Leadership Test 1

Supervision

"...the provision of guidance or direction, oversight, evaluation and follow-up by the licensed nurse for accomplishment of a delegated nursing task by assistive personnel" Closing the loop. Not only saying I'm assigning four pts. To nancy, 3 critical to Joe, and now I'm done.....it's going further and see how the nurses are doing with the pt. load and give feedback.

Accreditation

"A process by which a voluntary, nongovernmental agency or organization approves and grants status to institutions or programs (not individuals) that meet predetermined standards or outcomes." Peer review and voluntary process Uses standards and criteria for the evaluation peer review process ACEN (Accreditation Commission for Education in Nursing) formerly NLNAC or CCNE (Commission on Collegiate Nursing Education) are the two accrediting bodies

Accountability

"Being responsible and answerable for actions or inactions of self or others in the context of delegation." (NCSBN, 1995, p. 1). and... "The delegatee is accountable for accepting the delegation and for his/her own actions in carrying out the task." (NCSBN, 1995, p. 3).

What is the Professional duty owed?

"How will my attorney prove that I acted as a reasonable nurse?" ...Nurse Practice Act ...Expert witness (typically another nurse) ...Established policies and procedures ...Accreditation and facility licensing standards ...Textbooks and journals ...Professional standards for organizations ...Professional standards of care applied to the particular case

Delegation

"The transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome."

Certification

"Voluntary process by which a nongovernmental agency or association certifies that an individual licensed to practice a profession has certain predetermined standards specified by that profession for specialty practice" (PNCB, ANCC) Certification is the credential that provides recognition of professional achievement in a defined functional or clinical area of nursing practice Examples: CRNA (Certified Registered Nurse Anesthetist) and CPNP (Certified Pediatric Nurse Practitioner)

Career Goals (Why?)

*Why have goals? To help define your own professional identity.* What are my first year goals? (becoming a more competent pediatric nurse) What are my three year goals? (certification in pediatric IV therapy, charge nurse duties, professional organizations-Pediatric Nurses Association) What are my five year goals? (advanced degree as a pediatric nurse practitioner, leadership position in specialty practice) ...ten years? twenty years? etc, etc, etc???!!!

Ethical dilemma:

1. A situation involving competing rules or principles that appears to have no satisfactory solution. 2. A choice between two or more equally undesirable alternatives.

Competent Nurse

2-3 years of clinical nursing experience Conscientious, deliberate planning Begins to see nursing actions in light of client's long-term plans Able to handle when a wrench gets thrown in Demonstrates ability to cope with and manage different and unexpected situations that occur

Defamation-

A civil wrong in which an individual's reputation in the community, including the professional community, has been damaged

Durable power of attorney for health care:

A document that allows a person to name someone else to make medical decisions for him or her if he or she is unable to do so. This authority begins only when the client is incompetent to make those decisions.

Living will:

A document that allows a person to state in advance that life-sustaining treatment is not to be administered if the person is terminally ill and incompetent (used interchangeably w/advanced directive)

Good Samaritan Law-

A law that provides civil immunity to professionals who stop and render care in an emergency. Care cannot be rendered in a grossly negligent manner

Autonomy:

A patient's or person's right to self-determination without outside control; autonomy implies the freedom to make choices and decisions about one's own care without interference, even if those decisions are not in agreement with those of the health care team (implies rational thinking on the part of the individual; may be challenged when the individual infringes on the rights of others) Mr. Johnson has been diagnosed with metastatic lung cancer and is given 6 months to live. The doctors have expressed that with aggressive experimental treatment, he may have a better prognosis. He does not wish to receive any treatment.

