National Association of Indian Nurses of America (NAINA) joined the Nursing Now global campaign in July 2019, and NAINA marked the official inauguration of its campaign activities at the 2019 Clinical Excellence conference held on November 2nd in New Jersey. As part of Nursing Now, NAINA is collaborating with the American Nurses Association as well as other local nursing organizations and global campaign supporters.
On February 27, 2018, Her Royal Highness, The Duchess of Cambridge Kate Middleton, patron for the Nursing Now campaign, officially inaugurated the campaign that runs through December 2020. The campaign was launched in response to the World Health Organization’s (WHO) Triple Impact report. The Triple Impact report accentuated that “developing nursing will improve health, promote gender equality and support economic growth.”
A Well-Timed Campaign
The year 2020 will be a historic year for nursing profession as it marks the 200th anniversary of the birth of Florence Nightingale.The nursing world is preparing to honor and celebrate this great nurse. As the global community prepares to celebrate nursing, momentous endeavors are in the planning. WHO has designated 2020 as The Year of the Nurse and Midwife. The WHO State of the World’s Nursing Report that highlights nurses’ role in Universal Health Coverage and the Sustainable Development Goals is anticipated in April 2020. The Robert Wood Johnson Foundation team is releasing another landmark report in 2020 as a follow up of the 2010 Institute of Medicine report, “The Future of Nursing: Leading Change, Advancing Health.” The RWJ report will highlight the nurse’s role in addressing the social determinants of health and health equity. To set the stage for these great events and to create global momentum to mark the epic year, Burdett Trust for Nursing in collaboration with WHO and the International Council of Nurses (ICN) launched the Nursing Now global campaign. As of October 2019, Nursing Now has spread to 103 countries.
Nursing Now Global Campaign
Nurses practice in many settings and in different roles. Nurses have different levels of education and competencies, which makes nurses capable of generating positive outcomes in health care. With their education and training, nurses are adroit in health care policy decisions. However, there is a paucity of nurses’ involvement in health care policy and decision making. As the WHO Triple Impact report highlighted, empowering nurses may create a paradigm shift in health care that will address global health care concerns. To highlight nurses and to improve the status of nursing, the campaign chose five focus areas:
Health Care Policy – Create global awareness on positive impact of nurses and midwives in health policy decisions
Clinical Practice and Education – Influence investment in nursing education and training
Leadership – Empower nurses to assume leadership positions; increase the number of nurses in leadership positions.
Research Priority – Identify areas where nurses have a potential for the greatest impact, explore impediments to achieving their full potential and practicing at the scope of their training, and generate practical solutions for workplace conundrums
Best Practice – Share examples of best nursing practice
Nursing Now USA
American Nursing Association, U.S. Public Health Service Chief Nurse Officer, the University of North Carolina Chapel Hill School of Nursing, and the University of Washington School of Nursing collaborate in leading the Nursing Now USA campaign. With the vision, ‘Nurses Lead America to Health,’ Nursing Now USA is developing and leading activities focused on creating public awareness on nurses’ vital role in achieving equitable quality health care for all.
Nursing Now NAINA
National Association of Indian Nurses of America (NAINA) decided to join the global campaign as a local group because NAINA’s vision and goals align with the campaign focus. The official launch of Nursing Now NAINA campaign took place at the 2019 Clinical Excellence Conference. The theme of the Clinical Excellence Conference – ‘Population Health: Bridging Gaps and Improving Access to Care’ aligns with the overarching aim of the campaign. The Clinical Excellence Conference provided a venue for NAINA nurses to share examples of best clinical practice, which is one of the priority areas of the global campaign. Susan Michaels-Strasser, PhD, MPH, RN, FAAN, Senior Implementation Director & Associate Director for Nursing Programs at Columbia University discussed “Nursing Now: Empowering Nurses and Tackling Health Care Challenges” and NAINA lead the campaign. Letha Joseph, DNP, AGPCNP-BC discussed NAINA programs that commemorate with the campaign. Nursing Now NAINA will create opportunities for NAINA nurses to improve their competencies, maximize their professional contributions, and enhance their influence. NAINA’s campaign focus areas are enhancing clinical practice by ongoing education, empowering nurses to be leaders at bedside and beyond, and sharing examples of best nursing practice while recognizing nurses for their contributions to health care and professional nursing community.
