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Workplace Issues Nurses’ Quick Reference to Workplace Issues The Iowa Nurses Association (INA) is dedicated to advancing the development of professional nurses and the practice of nursing professional nurses and the practice of nursing in order to promote health care for the people of Iowa. The Association recognizes that there are many alternative methods to achieve an environment supportive of professional practice. An effective workplace advocacy program focuses on the individual nurse rather than the employer or organization. The core pieces of the program are education and communication. The education focus is planned to assist nurses refine communication skills that promote open communication, that are collaborative and not adversarial, and that invoke a spirit of building bridges to understanding. The communication focus aims to work collaboratively with nurse executives and managers as well as with chief executive officers from various healthcare systems to recognize the variety of patient care issues and the nursing practice essential to achieve quality care. The Iowa Nurses Association gratefully acknowledges the Arkansas Nurses Association as the publishers of "Nurses’ Quick Reference to Workplace Issues", that serves as a model for this publication. PURPOSE The purpose of this document is to provide professional nurses with information and tools that will assist them in communicating and resolving workplace issues. INTERNAL RESOURCES: A.Review of job description and performance appraisal/competency criteria: Nurses should be aware of their job description and performance appraisal/competency criteria at the time of employment and when the employer makes any changes to those documents. B.Review of policies/procedures: Nursing policies/procedures Administrative policies/procedures Infection control policies/procedures Safety; hazardous materials information Personal policies (you should receive a copy upon employment and when revisions have been made) Practice standards (ANA, Specialty organization) Governmental regulations (JCAHO, State licensing and regulation) C.Workplace issues: FACTS, THE FACTS, AND NOTHING BUT THE FACTS! When a problem or issues exists within the workplace, the nurse should gather the FACTS (leave out EMOTION)! Write the FACTS down! Documentation is essential in establishing credibility, clarifying circumstances, and enhancing recollection of details. When documenting workplace issues or concerns include the following information:
If other personnel share your concern or have had similar experiences, they should be encouraged to document their concern, issue, or problem as well. D.Communication After fact-finding, discuss your concerns with your immediate supervisor. This may be accomplished in an informal manner. Work with your supervisor to determine the following information: whether the problem is a deviation from a standard, facility mission statement, facility policy/procedure, (e.g. JCAHO, Standards of Care, Board of Nursing Rules Regulations, Federal/State laws); possible resolutions satisfactory to all parties involved; IF YOU FEEL UNABLE TO RESOLVE YOUR CONCERN WITH INFORMAL DISCUSSION WITH YOUR SUPERVISOR, EXAMINE OTHER OPTIONS FOR RESOLUTION! Inform your supervisor of your decision to take the next step toward resolution. Example: 1. If you were having a conflict over your performance appraisal or wages, your options would include discussion with the next level of upper management or a representative from Human Resources. 2. If you disagree with a particular policy or procedure, your options would include discussion with the next level of upper management OR review by the Nursing Policy and Procedure committee OR review by Quality Improvement. E. Formal Grievance Resolution If your issue remains unresolved, you may pursue the discussion with your supervisor’s manager. Refer to your organization’s Human Resource Policy Manual and/or the Administrative Policy Manual for organizational charts in order to identify the senior administrative person with the authority to resolve your issue. It is imperative that you follow the chain of command and utilize appropriate communication strategies to resolve your problem! This will protect you if your problem is not resolved satisfactorily and a conflict arises! If conflict results from your attempt to follow your organization’s grievance policy , you may seek advice from your professional nursing organization (INA 515-225-0495) EXAMPLES OF RESOLVING CONFLICT IN THE WORKPLACE
You are asked repeatedly to work overtime. This could be several hours or an additional shift. Are you required to work these overtime hours? Every nurse has a professional responsibility to his/her patients. However, by accepting the assignment of working overtime, you are accountable and responsible for your actions. If due to fatigue, illness, or other reasons, you question your ability to practice safely, then you should take-the following steps. 1. Notify your immediate supervisor in a timely manner of your decision not to work the extra hours. Give your supervisor adequate time to make other personnel arrangements. 2. If your- immediate supervisor remains adamant about the assignment of extra hours, inform the next level of management. 3. Remember to use prudent judgment in your decision-making. (prudent judgment is whereby a nurse acts in a manner to uphold the standards of nursing care as set by nurses with comparable education and experience practicing under similar circumstances.) 