NUR 4327 Rasmussen College Influence of Policy Essay

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Health Medical

NUR 4327

Rasmussen University

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Description

Scenario

The Board of Nursing in your state has decided to utilize a tool developed by the National Council of State Boards of Nursing called the Taxonomy of Error, Root Cause Analysis Practice- Responsibility (TERCAP). Your nurse manager has provided you with a summary of the completed TERCAP report by your Board of Nursing’s Disciplinary Action Committee. She has asked you to review this summary and to develop a proposal of suggestions for continuing education topics on ways to minimize legal risks for your hospital’s practicing nurses. The nurse educators will develop an education series based upon your recommendations. Refer to Minnesota Boards of Nursing.

Instructions

Prepare a proposal based on the summary of the TERCAP with recommendations and suggestions on minimizing legal risks that:

Part One – Review summary of completed TERCAP report below.

A patient, aged 54, admitted for back surgery secondary to compressed vertebrae and intense pain. The difficulty with pain management has caused the patient some depression and insomnia over the last month. During her first post-operative day, the patient fell attempting to go from the bed to the bathroom without assistance. Her injury was serious and involved significant harm requiring two additional days of hospitalization and an addition six weeks of physical therapy.

A review of the case determined that her assigned nurse on night shift was an RN (age 24) with nine months of experience in this unit. This was her third 12 hours shift in a row, and she was 29 weeks pregnant. There were 28 beds occupied with only two RNs and one patient technician, due to one vacancy and a call-in for illness. This community facility has experienced a turnover rate of 12% in the last year (community average of 4.5%), and has a high number of new graduates working on medical surgical units, particularly on the 7 pm- 7 am shift.

A review of the chart showed that the patient had been advised by the out-going nurse, who admitted her to the unit post-operatively, that she needed to ask for assistance with toileting for at least the next 24 hours due to the extensive back surgery and post-anesthesia response and pain medication. The RN coming on shift had received bedside shift report at 7 pm and noted the patient sleeping, so the issue of patient assistance was not repeated. She checked on her again at 8 pm and administered the requested prn medication (morphine) for pain. She was busy with other patients and did not see the patient again until the patient fell at 9:51 pm.

The patient reported that she did not recall having been instructed to ask for assistance, as she was very groggy from the anesthesia. She stated that she had pushed the nurse call button for assistance and “no one came.” There was no clerical support at the nursing station and the three staff members had been very busy with patients, so this statement could not be substantiated.

The risk manager found that the RN had not followed nursing policy for patient assessment 20 minutes after receiving pain medication, and had not done the recommended hourly rounding on the patient to assess for the need for elimination, pain, and patient comfort. The note in the chart indicated only that the patient requested pain medication, but did not provide specific nursing assessment details or comment that the patient had received the same dosage of morphine two hours earlier.

Part Two – Factors and Actions

  • Discusses the factors that contributed to event and how these factors could be addressed to minimize legal risks.
    • Situational factors
    • Nursing factors
    • Human factors
    • Organizational factors
  • Explains whether the nurse was negligent or did her actions reach the level of malpractice and support your reasoning with research.
  • Determines what options the nursing board had regarding this nurse’s license to practice nursing.
  • Describes your reasoning for what action would you recommend (warning, probation, revocation of license) if you were on the disciplinary committee of your Board of Nursing.
  • Explains how the level of nursing behavior relates to your proposed recommendation on licensure.

Part Three - Continuing Education

  • Summarizes a list of topics to be provided to the education department based on the summary of the TERCAP report.
  • Provides stated ideas with professional language and attribution for credible sources with correct APA citation, spelling, and grammar in the proposal.