Most registered nurses are familiar with the rights of patients under their care and work hard to alleviate suffering and maintain respect for human dignity. They advocate on behalf of patients, their families, the community, and society as a whole. But many nurses do not know their own legal rights and responsibilities as health care professionals.
Nurses with knowledge of whistle-blower laws, for instance, may be more likely to press administrators to end patient-care abuses or fiscal fraud. Standing up for what’s right is tough in any case, but especially for women and minorities, who make up a majority of the profession. Yet, minority nurses have historically demonstrated heroic activism for community health and social justice, during the civil rights era and the AIDS epidemic, for instance.
Nurses face the same legal issues as many other employees, such as sexual harassment in the workplace. But they also must protect against career-specific liabilities, such as being accused of violating the nurse practice act or similar regulations.
“There are three major concerns for nurses,” according to Gerard Brogan, RN, lead nursing practice representative at California Nurses Association and National Nurses United. “I travel and talk to nurses across the country and union or not, I hear the same things. The first concern is nurse-to-patient ratio, two is violence in workplace, and three is scope of practice.”
This article, then, will focus on legal issues that are unique to nurses.
Nurses across the country have expressed overwhelming concerns regarding these roadblocks to patient care and safety: short staffing on overcrowded units, limited ability to take even short breaks due to scheduling gaps, floating nurses without the proper training for certain departments, and so on.
According to Brogan, California is the only state in the country that has nurse-to-patient ratios. “Massachusetts and Arizona have them for the ICU only,” he says. “Nurses are working in understaffed hospitals, which are dangerous for patients and everyone else. We now have two nurse-to-patient bills in Washington. One is a house bill and one is a senate bill. They would require every hospital to adhere to ratios similar to the California bill.”
Brogan says that he often sees on social media the phrase “nurses should not be political.” But he believes that’s a naïve and possibly dangerous position. “Health care employers are heavily involved in politics, so as an organization and profession we have to also be involved in politics ourselves.”
Other aspects of staffing include how hospital plans are created and implemented allowing direct-care nurses to play a role. “The Oregon Hospital Nurse Staffing Law gives power to the hospital staffing committee,” says David Baca, RN, BSN, an emergency room nurse at Asante Rogue Regional Medical Center in Medford, Oregon.
The law is also a legal measure regarding rest-breaks and specialized staffing on specific units and departments. “The phrase ‘A nurse is a nurse is a nurse is a nurse’ is common, but that kind of thought process needs to go away as it becomes clear that appropriate education and training are needed,” says Baca.
The nurses at his hospital also recently won a new contractual right: break-relief nurses on units, when necessary, to allow nurses to schedule earned breaks and meals. Baca estimates that only 30-40% of nurses at his hospital know about the new staffing laws. “A little more education is needed,” including the hospital and individual nurse’s unit. “Standards and practices in the ER should be something we’re aware of. If not, we should be asking: ‘What does the ENA say about staffing and nurse patient ratios?’”
“When it comes to workplace violence, nurses have been in the top five forever,” says Baca. According to an U.S. Bureau of Labor Statistics analysis, 52% of all incidents of workplace violence in 2014 involved workers in the health care and social service industry. “The ER is open to everybody. We serve everyone, including the intoxicated or those with mental issues, so nurses are assaulted. It happens on almost a daily basis.”
“A few years ago, we had a huge problem with psychiatric crisis patients. We couldn’t secure them in appropriate rooms for their own safety and ours. They’d either elope or assault. That’s a huge risk, so the hospital invested a million dollars into ER security for the safety of everybody,” says Baca.
“Most assaults in the ER go unreported. If you regularly see colleagues assaulted, it becomes the norm,” warns Baca. “Maybe we need to prosecute more patients who assault nurses, medics on ambulances, or technicians. There’s a very low prosecution rate and almost no legal ramifications for patients who assault. We need to change the workplace culture that accepts violence.”