Expert witness-

A person who has specific knowledge, skills, and experience regarding a specific area and whose testimony will be allowed in court to prove the standard of care

Moral reasoning, Moral uncertainty, Values:

A process of considering and selecting approaches to resolve ethical issues A situation that exists when the individual is unsure which moral principles or values apply in a given situation Beliefs that are considered very important and frequently influence an individual's behavior

Diversion program-

A program for treatment and rehabilitation of substance abusers

Standard of Care-

A set of guidelines based on various types of evidence as to what is reasonable and prudent behavior for a health care professional

Advance directive:

A written statement of a person's wishes about how he or she would like care decisions to be made if he or she ever loses the ability to make such decisions independently. (used interchangeably with written will)

Controversial Ethical Issues Confronting Nursing

Abortion Euthanasia Futile care Physician-assisted suicide Transplantation Fetal tissue for stem cell research In vitro fertilization Genetics and genomics Allocation of scarce resources ...take a minute to review your own values and beliefs and how these might affect your patient care in these areas

Why is Accreditation so important?

Accreditation assures you, the student, and the public that the program has achieved educational standards over and above the legal requirements of the state Guarantees the student the opportunity to obtain a quality education Some graduate nursing programs require completion of an ACEN or CCNE-approved undergraduate program as a prerequisite for admission to their master's or doctoral programs This becomes a major concern as more and more courses and programs are offered by means of distance learning and nontraditional paths.

Key points about your responses during interviews

Answer honestly Do not brag or gloat, but show yourself in a positive light Remember you are your best salesperson!!! Do not criticize past employers or instructors Do not dwell on your shortcomings Demonstrate flexibility and willingness to work in an area of second or third choice

Ways to lessen a person wanting to file a suit against you

Approaching angry patients with an apology and an offer to help instead of running away from patients who have experienced an unexpected outcome (for example in a med error situation) Sharing uncertainties and a realistic viewpoint during informed consent (being honest and forthright) Refusing to participate in hospital gossip, to joust in the medical record, or to judge others on the medical team will contribute to an atmosphere of teamwork and compassion, rather than one of competition, blame, and retaliation

Setting up the interview

Are there specific dates for orientation, internships, and preceptorships? Identify when you want to begin employment and mark your calendar Plan dates and times for interviews Plan no more than two interviews in one day (better to have 1) Find out how much time you should plan for the interview Find out what the interview process involves? (Tours, multiple interviews with various staff, one interview with a panel of interviewers) Will there be more than one interview day? Ask for directions ahead of time. Do a dry run before the day of the interview. YOU DO NOT WANT TO BE LATE!!!

Shock and Rejection Phase

Bad days begin to outnumber good days Period of disillusionment Feelings of failure and self blame Feelings of frustration, fatigue, anger, and moral outrage may occur Hypercritical attitude about nursing may develop Some nurses drop out of nursing altogether

Incident Report

Can be used as evidence in a lawsuit Only the person directly involved should objectively complete the incident report This form should never be used for punitive reasons against employees You should not mention you have filled out an incident report in the patient record, but factual information about what happened should be documented in the medical record Document facts and not speculation Don't necessarily write in the notes that an incident report was filed. You'll still fill one out, just won't write it down in document.

Did the breach of duty cause the injury?

Causation must be proved by the plaintiff's attorney-Did the patient suffer damages or injury as a result of the breach of duty? Examples: Did the difficult birth cause the child to have cerebral palsy or did a genetic birth defect cause a difficult delivery? Was the injury caused by the auto accident or the medical care? Proving these is not an easy task for lawyers Good documentation of observations will make such proof impossible

The Right Direction and Communication (Four C's of Initial Direction)

Clear-Does the team member understand what I am saying? Concise-Have I confused the direction by giving too much unnecessary information? Correct-Is the direction according to policy, procedure, job description, and the law? Complete-Does the delegation have all the information necessary to complete the task?

