can use this defense.
There can be several other defenses depending upon your specific case. A skilled attorney will look into the case and decide which recourse will be most suitable for you. Remember, you need to provide enough evidence to prove your innocence. Thus, professional assistance is important.
With nursing malpractice claims rising each year, nurses need to become more cautious about their work and the quality of care they provide to the patient. However, in case you are sued by a patient, you have the choice to get legal help and prove your innocence. If you believe you aren’t at fault, then work with an experienced lawyer and get your name cleared.
Despite a nurse’s best efforts, some patients aren’t willing to follow instructions, but the impacts of patient noncompliance are too serious to ignore.
Prescription drugs provide an excellent example of the importance of adherence. It’s estimated that up to 30% of prescriptions go unfilled and as much as 50% of medications for chronic disease are not taken as directed according to a study published in Annals of Internal Medicine. The study’s authors go on to say that failure to follow prescriptions causes about 125,000 deaths per year and up to 10% of hospitalizations.
Nurses can enhance patient understanding of and adherence to their overall treatment plans by strengthening communication, rapport, and education.
It Starts with Communication
Asking the right questions and opening the lines of communication between patient and nurse can uncover critical barriers to treatment compliance.
- Pose questions in a constructive, problem-solving manner. For example, “I see that you have not been completing your daily exercises. I wonder if they are causing you too much pain, or if there is some other reason?”
- Try to relate personally to the patient to build a stronger therapeutic partnership. Get the patient to express what the nurse and care team can be doing to help them better meet their personal health goals.
- Set and adhere to a discussion agenda for every encounter. Begin with a discussion of the patient’s personal goals and issues before moving on, such as “First, tell me what concerns you most, and then we’ll discuss test results.”
Encouraging Cooperation and Participation
Explain to patients that they must take some responsibility for the outcome of their care and treatment. Let them know that everyone caring for them wants them to be successful in regaining their health. If barriers to compliance persist, try asking the patient what he or she believes would be more effective. The goal should be to achieve a mutually acceptable care plan.
- Clearly and explicitly convey the severity of the problem and the risks of not properly carrying out instructions. Give the patient an opportunity to ask questions and clarify the instructions.
- Find out if there are any underlying factors affecting compliance. For example, “It sounds as though you may be concerned about the medication’s possible side effects. Is that why you have not taken it as prescribed?”
- Identify any practical or logistical difficulties that may hinder compliance.
- End each encounter by having the patient verbalize at least one self-management goal.
Enhancing Patient Education and Understanding
Key barriers to communication – such as low health literacy, cognitive impairment, or limited English – need to be assessed early on to help uncover the best solution for successful communication.
- Have access to qualified and credentialed interpreters for use when necessary.
- Ask patients if they have any questions about their medications and ask that they describe in their own words how to take them.
- Consider involving a health coach, health navigator, and/or case manager for the patient.
- Ask patients to repeat critical instructions and paraphrase in everyday words the medical information they have been given.
Helping Patients Manage Logistics
Sometimes a patient’s noncompliance issue is out of their hands due to a lack of personal support at home or financial restraints. Uncover where those patients are struggling:
- Do health care information records note who can help your patient when they’re outside of the health care setting? Do they have the consistent help of a spouse, relative, friend, or paid caregiver to aid with their care?
- Are patients asked whether they can get to appointments via car or public transportation, and are responses documented in the patient care record?
- If a patient lacks the physical or mental capacity to perform such essential tasks as changing dressings or picking up prescriptions, has a relative or friend been asked to assist, with the permission of the patient or legal guardian?
- Does the patient lack the financial resources to comply with their current care plan? Are they concerned about the out of pocket costs for treatment, or having to take time off of work?
- Document these concerns in the patient care record, and work with the patient and their primary care provider (with the patient’s permission) to find solutions.
Supporting the Effort with Documentation
To help staff deal with hostile, manipulative, or uncooperative patients, written protocols should be in place to help all staff respond to and deal with difficult patients. This should include ways to document and procedures for such common concerns as:
- Repeated prescription refill requests of questionable nature
- Narcotic use and general pain management in drug-seeking patients
- Appointment or procedure cancellations
- Unacceptable behavior, such as belligerent voicemail messages or yelling or cursing at staff
- After-hours patient calls
- Refusal to consent to recommended treatment
- Neglecting to take medications, do exercises, or make necessary lifestyle changes
- Terminating the patient-provider relationship
Driving patient compliance often means health care teams need to repeat themselves again, and again, and again. Different tools and strategies can help nurses drive compliance.
- Remind patients of upcoming appointments, including referrals and laboratory visits, via telephone and/or email.
- Try electronic alerts to remind patients with a history of noncompliance about screening and monitoring requirements.
- Inform blind or visually impaired patients of subscription services that use wireless devices to deliver reminders to take medications or perform vital self-care activities.
- Schedule follow up and referral appointments before patients leave the facility.
- Document no-shows and conduct telephone follow-up within 24 hours.
Know if there is a written policy for terminating the patient-provider relationship if the patient is chronically noncompliant and fails to respond to reminders and other messages.
Keep at It
Patient noncompliance is a deep issue with no easy answers or simple solutions. Nurses in almost any setting will encounter noncompliant patients, but with consistent communication and a persistent, but cooperative, spirit nurses can work to overcome the risk of noncompliance one patient at a time. Nurses also can explore Nurses Service Organization’s patient self-assessment checklist to help facilitate open communications.
Disclaimer: This article is provided for general informational purposes only and is not intended to provide individualized business, risk management or legal advice. It is not intended to be a substitute for any professional standards, guidelines or workplace policies related to the subject matter.
Approximately 85.11% of candidates passed the NCLEX RN on their first attempt in 2017, according to the National Council of State Boards of Nursing (NCSBN). You can be one of those who passes the exam on the first try, too; you just have to know how and work through it.
