Sharing Supervision and Liability as A Nurse Manager Essay

Sharing Supervision and Liability as A Nurse Manager Essay

Sharing Supervision and Liability as A Nurse Manager Essay

Legal Perspectives Sharing supervision and liability as a nurse manager By Karen Wilkinson, MN, ARNP A question that’s frequently asked by nursing supervisors and nurse managers that has no one correct answer is: “Can I be held liable if a nurse I’m supervising commits malpractice?” Nurses are held responsible for their own acts of negligence, but there may be certain limited instances when the law imposes liability for the acts of another. Nurse managers have supervisory responsibilities in a facility and, with that responsibility, there’s potential personal liability and exposure to lawsuits.1 There are two forms of accountability in nursing. Personal accountability is the responsibility that nurses have to themselves and the patients for whom they provide care. Public accountability is the responsibility that nurses have to their employer and society in general. All nurses are held accountable for using their knowledge and skills when planning and providing patient care. Nurse managers have an additional accountability for those whom they supervise and are held to a higher legal standard than the nurse who isn’t in a management role.2 What’s acceptable as a reasonable and prudent course of action for a nonnurse manager may not be acceptable for a nurse manager. Failure to perform supervisory duties There are many areas of potential liability for the nurse manager in today’s healthcare environment, such as failure to carry out supervisory responsibilities or perform duties as a nurse manager.3 In the patient care setting, nurse managers are often seen as problem solvers. When difficult or unusual situations arise that clinical nurses are unable to deal with, the nurse manager is called on to resolve those difficulties. Nurse managers and supervisors may also be called on when a patient is responding unfavorably to treatment or deteriorating rapidly. For example, the clinical nurse is often required to notify his or her supervisor of a deteriorating patient, especially during the night shift. Once notified, it becomes the supervisor’s responsibility to notify the attending provider. Supervisors may be found liable if their failure to notify the provider of an important concern or change results in injury to the patient due to delayed treatment.4 Sharing Supervision and Liability as A Nurse Manager Essay

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The nursing supervisor or nurse manager may also be held liable if the provider fails to respond and the supervisor is aware of the patient’s declining condition. If the provider’s response doesn’t meet the standard of care that the nurse expects, it’s the responsibility of the supervisor to go through the chain of command to get the treatment needed for the patient, even if it means going over the provider’s head to the director or administrator. Failure to properly delegate The field of nursing management involves supervision of various personnel who directly provide care to patients. Nurse managers have a duty to ensure that the staff members under their supervision are practicing in a competent manner.5

Supervision is the active process of directing, guiding, and influencing the outcome of an individual’s performance of an activity. When nurse managers supervise, they retain personal liability for the reasonable exercise of supervision, delegation, and assignment activities. The failure to supervise, delegate, or assign within acceptable standards of professional nursing practice may constitute malpractice. Nurse managers need to know the language and understand the nurse practice acts of the state in which they practice. Many states offer assistance with understanding delegation by providing decision-making flowcharts. Delegation is defined by the American Nurses Association (ANA) as “the transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome.”6 The nurse may transfer the Nursing Management  April 2016 11 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Legal Perspectives responsibility and authority for performing nursing activities, but they still remain accountable for the overall nursing care.6 For this reason, the nurse manager must make safe and effective delegation decisions. Delegating safely involves knowing the patient, the staff member, and the task to be delegated; explaining the task and expected outcomes; expecting responsible action from the delegate; assessing and supervising job performance; and evaluating and following-up. These delegation practices should be learned and practiced by all RNs who may be delegating to LPNs/LVNs and unlicensed assistive personnel (UAP). Sharing Supervision and Liability as A Nurse Manager Essay

