Writing Homework Help

Chapters 10, 11, and 12 of the Pozgar text each address a different area of practice within the healthcare environment. Identify the chapter that most closely applies to your personal area of practice (current or aspirational), read that chapter, and be prepared to explore the legal and ethical issues in that practice area.

• Chapter 10: Medical staff organization and malpractice
• Chapter 11: Nursing and the law
• Chapter 12: Hospital departments and allied professionals

Based on the chapter you selected, your personal experience, and a biblical worldview, write a Discussion thread identifying and analyzing the legal and ethical issues specific to your area of practice.

Your analysis must be supported by at least 4 scholarly sources, including the textbook chapter(s) and the Bible, cited in current APA format (note that this is a different requirement than the previous Discussion). Title your thread in the subject line with the area of practice that you analyzed.

reply 1

In the future, I would like to go into the field of healthcare administration and use the degree to become a licensed nursing home administrator. In the field of nursing home administration, one is responsible for many different departments including but not limited to, nursing, dietary, laundry, housekeeping, maintenance, etc. As the administrator, he/she oversees these departments and makes sure everyone is doing their job properly. According to Nelson et al. (2020), “nursing home administrator’s routinely monitor care and the environment, and also staff actions and morale in stigmatized settings.” The role of nursing home administrator comes with a large number of responsibilities. A few of these responsibilities include making sure everyone if doing things, the right way in order to satisfy the legal and ethical aspects of the nursing home.

Legal Issues in Healthcare Administration

There are many different legal issues that can arise in the setting of nursing homes. One example of a legal issue that might arise in a nursing home would be the hiring of qualified candidates (Neil, 2020). By not hiring qualified and properly educated healthcare professionals, the organization is at risk for legal issues in the form of malpractice lawsuits. This could be due to the risk that is being placed on the patient by having an untrained healthcare professional provide care. An untrained nurse for example, could potentially not provide proper care in the form of giving medication, not practicing good hand washing techniques, etc., which could cause injury to a patient leaving the organization open to a lawsuit. Upon more recent events, another example of legal issues that might arise in the nursing home setting is that of the COVID-19 pandemic. According to Neil (2020), healthcare staff was not as prepared as they could have been for the surge of COVID-19 related illness that were being seen across healthcare settings. This again, opens organizations up to malpractice lawsuit based on the fact that they were ill prepared and had no education on the virus. One way that an organization can help combat these legal issues is through education. By education staff on the virus and updating organization practices and procedures, an organization can potentially decrease their risk of legal issues related to the COVID-19 pandemic. An organization might also consider the licensing of its employees as part of their job qualification. Liberty University Custom: Pozgar, (2019) describes licensing as “the process by which a competent authority grants permission to a qualified individual or entity to perform certain restricted activities that would be illegal without a license” (p. 335). This would also help ensure that the job is being done correctly and again potentially limit the malpractice lawsuits that could come upon the organization.

Ethical Issues in Healthcare Administration

Along with legal issues that one might face in the field of healthcare and nursing home administration, there are also many ethical issues that can be faced as well. According to the article written by Preshaw et al. (2016), “Ethical issues are unavoidable in healthcare and can result in opportunities for improving work and care conditions; however, they are also associated with detrimental outcomes including staff burnout and moral distress.” Seeing that all healthcare professionals face ethical issues, it is important to evaluate how they might affect myself, as a future nursing home administrator. Preshaw et al. (2016) gives an example of an ethical issues that might be faced in the nursing home setting. The article states that those living in a nursing home should have autonomy (Preshaw et al., 2016). The ethical issues come into play when considering the level of autonomy that a resident of a nursing home has and if that level of autonomy could end up with the resident causing harm to themselves of others (Preshaw et al., 2016). Therefore, the ethical issues being addresses is what to do if the resident has that autonomy but could cause harm to themselves, should a healthcare worker step in and tell them not to do something? This could be seen a taking away their autonomy and poses an ethical dilemma for a healthcare professional. Another example of an ethical issues that can arise in a nursing home that an administrator would have to handle would be that of decision making. As an administrator in a nursing home, decision making is an important responsibility. When it comes to making decisions, for the residents in the organizations, the administrator must remember that the resident is still a person and may want to make their own decisions. Although they may want to make their own decisions, their cognitive conditions may impact their decision making. Therefore, the ethical issues come into play as to what to do in this type of situation.