Civil Actions

Concern private interests and rights between the individuals involved in the cases Private attorneys handle these; plaintiff brings the lawsuit against a defendant The remedy is usually some type of compensation Malpractice, negligence, and informed consent issues fall into this category

Advanced Beginner Nurse

Could be a last-semester nursing student or a graduate nurse Demonstrates ability to deliver marginally acceptable care Requires previous experience in an actual situation to recognize it Begins to understand the principles that dictate nursing interventions Continues to concentrate on the rules and absorbs minimum information regarding a situation

Proficient Nurse

Could be a nurse clinician, nursing faculty, or a nurse who has worked in an area more than three years Demonstrates ability to recognize and understand the situation as a whole Demonstrates ability to anticipate events in a given situation Has a holistic understanding that enhances decision making

Novice Nurse

Could be a nursing student or an experienced nurse in a new setting No clinical experience in situation expected to perform Needs rules to guide performance Experiences difficulty in applying theoretical concepts to patient care and getting used to the routine

Expert Nurse

Could be an advanced practice nurse, nurse clinician, faculty, or a nurse who has worked in an area for a number of years Demonstrates an understanding of the situation and is able to focus on the specific area of the problem Operates from an in-depth understanding of the total situation Demonstrates highly skilled analytical ability in problem solving Performance becomes masterful

Phases of the interview

Critical first 5 minutes (or should we say 60 seconds!!!) Breaking the ice Fact finding (ask questions) The closing (ask when you will find out) How do you look? Go to the bathroom before. (no sweats/scrubs/fishnets) How do you sound? Does your voice sound interested or too high, too fast or slow. How do you smell? No gum!!! Not too much perfume. Think conservative.

After the Interview

Critique the interview you just had Write down details about the job After a couple of interviews, rank your jobs against your personal list of interests, likes and dislikes, needs, and career goals Take a few minutes to email or write a letter of thanks to the interviewer for the time and interest spent on your behalf If you have not heard from the recruiter by an agreed upon date, a follow-up phone call or email may be appropriate

Deontological Approach:

Derived from Judeo-Christian origins, this approach reasons that all persons are worthy of respect and thus should be treated the same, the rules represent beliefs about intrinsic good that are moral absolutes revealed by God. Based on a duty to act "All life is worthy of respect."

Situational Approach:

Derived from humanistic and Judeo-Christian influences, holds that there are no prescribed rules, norms, or majority-focused results that must be followed. Each situation creates its own set of rules and principles that should be considered in that particular set of circumstances, emphasizes the uniqueness of the situation and respect for the person in that situation "Decisions made in one situation cannot be generalized to another situation."

Teleological Approach:

Derived from humanistic origins, outcome-focused and places emphasis on results. That which is useful is good. Human reason is the basis for authority in all situations, not absolutes from God. The individual's actions are always based on the probable outcome. Rights of the individual may be overlooked or denied; the end justifies the means "That which causes a good outcome is a good action."

The Nurse Practice Act

Describes how to obtain licensure and enter practice within that state Describes how and when to renew your license Defines the educational requirements for entry into practice Provides definitions and scope of practice for each level of nursing practice Describes the process by which individual members of the board of nursing are selected and the categories of membership Identifies situations that are grounds for discipline or circumstances in which a nursing license can be revoked or suspended Identifies the process for disciplinary actions, including diversionary techniques Outlines the appeal steps if the nurse feels the disciplinary actions taken by the board of nursing are not fair or valid

Analyzing Ethical Issues Guidelines

Determine the facts of the situation. Identify the ethical issues of the situation. Consider possible courses of action and their related outcomes. After a course of action has been taken, evaluate the outcome.

4 Major Types of Transition

Developmental-becoming a new parent, midlife crisis (kids/adults) Situational-graduating from nursing school, career change, divorce (immediate things, divorce, change jobs) Health/Illness-dealing with a chronic illness (new health dx) Organizational-change in leadership, new staffing patterns (job/school related, new boss, new charge nurse, new preceptor)

What if my pt. falls?

Document factually how the fall was discovered. Document the nursing assessment data, any obvious injuries, and the nursing actions taken to maintain patient safety and prevent further harm Document what the patient says regarding the fall Document whom you notified (the physician and the family) Document what was done for the patient (examinations, x-rays, assistance) Document what teaching was done for the pt. Document adherence to any hospital policies Document the pts. Understanding of what was said. Walk into the room, didn't see the fall. Pt. on the floor. Pt. moving all extremities well. No bruising or lesions, pt. mental status intact. Pt. stated "Oh my gosh, I got up and forgot to use my call light" Call physicians and family.