The nurse manager must take this a step further when planning care and staffing a unit or clinic because the responsibility for delegation becomes layered as care is assigned to RN staff members working with a multiskilled team.4 The nurse manager must determine how to best staff a unit based on the nursing care delivery model, acuity of patients, skill level of staff, and costs of providing the care. Ultimately, it’s the nurse manager who retains responsibility to ensure that patient care is delivered safely and efficiently; caregivers are competent and legally qualified to perform the duties they’ve been assigned; and safe, quality care and staff satisfaction are maintained. Assignment is the transfer of both accountability and responsibility from one person to another.2 Assigning tasks isn’t the same as delegating tasks. The ANA defines assignment as “the downward or lateral transfer of both the responsibility and accountability of an activity from one individual to another.”6 When a task is assigned, it’s work that a staff member is responsible for performing as a condition of employment and consistent with the staff member’s job position and description, legal scope of practice, 12 April 2016  Nursing Management and training and educational background. The staff member—an RN, LPN/LVN, or UAP—assumes the responsibility for completing the assignment. The care of patients isn’t assigned to the UAP or LPN/ LVN, but rather certain tasks are assigned that fall within the scope of practice for that staff member. The RN remains responsible for patient care and all nursing practice activities, such as assessment, care planning, and patient teaching.2 The nursing supervisor or nurse manager who’s making patient assignments or equipping a charge nurse with this task must provide the RN who’s responsible for making assignments with the tools and training to consider many factors when assigning patient care. It isn’t simply assigning care based on warm bodies staffing the unit for the shift. The nurse manager will want the assigning RN to consider the patient’s acuity; infection control and isolation requirements; and the degree of supervision required for the staff based on level of education, skill level, and competence.5 Sharing Supervision and Liability as A Nurse Manager Essay

The degree of supervision is key for many legal cases in which liability for a poor outcome is being determined. As assignments are made to a less experienced nurse of a more complex patient, the level of supervision must increase. However, this doesn’t mean that the most experienced, skilled staff members must be assigned the most complex and difficult patients. Assigning staff members to more complex patient care with supportive supervision will actually increase nurses’ skill level, competence, and confidence while maintaining safe patient care and decreasing the risk of liability to nursing staff.3 Obligation to train, orient, evaluate Another area of nurse manager liability arises from the manager’s obligation to train, orient, and eval- uate the ability of clinical nurses to perform specific functions and procedures. Most major facilities have in-service education departments to orient new nurses and assist with continuing education. Beyond this general orientation, nurse managers are responsible for ascertaining that the nurse is oriented to the specific unit or setting under their management.7 In a malpractice lawsuit, the plaintiff’s counsel will try to show that the nurse failed to meet the standards adopted by the facility. The nurse manager is responsible for ensuring that the nursing standards described in the policy and procedure manual are reasonable and staff members on the unit know and understand them. The nurse manager must provide staff members with the policies and procedures they’re to follow and ascertain that they’re performing care in accordance. This is what nurse managers will be held to in a legal matter before the board of nursing or a court of law. It’s also the nurse manager’s responsibility to determine on a dayto-day basis whether nurses are capable of performing necessary procedures. Nurse managers are at risk for failure to properly train or educate staff and evaluate the skill levels of the staff members to whom they assign duties. The nurse manager must ensure that staff members know how to operate equipment safely and when they require additional education and retraining to provide the best quality of patient care. The nurse manager also has the responsibility to facilitate and enable an underperforming staff member and the unit to achieve the goal of providing safe and efficient care.8 Unfortunately, in some cases, it’s the nurse manager who’s found liable for negligent care when he or she fails to evaluate a staff member’s lack of skill and training that led to a poor care decision and patient injury.4 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Legal Perspectives Nurse managers must also accommodate for short staffing. Sharing Supervision and Liability as A Nurse Manager Essay

