A Little Bit of This and That ...
That's What Nursing and
Legalities Is All About

by Dr. Gloria Jo Floyd, The Nurses Coach

Greetings again my friends and colleagues! Today I share with you from a thoughtful space. Nursing as you know is so complex, yet simple and always intriguing, challenging, frustrating and/or rewarding.  And all of that frustration, challenge, intrigue or reward can happen in the same day. That was so for me today.

Early -- like 7:45 a.m. -- now that is "early" for me, I started doing what nurses everywhere do -- dealing with "whatever" comes. Today I advised a client from 7:45 a.m. - 9:35 a.m. on my own nickel from Houston, helped a nurse who had felt wronged draft a letter to her " superiors" or perhaps "inferiors" depending on how you looked at the situation, responded to several e-mail -- some really great, from Texas to Sweden about one of my columns, etc, etc, etc. You probably had a similar day as a nurse with your own level of  "uniqueness". We all have such unique, intriguing, challenging,
frustrating, and/or rewarding days.

I still need to pack for my day of travel and work for tomorrow. And then here I sit as well writing these words to you. Let me share what comes to mind. Nursing is so diverse we must think about many focuses at once every day.

I am going to if you will tolerate it, share several different legal tidbits with you. They are not in priority order but just for you to think about and think on. And when time permits contact me and share any thoughts on them that I can share here in the future. Or any issues they brought forth for you to ponder.

Standards of Practice

Are you taking your nursing license for granted? Have you thought much about your practice lately? If you are required to document, do you think your documentation requirements are just busy work with no real value to you or anyone else? Have you reflected lately on why you practice as you do? Would you feel comfortable if a nurse like you were caring for your most significant other? Are you blaming your inability to get your work done on managed care – as you have too much to do? If a jury reviewed your practice would you be found innocent of all clinical or administrative charges alleged against you? Are you accepting only assignments that you could reasonably be
expected to complete each day in a quality way? If you have duties of assignment, could you stand successfully against allegations of assigning an unqualified, poorly prepared and oriented staff member who has been accused of providing substandard care? Do you utilize the plan of care process properly each and every time you give, assign, or supervise care? If you supervise are you really evaluating quality in every aspect of your supervision? Have you thought about your clinical and/or administrative responsibility adequately when you have had responsibility to assess and reassess a patient? Did you and/or those assigned revise the care to be in line with the reassessment? Can you prove it? Are you doing your part to maintain a safe environment for your patient/clients, visitors and/or staff? Etc. etc…if not, you could lose your license to practice.

To be sure you are on the right clinical and/or administrative track:

  • Check out the determinants for findings of unprofessional conduct in your state

  • Review the standards of practice in your state's practice act. 

  • Reorient yourself to all your agency's policies and procedures to be sure that you are safely practicing.

  • Present yourself professionally in every encounter – from dress, to practice, in communication, to role modeling.  

  • Be of good professional conduct and character.

  • Follow your state's mandated standards of practice each and every time.

  • Always record your clinical actions.Stay abreast of legal and documentation issues, and

