NR 506 Week 1 Graded Discussion Topic: The Four Spheres of Political Action in Nursing.
Please discuss the four spheres of political action in nursing.
... [Show More] In addition, please develop a brief argument sharing how these spheres are interconnected and overlapping by applying an example from your practice. What are some ethical considerations here?
ANSWER
The four spheres of political action in nursing are the workplace, government, associations and interest groups, and the community (Mason, Gardner, Outlaw, & O'Grady, 2016). Nurses have the ability to affect change in those four areas (Mason et al., 2016). While each of these spheres exists in its own right, they are interconnected on many levels (Mason et al., 2016). What nurses do in the workplace is directed by regulations that are set in place on governmental levels. Special interest groups and the communities in which nurses serve directly affect how the hospitals care for the patients. Nurses make up one in four voters and have the knowledge and expertise to shape legislation to advocate for their patients (Phillips, 2012). I work at a magnet hospital and one of the tenants of magnet is shared governance (Clavelle, O'Grady, & Drenkard, 2013). Through shared governance, nurses are empowered to change the organization to better care for their patients (Clavelle et al., 2013). By getting the staff actively involved in the organization they have the feeling of control, which allows them to bring ideas to the table and be heard (Clavelle et al., 2013). Smoking in the workplace is a public health risk. The Cleveland Clinic has enacted a no smoking policy for its employees through working with shared governance, various levels of employees, management, insurance companies and other organizations. If you belong to the Cleveland Clinic health insurance, in order to receive a discount on your insurance, you have to wear a pedometer and meet a certain number of steps each month. This is to combat the public health epidemic of obesity. The organization is trying to encourage activity in its staff which will help us better serve the community. Ethical considerations of the four spheres and the interconnection is obviously corruption or making decisions for the benefit of one and not the many. If interest groups have too much sway with the government, they will be able to legislate issues that are may be harmful to the community.
References
Clavelle, J., O'Grady, T., & Drenkard, K. (2013). Structural empowerment and the nursing practice environment in Magnet (R) organizations. Journal of Nursing Administration, 43(11), 566-573.
Mason, D. J., Gardner, D. B., Outlaw, F. H., & O'Grady, E. T. (Eds). (2016). Policy & politics in nursing and healthcare (7th ed.). Retrieved from https://bookshelf.vitalsource.com
Phillips, C. D. (2012). Emergency nursing advocacy: Nurses becoming political advocates. Journal of Emergency Nursing, 38, 470-471. doi:10.1016/j.jen.2012.05.022
ameka,
Thank you for your post! I especially liked your explanation of nurse to patient ratios and how the political climate has influenced this. Should not the institution hire more caregivers if they are making more money?? Just saying......
Dr. Stiller:
Nurse to patient ratios is another way in which nurses can show their collective legislative power. Campaigning on a patient safety platform, California was able to mandate patient ratios of four patients or less to every one registered nurse depending on the unit acuity (Strachan-Hall, 2017). When this mandate was passed, there was a concern about having enough funding for this number of nurses and being able to recruit the right number, but these fears were not realized (Strachan-Hall, 2017). Here in Ohio, there is no such mandate. Luckily, I work at a main campus and during the day on my stepdown unit we rarely have greater than a four to one ration, sometimes it is five to one. At night however, it can be five to six to one. The Cleveland Clinic is the number one heart center in the country. We care for the sickest of the sick, and the post-operative patients we see on my floor are often 24 hours out of open heart surgery. We also care for LVAD and total artificial heart patients. Our patients on stepdown are easily ICU patients in other hospitals. I say this not to brag, but to say it is difficult to recruit, train and maintain experienced nurses. Nurses become overworked and fatigued quickly in this environment. It is difficult to stay motivated when you feel you’re not able to care for your patients thoroughly because you do not have time. This is where nurses should advocate not just for their patients but for themselves as well. If we used the special interest groups and tried to lobby our states for mandates, perhaps we would have a happier, healthier workforce. California has seen up to a two percent drop in staff sicknesses and a drop in turnover (Strachan-Hall, 2017). This leads to better outcomes for the patients (Strachan-Hall, 2017). While it seems like it would cost the hospitals more to hire additional nurses, it would actually save them money because it would lower turnover and training costs (Strachan-Hall, 2017). It is easier and less expensive to keep the skilled nurses you have than to hire new nurses each year.
Reference
Strachan-Hall, E. (2017). California has won case for nurse-patient ratios. Nursing Management - UK, 23(9), 15.
Look at your responses on the threaded discussion this week to ensure that you answer the question this week completely. Some of you outlined theory but did not apply it to a specific example. Also there was a question regarding ethics. We all know that there are times when there are ethical considerations that are being "glossed over" and not fully considered either by the organizations that we work for or by one of the other drivers. If you did not hit upon these ethical considerations in your example please elaborate now. Also I took it easy on everybody this first week and did not ask many questions. I am sorry. I forgot you need a question from me to elaborate on for your second post. If you simply created a post #2 in response to your peers comments or questions this first week that is OK. In your example which driver do you think might be having the greatest influence and why? What factors do you think are contributing to this? Best wishes as you finish out week #1 and start preparing week #2!
