CHAPTER SIXProfessional Gatekeeping as a Function of Role Fidelity

Edited by Brenda Holmes MSN/Ed, RN

ELEMENTS OF A PROFESSION

Being professional vs. being a member of a profession

Historical criteria for a profession Specialized body of knowledge Education standards Practice standards

Professional etiquette which is your behavior that is expected in the workplace

Code of Ethics Self-regulating Fiduciary relationship with those served

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PROFESSIONAL CODES OF ETHICS

An important tool for self-regulation found in most health care specialties

HOWEVER An all encompassing code of ethics, which covers

every conceivable ethical problem, does not exist Common problems:

Vagueness as to duties and prohibitions Incompleteness to duties Excessive concern with promotion and prestige of

profession Vagueness in regard to self-regulation and peer

enforcement Excessive concern with financial and business

interest

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PROFESSIONAL CODE OF ETHICS

Obligations To be a peer to others on a health care team

Can be seen as gatekeeping functions whereby you look out for the interests of the profession Gatekeeping: comes as a result of professional

obligations and training Whole series of activities needed to protect the

profession those who would misuse the appropriate functions for the specialty

Monitoring system Sense of collegiality and mutual support

Flow naturally as a result of our professional obligations and educations

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PROFESSIONAL CODES OF ETHICS (CONTINUED)

Review the professional code of ethics for your specialty (Do an internet research for CNA code of ethics or code of ethics for your profession) C

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DISPARAGEMENT OF PROFESSIONAL COLLEAGUES

Disparagement Definition: belittle or criticize the skill, knowledge, or

qualification of another professional Many of us have heard of Cain’s questioned about

“Am I my brother’s keeper?” Health care you are “brother’s keeper”

Responsible for our actions but also charged with the duty to ensure that the rest of the health team is practicing appropriately

Need to protect patients from exploitation, regulatory licensing mechanisms, legal remedies, and peer review system

Code of ethics Not only ethical rules but symbolizes that this group

of professionals is differentiating itself from the broader group of occupations and technical careers

Characteristic: generate a code of ethics and self-regulating

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CONFLICT OF INTEREST

Fiduciary relationship Special relationship of loyalty and responsibility

between the patient and practitioner Practitioner will practice with good faith and candor Patient has the right to believe that the practitioner

will maintain a higher level of accountability in regard to health care

Conflicts of interest where patient-interests are served Owning a health care supply business can be

considered conflict of interest if any health care professional recommends their business. This is called joint venture i.e part owner to a nursing facility.

Caring for your own family in a health care facility Does intent make the difference? Rule of thumb: due to emotional conflict, many

practitioner are advised not to care for family and family members.

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SEXUAL MISCONDUCT

Sexual relations between practitioners and patients Basic principles involved

Considered unethical nor condonable Effects on therapeutic relationship

Places the practitioner in the advantage in the critical areas and personal vulnerability

Intimate relationship of roles and can be powerful and intense for both

As soon as the practitioner feels like there is a potential misunderstanding, it is time to end the professional relationship

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SCOPE OF PRACTICE Scope of practice

Definition: Tasks that are included within the practice of a specialty (legal regulations that allow practice within a state; determination of questions regarding role-fidelity) Role-fidelity: requires that we remain within our scope of

legitimate practice. Problem of role evolution, for example, nursing

Legislated practice acts General elements

Scope of professional practice Requirements and qualifications for licensure Exemptions Grounds for administrative action Creation of an examination board and processes Penalties and sanction for unauthorized practice

Legal sanctions

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IMPAIRED COLLEAGUES Basic problem

6-8% nurses in the US today are addicted to drugs/or alcohol

In one state, 90% of the disciplinary hearings within the state were related to substance abuse

Rationale for a duty to act: Protection of patients

You are the patient’s advocate in which you can mediate patient’s problems and complaints in relation to health care

Reporting an impaired colleagues, is for the safety of a patient

Protection of specialty Protection of colleague Protection of institution

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STEPS IN PROBLEM SOLVING

1. Problem sensing – gather and review facts2. Formulate and state problem3. List solutions of initial credibility4. Evaluate consequences to individuals

involved5. Evaluate solutions in regard to basic

principles

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STEPS IN PROBLEM SOLVING (CONTINUED)

6. Select solution7. Prepare a defense C

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WHISTLE-BLOWING Definition:

where the colleague or institution is reported for misconduct.

A process of gatekeeping, a function of role duty and professionalism that cannot be ignored

In nursing facility: Office of Long-Term Care Ombudsman (patient advocate and staff)

Downside Harassment, avoidance, demotion, termination

What principles are involved? Everyone that is involved

Making the decision Elements to consider

Understand that whistle-blowing is high risk, lonely, and rarely appreciated

Process Clear and concise documentation and information Follow facility protocol and chain of command

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INSTITUTIONAL ETHICS COMMITTEE Definition:

As an interdisciplinary body of health care providers, community representatives, and nonmedical professionals

Membership Include: physicians, nurses, social workers,

philosophers, laypersons, lawyer, administrators, and religious leaders

Common functions: Policy and procedure development Educational role Case consultation Retrospective case review

Decision making not function of IEC

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KEY CONCEPTS

Key elements of a profession Codes of ethics as important statements of

self-regulation Problems associated with disparagement of

colleagues

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KEY CONCEPTS (CONTINUED) Problems associated with sexual misconduct

with patients Problems associated with conflicts of

interests Functions of institutional ethics committee Requirements for role fidelity

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DISCUSSION

Discuss case study: Is There a Duty to Lie?

Questions1, 2, 3, 4 An Old Friend, a New Relationship.

Questions 1, 2, 3

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