Meeting nursing practice standards

Meeting nursing practice standards

Hardingham, Lorraine

The new AARN Nursing Practice Standards arrived in the mail a few weeks ago. The Standards are a guide to providing safe, competent and ethical nursing care to society,, representing a consensus of the minimum standards practicing nurses must meet. Two related ethical issues arise for nurses from the standards. The first is that of accountability@ The second is authority to apply the standards in practice. Before discussing these issues, let’s look at why a profession requires practice standards. Why do we have Nursing Practice Standards? One of the four essential attributes of a profession is a high degree of self-regulation of behavior through codes of ethics and through associations organized and operated by the members themselves (Barber, 1988). In the nursing profession, the practice standards are part of this attribute. They provide a formal statement to measure extent, value and quality of nursing care. As well as providing guidelines for nurses, they inform the public and others about what they can expect from practising nurses. The standards are also used as a legal reference. As such, they would define in a court of law what a “reasonable and prudent” nurse would do in a similar situation. A nurse would be liable if her/his care failed to meet this standard (CNA, 1994).

Accountibility To be accountable is to take responsibility and to answer for one’s actions. Accountability implies that the individual can decide not only on various aspects of an act, such as its worthiness, but also that the individual has a range of open options, for example, that she can refuse to undertake the act, or that it is in her power to decide precisely how a particular act will be performed. If such choices are not available, or they are so restricted as to be meaningless, then it is difficult to see how individuals can be held to account (Tadd, 1994).

Authority Last year the B.C. Nurses’ Union published results of a poll in which one-third of nurses potted said that, given their workload, they could not meet standards set by their own profession (National Post, 1999). Such reports raise an important question: Are the standards an ideal to aim for or an actual requirement for practice? While legal definitions of negligence would say they are actual requirements, an ethical perspective would not give such a straightforward answer. Such a perspective would examine the authority a nurse has to uphold

the standards. While many nurses might say that they want more power, a notion which means the capacity to command obedience, authority might be a better concept for them to aim for, Authority is a rights notion, a power given to someone who has the right to command (Hardingham, 1994). Expertise is one reason to accept an authority. Professionals’ respect for their standards and codes may be subverted when they notice that they include as requirements specific obligations which they know they regularly cannot meet under existing circumstances, and when they do not have the authority to do so. One author puts it this way: How can a code be taken seriously if it includes requirements which, as things stand, are ridiculous – e.g. requiring that all patients are to be given full counselling ‘appropriate to their needs’? The actual logistics, the number of patients, turnover of patients and number of qualified clinicians may make nonsense of this as a requirement. (Jackson, 1994, p. 124) Ethical and Practical Implications Nursing practice standards put nurses in a very vulnerable position, both ethically and legally. Each registered nurse and nursing student has a responsibility to understand the Nursing Practice Standards and apply them to their nursing practice, regardless of their areas of practice or roles. Thus, the standards apply to individual nurses. The AARN has the right to discipline a nurse who fails satisfy them, but has no authority to discipline organizations that do not provide the resources the nurse requires to do so. This emphasis on individual accountability is inadequate. The nature of role responsibility demands that attention is paid not only to the actions of individual agents, but also to the institutional and social settings in which a role is enacted. To a great extent, the kind of nursing care that can be delivered depends very much upon the environment in which it is delivered and the resources that are available to nurses to provide

that care. The new standards attempt to address this issue by including Appendix C, “Organizational supports needed in the practice setting”, but two considerations need to be kept in mind here. First, an appendix is necessarily considered to be less important than the document to which it is attached. And secondly, for purposes of discipline, the appendix also applies only to individual nurses, and not to others who may have the power to put those organizational supports into place. So why have the appendix? I think that nurses can make use of the appendix if they make use of certain strategies. Strategies For Dealing with Problems: The following are suggestions for nurses who find it difficult to apply the standards: 1. Document any problem when it occurs. Pass it on to your supervisor. Whether it is an incident report, a professional responsibility form, or a note to your supervisor, keep a copy,

2. Learn about and use the Professional Responsibility Clause in your contract. It offers nurses a means to inform management, in writing, of complaints regarding patient care.

3. Report situations to the AARN when you cannot meet nursing practice standards. Practice consultants collect this data, and use it to lobby government and employers for-change. 4. Speak out! As a member of a profession that the public trusts, respects and recognizes as expert in patient care, advocate individually and collectively for adequate nursing practice environments.

5. Review vour institution’s mission statement, vision, goals and policies. Are actual practises in line with these? In other words, does the organization practise what it preaches to its staff and its public? If not, draw it to the administration’s attention, and give them examples. A health care institution offering nursing care to the public has an obligation to meet certain standards. If an organization knowingly allows substandard nursing practice to occur, it is failing to meet this obligation. But, if the organization does not know that substandard nursing practice occurs, then the fault lies with the professionals who do not recognize and inform the organization about their concerns.’ ‘

References:

Barber, B. (1988). Professions and emerging professions. In J.C.Callahan (Ed.), Ethical Issues in Professional life. Oxford: Oxford University Press, 35-39.

Canadian Nurses Association. (1994). Negligence. InfoLaw, 30).

Hardingham, L.B. (1994). Ethics in the workplace: Power and authority and the nurse. AARN Newsletter 50(3).

Jackson, J. (1994). Common codes: Divergent practices. In R. Chadwick (Ed.), Ethics and the professions. Aldershot, UK: Avebury, 116-124.

National Post. (1999). Who in their right mind would want to be a nurse? Too many, especially young women in the profession, are looking for away out. October 14, 1999.

Tadd, W (1994). Accountability and nursing. In R. Chadwick (Ed.), Ethics and the professions. Aldershot, UK: Avebury, 88-103.

About the Author:

Lorraine (Laurie) B. Hardingham, RN, BN, MA is in the doctoral program in the Dept. of Philosophy, University of Calgary

Copyright Alberta Association of Registered Nurses Jan/Feb 2000

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