NURS 321: Leadership Module 13: Ch. 6 Patient, Subordinate, Workplace, and Professional Advocacy

Advocacy

1. Involves helping others to grow and self-actualize.

2. The actions of an advocate are to inform others of their rights and ensure they have adequate information on which to base their decisions.

3. Nurses must advocate for themselves, clients, subordinates, and their profession.

How Nurses Can Act as Advocates

1. Helping others make informed decisions.

2. Acting as intermediaries in the environment.

3. Directly intervening on behalf of others.

4. Advocating for social justice.

Controlling Patient Choices Versus Assisting Patient Choices

It is important for the patient advocate to differentiate between controlling patient choices (domination and dependence) and assisting patient choices (allowing freedom).

Common Areas Requiring Nurse-Patient Advocacy

1. End-of-life decisions.

2. Technological advances.

3. Health care reimbursement.

4. Access to health care.

5. Transitions in health care.

6. Provider-patient conflicts regarding expectations and desired outcomes.

7. Withholding of information or blatant lying to patients.

8. Insurance authorizations, denials, and delays in coverage.

9. Medical errors.

10. Patient information disclosure (privacy and confidentiality).

11. Patient grievance and appeals processes.

Continued - Common Areas Requiring Nurse-Patient Advocacy

1. Respect for patient dignity.

2. Inadequate consents.

3. Incompetent health care providers.

4. Complex social problems including AIDS, teenage pregnancy, violence, and poverty.

5. Aging population.

6. Note: Since the 1960s, some advocacy groups, professional associations, and states have passed Bills of Rights for patients. Although most are not legally binding, they can guide professional practice.

1998 Patient's Bill of Rights

1. Helps patients feel comfortable in the system.

2. Stresses strong patient-provider relationships.

3. Stresses the key role patients play in staying healthy.

2010 Affordable Care Act

Gives patients protection in dealing with insurance companies.

Genetic Information Nondiscrimination Act

Federal law passed in 2008 making it illegal for health insurers or employers to discriminate against individuals based on their genetic information.

Person-and Family-Centered Care

The philosophy suggests that care should be organized first and foremost around the needs of patients and family members. This approach humanizes, personalizes, and demystifies the patient experience.

The National Right to Die Movement

1. Has gained momentum in the past decade.

2. Typically applies only to patients who are at least 18 years old, with the capacity to make medical decisions, and with a terminal disease expected to result in death within six months.

Subordinate Advocacy

1. Nurse administrators should advocate for other health care providers (including subordinates) as well as patients, especially concerning health and safety.

2. Leaders can also advocate for subordinates by creating a work environment that promotes risk-taking and leadership. Workers then feel empowered to speak up for patients, themselves, and their profession.

Workplace Advocacy

Occurs when the manager ensures the work environment is both safe and conducive to professional and personal growth for subordinates.

Whistleblowing Internal vs External

1. Internal whistleblowing occurs within an organization by reporting up the chain of command.

2. External whistleblowing involves reporting outside the organization (e.g., to media or elected officials).

3. Note: Although much of the public supports reporting wrongdoing or corruption, whistleblowers are often viewed with distrust and may face negative repercussions for their actions.

Leader-Managers' Role

1. Must be willing to advocate for whistleblowers who speak out about harmful or inappropriate organizational practices.

2. Must also advocate for the nursing profession by addressing discrepancies between nurses' perceived roles and society's expectations.

Nursing's Advocacy Role in Legislation and Public Policy

Writing a Letter to a Legislator: Nurses can influence policy by educating legislators on health care issues from a nursing perspective. Media: Nurses have great potential to educate the public and influence policy through media due to: The public's high trust in nurses. The public's interest in hearing about health care issues from a nursing perspective.

Bullying

As repeated, health-harming mistreatment of one or more persons (the targets) by one or more perpetrators. It is abusive conduct that is threatening, humiliating, or intimidating in nature. Sometimes, bullying is passed down from superiors.

Horizontal bullying

Bullying that occurs between coworkers.

Incivility

1. Is another term used to describe mistreatment or discourtesy to another person.

2. A continuum, with disruptive behaviors, such as eye-rolling and other nonverbal behaviors and sarcastic comments, on one end of the spectrum, and threatening behaviors, such as intimidation and physical violence, on the opposite end.

3. Pearson (2016) suggests that nearly half of workers experience workplace incivility at least once per week, and many pass along the effects to others.

Mobbing

When employees gang up on an individual.

Workplace Violence

1. When bullying, incivility, and mobbing occur in the workplace, it is known as workplace violence.

2. It includes, but is not limited to, such behaviors as engaging in favoritism, being verbally abusive, sending abusive correspondence, bullying, pranks, and setting workers up for failure. It also includes economic aggression such as denying workers promotional opportunities.

3. Countless practice settings are hindered by maladaptive social behaviors that victimize nurses and impact patient care.

4. Workplace violence impacts the physical, emotional, and socioeconomic health of employees and threatens patient safety.