Here are five tips to help guide you.
1. Familiarize yourself with the NCSBN website.
The NCSBN website provides critical information that you need to know about the NCLEX before taking the exam. Check all the rules and requirements. You need to get to know anything and everything you can about the exam so you can take the NCLEX exam with confidence.
2. Start preparing early.
Give yourself enough time to study. Establishing a timetable for your study is essential. Manage your study as if it is your full-time job. Try and get rid of all distractions, and make sure you feel as comfortable and able to focus as possible. Everyone is different, so make sure you develop a study routine that works for you, whether that’s studying in the AM if you’re a morning person OR in the evening if you are most productive at night.
3. Discover your knowledge early on.
It is crucial that you figure out the areas where you feel especially weak and that you need to focus on the most. Make sure that you spend more time reviewing content material related to these areas and keep practicing.
4. Take practice exams every day.
One of the most effective ways to prepare for the NCLEX exam is to practice taking past versions. It is important to take multiple practice tests and answer hundreds of questions in order to become increasingly familiar with the test format and questions. Also, take more time to review the correct answers for the questions you got wrong. The NCLEX exam is designed to determine if you have nursing knowledge and critical thinking skills required to begin practicing as a nurse. You are required to analyze the test questions using your critical thinking skills and nursing knowledge to make decisions about common nursing situations. There are a great deal of online guides and test questions, many of them free or at an affordable price. Make sure that you take advantage of these resources. A particular resource that I would recommend is the NCSBN’s Review for the NCLEX Exam.
5. Last but not least, set yourself up for success on the test day.
Stay positive and expect to pass. What everyone says is true–a good night’s sleep can make all the difference. Make sure you go to bed early the night before the test and regulate a full night of sleep (at least 7-8 hours). Be relaxed during the exam and remind yourself that you are well-prepared for the exam and ready to pass.
Prostate cancer is the second most common form of cancer in men (skin cancer is first), with the American Cancer Society estimating 161,360 new cases in 2017. A nurse’s role in prostate cancer awareness, prevention, diagnosis, and treatment is essential. As a professional nurse, a loved one, friend, or peer, nurses are on the front lines. They have the knowledge to help people identify what’s going on and have the resources and expertise to help them with treatment options and cutting-edge developments.
Leanne Schimke, MSN, FNP-C, CRNP, CUNP, works with urology patients in private practice and also with the Lancaster Rehab Hospital, and uses Prostate Cancer Awareness Month as a great opportunity to inform people about the disease. Of all things a patient might hear, getting any kind of life changing diagnosis like a cancer diagnosis is overwhelming. A nurse can help educate patients and also offer support. “Nurses need to understand it will take multiple discussions for the patient to retain the information,” says Schimke. “It is helpful to include family members and correct any misconceptions.”
Involving the patient and their loved ones in discussions helps ensure that the information will be understood and retained. Nurses can help patients by answering their questions, of which they probably have many, and making sure they know where to find additional reliable and accurate information. Surfing the internet for information about prostate cancer treatment and prognosis isn’t going to give them the information a nurse can. “I help provide context on information they obtain through the Internet, friends and family,” says Schimke, “such as helping them understand if a certain treatment is an option for them, especially at later stages of disease progression.”
And she also acts as a reference. She encourages patients and their loved ones to write down questions and to understand that while they can’t delay treatment decisions, they should not rush into them. They can take the time to choose the best option for them, and they have time to get a second opinion. “I help them have realistic expectations – some assume when they are diagnosed with prostate cancer they are going to die soon when that is not the case – and in others I need to help them understand that their time is limited. I am a contact for patients to answer their questions and help with their symptoms.”
Schimke also helps dispel the many myths about prostate cancer. Prostate cancer may not be the leading cause of cancer deaths in men, but it is a killer. “I would like to discuss the statement ‘no one dies from prostate cancer,’” she says. “Approximately 14 to 20 percent of men diagnosed with prostate cancer will progress and die from advanced prostate cancer and not another cause. This statement trivializes prostate cancer and may lead men to make decisions that are not in their best interest.”
As a nurse working closely with patients, Schimke is able to work with men and notice signs of the disease’s progression. “When left untreated in an advanced stage, prostate cancer can spread to other bones in the body, which is difficult to treat and can impact survival,” she says. But there are new options for patients. “There are many treatments for prostate cancer depending on the stage of the prostate cancer when diagnosed,” Schimke says. “Our goal is to hopefully cure the cancer if at an early stage, but if it is metastatic at diagnosis, we want to maintain their quality of life and prolong their life through the various treatment options that are available.” One new option is a short-range radioactive treatment that kills cancer cells in men whose cancer has been resistant to medical and surgical treatments. They may have metastasized cancer that has spread but the spread is limited to the bones. Called Xofigo, the option can help extend the life of metastatic castration-resistant prostate cancer (mCRPC) patients.
What can men who do not have prostate cancer do to protect their health? Schimke says getting a PSA test is important. While some men think the test isn’t useful, Schimke says the test is a screening tool, not a diagnostic tool, that can spot potential red flags in men who are at high risk of prostate cancer or those in the 55- to 70-year-old age range who feel they would like the test and understand it. “PSA testing should be done in men with a high risk for prostate cancer, such as men who have a father or brother that has had prostate cancer,” she says. “The American Urological Association has guidelines for which men should be tested.” And while the test results might lead to a biopsy to rule out cancer, the biopsy isn’t always going to come back positive.
And if men do get a cancer diagnosis, each case is very different and finding a reliable and knowledgeable healthcare team with expert urology and oncology teams working together is essential. “Not all prostate cancer needs to be treated,” says Schimke. “Many men can be followed and treated only if their prostate cancer progresses.”