What to document

Document the facts Document what you see and do Your job is to render nursing services, not to judge or give your opinion Leave the determination of fault to the courts Your actions and truthful documentation will be your best defense!!!

Rehearsing the interview

Dress for the part (page 80, Box 4-4) Choose a supportive friend or family member to role-play the interviewer Practice your verbal responses to sample questions Ask for constructive feedback Come up with questions of your own for the interviewer

Beneficence:

Duty to actively do good for patients or persons ("take action" by helping) You are shopping at Walmart and another shopper drops to the floor down the aisle from where you are. You run over to assess the person and find they are not breathing and do not have a pulse. You perform CPR on the person until EMS arrives. vs. You are a fireman in New York City, the Twin Towers have just been hit by a terrorist attack, you decide to climb the stairs of the tower to rescue any survivors.

Nonmaleficence:

Duty to prevent or avoid doing harm, whether intentional or unintentional. (avoiding actions that cause harm) Judy is an RN on a medical-surgical unit. She has been asked to float to the hematology/oncology unit for her next shift. She is concerned as she has not received training in administering chemotherapy drugs and has never floated to this floor before. vs. An elderly woman is now in a persistent vegetative state from end-stage Alzheimer's disease. A decision is made not to place her on a respirator or place a feeding tube.

Bioethics and Bioethical issues:

Ethics concerning life Subjects that raise concerns of right and wrong in matters involving human life (Ex. euthanasia, abortion)

How will I be involved in an EBP?

Every nurse may not do research, but every nurse will do evidence-based practice . For nurses providing direct patient care it is the right time and the right thing to do to improve patient outcomes.

What is EBP?

Evidence-based practice has been "identified as the foundation of accountable, professional nursing practice"

Negligence-

Failure to act as an ordinary prudent person when such failure results in harm to another

Honeymoon Phase

First phase See the world of nursing looking quite rosy Often fascinated with the thrill of "arriving" in the profession Short-lived as the graduate begins to see the conflicts between what he or she was taught and the reality of what is done

Moral or ethical principles:

Fundamental values or assumptions about the way individuals should be treated and cared for. These include autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity

Recovery Phase

Graduate nurse begins to have an increased ability to look at the situation objectively Prioritization, conflict management, time management, and support groups can make a difference here First sign of recovery...beginning to have a sense of humor about the situation There is a decrease in tension

Delegatee Responsibilities

His or her own actions in the delegation Accepting delegation within the parameters of his or her training and education Communicating appropriate information to the delegator Asking for clarification if needed Completing the task Accepting feedback for the delegation

Phases of Reality Shock

Honeymoon phase Shock and Rejection phase Recovery phase

Identify a Problem

Identify a problem area in nursing or an area that you feel could use some improvement in nursing practice (in other words...something that could use some evidence-based practice). For this assignment you will find one (1) current (within past three years) nursing research article applicable to the problem you have identified-The nursing problem could be anything related to a nursing issue, nursing skill, or any aspect of nursing you feel needs to be addressed. Be sure to submit the research article with your paper!!!

Do you have a professional duty?

Implied if you are employed by and render services at a health care institution such as a hospital, nursing home, home health agency, school, or physician's office. What about giving medical advice in your home? Not necessarily implied here. What if you stop at an accident to assist someone who is injured? Not necessarily implied (maybe if you are wearing uniform) What about volunteer activities? May or may not imply

Malpractice-

Improper performance of professional duties; a failure to meet the standards of care that results in harm to another person

Credentialing

Indicates both academic achievement and the attainment of a minimum level of competency in nursing skills Academic achievement credential-ADN Legal credential-RN nursing license after passing NCLEX Additional nursing credentials-CCRN (Critical care registered nurse)

What happens when I go to court?

