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  1. RN2020scm

    Ethical Issues

    Hey everyone. I have a question. There is a nurse that I know of who takes exotic photos, has an OnlyFans account, "models" in music videos & doesn't mind posing near naked in sexually suggestive positions on social media sites. (She doesn't hide ANYTHING!) That's her life BUT my question is: Can a healthcare employer fire someone for what they do outside of their career as a nurse??? I know we are pillars in the community & are held to a high standard but I want to know, technically, is this woman in the wrong & would or could her job or license be on the line........Thanks in advance for the feedback given! 🙂
  2. I will try to be as succinct as possible: a. I accepted a once per week job doing PRN disability exams on Sunday's. I signed a contract as a 1099 worker that did not specify any damages for breech, but said I could be terminated if my exams were not up to industry standard. It takes up to six weeks to get paid. b. My "main job" was to pay me a 10K bonus which they concluded I was not in fact eligible for and will not be paid. Since I was "counting" on this income until my PMHNP practice was built up I am forced into the position of finding "part time" work. Thus, I was offered a Psych RN position on Friday, Saturday, and Sunday at $57.00 per hour. This would more than "pay the basic bills" until my practice on Monday, Tuesday and Thursday filled up. c. I wrote the "disability exam" place and stated that I would not be able to start next Sunday week for the above reason (I need to earn money to pay my bills I need cash flow). I literally only have money for one more month's rent. They said I didn't have "an emergency" I pointed out that not only was I going to go late on my credit cards (for the first time in over a decade), but that I literally faced being homeless if I did not generate cash flow. d. They stated they would pay me 50% of the $110 per exam when the exams were performed (the rest later), but that they considered me under an "ethical/legal" obligation" to perform all shifts signed up for (through the end of May) unless they could find a replacement (these exams are located all around the state of Washington). Furthermore, they said since patients have been scheduled for these appointments that failure to perform the exam would result both in civil litigation (for damages without regard to what the contract says which does not specify damages) and direct action against my license. They said that "unlike being an RN your obligation starts when you agree to do the exam" since I pointed out that as an RN the obligation started once you had accepted report. e. I said that while I disagreed with their perspective (specific performance to perform work is generally considered to be a 13th Amendment violation which is why you can force someone into a Chap Seven, but not a Chapter 13 bankruptcy, basically you would be requiring them to work to pay their debts and this had been found to be unconstitutional in most cases-child support being a noted exception). Still, I pointed out that I had moved from Florida to Washington and did not even have the resources for an attorney so I would "go along" as they don't seem to be giving me a choice. I re-read my contract and there is nothing about damages for non performance. But that doesn't mean they couldn't take action against me anyway or with the Washington State Board (especially since they are a contractor to do disability exams for the state of Washington). f. What if someone became ill or their spouse or child suffered a situation or they found they just couldn't do the job? Would they face sanction against their NP licenses? If someone can be held on the hook for disability exams three months down the line it seems a bit like involuntary servitude. Part of me just wants to "shut up and take what's due me for a poor decision", but the other part finds it difficult to take. Still, there is a point that people are expecting to show up starting next Sunday and see someone for their disability exams.
  3. Insubordination can result in serious disciplinary action by employers and licensing boards. The unique characteristics of nursing may be a prelude to insubordinate actions and behaviors. This article will explore the definition, criteria and triggers for nurse insubordination. What is Insubordination in Nursing? Insubordination in the workplace occurs when an employee intentionally refuses to obey a direct, lawful and reasonable order or directive. Such refusal is often a reason for disciplinary action and possibly termination. Defining insubordination is often tricky, especially in the nursing profession. There are 3 factors that may be used to determine if a nurse is insubordinate: The nurse must be given a direct, reasonable and ethical order relating to their job role. The nurse must fully understand what is expected of them. The nurse must refuse to obey the order and doesn’t perform the task. An insubordinate nurse may verbally or physically disobey an order or simply ignore the request. Although these guidelines seem straight-forward, the unique characteristics of nursing are complex and often further muddy the waters surrounding the issue. Insubordination or Misconduct? People often confuse insubordination with insolence and employee misconduct. This is because insubordination often leads to conduct violations. Insolence is behavior that undermines a manager’s authority by swearing, making fun of and mocking them. Misconduct is fairly straightforward and is more serious than insubordination or insolence. It is characterized by an offensive and/or unacceptable action that is purposeful and not by mistake or carelessness. Misconduct typically requires swift disciplinary action and may also have legal or criminal consequences. Dissatisfaction, The Prelude to Insubordination The nursing profession is riddled with stress and dissatisfaction. We have all heard these declarations from nursing leadership, “We must do more with less”, “We must improve our outcomes” and “We need to be good stewards of the company’s money and work with what we have.'' Unfortunately, “working more with less” often takes us away from why we entered nursing and what we find most rewarding about the profession. Workplace dissatisfaction often leads to counterproductive and emotionally driven behavior that sets the stage for insubordination. The Zone of Acceptance Nurses are often triggered when given a task perceived to be outside of traditional nursing work. Surely you have heard, or even stated, these words of protest, “that is not within my job description!”