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

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

Workplace Advocacy

and Workplace Issues


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


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


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


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


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


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


Advocacy Strategic Planning Model

Research

Issues/Problems

Goals/Objectives

Strategy Development•Coalition building•Networking•Institution building•Sensitization•Etc.

OutputsOutcomes Pre-testing & Piloting

Implementation

ImpactEvaluation

Monitoring


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


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



Workplace Issues

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


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


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


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

Nursing Shortage Issues—cont’d


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


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


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


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


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)


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


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


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


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


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


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


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


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


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


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


Documents

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