06Jones Leadership(F)-ch 06 88 1/15/07 6:42 PM Page 88 Understanding Organizations OSHA standard, resulting in a safe and healthy work environment for the health-care provider Nursing plays an active role in OSHA’s functions Nurses are not only regulated/protected by OSHA standards but also play an important role in their implementation to meet standards for patient safety CENTERS FOR DISEASE CONTROL (CDC) The Centers for Disease Control and Prevention (CDC, 2004) is the leading federal agency for protecting the patient’s health and safety both at home and abroad The CDC is responsible for (1) developing and applying disease prevention and control, (2) maintaining environmental health, and (3) promoting health and education activities designed to improve the well-being of the people of the United States But research has demonstrated that more nursing expertise is needed in the area of disease control, as this environmental concern is a “front line” patient care safety issue in nursing practice Disease Control: A Safety Issue in Nursing Practice According to Larson and Butterfield (2002), clients often use nurses as their primary contact for expressing concerns about health problems related to environmental disease control In response to this need, core competencies for nursing expertise in the field of environmental disease control were developed by the Institute of Medicine, Agency for Toxic Substances and Disease Registry, and National Institute of Nursing Research These core disease control competencies comprise a baseline of knowledge and awareness as well as a standard by which nurses intervene to prevent and minimize environmental disease Nursing standards for disease control focused on the following four competencies: Basic knowledge and disease control concepts: “Understanding scientific principles [of] … basic mechanisms of exposure…prevention and control strategies … applied research, and the interdisciplinary nature of environmental health.” Assessment and referral: “Completing a comprehensive environmental exposure history and making appropriate referrals … locating and providing appropriate scientific information for individual patients and communities.” Advocacy, ethics, and risk communication: “Understanding the role of advocacy, principles of environmental justice, and risk communication in addressing environmental health issues.” Legislation and regulation: “Understanding … environmental health policy as well as state and national regulations” (Larson & Butterfield, 2002, pp 301–308; quoting Pope, Snyder, & Mood, 1995) Establishing Safety Protocols Based Upon CDC and OSHA Recommendations In 1987 OSHA was petitioned by the ANA and labor unions to issue an emergency infection control standard, subsequent to the first documented reports of occupationally acquired human immunodeficiency virus (HIV) in health-care providers (Miramontes, 1990) OSHA responded by enforcing voluntary guidelines developed by the CDC years earlier Subsequently, OSHA drafted regulations containing the final set of HIV safety protocols in1991 According to Miramontes (1990), OSHA established HIV safety standards and protocols to be utilized by all health-care providers, addressing (1) types of protective clothing and equipment, (2) housekeeping and laundry areas, (3) infectious waste disposal, and (4) tracking employees, preand postexposure In enforcing these standards, hospitals stress continued education and training in order to increase compliance Miramontes (pp 561–562) cited a research study that found “after a two-year training/evaluation period, physician compliance with infection control procedures increased from 20% to 80%, and nurse compliance rose from 50% to 86%.” All Good Things… Nursing practice is regulated on the state and federal levels On the state level, nursing is regulated via the state’s nursing practice act, which provides for licensure as a registered nurse Subsequently, 06Jones Leadership(F)-ch 06 1/15/07 6:42 PM Page 89 Regulating Nursing Practice to Strive For 6-1 Best practice is the process through which competence and evidence-based practice lead to the desired health-care outcome Brief, concrete tips to promote best practice in consideration of the previously identified nursing regulations, which focus on combined competence and evidence-based practice, include: Knowing the standards of practice in your state’s nursing practice act for the registered nurse and/or for advanced practice Knowing the definition of unprofessional conduct in your state’s nursing practice act Knowing the grounds for disciplinary action by the governing board for nursing practice Knowing whether your state participates in the nurse licensure compact and your multistate licensure privileges under the compact Knowing the competencies required to perform your role as a nurse, whether a generalist or a specialist Documenting attainment of, compliance with, and/or updating of competencies Developing nursing informatics competencies Practicing evidence-based nursing by utilizing the best current clinical evidence or research when implementing the nursing process Knowing the standard of care as defined in the employer’s policy and procedures 10 Working with accrediting agencies to provide certification that the health-care provider meets nationally accepted standards for patient care 11 Ensuring the staffing necessary to deliver and meet the standard of patient care 12 Complying with federal regulations regarding the standard of care related to privacy of health-care data 13 Complying with