Resources

Library Databases

Websites and Resources

  • Make sure to refer to your own state’s Board of Nursing guidelines for practice and reporting requirements. Board of Nursing’s actions regarding nursing complaints and their decisions are publicly available on their website.
  • TERCAP Resource Document

Unformatted Attachment Preview

NUR4327 Del 6 Material Disciplinary Action Disciplinary Process Issues of nursing practice negligence that have potential civil or criminal liability must be reported to the Board of Nursing. All nursing boards have specific policies on reporting nursing impairment due to drugs and alcohol. Hospitals and agencies often have a “Fit for Duty” standard that addresses both physical and mental health issues. Boards have disciplinary review committees; whose role is to investigate the incident and recommend any disciplinary actions the full Board. The names of nurses under discipline by the board are public record and are used by employers for their own decisions and for future employers and schools invalidating an active-unencumbered license to practice as an RN. Any past or present disciplinary action must be disclosed to employers. Many of the boards of nursing have adopted an investigative tool referred to as the Taxonomy of Error, Root Cause Analysis and Practiceresponsibility (TERAP) for consistency among the boards in assessing and reporting errors into a central database for quality analysis. The TERCAP review does include system breakdowns, particularly insufficient nurse staffing. The nurse, however, is responsible for her practice regardless of system issues. In the TERCAP report, the data from the first round of use found that over 72% were unintentional errors and that 55% of cases of practice breakdown occurred when a nurse worked in a patient care position for two years or less (Benner et al. 2006). A nurse’s previous disciplinary history predicted future practice breakdown. The most common failures are safe medication administration, documentation, attentiveness/surveillance, clinical responding, prevention, intervention, interpretation of providers’ orders, and professional responsibility as the patient advocate. Potential Actions The boards have the authority to recommend the nurse be allowed to continue practice, practice under supervision for a period, or suspend a license until certain conditions are met. Regardless of the board of nursing decisions, employers have the choice over whether to discipline or fire the employee. Individuals may seek civil prosecution. The District Attorney may seek criminal prosecution. Malpractice Coverage The purpose of liability insurance is to spread the risk of economic loss among a group of individuals with shared risk. A fee or premium is paid by the individual member for coverage that includes legal consultation, costs of litigation, and payment of awards. There are limits to various nursing liability policies, so it is essential to read and understand. Nurses usually work for an employer who has liability insurance to protect their interests. Claims that an employer is directly liable for the actions of the employee commonly state that the employer failed in its duty to ascertain that the employee had the necessary qualifications and ability to render safe care, the employer was unable to supervise the employee properly, and the employer failed to provide employees with the proper training to provide safe care. The question of whether a nurse should have personal liability insurance is complicated. Nurses who are independent contractors and nurse practitioners benefit from individual insurance policies. Nurses who work for organizations seeking to limit their liability may face them taking the position that the employee was not acting within the scope of their duties, and the insurer may decline to cover the nurse. You may wish to consult with your attorney, financial planner, or a representative from a company that issues nursing liability policies to determine if an individual insurance policy is right for you. Source(s) Benner et al. (2006). TERCAP: Creating a national database on nursing errors. Retrieved from https://www.ncsbn.org/Harvard_Health_Policy_Review.pdf Erstad, W. (2018, October 29). Civil law vs. criminal law: Breaking down the differences. Retrieved from https://www.rasmussen.edu/degrees/justice-studies/blog/civil-law-versuscriminal-law/ Justia. (n.d.) Stages of a criminal case. Retrieved from https://www.justia.com/criminal/docs/stages-of-a-criminal-case/ World Health Organization. (2014). Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK214359/ Minimizing Legal Risk Every nurse should be aware of the risks involved in nursing practice and should take measures to protect themselves and their license. Five chief nursing officers were interviewed on how nurses can minimize their legal risks in nursing practice. Here are their recommendations. Know your scope of practice and the best way to do this is to have recent publications from your professional nursing association, often free to members. Professional membership and attendance at continuing education is an excellent way to stay up to date. Considering the cost of a lawsuit or your nursing license, this is a small expense. Review the policies and procedures and confirm that they are consistent with current standards and guidelines for evidence-based practice. If they are not, make a suggestion to your managers that supports a need for practice change and amending policies and procedures. Make sure that all the policies and procedures are readily available, particularly with new nursing staff during and after orientation. It pays to have these readily accessible in your electronic health record system for decision support. Follow your organization policy and procedures and document your actions and patient response to the plan of care. If you do not know what to do, follow your chain of command and document your conversation. If you are still not comfortable with a policy or procedure, you have the right to refuse and report to the administration why you are making that decision. Make sure to report your actions immediately if you refuse. If you are overwhelmed on a shift, ask for help by following your chain of command. Do not risk your patient’s health or your nursing license for failure to provide adequate care. Managing Environmental Risks Survey your nursing environment for environmental risks such as nonfunctioning equipment, frayed electrical outlets, leaks or slick surfaces that increase the risk for patient falls. If you have new equipment or software, ask for assistance. Keep your cell phone in your locker. Your cell phone is not a secure device for messaging of private patient or hospital communication. Texting your colleague to ask for help on your device is not considered evidence in a court of law. Therefore, secure messaging systems like Voicera are used to ask for assistance. Follow all regulations issued by the Occupational Safety and Health Administration regarding environmental protection, which includes firesafety procedures, handling hazardous materials, personal protective equipment, slips/trips/falls, workplace harassment and violence, latex allergy, and radiation exposure. Follow labor relations policies, which are spelled out in the employee handbook and the human relations policies. These policies are related to hiring and discipline practices, which can result in litigation for the hospital and you individually. When in doubt, consult with the Human Resource Officer. Supervision and Documentation Supervise your unlicensed personnel and evaluate their work with both a regular rounding and dropping in on patient care. If there is a problem, address it immediately in a private area. A great resource is “Crucial Conversations” by Kerry Patterson. Focus on the well-being of the patient, not the person. Be open to feedback and insights from UAPs. Document when communication with physicians or other professionals is at odds with what you think best as the patient advocate. If you have a question on medications, ask first – confirm with the pharmacy. The patient is your responsibility. If you have personal issues that are putting you at risk for drug or alcohol abuse, most employers have confidential support with outside agencies. Reach out before you compromise your critical thinking. If other colleagues express concern, pay attention. Nursing leadership wants to support you and your value as an individual as well as a nursing professional. Remember, the authority for the practice of nursing is based upon social responsibility, which means that the nurse is accountable to the public for providing culturally sensitive, safe, timely, efficient, patient-centered, quality, and effective nursing care for individuals, families, and populations across the continuum of care. To do otherwise jeopardizes your license to practice and the image of the nursing profession. Source(s) Healthcare team. [Photograph]. Retrieved from Encyclopedia Britannica Image Quest. https://quest.eb.com/search/132_1434736/1/132_1434736/cite Lazzarotti, J. (2019). Policies. Retrieved from https://www.healthcareworkplaceupdate.com/category/policies/ Occupational Safety & Health Administration. (n.d.) Hospital eTool. Retrieved from https://www.osha.gov/SLTC/etools/hospital/ Policy & Politics in Nursing and Health Care (7th ed.), Chapter 63 (pp 523-532)
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Running head: TERCAP PROPOSAL