In 2014, California enacted a trailblazing law to reduce workplace violence incidents in health care facilities. “Every hospital has to develop a comprehensive workplace violence program to protect the safety of patients and employees,” Brogan explains. “We’re not just interested in working on the welfare of nurses in California or nurses in the union. Our efforts are for nurses across the nation.”
Then there’s the more common, less intense form of violence: bullying…
Brittney Wilson, BSN, RN, a social media influencer also known as The Nerdy Nurse, started blogging as a response to the stress of nurse-on-nurse bullying as a newly graduated floor nurse.
“What I learned from my experience with lateral violence is that in a right-to-work state it is very difficult to make a stand for yourself,” Wilson explains. “I did learn that in order to build a strong case for yourself you should keep notes including dates/times/names of incidences. You should also report incidences as soon as they occur. But if your hospital does not have a union, it is pretty much your word against another employee.”
In Wilson’s case, the nurses who witnessed the bullying weren’t her allies, and neither was management. “My employer didn’t support me and believe me enough to address the work environment, pursuing the issue just made things more difficult for me and lead to me being forced to take a different position and a pay cut until I ultimately left the organization,” she adds.
Though nurses have a right to be treated with dignity, respect, and civility, they sometimes must fight just for an environment that isn’t downright hostile. Wilson advises nurses in that situation to “find new employment and an organization that will support and value them. We are living in an economy where there are more jobs than there are nurses. If you aren’t being treated respectfully, you owe it to yourself to remove yourself from a damaging situation.” That’s just what Wilson did, parlaying her newly accrued digital skills into a well-paying and satisfying career in nurse informatics and technology product development.
It goes without saying, but nurses must themselves also avoid those types of uncivil, hostile, bullying, or intimidating behaviors that show disrespect for patients or colleagues. Otherwise, they put themselves at risk of censure for trampling the rights of others.
Scope of Practice
“There are fifty states and 50 different nurse practice acts,” says Brogan. “Hospitals don’t really educate employees on the legal scope of practice. I’ve been educating nurses for 20 years and find that hospitals see nurses as a unit of labor, not as a professional.”
In today’s fiscally-focused health care landscape, there is always a concern that the scope of professional nursing practice is at risk from understaffing, de-skilling, and other encroachment, warns Brogan.
“The hospital industry is trying to expand the scope of nurse’s aides and medical assistants. Nurses are professionals with independent judgment,” he says. “If they are given too many patients to care for, as is often the case in non-unionized hospitals, they have to take them or they can be fired.”
All nurses need to remain current, competent, and within their scope of practice, or risk losing their license—and their career. Protect yourself by taking continuing education courses in nursing (online or in-class) or enrolling in an advanced degree program. If further formal education is problematic, you can learn informally through a professional nursing association, either for your particular minority group or one in your specific area of
Rachel Seidelman, RN, a direct care nurse at Providence Health & Services in Portland, Oregon, has been a nurse for eight years and continually updates her understanding of the law. She knows her state nurse practice act rules and reviews them regularly to ensure she protects her practice and her license. “The biggest thing that’s helped guide me comes through my union; there’s a branch for practice. I know state and federal law and the overlap. I make sure I know who I can delegate to, because it’s all on me if a colleague messes up under my umbrella.”
“How I was precepted really helped me as a young nurse without much work experience,” Seidelman says. “Part of the onboarding process is to ensure they understand the wage scale, the contract and their rights within it, and a lot of other things, too. I’m a preceptor now and will never stop because I learn so much from doing it.”
One example of how Seidelman expands her knowledge of issues related to nursing practice concerns the opioid epidemic. After reading a series about it in the state’s major newspaper, she wondered what her response should be as an off-duty nurse encountering a stranger overdosing. Should she carry the opioid antidote naloxone as a precaution? “That question led me to the Oregon Nurses Association, my employer, and discussions with pharmacists and mentors.” She couldn’t obtain the antidote without a prescription, but new laws enacted in 47 states make it more freely available. The surgeon general recently urged opioid users, concerned family members, and professionals to keep it on hand.
“In this day and age, it’s important to protect our own license and also protect our patients and colleagues. I advise fellow nurses to ask good questions, be curious, find answers, and then tell others,” says Seidelman.