federal regulations regarding the standard of care related to workplace health and safety certification acknowledges nursing competence at an advanced level of practice The nursing practice act establishes the standard of care and scope of practice, which are monitored by the state’s governing board, usually the board of nursing examiners The nursing practice act also regulates advanced practice; for example, the clinical nurse specialist The scope of nursing practice 89 has been expanded by telenursing, requiring the development of the Nurse Licensure Compact (NLC) The NLC creates standardization within nurse practice acts that vary and lack uniformity from state to state, providing more standard methods of compliance, discipline, and rehabilitation Nursing has been developed upon the core competence of caring, a concept difficult to measure, document, or legislate Other essential competencies, which appear to be measurable behaviors, include health promotion, supervision, interpersonal communication, direct care, computer, and case load competencies Competencies may be documented with videotaping, orientation records, portfolios, self-assessment tools, records of mandatory intranet training courses, and continuing education records Advanced areas of nursing practice have more specialized sets of competencies Specific competencies are required in nursing informatics at four levels, consisting of the beginning, experienced, informatics specialist, and informatics innovator nurse Informatics may be integrated into the nursing standards Evidence-based nursing practice is the expected standard of care Nursing research is the mechanism to provide evidence-based practice The nurse may integrate evidence-based practice into the nursing process, for example, by following a four-step clinical decision-making process Policies and procedures also establish the standard of care and thus regulate nursing practice Independent organizations, such as JCAHO, monitor a health-care provider’s compliance with state and federal laws and regulations Accreditation is the process utilized by an organization, such as a school of nursing or health-care facility, to verify competency of its educational or health-care program, respectively Staffing and productivity must also be regulated under these accreditation guidelines to meet the standard of care Legislative and administrative regulation of nursing occurs on the federal level; for example, through CMS CMS oversees the administration of HIPAA, a federal law that regulates confidentiality issues related to patient care OSHA is a federal agency that promotes standards for patient safety in the health-care environment The CDC is the federal agency that develops and promotes disease prevention and control 06Jones Leadership(F)-ch 06 90 1/15/07 6:42 PM Page 90 Understanding Organizations Let’s Talk What is the nursing standard for advanced practice, management, and informatics? Do you believe that nurses should seek certification? If so, why? In what areas can a nurse specialize that are considered advanced practice? How has telenursing expanded nurse practice acts? Does an interstate compact have to exist for a nurse to practice telenursing in those states? How does lack of uniformity in state nurse practice acts affect interstate compacts and telenursing? What can influence student nurse learning of competencies in the clinical area? NCLEX Questions A nursing competency: A Is a skill that the nurse has to perform B Is a specific behavior that a nurse must demonstrate C A and B D Is the proficiency level that the nurse must obtain A standard of care: A Requires use of the nursing process B Is the degree of care, expertise, and judgment exercised by nurses under similar circumstances C A and B D Is the number of patients that a competent nurse can care for on any given shift What affects nursing regulation? A A state nurse practice act B Accreditation by an official body C Policies and procedures D All of the above The goal of state and federal legislation is to: A Protect the public B Regulate nursing education C Oversee nurse competency via licensure and discipline D All of the above A nurse practice act: A Governs the role of the nurse B Governs nursing education C A and B D Prescribes the competencies for the nursing role Certification is: A An examination B Developed by a professional organization C Aids a nurse in demonstrating competency D All of the above What types of disciplinary action can a board of nursing take? A License suspension B Licensure denial C Mandate that the offender take courses in legal ethical decision making or pharmacology D All of the above An advanced practice nurse: A Is a registered nurse B Has studied in a post-basic or advanced educational program of study C Acts independently of other health-care professionals in the delivery of health-care services D All of the above Portfolios: A Can be used to demonstrate to state boards of nursing that one is qualified to be a registered nurse B Can be designed to demonstrate one’s competence C Consist of documentation that captures learning from experience D B and C 10 Modeling: A Is the facilitation and nurturance of an individual B Assists one in attaining, maintaining, and promoting health C Is a purposeful nursing intervention D Is a process used by nurses to develop an understanding of the client’s world 06Jones Leadership(F)-ch 06 1/15/07 6:42 PM Page 91 Regulating Nursing REFERENCES Alspach, J (1995) The educational process 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