Nurses' Work Life - Group 4

Political

According to Canadian Institute for Health Information (2018) Canada was expected to reach $242 billion which equals out to 6,406 per person overall in health spending Local health integration network (LHINS), mandate, plan and integrate health care services for more efficient care. They also authority to restructure, merge, and close facilities within their regions Barriers that limit the nurse's participation in policy and politics such as formal health care policy education, little opportunity to be involved in decision making, and lack of awareness

Issues/Consequences 1. Professional Accountability

Accountability as defined by the RNAO (2007) is "Responsibility for one's conduct, or the willingness to be answerable for one's actions" A lack of power regarding inadequate staffing, increased workload, and work environment can be related to a nurses' ability to provide up to standard care for their patients Nurses are being exploited by other healthcare providers who have more power and therefore feel a sense of powerlessness themselves This ultimately coincides with nurses performing non-nursing tasks, because other healthcare providers assigning them roles that are not necessarily expected of them within their professional domain. As such, nurses are taking on heavier workloads, which can lead to burnout in the workplace, compromising the quality of patient care

Cultural

Based on gender and social class with strong ties to religion Nursing is a female-dominated profession with high rates of horizontal violence and developed cultural norms such as "nurses eating their young" Nurses are an oppressed group who, through horizontal violence, oppress each other. In turn creating uncivil and intolerable work environments resulting on many new nurses leaving the profession Nursing culture, favours characteristics of female nurses. In turn, creating a gender bias that excludes male nurses and limits their opportunities

Cycle of Oppression

Bias: Females make better nurses, nursing is a caring subservient role Prejudice: Males are not good nurses, nurses could not further their education Discrimination: No control over work life or resources, decisions are made about medicine without considering nursing Oppression: Policies through the system do not advocate for nurses/consider the nursing profession when making decisions Cyclic Process: Nurses not reporting incidents because they feel like they could have done better to prevent it

Implications for Nursing/Barriers to Resolving Workplace Issues

Decisions are made beyond nurses control Changes are systemic Decisions are made by those at a distance from care, rather than the nurses themselves Decision makers in health care fail to recognize the impact of the current situation in regard to patients and nurse's health

Demands of Nurses' Work

High expectations, wide scope of practice, complex care: -Caring for assigned patients, families, communities, other nurses' patients -Expected to complete multiple tasks in an unrealistic time frame Three types: physical, mental, and emotional demands Heavy workloads are linked with poor work life, health, and patient outcomes Consecutive, irregular shifts with long hours and heavy workloads accumulate fatigue, especially without a proper recovery period Increases likelihood of poor work performance and errors Relevant documents: RNAO Healthy Work Environments Best Practice Guidelines: Preventing and Mitigating Nurse Fatigue in Health Care & KGH Collective Agreement with ONA

Economic

In the early days of the nursing profession, nursing students were sources of unpaid labour. This unpaid labour can be seen as exploitation as "was often described as the equivalent of tuition, in fact it represented a source of savings far beyond the value of tuition" The importance of nursing care cannot be quantified with a number Tommy Douglas creating equal access to health care A consistent struggle for nurses includes "gaining respect for nursing profession, ensuring good working conditions and adequate pay" Today's pay gap differences: women are earing 89 cents to every dollar a male nurse makes Female nurses feel that they are denied access to promotions in nursing procession, "while women climb the ladder in female-dominated professions, their male peers glide past them on an invisible escalator, shooting straight to the top"

Critical Social Theory (CST):

Social institutions maintain oppression of groups with strict rules Restricted opportunities for groups at the bottom of the hierarchy Registered nurses are marginalized because of outside forces workload, scheduling, expected behaviour, and ability to make decisions Results in poor health work performance, quality of work life, and poor patient outcomes CST aims to expose oppression and emancipate marginalize groups from constraint through praxis and reflection in action

Feminist Theory

Strives for equal opportunities for women and men and liberating women from oppression Nursing is a female-dominant profession because it is associated with "female" qualities such as caring, submissiveness, and emotions Males are "not suited" for nursing because they are expected to be tough and masculine Nursing and females historically considered low class and low value

Strategies to Resolving Workplace Issues

The nursing workplace as a whole is divided into sections: employers, educators, and researchers. For example: nurses should be encouraged to practice the use of their knowledge and expert judgment in an optimal way

Issues/Consequences Workplace Violence - Patient-to-Nurse Violence

Three categories: Physical, sexual or psychological violence Type II: Patient to nurse violence In 2014 Nursing had the 5th highest violent incident rate across Ontario-even more than corrections Violent patient episodes are emotionally and physically damaging tot nurses Patient to nurse violence leads to decreased job satisfaction Workplace violence leads to decreased performance of nurses Under reported, as nurses fee it is "just part of the job" Nurses are experiencing powerlessness, as they are that if they report the violence there will be no change

Historical

Throughout the history of nursing, both males and females have been subject to the many forms of oppression Men were originally the care providers until around the mid nineteenth century when the comparison between masculinity and femininity occurred leady by Florence Nightingale The characteristic of the nurse switched, alluding to the fact that only females can be nurses because of their feminine attributes Florence commented on the fact that to be a "good nurse" was directly related to being "a good women", excluding males from the nursing role entirely thus leading to modern day stereotypes that nursing is best suited for women only

Issues/Consequences Workplace Violence - Nurse-to-Nurse Violence

o Horizontal violence is defined as aggressive behaviour that one nurse commits against another nurse in the workplace. Type III violence includes staff/worker to worker, which then included managers, coworkers, physicians, or other health care workers. This behaviour may be physical, verbal or non-verbal expressed either directly to the person or indirectly. In 2011 44 % of female nurses and 50% of male nurses reported being exposed to hostility or conflict in the workplace. Nurses face the greatest risk of workplace bullying compared to any other profession. The RNAO has 6 foundational healthy work environment best practice guidelines