Professional Issues in Nursing; Challenges and Opportunities

Professional Issues in Nursing Challenges & Opportunities
CONTENTS
UNIT 1: FURTHERING THE PROFESSION
CHAPTER 1: Entry into Practice: The Debate Rages On
Learning Objectives
PROLIFERATION OF ADN EDUCATION
LICENSURE AND ENTRY INTO PRACTICE
EDUCATIONAL LEVELS AND PATIENT OUTCOMES
STUDY FINDINGS
STUDY FINDINGS
STUDY FINDINGS
STUDY FINDINGS
EMPLOYERS’ VIEWS AND PREFERENCES
SHIFTING HEALTH CARE DELIVERY SITES AND REQUIRED COMPETENCIES
ENTRY LEVEL AND PROFESSIONAL STATUS
THE TWO-YEAR ADN PROGRAM?
SHORTAGES AND ENTRY-LEVEL REQUIREMENTS
PROFESSIONAL ORGANIZATIONS, UNIONS, AND ADVISORY BODIES SPEAK OUT
COLLABORATION AND CONSENSUS BUILDING: IS IT POSSIBLE?
GRANDFATHERING ENTRY LEVELS
LINKING ADN AND BSN PROGRAMS
AN INTERNATIONAL ISSUE
CONCLUSIONS
FOR ADDITIONAL DISCUSSION
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
CHAPTER 2: Evidence-Based Practice
Learning Objectives
WHAT IS EVIDENCE-BASED PRACTICE?
WHY, WHEN, AND WHERE IS EVIDENCE-BASED PRACTICE USED?
Why Is Evidence-Based Practice Important?
When and Where Is Evidence-Based Practice Used?
Evidence-Based Practice Around the World
How Do Nurses Determine Evidence-Based Practices?
FINDING EVIDENCE TO ANSWER NURSING QUESTIONS
SUPPORTING EVIDENCE-BASED PRACTICE
Garner Administrative Support
Collaborate With a Research Mentor
Seek Assistance From Professional Librarians
Search Already Reviewed or Summarized Research
Access Resources From Professional Organizations
STUDY FINDINGS
Benchmark With High-Performing Teams, Units, or Institutions
CHALLENGES AND OPPORTUNITIES: STRATEGIES FOR CHANGING PRACTICE
Challenges to Implementing Evidence-Based Practice
STUDY FINDINGS
CONCLUSIONS
FOR ADDITIONAL DISCUSSION
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
CHAPTER 3: Blending the New Essentials of Baccalaureate Education and Distance Learning Education Models
Learning Objectives
AACN’S ESSENTIALS OF BACCALAUREATE EDUCATION FOR PROFESSIONAL NURSES
DISTANCE EDUCATION PROGRAMS
DISTANCE LEARNING: HISTORICAL PERSPECTIVES
ACCESS TO CONTEMPORARY FORMS OF DISTANCE LEARNING
WHY DISTANCE EDUCATION IN NURSING?
FINANCIAL AID FOR DISTANCE EDUCATION
SCOPE OF DISTANCE EDUCATION IN NURSING
STUDENT NEEDS IN DISTANCE LEARNING
CONTROVERSIES REGARDING DISTANCE EDUCATION IN NURSING
Can Nursing Be Taught Online?
Can Distance Education Nursing Students Be Socialized to the Professional Nursing Role?
STUDY FINDINGS
Can Students in Distance Learning Programs Achieve Desired Learning Outcomes?
How Do Faculty Roles Differ in Distance Education from Traditional Settings?
How Can Quality in Distance Education Programs Be Assured?