TERCAP Proposal
Student’s Name
Institutional Affiliation
Date:

TERCAP PROPOSAL

2

TERCAP Proposal
Part One-Review Summary
The case is a about a 54 year old patient admitted for back surgery secondary to
compressed vertebrae and intense pain. The injury was serious and needed two days of
hospitalization and six more days of therapy. The nurse assigned to the patient was a pregnant
RN with nine months experience. Unfortunately, certain aspects of practice went wrong,
exacerbating the patient’s pain. The patient could not get the assistance she needed from the
nurse. The nurse was found to have breached nursing policy by not taking responsibility and not
assessing the patient well. The nurse was also expected to undertake hourly checks, which did
not happen.
Part Two: Factors That Contributed To the Event and How They Can Be Addressed
In light of situational factors, it is important to mention that the RN nurse overworked
and exhausted as she was on her third 12-hour successive shift. It was inappropriate to make her
work overtime for she was pregnant. Hospitals can minimize legal risk in future by giving
pregnant staff shorter shift hours. Even though the scenario regards a 54-year old post-surgery
patients, the pregnant RN would exercise her legal rights to sue the facility in case she suffered
from an injury in the course of working overtime. Pregnancy is the nurse’s situational factor that
make her unsuitable for longer shift hours. The patient would have been given a bedpan to
address the need of going to the restroom. According to Eltaybani, Mohamed, and Abdelwareth
(2019), post-surgery patients are always weak and cannot perform basic physical activities such
as visiting a restroom. The Lack of a bedpan is a situational factor in the patient’s environment,
which the management can address by having an effective nurse call system for comfort...


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