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
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
3. Document Effectively - It is really true, if you didn't chart it, it will
be hard to prove you
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.
your team playing by supporting planned change.
6. Improve Performance Evaluation - Don't be fair/average in your work. It
back to haunt you.
7. Set and Follow High Standards of Operation - Be a great role model. Walk
Do what you promised at all times.
8. Be Sure You Have A High Quality and Adequate Staff - Warm bodies don't cut
if you supervise hire the best. If you are the one
hired - shine.
9. Monitor Your Operations Constantly - Set goals at whatever levels you
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
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.
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
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.
Treat all with dignity and respect
Be a semanticist
Get to know the person
Ask his/her preferences
Know the emotional connotations of "Labels" for the person
Treat others like you would like to be treated
Don't talk down to the person
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
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,
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