DISTANCE LEARNING AND SPECIFIC STUDENT POPULATIONS
RN-to-BSN Students
Refresher Course Students
CONCLUSIONS
FOR ADDITIONAL DISCUSSION
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
CHAPTER 4: Using Simulation to Teach Nurses
Learning Objectives
THE EMERGENCE OF HIGH-FIDELITY PATIENT SIMULATORS
DEMANDS ON NURSING EDUCATION
SIMULATION AND HEALTH CARE QUALITY
USING SIMULATION FOR NURSING EDUCATION AND STAFF DEVELOPMENT
CAPABILITIES OF PATIENT SIMULATORS
BENEFITS OF SIMULATION
DISADVANTAGES OF SIMULATION
SIMULATION FOR PRACTICE SETTINGS
RESEARCH ON SIMULATION OUTCOMES
Perceived Satisfaction, Decreased Anxiety, and Increased Confidence
Attitudes of Practicing Nurses toward Simulation
Learning Outcomes with Simulation
STUDY FINDINGS
REGULATORY TRENDS RECOGNIZE THE VALUE OF SIMULATIONS
SIMULATION AND PATIENT SAFETY
SIMULATION IN CONTINUING EDUCATION FOR NURSES
DEVELOPING A SIMULATION CENTER
STUDY FINDINGS
QUESTIONS FOR DISCUSSION
CONCLUSIONS
FOR ADDITIONAL DISCUSSION
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
JOURNALS
UNIT 2: WORKFORCE ISSUES
CHAPTER 5: The Current Nursing Shortage: Causes, Consequences, and Solutions
Learning Objectives
THE DEMAND
Causes of Increased Demand
Geographical Maldistribution of Nurses
THE SUPPLY
Enrollment in Nursing Schools
Part-Time and Unemployed Nurses: An Untapped Pool?
Using Foreign-Born Nurses to Relieve the Shortage
STUDY FINDINGS
ROOTS OF THE SHORTAGE
Nursing as a “Graying” Population
The Nursing Faculty Are Grayer Yet
The Exodus to Nonacute Care Settings
The Free Agent Nurse
Workplace Dissatisfaction
Is Pay an Issue?
Retention: An Undervalued Strategy
THE CONSEQUENCES OF THE SHORTAGE
ADDITIONAL STRATEGIES FOR SOLVING THE SHORTAGE
Redesigning the Workplace for an Older Workforce
Changing Nursing’s Image
A Self-Service Approach to Patient Care
CONCLUSIONS
FOR ADDITIONAL DISCUSSION
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
CHAPTER 6: Importing Foreign Nurses
Learning Objectives
GLOBAL MIGRATION OF NURSES: “PUSH” AND “PULL” FACTORS
STUDY FINDINGS
THE EFFECT OF GLOBAL MIGRATION ON DEVELOPING COUNTRIES
GLOBAL NURSE RECRUITMENT AND MIGRATION AS AN ETHICAL ISSUE
PROFESSIONAL ORGANIZATIONS RESPOND
The International Council of Nurses
The International Centre on Nurse Migration
The AcademyHealth Project: Achieving Consensus on Ethical Standards of Practice for International Nurse Recruitment
The World Health Organization
THE MISTREATMENT OF FOREIGN NURSES
THE INTERNATIONAL COMMUNITY ADDRESSES THE PROBLEM
Some Governments Respond
U.S. Immigration Policy
ENSURING COMPETENCY OF FOREIGN NURSES: COMMISSION ON GRADUATES OF FOREIGN NURSING SCHOOLS AND THE NCLEX-RN EXAMINATION
ASSIMILATING THE FOREIGN NURSE THROUGH SOCIALIZATION
CONCLUSIONS
FOR ADDITIONAL DISCUSSION
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
CHAPTER 7: Unlicensed Assistive Personnel and the Registered Nurse
Learning Objectives
MOTIVATION TO USE UNLICENSED ASSISTIVE PERSONNEL
EDUCATIONAL REQUIREMENTS FOR UNLICENSED ASSISTIVE PERSONNEL
UNLICENSED ASSISTIVE PERSONNEL SCOPE OF PRACTICE
UNLICENSED ASSISTIVE PERSONNEL AND PATIENT OUTCOMES
