RN's: Who helps you with controversial issues in your practice?

Nurses Activism

Published

  1. Would you consider using a RN advocate?

    • 5
      yes
    • 0
      no
    • 0
      may be

5 members have participated

Since completing my MSN this last month, I have been asking myself why is there no experts available to field controversial issues nurses face?

I recently completed a large project that led me into nursing as a large group that has very limited power in designing their practice methods. Employers dictate how nurses do thier work and many entities do not allow nursing voice in designing RN work loads as one example.

Other employers, have an organizational model without a nursing infrastructure. HR, Social services, and CEO's design policies that are murky. What I have learned is that as a licensed professional, I was responsible for every action or non action carried out by unlicensed assistive personnel.

I had no one to go to. The other RN's went along with the need for their licensure but did nothing to create dialogue with management. I decided to keep speaking up at any table I could diplomatically. I mainly asked provocative questions. The result at one organization: I was ignored and felt invisible. Not for long however, once I had a clear understanding of the expectations of my licensure, I took some steps. Then I was written up for situations that were complex and required a peer review. Since there were no RN leaders, the odd outlier occurances became an HR black and white write up. I did my job above and beyond from my view, however the correct form which does not exist was not filled out. I see these thoughtless actions from non nursing administrators as damaging to one who has 25+ years RN experience, an MSN ed specialization.

Specifically, a black mark on my license. Consumers are hurt too. They get nurses who are caught up in tensions that affect the care they deliver. Nurses need to know what they can do to clarify concerns when management cannot or will not listen, investigate, plan, and act.

I am considering the advocate role to field questions and concerns. I would try to build a team of multidisiplinary consultants to give resource direction. If counsel or teasing apart rules, codes, and research work that could be facilitated. It is kept anonymous.

Does any RN see a need for such a service?

Thanks, Julia

Questions and comments welcome

Specializes in Vents, Telemetry, Home Care, Home infusion.

Larger facilities are now hiring Nurse Coaches to help improve nurses lives and decision making

The Strategic Role of Integrative Nurse Coaches in Health Care

The Art and Science of Nurse Coaching

Coaching in Nursing

Coaching is not giving advice, not teaching,

and not directing-- it is a collaboration in

which the coach acts like a midwife: sup

porting, encouraging and helping the client

through the experience while acknowledging

the client as the expert and the person

"making it happen" (Donner & Wheeler

2005).

To facilitate these coaching conversations,

a coach must have the ability to listen, discuss

and question; to clarify core values, beliefs

and sense of purpose; to identify gaps

between a client's vision and reality; and to

encourage, motivate and instill confidence.

Coaching is a key competency for leaders,

managers, educators, researchers

and practitioners. Coaching helps nurses

engage in conversations and relationships

that are directed at enhancing professional

development, career commitment and

practice. Individuals act as coaches or are

coached to advance their career opportunities

and practice. They may also use coaching

to help them increase enjoyment of and

satisfaction with their current roles

Specializes in Psych, Corrections, Med-Surg, Ambulatory.

Coaching is not a bad idea, but the piece that's always missing is nurse empowerment. Nursing journals either preach to the choir or toss the onus back into the individual nurse's lap. So many nurses on the ground go along with whatever is dictated to them by non-nurses or administrative "nurses" who have never nursed. Shared governance committees are often naked emperors that look good on paper but offer little else.

I've posted in other threads that nursing schools really need to be teaching labour laws and avenues of nurse empowerment. I've worked units where I was the only one to fill out a short staffing form. Everyone else was either too brainwashed or intimidated. So yes, I think we need nurse advocates to get the ball rolling. We don't need more rah! rah! yay team! We need real empowerment.

I see this a bit differently. I believe that until we have management that is made up entirely of long term practicing bedside nurses, then these type of situations will never change.

Even a number of our DONs are in fact nurses who have not worked any of the units they are attempting to direct.

Most managers see a business prospective. They work for the company, their goal is the least expensive most effective patient care (or the illusion of patient care) and have absolutely no interest in those who are not drinking the kool aid.

Strong nurses leaders who advocate for safe staffing, among other basic needs to have a staff nurse function well for the patient are soon finding themselves without a job.

Nurses who have advanced degrees to those who have diplomas, even the CNA's who buck the system in place also find themselves without a job. The squeaky wheel in this case doesn't get the grease, they find themselves stuck under the tire.

Coaching, in my opinion, is just suggesting. And suggestions may or may not be put into play. Same with advocating. Even some unit managers with great ideas find themselves micro-managed by the upper management into a "what's best for the business" as opposed to "what's best for the nurses" which equates what's best for the patient. Any an all "groups" and "direct your own course" and other nifty little motivational sayings that create nurse groups to look at issues find themselves at a standstill when what they want and/or need to do their job well is veto-ed by management.

