NR 446 Edapt Week 3 Leading a Team

NR 446 Edapt Week 3 Leading a Team

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Chamberlain University

NR-446 Collaborative Healthcare

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Week 3 Edapt NR446 Leading a Team

When transitioning from a bedside nurse to a leadership role, nurses face expanded legal and ethical responsibilities. This progression involves influencing policy development, ensuring client and colleague safety, understanding healthcare legislation, advocating effectively, and following laws that regulate nursing practice. Nurse leaders set the tone for legal and professional standards within their teams, ensuring that care is provided within the scope of practice and aligned with federal regulations such as those from the U.S. Equal Employment Opportunity Commission (EEOC). While leaders are responsible for creating a safe environment, individual staff remain liable for their own actions. It is vital that nurse leaders foster awareness and understanding of personal accountability.

During clinical observations, such as when a nurse prepares medication for multiple clients simultaneously, the leader must consider key ethical principles: the principle of nonmaleficence (to do no harm), fidelity (commitment to professional standards), and confidentiality (addressing errors privately). Leadership should avoid paternalistic behavior except in urgent situations requiring immediate decisions to ensure safety.

Empowerment Through Ethical Actions

Ethical Leadership

According to the American Nurses Association (ANA, 2015), both direct care nurses and nurse leaders must uphold ethical principles. Leaders, however, are additionally tasked with modeling ethical conduct and guiding teams with transparency and fairness.

Ethical Responsibilities

Ethical decision-making is a core responsibility of nurse leaders and managers. Their behavior heavily influences staff conduct and client care. They must maintain and promote ethical standards, acknowledge risks, protect human rights, and act as ethical role models.

Leadership Roles

• Demonstrate self-awareness and understanding of core beliefs.
• Accept and manage uncertainty in ethical decision-making.
• Model ethical conduct and communicate expected behaviors.
• Promote autonomy and advocate for both clients and staff.
• Represent nursing on interdisciplinary ethics teams.

Management Functions

• Use ethical frameworks in problem-solving.
• Consider legal implications of ethical decisions.
• Monitor employee ethical distress.
• Intervene in cases of unethical behavior.
• Acknowledge ethical performance among staff.

Creating Healthcare Policies

The National Academy of Medicine’s report, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity, outlines key goals to influence health policy. These include:

• Advancing health equity through nursing
• Supporting nurse well-being
• Promoting inclusive data practices
• Expanding nursing education
• Preparing for public health emergencies

Nurse leaders are encouraged to integrate social determinants of health into practice and advocate for policies that ensure access to quality care for all.

Leader Versus Manager: Legal and Legislative Responsibilities

Since the introduction of the Nurse Practice Act, nurse leaders have held responsibility not only for their own practice but also for ensuring legal compliance among their teams.

Leadership Responsibilities

• Prioritize client welfare and informed consent
• Model professional nursing care
• Create inclusive, legally compliant environments
• Pursue continuing education
• Report poor care and foster respectful relationships

Management Functions

• Maintain current knowledge of legal guidelines
• Ensure policies align with state regulations
• Educate staff on consent and confidentiality laws
• Monitor staff credentials and equipment safety

Key Legal Topics

Advocacy in Leadership

Effective advocacy includes speaking up for clients, facilitating ethical discussions, and guiding staff. Nurse leaders must foster autonomy, respond to staff concerns, and build systems that support both clients and teams.

Leadership Traits

• Promote a culture of advocacy and transparency
• Collaborate with policymakers and professional organizations
• Support safe care practices and whistleblower protections
• Empower colleagues to act on ethical concerns

Management Traits

• Prioritize client values in decision-making
• Ensure legal protections for staff
• Create supportive environments for ethical action

Ethical Prioritization

Ethical Scenarios and Principles

When a nurse fails to prevent a client fall or administers unsafe care, they violate professional duties like nonmaleficence and basic safety standards. Similarly, a nurse manager supporting a nurse who refused to give a medication due to an allergy is an example of ethical advocacy.

Ethical Principles Overview

• Autonomy: Support for informed decision-making
• Beneficence: Promote good
• Nonmaleficence: Avoid harm
• Justice: Ensure fairness
• Veracity: Maintain truthfulness
• Fidelity: Keep commitments
• Paternalism: Make decisions to protect others in urgent cases
• Confidentiality: Protect private information

MORAL Decision-Making Framework

The MORAL model guides ethical decisions:

• Massage the Dilemma: Identify issues and stakeholders
• Outline Options: List potential solutions
• Review and Resolve: Weigh pros and cons
• Affirm and Act: Choose and implement a plan
• Look Back: Evaluate outcomes

Application Example: When staff express concern over ICU transfers, nurse leaders should first examine transfer data and collaborate with stakeholders to identify ethical concerns and propose practical solutions.