REGISTERED NURSE LIABILITY FOR SUPERVISION AND DELEGATION OF UNLICENSED ASSISTIVE PERSONNEL
CREATING A SAFE WORK ENVIRONMENT
THE UNLICENSED ASSISTIVE PERSONNEL SHORTAGE
STUDY FINDINGS
CONCLUSIONS
FOR ADDITIONAL DISCUSSION
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
CHAPTER 8: Socialization and Mentoring
Learning Objectives
SOCIALIZATION: ROLES, SKILLS, VALUES, AND CHANGE
THE HEALTH CARE WORKPLACE IN THE 21ST CENTURY
Anger and Hostility
Oppression and Horizontal Violence
SOCIALIZATION AND MENTORING: EMPOWERMENT
Mentoring Opportunities for Men and Women: Historical Differences
Mentoring in Nursing
Increasing Opportunities for Mentoring
Value of Mentoring in Recruitment and Retention
Mentoring and Developmental Stages
CREATING A SUPPORTIVE ENVIRONMENT FOR SOCIALIZATION AND RESOCIALIZATION
Leadership
STUDY FINDINGS
Sponsors, Guides, Preceptors, and Role Models
CONCLUSIONS
FOR ADDITIONAL DISCUSSION
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
CHAPTER 9: Diversity in the Nursing Workforce
Learning Objectives
ETHNIC DIVERSITY
Ethnic Diversity in the United States
Ethnic Diversity in Nursing
Recruiting Minority Students into Nursing
Retaining Minority Students in Nursing
Ethnic Diversity in Education and Health Care Administration
Minority Nurse Educators
Minority Nurse Administrators
STUDY FINDINGS
Ethnic Professional Associations in Nursing
GENDER DIVERSITY
Gender Diversity in Nursing
Is There a Male Advantage in Nursing?
Why Are Men Leaving Nursing?
Recruiting Men into Nursing: Is Affirmative Action Required?
GENERATIONAL DIVERSITY IN NURSING
Defining the Generations
PROFESSIONAL ORGANIZATIONS SPEAK OUT
CONCLUSIONS
FOR ADDITIONAL DISCUSSION
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
UNIT 3: WORKPLACE ISSUES
CHAPTER 10: Mandatory Minimum Staffing Ratios: Are They Working?
Learning Objectives
STAFFING RATIOS AND PATIENT OUTCOMES
STUDY FINDINGS
ARE MANDATORY MINIMUM STAFFING RATIOS REALLY NEEDED?
CALIFORNIA AS THE PROTOTYPE FOR MANDATORY MINIMUM STAFFING RATIOS
Passing the Legislation
The Struggle to Determine Appropriate Ratios
Delays in Implementation
The Struggle to Implement the Ratios
The “At All Times” Clause
Assuring Compliance: The Role of the California Department of Health Services
The Bottom Line: Has Registered Nurse Staffing Improved in California Hospitals as a Result of Mandatory Minimum Staffing Ratios?
SIMILAR INITIATIVES IN OTHER U.S. STATES
OTHER ALTERNATIVES
CONCLUSIONS
FOR ADDITIONAL DISCUSSION
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
CHAPTER 11: Mandatory Overtime in Nursing: How Much? How Often?
Learning Objectives
MANDATORY OVERTIME AS A WAY OF LIFE IN THE UNITED STATES
LEGISLATING MANDATORY OVERTIME
The Fair Labor Standards Act
Recent Changes to Federal Overtime Rules
Legislating Limits on Nursing Overtime
PATIENT ABANDONMENT
THE CONSEQUENCES OF MANDATORY OVERTIME
STUDY FINDINGS
PROFESSIONAL DUTY AND CONSCIENCE
UNIONS AND MANDATORY OVERTIME
ALTERNATIVES TO MANDATORY OVERTIME
CONCLUSIONS
FOR ADDITIONAL DISCUSSION
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
CHAPTER 12: Violence in Nursing: The Expectations and the Reality
Learning Objectives
WHAT IS VIOLENCE IN NURSING?