  • Remember to study the legalities of documentation

Concerned About Legal Liability

Then Remember to Do These Things to Enhance Your Management of Risks

1.   Improve Agency Wide Communication - Be sure your team knows what is being   
      communicated in all directions.
2.   Increase Staff Inservice Education - Staff quality is important for the supervisor and
      the supervised.
3.   Document Effectively - It is really true, if you didn't chart it, it will be hard to prove you
      did it.
4.   Be Sure You Have Adequately Known and Understood Policies and Procedures -
      Policies and procedures give you guidance. You must be cognizant of them.
      You should know them and follow them. It is a good idea to review them frequently.
5.   Be Open to Constructive and Positive Change - Change can be good. Demonstrate
      your team playing by supporting planned change.
6.   Improve Performance Evaluation - Don't be fair/average in your work. It will come
      back to haunt you.
7.   Set and Follow High Standards of Operation - Be a great role model. Walk your talk.
      Do what you promised at all times.
8.   Be Sure You Have A High Quality and Adequate Staff - Warm bodies don't cut it...so
       if you supervise hire the best. If you are the one hired - shine.
9.   Monitor Your Operations Constantly - Set goals at whatever levels you function.   
       Know  where you are trying to go so you won't end up someplace else.
10. Encourage Peer Review - Challenge yourself and your peers to be the best
       everyday and every hour.
11. Assure Adequate and Well Operating Equipment - It is too late to turn in a repair
       request when the equipment has caused an injury. Do all you can do to have
       effective and efficient equipment.
12.  Keep All Needed Supplies/Resources Available - You don't want a patient to be
       able to testify that you did not have or utilize items needed for his care.
13.  Remove Impaired, Careless Workers - Think about the people who provide care or
       supervise in your facility.  Would you want them to provide care to your mother?  If 
       not,  speak up -- before someone gets hurt and you get sued.
14. Encourage High Staff Morale - A team is only as good as its spirit. To avoid legal
       liabilities do your part to boost team spirit. Encourage together time. Fun time and
       good morale.
15. Aid Staff in Staying Goal and Standards Focused - Where is your team headed?   
      Are you safe from accusations of misconduct?  Does everyone know your
      mission?   Is the unit safe? Are good systems in place? If not, you could be headed
      for legal  liability.

Performance Evaluation

Leaders are called upon to evaluate performance daily of themselves or others. Keep in mind these principles for performance evaluation. Be reminded that performance is done when...

  • Prior standards are set

  • Goals are predetermined and shared

  • Open communication is encouraged

  • A job description exists

  • Orientation has occurred

  • Questions have been asked

  • A clear agreement of role has evolved

  • The evaluated takes part in the evaluation

  • The evaluator helps the evaluate to grow

How well are you doing performance evaluation? What could you do to improve your performance in this area? Jot down a few points now.

Eleven Strategies for Culturally Sensitive Interactions

There are at least eleven things we can do to be culturally sensitive. Review these and think through at least one way for each that you could operationalize.

  1. Treat all with dignity and respect

  2. Ask questions

  3. Be a semanticist

  4. Get to know the person 

  5. Ask his/her preferences

  6. Know the emotional connotations of "Labels" for the person

  7. Treat others like you would like to be treated

  8. Don't talk down to the person

  9. Don't stereotype

  10. Forget labeling

  11. Listen first to learn the lay of the land

Now these issues should give you and your team much fodder for a day of dialogue. If I am correct these legal  thoughts to ponder specific to (1)standards of practice, (2)legal
liability, (3)performance evaluation and (4)culturally sensitive interactions should make great dialogue for your team. Ask around and respond to this survey question to me at
DrGloriaJoFloyd@ncehs.com. "Do most of these four specific areas and the points spelled out under each in the example above have day to day practical legal significance to keep in mind for nurses practicing today?" Your answer options are yes, no, I hope so, I hope not, unsure. Let's get interactive here. Let me hear from you and your team. Answer with one of the answer options noted, add any constructive and printable comments applicable or desired to me. I will share back here a compilation of your responses. Why? I want to know what you thing and Your input is important.  Team dialogue and consensus is a must in today's managed cost, patient/client and staff challenged and restructured health care environment. All of us need to be on the same versus variant pages if we are going o practice "safe". That is -- safe for our patient/client ...safe for us and -- safe for the institution. Safe practice is understanding all of the above and more. Share your ideas with me on safe, legal and correct nursing practice at DrGloriaJoFloyd@ncehs.com. Until next time... KEEP ON NURSING!

Dr. Gloria "Jo" Floyd, Ph.D., RN, The Nurses Coach is a nationally recognized speaker, consultant, author and survival strategist working throughout the united states who resides in San Antonio. You may contact her by email at DrGloriaJoFloyd@ncehs.com.

1999-2011, Dr. Gloria "Jo" Floyd, NCEHS, 14439 N.W. MILITARY HWY #108 PMB 615
SAN ANTONIO, TX 78231,O=210-698-8700, F=210-698-8701

[O] 210-698-8700, [F] 210-698-8701,
email:  info@ncehs.com; www.ncehs.com; or www.DrGloriaJoFloyd.com
2011 All Rights Reserved

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