This comes from a continuing nursing shortage, increased patient acuity with our aging population, and ongoing budget constraints with a focus on reducing the cost of providing care. The nurse manager is responsible for meeting The Joint Commission guidelines concerning staffing requirements and various state laws establishing minimum nurse-to-patient ratios for licensed hospitals. The nurse manager must consider these requirements when determining policies on nurses floating to other units and the use of agency or pool nursing staff. The highest standard Nurse managers are held to a high legal standard of care when they take on supervision and responsibility for nurses staffing their clinical settings. They must be aware of the legal obligations they have when performing their supervisory duties as a nurse manager. The nurse manager who supervises and leads with a thorough understanding of safe delegation practices is less likely to be found liable for negligence. Nurse managers must be dedicated to continuous training, orientation, and evaluation of staff members providing care on their units as they strive to meet the requirements for quality patient care in a challenging healthcare environment. NM REFERENCES 1. Fremgen B. Medical Law and Ethics. 5th ed. Upper Saddle River, NJ: Pearson Prentice Hall; 2015. 2. Cherry B, Jacob S. Contemporary Nursing: Issues, Trends, & Management. 6th ed. St. Louis, MO: Elsevier Mosby; 2013. 3. Weld KK, Garmon Bibb SC. Concept analysis: malpractice and modern-day nursing practice. Nurs Forum. 2009;44(1):2-10. 4. Yoder-Wise P. Leading and Managing in Nursing. 6th ed. St. Louis, MO: Elsevier; 2014. 5. Kallas KD. Profile of an excellent nurse manager: identifying and developing health care team leaders. Nurs Adm Q. 2014;38(3):261-268. 6. American Nurses Association. Nursing: Scope and Standards of Practice. 3rd ed. Silver Spring, MD: American Nurses Association; 2015. 7. Fagan MJ. Techniques to improve patient safety in hospitals: what nurse administrators need to know. J Nurs Adm. 2012;42(9):426-430. 8. Cadiz DM, Truxillo DM, O’Neill C. Common risky behaviours checklist: a tool to assist nurse supervisors to assess unsafe practice. J Nurs Manag. 2015;23(6):794-802. Karen Wilkinson is the founder of Wilkinson Legal Nurse Consulting in Seattle, Wash. The author has disclosed no financial relationships related to this article. DOI-10.1097/01.NUMA.0000481787.21944.c6 Nursing Management  April 2016 13 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.Sharing Supervision and Liability as A Nurse Manager Essay

What are the ethical 18 August 2017  Nursing Management Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. 1.0 CONTACT HOUR The ethics/advocacy connection leadership qualities of nurses, and how do these traits contribute to competent, safe patient care? By Mary Atkinson Smith, DNP, FNP-BC, ONP-C, CNOR, RNFA W orking on the frontline of care delivery and patient communication, nurses inevitably encounter ethical dilemmas. That said, all nurses have an ethical obligation to advocate for patients in a way that protects them from harm, regardless of the nurse’s environment or title in their organization. A nurse’s education and license serve as the basis for the expected standards of competent nursing practice. When patient care practices become substandard and lack competency, the nurse increases the risk of patient harm. Every nurse must cultivate ethical leadership qualities to build his or her own moral compass in a way that guides the delivery of ethical and competent nursing care, and provide a model for other nurses to follow. Building a moral compass In 2015, the American Nurses Association (ANA) introduced a revision of the Code of Ethics for Nurses with Interpretive Statements to guide nurses in all areas of practice.1 Daily, nurses are vital leaders in the delivery and design of life-saving care. The ethical leadership of nursing covers more than just the delivery of direct patient care; it also applies to the development and design of systemwide models of nursing care delivery that impact indirect patient care. Ethical leadership is critical in both direct and indirect delivery of optimal nursing care. This code revision may serve to guide nurses in recognizing and developing ethical leadership qualities. Nursing Management  August 2017 19 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. The ethics/advocacy connection The ANA Code of Ethics for Nurses with Interpretive Statements contains nine provisions that have been revised from the 2001 version.1 The nine provisions contain a centralized relative theme—the nurse—and focus on his or her national and global convergence with patients, other nurses, other individuals, the nursing profession, and society. Sharing Supervision and Liability as A Nurse Manager Essay

