HCA400 Course Paper Charge Nurse

HCA310 Health Administration Ethics

Professor Bull

ECPI Course Paper Charge Nurse

Cindi Davis

I pledge to support the Honor System of ECPI. I will refrain from any form of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a member of the academic community it is my responsibility to turn in all suspected violators of the honor code. I understand that any failure on my part to support the Honor System will be turned over to a Judicial Review Board for determination. I will report to a Judicial Review Board hearing if summoned.

HCA400 Course Paper Charge Nurse

2 Introduction A charge nurse is a nurse whose duties include management and supervision of other nurses. Provider A currently works at Kindred Healthcare Rose Manor, a nursing and rehabilitation facility. They provide sub-acute and long-term care to their patients, and Provider A, a Registered Nurse, works third shift from 11 p.m. to 7 a.m. The interview was given on August 15, 2013, and despite many attempts to do it in-person, the result was a telephone interview. According to the Nursing Practice Manual for John Dempsey Hospital, a charge nurse is responsible for many different things. Because the charge nurse is the first level of administration in the absence of a Nursing Manager, there are several duties assigned, including organizing and delegating workflow, supervising CNAs, and assisting in care of patients. (Nursing Administrative Council, 2012) The Society for Human Resource Management adds patient medication management, patient evaluation, conferring with families and documentation supervision as charge nurse responsibilities. (Society For human Resource Management, 2013)

Description of Provider Experience During the interview, Provider A explained that her job duties not only included most everything Id learned during research, but other things as well. She stated that she chose nursing as a profession a bit later in life, after joining corporate America for a few years first. Coming from a family with a medical background, the normal world just did not make her feel that she was making a positive difference, and that through nursing she could change that. One of the things Provider A said she likes about her job (and the nursing profession in general) is the flexible hours. Because it is a profession that operates twenty-four hours a day every day, employees are not locked into a Monday-Friday 9-5 life. Additionally, she enjoys the financial security the medical profession brings.

HCA400 Course Paper Charge Nurse

3 One cause of frustration at Provider As job is the aspect of dealing with management. She says that the administrative personnel are more concerned with finances and the budgetary bottom line than with patient care. She stated that she highly suspects some bonuses directly affiliated with budgetary goals. Another challenge that she faces is time management. There are two charge nurses on the shift she works, each responsible for 52 patients. She must supervise their care which includes not only physically visiting each one but also reviewing all patient documentation from caregivers. She said that some nights it is literally impossible and she must rely on the information given by the CNAs. Application of Ethics to the Providers Experience Provider A says that she makes ethical decisions on a nightly basis. She says that given the health condition of the residents, situations occur almost nightly that require an ethical decision. One such example was a recent patient receiving blood pressure medication at an interval of every 8 hours, per the physician. Nurses have a window of one hour to dispense timed medications, and the medication times for this patient were 4 p.m., midnight, and 8 a.m. The patient, however, didnt want to take the medicine then, and ref used many times. Claiming the principle of autonomy (I have the right to take that when I want to!) he took the medication at 8 p.m. more than once. When my interviewee went on shift and had to give him his medication at midnight, it was too soon, but by law she had from 11:30 to 12:30 and couldnt alter it without a doctors permission. Needless to say, this created a difficult ethical quandary, and once it caused the blood pressure of the patient to bottom out and he had to be rushed to the hospital. She states that the reasoning behind the first nurses decision to abide by the patients wishes stemmed from the facility rule that if patients are alert x 3, meaning they know the date, their name, and where they are, then they have the right to make all medical decisions. The patient definitely met those criteria, and therefore the nurse thought he should be able to determine his medication schedule.

HCA400 Course Paper Charge Nurse

4 Provider A stated that there are numerous examples of decisions made ethically (or not so ethically) at her facility, but feels the bureaucracy of administration is too thick to penetrate.

Summary My findings during this project were that many health care challenges exist in all areas, and having responsibility does not always equivocate to having power. I also think that a personal ethics statement should be firm, but not exceptionally broad. There should be room for judgment error as well as allowances for others and their decisions. Its true that you very well may need to decide which ethical issues you are willing to go to bat (perhaps lose your job) for, and which you are able to overlook. Ethical choices have to be made by each person involved in the delivery of health care, and the significance of them is varied to all. I also learned that the conflict that arises when a nurses commitment to the organization and/or physician is misaligned with their duty to patients it is called moral distress. This moral distress can result in all types of maladies for nurses. (Edmonson, 2010) Because Provider A is the new kid on the block and very much needs her job, she is subjected to moral distress daily. According to the American Association of Critical-Care Nurses, the prevention/alleviation of moral distress is one of the greatest areas in need of resolution in healthcare. They suggest utilizing strategies to develop moral courage, which transcends moral distress. (Edmonson, 2010)

References

HCA400 Course Paper Charge Nurse

Provider A, personal communication, August 15, 2013

Nursing Administrative Council. (2012, March).Protocol for charge nurse responsibilities. Retrieved from http://nursing.uchc.edu/nursing_standards/docs/Charge Nurse Responsibilities.pdf

Society For human Resource Management. (2013). Charge nurse . Retrieved from http://www.shrm.org/TemplatesTools/Samples/JobDescriptions/Pages/CMS_001115.asp x

Edmonson, C. (2010, September 30). Moral courage and the nurse leader. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Courage-andDistress/Moral-Courage-for-Nurse-Leaders.html