Ethics in Leadership and the Work Environment

Creating an ethical culture prevents moral distress, enhances job satisfaction, and improves care outcomes. Nurse leaders can use the following practices:

• Provide ethical education
• Promote open dialogue
• Identify recurring ethical concerns
• Support team collaboration on ethical issues

Resolving Ethical Conflicts in Nursing

Understanding the Ethical Dilemma

To address an ethical conflict, the nurse must first fully comprehend the issue at hand. This initial step involves collecting relevant and comprehensive data that may influence the ethical discussion and guide the final decision. After gathering the facts, the nurse can then identify the individuals capable of resolving the conflict, clarify values associated with the dilemma, and explore possible courses of action.

Contribution to Interdisciplinary Ethics Consultation

When participating in an interprofessional ethics consultation, especially in cases involving advance directives, the nurse brings a unique perspective. Nurses often maintain ongoing interactions with patients, allowing them to share nuanced insights into the patient’s preferences, behaviors, and circumstances, thereby adding valuable context to ethical decisions.

U.S. Government and Healthcare Legislation

Branches of Government and Responsibilities

The three branches of the U.S. federal government have distinct functions:

Administrative bodies such as the Department of Health and Human Services (HHS) and Department of Justice (DOJ) implement and enforce these laws.

Legal Precedence and Executive Orders

Legal precedence refers to court rulings based on prior similar cases. Courts often rely on precedence when statutory language is ambiguous. Although executive orders cannot replace laws, they supplement legal frameworks where guidance is unclear or lacking.

Constitution and Statutory Law

The U.S. Constitution establishes the government’s foundational principles. Legislative bodies create more detailed statutory laws, such as those defining healthcare standards and nursing practice.

Legislative Process

Steps in the Senate

1. Introduction of a bill by a Senator
2. Bill is read and assigned a Senate bill number
3. Referred to committee by the Majority Leader
4. Committee holds hearings and revises the bill
5. Senate votes on the bill
6. Referred to the House of Representatives for a vote
7. Sent to the President for signature or veto

Nursing Practice and Legal Considerations

Malpractice Criteria

For a case to be considered malpractice, the following conditions must be met:

• A nurse-client relationship exists.
• The nurse failed to meet the standard of care.
• Harm was foreseeable.
• Actual injury occurred.

Negligence in Nursing

Negligence involves a failure to provide the expected standard of care, such as giving the wrong medication or failing to report changes in patient condition. Consequences may include lawsuits or disciplinary actions like license suspension.

Regulatory Oversight

State Boards of Nursing and legislative bodies regulate nursing practices. For example, in California, the Board of Nursing and State Legislature influence nursing standards. The Nurse Practice Act, available through the National Council of State Boards of Nursing, outlines state-specific regulations (https://www.ncsbn.org/npa.htm).

Error Reporting and Incident Management

When an error occurs, such as administering an incorrect drug dosage, the nurse should:

• Notify the provider immediately.
• File an incident report.
• Document the error accurately.
• Inform appropriate supervisors.

Policy Making in Healthcare

Legislative Responsibilities

The Executive branch enforces laws, while the Legislative branch drafts them. The Judicial branch interprets them. Entities like the Veterans Affairs (VA) manage benefits, and the Pentagon handles defense matters.

Employment Law and Safe Work Environments

Employment laws govern working conditions, break times, job protection, and breastfeeding rights. These laws help ensure a safe and equitable workplace.

Advocacy in Nursing

Defining Advocacy

Advocacy involves protecting clients’ rights, ensuring informed decision-making, and offering equitable care regardless of personal judgments. Vulnerable populations (e.g., elderly, disabled, LGBTQIA+, racial minorities) often require additional advocacy.

Advocacy Scenarios

Examples of advocacy include ensuring consent is understood before procedures, supporting clients who refuse care for religious reasons, and providing unbiased care to stigmatized individuals.

Evaluating Policy Effectiveness

Case Study: Leeland Hospital System

A hospital system addressing nurse shortages uses policy changes to improve nurse well-being. Committee members review exit interviews, sick call data, and workforce demographics to guide decisions. Areas like back injuries, HR conflicts, and equipment shortages may indicate policy gaps.

Law and Employment Practices

Employment Categories

Legal Hiring Practices

Employers may not legally inquire about age, disability, or parental status. Hiring decisions must comply with anti-discrimination laws covering gender, race, religion, and other protected categories.

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Nursesbooks.org.

National Council of State Boards of Nursing. (n.d.). Nurse Practice Act. Retrieved from https://www.ncsbn.org/npa.htm

U.S. Government. (n.d.). Branches of the U.S. Government. Retrieved from https://www.usa.gov/branches-of-government

U.S. Department of Labor. (n.d.). Employment Law Guide. Retrieved from https://www.dol.gov/general/aboutdol/majorlaws

NR 446 Edapt Week 3 Leading a Team

Institute of Medicine. (2011). The Future of Nursing: Leading Change, Advancing Health. National Academies Press.