Know that very few claims go to court and 95% of personal injury lawsuits are either dismissed or settled out of court Fact finding may be in the form of interrogatories which are written questions or deposition which is a process of recorded oral questioning Look and act professional. Be clear, accurate, and concise. (lawyers will help coach through this) Never give opinions unless asked. Stick to the facts. Speak slowly and in a well-modulated tone of voice. If you do not remember or understand a question ask for it to be repeated or clarified. If you have made a statement and later realize it was incorrect, do not be afraid to say so. Do not allow yourself to be goaded into an angry or emotional response. Ask for a break if needed. Avoid the use of "always" and "never" and vague comments like "maybe", "I think", or "possibly". Do not answer more than is asked for by the question.

Statutes of limitations-

Laws that set time limits for when a case may be filed which differ from state to state (often seen in peds, when a nurse saw a pt. at 5 yrs old and they can file a suit up to 18 yrs. Old)

Identify/review/evaluate data

Library Health Databases - CINAHL Plus with Full Text (EBSCO General Health) or Health Source: Nursing/Academic Edition (EBSCO General Health) http://www.guideline.gov These are NIH guidelines where you can go to find ideas, but you need to find the actual nursing journal. This is a great site to go to in practice if you are questioning something. http://ebn.bmj.com -This is an evidence-based nursing online site which is the British Medical Journal and not a nursing journal site. Do not use this site! Remember the librarian can be your friend!!!

Registration and Licensure

Licensure affords protection to the public by requiring an individual to demonstrate minimum competency by examination before practicing certain trades Nursing licensure is a process by which a governmental agency grants "legal" permission to an individual to practice nursing Registration is the process of being formally recognized in each state as an RN State boards of nursing (NCSBN) oversee both licensure and registration Process of "I've passed NCLEX, now what do I do?" Must register in place you want to be a nurse. Renew q2yrs

RN Responsibilities with Delegation

Making the decision to delegate in the first place Assessing the patient's needs Planning the desired outcome Assessing the competence of the delegatee Giving clear directions and obtaining acceptance from the delegatee Following up on the completion of the task, providing feedback to the delegatee

Benner's Theory

Novice Advanced Beginner Competent Proficient Expert

Deposition-

Out-of-court oral testimony given under oath for the purpose of enabling attorneys to ask and have answered questions related to a case

Was there a breach of professional duty?

Plaintiff must prove that you did not meet the standard of care "You fell below the standard of care" or "you breached the duty owed a patient" In other words, you did not act as a reasonable and prudent nurse would have under the circumstances

Strategies for Practicing Nurses

Read widely and critically Attend professional conferences Expect evidence that supports or does not support your practice problem (Ex. One research article supports a procedure. Another article does not support the procedure.) Seek environments that support research utilization Become involved in a journal club Participate in institutional research utilization and evidence-based practice projects

False imprisonment, assault/battery, defamation

Restraining a pt. by using extra propofol: false imprisonment CIWA protocol and nurse punches pt. back when they punch: assault and battery Defamation: say something about someone that may be untrue and messes with way that people view them. (libel and slander) Libel: literature or written Slander: spoken or said

Statutory Laws

Rules for our relationships with one another and can be viewed as the ethics of our society written down Nurse practice act is an example of a statute Ethics of society written down on paper Nursing practice act: Rules for our relationships with pts. And ethics of society as nurses written on paper

Ethics:

Rules or principles that determine which human actions are right and wrong

Sources of Law

Statutory law- laws about the ethics of our relationships (The Nurse Practice Act) Constitutional law- laws of our rights, privileges, and responsibilities inferred from the U.S. Constitution, (Bill of Rights-freedom of speech, religion, right to privacy); states may not pass laws that conflict with these Administrative law- laws made by administrative agencies (State Board of Nursing) Common law- decisions made by judges in court cases or established by rules of custom and tradition Case law- composed of the decisions rendered in court cases by appeal courts

EBP Steps

Step 1-Define the problem Step 2-Identify, review, and evaluate the data applicable to the problem Step 3-Design a practice change based on the data Step 4-Implement the change in nursing practice