Defining Violence in Nursing
What Types of Violence Do Nurses Experience?
What Can Be Done to Stop Workplace Violence?
Organizational Approach
Legislative Approach
WHAT IS BEING DONE TO ADDRESS VIOLENCE IN NURSING?
Global Approaches
Individual Research
CONCLUSIONS
STUDY FINDINGS
FOR ADDITIONAL DISCUSSION
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
CHAPTER 13: Technology in the Health Care Workplace: Benefits, Limitations, and Challenges
Learning Objectives
NEW TECHNOLOGIES IN HEALTH CARE
Robots and Health Care
Biometrics
Smart Cards and Smart Objects
Point-of-Care Testing
Automated Medication Administration: Point-of-Care Bar Coding and Intravenous Smart Pumps
Computerized Physician/Providers Order Entry
STUDY FINDINGS
Clinical Decision Support
Electronic and Wireless Communication
Electronic Health Records
Other Electronic Data Repositories and Intranets
TELEHEALTH AND TELENURSING
How Telehealth Works
Telehealth and Telenursing Outcomes
IS TECHNOLOGY WORTH THE COSTS?
STUDY FINDINGS
THE INTERNET AND HEALTH CARE
The Exponential Growth of the Internet
The Effect of the Internet on Provider–Patient Relationships
The “Expert Patient”
Nursing Informatics
The TIGER Initiative
CONCLUSIONS
FOR ADDITIONAL DISCUSSION
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
CHAPTER 14: Medical Errors: An Ongoing Threat to Quality Health Care
Learning Objectives
DEFINING TERMS: MEDICAL ERRORS, MEDICATION ERRORS, AND ADVERSE EVENTS
SEMINAL RESEARCH ON MEDICAL ERRORS: 1990 TO 2000
To Err Is Human
The Response to the Institute of Medicine Report
WORKING TO ACHIEVE THE INSTITUTE OF MEDICINE GOALS
Quality Interagency Coordination Task Force
The National Forum for Health Care Quality Measurement and Reporting
Floyd D. Spence National Defense Authorization Act of 2001
The National Patient Safety Foundation
The Joint Commission
Centers for Medicare and Medicaid Services
Patient Safety Task Force
Mandatory Report Cards
CONTEMPORARY RESEARCH ON MEDICAL ERRORS
STUDY FINDINGS
CREATING A CULTURE OF SAFETY MANAGEMENT
A Six-Sigma Approach
Mandatory Reporting of Errors
Legal Liability and Medical Error Reporting
Leapfrog Group
Bar Coding Medications
Changing Organizational Cultures
Patient Safety Solutions
The 100,000 Lives and 5 Million Lives Campaigns
CONCLUSIONS
FOR ADDITIONAL DISCUSSION
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
UNIT 4: LEGAL AND ETHICAL ISSUES
CHAPTER 15: Whistle-Blowing in Nursing
Learning Objectives
GROUPTHINK AND WHISTLE-BLOWING
EXAMPLES OF WHISTLE-BLOWING IN NURSING
STUDY FINDINGS
THE PERSONAL RISKS OF WHISTLE-BLOWING
ETHICAL DIMENSIONS OF WHISTLE-BLOWING
WHISTLE-BLOWING AS A FAILURE OF ORGANIZATIONAL ETHICS
LEGAL PROTECTION FOR WHISTLE-BLOWERS
The False Claims Act
Other Federal Legislation Related to Whistle-Blowing
WHISTLE-BLOWING AS AN INTERNATIONAL ISSUE
CONCLUSIONS
FOR ADDITIONAL DISCUSSION
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
CHAPTER 16: Impaired Nursing Practice—What Are the Issues?
Learning Objectives
PREVALENCE OF THE PROBLEM
OVERVIEW OF THE LITERATURE
Identifying Early Risk Factors for Substance Abuse
National Nursing Organizations
Nurses Reporting an Impaired Colleague—Issues and Ethics
Impaired Practice Policies in the Workplace
Nondiscipline Treatment/Diversion Programs
The Recovered Nurse: Re-entry into Practice
Research Dissemination—Is It Happening?