The Bible and Ethics

In the article written by Rabens (2017), the writer address how one should live a Christian life and remain ethical. This article states that bible is the “operating instructions for life” (Rabens, 2017). This means that in every decision, conflict, or ethical dilemma that a Christian faces, they should consider the bible as a road map. The article states that the reasoning behind this thinking is that “‘God has created us, and he knows best how we should live” (Rabens, 2017). Therefore, we should follow his teaching in all aspects of life, including when facing legal and ethical issues in the workplace. A verse that is an example of this is “All scripture is inspired by God and useful for teaching, for reproof, for correction, and for training in righteousness, so that everyone who belongs to God may be proficient, equipped for every good work” 2 Timothy 3:16 (The Holy Bible, 2011). This verse, along with the article is an excellent example of how Christians should live their lives and make legal and ethical decisions in the healthcare profession.

Conclusion

Overall, in the healthcare profession, there are many decisions that a nursing home administrator would have to make in terms or legality and ethics. Legal considerations would include the quality of staffing and how well the healthcare professionals in the organization are performing their job. Ethical considerations would include decisions being made that could impact a resident’s autonomy and decision-making powers. When a healthcare professional is faced with legal and ethical decision it is important to remember your faith and beliefs and use the bible and teachings of the bible as a road map when faced with tough situations. 

reply 2

Nursing and the Law: The Legal and Ethical Issues of the Nurse Supervisor

The nurse supervisor’s (NS) role is to provide broad oversight and management of the hospital function during non-business hours. The primary responsibilities are to ensure patient and nurse safety and are often called to address various issues that arise after-hours, serving as the 411 and 911 call of most hospital staff. Facilitating a safe environment requires the nurse supervisor to ensure adequate staffing, appropriate and timely patient bed placement, safe quality nursing and medical care, and facilitate collaborative communication and teamwork (Bertino-Lapinsky, 2021). Purposeful rounding is instrumental in building effective communication, physician-nurse relationships, helps identify patient care needs, and promotes a zero-harm environment (Bertino-Lapinsky, 2021). In research by Weaver and Lindgren (2017), NS indicated that making physical rounding on each unit has the most significant impact on patient safety, a finding that correlates well with personal experience.

The supervisor offers guidance to the nursing staff, reinforces nursing practice guidelines and unit-specific policies, helps determine the appropriate level of patient care, addresses conflict issues, acts as a patient relations representative, provides crisis management, and responds to emergency codes (Weaver, 2016, p. 65). Additional responsibilities occur when working at a military facility with a medical residency program and a growing trauma center, with nurses of various skillsets and working guidelines.

The NS must promote a positive attitude, become familiar with the nurses and their skillset, and form a rapport of trust with the staff of all disciplines. The NS must also be aware of facility limitations and physicians’ credentials, determining if a patient is appropriate for admission or if transfer to another facility is optimal. The many decisions and interactions of an NS can lead to a high risk for legal and ethical challenges.

Legal Issues

Pozgar (2019) notes that each state has a Nurse Practice Act (NPA) which sets the legal aspects of nursing and outlines the authorized scope of practice to protect the citizens from unsafe care. A nurse may be licensed in one state but able to work in multiple states. The state board of nursing facilitates working in other states by establishing a Nursing Licensure Compact. The practicing nurse and nurse leaders must remain informed of the rules, regulations, and amendments that guide the professional practice to ensure compliance and be diligent when practicing in a new environment (Grant & Ballard, 2011).

Legal liability is an officially recognized obligation or responsibility and can be categorized as joint and several liabilities, strict liability, personal liability, and vicarious liability (Grant & Ballard, 2011). Liability for the NS is most often associated with the professional negligence of failure to perform supervisory duties, delegate appropriately, and ensure a staff member is adequately trained and oriented to an assigned area (Wilkinson, 2016). An example of failure to perform a duty is that the NS can be liable if they do not address concerns regarding a patient’s treatment or status and neglect to engage the chain of command if necessary to ensure prudent and acceptable patient care. In addition, when floating a staff member to another area, one must ensure the staff member is given a suitable assignment considering skillset, the scope of practice, and professional guidelines; and follow-up with staff to ensure patient safety and nurse safety. A crucial component in liability of a poor outcome is the amount of supervision required by a staff member and the amount provided (Wilkinson, 2016).