Advocating for Your Patients, Community, and Profession
Nurses have long participated in the political process and sought to shape health care legislation that supports nurses as well as benefiting patients and communities.
Martese Chism, RN, a Chicago nurse, is inspired by the example of her great-grandmother, Birdia Keglar, a civil rights activist in the 1960s. “She marched in Selma with Rev. Martin Luther King Jr. and lost her life because of it. Dr. King, in his speech, said he would like to have a long life, but that wish didn’t stop him from protesting,” she says.
Chism explains that her first college degree was in accounting, but she discovered “my calling is advocating for patients,” so she went back to school to become a nurse. “We’re supposed to advocate for our patients… I believe my fiduciary duty is to my patients, not the hospital. I advocate for my patients, but in the back of my mind, I worried about job security. I was single and didn’t have a family to support, but if I had, I wouldn’t have been so vocal without my union,” she explains.
One matter that Chism has spoken out about is the closure of public hospitals and other health care facilities in minority communities. “When elderly patients with no insurance need skilled nursing care our hands are tied [because of the closures] so now our uninsured patients have nowhere to go,” she says.
Some of Chism’s patients were retired public employees who aren’t eligible for Medicaid or Medicare. “They’re now turning 70 or 80 and they have no insurance. That’s why I’m fighting for Medicare for all,” she says. “As nurses, we’re supposed to advocate for our patients, but I don’t feel like I can without union protection. If I do, I’m branded a troublemaker. I’ve been speaking out in public for a long time and I could never get a promotion. If it wasn’t for the support of my patients, and union, I wouldn’t have lasted this long on the job.”
According to The Code of Ethics for Nurses (2001), nurses do have the right to advocate for themselves and their patients, and to do so without fear of retribution. Each state’s nurse practice act varies, but Chism was outraged when Illinois tried to remove “advocacy” from its nurse act. “They tried to say that your duty is to your employer, but our union fought to stop that. We don’t know about the future, though, especially with the recent [Supreme Court] Janus decision. The union movement might be weakened even more.”
Finding an Attorney to Explain Your Rights or Represent You
Even though you do your best to learn the laws related to nursing, you can’t always avert legal trouble. There may be a claim of professional negligence, say, and then you’d need to retain a qualified attorney in your area to defend you.
“Generally, look for an employment lawyer, they will understand the federal and local laws on wages, overtime, discrimination,” says Jeffrey M. Edelson, JD, attorney at Markowitz Herbold in Portland, Oregon. “They’re often divided by union and non-union. The tradeoff with collective bargaining is that an agreement could be in conflict with state law.”
If facing disciplinary action with the nurse licensing board, you may require an attorney who specializes in licensure protection.
Or your case may call for an attorney with experience in an entirely different area of practice. “For example, in the case of the Utah nurse [Alex Wubbels refused to draw blood from an unconscious patient], you’d need a criminal lawyer,” he explains. Or, if you work at a state hospital and are fired for expressing an opinion or acting on a matter of conscious, “you may need a constitutional lawyer in that you may have additional first amendment rights, versus if you’d worked at a private clinic,” Edelson adds.
A common way to find an employment lawyer is to checking profiles in listings such as “Best Lawyers in American,” he suggests. Or use your personal network of nurse colleagues, friends, or family to find an attorney. “Call your family lawyer, the one who does wills, and ask ‘do you know an employment lawyer?’” You’ll likely be referred to an appropriate attorney. Plus, “you’ll get that lawyer’s ear because you’ve been referred,” says Edelson, and they’ll each want to protect their professional relationship. Ask about their experience with your type of legal trouble or concern. Then inquire about fee structure. Some will charge for an initial consultation, while others won’t, and most work on a retainer basis, though some will take a case on a contingency basis.
Other resources for finding local attorneys: your professional nursing organization or union, the American Association of Nurse Attorneys (TAANA), and the State Bar Association.
In addition, you may want to purchase malpractice insurance (including license defense coverage) in advance of any need. Some professional nursing associations even offer a discounted rate, making it a prudent and affordable option.
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