. Managerial theorists, Simon and Barnard, describe employees using a “zone of acceptance” when processing orders and directives. This means employees have in their minds what activities the supervisor has a right to ask them to do. If ordered a task that falls outside of this zone, there is a higher chance the order be disobeyed. With the nature of patient care, it is common for orders to fall outside of what the nurse considers ethical. The Unique Dilemma of Nursing Patient care is at the center of nursing care, therefore, there are times when insubordination is a result of a legitimate ethical concern. The American Nurses Association (ANA) released a position statement regarding nurse rights and responsibilities. The statement includes a few key points contributing to a potential grounded reason for a nurse’s order refusal. The ANA published “Patient Safety: Rights of Registered Nurses When Considering a Patient Assignment” states “nurses have the professional right to accept, reject or object in writing to any patient assignment that puts patients or themselves at serious and immediate risk for harm” The ANA Code of Ethics for Nurses with Interpretive Statements (2001) and Nursing: Scope and Standards of Practice (2009) outlines a nurse’s obligation to raise concerns regarding any patient assignment that puts patients, or themselves, at risk for serious harm. Also outlined is the professional obligation of nurses to promote, advocate for and protect the rights, health, and safety of the patient. The issue of insubordination becomes complex when a nurse’s rights and responsibilities conflict with orders or directives. The Fine Line Between Obligation, Ethics and Insubordination In my many years of nursing, I have rarely witnessed a nursing refusing an order or assignment. When I did, the refusal usually centered around a legitimate patient or nurse safety concern. The following are common reasons nurses refuse patient assignments: Lack of training and preparation to meet the patient’s needs High patient load Not receiving report on a patient Patient acuity too high It is possible a nurse refuses an “unethical” assignment but the real underlying issue is their own discomfort with the environment or patient care. Consequences When a nurse refuses an order, the consequences can be severe. The employer may discipline or even terminate the nurse. Depending on the circumstances, the nurse could be reported to the state’s governing board of nursing for patient abandonment or other discipline. Part 2: Conscientious Objection Part 2 of this article will explore the role of conscientious objection in protecting nurses from assignments that are against personal moral or religious beliefs. What are your thoughts on insubordination in nursing? Do you have a management perspective to share? Resources: Disciplinary Issues: What Constitutes Insubordination (Article) ANA Code of Ethics for Nurses ANA Scope of Practice Managing the Insubordinate Nurse (Article)
  4. SunnyPupRN

    Nursing Ethics

    If there are any ethical issues in nursing, one that is definitely developing is that our roots are disappearing. As trite as 'caring' sounds, it is the cornerstone of our career birth. Too often, now we find ourselves in the position of being little more than waitresses or waiters with medicine [or procedures] and off to the next 'table'. Ethics in nursing isn't about the big issues like ending life support, it's about us as individuals, risking our licenses because of managed care plans that demand staffing ratios at impossible numbers to deliver excellent care. Ethical issues are about corporate executives shaking hands on deals to merge hospitals because they hear "cha-ching" and not because they have ever set foot on 4 East [just an example, not my floor, and never was] to see that the nurses there regularly suck it up because they don't get dinner breaks. Nevermind that it's against the law. If they balk about it, they're not "team players", right? Ethical issues in nursing remain at the common denominator - the nurse him or herself, because we still haven not risen above nurse-on-nurse bullying. It's a well known, well documented phenomenon, and we need to start to improve our lot in this career by putting a stop to it. Now. There's nothing cute or funny about the expression "Nurses eat their young". If we want to be ethical nurses who bring in a generation of supportive people, we teach them what we know, that we are patient, we welcome them to our work environments. Hospitals are corporations now, mostly for profit, not passion - and if we are divided, they will conquer. That means these ethics conversations will remain academic, Powerpoint meetings that boil down to avoiding lawsuits. Our nurse managers have the power to lead us in this direction to some extent. They are responsible for creating the atmosphere in which we work, even if they cannot do all staffing we would like. We are the advocates for our patients - our ADON's and DON's should be *our* advocates. Their will always be personalities that clash at work - and that's ok. We need to make a committment to do our best learning from our enemies. Yes, I am saying, the nurse that you cannot stand - offer to cover his patient care so he can go eat dinner. These are the actions that forge unity in our ranks, which we so urgently need. This is what a nurse of the highest ethical standard does. When you feel good about what you have done, it trickles down to your performance for your patient. In the meantime, we wait for political changes to makes our jobs safer. Nurses - the core of patient care - are our own worst enemy at times, so why should executives, managed care outfits, or even the government listen to our ethical concerns on an individual level? In what other profession do you see this toe-stepping? Does a school district listen when teachers say that a classroom of XX number of children is not safe or practical? They do! Parents of students demand it because they have some knowledge of that system. Patients, on the other hand, are in the dark about patient safety, hospital profit, even their own medicines! Do hospitals want us to advocate for our patients? Only to a point. What would the corporate executives say if we encouarged our patients to demand higher staffing ratios because their safety was at risk? We would be fired. The bottom line is, if doctorate and graduate level nurses want to take on ethics, forget a thesis on end of life care or bioethics. Start where it really counts, where we really need help: the ethical concerns nursing on a daily basis on an individual level. Help us get these issues out of an academic hall and into legislation -uniformly across the country- that actively prevents a hostile work environment and promotes safety, cameraderie, and motivation to stay in nursing. At heart, nurses are nice people. The nice guys and girls shouldn't finish last.
