Healthcare Value and Ethics Chapter 11

employee responsibilities: honor and respect patient rights

1. caregivers have a duty to honor a patient's right to participate in decisions regarding his or her care, including the right to formulate advance directives and have those directives honored 2. recognizing and respecting patient rights directly affects the provision of care 3. care, treatment, and services should be provided in such a way that respects and fosters the patients dignity, autonomy, positive self-regard, civil rights, and involvement in his or her care 4. care, treatment, and services should also be carefully planned and provided with regard to the patient's personal values, beliefs, and preferences

bullying

1. abusive conduct that includes threatening and or humiliating behaviors, such as name calling and personal insults 2. such actions can lead to psychological harm 3. the workplace bullying institute "is the first US organization dedicated to the eradication of workplace bullying that combines help for individuals, research, books, public education, training for professionals-unions-employers, legislative advocacy, and consulting solutions for organizations 4. the impact of bullying behaviors on the organization can include lower morale, reduced productivity, and increased absenteeism and turnover 5. this in turn can affect patient safety 6. workplace bullying also leads to lawsuits, compensation for disability, loss of profits, negative impact on organizational reputation, and a corrosion of the patient to healthcare worker relationship

employee responsibilities: stand as a patient advocate

1. all caregivers should consider themselves as patient advocates 2. thus, it is necessary for both caregivers and family members to engage in patient advocacy 3. the moral of the story is that both family and caregivers alike bear some responsibility to help guide the patient to better health and ultimately conquer his/her fears and ultimate journey home 4. in many situations, nurses act as patient advocates -they not only are familiar with how care is delivered, they know the doctors and support staff who are treating the patients -moreover, nurses are in a better position to educate the patients about their medical options, problems with their condition, medications, and explaining the patient's needs to their caregivers 5. if the patient is receiving out of patient care or is going into the hospital for surgery (and may become mentally incapacitated), then a friend or family member who is equipped to represent the patient's needs and desires should be selected by that patient to advocate for him or her -there is a designation form, which the patient advocate must sign accepting the designation

the caregiver's pledge

1. I will be compassionate -not neglect my duties and responsibilities -read instructions and follow protocols -seek verification of questionable orders -report concerns for patient safety (e.g., staffing concerns) -not assume responsibilities beyond my capabilities -call for help when a patient's medical needs suddenly change -continuously improve my skills and participate in continuing education opportunities

employee rights: question patient's care

1. a caregiver has the right to question the care being rendered to a patient by another caregiver if there is reason to believe that the care is likely to be detrimental to the well-being of the patient 2. if the prescribing physician believes the order to be correct and the caregiver still questions the order, the concern must be relayed to the employee's supervisor for verification and further follow-up if necessary

employee responsibilities: adhere to safe practices

1. caregivers have a responsibility to adhere to safe practices in order to minimize patient injuries 2. requires employees to adhere to national patient safety goals, the purpose of which is to protect the health of the patient 3. improving care quality will drive down costs 4. quality care is cheaper to deliver than to heal the consequences of common medical errors

employee responsibilities: adhere to professional standards

1. caregivers have a responsibility to maintain a professional attitude in the performance of their work 2. staff cooperation and communication are essential for ensuring professionalism in the provision of high-quality patient care 3. unprofessional conduct, in compatibility, and lack of cooperation in a hospital are appropriate considerations for discharging an employee or denying staff privileges -the operation of a hospital requires the coordination of numerous employees and departments, each with different responsibilities that build and depend on each other 4. thus, staff cooperation and communication are essential to ensuring a high quality of patient care -disruptive behavior in the workplace can affect the morale and teamwork of the staff, as well as cause actual harm to patients

employee rights: refuse to participate in patient care

1. caregivers have a right to refuse to participate in certain aspects of patient care and treatment -this can occur when there is conflict with one's cultural, ethical, and/or religious beliefs, such as the administration of blood or blood products, participation in elective abortions, and end-of-life issues such as disconnecting a respirator 2. however, a patient's health must not be compromised in the attempt to honor staff rights 3. ex. refusal to participate in elective abortions upheld -caregivers have a right to refuse to participate in elective abortions and can abstain from involvement in abortions as a matter of conscience, religious beliefs, or moral conviction 4. refusal to participate in therapeutic abortion insubordinate 5. pharmacist refusal to fill prescriptions -some pharmacists' religious beliefs prohibit abortion or the use of birth control -they believe that dispensing such medications to others is an infringement on their freedom of religion -there are others who believe that pharmacists have an obligation to fill all prescriptions and that refusing to fill them violates the patient's freedom of conscience

employee responsibilities: protect patients from harm

1. caregivers have an ethical and legal responsibility to protect patients from harm -ex. the rules of ethics applicable to nurses, specifically recognize a nurse's obligation to safeguard not only patients health but their safety as well