HOW CAN WE STOP LOSING NURSES TO SUBSTANCE ABUSE?
CONCLUSIONS
FOR ADDITIONAL DISCUSSION
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
CHAPTER 17: Collective Bargaining and the Professional Nurse
Learning Objectives
HISTORICAL PERSPECTIVE OF UNIONIZATION IN THE UNITED STATES
HISTORICAL PERSPECTIVE OF UNIONIZATION IN NURSING
UNIONS REPRESENTING NURSES
MOTIVATION TO JOIN UNIONS
STUDY FINDINGS
REASONS NOT TO JOIN UNIONS
ELIGIBILITY FOR UNION MEMBERSHIP
UNION ORGANIZING STRATEGIES
SEEKING UNION REPRESENTATION
LABOR–MANAGEMENT RELATIONS
AMERICAN NURSES ASSOCIATION AND COLLECTIVE BARGAINING
NURSES AND STRIKES
CONCLUSIONS
FOR ADDITIONAL DISCUSSION
ACKNOWLEDGMENT
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
CHAPTER 18: Assuring Provider Competence through Licensure, Continuing Education, and Certification
Learning Objectives
DEFINING COMPETENCE
PROFESSIONAL LICENSURE
Licensure Processes in Nursing
Licensure Processes in Medicine
Licensure Processes in Pharmacy
CONTINUING EDUCATION
Continuing Education in Nursing
Continuing Education in Medicine
Continuing Education in Other Health Care Professions
Does Requiring Continuing Education Ensure Competence?
CERTIFICATION
Becoming Certified
The American Board of Nursing Specialties
The American Nurses Credentialing Center
Certification and the Advanced Practice Nurse
The Effect of Professional Certification
Creating Work Environments That Value Certification
STUDY FINDINGS
REFLECTIVE PRACTICE
Portfolios and Self-Assessment
WHO IS RESPONSIBLE FOR COMPETENCE ASSESSMENT IN NURSING?
CONCLUSIONS
FOR ADDITIONAL DISCUSSION
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
UNIT 5: PROFESSIONAL POWER
CHAPTER 19: The Nursing Profession’s Historic Struggle to Increase Its Power Base
Learning Objectives
FACTORS CONTRIBUTING TO POWERLESSNESS IN NURSING
Oppression of Nurses as a Group
Failure to Align Fully with the Feminist Movement
Limited Collective Representation of Nurses
Socialization of Women to View Power and Politics Negatively
Inadequate Recognition of Nursing as an Educated Profession with Evidence-Based Practice
The Nursing Profession’s History of Being Reactive in National Policy Setting
DRIVING FORCES TO INCREASE NURSING’S POWER BASE
Timing Is Right
Size of the Nursing Profession
Nursing’s Referent Power
An Increasing Knowledge Base and Education for Nurses
Nursing’s Unique Perspective
Consumers and Providers Want Change
ACTION PLAN FOR THE FUTURE
Place More Nurses in Positions That Influence Public Policy
Stop Acting Like Victims
Become Better Informed about All Health Care Policy Efforts
Build Coalitions Inside and Outside of Nursing
Conduct More Research to Strengthen Evidence-Based Practice
Support Nursing Leaders
Mentor Future Nurse Leaders and Plan for Leadership Succession
STUDY FINDINGS
CONCLUSIONS
FOR ADDITIONAL DISCUSSION
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
CHAPTER 20: Professional Identity and Image
Learning Objectives
NURSING STEREOTYPES
Angel of Mercy
Love Interest (Particularly to Physicians)
Sex Bombshell/Naughty Nurse
Handmaiden to the Physician
Battle Axe
The Male Nurse: Gay, Effeminate, and Sexually Predatory
CONTEMPORARY NURSING STEREOTYPES ON TELEVISION
THE IMAGE OF NURSING ON THE INTERNET
HOW INGRAINED ARE NURSING STEREOTYPES?