Probable Interview Questions

Tell me about yourself? What would others say about you? What are your strengths? What are your weaknesses? What causes you to lose your temper? Tell me about a difficult situation you have been in and how you handled it?/What was a most difficult decision for you? What kind of worker are you? Where do you expect to be in 5 years? What interests you most in the position? What do you feel are your employer's obligations? Tell me about a time you went out of your way to assist a family or client? ETC, ETC, ETC... (page 79, Box 4-4)

Professional Standards of Nursing Practice

Tells you the scope of practice (what you are legally permissible to do as an RN)! If you work outside of the scope of practice you could be disciplined. "standards are authoritative statements by which the nursing profession describes the responsibilities for which its practitioners are accountable

Trends in Nursing

The "Nursing Shortage" The workforce of nurses is growing older (average age of an RN is 47) A large number of nurses are retiring The American population is growing older and their level of care will vary widely from assisted living settings to high-technology environments Employment of RNs is expected to grow 26% from 2010 to 2020. Everything will continue to change at an increased pace!!!

Future Trends in Nursing

The changing student profile: 2nd career older adult with life experience Educational mobility: always learning, never stop A shortage of RNs: average age of practicing RN is 47 A shortage of qualified nursing faculty: shortage of masters and doctoral prepared too Technology and education: changing every minute Changing health care settings: more outpatient, less inpatient and the inpatient ones are super sick The aging population: old!

Fidelity:

The duty to be faithful to commitments; involves keeping information confidential and maintaining privacy and trust Joe is an RN working in a teen clinic. Jessica, a teen client, has just received a diagnosis of HIV. After Jessica leaves the clinic, her mother calls asking for the results of her tests. vs. Parents bring their 1-month-old child to the ER with swelling and redness over the left femur. X-ray shows a left femur fracture. The parents tell the RN that their infant rolled off the sofa onto the floor.

Veracity:

The duty to tell the truth. You are caring for 8-year-old Billy who has just been diagnosed with a terminal brain tumor. His parents have asked that he not be told about his diagnosis. On your shift Billy asks you "Am I going to die?" (favorite answer is Billy what do you think?) vs. An RN working on a busy surgical unit witnesses a physician adding extra diagnoses codes into his patients' medical records, so that he can bill the insurance company for more money and she is faced with what to do here.

Justice:

The duty to treat all patients fairly, without regard to age, socioeconomic status, or other variables. The Smith family has just moved to the United States. Their 2-month-old infant son has spiked a fever of 104 degrees and has been vomiting for the past 24 hours. They present to the pediatric emergency room for care. They are uninsured. vs. During the Tuskegee syphilis study that continued for 40 years, 600 African American impoverished sharecroppers from Macon County, Alabama (399 men had syphilis, 201 did not have syphilis) were studied. They were told they were being treated for "bad blood", but never told they had syphilis. Those with syphilis were not treated, even though PCN was available. Researchers used various offers to stimulate and sustain the subjects' interest in continued participation; these offers included free burial, assistance and insurance, free transportation to and from the examinations, and a free stop in town on the return trip. Subjects also received free medication and free hot meals on the days of the examination. The subjects' socioeconomic deprivation made them vulnerable.

What can't be delegated?

The functions of assessment, evaluation, and nursing judgment should not be delegated Must use critical thinking to know what to delegate. If a person is gagging/puking and you want to delegate feeding DON"T delegate! But if it's basic feeding you can delegate. Initial nursing assessment and any subsequent assessment that requires professional nursing knowledge, judgment, and skill Determination of nursing diagnoses, establishment of patient care goals, development of patient care plans, and evaluation of progress toward goals Any provision of health counseling, teaching, or referrals to other health care providers Any nursing intervention that requires professional knowledge, judgment, and skill

Reasonable care-

The level of care or skill that is customarily rendered by a competent health care worker of similar education and experience in providing services to an individual in the community or state in which the person is practicing