  5. Starting in a few years, my state is going to requiring background checks and fingerprints as a condition of license renewal for all nurses. Whew! What a pain in the posterior! I mean, I've been a nurse for over three decades and they're just asking for it NOW? And I'll have to pay for all that in the last few months before I retire -- either that or retire a few months before I'm actually eligible. I've heard all of my colleagues complaining about the new law; I've done my fair share (or more) of complaining about it as well. But the truth of the matter is, I get it. It's a personal inconvenience and potential financial hardship for me, but I get it. Ethics in nursing is neither very different nor very separate from ethics in life. We can -- and do -- talk about ethics in nursing although it was a very separate thing. We talk about not charting treatments you haven't done or medications you haven't given, truthfulness and accuracy in charting, hand-offs and updating the providers and we talk about personal accountability and responsibility in everything from assignments to the way you use your paid time off. It's all part and parcel of the same thing. It's ethics. The background check, I think, is to ensure that the people who hold nursing licenses are not people who have demonstrated a lack of ethics in their personal lives. And the credit check often run by employers before making hiring decisions is to ensure that the nurses they hire are people who have not proven themselves unethical in the way they handle their money -- they're people who accept their financial obligations and work, however slowly, at meeting them. What do you do if you make a mistake? In nursing, you own up to it as soon as you recognize it, contact the provider, your manager and possibly risk management and set about to mitigate the damage as soon as possible. An ethical person who makes a mistake in balancing their checking account will do essentially the same thing -- own up to the mistake and set about mitigating the damage as soon as possible. (And hopefully before paying hundreds of dollars in overdraft fees or returned checks.) If your family owns two cars and has four drivers, each of whom wants to do something different on a Sunday afternoon, you work it out among yourselves. Elmer may have to drop his sister Elsie off at her soccer practice on the way to his football game or your spouse Spike may have to be half an hour late to his golf game after dropping Elsie off or an hour early because he's taken Elmer to his game on the way. You may have to wake Spike up at 6 AM to take you to work so he can use the car, or maybe you make Elsie do it as a condition of using your car. You work it out. That same thing should happen when a popular co-worker is getting married and everyone wants to go to the wedding. Obviously, someone has to staff the unit. You work it out. Maybe Horace will offer to work in the afternoon so Hortense can attend the ceremony, and she'll work the evening so Horace can go to the reception. Or maybe Humphrey volunteers to work Christmas for Horatio in return for Horatio woking Humphrey's shift the day of the wedding. You work it out. If Elsie were to take your car without permission when you were counting on using it to get to work, that would be unethical. As would calling in sick to work and showing up at the wedding. If both of your children like to wash dishes and hate to clean toilets, you switch off the chores. Elsie cleans toilets this week, Elmer next week. Or Elsie cleans the toilets both weeks in return for taking Elmer's turn to use the car. They work it out -- or you do. As a charge nurse, you don't assign the same person to the same awful assignment day after day. You spread the wealth. Everyone takes their turn taking care of the 500 pound chronic patient with the vile personality or the obnoxious family. Or Hortense, who really doesn't mind him volunteers to take care of him if Humphrey will please take care of the man with the grabby hands. You expect your children to tell you the truth about their activities and their whereabouts. You expect your employees to do the same. And while you trust that your employer is actually putting the money into your pension fund that they claim they are, you also make sure to charge the correct patient for that expensive piece of equipment you're checking out. If you take out Percocet for Mrs. Ryder, you actually GIVE it to Mrs. Ryder instead of saving it for yourself for a rainy day. And if you pick up a chocolate bar at the grocery store, you place it into your cart and pay for it at the check-out rather than into your purse and attempt to sneak it out without paying. It's all ethics. A person with four or five arrests for car theft is unlikely to be an ethical, accountable nurse and a person with two bankruptcies on their credit report is either incredibly unlucky or a poor manager of their resources. A person with one arrest for disturbing the peace on the night of their high school graduation fifteen years ago -- well, you get to decide. My point is this: An ethical, fair, responsible and accountable PERSON is likely to be an ethical, responsible and accountable NURSE. And vice versa.
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