employee responsibilities: report unethical behavior

1. caregivers have both a right and responsibility to report impaired, incompetent, and unethical colleagues in accordance with the legal requirements of each state 2. unethical behavior includes conduct that threatens patient care, violation of state licensing provisions, and other applicable laws, rules, and regulations 3. employees are responsible, for maintaining appropriate professional relationships with patients, families, coworkers, and others with whom they may come into contact in the organization

employee responsibilities: report patient abuse

1. caregivers have both a right and responsibility to report patient abuse 2. statutes protect employees against retaliation for reporting patient abuse 3. an employer may not discharge an employee for fulfilling societal obligations or one who acts with a socially desirable motive

employee rights: freedom from disruptive behavior

1. disruptive behavior includes verbal outbursts and physical threats 2. civility is commonly recognized as improving safety in the healthcare workplace and includes hospitals, nursing facilities, physician offices, and other such healthcare entities 3. strategies to address disruptive behaviors should -prevent disruptive events from occurring -deal with events in real time to prevent staff or patient harm -initiate post-event review, actions, and follow up 4. a disruptive physician is described as "one whose behavior is described as demeaning, aggressive, uncivil, or hostile to colleagues, patients or ancillary staff 5. the American Medical Association (AMA) has defined disruptive behavior as a style of interaction with physicians, hospital personnel, patients, family members, or others that interferes with patient care

employee rights: treatment with dignity and respect

1. each employee has the right to be treated with dignity and respect in a fair and consistent manner by the employer 2. employers have a responsibility to respond to employee complaints and concerns regarding their rights to be treated with dignity and respect 3. furthermore, employers should take action without delay as to employee reports of an abusive work environment

employee responsibilities

1. employees are expected to adhere to their codes of professional ethics and to comply with their job-related duties and responsibilities as defined in their job description and the organization's policies and procedures -with every right, there is a corresponding duty

employee responsibilities: comply with hospital policy

1. employees are required to comply with an organization's policies and procedures 2. as a surveyor of an accrediting body one would look for an approved disaster plan etc 3. a disaster plan, test tubes, surgical procedures, anesthesia gases and oxygen containers properly secured and stored

employee responsibilities: maintain professional relationships

1. employees are responsible for maintaining an appropriate professional relationship with patients, families, coworkers, and others who come into contact with the organization

employee responsibilities: comply with assigned duties

1. employees have a responsibility to comply with the responsibilities outlined in their job descriptions 2. failure to do so can be hazardous to patient safety as well as lead to termination of the employee who fails to perform the duties required in a professional and acceptable manner

employee rights: freedom from discrimination

1. employees have a right to be considered for a job based on their skills and qualifications for the jobs for which they are applying without discrimination 2. the US equal employment opportunity commission (EEOC) is responsible for enforcing federal laws that make it illegal to discriminate against a job applicant or an employee because of the person's race, color, religion, sex (including pregnancy), national origin, age (40 or older), disability, or genetic info 3. it is also illegal to discriminate against a person because the person complained about discrimination, filed a charge of discrimination, or participated in an employment discrimination investigation or lawsuit

employee rights: freedom from intimidation

1. employees have a right to be free from intimidation and veiled threats by managers, disgruntled physicians, patients, visitors, and fellow employees in the workplace 2. employees have a right to be protected from the mistreatment by others regardless of their position in the healthcare setting 3. there is attending for those in power to abuse that power through threats, abuse, intimidation, and even retaliatory discharge, all of which are cause for legal action 4. retaliatory discharge is a liability

employee rights: sexual harassment

1. employees have a right to be free from sexual harassment 2. it can be verbal or physical , and it includes a request for a sexual favor, sexual advances made as a condition of employment, unreasonably interfering with an employee's work performance, and creating an intimidating or offensive working environment 3. the guidelines that prohibit unwelcome sexual advances or requests that are made as a condition of employment 4. also prohibit conduct that creates a hostile work environment -the US supreme court court held that a hostile work environment refers not only to conduct that is psychologically injurious but also to conduct that is perceived as abusive

employee rights: privacy and confidentiality

1. employees have a right to privacy and confidentiality, such as information that the employer may become aware of as to an employee's health status 2. modern technology enables employers to monitor their employee's activities through their computer site visits, emails, voicemail and video monitoring -video monitoring is not permissible in bathrooms and locker rooms 3. such monitoring is generally unregulated, and unless an organization's policy specifically states otherwise, the employer may listen, watch, and read and employee's workplace communications 4. such information must be used wisely and discreetly without malice