Informed Consent

The nature of the proposed care, treatment, services, medications, interventions, or procedures The potential benefits, risks, or side effects, including problems related to recovery The likelihood of achieving care, treatment, and service goals Reasonable alternatives and their respective risks and benefits including the alternative of refusing all interventions Ultimately it is the responsibility of the person doing the procedure (i.e. physician) In some settings, the nurse is part of an educational process involving videos, booklets, handouts, and other aids to the patient's understanding When nurses are asked to "get the consent" this usually means the nurse is asked to witness a signature, document the patient's level of understanding or refusal to receive the information, or reluctance to have the procedure done-these are critical to the witnessing role Patient must be competent to give consent Nurses should never obtain a patient's consent to a procedure that has not been fully explained to the patient

Plaintiff-

The person who files the lawsuit and is seeking damages

Defendant-

The person who is being accused of wrongdoing

5 Rights of Clinical Delegation

The right task Under the right circumstances To the right person With the right directions and communication Under the right supervision and evaluation

Telling Others About EBP

This is not part of the assignment, technically, but feel free to share with your fellow students and colleagues the cool information you found in your research so that others can start thinking about how to provide evidence-based care to their patients!!!!!!

4 Groups of Graduate Nurses that Emerge in the Recovery Phase

Those who "make a lot of waves" in their job setting and professional organizations to effect a better system (try to have a voice using articles, other things) <<ME!! Those who limit their involvement with nursing by approaching it as a way to "support themselves" or "provide for their families" Those who seem to find their niche and are content in their setting, but this feeling of content with job does not translate to content with nursing Those who change jobs frequently or "do something else in nursing"

Questions from ME during the interview

What are your expectations for recent graduates? What is the evaluation process like? Who will evaluate me? How will I receive feedback about my performance? Can I get some more information about your preceptorship program? How long is the orientation process and will I have a mentor or preceptor? What is the nurse-to-patient ratio on the unit? What is your policy regarding weekend coverage? What opportunities are there for professional development?

Practice Context

What is a practice context: taking nursing research and applying it to your practice problem. Resources? Health characteristics? Healthcare deliver system like? Pros and cons of incorporating into nursing practice Determines to what degree you can apply the findings from nursing research to your practice problem...a blending of all the factors and systems that contribute to the delivery of nursing care Health, social, and cultural characteristics of the patient population being served Health care delivery characteristics of your setting (type of practice setting, economic constraints of the setting, type of health care delivery system, existing policies and procedures, staffing patterns, and administrative structure What are the motivators and barriers for incorporating nursing research into your practice?? What's standing in your way and what's supporting you to do that.

Criminal Actions

When you have done something that is considered harmful to society as a whole Involves the state against a defendant Examples include murder, theft, drug violations, misuse of narcotics Serious crimes often involving imprisonment are called felonies Less serious crimes often resulting in fines are misdemeanors

Basic Elements of Malpractice

You must have a duty. In other words there must be a professional nurse-patient relationship. You must have breached that duty. In other words you must have fallen below the standard of care for a nurse. Your breach of duty must have been a foreseeable cause of the injury. (hardest to prove) Damages or injury must have occurred.

Interrogatory-

a process of discovering the facts regarding a case through a set of written questions exchanged through the attorneys representing the parties involved in the case

Assumption of risk- (defense for malpractice claims)

defense states that plaintiffs are partially responsible for consequences if they understood the risks involved when they proceeded with the action (mentally competent patient who had been warned against the risks of getting up alone and told to use the call light, does not do so, and falls)

Contributory negligence-(defense for malpractice claims)

did the patient 1)refuse to follow advice, 2)cause a delay in treatment or not follow up 3)furnish false, misleading, or incomplete information, and 4) cause the injury that resulted in the need for medical care in the first place

Statute of limitations- (defense for malpractice claims)

set time period after an event during which a lawsuit must be filed; this time is measured from the time of the event, last date of treatment, or the time the event was discovered; States have different statutes and case laws surrounding this time limit; for minors that may be until they reach majority or 18 years; failure to file the lawsuit in that time results in the loss of the right to sue