5. Violence against health care workers is a problem worldwide.

6. The health care industry leads all other sectors for non-fatal workplace assaults.

7. This violence has increased dramatically since the beginning of the COVID-19 pandemic.

Consequences of Workplace Violence

1. Nurses exposed to workplace violence are more likely to experience posttraumatic stress disorder, anxiety, depression, and burnout than nurses with no exposure.

2. Medical consequences include an increase in employee health complaints such as neck pain, musculoskeletal complaints, acute pain, fibromyalgia, and cardiovascular symptoms.

3. Emotional/psychological consequences may include increased mental distress, sleep disturbances, fatigue, lack of vigor, depression and anxiety, and adjustment disorders, all of which increase the risk of absenteeism and turnover. It may even lead to increased risk of suicide.

4. The quality of care provided by an affected nurse often decreases significantly.

Zero Tolerance Policy

1. All organizations should have policies in place with zero tolerance as the expectation for certain behaviors.

2. Should be the expectation because bullying and incivility impact turnover, productivity, and quality of care.

3. To end abusive behaviors, these policies must be communicated loudly and clearly and open, respectful communication must be encouraged

"Workplace Violence and Bullying: You Can Survive": Overview and Context

1. Workplace violence and bullying are significant and growing challenges in the healthcare industry.

2. These issues lead to:

A) Ineffective patient care Job dissatisfaction

B) Psychological distress among staff

3. The Joint Commission has recognized the trend, tracking incidents and instituting new requirements (as of 2022).

4. Direct, curt communication is replacing respectful, interactive dialogue, reflecting broader sociopolitical trends.

Key Statistics: Arizona Healthcare Staff Risk Assessment Survey

1. 68% of staff are concerned for their safety.

2. 57% experienced emotional distress from incidents in the previous 12 months.

3. 74% of staff with patient/visitor contact experienced misconduct by a patient, family, or visitor in the past year; 41% had six or more incidents.

4. 17% considered leaving their positions due to these incidents in the past year.

Key Statistics: U.S. and European Data

1. 79.3 million workers are affected by workplace bullying.

2. Non-leadership staff experience bullying at double the rate of those in managerial positions.

3. Over 60% of U.S. organizations lack policies to manage workplace violence.

Organizational Gaps

1. There is a clear lack of workplace bullying policies and procedures.

2. Most organizations either dismiss, deny, or discount bullying behaviors.

10 Personal Strategies for Addressing Bullying

1. Address Incivility Early

2. Use Human Resources

3. Stay Engaged

4. Document Everything

5. Show Resilience

6. Recognize Your Value

7. Seek Behavioral Health Support

8. Advocate for Change

9. Know When to Move On

10. Repeat Empowering Mantras

Address Incivility Early

1. Tackle behaviors directly and early, preferably with a witness present.

2. Everyone has rough days, but there's a big difference between "one-and-done" events versus a more enduring pattern. Address the behaviors early, and directly, with the person involved. Grab a witness to the conversation whenever possible

Use Human Resources

1. Engage HR even if you doubt their usefulness; it's vital for legal recourse.

2. Most people resist involving human resources, but it's important to do so. Should you seek legal recourse, it is vital to demonstrate how all employer channels were accessed, even if you question their usefulness.

Stay Engaged

Bullies try to isolate victims; maintain connections with colleagues for support.

Document Everything

Keep detailed records of all bullying interactions, including dates and witnesses.

Show Resilience

Avoid immediate reactions; pause to process and manage your response.

Recognize Your Value

Bullies often target ethical, competent employees. Acknowledge your strengths.

Seek Behavioral Health Support

Bullying can cause anxiety, depression, insomnia, and stress; seek mental health help.

Advocate for Change

Participate in public policy and advocacy. Bullying is now addressed in many professional standards and codes of ethics. The Healthy Workplace Bill has been introduced in 31 states.

Know When to Move On

If the culture cannot or will not change, consider a career shift.

Repeat Empowering Mantras

Refer to Figure 1 for affirmations about respect, safety, and accountability.

Empowerment Mantras

1. We deserve respect.

2. We deserve to have our knowledge and expertise valued.

3. We deserve to feel safe.

4. We deserve not to feel trapped in a toxic workplace.

5. We deserve confidence that all are accountable for their actions.

6. We deserve to confront workplace bullying without fear of retribution.

Intellectual Humility and Team Function

1. Quality, patient-centered care depends on effective teamwork.

2. Intellectual Humility is Crucial.

3. Low Intellectual Humility

4. Improving Intellectual Humility

Intellectual humility is crucial

1. Many people overestimate how "right" they are in disagreements.

2. 82% believe they are usually correct in disagreements.

3. Overconfidence leads to intractable disagreements and undermines compromise.

Low intellectual humility results in

1. Stronger negative reactions to disagreement.

2. Disregard for differing views

Improving intellectual humility

1. Recognize the possibility of being incorrect.

2. Respectfully ask questions and consider alternative perspectives.

3. Reassess your certainty when presented with new evidence.

Causes of Bullying and Violence

1. Multiple factors can lead to lashing out at colleagues.

2. A key factor: Belief in one's absolute correctness.

Recommendations for Culture Change

1. Check your "correct-O-meter" at the door.

2. Foster respectful questioning and openness to new ideas.

3. Encourage a workplace culture where differing opinions are valued.