employee rights: family medical leave

1. employees have a right to take a medical leave of absence under the family and medical leave act of 1993 (FMLA), which was enacted to grant temporary medical leave to employees under certain circumstances 2. the act provides that covered employers must grant an eligible employee up to a total of 12 work weeks of unpaid leave during any 12 month period for one or more of the following reasons -the birth and care of an employee's child -placement of an adopted or foster child with the employee -the care of an immediate family member (spouse, child, or parent) with a serious health condition; or inability to work because of a serious health condition 3. it is illegal to terminate health insurance coverage for an employee on FMLA leave 4. following an FMLA leave, the employee's job or an equivalent job with equivalent pay, benefits, and other terms and conditions of employment-must be restored

employee rights: unemployment compensation

1. employees have a right to unemployment compensation as well as worker's compensation for injuries resulting from the employees work environment

employee rights: safe environment

1. employees have a right to work in a safe environment, thus requiring the employer to provide appropriate equipment and signage posted as required in hazardous areas

employee rights: whistleblowing

1. employees have both a right and responsibility to report unethical conduct 2. whistleblowing has been defined as an act of someone "who, believing that the public interest overrides the interest of the organization he serves, publicly blows the whistle if the organization is involved in corrupt, illegal, fraudulent or harmful activity 3. moreover, statutes in several jurisdictions protect an employee from an employer's retaliation for engaging in certain types of protected activities, such as whistleblowing 4. health care organizations often describe their whistleblower policy in their compliance manuals

employee responsibilities: sexual harassment

1. employers have a responsibility to maintain a workplace that is free from sexual harassment 2. form of sexual harassment include a request for sexual favors, demeaning comments, sexually explicit jokes (also sent through email), pinching and fondling of a coworker, and so on 3. healthcare professionals must not breach their legal and ethical obligations through sexual harassment or illicit relationships with employees/patients 4. besides being subject to civil and criminal litigation, healthcare professionals also are subject to having their licenses revoked for sexual improprieties 5. policy and procedures regarding sexual harassment should be included in an organization's orientation programs 6. ex. nurse's relationship with patient 7. ex. physician's inappropriate house call 8. ex. avoid relationships with a patient's spouse

employee responsibilities: maintain professional competence

1. it is expected that each professional has a current understanding of one's area of specialization and practice 2. education has value and is a legal necessity in order to be in conformity with the national standard of care of one's profession 3. every professional is responsible for being current in his or her knowledge and skills 4. this comes from reading professional literature, attending continuing education programs and mentoring

employee responsibilities: be compassionate

1. it is the compassionate caregiver who guides the patient as he or she struggles through illness, pain, and suffering 2. it is the compassionate caregiver who provides hope when there appears to be no hope

employee responsibilities: admit to mistakes

1. such responsibility is driven by ethical principles and doing good 2. beneficence, fiduciary responsibility, respect for autonomy, justice and honesty 3. additionally the ethical principles or beneficence (doing good) and nonmaleficence (preventing harm) are violated when errors are not reported or disclosed

employee rights: fair treatment and employee at will

1. the common-law "employment at will" doctrine provides that employment is at the will of either the employer or the employee -the employer or employee may terminate employment for any or no reason, unless there is a contractual agreement 2. employment at will does not do away with employee rights 3. there has been a growing trend toward a restricted application of the at-will employment rule, whereby the right of an employer to discharge an at-will employee without cause is limited by either public policy considerations or an implied covenant of good faith and fair dealing 4. at will can never mean "without limit or qualification" 5. the concept of the employment at will doctrine is embroiled in a combination of legislative enactments and judicial decisions 6. some courts and legislative enactments have overturned the view that employers have total discretion to terminate workers who are not otherwise protected by collective bargaining agreements or civil service regulations 7. the mere fact that an employment contract is terminable at will does not give the employer an absolute right to terminate it in all cases 8. montana wrongful discharge statute of 1989 provides that a discharge is wrongful only if -it was in retaliation for the employee's refusal to violate public policy or for reporting a violation of public policy -not for good cause -the employer violated the expressed provisions of its own written personnel policy

employee responsibilities: encourage teamwork

1. the delivery of high-quality patient care requires that caregivers work together as a team by actively planning, collaborating, and coordinating each patient's care needs 2. success depends on teamwork 3. caregivers are responsible for working as a team and maintaining appropriate professional relationships with patients, families, coworkers, and others with whom they may come into contact in the organization

employee rights

1. the department of labor (DOL) administers and enforces more than 180 federal laws

employee responsibilities: maintain confidentiality

1. the duty of employees and staff to maintain confidentiality encompasses both verbal and written communications 2. this requirement also applies to consultants, contracted individuals, students, and volunteers 3. legal duty to keep the patient's information confidential as the law recognizes the right to privacy 4. the ethical duty is broader and applies at all times 5. healthcare professionals who have access to medical records have a legal, ethical, and moral obligation to protect the confidentiality of the information in the records 6. medical records, with proper authorization, may be used for the purposes of research, statistical evaluation, and education