4. If you do leave at the end of your assigned shift and do not work the overtime, you may face disciplinary action by your employer including but not limited to reprimand,suspension, probation or termination. 5. Document the facts! Suggestions of information to include are the following: unscheduled transfer into the unit, or an unscheduled absence of a staff member? 6. Problem-solve with your supervisor, if vacancies consistently occur at regular intervals, participate in scheduling alternatives designed to meet your units needs. Cooperate and collaborate together. Do not continue to be a part of the problem! B.RE-ASSIGNMENT You are asked by your supervisor to work in an area that is different. This is commonly known as "floating" or "being pulled". You should know that you have several options. 1. If the area you are re-assigned to is a like area in which you are competent, you may require only an orientation to the unit. You may request a brief tour of the area and a complete report on your assigned duties. Be sure that the supervisor in charge outlines your exact responsibilities and identifies whom you can report to or seek assistance from. A registered nurse is accountable both professionally and legally to provide safe nursing care to patients YOU MUST SEEK ASSISTANCE IF YOU ARE UNFAMILIAR WITH SPECIFIC TASKS! 2. If the area where you are re-assigned is unfamiliar or the patient population requires more advanced or technical interventions than you are capable of providing, you must be able to answer yes to the following question: ARE YOU COMPETENT TO PROVIDE - SAFE NURSING CARE TO PATIENTS IN THIS SETTING? (Competent-ability of the registered nurse to provide care according to the minimum standards of care set forth by the Board of Nursing and the organization’s policies/procedures.) These can be found at http://www.state.ia.us/nursing/655IAC.html in Chapter 6-Nursing Practice for Registered Nurses/Licensed practical Nurses. Oftentimes, there is confusion regarding competent care and expert care. Nurses who float to other units may feel -unprepared to accept an assignment, however, may very well be capable of delivering competent care based on their nursing knowledge and skills that can transfer from unit to unit. 3. If-you believe you are not qualified (competent) to deliver care within the area that you have been re-assigned, discuss your concerns with your immediate supervisor and request a different assignment. It may be feasible for you to remain on that unit and provide support to the staff without assuming responsibility for a patient load. Document your concerns objectively. 4. If you accept the assignment, you and your supervisor must lay out the responsibilities expected of you. REMEMBER: A NURSE IS LEGALLY AND PROFESSIONALLY ACCOUNTABLE AND RESPONSIBLE FOR HIS/HER NURSING CARE. C. DELEGATION There are certain nursing functions that may not be delegated. Under no circumstance should the following nurse care be delegated: 1. initial nursing assessments and any subsequent assessment requiring professional nursing judgment; 2. determination of-nursing diagnosis, nursing care goals, plan of care and progress in relation to that plan; The Iowa Board of Nursing governs the practice of nursing and provides protection for health care consumers by defining the rules and regulations of the practice of nursing. It is essential for each nurse to be aware of the provisions and recommendations of the board of nursing in the area of delegation. REMEMBER: Professional nurses are responsible and accountable for all delegated tasks. It is the nurse’s responsibility to determine that the individual performing the delegated act(s) has the necessary educational preparation and competence to perform the act in a safe manner! You may refuse to delegate a task you feel is inappropriate, however, the employer may undertake disciplinary action against you for your refusal even when your license supports the right to refuse. D.UNSAFE/INADEQUATE STAFFING You arrive on the unit and discover that the acuity and number of patients exceeds the current staff’s ability to provide safe nursing care as is mandated both professionally and legally. If, in your professional nursing judgment, the staffing levels are unsafe: 1. Report the problem to your immediate supervisor and voice your concerns, specifically regarding staffing needs. Collaborate and cooperate to problem solve. Give you Supervisor adequate time to make the additional staff requirements.If your supervisor cannot provide adequate staff, and your professional nursing judgment still deems the assignment to be unsafe, you may choose to remain on your unit in order to not compromise patient care. This is referred to as accepting an unsafe assignment. If you accept an unsafe assignment, you should follow the following guidelines:
REMEMBER: IT IS THE RESPONSIBILITY OF ADMINISTRATION TO PROVIDE ADEQUATE STAFF, HOWEVER, IT IS THE PROFESSIONAL NURSE’S RESPONSIBILITY TO PROVIDE SAFE, EFFECTIVE NURSING CARE. 3. If you decide to refuse the unsafe assignment, do so before you accept report
on the assignment. You may only refuse an assignment that you have not accepted.
Notify your supervisor of your intention and document all of the facts. Remember
to use prudent judgment in making this decision. You will most likely face disciplinary
action from your employer. If you have accepted the assignment and then refuse
it, you may have a complaint lodged against you with the State Board of Nursing
for patient abandonment. © 2008 The American Nurses Association, Inc. All Rights Reserved
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