So, in other words--IF you would like to keep a job, then go into work, do not complain, do not make waves. Follow the script, make sure you hit all of the "meaningful use" points, be 100% sure that you are able to document for best reimbursement. We like the idea that you have these lofty pipe dreams, but keep on dreaming--at the end of the day we would like to count cash and not listen to whining. Because we are SOOOOOO fortunate that we are working, cause there's 3 more just like you who would do anything to have your job--including doing as they are told, when they are told.

OP, are you really saying you got all the way to the end of your MSN program without realizing (without being taught) until now that you are responsible for the actions of unlicensed assistive people working under you?? How is that possible? (I was wondering if maybe you were in a direct-entry MSN program, but I'm confused by the comment later about having "25+ yrs RN experience," which sounds like you're talking about yourself). This is something I was taught "from day one" in my nursing program decades ago.

I'm not saying there aren't problems with nursing management in many places, but everywhere I've worked over the years (and I've worked lots of places, by this time) nursing practice P/P have been established and controlled by the nursing chain of command within the organization, and staff nurses did have some input in the process. I've always been able to either resolve ethical and professional issues I encountered by myself, within the organization, with the resources available to me, or I've "voted with my feet" and found a job someplace better organized and managed.

I wish you well in your efforts, however.

My thoughts are similar to Elkpark's.

In regard to dealing with controversial issues in nursing, I have found that reading and assimilating the Nurse Practice Act for my state, the Nurse's Code of Ethics, Standards of Practice, employer policy and procedures, risk management information provided by my malpractice insurer, and knowledge of other laws applicable to my practice, together with knowing where to find outside resources, has provided the answers I have needed, and continues to do so.

I appreciate your reply very much. I agree the term coaching suggests finding one's strengths in a situation where an error had occurred or similar. Similar to a debriefing....you take the situation apart and locate the point(s) where context and whatever else may need further investigation or correction.

Organizations employing a coach for nurses seems biased. The coach would have to adhere to a set of guidelines that may not be politically favorable. I believe a mediation style approach from a neutral party or parties guided by knowledge of policy, laws, diplomacy, and numerous other skills and resources would be positive.

Thanks again for your thoughtful and informative response

You put it very well that empowerment strategies are badly needed. I would like to see nurses being able to put their concerns forth to a person who can take the time needed to understand context. For example, particular policies and procedures of the context, knowledge of labour laws as you said, board of nursing for a state of practice and the administrative codes. Of course, this would need the expertise of different experts to tease apart the multiple influences. I am considering doing volunteer work at legal aid where I live to see how that end of the spectrum works. I've looked into Legal nurse consultant however, it seems more reactive than proactive.

Thanks for your reply it was great to read. Yes, we don't need more rah rah yay team we need real action backed up by solid knowledge and skills.

Your post says what many want to say but don't. I believe you hit the nail on the head so to speak. There are many peer reviewed journals that agree based on studies that nurses impact client outcomes positively when they are working in conditions that do not have barriers to their licensure requirements. Some studies have found that less nurses and more assistive personnel have poor client outcomes. The California Nurses Association demonstrated this and years later the staffing ratio legislation was passed. I think that is impressive-- taking real data, mobilizing, and staying the course to develop change. That legislation is controversial. However, it demonstrates what the group did and had to struggle through to make changes happen.

Good Questions! My first position on med surg was the primary care model. RN's did everything. When I went on to my next position RN's had to cosign LPN notes and give permission for numerous activities.

This last position was organized using a social work model. In other words, there was no nursing management structure. From our work as RN's with medically fragile, developmentally disabled adults through the continuum of policy and procedure we were governed by managers with bachelors degrees in psych, social work, education ect no nurses except for two of us and some prn's.

I kept asking the nurse who had worked there over 5 years why we had no voice, what the organizations policy was for delegation. She stated we are not responsible for the unlicensed personnel....I knew she was wrong but the question usually created a rift. I began to bring it up for clarity at any opportune time and was ignored. I really liked the work but the infighting was intolerable and led to poor communication, poor handoffs, and some cut throat tactics. As many who posted on my writing, all the problems above led to poor client outcomes. I did vote with my feet but before I did I went to every person I could to discuss what I believed to be risky. I chose carefully who I talked with and what I said. I always brought up the bigger picture of why RN's have the same interests as the rest of the organization. The client! There was a union but they had no clue how to assist RN's. I really have been fortunate to have worked in well organized and managed agencies. Leadership was also very high quality.

Thanks for the well wishes and sharing your experience

Thanks for your post. It sounds like you would know how to find resources for another RN if necessary and provide direction.

i believe that this is one of the major top issues in nursing. Had I known how nurses really have no control regarding many unrealistic demands put in place for us, I would have never became a nurse. The bar is set high extremely high for nurses and I have yet to understand why many allied healthcare professionals and even professionals (doctoral degree holders) have a more relaxed role performance and lowered expectations in comparison. I have worked a few specialties and it is always some additional workload placed on the nurses back or additional psychological stress that could easily be placed else where to evenly disperse the workload and make our jobs better manageable but nurses are bullied and accept the abuse.

+ Add a Comment