compliance officer and confidentiality

1. the employee who decides to place confidence and trust in a corporate compliance officer must understand prior to filing a complaint against any organizational practice, individual, and/or department within or entity owned by the organization 2. the compliance officer is hired by and responsible to the organization 3. compliance officers report directly to a top executive or the board, etc 4. the compliance officer is required to abide to the laws of the land and the code of ethics that apply to his or her profession 5. compliance officers are expected to maintain confidentiality of the names of the employees that report to them 6. organizations often have compliance hotlines to protect the identities of the employees who file complaints

employee rights: equal pay for eqaul work

1. the equal pay act of 1963 is essentially an amendment to the Federal labor standards act that was passed to address wage disparities based on gender 2. the epa prohibits gender discrimination in the payment of wages for women and men performing substantially equal work in the same establishment. 3. under the EPA, a lawsuit may be filed by the Equal employment opportunity commission (EEOC) or by individuals on their behalf 4. the EPA is applicable wherever the minimum wage law is applicable and is enforced by the EEOC 5. the EPA requires that employees who perform equal work receive equal pay

helpful advice

1. the following list provides some additional helpful advice to caregivers for building a spirit of teamwork and improving the quality of patient care: -building consensus -do not say anything that you know is a lie -take responsibility -listen -show respect and sensitivity -patient's decision-making capacity -avoid demeaning and criticizing a patient's wishes -family feelings -continue to improve competencies -patients can be challenging -patient handbooks and employee training

employee responsibilities: comply with state and federal regulations

1. the governing body and its agents are responsible for compliance with federal, state, and local rules and regulations regarding the operation of the organization 2. depending on the scope of the wrong committed and the intent of the governing body, failure to comply with the requirements of regulatory bodies can subject board members and/or their agents to civil liability and, in some instances, to criminal prosecution

employment at will public policy exception

1. the public policy exception to the at will doctrine provides that employees may not be terminated for reasons that are contrary to public policy 2. ex. public policy originates with legislative enactments that prohibit the discharge of employees on the basis of disability, age, race, color, religion, gender, national origin, pregnancy, whistleblowing, filing of discrimination of safety violation with various agencies, union membership, refusal to commit an unlawful act, breach of contract, or the organization's failure to follow its own policies and procedures for termination of employment 3. any attempt to limit, segregate, or classify employees in any way that would deprive any individual of employment opportunities on these bases is contrary to public policy 4. public policy also can arise as a result of judicial decisions that address those issues not covered by statutes, rules, and regulations 5. public policy favors the exposure of crime, and the cooperation of citizens possessing knowledge thereof is essential to effective implementation of that policy

employee responsibilities: educate and encourage patients to ask questions

1. the traditional paternalistic dynamic between patients and physicians sometimes creates a barrier preventing patients from asking questions 2. because patients are often reluctant to ask questions about their care, organizations and caregivers should educate and encourage patients to speak up and ask questions about their care 3. patient handbooks are helpful in this respect should be provided prior to admission 4. the joint commission created its speak up initiative in 2002, which encourages patients to become more involved in their care and treatment by emphasizing the importance of asking questions 5. suggestions -if you don't understand something or if something doesn't seem right -if you speak another language and would like a translator -if you need medical forms explained -if you think you're being confused with another patient -if you don't recognize a medicine or think you're about to get the wrong medicine -if you are not getting your medicine or treatment when you should -about your allergies and reactions you've had to medicines 6. pay attention 7. educate yourself 8. advocates can help 9. know your new medicine 10. use a quality healthcare organization that: -has experience taking care of people with your condition, -your doctor believes has the best care for your condition, -is accredited, meaning it meets certain quality standards -has a culture that values safety and quality and works every day to improve care 11. participate in all decisions about your care 12. caregivers, as well as patients, should be educated about the joint commission's speak up intiative -it is both relevant to their in-service education and can serve as a competency tool essential to their understanding of patient rights

employee rights: suggest changing physician

1. there are circumstances in which a caregiver has a right to suggest that a patient or patient's family change to a different, more responsive physician

employee responsibilities: know your patient

1. when assigned a new patient be sure to read pertinent medical records pertaining to the patient you have been assigned to care for and review the patient's treatment plan prior to selling the patient 2. review all open orders that relate to the services that you will be responsible for providing the patient 3. note any specific precautions relating to care of the patient that include any fall precautions, diet order changes, medication administration records as appropriate

Chapter 11

Employee Rights and Responsibilities