Sincerely,
Dr. Cate Stiller
Rebekah Rogers
2/28/2017 9:30:39 PM
Week 1 TD
Nursing as a profession has the capability, power, and resources to become politically active in promoting optimal public health, reducing health care costs, improving safe, quality, and evidence-based nursing care, and advocating for nurse managed community services for vulnerable and under-served populations (Woodward, Smart, & Benavides-Vaello, 2016). Government, workplace, professional organizations, and the community encompass the four spheres of political action in nursing (Mason, Gardner, Outlaw, & O'Grady, 2016). Although each sphere has its own independent function, each domain is an element of a more global and multifaceted system where change or action in one sphere often influences and stimulates change in other spheres. Government plays a substantial role in influencing and determining scope of nursing practice, eligibility for individuals to receive healthcare programs, reimbursement of healthcare dollars, and shaping policy to address health and social problems (Mason et al., 2016). Nurses’ work in a variety of different settings where resources are limited and policies guide many activities affecting staffing ratios, clinical procedures, and patient care. State laws also regulate nursing licensure, immunizations, and certifications (Mason et al., 2016). Professional nursing associations advocate for policies that support their concerns, promote political involvement, and enhance networking (Woodward et al., 2016). Identifying problems, advocating for change, organizing support, and serving on planning boards are approaches nurses can take to be influential in the community (Mason et al., 2016).
I currently work in a hospital where an accrediting organization, The Joint Commission, cited the facility a few years back for allowing nurses to “practice medicine without a license” based on nurses selecting a dose of an opioid medication from a range order for pain management based on a comprehensive pain assessment. The recommendation by the surveyors was for physician orders written with a specific opioid dose dependent on a specific pain intensity rating. As a result of this action, pain management policies and opioid medications orders were changed to reflect a dose based on a number leading to adverse patient outcomes including excessive sedation and respiratory depression as a result of overmedication. I participated in a pain task force to review and collect data related to the increase of Naloxone use and rapid response calls related to dosing opioids to a pain score. As a member of the American Society for Pain Management Nursing (ASPMN), this issue was also extensively discussed at national pain conferences and a hot topic on our pain list serve. This resulted in ASPMN writing a position statement advocating for prohibiting prescribing and administering opioid doses based solely on pain intensity numbers. Policy choices ultimately bring a significant loss to some groups while others benefit (Mason et al., 2016). Ethical considerations and care of patients is based on values and guided by professional code of ethics and principles including beneficence, non-maleficence, autonomy, and justice (Woodward et al., 2016). Ethical challenges associated with goals of care related to relieving pain and suffering with opioid analgesics, may lead to issues surrounding assessment, treatment, education, and control of pain.
References
Mason, D. J., Gardner, D. B., Outlaw, F. H., & O'Grady, E. T. (2016). Policy & politics in nursing and healthcare (7th ed.). Retrieved from http://online.vitalsource.com
Woodward, B., Smart, D., & Benavides-Vaello. (2016). Modifiable factors that support political participation by nurses. Journal of Professional Nursing, 32(1), 54-61. doi: 10.1016/j.profnurs.2015.06.005
Rebekah:
My hospital has had the same issues with pain medications that you have seen. We are all under the joint commission and in addition we are a magnet hospital. The ways we respond to orders are part of our magnet status (Clavelle, O'Grady, & Drenkard, 2013). Our physicians and nurse practitioners write orders for pain management in specific pain score ranges. In general, Oxycodone for severe pain 7-10, Ultram for moderate 4-6, acetaminophen 1-3. Often the Ultram will be written for breakthrough pain. If I have a patient that may be wary of opiods and wishes to take the Ultram, I must first administer oxycodone or acetaminophen or I am practicing out of my scope of practice. The pain rating scale is also extremely subjective. A 2 for my may be someone else’s 6, or any combination. Working with patients just hours and days out of open heart surgery, the pain can vary from person to person. Perhaps they know that one oxycodone helps relieve their pain and allows them to walk 3-5 times a day, do their hourly breathing treatments and be comfortable. When I am administering the medication, we know it is not suppressing their respiratory drive and they mention their pain score is only a 5. I have to either not give the medication they need or document that the pain score is a 7 or higher to be within my scope of practice. Without going on too much, nurses at my hospital do not have the ability to just nursing judgement. All patients are ordered a stool softener and laxative BID post-surgery. If I have a patient that is having liquid stools, I cannot hold the medication without notifying the doctor via a page, writing a note and educating the patient. These policies and procedures stem from governmental and special interest rules and regulations (Clavelle et al., 2013). Think about the ethical situations the pain score scenario puts nurses in. While we are not licensed to practice medicine, we have the ability to judge whether or not we should give a pain medication to an ambulating patient that is stable. I like that there is an organization lobbying against the simple order of pain score to medication ratio. The situation is more complex than that. As nurses, we can educate our patients about the safety of certain medication and advocate for the proper short term use. I tell my patients that while you do not want to take them forever, the do help in the short term to get you better. There is a great opioid crisis right now. A small part of this is the way medical professionals view and prescribe them in addition to the way they are taken.
Reference
Clavelle, J., O'Grady, T., & Drenkard, K. (2013). Structural empowerment and the nursing practice environment in Magnet (R) organizations. Journal of Nursing Administration, 43(11), 566-573. [Show Less]