The elements of negligence are founded in standards of care and the legal duty to provide standard nursing care. The breach of these standards with proximate cause to an injury creates a situation of negligence and potential legal action (Grant & Ballard, 2011, p. 257).

The unit policies and procedures, facility-specific standards, and governing bodies such as the Joint Commission help guide the decisions of the NS and help the courts determine legal liability (Wilkinson, 2016). For example, guidelines such as the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) provide some flexibility, whereas staff ratios determined by the Joint Commission are less flexible; both can be used to determine liability.

Ethical Issues

The American Nurses Association defines the ethical considerations of nursing in the Code of Ethics for Nurses and the Guide to the Code of Ethics for Nurses: Interpretation and application (Grant & Ballard, 2011). The focus is on the patient’s rights to autonomy, justice, fidelity, beneficence, nonmaleficence, veracity, and the best interest. For example, the patient has a right to active participation in care decisions, receive informed consent, refuse care, and self-determine code status (Grant & Ballard, 2011). The NS responds to all codes, rapid responses, and level one traumas, all situations that can lead to ethical dilemmas. One personal experience as a floor nurse was the resuscitation of an older man who had a do not resuscitate order. The wife demanded that the physician do everything possible to revive him. Unfortunately, he never regained consciousness and died a few days after resuscitation. The physician’s response paraphrased was, are you going to do what the family requests who are alive and ready to sue, or what the patient requested but is incapacitated and likely to die regardless? The demands of the wife drowned out the efforts of advocacy for the patient’s wishes. The wife had no complaints, but the nursing staff who had cared for the patient during multiple admissions to the oncology ward had complaints and ethical concerns.

Ensuring the confidentially of a mental health patient or staff member when admitted as a patient presents is a fragile line. Division officers need to know that a team member will not work, and the military needs to know the condition of their members and where they are located. The military commanding officer writes “fit for duty” reports and explains why the members will not be standing duty, and the information goes up the chain of command. The diagnosis can be sensitive and is privileged information, and a physician-to-medical officer conversation is recommended.

Challenges

The general prevalence of a tighter budget and nursing shortage challenges all facilities to continue providing care with less staff and less experienced staff, thus increasing the risk of litigation (Banks, 2001). Facility-specific issues include sudden staffing shortages when military nurses and medical providers suddenly deploy in times of war and crisis and the need to borrow and activate reservists who are experienced but unfamiliar with the work environment. Knowing union and contract constraints are especially important, for not all employees can work mandatory overtime or float to cover nursing in other units. Military rank can be a barrier to optimal patient care. For example, when a lower-ranking officer hesitates to speak up or question the actions of a higher-ranking officer. When dealing with patient care, medical and nursing knowledge and standards guide the conversation, not rank.

Analysis

The liability risk is unavoidable but can be reduced with diligent effort to stay informed and connect with the staff to provide meaningful leadership. Personal efforts to promote safety and reduce liability situations include creating a culture of mutual respect and employing frequent, open, transparent, intentional, and closed-looped communication. Huddling with the residents, charge nurse, and primary nurse regarding concerns and care changes that correlate with best practice and optimal outcomes. Remaining abreast of governing guidelines, legal constraints, changes in facility dynamics, and areas of concern permits patient-centered decisions and upholds the NS’s obligations.

Biblical World View

The biblical passage Psalms 78:72 speaks perfectly to leadership as a Christian; to be humble, lead with the proper motive and purpose, and lift others with knowledge and opportunity without hesitation (Kuzik, n.d.). God’s work is done by people who are not perfect but willing, using the knowledge and skills they have gained. Likewise, Philippians 2:3 instructs one to not act out of conflict or spite, nor for self-glory but to the betterment of others (Kuzik, n.d.). Collaboration and building solid teams come from seeking and sharing knowledge for collective growth.