These provisions assist nurses with identifying basic values and commitments, highlighting the limits of loyalty and duty, and recognizing the facets of responsibilities that extend beyond the singular encounter with a patient. The revision of these provisions also addresses the current environment of nursing in a way that encourages nurses to realize the global scope of nursing significance on health.1 To better understand the ANA’s Code of Ethics for Nurses with Interpretive Statements and how it correlates with ethical leadership qualities, it’s important to know the standard ethical principles of nursing, which are respect for autonomy, beneficence, fidelity, justice, nonmaleficence, and veracity.2,3 Becoming more familiar with these individ- ual principles may also help nurses identify and develop qualities needed to promote ethical leadership within the nursing profession. (See Table 1.) Morals vs. ethics Nurses may have difficulty comprehending the difference between morals and ethics. Although they’re often used interchangeably, the two terms have separate meanings, and it’s vital for clinicians to know the difference. Morals are “good” or “bad” thoughts and actions derived from ethical reasoning. Ethics, a broader term, is the study of moral values and the principles of humanitarian duty as they relate to a set of rules that a group or society follows.4 Ethics refers to the ideals of a group, organization, or society. Morals are based on a more personal and individualized set of values that guide the nurse’s beliefs or ideas.4 It’s also vital for nurses to understand how morality relates to ethical leadership. A nurse’s morality may serve to influence his or her thoughts and actions regarding patient advocacy, so it’s crucial for nurses to develop Table 1: The six principles of ethical leadership in nursing 1. Autonomy: self-governing and patients’ ability to independently make their own decisions that are respected by others. 2. Beneficence: doing good and acting in ways that benefit patients. 3. Fidelity: faithfulness, truthfulness, fairness, loyalty, and a commitment to caring for patients. 4. Justice: treatment that’s fair, equitable, and appropriate in relation to what’s due or owed, regardless of what’s been contributed or earned. 5. Nonmaleficence: the obligation to avoid harm that’s deliberate, at risk, or takes place while carrying out beneficial acts. 6. Veracity: telling the truth. Source: Rich K. Introduction to bioethics and ethical decision making. In: Butts J, Rich K, eds. Nursing Ethics Across the Curriculum and into Practice. Burlington, MA: Jones and Bartlett Learning; 2013:31-68. 20 August 2017  Sharing Supervision and Liability as A Nurse Manager Essay

Nursing Management a level of moral maturity that influences sound ethical decision making during challenging dilemmas in nursing practice.5 Ethical leadership in nursing that’s morally mature involves committing to a career-long learning process of developing ethical reasoning that promotes integrity in problem solving of ethical dilemmas on the behalf of patients and their family members. Regarding ethical dilemmas, nurses have a moral and ethical obligation to intentionally make patient safety a priority for themselves, their patients, and the organization and institutions they represent. The complex and heavy demands on nurses place them at high risk for experiencing moral distress—feelings of anger, frustration, and dissatisfaction, along with poor performance that results from the inability to follow moral values and do the “right thing” due to external constraints.4 To successfully promote ethics-driven patient advocacy among frontline nurses, leadership support must lack this distress.6 Characteristics of ethical leaders The individual qualities that constitute ethical nursing leadership and promote a systemwide culture of it within organizations can be viewed as the eight C’s: courage, competency, compassion, commitment, candor, consistency, communication, and the conviction of intuition.  Courage: Possessing moral courage refers to the nurse directly confronting an issue that doesn’t reflect his or her beliefs or values, or standing up for what’s right by speaking out, Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. even when faced with potential consequences.4,7 A recent study revealed that support from organizational administrators is essential for fostering nurses’ moral courage to speak up. This study also revealed the need for highlighting the code of ethics in nursing and applying it to patient safety in nursing school curricula—specifically by using moral courage in simulation scenarios. These findings highlight the importance of moral courage in academic and clinical practice settings regarding advocating for patient safety.8 Moral courage involves ethical nurse leaders being bold and having a moral compass with ethical boundaries that promote patient advocacy. Ethical leaders don’t stand in silence because it may be viewed as agreement. They boldly and courageously speak out against anything that undermines the delivery of safe, high-quality care because they know that silence could be fatal to their patient.  Competency: Patients have a right to competent nursing care, and nurses are responsible … Sharing Supervision and Liability as A Nurse Manager Essay


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