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Chamberlain College of Nursing Practicum NR-630
Advocacy and Ethical Issues
Review the advocacy skills demonstrated by the nurse executive/mentor in your practicum setting. What skills have you seen demonstrated by this nurse executive/mentor that have contributed to his or her success as an advocate?
our practicum course is almost completed! During the past several weeks, you have had the opportunity to observe your mentor and to practice some of the skills of a nurse executive. This week, the focus will be on the role of advocacy by the nurse executive as well as ethical responsibilities. Take some time to reflect on the last few weeks and identify situations in which the nurse executive was an advocate for the nursing profession or for a patient. Also, the executive role involves the responsibility to maintain high ethical standards in client care while maintaining fiscal responsibility. Identify an ethical issue in the healthcare organization and your mentors role in designing activities to resolve this issue.
Demonstrate the leadership skills of a nurse executive in an organizational setting. (PO 2, 10)
Outline the behaviors of the nurse executive that demonstrate the professional competence of advocacy.
Research avenues for nurses to become involved in decisions that affect their practice.
Demonstrate the incorporation of elements of human caring and legal and ethical principles into the role of the nurse executive. (PO 6)
Apply ethical principles to organizational operations.
Examine an environment in which you and others are held accountable for actions and outcomes.
Advocate for healthcare policy to meet the needs of a diverse society in a changing healthcare environment. (PO 6, 7)
Evaluate the changes in healthcare policy to organizational operations.
Discuss avenues for nurses to become involved in healthcare policy that affect their practice.
Advocacy and Ethical Considerations
Advocacy is defined as active support of an idea or a cause (American Organization of Nurse Executives, 2010). It involves the act of pleading or arguing in favor of something. Advocacy is identified in the American Organization of Nurse Executives (AONE) Nurse Executive Competencies under the competency of professionalism (AONE, 2010). The three skills documented under advocacy are
for the nurse executive to model and demonstrate that patient centered care is the core of leadership and organizations work;
ensure that the staff nurses and a clinical perspective is included in organizational decision making; and
ensure that staff nurses are empowered and actively involved in decision making that affect their scope of practice (AONE, 2010).
When we think about advocacy in nursing, we most often think about patient care and the role of the nurse as a patient advocate. Indeed, two of the three skills documented under advocacy by AONE focus on the patient. However, advocacy should be viewed in a broader sense in that the nurse executive advocates not only for patient care but for the nursing staff and nursing profession within the organization and the larger community.
Cherry and Jacob (2005) identified the importance of promoting a professional practice environment. They define professional-practice advocacy as an umbrella of professional activities encompassing two primary mechanisms to promote and maintain a professional practice environment: workplace advocacy and collective bargaining. (Cherry & Jacob, 2005, p. 102)
The American Nurses Association (ANA) supports legislation focusing on patient and nurse initiatives, such as safe patient handling and patients rights. Two of the main methods used by the ANA in the advocate role include the documentation and analysis of patient outcomes and promotion of accreditation and credentialing (ANA, 2009).
The ANA has developed the National Database of Nursing Quality Indicators (NDNQI) (https://www.nursingquality.org (Links to an external site.)Links to an external site.) to collect and evaluate data that are nurse sensitive and unit specific. Quality indicators include patient falls, pressure ulcers, nurse turnover, skill mix, and RN education and certification. The ability to collect unit-specific information allows the nurse executive to determine those practices that are exceptional as well as those practices that need improvement. The ability to compare hospital-specific results with results from other facilities allows the nurse executive to advocate for needed changes to improve patient care and the workplace for the nursing staff (ANA, 2009).
Another important component of advocacy promoted by the ANA is workplace advocacy. The focus here is the work environment of the nurse and employee rights under the law. The ANA position statements (2009) regarding workplace advocacy center on such issues as healthy nursing-work hours, working when fatigued, work-related musculoskeletal disorders, accepting or rejecting an assignment, and sexual harassment. The nurse executive must be aware of these position statements and advocate for the nursing staff to assure a safe workplace for nursing (ANA, 2009).
How will you see the nurse executive demonstrate advocacy for patient care and nursing staff? Some of the skills a nurse executive will need to develop to be proficient in the advocate role include: strong communication skills, determination, the ability to negotiate, leadership skills, confidence, problem-solving skills, time-management skills, clinical expertise, and fiscal-management skills. The nurse executive will be called upon to use all of these skills in working with the board of trustees of the organization to advocate for patients and nurses. In addition, the nurse executive must be politically savvy in working with local and national political representatives to develop legislation that will support nursing.
It does not matter if the nurse executive is advocating for the nursing staff, for the patient, or for new legislation; the skill set needed and the expertise of the nurse executive in using this skill set will be critical to the outcome. To be a successful nurse executive is to be a successful advocate.
The nurse executive is confronted with a multitude of ethical and legal dilemmas in todays healthcare setting. The AONE Nurse Executive Competencies identify ethics as an area of concern under the competency of professionalism (AONE, 2010). The specific skills listed under this section are
the nurse executive must have the ability to articulate and advocate the application of ethical principles to clinical practice and hospital operations;
the nurse executive must ensure that high ethical standards and core values are integrated into everyday work activities of the staff nurse; and
the nurse executive must create an environment that demonstrates quality standards and has a reputation for ethical standards.
As healthcare continues to become more complex, the ethical and legal dilemmas for the nurse executive become more complex. It is not unusual for the nurse executive to be confronted with an ethical or legal dilemma on a daily basis.
Code of Ethics
Laws are rules of conduct, while ethics is a science of right and wrong. They are separate entities; however, they can overlap in the healthcare setting. While violating a law can result in liability for the nurse, violation of an ethical principle is not as clear-cut (AONE, 2010).
The American Nurses Associations (ANA) code of ethics provides the values of the profession and the standards of conduct expected from nurses. In addition to the code of ethics, the ANA has developed position statements regarding ethics and human rights on a variety of ethical and legal issues (ANA, 2009). These include such diverse topics as
1. patients safe access to therapeutic marijuana;
2. stem-cell research;
3. employers role in ensuring healthy nursing-work hours for staff nurses in all role and settings; and
4. assisted suicide.
You have had the opportunity in prior course work to study ethics in relation to leadership and management. During this practicum experience, you will apply the knowledge gained from those courses to your practice. During this time, you will observe the nurse executive/mentors application of ethical theory in leadership and decision-making skills. You will also take some time to review your ethical decision-making philosophy and apply this philosophy to work situations.
American Nurses Association. (2009). ANA position statements. Retrieved from https://www.nursingworld.org/MainMenuCategories/HealthcareandPolicyIssues/ANAPositionStatements.aspx
American Nurses Association. (2009). ANA position statements. Retrieved fromhttps://nursingworld.org/MainMenuCategories/HealthcareandPolicyIssues/ANAPositionStatements/EthicsandHumanRights.aspx
American Organization of Nurse Executives (February, 2010). AONE nurse executive competencies. Retrieved from www.aone.org.
Cherry, B., & Jacob, S. (2005). Contemporary nursing (3rd ed.). St. Louis, MO: Elsevier.