STUDY FINDINGS
Why the Stereotypes Persist
CONSEQUENCES OF INACCURATE OR NEGATIVE IMAGES
Recruitment Challenges
Self-Concept and Self-Esteem
THE CENTER FOR NURSING ADVOCACY
CHANGING NURSING’S IMAGE IN THE PUBLIC EYE
Finding a Voice in the Press
Reclaiming the Title of “Nurse”
Dressing Like Professionals
Positive Talk by Nurses about Nursing
Emphasizing the Uniqueness of Nursing
Participating in the Political Arena
CONCLUSIONS
FOR ADDITIONAL DISCUSSION
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
CHAPTER 21: Advanced Practice Nursing: The Latest Issues and Trends
Learning Objectives
ROLE DEFINITION
Nurse Practitioners
Clinical Nurse Specialists
Certified Nurse-Midwives
Certified Registered Nurse Anesthetists
BACKGROUND OF ADVANCED PRACTICE NURSING IN THE UNITED STATES
THE DOCTOR OF NURSING PRACTICE
What Do the APRN Organizations Think?
Issues and Concerns
Recent Developments
THE CLINICAL NURSE LEADER
CONCLUSIONS
STUDY FINDINGS
FOR ADDITIONAL DISCUSSION
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
CHAPTER 22: Nursing and Public Policy: Getting Involved
Learning Objectives
DEFINING POLITICS AND POLICY
DEFENSE, DOMESTIC, AND FOREIGN POLICY
POLICIES AND VALUES
CONCEPTUALIZING POLITICS AND POLICY DEVELOPMENT
Kingdon’s Three Streams of Policy Development
Stage Sequential Systems Approach to Analyzing Policy Making and Interest Groups
Stages of Political Development
Continuum of Political Involvement
ROOTS OF INVOLVEMENT IN POLICY AND POLITICS: EARLY 1900S
Nursing Leaders as Public Policy Pioneers
STUDY FINDINGS
NURSING, PUBLIC POLICY, AND POLITICS: MID TO LATE 1900S
World War II
Effecting Social Change
National Health Insurance and Recognition of Nursing’s Impact
Nursing and Collective Bargaining
Emergence of Medicare and Medicaid
NURSING IN CONTEMPORARY POLITICS AND POLICY
Nursing Shortage
Environmental Health
Access to Health Care: Health Disparities and Social Justice
Preserving Medicaid and Medicare
Nursing Political Action Coalitions
Aligning with a Political Party
Getting Involved
CONCLUSIONS
FOR ADDITIONAL DISCUSSION
ACKNOWLEDGMENT
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
CHAPTER 23: Nursing’s Professional Associations
Learning Objectives
THE PUBLIC AND PROFESSIONAL ASSOCIATIONS
Disseminators of Information
Advocacy, Integrity, and Competency
THE GROWTH OF PROFESSIONAL ASSOCIATIONS
THE FORMATION AND WORK OF NURSING’S EARLY PROFESSIONAL ASSOCIATIONS
National League for Nursing
American Nurses Association
International Council of Nurses
SHAPING THE NURSING PROFESSION
DEVELOPMENT OF SPECIALTY NURSING PROFESSIONAL ASSOCIATIONS
Nursing Professional Associations in the Last 50 Years of the 20th Century
The Vital Role of Members
The Organization of an Association
CHALLENGES FOR CONTEMPORARY PROFESSIONAL ASSOCIATIONS IN NURSING
Membership
Finance
Communication: The Short Life Cycle of Information
Changes in Nursing Practice
STUDY FINDINGS
Diversity
THE ASSOCIATION FOR THE FUTURE
Reinvention for Relevance
Culture of the Future
Public Involvement
New Initiatives
Unification: A Radical Change?
Research Needed
CONCLUSIONS
FOR ADDITIONAL DISCUSSION
REFERENCES
BIBLIOGRAPHY
WEB RESOURCES
INDEX